bluuebunny/crossref_metadata_2025_split huggingface dataset:
2407. Multidisciplinary Endocarditis Team (MET): Establishing a Baseline of Infective Endocarditis in People Who Use Injection Drugs (PWID)
Authors: Patel Kaya , Duffield Olivia , Spivack Stephanie , Schultz Sara K 
Published: November 2023

Abstract

Background
Infective endocarditis (IE) is a serious infectious complication of intravenous drug use. Treatments include prolonged courses of IV antibiotics, surgical valve repair/ replacement, vacuum-assisted thrombectomy, and pulmonary autograft (Ross Procedure). We created a multidisciplinary team of treating physicians to review all cases of IE at our large academic medical center in Philadelphia starting in March 2023. To establish a baseline prior to the creation of MET, we describe the microbiological and clinical findings, treatment, and outcomes of a cohort of PWID found to have IE.

Methods
We queried our EMR for admissions with patients that had documented opioid use disorder with injection behavior and positive blood cultures from September of 2021 to March of 2022. We conducted a retrospective chart review of these patients and collected data regarding their hospital course and treatment.

Results
We identified 39 patients with definite IE (modified Duke’s criteria). The predominant organisms were MRSA (19, 43%), MSSA (14, 32%), and group A streptococcus (9, 20%). Thirty-six (92%) patients underwent TTE and 8 (20%) underwent TEE to evaluate for vegetations. On echocardiography, 23 (59%) vegetations were noted: 11 tricuspid valve, 3 mitral valve, 2 aortic valve, and 2 pulmonic valve. Five vegetations were found on prosthetic valves: 2 tricuspid valve, 2 pulmonic valve, and 1 aortic valve. Of the 23 patients with vegetations, 11 (48%) met ACC/AHA criteria for procedural intervention. Of these patients, 7 (63%) received intervention (1 valve repair, 2 valve replacements, 2 Ross Procedures, 2 vacuum-assisted thrombectomies). Intervention occurred on average of 7.8 days from diagnosis. Sixteen (41%) patients completed a full course of antibiotic therapy. Of the 23 (59%) patients that did not complete antibiotics, 5 were prescribed oral 2nd line therapies. Fifteen (38%) patients were readmitted within 90 days and 5 (13%) experienced mortality within 30 days. (Figure 1)

Conclusion
Treating IE in PWID is challenging and often requires a multidisciplinary approach. We demonstrated high rates of right and left sided IE as well as high rates of surgical intervention pre-implementation of MET. We anticipate an improvement in clinical outcomes with the implementation of MET.

Disclosures
Sara K. Schultz, MD FACP FIDSA, AbbVie: Advisor/Consultant
2412. Whole-body PET scans for infective endocarditis: differences in patient characteristics and outcomes
Authors: Simpson Kaitlyn , Park Jason , Riddell Jamie 
Published: November 2023

Abstract

Background
Whole-body 18F-FDG PET/CT (WBP) has the potential to impact management of infective endocarditis (IE) through identification of areas of occult primary or metastatic infection. This study compares the characteristics and outcomes in groups of patients with IE who did and did not have WBP as part of their evaluation to help guide how this imaging may be optimally utilized.

Methods
We performed a retrospective cohort study of hospitalized patients discussed at the multidisciplinary endocarditis meeting at a tertiary care center in Michigan, USA between June 2018 and January 2022. Protocolized chart review was performed by three study team members.

Results
There were 114 (26.7%) patients with suspected IE who had WBP and 313 (73.3%) who did not. The two groups were similar in age, gender, and race. Patients with ESRD on dialysis (p=0.01), cardiac and/or ascending aortic prosthetic material (p&lt; 0.001) or endocardial devices (p=0.01), and those who had cardiac PET (P&lt; 0.001) were more likely to have undergone WBP. Complications such as paravalvular abscess (p=0.004) and flail leaflet (p=0.01) were more common in the non-WBP group. There was no difference in surgical indication between groups, though the WBP group had a non-significant trend of not receiving cardiac surgery (p = 0.05). WBP was associated with a longer-course of antibiotics (6.36 vs 5.32; p&lt; 0.001) and suppressive antibiotics (30.70% versus 13.42%; p&lt; 0.001). Within the WBP group, 45.61% had a change in management after imaging with the most common changes being further infectious (20.18%) or non-infectious (9.65%) workup, source control procedure performed (10.52%), and antibiotic regimen change (9.64%). No other outcomes between groups were significantly different between groups including length of stay, 6-month readmission, 6-month infection relapse, 6-month mortality or in-hospital mortality.

Conclusion
Although a mortality benefit was not observed, WBP played an important role in the management of patients with IE with identification of areas of metastatic infection that required longer antimicrobial treatment or addition of suppressive antimicrobials. Further analyses are planned to understand which patients with IE may benefit most from WBP.

Disclosures
All Authors: No reported disclosures
2427. Characterization of Early Healthcare-Associated Infections (HAI) After Implantation of Left Ventricular Assist Devices (LVAD)
Authors: Kling Kendall , Moore William J , Zembower Teresa , Jirak Alison , Nonog Gretchen , Magliola Grace , Harap Rebecca , Wilcox Jane , Pham Duc , Wu Tingqing , Byrd Heather , Stosor Valentina 
Published: November 2023

Abstract

Background
LVADs are established for therapy for heart failure and are implanted in &gt; 2,500 patients in the US annually, but are complicated by infection in up to 60% of patients. Our aim was to characterize the spectrum and epidemiology of post-LVAD infections.

Methods
We performed a single-center prospective observational study of 17 patients post-LVAD implantation from 7/2022 to 3/2023. Demographics, clinical, and microbiological data were collected as part of a study examining these changes in the cutaneous microbiome of the LVAD driveline (DL) site over the duration of LVAD support. Summary and descriptive statistics were performed.

Results
Of the 17 patients, the mean age was 56.7, the majority were male, non-Hispanic White, and had chronic kidney disease (Table 1). Mean follow up was 136 days (range 17-265). VAD-related infections included 3 blood stream infections (mean post-LVAD date 42.3) (Table 2). There was a total of 8 episodes of hospital acquired pneumonia (HAP) in 4 unique participants. Urinary tract infections occurred in 35.3% (n=6), intra-abdominal infection in 17.6% (n=3), and skin and soft tissue infection in 5.9% (n=1). Multi-drug resistant organisms (MDRO) were detected in 8 participants, including vancomycin-resistant Enterococcus (n=1 for UTI and n=8 for rectal colonization), carbapenem-resistant Enterobacteriaceae (n=1), and C. difficile (n=3). Two participants expired due to heart failure (n=2) and infection (n=1).

Conclusion
We observed a high rate of early HAI post-LVAD implantation, including MDRO infections, and a strikingly high rate of VRE acquisition (47%). C. difficile infection rates were also high at 18%. Further study is needed to determine risks for MDRO infection and whether early HAI impact the LVAD DL microbiome and development of LVAD infection.

Disclosures
Valentina Stosor, MD, DiaSorin S.p.A.: Advisor/Consultant|Eli Lilly & Company: Grant/Research Support
2434. Healthcare-associated Infections in the Era of COVID-19 Pandemic: An Experience from a Tertiary Care Hospital in Long Island, New York
Authors: Sajib Monirul I , Adams Tamasin , Donelan Susan V , Go Roderick , Saldivar Miguel A 
Published: November 2023

Abstract

Background
Healthcare-associated infections (HAIs) such as central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), surgical site infections (SSI) and ventilator-associated events (VAE) are associated with increased patient morbidity, mortality, and healthcare related cost. One could expect a decrease in the incidence of HAIs during the COVID-19 pandemic due to the enhanced infection control measures and increased awareness among the healthcare workers. The aim of our study is to assess the prevalence of HAIs during the 2 years of COVID-19 pandemic compared to 2 years prior to the pandemic at Stony Brook University Hospital, located in Long Island, NY.

Methods
Standardized infection ratio (SIR) and percentile data for CLABSI, CAUTI, SSI and VAE were collected from the National Healthcare Safety Network website for hospitalized patients between January 2018 to December 2019 and between July 2020 and June 2022. Data between January 2020 to June 2020 was not available due to voluntary reporting at the beginning of pandemic. Superficial SSI cases were excluded. Data on organisms involved in CLABSI during this period were also collected.

Results
During January 2018 to December 2019, SIR (percentile) for CLABSI, CAUTI, SSI and VAE are 0.623 (38), 0.455 (31), 1.129 (72) and 0.941 (44) respectively, whereas during July 2020 to June 2022, SIR (percentile) are 0.558 (34), 0.854 (63), 0.870 (56) and 1.316 (53) respectively, with p-value of 0.6149, 0.0007, 0.2471, and 0.0035 and relative risk of 0.896, 1.877, 0.771, and 1.399 respectively. In addition, during January 2018 to December 2019, S. aureus (8), coagulase-negative Staphylococcus (10), Streptococcus (2), Enterococcus (12), gram-negative rods (21) and Candida spp (11) were associated with CLABSI, versus S. aureus (5), coagulase-negative Staphylococcus (2), Streptococcus (2), Enterococcus (14), gram-negative rods (19), and Candida spp (13) during July 2020 to June 2022.
Comparison of HAIs during 2 years prior to the COVID-19 pandemic to 2 years of pandemic.
Organisms associated with CLABSI during 2 years prior to the COVID-19 pandemic compared to 2 years of pandemic

Conclusion
We did not observe a significant reduction in CLABSI and SSI cases during the 2 years of COVID-19 pandemic compared to pre-pandemic phase; however, a significant rise in CAUTI and VAE cases were seen which we suspect is due to the increased urinary catheter and ventilator utilization during the COVID-19 pandemic.

Disclosures
Roderick Go, DO, Aptose Biosciences: Stocks/Bonds|Bristol Meyers Squibb: Stocks/Bonds|Cytodyn Inc.: Stocks/Bonds|Scynexis: Grant/Research Support
2435. Stewardship – It’s Not Just Antibiotics and Testing
Authors: Sampson Mindy , Passaretti Catherine , Eichenblat Siobhan , Kester Shelley , Layell Jessica , Noonan Laura , Billings Corrianne , Bischoff Werner 
Published: November 2023

Abstract

Background
Longer central line (CL) dwell times are associated with increased risk of central line associated blood stream infections (CLABSIs). Removal of invasive devices when they are no longer clinically indicated is key to CLABSI prevention.
Table 1
Comparison of the Device Review Programs Impact on Central Line Utilization Rates and CLABSI Rates

Methods
Our health system designed two quality improvement initiatives intended to serve as external review and feedback processes on the necessity of invasive devices. Line Stewardship (LS) was initiated March 2022 in Hospital A and later implemented in 6 acute care facilities. A team consisting of infection preventionists (IP), vascular access nurses and nurse leaders performed chart reviews to determine if CLs met institutional criteria for necessity. If no indication for the device was found, the clinical team was contacted to recommend removal. The second program was called Infection Prevention Integration Program (IPIP), which had a stepwise rollout throughout 2022 in 5 acute care facilities. This program involved IPs joining multi-disciplinary rounds to make recommendations on device removals.

Results
Hospital A piloted the LS program in 8 units and during the first year, removed 398 CLs, and saw a reduction in the CLABSI rate compared to the year prior (Table 1). Similarly, implementation of IPIP led to a reduction in the CLABSI rate. Both non-LS and non-IPIP units reported an increase in CLABSI rates during the intervention period compared to baseline (Table 1).

Conclusion
Both programs saw improvements in CLABSI rates, achieving the goal of reducing infections. IPIP units saw a larger decrease in the utilization rate compared to LS units. This may be due to differences in the criteria used to determine eligibility for line review. Also, there were differences in unit selection; general wards were selected in LS facilities and intensive care units in IPIP facilities. Both LS and IPIP teams noted benefits of the program beyond line removal in improved attention of staff to overall infection prevention practices. Given the increases seen on non-LS and non-IPIP units, it is important to ensure resources aren’t being diverted away from non-intervention units. While both interventions are time and resource intensive, they led to a reduction in CLABSI burden justifying the necessary institutional support.

Disclosures
All Authors: No reported disclosures
2436. Infections In Patients Undergoing Extracorporeal Membrane Oxygenation (ECMO) At A Tertiary Centre In India
Authors: Santosh Gattu , Narreddy Suneetha , Polati Vishnu Rao , Barigala Ravikiran , ramesh venkat , panigrahi niranjan , sharma ratnamani 
Published: November 2023

Abstract

Background
Infections are a major cause of mortality among patients receiving ECMO treatment. However, little is known about the prevalence and spectrum of infections affecting ECMO patients in India and the factors that contribute to increased risk of infections and mortality in these cases.

Methods
This study presents a retrospective analysis of ECMO patients admitted between 2018-2022. The study recorded demographic information, ECMO indication, duration, type of infection, and outcomes. The primary objective of the study was to determine the prevalence of microbiologically-proven nosocomial infections. The study also aimed to identify secondary factors associated with an increase in the number of infections and mortality.

Results
During the study period, 37 patients received ECMO support, with a mean age of 44.97±14.19 years. The most common indication for ECMO was respiratory failure secondary to ARDS. 26 (70.3%) patients were placed on VV-ECMO, while 11 (29.7%) patients received VA-ECMO. 29 patients (83.4%) developed infections, with an incidence of 147.1 infections per 1000 ECMO days. Ventilator-associated pneumonia (48.04%) was the most frequently reported type of infection, followed by bloodstream infection (47.1%). The most commonly isolated organisms were Klebsiella pneumoniae (27%), Acinetobacter baumanii (15%) and B. Cepacia (13%) with Staphylococcus and Enterococci accounted for only 10% of infections. Additionally, carbapenem resistance was found in 80% and 100% of Klebsiella and Acinetobacter isolates respectively. Candidemia accounted for 10% of infections, with one patient developing candidemia as early as 4 days after ECMO initiation. Our study revealed a mortality rate of 62% among those who developed infections versus 51% in those who did not develop infections. Patients who developed infections more frequently required CRRT (62% vs. 12.5%, p =0.013). Longer the duration of ECMO, greater the number of infections were observed ( &lt; 7d- 24%; 7-14d- 33.65% & &gt;14d- 42.3%) (Table-4).
Figure-1
Distribution (%) of Nosocomial infections
Figure-2
Distribution (%) of Pathogens
Table-2
Requirement of CRRT among ECMO patients

Conclusion
There was a high incidence of infections (particularly due to carbapenem resistant organisms) in ECMO patients in our study. Infection risk correlated with duration of ECMO and need for CRRT.
Table-3
Correlation between CRRT & Mortality
Table-4
Correlation of number of infections with ECMO Duration

Disclosures
All Authors: No reported disclosures
2446. Effect of the Implementation of a Fluconazole Prophylaxis Protocol on the Incidence of Invasive Fungal Infection in High-Risk Neonates
Authors: Isada Patricia Marie D , Pagcatipunan Marimel 
Published: November 2023

Abstract

Background
Invasive fungal infection (IFI) is one of the most important causes of morbidity and mortality in the neonatal intensive care unit. International societies have supported the use of fluconazole prophylaxis for neonates weighing &lt; 1000 grams, but administration to other high-risk patients remains controversial. An institutional fluconazole prophylaxis guideline was implemented in December 2020 to include two other groups of neonates.

Methods
One hundred thirty infants who were admitted at the NICU from January 2020 to January 2022 and fulfilled one of the following criteria: weight of &lt; 1000 grams (Group A), weight of ≤1500 grams and on broad-spectrum antibiotics (Group B), or weight of &gt;1500 grams and on prolonged nil per os (NPO) (Group C) were included in the study. They were divided into two groups: those who were born prior to the implementation of the protocol (January to December 2020) and not given fluconazole prophylaxis, and those born after (January 2021 to January 2022) and given prophylaxis. The primary outcome was the development of IFI.

Results
A total of 130 infants were included in this study with 21 (5 control, 16 prophylaxis), 69 (28 control, 41 prophylaxis), and 40 (16 control, 24 prophylaxis) patients in Groups A, B, and C, respectively. There were no significant differences in the development of IFI among the groups (Group A: control - 40%, prophylaxis - 62%; Group B: control - 21.4%, prophylaxis - 22%; Group C: control - 29.2%, prophylaxis 31.5%) with a p-value of &gt; 0.05. The presence of a central vascular access line, endotracheal tube, placement on NPO, histamine H2-blockers, and necrotizing enterocolitis were associated with the development of IFI. Candida parapsilosis comprised 60% of isolates. All isolates had 100% susceptibility to fluconazole. Jaundice developed in 3.7% of patients given fluconazole, with elevations in AST, ALT, and TB.
Incidence of fungal infection in high-risk neonates
There were no significant differences in the development of IFI among the three high-risk groups, with p-value of &gt; 0.05.

Conclusion
Invasive fungal infection remains a heavy burden to high-risk neonates. The protocol at present does not significantly prevent the occurrence of IFI. There is a need to revise the protocol to include the presence of a combination of multiple risk factors (central line, endotracheal tube, prolonged NPO, H2-blockers, and necrotizing enterocolitis) before initiating fluconazole prophylaxis.

Disclosures
All Authors: No reported disclosures
2448. Emergence of Candida auris in a Delaware Healthcare System
Authors: Pheiffer Rebecca , Briody Carol , Anderson Ken , Cyril Elicious , Harris Lajune , Heckman Timothy , Kelly Stephanie , Luckner Kathleen , Moeller Julia , Pal Carmen , Penn Ryan , Power Michelle , Ritter Carol , Stanton Ann-Catherine , Drees Marci 
Published: November 2023

Abstract

Background
In Aug 2022, a patient was admitted to our facility after blood cultures revealed C. auris; this was the first case identified in Delaware. The patient had been cared for in our system 2 mo previously and was admitted from a long-term acute care hospital. In Sep 2022, two additional cases were identified who had been recently or were currently admitted to our transitional medical (stepdown) unit (TMU).

Methods
We worked with the Delaware Division of Public Health (DPH) to establish protocols to identify colonized cases via biweekly point prevalence (PP) surveys of all patients currently admitted on TMU using the public health laboratory; later we transitioned to weekly PP via a commercial lab to improve frequency and turnaround time. Patients were screened using axillary/groin swabs. We provided ongoing staff education; improved adherence to hand hygiene and contact isolation precautions; created auto-isolation orders for newly identified and readmitted patients; and reviewed disinfectants. Environmental Services (EVS) performed enhanced cleaning of all patient rooms and auxiliary areas on the unit, and added ultraviolet light and curtain changes for all terminal cleans. DPH performed an Infection Control Risk Assessment (ICAR) to identify further opportunities. We expanded these interventions to our medical ICU (MICU) when cases were identified there, and added admission surveillance screening of high-risk patients to TMU or MICU.

Results
Between Aug 2022 – Mar 2023, 64 patients with C. auris were identified (55 [86%] via PP surveys) (Table). Greater than 94% of eligible patients were successfully screened each week; PP positivity rate ranged from 0-30% (Fig). Admission screening continued to identify new cases admitted to these units. Four (6.5%) patients initially identified with C. auris colonization developed clinical infections.
Characteristics of Patients Identified with Candida auris Colonization or Infection

Conclusion
Despite expending significant lab, EVS and other personnel resources to improve patient identification and infection control practices, once C. auris was established in the units it was unable to be eradicated. These resources were not sustainable; we are shifting from PP to expanded admission screening while maintaining environmental cleaning and infection prevention practices.

Disclosures
All Authors: No reported disclosures
2457. Improved Identification of Primary Infection Sites in Suspect Central Line Bloodstream Infections (CLABSI) through Preliminary Blood Culture Notifications
Authors: Bischoff Werner , Kieta Cheryl , LaFontaine Tiffany , Billings Corrianne 
Published: November 2023

Abstract

Background
Central Line Bloodstream Infections (CLABSI) pose a significant risk for patients with high burden of morbidity and mortality. Accurate and timely identification of these events is paramount for the development of effective interventions.

Methods
A quasi-experimental (before/after) study included all inpatients with central venous catheters (CVC) admitted to five acute care hospitals in North Carolina. Starting in 03/2022 all preliminary blood culture results were evaluated within 24 hours by surveillance infection preventionists (SIP) and results indicative of potential CVC infection were escalated to medical teams. Escalation included identification of potential primary site infections, and discussion of the need for further testing and documentation. Mid-P exact tests were used to compare CLABSI burden before and after the intervention.

Results
From 03/22 through 03/23 preliminary blood culture results in a total of 498 cases were reviewed by SIP. Of those, 201 (40%) were escalated to the IP team with 94 determined to be CLABSI, and 107 (53%) referred to further assessment by IP and medical teams. A primary infection site other than CVC was established based on escalation conversations in 23 events leading to a reduction in potential CLABSI cases by 11.4%. Standardized Infection Ratios for all and publicly reportable locations were reduced by 13% and 27% (table 1).
Of the 23 events interventions led to the establishment of a primary site of infection or documentation for exclusion criteria: pneumonia (9, 39%), burn (6, 26%), endocarditis (2, 9%), patient line injection (2, 9%), central line documentation clarification (1, 4%), intraabdominal infection (1, 4%), necrotizing enterocolitis (1, 4%), and skin infection (1, 4%). Interventions included imaging studies, culture collection of purulent sites, and documentation clarification including: abnormal/changes in wound characteristics, patient line injection, central line documentation.

Conclusion
Moving the process of CLABSI identification from finalized blood cultures to preliminary blood culture results improved the accuracy of CLABSI detection. Early inclusion of medical teams in the discussion of potential CLABSI increased awareness of the source of infection.

Disclosures
All Authors: No reported disclosures