Introduction: Hospital-onset Clostridioides difficile infection (HO-CDI), reported as laboratory-identified (LabID) event, is common in patients with chronic kidney disease (CKD), especially those with end-stage renal disease (ESRD), and is associated with prolonged length of hospitalization and more severe disease. CKD patients are at increased of developing CDI due to frequent antimicrobial and healthcare exposures. The objective of this study was to assess recent trends of HO-CDI in patients on a nephrology unit at our academic, tertiary care institution. Methods: Retrospective cross-sectional study of patients with HO-CDI who were hospitalized on a nephrology unit between January 2021 to December 2023. Collected variables included: demographic data, characterization of HO-CDI risk factors, infection and diagnosis (including prior history of CDI, toxin versus nucleic acid amplification test [NAAT] positivity, number of loose stools), CDI rate (defined as CDI count/patient days x1000), standardized antimicrobial administration ratio (SAAR) for high-risk for CDI antimicrobials (defined by the National Healthcare Safety Network), and infection prevention and control (IPC) practices, including hand hygiene audit rates. Results: A total of 30 HO-CDI infections were reported on the nephrology unit [Table], with 8 occurring in 2021, 5 in 2022, and 17 in 2023. The median age of patients was 70.8 (range: 37-96) years, and most patients (57%) were female. The majority of patients were admitted from home (73%), and two patients (7%) had a history of CDI in the last 6 months. Among the CDI cases, 60% were NAAT positive and toxin negative, and only 50% had >3 bowel movements (BM) within 24 hours prior to the positive test. Ten percent received promotility agents prior to testing. Most cases (77%) occurred when other CDI patients were on the unit. Hand hygiene compliance rates averaged 81% over the three-year period [Figure 1A]. Eight-four per cent of patients received antibiotics within 30 days of CDI diagnosis; SAAR was >1 for quarters 2 and 4 in 2022, and quarter 1 in 2023 [Figure 1B]. Conclusion: On our nephrology unit, patients often had < 3 BM within 24 hours of CDI diagnosis, and 60% of cases were toxin-negative, NAAT-positive, suggesting possible C. difficile colonization, rather than true infection. In addition, an elevated SAAR correlated with high CDI rates. Multicomponent interventions may be required to reduce the rates of HO-CDI in CKD patients. Opportunities include emphasis on diagnostic and antimicrobial stewardship, environmental cleaning and adherence to IPC practices, including hand hygiene.

Using a multicomponent approach that included blood-culture stewardship, evaluation for secondary sources of bloodstream infection, improved documentation, and prompt central-line removal, an interprofessional team improved patient care and reduced central-line-associated bloodstream infection rates in collaboration with the primary team on the surgical intensive care unit.

BACKGROUND:Whole-genome sequencing (WGS) has emerged as an alternative genotyping tool for outbreak investigations in the healthcare setting. We describe the investigation and control of a New Delhi metallo-B-lactamase (NDM)-producing Escherichia coli cluster in Southeast Michigan. METHODS:Michigan Bureau of Laboratories identified several closely related NDM-producing E. coli isolates with WGS. An epidemiologic investigation, including case-control study, assessment of infection control practices, and endoscope culturing, was performed to identify source of transmission. Targeted screening of potentially exposed patients was performed following identification of probable source. RESULTS:Between July 2021 and February 2023, nine patients were identified. Phylogenetic analysis confirmed the isolates were closely related with less than 26 single nucleotide polymorphism (SNP) differences between isolates, suggesting an epidemiological link. Eight (89%) patients had a duodenoscope and/or gastroscope exposure. Cases were compared with 23 controls. Cases had significantly higher odds of exposure to duodenoscopes (odds ratio 15.0; 95% CI, 1.8-142.2; P = .015). The mean incubation period, estimated as date of procedure to positive index culture, was 86 days (range, 1-320 days). No lapses in endoscope reprocessing were identified; NDM-producing E. coli was not recovered from reprocessed endoscopes or during targeted screening. No additional cases were identified after removal of implicated gastroscopes and replacement of duodenoscope with disposable end caps. CONCLUSIONS:In this investigation, WGS was utilized to identify transmission of an NDM-producing E. coli outbreak associated with endoscope exposure. Coupled with epidemiologic data, WGS can facilitate outbreak investigations by rapidly identifying linked cases and potential sources to prevent further transmission.

Musgrove, Hannah MSN, APRN, AGCNS-BC; Morales, Princetta MSN, APRN, ACNS-BC; Ruby, Abigail MPH, CIC; Thompson, Yolanda MBA, BSN, RN, NE-BC; Chami, Eman MHA, CIC; Gupta, Arielle MD, FACS Author Information

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Background: Between July 2021-March 2023, 9 cases of genetically similar New Delhi metallo-β-lactamase (NDM)-producing Escherichia coli (E. coli) were identified in our healthcare facility. Upon investigation, it was discovered that these patients had procedures in the same procedural area using the same five endoscopes. These endoscopes were also used in thousands of other procedures.

Abstract Background Healthcare facility-onset (HCFO) Clostridiodes difficile infection (CDI) is the most common hospital-acquired infection. Although risk factors associated with CDI have been described, characterization and outcome of HFCO-CDI are limited. Methods This was a retrospective observational study comparing disease severity among adult patients with HCFO-CDI from January 1, 2020, to December 31, 2022, at an 877-bed tertiary care hospital in Detroit. Patients were identified using National Healthcare Safety Network (NHSN) definition. CDI was classified as nonsevere, severe, or fulminant. Severe disease was defined as having white blood cell (WBC) count ≥ 15,000 cells/mm3 or acute kidney injury (AKI) defined as increase in creatinine of ≥ 0.3mg/dL within 48 hours of diagnosis. Fulminant disease included patients with ileus or toxic megacolon, or need for colectomy, intensive care unit or vasopressors. Risk factors, treatment and outcomes were evaluated. Results 98 patients were diagnosed with HFCO CDI during the study period (Table 1); 37 (38%) were non-severe, 47 (38%) severe and 14 (24%) fulminant. Median age was 66 years, 50% were female and 45% white. Almost half were immune suppressed; 5% had prior CDI. Most patients (88%) were exposed to antibiotics (abx) prior to CDI with no difference between the groups (p=0.427); 61% received cephalosporins. Cirrhosis was more common among patients with fulminant disease (p=0.048) and receipt of chemotherapy was associated with severe and/or fulminant disease cases (p=0.049). AKI (p< 0.001), fever (p=0.030), and WBC >25,000 or < 2,000 cells/mm3 (p< 0.001) were more prevalent among patients with fulminant CDI; combination or alternative therapy was more common among fulminant cases (p< 0.001). Most were eligible, but only 6% received bezlotoxumab (BZX). Although outcomes were not significantly different between the groups, length of stay was longer and refractory disease and recurrence were more common in severe/fulminant CDI. Conclusion In our HCFO-CDI cohort, most patients were exposed to abx, and cirrhosis and chemotherapy were associated with more severe CDI. Efforts should focus on appropriate abx utilization and increasing use of BZX to reduce burden of CDI and risk of recurrence and readmission. Disclosures All Authors: No reported disclosures