Texas Veterans Health Care System Research Articles

The effect of level of injury on diabetes incidence and mortality after spinal cord injury - a longitudinal cohort study.

Retrospective longitudinal cohort study of veterans with SCI. Spinal cord injury (SCI) is associated with an increased risk of developing diabetes mellitus (DM), likely due to body composition alterations and autonomic nervous system dysfunction. These factors are more pronounced in persons with tetraplegia (TP) versus paraplegia (PP). However, the effect of level of injury (LOI) on DM incidence is largely unknown. Therefore, the objective is to examine the effect of LOI on DM incidence in persons with SCI. South Texas Veterans Health Care System. We obtained electronic record data on age, sex, race/ethnicity, LOI and HbA1c concentration from January 1st 2001 through December 31st 2021. Cox proportional hazard regression analyses were used to assess the association between LOI, DM and all-cause mortality. Among 728 non-diabetic veterans with SCI (350 TP/ 378 PP, 52 ± 15 years, 690 male/38 female) 243 developed DM, of which 116 with TP and 127 with PP. Despite chronological variations between TP and PP, DM risk over the entire follow-up did not differ between the groups (hazard ratio (HR): 1.06, 95% CI: 0.82-1.38). Mortality was higher in TP versus PP (HR: 1.40, 95% CI: 1.09-1.78). However, developing DM did not increase the risk of death, regardless of LOI (HR: 1.07, 95% CI: 0.83-1.37). Despite chronological variations between both groups, the level of injury had minimal effect on long-term DM development in this cohort of veterans with SCI. Sponsorship NIH (DK105379; MS), RR&D SPiRE (I21RX003724-01A1; MT and SH).

Ethnic disparity in hospitalization among veterans with COVID-19 and cancer.

e18613 Background: COVID19 results in severe disease and resource utilization, particularly among patients with cancer. Hospitalization rates among COVID19 outpatient US veterans with cancer vary according to race (white vs non-Hispanic black). Less is known about ethnic (Hispanic vs non-Hispanic) disparities in hospitalization rates. We aimed to identify ethnic disparities in all-cause hospitalization rates among COVID19 outpatient US veterans with cancer. Methods: We conducted a retrospective cohort study of veterans with cancer and an index diagnosis of COVID19 (ICD10 U07) between 1/1/2020 and 3/31/2022 managed at the South Texas Veterans Health Care System. We included patients for whom ethnicity data (Hispanic or non-Hispanic white) were available. Our primary outcome was all-cause hospitalization rates at 30 days and 60 days following an index diagnosis of COVID19 among Hispanic and non-Hispanic white patients with cancer. We analyzed continuous variables using unpaired t test and categorical variables using Chi-square analysis for statistical significance (p < 0.05). Results: Of 968 outpatient veterans with a history of cancer and a COVID19 diagnosis between 1/1/2020 and 3/31/2022, 762 met our inclusion criteria. Of these, 300 (39.4%) identified as Hispanic (94% male, p < 0.05) and 462 (60.6%) identified as non-Hispanic white (90% male). At baseline Hispanic patients were younger and were more likely to have underlying comorbidities (T2DM, mild liver disease, AIDS; p < 0.05). Hispanic patients with cancer demonstrated hospitalization rates after the index COVID19 diagnosis comparable to those of non-Hispanic white patients at 30d (34% vs 28.8%) and 60d (35.7% vs 32%). Conclusions: Although Hispanic patients with cancer demonstrated a trend of higher hospitalization rates at 30d and 60d following a COVID19 diagnosis, this difference was not statistically significant. Further studies with a larger sample size and generalizability to assess ethnic disparities in other clinical settings are warranted.

Clinical utility of methicillin-resistant Staphylococcus aureus nasal PCR to streamline antimicrobial use in treatment of diabetic foot infection with or without osteomyelitis

BackgroundDiabetic Foot Infection (DFI) guidelines recommend empiric methicillin-resistant Staphylococcus aureus (MRSA)-targeted therapy in settings where there is high prevalence of MRSA infections or in cases of severe infection; however, they do not provide recommendations for de-escalation. This approach has the potential to increase unnecessary use of broad-spectrum antibiotics; therefore, additional strategies are needed to optimize appropriate antibiotic use. This study evaluates the effect of MRSA nasal PCR testing on MRSA-targeted antibiotic use and clinical outcomes in patients with DFI.MethodsThis was a retrospective quasi-experimental study of patients admitted to South Texas Veterans Health Care System for DFI, with or without osteomyelitis (OM), who had an MRSA nasal PCR and culture data. Eligible patients were identified from the Corporate Data Warehouse and reviewed via electronic health record. Patients were allocated into two groups: PRE (5/1/2019-4/30/2020) and POST (12/1/2020-11/30/2021) protocol implementation for de-escalation or avoidance of MRSA-targeted antibiotics. The primary outcome was median (interquartile range [IQR]) hours of empiric inpatient MRSA-targeted antibiotic therapy. A Wilcoxon Rank Sum test was used to assess the difference between the groups for the primary outcome. Secondary outcomes included the proportion of patients needing MRSA coverage added back for MRSA after de-escalation, hospital readmission, length of hospital stay (LOS), patient mortality, and acute kidney injury.ResultsA total of 151 patients were included (83 PRE; 68 POST). Most patients were male (98% PRE; 97% POST) with a median age of 64 (IQR, 56–72) years. Incidence of MRSA in DFI in the cohort was 14.7% overall (12% PRE and 17.6% POST). MRSA was detected via nasal PCR in 12% of patients 15.7% PRE and 7.4% POST). After protocol implementation, there was a significant decrease in empiric MRSA-targeted antibiotic therapy use, from a median of 72 (IQR, 27–120) hours in the PRE group, to 24 (IQR, 12–72) hours in the POST group (p < 0.01). No significant differences were found for other secondary outcomes.ConclusionThis study of patients presenting to a Veterans Affairs (VA) hospital with DFI identified a statistically significant decrease in median duration of MRSA-targeted antibiotic use post-protocol implementation. This suggests a favorable effect of MRSA nasal PCR for de-escalation or avoidance of MRSA-targeted antibiotics in DFI.

Outcomes in Patients With Curative Malignancies Receiving Filgrastim as Primary Prophylaxis.

Granulocyte colony-stimulating factor prophylaxis has been shown to reduce the risk and duration of chemotherapy-induced neutropenia and febrile neutropenia and is recommended for at-risk patients receiving chemotherapy. Within the South Texas Veterans Health Care System, daily filgrastim injections remain the preferred formulation of granulocyte colony-stimulating factor for primary prophylaxis of febrile neutropenia. This retrospective, single-center cohort study included 59 patients who received daily filgrastim as primary prophylaxis with a curative cancer diagnosis and a chemotherapy regimen at the South Texas Veterans Health Care System from September 1, 2015 to September 24, 2020. Patients had either a high risk for febrile neutropenia or a chemotherapy regimen with an intermediate risk for febrile neutropenia and additional risk factors. The primary outcome was the incidence of neutropenia/febrile neutropenia leading to treatment delays. Secondary outcomes included chemotherapy dose decreases or discontinuations, hospitalizations, days of hospitalization, infections, extended duration of filgrastim, and transitions to pegfilgrastim due to neutropenia/febrile neutropenia. Patients received a median (IQR) of 7 (5-10) doses of filgrastim for primary prophylaxis. Overall, 10 patients (17%) experienced treatment delays due to neutropenia/febrile neutropenia. Fifteen patients (25%) were hospitalized with a median (IQR) length of stay of 5 (4-7) days, 9 patients (15%) had documented infections, and 2 patients (3%) required a chemotherapy dose reduction. Additionally, 9 patients (15%) required an additional median (IQR) of 2 (2-5) doses of filgrastim, and 9 (15%) patients were transitioned to pegfilgrastim. These results suggest that additional measures such as tracking postnadir absolute neutrophil counts should be performed to ensure patients receive an appropriate number of filgrastim doses to prevent complications associated with neutropenia/febrile neutropenia.

Lessons From the Front Line of Fighting Gender Inequity

Ideas and OpinionsFebruary 2023Lessons From the Front Line of Fighting Gender InequityLuci K. Leykum, MD, MBA, MScLuci K. Leykum, MD, MBA, MScSouth Texas Veterans Health Care System, Harbor Health Team, and Dell Medical School at the University of Texas at Austin, Austin, Texas (L.K.L.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M22-3213 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In 2019, I filed a federal lawsuit against my then employer alleging both a violation of the Equal Pay Act of 1963 and its retaliation in response to my speaking up about my salary. The actions that led to the lawsuit began in 2016. I sought legal counsel soon thereafter but was reluctant to take formal action. My lawyers warned me that I could be isolated within my institution, and that efforts would likely be made to negatively portray me. Legal action might drag on for years, greatly favoring the institution with its deep pockets and expertise. Future potential employers ...

2023. Excess Cost of Healthcare-Associated Infections in the Central Texas Veterans Health Care System

Abstract Background Many studies reporting the excess cost of healthcare-associated infections (HAIs) have used data from positive cultures found in electronic medical records. These data are often limited in a number of ways including whether the positive culture truly represents an actual infection and not just colonization, when the onset of the infection occurred, and whether the infection was device related. Our objective was to generate estimates of the excess cost of HAIs in one facility, the Central Texas Veterans Health Care System (CTVHCS), using highly reliable information extracted from chart review regarding the infection. Methods Our study included data from all inpatient admissions between 1/1/2014 and 12/31/2019 at CTVHCS. HAIs were identified via chart review and were classified based on the infecting organism, specimen location, and whether the infection was device related using 2017 National Health and Safety Network definitions. To minimize time-dependent bias in our estimates of the excess cost of HAIs, we matched each patient with an HAI on day t of their inpatient stay to up to 4 patients who had not had an HAI up until day t of their inpatient stay. We used multivariable generalized estimating equations models to compare the inpatient costs prior to discharge between patients with and without HAIs. Finally, we used multivariable 2-part models to estimate the impact of HAIs on post-discharge readmission costs. Results Our analysis cohort consisted of 425 patients with HAIs who were matched to 1,645 patients without HAIs. HAIs were associated with $29,412 (95% CI:$18,064-$40,759) excess pre-discharge costs, 46.3% increase in the odds of a post-discharge readmission, and $16,049 excess post-discharge costs (see Table 1). The excess pre-discharge costs for central line, catheter-associated urinary tract, and surgical site infections (SSIs) were $96,655 (95% CI:$61,557-$131,754), $34,026 (95% CI:$9,562-$58,491), and $20,014 (95% CI:$5,324-$34,703), respectively. As seen in Table 2, the excess readmission cost for SSIs was $28,222 (95% CI:$9,523-$46,920). Table 1Multivariable regression model results - excess pre-discharge costs associated with healthcare-associated infectionsTable 2Multivariable regression model results - excess post-discharge costs associated with healthcare-associated infections Conclusion We found that HAIs significantly increased both pre- and post-discharge inpatient costs. These costs could potentially be saved if interventions to prevent HAIs could be successfully implemented. Disclosures Piyali Chatterjee, PhD, AHRQ Grant # 1R03HS027667-01: Grant/Research Support|AHRQ Grant # 1R03HS027667-01: Central Texas Veterans Health Care System Chetan Jinadatha, MD, MPH, AHRQ R01 Grant-5R01HS025598: Grant/Research Support|EOS Surfaces: Copper Coupons and materials for testing.

1190. Effect of Pulsed Xenon Ultraviolet Light (PX-UV) on Clonal Recovery of Escherichia coli in a Prospective, Sham-controlled, Double-blinded, Interventional, Crossover Trial Conducted in Two Detroit Hospitals

Abstract Background Healthcare-associated infections (HAIs) can be caused by some multidrug-resistant Escherichia coli, most commonly due to production of an extended spectrum beta-lactamase (ESBL), and lead to increased morbidity and mortality. Pulsed Xenon Ultraviolet light (PX-UV), in combination with terminal cleaning, has been shown to improve disinfection and has the potential to lower HAIs by reducing the horizontal spread of infections in hospitals. Here, we assess the effect of PX-UV on the clonal recovery pattern of several E. coli sequence types (STs) using Whole Genome Sequencing (WGS). Methods A prospective, sham-controlled, double-blinded, interventional, crossover trial was conducted to compare standard terminal cleaning with PX-UV (intervention, Group Q) and standard terminal cleaning with sham UV (control, Group W) in 2 Detroit hospitals from 2017 to 2020. Treatments lasted 12 months before crossover, with a 6-month washout period in between (Group R) during which UV was not used. A total of 67 E. coli samples were collected. WGS of the isolates was performed using the Nextseq 550 (Illumina). After de novo assembly, BioNumerics calculation engine (v7.6) was used to complete Whole Genome Multilocus Sequence Type (wgMLST) analysis, assembly free and assembly-based call, and construction of minimum spanning tree (MST). Results The total number of different STs found for the intervention UV device group (Q) and the sham UV device group (W) was 6 while the washout group (R) was 5. Out of the 9 total STs obtained, the most common was ST131 (Table 1). In Group Q, 11 of ST131 were found; 15 were found in Group W. During the washout period (R) 17 of ST131 were found. All other STs had 3 or less circulating clusters. After UV treatment ST1193, ST399, and ST7394 were not recovered. Fig. 1:Minimum spanning tree (MST) for E. coliTable 1:Total number of each sequence type (ST) per treatment group Conclusion During UV intervention 3 different STs (ST1193, ST399, ST7394) were not recovered, but there were negligible changes to the frequency of recovery of the other 6 STs as compared to sham UV treatment. ST131 was the dominant E. coli ST found in Detroit, which is consistent with previously published data stating ST131 as the predominant strain. While PX-UV has previously demonstrated effectiveness on decreasing bioburden, our data does not indicate any remarkable change in clonality and prevalence of E. coli STs after PX-UV use. Disclosures Piyali Chatterjee, PhD, AHRQ Grant # 1R03HS027667-01: Grant/Research Support|AHRQ Grant # 1R03HS027667-01: Central Texas Veterans Health Care System 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 Chetan Jinadatha, MD, MPH, AHRQ R01 Grant-5R01HS025598: Grant/Research Support|EOS Surfaces: Copper Coupons and materials for testing.

323. Comparing Two Whole Genome Sequencing Bioinformatic Software for Identifying Enterococcal Antibiotic-Resistant Genes

Abstract Background Enterococci are leading causes of infections, and many strains are multidrug-resistant. Identification of antibiotic resistance can be achieved either phenotypically using Clinical &amp; Laboratory Standards Institute (CLSI) minimum inhibitory concentration (MIC) cut-offs, or genotypically using whole genome sequencing (WGS). Here we compare the output from two software pipelines: EPISEQ CSTM (BIOMÉRIEUX, Marcy l ‘Etoile, France) and ResFinder to understand the similarities and differences in their ability to identify antibiotic resistance genes. Methods We performed WGS on 89 clinical isolates of Enterococci (both E. faecalis and faecium) from two distinct tertiary care Detroit hospitals admitted to 16 intensive care units (ICU) and non-ICU wards between 2017-2019. WGS was performed using the NextSeq (Illumina Inc., CA) and analyzed using two bioinformatics pipelines mentioned above. The antibiotic resistance outputs were compared to identify both similarities and differences. Results There was a significant difference in the genetic mutation output from both software. EPISEQ was able to identify 13 &amp; 15 different genetic mutations for Enterococcus faecalis and faecium respectively which were not identified by ResFinder (Table 1). There were 9 &amp; 12 common genetic mutations for Enterococcus faecalis and faecium respectively which were identified by both software. ResFinder was able to identify only two different gene mutations which were not identified by EPISEQ. Table 1:Genetic mutations identified by EPISEQ and ResFinder arranged by resistance to its respective drug class. Conclusion The ability to identify different genetic mutations by both software products likely depends on databases used to determine the antibiotic resistant genes. EPISEQ CS uses 4 different databases (including ResFinder) as well as other proprietary databases making it more sensitive, thereby able to identify more genetic mutations compared to ResFinder alone. The costs for analyzing the WGS data through proprietary software is steep compared to open-source software. Standards metrics and methods for interpretations are needed before these methods can be adapted for clinical applications. Further studies are needed to understand the value of identifying these additional genes by comparing it to phenotypic susceptibilities. Disclosures Piyali Chatterjee, PhD, AHRQ Grant # 1R03HS027667-01: Grant/Research Support|AHRQ Grant # 1R03HS027667-01: Central Texas Veterans Health Care System 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 Chetan Jinadatha, MD, MPH, AHRQ R01 Grant-5R01HS025598: Grant/Research Support|EOS Surfaces: Copper Coupons and materials for testing.

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.

137. Comparison of genotypic resistance pattern between Enterococcus faecium and Enterococcus faecalis to better understand the occurrence of mutations.

Abstract Background Enterococcus is one of the major causes of nosocomial infections many with vancomycin resistance. About 50,000 infections are reported per year due to vancomycin-resistant Enterococci. Understanding the genotypic mutations can help recognize the potential burden for antibiotic resistance that exists in a population. In this study, using whole genome sequencing (WGS) we aim to analyze the prevalence of genetic resistance markers for commonly used antibiotics for Enterococcal treatment. Methods Whole genome sequencing was performed using the NextSeq (Illumina Inc., CA) on 60 isolates of E. faecium and 29 isolates of E. faecalis. The isolates were obtained from two different Detroit area hospitals from 2017-2019. The data from WGS was analyzed using EPISEQ CSTM (BIOMÉRIEUX, Marcy l ‘Etoile, France) bioinformatic database to obtain specific resistance genes which would correspond to commonly used antibiotics for treatment of Enterococcal infections. Results Among the 89 Enterococcus faecium and Enterococcus faecalis investigated, we identified a total of 33 unique resistance genes across 18 classes of antibiotics (Table 1). We detected genetic mutations efmA, pbp5, tet(L), liar, liaS unique to E. faecium and only emeA unique to E. faecalis. E. faecium and E. faecalis share 14 similar resistance genes. E. faecium and E. faecalis had 12 and 7 unique resistance genes, respectively but are of same drug classes. The most common antibiotic classes include aminoglycosides, tetracyclines, quinolones, beta-lactams, glycopeptides, macrolides, and pyrimidine analogs. Table 1:Enterococcus faecium and E. faecalis genetic mutations and drug class resistance Conclusion Enterococcus faecium had a greater number of resistance genes with glycopeptide, aminoglycoside, and beta lactam resistance when compared to Enterococcus faecalis. Whereas Enterococcus faecalis had more resistance genes associated with macrolides, tetracyclines, pyrimidine analogs, and Bactrim. In general, both appear to have many genes that encode for resistance to major classes of antibiotics which are used for treatment of Enterococcal infections. Further comparison with phenotypic susceptibility testing data would help better understand the practical implications of our resistance gene testing. Disclosures Piyali Chatterjee, PhD, AHRQ Grant # 1R03HS027667-01: Grant/Research Support|AHRQ Grant # 1R03HS027667-01: Central Texas Veterans Health Care System 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 Chetan Jinadatha, MD, MPH, AHRQ R01 Grant-5R01HS025598: Grant/Research Support|EOS Surfaces: Copper Coupons and materials for testing.

1189. Clonal Recovery Pattern of Staphylococcus aureus during Sham-controlled, Interventional, Crossover Trial on the Effectiveness of Pulsed Xenon Ultraviolet Light (PX-UV) in Reducing Healthcare-associated Infections

Abstract Background PX-UV has shown great effectiveness at reducing Staphylococcus aureus (S. aureus) on healthcare surfaces. S. aureus is one of the most prevalent causes of healthcare-associated infections (HAIs). Here we assess the clonal recovery pattern and the disruption caused by PX-UV on S. aureus collected from patients, using Whole Genome Multilocus Sequence Type (wgMLST) analysis. Methods During a 3-year period, 2017 to 2020, a prospective sham-controlled double-blinded interventional crossover trial designed to assess the effectiveness of post-discharge PX-UV room disinfection on HAIs in 2 Detroit hospitals. The interventional group (Q) and the control group (W) was treated with PX-UV and sham UV light after terminal cleaning respectively, both treatments lasting 12 months. Crossover occurred after a 6-month washout period (R) during which no UV light was used. Whole Genome Sequencing (WGS) of the 291 S. aureus samples collected was performed using the Nextseq 550 (Illumina). Following de novo assembly, construction of minimum spanning tree (MST) and wgMLST analysis was completed using BioNumerics calculation engine (v7.6). Results A total of 20 sequence types (STs) were found throughout the trial, the most common being ST5 and ST8 with roughly 20 to 50 each found in all 3 treatment groups (Table 1. The other 18 STs were only found 7 times or less in each treatment group. ). During intervention (Q) 9 STs were found, however 11 were not recovered after PX-UV (ST1, ST1508, ST22, ST231, ST3287, ST3462, ST398, ST59, ST6790, ST840, ST97). During the sham treatment (W) 15 STs were found while 7 were found during the washout period (R). The minimum spanning tree (MST) shows clusters of related ST groups color coded by treatment type (Figure 1). Fig. 1:Minimum spanning tree (MST) for S. aureusTable 1:Total number of each sequence type (ST) per treatment group Conclusion The difference between the STs recovered during intervention and during sham UV treatment was inconsequential because many factors influence the amount of STs recovered (treatment, number of patients, sampling bias, and terminal cleaning methods). There was no clonality noted among any of the intervention group (Fig. 1). Both dominant strains (ST5, ST8) have been characterized as hypervirulent and predominant previously, consistent with our data. Our data does not demonstrate any notable change in the clonal prevalence of S. aureus after PX-UV use. Disclosures Piyali Chatterjee, PhD, AHRQ Grant # 1R03HS027667-01: Grant/Research Support|AHRQ Grant # 1R03HS027667-01: Central Texas Veterans Health Care System 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 Chetan Jinadatha, MD, MPH, AHRQ R01 Grant-5R01HS025598: Grant/Research Support|EOS Surfaces: Copper Coupons and materials for testing.

1188. Efficacy of Copper Impregnated Self-Sanitizing Surface Against Clostridioides difficile Spores

Abstract Background Clostridioides difficile (C. diff) is one of the most common causes of healthcare-associated infections (HAIs), leading to increased hospital stay, cost, and mortality. Elimination of C. diff spores is difficult as they are resistant to kill by common hospital grade disinfectants. Copper impregnated self-sanitizing surfaces (SSSCu) provide continuous reduction of vegetative pathogens, potentially lowering the risk of infections, but their efficacy on C. diff spores has not been previously evaluated. Methods Control (no copper) and copper coupons containing 20% copper-oxide were inoculated with varying C. diff spore loads ranging from 105 to 107 spores, prepared using environmental protection agency protocol, with or without 5% fetal bovine serum (FBS) soil load. After 4 hours of contact time, the C. diff spores were recovered and tested for viability. The efficacy of copper (log10 kill) was estimated using a Bayesian linear multilevel model. Results After 4 hours, the copper coupons, at mean initial spore load (6.67 log10) and no soil load, had a mean 1.21 (95% uncertainty interval: 1.13 - 1.31) log10 reduction compared to control coupons. With soil load, the treatment effect of copper decreased by 0.50 (95% uncertainty interval: 0.37 - 0.64) log10. Also, for each additional standard deviation (SD) increase in initial spore load there was a 0.59 (95% uncertainty interval: 0.47 - 0.72) log10 decrease in the treatment effect of copper. The soil load in combination with increasing initial spore load further decreased the treatment effect of copper by an additional 0.19 (95% uncertainty interval: 0.01 - 0.38) log10 for each SD increase in initial spore load. Conclusion Copper coupons can substantially reduce C. diff spores after 4 hours by 50%-97% depending on the initial spore concentration and presence or absence of organic material. Higher initial spore loads or excess organic material may prevent the spores from coming in contact with the copper-impregnated surface thus decreasing the kill efficacy. Continuous sporicidal effect of copper-impregnated surfaces might prevent transmission of spores and help reduce HAIs. Further studies are needed to evaluate the efficacy on C. diff HAI rates. Disclosures Piyali Chatterjee, PhD, AHRQ Grant # 1R03HS027667-01: Grant/Research Support|AHRQ Grant # 1R03HS027667-01: Central Texas Veterans Health Care System Chetan Jinadatha, MD, MPH, AHRQ R01 Grant-5R01HS025598: Grant/Research Support|EOS Surfaces: Copper Coupons and materials for testing.

375. Performance Evaluation of RT-qPCR and RT-dPCR Platforms for the wastewater surveillance of SARS-CoV-2

Abstract Background The COVID-19 pandemic is an ongoing global health emergency. Wastewater-based epidemiology is a valuable tool for supplementing clinical testing in identifying infected individuals early thus containing disease transmission. To assess early detection of COVID-19, a building-level wastewater-based surveillance pilot project was implemented within VHA. Here, we report the results from 2 methods of polymerase chain reaction (PCR) testing of 1073 wastewater samples from VHA CLCs (i.e., nursing homes). Methods Daily (Monday-Friday) wastewater samples were collected (January 11, 2021, to July 2, 2021) at eight CLCs located across the US and shipped overnight for processing. The samples were heat inactivated by incubating samples in a 65±1°C heating circulating water bath for 90 minutes. The virus in the wastewater was concentrated using InnovaPrep concentrating pipette select, and RNA was isolated from the concentrate and subjected to reverse transcription quantitative PCR (RT-qPCR) and RT-digital PCR. If SARS-CoV-2 was detected in the wastewater within the prior 10 days of a virus-positive occupant, the wastewater positivity was regarded as an early warning. Results Twenty-seven positives and 7 inconclusive results were reported by RT-qPCR during the surveillance. Among the 27, 15 wastewater positives qualified as early warning and 12 positives were not verified by occupant positivity. Digital PCR with a cutoff value of 0.25 copies/uL of RNA for defining positivity had 28 positives qualifying as early warnings, and 115 positives were not verified by occupant positivity (Figure 1). Figure 1Differences between RT-PCR and Digital PCR Positivity Conclusion The overall viral loads of the wastewater samples were very low corresponding to the dip in cases seen in the US during the pilot period. Although sensitivity of digital PCR appears (based on 0.25 copies/uL of RNA for defining positivity) higher than that of RT-qPCR, there were more occurrences of unverified early warning that could impact precision. The cut-off selected for RT-digital PCR reported here is arbitrary and lacks industry consensus. More controlled studies are needed to determine sensitivity and precision as well as to standardize RT-digital PCR cutoffs to define positivity for routine use. Disclosures Piyali Chatterjee, PhD, AHRQ Grant # 1R03HS027667-01: Grant/Research Support|AHRQ Grant # 1R03HS027667-01: Central Texas Veterans Health Care System Chetan Jinadatha, MD, MPH, AHRQ R01 Grant-5R01HS025598: Grant/Research Support|EOS Surfaces: Copper Coupons and materials for testing.

135. Comparing the Bioinformatic and Experimental Approaches for Identifying Antibiotic Resistance Genes on Plasmids of Acinetobacter baumannii

Abstract Background Antimicrobial resistance (AMR) genes of bacteria can be found in chromosomes or plasmids. Due to horizontal transfer from one bacterium to another, AMR genes on plasmids can be easily spread. However, distinguishing whether AMR genes are from plasmids or chromosomes is difficult. Here, we assessed two different approaches for identifying AMR genes on the plasmids of A. baumannii. Table 1.Comparison of informatics and experimental approach in studying AMR genes on plasmids in A. baumannii*Highlights indicate blaOXA-23 genes found in both approaches.*S-Susceptible isolates with no blaOXA-23 gene serve as control Methods Genomic DNA from 30 clinical isolates was sequenced using Illumina NextSeq 550. Two approaches were applied to identify which AMR genes were on plasmids: isolation of plasmid DNA experimentally using plasmid isolation kit (Qiagen, CA), and deduction of plasmid sequence from genomic DNA using the bioinformatic tool, plasmidSPAdes, which distinguishes the plasmid sequence based on the copy number. AMR genes from both approaches were identified using the open-source AMR database, ResFinder. The AMR gene data obtained from plasmids utilizing each approach were compared based on information from whole genome sequencing (WGS) data. Results As shown in Table 1, both approaches produced differences in the number of contigs, largest contig size, and number of AMR genes identified. The average number of contigs using plasmidSPAdes with WGS data was 7.4 and the largest contig size was 52939 base pairs, while with isolated plasmid DNA and analyzed by SPAdes was 1025 and 32274 bp, respectively. Plasmid DNA contigs are more fragmented. The average number of AMR genes identified using plasmidSPAdes was 1.2 and using plasmid DNA was 4. AMR information from WGS data showed 73.3% isolates have blaOXA-23, a carbapenem resistant gene. However, blaOXA-23 was found from 40% isolates using plasmidSpades and 50% isolates using plasmid DNA. In 36.7% isolates, blaOXA-23 was found by both approaches. Conclusion The information obtained by the two approaches for identifying resistance genes on plasmids mostly agreed with some exceptions. The bla OXA-23 identified in both could be on plasmids, while genes not identified from both could be on chromosomes. PlasmidSPAdes was a useful tool to discriminate plasmid sequence from WGS data. Stringent infection control measures can prevent spread of AMR gene containing plasmids in hospital 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.

1187. Analysis of the Clonal Recovery Pattern of Enterococcus faecium to Evaluate the Efficacy of Pulsed Xenon Ultraviolet Light (PX-UV) in Bioburden Reduction

Abstract Background Enterococcus faecium (E. faecium) is a common hospital-associated infection (HAI) that can lead to increased costs, morbidity, and mortality. Pulsed Xenon Ultraviolet light (PX-UV) has been shown to reduce bacterial bioburden levels on surfaces. This study aims to assess the effect of the addition of PX-UV to terminal cleaning on the clonal recovery of E. faecium sequence types (STs) using Whole Genome Sequencing (WGS) on patient isolates. Methods During 2017 to 2020 a prospective, randomized, double-blinded, sham-controlled, interventional, crossover trial in 2 separate Detroit hospitals (H1 and H2) compared HAI counts after the addition of either PX-UV or a non-UV sham device to terminal cleaning methods. The trial consisted of a total of 16 units randomized to have either the treatment of PX-UV (Group Q) or the sham control device with no UV (Group W) for 12 months. A washout period (Group R) of 6 months followed and the trial concluded with a 12-month crossover of treatments. A total of 60 E. faecium samples were collected, then WGS was performed by the Illumina Nextseq 550 instrument. de novo assembly was preformed using the SPAdes program. Whole Genome Multilocus Sequence Type (wgMLST) analysis was performed by BioNumerics (v7.6) to construct minimum spanning tree (MST). Results A total of 7 STs were obtained across the 2 hospitals (H1 and H2). ST117, ST17, and ST80 all had more than 10 total recovered isolates, ST117 being the most frequent with 24 isolates. Less than 3 isolates were recovered for all other STs. For all STs, Group Q (PX-UV) had 14, Group R (washout period) had 22, and Group W (non-UV sham) had 24. ST18 was only found in Group Q. ST412, ST584, and ST736 were not found in Group W. The data shows that the intervention PX-UV group had a reduction of clonal recovery by 10 STs as compared to the sham UV group. Table 1:Total number of each sequence type (ST) in H1 and H2 Conclusion The overall reductions in the number of isolates in the real UV units was driven by reductions in the ST117 a predominant strain in a hospital environment reported previously in Detroit and ST80. There were negligible differences in recovery of other ST between the groups. The reduction in clonal recovery of E. faecium isolates in Group Q as compared to Group R might be related to use of PX-UV following terminal room cleaning. Disclosures Piyali Chatterjee, PhD, AHRQ Grant # 1R03HS027667-01: Grant/Research Support|AHRQ Grant # 1R03HS027667-01: Central Texas Veterans Health Care System 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 Chetan Jinadatha, MD, MPH, AHRQ R01 Grant-5R01HS025598: Grant/Research Support|EOS Surfaces: Copper Coupons and materials for testing.

MORTALITY AMONG HISPANICS AND NON-HISPANICS WITH COMPARABLE COMORBIDITY BURDEN HOSPITALIZED FOR COVID-19

SESSION TITLE: Impact of Health Disparities and DifferencesSESSION TYPE: Rapid Fire Original InvPRESENTED ON: 10/19/2022 11:15 am - 12:15 pmPURPOSE: The COVID-19 pandemic resulted in an unexpected increase in mortality primarily among patients with preexisting comorbidities. San Antonio Texas and the surrounding areas are home to a proportionally larger Hispanic population relative to the remainder of the state and country. It has been well documented that patients with pre-existing comorbidities have increased mortality when admitted for COVID-19, but limited data are available regarding the Hispanic minority ethnic group. We determined whether Hispanic ethnicity contributed to 30-day mortality when compared to non-Hispanics among hospitalized COVID-19 patients with similar comorbidity burden.METHODS: We performed an observational cohort study among hospitalized patients that were enrolled at the South Texas Veterans Health Care System (STVHCS) from April 1, 2020 until December 31, 2021 and diagnosed with COVID-19 disease. The index data was defined as the day of COVID-19 diagnosis according to the ICD-10 code U07.1. Our independent variable was stratified according to the Hispanic ethnic group. We included COVID-19 patients with similar comorbidity burden, defined by a Charlson Comorbidity Index (CCI) of greater than or equal to 1. A priori adjustment was performed for variables that influence clinical outcome such as age, gender, and CCI, respectively. The primary outcome was 30-day all-cause mortality. Descriptive and multivariate analysis were performed using the IBM SPSS statistics software.RESULTS: Of the 1257 hospitalized patients during the study period, 1038 met inclusion criteria. There were 372 (35.8%) Hispanics and 666 (64.2%) non-Hispanics. Hispanic patients had similar demographic characteristics to non-Hispanic patients, regarding median age in years (68 [56-73] vs. 68 [58-74], male gender (n=354 [95.2%] vs. n=610 [91.6%]) and median CCI (4.0 [2.0-6.8] vs. 4.0 [2.0-7.0]), respectively. The 30-day all-cause mortality was 13.8% (n=50) in the Hispanic group compared to 14.0% (n=93) in the non-Hispanic group (p=0.81). After adjusting for age, gender and CCI, Hispanics had a similar 30-day all-cause mortality to the non-Hispanic group of COVID-19 hospitalized (AOR 0.98, 95% CI 0.66-1.43, p=0.97).CONCLUSIONS: Hispanic ethnicity was not associated with an increased 30-day all-cause mortality in a population of hospitalized COVID-19 patients with similar comorbidity burden.CLINICAL IMPLICATIONS: Hispanic ethnicity does not appear to be an independent risk factor for increased mortality related to COVID-19DISCLOSURES: No relevant relationships by Liwayway AndradeNo relevant relationships by Nicholas HodgemanNo relevant relationships by Marcos Restrepo SESSION TITLE: Impact of Health Disparities and Differences SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: The COVID-19 pandemic resulted in an unexpected increase in mortality primarily among patients with preexisting comorbidities. San Antonio Texas and the surrounding areas are home to a proportionally larger Hispanic population relative to the remainder of the state and country. It has been well documented that patients with pre-existing comorbidities have increased mortality when admitted for COVID-19, but limited data are available regarding the Hispanic minority ethnic group. We determined whether Hispanic ethnicity contributed to 30-day mortality when compared to non-Hispanics among hospitalized COVID-19 patients with similar comorbidity burden. METHODS: We performed an observational cohort study among hospitalized patients that were enrolled at the South Texas Veterans Health Care System (STVHCS) from April 1, 2020 until December 31, 2021 and diagnosed with COVID-19 disease. The index data was defined as the day of COVID-19 diagnosis according to the ICD-10 code U07.1. Our independent variable was stratified according to the Hispanic ethnic group. We included COVID-19 patients with similar comorbidity burden, defined by a Charlson Comorbidity Index (CCI) of greater than or equal to 1. A priori adjustment was performed for variables that influence clinical outcome such as age, gender, and CCI, respectively. The primary outcome was 30-day all-cause mortality. Descriptive and multivariate analysis were performed using the IBM SPSS statistics software. RESULTS: Of the 1257 hospitalized patients during the study period, 1038 met inclusion criteria. There were 372 (35.8%) Hispanics and 666 (64.2%) non-Hispanics. Hispanic patients had similar demographic characteristics to non-Hispanic patients, regarding median age in years (68 [56-73] vs. 68 [58-74], male gender (n=354 [95.2%] vs. n=610 [91.6%]) and median CCI (4.0 [2.0-6.8] vs. 4.0 [2.0-7.0]), respectively. The 30-day all-cause mortality was 13.8% (n=50) in the Hispanic group compared to 14.0% (n=93) in the non-Hispanic group (p=0.81). After adjusting for age, gender and CCI, Hispanics had a similar 30-day all-cause mortality to the non-Hispanic group of COVID-19 hospitalized (AOR 0.98, 95% CI 0.66-1.43, p=0.97). CONCLUSIONS: Hispanic ethnicity was not associated with an increased 30-day all-cause mortality in a population of hospitalized COVID-19 patients with similar comorbidity burden. CLINICAL IMPLICATIONS: Hispanic ethnicity does not appear to be an independent risk factor for increased mortality related to COVID-19 DISCLOSURES: No relevant relationships by Liwayway Andrade No relevant relationships by Nicholas Hodgeman No relevant relationships by Marcos Restrepo

LONG-TERM MORTALITY IN HOSPITALIZED PATIENTS WITH COVID-19 AND PREEXISTING ASTHMA

LONG-TERM MORTALITY IN HOSPITALIZED PATIENTS WITH COVID-19 AND PREEXISTING ASTHMA

Early Documentation of Life-Sustaining Treatment Orders Prior to Diagnosis of COVID-19 in Nursing Home Residents

Public health guidelines to prevent spreading COVID-19 place older adults at risk of loneliness and social isolation. Evidence suggests that participation protects older adults from such detrimental outcomes, therefore we aimed to identify the factors associated with participation in life roles among older adults living in the community during the COVID-19 pandemic. We conducted a telesurvey on a random sample of community-dwelling older adults living in Hamilton, Ontario, Canada, between May and July 2020. Outcome measures included participation in life roles, physical function, physical activity, mobility, mental health, nutrition, and demographics. We conducted two multivariate regression analyses with the Late Life Disability Instrument’s (LLDI) frequency and limitations scales as the dependent variables. Candidate factors were organized by International Classification of Functioning, Disability, and Health (ICF) framework domains; personal factors, body functions and structures, activities, and environmental factors. A total of 272 older adults completed the telesurvey (mean age 78 ±7.3 yrs, 70% female). Age, using walking aids, driving status, household income, education, mental health, nutrition, physical function, and dwelling type explained 47.1% (p<0.001) of the variance observed in LLDI frequency scores. Using walking aids, driving status, receiving health assistance, mental health, and physical function explained 33.9% (p<0.001) of the variance observed in LLDI limitation scores. These findings highlight factors from multiple ICF domains that are associated with participation limitation and frequency among older adults during the pandemic. Our findings have implications for developing public health initiatives to mitigate the effects of the pandemic on the participation of older adults.

1402. NTM Infections; A Rising Global Health Problem/Clinical Characteristics and Outcomes of Patients with Non-Tuberculous Mycobacterial Infections at Two Tertiary Academic Medical Centers

BackgroundNon-Tuberculous Mycobacteria (NTM) cause infections in immunocompetent as well as immunocompromised individuals affecting pulmonary and extra pulmonary sites. These pathogens are widely distributed globally and recent reports have shown their rise in many developed countries. Our study aimed to assess the disease magnitude, describe patient characteristics and risk factors, assess diagnostic and therapeutic measures and review outcomes furthering our understanding of the overall disease process. MethodsWe conducted a retrospective, multicenter review of patients with positive NTM cultures treated at University Hospital System and South Texas Veterans Health Care System (STVHCS) from 2011 to 2018. Infections were classified as pulmonary or extrapulmonary, and we recorded demographics, microbiological data, treatment regimens, duration, complications, follow-up and mortality. All categorical variables were described using percentages and compared between groups using the chi-square test. ResultsA total of 176 patients were included for analysis, of which 111 (63.1%) met criteria for NTM disease (2020 ATS/IDSA). The most common cultured mycobacterium was M. Avium Complex (MAC). M. abscessus-chelonae was more commonly associated with clinical disease and isolated from an extra pulmonary site whereas M. simiae complex had similar distribution between the infected and un-infected groups. Over 50% of patients received treatment (80% in the infected group). Cure was seen in 47.2%, all-cause mortality was 27% at last follow-up. Median duration of therapy was 10 months. 47% of patients experienced adverse effects which led to treatment discontinuation in one third of patients. Patients who were able to achieve a cure received a longer duration of therapy (12 vs 7 months; not statistically significant) and treatment was halted more commonly in the group that did not achieve eventual cure (42.6% vs. 16.7%, p=0.007). ConclusionNTM infections represent a therapeutic challenge with low cure rates and high mortality. An understanding of the risk factors, treatment options and outcomes is essential to guide appropriate management. Our study highlights high rates of adverse effects and discontinuation which precludes prolonged courses of therapy required to achieve cure.Disclosures All Authors: No reported disclosures

758. Increased Prevalence of Clostridioides difficile Infection During the COVID-19 Pandemic Among Hospitalized Veterans in South Texas, USA

Background Clostridioides difficile infection (CDI) continues to be a major global public health concern, particularly during the ongoing SARS-CoV-2 coronavirus disease 2019 (COVID-19) pandemic. Despite new social distancing guidelines and enhanced infection control procedures (e.g., masking, hand hygiene) being implemented since the beginning of COVID-19, little evidence indicates whether these changes have influenced the prevalence of CDI hospitalizations. This study aims to measure CDI prevalence before and during the COVID-19 pandemic in a local cohort of U.S. Veterans. MethodsThis was a cross-sectional study of all Veterans presenting to the South Texas Veterans Health Care System in San Antonio, Texas from Jan 1, 2019 to Apr 30, 2021. Monthly laboratory confirmed CDI events were collected overall and categorized as the following: hospital-onset, healthcare facility-associated (HO-HCFA-CDI), community-onset, healthcare facility-associated CDI (CO-HCFA-CDI), and community-associated CDI (CA-CDI). Monthly confirmed COVID-19 cases were also collected. CDI prevalence was calculated as CDI events per 10,000 bed days of care (BDOC) and was compared between pre-pandemic (Jan 2019-Feb 2020) and pandemic (Mar 2020-Apr 2021) periods.ResultsA total of 285 CDI events, 920 COVID-19 cases, and 104,220 BDOC were included in this study. The overall CDI rate increased from 20.33 per 10,000 BDOC pre-pandemic to 34.51 per 10,000 during the pandemic (p< 0.0001). This was driven primarily by a rise in CO-HCFA-CDI rates (0.95 vs 2.52 per 10,000 BDOC; p< 0.0001) during the pandemic, followed by increases in CA-CDI (15.58 vs. 18.61 per 10,000 BDOC; p< 0.0001) and HO-HCFA-CDI (2.66 vs. 5.43 per 10,000 BDOC; p< 0.0001). Lastly, CDI rates have tripled since the start of the pandemic (March-Apr 2020) compared to the current year (March-Apr 2021) (14.69 vs. 43.76 per 10,000 BDOC). ConclusionOverall, CDI prevalence increased during the COVID-19 pandemic, driven mostly by an increase in CO-HCFA-CDI. As COVID-19 rates increased, CDI rates also increased, likely due to greater healthcare exposures and antibiotic use. Continued surveillance of COVID-19 and CDI is warranted to further decrease infection ratesDisclosures All Authors: No reported disclosures