bluuebunny/crossref_metadata_2025_split huggingface dataset:
1216. An Outbreak Investigation of Pulmonary Infections Caused by Mycobacterium abscessus in a Cardiothoracic Transplant Population
Authors: Rathod Shardul N , Weber Rachel , Salim Asra , Tanna Sajal D , Stosor Valentina , Malczynski Michael , Chao Qi , Angarone Michael P , Ison Michael G , Williams Janna L , Zembower Teresa , Bolon Maureen K 
Published: December 2022

Abstract

Background
Nontuberculous mycobacteria (NTM) are environmental organisms that can form biofilms in municipal water systems and as such are difficult to eliminate. Mycobacterium abscessus is a rapid-growing NTM that can cause skin and soft tissue, disseminated, and pulmonary infections. M. abscessus is difficult to treat, often requiring prolonged therapy with several antibiotics due to its intrinsic drug resistance. In 2021, our institution identified a significant increase in pulmonary infections caused by M. abscessus in the cardiothoracic transplant population.

Methods
All M. abscessus cases among inpatients at our institution were extracted from the electronic medical record (EMR) between January 2019 and September 2021. Clinical characteristics were determined through EMR review and included demographics, transplant status, specimen type, COVID-19 history, and patient care practices involving water. A multidisciplinary team conducted an investigation to identify possible variations in practice related to the source of water used for clinical care activities in this identified population.

Results
Between January 2021 and September 2021, there were 12 cases of M. abscessus among inpatients at our institution compared to 6 cases in 2019 and 5 in 2020 (Figure 1).
Between 2019 and 2020, post-heart and pre-/post-lung transplant patients comprised 9% of cases, 55% of cases were pulmonary infections, and none had a history of COVID-19 infection. In 2021, post-heart and pre-/post-lung transplant patients comprised 58% of cases, 83% of cases were pulmonary infections, and 33% of cases had a history of COVID-19 infection.
There were varying sources of water utilized for the clinical care activities in this identified population (Table 1). Figure 1Mycobacterium abscessus epidemic curveTable 1Patient Care Practices Involving Water

Conclusion
To investigate the potential outbreak, we are actively collecting water samples and swabs from water fixtures in both patient and nourishment rooms for water culturing. To mitigate a potential water-borne source, we will use sterile water for all clinical care practices involving water and for all patient water drinking needs in the post-heart and pre-/post-lung transplant population impacted by the outbreak. The only use of tap water is hand hygiene and patient bathing.

Disclosures
Asra Salim, MPH, CPH, FAPIC, IRhythym Technologies Inc: Stocks/Bonds Valentina Stosor, MD, DiaSorin: Advisor/Consultant|Eli Lilly and Company: Grant/Research Support|Med Learning Group: Honoraria Michael P. Angarone, DO, Abbvie: Advisor/Consultant Michael G. Ison, MD MS, GlaxoSmithKlein: Grant/Research Support|Pulmocide: Grant/Research Support|Viracor Eurfins: Advisor/Consultant Janna L. Williams, MD, Abbvie: COVID19 Infection Prevention Consultant.
1217. An outbreak of carbapenem-resistant Acinetobacter baumannii in an isolation ward for COVID-19 and successful outbreak control with infection control measures
Authors: Lee Ki Hyun , Yeom Joon-sup , Ku Nam Su , Jeong Su Jin , Ahn Jin Young , Kim Jung Ho , Lee Hyuk M In , Kim Jinnam , Lee Se Ju , Lee Jung Ah , Hyup Kim Chang , Choi Jun Yong 
Published: December 2022

Abstract

Background
The superinfection of multidrug-resistant bacteria is an important complication in critically ill COVID-19 patients. An outbreak of carbapenem-resistant Acinetobacter baumannii (CRAB) occurred in an isolation ward for COVID-19. We performed an outbreak investigation, and successfully controlled the outbreak with the enhanced environmental cleaning and additional gowning and gloving.

Methods
This study analyzed all COVID-19 patients with CRAB in any specimen, who admitted to an isolation ward for COVID-19 of a tertiary hospital in South Korea from October to November 2021.

Results
During the outbreak period, a total of 23 patients with COVID-19 and CRAB were identified (Figure 1). Index case was 85-year old female patient who was referred from a long-term care facility. The mean age of cases was 72.9 and 14 (60.9%) patients were male. In most patients (91.3%), CRAB were identified in sputum culture, two were identified in blood culture at initial, and four patients were identified in sputum and blood culture at the same time. Most of the patients were applying high flow nasal cannula (26.1%) or mechanical ventilation (60.9%)(Table1). As shown in figure2, CRAB outbreak occurred mainly in the wards around the index case, and in particular, environmental culture was carried out in the area marked with a rectangle. CRAB was cultured on the floor, air inlet, air outlet, and window frame of the ward except for wards 3305 and 3319. Phenotypic antimicrobial resistance patterns of CRAB isolates from patients and environment were identical, and additional whole genome sequencing analyses are ongoing to find the clonality of isolates. We applied the infection control measures with the enhanced environmental cleaning using sodium hypochlorite(NaClO) 1000ppm and phenolic compounds more than twice a day, enhanced hand hygiene, and additional gowning and gloving over personal protective equipment (PPE) mandatory for COVID-19 on 29th October. No additional CRAB cases occurred since 2nd November 2021 for two weeks. Figure 1.Daily number of cases with carbapenem-resistant Acinetobacter baumannii during outbreak periodFigure 2.Floor plan of isolation ward with Acinetobacter baumannii outbreak

Conclusion
Even when PPEs and precautions for COVID-19 are applied to isolation wards for COVID-19, it is helpful for preventing transmission of multidrug-resistant bacteria to apply additional contact precautions and environmental cleaning.

Disclosures
All Authors: No reported disclosures.
1221. Stenotrophomonas maltophilia Outbreak Associated with Sink Drains in an Intensive Care Unit
Authors: Matheu Michelle M , Rice Nicholas , Singson Karen , John Bonnie St , Lindsay Heather , Burnett Kayla , Coombs Jana , Fernley Tasha , Lopansri Bert K 
Published: December 2022

Abstract

Background
Stenotrophomonas maltophilia (SMA) is an opportunistic pathogen that causes significant morbidity and mortality and has been associated with outbreaks in various hospital environments. We describe an outbreak of SMA in our intensive care unit (ICU) and highlight the sink drain as the probable source of SMA.

Methods
Clinical surveillance for hospital-acquired infections due to SMA was instituted in December of 2017, when a cluster of cases was identified in our ICU. We first performed an environmental survey in random sites in our ICU rooms: high-touch surfaces, drains in handwashing sinks, clean water, enteral feeding, and ice machines. SMA was only found in the sink drain. We then performed an environmental survey focused on sink drains and the surrounding areas. We identified rooms where patients positive for SMA were previously hospitalized. Sampling sites were standardized for all rooms: bed rail, sink drain, splash zone, and air near sinks. Bed rails were swabbed with sponge-swabs and sink drains with flocked swabs with liquid Amies transport media. Swab samples were cultured in broth and solid media. Splash zone samples were collected using MacConkey agar plates left for four hours immediately adjacent and at one foot from the sink. Air samples were also collected for 10 minutes onto MacConkey agar plates using EMD Millipore MAS-100 NT impactor air sampler. All media was incubated aerobically at 35-37°C. Identification of all isolated gram-negative organisms was performed using MALDI-TOF MS.

Results
Five rooms were surveyed (Table 1). All rooms were found to have medical supplies within the splash zone. 100% (5/5) of sink drain samples had SMA recovered in culture, compared to 10% (1/10) of splash zone samples, 20% (1/5) of air samples, and 20% (1/5) of bed rails. In addition, we isolated other gram-negative organisms. We repeated the environmental survey after placing a sink drain cover in rooms found to have SMA in areas other than the drain. In the follow-up survey, we found no growth in cultures except for air samples (Table 2).

Conclusion
Sink drains pose a risk for SMA, possibly via contamination of medical supplies near sinks. Further investigation, including sequencing of environmental and clinical isolates, is needed to understand the mode of transmission.

Disclosures
All Authors: No reported disclosures.
1224. The incidence of severe C. striatum hospital-acquired pneumonia sharply increased and was associated with a high mortality rate
Authors: Lee Yun Woo , Huh Jin Won , Hong Sang-Bum , Jung Jiwon , Jae Kim Min , Pil Chong Yong , Kim Sung-Han , Sung Heungsup , Do Kyung-Hyun , Lee Sang-Oh , Lim Chae-Man , Soo Kim Yang , Koh Younsuck , Choi Sang-Ho 
Published: December 2022

Abstract

Background
The clinical information on patients with severe C. striatum pneumonia who require intensive care unit admission is currently limited.

Methods
We investigated the incidence and characteristics of severe Corynebacterium striatum pneumonia during a 6-year period at Asan Medical Center in comparison with severe pneumonia associated with MRSA.

Results
Between 2014 and 2019, there were 27 adult cases of severe C. striatum pneumonia. The majority of the cases (70.4%) were hospital-acquired pneumonia (HAP), and about half of the patients (51.9%) were immunocompromised. The incidence of C. striatum HAP significantly increased from 1.0% (2/200) in 2014-2015 to 5.4% (10/185) in 2018-2019 (P &lt; 0.001), while the incidence of severe methicillin-resistant Staphylococcus aureus (MRSA) HAP significantly decreased from 12.0% to 2.7% during the same period. Of the 75 HAP cases whose bacterial pathogens were identified in 2018–2019, C. striatum was responsible for 13.3% of the cases. The 90-day mortality rates were similarly high in the C. striatum and MRSA groups (59.3% vs. 50.5%, P = 0.42).

Conclusion
In conclusion, C. striatum was a major pathogen of recent severe HAP and was associated with a substantially high mortality rate.

Disclosures
All Authors: No reported disclosures.
1226. Two consecutive outbreaks of carbapenemase-producing enterobacteriaceae (CPE) in a pediatric hospital
Authors: Mor Meirav , Rozenfeld Sigalit , Bitan Sarit , Zvi Haim Ben , Cohen Dalit , Levy Itzhak , Baruch Nurit , Bron-Harlev Efrat 
Published: December 2022

Abstract

Background
Carbapenemase-producing enterobacteriaceae (CPE) can cause hospital outbreaks with considerable health and economic implications. Intensive infection control measures are implemented to identify CPE carriers and contain outbreaks.

Methods
We describe a CPE-NDM (New Delhi Metallo-beta-lactamase) hospital wide outbreak, in a tertiary care pediatric hospital, which evolved into a CPE-KPC (Klebsiella pneumoniae carbapenemase) outbreak before subsiding.

Results
At 10/20/21 rectal screening for CPE was performed in patients in the NICU (neonatal intensive care unit) because of known CPE carriers hospitalized there. Multiple CPE carriers were discovered, and a hospital-wide outbreak of CPE-NDM was identified. All patients who were potential contacts of CPE carriers throughout the hospital were isolated and screened twice a week, as part of intensive infection control measures. Between 10/20/21 and 12/07/21 46 patients carrying CPE-NDM were discovered. Continued screening between 12/15/21 and 04/18/22 identified 81 additional patients carrying CPE, however the carbapenemases identified in 78 of them were KPC. No known CPE-KPC carrier was hospitalized at the beginning of the KPC outbreak. Surprisingly, in 6 of the patients carrying CPE-NDM, repeat screening done months later found the carriage shifted from CPE-NDM to CPE-KPC. The results were validated and analyzed at the National Infection Control Laboratory. No significant morbidity or mortality was observed due to CPE carriage.
CPE identification distribution by week and mechanism

Conclusion
We report an unusual sequence of two CPE outbreaks. We found no previous reports of consecutive outbreaks of CPE.

Disclosures
All Authors: No reported disclosures.
1233. System dynamics modelling for analysis of pre-surgical interventions to reduce surgical infections at a South Indian tertiary care centre
Authors: Edathadathil Fabia , Lebcir Reda , Singh Sanjeev 
Published: December 2022

Abstract

Background
Surgical site infections (SSIs) warrants exploring context-based interventions to minimise their occurrence especially in resource limited settings. Pre-operative interventions are highlighted as important in reducing infections along the surgical pathways. The aim of this study is to investigate whether these interventions can reduce SSIs to inform policy making.

Methods
A patient centred operational perspective of the entire surgical patients’ pathways including infection management was developed by employing the System Dynamics methodology using the STELLA software. The development process was based on the principles of Group Model building involving healthcare staff, and included: pre-surgery, surgery, post surgery, emergency, re-admission, clinical management, and infection management phases. The model represented (i) categories of patients entering the pathways, (ii) states of patients on the pathways and their evolution over their states, (iii) mix of resources involved in activities, (iv) rules and processes to manage patients, and (v) patients’ exit and discharge routes from the pathways. Literature and policy documents informed also the model building process and the model was validated with the participation of clinical staff involved in the pathways.

Results
The model was run over a period of 1 year and results regarding the total number of SSIs (TSSIs) and the total number of deaths (TND) following treatment from infections (includes deaths from both SSIs and non-surgical clinical management infections). Three World Health Organization recommended interventions scenarios namely (i) Decolonization of nasal and extranasal sites on hospital admission, (ii) administration of prophylaxis antibiotic 45 minutes before incision, and (iii) skin preparation using Chlorhexidine based alcohol were simulated. TSSIs are reduced from 48 to 33, 36, and 16 under scenarios 1, 2, and 3 respectively (Figure 1) whereas TND are reduced from 35 to 31, 32, and 31 under the same scenarios.

Conclusion
Pre-operative interventions can be effective in reducing SSIs. Some of these interventions can be successfully implemented in resources limited settings such as the hospital described in this study.

Disclosures
All Authors: No reported disclosures.
1241. Hepatitis C Cascade of Care in a Multidisciplinary Substance Use Bridge Clinic Model
Authors: Simonyan Ana , Chirunomula Samantha , Whelchel Kristen , Gispen Fiona , Marcovitz David , White Katie D , Chastain Cody A 
Published: December 2022

Abstract

Background
Hepatitis C virus (HCV) infection is common among persons who inject drugs. Treating HCV in patients who present for treatment of substance use disorder (SUD) is an opportunity to improve linkage to and retention in care. The Vanderbilt University Medical Center (VUMC) Bridge Clinic serves a unique patient population that includes individuals with opioid use disorder who recently presented to VUMC for complications related to substance use. These patients are treated by a multidisciplinary team for addiction with opioid agonist therapy as well as comorbid medical conditions. The aim of this study is to further characterize the HCV cascade of care (CoC) in a bridge clinic setting and identify barriers to HCV treatment.

Methods
We performed a single-center, ambispective cohort study of patients enrolled in the VUMC Bridge Clinic from 7/1/20 through 6/30/21. Data collection was continued through 12/31/21. All patients enrolled in the Bridge Clinic were reviewed, and patients with active HCV infection were monitored from initial evaluation through treatment and sustained virologic response (measured at least 12 weeks after completing therapy (SVR12). Descriptive statistics including demographics and progression through the CoC are presented.

Results
Characteristics of the 230 patients screened for HCV are reflected in Table 1. The CoC is reflected in Figure 1. Of these 230 patients, 96 (42%) had detectable virus as measured by blood HCV RNA. Of these 96 patients, 39 (40%) were approved for treatment, 33 (34%) initiated treatment, 25 (26%) completed treatment, and 13 (14%) achieved SVR12 with laboratory confirmation. The largest number of patients who did not progress through the CoC were those not approved for treatment; the most common reasons were loss to follow-up or incomplete workup. The majority of patients received opioid agonist therapy as part of their multidisciplinary treatment plan.

Conclusion
This study demonstrates opportunities and challenges for treating HCV in individuals with SUD in a bridge clinic model. Ongoing efforts should focus on linkage to care and strategies to keep individuals with SUD engaged throughout HCV treatment.

Disclosures
David Marcovitz, MD, Better Life Partners LLC: Stocks/Bonds|Silver Pines LLC: Stocks/Bonds.
1250. Screening for Hepatitis C as Part of an Opioid Stewardship Initiative: Identifying Infected Patients and Analyzing Linkage to Care
Authors: DeCamillis Becky , Hekman Aliza , Priest David H 
Published: December 2022

Abstract

Background
Hepatitis C (HCV) remains a major cause of liver-related morbidity and mortality even though direct-acting antiviral drugs (DAAs) are increasingly accessible and have cure rates approaching 100%. The demographics of HCV have shifted to younger patients, primarily due to the opioid epidemic and associated increased numbers of people who inject drugs (PWID). A robust screening program targeting patients with opioid use disorder (OUD) can identify patients with HCV and present opportunities for linkage to care, cure, and disease prevention by breaking the chain of transmission in high-risk groups.

Methods
As part of an organizational opioid stewardship long-term goal (2018-2020), Novant Health screened patients with OUD for HCV. A best practice alert (BPA) in the electronic health record (EHR) prompted providers to order HCV antibody. Management of positive tests was left to the discretion of the ordering provider. The disposition of patients with a positive HCV antibody was evaluated by retrospective chart review with patients categorized as: (a) known spontaneous virus clearance (b) linked to care with HCV specialist (c) previous treatment (d) not appropriately linked to care (e) not linked to care due to patient-directed discharge or nonadherence.

Results
Of 5560 patients encountered (average age 40.9, 49% female, 73.7% White, 21.8% AA/Black), 4405 patients were tested. Of those screened, 33.9% were positive. Among those with a positive HCV antibody, 24% had known spontaneous viral clearance and 73.9% needed linkage to care or follow up bloodwork, with 301 linked to care and 804 not successfully linked. Of eligible patients, 27.2% were linked to care.

Conclusion
There is a need for ongoing screening efforts in patients with OUD. Despite a BPA intervention, a large percentage of positive patients were not appropriately linked to care. Barriers to linkage include lack of provider education on HCV referral and treatment concurrent to the BPA rollout, as well as psychiatric comorbidities and social vulnerabilities more prevalent in patients with OUD.

Disclosures
All Authors: No reported disclosures.
1265. Effectiveness and Durability of Dolutegravir (DTG)-Based Regimens in Older People Living with HIV (PLWH) from the Veterans Aging Cohort Study (VACS)
Authors: Yan Lei , Henegar Cassidy , Gordon Kirsha , Hicks Charles , Vannappagari Vani , Justice Amy C , Aslan Mihaela 
Published: December 2022

Abstract

Background
HIV management among older people living with HIV (PLWH) may be complicated by the presence of multiple comorbidities and polypharmacy. This study evaluated effectiveness and durability of modern 3-drug antiretroviral regimens among older PLWH.

Methods
Using data from the Veterans Aging Cohort Study (VACS), PLWH ≥50 years old initiating a dolutegravir (DTG), bictegravir (BIC), elvitegravir (EVG), raltegravir (RAL), or darunavir (DRV)-based 3-drug regimen for the first time between January 1, 2014, and March 31, 2020 were followed from regimen initiation (baseline) until regimen discontinuation (d/c), death, loss to follow-up, or end of study (September 30, 2020). Suppression [viral load (VL)&lt; 50 copies/mL], change in CD4 cell count, and regimen d/c were compared between regimens 6- and 12-months post-baseline using multivariable logistic or linear regression. Virologic failure (VF; 2 consecutive VLs ≥ 200 copies/ml, or 1VL ≥ 200 copies/ml followed by regimen d/c) was evaluated over 12 months. For all outcomes, DTG-based regimens were compared to each other regimen. Outcomes were stratified by treatment experience (ART-naïve and ART-experienced).

Results
2,489 ART-naive (DTG: 912, BIC: 432, EVG: 751, RAL: 159, DRV: 235) and 13,810 ART-experienced (DTG: 5097, BIC: 1765, EVG: 3582, RAL: 1486, DRV: 1880) individuals were included. Included PLWH were 97% male and 30% were ≥65 years old (Table 1). For both naive and experienced PLWH, those on DTG were more likely suppressed and had greater increases in CD4 counts at 6 and 12 months compared to those on DRV or RAL (Table 2). Odds of VF did not differ by regimen for ART-naive. For ART-experienced, DTG showed reduced likelihood of VF compared to DRV and RAL. Discontinuations within the first year were higher for RAL and DRV compared to DTG. For ART-experienced PLWH, 6-month d/c was greater for DTG vs. EVG. Regardless of treatment status, no other statistical differences in outcomes were observed between DTG-, BIC-, and EVG-based regimens.

Conclusion
For both ART-naïve and ART-experienced PLWH &gt;50 years old, treatment responses during the first 12 months of follow-up were similar for those taking DTG-, BIC-, and EVG-based regimens. DTG-based regimens demonstrated greater effectiveness and durability compared to DRV- or RAL-based regimens.

Disclosures
Cassidy Henegar, PhD, MSPH, GlaxoSmithKline: Stocks/Bonds|ViiV Healthcare: full-time employee Charles Hicks, MD, MD, ViiV Healthcare: I am a full time employee of ViiV Healthcare. Vani Vannappagari, MBBS, MPH, PhD, ViiV Healthcare: I am full time employee of ViiV Healthcare and receive GlaxoSmithKline stock as part of my compensation package|ViiV Healthcare: Stocks/Bonds.