bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-364. Outbreak of bla-OXA-48 in the eastern part of Singapore
Authors: Conceicao Edwin , Cheong Hau Yiang , Tan Thean Yen , Jie Li , Nasir Suhailah Binte , Wu Toudi , Theresa Maria , Wong Crystal , Foo Ruby , Yen Tan Seow 
Published: January 2025

Abstract

Background
Changi General hospital (CGH) is a 1000 bed acute hospital that mainly serves the general population in the eastern region of Singapore and community. At the beginning of October 2023 till March 2024, we observed an increase in the number of the Carbapenemase producing Enterobacteriaceae (CP-CRE) bla-OXA-48 cases from the routine long-stayer inpatient surveillance screening in several wards.

Methods
Standard outbreak protocols are executed, including enhanced environmental testing and disinfection, inpatient contact tracing, and Box-PCR typing of Klebsiella pneumoniae spp. isolates.

Results
68% (n = 226) of the bla-OXA-48 are identified from the outbreak wards, of which 15% (n = 33) cases is likely due to the additional beds added in the outbreak wards, reported an OR of 3.6 times (p-value: 0.007, 95%CI: 1.3 – 9.0) of being colonized by bla-OXA-48 CP-CRE compared to the non-outbreak wards. Patients from the outbreak wards have 2.7 times higher odds of requiring significantly more nursing care compared to the non-outbreak wards (p-value: 0.009, 95%CI: 1.3 – 5.7). The limited space to manoeuvre during nursing care, especially during diaper changing for the bed bound patients which is 61% (n = 139) of bla-OXA-48 CP-CRE cases in the outbreak wards. Among the bedbound patients, the odds of being colonized with bla-OXA-48 CP-CRE is 5.6 times (p-value: 0.008, 95%CI: 1.3 – 24.7) in the outbreak wards compared to the non-outbreak wards due to possible surface contamination when the curtains are drawn during the diaper changing or through accidental contact with the adjacent beds by the healthcare workers.
The microbiological typing suggests 2 common types are circulating between patients in the outbreak wards in 79% (n = 58) of the samples tested. 3% (n = 194) of the environmental samples are positive for bla-OXA-48 detected in the toilet and drains, used only by ambulating patients during their hospitalization. No incidences (n = 75) of community onset of bla-OXA-48 CP-CRE is reported form a point prevalence survey (PPS).

Conclusion
Hence, bla-OXA-48 CP-CRE transmission is more likely from healthcare worker transmission. Ensuring adequate spacing between hospital beds is crucial to facilitate the work of healthcare staff, allowing them to move freely and efficiently while providing care.

Disclosures
All Authors: No reported disclosures
P-365. Outbreak of Carbapenemase-Producing Organisms in the Cardiovascular ICU Linked to "Hoppers"
Authors: Fersovich Jordana H , Buchanan-Chell Maureen , Smith Stephanie W 
Published: January 2025

Abstract

Background
Between June and October 2023, a Canadian cardiac centre recognized a growing number of carbapenemase producing organisms (CPO) in patients in the cardiovascular intensive care unit (CVICU). The organisms were mainly KPC-producing Enterobacterales. Following declaration of an outbreak in the CVICU at the Mazankowski Heart Institute, we investigated the sources of CPO across the unit and in patient rooms to determine environmental reservoirs and mechanisms of patient transmission.

Methods
We employed prevalence screening to identify cases, environmental sampling to identify source, and comparison of patient strains utilizing whole genome sequencing (WGS) during the investigation.

Results
Between June and October 2023, five patients were identified as being colonized or infected with CPO-KPC. WGS of patient samples confirmed clonality with less than 10 SNV differences in the plasmid . Environmental sampling revealed drains in the hand-hygiene sinks and medical sinks used for disposal of liquid clinical waste (“hoppers”) harboured CPO. Using GlowGermTM, we found that the faucets of the hoppers resulted in a ∼30cm splash zone causing contamination of medical supplies and health care workers. GlowGermTM did not reveal splash from drains of hand hygiene sinks. Because the hoppers were the only temperature controlled water source on the unit, the majority of faucet use was to collect warm water for bathing patients. As a solution, the unit was equipped with single-use packages of chlorhexidine wipes in warmers for patient bathing. To prevent accidental use of the hoppers, the faucet handles were removed. Since implementing these changes, prevalence screening has not identified any further cases of CPO carriage or infection over 5 months.

Conclusion
A CPO-KPC outbreak in CVICU was linked to splashback from faucets of hoppers primarily used to collect warm water for sponge-bathing. The outbreak was ended by cessation of faucet use and transition to chlorhexidine wipes for patient bathing.

Disclosures
All Authors: No reported disclosures
P-367. Containment of an Outbreak of Carbapenem-Resistant Acinetobacter baumanii in a Burn Intensive Care Unit
Authors: Kannangara Saman , Grossman Richard F , Sharp Cheryl , lejano-Shao Marice , Lee Pureum , Jiang Isabel , Gotico Erwin R 
Published: January 2025

Abstract

Background
Acinetobacter baumanii is a cause of serious infections in hospital settings. Carbapenem-resistant Acinetobacter baumanii (CRAB) is especially difficult to treat. Patients in a burn unit are particularly vulnerable to colonization and infection with few reports describing CRAB outbreaks in a burn intensive care unit and measures required for containment. This study highlights the infection control measures successful in controlling an outbreak.

Methods
After detection of a patient with CRAB in an urban burn unit in January 2023, all patients in the burn unit were screened for carbapenem resistant organisms. Six patients with CRAB were identified between January 2023 and May 2023. Whole genomic sequencing was used for confirmation of clonal relatedness. All patients with a positive CRAB culture of sterile or non-sterile sites are included in this retrospective study.

Results
Six patients ages 29-53 tested positive for CRAB between January 2023 and May 2023. Case 1 was admitted from a long term acute care facility, with sputum culture positive for CRAB. One had CRAB from a blood culture, and four in wound cultures. Longer length of stay, 80 days vs 13 days was seen with CRAB positive patients because of partial skin graft failure, slower to heal wounds, and barriers to placement. After judicious use of antibiotics, following infection control practices were implemented:
1. Screening for carbapenem resistant organisms (CPOs) on admission, weekly, and on discharge.
2. Fluorescent markers added to adenosine triphosphate (ATP) testing of environmental surfaces and equipment.
3. Double terminal cleaning of rooms with CRAB.
4. A cleaning process for every piece of equipment.
5. Hand hygiene education and proper use of personal protective equipment.
With the above measures, no cases of CRAB were seen after May 2023.

Conclusion
The CRAB outbreak was associated with patients with burn wounds, antibiotic use, similarities in age and demographics, slower wound healing, partial skin graft loss, and longer length of stay. The control measures listed were successful in controlling the outbreak.

Disclosures
All Authors: No reported disclosures
P-387. Exploring the Association Between Penicillin Allergy Labels (PAL), β-Lactam Utilization and Surgical Site Infections
Authors: Boger Michael S , Davidson Lisa , Neelakanta Anupama , Jaffa Rupal K , Passaretti Catherine 
Published: January 2025

Abstract

Background
Several studies have reported higher surgical site infection (SSI) risk in patients with a penicillin allergy label (PAL). We explore the association between PAL, receipt of β Lactam Antibiotics and SSI in patients undergoing hip and knee arthroplasty.Figure 1: SSI per 100 Hip and Knee Arthroplasty Patients with and without a Penicillin Allergy Label (PAL) Stratified by Receipt of Preoperative β-Lactam Antibiotic

Methods
We performed a retrospective cohort study of hip (HPRO) and knee arthroplasty (KPRO) patients who underwent procedures in a large health system between August 1, 2022 and December 31, 2023 after implementation of a penicillin allergy risk assessment tool in the electronic health record. We compared demographic, clinical, procedural and SSI outcome data in patients with and without a PAL. Univariate and multivariable logistic regression were performed to assess for factors associated with risk of SSI.Table 1:Demographic and Clinical Characteristics of Hip and Knee Arthroplasty Patients with and without a Penicillin Allergy Label

Results
Of 9,802 patients who underwent 11,019 HPRO and KPRO procedures, 1851 (19%) reported a penicillin allergy and 102 (1.0%) had one or more SSI. PAL was more common in patients who were older, white, female, lived in areas with socioeconomic status Social Vulnerability Index (SVI) &lt; 75th percentile and who had a higher American Society of Anesthesiologists (ASA) risk score. PAL patients were less likely to receive nasal iodine in the preoperative area. (Table 1) 77% of PAL patients received a preoperative β-lactam for prophylaxis with no reported adverse events. Patients with a PAL were 1.6 times more likely to have a SSI than those without a PAL. The trend toward higher risk of SSI in patients with PAL persisted regardless of whether the patient received preoperative β-lactam antibiotics (Figure 1). In the univariate analysis, day of surgery nasal iodine in the preoperative area and undergoing an outpatient procedure were protective whereas having a HPRO, revision, longer procedure, and higher ASA score were associated with higher odds of SSI. After adjustment for patient age, procedure type, revision, procedure duration, ASA score, outpatient procedure, receipt of a preoperative β-lactam antibiotic and receipt of nasal iodine in the preoperative area, PAL remained associated with 1.6 times higher odds of SSI (p=0.05).Table 2:Comparative Analysis of Unadjusted and Adjusted Odds Ratios for Hip and Knee Arthroplasty Surgical Site Infection

Conclusion
The increased risk of SSI in patients with PAL may not be fully explained by the lack of preoperative β-lactam antibiotic. More study is needed to assess further.

Disclosures
All Authors: No reported disclosures
P-410. Gastrointestinal multi-drug resistant bacterial tango in Singapore General Hospital
Authors: Venkatachalam Indumathi , Aung May Kyawt , Foo Mabel Z Q , Yang Yong , Lai Deborah C M , Ying Sim Jean Xiang , Ling Moi Lin 
Published: January 2025

Abstract

Background
The gastrointestinal tract (GIT) is an ideal reservoir of antibiotic resistance genes where, under antibiotic pressure, multidrug resistant organisms (MDROs) express and disseminate resistance genes via horizontal gene transfer. Control of GIT-MDROs such as vancomycin resistant Enterococci (VRE) and carbapenemase producing Enterobacterales (CPE) within healthcare-settings remains challenging.
VRE Epidemiology

Methods
In Singapore General Hospital (SGH), a 2000-bed tertiary healthcare institution, vertical infection prevention programs have been implemented for VRE and CPE control. Selected high risk patients undergo rectal swabs or stool sampling for VRE and CPE genes. Positive samples taken less than three days after admission are considered community onset (CO),others are hospital onset (HO). Data between January 2022 and March 2024 were reviewed.
CPE Epidemiology

Results
Burden of VRE total (surveillance and clinical) increased from a baseline of 40 cases per month (10 per 10,000 patient-days) to 200 per month (45 per 10,000 patient-days) after December 2022 when VRE surveillance was expanded (Figure 1a). CO-VRE total remained elevated but HO-VRE total reduced to a baseline of 20 per 10,000 patient-days after August 2023 (Figure 1b). Clinical VRE incidence was stable at 5 per 10,000 patient-days (Figure 1c). Median days to clinical VRE was 14 (1-250 days), 425 of 671 (63%) VRE clinical isolates were from urine. VRE acquisition was 30-35%.
Burden of CPE total (surveillance and clinical) has been stable at 120 cases per month with 57% being Klebsiella pneumoniae carbapenemase (KPC) type CPE (Figure 2a). Incident KPC total has been 90 per month (18 per 10,000 patient-days) (Figure 2b). CO-KPC total incidence increased from 4 per 10,000 patient-days in 2022 to 8 per 10,000 patient-days in 2023/2024 whilst HO KPC total remained stable (Figure 2c). Clinical KPC incidence was stable at 2 per 10,000 patient-days (Figure 2d). Median days to positive clinical KPC was 11 (1-204 days). 162 of 300 (54%) KPC clinical isolates were from urine. KPC acquisition was 30-40%.

Conclusion
Trend of the total burden of VRE and KPC, corresponds to active surveillance strategy butI clinical incidence has been stable over the 27-months. VRE and KPC acquisition remains high at 30-40%.

Disclosures
Moi Lin Ling, FRCPA, Solventum: Honoraria|Solventum: Educational grant for APSIC projects
P-411. Activity of Omadacycline Against 35,000 Bacterial Clinical Isolates and Resistant Organism Subsets from Patients in the United States (2019–2023)
Authors: Huband Michael D , Fedler Kelley A , Wright Kelly , Mendes Rodrigo E , Castanheira Mariana 
Published: January 2025

Abstract

Background
Omadacycline (OMC) is a tetracycline class (aminomethylcycline) antibacterial with potent activity against bacterial isolates expressing common mechanisms of resistance to tetracyclines, penicillins, fluoroquinolones, macrolides, β-lactams, and vancomycin. This study determined the in vitro activity and susceptibility of OMC against 35,000 bacterial isolates collected during the 2019-2023 OMC post-marketing surveillance program.

Methods
Bacterial isolates were recovered from patients (multiple infection types) in medical centers in the USA from 2019–2023. Species identification was confirmed by MALDI-TOF MS. MIC testing was conducted according to CLSI M07 (2023) and M100 (2024) guidelines. OMC MIC results were interpreted using FDA breakpoint criteria.

Results
Gram-positive isolates demonstrated at least 98% susceptibility to OMC. Species and phenotypes of interest including methicillin-resistant Staphylococcus aureus (MRSA; n=3,255), S. lugdunensis (n=148), vancomycin resistant E. faecalis (n=30), S. anginosus group (n=153), erythromycin-resistant S. pyogenes (n=133) and penicillin-resistant S. pneumoniae (n=193; oral breakpoint) demonstrated high susceptibility to omadacycline with 96.1%, 99.3%, 100%, 98.0%, 98.5%, and 100% susceptible, respectively. Overall Gram-negative susceptibility to OMC ranged from 92.4% to 99.9%. Gram-negative phenotypes of interest including beta lactamase positive H. influenzae/H. parainfluenzae (n=367), ceftazidime non-susceptible E. cloacae (n=355), and carbapenem resistant K. pneumoniae (n=50) demonstrated susceptibility to omadacycline of 100%, 85.8%, and 86.0% respectively. For the subset of strains that were tetracycline-resistant, S. aureus (n=422), E. faecalis (n=842), S. anginosus group (n=59), S. pyogenes (n=162), and S. pneumoniae (n=343), omadacycline susceptibility was 92.9%, 100%, 94.9%, 98.1%, 99.7% respectively.

Conclusion
OMC demonstrated potent and consistent in vitro activity with susceptibilities of &gt;90.0% against medically important FDA-indicated pathogens (including resistant phenotypes) during the 5-year post-marketing surveillance period (2019-2023) from medical centers in the United States.

Disclosures
Michael D. Huband, BS, Paratek Pharmaceuticals: Advisor/Consultant|Paratek Pharmaceuticals: Grant/Research Support Kelley A. Fedler, BS, Paratek Pharmaceuticals: Grant/Research Support Kelly Wright, PharmD, BCPS, Paratek Pharmaceuticals: Employee Rodrigo E. Mendes, PhD, JMI: RM is an employee of JMI. JMI was contracted by and received financial support from GSK to conduct gepotidac|Paratek Pharmaceuticals: Advisor/Consultant|Paratek Pharmaceuticals: Grant/Research Support
P-422. Incidence, Risk Factors, Etiology, and Clinical Outcomes of Pneumonia in Adults with Cancer at a Tertiary Care Centre: a One Year Prospective Cohort Study
Authors: Malik Simran , Bhattacharya Sanjay , Das Bhattacharya Sangeeta 
Published: January 2025

Abstract

Background
Pneumonia is an important cause of morbidity, mortality, hospital admission, and healthcare-associated costs in cancer patients. We investigated the incidence, risk factors, etiology, and clinical outcomes of pneumonia in adults with cancer admitted to the ICU in Tata Medical Center Kolkata from October 2022 to September 2023.Figure 1:Monthly Trend in Case Identification

Methods
We conducted a prospective cohort study involving two groups with malignancy admitted to the ICU: one with pneumonia and one without. Pneumonia was identified by clinical and radiological features.
Incidence was calculated as the proportion of patients in the ICU who developed pneumonia in one year. Community-acquired (CAP), healthcare-associated (HAP), and ventilator-associated pneumonia (VAP) were defined by NHSN and HAI Surveillance in India guidelines. Relative risks were calculated and logistic regression performed to assess risk factors for pneumonia and mortality; and clinical outcomes were compared using Z-tests on STATA-17.Figure 2:Kaplan-Meier Plot for the survival analysis for patients with or without pneumonia

Results
355 individuals with pneumonia and 356 without were enrolled among 2279 in-patients. The incidence of pneumonia was 15.6% (95% CI: 14.1-17.1%). 51.8% were CAP and 48.2% were HAP. 17.9% of HAP (7.3% of all pneumonia) was VAP.
Hematological malignancies (RR=2.08), diabetes (1.31), COPD (1.78), renal dysfunction (1.73), neutropenia (1.83), smoking (1.28), chemotherapy (2.01), radiotherapy (1.56), immunotherapy (1.61), and bone marrow transplantation (2.05) increased risk for pneumonia.
258 (72.7%) cases had a positive microbiology. Of these, 123 were polymicrobial (47.7%), termed “coinfections/ superadded infections” (table 1).
All-cause 90-day mortality (39.2%), mean length of hospital stay (18.6 days), ICU stay (10.9 days), and mechanical ventilation (2 days) were higher in patients with pneumonia than those without (p&lt; 0.05, figure 2). CAP (RR=1.42), hematological malignancies (1.59), renal dysfunction (1.51), neutropenia (1.74), chemotherapy (1.60), immunotherapy (1.55), days of ICU stay (logit OR=1.04), days of mechanical ventilation (logit OR=1.03), and co-infections/ superadded infections (logit OR=1.82) increased risk of death in pneumonia.Table 1:Etiology of pneumonia with positive microbiology segregated by type of pneumonia.
The denominator corresponds to the number of cases in each category that had positive microbiology.

Conclusion
Pneumonia in cancer patients admitted to the ICU is associated with worse clinical outcomes.Table 2:Clinical Outcome in patients with or without pneumonia

Disclosures
All Authors: No reported disclosures
P-425. A Scoping Review of Data Systems for HPV Vaccination and HPV-Related Outcomes in China
Authors: Wang Wei , Wang Ruixuan , Chen Ya-Ting 
Published: January 2025

Abstract

Background
Human papillomavirus (HPV) is a major cause of cervical cancer, the sixth most common cancer among women in China. In 2023, China launched a new government plan to facilitate the elimination of cervical, requiring reliable data systems for monitoring and evaluating progress. This study aimed to identify, understand, and summarize data systems that record HPV vaccination, cervical cancer screening, HPV infection, HPV-related cervical and non-cervical diseases, as well as sexual and life behaviors in China.

Methods
A scoping review of literature from PubMed and the China National Knowledge Infrastructure databases was conducted, covering publications from 2012 to 2023. Two reviewers independently reviewed articles in two rounds, and all disagreements were resolved by a third reviewer.

Results
From 234 studies, 146 data sources were identified, covering topics including HPV vaccination (n=2), HPV-related cervical and non-cervical diseases (n=121), cervical cancer screening and HPV infection (n=11), HPV-related knowledge, attitude, and belief (n=1), and sexual and life behaviors (n=7). The main source for HPV vaccination data is the National Immunization Program Information Management System, while HPV-related cancer data primarily come from the National Central Cancer Registry of China. Cervical screening and HPV infection data are recorded in clinical or laboratory databases, including KingMed Diagnostics Laboratory and the national “Two Cancer” Screening database. HPV knowledge, attitude and sexual behaviors are mainly collected from surveys of individuals registered in epidemiology registries. Notably, several cities, including Yinzhou, Chengdu, Suzhou, and Lecheng, have recently established population-level data systems linking vaccination, screening to cervical/other HPV outcomes; however, a national system linking HPV vaccination and cervical screening with HPV-related disease outcomes, health beliefs, and risk behaviors is lacking.

Conclusion
There is a clear need for comprehensive and integrated data systems in China to effectively monitor and evaluate the impact and progress of public health intervention for cervical cancer elimination.

Disclosures
Wei Wang, PhD, Merck: Stocks/Bonds (Public Company) Ruixuan Wang, MPP, Merck: Co-Op Ya-Ting Chen, PhD, Merck & Co., Inc: Stocks/Bonds (Private Company)
P-443. Outcomes in Pneumocystis Pneumonia Hospitalizations in Patients with HIV: A County Hospital Study 2015-2022
Authors: Chow Erica , Fetters Kirk B , Ziegenbein James C , Hatlen Timothy 
Published: January 2025

Abstract

Background
Therapy related complications, morbidity and mortality are still problematic in treating pneumocystis jirovecii pneumonia (PJP) in persons living with HIV (PWH) on antiretroviral therapy (ART). Our study aims to outline patient demographics and hospital outcomes among PWH in a safety-net hospital during the contemporary ART era.

Methods
We retrospectively reviewed and extracted data from inpatient encounters with HIV and PJP between 2015-2022 at a safety-net hospital in Los Angeles County, California

Results
We identified 55 PWH (58 admissions) with confirmed or presumed PJP. Only 6.9% had a known HIV diagnosis and linked to care the prior year. 37.9% had concurrent opportunistic infections (OIs), and 20.7% had prior OI history. Treatment with trimethoprim-sulfamethoxazole (TMP-SMX) was used in 84.5% of cases in whom 48% had treatment related adverse effects. 62.1% received steroids. At one-year post-hospitalization, 63.8% were linked to care and 27.6% were lost to follow up or out of network. Inpatient mortality was 5.2%, and 10.3% died at 1-year. Higher oxygen requirements predicted a higher 1-year mortality (OR 2.68, 95%CI = 1.28 – 5.64, p = &lt; 0.01), as did necessity of TMP-SMX alternatives (OR 18.8, p = 0.003, 95% CI 2.72 – 129.73).

Conclusion
A total of 32.8% of patients failed TMP-SMX. These patients also had higher 12-month mortality rate, likely reflecting underlying host comorbidities and disease severity. Atovaquone is inferior to TMP-SMX and primaquine-clindamycin is non-inferior to TMP-SMX, however, only in mild-moderate disease. There is a paucity of data for alternative treatments for severe disease.
Concurrent OI were found in 37.9%, of whom 81.8% had no prior history of OI. Of the three inpatient mortalities, two had concurrent OIs, emphasizing the clinical importance of screening for other OI in patients who present with PJP.
In-hospital mortality was 5.2%, compared to 9 -17% in other studies; 1-year mortality was 10.3% compared to estimates of 37-53% during early ART period, suggesting a positive trend compared to both pre- and early ART outcomes. The one-year follow-up mortality of 10.3% and having only 63.8% successfully linked with in-network HIV care underscores an opportunity to improve linkage and retention strategies for PWH.

Disclosures
All Authors: No reported disclosures