bluuebunny/crossref_metadata_2025_split huggingface dataset:
2001. Clinical management changes after positive multiplex gastrointestinal pathogen panel testing for evaluation of diarrhea
Authors: Mackow Natalie A , Eiffert Samantha R , Kinlaw Alan C , Kooken Banks W , Miller Melissa B , Bartelt Luther A , Ciccone Emily J 
Published: December 2022

Abstract

Background
IDSA guidelines for diarrhea include pathogen-specific management. Compared to non-molecular tests, multiplex gastrointestinal pathogen panels (GIPPs) may allow for more timely and cost-effective diagnoses and care. However, this has yet to be definitively demonstrated. Our objective was to determine the impact of positive GIPP results on clinical management, including antimicrobial use.

Methods
We performed a retrospective study of patients with diarrhea and a positive GIPP result (xTAG Gastrointestinal Pathogen Panel, Luminex) at an academic, tertiary-care medical center from January-December 2018. We excluded immunocompromised patients (solid organ or stem cell transplant, HIV with absolute CD4 count &lt; 200 cells/µL, primary immunodeficiency, and immunosuppressive medications including biologics). We collected patient and clinical data via electronic medical record review. Our primary outcome of interest was change in antimicrobial usage.

Results
A total of 2,333 GIPP tests were performed of which 266 (11.4%) were positive. Of 193 patients who met inclusion criteria, 34% were tested in an emergency room, 38% in outpatient clinics, and 29% on inpatient wards. Of these, 55% were men, 65% were white, and the median age was 31 years (interquartile range, IQR 5-56). The median turnaround time from GIPP collection to result was 31 hours (IQR 24-53). The most frequently identified pathogens were norovirus, Salmonella, and Campylobacter (Figure 1). In 43% of patients, results led to one or more management changes including antibiotic discontinuation (8%) and antibiotic initiation (25%). Antibiotics were most often discontinued for norovirus (Figure 1A) and started for Campylobacter (Figure 1B). Other management changes occurred in 13% of patients, including avoidance of further diagnostic testing and isolation precaution change. The median turnaround time did not differ for GIPPs that were (30 hours; IQR 22-50) or were not (32 hours; IQR 25-56) associated with management change.

Conclusion
Positive GIPP results can prompt changes in antimicrobial treatment in non-immunocompromised patients with diarrhea. Future efforts will evaluate the appropriateness of these management changes.

Disclosures
Melissa B. Miller, PhD, Abbott Molecular: Grant/Research Support|Agena Biosciences: Board Member|ArcBio: Grant/Research Support|Cepheid: Board Member|Luminex Molecular Diagnostics: Board Member|QIAGEN: Board Member|QIAGEN: Grant/Research Support|Sherlock Biosciences: Advisor/Consultant|Talis Biomedical: Board Member|Thermo Fisher: Honoraria|Werfen: Board Member.
2007. Multidirectional Transmission of Clostridioides difficile in Families with Young Infants
Authors: Clayton Jason , Golonka Gregory , Maruskin Lynn , Jencson Annette , Hailes Jennifer , Cadnum Jennifer , Donskey Curtis , Toltzis Philip 
Published: December 2022

Abstract

Background
Infants frequently excrete toxigenic C. difficile asymptomatically during their first year of life. Prior studies have demonstrated an association between acquisition of community acquired C. difficile infection in adults and contact with an infant, suggesting the latter is a reservoir of the organism. To probe this possibility further, we aimed to examine how frequently C. difficile is transmitted from infants to otherwise healthy adult caregivers.

Methods
Families presenting to a suburban pediatric clinic for their infants’ 4-month well-child visit were recruited. Consenting parents were instructed to mail soiled diapers every 2 weeks to a research laboratory with experience cultivating C. difficile, until their baby was 8 months old. Parents were requested to concomitantly send soiled toilet paper, or a rectal swab via a moistened wipe, from themselves. Samples were cultured for C. difficile by direct plating on selective media plus using a more sensitive broth enrichment method. For family groups with C. difficile colonization, PCR ribotyping was used to determine the relatedness of selected baby and parent isolates.

Results
To date 17 families have submitted at least 1 set of samples. Follow up has ranged from 2 to 16 weeks (median 8). In 15/17 families, at least 1 sample was positive for C. difficile: in 4/15 only a parent was positive, in 3/15 the baby plus 1 parent were positive, and in 8/15 all family members were positive. There were no families in which only the baby yielded the organism. The index was the mother in 6/15 families, and the baby in 3/15 families; in 6/15 families, the baby plus &gt;/= 1 parent were initially positive simultaneously. Excretion tended to be prolonged in infants (up to 16 weeks) whereas positivity was more transient in the adults. Isolates from 10 families in which the baby and at least 1 adult were positive for C. difficile were subjected to ribotyping; in 8/10 families the baby’s ribotype was concordant with &gt;/= 1 adults’.

Conclusion
C. difficile colonization is common among healthy household members caring for an infant. Longitudinal observation suggests that transmission is multidirectional, with the organism passed from adult to baby and from baby to adult.

Disclosures
All Authors: No reported disclosures.
2011. Use of Biofire®Filmarray gastrointestinal panel on clinical decision making and infection control in a General Pediatric Department.
Authors: Savvidou Parthena , Kourti Maria , Tsiatsiou Olga , Michailidou Elissavet , Zarras Charalambos , Antachopoulos Charalambos , Roilides Emmanuel , Iosifidis Elias 
Published: December 2022

Abstract

Background
The new Biofire® Filmarray Gastrointestinal Panel (BFGI-BioMérieux, France) offers advantage against conventional cultures of gastrointestinal tract specimens with rapid detection and a broader pathogen identification. Aim of this study is to evaluate the use of BFGI and compare detection of pathogens in GI samples with conventional cultures in hospitalized children with gastroenteritis.

Methods
A retrospective study was conducted in a General Tertiary level Pediatric Department from Jan 2020 to Apr 2022. Children were included if an appropriate GI tract specimen was obtained for clinical evaluation and was assessed by BFGI. Results were compared with conventional cultures. Demographic, clinical, laboratory data, treatment and the effect of the BFGI on clinical decision making were analyzed.

Results
Fifty-eight children were included, 27(46%) females, with mean age 5.1 (IQR 9.35). Thirty-one (53%) had an underlying condition, or a prolonged hospital stay. All children had diarrhea, 44% had fever and 25% had vomits. The most common pathogens were Norovirus (8/58), Campylobacter (7/58) and Enteropathogenic Escherichia coli (EPEC, 6/58), followed by Clostridium difficile, Rotavirus and Salmonella spp. Five of the Norovirus cases were detected within a 10-day period, in children that were hospitalized for other reasons, indicating an intrahospital outbreak. In five patients there was a co-infection with 2 or more pathogens. In 35 patients a stool culture (salmonella and shigella) was performed. All cultures were negative. In 20 (57%) patients, culture results were in accordance with a negative BFGI, but in the rest 15 (42%) patients the PCR detected at least one pathogen. Only 17 patients were treated with antimicrobials, because of age &lt; 3 months or the severity of disease/ comorbidities. A macrolide was prescribed in all campylobacter cases (clarithromycin, 57%, azithromycin, 43%).

Conclusion
In this cohort of hospitalized patients with gastroenteritis, BFGI offered a rapid and more precise result, in comparison to cultures. It helped recognize a norovirus outbreak in the department and improve the infection control measures. Finally, it assisted the clinical decision making leading to more rational and targeted antibiotic administration.

Disclosures
All Authors: No reported disclosures.
2016. CLABSIs in the Time of COVID
Authors: Espiritu Maria Rosa Velasquez , Dundas Mary , Chen Donald S , Keller Marina 
Published: December 2022

Abstract

Background
With the COVID-19 pandemic, acute care facilities experienced an initial increase in hospital-acquired infections, most notably Central Line-Associated Bloodstream Infections (CLABSIs). Interestingly, the positive correlation between COVID-19 and CLABSIs appeared to wane post surge. We sought to define the pre and post-pandemic CLABSI rates.

Methods
Single-center, retrospective review of the CLABSIs reported to the National Healthcare Safety Network (NHSN) for the five years previous to COVID and through to the First Quarter of 2022. Our center is a quaternary care, level 1 trauma center in New York, which serves a highly ill critical care population, including solid organ and bone marrow transplants, acute leukemias, and patients requiring extracorporeal membrane oxygenation (ECMO).

Results
Between January 2015 and December 2019, our Medical Intensive Care Unit (MICU) reported 15 CLABSIs with an overall Standardized Infection Ratio (SIR) of 1.007. During the second winter surge of COVID, we saw a sharp rise in CLABSIs. Between October 2020 and March 2021, our MICU reported eight CLABSIs, with an overall SIR of 4.601 and a p-value of 0.0005 (CI 2.137 – 8.737), representing a statistically significant increase (p-value 0.0019) in comparison to prior years. Of these patients, seven had COVID. All patients received high-dose steroids. The average number of days between hospital admission to CLABSI was 16.38 days, and mortality was 87.5%. Since that spike in CLABSI, we have reported seven CLABSIs in NHSN for a SIR of 2.026. After 2019 patients with CLABSI tended to be younger and had a higher Body Mass Index.

Conclusion
We reported a spike in CLABSIs in our adult medical Intensive Care during the second wave of COVID-19 that affected the Northeast United States in the winter of 2020/2021. Despite experiencing a sharp rise, our CLABSI rates are returning to pre-pandemic low levels even during subsequent surges in COVID-19, including the recent Omicron surge. It remains to be determined if the improvements in infection control measures, differences in the patient illness severity, and/or variations of COVID management have contributed to the stabilization of the CLABSI rate.

Disclosures
All Authors: No reported disclosures.
2020. Disinfection of Needle-less Connectors Using UVC Light
Authors: Rasooly Julia , Banaei Niaz , Fourkas Michael , Schears Gregory 
Published: December 2022

Abstract

Background
Nearly 50% of post-insertion catheter-related infections are due to microbial ingress from needleless connectors (NC), widely used devices which connect to the end of catheters or infusion sets and enable access for injection of medications and attachment of infusions. Infections arising from NC could result in central line associated bloodstream infection (CLABSI). The clinical guideline for disinfecting NC is to wipe the hub of the NC with a 70% alcohol and to manually scrub the connector surface for at least 15 seconds. Unfortunately, multiple studies have found low compliance with the 15 second disinfection scrub.

Methods
In this study, we investigated the efficacy of 1 second of ultraviolet light-C exposure in the reduction of the 3 most common CLABSI associated organisms: Staphylococcus aureus, Candida albicans, Candida auris, and Methicillin-resistant Staphylococcus aureus (MRSA). We tested a total of 30 NC samples for each organism with 3 positive controls and 1 negative control.

Results
The log reductions were 5.68, 5.05, 4.41, and 6.38 for S. aureus, C. albicans, C. auris and MRSA, respectively.
Growth of Candida albicans with and without UV-C exposure for 1 second.
The figure shows the observed growth of Candida albicans from the surface of the connector with and without UV-C exposure for 1 second, displaying no growth on the agar plate for samples that were exposed to 1 second of UV-C disinfection.
Log reduction of tested organisms after exposure of UV-C for 1 second.
Table 1 displays the overall log reduction of tested organisms after 1 second of UV-C exposure. The results are shown for positive control concentration and log reduction for the test organisms Staphylococcus aureus, Candida albicans, Candida auras, and Methicillin-resistant Staphylococcus aureus.

Conclusion
Our findings demonstrate greater than 4 log reduction of common CLABSI-associated organisms with 1 second of UV-C exposure, which we believe would decrease CLABSI rates, increase aseptic technique compliance, and reduce disruption in hospital workflow.

Disclosures
Julia Rasooly, MS, Puracath Medical, Inc: Board Member|Puracath Medical, Inc: Stocks/Bonds Michael Fourkas, MS, Puracath Medical, Inc: Grant/Research Support Gregory Schears, MD, Puracath Medical, Inc: Advisor/Consultant|Puracath Medical, Inc: Stocks/Bonds.
2021. Efficacy of Chronic Antimicrobial Suppressive Therapy in Ventricular Assist Device Infections
Authors: Teran Nicholas S , Russo Hannah , Rizwan Sohail M , Phe Kady 
Published: December 2022

Abstract

Background
Ventricular assist devices (VAD) prolong life expectancy or serve as a bridge to heart transplant in end stage heart failure but are not without risks. These patients are at high risk for device-related infections with a propensity for relapse. Indications and efficacy of chronic antimicrobial suppression (CAS) to prevent relapse are not well defined.

Methods
We conducted a retrospective study of all adult patients with VAD infections at our institution between 1/1/2013 and 10/31/2020. VAD-specific or VAD-related infections were defined by the International Society for Heart and Lung Transplantation criteria. Patients were stratified by receipt of CAS or no CAS after completing index infection treatment. Relapsed infections were defined as those recurred at the same site caused by the same organism seen in the index infection. Time-to-relapse infection was defined as the time in days between the index infection and first relapse. The primary outcome was CAS efficacy measured by time-to-relapse in VAD-specific or -related infections.

Results
A total of 83 patients were included with a documented VAD-specific (n = 68) or VAD-related (n = 15) infection. Driveline (n = 66) and bloodstream (n = 13) infections were the most common VAD-specific and VAD-related infections, respectively. For the index infection, all patients received antimicrobial treatment and 16.4% required incision and drainage. Staphylococcus aureus was most frequently isolated in 46 cases. Oral minocycline was the most commonly utilized agent in 22 of 47 patients receiving CAS. Agent-specific CAS efficacy was unable to be assessed due to the small sample. In patients who received CAS, 57% experienced a relapse infection compared to 81% in patients not receiving CAS (p = 0.03). The median time to relapse was 151 days (IQR 78-247) and 57 days (IQR 36-114) in the CAS and non-CAS groups, respectively (p &lt; 0.01).

Conclusion
The incidence of relapse infection in the setting of CAS was lower compared to those not receiving CAS. Patients receiving CAS were relapse-free for a significantly longer duration. Larger studies are warranted to assess if one agent confers a benefit over another.

Disclosures
M. Rizwan Sohail, MD, Aziyo Biologics: Honoraria|Boston Scientific Corporation: Honoraria|Medtronic: Grant/Research Support|TRYX: Grant/Research Support.
2029. Risk factors for a Central Line Associated Bloodstream Infection Amongst Hospitalized Patients with COVID
Authors: Fontana Lauren , Galdys Alison , Wang Qi , Ross Jennifer , Menier Terra , Dobbins Ginny , Alsaker Brady 
Published: December 2022

Abstract

Background
Central line associated bloodstream infections (CLABSI) are serious healthcare associated infections. During the COVID pandemic, we observed an increased incidence of CLABSIs in our healthcare system. We sought to identify risk factors for CLABSI among patients with COVID.

Methods
We performed a single-center, matched case-control study in patients admitted between Mar 2020 and Dec 2020 who were 1) diagnosed with COVID based on laboratory results or diagnosis code, and who were 2) at risk for developing a CLABSI based on the presence of a central line for ≥3 days. Cases were those diagnosed, based on National Healthcare Safety Network criteria, with CLABSI; controls were patients not diagnosed with CLABSI. Cases and controls were 1:4 matched based on age at admission (+/- 5 years) and COVID diagnosis date (+/- 45 days). Descriptive statistics were calculated for continuous and categorical variables. For comparisons, p values are from generalized estimating equations accounting for clustering by case-control matches. All analyses were performed in SAS version 9.4 (SAS Institute Inc., Cary, NC). Approval was granted by our institutional IRB.

Results
Characteristics of the patients who were diagnosed with COVID and at risk for developing a CLABSI are presented in table 1. Compared to patients with COVID and no CLABSI, patients with a CLABSI were more likely to be of a non-white race (p=0.0435). A longer length of stay was observed among CLABSI patients, (p=0.0011) and patients with CLABSI were less likely to be discharged to home (p=0.0084). There was a non-statistically significant trend toward a history of diabetes (p=0.0554), receipt of corticosteroids (p=0.052) and receipt of tocilizumab (p=0.0952) among CLABSI patients.

Conclusion
Patients hospitalized for COVID who developed a CLABSI had longer hospitalizations and were less likely to be discharged home. Race other than white was a risk factor for CLABSI among patients with COVID. The relationships between race, racism, and CLABSI should be further explored.

Disclosures
All Authors: No reported disclosures.
2030. Risk Factors for Recurrent Percutaneous Nephrostomy Tube Infections in Patients with Gynecological Malignancies
Authors: Szvalb Ariel D , Marten Claire A , Cain Katherine E , Taylor Jolyn , Huang Steven Y , Viola George M 
Published: December 2022

Abstract

Background
Percutaneous nephrostomy tube infections (PCNIs) are complex, affect quality of life, necessitate implant exchanges, and increase health care costs. Here, we analyzed risk factors for recurrent PCNIs in patients treated with our standardized institutional algorithm.

Methods
At our institution, we prospectively evaluated consecutive patients with gynecological malignancies who developed PCNIs between July 2019 to September 2021. All patients were treated using our institutional algorithm for PCNI, which consists of obtaining blood cultures plus urine analyses and cultures from each percutaneous nephrostomy tube (PCN); utilizing ultrasound or abdominal pelvic computed tomography scans to rule out obstructive hydronephrosis, pyelonephritis, or renal abscess; exchanging the PCN once patients are receiving concordant antimicrobial therapy; and having patients complete an adequate course of targeted antimicrobials. Thereafter, patients were followed up until reinfection, routine PCN exchange at 3 months, being lost to follow-up, or death.

Results
We treated 100 patients. Their median age was 54 years; 53% were White. The most common malignancies were cervical (61%), ovarian (23%), and endometrial (13%), with 60% being metastatic. To analyze the risk factors for developing a recurrent PCNI, patients were placed in 3 different groups: those reinfected with the same organism (19%), reinfected with a different organism (17%), and not reinfected (64%). Overall, there were no differences among the patient groups regarding demographics, comorbidities, clinical presentation, infection timing, PCN exchange (Table 1) or microorganisms encountered (Table 2). However, patients with prior radiation therapy or pelvic fistulas (urinary-vaginal-rectal or their permutations) had higher rates for developing a recurrent PCNIs with the same organism (P&lt; .002).

Conclusion
Patients with prior radiation therapy and underlying pelvic fistulas have an increased risk for reinfection with the same pathogen. Therefore, further studies should be performed to mitigate this increased risk of recurrent infections with more frequent PCN exchanges or, more invasive procedure such as ureteral embolization, sclerosis, or ligation to dissociate the upper and lower urinary tracts.

Disclosures
All Authors: No reported disclosures.
2036. Dual VIM-producing Proteus mirabilis, Including a Novel VIM-75, Among Elderly Patients in a Medical Center from Hungary: Report from the 2020 SENTRY Antimicrobial Surveillance Program
Authors: Deshpande Lalitagauri M , Burián Katalin , Csányi Ilona Dóczi , Castanheira Mariana 
Published: December 2022

Abstract

Background
Nonsusceptibility of Proteus mirabilis to imipenem allows this pathogen evade surveillance for carbapenemases. Metallo-beta-lactamases of the VIM family are widespread among Enterobacterales in Europe. We identified an outbreak of P. mirabilis carrying 2 VIM enzymes among elderly patients from a medical center in Hungary.

Methods
A total of 16 P. mirabilis isolates were received from Hungary during 2020 as part of the SENTRY Antimicrobial Surveillance Program. Isolates were susceptibility tested by the CLSI reference broth microdilution method. Carbapenem-nonsusceptible isolates were submitted to whole genome sequencing, screened for resistance mechanisms, and evaluated for core genome multi-locus sequence typing (cgMLST).

Results
Among the 16 P. mirabilis isolates from Hungary, 5 carbapenem-nonsusceptible, multidrug-resistant isolates (3 from urinary tract infections and 1 each from bloodstream infection and pneumonia) were identified from patients 66-92 years old. Four of these 5 isolates were listed as community acquired. All isolates were resistant to ceftriaxone (MIC, &gt; 8 mg/L), cefepime (16- &gt; 32), imipenem ( &gt; 8), gentamicin ( &gt; 16), levofloxacin (16- &gt; 32), nitrofurantoin ( &gt; 64), trimethoprim/sulfamethoxazole ( &gt; 4), and plazomicin ( &gt; 128), but susceptible to meropenem (0.25-0.5) and ertapenem (0.03-0.25). Isolates carried blaVIM-4 and blaVIM-75 on a class 1 integron within IS26 and separated by aac(6’)-IIc. IS26 was located on a compound plasmid carrying other resistance-encoding genes, including armA. The integron structure is identical to the blaVIM-4 and blaVIM-1-carrying integron described from a Vibrio cholerae isolated from a seagull in France in 2015 (KR262557). blaVIM-75 is a single amino acid variant (Q60R) of blaVIM-1. All isolates carried mutations in the QRDR (gyrA_S83I, parC_S84I). Based on cgMLST analysis, these 5 P. mirabilis isolates were highly similar, with only 7-19 SNPs detected.

Conclusion
The outbreak of multidrug-resistant P. mirabilis isolates carrying blaVIM-4 and blaVIM-75 in a Hungarian medical center is a cause of concern. Surveillance should be performed to understand the spread of and treatment options for infections caused by carbapenem-nonsusceptible P. mirabilis.

Disclosures
Lalitagauri M. Deshpande, PhD, Melinta: Grant/Research Support|Pfizer: Grant/Research Support Katalin Burián, MD, JMI Laboratories: Grant/Research Support Ilona Dóczi Csányi, MD, JMI Laboratories: 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.