bluuebunny/crossref_metadata_2025_split huggingface dataset:
1390. Talaromycosis: Differences between Patients with The Anti-interferon-γ Autoantibody and People Living with HIV/AIDS (PLWHA)
Authors: Krasaewes Kawisara , Patanadamrongchai Narootchai , Kaewpoowat Quanhathai , Yasri Saowaluck , Wongthanee Antika , Chaiwarith Romanee 
Published: November 2023

Abstract

Background
Talaromycosis has been increasingly reported among HIV-uninfected immunocompromised conditions in an endemic area. This study aimed to compare characteristics, and mortality associated with talaromycosis with adult-onset immunodeficiency caused by the anti-interferon-gamma autoantibody (anti-IFN- γ AAb) to those of people living with HIV/AIDS (PLWHA).

Methods
A retrospective cohort study was conducted at Maharaj Nakorn Chiang Mai Hospital, Thailand in adults with confirmed documentation of HIV infection or anti-interferon-gamma autoantibody, with a diagnosis of talaromycosis.

Results
Thirty-two patients with anti-IFN- γ AAbs and 64 PLWHA were enrolled. Anti-IFN- γ AAbs patients were older, more likely to have nodules and abscess skin lesions, bone and joint infections, leukocytosis, abnormal chest radiograph, and less likely to have fungemia. Time from the first symptom to treatment was longer in patients with anti-IFN- γ AAbs (44.5 days VS. 28.0 days, p-value=0.006). The 24-week-mortality rate was 9.4% (3 patients) in patients with anti-IFN- γ AAbs and 18.8% (12 patients) in PLWHA (p-value=0.225).

Conclusion
The clinical features of talaromycosis in patients with anti-IFN-γ AAbs were different from PLWHA. Clinicians in areas endemic for talaromycosis should be aware of differing characteristics of talaromycosis in anti-IFN- γ AAbs patients.

Disclosures
All Authors: No reported disclosures
1395. The Path of Healing: Demographic Features and Therapeutic Trajectory of Patients with American Tegumentary Leishmaniasis in a City of Northern Brazil
Authors: Alves Alana Pinheiro , Xavier Francisco Alrimar Silva , de Sousa Pereira Gustavo Alessandro , Cardoso Fernanda Jacqueline Teixeira , de Alencar Salgado Andrea Leite , do Nascimento Martins Nadia Vicencia 
Published: November 2023

Abstract

Background
American Tegumentary Leishmaniasis (ATL) is a neglected infectious disease caused by protozoa of the Leishmania genus. Its incidence in the state of Para, Northern Brazil, reached 38,95 cases per 100,000 individuals in 2017. During this illness, people will move through several layers of a healthcare structure on a path for solutions to their affliction. This is described as therapeutic trajectory or itinerary, and it is directly influenced by determinants of health. In this scenario, we question what the trajectory of patients with ATL within healthcare in the city of Ruropolis, Brazil, is.

Methods
This was a transversal retrospective study. Qualitative data was also obtained through patient interviews. The research was developed in the city of Ruropolis, in Northern Brazil, and included individuals who received care through the Brazilian Unified Health System (SUS). All patients or responsible adults involved in the research signed an informed consent form.

Results
A total of 49 patients were initially included, but only 27 were interviewed. In 2021, ATL was diagnosed and notified every month, although April had the highest incidence (12 new cases). Over half of the patients resided in rural areas, and most worked in agriculture. Clear differences in trajectory were noted between patients or urban versus rural areas, as the latter mostly visited the local Emergency Department (ED) for care. Histopathologic work-up of all patients as performed. Regarding treatment, individuals had to relocate up to 50 kilometers daily to receive injections. Home healthcare services were not available.
Overall, 23 patients received intravenous treatment with meglumine antimoniate, and 10 had a myriad of effects, such as fatigue, peripheral edema, and vertigo. Only four patients had intralesional therapy. Of 27 patients, 22 did not know how to prevent ATL or refused to answer.

Conclusion
The struggles faced by patients with ATL are diverse. The local population is unaware of the different layers of service within healthcare, and a hospital-centric model seems to prevail. Patients seek care wherever it seems appropriate to solve their trouble. The narratives on knowledge of the disease reveal the need for further health education, preferably with the introduction of active teaching methods.

Disclosures
All Authors: No reported disclosures
1408. Epidemiology of Nitroimidazole-refractory Giardiasis
Authors: Ydsten Karin , Öhd Joanna Nederby , Hellgren Urban , Asgeirsson Hilmir 
Published: November 2023

Abstract

Background
Giardia intestinalis (G. lamblia or G. duodenalis) is one of the most common pathogenic intestinal parasitic protozoa. Giardiasis refractory (resistant) to nitroimidazoles (e.g., metronidazole and tinidazole) has increasingly been reported, most notably noticed in travellers returning from the Indian subcontinent. Information on the proportion of nitroimidazole-refractory cases from different world regions is scarce, and is difficult to investigate in a high-endemic setting.

Methods
All reported cases of giardiasis in Stockholm County (population 2,391,990 as of Dec 31st 2020) between January 2008 and December 2020 were obtained from the Department of Communicable Disease Control and Prevention, as it is a notifiable disease in Sweden. Refractory cases in Stockholm are referred to the Karolinska University Hospital, a tertiary centre, for treatment since second line drugs are not easily available. Medical records were reviewed. Nitroimidazole-refractory giardiasis was defined as continued symptoms and positive stool sample for giardiasis (microscopy and/or PCR) after a full treatment course.

Results
During the study period 4285 cases of giardiasis were notified and 95 of those (2.2%) were identified as nitroimidazole-refractory. The median age was 38 years (range 5-78) in the refractory group and 30 years (range 0-89) in the non-refractory. In both groups 55% were males. In those who had acquired the infection in India the refractory rate was 11% (60/545) compared to 1.1% in rest of Asia, 1.3% (14/1113) in Africa, 0.9% (11/1247) in Europe, 0.3% (1/349) in the Americas, and 0% (0/5) in Oceania.

Conclusion
The proportion of nitroimidazole-refractory giardiasis was ten times higher in those who had acquired the infection in India compared to other parts of the world, and should be taken into consideration.

Disclosures
All Authors: No reported disclosures
1998. The State of Training in Infection Prevention and Control and Healthcare Epidemiology: A National Survey of Infectious Disease Fellowship Program Directors
Authors: Winkler Marisa , Paras Molly L , Wright Sharon B , Shenoy Erica S 
Published: November 2023

Abstract

Background
Infectious disease (ID) clinicians are often identified to lead infection prevention and control (IPC)/healthcare epidemiology (HE) programs, however, there is no standardized training in fellowship for this role. The most recent survey of ID fellows in 2001 found that only 51% of graduates reported adequate training in IPC/HE. Despite this, half of respondents had IPC/HE responsibilities and received compensation from those activities. We conducted a survey of Program Directors (PD) of United States ID fellowship programs to assess current IPC/HE training.

Methods
An electronic survey was distributed in March and April 2023 to all ID fellowship PD identified by the Infectious Disease Society of America using Research Electronic Data Capture (REDCap). Survey questions covered training program characteristics, current required and optional IPC/HE training components, barriers to IPC/HE training, interest among fellows in IPC/HE training, and support for formalization of IPC/HE training.

Results
Of 166 programs, 54 (32.5%) completed the survey, representing programs in 25 states (Figure 1) and size range from 1-10 fellowship positions (mean 4). The majority (49/54, 90.7%) offered didactics in IPC/HE (mean 4.4 hours, range 1-10), of which 45/49 (94%) and 4/49 (6%) were required and elective, respectively. 52/54 (96.3%) of programs reported a formalized curriculum in IPC/HE training for all fellows and 18/54 (33.3%) of the responding programs offered a specialized track in IPC/HE. Reported training components varied (Table 1). A minority of PDs 11/55 (20%) reported considering expanding their IPC/HE training, however, 23/54 (42.6%) reported barriers (Table 2). There was widespread PD support for a formal IPC/HE certification program through a professional society (52/54, 96.3%).Figure 1:Geographic distribution of survey respondents divided by FEMA regions (1-10) of the United States and Territories (N= 54).

Conclusion
ID fellowship programs with dedicated IPC/HE training remain limited and the majority of training in IPC/HE is restricted to a small number of hours of didactics. Among respondents, many barriers to increasing IPC/HE training were identified. Respondents supported creation of a formal IPC/HE training program through a professional society.

Disclosures
Molly L. Paras, MD, Angiodynamics: Honoraria|Angiodynamics: Honoraria
1427. The EpiRate: a multidimensional index for measuring effectiveness in infection prevention
Authors: Couto Braulio , Ladeira Ana Paula , Carvalho Walisson Ferreira , Lima Naísses Zóia , Starling Carlos E 
Published: November 2023

Abstract

Background
Measuring the effectiveness of infection prevention in a hospital setting is a crucial task, particularly from a global perspective and when considering various types of infections simultaneously (Fig. 1). In this paper, we introduce the EpiRate, a multidimensional index designed to assess the effectiveness of a hospital-wide ICP.Figure 1.There are many types of hospital-acquired infections. How to measure the effectiveness in preventing hospital-acquired infection in a global perspective?

Methods
EpiRate is calculated using a scoring system based on a comparison of observed values obtained from a list of hospital-acquired infection rates with the percentiles of their respective benchmarks. For each rate, the observed rate (Tx) is compared with the benchmark percentiles to assign a score. If Tx ≤ p10%, the score is set to 5.00; if Tx ≤ p25%, the score is 4.75; if Tx ≤ p50%, the score is 4.00; if Tx ≤ p75%, the score is 3.75; if Tx ≤ p90%, the score is 3.00; and if Tx &gt; p90%, the score is 0.00 (Fig. 2). The total score is the sum of all points obtained considering the k rates involved in the analysis. The EpiRate is then calculated as the total score divided by the maximum score (= k*5), expressed as a percentage (%), indicating the percentage of effectiveness in preventing the infections measured by the chosen indicators. Furthermore, the prevention effectiveness of each infection can be assessed individually based on the indicators used in the EpiRate, with automatic interpretation (Fig. 3).Figure 2.EpiRate Scoring Algorithm for Each Rate or Infection ConsideredFigure 3.Epidemiological scenarios and action plans associated with the values of EpiRate rate.

Results
Fig. 4 presents an example of the EpiRate for an ICU, utilizing 5 rates in the calculation (k=5). For each rate, observed values are compared with the benchmark percentiles, and the maximum score is 5 * 5 = 25 points. In this example, a total score of 19.5 points was obtained, resulting in an effectiveness rating of 78% for preventing infections in the ICU, from a global perspective. Fig. 5 illustrates the monthly EpiRate trends for two ICUs, from Jan/2021 to Dec/2022. Furthermore, Figure 6 showcases EpiRates specifically for Surgical Site Infections (SSIs), allowing an evaluation of the SSI prevention effectiveness in each service and enabling a summary of the hospital-wide SSI EpiRate.Figure 4.Example of a EpiRate Rate calculating in an Intensive Care Unit (ICU).Figure 5.EpiRate for two ICUs (Jan/2021 to Dec/2022): monthly rates.Figure 6.EpiRate for Surgical Site Infection.

Conclusion
Unlike traditional infection rates that focus on the "bad side of the problem," EpiRate Rate provides a positive perspective by evaluating the effectiveness of infection control program. This multidimensional index has the potential to enhance infection prevention strategies.

Disclosures
All Authors: No reported disclosures
1433. Hand Hygiene Products Consumption and Compliance in Intensive Care Units of 74 Hospitals in Shanghai
Authors: Han Mengge , Pan Hongping , Gao Xiaodong , Hu Bijie 
Published: November 2023

Abstract

Background
Understand the hand hygiene products consumption and compliance of the medical personnel in intensive care units (ICUs) of the secondary and tertiary hospitals in Shanghai to provide a scientific basis for hand hygiene monitoring.

Methods
The data was obtained through the Shanghai Hospital Infection Monitoring System from 2017 to 2021. The average daily consumption per bed was caculated for hand hygiene products. The hand hygiene compliance was calculated as the rate of performed disinfections per observed indications in any medical personnel involved in clinical care during an observation period of approximately 20 minutes. Pearson correlation coefficient was used for the correlation analysis of hand hygiene products consumption and compliance rate.

Results
In 105 ICUs of 74 hospitals in Shanghai, 39.85% of medical personnel selected soap and running water, 42.27% used alcohol-based hand rubs, 4.65% used gloves without performing hand hygiene, and 13.22% did not use golves nor perform hand hygiene. The average daily hand hygiene products consumption was 79.24ml per bed , and 46.14 ml and 33.10 ml per bed for soap and alcohol hand rubs, respectively. The hand hygiene products consumption incereasd from 2017 to 2021 (P&lt;0.001). The overall hand hygiene compliance rate was 81.64%.The hand hygiene compliance rate was 86.59%, 81.33%, 79.63%, 77.36%, 48.90% and 66.83% for nurses, doctors, continue education personnel/interns, nuring workers, medical technicians and others, respectively, and the rates varied statistically among different personnel (P&lt;0.001). The hand hygiene compliance rate incereasd from 2018 to 2021 (P&lt;0.001). There was a positive correlation between the average daily hand hygiene products consumption per bed and compliance rate (r=0.703, P=0.016).Table 1Hand hygiene measures in ICUs of the secondary and tertiary hospitals in Shanghai from 2017-2021Figure 1The trends of the hand hygiene products consumption and compliance rates from 2017-2021Figure 2The relationship between hand hygiene products consumption and compliance in ICUs of the secondary and tertiary hospitals in Shanghai from 2017-2021

Conclusion
Both the hand hygiene products consumption and compliance have shown an increasing trend in recent years in Shanghai. And hand hygiene compliance may be evaluated by continuously monitoring hand hygiene products consumption.

Disclosures
All Authors: No reported disclosures
1443. Characteristics of nursing homes with higher rates of invasive methicillin-resistant Staphylococcus aureus infections
Authors: See Isaac , Jackson Kelly A , Li Rongxia , Paul Prabasaj , Hatfield Kelly M , Nadle Joelle , Petit Susan , Wurm Daniel , Pall Allison , Ray Susan M , Harrison Lee , Jeffrey Laura , Bernu Carmen , Lynfield Ruth , Dumyati Ghinwa , Gellert Anita , Markus Tiffanie M , Schaffner William , Jacobs Slifka Kara M , Stone Nimalie D 
Published: November 2023

Abstract

Background
Invasive methicillin-resistant Staphylococcus aureus (MRSA) infections in nursing home residents now outnumber hospital-onset invasive MRSA infections. Elucidating characteristics of nursing homes with higher invasive MRSA rates could inform strategies to reduce rates of infections and prioritize facilities for prevention efforts.

Methods
Using active laboratory- and population-based surveillance data, invasive MRSA cases (MRSA in a normally sterile body site in a surveillance area resident) were identified in 25 counties in 7 states in 2011-2015. Nursing home-onset cases were those in a patient residing in a nursing home 3 days before collection of the index MRSA specimen. Facility-level characteristics were obtained from Centers for Medicare & Medicaid Services datasets. Facilities with invasive MRSA rates (cases/100,000 resident-days) in the top 15th percentile were defined as having “high rates” and a logistic regression model was used to assess factors associated with having high rates.

Results
There were 626 total nursing homes included, with 2,772 invasive MRSA infections over the 5-year time period; 82% of the facilities had a least one invasive MRSA infection. The median invasive MRSA rate was 1.78 cases per 100,000 resident-days (interquartile range: 0.73-3.14), and nursing homes categorized as having high rates had rates of at least 4.04. In multivariable regression, documented presence of a resident with a multidrug-resistant organism, higher hospital-onset MRSA rates in the surveillance area, and greater proportions of residents who were male, on dialysis, in the facility &lt; 100 days, or needed extensive assistance for bed repositioning were associated with having high invasive MRSA rates (Table). Increasing staffing of registered nurses (hours/resident/day) and a greater proportion of residents who were White were associated with lower rates.
Table
Adjusted odds ratios for facility-level factors associated with high rates (i.e., the top 15% of nursing homes) of nursing home-onset invasive methicillin-resistant Staphylococcus aureus (MRSA)

Conclusion
Our findings suggest facilities with higher invasive MRSA rates are likely to serve residents with more clinical and functional care needs. Increasing hours of registered trained nurses might assist with reduction of invasive MRSA rates. Understanding why differences in rates are associated with the racial composition of residents may reveal health equity issues contributing to risk.

Disclosures
Lee Harrison, MD, GSK: Advisor/Consultant|Merck: Advisor/Consultant|Pfizer: Advisor/Consultant|Sanofi: Advisor/Consultant Ghinwa Dumyati, MD, Pfizer: Grant/Research Support
1448. Characterizing Monkeypox in a Secondary Hospital in Madrid. Is HIV Playing a Role?
Authors: Alonso Samuel Estévez , Gozalbo Ana Simón , González Marta Vara , Guerrero María Gamo , Varela Samuel Manzano , García Jesús Troya , Botezat Ekaterina , de Buitrago Eva Jiménez González , Tomé Roberto Pedrero , Diaz Maria Ángeles Martin , de la Cueva Dobao Pablo , Gómez Beatriz Fernández , Huertas Elena Palma , Vidal Elisa Fernández , Lavalle David Esteban Brown 
Published: November 2023

Abstract

Background
Monkeypox (MPOX) is a zoonotic viral disease, endemic in some Central and West African countries. However, in May 2022, cases began to be reported in non-endemic countries, demonstrating community transmission. Since the beginning of the outbreak, different epidemiological and clinical behavior have been observed.

Methods
We conducted an observational study at a secondary hospital in Madrid, Spain, to characterize the MPOX suspected and confirmed cases epidemiologically and clinically. Besides the general descriptive analysis, we compared data between MPOX-confirmed cases vs MPOX-negative cases, between patients living with HIV (PLWHIV) and HIV-negative patients, and between patients vaccinated against smallpox vs unvaccinated.

Results
The study comprised 133 patients with MPOX suspicion, of which 100 were confirmed. Regarding positive cases, 71.0% were PLWHIV, and 99.0% were men with a mean age of 33. Sexual behavior in the previous year included 97.6% reporting having sex with men (MSM), 53.6% using apps for sexual encounters, 22.9% practicing "chemsex”, and 16.7% with sexual intercourse in saunas. Other epidemiological data are summarized in Table 1. In the clinical aspect, the presence of inguinal lymphadenopathy was significantly higher in positive MPOX cases (54.0% vs 12.1%, p&lt; 0.001), as the involvement of genital and perianal area (57.0% vs 27.3% and 17.0% vs 1.0%, p= 0.006 and p= 0.082 respectively). In addition, of them, 45.0% presented pustules as the most common skin lesions, and the genital area is the most frequently affected (57.0%). In PLWHIV, only 6.9% had a detectable viral load, and the mean CD4 count was 607.0/mm3. Compared to HIV-negative cases they had a trend towards greater involvement of the perianal area (3.6% vs 22.5%, p=0.05). This is more remarkable if PLWHIV had poor control criteria (CD4 count &lt; 500 cells/mm3), with perianal involvement in this group at 30.3% vs 0.0% if optimal HIV control. Other clinical results are summarized in Table 2 and Table 3.

Conclusion
The recent MPOX outbreak was epidemiologically related to sexual intercourses in MSM with no significant differences observed in the disease course between PLWHIV and HIV-negative cases, except for a greater tendency to appearance of perianal lesions.

Disclosures
All Authors: No reported disclosures
1450. Managing a Multidrug-resistant Acinetobacter baumannii Outbreak in the ICU: A Successful KAIZEN Program Using Process Indicators for Antimicrobial Stewardship, Hand Hygiene, and Standardization
Authors: Kawamura Hideki , Arimura Syoko , Murata Nao , Shigemi Akari , Niiyama Syuhei , Nishi Junichiro , Kakihana Yasuyuki 
Published: November 2023

Abstract

Background
Between 2016 and 2018, we detected Multidrug-resistant Acinetobacter baumannii (MDRA) carrying the IMP-1 gene in 15 patients including 14 of whom had been admitted to the ICU (Figure 1). The hospital environment including bed rail and mattresses became a reservoir for MDRA. We implemented the KAIZEN program in the ICU, which included process indicators for antimicrobial stewardship (AS), hand hygiene, and standardizing. The aim of this study is to evaluate the effectiveness of this KAIZEN program and establish infection control measures against MDRA.Figure 1.Epicurve of Multidrug-resistant Acinetobacter baumannii

Methods
In August 2018, we implemented several process indicators in the ICU at August 2018 to monitor antimicrobial use density (AUD) for carbapenems (target: less than 10 per 100 patient-days), use of an alcohol antiseptic agent (target: more than 200 times per patient-days), and weekly infection control rounds. We implemented a policy requiring staff to disinfect their hands when entering and exiting patient rooms, displayed posters reinforcing the rules of hand hygiene, used video monitoring to provide feedback on compliance rates, and encouraged staff to remind each other. Doctors were required to obtain permission using a checklist before prescribing carbapenems and held weekly conferences with ICU doctors to review AS bundles. We formed a 5S (Sorting, Setting-in-order, Shining, Standardizing, Sustaining) working group to discuss and implement strategies to maintain a clean environment and address infection control issues raised in the weekly rounds

Results
AUD for carbapenems decreased from 17.8 in 2016 to 6.7 in 2019, while use of an alcohol antiseptic agent increased from 51.5 in 2016 to 219.6 in 2019 (Figure 2). There was improvement in the issues identified during infection control rounds related to 5S, as demonstrated by a reduction in the number of previously identified problems (Figure 3). The MDRA outbreak was deemed successfully resolved based on improvements in process indicators and the absence of MDRA cases in patients or the environment for a year.Figure 2.Antimicrobial use density (AUD) for carbapenems and Use of an alcohol antiseptic agent from 2016 to 2019 in ICUFigure 3.The number of issues about 5S infection control rounds

Conclusion
The KAIZEN program, which involved planning and implementing improvement measures based on process indicators, effectively controlled the MDRA outbreak by standardizing infection control and antimicrobial use through the establishment of rules.

Disclosures
All Authors: No reported disclosures