bluuebunny/crossref_metadata_2025_split huggingface dataset:
2415. Health Outcome Disparities in Device-Associated Healthcare Infections Before and During the COVID-19 Pandemic
Authors: Bischoff Werner , Evans Joni , Passaretti Catherine , Fernandez Andrea 
Published: November 2023

Abstract

Background
The COVID-19 pandemic has led to a considerable increase in Central-Line Associated Bloodstream Infections (CLABSI) and Catheter Associated Urinary Tract Infections (CAUTI). However, it remains unclear how this affected different population groups.

Methods
This retrospective observational cohort study included CLABSI and CAUTI in a tertiary care facility. Information was collected on patient demographics, hospitalization, comorbidities, and COVID-19 status. Chi-square and Wilcoxon rank-sum tests were used for categorical and continuous variable comparisons. GEE models compared pre- and pandemic periods by interrupted time series analysis.

Results
From 1/1/2018 to 5/31/2022 98,791 patients had 151,550 hospital admissions. Of those, 17,796 patients had 29,483 central lines placed and 45,180 patients had 65,422 Foleys. 314 patients developed 338 CLABSI and 216 patients had 217 CAUTI. 1,552 patients tested positive for COVID-19 with 22 developing CLABSI and 14 CAUTI. The pre-pandemic downward trend in CLABSI and CAUTI was reversed during COVID-19 (p&lt; 0.05).
Black patients and those with other/unknown race had higher CLABSI per patient with central lines (p&lt; 0.02) and higher device days (p&lt; 0.0001) compared to white patients. Hispanic/Latino patients acquired more CLABSI per patient compared to non-Hispanic/non-Latino patients (p=0.04). During COVID-19 the already higher device days in Hispanic/Latino patients further increased compared to non-Hispanic/non-Latino patients (p&lt; 0.0001).
Black patients had higher CAUTI infection rates per patient with Foleys compared to white and other/unknown patients (p&lt; 0.05). CAUTI per device days were also higher in black patients compared to white patients (p=0.02). No difference in CAUTI burden was detected for ethnic groups throughout the study period. Black and non-Hispanic/non-Latino patients had higher Foley usage days than other patients (p&lt; 0.0001). Foley days decreased during COVID-19 (p=0.01).

Conclusion
We detected health outcome disparities affecting black (CLABSI and CAUTI) and Hispanic/Latino (CLABSI) patients. Infections increased during the pandemic without altering race/ethnicity differences. Device utilization was significantly higher in affected groups.

Disclosures
All Authors: No reported disclosures
2426. High Reliability Line Stewardship: A Novel Approach to Effective Central Line Associated Bloodstream Infection Risk Reduction
Authors: Kerr Nancy , Bland Jayme , Pasco Karen , Dwivedi Sukrut , Gurunathan Rajan , Hughes Nicole , Moran Christopher , Roman Alyssa 
Published: November 2023

Abstract

Background
Hospital-acquired infections (HAIs) impact health care quality and may cause patient harm. Central to the goal of preventable harm reduction are the tenets of high-reliability, specifically, the principle of deference to expertise and the principle of sensitivity to operations. Barriers can include lack of adherence to standardized criteria in support of best practice, inconsistent application of key concepts related to improvement and reliability, and limited time, resources and engagement.
We set forth to design and implement an effective and sustainable ‘line stewardship’ program, in hopes of improving utilization of CVCs and reducing central line associated bloodstream infection (CLABSI) risk at our academic community hospital in central New Jersey.

Methods
Jan - Feb 2022 : Baseline outcomes measured
Mar - May 2022 : Assessment and planning
Jul - Dec 2022 : Intervention and tracking
Jan - Feb 2023 : Follow-up outcomes measured
Intervention Phases

Results
During the 6 mon. intervention and tracking phase, OUMC experienced a 37% reduction in CVC utilization, with a decrease in the CVC utilization ratio (SUR, as defined by NHSN, from .751 to .537), yielding a reduction of over 550 line days/mon. When compared with baseline, the observed / expected infection rate decreased thru intervention phase (2.365 to 0.347), with an associated decline of CLABSIs. In comparison to the Jan - Feb 2022 data period, results from Jan - Feb 2023 continued to trend favorably, with both a continued decline in SUR (0.448), and sustained use of CVC alternatives (23.5 devices/mon).

Conclusion
The concept of stewardship is well-known in infectious disease circles and mirror principles of high-reliability and harm reduction, care standards, structured processes, and collaborative expertise are key to ensuring consistency and sustaining performance. After some initial push-back from providers who wanted to maintain their autonomy with access selection, the development of our vascular access order pathway and collaborative consult model became well-accepted as a way of triaging appropriate access to fit each patient. Our experience suggests that education, provider engagement, and a shared focus on care guidelines and reliability principles, can be the basis for a sustainable and effective CLABSI risk reduction strategy.

Disclosures
All Authors: No reported disclosures
133. Impact of the BioFire FilmArray Blood Culture Identification 2 (BCID2) Panel on Time to Antimicrobial Escalation or De-escalation in a Community Health System
Authors: DelRusso Katie , Colmerauer Jessica , Premus Jennifer 
Published: November 2023

Abstract

Background
The BioFire FilmArray Blood Culture Identification 2 (BCID2) panel is a rapid diagnostic tool that has been shown to decrease time to culture identification and effective therapy in bacteremia, particularly in conjunction with antimicrobial stewardship (AS) participation. The BCID2 panel was introduced at our 5-hospital community health system in May 2021. BCID2 results were relayed to care teams via the standard critical lab process (bedside nurse notified by phone) without notification of the AS team. This analysis compares outcomes after implementation of the BCID2 panel using a standard laboratory notification process.

Methods
This was a retrospective review of adult patients with positive blood cultures at a community health system in New Jersey. Patients with cultures performed using conventional methods (pre-BCID2) 7/1/2021-8/31/2021 were compared to patients with cultures performed using the BCID2 panel (post-BCID2) 7/1/2022-8/31/2022. Exclusion criteria was death within 72 hours, comfort care within 7 days of admission, organism determined to be a contaminant, culture results with a pathogen not on the BCID2 panel, transfer from an outside facility. The primary outcome was time to antimicrobial escalation or de-escalation. Secondary outcomes included time to culture identification, hospital length of stay (LOS), and duration of antimicrobial therapy.

Results
A total of 190 patients were included with 95 patients in each group. Time to de-escalation pre-BCID2 was 59.2 hours versus 35.3 hours post-BCID2 (p &lt; 0.001). Time to culture identification pre-BCID2 was 53.1 hours versus 22.4 hours post-BCID2 (p &lt; 0.001). LOS pre-BCID2 was 12.2 days versus 10.6 days post-BCID2 (p = 0.13). Duration of antimicrobial therapy was 20.2 days pre-BCID versus 18.4 days post-BCID2 (p = 0.29).

Conclusion
Addition of the BCID2 rapid diagnostic panel using a standard critical lab result notification process improved time to antimicrobial escalation or de-escalation by about 24 hours on average. In hospitals with limited stewardship resources, implementation of a rapid diagnostic blood test such as BCID2 without direct stewardship involvement is effective in improving time to antimicrobial escalation or de-escalation.

Disclosures
All Authors: No reported disclosures
2441. Implementation of Decolonization Strategies and Rates of Bacteremia in ECMO Patients
Authors: Taylor Madyson , Lee Rachael A , Griffin Russell , James Catina , Akinsanya Angela , duncan Mary , Walker Jeremey 
Published: November 2023

Abstract

Background
To date, there is little data on decolonization in extracorporeal membrane oxygenation (ECMO) patients and if decolonization efforts improve rates of bacteremia with multi-drug resistant organisms (MDROs). We sought to determine if implementation of universal nasal decolonization with daily chlorhexidine bathing will decrease blood stream infections (BSI) in patients undergoing ECMO.

Methods
A retrospective cohort study was conducted of all patients with admitted to UAB Hospital and placed on ECMO from 12/22/2017-6/1/2022. Data collected included baseline patient characteristics and clinical data, microbiology data, interventions for source control, dates of line placement, appropriate antibiotic treatment, and outcomes. Categorical variables were analyzed with the Fisher exact test, and continuous variables analyzed with the t test or Wilcoxon rank-sum test when appropriate. Only variables found to be statistically significant will be included in the model. A P value &lt; .05 are considered significant.Table 1.Group Demographics

Results
531 patients placed on ECMO were included in this study and separated into groups: Pre implementation: 401 (76%), post implementation: 130 (24%). (Table 1). 61 (15%) pre patients developed bacteremia with an average of 18.1 ECMO days. 29 (22%) of post patients had a BSI with an average of 25.0 ECMO days. While the average number of BSI per 100 ECMO days increased in the post-implementation group (0.58/100 ECMO days to 1.02/100 ECMO days), the overall incidence rate of MRSA decreased (0.22/100 ECMO days vs 0.09/100 ECMO days). Of note, 89 (17%) patients were found to have COVID-19 at time of ECMO, 12.6% of the pre-implementation group vs 31% of the post-implementation group, (p &lt; 0.001).
Incidence Rate: Number of BSI per ECMO Days

Conclusion
There was no statistical significance between the pre and post groups in the study with the amount of time on ECMO, the time from ECMO cannulation to BSI, the amount of BSIs or the amount of MRSA bacteremia. Implementation of universal decolonization with daily CHG reduced rates of MRSA bacteremia. The lack of research in this field and the timing of this study almost exclusively assessing ECMO patients during the COVID-19 pandemic during the post-implementation period warrants further investigation on if decolonization strategies can reduce BSIs and MDROs bacteremia in ECMO patients.

Disclosures
All Authors: No reported disclosures
2447. Clinical Features and Outcome of Persistent Candidemia Caused by Candida albicans versus Non-albicans Candida Species: A Focus on Antifungal Resistance and Follow-up Blood Cultures
Authors: Kitaya Shiori , Kanamori Hajime , Katori yukio , Tokuda Koichi 
Published: November 2023

Abstract

Background
Candidemia is a common hospital-acquired (HA) infection linked to extended hospitalization and high mortality rates. Risk factors for persistent candidemia (PC) include central venous catheter, empirical treatment, and metastatic infection foci. Antifungal resistance is a significant global infection control issue, especially in non-albicans Candida species. We investigated clinical outcomes and mortality rates associated with HA-PC, focusing on Candida species, antifungal resistance, and PC-clearance.

Methods
Data analysis was conducted using electronic medical records from Tohoku University Hospital from 2012 to 2021 (n = 60). HA-PC cases were categorized based on Candida species, azole or echinocandin resistance, and PC-clearance status, and analyzed respective characteristics. The primary outcome variables were 30-day, 30–90-day, and 90-day mortality after the initial blood culture.

Results
The HA-persistent non-albicans candidemia group had a higher ratio of immunosuppression and catheter-related bloodstream infection (CRBSI) than the HA-persistent Candida albicans bacteremia group (Odds ratio [OR] = 4.6, p = 0.049). CRBSI was more prevalent in the HA-PC resistant strain group than in the susceptible strain group (OR = 4.2, p = 0.008), while HA-PC resistant strain group had a lower incidence of intraocular candidiasis (p = 0.020). Mortality rates were slightly higher in the HA-persistent non-albicans candidemia group compared to the HA-persistent Candida albicans bacteremia group. Similarly, the HA-PC resistant strain group tended to have higher mortality rates compared to the susceptible strain group. In the HA-PC non-clearance group, there was a trend towards higher 30-day, and 90-day mortality rates, and the former group had a statistically significant difference (OR = 19, p = 0.028).

Conclusion
Patients with HA-PC caused by non-albicans Candida or azole or echinocandin resistant strains have higher mortality rates and require careful therapeutic management. Confirming the clearance of PC by performing follow-up blood cultures can improve the survival rate for both susceptive and resistant strain groups.

Disclosures
Shiori Kitaya, MD, AMANO Co., Ltd.: Grant/Research Support Hajime Kanamori, MD, PhD, MPH, Amano Co., Ltd.: Grant/Research Support Koichi Tokuda, MD, PhD, MPH, AMANO Co., Ltd.: Grant/Research Support
2450. Clinical Outcomes of Candida auris Infections at an Academic Medical Center
Authors: Wang Yifan , Drweiga Emily N , Danziger Larry H , Burgos Rodrigo M 
Published: November 2023

Abstract

Background
C. auris (CA) is a globally emerging fungus with a high case fatality rate (CFR). Cases of CA infection have been reported around US with a concentration in large metropolitan areas, but there is still little of data evaluating the prevalence and outcomes associated with CA. The purpose of this study was to evaluate the characteristics and outcomes in patients (pts) with CA isolation at a large urban academic medical center.

Methods
This was a retrospective, observational cohort study of hospitalized pts with a positive culture with CA between Oct 2020 and Dec 2021 via VITEK MS. We included pts ≥18 years of age and excluded those with only a positive surveillance screen from axillary swab. Demographic and clinical data at the time of CA isolation and up to 30 days or hospital discharge were collected from the electronic medical record. The primary outcome was 30-day CFR in patients with a culture positive for CA.

Results
We identified 37 patients, and 27 met inclusion. Of all included patients, 17 (63%) presented from acute or subacute long-term care facilities. 11 (40.7%) had CA isolated from a blood culture. 8/11 (72.7%) bloodstream infections were catheter-associated. Pts with fungemia had a median [IQR] length of antifungal treatment of 20 [6.5, 49.5] days, and all received micafungin. The median [IQR] days between index blood culture and first negative blood culture was 4 [3, 6.25]. 1 patient with fungemia never cleared repeat cultures despite treatment. Of all included pts, 7 of 27 (25.9%) expired within 30 days of CA isolation. The 30-day case fatality was 45.5% (5/11) in those with fungemia and 12.5% (2/16) in those with isolation from other sites.

Conclusion
In our study, we report a similar institutional CFR of CA infections compared to the crude CFR within the U.S. We also report a higher CFR associated with CA fungemia compared to patients without positive blood cultures. These findings should be validated with a larger study population.

Disclosures
Larry H. Danziger, PharmD, Ferring Pharmacetuicals: Advisor/Consultant Rodrigo M. Burgos, PharmD, MPH, Janssen Therapeutics & Vaccines: Grant/Research Support|Merck & Co., Inc.: Grant/Research Support|ViiV Healthcare: Advisor/Consultant
2451. The Impact of Common Variations in SOFA Score Calculations on Sepsis Surveillance Using Sepsis-3 Criteria
Authors: Alrawashdeh Mohammad , Klompas Michael , Rhee Chanu 
Published: November 2023

Abstract

Background
Sepsis-3 defines sepsis as infection associated with an increase in baseline Sequential Organ Failure Assessment (SOFA) score by ≥2 points. Consistent electronic application of Sepsis-3 criteria could allow for standardized estimates of sepsis incidence and outcomes. However, there are many methods of calculating SOFA scores that may contribute to variability in sepsis surveillance.

Methods
We retrospectively identified all adult patients hospitalized at 5 Massachusetts hospitals between 2015-2022 and calculated the incidence and mortality rates of sepsis, defined as suspected infection (any clinical culture and antibiotics continued for ≥3 days) with concurrent organ dysfunction (increase in SOFA by ≥2 points) using different strategies for calculating respiratory SOFA scores and for handling missing data. We calculated respiratory SOFA scores by 1) using the standard PaO2/FiO2 ratio method, and 2) using SpO2/FiO2 ratios when arterial blood gases were not performed. We managed missing data using: 1) normal value imputation for each organ system if values from that day were missing, 2) mean value imputation, using the mean of the worst values of the preceding and following day, and 3) carry forward imputation, carrying forward the last non-missing observation.

Results
The cohort included 1,064,498 hospitalizations, of which 299,427 (28.1%) had suspected infection. Using the standard respiratory PaO2/FiO2 method, sepsis incidence and mortality rates were 14.2% and 10.1% but incidence rose to 19.7% and mortality dropped to 7.8% using the SpO2/FiO2 respiratory score imputation and normal value imputation. Results were similar with mean value and carry-forward imputation.

Conclusion
We observed substantial differences in calculated sepsis incidence and mortality rates when using SpO2/FiO2 vs PaO2/FiO2 ratios alone to impute respiratory SOFA scores. Common SOFA missing value imputation strategies, however, had little impact on sepsis incidence and mortality rates. These findings highlight an important source of potential variability when applying Sepsis-3 criteria and underscore the need for standardized surveillance methodology.

Disclosures
Michael Klompas, MD, MPH, UpToDate, Inc.: Royalties for chapters on pneumonia Chanu Rhee, MD, MPH, Cytovale: Advisor/Consultant|Pfizer: Advisor/Consultant|UpToDate, Inc.: Honoraria
134. Yield of Fungal and Mycobacterial Cultures for Operative Specimens in Orthopedic Procedures
Authors: Cooper Margaret , Shihadeh Katherine C , Deaney Michael , Miller Whitney , Parry Joshua , Wilson Michael L , Jenkins Timothy C 
Published: November 2023

Abstract

Background
Fungal and mycobacterial cultures are routinely sent on orthopedic operative specimens, but their impact on clinical care is not well established. Processing fungal and mycobacterial cultures is time and labor intensive, associated with significant healthcare costs, and may yield false-positive results due to contamination. The objective of this study was to determine the utility and diagnostic yield of fungal and mycobacterial cultures for orthopedic infections.

Methods
Patients undergoing surgery by the orthopedic or podiatry service that had operative specimens sent for fungal and mycobacterial cultures from January through December 2022 were included. Descriptive statistics were used to evaluate yield of fungal and mycobacterial cultures and incremental yield of fungal cultures over standard bacterial culture media. A random subset of patients was manually reviewed to determine whether microorganisms identified by fungal or mycobacterial cultures were considered clinically relevant and whether culture results changed management.

Results
Fungal and mycobacterial cultures were ordered on a total of 1148 operative specimens in 428 patients. A mean of 2.1 ± 1.4 specimens was collected per operative procedure. A microorganism was identified in 33 (2.8%) of fungal cultures and in no mycobacterial cultures. Fungal organisms included yeast (90.9%) and mold (9.1%).
Of 50 randomly selected patients, a total of 249 operative specimens were collected (mean 5 per patient, 2.7 per operative procedure). A microorganism was identified by fungal culture in 5 (2%) specimens from 3 patients. All three patients were treated with antifungal agents indicating the fungi were deemed to be clinically relevant. However, the fungi also grew on the standard bacterial media from all 5 specimens suggesting there was no incremental benefit of the fungal cultures. There were no positive mycobacterial cultures, and no patients received mycobacterial treatment.

Conclusion
The diagnostic yield of fungal and mycobacterial cultures on operative specimens in orthopedic and podiatry surgery is very low and rarely results in a change in therapeutic management. The results of this study demonstrate an opportunity for diagnostic stewardship for these procedures.

Disclosures
Timothy C. Jenkins, MD, Basilea: Clinical events adjudication committee
2456. Methicillin-Resistant Staphylococcus aureus Bacteremia 30-Day Mortality During 2020 Compared to 2016-2019: Assessing the Impact of COVID-19
Authors: Biggs Holly , Jackson Kelly A , Nadle Joelle , Petit Susan , Ray Susan M , Dumyati Ghinwa , Tracy Marissa , Markus Tiffanie M , Schaffner William , See Isaac , See Isaac 
Published: November 2023

Abstract

Background
Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is associated with substantial mortality, but the effect of the COVID-19 pandemic on MRSA mortality has not been fully explored.

Methods
For 2016-2020, MRSA bacteremia cases among adults aged ≥ 18 years were identified through CDC Emerging Infections Program’s active laboratory- and population-based surveillance in 5 states (16 counties). Death within 30 days of initial MRSA blood culture was determined from medical record documentation or linked state vital statistics data. Cases were classified (epi class) as hospital-onset (HO), healthcare-associated community onset (HACO), or community associated (CA) (Figure 1). Thirty-day mortality was calculated by year and epi class and, for 2020, stratified by whether a SARS-CoV-2 test was positive in the 30 days preceding MRSA culture (recent COVID-19). Using multivariate logistic regression to adjust for potential confounders, the effect of recent COVID-19 on 30-day mortality was assessed.

Results
MRSA bacteremia 30-day mortality was 22% (2,113/9,689) during 5 surveillance years. Mortality in 2020 was higher than in 2016-2019 overall (25% vs. 21%, p&lt; .01), for HO cases (43% vs 32%, p&lt; .01), and for CA cases (19% vs. 13%, p&lt; .01). When limited to cases without recent COVID-19, mortality in 2020 was still higher than in 2016-2019 for CA (18%, p&lt; .01) but not HO (35%, p=.39). During 2020, cases with recent COVID-19 comprised 37% of HO deaths and a smaller proportion of HACO (13%) and CA (7%) deaths. Cases with recent COVID-19 had higher 30-day mortality than those without across all epi classes (Figure 2; p≤ .01 for all), with mortality highest among HO cases with recent COVID-19 (77%). After adjusting for other factors, recent COVID-19 remained a significant risk factor for 30-day mortality (adjusted odds ratio: 5.3, 95% CI: 3.6-8.0; Table).Table.Multivariate Analysis of Factors Associated with Methicillin-Resistant Staphylococcus aureus Bacteremia 30-Day Mortality, 5 Emerging Infections Program Sites, 2020

Conclusion
COVID-19 emerged as a significant independent risk factor for MRSA bacteremia-associated death in 2020, and the very high mortality for HO cases with recent COVID-19 resulted in a higher mortality for HO cases overall. Conversely, the contribution of COVID-19 to the increased mortality for CA cases in 2020 appeared small, and reasons for the increase in mortality for CA cases without recent COVID-19 need additional investigation.

Disclosures
Ghinwa Dumyati, MD, Pfizer: Grant/Research Support