bluuebunny/crossref_metadata_2025_split huggingface dataset:
2443. Clinical Characteristics and Outcome of Vascular Access Infections in Patients with hemodialysis : A 12 year study
Authors: LEE E U N J U N G , Yu Shinae , Baek Yae Jee , Jung Jongtak , Kim Tae Hyong , Hong Sunin 
Published: November 2023

Abstract

Background
Infection is the second most common cause of death in ESRD (end-stage renal disease) patients. Although vascular access-related infections are directly related to the prognosis and mortality of ESRD patients, related studies are rare.

Methods
The medical records of adult patients admitted due to hemodialysis vascular access-related infections to a 750-bed tertiary medical institution in Seoul, Korea, were retrospectively analyzed from January 1, 2009 to December 31, 2020. Patients younger than 19 years and history of previous vascular access infections in other sites were excluded.

Results
During the 12-years study period, 372 patients were analyzed. According to the vascular access type, there were 290 (78%) of AV graft infections, 34 (9.1%) of AV fistula infections, and 48(12.9%) of tunneled catheter-related infections. Hemodialysis vascular access-related infection occurred at a median (IQR) of 86 (30-132) days in the tunneled catheter, 357 (105-1283) days in AV graft, and 960 (401-2289) days in AV fistula. Bacteremia was present in 152 (40.8%) patients. Staphylococcus aureus is the most common organism isolated from blood culture (88, 57.8%). Eighteen patients with methicillin-resistant S.aureus (MRSA) bacteremia underwent nasal swabs, and MRSA colonization was confirmed in only 6 of them (6/18, 33.4%). Among the patients without bacteremia, 31 were cultured directly from infected graft tissue or pus.
Metastatic infection was shown in 15 (4%) patients. The most common complication was pneumonia, including septic lung.
Of the 372 patients, 325 (86.7%) underwent surgical treatment. Total excision was performed in 115 (35.3%), partial excision in 178 (54.7%), and incision and drainage in 32 (9.8%). Seventy-nine (24.3%) patients underwent re-operation due to uncontrolled infection.
Three patients died due to vascular access-related infection. Patients who received repeated surgery were at a higher mortality risk (p=0.31).

Conclusion
Tunneled catheter-related infections occurred earliest, while AV fistula infections occurred the latest. S. aureus remained the most common causative organism. Patients who underwent revision surgery were associated with death.

Disclosures
All Authors: No reported disclosures
2459. Prevalence of Nasopharyngeal Carriage of Macrolide and Lincosamide Resistance Genes Among a Household-based cohort of Children and Adults in a Peri-urban Community in Peru
Authors: Charnogusrky Cara , Gil Ana , Ecker Lucie , Cornejo Rubelio , Rios Stefano , Ochoa Mayra Rosana , Peña Peralta Bia M , Flores Omar , Lanata Claudio , Grijalva Carlos G , Howard Leigh M 
Published: November 2023

Abstract

Background
Antibiotic resistant infections commonly occur in healthcare settings, but the prevalence of antibiotic resistant genes (ARGs) in healthy individuals in the community is unknown. We provide an initial assessment of nasopharyngeal carriage of ARGs conferring resistance to macrolides and/or lincosamides, including erm, mph, ABC-F, and lnu genes.

Methods
Nasopharyngeal swabs were systematically obtained at enrollment and weekly thereafter from children and adults enrolled in a household-based prospective cohort study in Lima, Peru. Samples were sequenced using the Illumina Respiratory Pathogen/ID AMR Panel to detect common respiratory bacteria and ARGs. We defined ‘any erm gene’ (erm) as the detection of any specific erm gene class, ‘any mph gene’ as detection of any specific mph gene class, ‘any ABC-F gene’ as any specific ABC-F gene class, and ‘any lnu gene’ as any specific lnu gene detection. We compared the prevalence of erm, mph, ABC-F and lnu gene colonization at enrollment among age groups (ages 0-4, 5-17, 18-44, and 45+ years) using the Fisher's exact test. We then compared the frequency of co-detection of two or more macrolide or lincosamide ARGs between both pediatric age groups (ages 0-17 years) and both adult age groups (18+ years).

Results
114 individuals were included in this analysis (Table 1). At least one macrolide or lincosamide ARG was detected in 61/114 (53.5%) individuals. The prevalence of erm, mph, ABC-F, or lnu gene detection was similar among age groups (Figure 1). Two or more genes were co-detected in 45/114 (39.4%) individuals. Co-detections with two or more erm, mph, ABC-F, or lnu genes were more frequent in children 0-17 years compared to adults 18+ years (p=0.013) (Figure 2).

Conclusion
Conclusions: These preliminary results indicate that macrolide or lincosamide ARGs were commonly detected in healthy community-dwelling children and adults in Lima, Peru. The prevalence of erm, mph, ABC-F, and lnu genes was similar across age groups, and co-detection of ARGs was more common in children. Future studies will assess changes in ARG carriage over time, transmission among household members, and its clinical relevance.

Disclosures
Claudio Lanata, MD, MPH, CureVAc AG Germany: Grant/Research Support|HilleVac Inc.: Advisor/Consultant|HilleVac Inc.: Grant/Research Support Carlos G. Grijalva, MD, MPH, AHRQ: Grant/Research Support|CDC: Grant/Research Support|FDA: Grant/Research Support|Merck: Advisor/Consultant|NIH: Grant/Research Support|Syneos Health: Grant/Research Support
135. Impact of Clostridioides difficile Toxin Confirmation on Subsequent C. difficile Treatment in a Rural Health System (IT-CDI)
Authors: Crawford Jacquelyn , Cluck David B , Tharp Jennifer , Finniss Mathew , Patel Paras 
Published: November 2023

Abstract

Background
In January 2020, Ballad Health instituted the American College of Gastroenterology recommended algorithm for CDI diagnosis consisting of a reflex toxin confirmation post positive C. difficile PCR result. The study was designed to assess how the addition of the toxin confirmation impacted management of CDI in the inpatient setting.

Methods
IT-CDI was a retrospective, multicenter, observational quasi-experimental study of 200 patients. Patients included in the study were &gt; 17 years old with a positive C. difficile PCR and evaluated in two cohorts, pre-toxin confirmation versus post-toxin confirmation testing. The primary outcome was to determine if adding C. difficile toxin confirmation testing reduced antibiotic prescribing for the treatment of CDI. Secondary outcomes included duration of CDI treatment, impact of infectious diseases consultation, length of stay, accrued costs for C. difficile testing and treatment, and new incidence of vancomycin-resistant Enterococcus infection.

Results
A significant reduction in initiation of treatment was found between cohort 1 (98%) versus cohort 2 (77%) although 54% of toxin-negative patients in cohort 2 still received CDI-targeted therapy. There were also significant reductions in duration of treatment from cohort 1 vs cohort 2 (median 13 vs 12; p=0.002) and hospital length of stay between toxin-positive patients versus toxin-negative patients in cohort 2 (median 13 vs 12; p=0.0027). Infectious disease consultation was not associated with a reduction in treatment and overall incidence of vancomycin-resistant Enterococcus infection was rare. Additionally, results demonstrated that toxin confirmation testing did not significantly reduce the total cost associated with testing and treatment which included the price of each lab test completed and the sum of inpatient CDI-targeted antimicrobial therapy per patient from cohort 1 vs cohort 2 (median $56 vs $57; p=0.3356).

Conclusion
The addition of C. difficile toxin confirmation testing to hospital protocol reduced antibiotic prescribing for the treatment of CDI by 21%. However, over half of toxin-negative patients still received CDI antibiotic treatment. Toxin confirmation did not reduce length of stay nor total costs associated with testing and treatment.

Disclosures
David B. Cluck, PharmD, BCPS, BCIDP, AAHIVP, Astellas: Advisor/Consultant
2464. Implementation of a Candida auris admission surveillance protocol at the NIH Clinical Center
Authors: Forrester LaToya A , Odom Robin T , Michelin Angela V , Scaletta Joseph , Henderson David K , Palmore Tara 
Published: November 2023

Abstract

Background
Candida auris (C. auris) is a highly transmissible and usually multi-drug resistant yeast that causes serious invasive infections, with a high mortality rate, colonizes patients, and persists in the environment, resulting in outbreaks in healthcare settings. In 04/2019, The NIH Clinical Center (CC) identified a sensitive C. auris isolate from a blood culture. In 08/2019, the CC’s first case of resistant C. auris was identified from a patient recently hospitalized abroad. By the end of 2019, a total of 17 cases of C auris were identified in the state in which our institution resides (Maryland), as well as cases in institutions in the District of Columbia and Virginia (DMV). This led the CC to implement a C. auris admission surveillance program.

Methods
From 11/2019 to 03/2023, nares, axilla, throat, and groin swabs (n=1408) were collected on admission from patients hospitalized: 1) abroad, 2) in long-term care facilities (LTAC), or 3) in the DMV within the last 6 months. 467 unique patients were tested, 315 by culture utilizing Sabouraud dulcitol broth containing 10% NaCl, Gentamicin, and Chloramphenicol, incubated at 40 degrees and Candida chrome incubated at 30 degrees. 152 patients were tested by PCR, utilizing E-swabs to collect axilla/ groin specimens and aluminum shafted culturette swabs for the nares. PCR testing was conducted at a reference lab from 10/2021 to 07/2022, while routine culturing was unavailable at our facility.

Results
Of 1408 cultures and PCRs collected on admission, no additional patients were identified with C. auris.

Conclusion
C. auris surveillance is a vital strategy to identify colonized or infected patients. Despite the CC serving a large international patient population and patients hospitalized in facilities from states with a high prevalence of C. auris, our surveillance program has not identified additional positives. With cases steadily increasing across the United States (2022 – 2,377 clinical cases and 5,754 screening cases from 29 states) and because of the vulnerability of our patient population, we will continue screening.

Disclosures
Tara Palmore, MD, Abbvie: Grant/Research Support|Gilead: Grant/Research Support|Rigel: Grant/Research Support
136. Impact of a Tele-Stewardship and Tele-Infection Prevention Program on Hospital-Onset Clostridioides Difficile Rates in a Community Three-Hospital Health System
Authors: Davis Matthew R , Trzebucki Alex , McCreary Erin K , Gupta Nupur , Suzanne Templer 
Published: November 2023

Abstract

Background
Clostridioides difficile infection (CDI) is a common hospital-acquired infection (HAI) that can be difficult to diagnose accurately given the numerous test modalities with differing performance characteristics. Inaccurate diagnosis of CDI can negatively affect patient care decisions as well as reimbursement rates. Community and rural hospitals (CARH) may lack specialized personnel or knowledge to implement diagnostic best practices, but telehealth solutions like tele-infection prevention (TIP) and tele-antimicrobial stewardship (TASP) can provide specialist support for CARHs to optimize diagnostic pathways, improve accuracy, and reduce unnecessary treatment.

Methods
In June 2021 under the guidance of TIP and TASP recommendations, C. difficile testing was transitioned from a 1-step nucleic acid amplification test (NAAT)-only algorithm to a 2-step algorithm that included NAAT and toxin enzyme immunoassay (EIA) testing. A 6-month pre- and post-implementation assessment was conducted to assess the impacts of this change in hospital-onset CDI (HO-CDI) case rate. Additionally, total C. difficile (community- and hospital-onset CDI) rates per 1000 patient days (PD) and consumption of CDI therapeutics were assessed. For statistical analysis, Wilcoxon ranked-sum test to assess changes in CDI rates. Estimated annualized cost-savings for therapeutics were calculated based on institutional purchasing costs.

Results
Following implementation, a 35.9% reduction in HO-CDI was observed (pre 0.96 cases/1000PD vs. 0.61 cases/1000PD; p = 0.054). A 10.2% reduction was observed in total CDI (pre 3.66 cases/1000PD vs. 3.28 cases/1000PD; p = 0.37). Additionally, a 30.6% reduction was observed in consumption of CDI therapeutics (20.1 doses/1000PD vs. 14.0 doses/1000PD) resulting in an annualized cost-savings of approximately $9200.

Conclusion
Our TIP and TASP advised a community three-hospital health system on optimal diagnostics resulting in a change in their algorithm. Following this, considerable reductions were observed in HO-CDI, total CDI, consumption of CDI therapeutics, and the associated costs of care.

Disclosures
Erin K. McCreary, PharmD, Abbvie: Advisor/Consultant|Ferring: Advisor/Consultant|GSK: Honoraria|La Jolla (Entasis): Advisor/Consultant|LabSimply: Advisor/Consultant|Merck: Advisor/Consultant|Shionogi: Advisor/Consultant|Shionogi: Honoraria
2481. Interactive Dashboards for Improved Tracking and Communication of CLABSI Prevention Efforts
Authors: Rodriguez-Nava Guillermo , Shepard John , McIntyre Karen , Tompkins Lucy S , Salinas Jorge 
Published: November 2023

Abstract

Background
Central line-associated bloodstream infections (CLABSI) are associated with increased morbidity, mortality, and healthcare costs. Many CLABSIs can be prevented using evidence-based care. To make this information more accessible and actionable, we developed interactive dashboards that translate data on CLABSI-related metrics and prevention efforts into visual formats that can be easily understood by healthcare professionals.

Methods
A multidisciplinary work group of data analysts, infectious diseases physicians, and infection preventionists determined the content and layout of the dashboards. A query was written to extract necessary data elements from the Electronic Medical Record and NHSN. Data was then exported and used to build the dashboards using Tableau® software. The dashboard can be filtered at the facility level or at the unit level.

Results
We present the dashboard of one general ward (Figure 1), one intensive care unit (ICU) (Figure 2), and one cardiovascular ICU (CVICU) (Figure 3). The central line standard utilization ratio (SUR) was higher for the CVICU ( &gt;1.5), followed by the ICU (≈1), and the general ward (&lt; 1). Blood culture intensity (number of blood cultures collected/patient-days) was less for the general ward (&lt; 5%), variable for the ICU (8-14%), and persistently higher for the CVICU (11%). Compliance with daily chlorhexidine bathing was higher for both the CVICU (80%) and the ICU (75%) compared to the general ward (40-60%). The CLABSI rate per 1,000 central line-days has been downtrending for the CVICU and uptrending for the ICU. Besides lower compliance with daily chlorhexidine bathing, the examined ICU has also recently shown a higher proportion of long-term devices (40%), calculated as proportion of central lines ≥ 7 days/all central lines, compared to the CVICU (25%).

Conclusion
Dashboards should contain meaningful outcomes and standardized process metrics that are mapped to strategic goals and be timely to support prompt identification of deviations. Our CLABSI dashboards are effective tools for communicating and tracking performance data. Filtering at the unit level allows us to identify unique unit characteristics, or “fingerprints,” and recognize specific areas for improvement. This enables us to develop targeted interventions for each unit.

Disclosures
All Authors: No reported disclosures
2484. Clinical and genomic comparison of nosocomial-onset and community-onset listeriosis: a nationwide retrospective study in Japan, 2011-2021
Authors: Shinohara Koh , Tsuda Yusuke , Arasawa Soichi , Tsuchido Yasuhiro , Yukawa Satomi , Noguchi Taro , Yamamoto Masaki , Matsumara Yasufumi , Nagao Miki 
Published: November 2023

Abstract

Background
Sporadic, non-clustered, nosocomial-onset (NO) listeriosis has emerged in immunocompromised hosts. However, most previous reports were single-centered and nationwide study is lacked. The genomic investigation of Listeria monocytogenes isolates from NO and community-onset (CO) cases is also scarce.

Methods
We conducted a nationwide retrospective study of consecutive listeriosis cases from 2011 to 2021, in which 24 hospitals participated. Clinical characteristics and outcomes were reviewed. The preserved L. monocytogenes isolates were investigated using whole genome sequencing. NO was defined as onset of listeriosis symptoms after third day of admission for medical conditions other than listeriosis. Fisher’s exact test and Mann-Whitney U test were used to compare categorical and continuous variables, respectively.

Results
A total of 195 cases were included. All 11 perinatal cases were NO. Among 184 non-perinatal cases, 31 cases (17%) were NO cases. Clinical characteristics of the NO and CO cases were summarized in Table. In NO cases, median age was 73 years and male patients accounted for 55%, which were similar to those in CO cases. Median days of admission to onset was 10 (range, 3-127). NO cases significantly associated with immunosuppressive medical conditions, especially patients with solid organ tumor and recipients of cytotoxic chemotherapy. NO cases were less likely to involve central nervous system (CNS). In-hospital mortality was similar among both groups. A total of 95 isolates (NO cases: 19 isolates, CO cases: 76 isolates) were included in genomic analysis. A pair of isolates were suspected as clustered cases. 14 clonal complexes (CC) were identified in NO isolates and 23 CCs were in CO isolates (Figure). CC1, the most prevalent hypervirulent clone, was less likely to be found in NO cases; 1 isolate (5%) in NO cases and 20 isolates (26%) in CO cases.

Conclusion
In a retrospective nationwide surveillance in Japan, 17% of listeriosis was NO and mostly affected patients with immunosuppressive medical conditions. Genomic analysis revealed that NO isolates were less likely to be CC1 and have wider genomic diversity than that in CO isolates.

Disclosures
Yasufumi Matsumara, MD, PhD, Beckman Coulter: Grant/Research Support|Presicion System Science: Grant/Research Support|Toyobo: Grant/Research Support
138. Impact of Emergency Department Rapid Viral Respiratory Multiplex PCR Testing on Antimicrobial Prescribing
Authors: Falk Cassandra , Dumkow Lisa E , Geyer Abigail , Egwuatu Nnaemeka , Langholz Jennifer , Schmidt Kyle , Jameson Andrew 
Published: November 2023

Abstract

Background
Rapid multiplex polymerase chain reaction (mPCR) point-of-care tests detect a variety of viral respiratory pathogens. The impact of mPCR results on antibiotic prescribing in the ED or downstream is not well understood. The purpose of this study was to assess the impact of positive viral mPCR results on antibiotic prescribing for patients presenting with respiratory symptomsin the ED.

Methods
This retrospective cohort study included adult patients presenting to the ED with respiratory symptoms and a positive rapid upper RTI mPCR for a non-SARs-CoV-2 viral pathogen between 11/1/2021 and 10/31/2022. The primary objective was to describe the proportion of patients with appropriate antibiotic management within 24 hours of positive mPCR result. Appropriate management was defined as patients without risk factors for bacterial co-infection who did not receive or continue antibiotic therapy. Those with co-infection risk factors prescribed antibiotic therapy were also considered appropriate. This was determined through independent pharmacist and ID physician review. Secondary objectives compared patient outcomes of those appropriately vs inappropriately managed and admitted vs discharged home from ED. Risk factors for inappropriate antibiotic decisions were also evaluated using logistic regression.

Results
250 patients were included, 206 (82.4%) with appropriate management and 44 (17.6%) with inappropriate management. 164 (65.5%) patients were not prescribed empiric or definitive antibiotics. 39 (15.6%) patients empirically received antibiotics prior to mPCR; 9 (23%) were discontinued following positive viral result. Patients discharged home from the ED were more likely to have appropriate antibiotic management than those admitted (87.5% vs 77.7%, p=0.042). Patients with inappropriate antibiotic management were more likely to be readmitted to the hospital within 30 days (14% vs 3.5%, p=0.005). Purulent sputum (OR 3.61 [95% CI 1.64-8]) and unilobar infiltrate (OR 3.03 [1.22-7.58]) were independent risk factors for inappropriate antibiotic management.

Conclusion
Rapid viral RTI mPCR testing in the ED resulted in a high level of appropriate antibiotic management, with most patients not being prescribed antibiotics.

Disclosures
All Authors: No reported disclosures
2506. Impact of an Innovative Community Based Contracted Pharmacy on HCV Elimination in New Jersey
Authors: Rosmarin-DeStefano Corey L , Slim Jihad , Tempalski Barbara , Leyden Kevin , Levaggi Emily , Duprey Sheena , Torres Juan , Chavez Evelyn 
Published: November 2023

Abstract

Background
North Jersey Community Research Initiative (NJCRI) in Newark, New Jersey has piloted the addition of an innovative community based contracted pharmacy to their mobile hepatitis C clinic to provide seamless care and coordination to the patient.

Methods
A retrospective observational review of patients treated for hepatitis C between October 1st 2020 and Sept 31st 2022 at North Jersey Community Research Initiative (NJCRI), dividing patients in group 1: patients required by their insurance to fill up prescriptions through Managed Medicaid’s Preferred Specialty Pharmacies (PSP), which are corporate mail-order pharmacies and group 2: those who could fill their prescriptions with a local contracted community based pharmacy. We had two primary endpoints comparing those 2 groups: 1- Difference in wait time from the provider’s visit to starting therapy; 2- Difference in percentage of those completing therapy.

Results
NJCRI prescribed hepatitis C treatment to 614 patients during the study period, group 1 had 138 patients (22.4%) and group 2 had 476 patients (78%). The average time to start of therapy was 36 days for group 1 compared to 15 days for group 2. Group 1 on average have a longer wait time to start treatment therapy. Group 2 were more likely to complete therapy utilizing local pharmacies contracted by NJCRI. Patients who started and completion treatment was 81% in-group 1 and 92% for group 2 (p=0.0003). Percentage LTFU after starting therapy was 19% for group 1 and 8% for group 2.

Conclusion
Our study shows that community based pharmacy settings positively affect patient care and adherence because of the convenience and support to the patients as well as the providers. Restrictions of filling medications through corporate mail-order pharmacies.

Disclosures
Jihad Slim, MD, FACP, ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Grant/Research Support