bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-248. Implementation of a National Environmental Program Services (EPS) Ultraviolet-C (UV-C) No-touch Room Disinfection Toolkit in the Veterans Health Administration
Authors: Cunningham Goedken Cassie , Dukes Kimberly , Hockett Sherlock Stacey , Suh Daniel , Guerrero Bernardino , Zabarsky Trina , Perencevich Eli N 
Published: January 2025

Abstract

Background
Environmental disinfection reduces the risk of hospital infections. Prior evidence from the Veterans Affairs (VA) healthcare system suggests that adding UV-C systems to manual disinfection processes significantly reduced nosocomial infection rates. Many VAs have added UV-C disinfection, but with wide variation in implementation, effectiveness, and use. To address this, we developed, piloted, and implemented a national VA UV-C toolkit.

Methods
Our VA multicenter implementation science program project grant collaborated with VA Environmental Programs Service (EPS) to rapidly develop and implement a toolkit for VA facilities to establish and maintain UV-C processes that maximize efficacy. In our larger study, we interviewed Environmental Management Services (EMS) staff and identified barriers to UV-C (e.g., safety concerns, material degradation). From 5/23-9/23, we identified best practices and ways to address implementation challenges to create a mixed-methods data-driven national EPS UV-C toolkit. We incorporated our prior VA effectiveness research and concerns stakeholders raised in EPS meetings and interviews.

Results
The toolkit includes sections that were deemed important guidance for UV-C use: 1) Ultraviolet Light, 2) Disinfection, 3) Benefits, 4) Process for Disinfection, 5) Quality Assurance/Validation, and 6) Frequently Asked Questions. It was piloted at 6 geographically dispersed VAs (9/23-10/23). Pilot feedback was positive and led to revisions for site variability (e.g., revised room prep steps allowing for instructions to be more universally representative of room layouts), UV-C use (e.g., scenarios when UV-C can be useful), and monitoring details (e.g., track frequency and location of use). EPS implemented the final toolkit in March 2024 on the VA national SharePoint, online, and as a printable PDF.

Conclusion
Implementation work in collaboration with operational partners and partnered pilot testing was successful in rapidly developing and implementing a standardized UV-C toolkit across a large healthcare system. The toolkit guides EMS professionals in establishing and standardizing processes for UV-C disinfection to improve Veterans’ safety.

Disclosures
All Authors: No reported disclosures
P-265. No Flu in the Loo: Efficacy of a novel, automated far ultraviolet-C light technology for decontamination of surfaces and aerosolized viral particles in bathrooms
Authors: Memic Samir , Kaple Claire , Cadnum Jennifer , Donskey Curtis 
Published: January 2025

Abstract

Background
Aerosols generated during toilet flushing are a potential source for transmission of
viral and bacterial pathogens in bathrooms. However, manual decontamination of bathrooms
after each use is not feasible.
Log 10 reduction of organisms on steel disk carriers after 2 hours of far UV-C light exposure*
MRSA, methicillin-resistant Staphylococcus aureus; VRE, vancomycin-resistant enterococci; E. coli,
Escherichia coli, MS2, bacteriophage MS2
*, 5 of 9 test sites shown

Methods
We tested the efficacy of a wall-mounted far ultraviolet-C (UV-C) light technology
that only delivers far UV-C when people are not present for decontamination of surfaces and
aerosolized viral particles in unoccupied hospital bathrooms. A quantitative disk carrier test
method was used to test efficacy against organisms on steel disk carriers placed in 9 sites in the
bathrooms with an exposure time of 2 hours; Clostridioides difficile spores were exposed for 24
hours. Efficacy against aerosolized bacteriophage MS2 was tested with a 45-minute exposure.

Results
The far UV-C technology reduced methicillin-resistant Staphylococcus aureus
(MRSA), vancomycin-resistant enterococci (VRE), Candida auris, Escherichia coli, and
bacteriophage MS2 on disk carriers by &gt;1.9 log 10 at all test sites in 2 hours (Figure), and reduced
C. difficile spores by &gt;1.7 log 10 in 24 hours. Aerosolized bacteriophage MS2 was reduced by 4
log 10 plaque-forming units in 45 minutes. The technology consistently turned off when people
entered the bathroom and resumed far UV-C delivery after they exited.

Conclusion
The novel far UV-C light technology could potentially be useful for automated
decontamination of bathrooms in healthcare and community settings.

Disclosures
Curtis Donskey, MD, Clorox: Grant/Research Support|Pfizer: Grant/Research Support
P-274. Rates of Extended-Spectrum Beta-Lactamase-Producing Enterobacterales across Tennessee, 2019 – 2022
Authors: Gambrell Ashley , Velrajan Srilakshmi , Patel Dipen , Harriott Melphine , Muleta Daniel 
Published: January 2025

Abstract

Background
Extended-spectrum beta-­­lactamase (ESBL)-producing Enterobacterales were responsible for an estimated 197,400 infections and 9,100 deaths amongst hospitalized patients in 2017 in United States. Surveillance of ESBL-producing Enterobacterales, as a part of Multi-site Gram Negative Surveillance Initiative (MuGSI) project was conducted in four Tennessee counties (Maury, Marshall, Lewis, and Wayne). Little is known specifically about the rates of ESBL-Enterobacterales geographically over these areas. We calculated and compared rates at the county and census tract level for the TN MuGSI catchment area, for 2019 – 2022.
Prevalence Rates of ESBL-Enterobacterales Cases by Tennessee County and Census TractFigure 1.Rates of Cases of ESBL-producing Enterobacterales by County and Census Tract, 2019 – 2022. Rates are calculated per 1,000 residents for each census tract and grouped by natural breaks classification method. County and census tract boundaries are shown in grey outline outline.

Methods
Data from MuGSI Case Detection System for 2019 – 2022 were geocoded to the county and census tract level using ArcMap. Population counts, including demographics, were taken from the U.S. Census Bureau’s 2020 Census. Analysis was completed in SAS 9.4.

Results
At the county-level, the average prevalence rate was 16.76 cases per 1,000 residents. Wayne county had the highest prevalence at 29.69 cases per 1,000 residents, while Maury county had the lowest, at 9.39 cases per 1,000 residents. Prevalence rates amongst the census tracts varied widely, with a mean of 13.04 cases per 1,000 residents, and ranging from 0.73 cases up to 58.86 cases (Figure 1). Wayne County’s 4 census tracts consistently showed the highest rates, ranging from 13.48 to 58.86 cases per 1,000 residents, while Maury County’s 21 tracts had the lowest rates, ranging from 0.73 to 31.98 cases per 1,000 residents. From 2019 to 2022, most counties had stable prevalence rates, however Wayne County showed an increase from 3.60, to 9.60 cases per 1,000 residents by 2022.

Conclusion
Rates of ESBL-producing Enterobacterales varied substantially, even amongst a relatively small catchment area within the state. Highest rates of this pathogen were found in census tracts from Wayne and Lewis County, with Wayne County also showing a large increase of cases from 2019 to 2022. Understanding of what drives rates disproportionately in these areas is crucial to prevention and mitigation, not only for ESBL-producing Enterobacterales, but for many other gram-negative multidrug resistant organisms. More research is needed to highlight the drivers of these disparate rates.

Disclosures
All Authors: No reported disclosures
P-276. Outcomes Following Cefiderocol vs. Meropenem Treatment for Gram-Negative Pneumonia: A Real-World Data Analysis
Authors: Haslund-Gourley Benjamin S 
Published: January 2025

Abstract

Background
The prevalence of multidrug-resistant (MDR) gram-negative pneumonia continues to increase across the United States (U.S.). Recently, cefiderocol (Fetroja), was approved to treat MDR-negative pneumonia, overcoming several beta-lactam resistance mechanisms. While cefiderocol has been utilized over the last 6 years, additional studies are needed to assess its use long-term. The purpose of this study was to compare outcomes of gram-negative pneumonia patients treated with either cefiderocol or meropenem utilizing real-world data.

Methods
This was a retrospective cross-sectional study between 05/02/2018 and 05/02/2024 utilizing the TriNetX Research Network, consisting of 88 U.S. and ex-U.S. healthcare organizations. Patients were included if they had an ICD-10 code for gram-negative pneumonia and receipt of cefiderocol or meropenem after pneumonia diagnosis, defined by RxNorm codes. Antibiotic receipt after pneumonia diagnosis defined the index event date. Patient cohorts were balanced using demographic (age, sex, race) and clinical data (antibiotic use, and XX co-morbidities) via a 1:1 greedy, nearest neighbor propensity score matching (PSM) with a 0.1 caliper. Outcomes following this index event included mortality, Clostridioides difficile infection (CDI), epilepsy/recurrent seizures, coagulation defects, pulmonary fibrosis (PF), and sepsis. A Kaplan-Meier Analysis was used to compare the proportion of ceficerocol or meropenem patients with each outcome of interest one-year post-index.

Results
After PSM, cefiderocol (n=94) showed no significant differences in mortality (HR 1.38, 95% 0.87-2.18), CDI (HR 1.04, 95% 0.26-4.17), epilepsy/recurrent seizures (HR 1.64, 95% 0.67-4.01), PF (HR 1.20, 95% 0.40-3.60), or sepsis (HR 1.17, 95% 0.75-1.81) one year post-index vs. meropenem (n=94). Cefiderocol patients had lower rates of coagulation defects (HR 0.2, 95% 0.04-0.91, p=0.021).

Conclusion
Overall, cefiderocol patients showed no differences in mortality, CDI, epilepsy/recurrent seizures, PF, or sepsis. However, patients treated with cefiderocol for gram-negative pneumonia had a lower rate of coagulopathies. Additional real-world studies are needed to monitor its long-term outcomes.

Disclosures
All Authors: No reported disclosures
P-293. Epidemiology of Extraintestinal Invasive Escherichia coli Infections in 9 U.S. Communities, 2023
Authors: Grome Heather N , Brandenburg Joshua M , Grass Julian E , Parker Erin , Johnston Helen , Driscoll Jennifer , Rebolledo Paulina , Smith Gillian , Wilson Lucy E , Luckman Emily , Zipprich Jennifer , Garcia Marco , Hoffman Marisa , Flores Kristina , Che Looi Hsioa , Tellerman Julia , O’Brien Shannon C , Muleta Daniel , Denzie Olivia , Guh Alice 
Published: January 2025

Abstract

Background
Extraintestinal invasive Escherichia coli (iEC) is a leading cause of sepsis and hospitalization, but US surveillance for iEC has been frequently limited to multidrug-resistant (MDR) strains and hospitalized cohorts. To describe the incidence and clinical characteristics of MDR and non-MDR iEC and inform prevention and vaccine development, CDC’s Emerging Infections Program piloted active population- and laboratory-based surveillance in 9 US sites.

Methods
Among surveillance area residents ( &gt; 7.3 million people), an incident iEC case was the first isolation of E. coli in a 30-day period from a normally sterile body site (June–August 2023). Demographic, clinical, and laboratory characteristics were assessed by chart review. Annual incidence rates by surveillance area were estimated by multiplying total case number by 4 and used 2022 US census data for denominators.

Results
Among 1345 iEC cases in 1334 patients, E. coli was isolated from blood in 1223 (90.9%) and from other sterile sites in 122 (9.1%). Median age was 68 years (IQR 55–79); 766 (57.0%) were female. Overall estimated annual crude incidence rate was 74.5 cases per 100,000 population (range by area 51.3–95.6) and was higher for persons aged ≥ 60 vs &lt; 60 years (228.5 vs 30.4). Cases were most commonly community associated (554, 41.2%) or health care associated community onset (633, 47.1%). Most case-patients (1194, 88.8%) had comorbidities; diabetes was most common (457, 34.0%). Of all cases, 762 (56.7%) were associated with urinary tract infection (UTI), 192 (14.3%) with recurrent UTI, and 213 (15.8%) had a urinary catheter in the 2 days before collection of the iEC-defining specimen. Among 1160 hospitalized cases, median length of stay was 5 days (IQR 3–9), 103 (8.9%) died. Of reported E. coli susceptibilities, 144/500 (28.8%) were fluoroquinolone-resistant, 185/1345 (13.8%) were extended-spectrum β-lactamase producing, and 3/1345 (0.2%) carbapenem-resistant.

Conclusion
The burden of iEC disease was substantial compared to other invasive pathogens and primarily affected older adults. Over half of infections accompanied UTIs and involved hospitalization. Continued surveillance to monitor trends over time, inform vaccine development and evaluation, and advise prevention efforts are needed.

Disclosures
All Authors: No reported disclosures
P-318. Clinical and genomic characterization of patients with methicillin-resistant Staphylococcus aureus horizontal transmission identified through prospective whole-genome sequencing: opportunities in the hospital and beyond
Authors: Rosa Rossana M , Rosello Gemma , Manzanillo Kelley , Cifuentes Renzo , Ghaemmaghami Chris , Zambrana David , Martinez Octavio , Abbo Lilian M 
Published: January 2025

Abstract

Background
We describe the clinical and epidemiological characteristics of patients involved in horizontal transmission detected through an Infection Prevention and Control (IPC) program integrating prospective whole-genome sequencing (WGS) of methicillin-resistant Staphylococcus aureus (MRSA) into routine activities.

Methods
Study conducted at a large county hospital in Miami, Florida between March 2023-January 2024. Clinical cultures of hospitalized patients underwent short-read sequencing. Pairs with &lt; 25 SNPs were considered genomically related and investigated to determine the location and route of transmission. Cases were discussed by the IPC program with frontline healthcare workers and leaders to implement targeted measures where appropriate. Definitions are described in Table 1.

Results
A total of 501 unique isolates were sequenced. We identified 21 putative transmission events, 9 probable and 12 possible, involving 40 patients. Transmission occurred in intensive care units (5), medical-surgical wards (3), hospital (without unit link, 5), nursing homes (4), jails (2) and in the community (2). Overall, 61.9% of events were hospital-onset (HO) and 8 (38.1%) were community-onset healthcare-associated (CO-HA).
Compared to HO cases, CO-HA cases were older, had higher proportions of diabetes, chronic hemodialysis, and were nursing home residents. Most HO cases belonged to sequence type (ST) 8 (76.0%), while CO-HA cases were more evenly divided among the STs identified (Table 2). Prevalence of carriage of mupA and qacC genes among CO-HA cases was higher than in HO cases at 53.3%/46.7% versus 24%/36% respectively.
There were 25 patients involved in HO transmission (12 index and 13 acquiring patients [1 patient linked to 2 others]). Six index cases were culture-positive on admission. Index cases who were culture negative on admission had a median number of days from admission to first positive culture of 28.4 (IQR 17.6-40.9). The median number of days overlapped between pairs was 6 (IQR 3-10) (Figure 1).

Conclusion
Patients with CO-HA transmission of MRSA have a larger burden of chronic illness and antimicrobial resistance markers compared to HO cases. Mitigating the risk of MRSA infection requires efforts throughout the continuum of healthcare.

Disclosures
All Authors: No reported disclosures
P-332. A Discrete Choice Experiment to Evaluate Healthcare Personnel Preferences Regarding Risk-Tailored Policies for Contact Precautions for Patients with Methicillin-Resistant Staphylococcus aureus in Hospitals
Authors: O’Hara Lyndsay M , Calfee David P , Angelino Nicholas , Harris Anthony , Snyder Graham M , Martin Elise , O’Hara Nathan N 
Published: January 2025

Abstract

Background
The risk of MRSA transmission differs by healthcare personnel (HCP) role and care activity. An alternative to an “all or none” approach to contact precautions for patients with MRSA carriage is a “risk-tailored” approach – using gloves and gowns only for certain high-risk activities, locations, or roles. A discrete choice experiment is a proven method to assess HCP perspectives on varied implementation strategies.

Methods
We distributed a discrete choice experiment survey to HCPs at medical centers in three cities. Respondents were presented with eight choice sets, each consisting of two hypothetical policy options for glove and gown use to prevent MRSA transmission (Fig 1). In each comparison, respondents selected their preferred policy option. Using mixed logit modeling we calculated the utility derived from each policy component, the probability of uptake for the most favored policies, and heterogeneity in preferences based on HCP role.

Results
384 HCP completed the survey: 138 from New York, 128 from Pittsburgh, and 118 from Baltimore. Respondents’ occupations were physicians or advanced practice providers (93, 24%), nurses (87, 23%), environmental services (56, 15%), respiratory therapists (55, 14%), occupational or physical therapists (44, 11%), and “other” (46, 11%). 237 (54%) respondents reported wearing gloves and gowns ‘all the time’ when required. Respondents preferred policy with the highest utility score was to use gloves and gown for all HCPs roles (utility, 0.17; 95% CI, 0.12 to 0.23), in high-risk settings (utility, 0.12; 95% CI 0.07-0.18), when touching the patient (utility, 0.11; 95% CI 0.06-0.17) (Fig 2). Sixty-three percent (95% CI 60-66%) of respondents would support a risk-tailored approach over an approach where contact precautions are used by all HCP in all settings and for all activities. The support for this policy varied by HCP role (p&lt; 0.02), with the strongest probability of support from physicians and advanced practice providers (77%, 95% CI 72-82%) and the least support from environmental services (45%, 95% CI 37-53%) (Fig 3).

Conclusion
This discrete choice survey demonstrates that most HCP prefer a risk-tailored approach to contact precautions when caring for patients with MRSA.

Disclosures
Anthony Harris, MD, MPH, Innoviva: Advisor/Consultant|UpToDate: Infection Control Editor Graham M. Snyder, MD, SM, Infectious Diseases Connect: Advisor/Consultant Nathan N. O'Hara, PhD MHA, Arbutus Medical Inc.: Stocks/Bonds (Private Company)
P-345. The Changing Dynamics of the Candida auris Outbreak in Southern California
Authors: Shaw Bennett M , Uslan Daniel , Yang Shangxin 
Published: January 2025

Abstract

Background
The current global outbreak of Candida auris poses a serious public health threat. With both high levels of antifungal resistance and a propensity for nosocomial spread, Candida auris has the potential to cause devastating outbreaks within healthcare facilities, especially amongst long-term and intensive care patients. As in many viral and bacterial pathogens, pathogen genomics has proven to be an indispensable piece of the outbreak response toolkit by contributing information useful in diagnosis, drug-resistance testing, and epidemiologic investigations.
Phylogenetic analysis of C. auris reveals introduction of Clade I to Southern CaliforniaFigure 1.A) Distribution of sequenced C. auris case clade membership during study period. B) Maximum-likelihood phylogenetic tree constructed from concatenated SNP sites of sequenced C. auris isolates with antifungal resistance data. MIC breakpoints: Fluconazole ≥ 32, Micafungin ≥ 4, Amphotericin B Intermediate ≥ 2, Resistant ≥ 4

Methods
At our large healthcare system located in Los Angeles, patients admitted with epidemiologic risk factors such as residence in a long-term care facility undergo admission screening for C. auris via combined axillary/inguinal swab. Microbiologic data from 213 C. auris isolates collected either via admission screening or from clinical cultures, including 91 isolates with paired whole-genome sequencing data, were used to conduct an in-depth investigation of the changing dynamics of the local C. auris outbreak. Phylogenetic analysis was employed to investigate the relationships between isolates.

Results
Transmission of C. auris between 2021 and 2023 remained high, with an average of 59 patients per year determined to be colonized or infected with C. auris. While the local outbreak has overall been dominated by Clade III isolates that are resistant to fluconazole but susceptible to echinocandins and amphotericin B, phylogenetic analysis identified the first known introduction of Clade I to Southern California in late 2022, which may have led to the first amphotericin B resistant case within our healthcare system. Genotypes of ERG11 and FKS1 genes were found to correlate with fluconazole resistance and echinocandin susceptibility. Two cases identified nearly one month apart in an intensive care unit were genetically identical, supporting epidemiologic suspicion of in-hospital transmission.

Conclusion
Continued genomic surveillance of C. auris contributed to an enhanced understanding of local outbreak dynamics, helping inform and guide empirical treatments and epidemiologic investigations.

Disclosures
All Authors: No reported disclosures
P-351. Hospital associated outbreak of Crimean-Congo Hemorrhagic Fever, Dushanbe, Tajikistan, 2023
Authors: Sharifov Rajabali , Horth Roberta , Tilloeva Zulfiya H , Jafarov Navruz , Nabirova Dilyara 
Published: January 2025

Abstract

Background
On July 1, 2023, a surgeon (Patient B) in Dushanbe, Tajikistan, died of acute febrile illness with hemorrhaging. Patient B had been hospitalized with acute respiratory distress four days before. Clinicians suspected Crimean-Congo Hemorrhagic Fever (CCHF). CCHF is a rare tick-borne disease. Tajikistan records just 1-6 cases annually. Patient B had no known exposures to ticks. We aimed to identify source and additional cases, and determine source.Figure 1.Timeline of CCHF Hospital Outbreak, Dushanbe, Tajikistan, 2023

Methods
We conducted an outbreak investigation on July 1st. A confirmed case was defined as a person with a positive anti-CCHF IgM ELISA or RT-PCR and an epidemiological link. We reviewed medical charts to find contacts, defined as people who had been in direct contact with or had exposure to bodily fluids from any confirmed case in the last 21 days. We interviewed living cases and contacts and collected blood for testing. We also conducted an infection control assessment.Figure 2.Cases and contacts in CCHF Hospital Outbreak, Dushanbe, Tajikistan, 2023

Results
A hospitalized adult (Patient A) had died of internal bleeding with extensive peritonitis (Figure 1) on June 16th. Six days later, a physician (Patient B) who had performed surgery on Patient A developed fever. Another six days later, he was hospitalized with hemorrhagic fever and diagnosed with CCHF within 3 days. Another physician (Patient C) who had performed surgery on Patient A was diagnosed with CCHF the following day. A laboratory assistant (Patient D) who had given a direct transfusion to Patient B was also diagnosed with CCHF the next day. Case-fatality rate was 25% (Table 1). We identified 29 healthcare providers who had contact to Patients A-D. All were tested, isolated and given oral Ribavirin 400 mg for 3 days as prophylaxis. None became ill (Figure 2). Interviews with hospital staff revealed infection control gaps, including lack of personal protective equipment during surgery and invasive procedures.Table 1.Characteristics of CCHF cases in a hospital outbreak in Dushanbe, Tajikistan, 2023

Conclusion
Misdiagnosis and infection control gaps contributed to transmission of CCHF virus within the hospital. Direct blood transfusion is not a recommended practice, but performed due to lack of resources. Trainings were provided on infection prevention and control, and on CCHF diagnosis and care. No additional cases were detected.

Disclosures
All Authors: No reported disclosures