Long-term Hospital Research Articles

P-1179. Investigations of carbapenemase-producing bacteria among children in U.S. healthcare settings: review of CDC consultations, 2015–2023

Abstract Background The US Centers for Disease Control and Prevention (CDC) provides technical assistance (consultations) to health departments responding to single cases and clusters of carbapenemase-producing organisms (CPOs). We aimed to characterize consultations involving pediatric patients.Figure 1.Flow diagram of screening of CDC consultations for pediatric CPO cases requiring public health responses or clusters with suspected or confirmed transmission.Abbreviations: AR, antimicrobial resistance; CPO, carbapenemase-producing organism; HAI, healthcare-associated infection.*Includes one additional recent consultation not yet added to database at time of query.†One consultation involved two unrelated single cases and another consultation included 3 subclusters.‡Applicable public-health response components were contact screening, site visit/infection control assessment, and/or environmental sampling. Methods We searched CDC databases of healthcare-associated infection (HAI) consultations (November 2001 to January 25, 2024) using pediatric key-word patterns. We reviewed this subset for CPO investigation consultations with at least one pediatric case (age < 18 years with a CPO-positive clinical or screening specimen) or involving a pediatric healthcare facility. We classified CPO consultations as either (a) a cluster with likely transmission or (b) a single case with a public-health response (Figure 1). We abstracted and descriptively analyzed consultation characteristics regarding microbiology, healthcare setting, index patient characteristics, public-health response, and likely transmission mechanisms.Figure 2.Number of CDC consultations for CPOs by year among children in U.S. healthcare settings, 2015–2023. Results Among 2338 HAI consultations, 271 (12%) related to pediatric cases or facilities were reviewed (Figure 1). Thirty-three consultations from 2015–2023 across 20 states were included, which comprised 16 single cases and 20 clusters (Figure 2). Eight (40%) clusters only involved pediatric cases and the remainder included both pediatric and adult cases. Most commonly, for 17 (47%) index cases, Enterobacterales was identified in a clinical specimen from an acute-care hospital patient in an intensive care unit (e.g., burn unit; Table 1). The most common carbapenemases were NDM (53%), KPC (28%), and VIM (22%). Among the 16 clusters with available information, the most common transmission mechanisms were gaps in core infection control practices (9, 56%) and premise plumbing (3, 19%). Overall, 9 (56%) single cases and 6 (30%) clusters had history of international healthcare or travel for the index case-patient.Table 1.Microbiologic, healthcare setting, index patient, and public health response characteristics of consultations of CPO among children in U.S. healthcare settings, by consultation type, 2015–2023 Abbreviations: ACH, acute care hospital; CPO, carbapenamase-producing organism; ICU, intensive care unit; IPC, infection prevention and control; LTACH, long-term acute-care hospital; PFGE, pulse field gel electrophoresis; SNF, skilled nursing facility; WGS, whole genome sequencing. a Proportions may not add to 100% as values may not be mutually exclusive per consultation and/or rounding error. b Three clusters of VIM–P. aeruginosa in different facilities were part of multistate outbreak linked to artificial tears. c Denominator for clusters is 16 ACHs. “Other” includes one each of surgery, pediatrics, medicine, and adult ICU units. d Includes three single cases and one cluster where index case was a US-born patient in a neonatal ICU whose mother had history of international healthcare or travel. e Includes hand hygiene, Transmission-Based Precautions, and cleaning and disinfection of high-touch surfaces in patient rooms. Conclusion Review of CDC consultations for CPOs in pediatric patients identified multiple cases and clusters among high-risk inpatient units. Links to healthcare outside the U.S. were common. Admission screening, particularly on high-risk units, and adherence to core infection control practices may prevent future outbreaks. Disclosures All Authors: No reported disclosures

P-1810. Implementation of the Core Elements of Hospital Antibiotic Stewardship Programs and the Priorities for Hospital Core Element Implementation in Long-term Acute Care Hospitals Reporting to the National Healthcare Safety Network, 2014 and 2023

Abstract Background The Centers for Disease Control and Prevention (CDC) defines the 7 Core Elements of Hospital Antibiotic Stewardship Programs as a framework for antibiotic stewardship implementation. In 2022, CDC released 6 Priorities for Hospital Core Element Implementation to enhance the quality and impact of existing antibiotic stewardship programs. Acute care hospitals reported 97% uptake of the 7 Core Elements and 10% uptake of the 6 Priorities in 2022 as per reporting to the National Healthcare Safety Network (NHSN) Annual Hospital Survey. However, stewardship implementation in long-term acute care (LTAC) hospitals has not been widely assessed. The objective of this analysis was to assess the uptake of the 7 Core Elements and 6 Priorities in LTAC facilities in 2023 and compare Core Elements uptake to 2014.Table 1.Facility Characteristics of Long-Term Acute Care (LTAC) Hospitals Reporting to the National Healthcare Safety Network Annual Facility Survey for LTAC, 2014 and 2023 Methods We used the NHSN Annual Facility Surveys for LTAC hospitals (4/1/2024 data pull) for survey years 2014 and 2023 to characterize facility characteristics and self-reported responses to antibiotic stewardship program survey questions. We mapped stewardship survey questions to corresponding Core Elements and Priorities to describe the reported uptake of the 7 Core Elements and 6 Priorities.Figure 1.Reported Implementation of the Priorities for Hospital Core Element Implementation by Priority in Long-Term Acute Care (LTAC) Hospitals (N=337), 2023 Results In 2014 and 2023, 489 and 337 LTAC hospitals completed the annual survey. In 2023, most LTAC facilities were for-profit (79%), free-standing (58%), part of multi-facility organizations (47%), and in the South (50%) (Table 1). From 2014 to 2023, the number of facilities reporting uptake of all 7 Core Elements in LTAC hospitals increased from 60% to 98%. In 2023, 2% of LTAC hospitals reported meeting the 6 Priorities and 44% reported meeting 4-5 Priorities. The highest reported uptake of Priorities across LTAC hospitals was Pharmacy Expertise (81%) and Leadership (77%). The lowest reported uptake of Priorities was Tracking (7%) and Reporting (42%) (Figure 1). Conclusion LTAC hospitals reported uptake of the Core Elements of Antibiotic Stewardship increased from 2014 to 2023, on par with the increase acute care hospitals reported for Core Elements implementation. Engagement with LTAC hospital leadership and leveraging pharmacy expertise are important to support antibiotic stewardship Priorities, especially tracking & reporting of antibiotic use. Disclosures All Authors: No reported disclosures

P-372. Candida auris Outbreak in a Cardiothoracic Transplant Intensive Care Unit: Implications for Infection Prevention

Abstract Background Candida auris is a yeast that causes invasive infections such as bloodstream infections (BSIs); mortality rates for C. auris BSIs may be as high as 80%. Rates have been climbing in the U.S. Exposure to skilled nursing facilities (SNFs), long-term acute care hospitals (LTACHs), or inpatient rehabilitation facilities (IRFs) represents a known risk factor for C. auris. Our institution experienced a C. auris outbreak from September 2023 - January 2024. Figure 1: C. auris Outbreak Epidemic Curve Methods C. auris cases in the outbreak were identified from clinical specimens and admission and weekly surveillance via polymerase chain reaction (PCR). Clinical characteristics were determined through chart review. A multidisciplinary team implemented infection prevention (IP) interventions to curb nosocomial spread. Infection Prevention Interventions Results There were 20 cases of C. auris identified in our CTICU between July 2023 and January 2024 (Figure 1). Whole-genome sequencing and phylogenetic analysis based on pairwise single nucleotide polymorphism (WG-SNP) distance revealed two outbreak clusters. Of the 20 patients, 13 (65%) were solid organ transplant/acute mechanical circulatory support patients and three (15%) had prior SNF, LTACH, or IRF exposure. Four (20%) patients had C. auris BSIs and seven (35%) patients died, including all patients with BSIs. The mean duration of antibiotic use in the four patients was 67 days. IP interventions addressed potential vehicles of transmission including healthcare personnel hands, shared patient equipment, and the environment (Table 1). Conclusion Only 15% of patients had prior SNF/LTACH/IRF exposure; many were admitted from home and/or outside hospitals with risk factors including recent surgery and antimicrobial use. This suggests the epidemiology of C. auris may be changing, and it may be prudent to consider routine admission and weekly surveillance on inpatient units deemed high risk for C. auris. Effective IP interventions included interventional hand hygiene auditing, increased accountability and oversight for shared patient equipment, limiting the number of rounding providers in rooms, and auditing environmental cleaning. Sustaining these efforts is crucial to keep pace with an evolving C. auris landscape. Disclosures All Authors: No reported disclosures

P-347. Investigating Risk Factors for Candida auris Bloodstream Infections: A Case-Control Study from Los Angeles County

Abstract Background Candida auris (C. auris) has emerged as a significant pathogen due to its ability to cause bloodstream infections (BSIs) in highly vulnerable patient populations. Understanding the risk factors associated with C. auris BSIs is crucial for implementing targeted interventions to mitigate the burden of infection and ensure patient safety. In Los Angeles County (LAC), all C. auris cases are reportable to the Department of Public Health (DPH). Methods We conducted a case-control study to identify risk factors associated with C. auris BSIs. Using data reported to LAC from June 2019 to April 2024, cases included persons initially colonized with C. auris who subsequently developed confirmed C. auris BSI, while controls consisted of persons colonized with C. auris without C. auris identified from a clinical specimen site. C. auris cases and controls were identified via required laboratory and provider reporting of all positive C. auris tests. Data on various risk factors were collected from provider case reports that were completed on all C. auris-positive persons, excluding cases with missing risk factor data. We used logistic regression to estimate the adjusted odds ratios of a colonized case acquiring a C. auris BSI compared to only colonized persons, adjusting for age, sex, race/ethnicity, and healthcare facility where the positive specimen was collected. Results Of the 174 cases and 2,602 controls identified, increased odds of BSI were observed among patients with prior antifungal use (OR: 3.58, 95% CI: 1.12-11.41) and hemodialysis (OR: 2.33, 95% CI: 1.05-5.16). Other risk factors such as ventilator use, tracheostomy, central venous catheter presence, and wound presence showed no statistically significant associations. Conclusion Targeted infection prevention strategies are vital to mitigate C. auris BSI burden. Rigorous aseptic techniques during hemodialysis and judicious use of antifungal agents may reduce C. auris BSI risk. Although adjusted for in this analysis, specialized attention to infection control in healthcare facilities such as long-term acute care hospitals may be warranted, given their unique patient populations and care settings. Further investigation is warranted to identify additional strategies to mitigate C. auris BSI risk. Disclosures All Authors: No reported disclosures

P-1885. Continuous Infectious Diseases Coverage by Merging with a Hospitalist Practice in a Small Community Hospital System

Abstract Background There is a severe shortage of infectious diseases (ID) physicians in the United States, with > 80% counties without an ID physician. Insufficient compensation is a contributing factor, with many internal medicine graduates practicing as hospitalists. Based on community needs, we merged the ID practice into the hospitalists group to create an ID-Hospitalist position. Methods Corewell Health South is based in Berrien County, which is in Southwest Michigan, population 152,261, and includes large rural populations and several federally funded clinics. The hospital includes 2 acute care facilities, including 220-bed and 76 bed hospitals. In 2002, the ID physicians began seeing patients as hospitalists at a Long-Term Acute Care Hospital. An ID physician assumed the role of Hospitalist Director in 2005 and second physician became co-director in 2008. At that time, the ID service adopted a 7 day on-7 day off schedule and included primary hospitalist patients. Results Since 2011, the ID-Hospitalist group has had continuous coverage with at least 3 Full time and 1 part-time ID-Hospitalists. Coverage (2.63/100,000) exceeds the national average of 1.79/100,000 by 84%. All service weeks are based on a 7 day on-7 day off schedule. In 2013, the outpatient ID clinic was resumed after a 5-year hiatus and is Ryan White Funded. A clinic day is built into the 7-day work week. Over the last 22 years, the group has included 6 ID physicians, which include 5 American graduates and 1 international graduate. In surveying the group, 83% expressed that pay was a factor in working as an ID/Hospitalist. 67% reported more free time and improved work-life balance. 67% preferred doing ID only, although the majority enjoyed hospitalist practice. Perceived weaknesses included overextension of responsibilities and a de-emphasis on the ID service in favor of hospitalist responsibilities. Another limitation included inconsistent coverage at the smaller hospital, increasing the reliance on telephone consultations. Conclusion Merging an ID practice into a hospitalist group has been effective in sustaining an ID service. Strengths included stable salary support and ability to perform other administrative or clinical tasks. Weakness included a multitasking of duties. This may serve as a model for resource limited settings. Disclosures All Authors: No reported disclosures

P-1052. Identifying Facility and Specimen Type Associated with Screening-to-Clinical Candida auris Patients in the United States, 2013–2022

Abstract Background Candida auris (C. auris) is an emerging healthcare-associated fungal pathogen associated with high mortality and antifungal resistance. Targeted screening based on patient risk factors and facility type is important for identifying colonized patients and implementing recommended infection prevention and control (IPC) precautions. Understanding the epidemiology of C. auris colonized patients who subsequently have positive clinical specimens (screening-to-clinical patients (STC)) can help us understand the clinical course and impact of colonization. Methods Using national case surveillance data from 34 states and Washington DC, we described C. auris adult patients, as defined by Council of State and Territorial Epidemiologists, during 2013–2022. We analyzed facility and specimen source for STC patients and compared with screening or clinical only patients using chi-squared tests. Results Among 13,341 screening patients, 1,151 (9%) were STC. STC patients were more likely than screening only patients to be screened at long-term acute-care hospitals (LTACH) (48% vs 40%; p< 0.001) and were more likely than clinical only patients to have positive clinical specimens taken at LTACHs (35% vs 10%; p< 0.001). While blood was the most frequent clinical specimen source for STC and clinical only patients (39% and 35% respectively), respiratory specimens were more likely to be taken from STC patients than clinical only patients (12% vs 8%; p< 0.001). The median time between STC specimen collection was 47 days [interquartile range (IQR) 19-111] and was shorter for patients in LTACHs (median 37 days [IQR 17–78]) than ACHs (median 53 days [IQR 21–116]). Conclusion About half of STC patients were screened at LTACHs and over half of STC clinical specimens were collected at LTACHs. While blood specimens were most frequent clinical specimen source among STC, respiratory sources were more likely to be taken from STC patients than clinical only patients. As high-risk respiratory devices (e.g., mechanical ventilation) are associated with invasive infections, our findings emphasize the importance of timely diagnosis and monitoring STC patients with clinical respiratory sources in LTACHs to reduce risk of invasive infection. Disclosures All Authors: No reported disclosures

588. The Association Between Contact Precautions for Methicillin-resistant Staphylococcus aureus (MRSA) Colonization and MRSA Bloodstream Infection (BSI) Rates in Los Angeles County Hospitals: Results of a Countywide Survey

Abstract Background Contact precautions are frequently used to prevent in-facility transmission of MRSA, but their efficacy has been questioned. We hypothesized that contact precautions use would not correlate with MRSA bloodstream infection (BSI) rates in LA County hospitals. Methods The LA County Department of Public Health conducted a survey of LA County acute care hospitals’ use of contact precautions for MRSA colonization, history of MRSA infection/colonization, and active MRSA infection with or without uncontained purulence. We modeled National Healthcare Safety Network (NHSN) reported healthcare-associated MRSA BSI rates from 2022-23 via a negative binomial multivariable regression model. We controlled for hospital type (general acute care hospitals vs. long-term acute care hospitals (LTACHs)), number of intensive care unit (ICU) beds, and MRSA BSI admission prevalence rates. Results Of the 82 acute care hospitals in LA County, 69 completed the survey (84% response rate). MRSA contact precaution use was stratified into three groups: Least strict (no contact precautions or contact precautions only for active infection with uncontained purulence, 24% of hospitals), intermediate (contact precautions for any active infection, 32% of hospitals), and most strict (contact precautions for >2 reasons, 44% of hospitals). We found higher MRSA BSI in LTACHs vs. hospitals (Incidence rate ratio [IRR] 3.50, 95% CL 1.80-6.80, p = 0.0002), but no relationship with ICU beds (IRR 1.00, 95% CL 0.99-1.01, p = 0.15), MRSA BSI admission prevalence rates (IRR = 4.40, 95% CL 0.30-63.10, p = 0.27), or contact precaution use (IRR 0.80, 95% CL 0.50-1.30, p = 0.29 for the least strict group; IRR 1.40, 95% CL 0.89-2.20, p = 0.14 for the intermediate group, both in comparison to the most strict group). Conclusion Our survey of hospitals across LA County, which has a population of ∼10 million, found no significant association between stringency of MRSA contact precaution use and healthcare-associated MRSA BSI rate. Our findings support other data that fail to find clinical benefit to contact precautions for MRSA colonization/infection. Considering potential downsides of contact precautions for MRSA, the assumption that MRSA requires contact precautions may need to be reconsidered. Disclosures Loren G. Miller, MD MPH, Armata: Grant/Research Support|Contrafect: Grant/Research Support|GSK: Grant/Research Support|Merck: Grant/Research Support|Paratek: Grant/Research Support

P-236. Impact of a New Dressing Protocol for the Prevention of Central Line-Associated Bloodstream Infections in one Neonatal Intensive Care Unit (NICU)

Abstract Background Newborns in the neonatal intensive care unit (NICU) are vulnerable to infections due to their extremely fragile skin, underdeveloped immune systems, and usual long-term hospitalizations. These infants often require prolonged use of central venous catheters (CVCs). Bloodstream infections can arise from these CVCs and are a major cause of death in the NICU. Every CVC dressing change can damage their fragile skin, increasing infection risk, and potentially resulting in central line-associated bloodstream infections (CLABSIs). Centers for Disease Control and Prevention recommends dressing changes every seven days, more often if visibly damaged or dirty. Our objective was to evaluate the effectiveness of a new protocol and dressing optimized for long-term skin adhesion implemented in the Centre Hospitalier Universitaire Sainte-Justine (CHUSJ) NICU. Methods The CHUSJ NICU is a level III-IV NICU with 900 admissions a year from both inborn and outborn infants. CLABSI surveillance is done prospectively by the Infection Prevention and Control team. All CVCs installed in NICU patients are recorded daily. Inclusion criteria were all recorded NICU CVCs from January 1, 2017, to December 31, 2023. Segmented interrupted time-series analysis was conducted according to the three-stage intervention rollout (first for gestational age of 28 weeks or more, then large premature infants, then the entire unit), with a pre-intervention period of January 1, 2017, to May 1, 2021, modeling CLABSIs/1000 CVC days/month and adjusting for mean birth weight. Results 2653 CVCs and 71 CLABSIs were reported during the surveillance period. Pre-intervention rates were 1.85 CLABSIs/1000 CVC days. CLABSI rate ratios were: during initial intervention rollout 0.448 (95% confidence interval 0.407, 0.492), during the second stage 0.952 (0.932, 0.973), and since complete implementation 0.610 (0.581, 0.639) that of pre-intervention period rates, for the entire NICU population. Conclusion With reports of CLABSI rate rebounds during the COVID-19 pandemic and increasing NICU outbreaks from multidrug-resistant organisms with associated high mortality, new infection prevention protocols are crucial to combat these trends in CLABSI rates and severity of case outcomes, especially for the vulnerable NICU population. Disclosures All Authors: No reported disclosures

Spatial association of socioeconomic and health service factors with antibiotic self-medication in Thailand.

Antibiotic Self-Medication (ASM) is a major contributing factor to Antimicrobial Resistance (AMR) that can lead to both mortality and long-term hospitalizations. High provincial ASM proportions associated with mortality due to AMR have been observed in Thailand but there is a lack of studies on geographic factors contributing to ASM. The present study aimed to quantify the distribution of ASM in Thailand and its correlated factors. Socioeconomic and health services factors were included in the spatial analysis. Moran's I was performed to identify global autocorrelation with the significance level set at p=0.05 and spatial regression were applied to identify the factors associated with ASM, the proportion of which is predominant in the north-eastern, central and eastern regions with Phitsanulok Province reporting the highest proportion of Thailand's 77 provinces. Autocorrelation between Night-Time Light (NTL) and the proportion of ASM was observed to be statistically significant at p=0.030. The Spatial Lag Model (SLM) and the Spatial Error Model (SEM) were used with the latter providing both the lowest R2 and Akaike Information Criterion (AIC). It was demonstrated that the proportion of alcohol consumption significantly increased the proportion of ASM. The annual number of outpatient department visits and the average NTL decreased the proportion of ASM by 1.5% and 0.4%, respectively. Average monthly household expenditures also decreased the ASM proportion. Policies to control alcohol consumption while promoting healthcare visits are essential strategies to mitigate the burden of AMR in Thailand.

Directional Freeze-Casting Cryogel Loaded with Quaternized Chitosan Modified Gallium Metal-Organic Frameworks to Capture and Eradicate the Resistant Bacteria for Guided Regeneration in Infected Bone Defects.

Antimicrobial resistance and impaired bone regeneration are the great challenges in treating infected bone defects. Its recurrent and resistant nature, high incidence rate, long-term hospitalization, and high medical costs have driven the efforts of the scientific community to develop new therapies to improve the situation. Considering the complex microenvironment and persistent mechanisms mediated by resistant bacteria, it is crucial to develop an implant with enhanced osseointegration and sustained and effective infection clearance effects. Here, a positively charged quaternized chitosan (QCS) coated gallium-based metal-organic framework (GaMOF) is designed, to capture the antibiotic-resistant bacteria (Methicillin-resistant Staphylococcus aureus, MRSA) as a "captor", and rejuvenate Methicillin (Me) via disturbing the tricarboxylic acid (TCA) cycle. Then, a radially oriented porous cryogel loaded with the Me and QCSGaMOF is fabricated by the directional freeze-casting method. The oriented porous structure has an enhanced osseointegration effect by guiding the ingrowth of osteogenic cells. In vitro and in vivo experiments prove the advantages of as-prepared Me/QCSGa-MOF@Cryogel in combating resistant bacteria and guiding bone regeneration in infected bone defects.

Associations between regional supply and integration of home and community-based service providers and risk of institutionalization: Evidence from South Korea

Abstract Background and Objectives To examine whether the regional density of integrated home and community-based services (HCBS) providers affects long-term care (LTC) service utilization pattern and institutionalization risk in South Korea. Research Design and Methods This observational study utilized data from the National Health Insurance Service (NHIS) on individuals aged 65 and older who became newly eligible for LTC insurance benefits in 2018. The final sample excluded individuals admitted to long-term care hospitals during the previous year or those living away from home, resulting in a total of 91,302 individuals included in the study. We analyzed the impact of regional HCBS and integrated care provider density on four outcomes: choice of HCBS over LTC facilities (LTCF) as first LTC service, intensity and comprehensiveness of HCBS use, and risk of institutionalization within a year. Results Higher regional densities of integrated care providers are associated with increased odds of using HCBS as the first LTC service (Odds Ratio 1.066, model 1, p<0.01). Increased density was also associated with higher odds of using multiple HCBS (Odds Ratio 1.108, model 1, p<0.01). Additionally, higher density of integrated care providers was associated to decreased risk of institutionalization into LTC facilities (Hazard Ratio 0.98, model 1, p<0.01). Discussion and Implications The density integrated care providers significantly reduce institutionalization rates, by increasing the possibility of choosing HCBS over LTCF as their first LTC service and using a more comprehensive combination of HCBS services. Further investment in integrated care models may enhance the effectiveness of LTC systems.

요양병원간호사가 경험한 환자안전사고, 환자안전문화 및 안전간호활동에 대한 연구

This study aimed to analyze patient safety accidents experienced by nurses in long-term care hospitals, and to understand the relationships between these accidents, patient safety culture, and safety nursing activities. A survey was conducted from November 1 to November 30, 2023, involving 234 nurses who had been engaged in nursing duties for more than 6 months at five different long-term care hospitals. The collected data were analyzed using SPSS 29.0 software, employing the chi-square, the t-test, ANOVA, and the Pearson correlation test. The results revealed that 73.5% of participants had experienced a patient safety accident in the past year, with 3.5% of these accidents remaining unreported. The most frequently encountered accident was falls, predominantly occurring in inpatient wards. The accident stage most commonly identified was near misses, and the most common post-accident response was intensive monitoring. Nurses with more experience in terms of age, nursing career, and tenure in long-term care facilities, as well as those involved in accreditation evaluations, reported a higher incidence of patient safety accidents. Nurses with access to patient safety guidelines had higher scores for patient safety culture and safety nursing activities, and those who completed patient safety training had higher scores for patient safety culture. However, no significant relationship was found between the experience of patient safety accidents and both patient safety culture and safety nursing activities. Based on these findings, it is recommended to implement differentiated patient safety training according to nursing experience and to utilize guidelines based on patient safety regulations.

Predictors of Psychosocial Functioning Among Long-stay Schizophrenia Patients in a Malaysian Mental Institution.

A considerable number of schizophrenia patients still require long-term hospital care despite psychiatric deinstitutionalisation, especially in developing nations. Prolonged hospitalisation is associated with greater impairment in psychosocial functioning. This study aimed to determine the level of psychosocial functioning and its predictors among long-stay schizophrenia patients in a Malaysian mental institution. This cross-sectional study included 138 patients selected through universal sampling. Data on socio-demographics, illness characteristics such as psychopathology and illness severity [measured using the Brief Psychiatric Rating Scale (BPRS)], and cognitive function [assessed using the Montreal Cognitive Assessment (MoCA)] were collected. The Personal and Social Performance (PSP) scale was used to evaluate psychosocial functioning. Pearson correlation coefficients and multiple linear regression analyses were applied to identify the correlates and predictors of psychosocial functioning. This study found that 47.8% and 16.7% of the patients had moderate and severe cognitive impairments, respectively. The mean PSP score was 69.68 (standard deviation (SD) = 15.48). Female gender, previous unemployment and more severe cognitive impairments were significantly associated with poorer psychosocial functioning. Meanwhile, negative symptoms and age of onset were negatively correlated with psychosocial functioning. By contrast, the duration of illness was positively correlated with psychosocial functioning. The regression model indicated that being female (β = -7.32, p < 0.001), previously unemployed (β = -3.67, p < 0.047), having negative symptoms (β = -4.18, p < 0.001), experiencing a longer illness duration (β = -0.60, p = 0.004), and the presence of severe cognitive impairment (β = -9.80, p < 0.001) significantly predicted poorer psychosocial functioning. Long-stay schizophrenia patients experience substantial difficulties in psychosocial functioning. Factors such as gender, last employment status, negative symptoms, illness duration, and cognitive function affect psychosocial functioning.

Factors Affecting the Length of Hospital Stay in Hypercapnic Respiratory Failure

Background/Objectives: Hypercapnic respiratory failure (HRF) is a primary cause of admittance to the intensive care unit (ICU). This study aimed to investigate the factors that affect the length of hospital stay in HRF patients. Methods: This study was designed as a retrospective, cross-sectional analysis of patients who were admitted to the ICU because of HRF between 2022 and 2024. The demographic and clinical characteristics of the patients and laboratory results were recorded. The Charlson Comorbidity Index (CCI) was calculated. The relationship between these parameters and the length of hospital stay was assessed. Results: A total of 138 patients were included in the study. The average length of hospital stay was 11.45 days, and 37% of the patients were included in the long-term hospitalization group. The degree of hypercapnia was not associated with the length of hospital stay. It was determined that the patients’ albumin levels and CCI were significant determinants of the length of hospital stay. The combined assessment of these two parameters was found to be superior compared to their separate evaluations. Conclusions: In our study, hypoalbuminemia and a higher CCI were identified as predictors of a prolonged ICU stay in HRF patients. Albumin levels of &lt;3.25 g/dL and CCI scores of ≥5 were linked to longer stays, with this combined evaluation offering greater predictive value. These factors can guide patient management.

Frailty and Sarcopenia Assessment in Patients with Advanced Chronic Liver Disease in a Tertiary Center in Romania

Background/Objectives: Sarcopenia and frailty are both multidimensional and interrelated problems for patients with cirrhosis and require prompt assessment and appropriate management because of their impact on disease outcomes. Our purpose is to identify the prevalence of sarcopenia and frailty in patients with advanced liver disease. Furtherksdnvk more, our purpose is to explore the association between sarcopenia, frailty, and various complications and the impact of these conditions on short- and long-term hospital survival rates. Methods: A prospective, observational, unicentric study was conducted in an emergency university hospital in Romania between January 2021 and December 2023 that included patients with advanced liver diseases. The patients with sarcopenia and frailty were selected using measurements of handgrip strength (HGS), Short Physical Performance Battery (SPPB), liver frailty index (LFI), and skeletal muscle index (SMI). Patients were divided into four groups based on the presence of sarcopenia and/or frailty. Results: This study included 128 patients. Younger patients associated with both sarcopenia and frailty (55.76 ± 10.46 years). Most males were without sarcopenia and frailty (63.93%) compared to those with both sarcopenia and frailty (36.07%). The Child–Pugh score C was identified in the majority of those with both sarcopenia and frailty (69.70%). Higher values for MELD-Na scores were obtained in the group with sarcopenia and frailty (25.45 ± 6.924). Biomarkers like albumin, sodium, C-reactive protein, bilirubin, and platelets were statistically significant as mortality predictors in all four groups. Patients with both sarcopenia and frailty presented more often with encephalopathy and spontaneous bacterial peritonitis. Survival rates in the short and long term were lower for the patients who associated both sarcopenia and frailty compared to those without sarcopenia and frailty. Conclusions: The presence of sarcopenia and frailty significantly impacts outcomes in patients with decompensated advanced liver disease. When both conditions coexist in the same patient, they markedly increase in-hospital mortality, as well as short- and long-term survival rates.

Days at Home After Transcatheter Mitral Valve Repair Versus Medical Therapy Alone in Heart Failure.

Transcatheter edge-to-edge repair of the mitral valve (mTEER) reduced a hierarchical end point that included death and heart failure hospitalization in COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation Trial). However, the magnitude to which mTEER increases the number of days a patient spends at home (DAH) in the first few years after treatment, a patient-centered end point not captured routinely in clinical trials, has not been evaluated. We compared 1- and 2-year DAH among patients with functional mitral regurgitation and heart failure randomized to mTEER plus medical therapy versus medical therapy alone (control) by linking the COAPT trial to comprehensive health care claims data. We linked data from COAPT trial participants to Medicare fee-for-service claims. DAH was calculated as the number of days alive and spent outside a hospital, skilled nursing facility, inpatient rehabilitation, long-term acute care hospital, emergency department, or observation stay after randomization. Treatment groups were compared using quantile regression to calculate the area under the curve of cumulative distribution functions. We linked 271 patients (mTEER 136/302, control 135/312) for a 2-year follow-up. Mean±SD DAH at 1 year was 312.0±95.6 in mTEER and 298.1±107.5 in controls with similar area under the curve (difference 13.9 days [-10.5 to 38.3], P=0.26). DAH at 2 years was 577.2±235.6 in mTEER and 518.2±253.0 in control with a higher area under the curve in mTEER (difference 59.0 days [0.07 to 117.9], P=0.0497). In the COAPT trial linked to Medicare claims, patients randomized to mTEER spent a similar number of DAH at 1 year but more time at home at 2 years compared with medical therapy alone.

COVID-19 vaccine safety and effectiveness at 3 months in institutionalized old people.

Older age and associated comorbid conditions increase the risk of severe form of COVID-19 and death. The SARS-CoV-2 vaccination campaign began in France in December 2020 targeting institutionalized older population before having been evaluated in this population. The objective of our study was to assess the tolerability of vaccination 21 days (D21) and 90 days after the first vaccination (D90) in institutionalized old people. Secondary objective was to assess its effectiveness (mortality, hospitalization and occurrence of COVID) at D21 and D90. People living in nursing homes or in long-term hospitalization facilities in France were included 12-2020-06-2021. They were divided into SARS-CoV-2 vaccinated and unvaccinated groups. Vaccine tolerability was prospectively assessed by the occurrence of health events at D21 and D90 (local and systemic side effects, geriatric syndromes, cardiovascular events). Vaccine efficacy was assessed by the occurrence of COVID-19 and serious adverse events (unscheduled hospitalization and all-cause mortality). The mean age of the 2595 participants was 86 years, 83% received COVID-19 vaccine. There were no significant difference between the vaccinated and unvaccinated for systemic or local adverse events at D21 and D90. At D90, vaccinated participants had significantly fewer SARS-CoV-2 infections (odds ratio (95% confidence interval) = 0.35 (0.22-0.58)), fewer deaths or hospitalizations (0.50 (0.31-0.81)), fewer cardiovascular events (0.28 (0.12-0.64)) and fewer pressure ulcers (0.38 (0.17-0.88)). In this prospective cohort study, COVID-19 vaccine in a very old institutionalized geriatric population had a reassuring safety profile and a protective effect on COVID-19, hospitalizations and deaths, cardiovascular events and pressure ulcers.

Identifying risk factors for carbapenem-resistant Acinetobacter baumannii carriage upon admission: a case-case control study

BackgroundActive screening programs and early detection of asymptomatic carriers are effective in preventing carbapenem-resistant Acinetobacter baumannii (CRAB) dissemination in healthcare facilities. This study aims to identify risk factors associated with CRAB carriage among patients upon admission to an acute care hospital.MethodsA case-case-control study was conducted at an acute care hospital. Starting in June 2020, new admissions to medical wards underwent rectal and buccal screening. Patients with CRAB or carbapenem-susceptible A. baumannii (CSAB) carriage were compared to controls, randomly selected from patients with negative cultures, at a one-to-one ratio. Multinomial logistic regression using a backward stepwise method was employed to identify factors associated with CRAB and CSAB carriage. A Chi-square Automatic Interaction Detector analysis was also conducted to further elucidate risk factors.ResultsThe study included 115 CRAB carriers, 117 CSAB carriers and 121 controls. Increasing age was associated with a reduced risk of CSAB (OR: 0.96, p < 0.001) and CRAB carriage (OR: 0.97, p = 0.02), while higher Charlson Comorbidity Index scores increased the risk for both. CRAB carriage was significantly associated with admission from long-term acute care hospitals (OR: 7.68, p < 0.001) and presence of pressure ulcers (OR: 89.98, p < 0.001). Decision tree analysis identified pressure ulcers, prior location, and Charlson score as key predictors, with CRAB carriage reaching 77.3% in patients admitted from long-term acute care hospitals with pressure ulcers.ConclusionPressure ulcers were strongly associated with the carriage of both susceptible and resistant strains of A. baumannii. CRAB carriage was predominantly observed in patients transferred from long-term acute care hospitals, highlighting the need for targeted screening in this high-risk population.

Factors associated with post acute care utilization after mastectomy for breast cancer patients.

Although the demand for care immediately after mastectomy is rising, and such medical services are referred to as post-acute care (PAC), there is limited evidence on the factors influencing PAC choices among these patients in Korea. A total of 106,670 patients diagnosed with breast cancer and undergoing mastectomy were extracted from the Central Cancer Registry data from 2012 to 2019 using Public Cancer Library data of KCURE. PAC was defined as utilization of long-term care hospital (LTCH), hospital-based nursing care (HBNC), or HBC (hospital-based care) within 2 months post-surgery. Multinomial logistic regression was used to identify factors associated with different types of PAC utilization. The utilization patterns of different types of PAC within 2 months after mastectomy were associated with age, income, cancer severity, and particularly the region of residence (Metropolitan; HBNC, OR 0.16, 95% CI 0.10-0.26; LTCH, OR 2.35, 95% CI 2.21-2.50; HBC, OR 2.17, 95% CI 1.97-2.39), as well as the location (capital areas; HBNC, OR 12.46, 95% CI 4.97-31.25; LTCH, OR 1.21, 95% CI 1.15-1.28; HBC, OR 1.90, 95% CI 1.74-2.07) and type of the hospital (tertiary hospital; HBNC, OR 13.70, 95% CI 7.86-23.86; LTCH, OR 1.45, 95% CI 1.37-1.53; HBC, OR 3.38, 95% CI 3.00-3.80) where the surgery was performed. In this study, we found the factors associated with PAC utilization on mastectomy patients. Our study found that middle-aged breast cancer patients, residents of metropolitan or rural areas, and those who underwent surgery at hospitals in capital area were particularly associated with higher utilization of inpatient-related PAC services. Breast cancer patients with higher income, older adults, metropolitan residents, patients who underwent breast cancer surgery at metropolitan hospitals, and those treated at tertiary hospitals were strongly associated with higher utilization of HBNC services. Identifying factors that determine the use of PAC has meaningful implications for patients and healthcare systems.

Phenotypic and genomic changes in enteric Klebsiella populations during long-term ICU patient hospitalization: the role of RamR regulation.

The Klebsiella pneumoniae species complex (KpSC) is one of the major causes of nosocomial infections, especially in intensive care unit (ICUs). These bacteria are frequently highly resistant to antibiotics, leading to an increase in morbidity and mortality. The origins of multidrug-resistant KpSC strains isolated from ICU patients are still unclear, with at least two hypotheses of acquisition paths: (i) endogenous KpSC populations that are or became resistant to antibiotics and/or (ii) hospital acquisition of circulating KpSC clones. Genomic changes observed in this study might reveal mechanisms to better adapt to KpSC in the patient's gut in the face of heavy ICU medical care pressure.