bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-386. Assessing Implementation of Evidence-Based Practice Recommendations for Prevention of Surgical Site Infections Through a Statewide Survey of Nebraska Hospitals
Authors: Pavlovsky Lacey , Kanishka Fnu , Preusker Jenna , Baker Mikayla , Hill Tammy , Hoogestraat Laura A , Kinyoun Mary W , Nelson Emily , Martinez Rebecca , Penn Robert G , Plueger Angel , Scebold Jody , Tyner Kate , Van Schooneveld Trevor C , Vivekanandan Renuga , Ashraf Muhammad Salman 
Published: January 2025

Abstract

Background
Almost half of surgical site infections (SSIs) are preventable by application of evidence-based strategies. An online survey of Nebraska hospitals was conducted by the Nebraska Healthcare-Associated Infections/Antimicrobial Resistance Advisory Council’s SSI Subcommittee between March and May 2023 to assess implementation of evidence-based practice recommendations (EBPR) from national guidelines.

Methods
Infection preventionists completed the survey in collaboration with their perioperative teams. In addition to facility demographics, data was collected on general SSI prevention practices along with those specific to colon procedures, hysterectomies, and cesarean sections. Implementation frequencies were calculated for each EBPR after excluding missing responses.Figure 2:Routine Audits Conducted by Facilities

Results
Response rates for acute care and critical access hospitals were 72% (21/29) and 47% (30/64), respectively. Most EBPR (19/30) assessed were reported to be implemented by majority ( &gt;50%) of the hospitals. The least implemented EBPR was vaginal cleansing prior to all cesarean sections (16%, 5/31) (Figure 1). Audits to monitor operating room traffic and skin antisepsis were conducted by approximately a third of hospitals (31%, 15/49 and 33%, 16/48, respectively) (Figure 2). Among hospitals that performed hysterectomies (n=23), less than half reported performing vaginal cleansing prior to all hysterectomies (43%), presence of policies/protocols for pre- and intraoperative antibiotic use for hysterectomies (39%) and monitoring of antimicrobial prophylaxis practices for hysterectomies (43%). Least implemented colon procedure specific EBPR in hospitals performing these procedures (n=26) included having standardized policies/procedures for mechanical bowel preparation (35%), presence of policies/protocols for pre- and intraoperative antibiotic use for colon procedures (50%,) and monitoring of antimicrobial prophylaxis practices for colon procedures (54%).

Conclusion
Several EBPR for SSI prevention are not routinely implemented highlighting the need for educational efforts to raise awareness among hospitals. Future studies should focus on identifying practice barriers and mitigation strategies to increase implementation.

Disclosures
Trevor C. Van Schooneveld, MD, FSHEA, FIDSA, AN2 Therapeutics: Grant/Research Support|BioMerieux: Grant/Research Support|BioMerieux: Honoraria|Thermo-Fisher: Honoraria Renuga Vivekanandan, MD, MDconsult: Ownership Interest Muhammad Salman Ashraf, MBBS, Merck & Co. Inc: Grant/Research Support
P-389. Review of Post Cesarian Section Surgical Site Infections in a Tertiary Care Hospital
Authors: Alvi Rija B R , Shanahan Clare , Ruby Abigail , Chami Eman , Lanfranco Odaliz Abreu , Suleyman Geehan 
Published: January 2025

Abstract

Background
Surgical site infection (SSI) is one of the most common complications following cesarean section (CSEC), variably ranging from 3% to 18%, and adds a significant burden to the healthcare system. Given its substantial implications, developing strategies to prevent SSIs are essential. We aimed to explore factors associated with an increased risk of these infections.

Methods
Retrospective observational study of post-CSEC SSIs from Jan 2021-Dec 2023 at Henry Ford Hospital in Detroit. SSIs were defined according to the National Healthcare Safety Network (NHSN) criteria. Cases were categorized as superficial incisional (SI), deep incisional (DI) and organ space (OS). Demographics, risk factors, clinical features, treatment, and outcomes were evaluated.

Results
70 (3%) of 2,230 CSECs performed during the study period met criteria for post-CSEC SSI, of which 42 (60%) were SI, 4 (6%) DI, and 24 (34%) OS; 42 (60%) were emergency cases. The majority of patients were Black with mean age of 30.3 years (Table 1). Obesity (BMI &gt;30), anemia (hemoglobin &lt; 11), hypertension, prior abdominal surgery, Group B Strep colonization, and ruptured membranes at presentation were common. Most (86%) received perioperative antibiotics, and 69% were administered within 1 hour of incision; cefazolin was frequently used. Infection was diagnosed after a median of 11.5 days. Wound pain and drainage were the most prevalent symptoms. Manual chart review revealed 21% of cases did not have clinical symptoms or signs of infection. Cultures were obtained in 33% of patients, of which 91% were positive; common skin commensals were frequently isolated (Figure 1). Readmission was common, a quarter of patients required surgical intervention, and most cases were treated with antibiotics (Table 2). Complications included uterine dehiscence (9%) and half of these required hysterectomy.
Organisms Identified on cultures in patients with post-CSEC SSI

Conclusion
In our cohort of patients with post-CSEC SSI, obesity and ruptured membranes were common, and more than half of the cases were performed emergently. Implementing evidence-based practices and recommendations are critical to reduce the burden of SSIs. Additionally, proper documentation and diagnostic stewardship are critical to accurately capture SSI cases and avoid unnecessary antibiotics.

Disclosures
All Authors: No reported disclosures
P-414. From Anecdotal to Analytical: Correlating Self-Reported Norovirus-Like Illness with Epidemiological Data
Authors: Quade Patrick , Jaykus Lee-Ann , Chapman Benjamin , Faircloth Jeremy , Goulter Rebecca 
Published: January 2025

Abstract

Background
Human norovirus is a leading cause of foodborne illness globally, with hallmark symptoms of vomiting and diarrhea. The Norovirus Sentinel Testing and Tracking (NoroSTAT) network is a collaborative network of select U.S. state public health departments and the U.S. CDC, designed to collect epidemiologic and laboratory data on suspected or confirmed norovirus outbreaks. The global crowdsourcing website Iwaspoisoned.com (IWP), established in 2009, provides a means by which the public can self-report foodborne disease-like symptoms in real-time, world-wide. The value of crowdsourced data in relation, or complementary, to classic epidemiologic approaches, is largely unknown.
This study aims to investigate correlations between self-reported norovirus-like illness from IWP and norovirus epidemiological data from NoroSTAT.

Methods
The analysis was limited to reports between August, 2018 and May, 2022. NoroSTAT data were obtained from their website and internet archives. Data was extracted directly from the IWP database, with the following inclusion criteria: (i) symptoms of both vomiting and diarrhea reported together (used as a proxy for norovirus-like illness); and (ii) reports originating from a NoroSTAT-participating state. Reports were excluded if spam or duplicate. Associations were investigated using Pearson Correlation and Granger Causality tests using the Minitab (State College, PA) software package.

Results
The Pearson Correlation value of 0.669 was highly significant (p&lt; 0.001), indicating a strong linear relationship between IWP and NoroSTAT dataset outcomes (those being time and number of reports/cases). The Granger Causality analysis indicated a highly significant directional correlation between the two datasets (p=0.003).

Conclusion
There was a strong positive correlation between self-reported norovirus-like illness trends reported to the IWP crowdsourcing website, and NoroSTAT-reported outbreaks over the same timeframe. The alignment of the crowdsourced symptom data with public health surveillance lends credibility to the value of curated self-reporting as a complementary signal for detecting and perhaps predicting emerging norovirus epidemiological reports over time.

Disclosures
All Authors: No reported disclosures
P-420. Epidemiology of Patients with Laboratory-confirmed Aspergillus species in a Singaporean Hospital
Authors: Arora Shalvi , Myat Oo Aung , Kyawt Aung May , Chan Darius Y W , Foo Mabel Z Q , Yang Yong , En Wee Liang , Ying Sim Jean Xiang , Ling Moi Lin , Venkatachalam Indumathi 
Published: January 2025

Abstract

Background
Aspergillus species is an opportunistic mould associated with serious complications, healthcare costs and mortality, especially in immunocompromised patients. WHO has declared Aspergillus fumigatus as a “critical pathogen”. This study aims to report clinical epidemiology of patients with Aspergillus species in Singapore General Hospital (SGH), an acute-care hospital.Table 1:Demographic and clinical characteristics of patients

Methods
Inpatients with laboratory-confirmed Aspergillus species were included in this retrospective, observational study between January 2018 and April 2024. For patients with &gt; 1 positive cultures, first positive culture was used to describe clinical characteristics. Comorbidities were identified using ICD-10AM codes. Immunocompromised patients were those under haematology-oncology at time of specimen collection, received immunosuppressants within preceding 90 days and/or were neutropenic (count &lt; 1x109/L) within 30 days preceding specimen collection. Trends were reported as monthly incident rates (IR) per 10,000 patient-days.Table 2:Breakdown of microbiology cultures

Results
The mean IR was 1.2 per 10,000 patient days (n=399). Median patient age was 67 years. 151 of 399 (38%) patients tested positive on a specimen taken ≥ 7 days after admission. 172 (43%) patients were immunocompromised. 213 (53%) patients had non-pneumonia respiratory illnesses, 211 (53%) had pneumonia and 201 (50%) had acute/chronic kidney disease. 79 (20%) patients were admitted under haematology-oncology and 53 (14%) had haematological malignancies. 151 (38%) patients received Aspergillus targeted anti-fungal treatment within ±7 days of positive result (surrogate for infections). Crude mortality was 29% (n=115) of whom 98 (85%) patients died within 30 days and 112 (97%) patients died within 90 days of positive specimen. Median duration between specimen collection and mortality was 11.7 days. Pneumonia was the most common cause of death (51%). 187 (47%) patients had positive Aspergillus species cultured from lower respiratory specimens. The common species was Aspergillus fumigatus complex (45%). No outbreaks were identified during this period.Table 3:Breakdown by Aspergillus species isolated

Conclusion
Aspergillus species causes significant morbidity and mortality in hospitalized patients, including non-immunocompromised. Hence hospital-wide surveillance should be implemented.
Trend of monthly incidence rates of laboratory-confirmed healthcare-associated Aspergillus patients

Disclosures
Moi Lin Ling, FRCPA, Solventum: Honoraria|Solventum: Educational grant for APSIC projects
P-449. Healthcare Burden of Venous Thromboembolism (VTE) among People Living with Human Immunodeficiency Virus (PLHIV): A Nationwide Inpatient Data Analysis (2019-2021)
Authors: Macaraeg Chef Stan L , Aldecoa Kim Abbegail , Vergara Cunegundo 
Published: January 2025

Abstract

Background
Venous Thromboembolism (VTE) imposes a substantial economic burden, estimated to incur almost $10 billion each year. People Living with Human Immunodeficiency Virus (PLHIV) face an almost two- to tenfold higher risk of developing VTE compared to the general population. However, limited data exists on the healthcare burden of VTE among PLHIV. The study investigated the healthcare burden of VTE among PLHIV compared to non-HIV patients. Additionally, the study examined the difference in sociodemographic factors between the two groups.

Methods
We analyzed data from the National Inpatient Sample database from 2019 to 2021 to identify all hospitalizations with a primary diagnosis of Acute Venous Thromboembolism. Subsequently, we categorized patients into HIV and non-HIV groups. Stata 18.0 was utilized for analysis, with a p-value &lt; 0.05 indicating statistical significance. Hospital costs were adjusted for inflation using the US Consumer Price Index.

Results
Among the 821,494 hospitalizations for VTE, 2230 patients had HIV infection. HIV patients were significantly younger (52.5 vs. 63.4 years) and predominantly male, Black (56.3% vs. 20.0%), and Hispanic (11.3% vs. 7.2%) individuals. The HIV group exhibited longer hospital stays (6.23 vs. 4.37 days) and incurred higher total hospital costs ($19,117 vs. $14,115) after adjusting for age and sex. Notably, there was a positive correlation between length of stay and hospital costs (r=0.68, p&lt; 0.001). The incidence of AKI and pneumonia significantly prolonged hospital stays in the HIV subgroup (aOR: 2.96, 95% CI: 1.21-4.70; aOR: 2.92, 95% CI: 0.42-5.42). From 2019 to 2021, hospital costs showed a significant increase ($18338, $20330, $24507, p=0.034), while the hospital length of stay displayed an increasing trend but was not statistically significant (mean in days: 5.9, 6.4, 7.0, p=0.147). There was no specific trend observed in the VTE rate each year (0.28%, 0.26%, 0.28%, p=0.7875) among the HIV subgroup.

Conclusion
The healthcare burden of VTE hospitalization is higher among PLHIV. There has been a concerning increasing trend in hospital costs among PLHIV from 2019 to 2021. Future studies should investigate additional factors contributing to this healthcare burden to enhance the cost-effectiveness of care.

Disclosures
All Authors: No reported disclosures
P-477. What Can be Learned from Vermonters Living with HIV Viremia?
Authors: Pilcher Finlay , Tompkins Bradley , Lynn Keara , Singh Devika 
Published: January 2025

Abstract

Background
Lower rates of viral suppression have been identified in people living with HIV (PLHIV) residing in rural compared to metropolitan areas. This is a barrier to ending the HIV epidemic in the US, and thus represents an urgent focus topic.
Vermont is a rural state with roughly 700 PLHIV. Vermonters living with HIV tend to be rigorously engaged into clinical care and have high rates of viral suppression. Yet, there are PLHIV in Vermont that have unsuppressed viral loads, and little is known about the characteristics of this cohort.
Our study aims to epidemiologically describe Vermonters with an HIV viral load greater than 200 copies/mL. This characterization can aid in appropriate allocation of resources and improve our understanding of PLHIV with viremia residing in rural areas.

Methods
Our study used electronic health record data from Epic Systems Corporation (Epic) from 2019 and 2020. We included PLHIV from three infectious disease clinic sites within the University of Vermont Health Network (UVMHN; n = 456) that had at least one clinical visit in the past 18 months. The following data were extracted from patient charts: HIV detection and quantitation, clinic location, race, sexual orientation, and substance use.

Results
The results of our study are shown in Tables 1 and 2. There was no significant association between clinic location, race, sexual orientation, or substance use and having a viral load greater than 200 copies/mL.

Conclusion
Our results suggest that in Vermont, the presence of viremia in PLHIV cannot be easily predicted by clinic location race, sexual orientation, or substance use. The authors suggest that traditional clinical markers including low CD4 counts, HIV resistance mutations, pill burden, older age and concomitant clinical comorbidities (dementia, etc.) may be more reliable factors associated with active viremia.
Although Vermont is demographically distinct from other rural areas, its residents share many barriers related to HIV care, including long travel distances to visits, limited HIV provider availability, and limited access to harm reduction services. These challenges necessitate our continued efforts to better understand and serve PLHIV living in rural areas to improve HIV equity and ultimately end the HIV epidemic.

Disclosures
All Authors: No reported disclosures
P-497. Performance of the Brief Patient Health Questionnaire-2 and Generalized Anxiety Disorder-2 Screeners for Identifying Depression and Anxiety in People with HIV
Authors: Lee Ye Eun , Latimer Maria C , Kelly Sharon , Verinumbe Tarfa I , Agee Tracy , Hutton Heidi , Jones Joyce L , Schwartz Sheree R , Hsu Jeffrey H , Falade-Nwulia Oluwaseun 
Published: January 2025

Abstract

Background
Mental health disorder (MHD) prevalence is high among people with HIV (PWH) and linked to poor health outcomes, including HIV non-suppression. Despite recommendations for routine mental health screening in HIV care settings, screening uptake remains low. The brief Patient Health Questionnaire-2 (PHQ-2) and Generalized Anxiety Disorder-2 (GAD-2) are validated screeners for depression and anxiety symptoms with potential for integration into HIV care. This study evaluates the accuracy of the PHQ-2 and GAD-2 in detecting depression and anxiety among PWH and co-occurring MHD or substance use disorders (SUD).

Methods
Routine screening using the PHQ-2, GAD-2, and NIDA Quick Screen for SUD was implemented in an HIV care setting in Baltimore in April 2022. Patients who screened positive on any screener and enrolled in a study evaluating an intervention for SUD and MHD care were included in the analysis. Participants completed the longer PHQ-8 and GAD-7 screeners at enrollment, which served as reference standards using recommended cut points of ≥10 to indicate moderate or severe depression or anxiety, respectively. PHQ-2 and GAD-2 scores are derived from the first two questions of their corresponding longer measure. Area under the curve (AUC), sensitivity, and specificity were obtained for the PHQ-2 and GAD-2 at various cut points against their corresponding longer measure.

Results
Of the 204 patients included in this study, 68% were male, 80% were Black, and mean age was 51 years. Compared to the PHQ-8 using a cut point of ≥10, the PHQ-2 at the cut point of ≥3 demonstrated high accuracy in detecting depression at a cut point of ≥3 (AUC = 0.86; 95% CI: 0.81, 0.91) with a sensitivity of 0.82 (95% CI: 0.72, 0.89) and specificity of 0.90 (95% CI: 0.83, 0.95). Compared to the GAD-7 using a cut point of ≥10, the GAD-2 was highly accurate in identifying anxiety at a cut point of ≥3 (AUC = 0.90; 95% CI: 0.86, 0.94), achieving a high sensitivity (0.89; 95% CI: 0.81, 0.95) and specificity (0.91; 95% CI: 0.84, 0.95).

Conclusion
In the context of HIV care in busy clinical settings, our findings indicate that implementation of the PHQ-2 and GAD-2 screeners accurately detect depression and anxiety symptoms at the optimal cut point of ≥3. Simplified identification and treatment of comorbid MHD may improve HIV outcomes.

Disclosures
Oluwaseun Falade-Nwulia, MBBS ,MPH, Abbvie Inc: Grant/Research Support|Gilead Sciences: Advisor/Consultant
P-566. Long-term virologic outcomes of oral two-drug vs three-drug antiretroviral regimens in children, adolescents and adults living with HIV
Authors: Byrne Morgan , Koay Wei Li A , Unternaher Justin , O’Connor Lauren , Monroe Anne , Denyer Rachel V , Castel Amanda Derryck , Rakhmanina Natella 
Published: January 2025

Abstract

Background
Despite the availability and efficacy of two-drug regimens (2DR) for HIV treatment, three-drug regimens (3DR) are mostly used by people with HIV (PWH). We evaluated virologic outcomes of initiating or switching to a 2DR vs 3DR among PWH in Washington, DC.
Adjusted Cox Proportional Hazard Regression Model for Virologic Non-Suppression (viral load &gt; 200 copies/mL) among PWH by Two- and Three-Drug Regimens in the DC Cohort, 2019-2023

Methods
We included DC Cohort treatment-experienced participants initiating or switching to a 2DR or 3DR on or after July 2019 with ≥2 years of follow-up. Descriptive statistics for demographic and clinical factors at regimen initiation, including HIV viral load (VL) and CD4 count (cells/µL), were stratified by 2DR or 3DR. Multivariable Cox proportional hazard modeling was performed among participants virally suppressed (VS; VL&lt; 200 copies/mL) at regimen initiation to assess the time to non-virologic suppression (non-VS) using adjusted hazard ratios (aHR) and 95% CI adjusting for demographics, HIV risk, and regimen. Among participants who were not VS at the time of regimen initiation, we conducted a sub-analysis of the time to VS.

Results
We analyzed 1782 participants (72.8% 3DR, 28.2% 2DR (161 switched from a 3DR); age 54.3 years (IQR 43.8-61.3), 68.8% male; 78.1% Black) with a median CD4 621 (IQR 409-868) at regimen initiation. Participants on 2DR were older (56.4 vs 53.6 years; p&lt; 0.001) and had higher VS rates (93.8% vs 88.2%; p&lt; 0.001) at regimen initiation and shorter regimen times (3.2 vs 3.8 years; p&lt; 0.001) compared to 3DR. 2DR participants were more likely to have public vs private insurance and receive hospital vs community-based care. The risk of non-VS was higher among those with CD4 &lt; 200 and 200-500 (aHR 1.5(1.0-2.1) and aHR 2.0(1.1-3.6), respectively) compared to those with CD4 &gt;500. Those with public insurance were also more likely to experience non-VS (aHR 1.5; p&lt; 0.05). While regimen type was not a significant predictor of non-VS, there was an elevated risk among those on 3DR (aHR 1.2) compared to 2DR [Figure]. Among those non-VS at regimen initiation (n=146), the median time to VS was similar among PWH on 2DR (14.1 months) and 3DR (13.8 months; p=0.76).

Conclusion
Non-VS PWH have similar time to VS regardless of whether they receive 2DR or 3DR, suggesting similar efficacy of 2DR and 3DR in these populations. Patients with CD4 &lt; 500 had higher risk of non-VS on 2DR, supporting the usefulness of the CD4 criteria factor when selecting 2DR vs 3DR.

Disclosures
All Authors: No reported disclosures