bluuebunny/crossref_metadata_2025_split huggingface dataset:
2022. Evaluation of Antimicrobial Prophylaxis and Infectious Outcomes in Penile Prosthetic Implants at VA Long Beach Healthcare System
Authors: To Anna , Tran Thuong , Tan Susanna , Chun Patricia 
Published: December 2022

Abstract

Background
Penile prosthetic implants (PPI) offer an effective treatment for erectile dysfunction. The risk of postoperative infection in primary PPI is estimated at 0.33-11.4% and up to 18% in revision surgery. The most common causative organisms include Escherichia coli and coagulase negative Staphylococcus. The AUA guidelines recommend perioperative antibiotics for no more than 24 hours. However, a survey of urologists revealed that the majority used oral antibiotics for 5-14 days after surgery. There have been increasing reports of anaerobic and fungal infections, but the AUA guidelines do not recommend antimicrobial prophylaxis against these organisms.

Methods
This is a retrospective, chart review, quality-improvement study. Veterans who had a PPI procedure between May 1999 to July 2021 were included. Patients with only removal of the prosthesis were excluded. For patients who had multiple procedures, only the most recent procedure was considered. Data collection included demographics, pertinent medical history (history of polysubstance abuse, homelessness, smoking, chronic immunosuppression, anticoagulation, diabetes, HIV, spinal cord injury, Peyronie’s disease or priapism), prior PPI, relevant labs (BMP, A1C), microbiologic results, and medications prescribed.

Results
176 patients underwent a PPI-related procedure between May 1999 and July 2021. 137 patients were included in this study. 14 patients (10.2%) experienced a PPI infection. For all patients, the average total duration of antimicrobial prophylaxis was 11.8 days. Mean duration of antimicrobial therapy after procedure was 12.4 days and 10.5 days for the infection and no infection group, respectively (p-value 0.118). The most common antibiotic combination was vancomycin and gentamicin. There were no statistically significant difference in patient risk factors between infection and no infection groups, but the most common risk factors were smoking and prior implant. Gram positive organisms were most commonly isolated. There were no incidences of fungal infections. 2.2% incidence of AKI and 1.5% incidence of antimicrobial resistance were observed.

Conclusion
Further evaluation of the necessity of prolonged duration of antimicrobial prophylaxis and antifungal prophylaxis should be evaluated.

Disclosures
All Authors: No reported disclosures.
2035. Detecting Vancomycin-resistant Enterococci infection in an immunosuppressed population after screening
Authors: Hamad Yasir , Hashem Nehal G , Henderson David K , Decker Brooke K , Odom Robin T 
Published: December 2022

Abstract

Background
Vancomycin-Resistant Enterococci (VRE) are major pathogens for severely immunosuppressed patients. Because VRE are common pathogens in our institution, such patients are often empirically treated to cover VRE, exposing them to broad-spectrum antimicrobials. Analogous to nasal screening for Methicillin-resistant Staphylococcus aureus carriage, targeted VRE surveillance is performed to identify and isolate colonized patients to reduce transmission. To assess risks and benefits of empiric therapy, we evaluated this surveillance procedure.

Methods
All patients admitted to two inpatient hospital units from 01/01/2019 to 12/31/2021 had routine perirectal VRE surveillance ordered and results retrospectively reviewed. One swab from each Culturette set was tested by vanA PCR, and the other was inoculated on CHROMEID® VRE (Biomerieux) if the PCR was positive. Subsequent clinical cultures of any site within 14 days of surveillance screening were reviewed for VRE.

Results
1133 patients were screened; 46 (4.1%) patients had VRE colonization. Within 2 weeks following VRE screening 20 patients had clinical samples that were positive for an Enterococcus species (14 in the first 7 days and 6 in days 8-14). The most common sites of clinical cultures were urine, 8 (40%), wound, 4 (20%), intra-abdominal, 4 (20%), and blood, 2 (10%). No clinical culture sample contained VRE.

Conclusion
The rate of VRE carriage was low in this population, raising the question of the value of broad-spectrum empiric therapy coverage for VRE. No VRE infections were subsequently detected in any patients irrespective of surveillance. The negative predictive value for clinical VRE infection was 100% with negative surveillance screening in this population.

Disclosures
All Authors: No reported disclosures.
2038. Epidemiology of Carbapenem-Resistant Organisms in Alameda County, California (July 2019 - June 2021)
Authors: Marusinec Rachel , Shemsu Munira , Lloyd Tyler , Kober Brendan M , Herrera Jade A , Gregory Misha , Heaton Dustin T , Varghese Vici , Trivedi Kavita K 
Published: December 2022

Abstract

Background
Carbapenem-resistant Enterobacterales (CREs) and some Carbapenem-resistant organisms (CROs) are considered urgent threats by the CDC. Since 2017, the Alameda County Public Health Department has mandated the reporting of CRE and encouraged voluntary reporting of non-CRE CROs. Surveillance data from these cases were analyzed to describe the epidemiology of infections and to target local public health interventions.

Methods
Healthcare facilities in Alameda County reported cases of CROs to the public health department directly to staff or through Electronic Laboratory Reporting and submitted isolates to the public health laboratory for ascertainment of carbapenemase genes by whole genome sequencing on the Illumina MiSeq platform; deaths were recorded via the California Electronic Death Registration System. Surveillance data were analyzed for cases July 2019 – June 2021 identified by the clinical laboratory as resistant to one or more carbapenems.

Results
From July 2019 – June 2021, 444 cases of CROs were reported to Alameda County from 409 patients. The county case rate for CROs over the two-year period was 29 cases per 100,000 population. Of the reported cases, 218 (49%) were CRE species: Escherichia coli, Klebsiella spp., and Enterobacter spp. Of the remaining cases, 157 (35%) were carbapenem-resistant Pseudomonas aeruginosa, 46 (10%) were carbapenem-resistant Acinetobacter baumannii (CRAB), and 23 (5%) were other carbapenem-resistant species. Cases by carbapenemase status are described in Table 1. Of the cases, 192 (43%) were among residents of long-term care facilities or long-term acute care hospitals; 340 (77%) cases were identified in patients over &gt;50 years, and 168 (38%) cases have a death on record through January 2022. Among isolates with a carbapenemase gene (n = 129), KPC (32%) was the most commonly identified (Table 2).

Conclusion
The high burden of CROs in Alameda County highlights the need for continued partnership on reporting, testing and infection prevention measures to limit the spread of resistant organisms. A large proportion of cases were identified in vulnerable long-term care residents and 104 (24%) cases were identified as carbapenemase-producing, with a higher percentage among CRAB isolates, informing future targeted public health interventions.

Disclosures
All Authors: No reported disclosures.
2039. Evaluation Of Diagnostic Considerations In The Evaluation Of Hospital Acquired Pneumonia
Authors: Mendoza Maria A , Bhatia Monisha C , Lazo-Vasquez Alex F , Abbo Lilian M , Shukla Bhavarth S 
Published: December 2022

Abstract

Background
Hospital-Acquired Pneumonia (HAP), defined as pneumonia that occurs 48 hours or more after hospital admission, is considered a part of the health care-associated infections (HAIs). HAIs are one of the top ten causes of death in the United States. Correct diagnosis of HAIs is key to reducing its impact, however, the diagnosis of HAP is challenging because clinical findings are nonspecific and there is no combination of signs, symptoms, and laboratory or imaging results that can predict this diagnosis with a good sensitivity or specificity. This study aims to clarify the prioritization of clinical elements considered in the diagnosis of HAP by physicians at our center.

Methods
This is a cross-sectional study at a large, tertiary care academic center in Miami, Florida. The target population included hospitalists, internal medicine residents, critical care and infectious disease fellows. REDCap was used to administer the survey and collect data. A rank individual analysis was conducted to assess for the most significant diagnostic criteria overall. Kruskal-Wallis analysis was conducted to assess for significance of the individual diagnostic criteria.

Results
At the end of the survey period, 130 people responded (45.8% of sent surveys). Overall Kruskal-Wallis rank sum test of the systemic factors showed significant differences between the diagnostic criteria chosen. The presence of a new or worsening infiltrate on imaging was selected as most important. After that, fever, a positive respiratory culture, worsening hypoxia and new cough and shortness of breath were in the second tier of important criteria (Figure 1). The median number of factors needed to have HAP in the differential diagnosis and start empiric treatment was 3, while the needed number to secure the diagnosis of HAP was 4. In an immunocompromised patient, the median number of factors needed was 2 (Figure 2). Color red, represents selection 1 - meaning, the larger the tab, it means that specific factor was highly considered as the first factor in the diagnosis of HAP.
Color green represents second most selected factor
Color blue represents third most selected factor
Upper box: median number of factors needed to secure the diagnosis of HAP
Mid box: median number of factors needed to include HAP as the differential diagnosis in an immunocompromised patient
Lower box: media number of factors needed to have HAP in the differential and start empirical treatment

Conclusion
In this study, we observed that the most highly considered criteria for the diagnosis of HAP are new or worsening infiltrate on imaging, new or worsening hypoxia, and respiratory cultures with growth of a classical respiratory pathogen. Most of these criteria are part of the IDSA guidelines on the evaluation and treatment of HAP. Future directions include developing a decision support tool for diagnosing HAP.

Disclosures
All Authors: No reported disclosures.
2043. In Vitro Activity of Manogepix Against 2,810 Fungal Isolates from the SENTRY Surveillance Program (2020-2021) Stratified by Infection Type
Authors: Huband Michael D , Pfaller Michael , Carvalhaes Cecilia G , Bien Paul , Castanheira Mariana 
Published: December 2022

Abstract

Background
Manogepix is a new antifungal with a novel mechanism of action and potent in vitro activity against Candida (except C. krusei), Aspergillus, and rare mold isolates. The manogepix prodrug fosmanogepix is in Phase 2 development for the treatment of invasive mold infections caused by Aspergillus and rare molds (NCT04240886) and has completed Phase 2 studies for candidemia (NCT03604705) and C. auris (NCT04148287) infections. We evaluated the in vitro activity of manogepix and comparators against 2,810 geographically diverse fungal isolates collected in the SENTRY Surveillance Program during 2020-2021 and stratified them by infection type.

Methods
Antifungal susceptibility testing of manogepix and comparator agents was conducted according to CLSI M27 (2017) and M38 (2017) guidelines. Fungal surveillance isolates were collected from medical centers located in North America (30 sites; 37.9%), Europe (30 sites; 38.4%), Asia-Pacific (11 sites; 14.7%), and Latin America (6 sites; 9.0%). Infection sites included bloodstream infections (BSI; 48.3%), pneumonia in hospitalized patients (PIHP; 19.9%), skin and skin structure infections (SSSI; 7.8%), urinary tract infections (UTI; 3.1%), intra-abdominal infections (IAI; 1.6%), and other infection types (19.3%).

Results
Manogepix demonstrated potent in vitro activity against Candida spp. isolates (MIC50/90, 0.004-0.03/0.008-0.06 mg/L) regardless of infection type (Table). Similarly, manogepix was highly active against 534 Aspergillus spp. isolates (MEC50/90, 0.015/0.03 mg/L). Manogepix was active against 53 Cryptococcus neoformans var. grubii (MIC50/90, 0.25/1 mg/L), 19 Fusarium spp. (MEC50/90, 0.015/0.06 mg/L), 12 Lomentospora prolificans (MEC50/90, 0.03/0.06 mg/L), and 17 Scedosporium spp. isolates (MEC50/90, 0.06/0.12 mg/L).

Conclusion
Manogepix showed potent in vitro activity against Candida spp., Aspergillus spp., C. neoformans var. grubii, and rare molds, including Fusarium spp., L. prolificans, and Scedosporium spp. isolates. Notable activity was also demonstrated by manogepix against C. auris isolates. Further clinical development of fosmanogepix in difficult-to-treat, resistant fungal infections is warranted.

Disclosures
Michael D. Huband, BS, AbbVie: Grant/Research Support|Melinta: Grant/Research Support Cecilia G. Carvalhaes, MD, PhD, AbbVie: Grant/Research Support|Cidara: Grant/Research Support|Melinta: Grant/Research Support|Pfizer: Grant/Research Support Mariana Castanheira, PhD, AbbVie: Grant/Research Support|Cidara: Grant/Research Support|GSK: Grant/Research Support|Melinta: Grant/Research Support|Pfizer: Grant/Research Support|Shionogi: Grant/Research Support.
2051. Relebactam enhances Imipenem activity across the Imipenem susceptibility spectrum among Pseudomonas aeruginosa isolates collected in the United States--SMART 2018-2020
Authors: Hilbert David W , DeRyke Charles A , Motyl Mary , Young Katherine 
Published: December 2022

Abstract

Background
The Beta-Lactamase Inhibitors (BLIs) Relebactam (REL) and Avibactam (AVI) both inhibit class A and C beta-lactamases and are approved in combination with the beta-lactam antibiotics imipenem (IMI/REL) and ceftazidime (CAZ/AVI), respectively. Our goal was to evaluate the effect of these BLIs on susceptibility of Pseudomonas aeruginosa isolates that are either nonsusceptible (NS), Intermediate (I) or Susceptible (S) to the partner beta-lactam antibiotic.

Methods
In 2018-2020, ∼20 unique participating sites in the United States each collected up to 250 consecutive aerobic gram-negative isolates per year (50 each from urine, intraabdominal and blood; 100 from lower respiratory tract). Susceptibility to Imipenem (IMI) and Ceftazidime (CAZ) were determined alone as well as in combination with their cognate BLIs. MICs were determined using broth microdilution and evaluated by CLSI interpretive criteria.

Results
A total of 2,537 P. aeruginosa isolates were evaluated. Among IMI-NS isolates (MIC &gt;2 μg/mL) REL restored IMI susceptibility to 75% and among CAZ-NS isolates (MIC &gt;8 μg/mL) AVI restored CAZ susceptibility to 73%. For IMI-I isolates (MIC of 4 μg/mL), the presence of REL restored susceptibility to 98%, and 95% had MICs at least one dilution less than the susceptible breakpoint. For CAZ-I isolates (MIC of 16 μg/mL), AVI restored susceptibility to 84% of isolates, and 62% had MICs at least one dilution below the susceptible breakpoint. The addition of REL shifted the mode IMI MIC of IMI-S (MIC ≤ 2 μg/mL) isolates 4-fold, from 2 to 0.5 μg/mL, whereas there was no change in the mode CAZ MIC of CAZ-S (MIC ≤ 8 μg/mL) isolates in the presence of AVI.

Conclusion
Both REL and AVI restore susceptibility to P. aeruginosa isolates nonsusceptble to their cognate beta-lactam antibiotics (IMI and CAZ, respectively). However, REL had greater enhancement of IMI towards IMI-I isolates when compared to the effect of AVI on CAZ towards CAZ-I isolates. REL substantially enhances IMI activity towards IMI-S isolates whereas no such enhancement was observed for AVI upon CAZ activity towards CAZ-S isolates. REL is differentiated by its ability to enhance the activity of the cognate beta-lactam (IMI) across the susceptibility spectrum.

Disclosures
Charles A. DeRyke, PharmD, Merck & Co., Inc. Merck Research Laboratories: Stocks/Bonds Katherine Young, M.S., Merck & Co., Inc.: Stocks/Bonds.
2053. The Need to Expand the Infection Prevention Workforce in Home Infusion Therapy
Authors: Oladapo-Shittu Opeyemi , Hannum Susan M , Salinas Alejandra B , Weems Kimberly O , Marsteller Jill A , Gurses Ayse P , Cosgrove Sara E , Keller Sara C 
Published: December 2022

Abstract

Background
Infection preventionists who perform surveillance for central line-associated bloodstream infections (CLABSIs) in hospitals receive training in application of rigorous surveillance definitions. However, in the home infusion setting where CLABSIs also occur, the approach for training and methods to perform surveillance has not been well defined.

Objective
In this qualitative study, we sought to characterize how home infusion surveillance staff are trained in CLABSI surveillance and to identify barriers to CLABSI surveillance in the home infusion setting.

Methods
We interviewed 21 surveillance staff members of five non-profit home infusion agencies covering portions of thirteen states and Washington, DC across the Mid-Atlantic, Northeast, and Midwest. Interview questions were developed using the Systems Engineering in Patient Safety (SEIPS) 2.0 framework. Data were analyzed both inductively and deductively by two team members. These interviews are part of a larger study, some of whose findings have been previously discussed in prior publications. Data specific to training home infusion surveillance staff in CLABSI surveillance are presented (Table 1).

Results
Many of the CLABSI surveillance staff had received no formal training in CLABSI surveillance. Instead, many either learned on the job (often from predecessors who also had not been formally trained), drew from previous clinical experience, perused online resources, or attended conferences. A lack of (1) resources for learning, (2) formal training offered by their agencies, and (3) awareness of professional development resources were identified as barriers to CLABSI surveillance training in the home infusion setting.

Conclusion
Our findings indicate a current lack of formal training in CLABSI surveillance for staff performing CLABSI surveillance in home infusion therapy. The home infusion surveillance workforce can be strengthened by providing home infusion-specific standardized training, perhaps through adaptations of resources used for training surveillance staff in other settings.

Disclosures
Sara E. Cosgrove, MD, Basilea: Member of Infection Adjudication Committee.
2067. Missed Opportunities for Confirmatory HIV Testing at a Midwestern Medical Center
Authors: Paetz Olivia R , Sayles Harlan R , Fey Paul D , Bares Sara H 
Published: December 2022

Abstract

Background
The currently recommended HIV testing algorithm begins with a 4th generation antigen/antibody (Ag/Ab) combination immunoassay, which allows for early detection of HIV. However, this assay’s high sensitivity can result in false positives that must be distinguished from acute infections via an HIV nucleic acid test (NAT). At our medical center, HIV NATs are recommended in the lab report for anyone with a positive p24Ag component on the screening assay, but they are not done reflexively by the lab as it requires a different blood tube. Thus, difficulties arise in obtaining the NAT, such as providers failing to order the test or patients failing to return for another blood draw, jeopardizing the diagnosis of early HIV.

Methods
We conducted a retrospective chart review of adult patients at a Midwest academic medical center with a positive p24Ag on the HIV-1/2 Ag/Ab combination assay between Jan. 1, 2017 and Feb. 21, 2021. We assessed if appropriate confirmatory testing was performed, identified barriers to missed opportunities for confirmatory testing, and used t-tests and Fisher’s exact tests to evaluate differences between those who did and did not receive confirmatory testing.

Results
Of 37 people with a positive p24Ag on the HIV Ag/Ab immunoassay, 6 (17%) did not have an HIV NAT performed within 30 days of their positive screening test. Of these 6 cases, the ordering provider did not acknowledge the need for a confirmatory test in 3 cases, the patient did not return for the test in 1 case, and other factors prevented follow-up in 2 cases. Of those who had an HIV NAT ordered, 7 (23%) had a positive HIV NAT. Younger age was significantly associated with completion of appropriate confirmatory testing (p=0.05), but other factors including sex, race, insurance status, having a primary care provider, specialty of ordering provider, encounter location, and test indication were not.

Conclusion
Our review identified multiple missed opportunities for confirmatory HIV testing following a positive p24Ag component on the HIV screening test. Provider lack of knowledge/awareness of the need for appropriate testing was the most common barrier. A quality improvement initiative will be undertaken to minimize future risk of missed opportunities for confirmatory testing.

Disclosures
Paul D. Fey, PhD, BioFire: Advisor/Consultant|BioFire: Grant/Research Support|Merck: Grant/Research Support Sara H. Bares, MD, Gilead Sciences: Expert Testimony|GSK ViiV Healthcare: Grant/Research Support|Janssen: Grant/Research Support.
2068. Molecular and Clinical Features of New HIV-1 diagnoses in Northern Dominican Republic
Authors: Sanchez Martha C , Lerebours Alain , Darpolor Josephine , Manne Akarsh , Novitsky Vladimir , DeLong Allison , McCarthy Meghan , Carlo Dominique , Solomon Matthew , Rodriguez Claudia , Kantor Rami 
Published: December 2022

Abstract

Background
Surveillance of transmitted drug resistance (TDR) and molecular epidemiology of newly diagnosed persons with HIV can impact care and prevention and inform efforts towards ending the HIV epidemic. Both interventions are not routinely available in the Dominican Republic (DO).

Methods
During 10/2019-4/2021, we attempted to enroll all newly HIV-diagnosed antiretroviral naïve adults (≥18 years) presenting at the regional hospital in Santiago, DO. Demographic, clinical and laboratory data were collected, and blood samples obtained for partial pol genotyping. Subtyping and resistance interpretation were done with Stanford Database tools. Maximum likelihood phylogenies were inferred by RAxML and clusters were defined as clades with bootstrap support of ≥0.8. Extended phylogenetic analyses included ∼1,500 publicly available Caribbean sequences. Demographics and TDR were compared by cluster status using Fisher Exact or Wilcoxon rank sum tests.

Results
Of 100 HIV-diagnosed participants (mean age 40 years; 61% male; 84% heterosexual; 50% never tested prior), 56% were hospitalized, 48% tested via doctor advise and 28% for feeling sick. Available CD4 count was &lt; 200 cells/µL in 49% (43/87) more prevalent (vs CD4 &gt;200) in heterosexuals (93% vs 7% in gay/bisexuals; p=0.003). Genotyping from 68/100, were 29% HIV-1 subtype B, 69% B-containing recombinants and one HIV-1 subtype C. TDR was in 12% (95% CI: 5-22%), all to NNRTIs (K103N and Y188L most common; two with multiple mutations). Six identified clusters included 25% of participants, 92% from downtown Santiago. Individuals in the largest 6-member cluster met partners online and were gay/bisexual. Participants in clusters had higher TDR (24% vs 8%, p=0.100), were younger (34 vs 43 years, p=0.01), and were gay/bisexual (41% vs 8%, p=0.003). In extended phylogenetic analyses participant sequences clustered with other DO sequences, as well as some from Haiti.

Conclusion
In this snapshot of new HIV diagnoses in the DO, findings of high AIDS at diagnosis, particularly in heterosexuals, high TDR, more clustering in gay/bisexual younger individuals, and existing non-local-only transmission networks, should inform focused surveillance and prevention strategies to disrupt HIV transmission and improve care.

Disclosures
All Authors: No reported disclosures.