bluuebunny/crossref_metadata_2025_split huggingface dataset:
2040. Healthcare-Associated Infection Surveillance During the COVID-19 Pandemic in New Mexico
Authors: Edwards-Fligner Morgan , Phipps Erin C 
Published: December 2022

Abstract

Background
The COVID-19 pandemic changed accessibility of care and practices within healthcare environments. This period has been associated with healthcare-associated infection outbreaks and shifts in healthcare-associated infectious disease epidemiology. This study’s objective is to describe changes in rates and characteristics of antimicrobial-resistant gram negative and Clostridioides difficile (CD) infections during the COVID-19 pandemic in Bernalillo County, New Mexico.

Methods
The NM EIP, a collaboration between University of New Mexico and the NM DOH, conducts ongoing laboratory- and population-based surveillance of infectious disease including Clostridium difficile, extended-spectrum beta lactamase (ESBL-E) and carbapenemase-producing gram negative bacteria (CRE). Stata statistical software was used for retrospective analysis of rates and characteristics on NM EIP data from Bernalillo county, NM between 2016 and 2021.

Results
Reported C. difficile rates decreased from 76 to 49 cases/month and ESBL-producing Enterobacterales decreased from 145 to 86 cases/month during the pandemic period from March-December 2020 compared with the prior 14 months. Monthly case counts for 2020 are lowest during initial public health orders for the state of New Mexico. Rates of CRE remained constant between 2018-2021.
The proportion of CDI cases originating from long-term care facilities decreased significantly from 17.2% to 10.4% (p=0.006) while the proportion attributable to hospital inpatient and community populations remained constant. The proportion of ESBL-E cases from sterile sample sites increased from 3.1% to 4.9% (p=0.05) and the proportion of patients who died within 30 days or prior to discharge increased from 2.2% to 3.2% (p=0.019).

Conclusion
Rates and characteristics of CD and ESBL-E infections in Bernalillo county NM changed significantly during the COVID-19 pandemic, while rates of CRE remained constant. It is still unclear whether this is related to changes in actual disease rates due to risk factor exposure (healthcare), or if this trend reflects changes in care-seeking behavior and/or reporting of cases.

Disclosures
All Authors: No reported disclosures.
2041. Impact of Coronavirus Disease 2019 pandemic on healthcare-associated infections at intensive care unit in South Korea: Data from Korean National Healthcare-associated Infections Surveillance System (KONIS)
Authors: Lee Yu-Mi , Kim Dong Youn , Kim Eun Jin , Park Ki-Ho , Lee Mi Suk 
Published: December 2022

Abstract

Background
Coronavirus Disease 2019 (COVID-19) pandemic has influenced hospital infection control practices. We evaluated the impact of the COVID-19 pandemic on healthcare-associated infections (HAIs) in the intensive care unit.

Methods
We conducted a retrospective analysis using data from the Korean National Healthcare-Associated Infections Surveillance System (KONIS). KONIS has conducted nationwide prospective surveillance of HAIs in intensive care units. Comparisons of incidence rates of bloodstream infection (BSI), central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), and ventilator-associated pneumonia (VAP) before (Jan 2018-Dec 2019) and during the COVID-19 pandemic (Jan 2020-Jun 2021) were performed according to hospital size. The microorganism distributions in BSI, urinary tract infection, and pneumonia were compared between the period before and during the COVID-19 pandemic.

Results
The incidence rate of BSI significantly decreased during the COVID-19 pandemic than in the pre-COVID-19 period (1.38 vs. 1.19 per 10,000 patient-days; P &lt; 0.001) [Table 1]. Incidence rates of CLABSI (2.30 vs. 2.17 per 1,000 device-days; P = 0.03) and VAP (1.03 vs. 0.81 per 1,000 device-days; P &lt; 0.001) decreased significantly during the COVID-19 pandemic than in the pre-COVID-19 period, whereas that rate of CAUTI was similar between the two periods. The annual trends of incidence rate of CLABSI and VAP also has decreased (Figure 1). According to the hospital size, the incidence rate per 1,000 device-days of CLABSI significantly decreased during the COVID-19 pandemic than in the pre-COVID-19 period in small to medium-sized hospitals (300-699 beds). The incidence rate per 1,000 device-days of VAP significantly decreased only in small-sized hospitals (200-449 beds). The microorganism distributions in HAIs did not change significantly.

Conclusion
The incidence rates of CLABSI and VAP decreased during the COVID-19 pandemic than in the pre-COVID-19 period, which was attributable to the changes in small to medium-sized hospitals.

Disclosures
All Authors: No reported disclosures.
2042. Impact of the COVID-19 Pandemic on Healthcare-Associated Infections (HAI) by Race and Ethnicity in a Large Network of Community Hospitals: A Call to Action
Authors: Gettler Erin , Kalu Ibukunoluwa , Advani Sonali D , Seidelman Jessica , Raj Krishnan Jay , Campbell Melissa , Lewis Sarah S , Smith Becky A , Anderson Deverick J 
Published: December 2022

Abstract

Background
Inequities in healthcare among racial and ethnic minorities are globally recognized. The focus has centered on access to healthcare, equitable treatment, and optimizing outcomes. However, there has been relatively little investigation into potential racial and ethnic disparities in HAI.

Methods
We performed a retrospective cohort analysis of select HAI prospectively-collected by a network of community hospitals in the southeastern US, including central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), and laboratory-identified Clostridioides difficile infection (CDI). Outcomes were stratified by race/ethnicity as captured in the electronic medical record. We defined the pre-pandemic period from 1/1/2019 to 2/29/2020 and the pandemic period from 3/1/2020 to 6/30/2021. Outcomes were reported by race/ethnicity as a proportion of the total events. Relative rates were compared using Poisson regression.

Results
Overall, relatively few facilities consistently collect race/ethnicity information in surveillance databases within this hospital network (&lt; 40%). Among 21 reporting hospitals, a greater proportion of CLABSI occurred in Black patients relative to White patients in both study periods (pre-pandemic, 49% vs 38%; during pandemic, 47% vs 31%; respectively, Figure 1a), while a higher proportion of CAUTI and CDI occurred in White patients (Figures 1b-c). Black patients had a 30% higher likelihood of CLABSI than White patients in the pre-COVID period (RR, 1.30; 95% CI, 0.83-2.05), which was not statistically significant (Table 1). However, this risk significantly increased to 51% after the start of the pandemic (RR, 1.51; 95% CI, 1.02-2.24). Similar trends were not observed in other HAI (Tables 2-3).

Conclusion
We found differences in HAI rates by race/ethnicity in a network of community hospitals. Black patients had higher likelihood of CLABSI, and this likelihood increased during the pandemic. Patient safety events, including HAI, may differ across racial and ethnic groups and negatively impact health outcomes.

Disclosures
Sonali D. Advani, MBBS, MPH, FIDSA, Locus Biosciences: Advisor/Consultant|Locus Biosciences: Honoraria|Sysmex America: Advisor/Consultant.
2049. National Trends in Infections caused by Pseudomonas aeruginosa and Carbapenem Resistant Pseudomonas aeruginosa, 2017 – 2020
Authors: Rose Ashley , Baggs James , Wolford Hannah , Natalie McCarthy , Olubajo Babatunde , Reddy Sujan 
Published: December 2022

Abstract

Background
Pseudomonas aeruginosa is an opportunistic pathogen commonly found in the environment, including water and plumbing, which may serve as a reservoir of spread. We examined P. aeruginosa and carbapenem resistant P. aeruginosa (CRPA) rates and trends in recent years.

Methods
We assessed rates of P. aeruginosa using microbiology data from over 265 hospitals in the Premier Healthcare Database from January 2017 – December 2020. We identified a cohort of inpatients with any clinical culture yielding an isolate of P. aeruginosa with accompanying susceptibility testing results. Any isolate with at least 1 resistant result to imipenem, meropenem, or doripenem was considered CRPA. Cases were defined as community-onset (CO) when the culture was obtained immediately preceding admission or within the first 3 days of hospitalization, and hospital-onset (HO) when the culture was obtained on day 4 or later. Using monthly hospital level data we modeled cases per discharge, controlling for hospital characteristics, month of discharge, proportion of patients in specific age groups, and proportion of male patients. We developed weights using a raking procedure to match the American Hospital Association distribution for acute care hospitals to produce national estimates. Weighted multivariable logistic regression models were used to estimate national trends in rates per 10,000 discharges.

Results
Weighted rates of overall, HO, and CO P. aeruginosa and CRPA are shown in Figure 1. From 2019 – 2020, P. aeruginosa adjusted rates increased 7% (p=0.037) (Figure 2). HO P. aeruginosa rates declined 15% from 2017 – 2018 (p=0.014), however HO rates increased 29% in 2020 compared with 2019 (p&lt; .0001). HO CRPA rates did not change during 2018 – 2019 compared with 2017, however HO rates increased 44% in 2020 compared with 2019 (p=0.001). Figure 1.Weighted Rates per 10,000 discharges, 2017 – 2020Figure 2.Pseudomonas aeruginosa and Carbapenem Resistant Pseudomonas aeruginosa Non-Linear Trend Comparisons, 2017 – 2020*Indicates statistical significance at p&lt;0.05.

Conclusion
We observed an increase in the overall rate of P. aeruginosa in 2020 compared with 2019, driven by an increase in HO P. aeruginosa rates. HO CRPA rates also increased. Further evaluation of drivers of increasing HO P. aeruginosa infections is warranted, including exploration of the hypothesis that pandemic-associated changes in water use and management, such as intermittent closure and reopening of hospital units, may have increased exposure to water harboring P. aeruginosa.

Disclosures
All Authors: No reported disclosures.
2050. Proportion of hospital-onset infections expressing antibiotic resistant (AR) phenotypes in US Hospitals, 2018 – 2020
Authors: Olubajo Babatunde , Wolford Hannah , Rose Ashley , Natalie McCarthy , Reddy Sujan , Jernigan John A , Baggs James 
Published: December 2022

Abstract

Background
Reports suggest the COVID-19 pandemic in 2020 was associated with increases in hospital-onset AR infections, including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp., carbapenem-resistant Enterobacterales (E. coli, Klebsiella spp., and Enterobacter spp.) (CRE) and Acinetobacter spp. (CRAsp), extended-spectrum cephalosporin resistance suggestive of extended-spectrum β-lactamase producing Enterobacterales (ESBL-E), and multidrug-resistant Pseudomonas aeruginosa (MDR-PA). To evaluate whether trends were similar for susceptible and resistant strains, we estimated the proportions of these resistant phenotypes in U.S. hospitals. Figure 1.Proportion of hospital-onset pathogens expressing resistant phenotypes, 2018 – 2020

Methods
We analyzed 2018–2020 hospital microbiology data in the Premier Healthcare and BD Insights Research Databases. Hospital-onset (HO) infections were those with positive cultures collected after hospital day 3. We used a raking procedure to produce weights to match national hospital characteristics, specifically: U.S. census division, bed size, teaching status, age, gender and urban/rural designation. We used a weighted means survey procedure for annual national estimates and generated annual comparisons with multivariable logistic regression adjusted by hospital characteristics.

Results
In 589 hospitals, the percentages of HO ESBL-E and CRAsp increased from 2019 to 2020 (Table). Among enterococci, the percentage with vancomycin resistance decreased. The percentages of MRSA, CRE, and MDR-PA did not change.

Conclusion
Our findings suggest pandemic-related factors, such as changes in antibiotic use or infection control, may have differentially affected susceptible and resistant phenotypes of hospital pathogens. Increases in the percentages of HO CRAsp and ESBL-E suggest these resistant phenotypes may have had a selective advantage over susceptible strains during the pandemic. In contrast, no changes in the percentages of HO MRSA or MDR-PA were observed, suggesting that infection rates increased similarly for resistant and susceptible strains. These findings underscore the importance of strategies to prevent hospital-associated infections and AR that are resilient to pandemic-related stresses on the healthcare system.

Disclosures
All Authors: No reported disclosures.
2052. Temporal and Geographical Prevalence of Carbapenem-Resistant Pseudomonas aeruginosa and the In Vitro Activity of Ceftolozane/Tazobactam and Comparators in Taiwan – SMART 2012-2020
Authors: Hsieh Tai-Chin , Chen Wei-Ting 
Published: December 2022

Abstract

Background
Carbapenem-resistant Pseudomonas aeruginosa (CRPA) is listed as a critical pathogen by World Health Organization (WHO). Using clinical isolates collected in Taiwan as part of the global SMART surveillance program, we evaluated the trend of CRPA prevalence in recent nine years (2012-2020) as well as in vitro activity of ceftolozane/tazobactam (C/T) and comparators against CRPA collected from ICU vs non-ICU wards from 2016 to 2020.

Methods
Between 2012-2020, Pseudomonas aeruginosa (PA) isolates were collected from nine sites in Taiwan (2 in Northern, 3 in Central and 4 in Southern Taiwan). MICs were determined and interpreted based on CLSI broth microdilution guidelines and 2021 CLSI breakpoints. PCR screening and β-lactamase gene sequencing were performed for isolates non-susceptible to imipenem or imipenem/relebactam or C/T.

Results
During the study period, a total of 2639 PA isolates were collected. Among these, 448 isolates were resistant to either imipenem or meropenem (17.0%). Yearly prevalence rate of CRPA increased from 12.3% in 2012 to 22.8% in 2020: 12.3% in 2012 (14/114), 11.5% in 2013 (16/139), 11.5% in 2014 (13/113), 12.2% in 2015 (41/336), 15.5% in 2016 (57/367), 15.9% in 2017 (68/428), 20.4% in 2018 (73/357), 19.4% in 2019 (75/386) and 22.8% (91/399) in 2020. Hospitals in Northern Taiwan had higher CRPA prevalence rate (22.8%, 131/574) compared to those in Central (15.7%, 126/802) and Southern Taiwan (15.1%, 191/1263). Percentage susceptibility of CRPA isolates to C/T from 2016 to 2020 showed 89.47% (51/57) in 2016, 79.41% (54/68) in 2017, 93.2% (68/73) in 2018, 90.7% (68/75) in 2019 and 98.9% (90/91) in 2020. For ICU vs. Non-ICU CRPA isolates, the susceptibility to C/T were 88.3% vs.93.8%, 77.8% vs. 82.5%, 92.3 % vs. 92.9%, 87.1% vs.93.2% and 100% vs. 98.26%, in 2016,2017, 2018, 2019 and 2020, respectively.

Conclusion
During the period of 2012-2020, the yearly prevalence of CRPA in Taiwan hospitals increased from 12.3% to 22.8%. The high prevalence and increasing trend of CRPA warrant continuous monitoring of evolving antibiotic resistance in Taiwan.

Disclosures
Tai-Chin Hsieh, MBBS, MSD Taiwan: Advisor/Consultant|MSD Taiwan: Employee of MSD Taiwan|MSD Taiwan: Stocks/Bonds.
2060. Evaluation of the real world incidence of integrase inhibitor resistance since adoption as guideline preferred therapy
Authors: Januszka Jenna , Drwiega Emily N , Drwiega Emily N , Burgos Rodrigo M , Michienzi Sarah M , Smith Renata , Badowski Melissa E 
Published: December 2022

Abstract

Background
There are limited data reporting real-world incidence of integrase inhibitor resistance (INSTI-R) since the approval and first-line treatment recommendation of INSTIs in the US. A recent analysis of the national surveillance data estimated INSTI-R to be 6.3%. The purpose of this study was to describe real-world incidence of INSTI-R in patients who used an INSTI-based single tablet regimen (STR) in a major metropolitan area and identify risk factors for resistance.

Methods
This was a retrospective study of adult patients living with human immunodeficiency virus (HIV) who were prescribed an INSTI-STR between September 2017 and September 2020 and followed for &gt; 12 months at the University of Illinois Chicago Community Clinic Network (UCCN). The primary endpoint was the difference in INSTI-R in UCCN patients compared to the national prevalence of 6.3%. Other outcomes included development of virologic failure (VF), defined as 2 consecutive HIV-1 viral loads (VL) &gt; 200 copies/mL after week 24, and documented INSTI-R mutations. Patient specific factors associated with medication nonadherence were also collected. All endpoints were analyzed using chi-square and Fisher’s exact tests.

Results
Of 948 patients screened, 248 patients were included. Baseline characteristics are summarized in Table 1. VF occurred in 17 subjects (6.8%). Two of the 17 (11.8%) received subsequent INSTI-R testing and nine eventually virally suppressed without regimen changes (52.9%). Patients without VF were assumed to have no INSTI-R.
No subjects developed INSTI-R, which was significantly less than the national prevalence of 6.3% (p=0.0029). Patients with a high VL at baseline were more likely to experience VF (p=0.001). The most common factors associated with nonadherence in patients with VF are summarized in Table 2.

Conclusion
The true rate of INSTI-R in UCCN patients is still unknown and factors associated with developing INSTI-R were unable to be assessed. Among patients at UCCN on INSTI-based STRs, INSTI-R rates were lower than the national average. Future analyses should also include patients on INSTI-based non-STR regimens as increased pill burden is a known risk factor for nonadherence leading to VF and drug resistance.

Disclosures
All Authors: No reported disclosures.
2066. Introduction of a Universal HIV Screening Electronic Health Record Alert at a Midwest Academic Health System
Authors: Allen Genevieve , Ahmed Mehwish , Coda John , Saravolatz Louis , McLane Michael , Heidemann Lauren , Cox Amanda 
Published: December 2022

Abstract

Background
Universal human immunodeficiency virus (HIV) testing is recommended for patients ages 13-64 at least once by the Centers for Disease Control and Prevention. Screening lags behind these recommendations.

Methods
We performed an analysis of the current state of HIV screening at three university-based internal medicine and one internal medicine/pediatrics clinics serving counties with HIV prevalence in 2020 from 51/100,000 to 176/100,000. We completed a chart review to examine current screening practices and conducted an electronic survey of primary care providers inquiring about awareness of universal screening recommendations and barriers to screening.
Based on this analysis, we implemented an automated electronic health record (EHR) reminder for HIV screening for patients aged 15-64 during health maintenance exams.
Our primary outcome was the number of patients screened for HIV pre-intervention (2017-July 2021) and post-intervention (August 2021-December 2021). We used odds ratio to compare the proportion of tests which were false positive and true positive pre- vs post-intervention. To evaluate the effect of the intervention on total HIV tests ordered across the institution, we used control chart methodology.

Results
Survey response rate was 59% for residents (n=97) and 18% for faculty (n=29). 93% were aware of the screening recommendation. The most common barrier to screening was forgetting to screen (Figure 1).
Pre-intervention, 25% of reviewed charts (n=4393) received recommended HIV screening. Post-intervention, HIV testing increased across the institution by 49% (Figure 2) and weekly testing was consistently three standard deviations above the mean compared to pre-intervention (Figure 3). The proportion of true positive tests decreased (p&lt; 0.05). Figure 1.Common Reasons for Not Performing Universal HIV ScreeningFigure 2.Summary of HIV Testing 2017-2021Figure 3.Control Chart for HIV Testing by Week 2017-2021

Conclusion
Implementation of an automated HIV screening EHR reminder increased HIV screening. The proportion of true positive tests decreased, likely due to the low prevalence of HIV in our community

Disclosures
All Authors: No reported disclosures.
2071. HIV reservoir evaluation in GALT and PBMCs of virologically suppressed patients
Authors: Compagno Mirko , Scutari Rossana , Ferrari Ludovica , Teti Elisabetta , Piermatteo Lorenzo , Matteucci Claudia , D’Avolio Antonio , Malagnino Vincenzo , Grelli Sandri , Marco Iannetta , Silberstein Francesca Ceccherini , Perri Giovanni Di , Sarmati Loredana , Andreoni Massimo 
Published: December 2022

Abstract

Background
The extension of HIV reservoir in the rectal gut associated lymphoid tissue (GALT) and the ART influence on this compartment are still poorly studied. We aimed to evaluate the extent of HIV-DNA in GALT and peripheral blood of virologically suppressed patients (VS)

Methods
40 HIV-1+ VS pts were enrolled. Blood and GALT HIV-DNA levels and residual plasma viremia (RV) were quantified by droplet digital-PCR. Rectal biopsies were collected during high resolution anoscopy. Lymphocyte (L) phenotype and antiretroviral drug concentrations were analysed in tissue and peripheral blood

Results
Pts median age (IQR) was 37 (32-45) yrs, 39 (97.5%) were males. At HIV-1 diagnosis, median (IQR) viremia and CD4+ were 4.7 (4.3-5) Log10cps/mL and 469 (299-627) cells/µL, respectively. 27 (67.5%) pts had HIV-1 B subtype. At the enrolment, median (IQR) CD4+ was 720 (583-1041) cells/µL and RV was 3 (2-6) cps/mL. All pts were on 2 NRTI-regimen with a 3rd drug (20 INSTI, 15 NNRTI, 5 PI). A positive correlation emerged among HIV-DNA levels in the GALT and PBMC (Rho= 0.432; p=0.005), CD8+ L counts (Rho=0.367; p=0.02), and a negative correlation emerged with blood CD3+ L percentage (Rho=-0.489; p=0.006). Peripheral blood HIV-DNA values were inversely correlated with the CD4+ nadir (Rho= -0.379; p=0.017) and blood CD4+/CD8+ ratio (Rho= -0.362; p=0.022), and directly correlated with GALT CD4+CD38+ (Rho= 0.414; p=0.028) and blood CD8+CD38+ L (%) (Rho= 0.400; p=0.026). A positive correlation among GALT and peripheral blood CD4+CD38+ (Rho= 0.555; p=0.005), CD8+CD38+ (Rho= 0.417; p=0.030), and CD19+CD38+ L (Rho= 0.498; p=0.007) was found. There was no difference in HIV-DNA levels in the GALT and PBMCs according to the ART 3rd drug. In a subgroup of 20 pts the analysis of rectal tissue and blood drug concentrations showed that tissue/plasma ratio was higher in pts on Elvitegravir (EVG) and Rilpivirine (RPV) (median ratio 2.8 and 1.7, respectively)
GALT and Blood HIV-DNA levels
Tissue-Plasma Drug concentration

Conclusion
HIV-DNA from rectal GALT is a valid marker to characterize viral reservoir. The correlation of higher GALT HIV-DNA levels, CD8+ T L counts and CD4 and CD8 activation levels suggests that a greater amount of virus in the anorectal reservoir can perpetuate the inflammatory state characteristic of HIV+ pts. EVG and RPV showed higher tissue exposure than other ART regimens

Disclosures
All Authors: No reported disclosures.