bluuebunny/crossref_metadata_2025_split huggingface dataset:
704. Antibiotic Use Audit in Hospital-onset Clostridioides difficile (HO-CDI) Cases in a Tertiary Medical Center in New York City
Authors: Swaminathan Neeraja , Yune Philip , Cowman Kelsie , Weston Gregory D , Nori Priya , Bartash Rachel , McSweeney Terrence D , Guo Yi 
Published: November 2023

Abstract

Background
Hospital-onset Clostridioides difficile infection (HO-CDI) is a nosocomial infection that adversely impacts length of stay, morbidity, and mortality, and contributes to 6 billion dollars in U.S. healthcare expenditures. Our aim was to identify and categorize antibiotic prescribing patterns amongst patients with HO-CDI at our institution and design targeted interventions based on these findings.

Methods
A physician-assigned review of electronic medical records for all laboratory-confirmed cases of HO-CDI was conducted at Montefiore Medical Center Moses Campus (Bronx, NY) from July 2022 to March 2023. HO-CDI was defined using the CDC’s NHSN definition as a positive stool test for Clostridium difficile occurring after 3 days of hospital admission. Our hospital follows a 2-step testing algorithm: a positive test occurs when both glutamate dehydrogenase (GDH) and C. difficile toxin are detected. If there is discordance at this stage, a confirmatory polymerase chain reaction (PCR) test is performed. Formed stool specimens are rejected and Montefiore has institutional guidance for appropriate C. difficile testing. Antimicrobial choice, indication, and duration were reviewed. We characterized the inappropriateness of antibiotic use into 3 non-mutually exclusive categories (inappropriate indication, spectrum of activity, or duration).

Results
77 HO-CDI cases were identified from 15 inpatient services encompassing medical, surgical, and intensive care services. Exposure to one or more antibiotics within 30 days prior to CDI diagnosis was seen in 88% of cases (n=68). Of these, 16 (23.5%) had inappropriate antibiotic use (Table 1). Antibiotics were used for longer than clinically indicated in 11 (69%) cases. Inappropriately broad-spectrum antibiotics were used in 9 (56%) cases. Antibiotic use was deemed unnecessary in 4 (25%) cases (Figure 1). The most frequently used antibiotics were piperacillin/tazobactam in 8 (50%) cases, followed by ceftriaxone in 5 (31%) cases, and meropenem in 2 (12.5%) cases (Figure 2).

Conclusion
Targeting inappropriate antibiotics is an important strategy to reduce HO-CDI. We intend to follow-up with directed provider feedback and education and heightened antibiotic stewardship efforts.

Disclosures
All Authors: No reported disclosures
728. Potential Reservoirs for Additional Carbapenemase Gene Spread: Detection of Carbapenemase Genes in non-Pseudomonas aeruginosa and non-Acinetobacter baumannii isolates
Authors: Sabour Sarah , Kent Alyssa , Brown Allison C 
Published: November 2023

Abstract

Background
Public Health Laboratories (PHL) across 50 U.S. states, several cities and Puerto Rico participate in CDC’s Antimicrobial Resistance Laboratory Network (AR Lab Network), to test clinical isolates of carbapenem-resistant Pseudomonas aeruginosa (CRPA) and Acinetobacter baumannii (CRAB) for the presence of targeted carbapenemase (CP) genes. PHLs have submitted reports of these targeted genes in CR non-aeruginosa Pseudomonas (CR-NAP) and non-baumannii Acinetobacter (CR-NBA) isolates. Here we describe the ad-hoc detection of targeted CP genes in CR-NAP and CR-NBA species tested by the Network.

Methods
Clinical laboratories submitted CR isolates to PHLs for organism identification. Isolates were deemed suspected CR-NAP and CR-NAB when a PHL ruled out aeruginosa or baumannii, respectively, but their MALDI ToF MS database prevented further speciation. PHLs used real-time polymerase chain reaction or whole genome sequencing to detect the presence of targeted CP genes: blaKPC,blaNDM,blaOXA-48-like,blaIMP, and blaVIM in Pseudomonas and Acinetobacter, and blaOXA-23-like,blaOXA-24/40-like, and blaOXA-58-like in Acinetobacter.

Results
During 2017–2021, the AR Lab Network tested 56,092 CR-Pseudomonas isolates, 71 of which were CR-NAP; P. putida (n=15; 21%), P. fluorescens (12; 17%) P. otitidis (5; 7%), P. monteilii (3; 4%), 1 (1%) each of P. koreensis and P. mosselii, and 34 (48%) other suspected CR-NAP. Three (4%) of the 71 CR-NAP isolates tested carried a targeted CP gene: 1 P. fluorescens with blaIMP, 1 P. putida with blaVIM, and 1 P. Japonica with blaKPC.
Of 13,624 CR-Acinetobacter isolates tested, 25 (&lt; 1%) were CR-NBA; A. pitti (10; 40%), A. radioresistens (6; 24%), A. variabilis (2; 8%), 1 (4%) each of A. berezinaiae, A. lwoffii, and A. ursingii, and 4 (16%) other suspected CR-NBA. The A. variabilis isolates each harbored both blaNDM and blaOXA-58-like genes.

Conclusion
Although CR-NAP and CR-NBA isolates are not solicited by the Network, some of these species are submitted for characterization. Our findings suggest these other species do harbor some targeted CP genes and may represent unmonitored reservoirs for CP gene spread in the U.S. An expansion of testing to include these species in the AR Lab Network may improve our ability to slow the spread of antimicrobial resistance.

Disclosures
All Authors: No reported disclosures
739. Impact of Alcohol-based Nasal Decolonization’s Method of Documentation in Reducing Methicillin-resistant Staphylococcus aureus Hospital-associated Infections
Authors: Alderman Shawn , Heishman Crystal , Skiff Richard 
Published: November 2023

Abstract

Background
Infections related to multi-drug resistant organisms (MDRO) are increasingly difficult to treat and contribute to elevated mortality, prolonged length of stay and financial burden. At a 382-bed academic medical center, universal decolonization using an alcohol-based nasal decolonizing agent is performed twice daily on all inpatients, as well as chlorhexidine gluconate (CHG) bathing on select populations. Numerous studies cite decolonization as an effective reduction method for MDRO such as methicillin-resistant Staphylococcus aureus (MRSA). Unfortunately, documentation method is a seldomly considered variable.
The purpose of this review was to evaluate the impact of documentation method for an alcohol-based nasal decolonization agent in reducing MRSA hospital-associated infections.

Methods
The study included all National Healthcare Safety Network (NHSN) defined hospital associated laboratory identified (Lab ID) MRSA blood infections from July 2019 through March 2023. Data was divided into descriptive categories with number of infections noted. The baseline period included population specific decolonization (n=35), followed by universal decolonization documentation via nursing task list (n=13), and concluded with electronic medication administration record (EMAR) implementation (n=7). The Kruskal Wallace Test was utilized for evaluation due to non-normative distribution.

Results
A Kruskal Wallace H Test indicated a statistical significance in medians between the task list and EMAR H(1) =5.10, p=0.024. There was no significance noted between the baseline and task list H(1 =0.04), p=0.841. Medians between baseline and EMAR approached significance but did not meet for this study H(1) =3.24, p=0.072.
Clinically, there was a reduction in MRSA Lab ID of 48% between baseline and task list, followed by a 46% reduction between task list and EMAR. Overall reduction from baseline to EMAR was 80%.

Conclusion
Reduction of infection is crucial for patient safety and quality outcomes. Documentation is not typically highlighted as a risk reduction method. This study noted a significant decrease in hospital-associated MRSA Lab ID events after transition of documentation from the nursing task list to the EMAR.

Disclosures
All Authors: No reported disclosures
741. Assessing the Concordance of MRSA Carriage Screening with MRSA Infections
Authors: Mannheim Jonathan , Kumar Madan , Bhagat Palak , Nelson Allison 
Published: November 2023

Abstract

Background
There is a lack of research on MRSA surveillance in children. This study focused on children with confirmed MRSA infections to determine the utility of MRSA screens in guiding empiric anti-MRSA treatment for children without history of MRSA infection. We examined the concordance of screens to assess for differences by infection type, and used statistical analysis to determine significant contributors to concordance.

Methods
Pediatric hospital patients admitted from 2002-2022 were included. Subjects had MRSA infections subsequent to a MRSA surveillance screen performed in the preceding year. Statistical analysis, namely multivariable and binomial regression, identified associations between MRSA screens and infections. Number needed to treat analysis calculated the utility of re-screening.

Results
Among 246 subjects, 39.0% had concordant screens. 151 (61.4%) screens were obtained in the two weeks preceding infection. Sensitivity for bacteremia was 50.0% (n=42), for ET/respiratory 44.4% (n=81), for SSTI 29.4% (n=102). For children under 6 months of age, sensitivity was 35.9% (n=78). Multivariable analysis significantly associated days since MRSA screening and decreasing likelihood of concordance. Binomial regression modeled the probability of concordance to drop below 50.0% for all infections after four days, after six days for bacteremia specifically, and twelve days for ET/respiratory infections.
Probability of Concordance Over Time
The probability of MRSA screening concordance over time based upon binomial prediction modeling. Each line represents the probability of concordance on a given day subsequent to MRSA screening.
Number Needed to Treat (test) Analysis
A theoretical control arm of patients receiving no re-screening is compared to a theoretical treatment arm receiving re-screening. Each column represents the number needed to re-screen (for a given number of days) to predict one MRSA infection. Absolute risk reduction is overlaid.

Conclusion
The concordance of screens was far lower than NPV found in past studies. Bacteremia concorded at 50.0%, ET/respiratory infections 44.4%, SSTI 29.4%. The number of days elapsed since MRSA screening proved the only significant covariate. When that covariate modeled the probability of screening concordance with infection, 7 days represented when the probability of concordance fell to or dropped below 50.0% for infection types. Only patients with a known MRSA infection were included in our study, and concordance of screens was far lower than NPV found in past studies; previous results may have been impacted by low prevalence to inform high NPV. We suggest that negative MRSA screens should not invalidate reasonable suspicion for MRSA infection in patients with high pre-test probabilities for infection. Re-screening patients may optimize concordance.

Disclosures
All Authors: No reported disclosures
750. Launching the South Carolina Regional Infection Prevention Training (SCRIPT) Center: A Pilot in Interprofessional Education
Authors: Bailey Pamela , Dash Sangita , Williams Shanetta , Custer Sabra , Derrick Caroline , Green Katherine , Al-Hasan Majdi N , Justo Julie Ann 
Published: November 2023

Abstract

Background
Structured education of healthcare professionals around infection prevention practices and protocols is currently lacking. We launched a pilot program of an infection prevention interprofessional education (IPE) elective for students in their clinical years of medical, pharmacy, nursing, and physician assistant school.

Methods
Both quantitative and qualitative assessments prior to initiation and at completion of the 2-week multidisciplinary interactive and practical IPE elective were performed. We assessed students’ confidence with specific infection prevention skills knowledge, and attitudes towards IPE, and obtained qualitative feedback. Wilcoxon signed rank test was used to compare assessment results before and after IPE elective.

Results
Twelve students completed the IPE elective. There was a significant increase in Lickert scale rankings of students’ comfort level with various infection prevention concepts and skills after IPE (p&lt; 0.001). Similarly, a significant improvement in students’ assessment of their IPE attitudes was noted after completion of the IPE elective (p=0.001).
Feedback comments included: “I really enjoyed learning the ‘why’ behind everything [because] it's made me comfortable passing the information to others and speaking up if needed--even still as a student”; “learned information I will use every day”; “people from different backgrounds”; “knowledgeable facilitators, excited to teach & facilitate learning.”

Conclusion
Infection prevention education was impactful via the incorporation of an IPE elective into clinical rotations, and use of knowledgeable and adept teachers from multiple disciplines. Leaders emphasized the “why” behind protocols, and allowed students to practice the hands-on skills of infection prevention.

Disclosures
Julie Ann Justo, PharmD, MS, FIDSA, BCPS, Gilead Sciences: Advisor/Consultant|Shionogi: Advisor/Consultant|Vaxart: Stocks/Bonds
785. British Transplant ID, Mycology, and Infection in the Immune Compromised Network (BRITMIC) -Addressing the unmet need of Transplant ID in the United Kingdom
Authors: Stone Neil R H , Murthy Saraswathi , Wey Emmanuel , Lambourne Jonathan 
Published: November 2023

Abstract

Background
There is currently no formal sub-specialty training program in transplant ID or mycology in the UK. Practice is diverse and is provided by either ID physicians or clinical microbiologists with a self declared interest in these aspects of infection medicine. To address this, we established a new network is designed to promote this ever expanding niche within the wider specialty of infectious diseases and microbiology

Methods
British Transplant ID, Mycology, and Infection in the Immune Compromised Network (BRITMIC) was established in 2021 as a UK-wide network for infection specialists with an interest in clinical mycology, infections in solid and stem cell transplants and infections in the immunocompromised host. Our aim is to share interest and experience in invasive fungal infections and transplant infectious diseases, and provide a platform for communication, education and research, as well as real-time clinical case discussions.

Results
Since establishment we have 117 registered members and have run quarterly meetings (currently virtual), with our inaugural meeting having been held in July 2021. We have held 10 meetings to date had outstanding international guest speakers, complex case discussions, as well as hosting a highly successful session on Transplant ID at the Federation of Infection Societies (FIS) Conference in November 2021. We are now affiliated to the larger British Infection Association (BIA) and have an established governance framework and terms of reference.
Achievements to date include developing a UK working group on treatments for COVID-19 in the immune suppressed and establishing a national case conference for complex mycology or transplant related infections.

Conclusion
The BRITMIC Network has established a new resource for mycology and transplant ID in the UK, and is an important stepping stone to establish these as recognised sub specialties within the field of ID in our setting. This can act as a model for others in settings with limited existing networking and education infrastructure in this branch of ID

Disclosures
Neil RH Stone, MD PhD, Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Gilead: Honoraria|Pfizer: Honoraria|Shionogi: Honoraria Emmanuel Wey, MBBS, Clover Biosoft: Advisor/Consultant Jonathan Lambourne, MB BS, BA, MSc, DTM&H FRCP, FRCPath, PhD, Mundipharma: Advisor/Consultant|Mundipharma: Advisor/Consultant
807. Trimethoprim/Sulfamethoxazole for Pneumocystis jirovecii pneumonia prophylaxis in B-cell lymphoma: A multicenter randomized double-blinded placebo-controlled trial
Authors: Angsutararux Taksaon , Wongwatcharanon Kiattikon , Dhitinanmuang Wutthiseth , Chintabanyat Anothai , Jit-Ueakul Dusit , Owattanapanich Weerapat , Karoopongse Ekapun , Jangkananun Piyanut , Piyabun-yanon Chavada , Munsakul Warangkana , Chayakulkeeree Methee 
Published: November 2023

Abstract

Background
The studies to compare the efficacy and safety of trimethoprim/sulfamethoxazole (TMP/SMX) for Pneumocystis jirovecii pneumonia (PJP) prophylaxis in lymphoma patients are scared.

Methods
A multicenter randomized double-blinded placebo-controlled trial was conducted in adult B-cell lymphoma patients receiving R-CHOP. Participants were randomly assigned to received either TMP/SMX (160/800 mg) or placebo trice weekly until 1 month after the last chemotherapy cycle. The primary outcome was PJP at 30 days after cessation of chemotherapy. The secondary outcomes were bacterial infection, survival at day 90 and adverse drug reactions. The modified-intention-to-treat analysis included participants who received at least one dose of the study drugs. Per-protocol analysis included participants who received a complete course of the study drugs or met the study endpoints.

Results
A total of 110 patients were enrolled to the study. Five patients were self-withdrawn after randomization and did not receive any of the study drugs given. Thirteen patients were lost to follow up during the study and 4 patients were prematurely terminated. Therefore, 105 patients were included in the modified intention-to-treat analysis, 55 in TMP/SMX and 50 in placebo group. Eighty-eight patients were included in the per-protocol analysis, 48 in TMP/SMX group and 40 in placebo group. For modified intention-to-treat analysis, 1 patient in the TMP/SMX group developed PJP (1.8%), compared to 0% in the placebo group (p-value 1.0). There was indifference of bacterial infection rate between the TMP/SMX and placebo groups (16.3% and 14%, respectively; p-value 0.7). The survival rate without PJP events within 90 days was comparable between TMP/SMX and placebo group, 96.4% and 96%, respectively (p-value 1.0). Adverse events were significantly higher in the TMP/SMX group compared with the placebo group (18.2% vs. 2%; p-value 0.007). Per-protocol analysis also showed no statistically significance in PJP, bacterial infection and 90-day survival between two groups.

Conclusion
TMP/SMX cannot be recommended for primary prophylaxis in lymphoma patients receiving R-CHOP at this time, as it showed higher adverse effects with no benefit on prevention of PJP and bacterial infection as well as survival.

Disclosures
All Authors: No reported disclosures
840. Risk-Based Screening on Admission Cultures (SOAC) vs. Unit-Wide Reactionary Surveillance Cultures (UWRC) for Candida auris: A Pilot QI Study in a Tertiary Care Center ICU
Authors: Strong Nora , Patel Bela , Daniels LaRhonda , Ausborn Valerie , Mitchell Elizabeth , Denman Chris , Von Wenckstern Toni , Ellsworth Misti G , Ostrosky-Zeichner Luis , Wanger Audrey 
Published: November 2023

Abstract

Background
Candida auris (C. auris) is a highly pathogenic, often multidrug resistant organism, that spreads in healthcare facilities. CDC recommends UWRC when a case is found in a unit. Currently, no recommendation exists for C. auris SOAC. We investigated if UWRC can be avoided, and clinical cases be prevented by SOAC in high-risk patients being admitted to an ICU.

Methods
We conducted a pilot QI study in which high-risk patients for C. auris colonization (defined as those admitted from long term care facilities, a history of echinocandin use in the last 3 months, or a history of C. auris infection or colonization) were screened for skin colonization with fungal axillary and groin swab cultures. These patients were placed on contact precautions pending test results. If C. auris was recovered, the patient would be upgraded to “Contact plus” precautions. If cultures were negative, precautions were downgraded to standard. No UWRC would be required if patients were identified and isolated upfront. We tracked the number of SOAC and clinical cases and compared them to the number of UWRC and clinical cases in the pre-study period.

Results
Between January 2023 and March 2023, an average of 273 C. auris UWRCs were performed per month in reaction to 18 clinical cases, with 8 positive surveillance cultures over those 3 months (0.98% positive rate). In April 2023, our pilot study month, a total of 13 admission screening cultures were collected, of which none were positive. No UWRC were performed, and no clinical cases were detected.

Conclusion
Although limited by the pre- and post-nature, the abbreviated time, and the sample size of this pilot QI study, we found that risk based SOAC is a strategy that warrants further study as an alternative to UWRC, which are costly and labor intensive.

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
852. Epidemiology, clinical characteristics and outcomes of invasive pulmonary aspergillosis among critically ill patients in medical intensive care unit: A retrospective study from the tertiary care hospital in Thailand
Authors: Yutthana Noppharut , Jutivorakool Kamonwan , Vanichanan Jakapat 
Published: November 2023

Abstract

Background
Invasive pulmonary aspergillosis (IPA) is a serious infection which leads to poor outcomes particularly in immunocompromised patients. Recently, IPA in critically ill patients in intensive care unit (ICU) has been increasingly recognized owing to its substantial morbidity and mortality. However, clinical data of IPA in ICU is scarce especially in Thailand.

Methods
A single-center, retrospective, observational study was conducted in King Chulalongkorn Memorial Hospital. We collected data on demographic, clinical characteristics, and outcomes of the patients who developed IPA during admission in the medical intensive care unit (MICU) between Jan 2016 to Dec 2021. IPA was identified by using ICD-10 and medication code for voriconazole, amphotericin B or liposomal amphotericin B. Patients met proven, probable IPA according to EORTC/MSG definition or putative IPA were included. The primary outcome was the incidence of IA in the MICU. Clinical characteristics, 12-week all-cause mortality and associated risk factor were the secondary outcomes.

Results
During the study period, a total of 5,019 patients were admitted in MICU. Fifty-seven met definitions of IPA which represented incidence of 1.14%. Seven patients (12.3%) had proven IPA, while 37 (61.4%) and 13 (22.8%) patients had probable and putative IPA, respectively. Cardiovascular disease (33.3%), chronic liver disease (26.7%), and diabetes (20.0%) were common comorbidities in patients with putative IPA. Diagnosis was made at median of 5 (3-10) days after ICU admission. Organisms were identified in 36 patients (63%) which Aspergillus fumigatus was the most common species (36.8%). All-cause mortality at week 12 was 89.5%. SOFA score (OR 1.494, 95%CI 1.058-2.110) and vasopressor used on admission (OR 16.00, 95%CI 2.209-115.92) had trend toward increase mortality. Median survival in putative and probable IPA group were 4 and 8 days after diagnosis (p= 0.023). Patients who received treatment with voriconazole had median survival 13 days compared to 5 days in other antifungal agents (p= 0.006).

Conclusion
IPA carried a high mortality among critically ill patients in MICU. High SOFA score and vasopressors used at the MICU admission were associated with mortality. Voriconazole therapy appeared to correlate with longer survival time.

Disclosures
All Authors: No reported disclosures