bluuebunny/crossref_metadata_2025_split huggingface dataset:
2439. Excess Length of Stay and Mortality among the Critically Ill Adult Patients with Catheter-Associated Urinary Tract Infections in a Tertiary Care Teaching Hospital in Nepal
Authors: Shrestha Sailesh K 
Published: November 2023

Abstract

Background
Patients in the Intensive Care Units (ICU) with Catheter-associated Urinary tract infections (CAUTI) stay longer in the hospital and have excess mortality. Conventional techniques like matching designs or regression analyses to obtain these estimates are prone to time-dependent bias and bias due to competing events. Instead, a survival analysis technique called multistate modeling that describes the occurrence of events as transitions between multiple states over time, has been recommended. Reliable estimates of excess length of stay and mortality among patients with CAUTIs, using appropriate methodologies, have not been reported from Nepal. In this study, we examined the mortality and length of stay that could be attributed to CAUTIs in the ICU of our center.

Methods
We conducted this prospective cohort study in the 8-bedded medical ICU of a 458 bedded tertiary care teaching hospital in Kathmandu, Nepal. We included all the patients aged ≥ 16 years admitted to the medical ICU and with an indwelling urinary catheter for more than two calendar days during the one-year study period from June 2021 to July 2022. We diagnosed CAUTI using US CDC definitions and determined the antibiotic susceptibility of the bacteria when isolated. We summarized the categorical variables with frequency and numerical variables with median (interquartile range [IQR]). With the assumption of a constant hazard model, we used multistate models to calculate the transitional probabilities and estimate the excess length of stay and mortality.

Results
Of the 209 patients receiving urinary catheterization, more than half of them (120, 57.42%) were males and the median age was 50 (IQR 38 – 67.25) years. There were 32 (15.3%) CAUTI events identified. The urine samples of 25 patients yielded 27 microorganisms; 20 isolates among them were multi-drug resistant isolates. Escherichia coli was the most common microorganism. Overall, the patients with CAUTI stayed 2.5 days longer in the ICU and had 13% higher mortality than those without CAUTI.

Conclusion
The high burden of CAUTIs and the associated excess length of stay and mortality provide an approximation of the number of lives that could be saved and the number of bed days that could be gained by the appropriate CAUTI preventive and management strategies and should be reinforced.

Disclosures
All Authors: No reported disclosures
2440. Central Line-Associated Bloodstream Infection Incidence Reduction Accompanies Initial-Specimen Diversion Device Adoption
Authors: Stroupe Cody G 
Published: November 2023

Abstract

Background
Established lines are poor sites for sampling blood (frequently host to enterococci and Candida species) but peripheral venipuncture is an imperfect alternative as antiseptics struggle to eliminate deeply embedded microorganisms. State-of-the-art initial-specimen diversion device (ISDD) use can facilitate near-zero blood culture contamination rates, but impact on central line-associated bloodstream infection (CLABSI) incidence is unclear.

Methods
Intervention took place within a Joint Commission-accredited, 200-bed, acute-care community hospital serving nine Southeastern United States counties toward the objective of reduced CLABSI reporting. From September 2021 through March 2023, ISDD use augmented all peripheral venipuncture sample collection for adult patient blood culture. CLABSI reporting and the associated National Healthcare Safety Network (NHSN) standardized infection ratio (SIR) data for the 18-month intervention period was compared to the preceding 18-month period.

Results
For the 18 months prior to ISDD use, 6.5 CLABSIs were predicted and 17 CLABSIs were reported. For the 18 months during which ISDD use augmented standard procedure, 5.5 CLABSIs were predicted and 3 CLABSIs were reported. ISDD use accompanied an 80% reduction in SIR, from 2.6 to 0.5.

Conclusion
The study period coincided with the COVID-19 pandemic, a nationwide struggle with considerable quality control shortcomings observed in this space that, by juxtaposition, reinforce the strengths of the intervention. SIRs are the primary means of tracking healthcare-associated infection trends, and financial penalties follow performances failing to meet predictions. As CLABSI reporting throughout the intervention period was dramatically below NHSN prediction, the author concludes that ISDDs have standard-of-care potential and encourages further study in the interest of antimicrobial stewardship and quality control.

Disclosures
All Authors: No reported disclosures
2442. Etiology of Leukemoid Reaction in Patients Undergoing Extracorporeal Membrane Oxygenation
Authors: Wells Christian , Sobieszczyk Michal , Marcus Joseph 
Published: November 2023

Abstract

Background
Infections are a common in patients undergoing extracorporeal membrane oxygenation (ECMO), yet there is limited literature describing best practices for identifying infections. Leukemoid reaction, defined as &gt; 50,000 white blood cells (WBC) per microliter, has been associated with infection in some populations. However, the etiology of leukemoid reactions in ECMO is unknown.

Methods
A retrospective cohort study was performed of all adult patients admitted to Brooke Army Medical Center who received ECMO for greater than 72 hours between the years of 2018-2022. Maximum WBC was obtained for all charts. For patients with a leukemoid reaction, charts were examined to determine both demographic information as well as clinical management of patient at time of leukemoid reaction.

Results
Among 182 patients receiving ECMO for greater than 72 hours, 181 (99%) of patients had a WBC greater than 10,000 cells per microliter during their ECMO course. 15 (8%) developed a leukemoid reaction while on ECMO and were included for further analysis. In this cohort, the median age was 38 [32-44.5] with median [IQR] WBC of 53.94 [50.98-62.55]. Among these patients, 14 (93%) underwent an infectious workup with infectious disease being consulted in 10 (67%) cases. Two (13%) patients had antibiotics started and 2 (13%) had their antibiotics broadened. Patients had a median of 2 [IQR: 2-3] contributing factors to their leukemoid reaction. Of these contributing etiologies, eleven (73%) patients were receiving treatment for a known infection, 6 (40%) were found to have a new thrombus, and 4 (27%) were receiving glucocorticoids (Table). One (7%) patient was found to have a new infection, an Acinetobacter bacteremia.Table 3.Contributing Etiologies of Leukemoid Reaction in patients receiving ECMO at Brooke Army Medical Center

Conclusion
Leukocytosis is almost universal in ECMO and leukemoid reactions occur frequently. In this cohort, infectious workups were common for leukemoid reaction, yet new infections were rarely identified. Future studies are needed to determine better infectious markers in this patient population.

Disclosures
All Authors: No reported disclosures
2444. Descriptive Analysis and Control Measures of Candida auris Infections: An Experience form a Quaternary Healthcare Center in Saudi Arabia
Authors: Amer Hala A , Alfaraj Sarah , Memish Ziad 
Published: November 2023

Abstract

Background
Candida auris is a multidrug-resistant fungal pathogen causing a worldwide epidemic. Since C auris has high mortality rate, ambiguous spread, frequent misidentification, and multidrug resistance, therefore it’s considered as a major global public health threat. In Saudi Arabia (SA), 1st case of C auris was identified in 2018.

Methods
We described patients with C auris positive specimens reported between January 2021 and June 2022 at one of the main healthcare facilities in SA. A multiciliary committee headed by the hospital leadership and involved infection control, infectious diseases, intensive care, nursing, environmental services, pharmacy, and laboratory has been formulated to investigate the potential outbreak among clusters of cases at intensive care unit (ICU). A bundle of containment measures has been applied at ICU including, C auris admission screening, point prevalence testing every two weeks, patients and staff post exposure screening, environmental samples, high level disinfection (fig1), dedicated of patients’ placement and equipment of care , enhancing patient hygiene, universal contact precautions , and frequent education and auding of infection control practices.Figure 1:Protocol of Cleaning and Disinfection Process for Candida auris

Results
129 cases of C auris were identified in our facility during the study period with two peaks of cases in June 2021 and March 2022. 78.3% were ICU patients with average length of stay 36.2 days. Demographics, comorbidities and risk factors were analyzed (tables1&2). Mortality rate was 43.4% occurred within 20.13 days of infection. Factors significantly associated with mortality were age, trauma patients, ICU admission, vascular access, foley catheters, mechanical ventilation, tracheostomy and endotracheal tube (table 3). Hundreds of exposed staff screened for C auris , none of them turned positive. C auris was isolated from glucometer and body thermometer. The trend gradually decreased following the mitigation actions.

Conclusion
Transmission of C auris infection presents a risk to chronic critical patients with multiple medical devices. Early detection through active screening in addition to intensive cleaning of patients care area and equipment, strict adherence to infection prevention, leadership support and team coordination are highly effective to reduce C auris transmission.

Disclosures
All Authors: No reported disclosures
2449. Attributable mortality and cause of death of Candida auris cases, Los Angeles County
Authors: OYong Kelsey , Knight Wendy , Nguyen Jennifer , Bhaurla Sandeep , Archer Roxanne , Rubin Zachary 
Published: November 2023

Abstract

Background
Candida auris is a drug-resistant nosocomial pathogen that has a reported mortality rate of 30-50% in infected persons. Mortality among colonized cases has rarely been characterized. The Los Angeles County Department of Public Health (LACDPH) sought to determine attributable mortality among C. auris cases with specimens from sterile and non-sterile body sites.

Methods
C. auris is a reportable condition to LACDPH, and laboratory and epidemiological factors are collected for each case. Sterile body sites included blood, surgical wound, bone, and peritoneal, ascitic, body, and bile fluids. All other body sites, including skin swabs, were categorized as non-sterile. Case data were linked with California death registry data by name and date of birth. C. auris-attributable deaths included any death where the terms ‘Candida auris,’ ‘fungemia,’ ‘Candidemia,’ ‘Candidal sepsis,’ ‘Candida urinary tract infection,’ ‘Candida endocarditis,’ or ‘Candida septic shock’ were listed as the immediate cause of death (COD), as a condition leading to COD, and/or listed in significant conditions contributing to death. Thirty-day mortality was defined as a death within 30 days of the first positive specimen collection.

Results
Among 2,055 reported C. auris cases between January 2020 and March 2023, 1,080 matched a death certificate (53%); 74 deaths were cases with sterile site specimens and 970 deaths were cases with non-sterile site specimens. Thirty-day mortality varied by cases with sterile site specimens vs. non-sterile sites (26% vs. 20%, respectively), as did 30-day attributable mortality (17% vs. 1.9%, respectively). Three cases had C. auris listed as an immediate COD, all of which were cases with non-sterile specimens. The most common COD among cases were cardiopulmonary arrest, pneumonia, and respiratory failure.

Conclusion
Attributable mortality among C. auris cases with sterile site specimens was lower than previously reported, possibly because the circulating clade in LAC is relatively drug-susceptible. Attributable mortality among cases with non-sterile site specimens, including skin swabs, was quite low. Vital records can provide a valuable supplement to traditional public health surveillance, but accuracy and completeness are subject to individual providers’ practice.

Disclosures
All Authors: No reported disclosures
2455. National Trends in the Rates of Drug-resistant Bacteria Commonly Associated with Healthcare in U.S. Acute Care Hospitals, 2019-2021
Authors: Baggs James , Wolford Hannah , McCarthy Natalie , Olubajo Babatunde , Li Deana , Maillis Alex , Reddy Sujan 
Published: November 2023

Abstract

Background
The 2022 Special Report: COVID-19 U.S. Impact on Antimicrobial Resistance identified significant increases in the rate of hospital-onset (HO) infections during the year 2020 for bacteria commonly associated with healthcare. Using the same data sources and methodology, we provide updated estimates for the year 2021.

Methods
We identified a cohort of patients from the PINC AI PHD and BD Research Insights databases with a clinical culture yielding an isolate of an organism of interest with accompanying susceptibility testing. Isolates from patients with no culture yielding the same resistance phenotype of interest in the previous 14 days were counted as an incident case. Community-onset (CO) cultures were obtained ≤ day 3 of hospitalization; HO cultures were obtained ≥ day 4. We used a raking-procedure to determine weights for extrapolating the number of discharges included in our sample to match the distribution of discharges, stratified by bed size, U.S. census division, urban/rural designation, and teaching status, for U.S. hospitals included in the American Hospital Association survey. We examined temporal trends using a multivariable logistic model incorporating a survey design with the corresponding weights and hospital designation as the specific cluster controlling for hospital characteristics, month of discharge, proportion of patients in specific age group, proportion of male patients, and database. Results were stratified by HO and CO.

Results
From 2019-2021, the overall number of hospitals contributing data was 640. HO rates were significantly higher in 2020 and 2021 compared with 2019. The HO rates of VRE, MDRPseu, and CRE were significantly higher in 2021 when compared to 2020 (Table 1). For CO infections, we found that MRSA rates decreased significantly during the study period, while VRE and CRAB were significantly higher in 2021 compared to 2019 (Table 1).

Conclusion
Hospital onset antibiotic resistant infection rates in 2021 remain higher than pre-pandemic rates with increasing rates for several pathogens in 2021 compared to 2020, while CO MRSA declined. As infections caused by resistant pathogens represent a serious threat to patient safety, further study of factors contributing to the continued increases and decreases may inform prevention strategies.

Disclosures
All Authors: No reported disclosures
2458. Carbapenem-resistant Acinetobacter baumannii complex infections and SARS-CoV-2 positivity in 9 U.S. sites, 2020-2022
Authors: Bulens Sandra N , Hall Amanda , Jacob Jesse T , Smith Gillian , Wilson Lucy E , Vaeth Elisabeth , Wilson Christopher , Muleta Daniel , Dumyati Ghinwa , Tsay Rebecca , Maloney Meghan , Stabach Nicole , Lynfield Ruth , O’Malley Sean , Pierce Rebecca , Hertzel Heather , Czaja Christopher A , Johnston Helen , Grass Julian E , Brandenburg Joshua , Guh Alice , Magill Shelley 
Published: November 2023

Abstract

Background
Reports have shown increases in carbapenem-resistant Acinetobacter baumannii complex (CRAB) infections during the COVID-19 pandemic. To describe the effect of SARS-CoV-2 (SC2) infection on CRAB infection epidemiology, we analyzed data from the Centers for Disease Control and Prevention’s Emerging Infections Program (EIP) population-based CRAB surveillance in 9 U.S. sites.
Methods: In 2020–22, among surveillance-area residents, an incident CRAB case was defined as the 1st isolation of A. baumannii complex resistant to ≥1 carbapenem (excluding ertapenem) from a normally sterile site or urine (or lower respiratory tract or wound, as of 2021) in a 30-day period. We included cases that underwent chart review. Cases with a culture collected ≥3 days after hospitalization were considered hospital-onset (HO); all others were community-onset (CO). Cases with a SC2+ test ≤14 days before the incident CRAB culture were compared to other CRAB cases.

Results
Of 406 CRAB cases representing 344 patients, 26 (6%) cases in 24 patients were SC2+. SC2+ case-patients were more likely to be female than other CRAB case-patients (58% vs 34%, p=0.02); there were no significant differences in race/ethnicity or age distribution. SC2+ cases were more likely to be obese (42% vs. 23%, p=0.03), have bacteremia (23% vs. 10%, p=0.05), and to have died (39% vs. 16%, p=0.003). SC2+ cases were also more likely to require hospitalization (100% vs. 75%, p=0.005) and have HO CRAB (58% vs 29%, p=0.003). Median hospital length of stay was longer in SC2+ cases (19 days, interquartile range [IQR] 8–30) than in other CRAB cases (14 days, IQR 7–26, p=0.42), but there were no significant differences in the percentages with intensive care unit stays or mechanical ventilation in the 7 days before CRAB culture. Culture sources and infection types in SC2+ cases vs. other CRAB cases are shown in the Table.

Conclusion
A small minority of CRAB patients were infected with SC2+ in the 14 days before CRAB infection but these patients had epidemiological and clinical features that were distinct from other CRAB patients, including higher mortality. Infection control and clinical measures are needed to protect SC2+ patients from secondary bacterial infection and mitigate poor outcomes in those with SC2 and CRAB infection.

Disclosures
Ghinwa Dumyati, MD, Pfizer: Grant/Research Support Rebecca Tsay, MPH, CDC: Grant/Research Support
2461. Carbapenem-resistant Enterobacterales reported to the National Healthcare Safety Network Multidrug-Resistant Organism & Clostridioides difficile Infection Module, January 2018 to July 2022
Authors: Cincotta Samuel E , Octaria Rany , Maroya Walters 
Published: November 2023

Abstract

Background
To describe the COVID-19 pandemic’s impact on the spread of multidrug-resistant organisms, we compared pre-pandemic and pandemic laboratory-identified carbapenem-resistant Enterobacterales (CRE) events reported to the National Healthcare Safety Network (NHSN).

Methods
A CRE event was a patient’s first Escherichia coli, Klebsiella aerogenes, K. oxytoca, K. pneumoniae, or Enterobacter spp. collected on an inpatient unit in a 14-day period and resistant to ≥ 1 of the following: imipenem, meropenem, doripenem, ertapenem, meropenem/vaborbactam (as of 2021), or imipenem/relebactam (as of 2021). We included events from acute care general hospitals (ACH) performing and continuously reporting facility-wide inpatient CRE surveillance for the same specimen sources in each month, from 2018 through 2019 (Period 1) and July 2020 to July 2022 (Period 2); the first half of 2020 was excluded due to initial pandemic disruptions in reporting to the NHSN. We compared patient demographics and epidemiological changes of events between the periods using Pearson’s χ2 or Wilcoxon rank-sum test as appropriate.

Results
Overall, 523 ACHs in 28 states met inclusion criteria. During Period 1, there were 5499 events from 4725 patients in 22 states compared to 5483 events from 4690 patients in 22 states in Period 2; 21 states were consistent in both periods. More facilities had ≥ 1 event in Period 1 compared to Period 2 (56% versus 51%; p&lt; 0.001). Four public health jurisdictions with mandates to report CRE to the NHSN accounted for 86.7% of Period 1 events and 86.0% of Period 2 events. Between Periods 1 and 2, the proportion of events that were hospital onset (on or after admission day four) (54.3% to 62.6%, p&lt; 0.001), from respiratory sources (26.3% to 31.5%, p&lt; 0.001), and bloodstream infections (10.4% to 12.6%, p&lt; 0.001) increased, and the median patient age decreased (66.5 to 64.6, p&lt; 0.001) (Table 1).

Conclusion
Despite a consistent number of events in ACHs during the two periods, we observed a shift toward events that were hospital onset, associated with invasive infection, and occurring in younger people. The timely availability of robust laboratory-based surveillance is an important public health resource for understanding potential epidemiological changes in antimicrobial resistant threats.

Disclosures
All Authors: No reported disclosures
2466. The Evolution of Candidemia during the COVID-19 Pandemic in Connecticut
Authors: Gleason-Vergados Johanna , Correa Maria , Meek James , Banach David 
Published: November 2023

Abstract

Background
Candidemia is a life-threatening bloodstream infection. The changing epidemiology of candidemia during the COVID-19 pandemic has not been well described. The goal of this study is to describe trends in candidemia epidemiology throughout various phases of the COVID-19 pandemic in Connecticut.

Methods
Using statewide surveillance we identified all adult Connecticut residents with candidemia between January 2020 and October 2022. Cases were aggregated by four-month intervals. Three surges of COVID-19 (Initial, Delta, and Omicron variant surges) were identified based on statewide COVID-19 case numbers. Incidence rate ratios (IRR) were calculated to compare the incidence rate (IR) of candidemia during surge periods to the IR of candidemia in non-surge periods (four-month intervals before and after surges). Patient demographics and clinical characteristics were compared using chi-square analysis.

Results
721 candidemia cases were included in the analysis (255 in 2020, 290 in 2021, and 176 in 2022). The IR of candidemia during the Initial surge was 1.49 times higher than the 4 months after the Initial surge (95% CI: 1.09-2.03). The IR of candidemia during the Delta surge was 1.46 times higher than the preceding 4 months (95% CI: 1.07-1.99) and 1.13 times higher than the 4 months after the Delta surge (95% CI: 0.84-1.51). The IR candidemia during the Omicron surge was 1.05 times higher than the preceding 4 months (95% CI: 0.78-1.41) but 1.56 times higher than 4 months after the surge (95% CI: 1.12-2.17). During surge periods candidemia was more frequently associated with persons of non-white race/ethnicity, hospital-onset infection, mechanical ventilation and mortality (all p &lt; 0.05).

Conclusion
We identified an association between COVID-19 surges and increased rates of candidemia. Candidemia cases during surge periods occurred more frequently among non-white persons, were more likely to have hospital-onset and were more severe suggesting that COVID-19 treatments or interventions may have impacted candidemia rates. Further study is needed to understand factors that resulted in different IRs of candidemia during various phases of the COVID-19 pandemic to inform strategies to prevent candidemia during future public health crises.

Disclosures
All Authors: No reported disclosures