bluuebunny/crossref_metadata_2025 huggingface dataset:
1972. Sources of COVID-19 Exposure Among Health Care Personnel in a Large Tertiary Care Medical Center.
Authors: Shaw Jana , Steigerwald Heidi , Suits Paul , Thomas Stephen J , Formica Margaret
Published: December 2022

Background

Introduction: Health care personnel (HCP) are at increased risk for SARS-CoV-2 exposure. However, the exposure sources among HCP are poorly understood.

Methods

Design: We conducted active surveillance for all employed HCP newly diagnosed with COVID-19 between March 2020 and February 2022. We inquired about their sources of exposure using a standardized health department checklist and CDC guidance for managing healthcare personnel with SARS-CoV-2 infection or exposure.

Results

Among all 8,766 HCP, 2,220 (25.3%) tested positive. Among positive cases, 749 (33.7%), 651 (29.3%), and 221 (10%) were among ancillary services HCP, RNs, and allied HCP, respectively (Table 1). The majority of the sources of exposures were unknown (57.8%), followed by household (26.2%), community (10.5%), and health care (5.5%), respectively. The incidence of COVID-19 increased with level of patient contact regardless of source of exposure. The majority of the cases, N=1054 (47.5%), occurred among HCP who were not up-to-date on COVID-19 vaccines and had unknown exposure, and vaccination status varied by source of exposure (Table 2). HCP COVID-19 cases mirrored transmission in the community (Figure). Table 1.Incidence of COVID-19 Among Employed HCP Overall and by Exposure Type (N=8766)Table 2.Vaccine status among Employed HCP Covid-19 Cases by Source of Exposure (N=2220)Figure.HCP COVID-19 cases by exposure type (Left Axis) in the Central New York region (Right Axis) between March 2020 and February 2022.

Conclusion

The majority of HCP cases had no known exposure to SARS-CoV-2 and were not up-to-date on COVID-19 vaccines highlighting the importance of vaccination as the single most effective mean to COVID-19 prevention among HCP.

Disclosures

Jana Shaw, MD,MS,MPH, Pfizer: Advisor/Consultant Stephen J. Thomas, MD, Clover: case adjudication committee (compensated for time)|EdJen: Advisor/Consultant|Icosavax: data monitoring (compensated for time)|Island Pharma: Ownership Interest|Merck: Advisor/Consultant|Moderna: chair, safety monitoring committee (compensated for time)|New Day Diagnostics: Honoraria|Pfizer: Advisor/Consultant|PrimeVax: Ownership Interest|Sanofi Pasteur: Advisor/Consultant|Takeda: Advisor/Consultant|Takeda: case adjudication committee (compensated for time)|Vaxxinity: data monitoring committee (compensated for time).
1975. Trends in the parents’ intention to vaccinate their children against COVID-19: A comparative study in Peru
Authors: Gonzales-Zamora Jose A , Soriano-Moreno David , Ponce-Rosas Linda , Alarcón Parra Mariano G , Morocho-Alburqueque Noelia , Murrieta-Ruiz Valentina , De-Los-Rios-Pinto Abraham , Soriano-Moreno Anderson , Caira-Chuquineyra Brenda , Ccami-Bernal Fabricio , Fernandez-Guzman Daniel , Alave Jorge
Published: December 2022

Background

Although COVID-19 vaccination has shown to be clearly beneficial in children and adolescents to reduce hospitalization and potentially transmission, there is still a lot of hesitation among parents due to concerns about vaccine safety and efficacy, especially in children under 12 years of age.

Methods

We conducted a comparative study in Peru to evaluate the trends in parents’ intention to vaccinate their children under 12 years of age against COVID-19, for which an online survey was administered. The survey was distributed through social networks (Facebook, Twitter, etc.), and was applied during two periods: 11/25/2021 to 12/06/2022 (Period 1) and 01/16/2022 to 01/24/2022 (Period 2). We also assessed the factors associated with the intention to vaccinate in each period through crude (cPR) and adjusted prevalence rates (aPR).

Results

During period 1, there were 673 participants (69.7% women). In period 2, we had 1139 respondents (77.7% women). Regarding intention to vaccinate, 83.5% of parents intended to vaccinate their children under 12 years of age during period 1. This percentage was almost the same during period 2 (83.3%). During period 1, the factors associated with a decrease in this intention were to believe that the vaccine was not necessary (aPR 0.65; 95% CI 0.44 – 0.94, p=0.022), that it would not protect (aPR: 0.14; 95% CI 0.03 – 0.63, p=0.011), that it would not be safe (aPR: 0.80; 95% CI 0.70 – 0.92, p=0.001), that it could cause long-term side effects (aPR: 0.92; 95% CI 0.85 – 1.00, p=0.037), and to think it should not be mandatory (aPR: 0.89; 95% CI 0.80-0.99, p=0.038). During period 2, besides the factors identified in period 1, not knowing about COVID-19 infection risk in children (aPR: 0.92; 95% CI 0.85-1.00, p=0.042) was also associated with a decrease in the intention. Living on the highlands or jungle was associated with an increase in the intention in both periods.

Conclusion

A high rate of intention to vaccinate children under 12 years of age was noted among parents in Peru, which was maintained until the end of January of 2022, right before COVID-19 vaccination started for this age group. There was a perception in some parents that the vaccine might not be necessary or safe, leading to a lower intention to vaccinate their children.

Disclosures

All Authors: No reported disclosures.
1981. Alternatives to guideline directed therapy in bacterial endocarditis
Authors: Ruiz-Conejo Marice , El-Dalati Sami , Stoner Bobbi Jo
Published: December 2022

Background

Existing society guidelines recommend therapy with intravenous antibiotics for 4-6 weeks for most cases of endocarditis. Recent literature has demonstrated that partial oral antibiotic treatment is non-inferior to intravenous therapy and that partial treatment with dalbavancin or shorter durations of therapy in patients undergoing valve surgery can also lead to positive clinical outcomes. However, there is not currently a standardized approach to how these alternative treatments should be utilized.

Methods

A standardized protocol for use of shortened duration of antibiotic treatment post-operatively, oral antibiotic therapy, and dalbavancin was developed by the endocarditis consult service in conjunction with the University of Kentucky multidisciplinary endocarditis team. Subsequently, consecutive patients with endocarditis treated with these alternative therapies were identified and reviewed by study investigators. The primary outcomes were 90-day mortality, 30-day readmission, relapsed infection, and completion of therapy.

Results

Between September 7th, 2021 and April 15th, 2022 we identified 20 cases of endocarditis managed with one of the alternative treatment regimens. Fourteen patients had recent injection drug use. Twelve patients were initially treated with partial oral therapy. Five patients were initially treated with dalbavancin. Three patients received two-week courses of intravenous antibiotics after valve surgery. For all patients, 90-day mortality was 0% and 30-day readmission rate was 10%. Ten patients completed oral treatment. Three patients completed therapy with Dalbavancin with two patients transitioning to the oral group due to side effects. All three patients with shortened durations of therapy completed treatment. One patient treated with dalbavancin with crossover to oral therapy developed relapsed bacteremia with the same organism after self-discontinuing a suppressive oral antibiotic.

Conclusion

A systematic approach involving a multidisciplinary team can allow for successful utilization of alternative approaches to guideline directed treatment for endocarditis with high rates of therapy completion, low rates of mortality, re-admission, and relapsed infection, including in persons who inject drugs.

Disclosures

All Authors: No reported disclosures.
1986. Multicenter evaluation of Staphylococcus aureus prosthetic valve infective endocarditis with and without gentamicin treatment: Is it time to revisit?
Authors: Pham Tho H , Molina Kyle C , Erdman Grace , Miller Matthew A , Huang Vanthida
Published: December 2022

Background

Staphylococcus aureus prosthetic valve infective endocarditis (SA-PVIE) is associated with high mortality. Gentamicin (GEN) with anti-staphylococcal antibiotics and rifampin are guideline recommendations for SA-PVIE extrapolated from in vitro data. GEN can lead to acute kidney injury (AKI), meanwhile, the clinical benefit on infection-related outcomes remains unclear. Therefore, we evaluated the impact of GEN on outcomes in SA-PVIE.

Methods

This is a multicenter, retrospective cohort conducted at HonorHealth and UCHealth systems. Adults admitted between January 2014-2022 with definite/possible SA-PVIE by Duke Criteria were included if they received ≥2 days of treatment within 2 days of index culture. Cohorts were stratified by GEN receipt. The primary outcome was 90-day all-cause mortality. The secondary outcomes were treatment failure (change in antimicrobials, abscess development, new indication for cardiac surgery), 30-day all-cause mortality, and incidence of AKI by KDIGO Criteria.

Results

Overall, 38 patients with definite (40%) and possible SA-PVIE (60%) met inclusion (13 GEN, 25 without GEN [no-GEN]). At baseline, 15 (40%) patients were in an ICU, median Pitt bacteremia score was 2, and methicillin-susceptible S. aureus predominated (71%). A total of 10 (26%) patients had valve surgery; median bacteremia duration was similar between GEN and no-GEN (4 vs 3 days, p = 0.26). Common antibiotics were vancomycin (95%), cefazolin (63%), and nafcillin (21%); rifampin was more common in GEN than no-GEN (20% vs 77%, p < 0.001). Baseline AKI (44% vs 46%) and renal impairment (8% vs 0%) were not different between GEN and no-GEN, respectively. GEN was initiated a median 3 days after index culture, most commonly as intermittent strategy (69%) with 3 mg/kg daily equivalent (84.6%). There was no statistical difference in treatment failure (23% vs 24%, p=0.17), 30-day mortality (20% vs 39%, p=0.22), or 90-day mortality (28% vs 43%, p=0.263) between GEN and no-GEN, respectively. Three in the (23%) GEN group experienced AKI, compared to 10 (40%) in no-GEN.

Conclusion

We did not find that the addition of GEN to SA-PVIE therapy enhanced mortality benefit, yet patients without GEN may live to experience adverse events. Further studies were warranted.

Disclosures

All Authors: No reported disclosures.
1989. Prognostic Factors Associated With In-hospital Mortality In Patients With Infective Endocarditis In 4 Colombian Hospitals From 2007 To 2017
Authors: Pérez María Alejandra , Zuluaga Juan , Dennis Rodolfo , Kock Joshua , Millán Henry , Noreña Ivan , Uribe Luis , Ospina Leonardo , Gerson Arias
Published: December 2022

Background

In Colombia there are few studies on the behavior of this disease, with incidence reports of 8.3 patients per 100,000 inhabitants per year. This study is the first to be carried out in several centers in the country with the aim of reaching a representative number of patients with endocarditis, and thus reflect the behavior of this pathology in Colombia, determining possible associations with prognostic factors for mortality.

Methods

Observational, multicenter, analytical, historical cohort study, which was carried out in 4 high-complexity hospitals in Colombia from 2007 to 2017. The target population was adult patients hospitalized between 2007 and 2017 in the hospitals of: Fundación cardioinfantil (Bogotá), Hospital Mayor de Méderi (Bogotá), Shaio Clinical Foundation (Bogotá), and the Cardiovascular Foundation of Colombia (Bucaramanga) with a diagnosis of definitive infective endocarditis. As inclusion criteria, patients over 18 years of age hospitalized in these institutions and who met the definitive infective endocarditis criteria according to the modified Duke criteria were taken into account. Those patients without complete information in the clinical history for the collection of variables were excluded.

Results

308 patients were included In hospital mortality was 32.7%. The main prognostic variables were: Complication with renal replacement therapy OR 6,669 CI 3.77 - 12.17, p< 0.001, moderate mitral compromise OR 3.9 CI 1.02-17.5, p=0.057, renal replacement therapy (RRT) prior to hospitalization OR 3.72 CI 1.89 - 7.51, p < 0.001 and central nervous system embolism OR 2.6 CI 1.53 - 4.44, p< 0.001. As protective factors: surgery during hospitalization OR 0.39 CI 0.24 - 0.64, p< 0.001 and tricuspid involvement OR 0.39 IC 0.15 - 0.87, p=0.032.

Multivariate analysis of mortality with prehospital variables in patients with infective endocarditis.

Abbreviations: GFR, Glomerular Filtration Rate. CKD-EPI, Chronic kidney disease epidemiology collaboration. LVEF, Left Ventricular Ejection Fraction

Multivariate analysis of mortality with hospital variables in patients with infective endocarditis

Abbreviations: RRT, renal replacement therapy. CNS, Central nervous system, mm: millimeters.

ROC curve of the mortality prediction model with pre-hospital variables

Conclusion

Both the epidemiological characteristics and in-hospital mortality are similar to those reported in international studies. The main prognostic factor associated with in-hospital mortality was the development of acute kidney injury with indication for RRT.

Disclosures

All Authors: No reported disclosures.
1990. Prognostic factors for long-term mortality in left-sided infective endocarditis after surgical treatment
Authors: Ju Lee Se , Ho Kim Jung , Jae Lee Hi , Kim Jinnam , Hyun Lee Ki , Ah Lee Jung , Hyup Kim Chang , Yeom Joon-sup , Yong Choi Jun , Jin Jeong Su , Ahn Jin Young , Su Ku Nam , Hyun Lee Seung
Published: December 2022

Background

Infective endocarditis is not a prevalent disease but has a high mortality rate. Especially left-sided infective endocarditis (LSIE) shows a higher mortality rate than right-sided infective endocarditis. Surgical treatment is occasionally considered for LSIE, but not much data is available on the long-term prognostic factors for LSIE after surgical treatment. This study investigated the risk factors for long-term mortality in LSIE patients who underwent surgical treatment.

Methods

This retrospective study enrolled adult patients with LSIE admitted to Severance Hospital in South Korea and underwent surgical treatment from November 2005 to August 2017. The primary outcome was overall all-cause mortality. Multivariate Cox regression analyses were performed to assess the risk factors for long-term mortality of LSIE with surgical treatment.

Results

239 cases with LSIE who underwent surgery were enrolled in this study. The median follow-up period was 6.2 years, and there were 34 deaths (14.2%) during the period. The mortality group showed older age (61.0 [53.0-72.0] vs 51.0 [39.0-61.0] years, P = 0.001), more chronic kidney disease (17.6% vs 3.9%, P = 0.007), more chronic liver disease (CLD) (14.7% vs 3.4%, P = 0.017), more cerebral embolisms (58.8% vs 26.8%, P < 0.001), less isolated mitral valve involvement (29.4% vs 52.7%, P = 0.020), and higher Sequential Organ Failure Assessment score (2.0 [1.0-4.0] vs 1.0 [1.0-2.0], P = 0.014). The survivor and mortality groups showed no statistical difference in the time to surgery. Multivariate Cox analyses demonstrated cerebral embolism (Hazard ratio (HR): 3.62, 95% Confidence Interval (CI): 1.79-7.31, P < 0.001), CLD (HR: 4.24, CI: 1.53-11.76, P = 0.005), and age (HR: 1.03, CI: 1.00-1.06, per 1 year, P = 0.021) as risk factors for overall mortality. Kaplan-Meier survival curve showed significant difference between the patients with and without cerebral embolism (P < 0.001, log-rank). Figure 1.Kaplan-Meier survival curve for overall mortality

Conclusion

Cerebral embolism, CLD, and older age were associated with the long-term mortality in LSIE patients who underwent surgery. Preventive strategies for cerebral embolism are essential for the improvement in LSIE treatment.

Disclosures

All Authors: No reported disclosures.
1994. The use of whole body PET scans in management of infective endocarditis
Authors: Park Jason , Simpson Kaitlyn , Riddell James , Neils Megan E
Published: December 2022

Background

Whole-body 18F-FDG PET/CT (WBP) can have diagnostic utility in evaluating extracardiac sites of metastatic infection in patients with infective endocarditis (IE). However, the IE patient population that most benefits from this test is not certain. The purpose of this study is to investigate the clinical characteristics of patients with IE who had WBP performed and to evaluate how WBP results impacted management.

Methods

We performed a retrospective cohort study at a tertiary care center evaluating patients with suspected IE who were discussed at an internal multidisciplinary endocarditis conference between June 2018 and January 2022. Adult patients with suspected IE who also had a WBP during their inpatient stay were included. Patient demographics, IE risk factors, and WBP details were collected.

Results

114 patients with suspected IE had a WBP out of 431 (26.5%). The majority (n=107, 93.9%) had definite or possible IE by mDuke criteria. Prosthetic valves and endocardial devices were present in 83 (72.8%) and 34 (29.8%) patients respectively. There were 67 (60.5%) patients with 2 or more days of bacteremia and 21 (22.1%) patients with over 7 days of bacteremia. Causative pathogens included S. aureus (n=26, 24.2%), Enterococcus (n=26, 24.2%), and Streptococcus species (n=24, 22.4%). Among the 70 (61.4%) patients with indications for cardiac surgery, 38 (54%) had cardiac surgery performed. Common WBP findings were bone/joint infections (n=18, 15.8%), pulmonary infection (n=32, 28.1%), and skin/soft tissue infection (n=15, 13.2%). WBP changed the management in 44.7% (n=51) of patients, including antibiotic change (n=11, 9.7%), source control procedure (n=12, 10.5%), and further workup of infectious or non-infectious findings (n=33, 29.0%). Six-month all-cause mortality was 25% and hospital readmission was 48.1%.

Conclusion

Many patients who underwent WBP had prolonged bacteremia, a history of cardiac prostheses, and had complicated IE with indications for cardiac surgery. WBP results changed treatment in some cases, but true clinical impact on morbidity and mortality is uncertain. We plan to do further research to compare outcomes between patients who get WBP and those who do not and to determine which patients may most benefit from this test.

Disclosures

All Authors: No reported disclosures.
1995. A Study of Amoebic Liver Abscesses from Mumbai, India
Authors: Kaneria Mala V , Shetty Nishant
Published: December 2022

Background

Microbial contamination of the liver parenchyma leading to liver abscess can occur via the bile ducts or vessels or directly, by contiguity. In India, amoebiasis is endemic and amoebic liver abscess (ALA) is the most common extraintestinal site of involvement. The epidemiology and characteristics of ALA have changed and the distinguishing features between pyogenic and amoebic liver abscess are unclear.

Methods

32 consecutive patients presenting with liver abscess were included over a period of 18 months. Their demographic profile, comorbidities, characteristics of the abscesses on imaging (number, size, liquifaction, lobe involved, etc), complications, treatment given (both medical and interventional) were recorded. The abscess size was monitored by periodic sonography, both for liquification and response to therapy.

Results

A male preponderance was observed. 50 abscesses were noted in the 32 patients. 29 patients (90.63%) had ALA, 2 pyogenic (6.25%) and 1 cholangitic (3.125%). Fever and right hypochondrial pain were common complaints. Chronic diarrhoea was noted in only 4 (12.5%) patients. 92% were in the right lobe. Majority were unliquified / partially liquified at presentation. All underwent percutaneous drainage. 11 (34.375%) had rupture, with majority (25%) being in the perihepatic space. This local complication was associated with large and/or multiple abscesses. All ALA were treated with metronidazole for 3-4 weeks and a luminal amoebicide, with a good response. Only 2 patients expired, due to their comorbidities.

Conclusion

The traditional belief that amoebiasis causes solitary abscess and bacteria cause multiple abscesses does not hold true anymore. Leucocytosis is seen with ALA too. Alcoholism and underlying comorbidities are not prerequisites for developing liver abscess. A combination of medical and interventional therapy produces good results, even in multiple abscesses.

Disclosures

All Authors: No reported disclosures.
2000. Clinical characteristics and prognosis of patients with Shiga toxin-producing Escherichia coli hemolytic uremic syndrome and encephalopathy: a nationwide observational study in Japan
Authors: Myojin Shota , Michihata Nobuaki , Shoji Kensuke , Takanashi Jun-ichi , Matsui Hiroki , Fushimi Kiyohide , Miyairi Isao , Yasunaga Hideo
Published: December 2022

Background

Shiga toxin-producing Escherichia coli (STEC) may cause hemolytic uremic syndrome (STEC-HUS) and encephalopathy which possibly lead to neurological sequelae and mortality. However, the detailed epidemiology of this disease remains unclear due to its low frequency. This study aimed to describe the characteristics, demographics, and mortality of patients with STEC-HUS using a nationwide database.

Methods

We performed a retrospective cohort study using the Diagnosis Procedure Combination database, which includes approximately half of acute-care inpatients across Japan. We enrolled patients who were hospitalized for STEC-HUS from July 2010 to March 2020. We defined patients with unfavorable outcomes as any of the following at discharge: in-hospital death within three months, tracheostomy, mechanical ventilation, dialysis, and rehabilitation.

Results

This study included 655 patients with STEC-HUS (median age, 7 years). 62 patients (9.5%) were admitted to intensive care units within 2 days of admission. A total of 125 (19.1%) patients had any one of the composite unfavorable outcomes: 24 (3.7%) in-hospital death within 3 months, 9 (1.4%) tracheostomy during hospitalization, 24 (3.7%) mechanical ventilation at discharge, 22 (3.4%) dialysis at discharge, and 95 (14.5%) rehabilitation at discharge. Thirty-one patients (4.7%) developed STEC-HUS related acute encephalopathy.

Conclusion

Regardless of advances in multidisciplinary medicine, we found STEC-HUS remains a poor prognostic condition.

Disclosures

All Authors: No reported disclosures.
2002. Clostridioides difficile Infection Recurrence Trends and Characteristics at a Community Medical Center
Authors: Anwar Lara , Box Maggie
Published: December 2022

Background

Updated IDSA C. difficile Infection (CDI) guidelines recommend fidaxomicin as preferred therapy for initial infection as studies demonstrate increased sustained response 4 weeks after the end of therapy compared with vancomycin. Implementation of this is dependent upon available resources and vancomycin is recommended as an acceptable alternative. A course of fidaxomicin costs 30-50 times more than oral vancomycin and presents a pharmacoeconomic challenge. This study evaluated the incidence and characteristics of CDI recurrence in a community medical center to assess feasibility of implementing new CDI treatment recommendations.

Methods

This multicenter, retrospective study was conducted at Scripps Health from 1/1/2019 - 12/31/2019. Adult patients with an initial CDI diagnosis (EIA antigen/toxin positive) were included. The primary endpoint was clinical cure, defined as no recurrent episodes of CDI one year after treatment. Secondary endpoints evaluated baseline characteristics and treatment between patients experiencing recurrence or no recurrence. Outcomes were assessed using count and proportion for descriptive data and Chi-Square, Fisher’s Exact and Logistic Regression for categorical data.

Results

A total of 223 patients were included, of which 18.4% (41/223) had recurrence. There was no difference in recurrence based on age > 65, sex, ethnicity, severity, and inpatient status (p > 0.05). There were no differences in comorbidities (kidney disease, cardiovascular disease, diabetes, malignancy, or pulmonary disease, p > 0.05) with the exception of cerebrovascular disease which was significantly higher in patients with recurrence (34.2% vs 13.2%, P = 0.001). Recurrence rates were similar between treatment groups (p = 0.383) which included vancomycin (n = 193, 20%), fidaxomicin (n = 4, 25%), metronidazole (n = 9, 0%), and vancomycin + metronidazole (n = 17, 12%).

Conclusion

Presence of cerebrovascular disease was the only characteristic associated with a higher incidence of CDI recurrence. The majority of patients were treated with oral vancomycin, and there was no difference in recurrence based on treatment although there were low numbers in non-vancomycin cohorts. Vancomycin is an acceptable alternative for the management of CDI in our population.

Disclosures

All Authors: No reported disclosures.
2005. Direct Hospitalization Costs Associated with Resistant and Susceptible Salmonella and Shigella Infections in the United States — 2012–2019
Authors: Tobolowsky Farrell A , Salah Zainab , Kim Sunkyung , Baggs James , Olubajo Babatunde , Cui Zhaohui , Douglas Scott R , Wolford Hannah , Natalie McCarthy , Medalla Felicita , Watkins Louise F
Published: December 2022

Background

Foodborne illnesses cost ∼$90 billion in the United States annually. Antibiotic-resistant infections may be more difficult to treat and can be associated with severe outcomes, leading to higher costs and longer length of stay (LOS). We described LOS and costs for hospital admissions for Salmonella and Shigella infections by resistance status.

Methods

We reviewed all inpatient admissions from ∼300 hospitals in the Premier Healthcare database during 2012–2019 and included records with culture-confirmed nontyphoidal Salmonella (NTS), typhoidal Salmonella (serotypes Typhi and Paratyphi A, B, and C), or Shigella. We classified infections as resistant if laboratory testing found resistance to ≥1 drug in the clinically important antibiotic categories (fluoroquinolones, macrolides, penicillins, folate pathway antagonists, or third-generation cephalosporins) or susceptible otherwise. We used the Wilcoxon rank sum test to assess difference in median LOS and cost of patient hospitalization for resistant vs. susceptible infections by pathogen type.

Results

Of 4,168 persons hospitalized, about half (n=2,129, 51%) were female; median age was 52 [IQR: 26‒68] years; 29% (n=1,217) of infections were resistant. For NTS infections, median LOS was 4 [IQR: 3‒7] days for resistant and 4 [IQR: 3‒6] (p=0.04) for susceptible; for typhoidal Salmonella, 6 [IQR: 5‒8] for resistant and 5 [IQR: 3‒8] for susceptible (p=0.15); and for Shigella, 3 [IQR: 2‒4] for both (p=0.09). Median costs were highest for typhoidal Salmonella ($12,577 resistant vs. $9,238 susceptible; p=0.21), followed by NTS ($7,179 vs $6,421, p=0.01) and Shigella ($4,975 vs $5,335; p=0.26).

Conclusion

Hospitalization costs were higher for patients with some resistant infections. Longer LOS may contribute to higher costs; however, it is not clear whether other pathogen or patient factors (e.g., comorbidities) also contributed. Additional data and adjusted analyses may provide insight into reasons for the cost difference. If resistant infections are shown to be the cause, our findings support that public health interventions to limit the spread of resistant infections could reduce costs.

Disclosures

All Authors: No reported disclosures.
2006. Long-term efficacy of lower-gastrointestinal delivery fecal microbiota transplantation for recurrent Clostridioides difficile infection
Authors: Greene Devin M , Fabian Amy , Taylor Colton
Published: December 2022

Background

The rate of recurrent Clostridioides difficile infection (rCDI) is 15-28% for those that initially respond to antibiotics and increases to about 50% in those with more than two recurrences. Fecal microbiota transplantation (FMT) is a treatment option for patients that have failed antibiotics for at least two rCDIs or for those with severe or fulminant CDI refractory to antibiotics. Data assessing the long-term efficacy of FMT beyond 1 year are scarce. The objective of this study is to evaluate the long-term efficacy of lower-gastrointestinal (GI) delivery FMT in addition to standard of care pharmacotherapy (SOCp) for rCDI compared to patients that received SOCp alone.

Methods

This is a single center, retrospective cohort study that included patients 18-99 years old who received either SOCp or FMT in addition to SOCp for rCDI between January 1, 2018 and December 30, 2020. Exclusion criteria were pregnancy or receipt of upper-GI delivery FMT. The primary endpoint was rCDI within 12 months. Secondary endpoints were all-cause mortality at 6, 12, 18, and 24 months, recurrence at 6, 18, and 24 months, and time to first recurrence of CDI (months). Patients were propensity matched based on age, immunocompromised status, and antibiotic received for index rCDI episode.

Results

The rCDI rate at 12 months was 8% and 50% in the FMT (n = 24) and SOCp (n = 24) groups, respectively (p = 0.0001). The rCDI rate at 24 months was 8.3% and 50% in the FMT and SOCp groups, respectively (p=0.0015). Mean time to 1st rCDI episode was 15.5 and 1.5 months in the FMT and SOCp groups, respectively (p = 0.0255). All-cause mortality at 24 months was 17% and 21% in the FMT and SOCp groups, respectively (p = 0.81).

Conclusion

Patients who received FMT in addition to SOCp had a significantly lower rate of recurrence and a significantly longer time to subsequent recurrence compared with the SOCp group. There was no significant difference in all-cause mortality between the groups.

Disclosures

All Authors: No reported disclosures.
2010. Severity of antimicrobial-resistant non-Typhoidal Salmonella infections treated in two large facilities of a health system in Pennsylvania, 2018-2020
Authors: Hackman Nicole M , Watkins Louise F , Sayeed Sameera , Boktor Sameh , Dettinger Lisa , Thirumalapur Nagaraja , Dudley Edward G , M’ikanatha Nkuchia M
Published: December 2022

Background

Nontyphoidal Salmonella (NTS) is a leading cause of foodborne illness. Characterization of clinical outcomes of salmonellosis from antimicrobial-resistant (AMR) NTS is limited. The Pennsylvania Department of Health collaborated with federal and academic partners to enhance surveillance for NTS (AMR and outcomes).

Methods

We evaluated 82 patients with salmonellosis whose NTS isolates were submitted to the PA Public Health Laboratory during 2018–2020 from two Pennsylvania hospitals. We used broth microdilution to test NTS isolates for susceptibility to antibiotics tracked by the National Antimicrobial Resistance Monitoring System. Isolates resistant to ≥3 antimicrobial classes were considered multidrug-resistant (MDR). Electronic medical records of source patients were reviewed for medical history, diagnoses, treatment, and outcomes. Invasive infection was defined as isolation from normally sterile sites (e.g., blood).

Results

Seven (9%) of 82 isolates were MDR. Twelve (15%) had decreased susceptibility to ciprofloxacin (MIC ≥0.12 µg/mL), 3 (4%) were ceftriaxone resistant, 3 (4%) were trimethoprim-sulfamethoxazole resistant, and 1 (1%) was azithromycin resistant. The median patient age was 29 years; 31 (38%) patients were ≤18 years and 42 (51%) were female. Nearly a quarter of all patients were immunosuppressed (Figure). Outcomes included hospital admission in 38 (46%), intensive care for 5 (6%) patients, and 1 (1%) death. Ten (12%) patients had invasive infections, including 8 with bacteremia; all were hospitalized. Four (40%) of the invasive disease isolates were resistant to ≥1 antimicrobial, compared with 16 (22%) isolates from patients with the non-invasive disease. Fifty-seven (70%) patients were prescribed empiric antimicrobials for their infection. Antibiotics were changed in 45 (79%) after laboratory diagnosis.

Demographic and clinical characteristics of patients with nontyphoidal Salmonella treated in two facilities associated with a health system in Pennsylvania, 2018–2020. The five patients treated in intensive care units are included in the total admissions (n=38). Salmonellosis was considered invasive if the organism was isolated from the blood or other normally sterile site (excluding urine).

Conclusion

NTS can cause severe invasive illness in some patients; drug-resistant NTS infections may be associated with more severity as compared with susceptible NTS. Resistance to clinically consequential drugs coupled with the severity of infections suggests the need for antimicrobial stewardship and highlights the value of clinical data in enhancing surveillance for salmonellosis.

Disclosures

All Authors: No reported disclosures.
2013. Bloodstream Infections in Advanced Heart Failure Patients Requiring Prolonged Use of Axillary Intra-Aortic Balloon Pumps - A Single Center Study
Authors: Dreucean Diane , Donahue Kevin R , Donahue Kevin R , Morton Celia , Succar Luma , Krisl Jill , Agrawal Tanushree , Perez Katherine K , Jaramillo Taylor , Kassi Mahwash , Yousefzai Rayan , Hussain Imad , Guha Ashrith , Kim Ju , Bhimaraj Arvind
Published: December 2022

Background

Bloodstream infections (BSI) impact outcomes in critically ill patients. Institutions and quality and performance improvement efforts to minimize catheter associated infections are valued to optimize outcomes. While intra-aortic balloon pumps (IABP) implanted through the axillary route have been recently used in cardiogenic shock patients for prolonged support, the incidence and associated significance of BSI remains unknown in this cohort. The aim of this study was to assess the incidence of BSI in patients with axillary-placed IABP and evaluate its impact on patient outcomes.

Methods

We retrospectively reviewed 141 patients that underwent axillary IABP placement from May 2016 through August 2020. The primary endpoint was the incidence of BSI during axillary IABP, reported as the proportion of patients who developed a BSI and BSI per 1000-device days.

Results

BSI occurred in 13% of patients and accounted for 4.3 infections per 1000-device days. Prior femoral device use and longer duration of axillary IABP support occurred more frequently in the BSI cohort. Presence of traditional BSI risk factors including central line days, use of parenteral nutrition, and prior positive cultures did not differ between those who developed BSI and those who did not. The rate of end-outcome attainment (transplant, LVAD, recovery) was not statistically different in those that developed BSI vs not (72% vs 88% p=0.08). A total of 41% of BSI were caused by Staphylococcus epidermidis. Use of peri-procedural antimicrobials was associated with lower risk of BSI development (24% vs 8%; p=0.01)

Conclusion

Patients in cardiogenic shock requiring use of life-saving temporary mechanical support pose a challenge to maintain free of BSI during prolonged support with an indwelling catheter that allows for ambulation and movement. Mitigation of modifiable BSI risk factors, such as the use of peri-procedural antimicrobial prophylaxis, accompanied by a low threshold for screening and treatment are reasonable strategies to improve patient outcomes. Future research is needed to further evaluate BSI risk in this patient population and its subsequent impact on patient outcomes.

Disclosures

All Authors: No reported disclosures.
2025. Outcomes of Pseudomonas aeruginosa Ventricular Assist Device Infection
Authors: Murugan Lalithaa Thirunavukarasu , Murugan Lalithaa Thirunavukarasu , Murugan Lalithaa Thirunavukarasu , Shrestha Nabin K , Banzon Jona
Published: December 2022

Background

Ventricular assist device (VAD) infections caused Pseudomonas aeruginosa (PA) are difficult to treat given limited antibiotic options, development of resistance and biofilm formation in the presence of retained hardware. We looked at outcomes of patients who developed Pseudomonas aeruginosa LVAD infection (PA-LVADI)

Methods

Single center retrospective study of patients older than 18 years who received LVAD from 7/1/2007 to 2/1/2021 and subsequently developed PA-LVADI. Patients with proven or probable VAD-specific infections: driveline infection (DLI), pump pocket, and pump/cannula infections were included. The cumulative incidences of death, transplant, and LVAD explant, following Pseudomonas aeruginosa infection, were evaluated as competing outcomes. Fig 1:Classification of Pseudomonas aeruginosa LVAD Infections at diagnosisFigure 3:Cumulative incidence of death, transplant, or explant following Pseudomonas aeruginosa LVAD infection

Results

51 patients with VAD-specific PA-LVADI were identified (Fig 1). Median age at the time of first LVAD placement was 55 years (23 – 74). Of the 28 patients ever listed for transplant, 13 (46%) received heart transplant, 8 (29%) were delisted, 7 (25%) were alive on transplant list (Fig 2).

The median number of days from LVAD placement to first PA infection was 587 (54 – 3389). 30 (59%) had PA as the first causative organism. The extent of first PA-LVADI was superficial DLI in 43(84%), deep DLI in 5 (10%), pump pocket in 2(4%) and pump/cannula in 1(2%).

46 (90%) of patients received intravenous (IV) therapy with median duration of 84 (2 – 525) total IV antibiotic days. Antibiotic resistance emerged in 25/51 (49%) patients, with 32% being multi-drug resistant (MDR). Surgery was performed in 30 (58%).

12/13 who received heart transplants were followed for at least 1 year post-transplant and all were alive. 5 of the remaining 38 patients underwent pump exchange or explant. 20/38 (53%) of patients who were not transplanted died (Fig 3).

Conclusion

This is the largest study on PA-LVADI to date. We noted significant morbidity and mortality, with 90% of patients requiring prolonged IV antibiotics and over half requiring surgical treatment. Drug resistance emerged in a significant proportion of patients. Survival after transplant was excellent, but by 2 years of infection over half of the patients have been transplanted, explanted, or died.

Disclosures

All Authors: No reported disclosures.
2028. Reduction in Health Care Facility Onset Catheter-Associated Urinary Tract Infections: A Resident-Led Quality Improvement Initiative
Authors: Ramakrishna Jahanavi M , Schmidt Bernadette , Hessler-Waning Monica , Reddy Trishya , Hester Thomas , Kashlan Reem , Tariq Osama , McCready Tess , Tegeltija Vesna
Published: December 2022

Background

Hospital-acquired catheter-associated urinary tract infection (CAUTI) was estimated to cause 19,700 cases in 2020 across the United States per the Centers for Disease Control and Prevention (CDC). While this is a 25% decrease in reported incidence rates since 2015, ad-hoc changes in care practices and limitations of surveillance definitions brought on by the giant burden of COVID-19 on the healthcare system possibly resulted in underreporting of CAUTIs. In a 290-bed tertiary, community hospital in the Detroit metropolitan area, there was a 200% increase CAUTIs from 2020 (5 CAUTIs) to 2021(16 CAUTIs). A multidisciplinary, resident-led team was assembled to reduce hospital-acquired CAUTIs.

Methods

A multi-pronged quality improvement initiative was conducted from January 1, 2021, through March 31, 2022. CAUTIs were identified and reviewed via electronic health records using predefined criteria related to CDC surveillance definitions, urinary catheter insertion indications, laboratory data, and antibiotic use. Plan-Do-Study-Act (PDSA) Cycle model was used to guide the initiative. Thus far one PDSA cycle has been completed. The initial intervention bundle was designed by the multidisciplinary team and led by internal medicine and transitional year residents. The intervention bundle included 1. Provider (including physician and RN) education, 2. Design and implementation of an appropriate urinary catheter practice algorithm, and 3. Expert review of positive urine cultures and CAUTI cases.

Results

Baseline data collected from January to December 2021 showed 16 CAUTIs. Post-implementation of the intervention bundle from January to March 2022 resulted in a 75% reduction in CAUTI incidence (1 CAUTI flagged).

Conclusion

A targeted intervention bundle improved CAUTI incidence by reducing inappropriate urinary catheter insertion and prolonged removal. Ongoing local initiatives focused on hospital-acquired infections, such as this one, are paramount to the persistent optimization of infection prevention despite national trends.

Disclosures

All Authors: No reported disclosures.
2033. Use of Sterile, Single-Use Bronchoscopes Reduces Procedure-Associated Readmissions Rates and Eliminates Potential Device Cross-Contamination
Authors: Garrett John H
Published: December 2022

Background

Improper reprocessing of reusable bronchoscopes poses a serious patient safety risk. The risk of patient infection resulting from use of contaminated bronchoscopes has been reported to be 2.8%. By virtue of being sterile, SFB eliminates device-related infection risk, subsequent readmission rates, and associated costs. Readmissions following bronchoscopy may occur for many reasons, but most frequently are due to infection, bleeding, or pain. These infections are preventable and can be eliminated with the use of a sterile, single-use bronchoscope when the device is used according to the manufacturer’s instructions for use.

Methods

Bronchoscopies with SFB and RFB were identified along with their corresponding readmission information in the Premier Healthcare Database from 2016- 2019. A logistic regression analysis was conducted with 30-day readmission as the dependent variable. Independent variables included use of a RFB, gender, race, age, payer, and discharge status. For the inpatient setting, the 3M™ APR DRG Severity of Illness classification was included as an independent variable.

30 Day Readmissions

Results

A total of 14,228 procedures were identified, of which 1,795 used SFB and 12,433 used a RFB. In the inpatient setting, the RFB group was ∼2.5 times more likely to be readmitted within 30 days compared to the SFB group (OR=2.5, p< 0.01), controlling for patient demographics and risk. In the outpatient setting, the RFB group was ∼1.5 times more likely to be readmitted than the SFB group (OR=1.5, p >0.05). Across all settings, the RFB group was ∼2.3 times more likely to be readmitted than the SFB group (OR=2.3, p< 0.01). The inability to fully risk-adjust in the outpatient setting may have been a factor in the smaller OR and lack of statistical significance; this limitation will be addressed with further analysis that includes an outpatient severity of illness classification variable.

Conclusion

Patients undergoing bronchoscopy typically have significant comorbidities which increase their risk for the development of potential device-related infections. To reduce these risks, the use of a sterile SFB should be considered to eliminate reprocessing failures, improve overall operational efficiency, and reduce potential acquisition of healthcare-associated infections.

Disclosures

John H. Garrett, PhD, MSN, MPH, MBA, FNP-BC, FNAP, FSHEA, FIDSA, Aerobiotix: Advisor/Consultant|Ambu: Advisor/Consultant|American Academy of Nurse Practitioners: Honoraria|Clorox Pro: Advisor/Consultant.
2359. Evaluating Hepatitis C Virus (HCV) Diagnostic Testing, Cure and Reinfection among People Living with HCV and HIV Coinfection in New York City
Authors: Graf Laura , Bocour Angelica , Huang Yanting Kelly , Romano Anthony , Varigonda Renuka , McPherson Tristan D
Published: December 2022

Background

Untreated hepatitis C virus (HCV) infection can lead to liver disease, cancer and premature death; HIV coinfection can accelerate adverse outcomes. People living with HIV (PLWH) should be screened for HCV with an antibody test at least once and more frequently if other risk factors. A diagnostic HCV RNA test should be used to determine cure/clearance (RNA-negative) vs active infection (RNA-positive). Among people with HCV/HIV coinfection in New York City (NYC), we aimed to 1) describe HCV testing, cure/clearance, reinfection and identify disparities; 2) assess relative timing of HCV/HIV coinfection diagnosis to evaluate HCV testing among PLWH.

Methods

PLWH as of September 30, 2021 were matched to people with a positive HCV test July 1, 2014–December 31, 2020; HCV test results through December 31, 2021 were used for analyses and to observe cure. A HCV clearance cascade was created to evaluate testing, cure/clearance and reinfection, and was stratified by age, sex and race/ethnicity. Timing of coinfection was assessed for people with new HCV/HIV diagnoses January 1, 2014–December 31, 2020 to identify recent trends. Coinfection date was defined as the later HCV or HIV diagnosis date.

Results

There were 11,137 PLWH with any positive HCV test. Of these, 10,773 (97%) had an RNA test; 8,926 (83%) had initial active infection; 6,901 (77%) had cure/clearance and 302 (4%) with cure/clearance were reinfected (Figure 1). Black Non-Hispanic (NH) people and those aged 20–39 had a high burden of active infection, with 3,653 (87%) and 803 (93%), respectively. Both groups had proportionally lower cure/clearance (77% and 63%, respectively) compared to Asian NH people (86%) and people ≥ 60 (81%) having the highest proportions. Most people with recent coinfections were diagnosed with HIV prior to HCV (annual range: 39%–71%) (Figure 2).

Conclusion

HCV diagnostic testing and cure/clearance were high and reinfection was low among people with coinfection in NYC. Most people with coinfection had HCV RNA tests, indicating appropriate HCV testing in this population. Cure/clearance could be improved among younger and Black NH people; provider and patient education might improve outcomes. To initiate timely treatment, providers should continue screening PLWH for HCV as HIV infection often precedes HCV infection.

Disclosures

All Authors: No reported disclosures.
2040. Healthcare-Associated Infection Surveillance During the COVID-19 Pandemic in New Mexico
Authors: Edwards-Fligner Morgan , Phipps Erin C
Published: December 2022

Background

The COVID-19 pandemic changed accessibility of care and practices within healthcare environments. This period has been associated with healthcare-associated infection outbreaks and shifts in healthcare-associated infectious disease epidemiology. This study’s objective is to describe changes in rates and characteristics of antimicrobial-resistant gram negative and Clostridioides difficile (CD) infections during the COVID-19 pandemic in Bernalillo County, New Mexico.

Methods

The NM EIP, a collaboration between University of New Mexico and the NM DOH, conducts ongoing laboratory- and population-based surveillance of infectious disease including Clostridium difficile, extended-spectrum beta lactamase (ESBL-E) and carbapenemase-producing gram negative bacteria (CRE). Stata statistical software was used for retrospective analysis of rates and characteristics on NM EIP data from Bernalillo county, NM between 2016 and 2021.

Results

Reported C. difficile rates decreased from 76 to 49 cases/month and ESBL-producing Enterobacterales decreased from 145 to 86 cases/month during the pandemic period from March-December 2020 compared with the prior 14 months. Monthly case counts for 2020 are lowest during initial public health orders for the state of New Mexico. Rates of CRE remained constant between 2018-2021.

The proportion of CDI cases originating from long-term care facilities decreased significantly from 17.2% to 10.4% (p=0.006) while the proportion attributable to hospital inpatient and community populations remained constant. The proportion of ESBL-E cases from sterile sample sites increased from 3.1% to 4.9% (p=0.05) and the proportion of patients who died within 30 days or prior to discharge increased from 2.2% to 3.2% (p=0.019).

Conclusion

Rates and characteristics of CD and ESBL-E infections in Bernalillo county NM changed significantly during the COVID-19 pandemic, while rates of CRE remained constant. It is still unclear whether this is related to changes in actual disease rates due to risk factor exposure (healthcare), or if this trend reflects changes in care-seeking behavior and/or reporting of cases.

Disclosures

All Authors: No reported disclosures.