Coagulase-negative Staphylococci Research Articles

P-1898. Reduction of Blood Culture Contamination Rates and Associated Healthcare Costs Through Implementation of Certified Phlebotomist-Drawn Blood Cultures at a Community Teaching Hospital

Abstract Background Blood culture contamination (BCC) is a drain on healthcare resources, with clinical implications such as delayed diagnosis. At Kern Medical (KM), a safety net teaching hospital in Bakersfield, CA, BCC in some areas had continually exceeded the 3% recommended maximum, with 59% of new positive blood cultures per patient representing contamination in early 2023. In response, a quality improvement initiative was launched in 2023 to reduce BCC through certified phlebotomist-drawn blood cultures (PDBC). Methods A retrospective cohort study was conducted to assess the clinical and financial impact of BCC reduction through PDBC. Any blood culture with growth of a common commensal organism during the first 2 months of 2024 was reviewed for attributable hospital length of stay (LOS) and ED, laboratory, procedure and pharmacy resources associated with BCC. Patients were excluded if blood culture growth was indicative of true infection or if the patient was still admitted at the time of review or transferred to another hospital. Costs were calculated based on literature and institution-specific charges. Results BCC was identified in 35 patients over the study period, with coagulase-negative Staphylococcus (CoNS) species isolated in 71% of patients and polymicrobial growth in 34% of cases. Forty percent of patients had been admitted with a non-infectious principal diagnosis, and 14% of patients had been discharged at the time of blood culture positivity and were readmitted or called back to the ED for management of possible bacteremia. Transthoracic echocardiogram had been performed for assessment of infective endocarditis in 34% of all patients and 40% of patients with CoNS prior to final identification of the blood culture isolate(s), which required 5.5 days on average. Sixty-six percent of patients received vancomycin, including 43% of patients admitted for noninfectious diagnoses. Twenty-three percent of patients had new or additional LOS due to BCC, with an average of 1.4 days. The average additional cost associated with a BCC event at KM was $2931. Conclusion Given that BCC rates decreased at KM from 4.6% with non-certified phlebotomy staff collection compared to 1.2% with certified phlebotomist collection, introduction of PDBC resulted in an estimated cost avoidance of $778,596 per year. Disclosures All Authors: No reported disclosures

P-840. Is Staphylococcus lugdunensis just another coagulase-negative Staphylococcus? A Comparative Study of community-acquired Staphylococcus lugdunensis and methicillin-susceptible Staphylococcus aureus Bacteremia

Abstract Background Staphylococcus lugdunensis (SL), a coagulase-negative staphylococcus (CoNS), usually a skin commensal, has demonstrated similar virulence to Staphylococcus aureus. Current studies have compared SL bacteremia (SLB) to S. aureus bacteremia, primarily hospital-onset methicillin-resistant Staphylococcus aureus bacteremia. Our study is the first to compare the clinical characteristics and outcomes between community-acquired SL bacteremia (SLB) and MSSA bacteremia (SAB).Table 1:Patient Demographics Methods This retrospective cohort study evaluated hospitalized adults with SLB and SAB at an urban tertiary care center from January 1, 2017 to December 31, 2022. CA-BSI was defined as at least one positive blood culture with SL or methicillin-susceptible Staphylococcus aureus (MSSA) within 72 hours of admission. Patients previously hospitalized within 30 days, on chemotherapy, or transferred from another facility were excluded. The primary outcome was in-hospital mortality rate with a secondary outcome of hospital length of stay (LOS). The Whitney Mann U test and chi-square test were used for the analysis. Figure 2 Results 33 SLB patients and 66 SLB patients were included. The demographics of both groups are seen in Table 1. The SLB group was older and had a higher Charlson Comorbidity Index score compared to the SAB group. The incidence of SLB increased during the study period while the incidence of SAB remained the same (Figure 1). Two-thirds of the patients in both groups met sepsis criteria on presentation. 33% of SLB and 18% of SAB had a Pitt bacteremia score of ≥4 points. Endocarditis, skin and soft tissue infections, osteoarticular, line-related, and pneumonia are the primary sources of infections in SLB and SAB. There was no statistical difference in rates of ICU admission, need for ventilator support, need for renal replacement therapy, and length of stay between the two groups. In-hospital mortality was 15% for both groups. Conclusion SL is a CoNS recognized as an emerging pathogen. The incidence of CA-SLB is increasing, particularly in older individuals with underlying comorbid conditions. The in-hospital mortality rate associated with SLB is as high as CA-SAB. Clinicians must recognize the high pathogenicity of SLB and implement comprehensive strategies to prevent morbidity and mortality. Disclosures All Authors: No reported disclosures

Microbiology of Diabetic Foot Infections in U.S. Veterans

This study examined the prevalence of various microbes isolated from diabetes-related foot infections (DFIs) within the U.S. veteran population. A total of 68 different microbes were identified. The most frequently isolated organisms were methicillin-sensitive Staphylococcus aureus (32.7%), coagulase-negative staphylococci (21.8%), methicillin-resistant S. aureus (15.9%), Enterococcus faecalis (14.6%), group B streptococcus (12.4%), Pseudomonas aeruginosa (10.1%), Proteus mirabilis (8.1%), viridans streptococci (7.3%), Escherichia coli (6.5%), Enterobacter cloacae (5.9%), and Corynebacterium species (5.6%). A better understanding of common DFI pathogens may help to guide empiric antibiotic selection when treating DFIs.

P-408. Utility of a Large Language Model for Identifying Central Line-Associated Bloodstream Infections (CLABSI) Using Real Clinical Data at Stanford Health Care

Abstract Background Central line-associated bloodstream infections (CLABSI) surveillance can be subjective and time-consuming. Large language models (LLMs) are advanced artificial intelligence systems with potential to assist healthcare professionals in classification tasks. Stanford Health Care recently implemented one of the first secure LLMs, powered by OpenAI’s GPT 4.0, cleared for sensitive health data. We assessed its performance in classifying CLABSI cases.Figure 1:Confusion Matrix of LLM Performance in CLABSI Classification. Methods We selected 40 patients flagged by our surveillance system for CLABSI review from November 2023–March 2024: 20 CLABSIs, consecutively identified, and 20 not-CLABSIs (randomly sampled). We prompted the LLM to determine if patients met the NHSN definition for CLABSI and provided the blood culture results that triggered the alert and the last 2 progress notes from the primary care team at the infection window end (within 3 days after the first positive test). We compared the secure LLM's determinations with those of infection preventionists.Table 1.Cases in which the LLM did not agree with IP assessment for CLABSI.*Community-onset: Blood cultures obtained within 2 days of admission.+NHSN guidelines list Fusobacterium nucleatum as an MBI organism (https://www.cdc.gov/nhsn/pdfs/pscmanual/17pscnosinfdef_current.pdf)Abbreviations: BSI, bloodstream infection; CLABSI, central line-associated infection; CoNS, coagulase-negative Staphylococci; ESBL, extended-spectrum beta lactamase; HIDA scan, IP, infection preventionist, LLM, large language model; MBI, mucosal barrier injury; MSSA, methicillin-susceptible Staphylococcus aureus; NHSN, National Healthcare Safety Network. Results Across 20 CLABSI-positive and 20 CLABSI-negative cases reviewed, the LLM accurately identified 16 of 20 CLABSIs and 7 of 20 not CLABSIs. The sensitivity was 80% (95% CI 57.6%–92.9%), specificity was 35% (95% CI 33.3%–86.5%), and the agreement rate was 57.5% (95% CI 41.2%–73.3%). Among 17 discordant cases, 11 involved clinical data available in the chart but unavailable to the LLM—admission information (4 false-positives), matching organisms (4 false-positives), and central line or symptom status (2 false-negatives, 1 false-positive). If this information was available to the LLM, we expect an adjusted sensitivity of 90% (18/20) and adjusted specificity of 80% (16/20). The remaining discordant cases involved misclassifications of organisms and incorrect identification of infection sources by the LLM. The mean review time by infection preventionists was 75 minutes (SD 48.7 minutes) compared to 5 minutes using the LLM. Conclusion An LLM not specifically trained for CLABSI classification showed high sensitivity using limited patient data. LLM case review required 5 minutes, versus 1 hour for traditional review. These results suggest LLMs could serve as a "first-pass" screening tool for CLABSI detection, helping infection preventionists narrow records needing human review. Disclosures All Authors: No reported disclosures

P-1143. Etiology and resistance phenotypes of blood-culture proven neonatal sepsis from two large NICUs in Mexico: a multicenter three-year retrospective analysis

Abstract Background Neonatal sepsis is a significant cause of morbidity and mortality in newborns. Etiology depends on multiple factors, particularly regional epidemiology. Current international guidelines are based on data from developed countries, which may not reflect the situation of developing regions. Microbiological surveillance in Mexican NICUs is limited, which may lead to inappropriate antimicrobial use. Methods This is a retrospective multicenter study conducted in two NICUs from NL, Mexico (2021-2023). Clinical and microbiological data on ≤28-day newborns with blood culture-proven neonatal sepsis were collected. Neonatal sepsis was classified as early (≤3 days) and late onset ( >3 days). Descriptive statistical analyses were performed to assess microbiologic etiologies, as well as clinically-relevant resistance phenotypes (VITEK® 2). Results A total of 928 blood cultures from 775 patients were included. 49.0% were preterm. Mean gestational age was 35.2. Most episodes (66.9%) were classified as late-onset sepsis (Table 1). Staphylococcaceae were the most commonly identified family (48.6%). Coagulase-negative Staphylococci were the most common group (42.7%), being S. epidermidis the most common. Gram-negative bacilli were the second most common cause of neonatal sepsis (33.7 %), mostly due to K. pneumoniae (12.7%). Low prevalence of GBS was observed (3.0%). Fungal (4.1%) and enterococcal (5.2%) isolations were uncommon. The prevalence of ESBL-producing Enterobacterales were 39.4%; MRSA was 30.2% (Table 2). 4 cases (1.4%) of carbapenem-resistant Enterobacterales (CRE) and 2 cases (0.7%) of AmpC Enterobacterales were identified. Notably, 5 cases (10.4%) of vancomycin-resistant Enterococci (VRE) were identified. Conclusion The study reported clinical and microbiological data of blood culture-proven neonatal sepsis. In contrast with U.S. data, this study showed a lower prevalence of GBS and a significant presence of Gram-negative pathogens, alongside notable resistance profiles such as ESBL-producing Enterobacterales and VRE. Antimicrobial surveillance in developing regions is necessary in order to recognize the most common etiologies and develop treatment guidelines according to local epidemiology. VRE is a worldwide concern and should be closely monitored. Disclosures All Authors: No reported disclosures

P-832. The Skip Phenomenon in Patients with Staphylococcus lugdunensis Bloodstream Infection

Abstract Background Staphylococcus lugdunensis (SL) is a coagulase-negative staphylococcus with virulence comparable to that of Staphylococcus aureus. The “skip phenomenon” (SP) is a pattern where blood cultures are intermittently negative before final clearance of bloodstream infection (BSI). SP is well-documented in S. aureus bacteremia but has not been described previously in SL. In this report, we present a cohort with SL BSI and describe its prevalence and their clinical features and outcomes. Methods We conducted a retrospective review of patients with blood cultures positive for SL in samples referred to the Mayo Clinic reference lab between June 2012 and June 2022. We assessed clinical characteristics, including time to positivity, prevalence of the skip phenomenon (defined by a positive culture after 24 hours of negative cultures), patient demographics including Charlson Comorbidity Index, mortality and length of hospital stay. Results We identified 55 patients with SL BSI and 33 of them had enough laboratory data to determine the prevalence of the skip phenomenon. SP was present in 5 of 33 (15.2%) patients. For all patients with SL BSI, the median age was 67 years (interquartile range [IQR] 61-79); mean CCI in the group with SP was 5.6 (standard deviation 2) and those without SP was 5.9 (standard deviation 2.7); median duration of bacteremia was 3 days (IQR 1-4); median hospital length of stay was 14 days (IQR 8-20); and 1-year mortality was 45%. Oxacillin susceptibility was present in 33 of 34 cases. Conclusion A total of 15% of patient cases with SL BSI demonstrated the SP. Recognition of the SP in patients with SL BSI is important as this may impact duration of antibiotic therapy and timing of long-term cardiovascular device placement. Disclosures Larry M. Baddour, MD, UpToDate, Inc.: Royalty payments (authorship duties).

P-68. Comparison of vancomycin vs daptomycin for prosthetic joint infections

Abstract Background A combination of surgery and extended durations of antimicrobials are the mainstays of therapy for patients with prosthetic joint infections (PJI). In the Infectious Diseases Society of America Clinical Practice Guidelines for Diagnosis and Management of PJI, daptomycin is an ‘alternative regimen’ for patients with methicillin-resistant Staphylococcus aureus (MRSA) and other methicillin-resistant coagulase-negative Staphylococcus (CoNS) species. The side effect profile of daptomycin may also be more tolerable than that of vancomycin, the preferred agent. This study aims to investigate the tolerability and efficacy of vancomycin versus that of daptomycin for patients with PJI. This topic has not been widely compared in literature for patients with monomicrobial PJIs. Methods This was a retrospective, observational assessment of patients who received vancomycin or daptomycin after surgery for prosthetic knee or hip infections. Patients were followed in our University Hospital’s Orthopedic Infectious Diseases Clinic between 1/1/2019 and 4/30/2023. Medical records were reviewed including demographics, type of surgery, adverse effects (AEs), and relapse rates at 6 weeks, 6 months, and one year. Results Seventy-nine patients were included: 56 initiated therapy with vancomycin and 23 with daptomycin. The primary outcome was the incidence of therapy-altering AEs. Twenty-two patients in the vancomycin group and 4 patients in the daptomycin group experienced AEs that led to therapy changes (39.3% vs 26.1%, p=0.07). The secondary outcome was the incidence of recurrent infection and was tracked in a subset of 39 vancomycin and 23 daptomycin patients. At 1 year, 10 vancomycin patients required additional unplanned surgery, while only 1 daptomycin patient experienced this (17.9% vs 4.3%, p=0.04). The only statistically significant difference found in baseline characteristics was that more antibiotic spacers were placed in the long-term follow-up daptomycin patients (15 vs 16, p=0.034). Conclusion There was no statistically significant difference in tolerating vancomycin vs daptomycin, however, daptomycin may lead to fewer relapses long-term in patients with MRSA and CoNS infections. Disclosures All Authors: No reported disclosures

P-1684. Characterization of Bacteremia and de-escalation practices among 13 public hospitals in Chile: Results from the 2022-2023 Chilean PPS

Abstract Background Antimicrobial resistance (AMR) is a global concern. Collecting data and implementing interventions to optimize antimicrobial (AM) use has significant potential to lower AMR.There is no information in Latin American Region on how prescribers are using data from positive blood culture results to de-escalate AM. We present a sub-analysis of the 2022-2023 Latin-PPS performed in Chile including the characterization of bacteriemia and de-escalation practices. Antimicrobial distribution to treat bacteremia Methods 13 public hospitals joined the Latin-PPS group. This PPS is based on the WHOPPS methodology. Each hospital conducted a survey in which everyday data from AM prescriptions was collected by ward. We include only patients that received AM related to documented bacteremia. The purpose of this study is to describe the etiological agents that caused bacteremia, AM use and compare the blood culture result with appropriate AM prescription. Most common etiological agents and antimicrobials used. Results Chilean PPS included 3,342 beds, where 1302 AM treatments were given and 1,928 AM were administered to a national prevalence of 38.84%. Bacteremia is the 6th most common diagnosis related to AM use and corresponds to 3,76% . We found 49 bacteremia episodes, 9 occurred in ICU. The most common etiological agent was Staphylococcus aureus (16/49). Table 1 describes: most common etiological agents and AM used. The AM distribution to treat bacteremia is shown in graphic 1. 37/49 (75.5%) bacteremia had an organism that matched an appropriate AM. 10 of those missed an opportunity of de-escalation and 7 possibly represented contaminations in which AM could be stopped. Conclusion The AM prescription in hospitalized patients in Chile is lower compared to other LMIC. We found opportunities for AM optimization by de-escalating or stopping AM when blood culture results are available in bacteremia. We plan to recommend evidence-based strategies implementation aiming to de-escalate AM to a narrow more tailored regimen by audit and feedback supported with guidelines. Also to raise awareness about the possibility of contamination when blood cultures isolate coagulase negative staphylococcus as an opportunity to stop antimicrobials. PPS is an effective method to detect antimicrobial prescription habits and prioritize Antimicrobial Stewardship activities with local data. Disclosures Dona Benadof, MD, Biomerieux: Grant/Research Support Mirta Acuña, MD, Pfizer: Grant/Research Support P. , PharmD, Eli Lilly: Stocks/Bonds (Private Company)|MSD: Advisor/Consultant|Pfizer: Advisor/Consultant Ruth A. Rosales, n/a, BECTON DICKINSON DE CHILE: Advisor/Consultant|BECTON DICKINSON DE CHILE: Speaker|Pfizer SA: Speaker

P-1804. Evaluating Implementation Outcomes of Stewardship Interventions for Rapid Blood Culture Diagnostics

Abstract Background Rapid diagnostic testing for bloodstream infections, when coupled with antimicrobial stewardship (AS) intervention, has demonstrated improved clinical outcomes. Yet, data regarding implementation outcomes and the necessary strategies for these interventions are limited.Table 1:Verigene Gram Positive Blood Culture Nucleic Acid Test (BC-GP) results Pre-intervention and During the Intervention Frequency and percentage of BC-GP results during the pre-intervention phase and intervention phases are reported. Coagulase negative staphylococci includes Staphylococcus species, Staphylococcus epidermidis, methicillin susceptible Staphylococcus epidermidis, and methicillin resistant Staphylococcus epidermidis BC-GP results. Methods A pre-post quasi-experimental design was used to compare children with positive blood culture results. Pre-intervention causative organisms were identified using the Verigene Gram Positive Blood Culture Nucleic Acid Test (BC-GP) and reported to clinicians by a microbiology technologist. Post-intervention organisms were identified and reported similarly, in addition to 24 hours a day/7 days a week (24/7) AS intervention. AS members received BC-GP notifications and communicated antibiotic recommendations to the primary team. Hospital stakeholders were identified in the pre-intervention phase to assess divisional needs. The primary outcome was time to targeted therapy (TTT), calculated as time from BC-GP result to order of predetermined narrowest antibiotic regimen or discontinuation of therapy. TTT was compared by time-series analyses. Secondary outcomes included acceptability, appropriateness, and feasibility, assessed using validated surveys completed by pediatric infectious diseases (ID) clinicians and non-ID clinicians who received the AS intervention. Proportion of Patients Receiving Targeted Antibiotic Therapy Over Time A Kaplan-Meier analysis with a hazard function for time to targeted therapy (TTT) in children with positive blood cultures. Cases in the intervention phase (11/2023-04/2024) are represented in blue, and preintervention (10/2022-10/2023) controls are represented in orange. Censored cases included patients who did not receive targeted antibiotic therapy within their hospital admission. Log rank test demonstrated a statistically significant reduction in TTT in the intervention group versus the pre-intervention group, with a larger proportion of patients in the intervention group receiving targeted antibiotic therapy more rapidly than patients in the pre-intervention group (P-value of 0.013). Results The median TTT decreased from 15.9 hours before intervention to 0.9 hours with AS intervention (P=0.013). Validated surveys were completed by 23 ID and 38 non-ID clinicians. Over 80% of ID and non-ID clinicians agreed or strongly agreed that the intervention was acceptable and appropriate. However, significant differences were noted in all feasibility domains, including “doable,” “easy to apply,” “implementable,” and “possible" measures. Specifically, 39% of ID clinicians reported the intervention was “easy” or “very easy” to apply, as compared to 84% of non-ID clinicians (P < 0.0001). Infectious diseases (ID) respondents categorized by their role within the medical team. APRNs: Advanced Practice Registered Nurses, RPh: Registered Pharmacist. Non-infectious diseases (ID) respondents categorized by their role within the medical team. APRNs: Advanced Practice Registered Nurses, ICU: Intensive Care Unit. Conclusion 24/7 AS intervention paired with rapid blood culture diagnostics is associated with reduced TTT and is deemed appropriate and acceptable by ID and non-ID clinicians. The difference in feasibility perception by ID and non-ID clinicians highlights implementation challenges, and warrants evaluation of future strategies. Frequency and percentage of responses from infectious diseases (ID) clinicians in comparison to non-ID clinicians for the three domains of successful implementation outcomes including 1) acceptability, 2) appropriateness, and 3) feasibility. Agreement on the acceptability and appropriateness for the AS intervention was observed among ID and non-ID clinicians with no significant difference between the two groups. Statistically significant differences were noted among responses between ID and non-ID clinicians in the feasibility domain. Table 2: Frequency and percentage of responses on a Likert scale from ID clinicians (n=23) in comparison to non-ID clinicians (n=38) in the feasibility domain. Chi-Square or Fisher's Exact tests demonstrated significant differences in responses when comparing ID to non-ID clinician’s perception of “doable”, “easy to apply”, “implementable”, and “possible” measures for AS interventions on the BC-GP. Disclosures Jason G. Newland, MD, MEd, Moderna: Grant/Research Support|Pfizer: Grant/Research Support

P-745. Skin and Soft-tissue Infections among Military Recruits

Abstract Background Skin and soft-tissue infections (SSTIs), commonly Staphylococcus aureus, are an important cause of morbidity in congregate military populations with high rates among military recruits. We characterized SSTI epidemiology over an ∼10-year period at a military training facility in GA (largest U.S. training facility; ∼30,000 recruits per year). Methods SSTI data were collected from US Army Infantry recruits during basic training, through four studies (2 observational and 2 interventional studies spanning 2010-2019) and pooled into a single resource for retrospective research. SSTI characteristics (syndromes and diagnosis timing) and microbiology are described. Results The study population includes 3288 recruits who developed SSTIs during the training period for a total of 3690 SSTIs. Median age was 19 years and median time for initial SSTI development was 7 (IQR 4 -11) weeks of training. Cellulitis (N=1600, 43%) and abscesses (N=1098, 30%) were most common and median time to diagnosis was 7 (IQR 4-11) and 8 (IQR 4-11) weeks of training, respectively. Cultures were collected from 1620 (44%) SSTIs, including 77% of abscesses. Methicillin-resistant and methicillin-susceptible S. aureus (MRSA and MSSA) were identified in 784 (48%) and 610 (38%) cultures, respectively (Table). Other findings include coagulase-negative staphylococci (4%), group A streptococci (0.2%), and group B streptococci (0.4%). A total of 373 recruits had ≥ 2 SSTIs and 55% of the subsequent 402 SSTIs were abscesses. Median time to 2nd and 3rd SSTIs was 10 (IQR 7.5-12) and 12 (IQR 10-13) weeks of training, respectively. There was a significant difference among the bacterial distribution for abscesses (p< 0.001) with MRSA contributing the highest proportion (62%), followed by MSSA (28%). MRSA was also identified with 64% of the 166 subsequent SSTIs with cultures. Conclusion Cellulitis and abscesses are frequent infections affecting military recruits during high-intensity congregate training. The most common bacteria with purulent infections (i.e., abscesses), as well as subsequent infections, was MRSA. Pooling data from multiple studies allows for examination of syndromes and etiology to inform targeted interventions. Disclosures David Tribble, MD, DrPH, AstraZeneca: The IDCRP and HJF were funded to conduct an unrelated phase III COVID-19 monoclonal antibody immunoprophylaxis trial as part of US Govt COVID Response

P-936. Incidence and Risk Factors for Ventricular Assist Device Infections: A Retrospective Review from the Middle East Gulf Region

Abstract Background A ventricular assist device (VAD) is either a destination therapy or a bridge to heart transplant for patients with end-stage heart failure. Unfortunately, VAD infections are a major complication postimplant. We aimed to evaluate the incidence, risk factors, and outcomes for patients with VAD infections. Baseline characteristics and risk factors for patients implanted with ventricular assist device. Methods We performed the single-center, observational, retrospective study on all patients who underwent VAD implantation between May 2016 and August 2022 with a minimum of 12-month follow-up post-placement. We defined VAD infections according to the International Society of Heart and Lung Transplantation (ISHLT) criteria, classifying infections into VAD-specific and VAD-related. We included all patients above 18 years of age with VAD and excluded patients who underwent VAD implantation outside our facility. Results We included 29 VAD patients, of which 16 were HeartMate 3 left ventricular assist devices (LVADs), 12 were HeartWare ventricular assist devices (HVADs), and one was a biventricular assist device (BiVAD). We reported an overall incidence of 41.3% (n=12/29) of VAD infections during the study period. Within one year post-implantation, we had two VAD-specific driveline infections, which isolated Pseudomonas aeruginosa and methicillin-sensitiveStaphylococcus aureus from the pus culture, and seven VAD-related infections (mediastinitis and bloodstream infections). Bloodstream infections included coagulase-negative staphylococci (n=4), Klebsiella pneumonia (n=1), andCandida tropicalis (n=1). We also had three patients with driveline infections one year after implantation. There were 15 patients requiring extracorporeal membrane oxygenation (ECMO) and one on Impella®. The mean (SD) length of stay during VAD infection was 56.5 (±37.6) days, all-cause mortality for patients with VAD infections was 41.6% (n=5/12), and the overall all-cause mortality in our study was 44.8% (n=13/29). Conclusion The VAD infections for patients on additional cardiac implantable electronic devices, multiple device reinterventions, or requiring temporary mechanical support complicate the overall outcome. Further studies with a larger population from the region are necessary to make better decisions about preventing and treating VAD infections. Disclosures All Authors: No reported disclosures

Bacterial Contamination and Antimicrobial Resistance Patterns of Healthcare Workers' Mobile Phones in Hospitals at Khartoum City

Background: Mobile phones used by healthcare workers (HCWs) have emerged as potential reservoirs for pathogens, posing a risk of healthcare-associated infections (HAIs). This study aimed to investigate the prevalence of bacterial contamination on HCWs' mobile phones, determine the antimicrobial susceptibility patterns, and compare findings with global data. Methods: We collected swabs from 94 mobile phones of HCWs across two hospitals in Khartoum. We identified bacterial isolates using standard microbiological techniques and evaluated antimicrobial resistance using the Kirby-Bauer disk diffusion method. Results: Bacterial contamination appeared in 93.6% of mobile phones. Gram-positive bacteria, such as Coagulase-negative staphylococci (36%) and S. aureus (31.8%) were prevalent. Gram-negative organisms were isolated. The predominant organisms were Klebsiella pneumoniae 15 (37%) isolates followed by Pseudomonas aeruginosa 12 (30%) isolates, Proteus mirabilis 5 (12%) isolates, Acintobacter baumannii 4 (10%), Enterobacter spp 3(8%) and Escherichia coli 1 (3%). Antimicrobial susceptibility tests revealed high resistance to penicillin among Gram-positive isolates. The tests revealed no multidrug-resistant (MDR) or extended-spectrum beta-lactamase (ESBL) production. Conclusion: HCWs' mobile phones represent a critical vector for bacterial transmission in hospitals. Stringent infection control measures and regular disinfection should mitigate the associated risks.

Effect of external infusion connection devices replacement frequency on catheter related bloodstream infection

Timely and effective rescue of critically ill children no longer solely relies on advanced medical technology; vascular access plays a pivotal role. Best practice recommendations for nursing in vascular access are critical for ICU patients. However, clear guidelines for the maintenance of external infusion connection devices remain lacking. To address this gap, we conducted a prospective observational cohort study to examine the relationship between the number or replacement frequency of external infusion connection devices and catheter-related bloodstream infection (CRBSI). From September 2021 to December 2022, a total of 304 patients with a single non-tunneled central catheter were enrolled in our study. Our findings revealed no significant differences in CRBSI incidence based on the number or replacement frequency of external infusion connection devices during the catheter’s indwelling time (P > 0.05). Notably, coagulase-negative staphylococci, particularly Staphylococcus epidermidis, were the predominant pathogens in CRBSI cases.In real-world clinical settings, adherence to strict aseptic principles during infusion set use and replacement appeared to mitigate the correlation between device replacement frequency or number and CRBSI incidence.

Infusion line contamination in preterm neonates: impact of infusion line design, length, and use duration: the multicenter ChronoBIOline study

IntroductionCentral venous catheters are critical in preterm neonatal care but increase the risk of central line-associated bloodstream infections (CLABSIs). The incidence of S. haemolyticus-associated CLABSIs in French neonates is increasing, but the mechanisms underlying this trend remain unclear.MethodsWe examined microorganisms in 108 central line infusion sets used in preterm infants across 12 neonatal intensive care units, and collected at the time of removal.ResultsThe infusion sets varied widely in type (28 types; 1-6 parts) and length (10-180 cm, mean 52.9 cm). Contamination was detected in 24 infusion sets (22.2%), mainly by coagulase-negative Staphylococci (50.0%) and Bacillus species (41.7%). Higher contamination rates were linked to longer infusion lines (> 50 cm; p < 0.001), usage beyond 7 days (p = 0.002), and multi-line infusion systems (p < 0.001).DiscussionOur findings are fully consistent with guidelines, which recommend simpler designs and a 4 or 7-day use of infusion sets, emphasizing the importance of adhering to these guidelines to reduce the risk of CLABSIs. Additionally, our findings raise concerns regarding the use of multi-line infusion systems. These devices, which combine extended infusion line length, manufacturer-authorized use of up to 21 days, and intermittent use of certain infusion lines, are easily contaminated during use, creating a high-risk situation for central line contamination.

Flies as carriers of antimicrobial resistant (AMR) bacteria in Nigerian hospitals: A workflow for surveillance of AMR bacteria carried by arthropod pests in hospital settings.

The dissemination of antimicrobial resistant (AMR) bacteria by flies in hospitals is concerning as nosocomial AMR infections pose a significant threat to public health. This threat is compounded in low- and middle-income countries (LMICs) by several factors, including limited resources for sufficient infection prevention and control (IPC) practices and high numbers of flies in tropical climates. In this pilot study, 1,396 flies were collected between August and September 2022 from eight tertiary care hospitals in six cities (Abuja, Enugu, Kaduna, Kano, Lagos and Sokoto) in Nigeria. Flies were screened via microbiological culture and bacterial isolates were phenotypically and genetically characterised to determine carriage of clinically important antibiotic resistance genes (ARGs). Several clinically relevant ARGs were found in bacteria isolated from flies across all hospitals. blaNDM was detected in 8% of flies and was predominantly carried by Providencia spp. alongside clinically relevant Enterobacter spp, Escherichia coli and Klebsiella pneumoniae isolates, which all exhibited a multidrug resistant phenotype. mecA was detected at a prevalence of 6.4%, mostly in coagulase-negative Staphylococci (CoNS) as well as some Staphylococcus aureus, of which 86.8% were multidrug resistant. 40% of flies carried bacteria with at least one of the two ESBL genes tested (blaOXA-1 and blaCTX-M-15). This multi-site study emphasised that flies in hospital settings carry bacteria that are resistant to multiple classes of antibiotics, including both routinely used and reserve antibiotics. A greater understanding of the global clinical significance and burden of AMR attributable to insect pests is required.

Nasal microbiota predictors for methicillin resistant Staphylococcus colonization in critically ill children.

Surveillance cultures to identify patients colonized with methicillin-resistant Staphylococcus aureus (MRSA) is recommended at pediatric intensive care unit (PICU) admission but doesn't capture other methicillin-resistant Staphylococcus and is resource intensive. We determined the prevalence and identified nasal microbiome predictors for methicillin-resistant Staphylococcus colonization at the time of PICU admission. A prospective cohort study was performed in a 20-bed pediatric intensive care unit (PICU) between 2020-2021. Anterior nares nasal swabs processed for MRSA culture, nasal microbiome and mecA+ qPCR were obtained within first five days after PICU admission. Predictive values of methicillin-resistant Staphylococcus carriage on symptoms of infection and for nasal microbiome attributes were calculated. A total of 5 (8.0%) of 62 patients had a nares culture positive for MRSA and 22 (35.5%) of 63 patients had methicillin-resistant Staphylococcus (MRSA or methicillin-resistant coagulase-negative Staphylococci). In univariate analysis, carriage with MRSA or MRCoNS was associated with having a fever during PICU stay. Colonization with a distinct set of microbes (including Haemophilus, Streptococcus, Prevotella and Corynebacterium sp.) was predictive of having methicillin-resistant Staphylococcus colonization. Carriage with methicillin-resistant Staphylococcus may lead to transmission in critically ill pediatric patients. Carriage of particular nasal microbes appears to facilitate colonization with methicillin-resistant Staphylococcus.

Minimum inhibitory concentrations of antibacterial drugs for Staphylococcus epidermidis strains isolated from the contents of the tracheobronchial tree of newborn children

Introduction. Over the past decades, outstanding progress has been made in caring for extremely premature infants and newborns with severe pathologies. Management of this vulnerable category of patients is associated with the continued risk of developing infectious pathology. In the structure of nosological forms, neonatal sepsis caused by coagulase-negative staphylococci occupies one of the leading positions. There is an increase in the number of antibiotic-resistant strains, including among Staphylococcus epidermidis, a typical representative of the normal microbiocenosis of human skin, so colonization of a premature newborn child who is at the stationary stage of nursing with it is a typical process.Objective. To study changes in the minimum inhibitory concentration of antibacterial drugs for Staphylococcus epidermidis strains isolated from the contents of the tracheobronchial tree of newborn children at the nursing stage in a hospital setting.Material and methods. To assess the statistical significance of the results obtained, the Chisquare test with Yates correction and the Mann-Whitney U test were used. Research results. All strains tested were resistant to cefoxitin. This, in turn, determines resistance to protected penicillins, amoxicillin clavulanate, ampicillin, sulbactam, and cephalosporins of I-IV generations. 44.4% and 87.5% of Staphylococcus epidermidis strains resistant to gentamicin were registered in 2022 and 87.5% in 2024.When comparing the MIC to gentamicin of Staphylococcus epidermidis isolated from TBD, a significant increase in indicators was established in 2024 compared to 2022 (Mann-Whitney U test is 7.5; p<0.05). The proportion of clindamycin-resistant Staphylococcus epidermidis strains is 44.4% in 2022 and 12.5% in 2024 (p = 0.179). > < 0.05). The proportion of clindamycin-resistant Staphylococcus epidermidis strains is 44.4% in 2022 and 12.5% in 2024 (p = 0.179).Conclusion. Thus, the analysis of antibiotic resistance of staphylococci isolated during bacteriological examination of the contents of the tracheobronchial tree demonstrates an increase in the MIC of Staphylococcus epidermidis to gentamicin.The high therapeutic potential of vancomycin, a deep reserve antibiotic for the treatment of congenital and hospital-acquired pneumonia in premature newborns, remains high.

Molecular Epidemiological Characteristics of Staphylococcus pseudintermedius, Staphylococcus coagulans, and Coagulase-Negative Staphylococci Cultured from Clinical Canine Skin and Ear Samples in Queensland.

Background/Objectives: Infections in dogs caused by methicillin-resistant staphylococci (MRS) present limited treatment options. This study's objective was to investigate the molecular epidemiology of Staphylococcus spp. cultured exclusively from clinical canine skin and ear samples in Queensland, Australia, using whole-genome sequencing (WGS). Methods: Forty-two Staphylococcus spp. isolated from clinical canine skin and ear samples, from an unknown number of dogs, were sourced from two veterinary diagnostic laboratories between January 2022 and May 2023. These isolates underwent matrix-assisted laser desorption ionisation- time of flight bacterial identification, minimum inhibitory concentration testing using SensititreTM plates and WGS. Phylogenetic trees and core genome multilocus sequence typing (cgMLST) minimum spanning trees (MSTs) were constructed. Results: The isolates included methicillin-resistant and -sensitive S. pseudintermedius (MRSP: 57.1%, 24/42; and MSSP: 19.1%, 8/42), methicillin-resistant and -sensitive S. coagulans (MRSC: 14.3%, 6/42; and MSSC: 2.4%, 1/42) and methicillin-resistant coagulase-negative staphylococci (MR-CoNS: 7.1%, 3/42). Thirty-nine isolates were included after WGS, where all MRS harboured the mecA gene. Eighteen sequence types (STs) were identified, including three novel MRSP and six novel MSSP STs. MRSP ST496-V-VII (23%; 9/39) and MRSP ST749-IV-(IVg) (12.8%; 5/39) were commonly isolated. Phylogenetic analysis of single nucleotide polymorphisms showed that MRSP, MRSC and MSSC were similar to globally isolated staphylococci from canine skin and ear infections. Using cgMLST MSTs, MRSP isolates were not closely related to global strains. Conclusions: Our findings revealed a genotypically diverse geographical distribution and phylogenetic relatedness of staphylococci cultured from clinical canine skin and ear samples across Queensland. This highlights the importance of ongoing surveillance to aid in evidence-based treatment decisions and antimicrobial stewardship.

First Report of Antibiotic-Resistant Coagulase-Negative Staphylococcus Strains Isolated from Technical Snow on Ski Slopes in Mountain Areas

Coagulase-negative staphylococci form a heterogeneous group defined solely by the lack of coagulase. Initially considered non-pathogenic, they are now known to be opportunistic pathogens of increasing importance. This study was conducted to examine the prevalence of Staphylococcus spp., their taxonomic diversity, antibiotic resistance patterns and genetic determinants of antibiotic resistance in the water resources used within the technical snow production process. The types of samples included (1) river water at intakes where water is drawn for snowmaking, (2) water stored in technical reservoirs, from which it is pumped into the snowmaking systems, (3) and technical snowmelt water. The study was conducted in the catchments of five rivers: Białka, Biały Dunajec, Raba and Wisła in Poland, and Studený Potok in Slovakia. Staphylococcus spp. was detected in all types of samples: in 17% of river water, 25% of reservoir-stored water and in 60% of technical snowmelt water. All staphylococci were coagulase-negative (CoNS) and belonged to 10 species, with S. epidermidis being the most prevalent in river water, S. warneri and S. pasteuri in reservoir-stored water and S. haemolyticus in snowmelt water. The highest resistance rates to erythromycin and macrolide/lincosamid/streptogramin b (MLSb) types of resistance were detected in all types of samples, accompanied by the erythromycin efflux pump-determining msrA gene as the most frequent genetic determinant of antibiotic resistance. This study is the first report of the presence of antibiotic-resistant, including multidrug-resistant, CoNS carrying more than one gene determining antibiotic resistance in technical snow in the mountain areas of the Central European countries.

Intra-articular procedures and associated septic arthritis: A mini-review.

Native joint septic arthritis (SA) is a severe, potentially life-threatening condition characterized by the invasion of synovial fluid and membrane by pathogens, most commonly bacteria. The rising frequency of intra-articular procedures such as joint aspirations and injections has led to increased concern regarding iatrogenic septic arthritis. This mini-review aims to summarize current understanding of the incidence, risk factors, bacterial etiology, and strategies for preventing SA associated with intra-articular procedures. Recent studies report that while iatrogenic SA incidence remains low, ranging between 0.002% and 0.008% following injections, it is higher following arthroscopy (0.14%). Risk factors for iatrogenic SA mirror those of hematogenous SA, comprising older age, male gender, comorbidities such as diabetes mellitus, and systemic corticosteroid therapy. Staphylococcus aureus remains the most frequently implicated pathogen, followed by coagulase-negative staphylococci and streptococci. Preventive measures, including hand antisepsis, patient skin disinfection, and the wearing of surgical masks, are essential to reducing the risk of SA during intra-articular procedures. Despite low incidence, SA poses significant morbidity and mortality risks, underscoring the need for adherence to infection control protocols. This review highlights the importance of standardized preventive measures and further research into optimized aseptic techniques, the objective being to mitigate the risk of iatrogenic infections in clinical practice.