bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnostic accuracy of antibiograms in predicting the risk of antimicrobial resistance for individual patients
Authors: Hasegawa Shinya , Church Jonas , Perencevich Eli , Goto Michihiko 
Published: September 2023

Background: Many clinical guidelines recommend that clinicians should use antibiograms to decide on empiric antimicrobial therapy. However, antibiograms aggregate epidemiologic data without consideration for any other factors that may affect the risk of antimicrobial resistance (AMR), and little is known about an antibiogram’s reliability in predicting antimicrobial susceptibility. We assessed the diagnostic accuracy of antibiograms as a prediction tool for E. coli clinical isolates in predicting the risk of AMR for individual patients. Methods: We extracted microbiologic and patient-level data from the nationwide clinical data warehouse of the Veterans Health Administration (VHA). We assessed the diagnostic accuracy of the antibiogram for 3 commonly used antimicrobial classes for E. coli: ceftriaxone, fluoroquinolones, and trimethoprim-sulfamethoxazole. First, we retrospectively generated facility-level antibiograms for all VHA facilities from 2000 to 2019 using all clinical culture specimens positive for E. coli, according to the latest Clinical & Laboratory Standards Institute guideline. Second, we created a patient-level data set by including only patients who did not have a positive culture for E. coli in the preceding 12 months. Then we assessed the diagnostic accuracy of an antibiogram for E. coli to predict resistance for the isolates in the following calendar year, using logistic regression models with percentages in the antibiogram as dependent variables. We also set 5 stepwise thresholds at 80%, 85%, 90%, 95%, and 98%, and we calculated sensitivity, specificity, and accuracy for each antimicrobial. Results: Among 127 VHA hospitals, 1,484,038 isolates from 704,779 patients were available for analysis. The area under the ROC curve (AU-ROC) was 0.686 for ceftriaxone, 0.637 for fluoroquinolones, and 0.578 for trimethoprim-sulfamethoxazole, suggesting their relatively poor prediction performances (Fig. 1). The sensitivity and specificity of the antibiogram widely varied by antimicrobial groups and thresholds, with substantial trade-offs. Along with AU-ROC, these metrics suggest poor prediction performances when antibiograms are used as the sole prediction tool (Fig. 2). Conclusions: Antibiograms for E. coli have poor performances in predicting the risk of AMR for individual patients when they are used as a sole tool, and their contribution to the clinical decision making may be limited. Clinicians should also consider other clinical and epidemiologic data when interpreting antibiograms, and guideline statements that suggest antibiogram as a valuable tool for decision making in empiric therapy may need to be reconsidered. Further studies are needed to evaluate the contribution of antibiograms when combined with other patient-level factors.Disclosures: None
Evaluating racial disparities in central-line–associated bloodstream infections for Tennessee hospitals, 2018–2021
Authors: Godwin Simone , Kirtz Erika , Wilson Christopher 
Published: September 2023

Background: Central-line–associated bloodstream infections (CLABSIs) significantly burden the US population and healthcare system. Reporting facilities in Tennessee consistently omit race and ethnicity data in the NHSN despite having the option to enter. Racial and ethnic disparities are well documented across many health outcomes, including patient safety. CLABSIs were compared among 3 racial groups to better understand the impact of race on CLABSI incidence in Tennessee. Methods: CLABSI data from NHSN were linked with records from the TN Hospital Discharge Data System (HDDS) for 2018–2021. A multivariable linear regression model was used to determine relative risk (RR) between racial groups for contracting a CLABSI after controlling for confounding variables including Charlson comorbidity index (CCI) and social vulnerability index (SVI) scores. Statistical significance was set at P < .05. Data linkage and statistical analyses were performed in SAS version 9.4 software. Results: In Tennessee between 2018 and 2021, 342 (17.2%) of the 1,980 CLABSI events had race documented, and no ethnicity variables exist in the NHSN. The data linkage process yielded a 72% match (1,426 CLABSIs). The remaining 28% were excluded from the analysis. Per 1,000 central-line days (CL days) for all races, white patients had the highest CLABSI rate (17.5), followed by Black patients (1.36), and Native American or Alaskan Native patients (0.68). Per 1,000 admissions by race, Black patients had a higher CLABSI rate (1.26) than Native American/Alaskan Native patients (0.85) and white patients (0.75). The risk of contracting a CLABSI was 79% higher in Black patients than in white patients (RR, 1.79; 95% CI, 1.55–2.07; P < .0001) when controlling for CCI, age group, and SVI. Conclusions: These results suggest that racial disparities between Black and white patients are present in Tennessee hospitals regarding CLABSIs. Although most CLABSI events were linked to HDDS patients, there were limitations in the ability to match all cases and calculate CL days by race. This study highlights the need for complete race and ethnicity data in the NHSN. Further studies should examine infection types at the regional and facility levels to target interventions for reducing HAI inequities in Tennessee.Disclosures: None
Examining CLABSI rates by central-line type
Authors: DiBiase Lauren , Summerlin-Long Shelley , Stancill Lisa , Vavalle Emily Sickbert-Bennett , Teal Lisa , Weber David 
Published: September 2023

Background: Central-line–associated bloodstream infections (CLABSIs) are linked to increased morbidity and mortality, longer hospital stays, and significantly higher healthcare costs. Infection prevention guidelines recommend line placement in specific insertion locations over others because of the relative risk of infection. The purpose of this study was to assess CLABSI rates by line type to determine whether some central lines had a lower risk of infection and should be recommended over others given similar clinical indications. Methods: At UNC Hospitals, data were obtained on central lines across a 3-year period (FY20–FY22) from the EMR (Epic Systems). Central lines were categorized as apheresis catheters, CVC lines (single, double, or triple lumen), hemodialysis catheters, introducer lines, pulmonary artery (PA) catheters, PICC lines (single, double, or triple lumen), port-a-catheters, trialysis catheters, or umbilical lines. The line type(s) associated with each CLABSI during the same period were recorded, and CLABSI rates by line type per 1,000 central-line days were calculated using SAS software. If an infection had >1 central-line device type associated, the infection was counted twice when calculating the CLABSI rate by line type. We calculated 95% CIs for each point estimate to assess for statistically significant differences in rates by line type. Results: During FY20–FY22, there were 264,425 central-line days and 458 CLABSIs, for an overall CLABSI rate of 1.73 CLABSIs per 1,000 central-line days. Also, 16% of patients with a CLABSI had >1 type of central line in place. Stratified data on CLABSI rates by each central-line type is presented in the Figure. CLABSI rates were highest in patients with apheresis lines (6.22; 95% CI, 3.96–9.35) and PA catheters (6.22; 95% CI, 3.54–10.20), and the lowest CLABSI rates occurred in patients with PICC lines (1.44; 95% CI, 1.19–1.73) and port-a-catheters (1.14; 95% CI, 0.89, 1.45). For both CVC and PICC lines, as the number of lumens increased from single to triple, CLABSI rates increased, from 0.91 to 2.63 and from 0.57 to 1.20, respectively. Conclusions: At our hospital, different types of central lines were associated with statistically higher CLABSI rates. Additionally, a higher number of lumens (triple vs single) in CVC and PICC lines were also associated with statistically higher CLABSI rates. These findings reinforce the importance of considering central-line type and number of lumens to minimize risk of CLABSI while ensuring that patients have the best line type based on their clinical needs.Disclosures: None
Identifying COVID-19 clusters in Tennessee long-term care facilities based on weekly staff vaccination rates
Authors: Turner Marissa , Gambrell Ashley , Hitchingham Erin , Godwin Simone 
Published: September 2023

Background: In September 2021, the CMS mandated that long-term care facility (LTCF) healthcare workers be vaccinated for COVID-19 unless medically or religiously exempt. Vaccinating healthcare workers reduces transmission of COVID-19 among patients and workers, reducing the risk of illness among residents and patients. We examined the relationship between COVID-19 clusters and staff vaccination rates in Tennessee LTCFs. Methods: COVID-19 cluster data were collected using REDCap from January 3, 2021, to September 25, 2022, and LTCF vaccination rates were collected from the NHSN. Clusters were identified in facilities with 2 or more cases. The staff vaccination rate 2 weeks prior to the cluster was used, accounting for the lag time between vaccination dose and reaching full immunity. We selected 75% as the critical immunization threshold. The facility case rate was calculated per 100 beds. A test was performed to determine whether reaching the critical vaccination threshold was associated with cluster occurrence. The relationship between vaccination rate and case number was tested using Pearson correlation. Statistical analyses were conducted using SAS version 9.4 software. Results: The average staff vaccination rate when NHSN first required long-term care facilities to report rates rose from 47% in June 2021 to 83% in September 2022. In total, 806 clusters were identified with 20,868 combined weeks from all facilities being reported after merging facilities’ weekly vaccine percentage rates with cluster data. Most weeks from all facilities did not identify a cluster (n = 20,064, 96.15%) and did not meet the critical immunization threshold (n = 11,050, 52.95%). The association between a cluster occurring and a facility meeting the threshold was significant (χ2 = 5.41; df = 1; P 95% CI, .7327–.9740). The Pearson correlation coefficient between vaccination rate and case number was 0.05560 (P = .2894). Conclusions: There was a significant association between facilities not reaching the immunization threshold and presence of a COVID-19 cluster. The facility case rate was not correlated with staff vaccination rate; however, a limitation of this analysis was that resident vaccination was not tested. Another limitation was that medical and religious exemptions could not be differentiated. Healthcare staff should consider getting vaccinated, if able, to reduce the risk of COVID-19 and to keep staff and residents safe from COVID-19.Disclosures: None
MRSA PCR improves sensitivity of detection of colonization in neonates
Authors: Hiermandi Nahid , Foster Catherine , Purnell Krystal , Dunn James , Campbell Judith , Marquez Lucila 
Published: September 2023

Background: Neonates colonized with methicillin-resistant Staphylococcus aureus (MRSA) are at high risk of developing life-threatening MRSA infection. Due to lack of evidence, national guidelines do not currently recommend a specific methodology for detecting MRSA colonization. We hypothesize that surveillance for MRSA colonization via polymerase chain reaction (PCR) is superior to culture for the detection of colonization. Methods: In this retrospective study, we compared results of MRSA surveillance by 2 methodologies, culture and PCR, after implementation of an MRSA surveillance and decolonization protocol in the Texas Children’s Hospital Pavilion for Women, a 42-bed neonatal intensive care unit. MRSA colonization of 3 body sites via the 2 methodologies was assessed from June 2017 through December 2020. All neonates were screened for MRSA upon admission to the NICU and weekly thereafter until MRSA-positive or discharged. Swab specimens were initially tested by PCR (Xpert MRSA NxG, Cepheid) and when MRSA-positive reflexed to culture to recover the organism for further characterization. This study was approved through the Baylor College of Medicine Institutional Review Board. Results: During the study period, 2,351 neonates were assessed for MRSA colonization by PCR; 81 (3.4%) infants were PCR positive (Fig. 1). Of those 81, 57 (70.4%) had concordant MRSA PCR and culture results, and 24 (29.6%) were MRSA PCR positive but no isolate was recovered in culture. Also, 8 specimens were indeterminate by PCR. However, 1 infant who was negative by culture but was PCR positive developed an MRSA orbital infection. Compared to PCR, the overall sensitivity of MRSA culture was 70.4% (range, 57.7%–80.8%, depending on the year) (Table 1). Conclusions: PCR is more sensitive than culture for detecting MRSA colonization in neonates. Utilizing a PCR method enhances the ability to identify MRSA colonized infants more readily and allows for prompt initiation of infection control interventions including isolation precautions and decolonization strategies. Reflex to culture remains important for strain characterization during outbreak investigations and for additional susceptibility testing. Resource utilization and cost–benefit analyses should be done in future studies to influence changes in national guidelines for the control of Staphylococcus aureus colonization and infection in neonatal intensive care units.Disclosures: None
Healthcare personnel with laboratory-confirmed mpox in California
Authors: Bailey Allison , Siegel Jane , Chai Shua , Bui David , Snyder Robert , Lewis Linda , Saadeh Kayla , Bertumen J.B. , Epson Erin 
Published: September 2023

Objectives: Few reports have been published about the transmission of mpox in healthcare settings. During the 2022 multinational outbreak, the California Department of Public Health (CDPH) conducted a systematic review of healthcare personnel (HCP) with mpox, including their community and occupational exposures, to understand the transmission risk in healthcare settings. We also sought to inform return-to-work protocols by describing the frequency of HCP working while symptomatic for mpox and identifying occurrences of secondary transmission from infected HCP to patients. Methods: We analyzed surveillance data for laboratory-confirmed mpox cases in California with symptom onset from May 17 to September 30, 2022, collected by investigators at local health departments and reported to the CDPH. The reported data were supplemented by review of free-text variables, interview notes, and other files uploaded to state and county disease surveillance data registries. We identified HCP as all persons working in healthcare settings with potential for direct or indirect exposure to patients or infectious materials, including clinical and nonclinical staff but excluding remote workers. Results: The CDPH received reports of 3,176 mpox cases during the study period: 109 were HCP. Of the 109 HCP identified from 19 counties, 78 (72%) were aged 30–49 years, 102 (94%) were male, and 43 (39%) were Hispanic or Latino. Also, 29 HCP (27%) had received at least 1 dose of the JYNNEOS vaccine. Occupations requiring frequent physical interactions with patients were reported for 66 individuals (61%). During interviews with local health department investigators, nearly all HCP (n = 98, 90%) reported potential or confirmed sources of community exposure; 1 had confirmed occupational exposure with symptom onset 9 days after a sharps injury acquired during collection of an mpox specimen for testing. Of the 60 HCP who provided information about the days they worked, 35 (58%) worked while symptomatic, for a mean of 3.14 days (median, 2; IQR, 3). Also, 2 HCP worked for 12 days after symptom onset. No secondary cases of mpox were associated with HCP reported to the CDPH. Conclusions: This analysis suggests that HCP are more likely to be exposed to mpox in community settings than healthcare settings. The findings support recommendations against sharps use for mpox specimen collection. Although transmission between symptomatic HCP and patients was not reported, HCP can decrease opportunities for mpox transmission by closely monitoring themselves for symptoms after potential exposures and staying home from work if symptoms develop.Disclosures: None
Mpox exposure on a congregate inpatient psychiatry unit: Description of the investigation and outcomes—New York City, 2022
Authors: Malik Waleed , Chan Justin , Dosovitz Simon , Gilmore Clyde , Cosico Jeanne 
Published: September 2023

Background: In May 2022, New York City (NYC) experienced a large outbreak of human mpox (clade IIb). Data on mpox transmission following exposure in healthcare facilities in nonendemic settings are limited. Because mpox was previously not seen in NYC, our healthcare staff may not always recognize a suspected case and therefore may neglect to implement timely infection prevention and control measures, leading to infectious exposures. The risk of transmission from unrecognized mpox may be higher in inpatient psychiatric units where direct physical contact is more common in the setting of common spaces for patients. In July 2022, a patient was admitted to NYC Health + Hospitals–Bellevue (Bellevue) psychiatry with signs and symptoms of mpox that were not recognized for 4 days, at which point the patient was tested for mpox and was isolated. We describe the investigation of staff and patients exposed during the 4 days prior to diagnosis and isolation of the index patient, and we report on the outcome mpox infection among those exposed. Methods: This study was a retrospective chart review of adult patients admitted to and staff working on an inpatient psychiatric unit where the patient with mpox was admitted to Bellevue, the largest municipal hospital in NYC. Each individual was classified regarding degree of exposure, based on criteria from the CDC, and was offered postexposure mpox vaccination where indicated. We describe the nature of contact with the patient for those with high-risk exposures. The outcome of interest was development of mpox infection during 21 days after last exposure. Results: In total, 29 patients and 84 staff members were identified to have been on the psychiatric unit prior to isolation of the index case of mpox. All exposed individuals were monitored for signs and symptoms of mpox for 21 days after last exposure. The exposed and unexposed patients were kept apart in the psychiatric unit. All patients who had contact were classified as having a low-to-intermediate risk exposure. Among 23 staff members exposed, 8 had high-risk exposures, 4 had intermediate-risk exposures, and 11 had low-risk exposures. Those with high-risk exposures were offered Jynneos as postexposure vaccination, but they declined. None of the exposed staff or patients developed mpox during the follow-up period. Conclusions: Mpox transmission was not observed despite several exposures in a congregate psychiatry unit. Given limited data, further studies are needed to better understand transmission risk in congregate healthcare settings.Disclosures: None
Addressing frontline healthcare worker perspectives on hand-hygiene monitoring badges
Authors: Smith Tucker , Hess Olivia , Pryor Rachel , Doll Michelle , Bearman Gonzalo 
Published: September 2023

Background: Hand-hygiene technology (HHT) intends to monitor and promote hand washing by healthcare workers, a critical measure of infection control. Healthcare worker noncompliance with HHT is a major limitation to its implementation and utility in clinical settings. We assessed perspectives on HHT in an academic hospital system. Methods: Hand-hygiene team members created an anonymous, 37-question, Likert-scale survey to assess healthcare worker attitudes toward HHT. Surveys targeted nursing staff, advanced practice providers, care partners, and internal medicine physicians. Clinical coordinators from 5 distinct nursing units and 1 physician department emailed surveys to eligible employees. Research coordinators and clinical coordinators also posted a QR code for survey fliers at nursing stations. Results: Overall, 120 surveys were completed. Most surveys were completed by nurses and physicians (66.4% and 14.0%). Most respondents (67.5%) do not find HHT useful. Additionally, 78.3% of respondents believe that HHT does not accurately record hand-washing events. Most (78.3%) do not like using HHT, and 75.8% find it annoying. Only 10.8% believe that patient care suffers because of HHT. Conclusions: Most healthcare workers dislike the HHT badges, primarily due to perceived inaccuracies, lack of utility, burden of use, and pressure to comply. Distrust and effect on patient care do not appear to be substantial factors contributing to negative perceptions of HHT. Weaknesses of the study include overrepresentation of nursing staff and potential bias because respondents may have provided exceptionally negative responses believing it could lead to the removal of HHT.Disclosures: None
Trajectories of SARS-CoV-2 viral shedding among admitted patients at a tertiary-care center in California, 2020–2022
Authors: Tayyar Ralph , Kiener Melanie , Ferguson Jessica , Liang Jane W. , Anez Gustavo Contreras , Nava Guillermo Rodriguez , Contag Caitlin A. , Zimmet Alex , Srinivasan Krithika , Shepard John , Pinsky Benjamin A. , Tompkins Lucy , Subramanian Aruna , Salinas Jorge 
Published: September 2023

Background: SARS-CoV-2 viral load decreases over time after illness onset. However, immunocompromised patients may take longer for viral load decrease or have a more erratic viral-load trajectory. We used strand-specific assay data from admitted patients to evaluate viral-load trajectories after illness onset. Methods: We reviewed records of hospitalized patients with a positive SARS-CoV-2 PCR and tested using the strand-specific SARS-CoV-2 PCR during July 2020–April 2022. At Stanford Healthcare, we use a 2-step reverse real-time polymerase chain reaction (rRT-PCR) assay specific to the minus strand of the SARS-CoV-2 envelope gene to assess infectivity. Restricting our analysis to each patient’s first strand-specific assay, we used logistic regression models to compare patients with single versus multiple assays. Among patients with multiple tests, we compared those who had an upward trajectory in cycle threshold (Ct) values (a surrogate of decreasing viral load) versus those who did not. We analyzed presence of symptoms, immunocompromised state, immunosuppression reason, and severe COVID-19 leading to ICU care in univariate and multivariate models that further adjust for additional covariates. Significant differences were assessed using logistic regression odds ratios and an α level of 0.05. Results: In total, 848 inpatients were included. Among them, 703 were tested only once and 145 were tested 2–6 times. The longest duration of minus-strand detection was 163 days. In univariate analyses, patients with a single minus-strand assay had lower odds of being symptomatic (OR, 0.55), of being immunocompromised (OR, 0.58), and of being admitted to the ICU with severe COVID-19 (OR, 0.49). In the multivariate analysis, being admitted to the ICU with severe COVID-19 was the only significant variable associated with having >1 test (OR, 2.44). Among patients who had multiple strand-specific SARS-CoV-2 assays, 119 had upward minus-strand trends of Ct values (as expected) and 26 did not. Being immunocompromised was associated with nonrising minus-strand CT values (OR, 33.3) when holding all other covariates in the model constant. Conclusions: Immunocompromised patients with COVID-19 tend to actively replicate for longer and have unexpected viral trajectories compared to immunocompetent patients. Among immunocompromised patients, suspension of transmission-based precautions may require a case-by-case evaluation.Disclosures: None