bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-252. Culture-based Viability PCR: Strategies to Harness its Sensitivity and Minimize False Positives
Authors: Duane Erin , Sharma Ayanna , Oldenburg Evan , Barrett Aaron , Fils-Aime Guerbine , Graves Amanda M , Anderson Deverick J , Warren Bobby G 
Published: January 2025

Abstract

Background
qPCR is a highly sensitive method for identifying the presence of potential pathogens. However, its utility as a tool to detect environmental contamination is limited by its inability to differentiate between viable and non-viable target cells.Table 1.Detection of target organisms via qPCR and Culture

Methods
We completed a prospective microbiological analysis of patient bed footboard samples at a tertiary care center using foam sponges and the stomacher method to process samples. Target species included E. coli (EC), S. aureus (SA), and C. difficile (CD).
Sponge homogenates were split into three paths: 1) T0: 500uL was added to 4.5ml of species-specific (SS) broth; 500uL of the resulting mixture underwent DNA extraction and qPCR with SS primers, 2) T1: 500uL was added to 4.5mL of SS broth, and 3) Growth negative control (GNC): 500uL was added to 4.5mL of 8.25% sodium hypochlorite, incubated for 10 minutes, centrifuged for 15 minutes at 3100 RPM, then decanted and added to 5mL of SS broth after 2 PBS washes. T1 and GNC samples were then incubated at SS conditions (24 hours at 37C for EC and SA, and 48 hours for CD). After incubation, 500uL from T1 and GNC samples underwent DNA extraction and qPCR. All samples were also cultured on SS agar. A sample was considered viable for each species if 1) it was detected at T0, and the CT decreased by at least 1.0 at T1 compared to GNC or 2) it was undetected at T0, detected at T1, and undetected for GNC, or 3) grew on standard culture agar.
Table 2: Viability of target organisms via qPCR and Culture

Results
468 samples from 26 patient rooms were analyzed, including 156 for each species. Of the 26 original samples, 24 (92%), 11 (42%), and 2 (8%), had detectable levels of EC, SA, and CD via qPCR at T0 or T1, respectively, and could be assessed for viability. Of those, 3 (13%), 8 (73%), and 0 (0%) contained viable cells of EC, SA and, CD via qPCR, respectively. Notably, 5 (19%) of SA samples were culturable at T1, indicating broth enrichment enhances culture sensitivity; however, all were determined viable via qPCR as well.

Conclusion
Culture-based viability PCR outperformed traditional culture methods in detecting viable pathogens with improved specificity compared to qPCR, highlighting its potential as a tool for assessing environmental contamination. Further large-scale studies are needed to confirm these results across different species.

Disclosures
All Authors: No reported disclosures
P-256. Development of Novel Clutter and Cleanliness Scales for Infection Prevention and Control in U.S. Home Healthcare Settings
Authors: Dualeh Khadra , Vergez Sasha , Onorato Nicole , Brasch Judith , Ramos Evette , Chastain Ashley , Russell David , Wang Jinjiao , McDonald Margaret V , Shang Jingjing 
Published: January 2025

Abstract

Background
In the U.S., homebound older adults often have multiple chronic conditions thereby increasing their infection risk. For those receiving home health care (HHC), environmental hazards in the home can not only exacerbate infection risk but can also impede effective infection prevention and control (IPC) practices for HHC clinicians, patients and their caregivers. Timely and accurate assessment of environmental risks are crucial. Yet, no tools exist specifically for HHC clinicians to assess infection risk factors in the home environment. To fill this gap, we developed scales to measure clutter and cleanliness in HHC patients’ homes.
The clutter and cleanliness rating scale.

Methods
First, we reviewed existing clutter and cleanliness scales, noting that most validated scales focused on hoarding. We adapted these scales and developed observational items focused on IPC in the home environment. During pilot testing with 15 HHC patients and caregivers from an urban HHC agency, we used a uniform rating scale for both clutter and cleanliness items, which posed challenges due to variable home environments and interviewer biases. Following pilot testing, we refined the scales based on interviewer feedback. To improve coding consistency, interviewers received training using a procedural manual and completed a home observation quiz with example pictures.

Results
Our revised observational items now have distinct rating scales for cleanliness and clutter. Clutter is rated on percentages of free space to reduce subjectivity, and cleanliness is rated on a scale of visible clean to not clean (Table 1). Even with refinement, there was still difficulty achieving consistent ratings among interviewers, specifically with the middle scale points (mostly and moderately clean; some and moderate clutter). However, after scale revisions and interviewer trainings, home observation quiz responses among interviewers achieved at least 80% consistency.

Conclusion
Our scales represent the first observational items designed to assess home cleanliness and clutter for IPC purposes. If widely adopted, these scales could enable HHC clinicians to effectively assess environmental hazards, informing patient/caregiver educational needs and enhancing patient safety by reducing infection risks.

Disclosures
All Authors: No reported disclosures
P-259. Facilitators and Barriers for the Use of Ultraviolet-C Disinfection at VA Hospitals: A Qualitative Analysis
Authors: Dukes Kimberly C , Hockett-Sherlock Stacey , Cunningham Goedken Cassie , Racila A M , Walhof Julia , Suh Daniel , Goto Michihiko , Perencevich Eli N 
Published: January 2025

Abstract

Background
Ultraviolet-C (UV-C) disinfection has been increasingly used to enhance terminal room cleaning and prevent hospital pathogen transmissions. We reported that UV-C implementation in Veterans Affairs (VA) hospitals was associated with a 17% reduction in Gram-negative bloodstream infections (BSI), but with a significant facility-level variation. To investigate this variation, we evaluated facilitators and barriers to implementing UV-C disinfection at VA hospitals.

Methods
We interviewed environmental management services (EMS) leaders, housekeepers, infection preventionists, and multidrug-resistant-organism prevention coordinators at 22 US VA hospitals that used UV-C during the study period. Interviews focused on the context of external and internal environments, organization, tools and technology, tasks, and persons. We conducted a thematic analysis on transcripts.

Results
21 of 22 participating VA hospitals report using UV-C as an adjunct to 2-step manual room cleaning. 34 staff completed interviews. The frequency of UV-C disinfection, locations, and rationales for use varied across hospitals. Interviewees reported using UV-C in operating rooms and patient rooms most often. Room use varied (e.g., routine discharge, contact precautions, other reasons).
Barriers at some hospitals included leaders’ distrust of manufacturer claims for exposure times, risks, and efficacy; concerns that non-VA data may not apply to the VA context; and a perceived lack of UV-C’s impact on local infection rates. Other barriers include high patient loads requiring fast room turnovers, reduced staffing, equipment and maintenance costs, and competing priorities. Facilitators for UV-C use included COVID-19-related financial resources, collaborative communication between EMS, Nursing, and Infection Prevention, and professional competence and commitment to infection prevention.

Conclusion
Given the reported barriers and facilitators, a UV-C implementation toolkit informed by VA staff feedback could improve acceptability of UV-C technology for staff and is worth further study. Interprofessional collaboration and leadership support could improve integration of UV-C into environmental cleaning best practices in VA hospitals.

Disclosures
Michihiko Goto, MD MSCI, Merck: Grant/Research Support
P-289. Short-Duration vs. Long-Duration of Therapy for Hospital-Acquired or Ventilator-Associated Pneumonia due to Multi-Drug Resistant Pseudomonas aeruginosa
Authors: Al Musawa Mohammed , Caniff Kaylee E , Judd Chloe , Veve Michael , Rybak Michael J 
Published: January 2025

Abstract

Background
The duration of therapy for hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP) due to non-lactose fermenter Gram-negatives bacilli including Pseudomonas aeruginosa (PsA) remains a topic of debate. Our study aimed to compare the efficacy of short-duration (≤8 days) to long-duration ( &gt;8 days) therapy for HAP/VAP due to multi-drug resistant (MDR) or difficult-to-treat (DTR) PsA infection.

Methods
A two-center, retrospective cohort study was conducted from 5/2010 to 12/2022. We included all patients ≥18 years old with HAP or VAP due to MDR- or DTR-PsA in respiratory cultures who were treated for ≥72 hours. The primary outcome was a 30-day recurrence from the index culture, and the secondary outcomes were a 60-day recurrence, 30-day, and 60-day mortality from the index culture.

Results
Overall, 203 patients (short duration, n=91 and long duration, n=112) were included. Sixty-nine percent were male, and 58.6% were of African American descent. The mean (SD) for age and APACHE II score were 58.5 (15.8) and 23.9 (7.9), respectively. The common comorbidities were diabetes (39.9%), cerebrovascular disease (28.6%), and chronic obstructive pulmonary disease (24.1%). The primary admission source was a nursing home (44.8%). VAP was diagnosed in 53.0% of patients, with DTR-PsA accounting for 58.1% of all infections. Polymicrobial infection was present in 20.1% of the cases with Enterobactarales species present in all cases. Ceftazidime-avibactam and ceftolozane-tazobactam were used for treatment in 33.0% and 47.8%, respectively; combination therapy was used for 11.8% of cases. The 30-day recurrence was significantly lower in the long-duration therapy compared with the short-duration (5.4% vs. 15.9%, p = 0.017). Similarly, there was a lower 60-day recurrence rate in the long-duration group vs. short-duration group (8.9% vs. 24.4%, p=0.026). There were no significant differences in 30-day and 60-day mortality rates observed.

Conclusion
Prolonged duration ( &gt;8 days) has resulted in lower recurrence rates of HAP/VAP caused by MDR/DTR PsA infection at 30 and 60 days. Although our study is insightful, a larger-scale study is necessary, and logistic regression should be conducted to determine the predictors of the significant differences in the primary outcome.

Disclosures
Kaylee E. Caniff, PharmD, BCIDP, T2Biosystems: Honoraria Michael J. Rybak, PharmD, PhD, MPH, Abbvie, Melinta, Sionogi, Merck, T2Biosystems: Advisor/Consultant|Abbvie, Melinta, Sionogi, Merck, T2Biosystems: Grant/Research Support|Abbvie, Melinta, Sionogi, Merck, T2Biosystems: Speaker
P-299. Clinical and microbiological characteristics of hospital-onset and community-onset invasive urinary tract infection caused by extended-spectrum β-lactamase-producing Escherichia coli
Authors: Tsuda Yusuke , Matsumara Yasufumi , Hayakawa Kayoko , Tsuzuki Shinya , Shinohara Koh , Arasawa Soichi , Tsuchido Yasuhiro , Yukawa Satomi , Noguchi Taro , Yamamoto Masaki , Nagao Miki 
Published: January 2025

Abstract

Background
In the era of community spread of extended-spectrum β-lactamase-producing Escherichia coli (ESBLEC), the differences in clinical and microbiological characteristics between hospital-onset (HO) and community-onset (CO) invasive urinary tract infection (iUTI) caused by ESBLEC have not been well documented in East Asia.

Methods
We conducted a post-hoc analysis of a multicenter, observational study between 2020 and 2021 at 10 facilities across Japan. The inclusion criteria were 1) diagnosis of iUTI, 2) isolation of ESBLEC from urine or blood cultures, and 3) treatment with cefmetazole (CMZ) or meropenem (MEM) as definitive therapy within 96 hours of culture collection and continued for at least 3 days. Patients diagnosed with iUTI within 3 days after admission were assigned to the CO group, while others were assigned to the HO group. Clinical characteristics of the HO and CO groups were compared after reduction of treatment bias between the CMZ and MEM groups using a propensity score-based adjustment. Antimicrobial susceptibility testing and whole-genome sequencing analysis were performed to investigate differences between the HO and CO isolates.

Results
Thirty-two and ninety-five patients were included in the HO and CO groups, respectively.
The clinical and microbiological characteristics were summarized in Tables 1 and 2, respectively.
In multivariable logistic regression analysis, exposure to β-lactam antimicrobials and indwelling urinary catheter were associated with the HO group. Clinical effectiveness in the early treatment period was more frequently observed in the CO group, although the 30-day mortality rates were not significantly different between the HO and CO groups. There was no difference in distributions of sequence types and CTX-M subtypes between the HO and CO isolates. The CO isolates had a higher resistance rate to gentamicin than the HO isolates. Pangenome analysis revealed that aac(3)-II (aac(3)-IId or IIe), which confers resistance to gentamicin, was frequently present in the CO isolates.

Conclusion
Compared to the patients with CO-iUTI by ESBLEC, those with HO-iUTI were characterized by prior exposure to β-lactam antimicrobials and indwelling urinary catheter. The CO isolates were associated with resistance to gentamicin and carriage of aac(3)-II.

Disclosures
All Authors: No reported disclosures
P-302. Changes in Antimicrobial Susceptibilities of Enterobacterales Causing Sepsis in Neutropenic Pediatric Patients with Underlying Hemato-oncologic Diseases
Authors: Kyung Cho Yoon , Ji Kim Ye , Won Yoo Jae , Mi Kang Hyun , Wook Lee Jae , Chung Nack-Gyun , Cho Bin , Chul Jeong Dae 
Published: January 2025

Abstract

Background
As neutropenia episodes in pediatric hemato-oncology often lead to sepsis and need antibiotics, monitoring resistance is crucial for empirical antibiotics choice. We analyzed antimicrobial susceptibility changes in Enterobacterales from sepsis pediatric patients at Seoul St. Mary’s bone marrow (BMT) center. Data from 2016-2020 and 2021-2023 were compared after shifting initial empirical antibiotics from piperacillin-tazobactam (PIP-TZ) to cefepime (CEF).

Methods
This was a retrospective cohort study of sepsis patients at the pediatric BMT center of Seoul St. Mary’s hospital. Data from two time periods, 2016-2020 and 2021-2023, were compared, as the initial empirical antibiotic was switched from piperacillin-tazobactam (PIP-TZ) to cefepime (CEF).

Results
Of 370 bacteremia cases, 70% (n=259) occurred during 2016-2020, and 30% (n=111) during 2021-2023. The proportion of sepsis by Enterobacterales increased, with 32.8% (n=85/259) during 2016-2020 and 57.6% (n=64/111) during 2021-2023 (P &lt; 0.001). After antibiotic switch, the proportion of extended-spectrum beta-lactamases-producing E.coli and K.pneumoniae increased from 14.1% (n=10/71) to 30.9% (n=17/55) (P = 0.02). The overall susceptibilities of to third and fourth generation cephalosporins decreased: cefotaxime (78.3% to 49.3%, P &lt; 0.001); ceftazidime (87.4% to 64.4%, P = 0.0046), and CEF (87.4% to 68.5%, P = 0.002). The overall susceptibilities to PIP-TZ increased: 78.2% to 83.6% (P = 0.30). For P.aeruginosa, the susceptibilities to PIP-TZ and CEF decreased: 78.6% to 66.7%, P = 0.53 and 85.7% to 77.8%, P = 0.62, respectively. Carbapenem-resistance was observed in P.aeruginosa, A.baumannii and K.pneumoniae during 2016-2020 while it was observed in S.pneumoniae, K.pneumoniae, P.aeruginosa, E.cloacae and M.morganii during 2021-2023. 3.5% (n=4/115) of gram negative sepsis patients had carbapenem-resistance in 2016-2020 while 10.9% (n=8/73) in 2021-2023 (P = 0.04).

Conclusion
Cephalosporin resistance increased after the change of initial empirical antibiotics, while P.aeruginosa showed the opposite resistance. Continuous monitoring for any increase in carbapenem resistance is necessary.

Disclosures
All Authors: No reported disclosures
P-313. Trends in Invasive Staphylococcus aureus infections in Monroe County, NY, 2016-2023
Authors: Walsh Marissa , Nakamura Lauren , Gellert Anita , Keller Elizabeth , Tracy Marissa , Felsen Christina , Dumyati Ghinwa 
Published: January 2025

Abstract

Background
Since the COVID-19 pandemic, increases in healthcare-associated invasive methicillin-resistant S. aureus (MRSA) infections were observed. Limited data exist for invasive methicillin-sensitive S. aureus (MSSA) infections. We identified trends in community and healthcare associated invasive S. aureus (iSA) infections during 2016-2023.Figure 1.Incidence of iSA infections by resistance-type, Monroe County, NY, 2016-2023.

Methods
Active, population-based surveillance data for iSA was collected as part of the CDC Emerging Infections Program. A case was defined as a resident of Monroe County, NY with S. aureus isolated from a normally sterile site. Cases were classified as hospital onset (HO) if the culture was obtained &gt;3 days after hospitalization, healthcare-associated community-onset (HACO) if the culture was obtained in an outpatient setting or &lt; 3 days after hospitalization in a patient with ≥1 prior major healthcare exposures, or otherwise community-associated (CA); incidence was calculated for each epidemiologic classification.Figure 2.Incidence of iSA infections by epidemiologic classification, Monroe County, NY, 2016-2023.

Results
A total 4,440 iSA cases were identified during 2016-2023; 3,512 had S. aureus isolated from blood and 942 were from other sterile sites. iSA incidence increased from 66.5 (per 100,000 population) in 2016 to a peak of 87.9 in 2023 (Figure 1). HACO comprised &gt;50% cases and incidence mirrored the pattern of overall rates, rising from 33.8 in 2016 to 48.9 in 2023 (Figure 2). HO incidence doubled, rising from 9 in 2016 to 18.2 in 2023; CA incidence remained stable.
MSSA incidence was approximately twice the rate of MRSA for each year. Incidence of MSSA rapidly increased from 2020 to 2021 (42.7 to 57.6) with increases in all epidemiologic classes (Figure 3). MRSA rose the following year (23.8 to 31.1) with a decline in CA cases; HO increased by 59% and HACO increased by 33%.Figure 3.Comparison of epidemiologic classification between MRSA vs. MSSA cases, Monroe County, NY, 2016-2023.

Conclusion
Our study highlights an increase in iSA infections since 2016, predominantly driven by HACO cases. MSSA infections surpassed MRSA infections throughout, with both experiencing sustained increases since COVID-19 emerged. These findings emphasize the importance of continued surveillance and targeted interventions to address the growing burden of iSA infections, particularly those associated with healthcare.

Disclosures
All Authors: No reported disclosures
P-333. Teaching Hand Hygiene Technique to Preschool-aged Students Using a Musical Mnemonic: A Vanguard Study
Authors: Thampi Nisha , Darbha Aparna , Zumbansen Anna , Comeau Gilles , Longtin Yves 
Published: January 2025

Abstract

Background
The World Health Organization (WHO) recommends a 6-step protocol for hand hygiene (HH). A musical mnemonic, with instructions sung before completion of each step, was developed in 2019 to increase awareness of HH technique. The primary objective of this study was to determine whether the musical mnemonic improves HH technique compared to prose instruction among preschool-aged children through a novel set of process and outcome measures. The secondary objective was to assess feasibility of rolling out the musical mnemonic as part of HH education at a class level.

Poster demonstrating hand hygiene technique with instructions according to musical mnemonic

Methods
We partnered with a local school and co-designed a vanguard trial involving students in toddler (age 1-2 years) and preschool (age 3-5 years) classrooms. In all rooms, we introduced the HH technique using conventional teaching, i.e., visual demonstration using a poster with written instructions (Figure 1) and lotion visible under ultraviolet light. Intervention rooms had additional musical mnemonic, or lyrical, instructions. The demonstration was repeated one week later. Four classes (2 toddlers and 2 preschool) were randomized to either conventional or lyrical teaching and followed on Day 1, 2, 5, 8, 9, 22 and 29 to assess the immediate and long-term impact on the degree of completion of the HH steps (scores from 0 to 9).

Overall impact of hand hygiene teaching on hand hygiene score (combined toddler and preschool age groups)

Results
We performed 378 HH observations in January and February, 2024. Both lyrical and conventional instruction groups were comparable in terms of HH score at baseline (median [IQR], 1 [0-1] vs 1 [0-1], respectively, p=0.90). Immediately after training, the lyrical group achieved a significantly better HH score than the conventional group (median [IQR], 2 [1-7] vs 1 [0-4], p=0.007). The effect of the intervention was sustained, with significantly higher HH scores in both toddler and preschool age groups on Day 2, 15, 22 and 29 after intervention (p&lt; 0.05 for each comparison, Figure 2).

Conclusion
A musical mnemonic was associated with an immediate, improved uptake of the WHO-recommended HH technique, then decreased but remained significantly higher compared to conventional teaching over 4 weeks among preschool- and toddler-aged students. A multimodal HH education program that incorporates the musical mnemonic can be co-designed with education specialists and evaluated in a school setting.

Disclosures
All Authors: No reported disclosures