bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-346. Candida auris: Colonization, Risk Factors and Antifungal Susceptibility at a Tertiary Healthcare Setting
Authors: Jonnalagadda Kirtana , Goel Ayush , Ajayababu Anuj , Xess Immaculata , Singh Gagandeep , Soneja Manish , Biswas Ashutosh 
Published: January 2025

Abstract

Background
Candida auris, a multidrug-resistant nosocomial pathogen, has emerged globally as a major threat to healthcare settings, and several hospital outbreaks continue to be reported. We attempted to study the risk factors associated with C. auris colonization and its antifungal susceptibility at a tertiary healthcare center.
1.Distribution of Candida auris isolates

Methods
A prospective observational study was conducted over 18 months. Patients were screened for Candida auris colonization by axillary, groin swabs, and urine cultures within 48 hours of admission. Patients with extended hospital stays, exhibiting clinical isolates positive for C. auris, were also included. Baseline characteristics and risk factors were assessed. In patients with positive C. auris isolates, samples from inanimate surfaces, hands of healthcare workers and patient care attendants were also screened for C. auris colonization. Antifungal susceptibility testing was done for all isolates.

Results
Ninety-nine patients (59% males) were included with a mean age of 43.1±18.06 years. There were 34 Candida auris isolates from 20 patients. Sixteen patients (80%) were colonized, and four (20%) had candidemia. Median duration of urinary catheterization (9 vs 3 days [p=0.01]) and prior antifungal exposure(p=0.04) were significant risk factors for C.auris colonization. Seventy-eight samples from bed rails, monitors, healthcare workers, and patient-care attendants showed no growth of C.auris. Antifungal susceptibility testing showed 87.5% and 37.5% of isolates were resistant to Fluconazole and Amphotericin B respectively, while all isolates were susceptible to Micafungin and Caspofungin.

Conclusion
Prior outbreaks of Candida auris at our medical ICU prompted the need for early identification, effective contact precautions, and decolonization to prevent fatal invasive infections. Patients with long-term urinary catheters in situ, prior exposure to antifungals, and prolonged hospital stay were found to be at risk for C.auris colonization, warranting further studies to implement routine screening in these high-risk groups.

Disclosures
All Authors: No reported disclosures
P-350. Epidemiology of Candida auris isolated from blood cultures at a tertiary care facility in metro Detroit
Authors: Scipione Marco R , Zhao Jing , Jabbo Lavina , Salimnia Hossein , Chopra Teena 
Published: January 2025

Abstract

Background
Candida auris is a serious global health threat and the number of cases has increased recently. C. auris is often resistant to commonly used antifungals, making it difficult to treat. The objective of this study is to describe the epidemiology of C. auris isolated from blood cultures at a tertiary care facility in metro Detroit.

Methods
All C. auris isolates from blood cultures at the Detroit Medical Center from 8/1/2019 to 4/25/2024 were reviewed. Patient characteristics as well as microbiological characteristics were evaluated. There are no established susceptibility breakpoints for C. auris but the CDC has published tentative MIC breakpoints (mcg/mL) based on closely related Candida species and expert opinion.

Results
Thirty-eight patients had a positive blood culture with C. auris. The median age was 66 years (IQR 60-72). Length of stay was 37 days (IQR 22-62) and length of stay prior to positive blood culture was 25 days (IQR 11-43). Twenty-one (55%) patients had a C. auris isolation flag in the electronic medical record (EMR) prior to the positive blood culture. Only 31 patients had susceptibility testing done. All 31 isolates that were tested were resistant to fluconazole (MIC ≥ 32 mcg/mL) and all were susceptible to micafungin (MIC ≤ 2 mcg/mL). Thirty of 31 (97%) isolates were also susceptible to amphotericin B (MIC ≤ 1 mcg/mL). The antifungals with no published breakpoints had the following median MICs: voriconazole 2 mcg/mL (IQR 1-4); itraconazole 1 mcg/mL (IQR 1-1); isavuconazole 2 mcg/mL (IQR 1-2); posaconazole 0.25 mcg/mL (IQR 0.25-0.5); caspofungin 0.25 mcg/mL (IQR 0.15-0.5); anidulafungin 1 mcg/mL (0.5-1). The distribution of MICs for each agents are shown in figure 2 and figure 3.

Conclusion
Data are lacking to determine the most appropriate therapy for C. auris but based on local epidemiology, the use of an echinocandin as a first-line option for C. auris infections is appropriate.

Disclosures
All Authors: No reported disclosures
P-354. Clinical Utility of Tuberculosis Screening Tests After Tuberculosis Exposure at an Infusion Clinic
Authors: Li Aldon , Belleau Tawny , Faiad Graciela 
Published: January 2025

Abstract

Background
Tuberculin skin testing (PPD) and interferon gamma release assays (IGRA) facilitate screening of patients exposed to active tuberculosis (TB), but the clinical utility of TB screening tests in determining management of exposed high-risk patients is not well described. Because the sensitivity of TB screening tests is dependent on patient’s immunocompetency, further studies looking at the correlation between exposure, testing, and risk of progression to active TB in immunocompromised patients are needed. This study aims to describe TB testing and TB transmission among a large cohort of immunocompromised patients after a known TB exposure event.

Methods
Retrospective case series of patients who were exposed to TB as defined by CDC Guidelines, identified through contact tracing reports during exposure period April-July 2019. Local infection control protocol was to assess exposed patients with an IGRA initially, then place a PPD if IGRA was inconclusive.

Results
During the exposure period, an employee with direct patient care duties at an oncology infusion clinic developed active TB, exposing 443 patients. Of the 443 exposed patients, 57 either passed away prior to testing or declined testing. Of the 386 patients who underwent screening tests, 351 (91%), 23 (6%), and 12 (3%) were IGRA negative, positive, and indeterminate, respectively. Of the 12 IGRA indeterminate patients, 8 (67%) had a negative PPD, 2 (16%) refused PPD testing and a repeat IGRA turned negative, and 2 (16%) passed away without further testing. Of the 23 IGRA positive patients, latent TB infection (LTBI) treatment was given in 16 (70%) patients with 7 patients either declining therapy or passed away. None of the 443 patients developed active TB after a 5 year follow up.

Conclusion
The results of this study found no TB transmission occurred during a high-risk exposure event involving immunocompromised patients when protocol driven testing, treatment, and follow-up was completed. Although CDC publications report low sensitivities of IGRAs in immunocompromised patients, given the large number of exposed patients, serum testing was a practical choice for initial exposure testing and this study showed successful interventions when paired IGRA-PPD testing was used to risk stratify high-risk patients for LTBI therapy.

Disclosures
All Authors: No reported disclosures
P-362. Outbreak of neonatal sepsis in a maternity hospital in Kyrgyzstan, 2022-2023
Authors: Baibolotova Perizat , Nabirova Dilyara , Bekturova Lilya , Otorbaeva Dinara , kyzy Nasyat Kemelbek , Alymkulova Venera , Horth Roberta 
Published: January 2025

Abstract

Background
Sepsis is a leading cause of neonatal mortality and morbidity worldwide, notably in Kyrgyzstan. In January 2023, six neonatal sepsis deaths were reported within two weeks at a 157-bed maternity hospital, which usually has &lt; 2 cases/month. We investigated to identify sources of infection and risk factors.Table 1.Factors associated with neonatal sepsis in a maternity hospital in Kyrgyzstan, 2022-2023*AOR- adjusted odds ration; ** CI- confidence interval; ***1. Healthy population (Reference group): Apgar scores at 1 and 5 min above 7; Unhealthy population: Apgar scores at 1 min below 7 and at 5 min below 7; Improved population: least one below 7

Methods
A concurrent case-control study included infants (&lt; 28 days old) born at the hospital in January 2022-February 2023 and diagnosed with sepsis. Controls met same criteria and were born +/- 1 day from cases without sepsis. In February 2023, we collected rectal, nasopharyngeal, and high-touch environmental areas swabs in a single-day cross-sectional sample of hospitalized case-patients and mothers for culturing and MALDI-TOF. We used logistic regression to identify factors associated with sepsis.Figure 1.Two clusters of Acinetobacter baumannii detected among newborns with neonatal sepsis in a maternity hospital in Kyrgyzstan, 2022-2023

Results
The study comprised 129 cases and 509 controls. More cases than controls weighed &lt; 2500g at birth (52% vs 5%, p&lt; 0.01), had anhydrous interval of ≥12 hours (43% vs 29%, p&lt; 0.01), had Apgar scores of &lt; 7 at 1 minute (83% vs 20%, p&lt; 0.01), were more likely to receive both ventilation and an invasive device (98% vs 1%, p&lt; 0.01) and to be admitted to the intensive-care unit (ICU) (82% vs 17%, p&lt; 0.01) (Table 1). Sepsis was associated with birth weight of ≤2500g vs greater (adjusted odds ratio: 5.6; 95% confidence interval: [2.1-15.1]), infant blood transfusion vs no (9.9 [3.8-26.0]), use of ventilation and invasive device vs no (144 [28.8-729.7]), Apgar scores at 1 and 5 minutes &lt; 7 vs greater (2.8 [1.0-7.8], urinary tract disease in mother vs not (3.5 [1.1-10.6]), and anhydrous interval ≥12 hours vs less (2.6 [1.2-5.5]). Acinetobacter baumannii resistant to cephalosporins, aminoglycosides, and fluoroquinolones was detected in 8/8 pharyngeal swabs from case-patients in two ICU rooms, forming two distinct clusters (Figure 1). Acinetobacter baumannii was not detected in environmental sampling, but the hospital had conducted deep cleaning shortly before the environmental team arrived.

Conclusion
Resistant Acinetobacter baumanni likely contributed to the outbreak. The hospital conducted environmental cleaning, replaced non-disposable instruments (cannulas, masks, tubes) and updated infection control practices. Neonatal sepsis cases dropped sharply to &lt; 2/month by May 2023.

Disclosures
All Authors: No reported disclosures
P-366. Investigation of a Bacteremia Outbreak in Dialysis Patients Linked to Closed System Needleless Valve Connectors
Authors: De Souza Bruna , Oliveira Laryssa Aryadne , De Jesus Cinthia Carolini , Pereira Hoberdan , Couto Bráulio R G M 
Published: January 2025

Abstract

Background
Closed system needleless connectors are commonly used in central venous access for long-term intravenous treatments like chemotherapy or dialysis. This paper details an investigation into a sudden rise in bacteremia among dialysis patients.Figure 1Monthly Rate of Central Line-Associated Bacteremia (#Bacteremia per 1,000 Central Line-Days), February 2023 to March 2024.
Monthly Rate of Central Line-Associated Bacteremia (#Bacteremia per 1,000 Central Line-Days), February 2023 to March 2024.

Methods
Continuous surveillance of hospital-acquired infections (HAIs) in dialysis patients, as prescribed by Brazil's ANVISA. Monthly data analysis revealed an increase in the rate of central line-associated bacteremia in February 2024, which worsened in March (Fig. 1). To define the outbreak, we compared the incidence of bacteremia from the previous period (Feb/2023 to Jan/2024) to the current period (Feb-March/2024). Investigation of the outbreak commenced in February itself.Figure 2Comparative Analysis of Bacteremia Incidence: Previous Period (February 2023 to January 2024) vs. Current Period (February to March 2024).

Results
The outbreak was clearly defined, with the risk of bacteremia significantly doubling from February to March 2024 (Fig. 2), primarily caused by Staphylococcus species. After interviewing dialysis service professionals about changes in practices, we discovered that a new brand of closed-system valve connectors, purchased from China, began to be used on January 30, 2024. Tests and field evaluations revealed an accumulation of blood in the catheter hub, which could indeed have compromised the integrity of the accesses and facilitated bacterial growth (Fig. 3). The Infection Control and Hospital Epidemiology team suggested discontinuing the use of the device to assess whether there would be a decrease in the number of bacteremia cases. However, due to the high number of devices in stock, it continued to be used throughout the month of March, resulting in a further increase in infection cases. Due to the impact caused by the increase in bacteremia cases, the team decided to suspend the use of all valved devices after the first weeks of April. Consequently, after April 10th, the device was definitively discontinued in the department. The discontinuation of the device resulted in a decrease in the number of infections in April. By April 25th, the total number of bacteremia was 8 cases, of which 6 were reported between April 1st and 10th.Figure 3Tests and Field Evaluations Demonstrated Blood Accumulation in the Catheter Hub Using the New Brand of Closed-System Valved Connectors.

Conclusion
It was possible to link the use of the Chinese-made closed-system valved connector to an increase in the number of bacteremia cases, and its discontinuation resulted in a significant reduction in HAIs.

Disclosures
All Authors: No reported disclosures
P-372. Candida auris Outbreak in a Cardiothoracic Transplant Intensive Care Unit: Implications for Infection Prevention
Authors: Rathod Shardul N , Barajas Grace , Mitchell Brooks I , Malczynski Michael , Moore William Justin , Weslander Erin , Bertram Christie M , Sutton Sarah , Stosor Valentina , Qi Chao , Zembower Teresa , Bolon Maureen K 
Published: January 2025

Abstract

Background
Candida auris is a yeast that causes invasive infections such as bloodstream infections (BSIs); mortality rates for C. auris BSIs may be as high as 80%. Rates have been climbing in the U.S. Exposure to skilled nursing facilities (SNFs), long-term acute care hospitals (LTACHs), or inpatient rehabilitation facilities (IRFs) represents a known risk factor for C. auris. Our institution experienced a C. auris outbreak from September 2023 - January 2024.
Figure 1: C. auris Outbreak Epidemic Curve

Methods
C. auris cases in the outbreak were identified from clinical specimens and admission and weekly surveillance via polymerase chain reaction (PCR). Clinical characteristics were determined through chart review. A multidisciplinary team implemented infection prevention (IP) interventions to curb nosocomial spread.
Infection Prevention Interventions

Results
There were 20 cases of C. auris identified in our CTICU between July 2023 and January 2024 (Figure 1). Whole-genome sequencing and phylogenetic analysis based on pairwise single nucleotide polymorphism (WG-SNP) distance revealed two outbreak clusters.
Of the 20 patients, 13 (65%) were solid organ transplant/acute mechanical circulatory support patients and three (15%) had prior SNF, LTACH, or IRF exposure. Four (20%) patients had C. auris BSIs and seven (35%) patients died, including all patients with BSIs. The mean duration of antibiotic use in the four patients was 67 days.
IP interventions addressed potential vehicles of transmission including healthcare personnel hands, shared patient equipment, and the environment (Table 1).

Conclusion
Only 15% of patients had prior SNF/LTACH/IRF exposure; many were admitted from home and/or outside hospitals with risk factors including recent surgery and antimicrobial use. This suggests the epidemiology of C. auris may be changing, and it may be prudent to consider routine admission and weekly surveillance on inpatient units deemed high risk for C. auris. Effective IP interventions included interventional hand hygiene auditing, increased accountability and oversight for shared patient equipment, limiting the number of rounding providers in rooms, and auditing environmental cleaning. Sustaining these efforts is crucial to keep pace with an evolving C. auris landscape.

Disclosures
All Authors: No reported disclosures
P-380. Risk Factors and Clinical Outcomes of Breast Surgery Related Surgical Site Infections in Southeast Michigan
Authors: Malik Ambreen , Brar Simran , Shallal Anita , Suleyman Geehan 
Published: January 2025

Abstract

Background
Surgical site infections (SSI) after breast surgery are important healthcare-associated infections (HAI) that may delay initiation of chemotherapy for underlying malignancy, in addition to accruing substantial healthcare costs. The reported incidence of breast surgery-related SSI (BSSI) ranges from 0.8%-26% depending on underlying comorbidities. We aimed to describe risk factors and clinical outcomes associated with BSSIs in southeast Michigan.Table 1.Characteristics of patients with breast surgical site infections

Methods
Retrospective cross-sectional study of adult patients with BSSI at a six-hospital healthcare system. Patients who met the definition of BSSI (per National Healthcare Safety Network) from 2021 to 2023 were included. Charts were reviewed for demographics, comorbidities, risk factors, microbiological data, and clinical outcomes.Table 2:Microbiological data of breast surgical site infections

Results
A total of 146 patients were identified, of which 78 patients (53%) had clinical infection [Table 1]. Most of the patients were female (95%) and white (62%). Common comorbidities included obesity (36%), active breast cancer (55%), and diabetes mellitus (18%). Prior breast surgery (10%), chemotherapy within last 6 months (12%), and prior chest radiotherapy (9%) were less common. Mastectomy was the most common surgery (51%), often with lymph node dissection (46%), and many had artificial material placed (implant; 32% and tissue expanders; 18%). Only 88% of patients received peri-operative antibiotics, of which 72% received cefazolin. The most common microbes isolated were Staphylococcus aureus (24%), coagulase-negative Staphylococcus spp (23%), Streptococcus spp (19%) and Pseudomonas spp (19%). Most patients required repeat surgical intervention (81%), with hospitalization (59%) and removal of implants (45%). No patients died at 30 and 90 days after initial surgery.

Conclusion
In this large study, BSSI was often associated with artificial material implantation, and Staphylococcus aureus was a common pathogen. Most patients required repeat surgical intervention and removal of implants. Significant opportunities were observed with surgical infection prophylaxis.

Disclosures
All Authors: No reported disclosures
P-381. Enhancing Economic Outcomes by Strategic Investment in Orthopedic Surgical Infection Control
Authors: Bandeira Raquel , Bahia Filho José Américo , Luz Neto Vespasiano C , Messias Glauco , Mota Gabrielle R , Gontijo Thiago C , Colen Gabriel , Morganti Ana Carolina , Paula Ladeira Ana , Couto Bráulio R G M , Miranda Lívia , Messias Isabela , Messias Beatriz 
Published: January 2025

Abstract

Background
This study aims to assess the financial impact of investments in combating hospital-acquired infections, particularly surgical site infections (SSIs) in orthopedic procedures.Figure 1The infection prevention programs to prevent Surgical Site Infections (SSIs)

Methods
A retrospective cohort study from January 2019 to September 2023 included patients undergoing knee arthroplasty (KA), hip arthroplasty (HA), and open fracture reduction (OFR), defining SSI according to CDC criteria. Costs per SSI patient were retrieved from literature sources: $13,539.50 for hospital costs (LUNA et al., 2022) and $7,523.77 for direct treatment costs, adjusted for inflation (STARLING et al., 2022).Figure 2.Chart of Year-to-Year Surgical Site Infection Rates, Stratified by Type of Orthopedic Surgery
Chart of Year-to-Year Surgical Site Infection Rates, Stratified by Type of Orthopedic Surgery

Results
During the baseline period, January 2019 to to December 2022, 4,258 patients underwent orthopedic surgeries: HA (11%), KA (9%), OFR (80%). Of these, 2,439 were female (57%), 1,819 male (43%), mean and median age 51 years, standard deviation 21 years. 68 patients died in-hospital (1.6%), 239 diagnosed with SSI (5.6%). Postoperative infection increased mortality risk over twofold: without infection (1.5% mortality risk), with infection (3.8% mortality risk), relative risk 2.5, p-value=0.014. SSI was associated with prolonged hospitalization; average length of stay doubled with infection (18.2 days) compared to without (9 days), p-value: 0.001. Comparing infection risks from 2019-2022 (5.6%) to 2023 (1.4%) post-investment in infection control demonstrated a risk reduction. Relative risk (0.25) p-value &lt; 0.001.Table 1.Annual Comparative Analysis of Surgical Site Infection Rates by Orthopedic Surgery Type

Conclusion
SSIs in orthopedic surgeries pose dual risks, increasing readmissions and impairing hospital performance. Investing in SSI reduction enhances patient care, safety, and yields significant financial returns. This study underscores the ROI of infection prevention, especially targeting orthopedic surgical infections. Preventing SSIs can yield monthly savings of $25,781.49 to $46,393.48Table 2.Reduction in Costs, Hospital Stay Duration, and Prevented Deaths Associated with Surgical Site Infections after Orthopedic Surgeries

Disclosures
All Authors: No reported disclosures
P-384. Cutting Through the Data: A Comparative Analysis of Surgical Site Infection Surveillance in Peripheral Vascular Bypass Surgery
Authors: Kim Young , Smith Becky A , Wood Brittain A , Padgette Polly W , Anderson Deverick J , Seidelman Jessica 
Published: January 2025

Abstract

Background
Different societies and organizations use different surgical site infection (SSI) definitions for surveillance. With multiple definitions in use, validation of surveillance findings becomes paramount, particularly for maintaining surgeon buy-in during data review and developing countermeasures. The goal of our study was to assess concordance between SSI diagnoses following peripheral vascular bypass (PVBY) surgery derived from review by a vascular surgeon (vascular) and those identified through SSI surveillance performed by the infection prevention (IP) team.

Methods
The IP team performs SSI surveillance using EPIC “Bugs” tool to identify potential SSIs from NHSN selected CPT codes. EPIC then identifies cultures within the infection window period and IP reviews the case to ensure it meets SSI criteria. Conversely, the vascular surgeon reviewed every PVBY CPT coded surgery to determine if an SSI occurred. The vascular review used the Southampton Scoring System. Both surveillance systems queried PVBY surgeries from 1/1/2018 to 12/31/2022 and used a 90-day surveillance period.

Results
Among the CPT codes used for surveillances, 569 PVBY surgeries and 133 SSIs (23.4%) were identified. Both surveillance systems picked up 484 cases (85.1%), IP noted 51 (9.0%) additional cases, and vascular found the remaining 34 (6.0%) cases. (Figure 1) Among the SSIs, both datasets detected 32 SSIs (24.1%), IP recognized 12 more SSIs (9.0%) and the vascular review designated the remaining 89 (66.9%) SSIs. (Figure 2) Of the 89 SSIs picked up by the vascular review, 5 SSI surgeries were not in the IP denominator. The other 84 SSIs were included in the IP denominator, but those were not denoted as SSIs. Among the 84, the majority (64, 76%) were Southampton scores of 2 or 3. (Figure 3) Of those 84, 51 (60.7%) did not have a culture taken.

Conclusion
The vascular SSI review identified 89 additional PVBY SSIs compared to the IP surveillance over the 5-year period. NHSN has limitations in PVBY SSI surveillance, particularly for superficial incisional SSIs. Although IP is not resourced to perform surveillance on every surgery, IP working with surgical teams to understand differences in surveillance can facilitate alignment needed to develop successful SSI prevention initiatives.

Disclosures
Becky A. Smith, MD, UpToDate: royalties Jessica Seidelman, MD, MPH, 3M: Expert Testimony