bluuebunny/crossref_metadata_2025 huggingface dataset:
881. Efficacy of Antibiotic Prophylaxis with Vancomycin in Cardiothoracic Surgery
Authors: Cooper Margaret , Zhao Jing
Published: January 2021

Background

Due to the high incidence of methicillin-resistant Staphylococcus aureus (MRSA) at the Detroit Medical Center, vancomycin is now routinely part of the prophylaxis regimen for cardiothoracic (CT) surgery. The study aims to compare the rate and types of surgical site infections (SSIs) when vancomycin is added to cefazolin for CT surgery compared to cefazolin alone.

Methods

This was a retrospective cohort study conducted at two university-affiliated hospitals. Patients who underwent CT surgery between January 2008 and August 2017 and had a readmission for SSI within 90 days of procedure were included. Patients who received cefazolin were compared to patients who received both cefazolin and vancomycin for CT surgery prophylaxis. The primary outcome was incidence of SSIs within 90 days of surgery as defined by the Centers for Disease Control and National Healthcare Safety Network.

Results

Out of 828 patients who underwent CT surgeries, there were 32 patients readmitted within 90 days for SSI. SSI occurred in 4.7% of patients who received cefazolin monotherapy, and 2.4% of patients who received both cefazolin and vancomycin (p=0.095). There was no discernible difference in types of SSI between groups. Pathogens were isolated in 78% of SSIs, with 75% Gram-positive and 19% Gram-negative organisms. SSIs resulted in an average 9.8 days in the hospital and 28.9 days of antibiotic therapy, and led to a total of 15 additional procedures.

Conclusion

Vancomycin added to cefazolin for prophylaxis in CT surgery resulted in lower incidence of SSI, however the difference was not statistically significant.

Disclosures

All Authors: No reported disclosures
882. Evaluating the Risk Factors in Postoperative Infections Following Hysterectomy Procedures: Is Antibiotic Prophylaxis the Issue?
Authors: Yi Stacie , Doan Thien-Ly , Jain Sumeet
Published: January 2021

Background

Infectious complications after hysterectomy procedures are associated with an additional financial burden and length of stay for patients. In addition, post-hysterectomy surgical site infection is a metric tied to hospital ranking and financial penalties. The objective of this study was to evaluate the appropriateness of surgical prophylaxis for hysterectomies in patients with postoperative infections.

Methods

This is a 1:1 case-control study, matched based on the year of surgery and surgeon performing the procedure, of women ≥ 18 years who underwent hysterectomies between 2013 and 2019. Cases were diagnosed with infection(s) attributable to the procedure within 90 days post-hysterectomy. Patients who did not receive prophylaxis were excluded. The primary outcome of this study was to determine if postoperative infections following hysterectomies were due to inappropriate antibiotic prophylaxis. Secondary outcomes included hospital readmission and mortality. The primary statistical tests utilized included descriptive statistics and chi-square test.

Results

The study included 86 patients, 43 in each group. Thirty percent of cases and 7% of controls received inappropriate prophylaxis. For cases, reason for inappropriateness was due to underdosing of cefazolin (38%) and gentamicin (54%), and overdosing of cefotetan (8%). For controls, cefazolin (33%) and gentamicin (67%) were underdosed. Twenty-three percent of the cases and 14% of the controls received inappropriate intraoperative redosing. The most common reason for inappropriateness was timing (40% of cases vs 50% of controls) followed by missed intraoperative redosing (50% of cases vs 33% of controls). No difference was observed in the proportion of cases and proportion of controls who received inappropriate treatment (p=0.21). Eighty-eight percent of cases and 5% of controls were readmitted within 3 months (p< 0.0001). Mortality was not noted in either group.

Conclusion

In this study, there was no statistically significant association between inappropriate antibiotic prophylaxis and infection. There was still a high incidence of inappropriate antibiotic prophylaxis in the cases. Therefore, education of providers on antibiotic dosing and criteria for intraoperative redosing is warranted.

Disclosures

All Authors: No reported disclosures
883. Evaluation of Post-operative Antibiotic Prophylaxis in Patients Undergoing Urologic Procedures
Authors: Elmarakbi Mohamed , Care Julianne , Laude Jillian , D Pharm
Published: January 2021

Background

Many national guidelines do not recommend post-operative antibiotic prophylaxis due to lack of literature supporting its use; however, they are frequently prescribed at ChristianaCare for urologic procedures. Use of post-operative antibiotics has not correlated with reduction in post-operative infections, and has been show to increase risk for resistant infections, Clostridiodes difficile (C. difficile) and acute kidney injury (AKI).

Methods

A single center retrospective chart review was conducted to evaluate endpoints of patients who underwent a urologic procedure and received post-operative antibiotics (intervention group) compared to those who did not (control group) from June 1st 2018 to September 1st 2019. The primary endpoint was to compare the incidence of post-operative infections, including surgical site infections (SSIs), bacteremia, and urinary tract infections (UTIs) between the intervention and control groups. The secondary endpoints included comparing the incidence of prespecified adverse outcomes, between the two groups.

Results

A total of 250 patients were included in this study. Baseline demographics were similar across a number of characteristics in both groups. There was no difference between the intervention and control groups in the incidence of post-operative bacteremia (p = 0.608), SSIs (p = 0.491) and 30 day UTIs (p = 0.307). The rate of AKI between both groups were similar. There was a higher percentage of resistant organisms seen in the intervention group compared to the control group (21.4 % vs. 16.7%). The intervention group experienced an increase in post-operative antibiotic related adverse effects. Although a small number of patients were tested for C. difficile, there was one positive C. difficile PCR in the intervention group compared to zero in the control group.

Conclusion

The results of this study support withholding post-operative antibiotics in urologic procedures given no benefit in reducing post-operative infections and potential to increase adverse effects and development of resistant organisms. Efforts to change this current practice at our institution will be implemented via collaboration with the urology section and review of current order sets.

Disclosures

Jillian Laude, Pharm D, BCPS, Shionogi Inc (Other Financial or Material Support, Received one-time speaker fee for a round table discussion. The financial relationship does not relate to this research project.)
884. Evaluation of Surgical Site Infections in Solid Organ Transplant Recipients with Beta-Lactam Allergies
Authors: Mowrer Clayton , Van Schooneveld Trevor C , Matthews Stephen , Stohs Erica J
Published: January 2021

Background

Beta-lactam allergies (BLA) are common, but the prevalence and impact on solid organ transplant (SOT) recipients is largely unknown. We assessed the prevalence of BLA labels in SOT recipients at the time of transplant and evaluated their influence on surgical site infection (SSI) prophylaxis and SSI incidence.

Methods

All patients undergoing first heart, kidney, liver SOT at our institution were retrospectively reviewed (1/1/2015-12/31/2019). Antibiotic allergies, surgical antibiotic prophylaxis, and SSIs were abstracted from the electronic medical record. Reported BLA reactions were classified as potentially IgE-mediated, delayed, or non-allergic based on documentation. SSIs were reported according to NHSN definitions, and the incidence of SSI was compared between patients with and without reported BLA. SSI prophylaxis regimens were compared to institutional guidelines. Basic descriptive statistics were performed.

Results

Out of a total cohort of 751 patients (122 heart, 435 kidney, 209 liver, 4 multi-organ), 129 (17%) reported at least one BLA, with 104 (15%) with reactions to penicillins, 26 (3%) to cephalosporins, and 1 (0.1%) to carbapenems. Commonly reported reactions were rash (38%), hives (25%), and “other” (21%); 28% of documented reactions were not documented or classified as non-allergic. SSI developed in 7 (6.1%) of heart, 10 (2.5%) of kidney, and 16 (9.4%) of liver transplant recipients. Excluding 44 patients already on antibiotics for treatment of systemic infection, guideline concordant beta-lactam antibiotic surgical prophylaxis was administered to 6 (5.2%) of BLA group vs 490 (85.8%) in the non-BLA group (p< 0.01); among the BLA group who did not receive a beta-lactam, 96 (83%) received a regimen concordant with institutional guidelines for penicillin allergy and 14 (12%) received guideline non-adherent regimens. Patients reporting BLA did not have a higher incidence of SSIs compared to those without BLA: 6 (4.8%) vs 27 (4.5%) respectively, p=0.86.

Conclusion

BLA prevalence in our SOT population was similar to previously reported rates, but many reported reactions were not allergic in nature. Pre-transplant allergy evaluation for patients with reported BLA may improve SSI antibiotic prophylaxis compliance.

Disclosures

All Authors: No reported disclosures
889. Improving patient compliance with preoperative universal decolonization to reduce surgical infection rate and costs
Authors: Candray Kimberly
Published: January 2021

Background

In order to address spine patient non-compliance with preoperative nasal decolonization, a trial was undertaken to replace nasal povidone iodine (PVI) with alcohol based nasal antiseptic paired with chlorhexidine (CHG) bathing for all spine fusion and laminectomy patients for a period of three months.

Methods

In addition to preoperative CHG bathing already in place, an alcohol based nasal antiseptic was applied to the nose of all spine surgery fusion and laminectomy patients within one hour of surgery instead of the PVI nasal antiseptic that had been in use previously.

Results

After switching the alcohol based nasal antiseptic, there was a reduction in surgical site infections (SSI) of 64% from 0.58 to 0.21/100 spine fusion procedures and a reduction in SSI of 100% from 0.46 to 0.00/100 laminectomy procedures. This represents an estimated cost avoidance of $127K associated with infections prevented. There was also a $37K cost savings resulting from switching from nasal PVI to alcohol based nasal antiseptic, with patients reporting greater satisfaction.

Conclusion

Universal preoperative decolonization for spine fusion and laminectomy patients using an alcohol based nasal antiseptic and CHG bathing resulted in reduced infection rates and associated costs, reduced nasal antiseptic cost and improved patient satisfaction.

Disclosures

All Authors: No reported disclosures
894. Patient and Surgery Characteristics on Wound Complication and Surgical Site Infection in Sarcoma Patients undergoing Hemipelvectomy
Authors: Katzman Ju Hee , Sun Steven , Joyce David , Greene John
Published: January 2021

Background

Hemipelvectomy is associated with a significant risk of wound complications, including infections, bleeding and injuries to nearby neurovascular structures as well as the gastrointestinal and genitourinary tract. This study aimed to determine the patient characteristics and approach to treatment that could affect the occurrence of surgical site infection or wound complications in sarcoma patients undergone hemipelvectomy.

Methods

We conducted a retrospective analysis of 33 adult patients who underwent hemipelvectomy at Moffitt Cancer Center, Tampa, FL, from 2008 to 2016. We used Chi-square (Exact Fisher) test to investigate the association between wound complication and categorical variables. We used a T-test to evaluate the difference in numerical variables for outcomes.

Results

Out of 33 patients, 12 (36.4%) patients experienced wound complications after hemipelvectomy (Table 1). The average age of patients with wound complications was 63.3 3 (57.1±15.4) years old, significantly higher than that of patients without wound complications (p=0.004). Without adjustment, the use of computer navigation had a lower wound complication rate (p=0.027). Patients with wound complications had longer hospital length of stay (14.8 vs. 7.0 days, p=0.016). Among patients with surgical site infection (Table 2), there were no patients’ characteristics or surgical characteristics associated with this outcome. Five (15%) patients developed surgical site infection and they had longer hospital stay (19.4 vs. 8.1 days, p=0.001). The organisms identified from wound cultures include methicillin-resistant Staphylococcus aureus, viridans Streptococcus, Peptostreptococcus asaccharolyticus, Enterobacter cloacae, Pseudomonas aeruginosa, Candida albicans. The organisms in late infections (more than 6 months since surgery), included above organisms plus Stenotrophomonas maltophilia and Achromobacter xylosidans.

Conclusion

Older patients undergoing hemipelvectomy are at an increased risk of developing wound complications with a prolonged hospital stay. Initial antimicrobial therapy for suspected surgical site infection should include a broad-spectrum coverage to include skin and gastrointestinal flora.

Disclosures

All Authors: No reported disclosures
898. Prevalence of Extended Spectrum Beta-Lactamase Producing Escherichia coli, Klebsiella Pneumoniae and Pseudomonas Aeruginosa from Hospital Acquired Surgical Site Infections in Ghana
Authors: Egyir Beverly , Nkrumah-Obeng Noah , Nyarko Edward , Fox Anne , Letizia Andrew , Sanders Terrel
Published: January 2021

Background

Globally, ESBL-producing bacteria pose a great challenge for treating hospital acquired SSI. Currently, the prevalence of ESBL pathogens in Ghana hospitals is poorly understood. Determining the frequency ESBLs are encountered will, in turn, provide insight for antibiogram development and shape antimicrobial stewardship policies in Ghana.

Methods

Using U.S. CDC criteria for SSI, wound swabs or aspirates were collected from 112 participants who met study inclusion criteria. Specimens were plated on MacConkey and blood agar; then colonies were isolated and identified using MALDI-TOF. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method and interpreted according to the 2018 Clinical and Laboratory Standards Institute (CLSI) guidelines. The combined disk method was used to screen for ESBLs among E.coli and K. pneumoniae isolates. Genes associated with ESBL production (SHV, TEM and CTX-M) were detected using PCR analysis.

Results

Thirty-eight percent of the bacterial isolates recovered were E. coli, K. pneumonia accounted for 32%, and P. aeruginosa accounted for 16% of the total isolates; remaining isolates were gram positive pathogens not discussed here. ESBL production was detected in 50% of E. coli isolates and 73% of K. pneumoniae isolates. ESBL-producing isolates were susceptible to meropenem but resistant to cefuroxime, cefotaxime, tetracycline, trimethoprim-sulfamethoxazole, gentamicin, ciprofloxacin and chloramphenicol. P. aeruginosa isolates were only sensitive to meropenem, gentamicin, and ciprofloxacin. In our study, CTX-M was the most frequently detected gene producing the ESBL-phenotype: 33% of E. coli isolates and 73% of K. pneumoniae isolates possessed the CTX-M gene.

Conclusion

Approximately 70% of total bacterial isolates recovered from our SSI study were ESBL producers. The presence of these multi-drug resistant organisms raises clinical concerns due to the absence of routine antimicrobial resistance (AMR) testing and lack of suitable first-line antimicrobials for ESBL pathogens. Improved laboratory capacity to more readily detect MDROs is essential for effective clinical management of patients, antibiogram development and refining antimicrobial stewardship practices in Ghana hospitals.

Disclosures

All Authors: No reported disclosures
900. Retrospective Review of Microbiological profile in Post Surgical Spine Infections and Assess the Appropriateness of Current Pre-Op Antibiotic Prophylaxis Policy
Authors: Patel Kavya , Smulian Alan , Apewokin Senu , Grawe Erin , Vargas Edwin , Liao Siyun
Published: January 2021

Background

SSI is a devastating complication of spine surgery that results in significant morbidity as it requires prolonged antibiotic courses and multiple surgical debridements. It also increases the economic burden on the health care system. So, it becomes important to learn the microbiological profile and assess the current pro-op antibiotic prophylaxis policy.

Methods

All cases reported by the hospital infection control surveillance program based on CDC/NHSN Surveillance definitions between January 2017 and July 2019 were retrospectively reviewed for microbiological data and surgical characteristics using electronic medical record, and non-parametric test was used to assess the difference in proportional distribution of gram-negative organisms between upper and lower spine groups.

Results

Between January 2017 and July 2019, 3561 spine surgeries were performed, 51 cases of SSI were reported, and 50 patients have microbiological data available. The most commonly isolated organism was Staphylococcus aureus (38%), followed by Escherichia coli (12%). There was no statistical difference for the distribution of gram-negative organisms in upper spine (17) and lower spine (33) surgeries (29.4% vs 48.4%, P Value = 0.24). However total gram-negative organisms accounted for 42% cases and lower spine surgical procedures were more likely to be associated with mixed infections including both gram negative and gram-positive organisms (15.1% vs 0%). Cefazolin resistant gram-negative organisms accounted for 22% of all gram-negative infections. Our current pre-op antibiotic policy recommends cefazolin plus or minus vancomycin (If MRSA screen positive) and clindamycin plus vancomycin in patients with severe penicillin allergy.

Table 1: Characteristics of the cultures

Table: 2 Microorganisms isolated from 50 patients with post-surgical spine infections

Figure 1: Proportional distribution of Micro-organisms between lower and upper spine (Percentage on left side and No. of positive cultures on right side)

Conclusion

Although gram-positive organism predominated, there was a substantial portion of gram-negative organisms in post-surgical spine infections. Cefazolin would cover at least half of the gram-negative organisms identified based on our antibiogram susceptibility pattern. However, in patients with penicillin allergy, our current recommended pre-operative antibiotic prophylaxis does not provide gram-negative coverage. We will therefore explore the value of adding an agent with gram negative coverage based on our institutional antibiogram.

Disclosures

All Authors: No reported disclosures
908. Evaluation of Blood Culture Submission Rates in Japan
Authors: Tajima Taichi , Tsuzuki Shinya , Asai Yusuke , Endo Mio , Matsunaga Nobuaki , Hayakawa Kayoko , Ohmagari Norio
Published: January 2021

Background

Blood culture tests are useful for accurate diagnosis of bacteremia and selection of antimicrobial treatment, and they are essential for instituting antimicrobial resistance (AMR) countermeasures. This study investigated blood culture submission rates in Japan and their association with the incidence of bloodstream infections.

Methods

Blood culture data recorded in the Japan Surveillance for Infection Prevention and Healthcare Epidemiology (J-SIPHE) database from January to December 2019 and data submitted for consecutive 12 months from acute care hospitals (hospitals with a mean length of patient stay of ≤19 days) were included for analysis. Samples comprised 1 set of blood culture samples (aerobic and anaerobic bottles) defined as one submission. The annual blood culture submission rate was calculated as the total number of submitted blood cultures per 1000 patients/day. The incidence of bloodstream infections was calculated as the number of positive blood cultures excluding contaminated specimens per 1000 patients/day. The blood culture submission rate was then divided into four categories, respectively: category 1: 0–15; category 2: 15–30; category 3: 30–45; and category 4: 45–80.

The Kruskal-Wallis test was performed to determine overall difference among 4 submission rate categories and the Dunn test with Bonferroni correction was used to compare pairs of submission rate categories.

Filtering of facilities for data analysis

Results

A total of 117 hospitals were included in the analysis. The median number of beds was 415.0 (interquartile ratio [IQR]: 274.5–549.5). The median incidence of bloodstream infection was 2.78 (2.17–3.87). The median blood culture submission rate was 26.18 (17.20–35.76). The median incidence of bloodstream infection by category of blood culture submission rate was 1.39, 2.53, 3.61, and 4.48, respectively; with a significant difference observed among the four categories overall (p< 0.01). Significant differences were observed between categories 1 and 2 and between categories 2 and 3 (both p< 0.01) but not between categories 3 and 4 (p=0.758).

Characteristics of the acute hospitals by category of blood culture submission rate

Incidence of bloodstream infections by category of blood culture submission rate

Conclusion

The blood culture submission rate is considered to be around 45 in the acute hospital setting in Japan. The incidence of bloodstream infections is greatly affected by submission rates.

Disclosures

All Authors: No reported disclosures
909. Reassessing Pathogens Eligible for the Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN) “Mucosal Barrier Injury-Laboratory Confirmed Bloodstream Infection” Criteria
Authors: Chea Nora , Magill Shelley , Benin Andrea L , Allen-Bridson Katherine , Dudeck Margaret , Patel Prachi , Thomson Nicola D
Published: January 2021

Background

NHSN Mucosal Barrier Injury-Laboratory Confirmed Bloodstream Infection (MBI-LCBI) includes pathogens likely to cause bloodstream infections (BSI) in some oncology patients. MBI-LCBIs are excluded from central line-associated BSI (CLABSI) reporting to the Centers for Medicare & Medicaid Services. NHSN users have requested other pathogens be added to MBI-LCBI. To make decision, we compared CLABSI pathogen distributions in three NHSN patient location groups.

Methods

We analyzed CLABSI data from hospitals conducting surveillance for ≥ 1 month from January 2014–December 2018 in ≥ 1 MBI high-risk location (leukemia, lymphoma, and adult and pediatric hematopoietic stem cell transplant wards). We compared CLABSI pathogen distributions and rates in MBI high-risk locations to medium-risk (solid tumor, adult and pediatric general hematology-oncology wards) and low-risk locations (adult and pediatric medical, surgical, and medical-surgical wards), and used χ2 tests to compare percentages with statistical significance at P ≤ 0.05.

Results

Overall, 122 hospitals reported 23,578 CLABSIs and 12,961,921 central line (CL)-days (1.81 CLABSIs per 1,000 CL-days) (Table). Percentages of CLABSIs due to three MBI-LCBI pathogens (E. coli, E. faecium, Viridans streptococci) were significantly higher in high- versus low-risk locations, while for other MBI-LCBI pathogens (K. pneumoniae/oxytoca, E. faecalis, Candida spp., Enterobacter spp.) percentages were significantly lower in high-risk locations (Figure). For pathogens not currently in MBI-LCBI, coagulase-negative staphylococci caused similar percentages of CLABSIs across locations, S. aureus caused a significantly higher percentage of CLABSIs in low-risk locations, while PA caused a significantly higher percentage of CLABSIs in high-risk locations.

Table CLABSIs attributed to MBI high-risk, medium-risk, and low-risk locations, NHSN, 2014–2018

Figure Percentages of top 10 pathogen-specific CLABSIs in MBI high-risk, medium-risk, and low-risk locations, NHSN, 2014–2018

Conclusion

Differences in percentages of CLABSIs due to selected pathogens between MBI high-risk and low-risk locations are evident in NHSN data. Lower percentages of Klebsiella and Candida spp. in high-risk locations might be partially due to antimicrobial prophylaxis in oncology patients. Although PA caused a significantly higher percentage of CLABSIs in high-risk locations, the absolute difference was modest. Additional analyses are needed.

Disclosures

All Authors: No reported disclosures
915. Global 2018 Surveillance of Eravacycline Against Gram-positive Pathogens, Including Resistant Isolates
Authors: Morgan Steven , Hwang Sara , Efimova Ekaterina , Hawser Stephen , Morrissey Ian , Lijfrock Virgil
Published: January 2021

Background

Eravacycline (ERV) is a fully-synthetic, fluorocycline antibacterial approved by the FDA and EMA for the treatment of complicated intra-abdominal infections (cIAI) in patients ≥18 years of age. The purpose of this study was to further monitor the in vitro activity of ERV against Gram-positive pathogens, such as Staphylococcus aureus (including methicillin-resistant S. aureus, MRSA), Enterococcus spp. (including vancomycin-resistant Enterococcus, VRE) and Streptococcus spp.

Methods

Isolates were collected globally during 2018 from various body sites. Minimum inhibitory concentrations (MICs) were determined by CLSI broth microdilution. Antibiotic susceptibility was determined using the most recent CLSI breakpoints (30th ed CLSI M100 document), except for ERV and tigecycline (TGC) where FDA breakpoints from 2018 and 2005, respectively, were applied.

Results

Summary MIC data for ERV and select comparators are shown in the Table. ERV MIC50/90 for Enterococcus spp were 0.06/0.12 μg/mL and were not affected by the presence of vancomycin resistant mechanisms. The MIC90 of ERV against VRE was 2-fold lower than TGC, at a value of 0.12 μg/mL. ERV MIC90 values for methicillin-susceptible S. aureus (MSSA) was 0.12 μg/mL and for MRSA was 0.25 μg/mL. Generally, for all pathogens, ERV MIC90 values were 2- to 4-fold lower than TGC.

Table

Conclusion

ERV in vitro activity was demonstrated for clinically important Gram-positive pathogens, including resistant isolates. Overall, ERV demonstrated lower MIC90 values than comparators for all organisms. This 2018 global surveillance highlights ERV’s utility against Gram-positive organisms and further underscores its role in cIAI, where these pathogens play a causative role.

Disclosures

Steven Morgan, PharMD, Tetraphase Pharmaceuticals (Employee) Sara Hwang, PharMD, Tetraphase Pharmaceuticals (Employee) Ekaterina Efimova, PharMD, Tetraphase Pharmaceuticals (Employee) Stephen Hawser, PhD, Tetraphase Pharmaceuticals (Scientific Research Study Investigator) Virgil Lijfrock, PharMD, Tetraphase (Employee)
916. National Estimates of the Proportion of Bacterial Pathogens Expressing Resistant Phenotypes in US Hospitals, 2012-2017
Authors: Baggs James , Hatfield Kelly M , Wolford Hannah , Olubajo Babatunde , Reddy Sujan , McCarthy Natalie , Paul Prabasaj , McDonald Clifford , Kallen Alexander , Fiore Anthony , Jernigan John A
Published: January 2021

Background

In 2019, CDC updated national estimates of antibiotic resistance. In this abstract we provide national estimates of and trends in proportion of bacterial pathogens expressing resistant phenotypes (%R), specifically: MRSA, VRE, CRE, ESBL, CRAsp, and MDR Pseudomonas, see Figure.

Methods

We measured incidence of clinical cultures yielding the bacterial species of interest among hospitalized adults in hospitals submitting data to the Premier Healthcare Database, Cerner Health Facts and BD Insights Research Database from 2012- 2017. Community-onset (CO) cultures were obtained ≤ day 3 of hospitalization; hospital-onset (HO) were obtained ≥ day 4. We determined hospital-specific %R for each species. We generated national estimates using a raking procedure to generate weighted adjustments to match the distribution for all U.S. acute care hospitals based on U.S. census division, bed size, teaching status, and urban/rural designation. We applied a weighted means survey procedure to calculate national estimates for each year. We used weighted multivariable logistic regression adjusting for hospital characteristics to examine trends.

Results

From 2012-2017, the overall number of hospitals contributing data was 890 (over 20% of U.S. hospital hospitalizations annually). National estimates and trends of %R are shown in the Figure. Between 2012-2017, significant annual decreases in %R were observed for MRSA, VRE, CRAsp, and MDR Pseudomonas. CRE %R did not change. Overall ESBL %R increased by 44% (CO=49% increase, HO=27% increase).

Conclusion

Reductions in %R were observed among MRSA, VRE, CRAsp, and MDR Pseudomonas, suggesting that prevention efforts focused in health care settings are having a disproportionate effect on resistant strains. However, %R remains unacceptably high for all pathogens we studied, and %R among ESBL-producing Enterobacteriaceae has increased, most prominently among CO infections. Continued focus on currently recommended intervention strategies as well as new ones for community onset infections is needed.

Disclosures

All Authors: No reported disclosures
917. Persistence of Multidrug-Resistant Organisms during Occupancy Changes in the Nursing Home Setting, and Impact of Patient Hand Hygiene Assistance
Authors: Cassone Marco , Lansing Bonnie , Mantey Julia , Gibson Kristen , Gontjes Kyle , Mody Lona
Published: January 2021

Background

We investigated the effect of changes in room occupancy, and patient hand hygiene, on the burden of multidrug-resistant organisms (MDRO) in nursing homes. We assessed: 1/ persistence of MDRO after patients are discharged; and 2/ impact of hand hygiene assistance on colonization and room contamination.

Methods

Prospective cohort study of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and ceftazidime, ciprofloxacin or meropenem-resistant gram-negative bacilli (rGNB) in 9 single rooms screened three times a week for 34 weeks (five environmental surfaces, plus nares, groin, and hands of enrolled patients). Relative risk (RR) for patient colonization and room contamination were calculated in patient visits based on: 1/ performance of hand hygiene, and 2/ receiving assistance to perform it.

Results

We collected 4670 swabs over a total of 723 visits. Of 143 patient discharges, 31 times the room was swabbed before another patient was admitted (41 total visits), 48 times the next admitted patient was enrolled and available to be swabbed (295 visits), and 64 times the patient was not enrolled but the environment was sampled (387 total visits) (Figure).

Twenty-four (50%) patients were colonized at least once with an MDRO. Rooms were contaminated at least once with MDRO in 72 cases (64%). MDRO persistence during occupancy changes involving at least one screened patient was observed in 21 of 73 cases (29%). In addition, we detected 2 cases of contamination of unoccupied, terminally cleaned rooms with MDRO recovered also in the previous (MRSA) or the following occupancy (VRE).

In 40 occasions, patients performed hand hygiene with assistance from healthcare personnel, while in 169 occasions they performed hand hygiene by themselves. Requiring assistance was a risk factor for patient colonization (27.5% vs. 12.4% not requiring assistance (RR 2.20, 95% CI 1.16-4.18), and for room contamination (37.5% vs. 18.9%, RR 1.97, 95% CI 1.18-3.27) (Table).

Figure. Example of successive changes in room occupancy.

Table. Breakdown of colonization and contamination at each visit according to hand hygiene performance and need for assistance.

Conclusion

MDRO can persist during changes in patient occupancy. Patients requiring assistance with hand hygiene experienced a higher MDRO burden. These observations call for further investigation of improved cleaning practices and patient assistance.

Disclosures

All Authors: No reported disclosures
918. Pilot Surveillance for Carbapenemase Gene-positive Organisms Among Hospitalized Solid Organ Transplant Recipients
Authors: Chan June L , Nazarian Elizabeth , Musser Kimberlee A , Fung Monica , Doernberg Sarah B , Pouch Stephanie M , Pouch Stephanie M , Leekha Surbhi , Anesi Judith A , Kodiyanplakkal Rosy Priya , Turbett Sarah , Walters Maroya Spalding , Epstein Lauren , Epstein Lauren
Published: January 2021

Background

Carbapenemase gene-positive organisms (CPOs) are associated with infections with high mortality rates and have the potential to facilitate epidemic spread of carbapenem resistance. Passive reporting to CDC identified CPOs among organ transplant recipients, potentially representing an emerging reservoir for spread. We aimed to determine the prevalence of CPOs in hospital units where solid organ transplant (SOT) recipients receive care in order to inform public health action to prevent transmission.

Methods

All healthcare facilities identified one medical unit where SOT recipients received inpatient care and conducted point prevalence surveys (PPS) of all consenting patients on 1-2 designated calendar days. We used the Cepheid Xpert® Carba-R assay to identify carbapenemase genes (blaKPC, blaNDM, blaVIM, blaIMP, blaOXA-48) from rectal swabs; carbapenemase-positive swabs were cultured for organisms. All laboratory testing was conducted at the Wadsworth Center, part of CDC’s Antibiotic Resistance Laboratory Network.

Results

Five participating hospitals performed nine PPS from September 2019 through June 2020. In total, 154 patients were screened and 92 (60%) were SOT recipients (Table). The most common transplanted organs were kidney (44, 48%) and liver (39, 42%). Carbapenemase genes were detected among 5 (5%) SOT recipients, all from a single healthcare facility; 4 (80%) were blaKPC and 1 (20%) was blaNDM. Of the positive specimens cultured, blaKPC was carried by Enterobacter cloacae complex (ECC), Klebsiella pneumoniae, and Klebsiella oxytoca and blaNDM was carried by K. oxytoca; blaKPC was carried by both ECC and K. pneumoniae in a single individual. For SOT patients with CPOs, the median interval from transplantation to swab collection was 108 days (range: 12 to 323). CPOs were only detected in 1 (2%) of 62 non-transplant patients.

TABLE Characteristics of Carbapenemase Gene-positive Organism (CPO) Pilot Surveillance Participants

Conclusion

Among participating facilities, most did not identify CPOs among patients admitted to transplant units. These findings represent a small number of patients and facilities; additional PPS in areas with varied CPO epidemiology are needed to understand whether SOT recipients should be routinely screened for CPOs.

Disclosures

All Authors: No reported disclosures
927. Antiretroviral Laboratory Monitoring and Implications for HIV Clinical Care in the Era of COVID-19 and Beyond
Authors: Fantry Lori E , York lawrence , fisher Julia , august jessica , marquez jose , Ellis Kristen , Malladi Lakshmi , Kaveti Ashwini , Khachatryan Marine , paz Marissa , Adams Matthew , Bedrick edward
Published: January 2021

Background

In the era of COVID-19, providers are delaying laboratory testing in people with HIV (PWH) to avoid unnecessary exposures despite antiretroviral guidelines recommending periodic testing. The purpose of this study was to examine the clinical significance of periodic renal, liver, and lipid testing.

Methods

We reviewed the charts of 265 people with HIV (PWH) who initiated outpatient care at HIV clinic between 1/1/16 and 12/21/18 and had at least two clinic visits. Analysis included frequency distributions, descriptive statistics, one-sided binomial exact tests, and Poisson models with 95% confidence intervals (CI).

Results

Eighty-five percent (221) of PWH had no laboratory abnormalities while on antiretroviral therapy (ART). The most common abnormality was a glomerular filtration rate (GFR) < 60 ml/min found in 10% of PWH. Multivariate analysis revealed that diabetes mellitus (DM) was associated with an increased risk of GFR < 60 ml/min (estimated rate ratio 2.68, 95% CI 1.35-5.33) and age < 60 years (estimated rate ratio .122, 95% CI .05-.32) was associated with a decreased risk (estimated rate ratio .24, CI .14 –.43). When a GFR was < 60 ml/min or an AST or ALT was >2X upper limit of normal (ULN), no action was taken in 52% of the cases. When an action was taken, the most

common action was to repeat testing (18%). After a lipid panel result, the most common actions were to calculate a 10-year cardiovascular risk score (32%) and add a statin (18%). Taking action after lipid panel results was strongly associated with age ≥ 40 (estimated rate ratio 9.1, 95% CI 3.3-25). ART was changed in seven PWH based on GFR, AST/ALT, or lipid panel results. There were four individuals with poor outcomes including cerebrovascular accident, acute renal failure, end stage renal disease, congestive heart failure, myocardial infarction, and death. Contributing factors were hypertension, DM, and hypercholesterolemia.

Conclusion

Individuals < 40 years without ithout comorbidities had a low risk of having clinically significant renal and liver function abnormalities and rarely had actions taken after renal, liver, or lipid results. In the era of COVID-19 and beyond, it may be prudent for in certain groups to delay or eliminate liver, renal, and lipid testing to eliminate exposure, reduce cost, and avoid patient anxiety.

Disclosures

All Authors: No reported disclosures
931. Congestive Heart Failure in Persons Living with HIV: Are we providing standard of care?
Authors: Chowdhury Salil K , Seo Jung M , Keller Steven , Solanki Pallavi , Finkel Diana
Published: January 2021

Background

With antiretroviral therapy, Human Immunodeficiency Virus (HIV) infection has become a life-long chronic condition. Persons Living with HIV (PLWH) have increased risk of cardiovascular diseases including congestive heart failure (CHF) and increased morbidity and mortality from these diseases due to factors such as HIV-induced chronic inflammation. This study will assess if providers at University Hospital in Newark, NJ are providing standard of care for CHF in PLWH.

Methods

This study was approved by Rutgers IRB (Pro2020000391). A database of 154 charts including all patients with diagnoses of both HIV and CHF was generated using ICD-10 codes for HIV and CHF. After screening, 79 patient charts were eligible. Patients were excluded if their CHF was managed elsewhere, if they were misdiagnosed or deceased. Nine were diagnosed with heart failure with preserved ejection fraction (HFpEF) defined as an ejection fraction above 50%. Seventy were diagnosed with heart failure with reduced ejection fraction (HFrEF) defined as an ejection fraction below 40%. Treatment was assessed using the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines.

Recommendations for treatment of HFrEF

Recommendations for treatment of HFpEF

Results

For patients with HFrEF, 10% of eligible patients were not prescribed aldosterone antagonists due to an incorrect contraindication. Thirty eight percent of patients requiring consideration for device therapy were not considered. Fourteen percent of patients did not have NYHA/ACC/AHA class documented. Three additional charts were found to not follow class-based management. Thirty five percent of patients with hypertension did not have guideline-based titrated therapy. In terms of HFpEF, 43% of patients did not have proper hypertension treatment.

Heart Failure with Reduced Ejection Fraction

Heart Failure with Preserved Ejection Fraction

Conclusion

Adherence to evidence-based guidelines for CHF in PLWH is important due to their increased risk of mortality and morbidity. Improvements such as documentation of heart failure class, contraindications to medications, and consideration for devices may improve outcomes going forward.

Disclosures

All Authors: No reported disclosures
934. Diagnostic Utility of Blood (1- >3)-β-D-Glucan Testing in Patients with HIV in Arkansas
Authors: Krishnan Gayathri , Hasan Lana , Saccente Michael
Published: January 2021

Background

Blood (1- > 3)-β-D-Glucan (BDG) is a sensitive marker for Pneumocystis jirovecii pneumonia (PJP) in patients with AIDS (PWA). However, other fungal infections, including progressive disseminated histoplasmosis (PDH), cause high levels of BDG. At our hospital, PDH is a common diagnosis in PWA with fever and respiratory complaints, making it difficult to differentiate PJP from PDH based on clinical features alone. The objective of this study was to assess BDG as a diagnostic test for PJP in Arkansas where histoplasmosis is endemic.

Methods

We performed a retrospective review of patients with confirmed PJP and confirmed PDH who had BDG testing between 2014-2020. Positive cytological or histological evidence of P. jirovecii in bronchoalveolar lavage (BAL) or lung biopsy, or positive PCR on sputum or BAL confirmed PJP. Identification of Histoplasma capsulatum in culture of blood or other normally sterile site, histology showing typical yeast forms, or a positive urine H. capsulatum antigen assay (MiraVista Diagnostics) confirmed PDH. The Fungitell Assay determined BDG levels as follows: negative, < 60 pg/mL; indeterminate, 60-79 pg/mL, and positive > 80 pg/mL. Values below 31 pg/mL and those above 500 pg/mL were censored at 30 and 500, respectively. Respiratory symptoms were defined as the presence of cough, shortness of breath, or dyspnea on exertion.

Results

53 episodes of PDH occurred in 46 patients. 42 were accompanied by a BDG result. Of these, 38 (90%) were positive; 3 (7%) were negative; and 1 (2%) was indeterminate. 44 (83%) of the PDH episodes were associated with respiratory symptoms. 36 of these had a BDG result. 34 (94%) were positive; 1 (3%) was negative; and 1 (3%) was indeterminate. 44 episodes of PJP occurred in 40 patients. All had a BDG result. 43 (98%) were positive.10 (23%) episodes of PJP were accompanied by a concomitant infection.

The mean BDG level was significantly higher in the PJP group compared to those with PDH and respiratory symptoms (P=.002). However, values overlapped substantially, and BDG positivity was not significantly more frequent in the PJP group (P=.586).

Box-and-Whisker Display of (1->3)-β-D-Glucan Results

Conclusion

In Arkansas, BDG positivity is not a reliable marker of PJP because it cannot distinguish between PJP and PDH. Attributing an elevated BDG to PJP without additional evaluation risks misdiagnosis.

Disclosures

All Authors: No reported disclosures
937. Factors Associated with Metabolic Syndrome in People with HIV under 40 Years in Guatemala
Authors: Marroquín Hugo E , Ortiz Dean , Larson Lindsey , Franco Katherine , Spec Andrej , Melendez Johanna , Pinzon Rodolfo , Mejia-Chew Carlos , Samayoa Johanna , O’Halloran Jane A
Published: January 2021

Background

HIV infection and antiretroviral therapy (ART) can lead to metabolic abnormalities associated with increased cardiovascular disease risk, some of these abnormalities (central obesity, elevated fasting glucose, triglycerides, and blood pressure and low HDL cholesterol) are in metabolic syndrome (MetS). The prevalence of MetS increases with age. Currently, the status of MetS in people with HIV (PWH) Guatemala is unknown. We assessed the prevalence of MetS and potential predictors in PWH participating in prospective cohort study at Hospital Roosevelt in Guatemala City.

Methods

We performed a cross-sectional analysis of PWH under 40 years old receiving ART for at least 6 months from July 2019 to March 2020. The harmonized criteria for MetS and the cut-off for waist circumference recommended by the Latin American Diabetes Association were used. Association between MetS and gender, place of residency, ethnicity, educational level, baseline and current CD4 count, smoking, alcohol consumption, physical activity, viral load, body mass index (BMI) and ART exposure was assessed in bivariate analysis. Potential predictors (p-value < 0.1) were included in a multivariate binary logistic regression model.

Results

Of total cohort of 757 participants enrolled390 (51.5%) were younger than 40 years. Of those under < 40 years, 150 (38.5%) were women, 59 (15.1%) Mayan, median age was 32 years (IQR 27, 37). 93 (23.8%) had MetS. Between group differences in Table 1. Of those with Met, 51 (54.8%) had elevated waist circumference, 87 (93.5%) elevated triglycerides, 83 (89.2%) low HDL-c, 56 (60.2%) elevated blood pressure and 35 (37.6%) elevated fasting glucose. Body mass index (BMI) ≥ 25 kg/m2 or higher and 2 years or more of cumulative non-nucleoside reverse transcription inhibitors (NNRTI) where more common in those < 40 years with MetS compared to those without MetS. On multivariable regression, MetS was associated with current CD4 count < 200 (OR 3.1; IC 1.51, 6.34; p-value < 0.01) and BMI ≥ 25 kg/m2 (OR; 6.53; IC 3.64, 11.73; p-value < 0.01).

Table1. Between group differences (No MetS vs MetS)

Conclusion

Nearly one in every four PWH under 40 years old in our cohort was affected by MetS. Dyslipidemia (elevated triglycerides and low HDL-c) was the main driver of MetS. Lower CD4 count and overweight were predictors for MetS in PWH under 40.

Disclosures

Andrej Spec, MD, MSCI, Astellas (Grant/Research Support)Mayne (Consultant)Scynexis (Consultant)
938. Identifying Gaps in the Treatment of Hepatitis C in Patients Co-Infected with HIV in Edmonton, Alberta
Authors: Savaryn Bohdan , Round Jessica , Plitt Sabrina , Shafran Stephen , Charlton Carmen
Published: January 2021

Background

The Northern Alberta HIV Program (NAHP) provides care and support for about 2500 HIV positive individuals. Part of the program includes screening and therapy for co-morbidities such as hepatitis C virus (HCV) infection. This study aims to assess the occurrence of HCV co-infection among these patients, determine whether they had received treatment for HCV, and identify patients who are currently viremic so they can be linked to care.

Methods

NAHP patients from 2010 to 2019 were linked to their HCV antibody, RNA, and genotyping laboratory testing data from January 1, 2000 to December 31, 2019 as well as HCV medication dispensation data. Each patient’s current and previous state of HCV infection and treatment status was assessed. Chart reviews were conducted for patients presently HCV viremic to assess their HIV care and social determinants.

Results

Of the 2417 NAHP patients, 392 (16.2%) were identified as having been co-infected with HCV at some point between January 1, 2000 to December 31, 2019 and meeting the inclusion criteria. Overall, 198 (50.5%) of the HIV-HCV co-infected patients had received HCV treatment and 232 (59.2%) were no longer viremic at their most recent HCV RNA test. 99 (69.2%) of the 143 HCV viremic patients had a suppressed HIV infection suggesting they are active in their HIV care and good candidates for HCV treatment.

Figure 1. 2417 patients in the Northern Alberta HIV Program were evaluated for the presence of an HIV- HCV co-infection. 404 patients were identified as having been HIV-HCV co-infected at some point between January 1, 2000 and December 31, 2019.

Figure 2. 404 HIV-HCV co-infected patients from the Northern Alberta HIV Program were assessed for the occurrence of treatment as well as the current status of their HCV infection. 143 patients were found to currently have an active HIV-HCV co-infection.

Table 2. Characteristics of HIV-HCV co-infected patients from the NAHP with an active HCV infection (n=143)

Conclusion

The NAHP has been successful in identifying and treating many of their HIV HCV co-infected patients, however, there remain patients with viremic HCV. Despite the availability of direct-acting antivirals (DAAs) in Alberta and many of these patients being successfully treated for HIV, a significant proportion of co-infected patients have not initiated HCV treatment The HIV treating physicians of these individuals will be notified and encouraged to assist in getting them linked to HCV care and treatment.

Disclosures

All Authors: No reported disclosures