bluuebunny/crossref_metadata_2025 huggingface dataset:
P-232. Reduction in Catheter-associated Urinary Tract Infections (CAUTIs) Post-Implementation of External Urethral Catheters (EUC) in the Intensive Care Units at a Quaternary Medical Center
Authors: Bchech George , Bangash Salman , Noonan Joseph , Gill Arshpal , Rothman Ryan , Abalos Charmaine Clarisse D , Betancourth Adriana C , Young Meilin , Bhanot Nitin
Published: January 2025

Background

Catheter associated urinary tract infections (CAUTIs) have significant clinical and financial impact on the US healthcare system. In a systematic review published in 2018, the attributable cost of a CAUTI was estimated to exceed $1000 (1). Indwelling urinary catheters increase risk for CAUTIs proportionate to the length of catheter use (figure 1). External Urethral Catheters (EUC) have the potential to reduce risk of CAUTIs. We conducted this quality improvement project to study the impact of EUC use on CAUTIs in the ICUs at our institution.

Figure 1. Length of Foley Catheter placement to CAUTI by organisms.

Methods

EUC use was introduced in female (F) and male (M) patients since July 2018 and November 2021, respectively at our hospital. In this retrospective review, cases of CAUTIs were reviewed pre and post implementation of EUCs; in F from Jan 2015 to Jan 2021 and in M from Nov 2019 to Nov 2023 in patients admitted to the ICUs. National Healthcare Safety Network (NHSN) definition for CAUTIs was utilized for this project. Additionally, information on pathogens implicated in these infections was obtained.

Figure 1: Distribution of organisms in Female population

Results

There were a total of 157 CAUTIs noted in the study period; of the 132 F cases, 95 cases occurred pre and 37 cases post EUC implementation (RR 2.5 & RRR 61%). Of the 25 M cases, 15 cases were in pre and 10 cases post (RR 1.5 & RRR 33%) EUC use. Overall, there was an absolute risk reduction of 0.402. E.coli was the most common pathogen in both males (24%) and females (47%). There was an overall higher incidence of Enterococcus spp in the male population (20%) when compared to the female population (11.4%) (Figure 2&3).

Figure 3: Distribution of organisms in male population

Conclusion

Nosocomial infections are well described as a burden for ICU patients, but the results of this study demonstrate that there are possible interventions to mitigate CAUTIs. Clinicians and nursing staff should evaluate the need for indwelling urinary catheters on a daily basis. Favoring placement of EUC over indwelling urinary catheter has the potential to significantly reduce the burden of this disease.

Figure 4: Total case pre and post implementation of EUC.

Disclosures

All Authors: No reported disclosures
P-245. Not in the Bundle: Mitigating Central Line-Associated Bloodstream Infections in the Trauma ICU through Central Line Access Restriction
Authors: Pustorino Thomas , Keller Marina , Palazzo Jamie , Mikaya Charmaine , Quinn Moira , Yezzo Phyllis , Prabhakaran Kartik , Chen Donald S , Kennedy Stephanie , Anekwe Chinwe
Published: January 2025

Background

Central line-associated blood stream infections (CLABSI) pose a significant threat in healthcare. The CDC CLABSI reduction bundle focuses primarily on optimizing line insertion and has few recommendations addressing line maintenance. This ignores most of the line’s lifespan and risk for infection.

Methods

The single center observation study sought to reduce risk for CLABSI by focusing on central line maintenance and access within a Trauma Intensive Care Unit (TICU). Nurse epidemiologists observed front line staff and noted that many central lines had a long dwell time and were accessed multiple times a day. In order to reduce the number of line accesses, a process was instituted where blood draws were preferentially obtained via peripheral blood draw or arterial line. Education regarding line maintenance and proper line access technique was reviewed and reinforced. Compliance with this process was prospectively monitored.

Results

From February 2021 to February 2022, the TICU experienced a surge of 9 CLABSIs with all the lines having an extended dwell time of 5-147 days (mean 69 days). Of these patients, 4 were receiving total parental nutrition and 4 were undergoing dialysis (Table 1). Over the summer of 2022, education was used to change practice in the TICU and stop bloodwork drawing from central lines. After the process change, no CLABSIs were reported for over 24 months, until March 2024 (Figure 1). To sustain progress, a line access audit and blood draw audit were developed to ensure vigilant hand hygiene and scrub-the-hub technique were implemented and to ensure that blood draws were not obtained from central lines. As of March 2024, >95% of blood draws were not obtained from central lines decreasing line access. Job aid cards were developed to teach and reinforce how to critically evaluate blood draws (Figure 2).

Conclusion

The study underscores the likely connection between blood draw practices and risk for line contamination. Minimization of central line access can decrease the chance of line contamination; avoiding blood draws are an effective way to radically reduce line access and bring CLABSI rates to zero.

Disclosures

All Authors: No reported disclosures
P-248. Implementation of a National Environmental Program Services (EPS) Ultraviolet-C (UV-C) No-touch Room Disinfection Toolkit in the Veterans Health Administration
Authors: Cunningham Goedken Cassie , Dukes Kimberly , Hockett Sherlock Stacey , Suh Daniel , Guerrero Bernardino , Zabarsky Trina , Perencevich Eli N
Published: January 2025

Background

Environmental disinfection reduces the risk of hospital infections. Prior evidence from the Veterans Affairs (VA) healthcare system suggests that adding UV-C systems to manual disinfection processes significantly reduced nosocomial infection rates. Many VAs have added UV-C disinfection, but with wide variation in implementation, effectiveness, and use. To address this, we developed, piloted, and implemented a national VA UV-C toolkit.

Methods

Our VA multicenter implementation science program project grant collaborated with VA Environmental Programs Service (EPS) to rapidly develop and implement a toolkit for VA facilities to establish and maintain UV-C processes that maximize efficacy. In our larger study, we interviewed Environmental Management Services (EMS) staff and identified barriers to UV-C (e.g., safety concerns, material degradation). From 5/23-9/23, we identified best practices and ways to address implementation challenges to create a mixed-methods data-driven national EPS UV-C toolkit. We incorporated our prior VA effectiveness research and concerns stakeholders raised in EPS meetings and interviews.

Results

The toolkit includes sections that were deemed important guidance for UV-C use: 1) Ultraviolet Light, 2) Disinfection, 3) Benefits, 4) Process for Disinfection, 5) Quality Assurance/Validation, and 6) Frequently Asked Questions. It was piloted at 6 geographically dispersed VAs (9/23-10/23). Pilot feedback was positive and led to revisions for site variability (e.g., revised room prep steps allowing for instructions to be more universally representative of room layouts), UV-C use (e.g., scenarios when UV-C can be useful), and monitoring details (e.g., track frequency and location of use). EPS implemented the final toolkit in March 2024 on the VA national SharePoint, online, and as a printable PDF.

Conclusion

Implementation work in collaboration with operational partners and partnered pilot testing was successful in rapidly developing and implementing a standardized UV-C toolkit across a large healthcare system. The toolkit guides EMS professionals in establishing and standardizing processes for UV-C disinfection to improve Veterans’ safety.

Disclosures

All Authors: No reported disclosures
P-265. No Flu in the Loo: Efficacy of a novel, automated far ultraviolet-C light technology for decontamination of surfaces and aerosolized viral particles in bathrooms
Authors: Memic Samir , Kaple Claire , Cadnum Jennifer , Donskey Curtis
Published: January 2025

Background

Aerosols generated during toilet flushing are a potential source for transmission of

viral and bacterial pathogens in bathrooms. However, manual decontamination of bathrooms

after each use is not feasible.

Log 10 reduction of organisms on steel disk carriers after 2 hours of far UV-C light exposure*

MRSA, methicillin-resistant Staphylococcus aureus; VRE, vancomycin-resistant enterococci; E. coli,

Escherichia coli, MS2, bacteriophage MS2

*, 5 of 9 test sites shown

Methods

We tested the efficacy of a wall-mounted far ultraviolet-C (UV-C) light technology

that only delivers far UV-C when people are not present for decontamination of surfaces and

aerosolized viral particles in unoccupied hospital bathrooms. A quantitative disk carrier test

method was used to test efficacy against organisms on steel disk carriers placed in 9 sites in the

bathrooms with an exposure time of 2 hours; Clostridioides difficile spores were exposed for 24

hours. Efficacy against aerosolized bacteriophage MS2 was tested with a 45-minute exposure.

Results

The far UV-C technology reduced methicillin-resistant Staphylococcus aureus

(MRSA), vancomycin-resistant enterococci (VRE), Candida auris, Escherichia coli, and

bacteriophage MS2 on disk carriers by >1.9 log 10 at all test sites in 2 hours (Figure), and reduced

C. difficile spores by >1.7 log 10 in 24 hours. Aerosolized bacteriophage MS2 was reduced by 4

log 10 plaque-forming units in 45 minutes. The technology consistently turned off when people

entered the bathroom and resumed far UV-C delivery after they exited.

Conclusion

The novel far UV-C light technology could potentially be useful for automated

decontamination of bathrooms in healthcare and community settings.

Disclosures

Curtis Donskey, MD, Clorox: Grant/Research Support|Pfizer: Grant/Research Support
P-274. Rates of Extended-Spectrum Beta-Lactamase-Producing Enterobacterales across Tennessee, 2019 – 2022
Authors: Gambrell Ashley , Velrajan Srilakshmi , Patel Dipen , Harriott Melphine , Muleta Daniel
Published: January 2025

Background

Extended-spectrum beta-­­lactamase (ESBL)-producing Enterobacterales were responsible for an estimated 197,400 infections and 9,100 deaths amongst hospitalized patients in 2017 in United States. Surveillance of ESBL-producing Enterobacterales, as a part of Multi-site Gram Negative Surveillance Initiative (MuGSI) project was conducted in four Tennessee counties (Maury, Marshall, Lewis, and Wayne). Little is known specifically about the rates of ESBL-Enterobacterales geographically over these areas. We calculated and compared rates at the county and census tract level for the TN MuGSI catchment area, for 2019 – 2022.

Prevalence Rates of ESBL-Enterobacterales Cases by Tennessee County and Census TractFigure 1.Rates of Cases of ESBL-producing Enterobacterales by County and Census Tract, 2019 – 2022. Rates are calculated per 1,000 residents for each census tract and grouped by natural breaks classification method. County and census tract boundaries are shown in grey outline outline.

Methods

Data from MuGSI Case Detection System for 2019 – 2022 were geocoded to the county and census tract level using ArcMap. Population counts, including demographics, were taken from the U.S. Census Bureau’s 2020 Census. Analysis was completed in SAS 9.4.

Results

At the county-level, the average prevalence rate was 16.76 cases per 1,000 residents. Wayne county had the highest prevalence at 29.69 cases per 1,000 residents, while Maury county had the lowest, at 9.39 cases per 1,000 residents. Prevalence rates amongst the census tracts varied widely, with a mean of 13.04 cases per 1,000 residents, and ranging from 0.73 cases up to 58.86 cases (Figure 1). Wayne County’s 4 census tracts consistently showed the highest rates, ranging from 13.48 to 58.86 cases per 1,000 residents, while Maury County’s 21 tracts had the lowest rates, ranging from 0.73 to 31.98 cases per 1,000 residents. From 2019 to 2022, most counties had stable prevalence rates, however Wayne County showed an increase from 3.60, to 9.60 cases per 1,000 residents by 2022.

Conclusion

Rates of ESBL-producing Enterobacterales varied substantially, even amongst a relatively small catchment area within the state. Highest rates of this pathogen were found in census tracts from Wayne and Lewis County, with Wayne County also showing a large increase of cases from 2019 to 2022. Understanding of what drives rates disproportionately in these areas is crucial to prevention and mitigation, not only for ESBL-producing Enterobacterales, but for many other gram-negative multidrug resistant organisms. More research is needed to highlight the drivers of these disparate rates.

Disclosures

All Authors: No reported disclosures
P-276. Outcomes Following Cefiderocol vs. Meropenem Treatment for Gram-Negative Pneumonia: A Real-World Data Analysis
Authors: Haslund-Gourley Benjamin S
Published: January 2025

Background

The prevalence of multidrug-resistant (MDR) gram-negative pneumonia continues to increase across the United States (U.S.). Recently, cefiderocol (Fetroja), was approved to treat MDR-negative pneumonia, overcoming several beta-lactam resistance mechanisms. While cefiderocol has been utilized over the last 6 years, additional studies are needed to assess its use long-term. The purpose of this study was to compare outcomes of gram-negative pneumonia patients treated with either cefiderocol or meropenem utilizing real-world data.

Methods

This was a retrospective cross-sectional study between 05/02/2018 and 05/02/2024 utilizing the TriNetX Research Network, consisting of 88 U.S. and ex-U.S. healthcare organizations. Patients were included if they had an ICD-10 code for gram-negative pneumonia and receipt of cefiderocol or meropenem after pneumonia diagnosis, defined by RxNorm codes. Antibiotic receipt after pneumonia diagnosis defined the index event date. Patient cohorts were balanced using demographic (age, sex, race) and clinical data (antibiotic use, and XX co-morbidities) via a 1:1 greedy, nearest neighbor propensity score matching (PSM) with a 0.1 caliper. Outcomes following this index event included mortality, Clostridioides difficile infection (CDI), epilepsy/recurrent seizures, coagulation defects, pulmonary fibrosis (PF), and sepsis. A Kaplan-Meier Analysis was used to compare the proportion of ceficerocol or meropenem patients with each outcome of interest one-year post-index.

Results

After PSM, cefiderocol (n=94) showed no significant differences in mortality (HR 1.38, 95% 0.87-2.18), CDI (HR 1.04, 95% 0.26-4.17), epilepsy/recurrent seizures (HR 1.64, 95% 0.67-4.01), PF (HR 1.20, 95% 0.40-3.60), or sepsis (HR 1.17, 95% 0.75-1.81) one year post-index vs. meropenem (n=94). Cefiderocol patients had lower rates of coagulation defects (HR 0.2, 95% 0.04-0.91, p=0.021).

Conclusion

Overall, cefiderocol patients showed no differences in mortality, CDI, epilepsy/recurrent seizures, PF, or sepsis. However, patients treated with cefiderocol for gram-negative pneumonia had a lower rate of coagulopathies. Additional real-world studies are needed to monitor its long-term outcomes.

Disclosures

All Authors: No reported disclosures
P-293. Epidemiology of Extraintestinal Invasive Escherichia coli Infections in 9 U.S. Communities, 2023
Authors: Grome Heather N , Brandenburg Joshua M , Grass Julian E , Parker Erin , Johnston Helen , Driscoll Jennifer , Rebolledo Paulina , Smith Gillian , Wilson Lucy E , Luckman Emily , Zipprich Jennifer , Garcia Marco , Hoffman Marisa , Flores Kristina , Che Looi Hsioa , Tellerman Julia , O’Brien Shannon C , Muleta Daniel , Denzie Olivia , Guh Alice
Published: January 2025

Background

Extraintestinal invasive Escherichia coli (iEC) is a leading cause of sepsis and hospitalization, but US surveillance for iEC has been frequently limited to multidrug-resistant (MDR) strains and hospitalized cohorts. To describe the incidence and clinical characteristics of MDR and non-MDR iEC and inform prevention and vaccine development, CDC’s Emerging Infections Program piloted active population- and laboratory-based surveillance in 9 US sites.

Methods

Among surveillance area residents ( > 7.3 million people), an incident iEC case was the first isolation of E. coli in a 30-day period from a normally sterile body site (June–August 2023). Demographic, clinical, and laboratory characteristics were assessed by chart review. Annual incidence rates by surveillance area were estimated by multiplying total case number by 4 and used 2022 US census data for denominators.

Results

Among 1345 iEC cases in 1334 patients, E. coli was isolated from blood in 1223 (90.9%) and from other sterile sites in 122 (9.1%). Median age was 68 years (IQR 55–79); 766 (57.0%) were female. Overall estimated annual crude incidence rate was 74.5 cases per 100,000 population (range by area 51.3–95.6) and was higher for persons aged ≥ 60 vs < 60 years (228.5 vs 30.4). Cases were most commonly community associated (554, 41.2%) or health care associated community onset (633, 47.1%). Most case-patients (1194, 88.8%) had comorbidities; diabetes was most common (457, 34.0%). Of all cases, 762 (56.7%) were associated with urinary tract infection (UTI), 192 (14.3%) with recurrent UTI, and 213 (15.8%) had a urinary catheter in the 2 days before collection of the iEC-defining specimen. Among 1160 hospitalized cases, median length of stay was 5 days (IQR 3–9), 103 (8.9%) died. Of reported E. coli susceptibilities, 144/500 (28.8%) were fluoroquinolone-resistant, 185/1345 (13.8%) were extended-spectrum β-lactamase producing, and 3/1345 (0.2%) carbapenem-resistant.

Conclusion

The burden of iEC disease was substantial compared to other invasive pathogens and primarily affected older adults. Over half of infections accompanied UTIs and involved hospitalization. Continued surveillance to monitor trends over time, inform vaccine development and evaluation, and advise prevention efforts are needed.

Disclosures

All Authors: No reported disclosures
P-318. Clinical and genomic characterization of patients with methicillin-resistant Staphylococcus aureus horizontal transmission identified through prospective whole-genome sequencing: opportunities in the hospital and beyond
Authors: Rosa Rossana M , Rosello Gemma , Manzanillo Kelley , Cifuentes Renzo , Ghaemmaghami Chris , Zambrana David , Martinez Octavio , Abbo Lilian M
Published: January 2025

Background

We describe the clinical and epidemiological characteristics of patients involved in horizontal transmission detected through an Infection Prevention and Control (IPC) program integrating prospective whole-genome sequencing (WGS) of methicillin-resistant Staphylococcus aureus (MRSA) into routine activities.

Methods

Study conducted at a large county hospital in Miami, Florida between March 2023-January 2024. Clinical cultures of hospitalized patients underwent short-read sequencing. Pairs with < 25 SNPs were considered genomically related and investigated to determine the location and route of transmission. Cases were discussed by the IPC program with frontline healthcare workers and leaders to implement targeted measures where appropriate. Definitions are described in Table 1.

Results

A total of 501 unique isolates were sequenced. We identified 21 putative transmission events, 9 probable and 12 possible, involving 40 patients. Transmission occurred in intensive care units (5), medical-surgical wards (3), hospital (without unit link, 5), nursing homes (4), jails (2) and in the community (2). Overall, 61.9% of events were hospital-onset (HO) and 8 (38.1%) were community-onset healthcare-associated (CO-HA).

Compared to HO cases, CO-HA cases were older, had higher proportions of diabetes, chronic hemodialysis, and were nursing home residents. Most HO cases belonged to sequence type (ST) 8 (76.0%), while CO-HA cases were more evenly divided among the STs identified (Table 2). Prevalence of carriage of mupA and qacC genes among CO-HA cases was higher than in HO cases at 53.3%/46.7% versus 24%/36% respectively.

There were 25 patients involved in HO transmission (12 index and 13 acquiring patients [1 patient linked to 2 others]). Six index cases were culture-positive on admission. Index cases who were culture negative on admission had a median number of days from admission to first positive culture of 28.4 (IQR 17.6-40.9). The median number of days overlapped between pairs was 6 (IQR 3-10) (Figure 1).

Conclusion

Patients with CO-HA transmission of MRSA have a larger burden of chronic illness and antimicrobial resistance markers compared to HO cases. Mitigating the risk of MRSA infection requires efforts throughout the continuum of healthcare.

Disclosures

All Authors: No reported disclosures
P-332. A Discrete Choice Experiment to Evaluate Healthcare Personnel Preferences Regarding Risk-Tailored Policies for Contact Precautions for Patients with Methicillin-Resistant Staphylococcus aureus in Hospitals
Authors: O’Hara Lyndsay M , Calfee David P , Angelino Nicholas , Harris Anthony , Snyder Graham M , Martin Elise , O’Hara Nathan N
Published: January 2025

Background

The risk of MRSA transmission differs by healthcare personnel (HCP) role and care activity. An alternative to an “all or none” approach to contact precautions for patients with MRSA carriage is a “risk-tailored” approach – using gloves and gowns only for certain high-risk activities, locations, or roles. A discrete choice experiment is a proven method to assess HCP perspectives on varied implementation strategies.

Methods

We distributed a discrete choice experiment survey to HCPs at medical centers in three cities. Respondents were presented with eight choice sets, each consisting of two hypothetical policy options for glove and gown use to prevent MRSA transmission (Fig 1). In each comparison, respondents selected their preferred policy option. Using mixed logit modeling we calculated the utility derived from each policy component, the probability of uptake for the most favored policies, and heterogeneity in preferences based on HCP role.

Results

384 HCP completed the survey: 138 from New York, 128 from Pittsburgh, and 118 from Baltimore. Respondents’ occupations were physicians or advanced practice providers (93, 24%), nurses (87, 23%), environmental services (56, 15%), respiratory therapists (55, 14%), occupational or physical therapists (44, 11%), and “other” (46, 11%). 237 (54%) respondents reported wearing gloves and gowns ‘all the time’ when required. Respondents preferred policy with the highest utility score was to use gloves and gown for all HCPs roles (utility, 0.17; 95% CI, 0.12 to 0.23), in high-risk settings (utility, 0.12; 95% CI 0.07-0.18), when touching the patient (utility, 0.11; 95% CI 0.06-0.17) (Fig 2). Sixty-three percent (95% CI 60-66%) of respondents would support a risk-tailored approach over an approach where contact precautions are used by all HCP in all settings and for all activities. The support for this policy varied by HCP role (p< 0.02), with the strongest probability of support from physicians and advanced practice providers (77%, 95% CI 72-82%) and the least support from environmental services (45%, 95% CI 37-53%) (Fig 3).

Conclusion

This discrete choice survey demonstrates that most HCP prefer a risk-tailored approach to contact precautions when caring for patients with MRSA.

Disclosures

Anthony Harris, MD, MPH, Innoviva: Advisor/Consultant|UpToDate: Infection Control Editor Graham M. Snyder, MD, SM, Infectious Diseases Connect: Advisor/Consultant Nathan N. O'Hara, PhD MHA, Arbutus Medical Inc.: Stocks/Bonds (Private Company)
P-345. The Changing Dynamics of the Candida auris Outbreak in Southern California
Authors: Shaw Bennett M , Uslan Daniel , Yang Shangxin
Published: January 2025

Background

The current global outbreak of Candida auris poses a serious public health threat. With both high levels of antifungal resistance and a propensity for nosocomial spread, Candida auris has the potential to cause devastating outbreaks within healthcare facilities, especially amongst long-term and intensive care patients. As in many viral and bacterial pathogens, pathogen genomics has proven to be an indispensable piece of the outbreak response toolkit by contributing information useful in diagnosis, drug-resistance testing, and epidemiologic investigations.

Phylogenetic analysis of C. auris reveals introduction of Clade I to Southern CaliforniaFigure 1.A) Distribution of sequenced C. auris case clade membership during study period. B) Maximum-likelihood phylogenetic tree constructed from concatenated SNP sites of sequenced C. auris isolates with antifungal resistance data. MIC breakpoints: Fluconazole ≥ 32, Micafungin ≥ 4, Amphotericin B Intermediate ≥ 2, Resistant ≥ 4

Methods

At our large healthcare system located in Los Angeles, patients admitted with epidemiologic risk factors such as residence in a long-term care facility undergo admission screening for C. auris via combined axillary/inguinal swab. Microbiologic data from 213 C. auris isolates collected either via admission screening or from clinical cultures, including 91 isolates with paired whole-genome sequencing data, were used to conduct an in-depth investigation of the changing dynamics of the local C. auris outbreak. Phylogenetic analysis was employed to investigate the relationships between isolates.

Results

Transmission of C. auris between 2021 and 2023 remained high, with an average of 59 patients per year determined to be colonized or infected with C. auris. While the local outbreak has overall been dominated by Clade III isolates that are resistant to fluconazole but susceptible to echinocandins and amphotericin B, phylogenetic analysis identified the first known introduction of Clade I to Southern California in late 2022, which may have led to the first amphotericin B resistant case within our healthcare system. Genotypes of ERG11 and FKS1 genes were found to correlate with fluconazole resistance and echinocandin susceptibility. Two cases identified nearly one month apart in an intensive care unit were genetically identical, supporting epidemiologic suspicion of in-hospital transmission.

Conclusion

Continued genomic surveillance of C. auris contributed to an enhanced understanding of local outbreak dynamics, helping inform and guide empirical treatments and epidemiologic investigations.

Disclosures

All Authors: No reported disclosures
P-351. Hospital associated outbreak of Crimean-Congo Hemorrhagic Fever, Dushanbe, Tajikistan, 2023
Authors: Sharifov Rajabali , Horth Roberta , Tilloeva Zulfiya H , Jafarov Navruz , Nabirova Dilyara
Published: January 2025

Background

On July 1, 2023, a surgeon (Patient B) in Dushanbe, Tajikistan, died of acute febrile illness with hemorrhaging. Patient B had been hospitalized with acute respiratory distress four days before. Clinicians suspected Crimean-Congo Hemorrhagic Fever (CCHF). CCHF is a rare tick-borne disease. Tajikistan records just 1-6 cases annually. Patient B had no known exposures to ticks. We aimed to identify source and additional cases, and determine source.Figure 1.Timeline of CCHF Hospital Outbreak, Dushanbe, Tajikistan, 2023

Methods

We conducted an outbreak investigation on July 1st. A confirmed case was defined as a person with a positive anti-CCHF IgM ELISA or RT-PCR and an epidemiological link. We reviewed medical charts to find contacts, defined as people who had been in direct contact with or had exposure to bodily fluids from any confirmed case in the last 21 days. We interviewed living cases and contacts and collected blood for testing. We also conducted an infection control assessment.Figure 2.Cases and contacts in CCHF Hospital Outbreak, Dushanbe, Tajikistan, 2023

Results

A hospitalized adult (Patient A) had died of internal bleeding with extensive peritonitis (Figure 1) on June 16th. Six days later, a physician (Patient B) who had performed surgery on Patient A developed fever. Another six days later, he was hospitalized with hemorrhagic fever and diagnosed with CCHF within 3 days. Another physician (Patient C) who had performed surgery on Patient A was diagnosed with CCHF the following day. A laboratory assistant (Patient D) who had given a direct transfusion to Patient B was also diagnosed with CCHF the next day. Case-fatality rate was 25% (Table 1). We identified 29 healthcare providers who had contact to Patients A-D. All were tested, isolated and given oral Ribavirin 400 mg for 3 days as prophylaxis. None became ill (Figure 2). Interviews with hospital staff revealed infection control gaps, including lack of personal protective equipment during surgery and invasive procedures.Table 1.Characteristics of CCHF cases in a hospital outbreak in Dushanbe, Tajikistan, 2023

Conclusion

Misdiagnosis and infection control gaps contributed to transmission of CCHF virus within the hospital. Direct blood transfusion is not a recommended practice, but performed due to lack of resources. Trainings were provided on infection prevention and control, and on CCHF diagnosis and care. No additional cases were detected.

Disclosures

All Authors: No reported disclosures
P-369. Skilled Nursing Facility Characteristics Associated with Candida auris Transmission in Maryland
Authors: Smith Lauren , Leekha Surbhi , Lin Gary , Falvey Jason , Grace Brittany , Rubin Jamie , Vaeth Elisabeth , Perlmutter Rebecca , Roghmann Mary-Claire
Published: January 2025

Background

C. auris is a multi-drug resistant organism with high morbidity and mortality that is increasing throughout the United States. Skilled nursing facilities (SNFs) play a large role in transmission of this pathogen in healthcare settings. In this study, we compare characteristics of SNFs with and without C. auris transmission in Maryland.

Comparison of Resident Characteristics Between Facilities with and without C. auris Transmission

Methods

We conducted a retrospective analysis of all 226 Maryland SNFs to identify characteristics associated with C. auris transmission from June 2019, when transmission was first detected in the state, to December 2022. C. auris transmission was defined as ≥ 2 cases that were epidemiologically linked to the same SNF. SNF resident and facility characteristics were obtained from the public database Long Term Care Focus (LTCFocus) and the Maryland Health Care Commission (MHCC). A Maryland-specific patient transfer network was built using data derived from Centers for Medicare and Medicaid Services (CMS) fee for service beneficiary claims data linked to the CMS Data Set (Figure 1). Centrality measures were calculated based upon patient transfer networks. We used bivariate analyses to compare facilities with and without C. auris transmission.

Comparison of Centrality Measures (Connectedness)Between Facilities with and without C. auris Transmission.

Results

Fifteen SNFs had transmission of C. auris during the study period. SNFs with transmission had a greater number of residents (mean 141 v 95), higher resident acuity, higher percentage of black residents (64% v 34%) and higher percentage of residents on Medicaid (74% v 59%) (Table 1). The patient transfer network of SNFs with transmission generally had higher measures of centrality, including Betweenness Centrality and PageRank (Table 2). Based on the network analysis, facilities that influence and serves as a bridge between other facilities have a higher likelihood of transmission.

Network Characterization of Patient Transfer Network in Maryland Using CMS Data.

Conclusion

Maryland SNFs with more central patient transfer networks and with a higher proportion of residents on Medicaid, Black residents, and acutely ill were more likely to have C. auris transmission. Additional analyses on interactions between facility characteristics and transfer networks are needed to help direct infection prevention efforts.

Disclosures

All Authors: No reported disclosures
P-371. Mycobacterium Scrofulaceum Pseudo-Outbreak due to Laboratory Cross-Contamination
Authors: Zuccaro Patricia D , landon Emily , Marrs R , Tesic Vera , Chu Vera , Beavis Kathleen G , Love Nedra , Enriquez Aurea , Taslakjian Boghos , Bartlett Allison H
Published: January 2025

Background

Mycobacterium scrofulaceum is a non-tuberculous mycobacteria (NTM) that has been recovered from numerous sources. The species rarely causes adult disease in immunocompetent hosts, but has been closely linked to pediatric cervical lymphadenitis as well as disease in the lungs, GI tract, and soft tissues of immunocompromised hosts. We report an M. scrofulaceum pseudo-outbreak due to sample cross contamination, which has not been previously reported.

Methods

University of Chicago Medical Center is a tertiary care center containing an on-site microbiology lab. In March, 2023 the Infectious Diseases consultation service reported multiple M. scrofulaceum cases to the infection prevention and control program which prompted an investigation. Twenty-five positive cultures from seven different patients were reviewed.

Given the rarity of M. scrofulaceum infection, cross-transmission was suspected. Chart review was conducted by a multi-disciplinary team in order to determine if true infection occurred and identify potential epidemiological overlap.

Results

Positive samples originated from soft tissue, lymph nodes, bone, sputum, and pleural fluid. Six patients improved clinically without treatment for M. scofulaceum.

The final patient had underlying hidradenitis suppurativa, pyoderma gangrenosum, and dermatosis artefacta requiring frequent hospitalization and debridement. M. scrofulaceum was isolated from deep tissue. Given the severity of the patient’s disease, frequent healthcare exposure, and extensive surgical history, he was highly suspected to be the source patient of the pseudo-outbreak. Upon review, we confirmed that most of the other positive samples were processed that same day.

Conclusion

We present a series of 25 positive culture results growing mycobacterium scrofulaceum isolated from seven distinct patients. An investigation into potential cross-contamination within our mycobacteriology laboratory was conducted and confirmed our suspicion. This led to internal review of our standard processes and re-training of our laboratory personnel.

Disclosures

Allison H. Bartlett, MD, MS, CVS/Caremark: Advisor/Consultant
P-376. Impact of a preoperative in-person assessment (PIPA) on Hip and Knee Replacement Surgical Site Infections (SSI)
Authors: Neelakanta Anupama , Fitts lauren , Fischer Kristin , Layell Jessica , Kester Shelley , Rajan Vignesh , Passaretti Catherine
Published: January 2025

Background

SSI results in increased mortality, morbidity, length of stay and healthcare costs. SSI prevention is complex and preoperative optimization is an essential component. We aim to assess the impact of a preoperative in-person assessment (PIPA) on odds of SSI.

Methods

We performed a retrospective study of 4389 elective hip (HPRO) and knee (KPRO) replacement surgeries performed between April 2022 through December 2023. Demographics, clinical risk factors, procedural data including SSI prevention bundle compliance, and data on completion of a PIPA were collated from the electronic health record and merged with infection preventionist (IP) SSI data obtained through routine surveillance by trained IPs using standard definitions. Patients with SSI present at the time of surgery were excluded. Patients who had a PIPA were instructed to bathe with chlorhexidine (CHG) for 5 days prior to surgery but there were no other differences in practice between the groups. Descriptive statistics were used to compare patients with and without a PIPA before surgery. We used logistic regression to investigate the relationship between PIPA and SSI adjusting for demographic and clinical factors.

Results

4296 (98%) of patients completed a PIPA. KPRO procedures and compliance with CHG bath and nasal iodine administration in the preoperative area were significantly higher in patients who had a PIPA. Rates of SSI were not significantly different between those who completed a PIPA and those who did not. (Table 1) In the univariate analysis, undergoing KPRO, having an outpatient procedure, increased age, and use of alcohol containing skin preparation were associated with lower odds of SSI (Table 2). After adjustment for age, outpatient status, alcohol containing skin prep, nasal care and PIPA, only age and outpatient procedure were associated with lower odds of SSI. Completion of a PIPA had no impact on SSI.

Conclusion

PIPA did not impact odds of SSI however compliance with certain IP process measures such as nasal iodine and CHG was better in PIPA group. Alcohol containing skin prep is associated with improved SSI outcomes and should be encouraged. Limitations included single center study and small number of infections so more data needed to see impact of PIPA on SSI.

Disclosures

All Authors: No reported disclosures
P-421. Impact of Rapid Methicillin-Resistant Staphylococcus aureus (MRSA) Nasal Polymerase Chain Reaction (PCR) Screening on Duration of Vancomycin (Vanc) Therapy for Suspected Pneumonia (PNA) in Adult Patients (Pts) Admitted to the Trauma Intensive Care Unit (TICU)
Authors: Brookshire Shelby , Banoub Mary , Randazza Olivia , Hartis Charles , Beardsley James R , Williamson John C , Garner Seth , Rebo Kristin , Palavecino Elizabeth , Luther Vera P , Bischoff Werner , Miller Preston , Hoth J Jason , DeWitt Michael E , Taylor Alex D
Published: January 2025

Background

At this institution on June 30, 2022, universal nasal decolonization with mupirocin ointment was replaced by nasal MRSA PCR assay screening at ICU admission to capture MRSA colonization and direct nasal decolonization. The aim of this study was to evaluate the impact of nasal MRSA PCR assay screening on duration of vanc for suspected PNA in adults admitted to the TICU.Table 1.Baseline and Treatment Characteristics

Methods

This single-center, retrospective cohort study compared pts from Jan - Jun 2022 (pre cohort) and Jan - Jun 2023 (post cohort). Pts ≥ 18 years of age admitted to the TICU that received empiric cefepime, meropenem, or piperacillin/tazobactam for suspected PNA documented on chest imaging were included. Pts who received vancomycin for a non-PNA indication, were previously treated for PNA during the admission, had structural lung disease, or had a pathogen identified on culture at the time of antibiotic (abx) initiation were excluded. The primary outcome was duration of vanc (hrs). Secondary outcomes included nasal MRSA PCR assay correlation with culture results from respiratory specimens, opportunities for vanc de-escalation based on negative nasal MRSA PCR assay within 36 hrs, ICU and hospital length of stay and mortality.Table 2.Primary and Secondary Outcomes

Results

37 pts were included in each cohort. There were no significant differences in baseline characteristics (Table 1). 36 (97%) pts received vanc in the pre cohort compared to 26 (70%) pts in the post cohort (P < 0.01). The primary outcome (Table 2) of median vancomycin duration was 25 [14, 49] hrs in the pre cohort compared to 14 [0, 36] hrs in the post cohort (P = 0.02). Secondary outcomes are reported in Tables 2 and 3. The negative predictive value of the nasal MRSA PCR assay for PNA with MRSA was 100% in this study. MRSA was not identified on respiratory culture in either cohort.Table 3.Opportunities for De-escalation (Post Cohort)

Conclusion

Vanc usage and duration of therapy were significantly reduced after nasal MRSA PCR assay screening on ICU admission was implemented in the TICU. However, additional opportunities for improved stewardship of empiric initiation of vanc were identified based on the described vanc usage and lack of MRSA PNA.

Disclosures

John C. Williamson, PharmD, Armata Pharmaceuticals: Grant/Research Support|Blue Collar Vaccines and Therapeutics: Board Member|Blue Collar Vaccines and Therapeutics: Ownership Interest|Paratek Pharmaceuticals: Grant/Research Support|ST Pharm Co, Ltd: Grant/Research Support
P-424. Challenges in Developing a Non Ventilator Hospital-Acquired Pneumonia Surveillance System
Authors: Cooper stephen J , Fagan Katherine , Cawcutt Kelly
Published: January 2025

Background

Pneumonia has been identified as the leading cause of hospital-acquired infections (HAI) with Non Ventilator Hospital-Acquired Pneumonia (NVHAP) making up the majority of cases. The ambiguity of definitions and subjective diagnostic criteria make defining and tracking NVHAP cases a challenge. We attempted to duplicate a previously validated electronic medical record (EMR) based NVHAP surveillance systems at a Midwest Academic Medical Institution.

Defining NV HAP

Inclusion criteria for NVHAP.

Methods

Using previously established criteria a surveillance system was designed to determine possible cases of NVHAP using data from our institution’s EMR (Table 1). Institutional review board approval was obtained, and the surveillance system was retrospectively applied to adult patients hospitalized throughout 2023 at two Midwest academic hospitals. A validation study was conducted to compare ten percent of cases reported by the NVHAP surveillance system to that of a single physician reviewer. Interim analysis was conducted in instances of inclusion criteria failure to allow for refinement of the NVHAP surveillance system.

Results

The NVHAP surveillance system generated a list of 425 possible NVHAP events in 2023. Single reviewer analysis of 20 patients revealed 12 patients who did not meet CDC pneumonia criteria and three that did not meet all inclusion criteria: two for lack of chest imaging within 48 hours of recorded oxygen deterioration event and two with no documentation of new antibiotic administration. Additional lists of 338, 322, and 76 NVHAP episodes were generated after coding changes were implemented with repeat interim analysis demonstrating further issues with adherence to inclusion criteria and errors with reproducibility of data extraction.

Conclusion

The development of a NVHAP surveillance system would allow an objective way to track this significant HAI. Potential models exist for creating such a system. However, multiple challenges are still present from determining EMR specific coding for complex medical issues, such as oxygen deterioration events, to reproducibility of electronic extracted data. Our efforts show that even when attempting to replicate validated methodologies site specific challenges will pose significant barriers to the development of EMR based NVHAP surveillance systems.

Disclosures

Kelly Cawcutt, MD, MS, BD: Advisor/Consultant|BMJ: Honoraria
P-426. Antimicrobial Resistance Focus in French ICU: A national surveillance network analysis on ventilator acquired pneumonia
Authors: Bourge Xavier , Friggeri Arnaud , Lepape Alain , Prevot Claire , Machut Anais , Vacheron Charles-Hervé
Published: January 2025

Background

The aim of this study was to perform a characterization of patients who underwent mechanical ventilation, the incidence rate of ventilator acquired pneumoniae (VAP) as well as identification of the pathogens involved, their resistance profiles, and the associated clinical outcomes. This group will be scrutinized for patterns and outcomes specifically associated with ventilator use.

Cumulative incidence of VAP

Methods

Adult patients undergoing mechanical ventilation hospitalized in France for at least 48 hours in ICU participating to REA-REZO surveillance network between 2018 and 2021 were included in this cohort. To estimate the cumulative incidence of VAP, extubation and death were considered as competing event.

Description of the cohort

Results

In this cohort, 98 047 patients were included. Among them, 12 251 (12.5%) had a VAP; the incidence rate for 1000 ventilation days was 18.9 cases per 1000 ventilation days. The median age of the cohort is 66 [55-75] years old with a male predominance (63.0 %). The SAPS score is 49 [36-63], the mortality is 24.4 % and the median ICU length of stay is 7 [4-15] days. Ventilated patients are more frequently admitted for medical (63.0 %) compared to surgical (37.0%) reason.

At day 30, the attributable mortality associated with ventilator-associated pneumonia (VAP) was estimated at 4.9% (3.7% - 6.2%). Out of 15,575 diagnosed cases of VAP, there were 4,695 instances of polymicrobial VAP, which constitutes 30.1% of the cases. Non-fermenting Gram-negative bacteria were a significant group, contributing to 25.4% of the VAP cases, with Pseudomonas aeruginosa being the most significant contributor (3 924 cases, 76.2% of non-fermenters)

Description of the microbial ecology of VAP

Conclusion

The development of VAP is frequent, especially in patients admitted for medical reasons, with high severity and appears to be associated with an increased use of medical devices, like urinary and central venous catheters, reflecting the complexity of their clinical management.

Disclosures

Xavier Bourge, PharmD, MSD France: Employee Arnaud Friggeri, MD, MSD France: Advisor/Consultant Alain Lepape, MD, MSD France: Grant/Research Support Claire Prevot, n/a, MSD France: Employee Anais Machut, n/a, MSD France: Grant/Research Support Charles-Hervé Vacheron, MD, MSD France: Grant/Research Support
P-430. Reason for Hospitalization Contrasting Adjudication versus ICD-10 Coding Among Persons with HIV, 2016-2019
Authors: Commanday Alexander C , Browne Lindsay , Moy Amanda E , Henderson Heather , Farel Claire E , Dewalt Darren A , Eron Joseph J , Napravnik Sonia
Published: January 2025

Background

Persons with HIV (PWH) have disproportionately high hospitalization rates, the reasons for which are incompletely understood. Establishing hospitalization reasons based on ICD discharge diagnosis codes alone may lead to misclassification. In this study we evaluated the performance of ICD-based reason for hospitalization compared to a newly developed protocol for manual adjudication.

Methods

We randomly sampled 7.3% (N=107) of hospitalizations between 2016 to 2019 among PWH participating in the UNC Center for AIDS Research Clinical Cohort Study (UCHCC). ICD-based reason was defined as the primary ICD-10 discharge diagnosis or secondary discharge diagnosis if primary was HIV and assigned a diagnosis category. A protocol for adjudicating the primary reason for hospitalization was developed. Adjudicated results were categorized and compared to ICD-based reason, with four possible outcomes: complete agreement (same category and diagnosis), partial agreement (same category, different diagnosis), disagreement (different category and diagnosis), and ICD-10 codes inadequate (no available ICD-10 code that captures the complexity and/or nuance of reason for hospitalization).

Results

Among the 107 hospitalized PWH, the median age was 51 years (IQR, 37-57), 69.2% were male, and median CD4 count was 672 (IQR, 284-876) (Table 1). Adjudication completely agreed with ICD-based reason in 80 (74.8%) hospitalizations, partially agreed in 15 (14.0%), disagreed in 7 (6.5%), and ICD codes were inadequate in 5 (4.7%). Factors with higher proportion of disagreement or inadequate ICD codes compared to complete or partial agreement were older age, male sex at birth, lower CD4 count, > 15 discharge diagnoses, and longer or unplanned hospitalization (Figure 1).

Conclusion

ICD codes performed well in capturing reason for hospitalization in PWH but were inadequate or disagreed with adjudication in 11.2% of hospitalizations. Patient demographic and clinical factors which reflect the length and complexity of hospitalization may help predict ICD inaccuracy. This work can be expanded to construct an algorithm to determine when adjudication is needed to supplement ICD code review to improve the accuracy of determining reasons for hospitalization in PWH.

Disclosures

Joseph J. Eron, MD, Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|Merck & Co: Advisor/Consultant|ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Grant/Research Support