bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-331. Patient Perspectives Regarding the Use of Contact Precautions for Methicillin-Resistant Staphylococcus aureus in a VA Acute Care Hospital
Authors: O’Hara Lyndsay M , Bahr-Robertson Mary , Newman Michelle , Pineles Lisa , Rubin Michael , Khader Karim , Nelson Richard , Baracco Gio , Goetz Matthew B , Evans Martin , Linder Kathleen A , Perencevich Eli N , Harris Anthony 
Published: January 2025

Abstract

Background
The optimal approach to using contact precautions for patients known to be colonized or infected with MRSA remains unclear despite knowledge that transmission risk varies by healthcare personnel role and care activity being performed. Additionally, the patient perspective is not routinely represented in infection control policies. The aim of this study was to assess patient perspectives on risk-based application of MRSA contact precautions in VA hospitals.

Methods
We conducted an in-person 75-minute focus group with seven Veteran patients colonized with MRSA. The session was audio recorded and transcribed verbatim. We developed a codebook based on the interview guide and used Nvivo 9 for analysis. One research team member coded the transcripts. Thematic analysis was utilized to summarize the findings. Emergent themes and patterns were identified by initial inductive analysis and themes were condensed into overarching categories.

Results
All patients agreed that they would prefer if healthcare workers wore gloves and a gown the entire time when providing care to all patients with MRSA. As shown in Table 1, participants identified three themes related to perceived advantages to the use of contact precautions for all care of patients with MRSA. The most frequently mentioned advantage was that doing so aligns with the premise that protecting patients and making them feel safe while in hospital should be the top priority. Participants also acknowledged five themes describing disadvantages to contact precautions such as the environmental impact and cost but stressed that these disadvantages should not be used to rationalize provision of what they viewed as suboptimal care. Most participants were open to a risk-tailored approach instead of total removal of all contact although some articulated concerns this may make patients may feel less safe and feel like they are not being treated equally.

Conclusion
These qualitative findings suggest that Veteran patients with MRSA support the use of contact precautions and are willing to consider a risk-tailored approach to glove and gown use if this is accompanied by education for healthcare personnel, patients, and families.

Disclosures
Anthony Harris, MD, MPH, Innoviva: Advisor/Consultant|UpToDate: Infection Control Editor
P-349. Identification and Control of a Candida auris Outbreak in an Acute Spinal Cord Injury Unit at a Veterans Affairs Medical Center
Authors: Hitchcock Matthew M , Fleming Michele S , Poe Shaunta , Knowlson Shelley , Christian Melanie , Eckert Angela , Hill Emily , Markley John D 
Published: January 2025

Abstract

Background
Candida auris is an emerging pathogen that spreads easily in healthcare settings and can cause severe infections. In Dec. 2022, C. auris was identified at the Richmond VA Medical Center (VAMC) in an acute care spinal cord injury unit (SCIU). The SCIU is a regional SCI center in a 300-bed VAMC that provides medical and rehabilitation services to patients from multiple states.Figure 1.Point prevalence testing results and timeline of interventions during the outbreak investigation.

Methods
C. auris was identified in 1 urine culture from a SCIU patient, triggering an outbreak investigation. The Infection Prevention (IP) team performed point prevalence (PP) testing via superficial swabs of axilla and groin sent for polymerase chain reaction (PCR) testing. Initial screening included 31 unique patients in 2 units, A (n=16) and B (n=15). Admission testing was also initiated. Patients were isolated until tests resulted. Surveillance PP testing was performed biweekly and ceased after consecutive rounds of negative results. The IP team evaluated infection control practices in the SCIU that could contribute to transmission.

Results
The initial screening of 31 patients yielded 5 positives (16%; Figure 1). Overall, 92 PCR tests were completed on 51 unique patients for a positivity rate of 9.8% (n=5). Positive results occurred only during the initial testing. Positive patients were admitted for a median of 36 days (range: 16-412). No C. auris was isolated in culture and no invasive infections developed. Records and interviews revealed complex movement between healthcare facilities for the colonized patients. Multiple lapses in infection control practice were found. Admission testing with repeat testing at 90 days was implemented longitudinally, along with enhanced cleaning measures and reinforcement of transmission-based precautions (Figure 1). No new positive results were found over the subsequent 9 months.

Conclusion
PP testing for C. auris in an SCIU identified 5 colonized patients. As no isolates were recovered beyond the index case, IP could not determine whether this outbreak was due to intra-unit transmission versus multiple introductions. Improvements in infection control practices, along with implementation of surveillance testing, contributed to control of the outbreak. The SCIU remains vulnerable to C. auris due to the complex, multidisciplinary care needs of the patient population.

Disclosures
All Authors: No reported disclosures
P-370. Impact of a Multidisciplinary Intervention to Reduce Infection after Prostate Biopsy at a Veterans Affairs Medical Center
Authors: Whitman Melissa , Sabo Roy T , Eckert Angela , Hitchcock Matthew M , Hill Emily , Krzastek Sarah , grob baruch , Markley John 
Published: January 2025

Abstract

Background
Infection after prostate biopsy (IAPB) occurs in 2-6% of cases. Due to fluoroquinolone resistance at our facility, preprocedural prophylaxis for prostate biopsy was switched from Ciprofloxacin to Fosfomycin in 2017. However, the rates of IAPB at our facility increased from 0.93% to 4.27% between 2021 and 2022 (Figure 1). Herein we describe the impact of a series of interventions aimed at reducing the IAPB rate.
Table One

Methods
A multidisciplinary workgroup including infection control, antimicrobial stewardship, nursing, and urology was convened in February 2022. An outbreak investigation ensued utilizing active surveillance, direct procedural observation, and chart review for epidemiologic commonalities and appropriateness antibiotics (Table 1). Based on these findings, several interventions were implemented (Table 1). IAPB rates were modelled over time using a generalized additive spline model with 2 knots. Data analysis took place between Oct 2018 to Sept 2023 using SAS Statistical Software (version 9.4. Cary, NC, USA).
Figure One

Results
A total of 2,295 prostate biopsies and 37 infections were identified from Oct 2018 to Sept 2023. Numerous bacterial pathogens were implicated, and no point source of infection was identified. Multilocus sequence-typing of three Klebsiella pneumoniae isolates did not suggest a single-organism outbreak. Pseudomonas was implicated in 4 infections. Fosfomycin minimum inhibitory concentrations were elevated in 6/9 isolates available for testing (range 32 to &gt;1024 ug/mL). Three periods with different infection rates were identified (Figure 2). Mean infection rates were 1% (0.6%-1.7%) for the first period (Oct 2018 to Aug 2021), 4.4% (2.8%-6.7%) for the second (Sept 2021 to Oct 2022), and 0.7% (0.2%-2.0%) for the third (Nov 2022 to Sept 2023). Periods one and three had statistically significant lower infection rates than period two (p=0.0002 and p=0.004, respectively).

Conclusion
A multidisciplinary workgroup applying a series of interventions was associated with a significant reduction in IABP. In the context of evolving antimicrobial resistance and variable procedural practices, elevated IABP should prompt a systematic evaluation of antimicrobial prophylaxis and procedural practices.

Disclosures
All Authors: No reported disclosures
P-375. Long-Term Suppressive Antimicrobial Therapy in Prosthetic Vascular Graft Infection: a Five-Year Retrospective Evaluation
Authors: Imeneo Alessandra , Alessio Grazia , Ferrari Ludovica , Mulas Tiziana , Marco Iannetta , Marchetti Andrea Ascoli , Ippoliti Arnaldo , Sarmati Loredana 
Published: January 2025

Abstract

Background
Prosthetic vascular graft infection (PVGI) is a rare but life-threatening complication of surgery. Complete removal and replacement of the endograft is the only curative strategy but is frequently impracticable for the high mortality risk, therefore, suppressive antimicrobial therapy (SAT) is the best treatment option.
This retrospective study aimed to describe the indication and outcome of SAT in patients with a PVGI evaluated since 2019 at Tor Vergata Hospital in Rome.

Methods
Patients with a PVGI (no cardiac valve replacement infections) were enrolled. The outcome was defined based on the latest available outpatient evaluation. PVGI was stratified as early/late and suspected/diagnosed according to guidelines.

Results
Twenty-one patients were enrolled (Tab. 1-3). At least one causative organism was identified in 41% of cases, mainly through blood samples (57%): 38% were Gram positive (GPB) and 29% were Gram negative (GNB) bacteria. Unexpectedly, early PVGI were more frequently caused by GNB than GPB (p-value 0.006).
All patients were SAT treated; only 3 patients underwent surgery without reaching source-control. Several options, including long-acting antibiotics (LAA), were available for GPB, while cotrimoxazole, ciprofloxacin and ertapenem were the principal long-term SAT for GNB.
The CT-PET scan monitoring was done after a median follow-up (FU) time of 90 [IQR 90-180] days; a positive early CT-PET FU (≤3 months from the first test) was associated with treatment failure needing a modification of SAT (p-value 0.003). Drug adverse effects occurred in 38% of cases and were followed by a change in SAT.
Subsequently to clinical/radiological improvement (71%) or patient decision (29%), SAT was discontinued in 7 patients after a median time of 336 [292-404] days. Patients who experienced SAT discontinuation were younger, with fewer comorbidities, early infections, known pathogen and LAA therapy, although no statistically significant association was observed. Two patients showed a radiological failure needing to resume treatment; 3 patients (14%) successfully suspended SAT currently without relapse.

Conclusion
Our results support SAT as a suitable option for patients with PVGI at high surgical risk. Larger prospective studies are needed to guide empirical practice.

Disclosures
All Authors: No reported disclosures
P-390. Burden of Surgical Site Infections with pathogens resistant to perioperative prophylaxis in orthopedic tumor surgery: Secondary analysis of the PARITY trial
Authors: Kuster Sabine , Ghert Michelle , O’Shea Timothy , Gottlich Caleb , Mertz Dominik 
Published: January 2025

Abstract

Background
Treatment of malignant bone tumors of the lower extremity often requires complex surgical reconstruction with the use of endoprostheses. These procedures are associated with an increased risk for surgical site infection (SSI). Here, we describe the risk factors for microbial resistance, characteristics and microbiology of SSIs in this population in a secondary analysis of the PARITY trial.

Methods
The PARITY trial assessed the effect of short-term (24 hours) versus long-term (5 days) postoperative antibiotic prophylaxis with cefazoline or cefuroxime on SSI incidence in orthopedic oncology. Here, we evaluated the proportion of pathogens with presumed resistance to cephalosporine prophylaxis in this cohort. Resistance was defined either based on susceptibility testing, presence of intrinsic resistance mechanisms and/or based on the chosen antibiotics to treat a SSI episode.

Results
SSI were diagnosed in 96 of 604 patients (15.9%; Table 1). On average, SSIs occurred 77.4 days (IQR 81.25) after surgery. Among these, cultures were positive in 73 (76.0%). The most common pathogens were coagulase negative staphylococci (34.4%), followed by S. aureus (24.0%), and Enterobacterales (22.9%; Table 2). In 68.5% (n=50) SSI episodes, at least one pathogen was resistant to the prophylactic regimen. Polymicrobial infections were detected in 41.1% (n=30). Antibiotic cement was used in 40 (41.7%) patients, with resistance against the used antibiotic in 34 (85.0%). In the short-term group the proportion of resistant pathogens was lower (65.9% versus 71.9%; OR 0.75, CI 0.27, 2.06, p=0.385; Table 3). Proportionately more resistance was seen in patients with neutropenia (91.7% vs. 64.9%; OR 5.95, CI 0.72, 49.44, p=0.062), re-operation (80.0% vs. 66.7%; OR 2.00, CI 0.39, 10.27, p=0.328) and in those on postoperative antibiotics for more than 7 days prior to SSI diagnosis (75.8% vs. 62.5%; OR 1.88, CI 0.67, 5.21, p=0.169).Table 3:Risk factors for SSI caused by cephalosporin-resistant pathogens (univariate analysis)

Conclusion
SSI due to pathogens resistant to the systemic or local prophylactic agents used are common in patients undergoing reconstruction for bone tumors. Several potential risk factors associated with resistance were evaluated, but the sample size limited our ability to draw final conclusions.

Disclosures
Sabine Kuster, MD, Takeda Canada: Honoraria Michelle Ghert, MD, FRCSC, Stryker: Advisor/Consultant|Stryker: Grant/Research Support Dominik Mertz, MD, MSc, KCI Inc. USA: Grant/Research Support
P-391. Infections in Gender-Affirming Surgery: A Single-center Experience with Gender-affirming Vaginoplasty
Authors: Sheth Radhika , Bhaskara Apoorva , Brown Haley M , Varley Cara D , Streifel Amber C , Maier Marissa , Sikka Monica K , Evans Christopher 
Published: January 2025

Abstract

Background
There are an estimated 1.3 million transgender adults in the US and about 25% undergo some form of gender-affirming surgery (GAS). Data on infectious complications following GAS is limited. We describe the epidemiology and incidence of infections following gender-affirming vaginoplasty (GAV). We also describe HIV screening and pre-exposure prophylaxis (PrEP) use in this population as transwomen are disproportionately affected by HIV and have the highest prevalence compared to any other group of US adults.

Methods
In this single-center retrospective cohort study, we identified 398 patients aged ≥18 years who underwent GAV at Oregon Health & Science University from 2016 to 2023. We reviewed medical records up to 6 months from the initial surgery and used standardized criteria to diagnose surgical site infections (SSI), urinary tract infections (UTI), and sexually transmitted infections (STI). Data around HIV screening and PrEP use was also obtained.

Results
381 patients underwent primary vaginoplasty and 17 underwent revision of the primary surgery. 332 had standard penile inversion, 64 had robotic vaginoplasty, and 2 patients had intestinal vaginoplasty. UTI was the most common postoperative complication (incidence 13.8 per 100 individuals; n=55), followed by SSI (incidence 5.5 per 100 individuals; n=22). We identified 4 episodes of bacteremia related to surgery- all due to E coli- and one case of pelvic abscess. Only 2 STIs were identified and neither involved the neogenitalia- 1 was primary syphilis and the other was gonococcal urethritis.
16 patients had positive HIV serostatus. All 16 were prescribed ART and 11/16 had an undetectable viral load at the time of surgery. Only 22.5% of HIV seronegative patients had screening within a year before surgery and only 6% were on PrEP at the time of surgery.

Conclusion
In our study, UTIs and SSIs were the most common infections post-GAV. Serious infections were rare.
We also identified a significant gap in HIV screening and PrEP uptake in this especially vulnerable group. Transgender surgery programs should incorporate HIV screening and counseling around PrEP.

Disclosures
Monica K. Sikka, MD, F2G: Grant/Research Support Christopher Evans, MD, ViiV: Grant/Research Support
P-393. Examining Breast Surgical Site Infections: A Case-Control Study on the Effect of Skin Antisepsis Agents and Other Contributing Factors
Authors: Anic Sonja , Loisy Denice S , Knepper Bryan 
Published: January 2025

Abstract

Background
Postoperative surgical site infections (SSI) in breast mastectomy and reconstruction cases persist despite efforts to control extrinsic factors. SSI may lead to prolonged hospitalization, increased costs of patient and hospital, and patient hardship. Current skin antisepsis practices warrant strict observation, application, and exploration of efficacy, as Gram-positive microorganisms are most commonly associated with breast surgery. The use of an alcohol-based skin preparation has proven to be more effective than those that are aqueous-based, We evaluated potential patient and procedure risk factors for SSI, including the perioperative skin prep used in breast mastectomy, breast plastic reconstructive, and combination breast and plastic cases.

Methods
A case-control study of breast procedures was performed. Procedures were identified between January 1, 2022 and December 31, 2023 from two campuses in the same health system. Procedures were divided into three case types: breast-only, plastics-only, and combination of breast and plastics. In addition to skin prep solution, factors assessed for SSI risk were: age, in-patients, out-patients, body mass index, diabetes mellitus, duration of procedure, wound class, and ASA.

Results
45 SSI cases were identified, and 92 controls were randomly selected. Factors associated with SSI included duration of case, BMI, case type, inpatient procedure, emergent procedure, and wound class. Most SSIs were superficial with Staphylococci the most common organism isolated. Iodophor paint and/or scrub were used in the majority of cases and controls; Chloraprep was used in 0 SSI cases and 3 controls.

Conclusion
Attention should be focused on the prevention of SSI due to its serious nature. Multiple factors can contribute to the development of SSI and its prevention. The incidence of SSI was higher in patients who underwent either plastics-only or a combination breast/plastics procedures; iodophor skin prep may also be an area of concern. Next steps include implementing a trial of Chloraprep skin prep for all breast procedures, continuing to evaluate other known risk factors, and investigating other potential opportunities, including postoperative patient management.

Disclosures
All Authors: No reported disclosures
P-401. Cost-Effectiveness of Different Screening Strategies to Control the Spread of Carbapenemase-producing Organisms
Authors: Phua Hwee Pin , Beh Darius , Ang Brenda , Lim Wei-Yen 
Published: January 2025

Abstract

Background
The transmission of carbapenemase-producing organisms (CPO) in healthcare facilities is associated with increased morbidity and mortality. Recommended control measures include early detection of asymptomatic carriers coupled with isolation and contact precautions. Such measures can be costly and need to be balanced against the disruption of hospital operations. We assessed the effectiveness of different screening strategies at averting potential CPO infections and the corresponding cost savings.

Methods
A basic infectious disease transmission model was used to characterize colonization and transmission with inputs parameterized based on 2023 data from a 1700-bed academic teaching hospital (Fig. 1). Three strategies were compared to the baseline viz. high-risk screening (HRS) but at 70% compliance (based on previous audits) (Fig. 2): (i) HRS at 100% compliance (cHRS); Universal screening on admission (US); Long-stayer screening (LSS) of all inflight patients at every 10 days of stay till 30 days (where applicable) on top of HRS. Once CPO carriage is identified, we assumed no onward transmission, as per institution policy, timely isolation with contact precautions would be implemented. Outcomes included the monthly number of CPO infections and estimated cost of screening (using rapid PCR) and treatment. All costs were converted to US dollars at an exchange rate of USD$1 = SGD$1.343.

Results
The baseline strategy resulted in 17 infections/month with an estimated cost of USD$443,000 (Fig. 3). Among the three strategies, cHRS gave the best value with potential cost savings USD$39,000/month and 5 infections averted/month. In comparison, LSS in addition to HRS would similarly avert 5 infections/month but at an estimated cost of USD$74,000 (Fig. 4). For US, 8 infections/month would be averted at a cost of USD$79,000 (Fig. 4).

Conclusion
Improving compliance to HRS was the most cost-effective option to limit the spread of CPO.

Disclosures
Darius Beh, MBBS (S'pore) MMed (Int Med) MRCP (UK), AstraZeneca: Conference Sponsorship|Gilead: Conference Sponsorship
P-406. Implementation of an Initial Specimen Blood Culture Diversion Device to Reduce Blood Culture Contamination: Lessons Learned
Authors: Touzard-Romo Francine , Auld Diane , Deabreu Alison , Roberts Kimberly , Jackson Gail , Valerie Whitehead , O’Rourke Emerald , Has Phinnara , Mermel Leonard 
Published: January 2025

Abstract

Background
Blood culture (BCx) contamination (BCxC) leads to unnecessary antibiotic exposure, increased hospital stay, and cost. Despite best practices, our health system’s BCxC rates remain above the 1% benchmark. Implementation of an initial specimen diversion device (ISDD) have demonstrated reduced BCxC rates. 3,4 We assessed the impact of the Kurin Lock® ISDD on BCxC and vancomycin utilization in adult emergency departments (EDs), intensive care and step-down units (ICU/SD).

Methods
The Kurin Lock® was implemented in 3 Lifespan health system hospitals (The Miriam Hospital [TMH] ED October2022; Rhode Island Hospital [RIH] and Newport Hospital [NH] EDs January 2023, and in all 3 hospital’s ICU/SD units June 2023). We included adult BCx obtained by nurses (all hospitals) or phlebotomists (NH only). BCx were drawn per protocol; growth was monitored with the BioMérieux VIRTUO System. BCxC rates were calculated dividing the number of contaminated cultures (per CDC NHSN commensal list) by the total number of BCxs/month. Mean BCxC rates prior to Kurin Lock® implementation (6 months) and after implementation (subsequent months through December 2023), excluding the month of implementation, were compared using the Wilcoxon rank-sum test. An interrupted time-series analysis was performed using binomial regression models; vancomycin days of therapy (DOT) for ’bacteremia’ was analyzed using generalized linear models.

Results
Overall mean BCxC rates for all hospitals and locations decreased from 3% to 1.9% after ISDD implementation (P=0.009). This decline was observed in all EDs but only statistically significant in RIH ICUs/SDs. In the time-series analysis, an abrupt 65% decline in BCxC was observed immediately after implementation in all hospitals and locations (P = 0.04). Lower BCxC rates were sustained after 200 days in the ICUs/SDs and 400 days in the EDs; however, an upward trend was observed with time. Vancomycin DOT was not significantly different pre- vs. post-Kurin Lock® implementation (41/1000 patient days vs. 37/1000 patient days, P=0.9).

Conclusion
A sustained decline in BCxC is achievable with the Kurin Lock® ISDD in academic and community hospital settings. But consistent education on best practices is key to guarantee the efficacy and cost-effectiveness of this intervention.

Disclosures
Leonard Mermel, DO, ScM, Citius Pharmaceuticals: Advisor/Consultant|CorMedix Pharma: Advisor/Consultant|Destiny Pharma: Advisor/Consultant|Lightline Medical: Advisor/Consultant|Lightline Medical: Stocks/Bonds (Private Company)|Pristine Access Technologies: Advisor/Consultant|Pristine Access Technologies: Stocks/Bonds (Private Company)