bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-246. Candida auris Central Line Associated Blood Stream Infection Trends in Chicago Acute Care Hospitals, 2018-2023
Authors: Chundi Vaishali , Walblay Kelly , Zelencik Shane , Young Kim Do , Black Stephanie R 
Published: January 2025

Abstract

Background
The emergence of antifungal resistance and propensity of Candida auris to cause healthcare facility outbreaks and severe outcomes in patients has deemed it a target pathogen for public health mitigation efforts. Data sharing between the Chicago Department of Public Health (CDPH) and the National Healthcare Safety Network (NHSN) allows for the surveillance of central line associated blood stream infections (CLABSIs) in Chicago healthcare facilities. We reviewed the Candida species associated with CLABSIs to assess C. auris contribution to CLABSIs in Chicago over time.

Methods
Data was reported by 32 acute care hospitals (ACHs), including five long- term ACHs between July 1, 2018 and June 30, 2023. All but one ACH provided data for the entire reporting period. We examined trends of central line associated candidemia over time, specifically C. auris. A Fischer's exact test was calculated to determine if the proportion of C. auris significantly differed from 2019 to 2022. Patient demographics and outcomes were summarized for individuals with Candida species grown on culture.

Results
From July 1, 2018-June 30, 2023, 2,362 CLABSIs were reported of which 460 (19.5%) were associated with Candida species. The median age of patients with Candida CLABSIs was 60 years (IQR: 45-69 years), and over half (58.7%) of individuals were male. Among 160 patients who had a Candida associated CLABSI and cause of death data available, candidemia contributed to 18.8% of deaths. The contribution of C. auris to candidemia CLABSIs increased from 10.3% in 2019 to 19.4% in 2022 (p=.1353) and C. parapsilosis increased from 13.2% to 19.4%, while C. albicans declined from 32.4% to 24.3%, respectively (Table 1).

Conclusion
Candida species make up close to 20% of CLABSIs reported by Chicago ACHs during 2018-2023, with C. auris contributing to nearly one-fifth of them in 2022. While the growing proportion of CLABSIs associated with C. auris from 2019 to 2022 is not statistically significant, it has clinical significance, and demonstrates that healthcare facilities should emphasize critical assessment of need for central line placement and infection control interventions, such as hand hygiene and environmental cleaning, to prevent further spread of C. auris.

Disclosures
All Authors: No reported disclosures
P-257. Effectiveness of Pulsed-Xenon Ultraviolet Disinfection during Terminal Cleaning of Patient Rooms in the Intensive Care Unit on the Sustained Containment of Drug-resistant Acinetobacter baumannii
Authors: Morikane Keita , Yakuwa Jun , Nakane Masaki 
Published: January 2025

Abstract

Background
Environmental disinfection by ultraviolet (UV) has been shown to be effective in controlling transmission of multidrug-resistant organisms, and introduced into daily practices in addition to manual terminal cleaning in some hospitals in the US. However, its effectiveness outside the US healthcare setting is not well investigated. Moreover, its effectiveness to control gram-negative bacteria has not been well described.

Methods
This study was conducted in the intensive care unit (ICU) of Yamagata University Hospital, a 637-bed tertiary referral hospital. Sporadic transmission of two drug-resistant Acinetobacter baumannii (2DRA) began in late 2013. Despite intensified hand hygiene promotion and manual terminal cleaning, transmission of 2DRA continued. In January 2018, we added pulsed-xenon ultraviolet (PX-UV) disinfection for the terminal cleaning after every patient discharge. The study periods were defined as follows: the baseline period (August 2016 to January 2018, manual cleaning only) and the intervention period (February 2018 to December 2023, addition of PX-UV). All patients admitted in the ICU were regularly screened for 2DRA for the detection of possible acquisition of 2DRA throughout the study periods.

Results
The incidence of acquisition of 2DRA in the ICU significantly declined (4.45 per 1,000 patient days in the baseline period to 1.09 in the intervention period, relative risk (RR): 0.26, 95% confidence interval: 0.12-0.51). Cases in the intervention period were sporadic, and no cluster was found. In contrast, in non-ICU wards, where PX-UV disinfection was performed only after the discharge of patients known to be colonized or infected with 2DRA or other multidrug-resistant pathogens, possible transmission of 2DRA was observed several times.

Conclusion
Adding PX-UV after manual terminal cleaning was effective in controlling acquisition of 2DRA in the ICU patients. The effectiveness of PX-UV in controlling gram-negative MDROs in the non-US healthcare settings is suggested. In contrast, there was room for improvement in controlling of 2DRA in non-intervention wards.

Disclosures
All Authors: No reported disclosures
P-258. A Longitudinal Study on the Impact of Sink Interventions on Environmental Bioburden and Patient Infections within Two Intensive Care Units at an Academic Hospital
Authors: Gravagna Katie , Sickbert-Bennett Emily , Thompson Sharon , Warren Bobby G , Culbreth Cyndi , Schultz Kate , Alby Kevin , Barrett Aaron , Graves Amanda M , DiBiase Lauren , Fils-Aime Guerbine , Smith Becky A , Anderson Deverick J , Weber David J 
Published: January 2025

Abstract

Background
Patient room sinks are frequently identified as potential sources for hospital-associated infections (HAIs), but there are no clear recommendations for interventions to reduce sink-related pathogenic bioburden. We conducted one of the first longitudinal crossover trials to assess the impact of practical sink interventions in an academic hospital.Figure 1.Contamination levels in patient room sink p-trap and tap water between units over time.Black lines represent samples with CFU/mL above the limit of detection.

Methods
We conducted a 4-phase randomized crossover trial in a medical ICU (MICU) and burn ICU (BICU). Each phase was 8 weeks with a 2-week washout between phases: drain covers, point-of-use filters, both, or no intervention on patient room sinks by unit. Environmental samples from tap water, p-trap water, air, and swabs of the sink basin and adjacent surface were collected every 2 weeks from 5 patient room sinks per unit. Colony-forming units (CFU)/mL of non-tuberculous mycobacteria (NTM), carbapenem-resistant Enterobacterales (CRE), multidrug-resistant Enterobacterales (MDRE), and Stenotrophomonas maltophilia were calculated following MALDI-TOF speciation. Patient HAI results were also recorded.

Results
Without filters, 68.7% (68/99) of tap water samples were positive, compared to 2.2% (2/90) with filters (p&lt; 0.05). P-trap samples were highly variable with high bioburden and no clear time trends at the room or unit level (Figure 1). Positive air and surface samples rarely occurred but were most common in the drain cover phase (12/135). Within rooms, environmental samples were primarily positive before patient clinical isolates of the same species (7/8). Tap water samples across both units were primarily positive for NTM (71/189) yet no study-room-associated NTM infections were identified.

Conclusion
We identified that sinks, particularly p-traps, present a consistent source of pathogenic bioburden with fluctuating populations yet rarely contributed to surface/air contamination with organisms of interest in ICU patient rooms. Neither intervention impacted p-trap colonization (CFU/mL). We found that point-of-use filters consistently and effectively removed NTM from tap water. Drain covers were not found to be a useful intervention for reducing surface bioburden. Future research on decolonizing pathogenic bacteria from patient room p-traps is needed.

Disclosures
Becky A. Smith, MD, UpToDate: royalties
P-272. Prevalence and Predictors of Multi-drug Resistant Organisms in Critically Ill Patients with Opioid Use Disorder and Infection: A Multicenter Retrospective Cohort Study
Authors: Rizwan M Zeeshan , Stevens Ryan W W , Akhtar Haris , Cunningham Julie , Cole Kristin , Gajic ognjen 
Published: January 2025

Abstract

Background
The opioid crisis and the increasing prevalence of multi-drug resistant organism (MDRO) infections pose a threat to public health. Opioid Use Disorder (OUD) patient are prone to MDRO colonization and infections, thus potentially leading to adverse outcomes during periods of critical illness. Understanding the prevalence and predictors of MDRO infections within this vulnerable population is critical to improving patient outcomes by optimizing interventions and treatment plans.

Methods
We conducted a retrospective, multicenter, cohort study to evaluate the prevalence of MDRO isolation among adults with OUD admitted to an intensive care unit (ICU) with an infection across four Mayo Clinic regions. Patients were classified to the MDRO cohort if an MDRO was isolated from standard cultures or rapid diagnostic testing within 48 hours of admission. We utilized descriptive statistics, univariate and multivariate least absolute shrinkage and selection operator (LASSO) regression analysis including random effect to account for site variability, to analyze demographic data, clinical characteristics, and outcomes.

Results
790 critically ill adult OUD patients with infection-related admission were included in the study cohort. The prevalence of MDRO isolation was 22.5% (n=178), with MRSA being the predominant isolated MDRO. In LASSO regression analyses, we identified homelessness (OR: 1.79, p = 0.022), no Medications for OUD (MOUD) treatment (OR: 1.56, p=0.023), and positive Hepatitis C Virus (HCV) status (OR: 2.19, p = 0.012) as significant predictors for isolation of an MDRO. Intravenous (IV) antibiotic use in the preceding 90 days was also positively associated (OR: 1.04 per 24 hours, p = 0.007), alongside mental health disorders (OR: 2.03, p &lt; 0.001) and diabetes (OR: 1.54, p = 0.023).

Conclusion
The high prevalence of MDRO isolation in critically ill OUD patients with infection is associated with complex social and clinical factors.

Disclosures
All Authors: No reported disclosures
P-273. Risk Factors for 90-day Mortality Among Patients With Stenotrophomonas maltophilia Infection: A Retrospective Multicenter study
Authors: Al Qura'an Anood , Salazar Wilmer , Al khouri Zaid , Munshi Ruhul , Pichilingue Reto Patricia , Pinargote Paulette 
Published: January 2025

Abstract

Background
Stenotrophomonas maltophilia is a leading cause of mortality in critically ill and immunocompromised patients. This study aimed to characterize risk factors for mortality and evaluate if combination therapy or resistance patterns affect mortality in patients with S. maltophilia infections.

Methods
We conducted a retrospective, observational study at two academic medical centers in the United States including patients aged ≥ 18 years with positive S. maltophilia cultures between January 2019 and March 2024. Logistic regression analysis was performed to identify independent risk factors for 90-day mortality. A sub analysis for patients with pneumonia was performed. Standard of care was defined as monotherapy with trimethoprim-sulfamethoxazole (SXT) or levofloxacin.

Results
A total of 128 patients were included, median age was 66 years; 60.9% were male. 30- and 90-day mortality rates were 17.2% and 25%, respectively. The most common source of infection was pneumonia (52, 40.6%), which also had the highest mortality rates (32.7%, 46.2%) when compared to other sources of infection. Although non-survivors had higher rates of COPD (p=0.04), prior organ transplants (p=0.002), prior steroid use (p=0.03), and higher ICU admission rates (p&lt; 0.001), they were not found to be independent risk factors for mortality.
Risk factors for 90-day mortality include neutropenia (OR 12.237, p=0.047), polymicrobial infection (OR 7.93, p=0.009) and previous carbapenem use (OR 7.34, p=0.015). Enterobacterales and fungal infections were the most common co-infections.
Monotherapy (117, 91%), and resistance to STX or levofloxacin (4.69% and 10.9% respectively) were not risk factors for mortality (OR 0.9, p=0.9; OR 3.1, p=0.58). Interestingly, osteomyelitis was associated with reduced odds of 90-day mortality (OR 0.008, p=0.015). Independent risk factors for mortality in patients with pneumonia include prior carbapenem use (OR 6.54, p=0.029) and polymicrobial infection (OR 10.95, p=0.08).

Conclusion
S. maltophilia infection is associated with high mortality rates, particularly in patients with neutropenia, polymicrobial infection and prior carbapenem use. Although combination therapy or resistance to standard of care was not found to impact mortality, larger-scale studies are needed.

Disclosures
All Authors: No reported disclosures
P-290. Clinical and microbiological characteristics of patients infected with ceftazidime/avibactam-resistant Klebsiella pneumoniae carbapenemase-producing K. pneumoniae strains
Authors: Liu Szu-Yu , Chou Sheng-Hua , Chuang Chien , Ho Yu-Chien , Juan Chih-Han , Lin Yi-Tsung 
Published: January 2025

Abstract

Background
Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae with ceftazidime/avibactam (CZA) resistance emerged after the widely use of CZA. The most common resistance mechanism was mutations in blaKPC. We aimed to study the clinical and microbiological characteristics in patients infected with CZA-resistant KPC-producing K. pneumoniae, and focus on the comparison between the strains with or without KPC variants (wild-type KPC).

Methods
A retrospective study was conducted in Taipei Veterans General Hospital from February 2019 to July 2023. Hospitalized unique adult patients infected with CZA-resistant KPC-producing K. pneumoniae were included. Clinical characteristics and outcomes were collected, and genes encoding carbapenemases were detected by polymerase chain reaction followed by Sanger sequencing.

Results
A total of 44 cases with CZA-resistant KPC-producing K. pneumoniae infections were identified, and most of them were critically ill with the median APACHE II score 23.0 (IQR, 19.3-29.8). Pneumonia was the most common infection (n=18). Only 15 patients (34.1%) received appropriate treatment regimens, and tigecycline (n=8) and meropenem-based therapy (n=5) were the common regimens. Twenty-seven strains (61.4%) harbored KPC variants, and a total of 16 different types were identified. KPC-33 (n=10) was the most common, followed by KPC-35 (n=3). The overall 28-day mortality was similar between patients infected with and without KPC variants (22.2% vs 23.5%, p=1.000). A previous isolation of carbapenem-resistant K. pneumoniae and exposure to CZA were more common in KPC variants group compared with wild-type KPC group (92.6% vs 58.8%, p=0.017, 92.6% vs 41.2%, p&lt; 0.001, respectively). KPC variants-producing strains also had a higher proportion of CZA MIC &gt; 16 mg/L (85.2% vs 41.2%, p=0.002) and restored meropenem susceptibility (MIC≤ 4 mg/L) (70.4% vs 5.9%, p&lt; 0.001) than that in wild-type KPC strain.

Conclusion
CZA-resistant KPC variants-producing K. pneumoniae has the tendency of restored meropenem susceptibility and higher level of CZA resistance compared with the wild type KPC-producing strain. The optimal therapy in these patients needs further study.

Disclosures
All Authors: No reported disclosures
P-294. The pathway to a decade of carbapenem-resistant Enterobacterales (CRE) : A 9-years experience in a teaching hospital in the Dominican Republic
Authors: Hernandez-Landa Ricardo Ernesto , Rojas-Fermin Rita A , Guzman-Marte Anel E , Peralta-Agramonte Katherine 
Published: January 2025

Abstract

Background
WHO warns about carbapenem-resistant Enterobacterales (CRE) and carbapenemase production, posing challenges in hospitals owing to treatment failure and rapid dissemination. In order to design adequate infection control and prevention strategies and local treatment guidelines, it is important to characterize the prevalence of these isolates. We aimed to assess the frequency of CRE and carbapenemase production in hospitalized patients between October 2015- March 2024.

Methods
A retrospective, descriptive and longitudinal study was conducted including all patients with positive CRE cultures, from January 2015 to March 2024, in a 289-bed tertiary hospital in the Dominican Republic. A database of susceptible and resistant Enterobacterales isolates was obtained, reviewing electronic records for culture origin, microorganisms, and carbapenemase production. Annual CRE rates were calculated including all hospitalized patients with Enterobacterales isolates.

Results
The CRE rate over a 9-years period was 1.7% (83/4843). A slight decrease was observed from years 2015 to 2017, followed by the lowest CRE rate in 2018 (0.2%). 2020 reported an increase of 160% in the CRE rate when compared to 2019, peaking at 3.5% in 2022. The most common microorganisms isolated were Klebsiella spp. (42.6%; 43/101) and Enterobacter cloacae complex (33,7%; 34/101) while the most common carbapenemase produced was KPC (39.4%; 39/99) followed by MBL (21.2%; 21/99). Urine cultures were the most common samples to isolate CRE, but a shift in the trend was observed in 2020, with blood cultures becoming the most common source of CRE. Sequencing of a small sample as part of a previous study reported the presence of KPC2 and KPC3.

Conclusion
Despite being in a low resource country, infection prevention and control strategies have managed to limit the spread reported in other hospital settings in Latin America. The increase seen post pandemic emphasizes this importance. Although KPC is the most common carbapenemase type, NDM has been increasing, posing a major growing concern on treatment failure. Laboratory methods stand as a fundamental tool to understand the magnitude of dissemination, to elaborate clinical guidelines and improve diagnosis and patients outcomes.

Disclosures
Rita A. Rojas-Fermin, MD,FIDSA, Gilead: Advisor/Consultant|Pfizer: Advisor/Consultant|Pfizer: Honoraria
P-295. Risk Factors for Mortality in Patients with Klebsiella pneumoniae Carbapenemase (KPC)-Producing Organisms Treated with Ceftazidime/Avibactam: A Systematic Review and Meta-analysis
Authors: Munshi Ruhul , Salazar Wilmer , Taufiq Farah , Kauser Tanjina , Alam Mohammad , Pinargote Paulette 
Published: January 2025

Abstract

Background
Klebsiella pneumoniae carbapenemase (KPC)- producing organisms is a leading cause of mortality in hospitalized patients, potentially due to the emergence of resistance to novel antibiotics and limited treatment options. This meta-analysis aimed to elucidate the 30-day mortality rate and characterize risk factors associated with death in patients with KPC infections treated with ceftazidime-avibactam (CTZ-AVM).Figure 1:PRISMA flow diagram of studies selection

Methods
Our meta-analysis was conducted in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search terms used were “KPC” or “Klebsiella pneumoniae carbapenemase” in conjunction with “Avycaz” or “Ceftazidime/Avibactam”. Our analysis focused on mortality rate, risk factors, comorbidities, sites of infection, clinical outcomes, and treatment interventions. The primary endpoint was 30-day mortality.Figure 2:Mortality rate of ceftazidime-avibactam monotherapy

Results
Analysis of five observational studies with 1011 patients revealed an overall 30-day mortality rate of 33% (95% CI: 24%-44%). Mean duration of therapy was 14 days, 72% were male. Patients with comorbidities such as COPD (OR 1.54 [95% CI 1.04-2.29]), cerebrovascular accidents/dementia (OR 1.73 [95% CI 1.17-2.58]), hematologic malignancy (OR 2.01 [95% CI 1.24-3.25]), and neutropenia (OR 3.68 [95% CI 1.98-6.84]) exhibited significant higher mortality rates. Patients diagnosed with pneumonia were found to have a 77% increased risk of death (OR 1.77 [95% CI 1.15-2.72]), while septic shock effectively doubled the mortality risk (OR 2.22 [95% CI 1.82-2.70]). Monotherapy or combination therapy did not significantly influence the 30-day mortality rate.Figure 3:Mortality rate of ceftazidime-avibactam combination therapy

Conclusion
Our meta-analysis suggests that ceftazidime-avibactam monotherapy and combination therapy exhibit similar efficacy in terms of 30-day mortality in patients with infection by KPC-producing organisms. Mortality rates are impacted by different comorbidities, which need to be taken in consideration when managing these infections.

Disclosures
All Authors: No reported disclosures
P-297. Prospective Study on Microbiological Profile of Nosocomial Infections due to Gram negative lactose non-fermentative Bacteria in a Tertiary Care Hospital in South India
Authors: Radhakrishnan Sriram , Velmani Vaishnavi , Shailaja K , Dorairajan Sureshkumar 
Published: January 2025

Abstract

Background
Non-fermentative gram-negative bacteria (NFGNB) infections that are acquired in hospitals have particularly concerning characteristics; identifying these features can aid in prevention and improve the standard of care provided within hospital premises. This study aims to find out the nosocomial infections caused by NFGNB, its sensitivity pattern, length of culture reporting time, and patients with ICU stay.

Methods
A prospective observational study was conducted in a tertiary care hospital located in southern India during the 4 months of January-April 2024. Data were taken from the Department of Microbiology regarding the prevalence of NFGNB isolates from different culture samples and their sensitivity pattern. The number of MDR isolates throughout the four months, their susceptibility pattern, and the duration of culture reporting time for all NFGNB isolates were examined. Descriptive analysis was used to look at patient demographics, inpatient department, and ICU admission. Statistical analysis was done by Microsoft Excel.

Results
Total 72(18.6%) samples were recorded as NFGNB from 386 culture positive samples isolated from the Department of Microbiology. The most common isolate was Acinetobacter spp (38.8%) followed by Pseudomonas spp (27.7%). The mean of our study participants was found to be 55 years, with a male: female ratio 2:1. The General Medicine department showed maximum isolates i.e, 25% followed by Hepatology department i.e, 16.6%. Maximum NFGNB isolates are from Urine sample (33.3%) followed by Blood sample (27.8%). The mean time of culture reporting for NFGNB was 72 hours. Out of 72 NFGNB samples, 28(38.8%) were Multi-drug resistant isolates and 29(40.2%) required ICU admission.

Conclusion
NFGNB function as nosocomial pathogens, their startling resistance is a concern to epidemiology and medical care. These isolated pathogens have been manually reported for a considerable amount of time. Rapid culture identification methods would assist identify resistant diseases early and improve patient outcomes in low- and middle-income countries. Future studies should focus on implementation of approaches to reduce the incidence and resistance of nosocomial infections in LMICs.

Disclosures
All Authors: No reported disclosures