Background:Candidozyma auris, Candida glabrata, and C. krusei are all fungal pathogens intrinsically resistant to azoles. Patient characteristics and outcomes were compared for patients with cultures positive for these three pathogens. Methods:A retrospective cohort study was performed involving patients from an 11 acute care safety net hospital system in New York City. Echinocandin susceptibility rates and patient outcomes, including overall mortality and lengths of hospital stay, were compared for patients with C. auris versus C glabrata/krusei. Results:Resistance to caspofungin was low in all three pathogens. Compared to patients with C. glabrata/C. krusei, patients with C. auris had similar mortality rates. However, compared to patients harboring C. glabrata/C krusei, those with C. auris had longer hospital stays when discharged to a skilled nursing facility, including from the time from culture positivity to discharge (78 ± 148 vs 33 ± 44 d, P = .06). Multivariate regression analysis revealed two factors associated with length of stay: presence of C. auris (P < .001) and hemodialysis (P = .051). Discussion:Echinocandin resistance was unusual, and overall mortality rates were similar, for patients with C. auris, C. glabrata, and C. krusei. However, for patients discharged to skilled nursing facilities, the length of hospital stay was longer for patients with C. auris. The implementation of lifelong contact precautions for C. auris may be an impediment for discharge planning.

BACKGROUND:Surgical site infections (SSIs), including prosthetic joint infections (PJI), are one of the many complications that can occur after total hip arthroplasty. In this report, we examined risk factors associated with SSI following hip arthroplasties among patients in a 10-hospital safety network in New York City. METHODS:Data were obtained from the National Healthcare Safety Network (NHSN) on patients who underwent hip arthroplasty between 2015 and 2023. Surgical site infections were defined per NHSN criteria. Propensity score matching using NHSN risk adjustment variables was used to create a closely matched control group. RESULTS:Over the 8 years, 3,679 hip arthroplasties were performed across the 10 hospitals, which resulted in 54 SSIs (1.5%). Patients with SSIs had significantly higher body mass indexes (BMIs) and ASA scores (both P < .05). When examining the socioeconomic differences between our cases and controls, we found higher rates of infections occurred in geographical areas of higher poverty (P < .001). Lastly, Hispanic or Black patients had higher occurrences of SSIs compared to other races (P < .05). CONCLUSION:Our report demonstrated the association of poverty level with SSIs following hip arthroplasty. This underscores the need for comprehensive and aggressive post-discharge programs in under resourced communities in the prevention of SSI following hip arthroplasty.

Hospital-onset Clostridioides difficile infection (HO-CDI) is associated with significant clinical and economic consequences. Use of broad-spectrum antibiotics for patients in the Intensive Care Units (ICUs) is the leading risk for HO-CDI. Hospital outbreaks may still develop despite comprehensive antimicrobial stewardship programs and infection control measures. In response to a large tertiary care urban hospital CDI outbreak in the adult medical and surgical ICUs, a program of primary oral vancomycin prophylaxis (OVP) for select high-risk patients was initiated. Primary prophylaxis was administered for patients ≥ 60 years of age, hospitalized for ≥ 7 days, and receiving a beta-lactam, fluoroquinolone, and/or clindamycin. The Outbreak Period was from Oct 1, 2023 through Mar 15, 2024. The Prophylaxis Period started Mar 16, 2024 and terminated on Aug 31, 2024; a Follow-up Period then was from Sep 1, 2024 to Feb 28, 2025. Patients outside the ICUs were not administered OVP. The number of cases of incident HO-CDI and vancomycin-resistant enterococci (VRE) cases were gathered; rates of infection were determined using the number of patient-days for the ICUs and for the remainder of the hospital during each time period. In the ICUs during the Outbreak Period, there were 1.91 HO-CDI cases/1000 patient-days. During the Prophylaxis Period, this fell to 0.38 cases/1000 patient days (P=.02). This decrease in HO-CDI cases in the ICUs was sustained during the 6-month Follow-up Period (0.66 cases/1000 patient days, P=.06 compared to Outbreak Period). For patients outside the ICUs, rates of HO-CDI remained unchanged during the three periods: 0.20, 0.29, and 0.13 cases/1000 patient days, P=NS). The rate of VRE cases in the ICUs remained stable during the three time periods: 0.70, 1.52, and 0.82 cases/1000 patient days (P=NS). A restricted protocol of primary OVP helped terminate a sustained outbreak of HO-CDI in ICU patients; the favorable impact continued for 6 months after stopping primary OVP. OVP may be an effective option for preventing and controlling CDI in high-risk settings. All Authors: No reported disclosures

Abstract Background Surgical site infections (SSIs) following Cesarean section (CSEC) can be associated with serious adverse outcomes. Pre-operative and intra-operative protocols have been established to minimize the risk of developing SSIs. Methods Patients undergoing CSEC in an 11-hospital public health system in New York City in 2023 were reviewed. SSIs were defined according to National Healthcare Safety Network criteria. Propensity score matching, using six variables (age, body mass index, diabetes mellitus, surgery duration, American Society of Anesthesiology score, and wound class), was used to create a control group for the patients with SSIs. Results Among the 4643 CSEC surgeries, 73 SSIs were recorded, including 49 superficial incisional, 6 deep incisional, and 18 deep/organ space SSIs. SSIs were detected during the initial admission in 7 cases, repeat hospitalizations in 33 cases, and in outpatient settings in 33 cases. A higher rate of SSIs was observed from four hospitals; zip codes for these patients had higher poverty levels than for those patients from the four hospitals with the lowest infection rates (23.4±8.6 vs. 17.7±9.7 per cent, P=.08). Comparing the SSI and control groups, no differences were found in race, ethnicity, blood loss, or surgical team composition. Although both groups had a similar proportion of patients residing in shelters, the SSI group had more recent immigrants than the control group (15 vs. 3, P=.004). Notably, recent immigrants with SSIs had fewer prenatal visits compared to the rest of the SSI group (5.53±3.44 vs. 7.72±3.98, P=.04), and 14 of the 15 SSIs in the recent immigrants were detected post-discharge from CSEC. Conclusion In a large public healthcare system, overall rates of SSIs following CSEC were low. Most infections were detected following discharge; living in neighborhoods of high poverty and being a recent immigrant appear to be risk factors for SSIs. While pre- and intra- operative protocols have been established to prevent SSIs, it appears postoperative factors (including wound care following discharge) warrant emphasis as well. Disclosures All Authors: No reported disclosures

BACKGROUND:Prior studies have emphasized adverse outcomes of bacterial pneumonia, especially due to methicillin-resistant Staphylococcus aureus (MRSA), in patients co-infected with influenza. METHODS:Listings of patients, admitted from an 11-hospital system in New York City, with community-onset pneumonia due to SA were obtained during the winter 2024 and 2025 influenza seasons. RESULTS:Compared to winter 2024, in 2025 the number of patients admitted with SA pneumonia increased from 55 cases (2.2 patients per 1000 admissions) to 84 cases (3.2 patients per 1000 admissions, P = 0.03). This increase was driven by influenza-related cases: from 0.28 cases/1000 admissions in 2024 to 1.1 cases/1000 admissions (P = 0.0005) in 2025. Of the 28 influenza-related cases in 2025, 1) 27 had co-infection with influenza A, 2) 13 were bacteremic, and 3) 15 had methicillin-susceptible SA (MSSA). Patients with MSSA coinfection were more likely to require ICU admission. Only two of the 28 patients had received the seasonal influenza vaccination prior to admission. CONCLUSION:During the 2025 influenza season in New York City, there was a significant rise, compared to the 2024 season, of admitted patients with SA pneumonia co-infected with influenza. Nearly half had concomitant bacteremia and patients with MSSA had a more virulent onset of illness.

Objective:To identify risk factors for surgical site infections (SSIs) following abdominal hysterectomy in patients cared for in a large urban public hospital system. Design:Retrospective case control study. Setting:Multicenter safety net hospital system. Participants all:Women undergoing hysterectomy from 2015-2023. Methods:Propensity score matching, using Centers for Medicare and Medicaid Services (CMS) risk variables, created control groups. Receiver operating characteristics curves were created using current and augmented risk adjustment variables. Results:There were 6142 hysterectomy surgeries reported during the 9-year time period, with 160 (2.61%) with reportable SSIs. Compared to a matched control group, patients with SSIs were more likely to be of Black race, to have longer duration of surgery, to have open surgery (vs. laparoscopic), and to have received a clindamycin ± gentamicin for surgical prophylaxis. The addition of duration of surgery, endoscopic surgery, and wound class to current CMS risk variables significantly improved the prediction for SSI when all SSIs were included, but did not when patients with superficial SSIs were excluded from analysis. Conclusions:Predicting SSIs following hysterectomy is complex and current CMS risk assessments are overly simplistic. Until more robust and comprehensive risk assessment criteria are developed, use of SSIs following hysterectomy as a quality measure for reimbursement should be reconsidered.

Abstract Background Contamination of hospital environmental surfaces with resistant Enterobacterales and non-fermenting bacilli can facilitate nosocomial transmission. Little is known regarding the extent of contamination of environmental surfaces immediately outside the hospital setting. Methods Cultures of environmental surfaces surrounding hospitals in New York City were incubated at 37oC in MacConkey broth containing 4 mg/L ceftazidime and amphotericin B. Two sets of cultures were obtained: Group 1 cultures involved 42 high-touch surfaces within a two-block radius of each hospital that were cultured with rayon-tipped swabs. Group 2 cultures involved 5 surfaces of transportation centers near (n=8) and distant (n=8) from hospitals that were wiped with saline-saturated sterile gauze. Bacteria were identified using 16S ribosomal sequencing; β-lactamases were identified by PCR sequencing. Results In Group 1, the 336 swab cultures from surfaces around 8 hospitals yielded 66 cephalosporin-resistant bacteria, including 26 Brucella (Ochrobactrum) spp. and 12 Acinetobacter spp. One isolate of Brucella (Ochrobactrum) spp. was found to possess the carbapenemase OXA-24. Surfaces around 2 of the 8 hospitals accounted for 73% of the Brucella (Ochrobactrum) spp. In Group 2, the 40 gauze cultures of transportation center surfaces near 8 hospitals yielded 38 bacteria. Of the 38 bacteria, 15 were Brucella (Ochrobactrum) spp. and 8 were Acinetobacter spp. In comparison, the 40 gauze cultures of 8 transportation center surfaces distant from hospitals yielded 33 isolates, including only 5 Brucella (Ochrobactrum) spp. (P=.03 compared to cultures near hospitals) and 6 Acinetobacter spp. No members of Enterobacterales were recovered in any of the Group 1 or Group 2 cultures. Conclusion Cephalosporin-resistant Enterobacterales were not recovered in any environmental cultures around hospitals. Both Brucella (Ochrobactrum) spp. and Acinetobacter spp. were frequently recovered; Brucella (Ochrobactrum) spp. appeared to be territorial and a reservoir for OXA-type carbapenemases. Disclosures All Authors: No reported disclosures

Antibiotic resistant Gram-negative bacilli are being increasingly recognized in community-onset infections. Concerns have been raised regarding environmental surfaces as reservoirs for multidrug-resistant pathogens; in particular, community wastewater samples have been found to harbor cephalosporin- and carbapenem-resistant Enterobacterales. In this report, we used selective media to culture cephalosporin-resistant Gram-negative bacilli from high-touch surfaces in the environment surrounding hospitals in New York City. Of the 336 surfaces swabbed, 66 grew cephalosporin-resistant Gram-negative bacteria. No Enterobacterales were isolated. The most common isolate was Brucella (Ochrobactrum) spp., accounting for 26 of the 66 positive cultures; 19 originated from surfaces near two hospitals. One isolate of Brucella (Ochrobactrum) spp. was found to possess blaOXA-24. Acinetobacter spp. accounted for 12 of the 66 positive cultures. Forty cultures obtained with saline-saturated gauze were obtained at public transportation centers near hospitals; a comparable 40 cultures were obtained at transportation centers distant from hospitals. Of the 38 positive cultures from transportation surfaces near medical centers, 15 grew Brucella (Ochrobactrum) spp. In comparison, Brucella (Ochrobactrum) spp. accounted for only five of the 33 positive transportation cultures distant from medical centers (P = 0.03). Again, none of the cultures grew Enterobacterales. It is reassuring that dried environmental surfaces around hospitals did not contain resistant Enterobacterales. However, Brucella (Ochrobactrum) spp. was widespread and territorial and may be a reservoir for OXA-type carbapenemases.

OBJECTIVE:To identify risk factors for surgical site infections (SSIs) following C-sections in an underserved, urban population. DESIGN:Retrospective case-control study and multivariable regression analyses. SETTING:Multicenter urban hospital system. PARTICIPANTS:All women undergoing C-sections during 2023. METHODS:To identify risk factors for SSIs, patients suffering SSIs were compared to a propensity-matched control group (controlled for the following variables: age, body mass index, diabetes mellitus, American Society of Anesthesia (ASA) score, wound class, and duration of surgery). In addition, multivariable logistic regression analysis was performed to identify independent risks for SSIs. RESULTS:Of 4,642 C-sections performed, 73 SSIs were identified; 90% were detected after hospital discharge. Compared to a propensity-matched group, more patients in the SSI cohort received gentamicin with clindamycin (vs a cefazolin-based regimen); gentamicin dosing was consistently below recommended levels. Also, significantly more patients in the SSI group were recent immigrants to the United States compared to the control group (20.5% vs 4.1%, P = .004). Multivariate regression analysis revealed 3 independent risk factors for SSIs: ASA score, surgery at a hospital without an Obstetrics-Gynecology residency program, and residence in the borough of the Bronx, NY. CONCLUSIONS:For women living in areas of low socioeconomic status, most SSIs after C-sections are detected following hospital discharge. Women who are recent immigrants and living in areas of high poverty are particularly at higher risk. Addressing the broader social determinants of health, particularly in underserved areas, will be crucial in reducing SSIs and improving overall maternal health outcomes.

BACKGROUND:Surgical site infections (SSIs) following colon surgery are associated with clinical and financial consequences. The Centers for Medicare and Medicaid Services (CMS) and the New York State Department of Health (NYSDOH) use risk adjustment variables to determine quality measure scores. METHODS:Among patients in a large public system, surgical risk variables were compared between patients with and without SSIs. Propensity score matching, using CMS and NYSDOH risk variables, created control groups. Receiver Operating Characteristics (ROC) curves were created using current and augmented risk adjustment variables. RESULTS:When matched using CMS risk variables, more patients with SSIs had contaminated/dirty wounds, longer duration of surgery, and emergency surgery. The addition of these variables significantly improved the CMS ROC curve. When matching NYSDOH variables, more SSI patients were male, had contaminated/dirty wounds, and tended to be younger. The addition of these variables to the current NYSDOH adjustment criteria did not significantly improve the ROC curve. DISCUSSION:The CMS adjustment criteria for colon SSIs do not adequately account for complicated surgeries. The inclusion of additional variables significantly improved the performance of CMS risk adjustment. CONCLUSIONS:Until more robust risk adjustment criteria are developed, the reporting of SSIs following colon surgery as a quality measure should be suspended.

Catheter-associated urinary tract infections (CAUTIs) are a frequent hospital-acquired infection and public health concern. In an attempt to reduce the number of CAUTIs, an intervention that emphasized the appropriate laboratory evaluation by ordering providers was implemented. This intervention supplemented ongoing standard bundle protocols. Compared to the 16 months before the intervention, there was a significant decrease in the number of CAUTIs during the 12-month intervention period.

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BACKGROUND:Medical equipment can become scarce in disaster scenarios. Prior work has reported that four sheep could be ventilated together on a single ventilator. Others found that this maneuver is possible when needed, but no one has yet investigated whether cross-contamination occurs in co-ventilated individuals. OBJECTIVE:Our goal was to investigate whether an infection could spread between co-ventilated individuals. METHODS:Four 2-L anesthesia bags were connected to a sterilized ventilator circuit that used heat and moisture exchange filters and bacterial and viral filters, as would be expected in this dire scenario. Serratia marcescens was inoculated into "lung" no. 1. After running for 24 h, each lung and three additional points in the circuit were cultured to see whether S. marcescens had spread. These cultures were examined at 24 and 48 h to assess for cross-contamination. This entire procedure was performed three times. RESULTS:S. marcescens was not found in lung no. 2, 3, or 4 or the three additional sites on the expiratory limb at 24 and 48 h in all three trials. CONCLUSIONS:Cross-contamination does not occur within 24 h using the described ventilator circuit configuration.

Abstract Background Tocilizumab and baricitinib are immunomodulators that have been repurposed for the treatment of coronavirus disease 2019 (COVID-19). Whether one medication should be preferred over the other has not been established. Methods This multicenter retrospective cohort study comprised hospitalized patients with COVID-19 who received either tocilizumab or baricitinib. The primary outcome was improvement in respiratory status (at least 1-point reduction on the respiratory ordinal scale) at day 7 and up to day 28. Secondary outcomes included mortality, disposition, deep vein thrombosis, pulmonary embolism, or positive blood culture. Outcomes were stratified by baseline respiratory status and variant-predominating periods. Results were reported for the overall and propensity-matched cohorts. Results A total of 921 patients received tocilizumab and 638 received baricitinib. The propensity-matched cohort included 597 patients in each group. At day 7 in the overall and propensity-matched cohorts, significantly more patients had improvement in respiratory status in the baricitinib group. These improvements were seen in patients requiring supplemental oxygen and noninvasive ventilation/high-flow oxygen but not in patients requiring mechanical ventilation. Favorable outcomes with baricitinib were observed during the Alpha and Omicron periods. By day 28, there were no differences in the changes of respiratory status for the treatment groups in either cohort. Also, no differences were seen in mortality, disposition, development of deep vein thrombosis/pulmonary embolism, or bloodstream infections. Conclusions Baricitinib treatment was associated with more favorable respiratory improvement at day 7 when compared with tocilizumab, but no differences were observed up to day 28.

During the pandemic, the rate of healthcare facility-onset methicillin-resistant Staphylococcus aureus (MRSA) bacteremia was 5 times greater in patients admitted with coronavirus disease 2019 (COVID-19). The presence of central lines and mechanical ventilation likely contribute to this increased rate. The number of central-line-associated bacteremia cases may be underestimated in patients with COVID-19.

Objectives: To examine differences in risk factors and outcomes of patients undergoing colon surgery in level 1 trauma centers versus other hospitals and to investigate the potential financial impact of these reportable infections. Design: Retrospective cohort study between 2015 and 2022. Setting: Large public healthcare system in New York City. Participants: All patients undergoing colon surgery; comparisons were made between (1) all patients undergoing colon surgery at the level 1 trauma centers versus patients at the other hospitals and (2) the nontrauma and trauma patients at the level 1 trauma centers versus the nontrauma patients at other hospitals. Results: Of 5,217 colon surgeries reported, 3,531 were at level 1 trauma centers and 1686 at other hospitals. Patients at level 1 trauma centers had significantly increased American Society of Anesthesiology (ASA) scores, durations of surgery, rates of delayed wound closure, and rates of class 4 wounds, resulting in higher SIRs (1.1 ± 0.15 vs 0.75 ± 0.18; P = .0007) compared to the other hospitals. Compared to the nontrauma patients at the other hospitals, both the nontrauma and trauma patients at the level 1 trauma centers had higher ASA scores, rates of delayed wound closure, and of class 4 wounds. The SIRs of the nontrauma patients (1.16 ± 1.29; P = .008) and trauma patients (1.26 ± 2.69; P = .066) at the level 1 trauma center were higher than the SIRs of nontrauma patients in the other hospitals (0.65 ± 1.18). Conclusions: Patients undergoing colon surgery at level 1 trauma centers had increased complexity of surgery compared to the patients in other hospitals. Until there is appropriate adjustment for these risk factors, the use of infections following colon surgery as a reportable quality measure should be re-evaluated.

Introduction: During the COVID-19 pandemic, consideration was given to co-ventilating multiple patients on a single ventilator. Prior work had shown that this procedure was possible by ventilating four adult-size sheep for twenty-four hours, and other groups had performed this maneuver during dire circumstances. However, no investigation had examined the safety regarding cross-contamination. The purpose of our studies was to investigate if an infection could spread between individuals who were being co-ventilated. Method: Four sterile two-liter anesthesia bags were connected to a sterilized ventilator circuit to simulate the co-ventilated patients’ “lungs.” The circuit utilized Heat and Moisture Exchange filters and bacterial/viral filters, which were strategically inserted to prevent the transmission of infectious droplets. Serratia marcescens was inoculated into “lung” number one. The circuit was then run for 24 hours, after which each “lung” and three additional points in the circuit were cultured to see if S. marcescens had spread. These cultures were examined at 24 and 48 hours to assess for cross-contamination. This entire procedure was performed a total of four times. Results: S. marcescens was not identified in lungs two, three, or four or the three additional sampling sites on the expiratory limb of the tubing at 24 and 48 hours in all four trials. Conclusion: Cross-contamination between co-ventilated patients did not occur within 24 hours utilizing the described ventilator circuit configuration.

Background: Deep incisional and organ/space surgical site infections (SSIs) after colorectal surgery are associated with adverse outcomes. Multiple antibiotic regimens are recommended for peri-operative prophylaxis, with no particular regimen preferred over another. We compared the prophylaxis regimens used in patients with and without SSIs, and the impact of regimens on the flora involved in SSIs. Patients and Methods: Information was extracted from the National Healthcare Safety Network databank of patients undergoing colorectal surgery from 2015 to 2022 in a large public healthcare system in New York City. Patients with SSIs were identified, and controlling for nine variables, propensity score matching was used to create a matched control group without SSIs. Prophylactic regimens were compared between the matched groups with and without SSIs. Also, for the patients with SSIs, the impact of the prophylactic regimen on the subsequent pathogens involved the infection was examined. Results: A total of 275 patients with SSIs were compared to a matched cohort without SSIs. The prophylactic regimens were extremely similar between the SSI and control groups. Among the patients who developed SSIs, more patients who received cefoxitin had emergence of select cephalosporin-resistant Enterobacterales and Bacteroides spp. when compared with those who received β-lactam-β-lactamase inhibitors. Conclusions: The distribution of surgical prophylaxis regimens was remarkably similar between patients developing serious SSIs and a closely matched cohort that did not develop an SSI. However, given the downstream effects of more resistant and anaerobic flora should an infection develop, use of cefoxitin should be re-evaluated as a prophylactic agent.

Controlling the spread of carbapenem-resistant Enterobacterales is a global priority. Using National Healthcare Safety Network data, we characterized the changing epidemiology of carbapenem-resistant Klebsiella pneumoniae (CRKP) in a large public health system in New York, New York, USA. During 2016–2020, CRKP cases declined; however, during 2021–June 2022, a notable increase occurred. Of 509 cases, 262 (51%) were considered community-onset, including 149 in patients who were living at home. Of 182 isolates with proven or presumptive (ceftazidime/avibactam susceptible) enzymes, 143 were serine carbapenemases; most confirmed cases were K. pneumoniae carbapenemase. The remaining 39 cases were proven or presumptive metallo-β-lactamases; all confirmed cases were New Delhi metallo-β-lactamases. After 2020, a marked increase occurred in the percentage of isolates possessing metallo-β-lactamases. Most patients with metallo-β-lactamases originated from long-term care facilities. An aggressive and universal program involving surveillance and isolation will be needed to control the spread of CRKP in the city of New York.

The development of resistance to cefiderocol among multidrug resistant Acinetobacter baumannii has been attributed to downregulation in iron transport systems and a variety of β-lactamases. However, the precise contribution of each in clinical isolates remains to be determined.