Southeast Michigan Research Articles

Barriers to School-Based Mental Health Resource Utilization Among Black Adolescent Males.

Black adolescent males use available mental health services at a disproportionately lower rate compared to males of other racial groups. This study examines barriers to school-based mental health resource (SBMHR) use among Black adolescent males, as a means of addressing reduced usage of available mental health resources and to improve these resources to better support their mental health needs. Secondary data for 165 Black adolescent males were used from a mental health needs assessment of two high schools in southeast Michigan. Logistic regression was employed to examine the predictive power of psychosocial (self-reliance, stigma, trust, and negative previous experience) and access barriers (no transportation, lack of time, lack of insurance, and parental restrictions) on SBMHR use, as well as the relationship between depression and SBMHR use. No access barriers were found to be significantly associated with SBMHR use. However, self-reliance and stigma were statistically significant predictors of SBMHR use. Participants who identified self-reliance in addressing their mental health symptoms were 77% less likely to use available mental health resources in their school. However, participants who reported stigma as a barrier to using SBMHR were nearly four times more likely to use available mental health resources; this suggests potential protective factors in schools that can be built into mental health resources to support Black adolescent males' use of SBMHRs. This study serves as an early step in exploring how SBMHRs can better serve the needs of Black adolescent males. It also speaks to potential protective factors that schools provide for Black adolescent males who have stigmatized views of mental health and mental health services. Future studies would benefit from a nationally representative sample allowing for more generalizable results regarding barriers and facilitators to Black adolescent males' use of school-based mental health resources.

Mortality and Hospital Readmission Rates for Heart Failure Among Patients of Middle Eastern Ancestry Compared to Non-Middle Eastern Whites in Southeast Michigan.

Outcomes after hospital admission for heart failure are likely affected by cultural and ethnic factors. We obtained data from a large health system in Southeast Michigan on all patients admitted for heart failure from 2008 to 2015. Middle Eastern patients were identified through self-identification and a surname algorithm. Multivariate linear, logistic, and Cox regression models were used to evaluate length of stay and readmission rates compared to Caucasian patients. Mortality data was collected from the National Death Index. 7,784 white and 642 Middle Eastern patients were identified. Middle Eastern patients were younger, had higher rates of comorbid conditions, and had a greater mean hospital length of stay (7.96 vs 7.03days, p = 0.015). Middle Eastern patients had similar thirty-day hospital readmission risk (4.25% vs 4.47%, p = 0.370) but greater ninety-day readmission risk (9.01% vs 8.35%, p = 0.043); after controlling for covariates these differences were not significant. Middle Eastern patients had lower mortality risk (HR = 0.79, p = 0.003). After a hospital admission for heart failure, Middle Eastern patients had longer hospital lengths of stay, similar risk of hospital readmission, but lower all-cause mortality.

Relationship between Posttraumatic Stress Disorder and Sleep Disturbances in Syrian Refugees in the United States.

Background Posttraumatic stress disorder (PTSD) is associated with disturbed sleep. However, the impact of sleep disturbances and PTSD symptomology in refugee populations is not well known. This study examined how PTSD-related sleep symptoms and overall sleep quality were impacted by previous and current traumatic and stressful experiences. Methods Adult Syrian refugees living in Southeast Michigan were assessed via scheduled in-home interviews. Overall sleep quality was measured using the Pittsburgh Sleep Quality Index. PTSD-related sleep disturbances were measured using the Pittsburgh Sleep Quality Index Addendum. The presence of PTSD symptomatology was assessed via self-report using the Posttraumatic Stress Disorder Checklist. The Life Events Checklist for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition-5 screened for prior traumatic events experienced and the Postmigration Living Difficulties Questionnaire was assessed for postmigration stressors. Correlational analysis was conducted between overall sleep quality, PTSD symptom severity, and previous trauma experienced. A stepwise linear regression analysis was conducted to examine the role of overall sleep quality, PTSD-specific sleep disturbances, current living difficulties, and the number of preimmigration traumatic events directly experienced or witnessed due to the presence of overall PTSD symptomology. Results A total of 53 adults completed the study. PTSD-disturbed sleep was found to be positively associated with overall poor sleep quality ( r = 0.42, p < 0.01), PTSD symptomology ( r = 0.65, p < 0.01), and current living difficulties ( r = 0.37, p < 0.05). The PTSD-related sleep disturbances (B = 0.66, p < 0.01) and postmigration living difficulties (B = 0.44, p < 0.01) were found to be the strongest predictors of PTSD symptoms. Conclusion Disturbed sleep is strongly associated with current stressful experiences and PTSD symptomology among Syrian refugees.

An Equity Centered Approach to Prioritizing Flood Mitigation and Transportation Planning in Southeast Michigan

An Equity Centered Approach to Prioritizing Flood Mitigation and Transportation Planning in Southeast Michigan

Paddling Together: Water Trails as Innovative Public Health Strategies.

Blueways can help improve health and quality-of-life by providing places for exercise, recreation, and community gatherings. The Rouge River Watershed is an industrialized region in Southeast Michigan with high rates of chronic disease and historic disinvestment in social and environmental conditions. The purpose of this article is to describe the process taken to develop an equitable, community-driven vision and approach for developing a water trail along the Lower Rouge River and to identify the key elements that emerged. Project leaders incorporated community-driven planning, community outreach, and community ownership strategies. The Rouge River Water Trail Leadership Committee engages the public, those affected by decisions, with a transparent, fact-based process. The public is given equal status and shares decision-making authority. This approach led to the development of a Water Trail Strategic Plan, community-informed recommendations for capital improvements, development of key relationships, and coalitions that provide a vehicle for ongoing community engagement and ownership. Five main elements, considered through an equity lens, go into building a water trail: (1) creating access points, (2) water quality monitoring, (3) woody debris management, (4) signage, and (5) developing a safety plan. Water trail development should consist of (1) environmental change through the creation of access points and safe, navigable waterways and (2) opportunities to utilize the infrastructure through programming and initiatives to make the trail accessible to all communities.

The impact of prenatal dog keeping on infant gut microbiota development.

Prenatal and early-life dog exposure has been linked to reduced childhood allergy and asthma. A potential mechanism includes altered early immune development in response to changes in the gut microbiome among dog-exposed infants. We thus sought to determine whether infants born into homes with indoor dog(s) exhibit altered gut microbiome development. Pregnant women living in homes with dogs or in pet-free homes were recruited in southeast Michigan. Infant stool samples were collected at intervals between 1week and 18 months after birth and microbiome was assessed using 16S ribosomal sequencing. Perinatal maternal vaginal/rectal swabs and stool samples were sequenced from a limited number of mothers. Mixed effect adjusted models were used to assess stool microbial community trajectories comparing infants from dog-keeping versus pet-free homes with adjustment for relevant covariates. Infant gut microbial composition among vaginally born babies became less similar to the maternal vaginal/rectal microbiota and more similar to the maternal gut microbiota with age-related accumulation of bacterial species with advancing age. Stool samples from dog-exposed infants were microbially more diverse (p= .041) through age 18 months with enhanced diversity most apparent between 3 and 6months of age. Statistically significant effects of dog exposure on β-diversity metrics were restricted to formula-fed children. Across the sample collection period, dog exposure was associated with Fusobacterium genera enrichment, as well as enrichment of Collinsella, Ruminococcus, Clostridaceae and Lachnospiraceae OTUs. Prenatal/early-life dog exposure is associated with an altered gut microbiome during infancy and supports a potential mechanism explaining lessened atopy and asthma risk. Further research directly linking specific dog-attributable changes in the infant gut microbiome to the risk of allergic disorders is needed.

K-medoids clustering of hospital admission characteristics to classify severity of influenza virus infection.

Patients are admitted to the hospital for respiratory illness at different stages of their disease course. It is important to appropriately analyse this heterogeneity in surveillance data to accurately measure disease severity among those hospitalized. The purpose of this study was to determine if unique baseline clusters of influenza patients exist and to examine the association between cluster membership and in-hospital outcomes. Patients hospitalized with influenza at two hospitals in Southeast Michigan during the 2017/2018 (n = 242) and 2018/2019 (n = 115) influenza seasons were included. Physiologic and laboratory variables were collected for the first 24 h of the hospital stay. K-medoids clustering was used to determine groups of individuals based on these values. Multivariable linear regression or Firth's logistic regression were used to examine the association between cluster membership and clinical outcomes. Three clusters were selected for 2017/2018, mainly differentiated by blood glucose level. After adjustment, those in C171 had 5.6 times the odds of mechanical ventilator use than those in C172 (95% CI: 1.49, 21.1) and a significantly longer mean hospital length of stay than those in both C172 (mean 1.5days longer, 95% CI: 0.2, 2.7) and C173 (mean 1.4days longer, 95% CI: 0.3, 2.5). Similar results were seen between the two clusters selected for 2018/2019. In this study of hospitalized influenza patients, we show that distinct clusters with higher disease acuity can be identified and could be targeted for evaluations of vaccine and influenza antiviral effectiveness against disease attenuation. The association of higher disease acuity with glucose level merits evaluation.

"Bringing the Music to the People": Building Texas-Mexican Musical Community in Southeast Michigan and Northwest Ohio, 1950–1995

"Bringing the Music to the People": Building Texas-Mexican Musical Community in Southeast Michigan and Northwest Ohio, 1950–1995

Respiratory virus circulation during the first year of the COVID-19 pandemic in the Household Influenza Vaccine Evaluation (HIVE) cohort.

The annual reappearance of respiratory viruses has been recognized for decades. COVID-19 mitigation measures taken during the pandemic were targeted at respiratory transmission and broadly impacted the burden of acute respiratory illnesses (ARIs). We used the longitudinal Household Influenza Vaccine Evaluation (HIVE) cohort in southeast Michigan to characterize the circulation of respiratory viruses from March 1, 2020, to June 30, 2021, using RT-PCR of respiratory specimens collected at illness onset. Participants were surveyed twice during the study period, and SARS-CoV-2 antibodies were measured in serum by electrochemiluminescence immunoassay. Incidence rates of ARI reports and virus detections were compared between the study period and a preceding pre-pandemic period of similar duration. Overall, 437 participants reported a total of 772 ARIs; 42.6% had respiratory viruses detected. Rhinoviruses were the most frequent virus, but seasonal coronaviruses, excluding SARS-CoV-2, were also common. Illness reports and percent positivity were lowest from May to August 2020, when mitigation measures were most stringent. Seropositivity for SARS-CoV-2 was 5.3% in summer 2020 and increased to 11.3% in spring 2021. The incidence rate of total reported ARIs for the study period was 50% lower (95% CI: 0.5, 0.6; p < 0.001) than the incidence rate from a pre-pandemic comparison period (March 1, 2016, to June 30, 2017). The burden of ARI in the HIVE cohort during the COVID-19 pandemic fluctuated, with declines occurring concurrently with the widespread use of public health measures. Rhinovirus and seasonal coronaviruses continued to circulate even when influenza and SARS-CoV-2 circulation was low.

Is There a Formaldehyde Deficit in Emissions Inventories for Southeast Michigan?

Formaldehyde is a key Volatile Organic Compound (VOC) and ozone precursor that plays a vital role in the urban atmospheric radical budget on par with water vapor, ozone, and nitrous acid. In addition to modulating radical and ozone production, ambient formaldehyde has both carcinogenic and non-carcinogenic inhalation health effects. This study concludes that ambient formaldehyde in the Southeast Michigan (SEMI) ozone nonattainment area may be underestimated up to a factor of two or more by regional air quality models. The addition of plausible amounts of primary formaldehyde to the U.S. National Emissions Inventory based on estimated formaldehyde-to-CO emission ratios partially alleviates this modeling deficit and indicates the presence of formaldehyde concentrations above 5 ppb at a previously unsuspected location northeast of Detroit. Standard 24-h formaldehyde samples obtained during the Michigan-Ontario Ozone Source Experiment (MOOSE) verified the presence of high ambient formaldehyde concentrations at this location. Moreover, the addition of plausible amounts of primary formaldehyde to VOC emissions inventories may add more than 1 ppb of ozone to ambient air in the SEMI nonattainment area, where ozone design values exceeded the U.S. National Ambient Air Quality Standard (NAAQS) by 1–2 ppb for the 2018–2020 design value period.

Environmental Drivers of Amphibian Breeding Phenology across Multiple Sites

A mechanistic understanding of phenology, the seasonal timing of life history events, is important for understanding species’ interactions and the potential responses of ecological communities to a rapidly changing climate. We present analysis of a seven-year dataset on the breeding phenology of wood frogs (Rana sylvatica), tiger salamanders (Ambystoma tigrinum), blue-spotted salamanders (Ambystoma laterale), and associated unisexual Ambystoma salamanders from six wetlands in Southeast Michigan, USA. We assess whether the ordinal date of breeding migrations varies among species, sexes, and individual wetlands, and we describe the specific environmental conditions associated with breeding migrations for each species/sex. Breeding date was significantly affected by species/sex identity, year, wetland, and the interactions between species/sex and year as well as wetland and year. There was a great deal of variation among years, with breeding occurring nearly synchronously among groups in some years but widely spaced between groups in other years. Specific environmental triggers for movement varied for each species and sex and changed as the breeding season progressed. In general, salamanders responded to longer temperature lags (more warmer days in a row) than wood frogs, whereas wood frogs required longer precipitation lags (more rainy days in a row) than salamanders. Wood frogs were more likely to migrate around the time of a new moon, whereas in contrast, Ambystoma salamander migration was not associated with a moon phase. Ordinal day was an important factor in all models, suggesting that these amphibians require a latency period or similar mechanism to avoid breeding too early in the year, even when weather conditions appear favorable. Male wood frogs migrated earlier than female wood frogs, and male blue-spotted salamanders migrated earlier than female A. laterale and associated unisexual females. Larger unisexual salamanders migrated earlier than smaller individuals. Differences in species’ responses to environmental cues led to wood frogs and A. laterale breeding later than tiger salamanders in colder years but not in warmer years. This suggests that, as the climate warms, wood frog and A. laterale larvae may experience less predation from tiger salamander larvae due to reduced size differences when they breed simultaneously. Our study is one of few to describe the proximate drivers of amphibian breeding migrations across multiple species, wetlands, and years, and it can inform models predicting how climate change may shift ecological interactions among pond-breeding amphibian species.

How spatial patterns affect urban green space equity at different equity levels: A Bayesian quantile regression approach

In many cities, urban green space (UGS) is not evenly distributed, and marginalized communities often lack UGS due to legacies of disinvestment. Existing research mainly focused on the effect of socioeconomic factors to understand the disparity in access to UGS. However, little is known on how spatial patterns affect UGS equality at the regional and subregional levels. Moreover, the potential quantile effects in the UGS pattern and equality relationship remain unclear. Here, we explored how UGS equality varied among UGS spatial patterns and socioeconomic gradients in seven counties (1,227 census tracts) in Southeast Michigan. First, we quantified UGS equality of each tract with a spatially explicit Gini coefficient and UGS spatial patterns via landscape metrics. Then, we applied a Bayesian quantile regression model to investigate the nonlinear relationship between spatial pattern and UGS equality in the whole study area and its three subregions of different population density. Our results showed that spatial patterns had quantile effects on UGS equality. At the regional scale, patch density and the largest patch index had significant positive effects on UGS equality at all equality levels. The mean patch shape index positively correlated with UGS equality in areas with higher equality level (Gini coefficient: 0.52–0.92). At the subregional level, patch density most efficiently predicted UGS equality in densely populated areas, while the largest patch index also affected UGS equality in areas with low population density. We suggest policymakers should focus on areas with extremely unequal access to UGS to increase the number rather than the cumulative area of UGS. Besides, more linear and irregular UGS patches with longer perimeters have potential to serve more communities.

Treating Prehospital Pain in Children: A Retrospective Chart Review Comparing the Safety and Efficacy of Prehospital Pediatric Ketamine and Opioid Analgesia

Prior to 2020, pain management in the Washtenaw/Livingston County Medical Control Authority (W/L MCA) Emergency Medical Service (EMS) system in Southeast Michigan was limited to morphine, fentanyl, ketorolac, and acetaminophen. Based on the increasing evidence describing its safety and efficacy, ketamine was added to local protocols for pain management. This study aimed to evaluate differences in pain management and adverse effects of ketamine and opioid administration. Data from pediatric patients who received ketamine or an opioid in the W/L MCA EMS system from October 2019 to March 2021 were analyzed. The primary outcome was the difference in pain score, and the secondary outcome was adverse effects observed after analgesic administration. The decrease in pain scores was greater among ketamine patients (mean: 5.2) compared to opioid patients (mean: 2.9), p < 0.001. The prevalence of adverse effects was higher among patients in the ketamine group (28.6%) compared to patients in the opioid group (2.4%, p < 0.001). Of 14 patients who received ketamine, one 17-year-old male experienced mild anxiety (7.1%), two teenage females experienced mild dissociation (14.3%), and one 20-year-old female experienced mild nausea (7.1%). Overall, ketamine is a safe and effective option compared to opioids for pediatric patients experiencing moderate to severe prehospital pain.

Risk factors associated with glycated hemoglobin A1c trajectories progressing to type 2 diabetes

Background and objective The notion of prediabetes, defined by the ADA as glycated hemoglobin A1c (HbA1c) of 5.7–6.4%, implies increased vascular inflammatory and immunologic processes and higher risk for developing diabetes mellitus and major cardiovascular events. We aimed to determine the risk factors associated with rapid progression of normal and prediabetes patients to type 2 diabetes mellitus (T2DM). Methods Retrospective cohort study in a single 8-hospital health system in southeast Michigan, between 2006 and 2020. All patients with HbA1c <6.5% at baseline and at least 2 other HbA1c measurements were clustered in five trajectories encompassing more than 95% of the study population. Multivariate linear regression analysis was performed to examine the association of demographic and comorbidities with HbA1c trajectories progressing to diabetes. Results A total of 5,347 prediabetic patients were clustered based on their HbA1c progression (C1: 4,853, C2: 253, C66: 102, C12: 85, C68: 54). The largest cluster (C1) had a baseline median HbA1c value of 6.0% and exhibited stable HbA1c levels in prediabetic range across all subsequent years. The smallest cluster (C68) had the lowest median baseline HbA1c value and also remained stable across subsequent years. The proportion of normal HbA1c in each of the pre-diabetic trajectories ranged from 0 to 12.7%, whereas 81.5% of the reference cluster (C68) were normal HbA1c at baseline. The C2 (steady rising) trajectory was significantly associated with BMI (adj OR 1.10, 95%CI 1.03–1.17), and family history of DM (adj OR 2.75, 95%CI 1.32–5.74). With respect to the late rising trajectories, baseline BMI was significantly associated with both C66 and C12 trajectory (adj OR 1.10, 95%CI 1.03–1.18) and (adj OR 1.13, 95%CI 1.05–1.23) respectively, whereas, the C12 trajectory was also significantly associated with age (adj OR 1.62, 95%CI 1.04–2.53) and history of MACE (adj OR 3.20, 95%CI 1.14–8.93). Conclusions We suggest that perhaps a more aggressive preventative approach should be considered in patients with a family history of T2DM who have high BMI and year-to-year increase in HbA1c, whether they have normal hemoglobin A1c or they have prediabetes. KEY MESSAGES Progression to diabetes from normal or prediabetic hemoglobin A1c within four years is associated with baseline BMI. A steady rise in HbA1c during a four-year period is associated with age and family history of T2DM, whereas age and personal history of MACE are associated with a rapid rise in HbA1c. A more aggressive preventative approach should be considered in patients with a family history of T2DM who have high BMI and year-to-year increase in HbA1c.

Nocturia in men and associated comorbidities: a southeast Michigan study

Nocturia is a highly prevalent condition associated with poor quality of life and increased adverse health outcomes. Our study investigates the prevalent condition of nocturia and its profound impact on individuals’ quality of life and adverse health outcomes. We explore the correlation between nocturia and various comorbidities in a southeast Michigan population by analyzing data from 1023 participants who completed self-administered questionnaires during the 2021 Michigan Institute of Urology’s Men’s Health Event; 892 participants responded to the nocturia questionnaire. Categorizing participants based on the severity of nocturia into three groups—no nocturia, nocturia once per night, and multiple nocturia episodes per night—we employed Pearson’s Chi-square test to examine the relationship between nocturia severity and the presence of comorbidities. Our findings demonstrate significant associations between increasing episodes of nocturnal voids and the prevalence of hypertension, non-insulin-dependent diabetes and anxiety. Additionally, arthritis and colorectal polyps exhibit notable links with multiple nocturia episodes, while participants with a family history of hypertension show decreased prevalence as nocturnal voids increase, and a family history of myocardial infarction is notably associated with nocturia, particularly in the nocturia once per night group. Our research highlights the widespread impact of nocturia and its strong associations with diverse comorbidities, underscoring the importance of further investigation to comprehend the underlying mechanisms and enhance patient outcomes.

HALF OF OLDER ADULTS HOSPITALIZED WITH COVID-19 EXPERIENCE SYMPTOMS ONE YEAR LATER

Abstract Older adults hospitalized with severe COVID-19 are at higher risk of experiencing serious in-hospital outcomes and long-term health consequences following discharge. Declines in health and functional ability post-hospitalization are important infection-related outcomes. This study’s aim was to examine functional recovery one year following COVID-19 hospitalization. Twenty-one adults ≥60 years of age hospitalized with confirmed COVID-19 infection between 3/2020–5/2020 in Southeast Michigan completed a survey 9–15 months post-discharge including items from the Fried Frailty score, Short Form 36 Physical Assessment, PROMIS Dyspnea Scale, and the World Health Organization Disability Assessment Schedule. Mean age at hospital admission was 69 (standard deviation 7). Half of participants (52%) indicated they had too little energy to do the things they wanted to do, 52% (n=11) indicated moderate to severe shortness of breath when walking up two flights of stairs, and 43% (n=9) indicated they were limited a lot in walking several blocks. Additionally, 57% (n=12) indicated they were severely or extremely emotionally affected by their health due to their COVID-19 infection. Results were similar in only those ≥70 years (n=7). Our survey indicates that half of patients hospitalized with severe COVID-19 from the first infection wave in Southeast Michigan are significantly affected up to a year or more after their initial infection, and may benefit from long-term outpatient care. More research is needed to inform development of effective treatments for the long-term emotional and physical impacts of severe COVID-19.

Endoscopists’ recommendations after a false positive multitarget stool DNA test: results from a multicenter study

Endoscopists’ recommendations after a false positive multitarget stool DNA test: results from a multicenter study

2048. Molecular Characterization and Resistance Factors of Circulating Acinetobacter baumannii isolates in South-East Michigan

Abstract Background Carbapenem-resistant Acinetobacter baumannii (CRAb) is increasing due to widespread use of antibiotics. Multidrug resistant (MDR) CRAb is a major threat to public health as treatment options are limited. The objective of this study is to elucidate the molecular epidemiology of circulating antibiotic resistance genes causing MDR CRAb infections by using a combination of whole-genome Multi-Locus Sequence Typing (wgMLST) and antibiotic susceptibility phenotyping. Table 1.Molecular characterization of MDR CRAb isolates*The numbers indicate % of sequence identity match for each Beta-lactamase gene. Methods Bacterial isolates were derived from cultures taken from subjects 48 hours following admission as part of routine clinical care for patients between 2017-2020. Isolates were obtained from 16 hospital units (both ICU and non-ICU) across two hospitals in the Detroit area. Whole Genome Sequencing (WGS) was performed using Illumina MiniSeq or Nextseq. WgMLST analysis was performed using BioNumerics software v7.6. ResFinder software was used for analysis of antibiotic resistance genes. Isolates underwent antibiotic susceptibility testing using a broth microdilution method (VITEK2) and Clinical &amp; Laboratory Standards Institute (CLSI) minimum inhibitory concentration (MIC) cut offs. Results Out of the 95 total isolates, 51(54%) were CRAb isolates and of the CRAb isolates, 21(41%) were MDR CRAb. WgMLST identified that majority of the circulating MDR CRAb isolates belonged to ST2Pas (ST195Ox and ST208Ox) based on CDC definitions (Table 1). MDR CRAb isolates were resistant to 3 different classes of antibiotics including aminoglycosides, fluroquinolones and β-lactams. β-lactamase genes present include (blaADC-25, blaOXA-23, blaOXA-66 and blaTEM1D) for both ST195Ox and ST208Ox and (blaADC-25, blaOXA-23 and blaOXA-223) for ST406Pas (ST310Ox). Among the patients with MDR CRAb infections, most were males with respiratory infections in a non-ICU setting. Conclusion The study demonstrated a high proportion of isolates belonged to ST2 Pas carrying multiple beta-lactamase genes including blaOXA-23 gene. ST406Pas might be an emerging lineage carrying the blaOXA-23 gene. In addition to stringent infection control measures, continuous surveillance is recommended in limiting the spread of MDR CRAb isolates in the healthcare settings. Disclosures Chetan Jinadatha, MD, MPH, AHRQ R01 Grant-5R01HS025598: Grant/Research Support|EOS Surfaces: Copper Coupons and materials for testing Keith S. Kaye, MD, MPH, Allecra: Advisor/Consultant|GlaxoSmithKline plc.: Receiving symposia honoraria|GlaxoSmithKline plc.: GlaxoSmithKline plc.-sponsored study 212502|Merck: Advisor/Consultant|qpex: Advisor/Consultant|Shionogi: Grant/Research Support|Spero: Advisor/Consultant Piyali Chatterjee, PhD, AHRQ Grant # 1R03HS027667-01: Grant/Research Support|AHRQ Grant # 1R03HS027667-01: Central Texas Veterans Health Care System.

2031. Role of Urine Culture Hard Stop in Reducing Catheter-associated Urinary Tract Infections

Abstract Background Catheter-associated urinary tract infection (CAUTI) is one of the most commonly reported healthcare associated infections (HAI) reported to the National Healthcare Safety Network (NHSN). However, asymptomatic bacteriuria is common in patients with indwelling urinary catheters (IUC), and inappropriate culturing leads to overdiagnosis in colonized patients, unnecessary antibiotics and increased resistance. We evaluated the effectiveness of an electronic medical record (EMR) “hard stop” in reducing inappropriate urine cultures (UC) and its impact on CAUTI rates. Methods This was a pre-post quasi-experimental retrospective study comparing CAUTI rate per 1000 catheter days, UC order rate per 1000 patient days, Standardized Utilization Ratio (SUR) and Standardized Infection Ratio (SIR) in the pre-intervention period (January 2019-December 2020) to the intervention period (April 2021-March 2022) in Southeast Michigan. In March 2021, we implemented a hard stop in Epic® that fired 24 hours after admission in patients with IUC &amp;gt;1 calendar day and until 4 days after IUC removal. The Medical Director of Infection Prevention and Control had the ability to override the hard stop when indicated after reviewing the case upon provider request; education was provided in real-time. We prospectively monitored outcomes, including pyelonephritis and/or bacteremia within 3 days and readmission for sepsis within 30 days in patients UC was deemed unnecessary. Results CAUTI rate was 0.52 in the pre-intervention period and 0.09 in the post-intervention period, an 83% reduction (Figure 1). Rate of UC performed was 0.283 in the pre-intervention period and 0.218 in the post-intervention period, a 23% reduction. SUR decreased from 0.809 to 0.716, an 11% reduction (95% CI, 0.875-0.894, p&amp;lt; 0.001). SIR decreased from 0.392 to 0.135, a 66% reduction (95% CI, 0.154-0.0689, p=0.0015). Post-intervention, there were 44 override requests that were denied with no adverse patient outcomes. Conclusion Urine culture stewardship, utilizing an electronic hard stop, was effective in reducing inappropriate UC orders, SIR and SUR in patients with IUC without causing patient harm. This strategy combined with real-time education can significantly reduce CAUTI rates. Disclosures All Authors: No reported disclosures.

344. VersaTrek versus Virtuo Blood Culture System’s Effect on Diagnostic Test Utilization and Patient Outcomes, a Quasi-Experimental Study

Abstract Background Prior studies evaluating the sensitivity blood cultures utilizing the Virtuo blood culture system versus the VersaTREK blood culture system have suggested increased sensitivity with the Virtuo system. Studies evaluating if this increased sensitivity effects patient outcomes are lacking. This study evaluates the effect of replacing the VersaTREK system with the Virtuo system on morbidity and mortality in patients with Staphylococcus aureus bacteremia. Methods This quasi-experimental study was performed at Henry Ford Health System in Southeast Michigan. We analyzed all patients with positive blood cultures for Staphylococcus aureus between 3/1/18 and 9/30/18 (VersaTREK system) and 3/1/19 and 9/30/19 (Virtuo system). The VersaTREK arm had 267 patients and the Virtuo arm 404. Patients transferred to or from outside facilities with ongoing bacteremia were excluded. Primary outcomes were differences in length of stay, mortality at 14, 30, and 90 days from completion of therapy, and hospitalization for recurrence of bacteremia within 30 days. Secondary outcomes were differences in length of therapy, rates of diagnostic imaging tests to assess for persistent foci of infection or an unknown source of persistent bacteremia, and length of bacteremia. Data were analyzed using SPSS for Macintosh using Pearson’s chi-square test and Student’s t-test. A p &amp;lt; 0.05 was considered statistically significant. Results Demographics of the study populations were equal however, the Charlson Comorbidity Index for VersaTREK arm compared to Virtuo (3.5 to 3.1) trended toward significance (p=0.05) (Table 1). There was no difference in length of bacteremia, lengths of antibiotic therapy, CT scans, or echocardiograms performed. More MRIs were performed in the Virtuo arm (p=&amp;lt; 0.001) (Table 2). There was no difference in recurrence of bacteremia, patient death due to bacteremia, length of hospital stay, or 30 day readmission for recurrence of bacteremia (Table 3). Conclusion This is the first study to evaluate how increased sensitivity of a blood culture system effects patient outcomes. Our results suggest that Staphylococcus aureus bacteremia may be over treated in blood cultures systems that are highly sensitive. Further prospective studies are needed to explore this further. Disclosures All Authors: No reported disclosures.