Abstract Introduction Candida auris (Corynebacterium auris) is an emerging multidrug-resistant fungal pathogen increasingly recognized as a cause of nosocomial outbreaks. Burn patients are at particular risk of acquiring this pathogen because of impaired skin integrity, frequent invasive procedures, immune dysfunction, and treatment with broad-spectrum antimicrobials. Herein, we describe our experience with C. auris in a 17-bed burn unit, to better understand their colonization and infection risks. Methods This is a program improvement project. Our epidemiology team collected information on burn patients who tested positive for C. auris from 10/29/2024 to 6/30/2025. Demographics, comorbidities, hyperglycemia on admission, burn injury information and management, and C. auris detection information were collected. Descriptive statistics were obtained. Results Eight burn patients were positive for C. auris, five (62.5%) via polymerase chain reaction as a part of point prevalence studies and three (37.5%) by culture. Six (75%) were defined as C. auris colonization and two (25%) as C. auris infections based on receipt of targeted therapy. All patients were placed on broad spectrum antibiotics. The median time from admission to positivity was 17 days [IQR: 10-30.8]. All patients were white and male with a median age of 55 years [IQR: 32-74]. Only two presented with a history of diabetes mellitus, one had a history of neoplastic disease. None had a history of chronic kidney disease, immunocompromised state, or recent surgery. The median total burn surface area (TBSA) was 17% [IQR: 5.6-48.8]. Six (75%) presented full thickness burns and three (37.5%) had inhalation injury. All patients were hyperglycemic on admission (glucose median level:174 [IQR: 144-199]). Four (50%) had a central venous line, seven (87.5%) had an indwelling urinary catheter. Four (50%) required mechanical ventilation and stayed on a ventilator for an average of 15 days. The median hospital length of stay was 47 days [IQR: 13-51]. Conclusions Over a 9-month period, eight burn patients were positive for C. auris colonization and infection. A positive C. auris culture led to screening procedures to identify transmission on the unit to other patients. Some traditional risk factors were not met for acquisition of C. auris, such as time in other facilities. Multiple traditional risk factors were present, including use of medical devices, prolonged inpatient stays, frequent surgical procedures, and widespread use of antimicrobials. Applicability of Research to Practice Burn units should consider a C. auris surveillance program for patients in a burn unit should C. auris be identified in a clinical specimen. Specifically, facilities may consider routine surveillance for patients with prolonged stays and/or risk factors. Further study is warranted to identify the clinical significance of C. auris positivity in burn-injured populations. Funding for the study N/A.

Central line-associated bloodstream infections (CLABSIs) are hospital-acquired infections tied to quality metrics and penalties, but their validity near the end of life is unclear. We hypothesized that critically ill patients experience gut translocation of mucosal barrier injury (MBI) organisms, leading to bloodstream infections misclassified as CLABSIs. We evaluated the microbiology near death to assess the impact of gut translocation on reporting.Figure 1Figure 2 A retrospective review of 191 adult inpatients with mucosal barrier injury (MBI) and non-MBI CLABSIs at University of Iowa Hospitals and Clinics (2021–2025) was conducted using National Healthcare Safety Network (NHSN) surveillance definitions. Patients were divided into survival and death groups, and blood culture data were analyzed relative to the time of death. Organisms were classified as MBI or non-MBI per NHSN criteria.Table 1 Of 191 patients, 48 (25%) died during admission, with 11 patients dying before the blood culture had resulted. Relative to the survival group, MBI organisms accounted for a greater proportion of bloodstream infections (68.0% vs. 58.0%, Figure 1). In the death group, CLABSIs occurring within 1 week of death were more often caused by MBI organisms (73.5%, Figure 2). Organism-specific analysis is shown in Table 1. Data demonstrates that MBI organisms are more frequently isolated as patients near death, suggesting that CLABSIs may result from gut translocation rather than true catheter infections. These findings warrant review of CLABSI surveillance definitions near the end of life to improve reporting accuracy. Philip M. Polgreen, MD, Eli Lily: Advisor/Consultant|Pfizer: Grant/Research Support

Staphylococcus aureus bacteremia (SAB) remains a leading cause of bloodstream infection in both community and healthcare settings, with reported mortality rates ranging from 10% to 30%. This study aimed to characterize the frequency, predictors, and clinical impact of palliative care consultation (PCC) in hospitalized patients with SAB.Figure 1.Distribution of Palliative Care Consults in hospitalized Staphylococcus aureus bacteremia patientsFigure 2.Distribution of Staphylococcus aureus bacteremia patients during hospitalization We conducted a retrospective cohort study of adult and pediatric inpatients with SAB, defined by ≥1 positive blood culture for S. aureus, between January 1, 2016, and December 31, 2018. Baseline characteristics were compared between patients who did and did not receive PCC using chi-square, Fisher’s exact, and Wilcoxon rank-sum tests. Temporal trends, predictors of PCC, and associated outcomes were assessed using multivariable regression models. Survival was analyzed using Kaplan-Meier methods. Among 479 patients with SAB, 89 (18.6%) received PCC. Although PCC use increased over time, the trend was not statistically significant. Goals-of-care (GoC) discussions were the most common indication. Independent predictors of PCC included older age (adjusted odds ratio [aOR], 1.03 per year; 95% CI, 1.02–1.05; P< 0.001) and prolonged bacteremia (aOR, 1.10 per day; 95% CI, 1.00–1.21; P=0.042). Female sex (aOR, 0.54; 95% CI, 0.29–0.97; P=0.043) and musculoskeletal/soft tissue source of infection (aOR, 0.35; 95% CI, 0.14–0.83; P=0.021) were associated with lower odds of PCC. PCC was associated with shorter antibiotic duration (aOR, 0.58; 95% CI, 0.55–0.61; P< 0.001), increased GoC documentation (aOR, 1369.48; 95% CI, 257.29–25,917.74; P< 0.001), and higher rates of transition to comfort care (aOR, 42.40; 95% CI, 19.96–98.50; P< 0.001) and hospice (aOR, 164.34; 95% CI, 26.55–360.32; P< 0.001). Median time from consultation to discharge was 4 days (IQR, 1–10), and was shorter among those who died in-hospital (2 vs. 8 days; P< 0.0001). PCC was infrequently utilized among patients with SAB but strongly associated with care transitions and antimicrobial stewardship outcomes. A substantial proportion of patients died without PCC involvement. These findings highlight the need for earlier integration of palliative care in the management of SAB to support patient-centered care. Paul G. Auwaerter, MD, Capricor: Board Member|Capricor: Stocks/Bonds (Public Company)|Johnson and Johnson: Stocks/Bonds (Public Company)|Pfizer: Grant/Research Support|Shionogi: Advisor/Consultant

BACKGROUND:Andes virus (ANDV) is a high-consequence infectious disease with substantial mortality. On May 2, 2026, the World Health Organization reported a multinational ANDV outbreak, raising questions regarding risk of transmission to healthcare personnel (HCP). METHODS:We performed a systematic review per PRISMA guidelines (PROSPERO:CRD420261283806) for studies describing healthcare-associated ANDV exposure or transmission events to HCP. RESULTS:Eight studies reporting on 7 events were included, describing a total of 17 healthcare-associated cases. Overall, 207 individuals were exposed, including 118 HCP, resulting in 8 infections and 4 deaths among HCP. Studies describing HCP infections reported none or inadequate personal protective equipment (PPE) use. CONCLUSIONS:Transmission of ANDV to HCP has been reported in the setting of delayed implementation of transmission-based precautions or breaches in infection control practice. Limitations in published exposure events highlight the need for standardized reporting of exposure events and outcomes as well as infection prevention measures implemented.

Background: Approximately half of all fevers in intensive care units (ICUs) are attributed to noninfectious causes. Despite this, most providers routinely culture urine from patients with indwelling urinary catheters who develop a new fever, which can lead to overdiagnosis and unnecessary antibiotic use. This study evaluated the impact of transitioning from a urinalysis (UA) with reflex to culture order to a stand-alone UA with microscopy in the Surgical and Neurosciences Intensive Care Unit (SNICU) on the frequency of urine cultures ordered and Catheter-Associated Urinary Tract Infections (CAUTIs). Methods: This quasi-experimental before-and-after study was conducted at the University of Iowa between July 2022 and August 2024 and included all SNICU patients. In August 2023, SNICU staff were educated to send a UA with microscopy, review results with the care team, and then decide whether a reflex to culture was warranted. This initiative was collaboratively developed by SNICU leadership and the hospital epidemiology team. Data on the frequency of urine cultures and CAUTI rates per 1,000 catheter days were compared before and after implementation using a P chart in QI Macros. Results: During the pre-intervention period, SNICU ordered approximately 66 urine cultures per 1,000 patient days, with a CAUTI rate of 1.55 per 1,000 catheter days (Figure 1a and 1b). While all data points remained within control limits, red data points between November 2022 and January 2023 indicated possible special cause variation; after further investigation, the specific cause was not identified and data points returned to normal cause variation. Following implementation, the frequency of urine cultures decreased to approximately 32 per 1,000 patient days, and the CAUTI rate dropped to 0.47 per 1,000 catheter days. The intervention also resulted in greater process stability, as evidenced by a narrower range between the upper control limit (48.97) and lower control limit (15.36). These improvements demonstrated the effectiveness of transitioning to a deliberate, decision-making process based on UA with microscopy. Conclusion: Transitioning from reflex urine culture orders to a stand-alone UA with microscopy, combined with provider decision-making and leadership engagement, significantly reduced the frequency of urine cultures and CAUTI rates in the SNICU. By requiring a deliberate review of UA results before ordering cultures, this intervention successfully optimized diagnostic stewardship. The pilot program will be integrated into the electronic medical record and expanded to other units.

Abstract Background Staphylococcus aureus is a common cause of both community-acquired and nosocomial bacteremia in children. Multiple studies evaluating the role of infectious disease consultation (IDC) in adult patients with Staphylococcus aureus bacteremia (SAB) have shown a protective effect of IDC on mortality and recurrence rates. However, there is limited data available regarding the impact of IDC on outcomes of SAB in the pediatric population. Literature Search on the Impact of Infectious Disease Consultation in Pediatric Patients with Staphylococcus aureus Bacteremia Methods This systematic literature review and meta-analysis were performed per the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement and the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines. A search strategy to identify publications about SAB and IDC in children was developed in collaboration with a health sciences librarian. The primary outcomes were all-cause mortality and SAB recurrence rates. Crude or unadjusted numbers were used for the pooled odds ratios (ORs) as adjusted ORs were not available in all articles. Meta-analysis of outcomes of Staphylococcus aureus Bacteremia in pediatric patients Results Among 972 articles screened, 8 studies were included in the systematic review, of which, 2 were retrospective cohort studies, 2 were prospective cross-sectional studies, and 4 were quasi-experimental studies. The quality of 6 studies was considered good ( >18 of 28 possible points) per the Downs and Black quality tool while two studies were considered fair (15 – 18 points). Five of 8 studies directly evaluated the impact of IDC on outcomes in pediatric SAB and included in the meta-analysis. Pooled results showed IDC was associated with significantly lower mortality in pediatric SAB with low heterogeneity (pooled OR = 0.44, 95% confidence interval [CI]: 0.20−0.97, I2 = 0%). IDC was associated with lower recurrence rates, however this was not statistically significant with moderate heterogeneity (pooled OR = 0.24, 95% CI: 0.04 to 1.34, I2 = 56%). Funnel Plot of Mortality and Recurrence in Pediatric Patients with Staphylococcus aureus Bacteremia Conclusion Our study suggests that IDC significantly improves the mortality of pediatric patients with SAB. Given there have been only five papers evaluating the same topic, with most being retrospective studies at a single center, a multicenter prospective study will be required. Our study provides a strong argument in favor of policies such as “automatic” IDC for children with SAB. Disclosures All Authors: No reported disclosures

Background: Catheter-associated urinary tract infections (CAUTIs) are among the most common healthcare-associated infections (HAIs), often resulting in prolonged hospital stays, increased healthcare costs, and additional clinical interventions. The COVID-19 pandemic introduced new challenges to infection prevention, with global reports indicating increased rates of certain HAIs, such as ventilator-associated pneumonia and bloodstream infections, due to healthcare strain and the intensified use of invasive devices. However, trends in CAUTI rates during the pandemic varied across healthcare settings. Methods: This retrospective study was conducted at the University of Iowa Health Care Medical Center, an 866-bed academic hospital, from 2018 to 2023. Manual chart reviews of CAUTI cases reported to the National Healthcare Safety Network (NHSN) were performed to collect data on patient demographics, medical histories, catheter usage, and infection prevention practices. CAUTI incidence was analyzed over time and compared with monthly COVID-19 admission rates. Results: A total of 226 CAUTI cases were identified during the study period. The average CAUTI rate per 1,000 catheter line-days declined from 1.23 in 2019 to 0.85 in 2020, but increased to 1.28 in 2021, coinciding with COVID-19 surges (Figure 1). The median patient age was 61 years, with females accounting for 56% of cases. Foley catheters were already in place upon admission in 24% of cases. Non-intensive care unit (ICU) inpatient settings accounted for 24% of catheter placements, while ICUs accounted for 18%. Additionally, 16% of cases originated from the operating room, and 7% from the emergency department. Neurologic disease was the most common admission diagnosis (27%), followed by cardiovascular disease (13%) and Hematologic/Oncologic disease (13%). Twenty six percent of cases were incontinent of urine and 24% of stool. Comorbidities included immunocompromised status (20%) and diabetes (36%). The primary indication for Foley catheter use was monitoring intake and output (42%). Of the 226 cases, 61% of patients were clinically considered to have a UTI. In-hospital mortality was 22%. Conclusion: The findings from this study provide insights into factors contributing to CAUTI at our institution. Fluctuations in CAUTI incidence, particularly during the COVID-19 pandemic, underscore the need for robust infection prevention strategies. The finding that only 61% of cases required treatment suggests urine cultures were often obtained inappropriately or positive results were not used in selected situations. This highlights an opportunity for diagnostic stewardship to improve urine culture practices. Addressing identified risk factors and enhancing catheter management are critical to reducing CAUTI incidence and improving patient outcomes.

Background: Central Line-Associated Bloodstream Infections (CLABSI) are multifactorial, making trends difficult to identify. CLABSI can occur from the time of insertion to delayed removals beyond the time central access was indicated. The objective of creating a CLABSI Preventability Index tool was to enable strategic quality improvement work. Methods: A preventability index tool was created with stakeholder input and was categorized into four categories (see Table 1): Indication for Line, Care and Maintenance and Line Access, Diagnostic Stewardship, and Specimen Collection. Each category had one or more questions prompting users to assign points for each preventable action. Scores range from 0 through 15, with the higher score indicating more prevention opportunities. (See table 2). Results: During the 2024 calendar year, there were 25 Adult CMS CLABSIs. The preventability index was applied to each case. There was 1 ‘extremely preventable’ case, 2 ‘very preventable’ cases, 6 ‘preventable’ cases and 16 ‘not preventable’ cases. In the 3 cases scoring very preventable or extremely preventable, the category “indication for line” was consistently scored high. Two of the 3 cases had preventable actions from a care and maintenance standpoint, 2 cases scored for diagnostic stewardship category and all 3 cases scored in the specimen collection category. In the 22 cases scoring 6 or lower, 0 scored in the indication for line category, 16 scored in the care and maintenance category, 11 scored in diagnostic stewardship and 4 scored in specimen collection. Conclusion: The preventability index objectively identifies the highly preventable CLABSIs in order to target high-priority actions to prevent future cases. Based on this tool, the use of central lines when not indicated causes the highest preventability scores, but care and maintenance activities score the most frequently.

BACKGROUND:Central venous catheters (CVCs) pose a risk of infection through fluid infusion, medication administration, and blood draws. We conducted a scoping review evaluating the risk of accessing a CVC and aiming to identify strategies for limiting CVC usage to decrease the incidence of central line-associated bloodstream infections (CLABSIs) in hospital settings. METHODS:This review adheres to the methodological framework proposed by Arksey and O'Malley and is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Searches were conducted in the CINAHL, EMBASE, PubMed, and Scopus databases, focusing on publications from the past decade. RESULTS:Six studies met inclusion criteria. Three interventions were identified: (1) establishing standardized CVC sampling times, (2) utilizing phlebotomists to perform peripheral blood cultures, and (3) avoiding the use of CVCs for both blood cultures and routine blood draws. CONCLUSIONS:Increased frequency of CVC access is associated with a higher risk of CLABSI. Interventions to reduce CVC access for blood draws can effectively lower CLABSI rates. Identifying and implementing strategies such as use of phlebotomy teams and standardized sampling protocols may help guide hospital policies and improve patient safety outcomes. Future research should focus on prospective evaluation of these approaches.

Background: Distinguishing outbreaks from pseudo-outbreaks is essential in healthcare settings. Pseudo-outbreaks are defined by an increase in identified organisms without clinical evidence of infection. Here we report two cases involving Pseudomonas aeruginosa identified in clinical specimens, later determined to represent a pseudo-outbreak. Methods: Patient #1 had vertebral osteomyelitis and epidural abscess; intraoperative and blood cultures grew Streptococcus mitis/oralis. Four days post-surgery, one colony of P. aeruginosa grew from one of three intraoperative aerobic cultures. Patient #2 developed a fracture-related infection of the ankle and underwent debridement and hardware removal; all intraoperative cultures grew methicillin-susceptible Staphylococcus aureus. Four days later, two colonies of P. aeruginosa were detected in one of three intraoperative aerobic cultures. Both these findings were deemed unusual, leading to an outbreak investigation, including chart review and laboratory investigations, to identify a source of contamination. Results: The two cultures were received and set up one day apart by different staff. Subsequently, the WASPLab incubation system’s photographic record of the plates demonstrated no P. aeruginosa within the expected first 48 hours, suggesting contamination during culture collection or processing was unlikely. Further review revealed a heavily inoculated culture of P. aeruginosa was processed by the same laboratory technician on an open bench immediately before handling plates for patients #1 and #2. P. aeruginosa typically grows within 24 hours of incubation, and the colony morphology of the contaminated plates matched those of the heavily inoculated culture. Furthermore, both patients had monomicrobial growth of a likely pathogen causing their infection. Therefore, we concluded that this was cross-contamination, likely via aerosolization or improper plate handling. For patient #1, cefepime was discontinued on post-operative day six and switched to ceftriaxone, completed for six weeks, followed by suppressive therapy with amoxicillin, with no recurrence at three months. Patient #2 completed six weeks of cefazolin without anti-pseudomonal coverage, also without recurrence at three months. Conclusions: The pseudo-outbreak likely stemmed from cross-contamination caused by aerosolization or handling heavily inoculated P. aeruginosa cultures near the time and location of the two patients’ plates on an open bench. Awareness of such rare contamination pathways is critical for microbiology labs and clinicians, especially when handling hazardous isolates such as Brucella spp. Careful record keeping and digital storage of serial plate images can narrow the source of contamination, and active surveillance by trained epidemiology personnel is essential to detecting pseudo-outbreaks. Clinical and microbiological correlation should guide treatment to avoid unnecessary antibiotic treatment.

We investigated the accuracy and completeness of four large language model (LLM) artificial intelligence tools. Most LLMs provided acceptable answers to commonly asked infection prevention questions (accuracy 98.9%, completeness 94.6%). The use of LLMs to supplement infection prevention consults should be further explored.

For adult patients with Staphylococcus aureus bacteremia (SAB), Infectious Diseases consultation (IDC) significantly lowers mortality and recurrence rate. Our systematic review and meta-analysis demonstrate that IDC is also associated with significantly lower mortality in children with SAB. Analysis of the impact of IDC on pediatric recurrence rates revealed moderate heterogeneity.

Universal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing of all persons admitted to acute care hospitals has become common practice. We describe why 1 hospital discontinued this practice after weighing potential benefits against known harms. Considerations around the benefits shifted as we saw a decline in SARS-CoV-2 community transmission and coronavirus disease 2019 (COVID-19) severity of illness, increased availability of vaccines and treatments, and better understood the many other transmission pathways in the healthcare environment. Considerations around harms included the additional strain on laboratory and infection prevention resources, and several unintended adverse consequences of admission screening for patients, including unnecessary isolation, antiviral treatments, and delays in care delivery. Poor test performance for detection of infectiousness also played a significant role in determining to stop universal screening. No increase in hospital-onset COVID-19 has been documented since discontinuation of admission testing. We continue to apply other established layers of prevention while monitoring for any change in incidence of within-facility transmission of SARS-CoV-2.

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Standardized methods for osteomyelitis (OM) diagnosis of the lower extremity have proven to be difficult. Preoperative probability of foot osteomyelitis necessitates a combination of clinical, laboratory, imaging evidence (i.e., X-ray, CT, MRI), and bone biopsy to guide diagnosis and treatment. In the recent past, the relative weight that clinicians give to these collections of data to advise potential surgical intervention has been challenged, particularly with histologic evaluation of bone biopsy-traditionally considered "gold standard" in OM diagnosis. This study seeks to further expand this dialogue by retrospectively comparing calcaneal bone biopsies performed by direct visualization trephine approach (performed by Surgeons) vs fine needle biopsy with fluoroscopy guidance (performed by Interventional Radiologists). Results obtained from 57 patients with suspected calcaneal osteomyelitis demonstrate that Trephine obtained samples are significantly more likely to produce histopathologic evidence of OM (p-value: .013), microbiologic evidence of OM (p-value: <.001) and have better histopathologic and microbiologic concordance (p-value: <.001) than calcaneal bone biopsies obtained from Fine Needle Biopsy with fluoroscopy guidance.

Background: Artificial intelligence (AI) tools have demonstrated success in US medical licensing examinations; however, their utility in infection prevention and control (IPC) remains unknown. Methods: The program of hospital epidemiology handles consultation calls and records each question and answer. Using 2022 data, we selected 31 frequently asked questions. We utilized four AI tools, including Chat GPT-3.5 and 4.0, Bing AI, and OpenEvidence, to generate answers. We predefined scales (Table 1) to capture responses by three reviewers, including two hospital epidemiologists and one infection preventionist. The mean score of ≥ 3 and ≥ 4 was considered acceptable in accuracy and completeness, respectively. We reported the percentage of responses with acceptable accuracy and completeness out of assessed questions for each category. Results: Among 31 questions, 16 were associated with isolation duration, 9 with healthcare personnel (HCP) exposure, 4 with cleaning contaminated rooms, and 2 with patient exposure. Regarding accuracy, most AI tools performed worse in questions about isolation duration, ranging between 75% and 93.8%. All AI tools, except OpenEvidence, had a 100% accuracy rate for HCP and patient exposure. All AI tools had a 100% accuracy rate for contaminated room handling. The highest overall acceptable accuracy rate was observed in Chat GPT-3.5. Regarding completeness, most AI tools performed worse in questions about isolation duration, ranging between 44% and 75%. All AI tools, except OpenEvidence, had a 100% completeness rate for contaminated rooms and patient exposure. The highest overall acceptable completeness rate was observed in Bing AI (Table 2). Conclusions: All AI tools provided reasonable answers to commonly asked IPC-related questions, although, there were variations among different tools used. AI could be used to supplement the infection control program, especially if resources are limited.

External urinary device (EUD) use and modification of the Electronic Medical Record (EMR) system with defaulting EUD for selected indications significantly decreased the utilization of indwelling urinary catheters while there was no observed significant reduction in Catheter-Associated Urinary Tract Infections (CAUTI). The introduction of EUD alone may not decrease CAUTI and a comprehensive approach involving various strategies from different perspectives will be necessary, particularly diagnostic stewardship.