bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-369. Skilled Nursing Facility Characteristics Associated with Candida auris Transmission in Maryland
Authors: Smith Lauren , Leekha Surbhi , Lin Gary , Falvey Jason , Grace Brittany , Rubin Jamie , Vaeth Elisabeth , Perlmutter Rebecca , Roghmann Mary-Claire 
Published: January 2025

Abstract

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

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

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

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

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

Abstract

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

Methods
University of Chicago Medical Center is a tertiary care center containing an on-site microbiology lab. In March, 2023 the Infectious Diseases consultation service reported multiple M. scrofulaceum cases to the infection prevention and control program which prompted an investigation. Twenty-five positive cultures from seven different patients were reviewed.
Given the rarity of M. scrofulaceum infection, cross-transmission was suspected. Chart review was conducted by a multi-disciplinary team in order to determine if true infection occurred and identify potential epidemiological overlap.

Results
Positive samples originated from soft tissue, lymph nodes, bone, sputum, and pleural fluid. Six patients improved clinically without treatment for M. scofulaceum.
The final patient had underlying hidradenitis suppurativa, pyoderma gangrenosum, and dermatosis artefacta requiring frequent hospitalization and debridement. M. scrofulaceum was isolated from deep tissue. Given the severity of the patient’s disease, frequent healthcare exposure, and extensive surgical history, he was highly suspected to be the source patient of the pseudo-outbreak. Upon review, we confirmed that most of the other positive samples were processed that same day.

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

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

Abstract

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

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

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

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

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

Abstract

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

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

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

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

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

Abstract

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

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

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

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

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

Abstract

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

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

Results
In this cohort, 98 047 patients were included. Among them, 12 251 (12.5%) had a VAP; the incidence rate for 1000 ventilation days was 18.9 cases per 1000 ventilation days. The median age of the cohort is 66 [55-75] years old with a male predominance (63.0 %). The SAPS score is 49 [36-63], the mortality is 24.4 % and the median ICU length of stay is 7 [4-15] days. Ventilated patients are more frequently admitted for medical (63.0 %) compared to surgical (37.0%) reason.
At day 30, the attributable mortality associated with ventilator-associated pneumonia (VAP) was estimated at 4.9% (3.7% - 6.2%). Out of 15,575 diagnosed cases of VAP, there were 4,695 instances of polymicrobial VAP, which constitutes 30.1% of the cases. Non-fermenting Gram-negative bacteria were a significant group, contributing to 25.4% of the VAP cases, with Pseudomonas aeruginosa being the most significant contributor (3 924 cases, 76.2% of non-fermenters)
Description of the microbial ecology of VAP

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

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

Abstract

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

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

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

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

Disclosures
Joseph J. Eron, MD, Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|Merck & Co: Advisor/Consultant|ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Grant/Research Support
P-462. Disparities in HPV Vaccination among HIV Patients at a Rural Federally Funded HIV Clinic- A Retrospective Study
Authors: Sripathi Shanthi Reddy , Sivasubramanian Barath Prashanth , Jagannathan Madhumithaa , Javvaji Avinash , Shanmugam Dinesh Kumar , Swami Kannan Bharath Duraisamy , Joshi Shashvat , Jain Priyanshu , Babu Sonia , Smith Kathyrn , Dalal Rutul , Tirupathi Raghavendra 
Published: January 2025

Abstract

Background
Our study aimed to evaluate the demographic factors of HPV vaccination among racial minorities of HIV patients at a non-academic Ryan White clinic in rural Pennsylvania.

Methods
A retrospective cross sectional study (n=143) was conducted on a population composed of White (51.05%), White Hispanics WH (11.19%), Black (27.97%), Black Hispanics BH (1.4%), and Unknown (8.39%). Proportions and chi-square tests were used and multivariate regression analysis was done with p≤0.05 as significant.

Results
Our study found that 35% of the population was vaccinated, with 60.7% receiving three doses and 23.2% receiving two doses. Age was a key factor (p=0.000) for vaccination acceptance (VA), with those aged 25-45 years having a higher VA than the nonvaccinated (NonVA) (62% vs. 24.7%). VA was lower among those aged 46-65 years (30% vs. 61.3%) and those over 65 years (8% vs. 14%). Lack of awareness of the benefits and misconceptions about the side effects of vaccination are common among different age groups. Males were predominant in our study, with VA higher than NonVA (86% vs. 81.7%, p=0.5), though the difference was not significant. VA by race showed marginal significance (p=0.1), with Whites having the highest VA (40%), followed by Blacks (32%) and Hispanics (20%). Multivariate regression revealed that the 46-65 age group had 80% lower odds of VA compared to the 25-45 group (aOR 0.2, p=0.000), while &gt;65 years had 78% lower odds (aOR 0.22, p=0.021). This regression analysis was adjusted for race (White=Ref, Black p=0.7, Hispanic p=0.1). Upon further stratification of the Hispanic population, VA in the 25-45 years was 6.4% for Black Hispanics and 22.6% for White Hispanics (p=0.000).

Conclusion
Our study highlights that age and ethnicity are significant predictors of vaccination acceptance, with younger individuals and Whites demonstrating a higher likelihood of vaccination acceptance. Among the racial minorities, vaccination acceptance was lowest in Hispanics. These findings underscore the importance of demographic and cultural factors affecting vaccination rates. Targeted interventions to increase awareness and future studies are needed to determine the factors associated with vaccine hesitancy and work toward implementing new strategies to improve it.

Disclosures
All Authors: No reported disclosures