bluuebunny/crossref_metadata_2025_split huggingface dataset:
1166. Botulism poisoning fatalities linked to home-canned food products - Tajikistan, 2021
Authors: Shoeva Sakina M , Aminov Safarali , Dzhurakhon Azizov , Horth Roberta , Zhakipbayeva Bakhytkul 
Published: December 2022

Abstract

Background
Botulism is a rare but fatal illness often caused by consumption of foods containing Clostridium botulinum neurotoxins. We investigated an outbreak among people having attended a family dinner in Kushkiya village, Tajikistan in December 2021.

Methods
We interviewed dinner participants using a structured questionnaire to collect clinical, demographic, and prior 48-hour food histories. We abstracted data from medical records. A case was defined as a person who attended the event with symptoms clinically compatible with botulism.

Results
Thirteen people attended the dinner event. Of these, 10 (77%) were classified as a case. Case-patients ages ranged from 2 to 40 years old; five were children &lt; 12 years old. All case-patients had muscle weakness, dizziness, dry mouth, nausea, and vomiting. Two had abdominal pain, five had symmetric paresis, two had shortness of breath, and two had double vision. Median time from dinner event to development of symptoms was 22 hours (range 17-30 hours). Four patients (40%) were hospitalized in serious condition, including two children in comas. Four patients died (40%). Deaths occurred on average 48 hours after the dinner (range 41-55 hours). All ten cases had eaten homemade canned salad. Two other dinner participants ate the canned salad, but did not get sick. The canned salad was made of tomatoes, onions, garlic, and oil. It had been prepared in September 2021. Due to limited capacity for botulism testing in Tajikistan diagnostics were not performed. The infectious disease hospital did not have botulism antitoxin in stock upon patient admission. Deceased patients had not received antitoxin. On the third day after exposure, botulism antitoxin (A, B, C and E) was given to 9 dinner participants; all of whom survived.

Conclusion
The high case fatality rate highlights the need to increase clinician awareness of botulism, educate and improve their ability to provide emergency and respiratory care, and ensure stocks of anti-botulinum serum in health facilities. Additionally, improved national diagnostic capabilities to detect botulism and identify toxin types can help identify sources. Lastly, public health messaging may help increase safe food preparation practices.

Disclosures
All Authors: No reported disclosures.
1173. Increased risk of dementia in patients after Scrub typhus: a nationwide, population-based study in Korea
Authors: Kim Jooyun , Park Dae Won , Seo Gi Hyeon , Jeon Ji Hoon , Seok Hyeri , Choi Won Suk 
Published: December 2022

Abstract

Background
Scrub typhus causes systemic vasculitis and can lead to complications ranging from pneumonia and acute renal injury to meningitis or encephalitis. In South Korea, it occurs not only in rural areas but also in urban areas, and especially high in older people. We hypothesized that patients with scrub typhus are predisposed to increased risks for developing dementia.

Methods
We performed a population-based cohort study, in which persons aged between 60∼89 years, used the Health Insurance Review and Assessment database of South Korea between 2009 and 2018. The case definition of scrub typhus was based on the ICD-10 diagnostic code and prescription of doxycycline more than three days. Dementia was defined as patients with the code in expending benefit coverage or patients with the ICD-10 codes, examination codes and drug codes. The control group was selected as stratifying by age and gender at a ratio of 1:5 to the number of the case group in study population.

Results
During the observational periods, Of 76,073 patients had diagnosed with scrub typhus, 5,026 excluded due to diagnosed with scrub typhus during window period, with dementia or died before index date, 71,047 patients were included as case group. 355,235 patients were included as controls. During a mean follow-up of 5.6±2.9 years, 14,089 (19.8%) patients with previous scrub typhus and 61,807 (15.2%) controls had been developed dementia. Scrub typhus was significantly associated with dementia (adjusted hazard ratio [aHR], 1.12; 95% confidential interval [CI], 1.10-1.15, P&lt; 0.001). Of dementia classification, the risk of Alzheimer dementia was significantly higher in the case group (17.8% vs 15.2%; aHR, 1.15; 95%CI, 1.13-1.18, p&lt; 0.001), however, there was no significant difference in the risk of vascular dementia (2.1% vs 2.2%; aHR, 0.98; 95%CI, 0.83-1.16, p=0.82).
Cumulative incidence of dementia during the follow-up period by the history of scrub typhus
It shows in both groups dementia incidence increased over time and the case group had higher incident dementia compared with control group.

Conclusion
History of scrub typhus infection in elderly was associated with increased risk for dementia, especially Alzheimer’s dementia. Our results suggest that prevent measures of dementia could be improved by preventing and treating scrub typhus.

Disclosures
All Authors: No reported disclosures.
1176. Metagenomic Next-Generation Sequencing of Nasopharyngeal Swabs in Acute Febrile Illness in Cambodia
Authors: Yek Christina , Lay Sreyngim , Chea Sophana , Bohl Jennifer , Oum Mengheng , Ly Sokna , Sath Ratanak , Ahyong Vida , Tato Cristina , Seng Heng , Ly Sovann , Lon Chanthap , Manning Jessica 
Published: December 2022

Abstract

Background
There is growing recognition of metagenomic next-generation sequencing (mNGS) as a valuable diagnostic tool capable of providing unbiased pathogen detection, but data on performance in low-resource settings remains scant. Here, we use mNGS of nasopharyngeal (NP) swabs taken from subjects in Cambodia to identify potential pathogens causing acute febrile illness.

Methods
Febrile subjects aged 2 months to 65 years were enrolled in a cross-sectional study conducted across 4 tertiary hospitals in Cambodia. NP swabs were collected at hospital presentation. Depending on reported symptom constellations, sera was also taken in a subset of subjects for comparison of mNGS results. RNA was isolated from biosamples, converted to cDNA libraries, and sequenced on a NextSeq2000 (Illumina). Raw sequence reads were stripped for host reads and aligned to NCBI nucleotide and protein databases using a cloud-based bioinformatics platform (CZID).

Results
NP swabs were collected from 97 subjects between April 2020 and June 2021. Subjects were predominantly male (53.6%) and young (median age 3 years [IQR 1-25]). Pathogens were identified in 42 (43.2%) NP swabs; of these, 26 (61.9%) were respiratory viruses including 9 rhinovirus, 7 coronavirus (1 SARS-CoV-2), and 5 respirovirus cases. Co-infection was identified in 3 subjects with coronavirus and respirovirus (N=2) and coronavirus and rhinovirus (N=1). Of subjects with paired sera and NP samples (N=61), 18 (29.5%) had positive NP swabs but negative sera, 7 (11.5%) had negative NP swabs but positive sera, 12 (19.7%) had positive NP swabs and sera, and 24 (39.3%) had negative NP swabs and sera. Pathogen hits correlated in NP swabs and sera in 10 of 12 subjects, including six subjects with chikungunya.

Conclusion
mNGS can be successfully implemented in low-resource settings to identify emerging pathogens and common respiratory pathogens, including co-infecting pathogens, from NP swabs of febrile patients. mNGS may also be able to detect chikungunya from NP swab alone, raising the possibility of non-invasive diagnostics for infections associated with high viremic states.

Disclosures
All Authors: No reported disclosures.
1177. Mind the GAPP: Global Arrivals and Pre-treated Patients screening at a children’s cancer center
Authors: Mukkada Sheena , Max Anita , Denzin Tessa , Gadir Ghussai Abd El , Adderson Elisabeth , Hakim Hana , Hayden Randall , Maron Gabriela , Wolf Joshua 
Published: December 2022

Abstract

Background
Clinical and laboratory evaluation for infectious diseases prior to initiation of cancer-directed therapy creates opportunities for risk assessment, infection prevention and targeted treatment. The need may be greater for patients from outside the United States (US) where the epidemiology of infectious diseases may differ. We created the Global Arrivals and Pretreated Patients (GAPP) program to address this need at a referral hospital for children with cancer and blood disorders.

Methods
Patients accepted for treatment at our hospital are referred to GAPP for the following reasons: 1) residence in the continental US for 1 year or less, 2) travel outside the continental US within 3 months of referral 3) hospitalization outside the continental US, or 4) clinician request. GAPP evaluation includes review of history and laboratory studies, and recommendations for screening tests and management.

Results
Between March 21, 2019 and May 2, 2022, 35 patients were evaluated; 9 (26%) with solid or CNS tumors, 25 (71%) with hematological malignancies and 1 (3%) with immune thrombocytopenic purpura. Of these, 20/35 (57%) were from Latin America, and 10/35 (29%) from Eastern Europe. Most patients (29/35 [83%]) were seen within 2 weeks of arrival to the institution. Evaluation prompted isolation precautions in 2/35 (6%) for communicable respiratory illness and in 4/35 (11%) for ESBL-producing organism on perianal screen. Additionally, 13 patients were under-immunized (mostly non-immune to hepatitis B [7/35, 20%] or varicella zoster virus [8/35, 22%]), and 9/35 (26%) had an exposure-related risk. Finally, parasitic infection prompted specific management in 4 patients; 3/35 (9%) had positive serology for Toxoplasma gondii requiring appropriate prophylaxis, and 1/35 (3%) was treated for cryptosporidiosis.

Conclusion
Screening new arrivals to the US prior to administration of immunosuppressive therapy is feasible and may identify risk factors for illness during therapy as well as opportunities for infection prevention, immunization, and treatment or suppression of existing infections. Providers focusing on acute hematologic or oncologic illness may otherwise miss this quality improvement opportunity in a patient group at high risk of poor infectious outcomes.

Disclosures
Randall Hayden, MD, Inflammatix: Advisor/Consultant|Quidel Corporation: Advisor/Consultant|Roche Diagnostics: Advisor/Consultant|T2 Diagnostics: Advisor/Consultant Gabriela Maron, MD, Astellas Inc,: Grant/Research Support|SymBio Pharmaceuticals: Grant/Research Support Joshua Wolf, MBBS, PhD, Karius: Grant/Research Support|Merck: Participation in industry sponsored research.
1178. Opportunities and Challenges to Emergency Department-Based HIV Testing Services and Self-Testing Programs: A Qualitative Study of Healthcare Providers and Patients in Kenya
Authors: Aluisio Adam , Bergam Scarlett , Ogory Agot , Ngila Beatrice , Sugut Janet , Bosire Rose , Bukusi David , Kinuthia John , Guthrie Kate , Katz David , Farquhar Carey , Mello Michael 
Published: December 2022

Abstract

Background
Young people in Sub-Saharan Africa, especially males, have been insufficiently engaged through HIV Testing Services (HTS). In Kenya, younger persons are often treated in emergency departments (EDs) for injuries, an interaction where HTS and HIV self-testing (HIVST) can be leveraged. Data from stakeholders on ED-HTS and HIVST is lacking and needed to understand opportunities and barriers for HIV testing and care, and inform program implementation.

Methods
Between December 2021 and March 2022, 32 in-depth interviews (IDIs) were conducted with 16 male and 16 female patients who had been treated in the Kenyatta National Hospital (KNH) ED, half of whom had been HIV-tested. Six focus-group discussions (FGDs) were also conducted with 50 nurses, doctors, HIV testing counselors, and administrators working in the ED. All transcripts were double-coded and thematically analyzed using Dedoose software and a parallel inductive and deductive coding approach which allowed for capture of both a priori and emergent themes.

Results
Patients and providers agreed that ED-HTS are facilitated by friendly staff, patient education, high perceived HIV risk, and confidentiality. However, ED-HTS is limited by burdens on staff, resources, time, and space, as well as severity of patient injuries limiting ability to consent to or prioritize HIV testing. These limitations provide opportunities for ED-HIVST: particularly the ability to test at a comfortable time and place, especially when provided alongside sufficient HIV and testing education, contact with healthcare providers, and psychosocial support. Barriers for ED-HIVST where identified and as patients’ concerns about HIVST accuracy and mental health impacts of a positive test, as well providers’ identified barriers on their concerns for loss to follow up and inability to complete confirmatory testing.
COM-B Model
Application of the COM-B Model of Behavior Change to ED-HIVST Acceptability in Kenya

Conclusion
ED stakeholders are receptive to HTS and HIVST, and patients desire the opportunity to use HIVST. Potential challenges—such as psychological effects of testing positive, worries about access to follow-up care, and confusion about how to self-administer testing, may be addressed through programming designed to promote education, access and ensure follow-up mechanisms.

Disclosures
All Authors: No reported disclosures.
1188. Efficacy of Copper Impregnated Self-Sanitizing Surface Against Clostridioides difficile Spores
Authors: Ashby Landon , Navarathna Thanuri , Coppin John David , Chatterjee Piyali , Williams Marjory D , Bennett Morgan , Choi Hosoon , Hwang Munok , Xu Jing , Nelson Richard , Allton Yonhui , Jinadatha Chetan 
Published: December 2022

Abstract

Background
Clostridioides difficile (C. diff) is one of the most common causes of healthcare-associated infections (HAIs), leading to increased hospital stay, cost, and mortality. Elimination of C. diff spores is difficult as they are resistant to kill by common hospital grade disinfectants. Copper impregnated self-sanitizing surfaces (SSSCu) provide continuous reduction of vegetative pathogens, potentially lowering the risk of infections, but their efficacy on C. diff spores has not been previously evaluated.

Methods
Control (no copper) and copper coupons containing 20% copper-oxide were inoculated with varying C. diff spore loads ranging from 105 to 107 spores, prepared using environmental protection agency protocol, with or without 5% fetal bovine serum (FBS) soil load. After 4 hours of contact time, the C. diff spores were recovered and tested for viability. The efficacy of copper (log10 kill) was estimated using a Bayesian linear multilevel model.

Results
After 4 hours, the copper coupons, at mean initial spore load (6.67 log10) and no soil load, had a mean 1.21 (95% uncertainty interval: 1.13 - 1.31) log10 reduction compared to control coupons. With soil load, the treatment effect of copper decreased by 0.50 (95% uncertainty interval: 0.37 - 0.64) log10. Also, for each additional standard deviation (SD) increase in initial spore load there was a 0.59 (95% uncertainty interval: 0.47 - 0.72) log10 decrease in the treatment effect of copper. The soil load in combination with increasing initial spore load further decreased the treatment effect of copper by an additional 0.19 (95% uncertainty interval: 0.01 - 0.38) log10 for each SD increase in initial spore load.

Conclusion
Copper coupons can substantially reduce C. diff spores after 4 hours by 50%-97% depending on the initial spore concentration and presence or absence of organic material. Higher initial spore loads or excess organic material may prevent the spores from coming in contact with the copper-impregnated surface thus decreasing the kill efficacy. Continuous sporicidal effect of copper-impregnated surfaces might prevent transmission of spores and help reduce HAIs. Further studies are needed to evaluate the efficacy on C. diff HAI rates.

Disclosures
Piyali Chatterjee, PhD, AHRQ Grant # 1R03HS027667-01: Grant/Research Support|AHRQ Grant # 1R03HS027667-01: Central Texas Veterans Health Care System Chetan Jinadatha, MD, MPH, AHRQ R01 Grant-5R01HS025598: Grant/Research Support|EOS Surfaces: Copper Coupons and materials for testing.
1192. Containment of Sustained Transmission of Drug-resistant Acinetobacter baumannii by Pulsed-Xenon Ultraviolet Disinfection of the Patient Room in the Intensive Care Unit
Authors: Morikane Keita , Yakuwa Jun , Nakane Masaki 
Published: December 2022

Abstract

Background
No-touch environmental disinfection has been highlighted in the last decade to control transmission of multidrug-resistant Gram-positive organisms including MRSA and VRE, but its effectiveness to control gram-negative bacteria has not been well examined. Also, its effectiveness outside the US healthcare setting is seldom reported.

Methods
This study was conducted in the intensive care unit (ICU) of Yamagata University Hospital, a 637-bed tertiary referral hospital. Sporadic acquisition of two drug-resistant Acinetobacter baumannii (2DRA) began in late 2013. Despite various infection control practices including hand hygiene promotion and intensified manual terminal cleaning, transmission of this pathogen continued. In February 2018, pulsed-xenon ultraviolet (PX-UV) disinfection was added. The study periods were defined as follows: the baseline period (August 2016 to January 2018, intensified manual cleaning) and the intervention period (February 2018 to December 2021, addition of PX-UV). Throughout the study periods, all patients were regularly screened for 2DRA to detect acquisition of those pathogens in the ICU.

Results
The incidence of newly acquired 2DRA significantly declined over time (4.45 per 1,000 patient days in the baseline period to 1.20 in the intervention period, relative risk (RR): 0.27, 95% confidence interval: 0.12-0.61). Notably, horizontal transmission of 2DRA was completely contained, not only in the ICU but also throughout the hospital (Figure).
Newly acquired 2DRA events (all wards, monthly)

Conclusion
Adding PX-UV after through manual terminal cleaning is effective in controlling acquisition of 2DRA in the ICU patients and led to termination of transmission of 2DRA in our hospital. The effectiveness of PX-UV in controlling gram-negative MDROs in the non-US healthcare settings is suggested.

Disclosures
All Authors: No reported disclosures.
1201. Reduction of Methicillin-Resistant Staphylococcus aureus Surface Microbial Burden and related Healthcare Associated Infections with the implementation of an Advanced Photocatalytic Oxidation Technology in a Medical-Surgical Intensive Care Unit
Authors: Stowe Caitlin , Lambert Beth Ann , Berthelot Lori , Baumgarten Katherine , Leger Nattie 
Published: December 2022

Abstract

Background
Methicillin Resistant Staphylococcus aureus (MRSA) bacteria have been long established as a major cause of infections. MRSA infections occurring in blood or other sterile sites are associated with poorer health outcomes and an increased risk of mortality, especially when acquired in a healthcare setting. The ongoing COVID-19 pandemic has not only stymied reduction efforts but has precipitated increases in invasive HO-MRSA infections, with increases seen of 12-34% in national MRSA standardized infection ratios in 2020 compared to 2019. The facility had seen similar increases of HO-MRSA infections, defined as a positive culture on or after the 3rd hospital day, despite no change in clinical practice.

Methods
A prospective study was conducted in a 22 bed Medical-Surgical Intensive Care Unit from November 2021 to March 2022. 50 surface samples were collected from surfaces throughout the unit including two nurses’ stations, physician charting area, and 5 areas in 7 patient rooms. The advanced photocatalytic oxidation (aPCO) equipment was then installed in the HVAC ductwork throughout the ICU and activated. Sampling was then repeated every four weeks during the study period. The facility’s normal disinfection protocols were unchanged. HO-MRSA infections attributed to the unit were also tracked during the study period. Changes in MRSA surface burden were calculated using a repeated methods ANOVA with post hoc analyses as appropriate. Rates of HO-MRSA infections per 1,000 patient days were compared using the chi-square test.

Results
There was a 98% statistically significant decrease in MRSA surface burden from the baseline to final post-activation test. The average colony forming unit count (CFU) went from 427 to 3 CFU/100cm2 during the same time. HO-MRSA infections also had a statistically significant decrease when compared to the same time frame a year prior and the immediate 6 months prior to the study. Figure 1Average MRSA Surface Reduction

Conclusion
The aPCO technology resulted in a reduction of MRSA on frequently touched surfaces in a high-traffic ICU. Corresponding decreases in HO-MRSA cases were also seen. This study highlights a novel aPCO technology and its efficacy at reducing microbial burden and healthcare-onset MRSA infections despite no change in practice and through the continued COVID-19 pandemic.

Disclosures
Caitlin Stowe, MPH, CPH, CIC, CPHQ, VA-BC, ActivePure Medical: Employee|PDI Healthcare: Employee.