bluuebunny/crossref_metadata_2025_split huggingface dataset:
1992. Risk of Infective Endocarditis in Streptococcal mitis Bloodstream Infections Among Patients with Neutropenia from Hematologic Malignancies
Authors: Monk Miranda M , Elshaboury Ramy H , Patel Nikitha R , Kubiak David W , Alobaidly Maryam , Hammond Sarah P 
Published: December 2022

Abstract

Background
Streptococcus mitis is a common colonizer of the human oral and gastrointestinal tract. Patients with neutropenia due to hematologic malignancy (HM), particularly those prescribed fluoroquinolone prophylaxis are at increased risk of a S. mitis bloodstream infection (BSI). Risk of infective endocarditis (IE) in this patient population remains unclear.

Methods
This was a multicenter, retrospective study of neutropenic (ANC &lt; 500 K/uL) patients with HM from November 2016 - February 2022. Patients were included if they had S. mitis isolated in at least 1 blood culture bottle. The primary outcome was number of patients who developed IE based on cardiac imaging. Secondary outcomes included number of patients who underwent IE workup via cardiac imaging and BSI recurrence within 12 weeks.

Results
Among 171 patients who met the inclusion criteria, 101 (59%) were male and median age was 60 years old (range 19-86). Patient demographics, microbiologic information and outcomes are shown in Table 1. All patients in the cohort had native cardiac valves. Acute leukemia/myelodysplastic syndrome was the most common HM (n=129, 75%), followed by lymphoma (n=27, 16%), multiple myeloma (n=10, 6%) and chronic leukemia (n=5, 3%). Most patients had a transthoracic echocardiogram (TTE) (n=97, 56.7%) within 7 days of BSI. Of these patients, 1 had suspected valvular vegetations on TTE, but transesophageal echocardiogram (TEE) was negative. Two patients had negative TTEs, but there was a high clinical suspicion, so cardiac computed tomography was performed and showed no valvular vegetations. Despite negative cardiac imaging, 1 patient completed 6 weeks of empiric treatment for IE based on radiographic findings in the torso suggesting visceral infarcts. One patient had S. mitis BSI recurrence within 12 weeks of first positive culture. Median duration of antimicrobial therapy for BSI was 15 days (range 8-43).

Conclusion
IE is uncommon in neutropenic HM patients with native cardiac valves and S. mitis BSI. In this cohort where approximately half had a TTE after bacteremia and median duration of BSI therapy was 15 days, recurrent BSI was rare, suggesting that IE cases were not underdiagnosed in those without cardiac imaging. Cardiac imaging such as TTE to rule out IE may not be necessary for all patients in this population.

Disclosures
Ramy H. Elshaboury, PharmD, Eli Lilly: Honoraria|Gilead Sciences: Grant/Research Support David W. Kubiak, PharmD, BCPS, BCIDP, FIDSA, Astellas Pharma, Inc.: Advisor/Consultant|AVIR Pharma Inc: Advisor/Consultant|Cidara Therapeutics: Advisor/Consultant Sarah P. Hammond, MD, F2G: Advisor/Consultant|F2G: Grant/Research Support|GSK: Grant/Research Support|Scynexis: Grant/Research Support.
2003. Comparison of Confirmed and Probable Cases of Vibriosis, Tennessee, 2017–2021
Authors: Hanna Samir , Carpenter Abby , Garman Katie , Dunn John R 
Published: December 2022

Abstract

Background
Vibriosis causes an estimated 80,000 illnesses and 100 deaths in the United States each year. Commonly reported exposures include consuming raw or undercooked seafood and contact with seawater. To facilitate case ascertainment and better understand the epidemiology of vibriosis, CDC requested inclusion of positive culture-independent diagnostic testing (CIDT) cases to the 2017 case definition. We reviewed confirmed (culture positive) and probable (CIDT positive) cases in Tennessee (TN) from 2017-2021.

Methods
Vibrio reports from clinical and state public health laboratories were reviewed. Demographic, clinical, and exposure data were collected through routine case interviews using The Cholera and Other Vibrio Illness Surveillance (COVIS) Report. Confirmed and probable cases were described and compared using Epi Info 7.

Results
A total of 164 Vibrio cases were reported from 44 counties across TN. In total, 135 (82%) cases were interviewed including 72 (53%) confirmed cases (all sources) and 63 (47%) probable cases. Half of cases from each case status were 40-69 years old. Twenty-four percent of probable cases versus 7% of confirmed cases were under 10 years old. Of confirmed cases, 64% were males compared to 51% of probable cases. Most cases (90% of confirmed and 75% of probable cases) were among non-Hispanic white population. Almost all probable cases (97%) reported gastrointestinal (GI) symptoms. Among confirmed cases, 70% reported non-GI symptoms such as cellulitis. Thirty three percent of both confirmed and probable cases were hospitalized. Confirmed cases were more likely to report travel out of state (OR 5.1, p-value &lt; 0.0001) and exposure to seawater (OR 3.4, p-value 0.002) compared to probable cases. When comparing confirmed cases from stool specimens (27 cases) to probable cases, travel out of state remained significant (OR 4.8, p-value 0.0001) as well as seafood consumption (OR 6.8, p-value 0.0008).

Conclusion
Demographic and clinical features differed between confirmed and probable cases. Out of state travel, seafood consumption, and exposure to seawater were reported more often by confirmed cases. Reflex culturing is recommended to better facilitate case ascertainment and understand the epidemiology of vibriosis.

Disclosures
All Authors: No reported disclosures.
2004. Contemporary Clinical Epidemiology of Pediatric Shigella spp. Infections in Houston, TX, 2016-2021
Authors: Tabarani Christy , Arias Cesar A , Wanger Audrey , Flores Anthony R 
Published: December 2022

Abstract

Background
Infections due to Gram-negative pathogens that cause gastrointestinal illnesses are a significant cause of morbidity in children. The contemporary clinical and epidemiological features of pediatric Shigella spp. infections in urban cities in the United States are not well described.

Methods
We used a retrospective cohort of patients (0-18 years of age) from a network of hospitals in Houston, TX. Only patients with Shigella spp. isolated from clinical samples dated from 2016 to 2021 were included in the study. Demographic, clinical, and microbiological data and susceptibility profile were extracted from the medical record.

Results
We identified a total of 73 pediatric patients with Shigella spp. Infections. The median age at presentation was 5 years. Hospital admission occurred in 32 % of infections with a median length of stay of 1 day (Table 1). Of cases with available clinical data, 80% of patients with Shigella spp. infections reported fever (Table 2). Of note, 62% of patients developed bloody diarrhea (Table 2). The majority of patients infected with Shigella flexneri (4/7) reported a history of international travel. Seizures were observed in 5 patients. No episodes of bacteremia were identified. Among patients with an identified exposure, daycare attendance and contact with individuals experiencing similar symptoms were the most common (Table 2). The majority of Shigella species were S. sonnei (90.4%) (Table 3). Resistance to trimethoprim-sulfamethoxazole (TMP-SMX) was common (45/68, 66%) among Shigella spp. isolates tested. No resistance to third generation cephalosporins was observed. (Table 3). Although azithromycin was the most common antibiotic used for treatment, susceptibility testing for this antibiotic was not performed in any of the cases.

Conclusion
Infections due to Shigella spp. are a significant burden among pediatric patients in a major metropolitan health care system (Houston, TX). Bloody diarrhea was the most common presentation, although the presence of Shiga-toxin-positive isolates was unknown. The observed high frequency of resistance to TMP-SMX and emergence of multi-drug resistant Shigella spp. in other countries warrants continued surveillance.

Disclosures
Cesar A. Arias, MD, PhD, Entasis Phramceuticals: Grant/Research Support|MeMed Diagnostics: Grant/Research Support|Merck: Grant/Research Support.
2356. Standardizing a centralized allocation process for rarely used anti-infective medications across a health system
Authors: Justin Moore W , Dickens Michael , Bland Virginia , Bertram Christie M , Zembower Teresa , Wang Sheila K , Polisetty Radhika S , Postelnick Michael , Hoff Brian M 
Published: December 2022

Abstract

Background
Obtaining scarce antimicrobials used to treat infrequently encountered infections such as malaria have posed a challenge to clinicians and health systems. Due to the rare occurrence of these infections, maintaining adequate, readily available supply for emergent need is challenging, and a lack of clear procurement processes from regional storage sites may contribute to delays in care. In March 2021, artesunate became commercially available for the treatment of severe malaria, a disease for which prompt initiation of therapy is paramount. To improve access to this and other critical but seldom used medications, a centralized storage and allocation process was established throughout our 10-hospital health system. We aim to describe the structure of this program which may serve as a model for other institutions to expedite and streamline access to these lifesaving therapies.
Tracking document for therapy supply management.

Methods
In May 2021, a centralized process was created to track and store rare anti-infective medications for uncommon infections, including those caused by tropical, parasitic, and mycobacterial pathogens (Table 1). Supply is monitored and maintained by clinical pharmacists monthly to ensure adequate courses are available. When needed for a specific patient, infectious diseases physicians and pharmacists recommend therapy which triggers a request to the central pharmacy.

Results
Medications are stored at our large academic medical center (AMC), which manages these cases more routinely compared to other sites. Community hospitals within the health system are able to contact the AMC for prompt distribution of these medications when needed. Since its inception, we have deployed rare use anti-infective medications to partner facilities twice for severe malaria cases, which resulted in expedited receipt of therapy for critically ill patients. The time from therapy recommendation to medication administration was reduced from 12–24 hours to 2–6 hours.

Conclusion
This centralized rare anti-infective medication process expedites and streamlines access for critical therapeutic agents to ensure they are readily available when needed by limiting procurement/storage concerns. This model may be used as a framework for other medications for which timely administration, but rare use, is critical to patient care.

Disclosures
All Authors: No reported disclosures.
2357. Risk Factors for COVID-19 Infection and Outcomes in People Living with HIV
Authors: Hanna John J , Geresu Liyu B , Diaz Marlon , Pickering Madison , Casazza Julia A , Ho Milan , Lanier Heather , Radunsky A L exander P , Saleh Sameh N , Most Zachary M , Perl Trish M , Turer Robert W , Lehmann Christoph U , Chow Jeremy Y , Medford Richard J 
Published: December 2022

Abstract

Background
As the risk for concomitant COVID-19 infection in people living with HIV (PLHIV) remains largely unknown, we explored a large national database to identify risk factors for COVID-19 infection among PLHIV.

Methods
Using the COVID-19 OPTUM de-identified national multicenter database, we identified 29,393 PLHIV with either a positive HIV test or documented HIV ICD9/10 codes. Using a multiple logistic regression model, we compared risk factors among PLHIV, who tested positive for COVID-19 (5,134) and those who tested negative (24,259) from January 20, 2020, to January 20, 2022. We then compared secondary outcomes including hospitalization, Intensive Care Unit (ICU) stay, and death within 30 days of test among the 2 cohorts, adjusting for COVID-19 positivity and covariates. We adjusted all models for the following covariates: age, gender, race, ethnicity, U.S. region, insurance type, adjusted Charlson Comorbidity Index (CCI), Body Mass Index (BMI), and smoking status.

Results
Among PLHIV, factors associated with higher odds for acquiring COVID-19 (Figure 1) included lower age (compared to age group 18–49, age groups 50–64 and &gt;65 were associated with odds ratios (OR) of 0.8 and 0.75, P= 0.001), female gender (compared to males, OR 1.06, P= 0.07), Hispanic White ethnicity/race (OR 2.75, P= 0.001), Asian (OR 1.35, P= 0.04), and African American (OR 1.23, P= 0.001) [compared to non-Hispanic White], living in the U.S. South (compared to the Northeast, OR 2.18, P= 0.001), being uninsured (compared to commercial insurance, OR 1.46, P= 0.001), higher CCI (OR 1.025, P= 0.001), higher BMI category (compared to having BMI&lt; 30, Obesity category 1 or 2, OR 1.2 and obesity category 3, OR 1.34, P= 0.001), and noncurrent smoking status (compared to current smoker, OR 1.46, P= 0.001). Compared to PLHIV who tested negative for COVID-19, PLHIV who tested positive, had an OR 1.01 for hospitalization (P = 0.79), 1.03 for ICU stay (P=0.73), and 1.47 for death (P=0.001).

Conclusion
Our study found that among PLHIV, being Hispanic, living in the South, lacking insurance, having higher BMI, and higher CCI scores were associated with increased odds of testing positive for COVID-19. PLHIV who tested positive for COVID-19 had higher odds of death.

Disclosures
Christoph U. Lehmann, MD, Celanese: Stocks/Bonds|Markel: Stocks/Bonds|Springer: Honoraria|UTSW: Employee Jeremy Y. Chow, M.D., M.S., Gilead Sciences: Grant/Research Support.
2031. Role of Urine Culture Hard Stop in Reducing Catheter-associated Urinary Tract Infections
Authors: Cherian John , Tibbetts Robert , Robinson Paula , Holsey Tarlisha , Alangaden George J , Suleyman Geehan 
Published: December 2022

Abstract

Background
Catheter-associated urinary tract infection (CAUTI) is one of the most commonly reported healthcare associated infections (HAI) reported to the National Healthcare Safety Network (NHSN). However, asymptomatic bacteriuria is common in patients with indwelling urinary catheters (IUC), and inappropriate culturing leads to overdiagnosis in colonized patients, unnecessary antibiotics and increased resistance. We evaluated the effectiveness of an electronic medical record (EMR) “hard stop” in reducing inappropriate urine cultures (UC) and its impact on CAUTI rates.

Methods
This was a pre-post quasi-experimental retrospective study comparing CAUTI rate per 1000 catheter days, UC order rate per 1000 patient days, Standardized Utilization Ratio (SUR) and Standardized Infection Ratio (SIR) in the pre-intervention period (January 2019-December 2020) to the intervention period (April 2021-March 2022) in Southeast Michigan. In March 2021, we implemented a hard stop in Epic® that fired 24 hours after admission in patients with IUC &gt;1 calendar day and until 4 days after IUC removal. The Medical Director of Infection Prevention and Control had the ability to override the hard stop when indicated after reviewing the case upon provider request; education was provided in real-time. We prospectively monitored outcomes, including pyelonephritis and/or bacteremia within 3 days and readmission for sepsis within 30 days in patients UC was deemed unnecessary.

Results
CAUTI rate was 0.52 in the pre-intervention period and 0.09 in the post-intervention period, an 83% reduction (Figure 1). Rate of UC performed was 0.283 in the pre-intervention period and 0.218 in the post-intervention period, a 23% reduction. SUR decreased from 0.809 to 0.716, an 11% reduction (95% CI, 0.875-0.894, p&lt; 0.001). SIR decreased from 0.392 to 0.135, a 66% reduction (95% CI, 0.154-0.0689, p=0.0015). Post-intervention, there were 44 override requests that were denied with no adverse patient outcomes.

Conclusion
Urine culture stewardship, utilizing an electronic hard stop, was effective in reducing inappropriate UC orders, SIR and SUR in patients with IUC without causing patient harm. This strategy combined with real-time education can significantly reduce CAUTI rates.

Disclosures
All Authors: No reported disclosures.
2032. Sources of Primary Bloodstream Infections in Internal Medicine Patients – a Cohort Study
Authors: Oster Yonatan , Ben-yosef Yonatan , Cohen Matan , Schwartz Carmela , Benenson Shmuel 
Published: December 2022

Abstract

Background
The sources of bloodstream infections (BSIs) in internal-medicine patients, on admission and during hospitalization, are not well-defined. We wish to evaluate these infections and determine the proportion of BSIs in which no secondary cause could be defined (i.e. primary-BSI).

Methods
We analyzed all BSIs at the internal-medicine wards of the two campuses of the Hadassah Hebrew-University Medical Center, during 2017-2018. We defined the BSI source of each event (secondary, Central-line associated BSI (CLABSI) or primary non-CLABSI) and compared BSIs present on admission (POA) to hospital acquired (HA).
Flow chart of the classification of bloodstream infection (BSI) events in the internal medicine wards 2017-2018.

Results
There were 595 patient-unique BSI events, 316 (53.1%) POA-BSI and 279 (46.9%) HA-BSI. Overall, 309 (51.9%) were secondary, 194 (32.6%) primary non-CLABSI and 92 (15.5%) CLABSI. Primary non-CLABSI in the POA-BSI group was 20.6% vs. 46.2% in the HA-BSI group (p=0.001). The length of hospital stay (LOS) from culture to discharge of the HA-BSI group was longer than in the POA-BSI group (mean LOS, 19 days vs. 13.6 days, p=0.01) and the mortality rate was higher (48.7% vs. 19%, p=0.001). Staphylococcus aureus was more common in primary non-CLABSI than in CLABSI and secondary BSI (29.5%, 12.8% and 16.2%, respectively).

Conclusion
The proportion of primary non-CLABSI among HA-BSI events is very high (46.2%). The absence of any plausible source for these BSIs, and the fact that most patients in Internal-medicine wards have peripheral lines, suggests that the peripheral catheter is a probable source for primary non-CLABSIs. Measures to prevent peripheral line associated BSI (PLABSI), similar to those implemented successfully for the prevention of CLABSI, should be considered.

Disclosures
All Authors: No reported disclosures.
2037. Epidemiology and Preventability of Hospital Onset Bacteremia and Fungemia in two Hospitals in India
Authors: Gandra Sumanth , Singh Sanjeev , Chakravarthy Murali , Moni Merlin , Dhekane Pruthu , Mohamed Zubair , Kumar Anil , Kaushik Arun , Shameen Fathima , Senthil Priyadarshini , Saravanan Tejaswini , George Anu , Sinclair Dorothy , Stwalley Dustin , van Rheenen Jacaranda , Westercamp Matthew , Smith Rachel Mann , Leekha Surbhi , Warren David K 
Published: December 2022

Abstract

Background
The National Healthcare Safety Network (NHSN) central line-associated bloodstream infection (CLABSI) is a widely accepted quality measure. However, studies from the United States indicate that NHSN reportable CLABSIs account for less than 20% of all hospital-onset bacteremia and fungemia (HOB, i.e., any positive blood culture obtained at least 3 calendar days after hospital admission) events and about 66% of all HOB events are potentially preventable. The incidence and overall preventability of HOB is unknown in low and middle-income countries (LMICs). This study evaluated the epidemiology and preventability of HOB in two hospitals in India.

Methods
Six months data on all consecutive blood cultures processed in two hospitals (Hospital A- 8.16.2020 to 2.15.2021; Hospital B- 1.1.2021 to 6.30.2021) were collected prospectively to calculate HOB and CLABSI incidence. Correlation between HOB and CLABSI rates was assessed using Spearman’s rank correlation. Medical records of 300 consecutive HOB events were retrospectively reviewed to determine the source and preventability of HOB utilizing a structured guide developed for the study.

Results
Among 3,558 hospitalized patients from whom blood cultures were obtained, 10.4% developed HOB with 409 unique HOB events (HOB incidence: 2.87 per 1000 patient-days). Only 15% (59 of 409) of HOB events were reported as CLABSI as per hospital CLABSI surveillance programs. The CLABSI rate was 4.4 per 1000 central line-days. There was a moderation correlation (r=0.51; p=0.07) between HOB and CLABSI rates. Among the 300 HOB events for which medical records were reviewed, the most common organism isolated was Klebsiella pneumoniae and 75% of K. pneumoniae were carbapenem resistant (Figure 1). The most common source of HOB was CLABSI (26.3%) (Figure 2). Fifty-two percent of all HOB events and 45% of HOB events not attributable to contaminants were potentially preventable (Figure 3). CLABSIs accounted for 69% of non-contaminant HOB preventable events.

Conclusion
We found that 69% of the non-contaminant related HOB preventable events were due to CLABSI. Prevention efforts in these hospitals could focus on CLABSI to reduce HOB rates while additional studies are performed to better understand the epidemiology of HOB in LMICs.
Microorganisms identified from 300 Hospital Onset Bacteremia and Fungemia Events in Two Hospitals in India.
Source of Hospital Onset Bacteremia and Fungemia Events in Two Hospitals in India (n=300).
Preventability Rating Source of Hospital Onset Bacteremia and Fungemia events in Two Hospitals in India (n=300).

Disclosures
All Authors: No reported disclosures.
2055. Trends in the Incidence of Carbapenem-Resistant Enterobacterales (CRE) and Carbapenemase Producing CRE (CP-CRE) in Davidson and Surrounding Counties, Tennessee, 2016-2021
Authors: Villegas Raquel , Hitchingham Erin , Wilson Christopher , Gambrell Ashley , Mounsey Jackie , Muleta Daniel 
Published: December 2022

Abstract

Background
The spread of Carbapenem-resistant Enterobacterales (CRE) continue to be a public health threat. Tennessee has participated in the Multidrug-Resistant Gram-Negative Bacilli Surveillance Initiative (MuGSI) since 2014. We investigated our data to describe the trends of CRE and CP-CRE and their changes during the COVID-19 outbreak.

Methods
Population-based surveillance targeting selected CRE organisms was conducted in Davidson County and seven surrounding counties in Tennessee. A CRE case was defined as isolation of Escherichia coli, Klebsiella spp., or Enterobacter spp. resistant to ≥1 carbapenem from a normally sterile body site or urine, in a surveillance area resident. A case was identified as incident if it was reported for the first time in the surveillance year or was a subsequent report of a case ≥30 days after the last report. The Tennessee state public health laboratory tests for carbapenemase production on CRE isolates received from clinical laboratories. The data analysis was conducted using SAS software version 9.4.

Results
474 incident CRE cases were reported from 2016 to 2021. Females made up 68.63% and the average age was 65 years for both sexes.
The incidence rate of CRE cases increased throughout study period and the rate in 2021 was 1.8-fold of 2016 (lowest rate for the study period) (P-value&lt; 0.001). The incidence rate of CP-CRE increased in 2017 and 2018 compared to 2016 (p-value=0.01). The incidence rate for CP-CRE declined to the lowest level in 2020 (0.3 per 100,000 population). In 2021, the CP-CRE rate significantly increased compared to 2020 (p-value=0.02). The carbapenemase production (CP) positivity rate was also significantly higher in 2017(28.8%), 2018 (26.6%), and 2021 (25.8%) compared to the year 2020 where the positivity rate was the lowest (10.0%) (P-value&lt; 0.05).

Conclusion
The transmission of CP-CRE cases decreased during the years prior to the COVID-19 outbreak despite the steady increase in CRE cases. The transmission of CP-CRE gained momentum during the COVID outbreak as evidenced by an increased infection rate and CP positivity rate in 2021. Renewed focus on implementing coordinated infection prevention strategies is likely to contribute to reducing the spread of antimicrobial-resistant pathogens.

Disclosures
All Authors: No reported disclosures.