bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-205. Investigating PCR (Polymerase Chain Reaction) Cycle Threshold’s Utility in Diagnosing and Treating Clostridioides difficile Infections
Authors: Carey Edward , Maramara Bennadette , Jacob Matthew , Totten Arthur H , Go Roderick 
Published: January 2025

Abstract

Background
Clostridioides difficile (C diff) is a pathobiont bacteria in the human gastrointestinal tract that can cause morbidity and mortality and has public health implications.
Guidelines suggest two-step testing to diagnose C diff infection (CDI). However, since polymerase chain reaction (PCR) tests can be positive in persons with colonization and no active disease, management of discordant results is challenging. Usage of facility-onset CDI as a quality metric further raises the need to accurately differentiate infection from colonization.
We hypothesize PCR cycle threshold (Ct) values may be useful for quantifying C diff disease burden and differentiation of infection from colonization. However, Cts are currently unvalidated and are not currently approved for use for clinical decision making.
Sample and results data for C diff infection and C diff PCR CT correlation
This table provides an overview of our data investigating the usage of C diff PCR CT to better diagnose CDI

Methods
We performed a retrospective, single center chart review of patients who tested positive for C diff, and analyzed clinical and laboratory data in 2022. We excluded minors, outpatients, and repeat C diff episodes, and performed multi variable analyses.

Results
70 patients met inclusion criteria. This cohort consisted of 37 (52.86%) male and 33 (47%) female patients. The mean and median ages were 70 and 73 years old respectively. Approximately 30 percent of our cohort was immunocompromised, and 90 percent of our patients were on antibiotics within 30 days of CDI testing.
Using a Ct of 26.35, a cutoff used in previous studies to indicate infection, 30 patients (42.9%) had a positive Ct, and of these, 16 (53%), had a positive confirmatory enzyme immunoassay (EIA) . Ct of less than cutoff had a positive predictive value of 53%, and negative predictive value of 85%, for positive EIA.
All patients analyzed underwent C diff treatment, with a mean length of treatment of 10 days. Mean time to recovery, classified as less than three documented bowel movements, or hospital discharge, was 4.6 days. Nine patients (13%) in our cohort died within 30 days of C diff testing.

Conclusion
This data show that C diff PCR Ct value threshold of &lt; 26.35 combined with EIA positivity may be a helpful parameter for evaluating possible C diff. The demonstrated high negative predictive value may show a utility for high Ct values in ruling out active disease.

Disclosures
Roderick Go, DO, Aptose Biosciences: Stocks/Bonds (Private Company)|Bristol Meyers Squibb: Stocks/Bonds (Private Company)|Cytodyn Inc.: Stocks/Bonds (Private Company)|Scynexis: Grant/Research Support|Shionogi, Inc: Grant/Research Support
P-208. Does an electronic alert for secondary C. difficile prophylaxis result in vancomycin prophylaxis and reduction in recurrent CDI?
Authors: Singh Harjot K , Gouveia Adam L , Ross Barbara , Kuang David , wang shirley , Horowitz Harold , Simon Matthew , Nelson Brian , Torres Heidi M , Kaplan Steven , Furuya E Yoko , Calfee David P 
Published: January 2025

Abstract

Background
Secondary vancomycin prophylaxis (VP) is one strategy to reduce recurrent C. difficile infection (CDI). Clinical decision support (CDS) was implemented in the electronic health record (Epic®) in 2020 to remind providers about eligibility for VP at time of prescription of broad-spectrum antibiotics in patients with a history of CDI. The effectiveness of this strategy was assessed.
CDIFF BPA
CDIFF Secondary Prophylaxis Best Practice Alert

Methods
Retrospective review of an interruptive best practice alert (BPA) for VP at 8 hospitals from 2021-2022. Patients were classified via manual chart review as immunocompetent (immune) or immunocompromised, and were eligible for 3 months and 12 months respectively after an episode of CDI. Demographic characteristics, immune status, receipt of VP, and outcomes (30-day recurrence CDI, death during hospitalization or within 30 days of discharge) were collected. Only the first BPA per patient was included in the demographic and death analysis. Only one alert per hospitalization was included in the VP use and recurrence analysis. Patients with CDI within 10 days prior to the BPA and on the same day as BPA alert were excluded. Descriptive statistics were used to analyze differences.

Results
Among 616 unique hospitalized patients for whom the BPA was triggered, median age was 64 years; 40% were immune. Approximately 50% were women, with 24% African American and 24% Hispanic. After 1562 BPAs, 13% of immunocompromised and 10% of immune patients were prescribed VP within 24 hours. Median days from previous CDI to BPA was 97 days for immunocompromised and 45 days for immune patients. For immunocompromised patients, frequency of CDI recurrence (11% versus 6%) and frequency of death (14% versus 18%) were not statistically different in the group that got VP and the group that didn’t. Similarly for immune patients, frequency of recurrent CDI (7% versus 8%) or death (16% versus 13%) were not statistically different in the group that got VP and the group that didn’t.

Conclusion
VP was infrequently initiated despite an interruptive BPA that identified patients with recent history of CDI at the time of prescription of broad-spectrum antibiotics. In this limited sample size, patients had similar outcomes regardless of VP. Further research is needed to understand the barriers for the low uptake, including CDS design and efficacy of VP.

Disclosures
All Authors: No reported disclosures
P-209. Evaluation of Hospitalized Clostridioides difficile (C. difficile) Polymerase Chain Reaction (PCR) Positive/Enzyme Immunoassay (EIA) Negative Patients
Authors: Harrington Nicole , Patel Drashti , Kelly Jennifer , Borja Clint 
Published: January 2025

Abstract

Background
Differentiating true infection versus colonization is challenging in C. difficile PCR positive/EIA negative patients. Prior studies estimate 50% of these patients have true infection and warrant treatment. The aim of this study was to describe treatment practices for hospitalized C. difficile PCR positive/EIA negative patients at ChristianaCare.

Methods
A single health system, retrospective study was conducted between January to December 2022. PCR positive/EIA negative patients were categorized as treated or not treated for C. difficile infection (CDI). The primary outcome was the percentage of patients treated for CDI. Secondary outcomes that influence the decision to treat including age, sex, immunocompromised status, white blood cell (WBC) count, systemic antibiotic use, Infectious Diseases (ID) consultation, or recurrent CDI were evaluated. Hospital length of stay (LOS) and 30-day hospital readmission rates were also collected. ChristianaCare’s C. difficile scoring tool was used to categorize patients as low, medium, and high risk for true CDI.

Results
Of the 101 patients included in this study, 82 (81%) of PCR positive/EIA negative patients were treated for CDI (95% CI [0.73, 0.89]). Treated patients were more likely to have received antibiotics within the last 30 days (p=0.014) and have an ID consultation (p=0.013). There were no statistically significant differences between treated and not treated groups based on age, sex, immunocompromised status, elevated WBC, recurrent CDI, hospital LOS, 30-day hospital readmission, and inpatient all-cause mortality. No patients had real-time documentation of the C. difficile scoring tool score. All retrospective, manually calculated high risk patients utilizing the C. difficile scoring tool were treated (20.7%).

Conclusion
We observed a higher percentage of treatment in patients who were C. difficile PCR positive and EIA negative compared to prior studies. Treated patients were more likely to have antibiotic use within the last 30 days and an ID consultation. Other risk factors commonly used to diagnose CDI did not impact treatment decisions. Opportunity to improve education using the ChristianaCare C. difficile scoring tool to assess CDI risk in patients and guide testing and treatment decisions is warranted.

Disclosures
All Authors: No reported disclosures
P-210. Real-World Utilization and Cost of Fidaxomicin versus Oral Vancomycin: A Comparative Analysis of Outpatient Medicaid Prescription Reimbursements
Authors: O’Neil Jessica C , Lautenbach Ebbing 
Published: January 2025

Abstract

Background
Clostridioides Difficile Infection (CDI) is a leading cause of infectious diarrhea in the United States. In 2017, the Infectious Diseases Society of America (IDSA) and Society of Healthcare Epidemiology of America (SHEA) joint guidelines added fidaxomicin (FX) as a first line therapy for initial and first recurrence of non-fulminant CDI alongside oral vancomycin (OV). Under a 2021 guideline revision FX became the preferred therapy based on lower CDI recurrence among those treated with FX. Multiple analyses have attempted to predict the economic impact of increased FX use but have yielded conflicting results. The use of real-world data on actual cost and utilization has been limited.Figure 1:Total Annual Outpatient Medicaid CDI Therapy Prescription CountCDI: Clostridioides Difficile Infection

Methods
We conducted a retrospective analysis of utilization and cost of FX and OV between January 1st, 2013 and December 31st, 2022 in the Medicaid State Drug Utilization Database (SDUD). The SDUD contains covered outpatient medications excluding those reimbursed under bundled services. Prescriptions for OV were distinguished from other vancomycin formulations using national drug codes. Utilization was estimated by the number of prescriptions reimbursed. Total cost was calculated as the sum of Medicaid and non-Medicaid reimbursement. We approximated the annual per prescription cost (APPC) as the quotient of total cost and prescription count.Figure 2:Total Annual Outpatient Medicaid CDI Therapy Prescription CostCDI: Clostridioides Difficile Infection

Results
Following the 2017 guidelines the average annual FX prescription count (Figure 1) increased by 32% compared to a 2013-2016 baseline. After the 2021 guideline revision, average annual FX prescription count grew by 113% as compared to a 2017-2020 baseline. The total annual cost of FX (Figure 2) surpassed the total annual cost of OV in 2019 with FX reaching $17,984,998 in 2022 as compared to $3,135,523 for OV. Throughout the study period the FX APPC (Figure 3) was substantially greater ($2,614-$3,956) than the OV APPC ($134-$1,579).Figure 3:Annual Per Prescription Cost of Outpatient Medicaid CDI TherapyCDI: Clostridioides Difficile Infection

Conclusion
Among Medicaid beneficiaries, outpatient FX use increased in time periods following the 2017 and 2021 guideline changes. While FX use was significantly lower than OV from 2013-2022, FX total cost and APPC far outweighed that of OV. Further analysis is necessary to determine the real-world cost effectiveness of FX, but our results highlight the budgetary impact associated with these IDSA/SHEA guideline changes.

Disclosures
All Authors: No reported disclosures
P-218. Treatment of Healthcare Facility-Onset Clostridioides difficile Infection Among Patients with Toxin Negative Stool Molecular Assay Results
Authors: Mobarakai Olivia Z , van den Berg Polly , Reid Kara , Terico Adrienne , Nwankwo Onyeka 
Published: January 2025

Abstract

Background
CDC's National Healthcare Safety Network (NHSN) defines a healthcare facility-onset Clostridioides difficile (C. diff) infection (HO-CDI) as a positive stool test result for C. diff toxin collected on or after hospital day (HD) 4. Currently, using two-stage algorithm testing, a nucleic acid amplification test (NAAT) that results positive for C. diff gene and negative for C. diff toxin (NAAT+/Toxin-) does not meet the HO-CDI definition as this may represent colonization. However, many NAAT+/Toxin- patients receive treatment given concern for clinical CDI. NHSN has proposed updating the healthcare facility-onset definition to include NAAT+/Toxin- patients who receive ≥ 5 days of antibiotic treatment for CDI within 2 calendar days (HT-CDI). To understand the increase in healthcare facility-onset CDI that may occur following this definition change, we describe the incidence of treated NAAT+/Toxin- patients at our hospital and examine factors associated with treatment.

Methods
Retrospective, observational cohort study evaluating patients ≥ 18 yo admitted between 7/2019 and 6/2023 with a NAAT+/Toxin- test collected on or after HD 4. Patients were identified using Theradoc software and variables were extracted by chart review. Comparisons between groups were performed using Fisher’s exact test.

Results
49 of 79 (62.0%) patients with NAAT+/Toxin- results received treatment for CDI and met the HT-CDI definition. There would have been 9, 14, 9, and 17 cases added during FY 2020, 2021, 2022, 2023 respectively (Figure 1). WBC was the only variable associated with treatment of NAAT+/Toxin- diarrhea (Table 1).

Conclusion
62.0% of patients with C.diff NAAT+/Toxin- diarrhea were treated for suspected CDI. The majority (64.6%) of patients had a documented alternative etiology for diarrhea and often lacked associated symptoms of CDI (e.g., fever, colitis). While the purpose of NHSN’s creation of the HT-CDI definition was to improve upon the existing measure of HO-CDI, our data suggests that incorporating a provider’s decision to treat may not be the best way to discern if NAAT+/Toxin- patients have CDI. Our study highlights the importance of diagnostic stewardship and provider education on incorporating relevant signs and symptoms of CDI into decision making regarding treatment.

Disclosures
All Authors: No reported disclosures
P-223. Risk Factors for Community-Associated Clostridium difficile Infection: A Retrospective Study
Authors: Mizrahi Barak , Weinberger Miriam , Lidar Shira , Ben David Shirley Shapiro 
Published: January 2025

Abstract

Background
Community-associated Clostridium difficile infection (CA-CDI) has emerged as a significant public health concern in recent years. The objective of this study was to evaluate the risk factors for CA-CDI including antibiotics-specific regimen and duration.Table 1Baseline characteristics of study cohort1- Tests were sent but rejected by the laboratory due to non-diarrheic stool; 2- SES socioeconomic status; 3- Based on registries; 4- minimum three sequential monthly purchases

Methods
Data from a large health maintenance organization was extracted between 2001-2023. The study population included patients who were sent to their first Clostridium difficile (CD) test ever, with no records of hospital admission within 84 days preceding the test. Patients with positive CD test were considered CA-CDI cases. They were compared to patients with negative tests and to patients whose test was rejected due to non-diarrheic stool. Correlates of CD were detected using multivariate logistic regression. Inverse probability weighting was used to examine the associations between exposure to different antibiotic regimes, types or durations, after controlling for potential confounders.Figure 1Risk factors for CA-CDICA-CDI, Community-associated Clostridium difficile infection

Results
During 2001-2023 25,274 patients with first CD tests were identified, of whom 940 (3.7%) were CA-CDI cases, 12,704 (50.3%) were CD test-negative, and 11,630 (46.0%) patients had rejected tests (Table 1). The mean age was 53.2 (22.7), 50.6 (21.3), and 48.0 (20.4), respectively, and the number of females was 614 (65.2%), 7395 (58.2%), and 7147 (61.5%), respectively. Various conditions or exposures were associated with increased risk for CA-CDI, including inflammatory bowel disease, dementia, homebound status, and proton pump inhibitor) (use, whereas metformin was associated with reduced risk of CA-CDI (Figure 1). The number of different antibiotic agents was a significant risk factor, with risk increasing twofold for 1 agent vs. none, and additional increments with each additional antibiotic (Figure 2). When the exposure was five days the risk was elevated only for clindamycin and quinolones, while with ≥10 days-exposure, the risk was significantly elevated for all antibiotics agents (Figure 3).Figure 2Risk of CA-CDI according to number of antibiotic exposure (7-90 days before infection)

Conclusion
This study provides insights into the risk factors for CA-CDI in the community setting and underscores the importance of judicious antibiotic prescribing practices and specifically longer duration of antibiotic use.Figure 3Risk of CA-CDI according to antibiotic exposure*- regimen and duration*7-90 days before infection

Disclosures
Shirley Shapiro Ben David, MD, GSK: Lecturer|Pfizer: Grant/Research Support|Pfizer: Lecturer
P-235. Non-utility of Catheter Tip Cultures in the Diagnosis of Catheter-related Bloodstream Infections
Authors: Jonnalagadda Kirtana , Goel Ayush , Ajayababu Anuj , Mohapatra Sarita , Gautam Hitender , Kumar Das Bimal , Soneja Manish , Wig Naveet , Dhawan Benu 
Published: January 2025

Abstract

Background
Catheter-related bloodstream infections (CRBSIs) affect approximately 3 to 27% of patients. As per IDSA (2009) criteria, concordant organisms from blood and catheter tip cultures, or specific criteria met by two blood samples are required for CRBSI diagnosis. Catheter tip cultures necessitate removal of the line and entail increased healthcare costs. Emerging evidence questions the reliability of this labor-intensive practice in diagnosing CRBSI. We aimed to determine the utility of catheter tip cultures in diagnosing CRBSI at our Institute.
Catheter tip culture and Blood culture results
CRBSI: Catheter-related Bloodstream Infection; TC: Catheter tip culture; BC: Blood culture; + or - , growth or no growth

Methods
We conducted a prospective observational study in patients with suspected CRBSI. Catheter tips and paired blood samples collected within 48 hours, were sent for culture. CRBSI was diagnosed as per IDSA 2009 guidelines. The utility of catheter tip cultures in diagnosing CRBSI was calculated.

Results
One-hundred and thirty events of suspected CRBSI were included in 116 patients. Sixty-two percent of patients were male with a mean age of 43.75 ± 16.5 years. The prevalence of CRBSI was 16.9%, of which only 27% of CRBSI were identified by catheter tip cultures. The sensitivity, specificity, positive predictive value, and negative predictive value of catheter tip cultures in diagnosing CRBSI were 27.3% (10.7- 50.2), 77.8% (68.8-85.2), 20.0% (10.4- 35.0) and 84.0% (79.9-87.4) respectively. Catheter tip colonization was observed in 20.8% of catheter tip cultures. All repeat blood cultures sent in the following two weeks in patients with catheter-tip colonization, were sterile. Amongst patients with CRBSI, Multidrug-Resistant Acinetobacter baumanii and Klebsiella pneumoniae were the most frequently isolated organisms, followed by Candida spp (predominantly Candida auris), accounting for 27% of CRBSI cases.

Conclusion
Our study showed poor sensitivity and low positive predictive value of catheter tip cultures in diagnosing CRBSI. Employing catheter-sparing methods, such as evaluation of differential time to positivity and quantitative paired blood cultures, will improve the diagnosis of CRBSI, and can lower hospital expenses.

Disclosures
All Authors: No reported disclosures
P-236. Impact of a New Dressing Protocol for the Prevention of Central Line-Associated Bloodstream Infections in one Neonatal Intensive Care Unit (NICU)
Authors: Kowatsch Katarina , Larone Juneau Audrey , Giroux Justine , Lapointe Marianne , Vlad Alina , Ocampo Laura , Audy Nathalie , Gravel Sophie , Lachance Christian , Buckeridge David , Quach Caroline 
Published: January 2025

Abstract

Background
Newborns in the neonatal intensive care unit (NICU) are vulnerable to infections due to their extremely fragile skin, underdeveloped immune systems, and usual long-term hospitalizations. These infants often require prolonged use of central venous catheters (CVCs). Bloodstream infections can arise from these CVCs and are a major cause of death in the NICU. Every CVC dressing change can damage their fragile skin, increasing infection risk, and potentially resulting in central line-associated bloodstream infections (CLABSIs). Centers for Disease Control and Prevention recommends dressing changes every seven days, more often if visibly damaged or dirty. Our objective was to evaluate the effectiveness of a new protocol and dressing optimized for long-term skin adhesion implemented in the Centre Hospitalier Universitaire Sainte-Justine (CHUSJ) NICU.

Methods
The CHUSJ NICU is a level III-IV NICU with 900 admissions a year from both inborn and outborn infants. CLABSI surveillance is done prospectively by the Infection Prevention and Control team. All CVCs installed in NICU patients are recorded daily. Inclusion criteria were all recorded NICU CVCs from January 1, 2017, to December 31, 2023. Segmented interrupted time-series analysis was conducted according to the three-stage intervention rollout (first for gestational age of 28 weeks or more, then large premature infants, then the entire unit), with a pre-intervention period of January 1, 2017, to May 1, 2021, modeling CLABSIs/1000 CVC days/month and adjusting for mean birth weight.

Results
2653 CVCs and 71 CLABSIs were reported during the surveillance period. Pre-intervention rates were 1.85 CLABSIs/1000 CVC days. CLABSI rate ratios were: during initial intervention rollout 0.448 (95% confidence interval 0.407, 0.492), during the second stage 0.952 (0.932, 0.973), and since complete implementation 0.610 (0.581, 0.639) that of pre-intervention period rates, for the entire NICU population.

Conclusion
With reports of CLABSI rate rebounds during the COVID-19 pandemic and increasing NICU outbreaks from multidrug-resistant organisms with associated high mortality, new infection prevention protocols are crucial to combat these trends in CLABSI rates and severity of case outcomes, especially for the vulnerable NICU population.

Disclosures
All Authors: No reported disclosures