bluuebunny/crossref_metadata_2025_split huggingface dataset:
2462. The impact of the COVID-19 pandemic on hospital-acquired infections and multidrug-resistant organisms, and comparison with seasonal influenza
Authors: Dabaja-Younis Halima , Silman Zmira , Tarabeia Jalal , Hussein Khetam 
Published: November 2023

Abstract

Background
Effective preventive measures can curb the spread of hospital-acquired infections (HAIs) and multidrug-resistant organisms (MDROs). However, the impact of coronavirus disease 2019 (COVID-19) and measures taken during it on these infections remains unclear. This study aimed to evaluate the impact of COVID-19 pandemic on HAIs and MDROs and compare it to seasonal influenza.

Methods
A retrospective cohort study that used prospectively collected data from a tertiary referral hospital in Haifa, Israel. The study spanned from 2016 to 2021 and compared the period before and after COVID-19 and the influenza season (December-February) and the non-influenza season (March-November) in terms of the rate of hospital-acquired bloodstream infections (HA-BSI), MDROs, and Clostridium difficile infections (CDI) per 10,000 hospital days (HD). The study also measured the rate of central line-associated BSI (CLABSI) per 1,000 catheter days (CD) and the hand hygiene compliance (HHC) rates.

Results
During the COVID-19 period, HAIs and MDROs decreased compared to before: methicillin-resistant Staphylococcus aureus (4.2 vs. 6.9/10,000 HD; p&lt; 0.001), carbapenem-resistant Acinetobacter baumani (2.2 vs. 3.1/10,000 HD; p=0.02), and nosocomial CDI (3 vs. 4.6/10,000 HD; p&lt; 0.001). However, there were higher rates of carbapenem-resistant Enterobacteriaceae (4.6 vs. 2.7/10,000 HD; p&lt; 0.001) and HA-BSI (29.7 vs. 27.3/10,000 HD; p=0.006) in the COVID-19 period. CLABSI rates were not significantly different (2.3 vs. 2.7/1000 CD; p=0.910). HHC rates were 70% in both periods (p=0.151), and there were no significant differences in rates of MDROs, CDI, HA-BSI, or CLABSI (p=0.233, 0.675, 0.267, and 0.563, respectively) between influenza and non-influenza seasons.
The median acquisition rate of multi-drug resistant organisms and Clostridium difficile infections before and during the COVID-19 pandemic and during or between influenza seasons

Conclusion
During the COVID-19 period, there was a significant decrease in rates of HAIs and MDROs, accompanied by an increase in CRE rates, which could be attributed to the nationwide increase in CRE rates in Israel since 2016. The decrease in these infections was not attributable to improvement in HHC, suggesting that other factors may be involved. Furthermore, influenza did not show an impact on these infections, likely due to the particular way it is perceived by healthcare workers.

Disclosures
All Authors: No reported disclosures
2467. Automated Genomic Healthcare Epidemiology with One Codex
Authors: Davis-Richardson Austin , Zdanavicius Petras , Reynolds Timothy , Stillwell Terri , Valyko Amanda , Washer Laraine , White Jackie , Hawken Shawn 
Published: November 2023

Abstract

Background
Genomic epidemiology is promising for precision Healthcare Associated Infection (HAI) tracking, and reducing the cost of infection prevention. Despite growing access to whole-genome sequencing (WGS), genomic healthcare epidemiology is not mainstream. For healthcare genomic epidemiology to become standard, tools for analysis and interpretation that are automated, reproducible, and accessible are required.

Methods
We have extended One Codex to support analysis and interactive data visualization for genomic pathogen surveillance and outbreak investigation. First, these capabilities were evaluated for concordance with previous results including probable transmission, strain, antimicrobial resistance and virulence marker detection. Next, we describe the use of One Codex Genomic Epidemiology to investigate a potential HAI cluster of Bacillus cereus in a neonatal intensive care unit (NICU) at an academic medical center.

Results
We developed a platform integrating sequencing, analysis, health record tracking, interactive visualization and interpretation (Figure 1). WGS data can be generated or uploaded manually or through an interface with lab information systems. Data QC, taxonomic classification, antimicrobial resistance and strain detection, variant calling and phylogenetics are automatically conducted. Analysis modes include an epidemiologic curve, patient exposure and location history across isolate phylogenies (Figure 2). Clinical and sequence data and analysis results are versioned, allowing for review and audit, and are available through the application programming interface. Investigation of datasets demonstrated concordance with previous results (Table 1). Evaluation of a B. cereus cluster revealed unlikely transmission involving two patients and an environmental NICU isolate. This analysis pinpointed a single plausible transmission event requiring further investigation by Infection Prevention (Figure 2).
Investigation of a B. cereus cluster using the Genomic Epidemiology interface showing summary of SNP distances, spatiotemporal information for patients, MLST designation, epidemiologic curve and metadata summary. Patients 1 and 3 had isolates from MLST 73 which had a pairwise distance of 17 core SNPs, warranting further investigation by infection prevention to evaluate plausibility of transmission.

Conclusion
One Codex facilitated accurate, and reproducible sequence to epidemiologic insight. Applications include evaluation of prospective surveillance, early outbreak detection, and genomics-driven deployment of infection prevention resources.

Disclosures
Austin Davis-Richardson, PhD, Invitae: Employee|One Codex: employee Petras Zdanavicius, MS, Invitae: employee|One Codex: employee Timothy Reynolds, PhD, Invitae: Employee|One Codex: employee Shawn Hawken, PhD, MPH, Invitae: employee|One Codex: employee
2475. Admissions Screening for Influenza and RSV Among a Highly Immunosuppressed Patient Population
Authors: Odom Robin T , Forrester LaToya A , Michelin Angela V , Scaletta Joseph M , Henderson David K 
Published: November 2023

Abstract

Background
During the Fall/Winter 2022-23, the U.S. experienced an early surge of Influenza and RSV cases, while SARS-CoV-2 cases persisted. With concerns of a potential “tripledemic” on the horizon, the NIH Clinical Center, a clinical research hospital with a heavily immunosuppressed patient population, implemented Influenza and RSV testing, in addition to SARS-CoV-2, for all patients on admission to facilitate early detection and prompt isolation of infected patients.

Methods
Nasopharyngeal (NP) swabs (n=1213) were collected on admission from 11/2022 to 4/2023 and tested for Influenza and RSV by PCR. 1213 NP swabs from 985 unique patients were tested (some patients had multiple admissions); 1100 were tested on the Panther Fusion® SARS-CoV-2 Assay (Hologic, Inc.) and 113 using the SARS-CoV-2 RT-PCR Xpert® Xpress test. Medical chart reviews and discussions with patient care providers elucidated whether cases identified on admission were asymptomatic.

Results
Of 1213 NP swabs collected from patients admitted to our hospital, 5 (0.41%) were identified with Influenza A infection, 4 (0.33%) RSV infection and no patients were identified with Influenza B. Two (0.16%) had a known history of RSV infection, 3 (0.25%) screened negative for symptoms but subsequently disclosed symptoms, 1 (0.08%) was asymptomatic on admission but disclosed a recent history of an upper respiratory infection, and 3 were asymptomatic. All infections were detected between late November 2022 to mid-January 2023, when community transmission was high, yielding a 2-month positivity rate of 2.3% during this time of peak community spread.

Conclusion
Admission surveillance for Influenza and RSV during a respiratory virus surge in our community allowed us to isolate nine patients on admission who would likely not have been appropriately isolated, as symptom screening alone is not reliable. Surveillance is important to be able to identify infected patients promptly when respiratory infections are rampant in the community, and especially for institutions serving immunosuppressed patients.

Disclosures
All Authors: No reported disclosures
2485. Candida auris Hospital Cluster: Were Our Unwelcome Guests Driven Away by the COVID-19 Delta Surge?
Authors: Somani Jyoti , Fauzi Nazira Muhammad , Sridhar Revathi , Chan Hwang Ching , Low Isaac Taoyang , Chew Ka Lip , Fisher Dale 
Published: November 2023

Abstract

Background
Candida auris (CA) is an MDR pathogen that persists in the environment, causing outbreaks. NUH is an academic medical centre in Singapore. We describe a cluster of CA cases from April 2019 – October 2021. Our last case was during our Delta surge, just before we changed our routine inpatient cleaning to bleach based from quarternary-ammonium.

Methods
Any CA from the micro lab is escalated to the Infection Prevention Team to initiate isolation, cleaning, and contact tracing (CT) up to 30 days prior to positive cultures. In September 2020, we started enhanced surveillance via NAG (Nasal, axilla and groin) swabs in all new CRE (Carbapenem-Resistant Enterobacterales) patients. Surveillance cultures used sabouraud dulcitol agar with 10% saline incubated at 40°C. Identification and susceptibility testing done using Bruker MALDI Biotyper and Etest (Biomerieux). Hospital onset (HO) is defined as positive cultures sent after day 3 of admission. CA isolates were sent for whole genome sequencing (WGS).

Results
The 10 cases included 7 from clinical isolates, 2 from enhanced surveillance and 1 from CT. 8 were HO. 7 deaths were during the CA admission, but only 1 due to CA, and 1 occurred &gt; 60 days after positive culture [Table 1]. Of 231 contacts swabbed all were negative, except for Case 8, in whom one contact (Case 9) was positive. Positive yield from enhanced surveillance of CRE patients, was 0.84% (2/239). WGS results indicated all except Case 9 belonged to Clade I with Y132F mutation in ERG111 gene [Table 2]. Cases 2, 3, 5, 6 were closely related with 2-7 SNPs difference, but spaced in years. Cases 7 and 8 differed by 3 SNPs hence, closely related. There were 2 related clones being transmitted, and 4 unrelated sub-types of CA. Case 8 and 9 were not related, though 9 was a contact of 8. Possible links were shared equipment or admission to a common room however, admissions were either non-overlapping or non-successive [Table 3]. Case 5 was admitted to the same room after a long stay by Case 3, with one patient in between. No links found between Cases 7 and 8.

Conclusion
WGS results suggest that various clones of CA remain in the environment as reservoirs, and related cases are not often spatiotemporally related. There have been no CA cases since Oct 2021, possibly due to the change to bleach-based cleaner during our Delta surge.

Disclosures
All Authors: No reported disclosures
2488. Healthcare-associated infections in acute care hospitals in Greece, results of the third Point Prevalence Survey, April – December 2022
Authors: Palaiopanos Konstantinos , Krystallaki Dimitra , Mellou Kassiani , Mellou Kassiani , Maragkos Antonios , Politi Lida , Paraskevis Dimitrios , Tsiodras Sotirios , Zaoutis Theoklis 
Published: November 2023

Abstract

Background
The burden of healthcare-associated infections (HAIs) in European acute care hospitals is estimated through periodic Point Prevalence Studies (PPS) coordinated by European Centre for Disease Prevention and Control (ECDC). In 2016, Greece had the highest HAI prevalence among European countries (10%). The current PPS aimed to estimate the prevalence of HAIs among inpatients, especially in the context of COVID-19 pandemic.

Methods
A cross-sectional study was conducted between April and December 2022, according to ECDC PPS protocol v.6.1, in a representative sample of 50 Greek hospitals across all country regions. Patients admitted in wards before 8.00 am of the study day were screened for inclusion. Infection control teams collected hospital characteristics (e.g., total beds, infection control markers), wards (specialty, bed occupancy) and active HAIs (type, origin, microbiological results). Active HAIs included present HAIs or past HAIs that are still being treated. ECDC HelicsWin.Net software v.4.4.0, was used for data entry and analysis.

Results
Overall, 12.1% inpatients (1,175 of a total 9,707) had at least one active HAI. Among the 1,408 HAIs, the most commonly observed were lower respiratory tract infections (28.9%), bloodstream infections (20%), among which 4.6% were catheter-related, and urinary tract infections (13.1%), as shown in table 1. HAI prevalence was higher in patients of intensive care units (45.7%), compared to medical (13.5%) and surgical ones (8.2%).
Laboratory data were available for 58.9% of HAIs and 1,259 microorganisms were identified. Klebsiella species (20.5%), Acinetobacter species (12.8%), P. aeruginosa (10.2%), Candida species (7.9%) and S. aureus (6.3%) were frequent isolates. Antimicrobial susceptibility patterns varied depending on the pathogen (table 2).

Conclusion
This study shows the increased burden of HAIs among inpatients and the emergence of difficult-to-treat pathogens in Greek hospitals. Subsequent prevalence studies will provide additional evidence regarding the trend in HAI prevalence among inpatients and support the identification of modifiable practices. The invigoration of infection control and antimicrobial stewardship programs in these settings is essential.

Disclosures
All Authors: No reported disclosures
2489. An Innovative Capacity-Building Approach to Enhance Acute Flaccid Paralysis Surveillance During a Wild Poliovirus Type 1 Outbreak in Malawi, October 2022 - March 2023
Authors: Dagoe Edward , Zgambo Austin C , Tobolowsky Farrell A , Mapemba Daniel D , Kabaghe Alinune Nathanael , Tafatatha Terence , Yelewa Mtisunge , Chisema Mike N , Funsani Grace M , Mhone Brenda 
Published: November 2023

Abstract

Background
After 30 years without a poliovirus case, a wild poliovirus type 1 outbreak was declared in Malawi on 16th February 2022. To improve detection of poliovirus transmission, the country implemented enhanced AFP surveillance by deploying Frontline Field Epidemiology Training Program (FETP) graduates who had received a three-month general epidemiology training. We describe the results from October 2022 to March 2023.

Methods
Ten districts with increased risk of polio transmission and suboptimal AFP surveillance performance indicators were identified for enhanced AFP surveillance. One FETP graduate already working in each priority district was selected to be trained on poliovirus epidemiology and AFP surveillance. FETP graduates conducted active case finding for AFP cases in 100 priority health facilities (defined by epidemiologic risk and population size), provided on-the-job training for health care workers, and sensitized community volunteers and traditional healers on AFP recognition and reporting. A senior technical coordinator provided supportive supervision to FETP graduates in all 10 districts.

Results
During the observation period, FETP graduates completed 811 (44%) of 1839 visits to priority health facilities and reported 84% (59/83) of all AFP cases in the priority districts. Eleven additional AFP cases were retrospectively identified during FETP graduates’ health facility register reviews. FETP graduates trained 5,047 health care workers and educated 2,093 community volunteers.Figure 2.Number of health care workers and community members that were educated by FETP graduates on AFP case detection and notification in the priority districts by visiting month, October 2022 - March 2023.

Conclusion
The enhanced surveillance contributed to almost half of all active case search visits, detected most AFP cases in the identified priority districts, and educated the community to improve poliovirus identification and reporting. Including FETP graduates to train the local public health workforce is an innovative approach in Malawi to build capacity, rapidly mobilize in-country staff, optimize the available resources, and strengthen surveillance during a novel disease outbreak.

Disclosures
All Authors: No reported disclosures
2495. Inpatient Hepatitis C Virus Testing Increased During the COVID-19 Pandemic
Authors: Fitzgerald Brendan J , Jain Mamta K , Radunsky A L exander P , Cooper Lauren N , Hansen Laura 
Published: November 2023

Abstract

Background
We have observed an unexpected increase in hepatitis C virus (HCV) testing in the inpatient setting since the beginning of the COVID-19 pandemic. We hypothesized that this increase was driven by abnormal liver function tests (LFTs) due to COVID-19. We undertook a large observational study to test this hypothesis and to better understand the predictors of inpatient HCV testing.

Methods
We obtained medical record data for inpatients at Parkland Health and Hospital System (PHHS) from either of two 18-month time periods, representing before (8/1/2018-1/31/2020) and during (3/1/2020-8/31/2021) the COVID-19 pandemic. We evaluated possible predictors of inpatient HCV testing, including LFTs and COVID-19.

Results
Among the 34940 patients examined (18170 pre-pandemic [PP] and 16770 during pandemic [DP]), those hospitalized DP were more likely to be Hispanic and to have charity coverage (Figure 1). DP, 14.8% of inpatients received an HCV antibody (Ab) test, as compared to 13.4% of inpatients PP (p&lt; 0.001). This increase specifically occurred among patients with COVID-19, of whom 18.5% received an HCV Ab test (Figure 2). This finding correlated with a much higher occurrence of elevated initial LFTs among patients with COVID-19 (Figure 3). The positivity rate of inpatient HCV Ab tests decreased from 9.07% PP to 4.87% among patients with COVID-19 (p=0.002), but there was no difference between time periods for patients without COVID-19 (Figure 2). When considering the subset of patients with COVID-19 who had an abnormal LFT, the Ab positivity rate was 4.13% (95% CI = [2.15%, 6.12%]). Among these Ab-positive patients, the HCV RNA positivity rate was 31.3% (95% CI = [8.5%, 54.0%]).

Conclusion
Hepatic injury associated with COVID-19 inadvertently resulted in more HCV Ab testing among inpatients. The Ab positivity rate and RNA detection were lower among these patients. Compared to non-COVID-19 inpatients who have abnormal LFTs, those with COVID-19 represent a lower risk population for HCV. Nevertheless, HCV testing still led to detection of new cases. Although abnormal LFTs among those with COVID-19 likely reflect hepatic injury due to SARS-CoV-2, it should be considered as an opportunity to screen a population who may not otherwise receive routine healthcare.

Disclosures
Brendan J. Fitzgerald, Pfizer Inc.: Stocks/Bonds|Viatris Inc.: Stocks/Bonds Mamta K. Jain, MD, MPH, Gilead Sciences: Grant/Research Support|Laurent: Grant/Research Support
2505. Using an Electronic Medical Record Alert to Screen Inpatient Encounters for People with Hepatitis C
Authors: Pryal Patrick , El-Nahal Walid , Grader-Beck Thomas , Wilson Grant , Beatson Brad , Falade-Nwulia Oluwaseun , Gebo Kelly , Berry Stephen 
Published: November 2023

Abstract

Background
Despite the availability of effective therapy, rates of linkage and uptake of hepatitis C virus (HCV) treatment remain suboptimal. People with HCV are hospitalized at a rate 3.7 times that of the general population, presenting an opportunity for linkage to care during inpatient admissions. We designed two novel electronic medical record (EMR) alerts to identify patients with HCV in two hospitals, and report on the alerts’ test-performance characteristics.

Methods
We developed two distinct EMR alerts and ran them silently on all adult hospitalizations at two academic medical centers in Baltimore, MD. Based on laboratory data, and diagnosis codes (Figure 1); the first alert identified all people ever infected with HCV (ever-alert); and, the second, only people with active HCV viremia (active-alert). We evaluated each alert’s positive predictive value (PPV) by manually reviewing all charts alerted during the study period. We evaluated alert sensitivity by reviewing a sample of consecutive hospital encounters during the same period to determine if they were alerted.

Results
From 6/29/2022-8/9/2022, the alerts examined 7,519 adult hospital encounters. The ever-alert was triggered for 569 encounters; 563 of 569 were truly ever-infected (PPV 98.9% [95% CI 98.1%, 99.8%]), and 202 of 569 were actively-infected (PPV 35.5% [31.6%, 39.4%]), corresponding to an active infection prevalence of 202/7,519 (2.7%). The active-alert was triggered for 267 encounters; 188 of 267 were actively-infected (PPV 70.4% [65.0%-75.8%]), corresponding to a 2.5% prevalence of active infection. The consecutive chart review examined 1157 patients, 122 (10.5%) of whom were ever-infected, including 44 (3.8%) actively-infected. The ever-alert identified 106/122 (sensitivity 86.9% [80.9%, 92.9%]) and the active-alert identified 37/44 (sensitivity 84.1% [73.3%, 94.9%]) of these respectively (Table 1).

Conclusion
An alert designed to identify only active infection has a comparable sensitivity (84.1% vs 86.9%) but significantly higher PPV (70.4% vs. 35.5%) for active infection than an alert designed to capture any infection (active or ever). These results support the use of an EMR alert for an HCV outreach program to link patients to care.

Disclosures
Oluwaseun Falade-Nwulia, MBBS ,MPH, Abbvie Inc: Grant/Research Support|Gilead Sciences: Advisor/Consultant Kelly Gebo, MD, MPH, Pfizer: Advisor/Consultant|Spark HealthCare: Advisor/Consultant