bluuebunny/crossref_metadata_2025_split huggingface dataset:
2413. Drug Use Associated vs Non-Drug Use Associated Endocarditis in an Academic Center from 2012-2017
Authors: Sobhanie Mohammad Mahdee , Clark Meagan J , Hebert Courtney , Haden Michael 
Published: November 2023

Abstract

Background
Drug use associated Infective Endocarditis (DU-IE) has been noted to be increasing over the last decade(Clinical Infectious Diseases® 2020;71(7):1664–7). In this study we sought to assess the unique aspects of DU-IE compared to IE not associated with drug use. We undertook an in-depth descriptive study of patients who presented with IE over the course of 5 years at one large academic medical center.
Table 1

Methods
This was a retrospective chart review of patients with IE admitted to the Ohio State Wexner Medical center between 2013 and 2017. Prisoners, patients &lt; 18 or &gt; 89 years of age, and pregnant patients were excluded from the study. The first admission during the study period in those with definitive or probable endocarditis by Duke criteria, were included. Persons who inject drugs (PWID) with IE were compared with those with IE without documentation of drug use. DU was determined by both ICD coding and manual chart review. Given the discrepancy between the two, chart review was used for the analysis. Differences in proportion were compared using Fisher’s exact, and continuous variables using student’s t-test.

Results
Overall, 713 patients met inclusion criteria. Approximately half (45.6%) of the patients had DU-IE, this proportion generally increased over the 5 years, with 59.8% of the cases being DU-IE in 2017. DU-IE patients were more likely to be younger, female, and have a lower Charlson comorbidity score. DU-IE patients were significantly more likely to have MRSA, Gram Negatives and Candida species, whereas non DU-IE was more likely to have Coagulase negative staph species. DU-IE patients were less likely to have a transesophageal echocardiogram, and unsurprisingly were more likely to have tricuspid valve involvement, and pulmonary septic emboli.

Conclusion
The patient population with DU-IE compared to non-DU IE differ from one another, and further studies are required to better understand long-term clinical outcomes in the treatment between each group.

Disclosures
All Authors: No reported disclosures
2418. Incidence and Characteristics of Midline-Associated Bloodstream Infections in an Urban Healthcare System
Authors: Choudhury Rebecca , Ehni Jordan , Rabinovitz Itay , Ekhelikar Nikita , Javaid Waleed , Camins Bernard , Jangda Mateen 
Published: November 2023

Abstract

Background
Midline catheters may carry a lower infection risk than central venous catheters, but available data is limited. Central line-associated bloodstream infection (CLABSI) incidence has increased during the COVID-19 pandemic, but is unclear what influence the pandemic has had on midline-associated bloodstream infections (MABSI). The objective of this study was to determine the incidence of MABSI during the COVID-19 pandemic and which pathogens were involved.

Methods
A health system infection prevention database was used to identify adult patients admitted to 6 acute care hospitals in 2021 who had a midline during admission and a positive blood culture. Cases were reviewed by a hospital epidemiologist and 3 supervised trainees for demographic data, microbiology data, and MABSI attribution using National Healthcare Safety Network (NHSN) CLABSI definitions.
Midline-Associated Bloodstream Infection Identification

Results
579 patients with possible MABSI were identified. 88 patients were determined to have a MABSI. 28 patients were excluded due to having a CLABSI-eligible central line at the time of the BSI. The remainder were excluded because the BSI did not fall within a MABSI eligibility period or because the BSI was secondary to another infection. MABSI and CLABSI rates for each hospital are shown in Table 1. MABSI occurred mostly in medicine patients (73, 82.95%). A slight majority of patients were male (48, 54.54%), and median age was 66 years (range 24-96). The most common organisms were Candida spp. (27), coagulase-negative Staphylococcus spp. (17), Enterococcus spp. (17), and Staphylococcus aureus (15). The 2021 yearly health system MABSI and CLABSI rates were similar (1.29 vs. 1.2), with variation between hospitals. Quarterly MABSI and CLABSI rates are shown in Figure 2. The health system MABSI rate appeared to increase during Winter 2021, while the CLABSI rate seemingly decreased.
MABSI and CLABSI Rates
MABSI and CLABSI rates by quarter of 2021. The blue line represents the MABSI rate, while the orange line represents the CLABSI rate.
Organisms isolated from blood cultures in MABSI patients. Gram positive bacteria were the most common isolates (57/123, 46.34%). More than 88 organisms were detected as many MABSI involved ≥2 possible pathogens (27/88, 30.68%).

Conclusion
In this study MABSI demographics were similar to those reported for CLABSI in other studies. While gram positive bacteria were common, as described in CLABSI, we also observed a high proportion of infections due to Candida spp. The health system MABSI rate was higher than the CLABSI rate, contrary to some studies. This was primarily driven by hospitals which were heavily impacted by the Omicron subvariant surge.

Disclosures
Bernard Camins, MD, MSc, Puro Lighting, LLC: Advisor/Consultant
2419. Increasing Misattribution of Bacteremia as CLABSIs by NHSN Definitions: A Tertiary Care Center Perspective
Authors: Ellsworth Misti G , Ausborn Valerie , Patel Bela , Chang Phillip , Ostrosky-Zeichner Luis 
Published: November 2023

Abstract

Background
The US has experienced a significant decrease in CLABSI rates over time but is stalling. NHSN has rigid definitions for secondary BSI attribution. We reviewed CLABSIs in a large tertiary acute care hospital to determine the frequency and trends of potential misattribution.

Methods
We reviewed 282 CLABSIs cases from 2019 to 2023 at a large tertiary hospital. A team of infection preventionists with high inter-rate reliability adjudicated each case strictly following NHSN methodology. A clinical review was performed by two hospital ID-trained epidemiologists to explore misattributed with an alternative primary infection.

Results
Of 282 CLABSI cases, 65% occurred in adults and 35% in children. 122 cases (43%) had a potential primary infection. The potential primary infections included: 33 (27%) pneumonia, 28 (23%) gastrointestinal infections, 6 (5%) urinary infections, 4 (3%) surgical infections, 13 (11%) skin and soft tissue infections, 11 (9%) vascular infections, 5 (4%) bacterial translocation, 8 (6.5%) infections that were present on admission, 4 (3%) CNS infections, 2 (1.6%) NEC infections, 2 (1.6%) musculoskeletal, 2 (1.6%) contaminates and 4 (3%) other non-NHSN specified sites. Pneumonia was the most frequent misattribution failing to meet imaging, laboratory, or documentation requirements within the infection window period (IWP). Intra-abdominal infection was the second most frequent cause of misattribution due to not meeting the imaging or matching site culture within the IWP. For the other categories, the most frequent reasons for not meeting the primary criteria included lack of matching culture, lack of clinical symptoms (often in intubated patients), or in the endocarditis category, the complexity of the criteria even with positive blood cultures and presence of vegetations. The graph shows an increasing proportion of misclassification over time.
Percent of Misattributed CLABSI by Fiscal Year

Conclusion
NHSN definitions and rules are becoming too prescriptive and may no longer be applicable to the complexity of cases, overestimating CLABSIs. As hospitals commit to CLABSI reduction, accurate and specific definitions are key in focusing efforts and attention and avoiding unfair penalties.

Disclosures
Luis Ostrosky-Zeichner, MD, FACP, FIDSA, FSHEA, FECMM, CMQ, Astellas: Grant/Research Support|Cidara: Advisor/Consultant|Cidara: Advisor/Consultant|F2G: Advisor/Consultant|Gilead: Advisor/Consultant|Gilead: Grant/Research Support|GSK: Advisor/Consultant|Melinta: Advisor/Consultant|NIH: Grant/Research Support|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Pfizer: Honoraria|Pulmocide: Grant/Research Support|Scynexis: Grant/Research Support|T2 Biosystems: Grant/Research Support|Viracor: Advisor/Consultant
131. Impact of an Algorithm to Triage Patients Discharged from the Emergency Department with Blood Cultures Positive for Staphylococcus aureus or Coagulase-negative Staphylococci
Authors: Brenneman Ethan , Theophanous Rebecca , Mando-Vandrick Jennifer , Toler Rachel , Jones Justin , Keil Elizabeth , Zhou Grace , Lee Hui-Jie , Moehring Rebekah W , Wrenn Rebekah 
Published: November 2023

Abstract

Background
Patients may be discharged from the emergency department (ED) prior to final data from blood cultures. When positive, the ED provider must evaluate to determine next steps in caring for the patient. Up to 55% of positive blood cultures can be contaminants, and calling patients back to the ED may cause undue burden to the ED if no treatment or further evaluation is needed. We developed a toolkit to assist provider response to positive blood cultures for Staphylococcus aureus and Coagulase-negative staphylococci (CoNS) in patients discharged from the ED. It identifies which patients need to return to the ED (callback) and which do not (likely contaminant).

Methods
We conducted a multi-center, retrospective cohort study of patients with positive blood cultures with staphylococci from January 2019 through October 2022 resulting after discharge from 3 EDs. The objective was to compare the rate of callback to the ED in a retrospective cohort to the rate guided by adhering to a newly developed callback algorithm. The rate of actual callback to ED and the rate of callback to ED based on adhering to the algorithm was calculated with 95% Wilson score binomial confidence intervals (CIs). Asymptotic McNemar’s test was used to compare the paired binomial proportions, and the difference in the rates was estimated with 95% CI using the Newcombe square-and-add approach.

Results
Out of 188 patients discharged from the ED with the growth of staphylococci in the blood cultures, the rate of patient callback was 61.2% (115/188, 95% CI 55.2% to 66.8%), compared to the algorithm advised callback rate of 45.7% (86/188, 95% CI 39.9% to 51.7%). The difference between the actual callback and the algorithm-based callback rates was 15.4% (95% CI 9.8% to 20.9%, p&lt; 0.001).

Conclusion
Implementation of an algorithm-based response to blood cultures can reduce unnecessary callbacks to the ED without compromising patient safety.

Disclosures
Rebekah W. Moehring, MD, MPH, FIDSA, FSHEA, UpToDate, Inc.: Author Royalties
2422. Relative Risk of Patients Having a Catheter-Associated Urinary Tract Infection Within 7 days of Having an Indwelling Urinary Catheter Reinserted Within 24 Hours of Indwelling Urinary Catheter Removal
Authors: Hadhazy Eric , Shepard John , Graf Angela , Goor Joy , Buchake Bilwa , Lee Yohan , McIntyre Karen 
Published: November 2023

Abstract

Background
Indwelling urinary catheters (IUC) are reinserted in patients who should initially be managed with intermittent straight catheterization for urinary retention. We hypothesize patients who have an IUC reinserted within 24 hours will be at higher risk of catheter-associated urinary tract infections (CAUTI) within 7 days compared to patients who were straight catheterized or did not have an IUC reinserted.

Methods
A retrospective review of electronic health records (EHR) using Epic Systems (Verona, Wisconsin) was conducted for all inpatients at Stanford Hospital, Palo Alto, CA who had an IUC removed and a CAUTI defined by the National Healthcare Safety Network (NHSN) between January 1, 2020 to March 31, 2023. Patients with an IUC reinserted within 24 hours from initial removal of an IUC were compared to patients who had an IUC removed and did not have a reinsertion of an IUC within 24 hours. Relative risk of a CAUTI was the primary outcome metric.

Results
Between January 1, 2020 and March 31, 2023 there were 30,161 IUCs removed and 204 NHSN defined CAUTI identified within 7 days of removal that were included in the study. Patients who had an IUC reinserted within 24 hours had significant risk (RR: 7.96, p&lt; 0.05) of having a CAUTI within 7 days post IUC removal compared to patients who did not have an IUC reinserted within 24 hours.Figure 1.Relative Risk of CAUTI with Indwelling Catheter Reinsertion

Conclusion
Reinsertion of IUCs in patients with urinary retention following IUC removal should be managed with intermitted straight catheterization or more conversative methods if possible. Patients who are re-catheterized with an IUC within 24 hours of removal are at significantly higher risk of developing a CAUTI within 7 days compared to patients who are straight catheterized or do not have a Foley catheter reinserted. Healthcare providers should use alternative methods of bladder management to improve patient outcomes.

Disclosures
All Authors: No reported disclosures
2423. Central venous catheter tip colonization and associated bloodstream infection in severe burn patients
Authors: Jeon Kibum , Han Seung Beom 
Published: November 2023

Abstract

Background
Because severe burn patients are at higher risk for catheter-related infections, routine changes of central venous catheters (CVCs) are commonly performed for them. However, there are limited information on pathogen colonization of the CVC tip and associated bloodstream infections (BSI) in burn patients.

Methods
In this study, medical records of severe burn patients, in whom routine CVC changes were performed every 7 days, were retrospectively reviewed. The results of CVC tip cultures and concurrently performed blood cultures were investigated.

Results
A total of 686 CVCs in 214 severe burn patients admitted to the burn intensive care unit were analyzed. A median of 2 CVCs (range: 1–15 CVCs) were inserted in each patient, and each CVC was maintained for a median of 8 days (range: 2–24 days). The median duration of catheterization was 17 days (range: 4–117 days). Of the 686 CVCs, 138 (20.1%) CVC tips were colonized by 150 pathogens (two pathogens in 12 CVCs), and 82 (59.4%) of them accompanied BSIs caused by the same pathogen. Non-flame burn (p &lt; 0.001), higher total body surface area burn (p &lt; 0.001), renal replacement therapy (p &lt; 0.001), and femoral catheter (p &lt; 0.001) were significantly associated with the development of catheter-related BSI in a multivariate analysis. Most cases of tip colonization (81.3%) and BSI (82.9%) were caused by Gram-negative bacteria: Acinetobacter baumannii and Klebsiella pneumoniae were most frequently identified.

Conclusion
Catheter-related BSI was accompanied in 12.0% of the changed CVCs: nine of ten CVCs might not require routine changing. Therefore, selective CVC changing at higher risk for catheter-related BSI seems to be appropriate rather than routine CVC changing in severe burn patients. Also, source control for burn wounds should be emphasized because most common pathogens of burn wound infection caused CVC tip colonization and BSI.

Disclosures
All Authors: No reported disclosures
2432. Antibiotic Lock Therapy as a Line Salvage Strategy for Catheter-Related Bloodstream Infections: A Retrospective analysis
Authors: Ranganath Nischal , Dumais Mitchell , Nair Vaisak , Tabaja Hussam , Stevens Ryan W W , O’Horo John C , Shah Aditya 
Published: November 2023

Abstract

Background
Catheter-related bloodstream infection (CRBSI) is an important complication of long-term central venous catheters (CVCs) and is associated with high morbidity and cost. While line removal is optimal, it is not always feasible and is not without complications. Antibiotic lock therapy (ALT) may be an alternative strategy for line salvage, but the efficacy of this approach particularly among immunocompromised hosts is unknown.

Methods
We retrospectively reviewed adult patients with CRBSI managed with ALT between 2018 and 2022 at our tertiary medical center. We reviewed patient comorbidities, type and indications for CVC use, microbiology of CRBSI, ALT, and use of systemic antibiotics. Outcomes included 30-day mortality, 90-day microbiologic relapse (with same bacteria as index case), 90-day recurrent BSI (with different bacteria from index case), and adverse events.

Results
86 patients were reviewed, a majority of whom were immunocompromised (91%) due to hematopoietic stem cell transplantation (85%) and thrombocytopenic (platelet count 36; IQR 17-112). 78% had tunneled CVC for indications including peri-transplant therapy (72%), chemotherapy (15%), and TPN (6%) (Table 1). The median time to CRBSI following CVC insertion was 45 days (IQR 19-86). Infections were frequently monomicrobial (80%) due to Gram-positive organisms (n=75) including coagulase-negative staphylococci and Enterococcus spp. The minority of Gram-negative (n=17) infections were due to E coli and Enterobacter spp. 94% of patients received systemic antibiotics and all patients received ALT for a median of 11 days [IQR 6-15] and 11.5 days [IQR 6-14], respectively (Table 2). The 30-day attributable mortality rate was low at 1%. Rates of 90-day microbiologic relapse (20%) and recurrent BSI (16%) were high, occurring at a median of 42 days (IQR 12-55) and 35 days (IQR 25-50) following completion of ALT, respectively (Table 3).

Conclusion
Despite high rates of microbiologic relapse and recurrent BSI, ALT may be an effective line salvage strategy extending the use of CVC by up to 30 days with minimal impact on mortality even among immunocompromised patients.

Disclosures
John C. O'Horo, Sr., MD, MPH, Janssen Pharmaceuticals.: Grant/Research Support|nference: Grant/Research Support
2433. Implementation of Midline Vascular Access Program and Reduction of Central Line-Associated Bloodstream Infections (CLABSI) in an Intensive Care Unit at a Community-Based Hospital
Authors: SAAD E L T A I B A , Meng Qingqing , Faris Mohammed , Stake Jonathan 
Published: November 2023

Abstract

Background
Central venous catheter (CVC) placement is the most frequently performed procedure in acute care hospitals for various indications in multiple clinical settings. CVCs are the main source of hospital-acquired bloodstream infections in the United States (US). Central line-associated bloodstream infections (CLABSIs) constitute a significant contributor to gross healthcare expenditure in the US health system. Reduction of the duration of the CVCs is a key factor to decrease the risk of CLABSI.

Methods
A retrospective study was conducted to compare the annual incidence of CLABSI rate, total CVC days, and device utilization ratio before and after the implementation of a midline vascular access program as an institutional-based intervention to reduce the CLABSI rate in the intensive care unit (ICU).

Results
The midline vascular access program was started in June 2021. Two study groups were compared (Group 1 includes the study period from January 2019 to June 2021 and Group 2 from July 2021 to December 2022). CLABSI number decreased from 22 to nine. The CLABSI rate (measured as CLABSI number per 1000 CVC days) decreased by 52% (6.8% o 3.3%) (P &lt; 0.05) . There was a reduction in the total CVC days (3198 days in Group 1 vs 2731 days in Group 2) but it was not significantly associated with the decline in the CLABSI rate (P=0.0702). A 60% significant reduction rate was observed in the device utilization ratio (measured as total CVS days/ total patients’ days) (0.6 to 0.3) (P &lt; 0.001), which was significantly associated with the decrease in the CLABSI rate (P&lt; 0.001).Table 1.Results of study variables between the two study groupsFigure 1.The monthly number of CLABSI infections during the study period.

Conclusion
The midline vascular access program was associated with a reduction in the CLABSI rate per 1000 CVC days and the device utilization ratio in our ICU. The authors of this project are currently conducting a larger prospective case-control study to ascertain our preliminary study’s results which have some limitations attributed to its retrospective nature and sample size.

Disclosures
All Authors: No reported disclosures
2437. The Impact of Healthcare Associated Infections on Costs and Lengths of Stay 2019-2023
Authors: Sentiff Jennifer L , Yenugadhati Vamsi , Spitz Courtney , Glassman Shannon , Phillips Matthew , Frey Stephany , Lesho Emil P 
Published: November 2023

Abstract

Background
As 85% of hospitals in the U.S. face unsustainable operating margins, extraordinary labor costs (LC) from nursing shortages, and have under resourced infection prevention departments, updated assessments of the costs of healthcare associated infections (HAI) are needed. However, most published cost analyses are either more than a decade old, or did not adjust for timing of infection. We sought to determine excess lengths of stay (LOS) and LC associated with HAI during the COVID-19 era, while adjusting for timing of infection.
Timing of Infection Onset In Patients with an HAI
Legend: dark orange = days before infection; light orange = days after infection; yellow bar = geometric mean national average length of stay of uninfected patients with the same diagnosis code; green circle = mean length of stay of local uninfected controls

Methods
All inpatients in an academic tertiary care center and 4 community hospitals in Western NY from 01-01-19 to 12-31-22 were included. Using nationally standardized definitions of catheter-associated urinary tract (CAUTI), central line associated bloodstream (CLABSI), and surgical site infections (SSI), 728 HAIs were identified and compared to patients during the same encounter with the same diagnosis codes (DRG) without an HAI (n= 90,046). Only days after infection onset were used to calculate excess LOS and cost.

Results
The mean yearly standardized infection ratios (SIRs), as defined by the National Healthcare Safety Network, were 0.89, 0.98, and 1.14 for CLABSI, CAUTI and SSI, respectively. Patients with an HAI had significantly higher LC and longer post-infection LOS (all p-values &lt; 0.005) compared to a national benchmark and their DRG-matched HAI-negative counterparts. Per admission, the average excess labor cost and excess LOS were $43,975, 13.4 days for CLABSI; $31,253, 8.9 days for CAUTI; and $5,985, 1.4 days for SSI (Table). The 4-year total was $23.4 M, and 4810 excess days. 100% of CLABSI and CAUTI occurred after the 13th day, and the pre and post-infection LOS were similar. SSI occurred early in admission, and the post-infection LOS was longer than the pre-infection LOS (Figure). Re-admission occurred for 83% of SSI. For CLABSI and CAUTI excess LOS and costs increased 178% over the study period.

Conclusion
These findings suggest that for CLABSI and CAUTI, minimizing pre-infection LOS can provide a greater economic and safety impact than focusing entirely on preventing the infection. However, for SSI, focusing on preventing the infection may provide the greatest benefit. Other hospitals can adjust these data based on their individual SIRs.

Disclosures
All Authors: No reported disclosures