From 2020 to 2021, Marion County, Indiana, USA, saw an increase in early syphilis diagnoses, primarily among gay, bisexual, and other men who have sex with men (GBMSM). This rapid ethnographic assessment combines survey data from GBMSM with data from key informant interviews with multiple groups of stakeholders, including GBMSM, to describe how COVID-19 impacted sexual behaviors, sexual decision-making, and access to sexually transmitted disease (STD) services among GBMSM in Marion County, Indiana. A total of 62 virtual, semi-structured qualitative interviews with 72 key respondents including health department staff, medical providers, community-based organization staff, and GBMSM were conducted from October 14 to November 22, 2021. Modifications to partner-seeking and sexual behaviors attributable to the pandemic were associated with the way in which individuals reacted to the pandemic in general. Some GBMSM adopted mitigation strategies to avoid COVID-19 when meeting sex partners, such as creating a “sex pod.” Effects on mental health included increased loneliness, heightened anxiety, and a sense of hopelessness regarding the perceived inevitability of acquiring COVID-19. For some, the latter prompted decreased engagement in preventive measures when engaging in sexual activity. The pandemic decreased access to STD services and significantly curtailed public health outreach efforts, which may have limited access to needed STD treatment and care. Efforts focusing on ongoing public health concerns during extreme health events like COVID-19 may want to consider the many ways these events affect ancillary behaviors, such sexual decision-making and sexual behaviors. The role of mental health is key; messaging and guidance may benefit from a trauma-informed approach.

BACKGROUND:Neonates admitted to the neonatal intensive care unit (NICU) are at risk for healthcare-associated infections, including central line-associated bloodstream infections. We aimed to characterize the epidemiology of bloodstream infections among neonates with central venous catheters admitted to three Indian NICUs. METHODS:We conducted a prospective cohort study in three tertiary NICUs, from May 1, 2017 until July 31, 2019. All neonates admitted to the NICU were enrolled and followed until discharge, transfer, or death. Cases were defined as positive blood cultures in neonates with a central venous catheter in place for greater than 2 days or within 2 days of catheter removal. RESULTS:During the study period, 140 bloodstream infections were identified in 131 neonates with a central venous catheter. The bloodstream infection rate was 11.9 per 1000 central line-days. Gram-negative organisms predominated, with 38.6% of cases caused by Klebsiella spp. and 14.9% by Acinetobacter spp. Antimicrobial resistance was prevalent among Gram-negative isolates, with 86.9% resistant to third- or fourth-generation cephalosporins, 63.1% to aminoglycosides, 61.9% to fluoroquinolones, and 42.0% to carbapenems. Mortality and length of stay were greater in neonates with bloodstream infection than in neonates without bloodstream infection (unadjusted analysis, p < 0.001). CONCLUSIONS:We report a high bloodstream infection rate among neonates with central venous catheters admitted to three tertiary care NICUs in India. Action to improve infection prevention and control practices in the NICU is needed to reduce the morbidity and mortality associated with BSI in this high-risk population.

Background: The epidemiology of extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) in hospitalized patients in low- and middle-income countries (LMICs) is poorly described. Although risk factors for ESCrE clinical infection have been studied, little is known of the epidemiology of ESCrE colonization. Identifying risk factors for ESCrE colonization, which can predispose to infection, is therefore critical to inform antibiotic resistance reduction strategies. Methods: This study was conducted in 3 hospitals located in 3 districts in Botswana. In each hospital, we conducted ongoing surveillance in sequential units hospitalwide. All participants had rectal swabs collected which were inoculated onto chromogenic media followed by confirmatory testing using MALDI-TOF MS and VITEK-2. Data were collected via interview and review of the inpatient medical record on demographics, comorbidities, antibiotic use, healthcare exposures, invasive procedures, travel, animal contact, and food consumption. Participants with ESCrE colonization (cases) were compared to noncolonized participants (controls) using bivariable and multivariable analyses to identify risk factors for ESCrE colonization. Results: Enrollment occurred from January 15, 2020, to September 4, 2020, and 469 participants were enrolled. The median age was 42 years (IQR, 31–58) and 320 (68.2%) were female. The median time from hospital admission to date of sampling was 5 days (IQR, 3–12). There were 179 cases and 290 controls (ie, 38.2% of participants were ESCrE colonized). Independent risk factors for ESCrE colonization were a greater number of days on antibiotic, recent healthcare exposure, and tending swine prior to hospitalization. (Table). Conclusions: ESCrE colonization among hospitalized patients was common and was associated with several exposures. Our results suggest prior healthcare exposure may be important in driving ESCrE. The strong link to recent antibiotic use highlights the potential role of antibiotic stewardship interventions for prevention. The association with tending swine suggests that animal husbandry practices may play a role in community exposures, resulting in colonization detected at the time of hospital admission. These findings will help to inform future studies assessing strategies to curb further emergence of hospital ESCrE in LMICs. Disclosures: None

Abstract Background Antimicrobial resistant (AMR) organisms are an increasing global health threat that are spreading within communities. Understanding the risk factors for colonization with AMR organisms is critical for implementing prevention and control strategies, particularly in resource-limited settings such as Bangladesh. Methods During 2019, we conducted a population-based observational study in Dhaka (surveillance site of icddr,b). We collected stool samples from randomly selected adults and tested for Enterobacterales with extended-spectrum cephalosporin resistance (ESCrE) and carbapenem resistance (CRE) using selective media followed by VITEK-2 confirmation. Participants completed demographic surveys assessing food consumption, animal contact, sanitation, water sources, and healthcare exposure. We identified factors associated with ESCrE and CRE colonization using bivariable and multivariable logistic regression, adjusting for potential confounders and clustering. Results Of 714 enrolled individuals, 557 (78%) were colonized with ESCrE and 66 (9%) with CRE. In bivariable analysis, factors associated with ESCrE colonization included fresh fruit consumption in the past week (OR 1.8, 95% CI 1.2-2.9), public tap as main source of drinking water compared with basic improved source (OR 3.3, 1.0-11.0), and unimproved toilet (pour/flush to open drain, pit latrine without slab) compared with basic improved toilet (OR 11, 2.9-42.0). Only consumption of fresh fruit was significant in the multivariable analysis (aOR 2.0, 1.3-3.2). Factors associated with CRE colonization in bivariable analysis were hospitalization in the last 3 months (OR 3.2, 1.2-8.6), limited sanitation facility (improved toilet shared with other households) (OR 2.0, 1.0-3.8), and limited hygiene (availability of handwashing facility on premises without soap and/or water) (OR 3.3, 1.4-7.7). The only factor that was significant in multivariable analysis was hospitalization in the last 3 months (aOR 3.0, 1.0-8.7). Conclusion While ESCrE colonization is common in urban communities, hospitals may be contributing to community spread of CRE. Targeted interventions focused on healthcare facilities may be needed to mitigate the transmission of AMR organisms. Disclosures All Authors: No reported disclosures.

Abstract Background The National Healthcare Safety Network (NHSN) central line-associated bloodstream infection (CLABSI) is a widely accepted quality measure. However, studies from the United States indicate that NHSN reportable CLABSIs account for less than 20% of all hospital-onset bacteremia and fungemia (HOB, i.e., any positive blood culture obtained at least 3 calendar days after hospital admission) events and about 66% of all HOB events are potentially preventable. The incidence and overall preventability of HOB is unknown in low and middle-income countries (LMICs). This study evaluated the epidemiology and preventability of HOB in two hospitals in India. Methods Six months data on all consecutive blood cultures processed in two hospitals (Hospital A- 8.16.2020 to 2.15.2021; Hospital B- 1.1.2021 to 6.30.2021) were collected prospectively to calculate HOB and CLABSI incidence. Correlation between HOB and CLABSI rates was assessed using Spearman’s rank correlation. Medical records of 300 consecutive HOB events were retrospectively reviewed to determine the source and preventability of HOB utilizing a structured guide developed for the study. Results Among 3,558 hospitalized patients from whom blood cultures were obtained, 10.4% developed HOB with 409 unique HOB events (HOB incidence: 2.87 per 1000 patient-days). Only 15% (59 of 409) of HOB events were reported as CLABSI as per hospital CLABSI surveillance programs. The CLABSI rate was 4.4 per 1000 central line-days. There was a moderation correlation (r=0.51; p=0.07) between HOB and CLABSI rates. Among the 300 HOB events for which medical records were reviewed, the most common organism isolated was Klebsiella pneumoniae and 75% of K. pneumoniae were carbapenem resistant (Figure 1). The most common source of HOB was CLABSI (26.3%) (Figure 2). Fifty-two percent of all HOB events and 45% of HOB events not attributable to contaminants were potentially preventable (Figure 3). CLABSIs accounted for 69% of non-contaminant HOB preventable events. Conclusion We found that 69% of the non-contaminant related HOB preventable events were due to CLABSI. Prevention efforts in these hospitals could focus on CLABSI to reduce HOB rates while additional studies are performed to better understand the epidemiology of HOB in LMICs. Microorganisms identified from 300 Hospital Onset Bacteremia and Fungemia Events in Two Hospitals in India. Source of Hospital Onset Bacteremia and Fungemia Events in Two Hospitals in India (n=300). Preventability Rating Source of Hospital Onset Bacteremia and Fungemia events in Two Hospitals in India (n=300). Disclosures All Authors: No reported disclosures.

Background.On August 29, health authorities were notified that 42 state prison inmates had become ill during the preceding 48 hours, with fever, headache, cough, and dyspnea.A respiratory virus was suspected, and the prison was placed on lockdown.During the following week, 50 additional inmates became ill.We aimed to identify a source and prevent further infections.Methods.We recommended laboratory testing for viruses, bacteria, and fungi; abstracted medical charts; interviewed inmates and staff; and conducted an environmental assessment.Cases were defined as illness in an inmate, including >2 of the following: temperature >100°F, chills, headache, chest pain, shortness of breath, cough, myalgia, or fatigue with onset after August 12.Results.Eighty-five inmates met the case definition, three of whom required hospitalization.Testing for 21 viral and bacterial respiratory pathogens was negative.Of the 82 symptomatic inmates who submitted blood or urine, 78 (95%) tested positive for acute histoplasmosis (64 had positive antigen; 69 had positive antibody).Seventyone of the 78 (91%) were housed in Cellblock X.Two weeks prior to the outbreak, two trees and their root systems directly outside Cellblock X had been removed for security reasons.These trees were roosting sites for some of the thousands of European starlings found nightly within prison grounds.Conclusion.Acute histoplasmosis can mimic a respiratory virus outbreak and should be considered in endemic areas.Disturbance of soil contaminated with the fungus Histoplasma capsulatum, which thrives in soil contaminated with bird droppings, likely aerosolized fungal spores and caused this large outbreak.To decrease the risk for future histoplasmosis cases, the prison should limit starling roosting sites by removing other facility trees without disturbing their roots.Disclosures.