bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-303. Mupirocin Resistance is Common in Tampa, Florida Staphylococcus aureus Clinical Isolates
Authors: Virgillio Ariana , Felton Emily , Becker Deanna , Lima Amorce , Silbert Suzane , Coughlin Emily , Shaw Lindsey , Kim Kami 
Published: January 2025

Abstract

Background
Mupirocin (Mup) is a topical drug used to decolonize carriers of Staphylococcus aureus (SA) to prevent later SA infection. A spot survey of SA isolates at Tampa General Hospital (TGH) revealed a prevalence in Mup resistance of ∼40%, leading to a change of decolonization protocol from mupirocin to povidone iodine in January 2020, just prior to the COVID pandemic. We determined the prevalence of Mup resistance in a random sampling of clinical isolates before and after change in decolonization protocol.

Methods
A total of 211 PreCOVID (before 2020) and 173 PostCOVID (after 2021) samples from various sources (blood, bone, eye, fluid, respiratory, urine, and wound) were tested with minimum inhibitory concentration for Mup resistance using literature values for susceptible, low resistance, and high resistance. Oxacillin sensitivity, to verify MRSA isolates, was tested in parallel. Results were analyzed via χ² for significance (p=0.05).

Results
Comparison of Mup resistance levels between the Pre- and PostCOVID time points showed no significant difference (p=0.460). PreCOVID: 71.1% susceptible, 8.1% low resistance, 20.9% high resistance. PostCOVID: 74.0% susceptible, 9.8% low resistance, and 16.2% high resistance. MRSA status correlated with Mup resistance in both Pre- (p&lt; 0.001) and PostCOVID samples (p=0.001).
Blood vs Non-Blood samples differed in Mup resistance in the PreCOVID period (20.7% blood vs 34.1% non-blood, p=0.037), whereas samples in the PostCOVID period showed no significant difference in Mup resistance (22.8% blood vs 28.7% non-blood, p=0.375). Notably, 46.2% PreCOVID Respiratory were resistant to Mup (p=0.016). 26.3% PostCOVID Respiratory were resistant to Mup (p=0.651).

Conclusion
Change in decolonization protocol did not influence the overall prevalence of Mup resistance. Respiratory samples made up a significant proportion of the resistant samples in the PreCOVID time point, suggesting differences in prevalence of Mup resistance in different clinical sites. Further molecular epidemiological studies are needed to determine if specific sites of infection or specific patient groups are more likely to be colonized with Mup resistant SA isolates.

Disclosures
All Authors: No reported disclosures
P-319. Genetic shift of Methicillin-resistant Staphylococcus aureus isolated from bloodstream infections over 12 years at a tertiary care university hospital in Japan
Authors: Motomura Yuka , Miyazaki Motoyasu , Kamada Mitsuhiro , Satho Tomomitsu , Takata Tohru , Kashige Nobuhiro 
Published: January 2025

Abstract

Background
Limited reports exist on the long-term trends in genotypes of Methicillin-resistant Staphylococcus aureus (MRSA) bloodstream isolates. Therefore, we aimed to investigate the longitudinal trends in genotypes of MRSA bloodstream isolates obtained from hospitalized patients during a 12-year study period from 2010 to 2021 at a tertiary care university hospital.

Methods
Over the 12-year period spanning from 2010 to 2021, we conducted a genetic investigation focusing on MRSA 245 strains isolated from the blood of hospitalized patients. The analysis involved the application of Staphylococcal Cassette Chromosome mec (SCCmec) typing, accessory gene regulator (agr) typing, PCR-based ORF Typing (POT), and Multi Locus Sequence Typing (MLST) to discern the genotypes of the MRSA bloodstream isolates. In this study, strains with the same POT type detected in two or more isolates were designated as epidemic clones, while strains without a common POT type were classified as sporadic clones.

Results
Until 2015, isolates with SCCmec II/agr II were prevalent, but from 2016 onwards, there was an increase in isolates with SCCmec IV/agr III. A total of 128 strains (52%) were identified as epidemic clone, while 117 strains (48%) were classified as sporadic clone. The detection rate of sporadic clone had significantly increased since 2016 (P &lt; 0.05). The epidemic clone was classified into three clusters, with MRSA of CC1 being prominently detected after 2016.

Conclusion
This study found that the genotypes of MRSA bloodstream isolates underwent a shift from SCCmec II/agr II type to SCCmec IV/agr III type, particularly with a notable increase in MRSA of CC1, after the year 2016. There was a significant increase in the proportion of sporadic strains among the isolates, suggesting a diversification of genotypes.

Disclosures
All Authors: No reported disclosures
P-326. Where Does the Glove Fit? Examining the Effect of Hand Hygiene Timing on Healthcare Personnel Glove Contamination
Authors: Gettler Erin , Warren Bobby G , Fils-Aime Guerbine , Barrett Aaron , Graves Amanda M , Anderson Deverick J , Smith Becky A 
Published: January 2025

Abstract

Background
Guidelines recommend performing hand hygiene (HH) prior to donning non-sterile gloves, yet strong evidence is lacking and overall adherence is low. This study evaluated the impact of different HH and gloving strategies on glove contamination.

Methods
Healthcare personnel (HCP) were enrolled on inpatient units and then randomized into 3 arms: 1) standard practice of alcohol-based hand rub (AHBR) before gloving, 2) ABHR after gloving, or 3) direct gloving without HH. Study personnel first collected 1 control glove per HCP from the same glove box used after randomization. After donning, HCP gloves were aseptically removed and placed into sterile bags by study personnel (left, right, control). Inverted gloves were aseptically filled with 50 mL of neutralizing buffer, sealed, and agitated. Buffer was centrifuged at 3100 rpm for 15 minutes and decanted leaving only ∼3 mL of sample. Each homogenate was vortexed and plated onto routine media to assess for bioburden and epidemiologically important pathogens (EIP), including Staphylococcus aureus, Enterococcus species, and gram-negative bacteria. Gloves were visually inspected and tested for microperforations by the water inflation test. Rate of glove contamination and bioburden were compared.

Results
60 HCP across 8 inpatient units were enrolled. Control gloves obtained were frequently contaminated (48.3%). Compared to standard practice, neither HH after gloving nor direct gloving led to significant differences in glove contamination or bioburden (Table 1). In fact, HH after gloving trended toward lower bioburden on the gloves, but this result was not significant. Importantly, the application of ABHR to gloves did not compromise the integrity of the glove or result in microperforations. Gloves were relatively void of EIP.

Conclusion
In this exploratory analysis, HH after donning non-sterile gloves or direct gloving did not result in higher glove contamination. These techniques may represent safe alternative HH practices for HCP and circumvent some of the common barriers limiting HH compliance. Additional studies are needed.

Disclosures
Becky A. Smith, MD, UpToDate: royalties
P-328. Compliance of Hand Hygiene Practice among Health Care Workers in Tertiary Care Military Hospitals of Bangladesh
Authors: Md Abdullah Syed Abul Hassan , Harun Md Golam Dostogir , Amin Sumon Md Shariful , Jahan Ishrat , Ul Anwar Md Mahabub , Siddiquee Taufiq H 
Published: January 2025

Abstract

Background
Hospital-acquired infection is still a major cause of morbidity and mortality in hospitals. Healthcare workers’ (HCWs) hands become progressively colonized with potential pathogens during their patient care and act as a vehicle for transmission of microorganisms to other patients. Hand hygiene (HH) is undisputedly one of the most effective infection control measures. Military hospitals in Bangladesh are known for better compliance of health system practice. This study aimed to evaluate HH compliance and associated factors among HCWs in two tertiary level military hospitals in Bangladesh.Table 1HH practice of Physicans

Methods
We conducted non-participatory observations at 02 tertiary Combined Military hospitals (CMH) at Dhaka (1650 bedded) and Jashore (500 bedded) during Oct to Dec 2021. We used the WHO’s ‘5 moments of Hand Hygiene tools’ to record HH compliance among physicians, nurses and cleaning staff. We also performed semi-structured interviews to determine the key barriers to complying with HH.Table 2HH practice of Nurses

Results
We observed total 172 HH opportunities. The overall HH compliance was 30.9%, highest among physicians (34.5%), followed by Nurses (25.2%). Physicians’ performance (49%) on HH practice before touching a patient was higher than the nurses (46%) but poorer (44.5%) after touching the patient than same practice of nurses (58%). Study also observed that only 24% physicians and 18% nurses practiced HH Before and after handling patient file. Responded opined that workload, shortage of time, lack of facility, distance of hand washing station, inadequate supply were the key hand hygiene barriers with soap. Insufficient supply, skin reaction, cost of product, lack of knowledge appeared. Qualitative assessment revealed that Inadequate handwashing station at wards (distance), insufficient training & orientation for HCWs, irregular monitoring and audit and lack of enforcement of IPC guidelines were key challenges at both study sites.Table 3HH practice barrier with soap

Conclusion
HH compliance among HCWs of study hospital was short of standard for safe patient care. Periodical training and motivation, ensuring HH supplies and enforcement of IPC guideline is needed to improve the situation.Table 4HH practice barrier of sanitizer

Disclosures
All Authors: No reported disclosures
P-347. Investigating Risk Factors for Candida auris Bloodstream Infections: A Case-Control Study from Los Angeles County
Authors: Nguyen Jennifer , OYong Kelsey , Rubin Zachary A 
Published: January 2025

Abstract

Background
Candida auris (C. auris) has emerged as a significant pathogen due to its ability to cause bloodstream infections (BSIs) in highly vulnerable patient populations. Understanding the risk factors associated with C. auris BSIs is crucial for implementing targeted interventions to mitigate the burden of infection and ensure patient safety. In Los Angeles County (LAC), all C. auris cases are reportable to the Department of Public Health (DPH).

Methods
We conducted a case-control study to identify risk factors associated with C. auris BSIs. Using data reported to LAC from June 2019 to April 2024, cases included persons initially colonized with C. auris who subsequently developed confirmed C. auris BSI, while controls consisted of persons colonized with C. auris without C. auris identified from a clinical specimen site. C. auris cases and controls were identified via required laboratory and provider reporting of all positive C. auris tests. Data on various risk factors were collected from provider case reports that were completed on all C. auris-positive persons, excluding cases with missing risk factor data. We used logistic regression to estimate the adjusted odds ratios of a colonized case acquiring a C. auris BSI compared to only colonized persons, adjusting for age, sex, race/ethnicity, and healthcare facility where the positive specimen was collected.

Results
Of the 174 cases and 2,602 controls identified, increased odds of BSI were observed among patients with prior antifungal use (OR: 3.58, 95% CI: 1.12-11.41) and hemodialysis (OR: 2.33, 95% CI: 1.05-5.16). Other risk factors such as ventilator use, tracheostomy, central venous catheter presence, and wound presence showed no statistically significant associations.

Conclusion
Targeted infection prevention strategies are vital to mitigate C. auris BSI burden. Rigorous aseptic techniques during hemodialysis and judicious use of antifungal agents may reduce C. auris BSI risk. Although adjusted for in this analysis, specialized attention to infection control in healthcare facilities such as long-term acute care hospitals may be warranted, given their unique patient populations and care settings. Further investigation is warranted to identify additional strategies to mitigate C. auris BSI risk.

Disclosures
All Authors: No reported disclosures
P-368. Long-range Air Dispersal as An Important Source of Environmental Contamination in Candida auris Clustering: Possible Infection Control Implication
Authors: Fung Wing-Yu , Cheng Ryan Yiu-Fai , Yau Anthony Pak-Yuen , Lee Suet-Yi , Chan Ngan-Han , Wong Yuk-Shan , Cheng Naomi Hua-Yin , Wong Sally Cheuk-Ying , Lung David Christopher 
Published: January 2025

Abstract

Background
Long-range air dispersal of Candida auris has recently been described. Contact precautions alone may not be sufficient to target this mode of transmission. Hence, we study the factors affecting the extent of environmental contamination including air grilles in sporadic C. auris hospitalized patients, and in outbreak settings.

Study flow chart

Methods
Outbreaks and sporadic C. auris cases involving two local hospitals from March to October 2023 were retrospectively analysed. C. auris screening was performed for patients with defined risk factors or regular surveillance as per hospital policy. Environmental samples were taken from high-touch surfaces and air grilles from patients’ environment. Correlation between scale of C. auris clustering and extent of environmental contamination was analysed.

Outbreaks with positive environmental sampling

Results
A total of 170 new C. auris patients were identified, including 65 patients from nine outbreaks and 105 sporadic cases. Environmental screening was performed in eight outbreaks and 46 sporadic isolated cases (Fig 1). Environmental contamination rate of the outbreak group was significantly higher than the sporadic group (15.1% vs 2.5%, P&lt; 0.05). Among outbreak groups, longer median duration of outbreak (34 [27-45] vs 7 [7-12] days, p&lt; 0.05), and more patients’ involvement (9 [6-10] vs 5 [4-7], p=0.05) were associated with higher environmental contamination rate (Table 1). Ward contamination was more frequently detected in sporadic patients with longer duration of stay, though it was not statistically significant (30.8% vs 10%, p=0.09). Air grille samples had a significantly higher contamination rate than high-touch surfaces in both outbreak (41.4% vs 16.7%, p&lt; 0.05) and isolated group (19.7% vs 6.7%, p&lt; 0.05).

Outbreaks with negative environmental sampling

Conclusion
Prolonged and sizeable C. auris clustering was associated with more extensive environmental contamination, particularly air grilles. Long-range air dispersal, as evidenced by air grille contamination, is a possible risk factor for propagation in outbreaks. Contact precautions together with physical segregation to limit air dispersal is recommended. Decontamination of air grille is necessary to prevent further spread. The role of air grille surveillance as a surrogate marker of ward contamination is worthy of further investigation.

Disclosures
All Authors: No reported disclosures
P-402. A Seven-Year Analysis of CRAB and CRE Urinary Tract Infections in Tennessee
Authors: Patel Dipen , Mutamba Glodi , Taylor Jacquelyn , Harriott Melphine , Muleta Daniel 
Published: January 2025

Abstract

Background
Urinary tract infections (UTIs) are a prevalent health concern, affecting millions worldwide. The data collected through the Tennessee Multi-site Gram-negative Surveillance Initiative (MuGSI) was analyzed for a comparative study of UTIs caused by Carbapenem-Resistant A. baumannii complex (CRAB) and Carbapenem-Resistant Enterobacterales (CRE). We aimed to evaluate the demographics, prevalence, and clinical characteristics of patients with UTIs caused by CRAB and CRE.

Methods
Tennessee has participated in the Center for Disease Control and Prevention (CDC) Emerging Infections Program MuGSI project since 2014. An incident case is defined as the first CRE of E. coli, E. cloacae complex, Klebsiella species or CRAB per patient within 30 days. We analyzed CRE and CRAB incident cases of primary or recurrent UTIs reported to MuGSI during 2016–2022. Descriptive analysis and odds ratio were performed using SAS 9.4.

Results
From 2016–2022, 521 UTI cases were reported: 448 (86.0%) CRE and 73 (14.0%) CRAB. More males (64.4%) had CRAB infections (p&lt; 0.0001); conversely, more females (68.5%) had CRE infections (p&lt; 0.0001). The mean ages of patients with CRAB and CRE were 64 and 67 years, respectively. Incidence of CRAB was 8.6 in non-white and 3.3 in white per 100,000 population (p&lt; 0.0001). CRE was associated with reduced odds (OR=0.17, p&lt; 0.0001) of having indwelling catheters compared to CRAB. CRAB cases were 2.59 times more likely to be admitted to the intensive care unit (ICU) (p=0.0020). CRAB cases had higher odds of neurological conditions (OR=3.44, p&lt; 0.0001), renal conditions (OR=2.27, p=0.0014), and diabetes (OR=1.67, p=0.0412). CRAB mortality was 6.9% compared to CRE at 2.0% (p=0.0178). Most CRAB and CRE cases were healthcare-associated infections (98.6% & 67.2%).

Conclusion
The study marks the first multi-year evaluation of TN patients with CRE and CRAB UTIs. As expected, CRAB patients frequently needed ICU admission and were more likely to have indwelling catheters, neurological and renal conditions, and diabetes. This could be linked to ICU patient severity, but further studies are required to clarify. Additionally, significant race and sex gaps were noticed between CRAB and CRE-infected patients, prompting further investigation into these disparities.

Disclosures
All Authors: No reported disclosures
P-403. Incidence of Surgical Site Infections in Selected Tertiary Care Hospitals in Bangladesh: Findings From A Pilot Surveillance Project
Authors: Harun Md Golam Dostogir , Sumon Md Shariful Amin , Islam Md Saiful 
Published: January 2025

Abstract

Background
Surgical site infections (SSI) are the most frequent type of healthcare-associated infections (HAI) and SSIs have substantial healthcare ramifications. In Bangladesh, most hospitals lack surveillance systems for HAIs, including SSI. We conducted this SSI surveillance to assess the rate and determine measures of SSI burden in Bangladesh
Common Organisms for Surgical Site Infections in Bangladesh
Common Organisms for Surgical Site Infections in Bangladesh

Methods
From January to August 2021, we piloted SSI surveillance in four tertiary care hospitals. Participants included undergoing cesarean section (C-section) or abdominal surgery. We enrolled SSI cases if any infection occurred within 30 days of the surgery and contained the skin, subcutaneous tissue and/or deep soft tissue, in or on any part of the anatomy. We also collected data on symptoms, antibiotic consumption, diagnosis, and treatment

Results
We enrolled 1,760 patients, with a majority (75.7%) undergoing C-sections. Within 30 days of surgery, 33.2% (585) of patients developed SSI symptoms. Abdominal surgery patients had a higher rate of SSI (40.9%, 175/426) compared to C-section patients (30.7%, 410/1334). Most patients (90.9%, 532/585) acquired SSI symptoms during hospital stay. Two-thirds (66.4%) of patients were prescribed antibiotics on admission, and 70.1% were given surgical antibiotic prophylaxis. Rates of SSI did not differ between those who received antibiotics or not. The most frequently prescribed antibiotics were ceftriaxone 57.5%, on admission and the combination of ceftriaxone and metronidazole (84.1%) in postoperative patients. Only 10. 7% (63/585) of participants performed wound cultures, of which 76.2% (48/63) demonstrated growth. The most frequently reported organisms were Escherichia coli (37.2%), Staphylococcus aureus (30.2%), and Klebsiella pneumoniae (20.9%).

Conclusion
Further study of the factors contributing to this high incidence and timing for surgical antibiotic prophylaxis administration is needed. The high rate of antibiotic consumption also suggests a need for examination of whether appropriate treatment is being administered and/or if antibiotic prophylaxis is targeting the correct organisms. Additionally, strengthening IPC practices, establishing antimicrobial stewardship programs, and updating antibiotic guidelines could help prevent SSIs and AMR in Bangladeshi hospitals

Disclosures
All Authors: No reported disclosures
P-404. A nationwide survey of Infection Prevention and Control and High-level Disinfection and Sterilization practices in the Dominican Republic
Authors: Castillo Elianet , Rojas-Fermin Rita A , Reyes Yeison , Blanco Claudia , Villegas Antonio M , Mena Lora Alfredo J 
Published: January 2025

Abstract

Background
Healthcare-Associated Infections (HAI) cause significantly morbidity and mortality worldwide. Infection Prevention and Control Programs (IPC) have proven to be effective in reducing HAIs. In low- and middle-income countries, 15% of patients in acute care hospitals acquire a hospital acquired infection (HAI) compared to 7% in high-income countries. Strong IPC can reduce HAIs and the spread of antimicrobial resistance (AMR). We seek to characterize IPC capabilities and practices in the Dominican Republic (DR).
Figure 1: Population density of the Dominican Republic and geographic distrubution of hospitals surveyed

Methods
We performed an anonymous survey of infectious diseases (ID) specialists in acute care hospitals in the DR. A survey based on the CDC Infection Control Assessment and Response (ICAR) tool for general infection and control was distributed via professional society listervs between March 4 and April 24, 2024. Data was tabulated and descriptive statistics performed.

Figure 2: Components of Infection Prevention and Control programs in the Dominican Republic

Results
A total of 20 hospitals responded to our survey, representing 16 facilities in Santo Domingo, and one in Santiago, San Cristobal, La Romana, and San Pedro de Macoris respectively (Figure 1). Of the 20 facilities, 60% (12) reported having an IPC Program, 55% (11) had a dedicated multidisciplinary IPC committee, and 90% had access to an IPC expert such as an ID physician (Figure 2). Education to patients was provided in 58% of hospitals, 83% set policies and procedures based on national or international guidelines, 75% conduct annual risk assessments, and 50% utilize software for data reporting and extraction. All IPC programs reported access to the medical record. Fourteen centers reported data on high-level disinfection and sterilization (HLD), of which 50% had formal training for staff, 50% reported having HLD specific policies, 35.7% track devices for errors, and 28.5% have a reporting process for device-related infections to public health authorities.

Conclusion
Our survey provides an overview of the current landscape of IPC in the DR. While there has been significant progress in standardizing IPC practices, our findings indicate that nearly half of the surveyed hospitals do not have formal IPC programs. Notably, existing IPC programs often lack formal IPC committees, device tracking, data extraction, and infection reporting mechanisms. Addressing these gaps may help recude HAIs and curb AMR.

Disclosures
Rita A. Rojas-Fermin, MD,FIDSA, Gilead: Advisor/Consultant|Pfizer: Advisor/Consultant|Pfizer: Honoraria