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Background: Carbapenem-resistant Enterobacterales (CRE) are an urgent public health threat, particularly those that produce carbapenemase (CP-CRE). Certain risk factors associated with CRE acquisition have been well described, such as older age, indwelling devices, prior hospitalizations, and underlying conditions. However, data are limited regarding the association of CRE and health disparities, such as race and ethnicity. Published literature has consistently shown that minority groups, including but not limited to Non-Hispanic Black persons, have higher risks of developing adverse health outcomes. To better understand the impact of race and ethnicity in CP-CRE cases, we compared 1-year mortality rates among Non-Hispanic Blacks and Non-Hispanic Whites. Methods: CRE are reportable in Tennessee; isolates must be sent to the State Public Health Laboratory for carbapenemase detection and resistance mechanism testing. We linked 2015–2019 CP-CRE surveillance cases and laboratory data from our statewide surveillance system, the National Disease Surveillance System (NEDDS)-Base System, with the Tennessee Hospital Discharge Data System (HDDS) and vital records databases. Database linkage and data analyses were performed using SAS version 9.4 software. Results: Among 615 CP-CRE cases, the mean age was lower among non-Hispanic Blacks (59 years; SD, 16.6) compared to non-Hispanic Whites (mean, 65 years; SD, 15.7). Among 156 non-Hispanic Blacks with CP-CRE, 101 (64.7%) were nursing home residents, whereas 281 (71.1%) among the 395 non-Hispanic Whites were nursing home residents. Also, 64 Non-Hispanic Blacks (41%) died within 1 year of their first specimen collection date compared to 92 Non-Hispanic Whites (23.3%). Non-Hispanic Blacks with CP-CRE who died within 1 year had a mortality rate of 5.6 per 100,000 (95% CI, 4.21–6.94) Black population, which was 1.6 times higher than Non-Hispanic White persons at 3.5 per 100,000 (95% CI, 2.94–3.95; χ 2 P < .001) White population. Conclusions: Despite a lower mean age, non-Hispanic Black CP-CRE cases had a higher 1-year mortality rate than non-Hispanic Whites. Racial and ethnicity data often are missing or incomplete from surveillance data. Data linkages can be a valuable tool to gather additional clinical and demographic data that may be missing from public health surveillance data to improve our understanding of health disparities. Recognition of these health disparities among CRE can provide an opportunity for public health to create more targeted interventions and educational outreach. Funding: None Disclosures: None

Background: Antimicrobial resistance is a growing problem in Candida spp., leading to treatment challenges and increased morbidity and mortality. The World Health Organization (WHO) fungal priority pathogens list classifies C. glabrata, C. tropicalis, and C. parapsilosis as high priority and leading causes of candidemia with high fluconazole resistance. In the US, these organisms are the most frequently isolated non-albicans Candida species. In 2016, the Antibiotic Resistance Laboratory Network (ARLN) was created to monitor resistance threats, including in Candida spp. This study describes the proportion of resistance in C. glabrata, C. parapsilosis, and C. tropicalis isolates sent to the Southeast ARLN from 2017 to 2023. Methods: This study evaluated C. glabrata, C. parapsilosis, and C. tropicalis submitted to the Southeast ARLN from Alabama, Florida, Georgia, Louisiana, Mississippi, and Tennessee from February 2017- September 2023. Species identification was confirmed by Bruker Biotyper matrix assisted laser desorption-ionization time of flight (MALDI-TOF). Antifungal susceptibility testing (AFST) was performed using TREK frozen broth microdilution panels. Minimum inhibitory concentration values from the clinical instrument were used to determine susceptibility based on Clinical and Laboratory Standards Institute (CLSI) standard interpretations from the 2020 CLSI M60 guidelines. Data were extracted from the laboratory information management system. Analyses were conducted using SAS v9.4. Results: AFST testing was performed on 660 C. glabrata, 500 C. parapsilosis, and 233 C. tropicalis isolates from within the Southeast region. The predominant specimen sources by species were blood 25.30% C. glabrata; other/not specified 27.80% C. parapsilosis; and lower respiratory 36.91% C. tropicalis. Resistance to fluconazole is as follows: C. glabrata, 12.88%; C. parapsilosis, 3.41%; C. tropicalis, 36.64%. Resistance to voriconazole is as follows: C. parapsilosis, 1.00%; C. tropicalis 30.04%. Resistance to at least one echinocandin (Anidulafungin, Capsofungin, Micafungin) is as follows: C. glabrata, 1.67%; C. parapsilosis, 0.60%; C. tropicalis, 0.43%. Overall, there was a decreasing trend in resistance to fluconazole, and voriconazole in all three species between 2017 and 2023. Conclusions: Antifungal resistance in non-albicans Candida species represents an emerging public health threat, however, within the Southeast region, ARLN data has shown a decreasing trend of azole resistance. This may be due in part to changes in reporting requirements and submission criteria from within the region. Nevertheless, C. tropicalis showed high resistance to azoles within the Southeast region. These Candida species should be monitored to inform clinical decision making and identify resistance patterns in other US regions due to their increase in resistance worldwide.

Background: Multidrug-resistant organisms (MDROs) are a global threat. To track and contain the spread, the Tennessee Department of Health (TDH) performs targeted surveillance of carbapenemase-producing and pan-nonsusceptible organisms. When these MDROs are identified, TDH conducts a containment response and collects epidemiological data, which includes risk factors such as indwelling devices and previous hospitalizations. The impact of the COVID-19 pandemic on these MDROs is not well understood. Therefore, we have described the characteristics of cases positive for both COVID-19 and select MDROs. Methods: MDRO investigation data from January 1, 2020–September 30, 2021 were matched with all COVID-19 case data from the TDH statewide surveillance system, National Electronic Disease Surveillance System Base System. MDRO-positive date was defined as the specimen collection date; COVID-19 case date was first defined as the date of symptom onset and if missing, then diagnosis date, and investigation creation date, respectively. Descriptive statistics and Fisher exact tests were calculated using SAS version 9.4 software. Results: Among 336 MDRO cases, 50 had a reported SARS-CoV-2–positive result. MDRO types were Enterobacterales (CRE) (n = 31), Acinetobacter spp (CRA) (n = 18), and Pseudomonas aeruginosa (n = 1). Of these 50 cases, 20 were MDRO-positive before and 30 days after the COVID-19 case date, respectively. Of the 18 CRA cases, 16 (89%), were positive after the COVID-19 case date, compared to 13 (42%) among 31 CRE cases ( P < .01). Also, 35 patients (70%) had a record of hospitalization, and 22 (63%) had their MDRO specimen collected after the COVID-19 case date ( P = .37). Of these 22 patients, 4 had their MDRO specimen collected during their COVID-19 hospitalization, with an average duration from admission to MDRO collection date of 17 days (range, 4–36). Among the 50 coinfected cases, 8 died, 7 (88%) of whom were MDRO-positive after their COVID-19 case date. Data on indwelling devices at time of MDRO positivity were completed for 17 cases; 14 had an indwelling device and, among these, 13 (93%) were MDRO-positive after their COVID-19 case date. Conclusions: MDRO cases with specimen collections after COVID-19 comprised the majority of hospitalized patients, patients who died, and patients with indwelling devices compared to those with MDROs collected before their COVID-19 case date. These results show a stark difference with CRA as the most common MDRO among post–COVID-19 cases. Our data were limited by reporting gaps. We recognize that patients can remain colonized with MDROs for lengthy durations, which could have result in undetected MDRO cases prior to the COVID-19 case date. More data and analyses are needed to make targeted public health recommendations. However, these findings highlight the burden of MDROs among COVID-19 cases. including adverse health outcomes. Funding: None Disclosures: None

Background: Carbapenem-resistant Acinetobacter (CRA) bacteria are an urgent public health threat. Accurate and timely testing of CRA is important for proper infection control practices to minimize spread. In 2017, the CDC estimated 8,500 CRA cases among hospitalized patients, 700 deaths, and $281 million in attributable healthcare costs. Treatment options are extremely limited for carbapenem-resistant Acinetobacter baumannii (CRAB) infections, making CRAB a unique concern. Colonization screening is a valuable tool for containment but requires sampling of 4 body sites. Identifying a reliable specimen collection site for CRAB is important to inform public health recommendations as screening can cost healthcare facilities valuable time and resources. Methods: Results of all screening specimens of patients with at least 1 site positive for CRAB on a unique collection date were extracted from the Southeast Regional data of Antimicrobial Resistance Lab Network (SEARLN) data. Non-CRAB screening and screenings that did not yield at least 1 positive result on a single collection date were excluded. We also limited our data to include only the following screening sites, which have been validated by the Tennessee Department of Health’s State Public Health Laboratory: axilla and groin, rectal, sputum, and wound. For each specimen source, we calculated the percentage of positive specimen among CRAB-colonized patients. Data were extracted and analyzed using SAS version 9.4 software. Results: The SEARLN data contained 594 CRAB screening specimens collected over 4 years, 2018 through 2021, and 486 of those specimens yielded CRAB. For CRAB-colonized patients screened in this study, wound specimens had the highest positivity rate at 93.4% (95% CI, 89.9%–96.9%) of samples culturing CRAB. Sputum followed at 87.7%, then axilla and groin at 77.6% and rectal at 59.7%. Conclusions: Wound specimens produced the highest proportion of positive cultures among CRAB-positive patients, making them the sample type with the highest prevalence in our study. For healthcare facilities with limited time and resources seeking to optimize their CRAB screening process, wound specimens may be the most reliable single site for detecting CRAB colonization in patients with an open wound. When a wound is not present, sputum may be a good alternative single-source collection site. More research should be conducted before CRAB screening recommendations are updated. Disclosures: None

Background: Since 2009, the CDC has invested in nationwide outbreak response capacity through Healthcare-associated Infections and Antimicrobial Resistance (HAI/AR) Programs in public health departments. The unpredictable nature of outbreaks requires public health programs to be able to scale operations and adapt strategies to effectively respond to emerging challenges, as demonstrated by the COVID-19 pandemic. This analysis characterizes HAI/AR Programs response capacity in scalability, adaptability, and technical expertise. Method: We reviewed data from HAI/AR Programs in 50 state, 6 local, and 2 territorial health departments (August 2019–December 2022). HAI/AR responses were defined as specific public health actions to assess an acute risk and prevent further harm in the context of a confirmed or possible healthcare outbreak; responses were categorized as involving novel or targeted multi-drug resistant organisms (nMDROs), COVID-19, and HAIs or infection control breaches. Descriptive statistics were used to analyze reported responses in three domains: scalability (number of responses per year), adaptability (number of pathogens and healthcare facility types involved in responses), and technical expertise (number of responses involving onsite or remote infection control assessments). The annual number of responses conducted in 2019 was estimated based on five months of data (Aug–Dec); all other results were calculated directly. Results: From August 2019 to December 2022, 58 HAI/AR Programs reported 141,445 responses (87% COVID-19, 11% nMDROs, 2% other HAIs or infection control breaches). Annually, programs conducted an estimated 5,546 responses in 2019, and this figure rose to 42,359 in 2020, 49,124 in 2021, and 47,651 in 2022. Outbreak responses involved 110 different pathogens, including emerging infectious diseases (e.g., SARS-CoV-2, mpox), nMDRO (e.g., carbapenemase-producing organisms, Candida auris), and other pathogens (e.g., hepatitis viruses, Mycobacterium abscessus) across >20 setting types (e.g., acute care hospitals, skilled nursing facilities, ambulatory surgery centers, assisted living facilities). Additionally, programs responded to infection control breaches in the absence of identified patient infections, including drug diversion, medical device reprocessing, and injection safety breaches. Programs conducted 50,245 infection control assessments during reported responses. Conclusion: From 2019–2022, as the COVID-19 pandemic took hold, HAI/AR Programs effectively utilized CDC funding to scale their response operations with an 8-fold increase in annual response activity, including a 24% increase for non-COVID-19 responses. Programs adapted responses to various pathogens, including emerging infectious diseases, across various setting types. Health department staff utilized technical expertise to conduct infection control assessments. This analysis provides valuable insights into the resilience and impact of HAI/AR Programs nationwide.

Background: Carbapenemase-producing organisms (CPOs) are a growing antibiotic resistance threat. Colonization screening can be used to identify asymptomatically colonized individuals for implementation of transmission-based precautions. Identifying high-risk patients and settings to prioritize screening recommendations can preserve facility resources. To inform screening recommendations, we analyzed CPO admission screens and screening conducted on point-prevalence surveys (PPSs) performed through the Antibiotic Resistance Laboratory Network’s Southeast Regional Laboratory (SE AR Lab Network). Methods: During 2017–2019, the SE AR Lab Network collected data via a REDCap survey for a subset of CPO screens on a limited set of easily determined patient risk factors. Rectal swabs were collected and tested with the Cepheid Carba-R. Specimens collected within 2 days of admission were classified as admission screening and the remainder were classified as PPS. Index cases were excluded from analyses. Odd ratios (ORs) and 95% confidence intervals were calculated, and a value of 0.1 was used for cells with a value of zero. Results: In total, 520 screens were conducted, which included 366 admission screens at 2 facilities and 154 screens from 27 PPSs at 8 facilities. CPOs were detected in 14 (2.7%) screens, including in 10 (2.7%) admission screens and in 4 (2.6%) contacts during PPSs; carbapenemases detected were Klebsiella pneumoniae carbapenemase (KPC) (n = 12), New Delhi Metallo-β-lactamase (NDM) (n = 1) and Verona Integron-Encoded Metallo-β-lactamase (VIM) (n = 1). One long-term acute care hospital (LTACH) performed universal admission screening, which accounted for 96% of admission screens and all 10 CPOs detected by admission screening. Mechanical ventilation (OR, 5.0; 95% CI, 1.4–18.0) and the presence of a tracheostomy (OR, 5.4; 95% CI, 1.5–19.4) were associated with a positive admission screen. Moreover, 8 facilities conducted PPSs: 4 acute care hospitals, 2 long-term acute care hospitals, and 2 nursing homes. CPO prevalence in long-term acute care hospitals was 4.8% (2 of 42), 2.4% (1 of 41) in acute care hospitals, and 1.5% (1 of 69) in nursing homes. Requiring assistance with bathing (OR, 4.8; 95% CI, 1.6–8.0) and stool incontinence (OR, 16.6; 95% CI, 13.4–19.8) were associated with a positive screen on PPSs. All 7 roommates of known cases tested negative for CPO colonization. Conclusions: Findings suggest that patients with certain easily assessed characteristics, such as mechanical ventilation, tracheostomy, or stool incontinence or who require bathing assistance, may be associated with CPO positivity during screening. Further data collection and analysis of such risk factors may provide insight for the development of more targeted admission and contact screening strategies. Funding: None Disclosures: None

Background Candida auris is an emerging multidrug-resistant yeast which can spread within healthcare facilities and is associated with significant morbidity. Over 160 clinical cases have been reported in NYS. This pilot aims to assess the feasibility of C. auris admission screening and to better understand its role in controlling spread of C. auris in an area where it has emerged. Methods One hospital and two nursing homes (NHs) with known prior cases participated (one NH and hospital are closely associated and are reported together). Patients were screened on admission to any of three hospital intensive care units (medical, cardiac, pulmonary) or to a ventilator unit in the NHs from November 2017 to April 2018. Screening consisted of bilateral nares and axilla/groin swabs sent to the NYS Department of Health Wadsworth Center (WC) for a WC-developed C. auris real-time polymerase chain reaction (rt-PCR) test. Specimens with detection of C. auris on rt-PCR underwent fungal culture. Facilities were alerted of positive results and infection control precautions were promptly initiated. Results To date, 575 patients (1,371 samples) were screened. Of patients not previously known to be colonized, 39 had C. auris detected on rt-PCR; 34 confirmed by C. auris culture at either site and one culture pending. Of these, 30 (88%) were detected and confirmed from the axilla/groin specimen (Figure 1). Mean age was 76 years and 59% were females. Patients had significant healthcare facility exposure (Figure 2). Eleven (32%) were from NH-A and 23 (68%) from the hospital/NH-B combined. Rates of positivity were 16.2% (11/68) for NH-A and 4.6% (23/498) for the hospital/NH-B. Conclusion C. auris rt-PCR is a useful tool within an admission screening program; however, more accessible and affordable rapid laboratory diagnostics are urgently needed. The axilla/groin site detected the majority of colonized individuals. Admission screening was feasible and increased facility knowledge of colonization status, which led to earlier implementation of infection control precautions potentially limiting spread. However, further study is needed to assess transmission dynamics and potential impact of admission screening on control of C. auris within an outbreak or endemic setting. Disclosures All authors: No reported disclosures.

Purpose: Although there has been extensive research on pain management, patients are still experiencing high levels of pain. The purpose of this study was to determine if there is a relationship between knowledge and attitudes and barriers to pain management in cancer patients who are receiving home care, and also if there is a similar relationship in caregivers of those cancer patients.Design: Correlational study with patients and caregivers (n=38) recruited from various homecare agencies in the Detroit area.Methods: Participants of the study completed a demographic form, the Barriers Questionnaire (BQ) and the Pain Questionnaire (PPQ, FPQ).Findings: The scores on the pain questionnaire identified that patient and caregiver levels of knowledge are similar, and that their concerns are similarly ranked in order of importance. Significant negative correlations were found between patient knowledge and attitudes and their barriers to pain management. Surprisingly, the relationship between caregiver knowledge and attitudes and barriers was negative, but not significant. A significant positive relationship was identified between patient barriers and caregiver barriers.Conclusions: Patients with cancer pain receiving home care and their caregivers have similar barriers to pain management. However, those with higher knowledge had less barriers, indicating that increasing the knowledge of cancer patients and their caregivers about pain management may decrease their barriers.Implications: Nurses need to educate both patients and caregivers about the importance of pain management. They also need to assess the patient and caregiver for potential barriers to pain management. Early and continued access to information provided by knowledgeable providers is imperative to anticipate barriers and improve pain management.

Now would be a good time to start talking to the Iraqi government about a shift in U.S. military involvement in Iraq (\"U.S. medical care for Iraqis has limits,\" @issue, June 18). Statewide watering restrictions imposed by misguided bureaucrats such as state Environmental Protection Division Director Carol Couch are absurd. For example, Macon Water Authority supplies all the water that we residents of Bibb County want to buy. No amount of water conservation in Bibb County will assist those communities that have inadequate water supplies. Restricting MWA water sales only prevents it from raising the capital that would be invested in the system for the needs of Bibb County. Being critical so very often of the columns written by Cynthia Tucker and Jay Bookman, I find it refreshing to have columns with which I can wholeheartedly agree (Tucker's column \"Campbell's blot will take time to eradicate,\" @issue, June 18 and Bookman's column \"'Please excuse my son Bill ...'\" @issue, June 19).