bluuebunny/crossref_metadata_2025 huggingface dataset:
P-121. Brucellosis outbreak in northwestern Tajikistan in 2023: a matched case-control study
Authors: Qurbonov Emomali , Silemonshoeva Jamila , Tilloeva Zulfiya H , Sharifov Rajabali , Yusufi Salomudin , Nabirova Dilyara , Horth Roberta
Published: January 2025

Background

A sharp increase in brucellosis incidence was observed in northwestern Tajikistan (from 1.0/100,000 people in 2022 to 32,7/100,000 by May 2023). Most cases, 82% (84/103), were from the same village (population=10,712). We investigated to identify risk factors and mitigate disease.

Epidemic curve of monthly cases of brucellosis from January to September 2023, Farob village, Panjakant district, Sughd region (n=123).

Methods

Using a case-control design, we conducted face-to-face interviews and collected blood from May-July 2023. Cases were the first person in a household diagnosed with brucellosis in February-June 2023 with positive Huddleson reaction test and Wright antibody titers ≥1/160. Two controls were selected for each case (neighbors from different households matched by age and sex). Controls testing positive were excluded (13%). We conducted conditional multivariable logistic regression to assess odds of brucellosis expressed as adjusted odds ratio (AOR) and 95% confidence intervals (CI).

Multivariate analysis of human brucellosis risk factors, Farob village, Panjakent district , Tajikistan, 2023

Results

Of 84 cases, 57 (58%) met inclusion criteria. Of which, 68% were 15-44 years old and 44% were male. Cases peaked in May. Common symptoms were joint pain (95%), fever (84%), weakness (72%), and night sweats (65%). All cases and 94% of controls (n=114) had livestock (mostly cattle, sheep or goats); no animals had not been vaccinated < 5 years. A greater proportion of cases than controls had consumed homemade kaymak (clotted cream from unpasteurized milk) (89% vs 36%), home-produced meat (98% vs 82%) or neighborhood-produced milk (81% vs 61%); or engaged in animal slaughter (42% vs 11%) or animal grooming (32% vs 10%). Brucellosis was associated with consumption of homemade kaymak (AOR=60.6 [CI=4.2-873.0], p=0.003), homemade meat (55.1 [1.2-2,549.0], p=0.040), neighborhood milk (8.6 [1.6-47.9], p=0.014), animal slaughter (50.9 [2.8-919.0], p=0.008) or animal grooming (15.6 [1.1-234.0], p=0.047).

Conclusion

Contact with unvaccinated livestock or consumption of their products was a key contributor to this outbreak. Cases were likely higher than reported. Following our investigation, an education and vaccination was carried out and no more brucellosis cases were reported after August 2023.

Disclosures

All Authors: No reported disclosures
P-123. Unlocking Synergy: Exploring Combination Therapies in Whipple's Disease for Enhanced Clinical Efficacy
Authors: Ghneim Hiyam , Haj Ebrahimi Hashem , Charles Reema , Farid Tahsin
Published: January 2025

Background

Whipple's disease (WD) is a rare chronic multisystemic infection that primarily affects the gastrointestinal tract. There are no FDA-approved treatments for WD. Standard treatment involves prolonged antibiotic regimens that can be controversial, especially in cases of relapse or neurological involvement. This study uses CURE ID, an online case reporting platform, to investigate WD cases in the literature, analyze combination therapies currently being used, and identify strategies that improve patient outcomes.Figure 1:Geographic Distribution of Whipple’s Disease Cases

Methods

We identified WD cases on PubMed and Embase reported between 2019-2024 using relevant keywords, MeSH terms, and Emtree terms. Rayyan.ai was used to screen articles following a PRISMA protocol. Out of 271 identified cases, 84 met inclusion criteria. They were added to CURE ID via the case report form. The aggregated WD data was then analyzed.Figure 2:Age Distribution of Whipple’s Disease Patients

Results

74/84 patients improved or recovered (Table1). Figure 1 displays that most cases originated in Europe and North America, followed by a minority in Asia and South America. WD predominantly occurred in males (61/84) and most cases occurred in middle-aged patients (Figure 2). Most cases were associated with favorable outcomes (Table 1). As shown in Figure 3, the most used antibiotic combination was ceftriaxone and TMP-SMX and was associated with the best outcome followed by doxycycline and hydroxychloroquine. Corticosteroids were added in 4 patients to prevent the formation of Immune Reconstitution Inflammatory Syndrome (IRIS), and all cases were associated with a positive result.Figure 3:Outcome of the most frequently used treatment regimens

Conclusion

There appears to be a geographic clustering of WD cases as well as higher incidence in males. This needs to be investigated further for explanations for this correlation. It was noted that the majority of the cases occurred in immunocompromised patients. We aim to investigate this further in a full manuscript. The standard treatment of WD is using combination therapy with ceftriaxone and TMP-SMX and this was associated with favorable outcomes. Interestingly, the combination of doxycycline and hydroxychloroquine also emerged as a successful alternative in cases where the preferred combination was not tolerated or failed. We aim to further explore the mechanism of this combination and establish it as a standard alternative regimen.Table 1:Composite table of patient outcomes and frequency of drugs used.

Disclosures

All Authors: No reported disclosures
P-144. The Introduction of Antimicrobial Prescription Guidance and Patient Education for a Medical Brigade to Honduras
Authors: Anderson Moira , Zerbini Gabriella , Abdallah Danielle G , James Amy M
Published: January 2025

Background

Antimicrobial resistance is a global problem that requires active interventions to combat. Misusage of antimicrobials contributes to the development of multi-drug resistant organisms that can be fatal. Many can be purchased over the counter in countries outside of the US, and medical brigades often provide a source of these drugs. PODEMOS is a medical brigade partnered with The Ohio State University College of Medicine and travels to Honduras twice yearly. Since this brigade prescribes antimicrobials for a variety of disease states, this project aimed to create guidelines on antimicrobial usage and community education materials to ensure that PODEMOS is not contributing to further resistance.

Patient Education Antimicrobial Resistance

This flyer was distributed to patients on the PODEMOS medical brigade to educate the community on antimicrobial resistance.

Methods

First, current literature on antimicrobial resistance was reviewed to understand the scope of the problem in Central America. Data was collected on antimicrobial consumption and community education within Honduras and surrounding area. Secondly, common infectious diseases encountered during the PODEMOS medical brigades were identified and the current drug formulary was reviewed in comparison to current treatment guidelines on UpToDate.

Medical Brigade Treatment Guidelines

The image shows a portion of the guidelines that were created for PODEMOS medical brigades, with this example being for upper respiratory infections.

Results

Results of our initial literature review indicated that there is no current standard of tracking antimicrobial usage in Honduras. There is also limited awareness and education on antimicrobial resistance. There were 16 common infectious disease states encountered on PODEMOS brigades which were used as basis for creating guidelines for students and providers on future brigades. These included information on clinical diagnosis, treatment protocols, and medication safety. Also, the drug formulary for PODEMOS was updated to include two antimicrobials that will lessen contribution to drug resistance. Lastly, a flyer was created with information to educate the community on antimicrobial resistance.

Conclusion

Guidance for the proper usage of antimicrobials is paramount in combating drug resistance. By creating treatment protocols and patient education materials, this project aimed to prevent contribution to antimicrobial resistance and improve the care of patients on future PODEMOS medical brigades. Prospectively, data will be collected on usage of these guidelines and patient understanding of antimicrobial resistance.

Disclosures

All Authors: No reported disclosures
P-156. Global burden of mortality and antimicrobial resistance of pathogens associated with peritoneal and intraabdominal infection in 2019: A Benchmarking Global Analysis
Authors: Hirapara Ishita , Enemuo Nkechi , Vala Lovekumar , Maddineni Kavya , Nandania Parthkumar , Markandu Keethanshan , Modi Dhruvi , Dineshbhai Desai Hardik
Published: January 2025

Background

Peritoneal and abdominal infections (PAI) are among the most serious complications in the clinical setting, often leading to significant morbidity and mortality worldwide. These infections, which can stem from a variety of pathogens, are further complicated by the increasing threat of antimicrobial resistance (AMR).

Deaths per 100k both associated with and attributable to bacterial antimicrobial resistance by pathogen Peritoneal & abdominal infection, Global, Age-standardized, Both sexes, 2019

Methods

Using Global Burden of Disease (GBD) AMR 2019 methodology, we estimated the number of deaths and the disability-adjusted life years (DALYs) globally attributable to and associated with AMR of pathogens associated with PAI in 2019.

DALYs per 100k both associated with and attributable to bacterial antimicrobial resistance by pathogen Peritoneal & abdominal infection, Global, Age-standardized, Both sexes, 2019

Results

The data reveals that in 2019, E. coli was the leading cause of AMR-associated deaths in the context of PAI, with an estimated 289,206 deaths (95% uncertainty interval [UI]: 187,670-423,363), followed by S. aureus with 169,222 deaths (95% UI: 105,231-252,817). Among the countries studied, Romania reported the highest mortality rate from E. coli associated with PAI at 8.45 per 100,000 population, followed closely by Bulgaria at 7.99, while the United States recorded a lower rate of 5.17. Additionally, the highest number of deaths linked to AMR overall was observed with E. coli (252,952 deaths), followed by K. pneumoniae (123,158), S. aureus (115,616), and E. faecium (107,226) in 2019.

Total DALYs per 100k by pathogen Peritoneal & abdominal infection, Global, Age-standardized, Both sexes, 2019

Conclusion

The findings of this study underscore the urgent need for enhanced public health measures to combat the escalating threat of antimicrobial resistance (AMR) associated with peritoneal and abdominal infections. Public health stakeholders must prioritize the development and implementation of robust surveillance systems, promote rational use of antibiotics, and invest in research to discover new antimicrobial agents. From a clinician's perspective, there is a critical need for adherence to stringent infection control practices, timely and accurate diagnosis, and tailored treatment strategies to effectively manage these infections and mitigate the burden of AMR. Together, these actions are essential for improving patient outcomes and curbing the global rise in antibiotic-resistant pathogens.

Total deaths per 100k by pathogen Peritoneal & abdominal infection, Global, Age-standardized, Both sexes, 2019

Disclosures

All Authors: No reported disclosures
P-163. Efficacy of Wolbachia-mediated sterility to suppress dengue
Authors: Tao Lim Jue
Published: January 2025

Background

Vector control remains the primary means to mitigate the spread of dengue. Matings between male Aedes aegypti mosquitoes infected with the wAlbB strain of Wolbachia and wildtype females yield non-viable eggs (Wolbachia-Aedes). We evaluated the efficacy of Wolbachia-Aedes to suppress dengue incidence. We present data comprising a field trial of 607,872 residents over 5 years.

Methods

We utilized the synthetic control method and trial emulation approach to evaluate large-scale field trials in Singapore involving the deployment of Wolbachia-Aedes for dengue control via vector population suppression, from epidemiological week (EW) 27, 2018, to EW 26, 2022. We selected two large towns (Yishun and Tampines) to adopt an expanding release strategy and two smaller towns (Bukit Batok and Choa Chu Kang) to adopt a targeted-release approach. All intervention and control locations practised the same baseline dengue control protocol. The main outcome was weekly dengue incidence rate caused by any dengue virus serotype (in the case of the synthetic control method) and risk of being test positive for dengue (when using the trial emulation approach). We used incidence data collected by the Singapore Ministry of Health as well as a nationally representative dengue test positive/negative database to assess the efficacy of the interventions, To compare interventions, we used the synthetic control method or constrained randomization protocols to generate appropriate counterfactuals for the intervention towns selected from a combination of 30 control towns from EW 1, 2014 to EW 26, 2022.

Results

Our study comprised an at-risk population of 607 872 individuals living in intervention sites and 3 894 544 individuals living in control sites. Interventions demonstrated up to 77⋅28% (121/156, 95% CI 75⋅81–78⋅58) intervention efficacy despite incomplete coverage across all towns. Intervention efficacies increased as release coverage increased across all intervention sites. Secondary analysis showed that these intervention effects were replicated across all age groups and both sexes for intervention sites.

Conclusion

Wolbachia-mediated incompatible insect technique can strengthen dengue control in tropical cities, where dengue burden is the greatest.

Disclosures

All Authors: No reported disclosures
P-164. Comparing long-term cardiovascular, neuropsychiatric, and autoimmune complications following dengue infection versus SARS-CoV-2 infection
Authors: Tao Lim Jue
Published: January 2025

Background

While persistence of chronic symptoms following dengue infection has been documented in small prospective cohorts, population-based studies are limited. The post-acute risk of new-incident multi-systemic complications following dengue infection was evaluated and contrasted against that following SARS-CoV-2 infection in a multi-ethnic adult Asian population

Methods

National testing and healthcare claims databases in Singapore were utilised to build a retrospective population-based adult cohort with laboratory-confirmed infection during overlapping waves of SARS-CoV-2 and dengue transmission (1 Jul 2021-31 Oct 2022). Risks of new-incident cardiovascular/neuropsychiatric/autoimmune complications 31-300 days post-dengue infection, contrasted with SARS-CoV-2 infection were estimated using Cox regression with overlap weights. Risks were reported in terms of adjusted-hazard-ratio (aHR) and excess-burden (EB) per-1000-persons.

Results

11,960 dengue-infected individuals and 1,265,329 contemporaneous COVID-19 cases were included; the majority had mild initial infection not requiring hospitalisation. Amongst dengue-infected individuals, there was 50% (aHR=1.50 [1.25–1.81]) increased risk of any sequelae (EB=1.51[1.40-4.42]), with 90% (aHR=1.90 [1.44–2.52]) increased risk of cardiovascular sequelae (EB=1.64[0.09-3.37]). Specifically, increased risk of ischemic-heart-disease (aHR=1.88[1.31-2.70]), other cardiac disorders (aHR=2.87[1.74-4.74]) and thrombotic disorders (aHR=4.56[2.37-8.75]) was noted. Elevated risk of individual neurological sequelae, including cerebrovascular disorders (aHR=2.05[1.29-3.25]) and cognition/memory disorders (aHR=2.31[1.40-3.84]) was observed in dengue-infected individuals compared to COVID-19 cases. Elevated risks of post-acute sequelae in dengue survivors were observed when contrasted against COVID-19 survivors infected during Delta/Omicron predominance, as well as across vaccination strata.

Conclusion

Increased risk of post-acute cardiovascular/neurological complications was observed in dengue survivors, when contrasted against COVID-19 survivors infected during Delta/Omicron predominance.

Disclosures

All Authors: No reported disclosures
P-174. Burden, Epidemiology, and Clinical Characteristics of Leptospirosis within the Military Health System
Authors: Graf Patrick J , Chu Xiuping , Davies Julian , Hickey Patrick , Blyth Dana M
Published: January 2025

Background

Leptospirosis (Lepto) remains underreported due to diagnostic limitations. Military personnel are considered high risk due to deployments in endemic locations and exposure in contaminated training sites. We analyzed the frequency, epidemiology, and clinical characteristics of lepto diagnoses in the Military Health System (MHS).Figure 1Leptospirosis Lab and Clinical Case Definitions and Criteria

Methods

Potential MHS lepto diagnoses were identified by lepto-specific ICD-9/10 codes or positive lepto laboratory tests between 1/1/2013-1/1/2022. Potential cases underwent chart review, were classified per CDC case definitions (Figure 1), and compared for clinical and lab findings.Figure 2Flowchart for Identification of Leptospirosis Cases

Results

Of 297 identified potential lepto cases, there were 11 confirmed, 134 probable, and 53 possible cases on chart review (Figure 2) of whom 77% (153/198) were hospitalized and one died (Table 1). Cases were confirmed via microscopic agglutination test (MAT, 6/11), blood culture (3/11), MAT and blood culture (1/11), and urine PCR (1/11) (Table 2). Of cases with demographic data, 89% were male (176/197) and 82% (162/197) were service members, with 16% (31/197) retired, dependents, or civilians. Of those with documented exposures, 52% (88/169) were recreational, and an additional 5 cases non-occupational (cumulatively 55%, 93/169). Fresh water exposures were common and more likely in confirmed/probable cases, with 67 associated with jungle warfare training in Okinawa. Of note, 44% of all cases (87/198) were diagnosed in those living in endemic areas without occupational exposure or deployment/travel. Japan (86/198), Guam (55/198), and Hawaii (22/198) were the most common areas of exposure. Confirmed cases were most likely to be exposed and diagnosed in Hawaii.Table 1Clinical Characteristics of Confirmed, Probable, and Possible Leptospirosis Cases

Conclusion

Lepto remains a common diagnosis within the MHS, especially among service members and in endemic areas. Despite classic teaching, a significant proportion of MHS cases occur in patients living in endemic areas without occupational or deployment exposures. This highlights lepto as a continual threat and burden on systems in endemic areas in addition to the classically recognized military exposures. Furthermore, despite a substantial amount of possible and probable cases, there remain few confirmed cases.Table 2Laboratory Testing of Confirmed, Probable, and Possible Leptospirosis

Disclosures

All Authors: No reported disclosures
P-177. Contemporary Clinical Characteristics and Outcomes of Leprosy— a Multicenter Network Analysis
Authors: Kaplan Samantha R , Henao Martínez Andrés F , Bliss Masson , Olivo Freites Christian , Agudelo Higuita Nelson I , Marcos Luis A , Ramirez-Garcia Edgar A , Casapia Martin , Mohareb Amir , Avanzi Charlotte , Chastain Daniel B , Franco-Paredes Carlos
Published: January 2025

Background

Leprosy, also known as Hansen's disease, is a chronic infectious disease caused primarily by Mycobacterium leprae, endemic to tropical countries. In 2022, WHO registered 165,459 cases of leprosy. We lack more contemporary clinical descriptions and outcomes of the disease. Understanding its clinical characteristics is essential for improving diagnosis, treatment, and patient outcomes. We aim to describe the clinical manifestations and outcomes associated with leprosy using a "real-world" database.

US Map of the proportion of captured cases by region

Methods

We queried TriNetX, a global research network database (https://trinetx.com/), to identify patients with Leprosy by ICD-10 code. We captured demographics, comorbidities, clinical manifestations, treatments, and outcomes within 1 year.

Clinical characteristics and outcomes of leprosy patients by region

Results

We captured 1,237 patients, with 965 (78%) originating from the US health system. The mean age was 48, and most were women (60.4%). US patients were predominantly from the South and West (Figure 1) and were predominantly White, Native Hawaiian, or Asian (table 1). The most common clinical manifestations included neuralgia, rash, neuropathy, and malaise. Blindness, corneal abrasions, and burns were present among 2-3% of US patients. Orchitis, iritis, and the Lucio phenomena were relatively uncommon. Rifampin, dapsone, and minocycline were most commonly used. However, significant geographical differences were noted in treatment regimens. Notably, clofazimine use was minimal. Steroids were used in 60% of cases, with a higher prevalence in US-based patients. Other immunosuppressants were uncommon, although methotrexate use was more frequent internationally. TB co-infection was 2%. The overall 1-year mortality was 24.3%.

Clinical characteristics and outcomes of leprosy patients by region

Conclusion

Women from the southern and western US were the most significantly affected demographic groups. Severe complications like blindness, corneal abrasions, and burns, though less frequent, underscore the potential impact on quality of life. The presence of conditions like TB co-infection and the use of steroids in treatment point to the need for comprehensive preventive care strategies. With an overall 1-year mortality of 24.3%, our findings stress the importance of early diagnosis and treatment to improve outcomes and reduce mortality rates.

Clinical characteristics and outcomes of leprosy patients by region

Disclosures

All Authors: No reported disclosures
P-178. Crotalic snakebites accidents: the clinical and epidemiological profile of patients treated at toxicology unit of a reference center in Brazil
Authors: Schulthais Chagas Victor , Da Silveira Luciana Reis , Rocha Valle Lucas , Freitas Ribeiro Aloisio Joaquim , da Silva Rosa Patryk Marques , Baroni Neves João Victor , Marcolino Milena S
Published: January 2025

Background

In Brazil, about 30,000 snakebites accidents are reported every year. Crotalus durissus is responsible for 9% of the cases. This study aimed to assess the clinical, epidemiological and laboratory profile of victims of crotalic accidents treated at a major toxicological reference in Brazil and the incidence of clinical complications.

Methods

Retrospective cohort study that analyzed medical records from victims of crotalic accidents treated at the Toxicology Unity of the reference center between January/2011 and December/2022. Suspected crotalic accidents with lack of clinical and laboratory diagnosis were excluded. Multivariate logistic regression was performed to evaluate the association between the severity of crotalic accidents with its factors, reported as odds ratio (OR) and 95% confidence intervals.

Results

From 411 patients included (median age 40 years, interquartile range [IQR] 23–56), 79.8% were men, 70.0% pardo, 74.0% of the accidents happened in rural areas and 77.6% of the bites were in lower limbs. Overall, 29.0% were late-admitted to the hospital ( >6 hours after the accident. Accidents were more frequent in summer (63.3%). Median hospital length of stay was 3 days (IQR 2-4). From those who had local manifestations (90.3%), pain was the most frequent symptom (80.5%). Regarding patients who had systemic manifestations (74.0%), neuroparalytic were the most frequent (66.7%), followed by myotoxic and hemolytic (37.8%), vagal (20.4%) and renal (17.3%). Four deaths were reported (1.0%). Age > 50 years (OR 1.85 [95% CI 1.11-3.11]), non-identification of the snake (OR 4.24 [95% CI 2.07-8.97]) and >6h until medical admission (OR 4.23 [CI 95% 2.55-7.12]) were associated with severe cases.

Conclusion

The results show the importance of the adequate and early management of crotalic accidents focusing on the main manifestations. The establishment of epidemiological, clinical and laboratory profiles related to severe cases is also important to help understand the socio demographic characteristics of the patients.

Disclosures

All Authors: No reported disclosures
P-184. Gastrointestinal Illness in Attendees of FIFA Football World Cup 2022 in Qatar
Authors: Shams Sherin , Saleh Thoraya M , Nafady-Hego Hanaa , Ibrahim Emad B , Malik Aimon , Thomas Anil G , Saleem Samah , Azad Aftab M , Abou-Samra Abdul-Badi , Butt Adeel A
Published: January 2025

Background

Mass gathering events may facilitate transmission of foodborne diseases. We determined the pattern and causative organisms of gastrointestinal illness in the attendees of the FIFA Football World Cup 2022 (FIFA-WC2022), one of the world’s largest sporting events, which was hosted by Qatar.

Table 1. Baseline characteristics of individuals who underwent stool testing.

Methods

The study was conducted at Hamad Medical Corporation in Qatar, which was the designated provider and overseer of healthcare during FIFA-WC2022 for all visitors and served as the national reference laboratory for all microbiology testing. We retrospectively retrieved all stool testing data from attendees of FIFA-WC2022 from October 1 to December 31, 2022. Routine stool microscopy for ova and parasite and stool culture and sensitivity tests were performed on all samples received. PCR testing was performed for suspected food poisoning or when a rapid result was required for public health response.

Table 2. List of organisms detected by culture and/or PCR. (Note that the number of organisms is higher than that of the patients as some patients had more than one organism identified). At least one organism was detected in 424 individuals.

Results

During the FIFA-WC2022, approximately 1.4 million visitors entered Qatar. During the study period, a total of 2,179 stool samples were received for testing. The most common reasons for testing were acute diarrhea/gastroenteritis (51.4%), abdominal pain (11.5%), screening/surveillance of potential contacts (10.6%), and fever (7.6%). At least one organism was identified in 424 cases. The most commonly identified organisms were bacteria (92.5%), viruses (7.8%), and parasites (2.8%). The most frequent bacteria detected were Salmonella spp. (40%), E. coli (25.7%), and Shigella spp. (8.8%).

Conclusion

A relatively small number of individuals attending the FIFA-WC2022 experienced laboratory confirmed infectious gastroenteritis. Bacteria were more frequently isolated than viruses. The yield of stool testing was higher for those presenting with acute diarrhea/gastroenteritis and fever, but not for those with abdominal pain or for surveillance/screening. These results have implications and lessons for planning future mass gathering events.

Disclosures

Adeel A. Butt, MD, MS, Gilead Sciences: Grant/Research Support
P-197. Summary of Recurrent Clostridioides difficile Infections using Whole Genome Sequencing, Minnesota 2019-2021
Authors: Friedman Bree E , Evans Daniel R , Pung Kelly , Weber Bonnie , Wang Xiong , Lees Christine , Holzbauer Stacy
Published: January 2025

Background

Recurrent Clostridioides difficile infection (CDI) is typically defined as a positive C. difficile toxin or assay in the 8 weeks following an incident CDI. However, positive detections outside of this timeframe could represent failure to clear the initial infection and positive detections inside this timeframe could represent a new CDI based on molecular analysis of C. difficile isolates. We performed whole genome sequencing on consecutive isolates of patients to compare and summarize isolate pairs in Minnesota.

Methods

We analyzed data from our active population- and laboratory-based surveillance for CDI as part of CDC’s Emerging Infections Program from 2019-2021. An incident CDI was defined as the first positive C. difficile toxin or molecular assay on a stool specimen from a person at least 1 year of age during the study period. A recurrent CDI was defined as an additional positive test > 2 weeks following an incident infection. Stool specimens were sent to the Minnesota Department of Health for C. difficile culture. DNA was extracted using QIAmp BiOstic Bacteremia DNA Kit, sequencing libraries prepared using Illumina’s DNA Prep Kit, and sequencing performed using Illumina MiSeq and NextSeq platform.

Results

There were 252 patients with two consecutive C. difficile isolates cultured and sequenced. Ninety-three (37%) of second instance CDI isolates had a sequence type (ST) that did not match the ST of their previous CDI, indicating a new infection and not a relapse of initial ST. Some (23%) relapses occurred outside the standard 8-week timeframe (range 58-486 days). The time between infections was significantly shorter for relapses (median 33 vs 50 days, p< 0.0001). Older age (≥ 65, p< 0.0001), antibiotic use prior to incident CDI (p=0.0003), and incident CDI that were hospital-onset or following recent hospitalization (p=0.0014) were associated with relapse.

Conclusion

Over a third of the patients with recurrent CDIs did not have a relapse of their initial ST. For those with a relapse, almost a quarter occurred greater than 8 weeks from their initial infection. While time between CDI episodes is important in determining new infection or relapse, there are other factors to consider such as age, antibiotic history, and hospital associated infections.

Disclosures

All Authors: No reported disclosures
P-198. Simulation: Advancing Healthcare Worker Education for C. diff
Authors: Ford Delvina , Cadena Jose , Garza Lauren N , Marrufo Dora , Bartoshevich Debra , Mella-Davila Ana , Beck Erica
Published: January 2025

Background

Use of scenario-based simulation for healthcare personal (HCP) in the prevention of healthcare associated infections remains an area that is proving to have positive educational effects. The Society for Healthcare Epidemiology of America (SHEA) 2022 Recommendations ongoing assessment and reinforced education of CDI knowledge for HCPs.

Methods

This simulation was developed as a learning intervention to increase the functional skills of bedside HCPs. An interdisciplinary team created a thirty-minute escape room theme for personal protective equipment, diagnostic stewardship processes.

Focused objectives included C. difficile laboratory testing indications, functional ability to locate the facility algorithm for collection and testing, direct hands-on use of personal protective equipment, hospital disinfectant use, appropriate hand hygiene, and the correct use of isolation signage for the facility was demonstrated.

HCP participants were sent a post participation evaluation utilizing a Likert Scale.

Staff Attendance During First Week of Simulation for C.diff Escape Room

Staff Attendance During First Week of Simulation for C.diff Escape Room

Results

A total of sixty-three HCP participated in the first week. Thirty-three registered nurses (52%), twenty-one nurses’ aides (33%), three clinical pharmacists (5%), three registered cardiovascular invasive specialists (5%), two health technicians (3%), and one licensed vocational nurse (2%).

Post evaluation of the ”C. diff Escape Room” from thirty-two responses of the sixty-three HCP that participated. (see table 1).

Most participants found the scenario-based learning useful, and a significant proportion would use the information and integrate it into their practice within the next six months (87.5% agreed/strongly agreed), facilitators were found to be knowledgeable (68% strongly agreed, 21.9% agreed) and made them feel comfortable (68.8% strongly agreed, 18.8% agreed).

Conclusion

Scenario-based simulation was an acceptable method to educate a diverse group of HCP on the diagnosis and isolation management of patients with the evaluation or diagnosis of CDI.

The utilization of the simulation in a fun environment provided for an educational experience with a focus on key objectives for learning. The event was well received, and overall respondents had positive feedback.

Disclosures

All Authors: No reported disclosures
P-200. Preliminary Results from a Multistate C. difficile Surveillance Network: The Surveillance Highlighting Existing/Emerging Resistance Limiting Our C. difficile Knowledge (SHERLOCK) Project
Authors: Carlson Travis J , Saleh Reeham , Dixon Jonah , Riley Colleen N , Eubank Taryn A , Gonzales-Luna Anne J , Alam M Jahangir , Begum Khurshida , Safdar Nasia , Garey Kevin W
Published: January 2025

Background

C. difficile infection is unique in that the diagnosis is made via the identification of toxins in stool rather than by bacterial growth. Therefore, strain typing and antibiotic susceptibility testing are not routinely performed on C. difficile isolates. Instead, active surveillance programs are required to identify new epidemic and/or antibiotic-resistant strains. The purpose of this project was to create a comprehensive, multistate surveillance program that can quantify the variability in C. difficile strain prevalence and antibiotic resistance across the United States.Table 1.C. difficile Ribotypes from Three Institutions in Two States

Results are reported as number (proportion)

Methods

All institutions participating in The Surveillance Highlighting Existing/Emerging Resistance Limiting Our C. difficile Knowledge (SHERLOCK) Project were asked to contribute a minimum of 40 leftover, C. difficile-positive stool samples each calendar year. The collection of stools for C. difficile testing was conducted as part of routine clinical care. All isolates were sent to the University of Houston for fluorescent polymerase chain reaction (PCR) ribotyping and antibiotic susceptibility testing.

Results

Between January 2021 and December 2023, institutions from three states (Iowa, North Carolina, and Wisconsin) contributed a total of 345 C. difficile-positive stool samples. Of those, 24 isolates from one institution have undergone fluorescent PCR ribotyping and were compared to 176 isolates previously collected in Texas between January 2018 and December 2021 (Table 1). The three most prevalent ribotypes in Texas were F027 (15.3%), F106 (14.8%), and F014-020 (14.2%). Conversely, the three most prevalent ribotypes in Wisconsin were F103 (16.7%), F002 (12.5%), and F014-020 (8.3%). Notably, two known, virulent ribotypes, RT027 and RT106, were absent from Wisconsin isolates.

Conclusion

These preliminary data demonstrate differences in C. difficile strain prevalence by state, which highlights the importance of a comprehensive, multistate surveillance program.

Disclosures

Travis J. Carlson, PharmD, BCIDP, Aimmune Therapeutics, Inc.: Speakers Bureau Anne J. Gonzales-Luna, PharmD, BCIDP, Ferring Pharmaceuticals: Advisor/Consultant|Innoviva Specialty Therapeutics: Advisor/Consultant|Merck and Co: Grant/Research Support|Paratek Pharmaceuticals: Grant/Research Support|Seres Therapeutics: Grant/Research Support Kevin W. Garey, PharmD, MS, Acurx: Grant/Research Support
P-206. Reducing Hospital Acquired Clostridioides difficile Infections: A Comparison of Two Equally Effective Testing Strategies
Authors: Nothdurft Elizabeth , Philip Nirmol , Campbell J William , Sirtak Elysa , Martin-Giacalone Madison , Martin Mackenzie , Leinauer Emily , Giblin Brenden
Published: January 2025

Background

A positive Clostridioides difficile (C. diff) test obtained after day three of admission qualifies as hospital acquired C. diff infection (HA-CDI). Given PCR’s high sensitivity for C. diff, the decision to test necessitates clinical judgement to avoid false positive results that may lead to increased nosocomial infection rates, unnecessary treatment, and increased financial burden. This study investigated two interventions to decrease unnecessary C. diff testing after day three of admission.

Methods

A multistep testing algorithm, which consists of an initial enzyme immunoassay for glutamate dehydrogenase (GDH) and Toxin A/B testing followed by C. diff PCR test by a reflex, is utilized in our institution. To ensure appropriate C. diff test ordering, our Infection Control (IC) team implemented two stages of interventions during a span of five years. In June 2019, Stage 1 involved a hard stop and manual review of all C. diff test orders placed after three midnights from Monday through Friday, requiring an IC or infectious diseases team member to approve these C. diff testing requests. Orders were cancelled if all established testing criteria were not met (Figure 1). In January 2023, Stage 2 was implemented which replaced manual review with an algorithm in electronic medical record (EMR).

Outcomes were measured by examining National Healthcare Safety Network (NHSN) LabID data and the standardized infection ratio (SIR) before and after each stage implementation.

Stage 1 SIR

Results

From 2019 to 2023, our testing interventions resulted in a reduction in HA-CDI incidence. Stage 1 implementation significantly decreased average HA-CDI incidence from 9.3 to 4.06 infections/1000 patient days (PD) (p< 0.0001) resulting in a decreased average HA-CDI SIR from 1.25 to 0.52 (p< 0.0001).

Further HA-CDI decrease resulted after Stage 2 implementation with HA-CDI rate decreasing from 4.06 to 3.29 infections/1000 PD (p=0.656) and with HA-CDI SIR decreasing from 0.52 to 0.48 (P =0.172) (Figure 2, 3). This decline was not statistically significant.

Stage 2 SIR

Conclusion

Manual testing review and EMR-based HA-CDI algorithm implementation effectively decreased the number of positive HA-CDI test results. Use of the electronic algorithm greatly reduced the workload burden on our IC team with no increase in HA-CDI.

Disclosures

Elizabeth Nothdurft, PharmD, BCPS, BCIDP, Abbvie: Honoraria Nirmol Philip, MD, MPH, Nestle: Honoraria
P-212. Outcomes Associated with Bezlotoxumab Use
Authors: Kole Amy , Schreck Daniel , Orenstein Robert , Kirchoff Robert
Published: January 2025

Background

Bezlotoxumab is a monoclonal antibody infusion approved to prevent recurrence of Clostridioides difficile infection (CDI). The objective of this study was to explore outcomes associated with bezlotoxumab use at three academic medical centers.

Methods

A retrospective cohort study was conducted with 180 patients who received bezlotoxumab from May 2018 through November 2023. The primary outcome was recurrence of CDI within 12 weeks of receipt of bezlotoxumab. The study also sought to evaluate risk factors for CDI recurrence in patients who received bezlotoxumab.

Results

Of the 180 patients who received bezlotoxumab at our institution, 165 were included in the study. Fifteen patients were excluded because they did not improve with standard of care CDI treatment. In the study cohort, 45% were immunosuppressed (n=75), 17% had a solid organ transplant (n=28), and 16% had a history of inflammatory bowel disease (n=27). Ninety-five percent of patients received bezlotoxumab as an outpatient (n=156). Recurrence of CDI within 12 weeks occurred in 16% of patients. Duration from diagnosis of CDI to bezlotoxumab infusion (p=0.022) and having greater than two prior CDI episodes (p=0.032) were statistically significant predictors for CDI recurrence within 30 days.

Conclusion

Our study demonstrated similar CDI recurrence rates for patients who received bezlotoxumab in a real-world setting compared to previous clinical trials. Patients with CDI may benefit from receiving bezlotoxumab earlier in the course of illness and prior to developing multiple recurrences.

Disclosures

Robert Orenstein, DO, FACP, Ferring: Advisor/Consultant|Ferring: Honoraria
P-227. Strategy for the accurate identification of CAUTIs in the ICU at a Tertiary Care Hospital
Authors: Bascara Christina J , Chaparro-Rojas Fredy , Panaccione Sophia
Published: January 2025

Background

The rates of CA-UTIs increased significantly after the COVID-19 pandemic. Many of these infections were considered "definitional infections", in which cases, they were considered reportable infections based on NHSN criteria, however, not conclusive by clinical presentation. The IDSA recommends removing and replacing indwelling catheters that have been in place for more than 14 days before obtaining a new urinary sample to evaluate for presence of UTI. This is currently not routinely performed.

Methods

In order to improve the yield of evaluating non-contaminated urine specimens for true infection, we developed a protocol that triggered a catheter exchange if the catheter has remained in place for more than 3 days. The protocol consists of removal and replacement of urinary catheter before processing the urine sample and obtaining a culture.

Results

A significant reduction in the number of UTIs was observed after 12 months of use and surveillance of our strategy despite a stable rate of use of urinary catheters. Our intervention was initiated in February 2023 and only 3 CA-UTIs were identified during this time period. It is important to mention that multiple other strategies were deployed during the COVID-19 pandemic in order to decrease the number of CA-UTIs, including an ED lead initiative to decrease the use of new Foley insertion for patients going to ICU and the use of GCH based perineal care (Pericare). In 2022 a significant decline in CA-UTIs was noted (5 CA-UTIs) and 3 cases in 2023.

Currently, we are processing data and additional variables to help us adjusting our findings for potential confounders.

Conclusion

The implementation of a catheter-exchange program for the accurate identification of catheter associated UTIs in the ICU setting, together with the use of GCH based pericare, are effective strategies to decrease the incidence of Catheter associated UTIs.

Disclosures

All Authors: No reported disclosures
P-228. A Multidisciplinary Approach to Reducing Central Line-Associated Bloodstream Infections (CLABSI)
Authors: Rhodes Katherine A , Youree Bryan
Published: January 2025

Background

Our acute care hospital experienced 17 CLABSI events during 2021. This was a significant increase over 2020 and well above typical performance. The COVID-19 pandemic negatively impacted adherence to best practices. Point prevalence studies pointed to continued issues surrounding line maintenance. Gaps included inconsistent dressing care and site assessment, lack of compliance with scrubbing the hub prior to access, inconsistent use of chlorhexidine bathing, inadequate line securement, inadequate flushing of lines, inconsistent onboarding of new RNs, and missed daily review of necessity. The facility has initiated ongoing education & training, tracer observations, and recommended best practices. Each CLABSI event is estimated to cost $45,814 with 10.4 avoidable days and a 30% increase in mortality. It is considered a preventable healthcare-associated infection (HAI). A multidisciplinary approach was implemented in late 2021 with a stated goal of maximum 2 CLABSI events per year.

Methods

CLABSI events are identified through daily review of blood culture reports by Infection Prevention. Events are defined using CDC NHSN criteria for CLABSI. Rates are calculated by number of events per 1000 device days and compared to national benchmarks and internal trending. A Standardized Infection Ratio (SIR) is utilized for external benchmarking.

Highlights of actions taken to drive improvement include:Creation of unit Central Line Champions to perform tracers and educationDevelopment of an Aseptic Access Tracer to standardize line maintenanceImplementation of a biweekly Central Line Huddle led by VAT to facilitate timely line removal when no longer indicatedStandardization of onboarding for new RNs to include line care and maintenance with a competency check off by VATFeedback on strategies and data provided to key stakeholders

Results

CLABSI events were reduced from 17 events to 2 events in 2022 and sustained through 2023. CLABSI rates were reduced from 1.54 per 1000 line days to 0.24. SIR was reduced from 1.87 to 0.24. The Central Line Huddle facilitated early removal of 44 unnecessary central lines. Aseptic Access Tracer compliance was improved from 40% to 96% and sustained.

Conclusion

A multidisciplinary approach was successful in improving CLABSI outcomes.

Disclosures

All Authors: No reported disclosures
P-230. Frequency and Outcomes of Coagulase-Negative Staphylococcus Isolation from Blood Cultures of Patients Receiving Extracorporeal Membrane Oxygenation
Authors: Wells Christian , O’Neil Erika , Sobieszczyk Michal , Marcus Joseph
Published: January 2025

Background

Coagulase-negative Staphylococcus (CoNS) are frequently cited as the most common cause of bacteremia in patients receiving extracorporeal membrane oxygenation (ECMO). CoNS bacteremia is concerning in ECMO as the biofilm it forms can adhere to the circuit. Alternatively, CoNS can be colonizing or contaminants, and there are no standard definitions of CoNS bacteremia in ECMO. Additionally, appropriate workup and follow-up for CoNS bacteremia in ECMO patients is unknown. This study evaluates the etiology and workup of CoNS in a cohort of patients receiving ECMO at a military medical center.

Characteristics of the 13 patients receiving ECMO with Coagulase-negative Staphylococcus isolated from blood cultures

Methods

All patients who received ECMO between January 2022 and March 2024 were included in this retrospective study. All blood cultures were reviewed and patients with a positive blood culture for CoNS were included for further analysis including patient demographics, indication for culture, follow-up of culture results, treatment, and patient outcomes.

Characteristics of CoNS with Repeated Blood Culture Positivity as Compared to Single Blood Culture Positivity in Patients Receiving ECMO.

Results

Of the 68 patients who received ECMO during the study period, there were 424 blood culture sets obtained, of which 20 (4%) yielded CoNS in 13 (19%) patients. Patients were predominantly male (85%) with a median age of 35 [IQR: 26-50] (Table 1). The most common indication for culture in this cohort was fever (62%) and most cultures were drawn from peripheral draws. All CoNS were monomicrobial and S. epidermidis (85%) accounted for the majority of cases. Only 5 (38%) patients had repeat growth of CoNS on repeat cultures, yet 8 (62%) were treated with antimicrobials (Table 2). Two (15%) patients, both with persistent culture positivity, were found to have infective endocarditis. Of patients with multiple isolations of CoNS, all survived to hospital discharge. No patient had reisolation of CoNS after treatment.

Conclusion

CoNS was frequently isolated in blood cultures from patients receiving ECMO. Despite the concern for biofilm formation, most CoNS was only isolated in one culture, and bacteremia was not associated with increased mortality, even when isolated repeatedly. Based on this data, it is reasonable to recommend treatment of CoNS bacteremia, only when isolated on repeat cultures. Standardization of CoNS bacteremia reporting, in addition to treatment in ECMO is needed.

Disclosures

All Authors: No reported disclosures