bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-184. Gastrointestinal Illness in Attendees of FIFA Football World Cup 2022 in Qatar
Authors: Shams Sherin , Saleh Thoraya M , Nafady-Hego Hanaa , Ibrahim Emad B , Malik Aimon , Thomas Anil G , Saleem Samah , Azad Aftab M , Abou-Samra Abdul-Badi , Butt Adeel A 
Published: January 2025

Abstract

Background
Mass gathering events may facilitate transmission of foodborne diseases. We determined the pattern and causative organisms of gastrointestinal illness in the attendees of the FIFA Football World Cup 2022 (FIFA-WC2022), one of the world’s largest sporting events, which was hosted by Qatar.
Table 1. Baseline characteristics of individuals who underwent stool testing.

Methods
The study was conducted at Hamad Medical Corporation in Qatar, which was the designated provider and overseer of healthcare during FIFA-WC2022 for all visitors and served as the national reference laboratory for all microbiology testing. We retrospectively retrieved all stool testing data from attendees of FIFA-WC2022 from October 1 to December 31, 2022. Routine stool microscopy for ova and parasite and stool culture and sensitivity tests were performed on all samples received. PCR testing was performed for suspected food poisoning or when a rapid result was required for public health response.
Table 2. List of organisms detected by culture and/or PCR. (Note that the number of organisms is higher than that of the patients as some patients had more than one organism identified). At least one organism was detected in 424 individuals.

Results
During the FIFA-WC2022, approximately 1.4 million visitors entered Qatar. During the study period, a total of 2,179 stool samples were received for testing. The most common reasons for testing were acute diarrhea/gastroenteritis (51.4%), abdominal pain (11.5%), screening/surveillance of potential contacts (10.6%), and fever (7.6%). At least one organism was identified in 424 cases. The most commonly identified organisms were bacteria (92.5%), viruses (7.8%), and parasites (2.8%). The most frequent bacteria detected were Salmonella spp. (40%), E. coli (25.7%), and Shigella spp. (8.8%).

Conclusion
A relatively small number of individuals attending the FIFA-WC2022 experienced laboratory confirmed infectious gastroenteritis. Bacteria were more frequently isolated than viruses. The yield of stool testing was higher for those presenting with acute diarrhea/gastroenteritis and fever, but not for those with abdominal pain or for surveillance/screening. These results have implications and lessons for planning future mass gathering events.

Disclosures
Adeel A. Butt, MD, MS, Gilead Sciences: Grant/Research Support
P-197. Summary of Recurrent Clostridioides difficile Infections using Whole Genome Sequencing, Minnesota 2019-2021
Authors: Friedman Bree E , Evans Daniel R , Pung Kelly , Weber Bonnie , Wang Xiong , Lees Christine , Holzbauer Stacy 
Published: January 2025

Abstract

Background
Recurrent Clostridioides difficile infection (CDI) is typically defined as a positive C. difficile toxin or assay in the 8 weeks following an incident CDI. However, positive detections outside of this timeframe could represent failure to clear the initial infection and positive detections inside this timeframe could represent a new CDI based on molecular analysis of C. difficile isolates. We performed whole genome sequencing on consecutive isolates of patients to compare and summarize isolate pairs in Minnesota.

Methods
We analyzed data from our active population- and laboratory-based surveillance for CDI as part of CDC’s Emerging Infections Program from 2019-2021. An incident CDI was defined as the first positive C. difficile toxin or molecular assay on a stool specimen from a person at least 1 year of age during the study period. A recurrent CDI was defined as an additional positive test &gt; 2 weeks following an incident infection. Stool specimens were sent to the Minnesota Department of Health for C. difficile culture. DNA was extracted using QIAmp BiOstic Bacteremia DNA Kit, sequencing libraries prepared using Illumina’s DNA Prep Kit, and sequencing performed using Illumina MiSeq and NextSeq platform.

Results
There were 252 patients with two consecutive C. difficile isolates cultured and sequenced. Ninety-three (37%) of second instance CDI isolates had a sequence type (ST) that did not match the ST of their previous CDI, indicating a new infection and not a relapse of initial ST. Some (23%) relapses occurred outside the standard 8-week timeframe (range 58-486 days). The time between infections was significantly shorter for relapses (median 33 vs 50 days, p&lt; 0.0001). Older age (≥ 65, p&lt; 0.0001), antibiotic use prior to incident CDI (p=0.0003), and incident CDI that were hospital-onset or following recent hospitalization (p=0.0014) were associated with relapse.

Conclusion
Over a third of the patients with recurrent CDIs did not have a relapse of their initial ST. For those with a relapse, almost a quarter occurred greater than 8 weeks from their initial infection. While time between CDI episodes is important in determining new infection or relapse, there are other factors to consider such as age, antibiotic history, and hospital associated infections.

Disclosures
All Authors: No reported disclosures
P-198. Simulation: Advancing Healthcare Worker Education for C. diff
Authors: Ford Delvina , Cadena Jose , Garza Lauren N , Marrufo Dora , Bartoshevich Debra , Mella-Davila Ana , Beck Erica 
Published: January 2025

Abstract

Background
Use of scenario-based simulation for healthcare personal (HCP) in the prevention of healthcare associated infections remains an area that is proving to have positive educational effects. The Society for Healthcare Epidemiology of America (SHEA) 2022 Recommendations ongoing assessment and reinforced education of CDI knowledge for HCPs.

Methods
This simulation was developed as a learning intervention to increase the functional skills of bedside HCPs. An interdisciplinary team created a thirty-minute escape room theme for personal protective equipment, diagnostic stewardship processes.
Focused objectives included C. difficile laboratory testing indications, functional ability to locate the facility algorithm for collection and testing, direct hands-on use of personal protective equipment, hospital disinfectant use, appropriate hand hygiene, and the correct use of isolation signage for the facility was demonstrated.
HCP participants were sent a post participation evaluation utilizing a Likert Scale.
Staff Attendance During First Week of Simulation for C.diff Escape Room
Staff Attendance During First Week of Simulation for C.diff Escape Room

Results
A total of sixty-three HCP participated in the first week. Thirty-three registered nurses (52%), twenty-one nurses’ aides (33%), three clinical pharmacists (5%), three registered cardiovascular invasive specialists (5%), two health technicians (3%), and one licensed vocational nurse (2%).
Post evaluation of the ”C. diff Escape Room” from thirty-two responses of the sixty-three HCP that participated. (see table 1).
Most participants found the scenario-based learning useful, and a significant proportion would use the information and integrate it into their practice within the next six months (87.5% agreed/strongly agreed), facilitators were found to be knowledgeable (68% strongly agreed, 21.9% agreed) and made them feel comfortable (68.8% strongly agreed, 18.8% agreed).

Conclusion
Scenario-based simulation was an acceptable method to educate a diverse group of HCP on the diagnosis and isolation management of patients with the evaluation or diagnosis of CDI.
The utilization of the simulation in a fun environment provided for an educational experience with a focus on key objectives for learning. The event was well received, and overall respondents had positive feedback.

Disclosures
All Authors: No reported disclosures
P-200. Preliminary Results from a Multistate C. difficile Surveillance Network: The Surveillance Highlighting Existing/Emerging Resistance Limiting Our C. difficile Knowledge (SHERLOCK) Project
Authors: Carlson Travis J , Saleh Reeham , Dixon Jonah , Riley Colleen N , Eubank Taryn A , Gonzales-Luna Anne J , Alam M Jahangir , Begum Khurshida , Safdar Nasia , Garey Kevin W 
Published: January 2025

Abstract

Background
C. difficile infection is unique in that the diagnosis is made via the identification of toxins in stool rather than by bacterial growth. Therefore, strain typing and antibiotic susceptibility testing are not routinely performed on C. difficile isolates. Instead, active surveillance programs are required to identify new epidemic and/or antibiotic-resistant strains. The purpose of this project was to create a comprehensive, multistate surveillance program that can quantify the variability in C. difficile strain prevalence and antibiotic resistance across the United States.Table 1.C. difficile Ribotypes from Three Institutions in Two States
Results are reported as number (proportion)

Methods
All institutions participating in The Surveillance Highlighting Existing/Emerging Resistance Limiting Our C. difficile Knowledge (SHERLOCK) Project were asked to contribute a minimum of 40 leftover, C. difficile-positive stool samples each calendar year. The collection of stools for C. difficile testing was conducted as part of routine clinical care. All isolates were sent to the University of Houston for fluorescent polymerase chain reaction (PCR) ribotyping and antibiotic susceptibility testing.

Results
Between January 2021 and December 2023, institutions from three states (Iowa, North Carolina, and Wisconsin) contributed a total of 345 C. difficile-positive stool samples. Of those, 24 isolates from one institution have undergone fluorescent PCR ribotyping and were compared to 176 isolates previously collected in Texas between January 2018 and December 2021 (Table 1). The three most prevalent ribotypes in Texas were F027 (15.3%), F106 (14.8%), and F014-020 (14.2%). Conversely, the three most prevalent ribotypes in Wisconsin were F103 (16.7%), F002 (12.5%), and F014-020 (8.3%). Notably, two known, virulent ribotypes, RT027 and RT106, were absent from Wisconsin isolates.

Conclusion
These preliminary data demonstrate differences in C. difficile strain prevalence by state, which highlights the importance of a comprehensive, multistate surveillance program.

Disclosures
Travis J. Carlson, PharmD, BCIDP, Aimmune Therapeutics, Inc.: Speakers Bureau Anne J. Gonzales-Luna, PharmD, BCIDP, Ferring Pharmaceuticals: Advisor/Consultant|Innoviva Specialty Therapeutics: Advisor/Consultant|Merck and Co: Grant/Research Support|Paratek Pharmaceuticals: Grant/Research Support|Seres Therapeutics: Grant/Research Support Kevin W. Garey, PharmD, MS, Acurx: Grant/Research Support
P-206. Reducing Hospital Acquired Clostridioides difficile Infections: A Comparison of Two Equally Effective Testing Strategies
Authors: Nothdurft Elizabeth , Philip Nirmol , Campbell J William , Sirtak Elysa , Martin-Giacalone Madison , Martin Mackenzie , Leinauer Emily , Giblin Brenden 
Published: January 2025

Abstract

Background
A positive Clostridioides difficile (C. diff) test obtained after day three of admission qualifies as hospital acquired C. diff infection (HA-CDI). Given PCR’s high sensitivity for C. diff, the decision to test necessitates clinical judgement to avoid false positive results that may lead to increased nosocomial infection rates, unnecessary treatment, and increased financial burden. This study investigated two interventions to decrease unnecessary C. diff testing after day three of admission.

Methods
A multistep testing algorithm, which consists of an initial enzyme immunoassay for glutamate dehydrogenase (GDH) and Toxin A/B testing followed by C. diff PCR test by a reflex, is utilized in our institution. To ensure appropriate C. diff test ordering, our Infection Control (IC) team implemented two stages of interventions during a span of five years. In June 2019, Stage 1 involved a hard stop and manual review of all C. diff test orders placed after three midnights from Monday through Friday, requiring an IC or infectious diseases team member to approve these C. diff testing requests. Orders were cancelled if all established testing criteria were not met (Figure 1). In January 2023, Stage 2 was implemented which replaced manual review with an algorithm in electronic medical record (EMR).
Outcomes were measured by examining National Healthcare Safety Network (NHSN) LabID data and the standardized infection ratio (SIR) before and after each stage implementation.
Stage 1 SIR

Results
From 2019 to 2023, our testing interventions resulted in a reduction in HA-CDI incidence. Stage 1 implementation significantly decreased average HA-CDI incidence from 9.3 to 4.06 infections/1000 patient days (PD) (p&lt; 0.0001) resulting in a decreased average HA-CDI SIR from 1.25 to 0.52 (p&lt; 0.0001).
Further HA-CDI decrease resulted after Stage 2 implementation with HA-CDI rate decreasing from 4.06 to 3.29 infections/1000 PD (p=0.656) and with HA-CDI SIR decreasing from 0.52 to 0.48 (P =0.172) (Figure 2, 3). This decline was not statistically significant.
Stage 2 SIR

Conclusion
Manual testing review and EMR-based HA-CDI algorithm implementation effectively decreased the number of positive HA-CDI test results. Use of the electronic algorithm greatly reduced the workload burden on our IC team with no increase in HA-CDI.

Disclosures
Elizabeth Nothdurft, PharmD, BCPS, BCIDP, Abbvie: Honoraria Nirmol Philip, MD, MPH, Nestle: Honoraria
P-212. Outcomes Associated with Bezlotoxumab Use
Authors: Kole Amy , Schreck Daniel , Orenstein Robert , Kirchoff Robert 
Published: January 2025

Abstract

Background
Bezlotoxumab is a monoclonal antibody infusion approved to prevent recurrence of Clostridioides difficile infection (CDI). The objective of this study was to explore outcomes associated with bezlotoxumab use at three academic medical centers.

Methods
A retrospective cohort study was conducted with 180 patients who received bezlotoxumab from May 2018 through November 2023. The primary outcome was recurrence of CDI within 12 weeks of receipt of bezlotoxumab. The study also sought to evaluate risk factors for CDI recurrence in patients who received bezlotoxumab.

Results
Of the 180 patients who received bezlotoxumab at our institution, 165 were included in the study. Fifteen patients were excluded because they did not improve with standard of care CDI treatment. In the study cohort, 45% were immunosuppressed (n=75), 17% had a solid organ transplant (n=28), and 16% had a history of inflammatory bowel disease (n=27). Ninety-five percent of patients received bezlotoxumab as an outpatient (n=156). Recurrence of CDI within 12 weeks occurred in 16% of patients. Duration from diagnosis of CDI to bezlotoxumab infusion (p=0.022) and having greater than two prior CDI episodes (p=0.032) were statistically significant predictors for CDI recurrence within 30 days.

Conclusion
Our study demonstrated similar CDI recurrence rates for patients who received bezlotoxumab in a real-world setting compared to previous clinical trials. Patients with CDI may benefit from receiving bezlotoxumab earlier in the course of illness and prior to developing multiple recurrences.

Disclosures
Robert Orenstein, DO, FACP, Ferring: Advisor/Consultant|Ferring: Honoraria
P-227. Strategy for the accurate identification of CAUTIs in the ICU at a Tertiary Care Hospital
Authors: Bascara Christina J , Chaparro-Rojas Fredy , Panaccione Sophia 
Published: January 2025

Abstract

Background
The rates of CA-UTIs increased significantly after the COVID-19 pandemic. Many of these infections were considered "definitional infections", in which cases, they were considered reportable infections based on NHSN criteria, however, not conclusive by clinical presentation. The IDSA recommends removing and replacing indwelling catheters that have been in place for more than 14 days before obtaining a new urinary sample to evaluate for presence of UTI. This is currently not routinely performed.

Methods
In order to improve the yield of evaluating non-contaminated urine specimens for true infection, we developed a protocol that triggered a catheter exchange if the catheter has remained in place for more than 3 days. The protocol consists of removal and replacement of urinary catheter before processing the urine sample and obtaining a culture.

Results
A significant reduction in the number of UTIs was observed after 12 months of use and surveillance of our strategy despite a stable rate of use of urinary catheters. Our intervention was initiated in February 2023 and only 3 CA-UTIs were identified during this time period. It is important to mention that multiple other strategies were deployed during the COVID-19 pandemic in order to decrease the number of CA-UTIs, including an ED lead initiative to decrease the use of new Foley insertion for patients going to ICU and the use of GCH based perineal care (Pericare). In 2022 a significant decline in CA-UTIs was noted (5 CA-UTIs) and 3 cases in 2023.
Currently, we are processing data and additional variables to help us adjusting our findings for potential confounders.

Conclusion
The implementation of a catheter-exchange program for the accurate identification of catheter associated UTIs in the ICU setting, together with the use of GCH based pericare, are effective strategies to decrease the incidence of Catheter associated UTIs.

Disclosures
All Authors: No reported disclosures
P-228. A Multidisciplinary Approach to Reducing Central Line-Associated Bloodstream Infections (CLABSI)
Authors: Rhodes Katherine A , Youree Bryan 
Published: January 2025

Abstract

Background
Our acute care hospital experienced 17 CLABSI events during 2021. This was a significant increase over 2020 and well above typical performance. The COVID-19 pandemic negatively impacted adherence to best practices. Point prevalence studies pointed to continued issues surrounding line maintenance. Gaps included inconsistent dressing care and site assessment, lack of compliance with scrubbing the hub prior to access, inconsistent use of chlorhexidine bathing, inadequate line securement, inadequate flushing of lines, inconsistent onboarding of new RNs, and missed daily review of necessity. The facility has initiated ongoing education & training, tracer observations, and recommended best practices. Each CLABSI event is estimated to cost $45,814 with 10.4 avoidable days and a 30% increase in mortality. It is considered a preventable healthcare-associated infection (HAI). A multidisciplinary approach was implemented in late 2021 with a stated goal of maximum 2 CLABSI events per year.

Methods
CLABSI events are identified through daily review of blood culture reports by Infection Prevention. Events are defined using CDC NHSN criteria for CLABSI. Rates are calculated by number of events per 1000 device days and compared to national benchmarks and internal trending. A Standardized Infection Ratio (SIR) is utilized for external benchmarking.
Highlights of actions taken to drive improvement include:Creation of unit Central Line Champions to perform tracers and educationDevelopment of an Aseptic Access Tracer to standardize line maintenanceImplementation of a biweekly Central Line Huddle led by VAT to facilitate timely line removal when no longer indicatedStandardization of onboarding for new RNs to include line care and maintenance with a competency check off by VATFeedback on strategies and data provided to key stakeholders

Results
CLABSI events were reduced from 17 events to 2 events in 2022 and sustained through 2023. CLABSI rates were reduced from 1.54 per 1000 line days to 0.24. SIR was reduced from 1.87 to 0.24. The Central Line Huddle facilitated early removal of 44 unnecessary central lines. Aseptic Access Tracer compliance was improved from 40% to 96% and sustained.

Conclusion
A multidisciplinary approach was successful in improving CLABSI outcomes.

Disclosures
All Authors: No reported disclosures
P-230. Frequency and Outcomes of Coagulase-Negative Staphylococcus Isolation from Blood Cultures of Patients Receiving Extracorporeal Membrane Oxygenation
Authors: Wells Christian , O’Neil Erika , Sobieszczyk Michal , Marcus Joseph 
Published: January 2025

Abstract

Background
Coagulase-negative Staphylococcus (CoNS) are frequently cited as the most common cause of bacteremia in patients receiving extracorporeal membrane oxygenation (ECMO). CoNS bacteremia is concerning in ECMO as the biofilm it forms can adhere to the circuit. Alternatively, CoNS can be colonizing or contaminants, and there are no standard definitions of CoNS bacteremia in ECMO. Additionally, appropriate workup and follow-up for CoNS bacteremia in ECMO patients is unknown. This study evaluates the etiology and workup of CoNS in a cohort of patients receiving ECMO at a military medical center.

Characteristics of the 13 patients receiving ECMO with Coagulase-negative Staphylococcus isolated from blood cultures

Methods
All patients who received ECMO between January 2022 and March 2024 were included in this retrospective study. All blood cultures were reviewed and patients with a positive blood culture for CoNS were included for further analysis including patient demographics, indication for culture, follow-up of culture results, treatment, and patient outcomes.

Characteristics of CoNS with Repeated Blood Culture Positivity as Compared to Single Blood Culture Positivity in Patients Receiving ECMO.

Results
Of the 68 patients who received ECMO during the study period, there were 424 blood culture sets obtained, of which 20 (4%) yielded CoNS in 13 (19%) patients. Patients were predominantly male (85%) with a median age of 35 [IQR: 26-50] (Table 1). The most common indication for culture in this cohort was fever (62%) and most cultures were drawn from peripheral draws. All CoNS were monomicrobial and S. epidermidis (85%) accounted for the majority of cases. Only 5 (38%) patients had repeat growth of CoNS on repeat cultures, yet 8 (62%) were treated with antimicrobials (Table 2). Two (15%) patients, both with persistent culture positivity, were found to have infective endocarditis. Of patients with multiple isolations of CoNS, all survived to hospital discharge. No patient had reisolation of CoNS after treatment.

Conclusion
CoNS was frequently isolated in blood cultures from patients receiving ECMO. Despite the concern for biofilm formation, most CoNS was only isolated in one culture, and bacteremia was not associated with increased mortality, even when isolated repeatedly. Based on this data, it is reasonable to recommend treatment of CoNS bacteremia, only when isolated on repeat cultures. Standardization of CoNS bacteremia reporting, in addition to treatment in ECMO is needed.

Disclosures
All Authors: No reported disclosures