bluuebunny/crossref_metadata_2025_split huggingface dataset:
2017. Comparison of California Acute Care Hospital Central Line-Associated Bloodstream Infection Incidence by Hospital Location Before and During the COVID-19 Pandemic
Authors: Brenes Lizette , Magro Monise , Mitsunaga Tisha , Epson Erin 
Published: December 2022

Abstract

Background
Central line-associated bloodstream infection (CLABSI) incidence among acute care hospitals (ACH) and in some patient care locations such as critical care (CC) units increased substantially nationwide during the COVID-19 pandemic. We compared California ACH CLABSI incidence by location before and during the pandemic to identify locations with high burden to inform targeted prevention efforts.

Methods
Using California ACH (n=327) CLABSI standardized infection ratio (SIR) data from the National Healthcare Safety Network, we compared incidence during the second halves of 2019 (2019H2) and 2020 (2020H2) to evaluate early pandemic changes, and during 2019 (pre-pandemic) and 2021 (pandemic) periods by hospital type, location type (e.g., CC), and patient care location (e.g., medical CC), excluding rehabilitation units. A mid-P exact test was applied to compare SIRs between study periods.

Results
ACH CLABSI SIR increased statewide from 2019H2 to 2020H2 by 50.8% (0.65 to 0.98) and from 2019 to 2021 by 34.3% (0.67 to 0.90). Community hospitals &lt; 125 beds had the highest SIR and percentage increase in 2021 as well as 2020H2. Of 9 location types and 58 patient care locations, CC units and medical and medical-surgical CC had significantly higher SIR in both comparisons (2020H2 versus 2019H2 and 2021 versus 2019); wards and medical wards in 2020H2 only, and step-down units and adult step-down in 2021 only. Trauma CC SIR was significantly higher only in 2020H2 compared to 2019H2, while surgical CC SIR was significantly higher in 2021 compared to 2019. Respiratory CC had the highest SIR (2.99, 95%CI 2.14-4.08) in 2021, but was not significantly higher when compared to 2019 (1.06, 95%CI 0.21-3.41).

Conclusion
We observed an overall statewide increase in hospital CLABSI incidence, especially in CC locations, during the pandemic. Although the SIR increase relative to pre-pandemic was smaller in 2021 than in 2020H2, with some exceptions, most locations had persistently higher incidence. We will further assess associations between CLABSI incidence and antimicrobial resistance, device insertion dates, and hospital COVID-19 burden. We will use our findings to guide public health support for hospital infection prevention programs to reduce their CLABSI incidence.

Disclosures
All Authors: No reported disclosures.
2027. Popliteal Peripherally Inserted Central Catheter (PICC) Use in Neonates
Authors: Shahoud Fadi , Rathore Mobeen H 
Published: December 2022

Abstract

Background
PICCs are widely used in the neonatal intensive care unit (NICU). PICCs play an essential role in providing IV access to maintain administration of fluids, parenteral nutrition (TPN), and antibiotics to premature neonates. Multiple anatomical sites can be used for PICC placement. Complication rates vary depending on the PICC insertion site. There are few published data on the use of Popliteal PICCs (P-PICC) in neonates.

Methods
We retrospectively reviewed charts of all neonates admitted to a Level III NICU between 1/1/2016 and 12/31/2020 and underwent PICC placement.
Demographic data, number of days with PICC (dwell time), and complications were gathered. Complications included infectious and mechanical. These data were compared between P-PICC and non-Popliteal PICCs (NP-PICC) using Chi-square (C), t-test (T), and Mann-Whitney U test (MW).

Results
A total of 1241 PICCs were inserted in 784 neonates: 126 (10.2%) were P-PICCs and 1115 (89.8%) NP-PICCs.
The average dwell time for P-PICCs was 15.4 days compared to 14.2 days for NP-PICCs (p=0.24).
P-PICCs were more likely to have complications (11.5%) compared to NP-PICCs (8.7%) (p= 0.039.). Infectious complications for P-PICCs (5.5%) compared to NP-PICCs (3.2%) were significantly higher (p=0.048). For mechanical complications there was no significant difference between P-PICCs (11.5%) vs NP- PICCs (8.7%); (p = 0.17).
P-PICCs were more likely to be placed in lower birth weight and lower gestational age neonates compared to NP-PICC group (p&lt; 0.001).

Conclusion
There was a significant increase in overall complication rate in P-PICCs compared to NP-PICCS. This difference was primarily due to a higher number of infectious complications. The increased complication rate may have been driven by the lower gestational age and birth weight of the neonates. Additional data are needed to confirm this finding.

Disclosures
All Authors: No reported disclosures.
2045. IVAC Plus in the Time of COVID-19: An Imperfect Metric?
Authors: Spears Camille , Ford Delvina , Martinez Jose , Reveles Kelly R , Beck Erica , Garza Lauren N , Hoffmann Ann , Hoskins Serene , Cadena Jose 
Published: December 2022

Abstract

Background
Prior to the COVID-19 pandemic, the incidence of infection related ventilator associated complications plus possible ventilator associated pneumonias (IVAC+) was decreasing; however, as the number of COVID-19 hospitalizations increased, so did the number of IVAC+. Our goal was to investigate if there was a relationship between these two occurrences.

Methods
This was a retrospective study at the Audie Murphy VA Hospital (ALMVA) from October 2017 to December 2021. ALMVA is a level 1A facility with 232 beds and an active bone marrow transplant program in San Antonio, Texas. This study included acute care COVID-19 hospitalizations per 10,000 bed days of care and IVAC+ per 1000 ventilator days. Monthly acute and intensive care COVID-19 hospitalization rates were correlated with IVAC+ rates using Pearson correlation for the overall study period and in the subgroup of COVID pandemic months (Mar 2020-December 2021).

Results
During the overall study period, COVID-19 hospitalization rates were significantly associated with IVAC+ rates: acute care correlation 0.86 (p&lt; 0.01) and intensive care correlation 0.33 (p=0.04). During the COVID-19 pandemic months, acute care COVID-19 hospitalizations but not intensive care COVID-19 hospitalizations, were correlated with IVAC+ (correlation 0.90, p&lt; 0.01 and correlation 0.21, p=0.53, respectively). There were 0 IVAC+ before the pandemic months and this rose to 14 during (0 per 1000 ventilator days and 3.05 per 1000 ventilator days, respectively). All but 2 cases of IVAC+ had COVID-19.
COVID-19 Hospitalizations and IVAC Plus, October 2017 to December 2021
A sharp increase in COVID-19 hospitalizations correlated with a rise in patients meeting criteria for IVAC Plus.

Conclusion
The natural history of COVID-19 disease has presented challenges for IVAC+ monitoring. COVID-19 can cause persistent fevers and worsening oxygenation, and antibiotic use is common during periods of clinical deterioration. These factors can fulfill criteria for IVAC+. In this study, each IVAC+ case was traced for safety bundle compliance. These bundles were followed, along with conservative fluid management, low tidal volume ventilation, and sedation breaks. Patients met NHSN criteria for IVAC+ despite these measures and most had COVID-19. Given the common occurrence of IVAC+ in COVID-19 patients, futures studies are needed to define if IVAC+ are preventable in this population and whether IVAC+ surveillance has any value among COVID-19 patients.

Disclosures
All Authors: No reported disclosures.
2054. Trends in Incidence and Epidemiology of Methicillin-Resistant Staphylococcus aureus Bloodstream Infection, 2005–2020
Authors: Biggs Holly M , Jackson Kelly A , Nadle Joelle , Petit Susan , Ray Susan M , Lynfield Ruth , Como-Sabetti Kathryn , Bernu Carmen , Dumyati Ghinwa , Gellert Anita , Tracy Marissa , Schaffner William , See Isaac 
Published: December 2022

Abstract

Background
Methicillin-resistant Staphylococcus aureus (MRSA) is a serious antimicrobial resistance threat; prevention efforts have focused primarily on healthcare-associated MRSA infections. We assessed progress in MRSA bloodstream infection (BSI) prevention during 2005-2020.

Methods
MRSA BSI data were from CDC Emerging Infections Program’s active, population-based surveillance for invasive S. aureus in 17 counties in 6 states (sites). A case was defined as isolation of MRSA from a blood culture in a resident of the catchment area. Cases were considered hospital-onset (HO) if the culture was obtained &gt; 3 days after hospitalization, healthcare-associated community-onset (HACO) if the culture was obtained in an outpatient setting or ≤ 3 days after hospitalization in a patient with ≥ 1 prior major healthcare exposures, or otherwise community-associated (CA). Annual incidence was calculated per 100,000 census population for each epidemiologic classification.

Results
MRSA BSI incidence decreased from 32.2 (per 100,000 population) in 2005 to a nadir of 15.7 in 2016, then increased during 2017-2019 to 17.0 and decreased in 2020 to 16.4. (Figure 1). HACO comprised &gt; 50% of all cases throughout 2005-2020 and mirrored the pattern of overall rates. HO rates decreased from 9.2 to 2.3 during 2005-2013 and fell below CA rates starting in 2012; rates were lowest during 2017-2019 (1.8-2.1) and increased in 2020 to 2.4. CA rates remained 3.0-4.6 throughout the surveillance period; during 2015-2019, rates increased from 3.0 to 4.0, then in 2020 decreased to 3.4. All sites saw decreases in overall MRSA BSI rates by &gt; 50% during 2005-2020, and HACO rates in 2020 were at least 50% of total rates for each site. However, the relative proportion of CA and HO rates during 2020 varied by site (Figure 2), with CA MRSA BSI more than twice as common as HO MRSA BSI in two sites. Figure 1.Incidence rates of methicillin-resistant Staphylococcus aureus bloodstream infection, by epidemiologic classification, in 6 Emerging Infections Program sites, 2005–2020Figure 2.Ratio of incidence (per 100,000 population) of community-associated (CA) to hospital-onset (HO) methicillin-resistant Staphylococcus aureus bloodstream infection, in 6 Emerging Infections Program sites, 2020

Conclusion
MRSA BSI rates fell by more than half during the 15-year surveillance period, reflecting substantial declines in HACO and HO cases; however, the recent plateau suggests a need for additional preventive measures that restore previous progress. Increased focus on CA MRSA BSI prevention may be needed in some areas depending on local epidemiology.

Disclosures
Ghinwa Dumyati, MD, Pfizer: Grant/Research Support William Schaffner, MD, VBI Vaccines: Advisor/Consultant.
2056. Trends in the Rates of Multidrug-resistant Bacteria Commonly Associated with Healthcare in U.S. Acute Care Hospitals, 2019-June 2021
Authors: Kazakova Sophia V , Baggs James , Wolford Hannah , Rose Ashley , Natalie McCarthy , Olubajo Babatunde , Jernigan John A , Reddy Sujan 
Published: December 2022

Abstract

Background
Several studies demonstrated an increase in hospital-onset (HO) infections during the COVID-19 pandemic. We examined trends in the rates of multidrug-resistant (MDR) infections among acute care hospitals in the United States (U.S.) for bacteria commonly associated with healthcare: methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum cephalosporin resistance in Enterobacteriaceae suggestive of extended-spectrum beta-lactamase production (ESBL), vancomycin resistant Enterococcus (VRE), MDR Pseudomonas aeruginosa, carbapenem resistant Enterobacteriaceae (CRE), and carbapenem-resistant Acinetobacter species (CRAB).

Methods
We measured incidence of clinical cultures yielding the bacterial species of interest among hospitalized patients in a dynamic cohort of hospitals submitting data to the Premier Healthcare Database Special COVID-19 Release during 2019-June 2021. Community-onset (CO) cultures were obtained ≤ day 3 of hospitalization; HO were obtained ≥ day 4. We determined monthly hospital-specific rates for each species. We used generalized estimating equations (GEE) multivariable negative binomial regression models adjusting for hospital characteristics to examine trends.

Results
From 2019-June 2021, the overall number of hospitals contributing data was 318. Rates for each pathogen are shown in Figures 1 and 2. All pathogens’ HO rates were significantly higher in 2021 compared with 2019. The rates of ESBL, VRE, and CRE were also significantly higher in 2021 when compared to 2020 (Table 1a). For CO rates, we found that MRSA rates decreased significantly during the study period, while ESBL, VRE, and CRE increased with varying degree of significance (Table 1b). Rates of CO MDR Pseudomonas and CO CRAB did not significantly change.

Conclusion
Our study confirmed that the rates of several MDR infections increased during the COVID-19 pandemic through June 2021, especially HO infections. CO MRSA was the only pathogen with consistent and significant decline. As infections caused by MDR pathogens represent a serious threat to patient safety, further study of factors contributing to the emerging trends may inform prevention strategies during a pandemic.

Disclosures
All Authors: No reported disclosures.
2361. Timing of antiretroviral therapy prior to diagnosis of cryptococcal meningitis
Authors: Chang Bickey , Wele Abduljewad , Atoma Bethlehem , Kagimu Enock , Muzoora Conrad , Musubire Abdu , Boulware David R , Meya David 
Published: December 2022

Abstract

Background
Cryptococcal meningitis (CM) is the most common cause of meningitis in adults in Sub-Saharan Africa (SSA), causing significant morbidity and mortality in people living with HIV. Early initiation of antiretroviral therapy (ART) after cryptococcal diagnosis is associated with increased mortality. With increasing access to ART in SSA, an increasing proportion of CM patients are now presenting on ART, and outcomes remain unclear.

Methods
We performed a retrospective study of 724 participants with positive CSF cryptococcal antigen in four clinical trials performed in Uganda from June 2017 to February 2022. We compared survival outcomes based on ART experience at the time of CM diagnosis. We had implemented structured ART interruption when ART had recently been initiated (&lt; 2weeks).

Results
Sixty-one percent (445/724) of participants were ART-naïve at the time of CM diagnosis. Compared to those receiving ART, those ART-naïve had lower CD4 counts and higher Cryptococcus colony forming units (CFUs)/mL on quantitative CSF culture (p&lt; 0.001). However, the two-week mortality between ART-naïve and ART-experienced groups did not statistically differ (16.6% vs. 16.8%, Hazard Ratio = 0.97 (95%CI, 0.67–1.40) as well as for ten-week mortality (25.4% vs. 26.2%, Hazard Ratio = 0.98 (95%CI, 0.73–1.31)). Further stratification of ART-experienced participants by length of ART experience (&lt; =2 weeks vs. &gt;2 weeks prior to diagnosis) and ART continuation status (ART continued vs. discontinued if ART started &lt; =2 weeks prior to diagnosis) demonstrated no statistically significant difference between the groups for two- or ten-week mortality.

Conclusion
Cryptococcal diagnosis after ART initiation is now increasingly common. In this study, we found no significant mortality differences between ART-naïve and ART-experienced participants at 2 weeks and 10 weeks. Accounting for length of ART experience did not change these short-term mortality outcomes. One potential limitation of our study is different CM treatment regimens were used across clinical trials.

Disclosures
All Authors: No reported disclosures.
2062. Impact of Indeterminate HIV Test Results on Efficacy of Emergency Department Routine HIV Screening
Authors: Aguilera Elizabeth A , Del Bianco Gabriela P , Rodriguez Gilhen , Perez Norma , Heresi Gloria , Murphy James , Prater Samuel J 
Published: December 2022

Abstract

Background
In 2019, 36,801 new HIV cases were reported in the United States. Emergency Department routine HIV testing is crucial to identify new asymptomatic HIV infections. Early diagnosis followed by prompt antiretroviral therapy decreases morbidity and mortality and reduces HIV transmission. The Emergency Department (ED) at Memorial Hermann Hospital (MHH) - Texas Medical Center (TMC) in Houston, Texas, implemented an ED-routine HIV screening program in June 2017. At times, the testing for HIV yields indeterminant results. Consequences of indeterminate HIV tests include individuals unaware of their HIV infection status transmitting infection and not receiving antiretroviral therapy.

Methods
39,288 adults who presented to ED MHH –TMC from June 2017 to March 2022 with a Glasgow score &gt; 9 were tested using an Opt-Out protocol for HIV infection. Testing comprised a screening assay (HIV 4th Generation (GEN) ADVIA Centaur TM Ag/Ab COMBO (Siemens)) followed by a confirmatory test (GenniusTM HIV1/HIV2). A second confirmatory test is performed if screening and first confirmatory tests yield conflicting (indeterminant) results (HIV1 RNA PCR or a repeat 4th GEN test).

Results
824 (2.0 %) patients tested positive for HIV infection; 94 (0.2%) yielded indeterminate test results. 61 (64.8%) of the patients with indeterminate findings received confirmatory testing; 37 (39.4%) before leaving the hospital (35 HIV negative, 2 positive). Of the 57 (60.1%) who left the hospital before confirmatory testing, 24 (42.1%) were traced and tested (21 HIV negative, 3 positive). 33 (35.1%) were lost to follow-up (11 of whom were reported homeless or in unstable housing).

Conclusion
The primary cause of failure to follow up testing on patients who tested indeterminant during an ED visit is a loss of contact with the patients after leaving the ED. In turn, failure to link these patients to HIV care relates to a failure to complete confirmatory testing before completion of the hospital visit. Therefore, the quantitative results presented will enable the assessment of the best deployment of resources in capturing those patients currently lost to follow-up.

Disclosures
Norma Perez, DO, Theratecnologies, Inc: Advisor/Consultant.
2064. Incidence and Risk Factors for Microscopic Hematuria in a US Military HIV Cohort
Authors: Wachs Stephanie , Xu Xiaohe , Daniels Colton , Sunil Thankam , Telu Kalyani , Colombo Rhonda E , Lalani Tahaniyat , Berjohn Catherine M , Ganesan Anuradha , Agan Brian , Okulicz Jason F , Lindholm David A 
Published: December 2022

Abstract

Background
Microscopic hematuria (MH) is a common finding on screening urinalyses in persons living with HIV (PLWH); however, a study in the pre-HAART era revealed that a complete urologic evaluation was generally non-diagnostic in young males with a benign history and normal renal function. Recent studies have shown a decreased incidence of hematuria in PLWH in the HAART era. We performed a nested case-control study in the prospectively enrolled US Military HIV Natural History Study (NHS) to evaluate characteristics of PLWH with and without MH.

Methods
We evaluated male participants diagnosed with HIV and enrolled in the NHS Jan 2007 to Dec 2019. MH cases were defined as having at least one urinalysis with ≥5 RBCs/hpf. We used descriptive statistics to compare cases and controls with respect to demographics, comorbidities, and laboratory findings to determine risk factors for MH. Cox regression models evaluated for independent associations with the development of MH since HIV diagnosis.

Results
Of 829 included participants, 142 (17.1%) had MH, of whom 87 (61.3%) had only one MH event. Cases had a shorter mean duration of study follow-up but more analyzable urinalyses per participant. There were no significant differences between cases and controls in demographics, CD4 count nadir, time from HIV diagnosis to HAART initiation, or inclusion of tenofovir disoproxil fumarate (TDF) in initial regimen. On univariate analysis, more cases had a history of urinary tract infection (UTI) or a hypertension diagnosis through the time of incident MH compared to controls, but were less likely to have proteinuria or pyuria at the time of MH. Cox regression models revealed that a history of UTI increased the hazard for MH (HR 2.07, p &lt; 0.05). In contrast, the presence of proteinuria (HR 0.42, p&lt; 0.01) and TDF use (HR 0.56, p&lt; 0.05) decreased the hazard for MH compared to controls.

Conclusion
A history of UTI, though not concurrent pyuria, was associated with an increased hazard for MH. The use of TDF in the initial HAART regimen and the presence of proteinuria were protective against hematuria. Future studies are needed to clarify these findings; however, they provide reassurance that in a young, otherwise healthy cohort, MH is typically self-limited and unrelated to intrinsic renal pathology, comorbidity, or HIV-related factor.

Disclosures
All Authors: No reported disclosures.
2362. Adoption and Utilization of Social Media among Adult and Pediatric Infectious Diseases Divisions and Fellowship Programs in the United States and Canada
Authors: Ryder Jonathan H , Mowrer Clayton , Van Roy Zachary A , Lyden Elizabeth , Lyden Elizabeth , Lyden Elizabeth , Cawcutt Kelly , Marcelin Jasmine R 
Published: December 2022

Abstract

Background
Social media (SoMe) is used by 72% of US adults. The utility of SoMe for infectious diseases (ID) has been highlighted by the COVID-19 pandemic. Adoption and utilization of SoMe by ID divisions is not well characterized.

Methods
We conducted a systematic search strategy for US and Canadian ID fellowship/division SoMe accounts – specifically Twitter, Facebook (FB), and Instagram (IG) – in November-December 2021. We collected data from program websites, SoMe accounts, and NRMP and FREIDA databases. Primary outcome was ID SoMe account prevalence. Secondary outcomes included measures of SoMe characteristics, adoption, and activity comparing adult and pediatric programs. We reported descriptive statistics.

Results
Of 243 ID programs in the US and Canada, 170 (70%) are adult and 73 (30%) are pediatric with 222 (91.4%) programs in the US. Twitter, FB, and IG accounts were found for 70 (31.5%), 14 (6.3%) and 14 (6.3%) US programs, respectively (Table 1); 2/21 (9.5%) Canadian programs had a SoMe account (Twitter). Twitter accounts were associated with larger programs and higher match rates (Table 2). SoMe activity and engagement before and during IDWeek 2021 is in Table 3. More adult programs had Twitter accounts (37.3% vs 17.2%, p=0.004), but utilization was similar between adult and pediatric programs. Most Twitter posts were educational (1653/2859, 57.8%); FB primarily promotional (68/128, 53.1%); IG mostly social (34/79, 43%). COVID-19 related posts were found in 821/2859 (28.7%) Twitter posts, 33/128 (25.8%) FB posts, and 5/79 (6.3%) Instagram posts. FB was the earliest adopted SoMe platform for ID, but Twitter and IG have more recent growth. The rate of Twitter account creation increased from 0.35 accounts/month prior to March 2020 (COVID pandemic declaration) to 1.95 accounts/month after March 2020. 71.4% (10/14) of IG accounts were created after March 2020.

Conclusion
SoMe remains underutilized across all ID divisions, but COVID-19 and virtual recruiting may have influenced recent account creation (Figure 1). Twitter is the most frequently used ID program SoMe platform in comparison to FB and IG, and use increased during IDWeek. ID divisions should embrace the digital and SoMe space with benefits for recruitment and amplification of their trainees, faculty, and specialty.

Disclosures
Jasmine R. Marcelin, MD, Pfizer/Mayo Clinic Global Bridges: Honoraria.