bluuebunny/crossref_metadata_2025_split huggingface dataset:
2002. Clostridioides difficile Infection Recurrence Trends and Characteristics at a Community Medical Center
Authors: Anwar Lara , Box Maggie 
Published: December 2022

Abstract

Background
Updated IDSA C. difficile Infection (CDI) guidelines recommend fidaxomicin as preferred therapy for initial infection as studies demonstrate increased sustained response 4 weeks after the end of therapy compared with vancomycin. Implementation of this is dependent upon available resources and vancomycin is recommended as an acceptable alternative. A course of fidaxomicin costs 30-50 times more than oral vancomycin and presents a pharmacoeconomic challenge. This study evaluated the incidence and characteristics of CDI recurrence in a community medical center to assess feasibility of implementing new CDI treatment recommendations.

Methods
This multicenter, retrospective study was conducted at Scripps Health from 1/1/2019 - 12/31/2019. Adult patients with an initial CDI diagnosis (EIA antigen/toxin positive) were included. The primary endpoint was clinical cure, defined as no recurrent episodes of CDI one year after treatment. Secondary endpoints evaluated baseline characteristics and treatment between patients experiencing recurrence or no recurrence. Outcomes were assessed using count and proportion for descriptive data and Chi-Square, Fisher’s Exact and Logistic Regression for categorical data.

Results
A total of 223 patients were included, of which 18.4% (41/223) had recurrence. There was no difference in recurrence based on age &gt; 65, sex, ethnicity, severity, and inpatient status (p &gt; 0.05). There were no differences in comorbidities (kidney disease, cardiovascular disease, diabetes, malignancy, or pulmonary disease, p &gt; 0.05) with the exception of cerebrovascular disease which was significantly higher in patients with recurrence (34.2% vs 13.2%, P = 0.001). Recurrence rates were similar between treatment groups (p = 0.383) which included vancomycin (n = 193, 20%), fidaxomicin (n = 4, 25%), metronidazole (n = 9, 0%), and vancomycin + metronidazole (n = 17, 12%).

Conclusion
Presence of cerebrovascular disease was the only characteristic associated with a higher incidence of CDI recurrence. The majority of patients were treated with oral vancomycin, and there was no difference in recurrence based on treatment although there were low numbers in non-vancomycin cohorts. Vancomycin is an acceptable alternative for the management of CDI in our population.

Disclosures
All Authors: No reported disclosures.
2005. Direct Hospitalization Costs Associated with Resistant and Susceptible Salmonella and Shigella Infections in the United States — 2012–2019
Authors: Tobolowsky Farrell A , Salah Zainab , Kim Sunkyung , Baggs James , Olubajo Babatunde , Cui Zhaohui , Douglas Scott R , Wolford Hannah , Natalie McCarthy , Medalla Felicita , Watkins Louise F 
Published: December 2022

Abstract

Background
Foodborne illnesses cost ∼$90 billion in the United States annually. Antibiotic-resistant infections may be more difficult to treat and can be associated with severe outcomes, leading to higher costs and longer length of stay (LOS). We described LOS and costs for hospital admissions for Salmonella and Shigella infections by resistance status.

Methods
We reviewed all inpatient admissions from ∼300 hospitals in the Premier Healthcare database during 2012–2019 and included records with culture-confirmed nontyphoidal Salmonella (NTS), typhoidal Salmonella (serotypes Typhi and Paratyphi A, B, and C), or Shigella. We classified infections as resistant if laboratory testing found resistance to ≥1 drug in the clinically important antibiotic categories (fluoroquinolones, macrolides, penicillins, folate pathway antagonists, or third-generation cephalosporins) or susceptible otherwise. We used the Wilcoxon rank sum test to assess difference in median LOS and cost of patient hospitalization for resistant vs. susceptible infections by pathogen type.

Results
Of 4,168 persons hospitalized, about half (n=2,129, 51%) were female; median age was 52 [IQR: 26‒68] years; 29% (n=1,217) of infections were resistant. For NTS infections, median LOS was 4 [IQR: 3‒7] days for resistant and 4 [IQR: 3‒6] (p=0.04) for susceptible; for typhoidal Salmonella, 6 [IQR: 5‒8] for resistant and 5 [IQR: 3‒8] for susceptible (p=0.15); and for Shigella, 3 [IQR: 2‒4] for both (p=0.09). Median costs were highest for typhoidal Salmonella ($12,577 resistant vs. $9,238 susceptible; p=0.21), followed by NTS ($7,179 vs $6,421, p=0.01) and Shigella ($4,975 vs $5,335; p=0.26).

Conclusion
Hospitalization costs were higher for patients with some resistant infections. Longer LOS may contribute to higher costs; however, it is not clear whether other pathogen or patient factors (e.g., comorbidities) also contributed. Additional data and adjusted analyses may provide insight into reasons for the cost difference. If resistant infections are shown to be the cause, our findings support that public health interventions to limit the spread of resistant infections could reduce costs.

Disclosures
All Authors: No reported disclosures.
2006. Long-term efficacy of lower-gastrointestinal delivery fecal microbiota transplantation for recurrent Clostridioides difficile infection
Authors: Greene Devin M , Fabian Amy , Taylor Colton 
Published: December 2022

Abstract

Background
The rate of recurrent Clostridioides difficile infection (rCDI) is 15-28% for those that initially respond to antibiotics and increases to about 50% in those with more than two recurrences. Fecal microbiota transplantation (FMT) is a treatment option for patients that have failed antibiotics for at least two rCDIs or for those with severe or fulminant CDI refractory to antibiotics. Data assessing the long-term efficacy of FMT beyond 1 year are scarce. The objective of this study is to evaluate the long-term efficacy of lower-gastrointestinal (GI) delivery FMT in addition to standard of care pharmacotherapy (SOCp) for rCDI compared to patients that received SOCp alone.

Methods
This is a single center, retrospective cohort study that included patients 18-99 years old who received either SOCp or FMT in addition to SOCp for rCDI between January 1, 2018 and December 30, 2020. Exclusion criteria were pregnancy or receipt of upper-GI delivery FMT. The primary endpoint was rCDI within 12 months. Secondary endpoints were all-cause mortality at 6, 12, 18, and 24 months, recurrence at 6, 18, and 24 months, and time to first recurrence of CDI (months). Patients were propensity matched based on age, immunocompromised status, and antibiotic received for index rCDI episode.

Results
The rCDI rate at 12 months was 8% and 50% in the FMT (n = 24) and SOCp (n = 24) groups, respectively (p = 0.0001). The rCDI rate at 24 months was 8.3% and 50% in the FMT and SOCp groups, respectively (p=0.0015). Mean time to 1st rCDI episode was 15.5 and 1.5 months in the FMT and SOCp groups, respectively (p = 0.0255). All-cause mortality at 24 months was 17% and 21% in the FMT and SOCp groups, respectively (p = 0.81).

Conclusion
Patients who received FMT in addition to SOCp had a significantly lower rate of recurrence and a significantly longer time to subsequent recurrence compared with the SOCp group. There was no significant difference in all-cause mortality between the groups.

Disclosures
All Authors: No reported disclosures.
2010. Severity of antimicrobial-resistant non-Typhoidal Salmonella infections treated in two large facilities of a health system in Pennsylvania, 2018-2020
Authors: Hackman Nicole M , Watkins Louise F , Sayeed Sameera , Boktor Sameh , Dettinger Lisa , Thirumalapur Nagaraja , Dudley Edward G , M’ikanatha Nkuchia M 
Published: December 2022

Abstract

Background
Nontyphoidal Salmonella (NTS) is a leading cause of foodborne illness. Characterization of clinical outcomes of salmonellosis from antimicrobial-resistant (AMR) NTS is limited. The Pennsylvania Department of Health collaborated with federal and academic partners to enhance surveillance for NTS (AMR and outcomes).

Methods
We evaluated 82 patients with salmonellosis whose NTS isolates were submitted to the PA Public Health Laboratory during 2018–2020 from two Pennsylvania hospitals. We used broth microdilution to test NTS isolates for susceptibility to antibiotics tracked by the National Antimicrobial Resistance Monitoring System. Isolates resistant to ≥3 antimicrobial classes were considered multidrug-resistant (MDR). Electronic medical records of source patients were reviewed for medical history, diagnoses, treatment, and outcomes. Invasive infection was defined as isolation from normally sterile sites (e.g., blood).

Results
Seven (9%) of 82 isolates were MDR. Twelve (15%) had decreased susceptibility to ciprofloxacin (MIC ≥0.12 µg/mL), 3 (4%) were ceftriaxone resistant, 3 (4%) were trimethoprim-sulfamethoxazole resistant, and 1 (1%) was azithromycin resistant. The median patient age was 29 years; 31 (38%) patients were ≤18 years and 42 (51%) were female. Nearly a quarter of all patients were immunosuppressed (Figure). Outcomes included hospital admission in 38 (46%), intensive care for 5 (6%) patients, and 1 (1%) death. Ten (12%) patients had invasive infections, including 8 with bacteremia; all were hospitalized. Four (40%) of the invasive disease isolates were resistant to ≥1 antimicrobial, compared with 16 (22%) isolates from patients with the non-invasive disease. Fifty-seven (70%) patients were prescribed empiric antimicrobials for their infection. Antibiotics were changed in 45 (79%) after laboratory diagnosis.
Demographic and clinical characteristics of patients with nontyphoidal Salmonella treated in two facilities associated with a health system in Pennsylvania, 2018–2020. The five patients treated in intensive care units are included in the total admissions (n=38). Salmonellosis was considered invasive if the organism was isolated from the blood or other normally sterile site (excluding urine).

Conclusion
NTS can cause severe invasive illness in some patients; drug-resistant NTS infections may be associated with more severity as compared with susceptible NTS. Resistance to clinically consequential drugs coupled with the severity of infections suggests the need for antimicrobial stewardship and highlights the value of clinical data in enhancing surveillance for salmonellosis.

Disclosures
All Authors: No reported disclosures.
2013. Bloodstream Infections in Advanced Heart Failure Patients Requiring Prolonged Use of Axillary Intra-Aortic Balloon Pumps - A Single Center Study
Authors: Dreucean Diane , Donahue Kevin R , Donahue Kevin R , Morton Celia , Succar Luma , Krisl Jill , Agrawal Tanushree , Perez Katherine K , Jaramillo Taylor , Kassi Mahwash , Yousefzai Rayan , Hussain Imad , Guha Ashrith , Kim Ju , Bhimaraj Arvind 
Published: December 2022

Abstract

Background
Bloodstream infections (BSI) impact outcomes in critically ill patients. Institutions and quality and performance improvement efforts to minimize catheter associated infections are valued to optimize outcomes. While intra-aortic balloon pumps (IABP) implanted through the axillary route have been recently used in cardiogenic shock patients for prolonged support, the incidence and associated significance of BSI remains unknown in this cohort. The aim of this study was to assess the incidence of BSI in patients with axillary-placed IABP and evaluate its impact on patient outcomes.

Methods
We retrospectively reviewed 141 patients that underwent axillary IABP placement from May 2016 through August 2020. The primary endpoint was the incidence of BSI during axillary IABP, reported as the proportion of patients who developed a BSI and BSI per 1000-device days.

Results
BSI occurred in 13% of patients and accounted for 4.3 infections per 1000-device days. Prior femoral device use and longer duration of axillary IABP support occurred more frequently in the BSI cohort. Presence of traditional BSI risk factors including central line days, use of parenteral nutrition, and prior positive cultures did not differ between those who developed BSI and those who did not. The rate of end-outcome attainment (transplant, LVAD, recovery) was not statistically different in those that developed BSI vs not (72% vs 88% p=0.08). A total of 41% of BSI were caused by Staphylococcus epidermidis. Use of peri-procedural antimicrobials was associated with lower risk of BSI development (24% vs 8%; p=0.01)

Conclusion
Patients in cardiogenic shock requiring use of life-saving temporary mechanical support pose a challenge to maintain free of BSI during prolonged support with an indwelling catheter that allows for ambulation and movement. Mitigation of modifiable BSI risk factors, such as the use of peri-procedural antimicrobial prophylaxis, accompanied by a low threshold for screening and treatment are reasonable strategies to improve patient outcomes. Future research is needed to further evaluate BSI risk in this patient population and its subsequent impact on patient outcomes.

Disclosures
All Authors: No reported disclosures.
2025. Outcomes of Pseudomonas aeruginosa Ventricular Assist Device Infection
Authors: Murugan Lalithaa Thirunavukarasu , Murugan Lalithaa Thirunavukarasu , Murugan Lalithaa Thirunavukarasu , Shrestha Nabin K , Banzon Jona 
Published: December 2022

Abstract

Background
Ventricular assist device (VAD) infections caused Pseudomonas aeruginosa (PA) are difficult to treat given limited antibiotic options, development of resistance and biofilm formation in the presence of retained hardware. We looked at outcomes of patients who developed Pseudomonas aeruginosa LVAD infection (PA-LVADI)

Methods
Single center retrospective study of patients older than 18 years who received LVAD from 7/1/2007 to 2/1/2021 and subsequently developed PA-LVADI. Patients with proven or probable VAD-specific infections: driveline infection (DLI), pump pocket, and pump/cannula infections were included. The cumulative incidences of death, transplant, and LVAD explant, following Pseudomonas aeruginosa infection, were evaluated as competing outcomes. Fig 1:Classification of Pseudomonas aeruginosa LVAD Infections at diagnosisFigure 3:Cumulative incidence of death, transplant, or explant following Pseudomonas aeruginosa LVAD infection

Results
51 patients with VAD-specific PA-LVADI were identified (Fig 1). Median age at the time of first LVAD placement was 55 years (23 – 74). Of the 28 patients ever listed for transplant, 13 (46%) received heart transplant, 8 (29%) were delisted, 7 (25%) were alive on transplant list (Fig 2).
The median number of days from LVAD placement to first PA infection was 587 (54 – 3389). 30 (59%) had PA as the first causative organism. The extent of first PA-LVADI was superficial DLI in 43(84%), deep DLI in 5 (10%), pump pocket in 2(4%) and pump/cannula in 1(2%).
46 (90%) of patients received intravenous (IV) therapy with median duration of 84 (2 – 525) total IV antibiotic days. Antibiotic resistance emerged in 25/51 (49%) patients, with 32% being multi-drug resistant (MDR). Surgery was performed in 30 (58%).
12/13 who received heart transplants were followed for at least 1 year post-transplant and all were alive. 5 of the remaining 38 patients underwent pump exchange or explant. 20/38 (53%) of patients who were not transplanted died (Fig 3).

Conclusion
This is the largest study on PA-LVADI to date. We noted significant morbidity and mortality, with 90% of patients requiring prolonged IV antibiotics and over half requiring surgical treatment. Drug resistance emerged in a significant proportion of patients. Survival after transplant was excellent, but by 2 years of infection over half of the patients have been transplanted, explanted, or died.

Disclosures
All Authors: No reported disclosures.
2028. Reduction in Health Care Facility Onset Catheter-Associated Urinary Tract Infections: A Resident-Led Quality Improvement Initiative
Authors: Ramakrishna Jahanavi M , Schmidt Bernadette , Hessler-Waning Monica , Reddy Trishya , Hester Thomas , Kashlan Reem , Tariq Osama , McCready Tess , Tegeltija Vesna 
Published: December 2022

Abstract

Background
Hospital-acquired catheter-associated urinary tract infection (CAUTI) was estimated to cause 19,700 cases in 2020 across the United States per the Centers for Disease Control and Prevention (CDC). While this is a 25% decrease in reported incidence rates since 2015, ad-hoc changes in care practices and limitations of surveillance definitions brought on by the giant burden of COVID-19 on the healthcare system possibly resulted in underreporting of CAUTIs. In a 290-bed tertiary, community hospital in the Detroit metropolitan area, there was a 200% increase CAUTIs from 2020 (5 CAUTIs) to 2021(16 CAUTIs). A multidisciplinary, resident-led team was assembled to reduce hospital-acquired CAUTIs.

Methods
A multi-pronged quality improvement initiative was conducted from January 1, 2021, through March 31, 2022. CAUTIs were identified and reviewed via electronic health records using predefined criteria related to CDC surveillance definitions, urinary catheter insertion indications, laboratory data, and antibiotic use. Plan-Do-Study-Act (PDSA) Cycle model was used to guide the initiative. Thus far one PDSA cycle has been completed. The initial intervention bundle was designed by the multidisciplinary team and led by internal medicine and transitional year residents. The intervention bundle included 1. Provider (including physician and RN) education, 2. Design and implementation of an appropriate urinary catheter practice algorithm, and 3. Expert review of positive urine cultures and CAUTI cases.

Results
Baseline data collected from January to December 2021 showed 16 CAUTIs. Post-implementation of the intervention bundle from January to March 2022 resulted in a 75% reduction in CAUTI incidence (1 CAUTI flagged).

Conclusion
A targeted intervention bundle improved CAUTI incidence by reducing inappropriate urinary catheter insertion and prolonged removal. Ongoing local initiatives focused on hospital-acquired infections, such as this one, are paramount to the persistent optimization of infection prevention despite national trends.

Disclosures
All Authors: No reported disclosures.
2033. Use of Sterile, Single-Use Bronchoscopes Reduces Procedure-Associated Readmissions Rates and Eliminates Potential Device Cross-Contamination
Authors: Garrett John H 
Published: December 2022

Abstract

Background
Improper reprocessing of reusable bronchoscopes poses a serious patient safety risk. The risk of patient infection resulting from use of contaminated bronchoscopes has been reported to be 2.8%. By virtue of being sterile, SFB eliminates device-related infection risk, subsequent readmission rates, and associated costs. Readmissions following bronchoscopy may occur for many reasons, but most frequently are due to infection, bleeding, or pain. These infections are preventable and can be eliminated with the use of a sterile, single-use bronchoscope when the device is used according to the manufacturer’s instructions for use.

Methods
Bronchoscopies with SFB and RFB were identified along with their corresponding readmission information in the Premier Healthcare Database from 2016- 2019. A logistic regression analysis was conducted with 30-day readmission as the dependent variable. Independent variables included use of a RFB, gender, race, age, payer, and discharge status. For the inpatient setting, the 3M™ APR DRG Severity of Illness classification was included as an independent variable.
30 Day Readmissions

Results
A total of 14,228 procedures were identified, of which 1,795 used SFB and 12,433 used a RFB. In the inpatient setting, the RFB group was ∼2.5 times more likely to be readmitted within 30 days compared to the SFB group (OR=2.5, p&lt; 0.01), controlling for patient demographics and risk. In the outpatient setting, the RFB group was ∼1.5 times more likely to be readmitted than the SFB group (OR=1.5, p &gt;0.05). Across all settings, the RFB group was ∼2.3 times more likely to be readmitted than the SFB group (OR=2.3, p&lt; 0.01). The inability to fully risk-adjust in the outpatient setting may have been a factor in the smaller OR and lack of statistical significance; this limitation will be addressed with further analysis that includes an outpatient severity of illness classification variable.

Conclusion
Patients undergoing bronchoscopy typically have significant comorbidities which increase their risk for the development of potential device-related infections. To reduce these risks, the use of a sterile SFB should be considered to eliminate reprocessing failures, improve overall operational efficiency, and reduce potential acquisition of healthcare-associated infections.

Disclosures
John H. Garrett, PhD, MSN, MPH, MBA, FNP-BC, FNAP, FSHEA, FIDSA, Aerobiotix: Advisor/Consultant|Ambu: Advisor/Consultant|American Academy of Nurse Practitioners: Honoraria|Clorox Pro: Advisor/Consultant.
2359. Evaluating Hepatitis C Virus (HCV) Diagnostic Testing, Cure and Reinfection among People Living with HCV and HIV Coinfection in New York City
Authors: Graf Laura , Bocour Angelica , Huang Yanting Kelly , Romano Anthony , Varigonda Renuka , McPherson Tristan D 
Published: December 2022

Abstract

Background
Untreated hepatitis C virus (HCV) infection can lead to liver disease, cancer and premature death; HIV coinfection can accelerate adverse outcomes. People living with HIV (PLWH) should be screened for HCV with an antibody test at least once and more frequently if other risk factors. A diagnostic HCV RNA test should be used to determine cure/clearance (RNA-negative) vs active infection (RNA-positive). Among people with HCV/HIV coinfection in New York City (NYC), we aimed to 1) describe HCV testing, cure/clearance, reinfection and identify disparities; 2) assess relative timing of HCV/HIV coinfection diagnosis to evaluate HCV testing among PLWH.

Methods
PLWH as of September 30, 2021 were matched to people with a positive HCV test July 1, 2014–December 31, 2020; HCV test results through December 31, 2021 were used for analyses and to observe cure. A HCV clearance cascade was created to evaluate testing, cure/clearance and reinfection, and was stratified by age, sex and race/ethnicity. Timing of coinfection was assessed for people with new HCV/HIV diagnoses January 1, 2014–December 31, 2020 to identify recent trends. Coinfection date was defined as the later HCV or HIV diagnosis date.

Results
There were 11,137 PLWH with any positive HCV test. Of these, 10,773 (97%) had an RNA test; 8,926 (83%) had initial active infection; 6,901 (77%) had cure/clearance and 302 (4%) with cure/clearance were reinfected (Figure 1). Black Non-Hispanic (NH) people and those aged 20–39 had a high burden of active infection, with 3,653 (87%) and 803 (93%), respectively. Both groups had proportionally lower cure/clearance (77% and 63%, respectively) compared to Asian NH people (86%) and people ≥ 60 (81%) having the highest proportions. Most people with recent coinfections were diagnosed with HIV prior to HCV (annual range: 39%–71%) (Figure 2).

Conclusion
HCV diagnostic testing and cure/clearance were high and reinfection was low among people with coinfection in NYC. Most people with coinfection had HCV RNA tests, indicating appropriate HCV testing in this population. Cure/clearance could be improved among younger and Black NH people; provider and patient education might improve outcomes. To initiate timely treatment, providers should continue screening PLWH for HCV as HIV infection often precedes HCV infection.

Disclosures
All Authors: No reported disclosures.