bluuebunny/crossref_metadata_2025_split huggingface dataset:
2471. Comparison of Dialysis Infection Events in Outpatient End Stage Renal Facilities Pre- and During the COVID-19 Pandemic: Louisiana, 2018-2021
Authors: Lee Grace , Washington Erica , Pinkins Ashlyn 
Published: November 2023

Abstract

Background
Bloodstream infections (BSIs) in patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD) are associated with significant morbidity and mortality. While robust infection prevention and control (IPC) education has lowered BSI rates in the last decade, the COVID-19 pandemic posed significant challenges in terms of IPC practices. The aim of this review is to determine if COVID-19, and associated strains on IPC capacity, impacted dialysis events (DEs) in outpatient ESRDs in Louisiana.

Methods
Dialysis events and associated patient-months data from the National Healthcare Safety Network (NHSN) Dialysis Event Surveillance Module from January 2018 to December 2021 were extracted to compare outcomes in patients receiving HD from free-standing ESRD facilities in Louisiana in the time preceding the COVID-19 pandemic (January 2018 to February 2020) and during the COVID-19 pandemic (March 2020 to December 2021). Incidence density rates (IDR) and relative risks (RR) were computed in the NHSN Statistics Calculator and openepi.com, respectively, for the retrospective cohort. Statistical significance was considered at the 95% confidence level.

Results
From 2018 to 2021, 189 facilities reported 12,583 DEs to NHSN. The pre-COVID IDR (184.22/10,000 patient-months) was higher than the COVID IDR (173.85/10,000 patient-months; p&lt; 0.001). ESRD patients with DEs were 23% more likely to be hospitalized pre-COVID in comparison to the COVID period (95% CI: 1.18-1.27), and were 4% more likely to die due to DE before COVID, though this risk was not statistically significant (95% CI: 0.92-1.17). Independent free-standing ESRD facilities had a lower rate of DE (15.03/10,000 patient-months) compared to corporate facilities (357.66/10,000 patient-months; p&lt; 0.001).

Conclusion
Despite disruptions in healthcare delivery and IPC practices during the COVID-19 pandemic, indicators of BSIs as reported to NHSN did not worsen during this period. This may be attributed to heightened awareness of vulnerabilities exposed to dialysis patients during the pandemic and increased IPC awareness despite constraints. Granularity with respect to data reviews is warranted due to PPE and staffing constraints over the study period to determine if risk differences were variable during the COVID period.

Disclosures
All Authors: No reported disclosures
2472. Hospital Onset Antibiotic Resistant Infections among Patients without COVID-19 Diagnosis in Pre-Pandemic and Pandemic Periods
Authors: Baggs James , McCarthy Natalie , Reddy Sujan , Wolford Hannah 
Published: November 2023

Abstract

Background
In 2022, Centers for Disease Control and Prevention reported that hospital onset (HO) antibiotic resistant (AR) infections increased during the COVID-19 pandemic. To determine whether these increases were related only to patients diagnosed with COVID-19 or to changes in healthcare utilization and case-mix, we compared the risk of HO AR infections before and during the COVID-19 pandemic among hospitalized patients without a diagnosis of COVID-19.

Methods
Using the PINC AI Healthcare Database, we included discharges from the pre-pandemic period (January 1, 2019-January 30, 2020) and the pandemic period (April 1, 2020-December 31, 2021), among facilities reporting microbiology data. We excluded discharges with a COVID-19 diagnosis, an inpatient COVID-19 diagnosis in the previous 90 days, or length of stay ≤ 3 days. Using a multivariable Cox proportional hazards model, we calculated hazard ratios (HR) comparing the risk of incident HO AR infections during the pre-pandemic and pandemic periods, adjusting for patient demographics, comorbidities, hospitalization in the previous 30 days, facility-level rate of community onset AR infections by discharge month, time-dependent intensive care unit stay and mechanical ventilation, facility characteristics, and inter-facility correlation.

Results
There were 1,153,799 discharges from 280 facilities in the pre-pandemic period, and 1,470,063 discharges from 287 facilities in the pandemic period. The risk of HO ESBL, CRAsp, MDR Pseudomonas, and VRE among patients without COVID-19 was significantly elevated during the pandemic period (Figure 1). The risk of HO MRSA was significantly decreased during the pandemic period.

Conclusion
The risk of HO AR infections, except for MRSA and CRE, was significantly increased in patients not diagnosed with COVID-19 during the pandemic period even after controlling for demographics, clinical, and facility characteristics. Understanding potential drivers for these increases, such as infection prevention barriers, is important for pandemic preparedness and healthcare resiliency.

Disclosures
All Authors: No reported disclosures
2474. Emergence of Candida auris in Michigan
Authors: McNamara Sara E , Brennan Brenda M , Mach Niki , McGuire Nicole , Sturgis Margaret , Rogers Jane E , Malani Anurag , Pogue jason M 
Published: November 2023

Abstract

Background
Candida auris is an emerging multidrug-resistant fungal pathogen associated with high rates of morbidity and mortality, and outbreaks in healthcare facilities (HCF). In May 2021, Michigan detected its first case of C. auris and has since seen an increase in C. auris cases. We aimed to characterize the epidemiology of the emergence of C. auris in Michigan and subsequent regional public health containment response activities.

Methods
Since 2018, cases of C. auris from clinical or colonization screening specimens are reportable to public health in Michigan. Epidemiologic information collected on each case included clinical status and HCF exposures. Contact investigations and colonization screenings were conducted to identify potential healthcare contact exposures. Facilities with confirmed cases were set up with Infection Control and Assessment Response (ICAR) visits to identify and address infection prevention and control (IPC) practice gaps. Action plans outlining all recommendations and resources were provided.

Results
From May 2021 – March 2023, 224 cases of C. auris have been identified in Southeast Michigan. 159 were from screening specimens and 65 from clinical specimens (25 of which were collected from patients previously known to be colonized). Cases were detected at 28 HCFs across 7 local health jurisdictions in Southeast MI, most frequently at long-term acute care hospitals (LTACHs; 103 cases), followed by acute care hospitals (98 cases). 2663 response-driven colonization screenings of healthcare contacts were collected at 56 HCFs, with the highest percent positive in LTACHs (9.3%). 32 ICAR visits were conducted which identified areas for improvement in IPC practices, personal protective equipment use, and cleaning and disinfection practices.

Conclusion
C. auris has recently emerged in Southeast Michigan HCFs with a 44-fold increase in cases within the second year. Vulnerable patient populations were at highest risk including those in high acuity care in a hospital or long-term care setting. Enhanced surveillance, early detection, and a robust public health containment response, including colonization screenings and assessments of IPC practices are essential to help mitigate future outbreaks and further spread of C. auris in MI HCFs.

Disclosures
jason M. Pogue, PharmD, AbbVie: Advisor/Consultant|Entasis: Advisor/Consultant|Ferring: Advisor/Consultant|GSK: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|Qpex: Advisor/Consultant|Shionogi: Advisor/Consultant
2477. Characteristics of patients infected with Carbapenem-resistant Acinetobacter baumannii complex and Carbapenem-resistant Enterobacterales in Tennessee, 2016–2021
Authors: Patel Dipen , Mutamba Glodi , Villegas Raquel , Gambrell Ashley , Bailey Cherlly , Mounsey Jacquelyn , Muleta Daniel 
Published: November 2023

Abstract

Background
The spread of Carbapenem-resistant pathogens is a growing global public health concern. Tennessee conducts surveillance of Carbapenem-resistant Enterobacterales (CRE) since 2011 and participates in Multi-site Gram-negative Surveillance Initiative (MuGSI) in Davidson County and seven surrounding counties since 2014.

Methods
We analyzed the CRE and Carbapenem-resistant Acinetobacter baumannii complex (CRAB) incident cases reported to the MuGSI project from 2016–2021. A CRE case is defined as the isolation of Escherichia coli, Enterobacter species and Klebsiella species from normally sterile site or urine, and resistant to ≥1 carbapenem. A CRAB case is defined as the isolation of A.baumannii complex from a normally sterile site or urine (2016-2020). In 2021, cultures from a lower respiratory tract or wound were added. Incident case is defined as a report of the first case in 30 days. Data analysis was performed using SAS Version 9.4.

Results
One hundred nine CRAB and 467 CRE cases were reported from 2016–2021. The proportion of males was higher for CRAB (62.39% vs 37.61%, p&lt; 0.0001), while the proportion of females were higher for CRE cases (68.74% vs 31.26%, p&lt; 0.0001). The mean age was 65 and 60 years for CRE and CRAB case respectively. The incidence rate of CRAB was significantly higher in non-white populations (15.90 per 100,000) compared to white populations (4.86 per 100,000) (p&lt; 0.0001). Smoking was more prevalent among CRAB patients (27.52%) than CRE patients (16.49%) (p=0.0076). The prevalence of neurological health conditions was higher in CRAB than CRE (59.63% vs 38.33%; p&lt; 0.0001), as were renal conditions (38.53% vs 26.12%; p=0.0097) and diabetes (48.62% vs 37.69%; p=0.0357). The prevalence of urinary tract infections was higher in CRE than CRAB cases (52.29% vs 77.09%; p&lt; 0.0001). CRAB (95%) and CRE (65%) cases were healthcare-associated infections.

Conclusion
Patients with CRAB had significantly higher prevalence of neurological, renal, diabetes and smoking history, while UTI was more common in patients with CRE. CRAB incidence was significantly higher in non-whites than whites. More research is needed to explain the disparities and reduce infection burden in vulnerable populations.

Disclosures
All Authors: No reported disclosures
2480. A Legionella pneumophila Investigation at an Outpatient Residence in a Tertiary Cancer Center
Authors: Rizzo Stephanie , Kullar Rajkiran , Reyes Michell , Bubb Tania N , Aslam Anoshe 
Published: November 2023

Abstract

Background
Legionella pneumophila (L. pneumophila) infections can severely affect immunocompromised patients. Found in water systems, the presence of Legionella in healthcare water sources creates an opportunity for hospital acquired infections. After a high-risk patient acquired L. pneumophila in June 2022 while at Memorial Sloan Kettering (MSK), a tertiary cancer center, Infection Control worked to identify the source. A timeline of events is illustrated in Figure 1. Between inpatient admissions, the patient stayed at MSK’s outpatient residence known as the Bone Marrow Transplant Residence (BMTR).

Methods
Monthly surveillance cultures are collected at BMTR following a 2021 L. pneumophila investigation. To date, all surveillance cultures for Legionella were negative. Table 1 shows L. pneumophila patient cases at MSK from 2019 to 2022. Targeted environmental cultures were collected from inpatient rooms and the BMTR apartment. Inpatient cultures were negative but the apartment shower tested positive for L. pneumophila along with a respiratory culture from the patient. Both positive cultures were sent to a third-party lab for whole genome sequencing (WGS). Mitigation included chlorinated cleaning of showerheads in all BMTR apartments. Infection Control collected 93 environmental samples from all BMTR showers and kitchen sinks. To identify further clinical cases, surveillance was deployed on 53 patient admissions from BMTR to MSK between June and September. Upon admission, urine antigen tests were collected on patients who reported respiratory symptoms and resided at BMTR 21 days prior to presentation at MSK.Table 1.L. pneumophila Patient Cases: 2019-2022. *It should be noted that the two cases listed in 2019 were investigated but found not to be definitively linked to BMTR.

Results
All 93 cultures were negative, and the patient and environmental isolates did not match from WGS. Of the 53 patients that were surveilled, 32 presented to MSK following or during their BMTR stays; 5 presenting with respiratory symptoms and zero testing positive for Legionella. The investigation was considered complete and closed.

Conclusion
Although the isolates did not match, proactive surveillance emphasizes the importance of monitoring Legionella in outpatient settings. Monthly cultures and passive patient surveillance continues. Additionally, Copper-Silver ionization and UV disinfection and ultra-filtration are part of the water system at BMTR and monitored.

Disclosures
All Authors: No reported disclosures
2482. Cross Validation of Surgical Procedure Data in National Healthcare Safety Network vs Hospital Discharge Data
Authors: Sato Yoran (Lana) , Parriott Andrea M , Kazerouni N Neely , Epson Erin 
Published: November 2023

Abstract

Background
California acute care hospitals (ACH) are required to report data on 28 types of inpatient surgical procedures via the National Healthcare Safety Network (NHSN). ACH also report discharge data, including procedure data, to the California Department of Healthcare Access and Information (HCAI). We compared the number of adult (age &gt;=18) procedures reported in NHSN versus HCAI in 2019 for cardiac surgery (CARD), coronary bypass with chest and donor incisions (CBGB), hip prosthesis (HPRO), kidney transplant (KTP), and rectal surgery (REC).

Methods
For both systems, we aggregated procedure counts to the facility level and matched individual facilities. HCAI ICD-10 codes were mapped to NHSN procedure codes. Because NHSN counts multiple procedures that map to the same procedure code done via the same incision as one procedure and HCAI does not specify how many procedures were done per incision, CARD, CBGB, and REC were counted only once per procedure code per patient per day. HPRO and KTP were counted up to twice per patient per day if ICD-10 codes for both right and left side surgeries were present. ANOVA was used to compare the means of log standardized infection ratio (SIR) by NHSN to HCAI procedure count ratio as categories of less than 0.9, between 0.9 and 1.1, and more than 1.1.

Results
Three hundred eleven facilities reported 82,847 procedures to NHSN and 300 facilities reported 91,961 procedures to HCAI. Median and interquartile interval for the facility-specific ratio of NHSN to HCAI procedures among facilities that reported procedures in both systems are displayed in Table 1. ANOVA failed to detect any difference in mean of log SIR by different NHSN to HCAI procedure count ratio at α of 0.05.

Conclusion
For all procedure types, there were more procedures documented in HCAI than NHSN, but the ratios of NHSN procedures to HCAI procedures varied widely by procedure type. However, difference in ratio was not associated with SIR. Ability to compare procedure counts was limited by inability to ascertain operating room deaths (which are not counted in NHSN) and if procedures were done using the same incision in HCAI. Further analysis is recommended since SSI denominator quality is crucial to the accuracy of SIR, which informs many analyses and interventions.

Disclosures
All Authors: No reported disclosures
2490. Improving Hepatitis C Continuum of Care in an Outpatient Internal Medicine Population
Authors: Sharath Deepali Boothankad , McCann Timothy , Patel Neha , Aryal Sarthak , Thapa Usha , Contreras Cynthia , Patel Anar 
Published: November 2023

Abstract

Background
According to the WHO, approximately 71 million people are infected with Hepatitis C virus (HCV), and more than 400,000 people die each year due to HCV-related liver diseases. Since the advent of safe and highly effective direct-acting antivirals (DAA) in 2014, treatment for HCV has been revolutionized with cure rates exceeding 90%. Although the detection of undiagnosed HCV infection itself likely has some inherent benefit, the impact of screening is greatly reduced if it does not lead to treatment and cure. Studies on the HCV continuum of care have concluded many patients are lost at each stage, highlighting the need to raise awareness among healthcare professionals and at-risk populations about hepatitis testing, referral, support, and care. A practical model to help fill care gaps in urban internal medicine clinics and improved treatment enrollment and adherence is necessary, which in turn will improve public health outcomes.

Methods
The objective of the study is to improve the continuum of care of HCV, from diagnosis to treatment of the disease at the outpatient Faculty Medical Center (FMC) Internal Medicine Clinic, and identify hurdles to treatment. We enrolled 31 patients who screened positive for hepatitis C antibody into a pooled cohort, where biweekly telephone encounters were initiated for 3 months to facilitate close follow-up, including scheduling labs and office visits and facilitating subspecialty referrals. (Table 1).
Hepatitis C Continuum of Care Workflow
HCV labs include HCV viral load and genotype, Fibroscan, Hepatitis B surface antigen, and antibody, Hepatitis A antibody, and HIV 1/2 antibody test.

Results
Six months post-study, 7 out of 31 (22%) patients enrolled in our intensive follow-up completed treatment. Among the patients who were lost to follow-up, the most common issue encountered was following up with specialists (58%). The most common communication barrier was patients having inactive phone numbers.
Results

Conclusion
Our next step is to establish an HCV clinic within our FMC Internal Medicine Center to expand access to care for HCV-affected patients. The HCV clinic will include coordination with the Infectious Diseases specialist through E-Consult and TriHealth Specialty Pharmacy. The impact will be early treatment of HCV-affected patients, improved treatment success which ultimately reduces the risk of transmission and progression of the disease, and improved quality of life.

Disclosures
All Authors: No reported disclosures
2492. Implementation of a Hepatitis C Referral Workflow: A Pilot Program
Authors: Chun Katherine , Lau Gary , Lee Jenica , Ham YoungYoon 
Published: November 2023

Abstract

Background
Direct-acting antiviral (DAA) treatment for hepatitis C viral infection (HCV) is typically initiated in the outpatient setting. Currently at Oregon Health and Science University (OHSU) hospital, there is no standardized method of connecting hospitalized patients who test positive for HCV with outpatient care for treatment. As a result, patients are infrequently referred. We created and implemented a pharmacist-led workflow to evaluate patients and officially refer admitted patients to outpatient care. The goal is to increase the rate of patients who attend follow-up appointments that address HCV diagnosis and treatment after a hospitalization, and increase the rate of patients who are treated.

Methods
The pharmacist-led workflow was implemented from October through December 2021. Pre- and post-implementation (Pre-I and post-I) data was collected and analyzed. Hepatitis C positive patients were identified and assessed for willingness to be treated. If willing, assessment was completed while inpatient and an official outpatient referral was placed. The data includes patients who attended an appointment (primary outcome) and patients who were prescribed a DAA (secondary outcome).

Results
In pre-I, 44 patients were screened and 18 patients met inclusion. In post-I, 75 patients were screened and 33 met inclusion.
Fourteen patients (33%) in post-I and 4 patients (22%) in pre-I were referred to hepatology. Nine patients (50%) in pre-I and 6 patients (14%) in post-I attended a clinic appointment within 3 months. Three patients (17%) in pre-I and 5 patients (12%) in post-I were prescribed a DAA within 3 months.
However, of the referred patients, 2 patients in pre-I and 3 patients in post-I attended an appointment within 3 months. No patients in pre-I and 1 patient in post-I were prescribed a DAA. In both pre- and post-I, 33% of those who attended an appointment received a prescription for a DAA within three months.

Conclusion
A pharmacist-led HCV referral workflow increased the rate of referrals to hepatology. However, this increase in referrals did not correspond with a substantial increase in appointments or receipt of a prescription.
While the workflow increased referrals, it did not increase patient receipt of DAAs. More intensive interventions may be needed to reach this population.

Disclosures
All Authors: No reported disclosures
2493. Barriers and Facilitators to Hepatitis B Screening, Vaccination, and Treatment Amongst West African Immigrants in The Bronx
Authors: Coe Jared , Birnbaum Jessie , Omarufilo Fatima , Sigal Samuel , Akiyama Matthew J 
Published: November 2023

Abstract

Background
There is a high burden of hepatitis B virus (HBV) in West Africa. Over the past 20 years, West African immigration to the U.S. has been increasing, especially to the Bronx. Prevalence of HBV infection in West Africa has been reported to be as high as 5-10%. We sought to understand knowledge and attitudes of and barriers and facilitators to HBV screening, vaccination, and treatment in a cohort of people living with and at risk for HBV.

Methods
We recruited participants through an HBV outreach program (The Starfish Program) which provides free HBV education, screening, and vaccination with a focus on West Africans. We conducted one-on-one in-depth, in-person qualitative interviews with West African immigrants over the age of 18 residing in the Bronx. Our interviews were guided by the modified socioecological model (SEM), which includes individual, social network, community, and societal domains. The interviews assessed participants’ understanding of HBV, social issues surrounding HBV in their community, and structural factors affecting their ability to seek healthcare. Data were analyzed in an iterative process using a thematic analysis.

Results
Participants (n=23) had origins in 6 different West African nations, although mainly from Ghana and Nigeria, with a median age of 49.5 (IQR 40-66). 56.5% were female. 7 were HBV surface antigen (HBsAg) positive, 6 were HBsAg negative, and 10 had unknown status at the time of interview. Median time since immigrating was 15.5 years (IQR 4-21). Key barriers included limited knowledge of HBV, HBV-related stigma, lack of health insurance, and undocumented immigration status/fear of deportation. Key facilitators included trust in U.S. healthcare providers and healthcare system, social support networks, and ease of accessing healthcare after obtaining health insurance.
Demographics of interview participants

Conclusion
Raising awareness of HBV, addressing social and structural barriers such as stigma and health insurance, and improving access to culturally sensitive programs among West African communities could help increase HBV screening, vaccination, and treatment in this vulnerable population.

Disclosures
Samuel Sigal, MD, Eli Lilly: Grant/Research Support|Gilead Sciences: Grant/Research Support|Gilead Sciences: Speakers Bureau|Intercept: Grant/Research Support|Mallenchrodt: Advisor/Consultant|Mallenchrodt: Grant/Research Support