bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-396. Can ‘Handshake Stewardship’ Decrease Multi-Drug Resistant Healthcare-Associated Infections and All-Cause Mortality? - Insights from A South Indian Tertiary Hospital
Authors: Issac Aleena , Sreeraj V , Puthoor Deljo , Prathibha V K , Geethalakshmi V , Thomas Maridas Tom , Joseph Thomas , Mohan Gopika P , Johnson Mariya , Thomas Alga P , Santhosh Sneha , Lubaina P R 
Published: January 2025

Abstract

Background
Multi drug resistant Healthcare Associated Infections (MDR HAI) pose significant challenges for both patients and healthcare facilities, often stemming from inappropriate antibiotic usage. 'Handshake Stewardship' involves a proactive approach of auditing and providing feedback on antibiotic prescriptions to ensure their rationality, with discussions held confidentially with treating physicians. Endorsed by the Centers for Disease Control and Prevention and The Joint Commission, this method aims to engage clinicians in addressing clinical barriers to antimicrobial stewardship.

Methods
This study compares MDR HAI in the inpatients of two timelines, pre period May 2021 to April 2022 and post period May 2022 to April 2023. In the post period, the rationality of the antibiotic therapy is discussed with the clinician (in-person approach) by the Antimicrobial stewardship pharmacists within 24 hours of starting the monitored antibiotic. The clinician may or may not accept the interventions and the outcome was documented electronically. The primary outcome was the MDR HAI. Antimicrobial susceptibility testing was performed by the Clinical and Laboratory Standards Institute and ‘MDR’ was assigned as per the joint initiative document by the European Centre for Disease Prevention and Control (ECDC) and the Centers for Disease Control and Prevention (CDC). HAI referred from the CDC’s National Healthcare Safety Network (NHSN) criteria. The secondary outcome was all-cause mortality. Descriptive cross-tabulations and chi-square tests (for all Categorical variables) were performed.

Results
83 HAIs in the pre phase period has 46 cases with MDR status in the culture report, whereas the post era reported 55 MDR status among 108 HAI cases. The post era has less percentage compared to the pre era with no statistical significance (p=0.319) (table -1). The MDR types depicted in table-2. It was found that all-cause mortality in MDR HAI showed no statistically significant difference (Pearson Chi-Square = 0.246) between pre and post phase.

Conclusion
'Handshake Stewardship' did not lead to a significant reduction in MDR HAIs or all-cause mortality during the study period, further long-term evaluations are warranted to assess its effectiveness comprehensively.

Disclosures
All Authors: No reported disclosures
P-399. Prevalence of gastrointestinal tract colonization by carbapenem-resistant Enterobacterales and vancomycin-resistant Enterococcus faecium in hematological patients at a referral hospital in Mexico City
Authors: Ramos Menchelli Ana Fernanda , González Lara María Fernanda , Guerra Bernardo Martínez , Fernández Oscar , Centeno Matus Edgar Daniel , Xancal Salvador Luis Fernando , Gómez Roberta Demichelis , Rodríguez Eucario León 
Published: January 2025

Abstract

Background
The prevalence of carbapenem-resistant enterobacteria (CRE) in patients with hematological neoplasias varies due to local epidemiology, antimicrobial prophylaxis and types of hematopoietic stem cell transplants (HSCT). Colonization by CRE is the main risk factor for infection, which carries a mortality up to 65%. This study evaluated CRE colonization in patients with acute leukemia (AL) and HSCT) within 28 days. Secondary goals included describing CRE bloodstream infections (BSI), colonization by Vancomycin-Resistant Enterococci (VRE), ESBL, and quinolone-resistant (QR) microorganisms, risk factors for CRE, and 28-day mortality.Table 1.Risk factors for CRE colonization among patients with acute leukemia and hematopoietic stem cell transplantRR: Relative risk, aHR: Adjusted hazard ratio, allo HSCT: Allogeneic hematopoietic stem cell transplant

Methods
This was a prospective cohort from March to October 2023 at a referral hospital in Mexico City. We included consenting adults with acute leukemia (AL) receiving induction chemotherapy and HSCT. Patients with prior 90-day CRE colonization or infection were excluded. Weekly stool screening, using the adapted CDC method, was performed throughout hospitalization, with a follow-up period of 28 days or until discharge or death. CRE were identified by MALDITOF-MS (Bruker), susceptibility testing done by Vitek2 (Biomérieux), using CDC breakpoints. Descriptive analysis was done for CRE colonization and mortality. A multivariate analysis for CRE colonization through logistic regression was done.

Results
Among 37 patients included, a CRE colonization prevalence of 21.8% was found, of which, 12.5% developed BSI compared to 3.5% of non-colonized individuals. Additionally, colonization rates for VRE, ESBL, and QR microorganisms were 5.4%, 35.1%, and 32.4%, respectively. Independent factors related to CRE colonization were older age and prior 6-month carbapenem use. 28-day mortality was 10.8%, with no differences between colonized and non-colonized groups. VRE colonization was significantly associated with VRE infection (p=0.04). CRE colonization resulted in increased 90-day mortality (50% vs. 10.3%, p=0.011).

Conclusion
The prevalence of CRE colonization in patients with AL or HSCT was 21.8%. It was associated with older age and prior carbapenem use and resulted in increased 90-day mortality. Colonization by ESBL and QR were frequent.

Disclosures
All Authors: No reported disclosures
P-400. Surgical Site Infections among Heart Transplant, Lung Transplant, and VAD Inserted Patients
Authors: Choudhury Bipasha , Smith Stephanie W , Buchanan-Chell Maureen 
Published: January 2025

Abstract

Background
Surgical site infections (SSI) after heart and lung transplantation and implantation of Ventricular Assist Devices (VAD) confer significant morbidity. Despite this, many sites do not perform routine surveillance of this population.
Considering the paucity of available data, this retrospective chart review evaluated the incidence, risk factors, associated microorganisms, and outcomes associated with surgical site infection by type of transplant received.

Methods
This review was conducted at a tertiary care hospital in Edmonton, Alberta. All patients who received a heart or lung transplant or VAD insertion between July 1, 2022, and December 31, 2023, that had at least 90 days of follow-up were included. Information collected included data on transplant/VAD insertion, age, sex, presence of SSI, microorganisms associated with infection, length of stay, and outcome. Other data collected included receipt of antibiotic prophylaxis, admission to hospital in the six months prior to transplant, and surgery in the six months prior to transplant.

Results
A total of 219 patients were included in the review (double lung transplant = 104, heart transplant = 38 and VAD insertion = 77)
SSI rate was found to be higher in the VAD insertion group (16%), compared to lung (12.5%) or heart transplant (7.8%) recipients. Post-transplant hospital stay was longer in lung transplant (17-131; median 55) and heart transplant recipients (81-115; median 112) who developed SSI, compared to their counterparts who did not develop SSI (12-197; median 32 and 13-120; median 20 respectively).
Coagulase-negative staphylococcus aureus was found to be the most common pathogen among all three groups of transplants that developed surgical site infections (SSIs). However, Cutibacterium acne was also frequently isolated in VAD recipients, while Yeast, E. fecalis and E. feceium were commonly found to be responsible for lung transplant SSIs.

Conclusion
Rates of SSI after heart and lung transplantation and VAD insertion are high and result in significant morbidity. The choice of antibiotic prophylaxis may need to be individualized in this patient population given prior antibiotic exposure, hospitalization, and risk of more resistant pathogens.

Disclosures
All Authors: No reported disclosures
P-417. Rectal Surveillance for Multi-drug Resistant Organisms colonisation Among High-Risk Patients Admitted in a Tertiary-Care Hospital in Greece
Authors: Protonotariou Efthymia , Tampakas Lampros , Meletis Georgios , Tychala Areti , Pontika Evagelia , Georgopoulou Ειrini , Bampi Konstantinia , Pantelidou Parthenopi , Trikoupis Petros , Sereni Zoe , Oikonomou Margarita , Katsanou Haroula , Mantzana Paraskevi , Metalllidis Simeon , Skoura Lemonia 
Published: January 2025

Abstract

Background
Antimicrobial Resistance (AMR) is a global urgent health threat that has escalated since the COVID-19 pandemic. Greece is a country with high rates of multi-drug resistant microorganisms (MDROs), including extended-sepctrum β-lactamases (ESBL), carbapenem-resistant Gram-negatives and vancomycin-resistant EnterococcI (VRE). In the present study rectal surveillance screening for the above mentioned MDROs was performed among high-risk patients admitted to our hospital.

Methods
High risk patients were defined as those previously hospitalized in our or other hospitals, those admitted from rehabilitation centers, oncology, and renal failure patients as well as patients that are already hospitalized in our hospital for more than 30 days. During the study period (Nov 2023 – Apr 2024), 425 patients were screened using Brilliance™ CRE Agar (Oxoid, UK) , Brillliance™ VRE Agar (Oxoid, UK) and CHROMID™ ESBL (bioMérieux, Marcy-l'Étoile, France). Carbapenem-resistant (CR) Enterobacterales and Pseudomonas aeruginosa were furtherly tested for carbapenemase production using the NG-Test CARBA 5 immunochromatographic assay (NG-Biotech, France). Isolates grown in the CHROMID™ ESBL plate were tested for ESBL production using ceftazidime and cefotaxime against ceftazidime/clavulanic acid and cefotaxime/clavulanic acid combinations.

Results
185 (43,52%) patients were positive and 240 (56,47%) were negative for the MDROs investigated. Detailed results are shown in Table 1. Among the patients found positive, 89 (48,1%) were from rehabilitation centers, 53 (28,64%) were previously hospitalized elsewhere and 30 (14,05%) were hospitalized in our hospital in previous months. CR Klebsiella pneumoniae (n=76), CR P. aeruginosa (n=56) and VRE (n=57) were the most common MDROs identified. Fourty-seven patients (25,4%) died, 116 (62,7%) showed improvement and the rest remained stable or moved to other facilities. Among the 240 negatives, 35 (14, 58%) died, 197 (82,08%) were improved and 8 (3,34%) remained stable.

Conclusion
Our results highlight the critical situation regarding the spread of MDR bacteria among hospitalised patients, especially the high-risk ones, showing the imperative need for strengthening the already existing infection control measures.

Disclosures
All Authors: No reported disclosures
P-419. The Epidemiology of Healthcare-associated Infections in Jordanian Hospitals before and after the COVID-19 Pandemic
Authors: Nasrat Salwa A , Alhawarat Mohammad , Gharaibeh Mohammad , Sayyouh Omar , Ramadan Mohamed , Said Mayar , Osman Tamer Saied 
Published: January 2025

Abstract

Background
The pandemic of COVID-19 resulted in an exceptional stress on the healthcare system. On the other hand, infection control measures were strengthened within the hospital settings. However, the effect on healthcare associated infections (HAIs) is still not clear, and data are still lacking. This study examines the rates of three HAIs [bloodstream infections (BSIs), Urinary tract infections (UTIs), and pneumonia] before the COVID-19 pandemics and compare them with corresponding rates after the pandemic.

Methods
HAI data were extracted from the national surveillance of HAIs conducted by the Ministry of Health in Jordan. Data for 18 ICUs in 3 tertiary care hospitals were extracted and analyzed for this objective. An active prospective surveillance of HAIs was implemented using US CDC NHSN case definitions. Pooled incidence rates of three HAIs during the pre-pandemic (July 2018–March 2020) and post-pandemic periods (June 2021–December 2023) were calculated and compared.

Results
During the study period, a total of 1642 HAIs were identified in 1624 patients for 302983 patient days. Male gender constituted 59.8% (412/689) among pre-pandemic patients compared to 61.6% (576/935) among post-pandemic patients (p value =0.4). Mean age of pre-pandemic patients was 44.68±1.12 years compared to 49.51± 0.88 years in the post-pandemic patients (p value =0.15). Specific HAI rates were significantly reduced after the pandemic compared to pre-pandemic period. Pooled pneumonia rate was reduced from 2.5/1000 patient-days to 1.4/1000 patient days (RR: 0.56; 95% CI, 0.47–0.67), UTI rate was reduced from 2.0/1000 patient days to 1.2/1000 patient days (RR: 0.59; 95% CI 0.49–0.71) and BSI rate from 2.6/1000 patient days to 2.6/1000 patient days to 2.0/1000 patient days (RR: 0.77; 95% CI 0.66–0.91). On the other hand, in hospital mortality rate for HAI patients significantly increased from 42.0% to 46.2% (p value =0.03).

Conclusion
Post COVID-19 period was associated with a significant reduction in HAI rates. This could be due to increased compliance of the healthcare workers with the standards of infection control. Sustaining HAIs surveillance and auditing of infection control practices are needed to monitor HAIs rates and alert for waning compliance with infection control practices.

Disclosures
All Authors: No reported disclosures
P-423. High Burden of Intestinal Colonization with Carbapenem-Resistant Organisms (CRO) at two Greek Intensive Care Units
Authors: Zarkotou Olympia , Louka Christina , Baziotis Georgios Alexandros , Roussou Anna , Charami Smaragdi , Vourli Sophia , Georgiou Panagiota Christina , Louka Styliani , Kousouli Elisavet , Mamali Vasiliki , Karakosta Polyxeni , Pournaras Spyros 
Published: January 2025

Abstract

Background
Screening for CRO intestinal colonization is part of the recommended interventions to limit their spread. We estimated the burden of carbapenem-resistant Enterobacterales (CRE), carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant Pseudomonas aeruginosa (CRPA) intestinal colonization at two Greek ICUs: Attikon University Hospital (AUH) and Tzaneio General Hospital of Piraeus (TGHP).

Methods
From October 2022, all ICU patients were screened for intestinal colonization by CRO; patients admitted post-surgery on a daily basis were excluded. The first isolate per patient was recorded as a colonization event, categorized as positive either at admission (&lt; 3 days from ICU admission) or during ICU stay ( &gt;=3 days). Admission prevalence rates per 100 admissions (APR) and incidence rates of ICU-acquired intestinal colonization per 1,000 patient-days (IR) were calculated. Rates from the 1st, 2nd and 3rd study semester were compared and incidence rate ratios were determined.

Results
APR and IR of ICU-acquired CRE, CRAB, and CRPA intestinal colonization are presented in Table 1. APR for CRO colonization remained stable, during the study period, with the exception of CRE at TGHP, which exhibited a significant increase (p=0.02). APR were significantly higher at TGHP for all 3 study periods apart from CRE in the first study semester (figure 1). IR of ICU-acquired CRE colonization were also significantly higher at TGHP, in all 3 semesters, possibly due to the higher colonization pressure (figure 2). The IR of ICU-acquired CRE and CRPA colonization remained essentially unchanged over the study period at each hospital. However, a significant reduction in the incidence density of ICU-acquired CRAB colonization was observed (figure 2).

Conclusion
Our study highlights the high burden of CRO colonization in Greek ICUs, which varies even across settings within the same region. CRE colonization presents the greater challenge, closely followed by CRAB, which however showed a significant reduction in ICU-acquired CRAB colonization during the last year. Active surveillance remains a crucial component of prevention bundles and can guide targeted prevention strategies.

Disclosures
All Authors: No reported disclosures
P-432. Understanding Weight Changes in HIV Patients on Integrase Strand Transfer Inhibitor-based Antiretroviral Therapy: Insights from Southern India
Authors: Siby Ashin , Biju Sanju , Paulson Shon 
Published: January 2025

Abstract

Background
As HIV infection continues to pose a significant public health challenge, especially in regions like Southern India, effective antiretroviral therapy (ART) remains pivotal for improving patient outcomes. Integrase Strand Transfer Inhibitors (INSTIs) have emerged as cornerstone agents in ART regimens, yet their specific impact on weight changes in HIV-infected individuals, particularly in Southern India, warrants comprehensive investigation due to limited existing data.

Methods
This retrospective study analyzed medical records of HIV-infected patients receiving care at healthcare facilities in Southern India. Patients who initiated INSTI-based antiretroviral therapy between April1, 2022, and December 31, 2023, were included in the analysis. Data on demographic characteristics, baseline weight, and weight measurements at follow-up visits were collected from electronic medical records. Statistical analysis, including descriptive statistics and paired t-tests, was conducted to assess changes in weight over time following initiation of INSTI-based therapy.

Results
The study included 84 patients diagnosed with HIV, predominantly HIV-1, with a male representation of 61% (n=51) and a median age of 36.3 years (range: 20–65 years). Common opportunistic infections observed were pulmonary tuberculosis, oral candidiasis, and herpes zoster. The primary antiretroviral therapy regimens were TDF+3TC+DTG or TDF+FTC+DTG. Following initiation of INSTI-based therapy, 69% of patients experienced weight gain, averaging 3.81 kg at 3 months, with 18.1% gaining over 4 kg. Median BMI increased from 23.82 kg/m² to 25.9 kg/m² at 8.5 months post-ART initiation. Among ART-naïve patients, 76% experienced weight gain, with 18.1% gaining 8.36 kg at 9 months. Gender and age did not show significant associations with weight gain. However, weight gain exhibited a positive correlation with time after INSTI initiation (r = +1), indicating an expected increase in weight per 0.1 months (F = 4.62, p = 0.032).

Conclusion
In conclusion, our findings underscore the significant weight gain associated with INSTI-based antiretroviral therapy among HIV-infected patients in Southern India, emphasizing the importance of monitoring and managing metabolic changes in clinical practice.

Disclosures
All Authors: No reported disclosures
P-435. Prevalence and Risk Factors for Toxoplasma gondii Seropositivity in a Geographically Defined Cohort of Persons with HIV in Southern Alberta, Canada
Authors: Rosen Charlotte , Gill M John , Fujiwara Esther , Krentz Hartmut , Kamaliddin Claire , Yuan Zhou Hong , McMillan Jacqueline M , Beckthold Brenda , Lang Raynell 
Published: January 2025

Abstract

Background
New evidence suggests Toxoplasma gondii infection may have inflammatory and neurocognitive effects. Among people with HIV (PWH) with immunosuppression, T. gondii infection can reactivate causing significant morbidity. We aimed to identify the prevalence and risk factors for T. gondii infection among a geographically defined cohort of PWH.Figure 1:The proportion of Toxoplasma seropositive and seronegative tests among people with HIV at Southern Alberta Clinic

Methods
The Southern Alberta Clinic (SAC) provides centralized HIV care to all PWH in southern Alberta. SAC is linked with a comprehensive database that collects T. gondii serology (IgG) on entry into the cohort. Using this database, we evaluated temporal trends and risk factors for T. gondii infection between January 1st, 1985 and January 6th, 2022. We used Poisson regression models with robust variance to estimate unadjusted and adjusted prevalence ratios (aPR) with 95% confidence intervals (CI) for factors associated with T. gondii seropositivity (vs. seronegativity) among PWH.Figure 2:Toxoplasma seropositivity by country of birth among people with HIV at Southern Alberta Clinic from 1985-2022

Results
Among 4,424 PWH receiving care at SAC between 1985-2022, 3,696 (84%) were T. gondii IgG negative and 728 (16%) T. gondii IgG positive at cohort entry. Over time, the prevalence of T. gondii infection has been increasing (Figure 1). In adjusted analyses, T. gondii seropositivity was associated with older age &gt;50 years (vs. &lt; 30 years) at serology testing (aPR: 1.7 [95% CI 1.2-2.5]) and birth outside of North America (vs. birth within North America), Central/South America (aPR: 4.5 [95% CI 2.9-6.7]), Sub-Saharan Africa (aPR: 4.3 [95% CI 2.8-6.5]), and Middle East/Northern Africa (aPR: 3.6 [95% CI 2.0-6.4]) (Figure 2).

Conclusion
We found an increasing prevalence of T. gondii infection among our population of PWH over time likely associated with a greater proportion of our population being both born outside of North America and age &gt;50 years. Identifying the prevalence and risk factors for T. gondii seropositivity is important for monitoring potential negative outcomes associated with T. gondii infection and risk stratification among PWH.

Disclosures
All Authors: No reported disclosures
P-444. Cerebral Small Vessel disease risk in people with HIV and substance use disorder
Authors: Ayoade Folusakin , Hernandez Salma , Tookes Hansel 
Published: January 2025

Abstract

Background
Cerebral small vessel disease (CSVD) is associated with an increased risk of stroke, dementia, and death. The risk of CSVD in people with HIV (PWH) is twice the general population but the CSVD risk in PWH with substance abuse is poorly defined. With national surveys showing approximately two-thirds of PWH admitting to using an illicit drug in their lifetime, the evaluation of CSVD risk in this population is needful.Table 1:Demographic and Clinical information of CSVD in PWH with substance use disorder (N=23)

Methods
We retrospectively analyzed brain magnetic resonance imaging (MRI) findings of PWH attending our ambulatory HIV needle exchange clinic. Brain MRIs done in the previous 5 years before study analysis were included. CSVD was determined by Cerebral small vessel disease score (0 to 4), assigning 1 point each for the following: (i) presence of lacunar infarct, (ii) microbleeds, (iii) prominent perivascular spaces, and (iv) white matter hyperintensities. The findings suggestive of CSVD such as age-related white matter changes and chronic microvascular ischemia were also included in the CSVD assessment. Substance use disorder (uncontrolled use of a substance despite harmful consequences) was determined to be present if this was included on the patient diagnosis list.Table 2:Cerebral Small Vessel disease Score in PWH with substance use disorder. 5 participants had a CSVD score of 0 but "age related white matter disease" on Brain MRI

Results
51 patients (PWH with substance use disorder) were included in the analysis. 23 participants out of this group had brain MRI imaging out of which 12 (52.2%) had CSVD. The mean age was 50 years. The demographic and clinical data of the cohort are shown in Table 1. The CSVD score ranged from 0 to 3 with an average score of 1. Table 2 illustrates the CSVD score of the cohort. 5 participants had a CSVD score of 0 but a brain MRI report of “age-related white matter changes”. The Pearson Correlation between age and CSVD score was 0.057 with a p-value of 0.86.

Conclusion
52% of PWH who use substance have CSVD on MRI brain imaging. This could translate to an increased risk of stroke, cognitive impairment, and death if not recognized early and aggressively addressed. CSVD score provides objective quantification of CSVD but age-related white matter changes, which are not captured on this score may be equally important especially as PWH continues to age. A systematic approach for screening for CSVD in PWH with substance use disorder is warranted to minimize the unfavorable outcomes associated with this cohort.

Disclosures
All Authors: No reported disclosures