Abstract Some people remain healthier throughout life than others but the underlying reasons are poorly understood. Here we hypothesize this advantage is attributable in part to optimal immune resilience (IR), defined as the capacity to preserve and/or rapidly restore immune functions that promote disease resistance (immunocompetence) and control inflammation in infectious diseases as well as other causes of inflammatory stress. We gauge IR levels with two distinct peripheral blood metrics that quantify the balance between (i) CD8 + and CD4 + T-cell levels and (ii) gene expression signatures tracking longevity-associated immunocompetence and mortality-associated inflammation. Profiles of IR metrics in ~48,500 individuals collectively indicate that some persons resist degradation of IR both during aging and when challenged with varied inflammatory stressors. With this resistance, preservation of optimal IR tracked (i) a lower risk of HIV acquisition, AIDS development, symptomatic influenza infection, and recurrent skin cancer; (ii) survival during COVID-19 and sepsis; and (iii) longevity. IR degradation is potentially reversible by decreasing inflammatory stress. Overall, we show that optimal IR is a trait observed across the age spectrum, more common in females, and aligned with a specific immunocompetence-inflammation balance linked to favorable immunity-dependent health outcomes. IR metrics and mechanisms have utility both as biomarkers for measuring immune health and for improving health outcomes.
Background: Urinary tract infections (UTIs) are common healthcare-associated infections. Evidenced-based practice (EBP) successes of catheter associated urinary tract infection (CAUTI) bundles has resulted in rates decreasing >50% in community-based nursing homes. The South Texas Community Living Center (CLC SA), our 42-bed long-term care and rehabilitation center, conducts routine infection prevention surveillance. During routine surveillance, the infection prevention team noticed an increase in UTI percentages and CAUTI rates. Thus, we sought to increase compliance with standard CAUTI bundles, and we implemented an intervention called the “bladder bundle.” Methods: A multidisciplinary team (ie, infection preventionist, clinical nurse leader, simulation director, educator, leadership and frontline staff champions) identified and evaluated practices through documentation of audits and safety rounds during April and May of 2017 (FY19 QTR 3). The comprehensive bladder bundle was initiated in June 2017, based on EBP interventions and included education for staff with audit and feedback. The team reviewed the literature and expanded the bladder bundle to include a comprehensive urinary note and oral hydration program for the veterans in addition to the standard CAUTI bundles (ie, minimize catheter use, use with appropriate indications, consider alternatives to catheters, proper insertion and securement). In May 2018, a facility-wide, hospital-wide initiative focused on a new urinary catheter insertion kit, insertion competencies and perineal care to improve outcomes. This initiative was added to our bladder bundle for CLC SA. Results: Before the intervention (FY16 Q3 to FY17 Q2), percentages of veterans with a UTI had increased to 4.65%, in FY17 Q3, this rate had increased to 11.76%. After the intervention (FY17 Q4 to FY19 Q3) the percentage dropped significantly to 0%, and this rate has now been sustained for 8 quarters. Our CLC SA has remained at zero harm and has no NHSN CAUTI has occurred since October 2017 (FY18Q1). The catheterization in bladder days has decreased from 162 days in FY14 to 49 in FY18, and for the first 2 quarters of FY19, there were only 25 days. For the last 8 quarters, documentation compliance has increased, as has use of BB interventions. Conclusions: The continuous improvement project targeted within the CLC SA, with education to staff, audit and feedback tools, and a comprehensive urinary note with the oral hydration program in combination with the standard CAUTI bundles, have improved veteran health outcomes and have expanded provider and nursing practices. The interprofessional team approach enhanced the success of this project. Funding: None Disclosures: None
Antimicrobial resistance is a growing problem. Novel resistance mechanisms continue to emerge, and the pipeline of antimicrobial development struggles to keep up. Antimicrobial stewardship and proper infection control are key in preventing the spread of these infections. A case of a carbapenem-resistant Enterobacter cloacae complex urinary isolate was identified in an 81-year-old male patient at the San Antonio Veterans Affairs hospital, Texas, USA. The patient was placed on isolation, and further testing of the isolate to other antibiotics requested. The purpose of this study is to analyze the details of reports of such cases and to review at-risk populations and appropriate treatment for resistant organisms.
The risk of severe coronavirus disease 2019 (COVID-19) varies significantly among persons of similar age and is higher in males. Age-independent, sex-biased differences in susceptibility to severe COVID-19 may be ascribable to deficits in a sexually dimorphic protective attribute that we termed immunologic resilience (IR).
Background: Drug-resistant pathogens are a significant source of increased cost and patient complications in long-term and/or congregate care settings. Once introduced, depending on the environmental niche in which they establish and the mechanisms they employ for survival, they can be difficult to eradicate. We report the details of an epidemiologic investigation of a multidrug-resistant Acinetobacter baumannii (MDR-A) outbreak in a spinal cord intervention (SCI) unit within a Veterans Affairs facility in San Antonio, Texas, that was identified after back tracing a positive wound culture from a long-term resident. Methods: All MDR-A isolates were matched to the patients harboring them. Their clinical, epidemiologic, and geographic histories within our facility were traced. All potentially shared characteristics between cases were evaluated closely. Results: In total, 5 cases were determined to be likely connected over a period of ~18 months starting December 2020. The extant isolates underwent molecular evaluation and were genetically related. Patient activity was traced by the infection prevention team to identify potential sources of transmission. Environmental sampling after standard cleaning found a common strain on a shower trolley shared by these patients. Following focused cleaning of this and other shared locations, no new related isolates have been identified from patient or environmental samples. Conclusions: In this case, investigation by the infection prevention team of a single multidrug-resistant organism led to identification and eradication of a potential pathogen. Despite standard cleaning processes, a likely shared fomite was identified and decontaminated, thereby preventing future infections. This case exemplifies the value of thorough epidemiologic study paired with modern molecular methods of identification. Disclosures: None
Abstract Background Use of scenario-based simulation for healthcare personal (HCP) in the prevention of healthcare associated infections remains an area that is proving to have positive educational effects. The Society for Healthcare Epidemiology of America (SHEA) 2022 Recommendations ongoing assessment and reinforced education of CDI knowledge for HCPs. Methods This simulation was developed as a learning intervention to increase the functional skills of bedside HCPs. An interdisciplinary team created a thirty-minute escape room theme for personal protective equipment, diagnostic stewardship processes. Focused objectives included C. difficile laboratory testing indications, functional ability to locate the facility algorithm for collection and testing, direct hands-on use of personal protective equipment, hospital disinfectant use, appropriate hand hygiene, and the correct use of isolation signage for the facility was demonstrated. HCP participants were sent a post participation evaluation utilizing a Likert Scale. Staff Attendance During First Week of Simulation for C.diff Escape Room Staff Attendance During First Week of Simulation for C.diff Escape Room Results A total of sixty-three HCP participated in the first week. Thirty-three registered nurses (52%), twenty-one nurses’ aides (33%), three clinical pharmacists (5%), three registered cardiovascular invasive specialists (5%), two health technicians (3%), and one licensed vocational nurse (2%). Post evaluation of the ”C. diff Escape Room” from thirty-two responses of the sixty-three HCP that participated. (see table 1). Most participants found the scenario-based learning useful, and a significant proportion would use the information and integrate it into their practice within the next six months (87.5% agreed/strongly agreed), facilitators were found to be knowledgeable (68% strongly agreed, 21.9% agreed) and made them feel comfortable (68.8% strongly agreed, 18.8% agreed). Conclusion Scenario-based simulation was an acceptable method to educate a diverse group of HCP on the diagnosis and isolation management of patients with the evaluation or diagnosis of CDI. The utilization of the simulation in a fun environment provided for an educational experience with a focus on key objectives for learning. The event was well received, and overall respondents had positive feedback. Disclosures All Authors: No reported disclosures
Abstract Background Covid-19 infection is associated with a lack of immune resilience that may be magnified using immunomodulators to suppress the cytokine storm, facilitating the emergence of opportunistic infections. We describe five cases of cryptococcal infection complications among Covid-19 hospitalized patients. Methods This was a retrospective cohort study based on chart review performed at the Audie Murphy Veteran Affairs Hospital from 8/2020 to 8/2021; a level 1A facility with 232 beds and an active bone marrow transplantation program. We included patients aged ≥ 18 with a diagnosis of Covid-19 and subsequent Cryptococcal infection based on cultures or antigen testing. Results Our patients were all male with ages ranging between 64 to 80 years. Three had underlying type II diabetes, hypertension, and two had end-stage renal disease. Only one had underlying immunosuppression with hydroxychloroquine for rheumatoid arthritis and one had underlying cirrhosis. Four patients had disseminated disease/fungemia while one had localized pulmonary disease. All the cases had low CD4 counts (158-300) and low CD8 counts (92-290). Two of the fungemia cases were diagnosed by blood culture and the other two by serum cryptococcus antigen test. All the patients had received corticosteroids with or without remdesivir, while one received additional tocilizumab, one baricitinib and one convalescent plasma infusion. Four cases of fungemia received liposomal amphotericin B and three of them received additional flucytosine. The patient with cryptococcal pulmonary disease received only fluconazole. Four patients expired at 28 days after diagnosis, only one recovered and is still alive at 1-year follow up. Table 1.Case details. ESRD: end stage renal disease; DM-2: diabetes mellitus type ; HTN: hypertension; A-fib: Atrial Fibrillation; HFpEF: heart failure with preserved ejection fraction; PVD: peripheral vascular disease; RA: rheumatoid arthritis; PTSD: post traumatic stress disorder; BPH: benign prostatic hyperplasia; CAD: coronary artery disease; HLD: hyperlipidemia; CVA: cerebrovascular accident. Conclusion Cryptococcus infection has been described among patients with Covid-19 during the pandemic. This may be due to immunosuppression caused by the Covid-19 infection and its related-treatments. Most of our patients presented with disseminated cryptococcus infection complicating covid-19 with resulting high mortality rates. Low CD4/CD8 counts and corticosteroid use were documented in all cases. Further studies are needed to better characterize at-risk patients for cryptococcal infection that may benefit from cryptococcal prophylaxis. Disclosures All Authors: No reported disclosures.
Abstract Background Coronavirus disease-19 (COVID-19) has been associated with an increase in healthcare-associated infections (HAI). This increase is likely multifactorial (i.e. higher hospitalization rates, COVID-19 and post-COVID-19 complications, lower staffing, delayed care among others). The objective of this study was to determine the association between COVID-19 hospitalization rates and central line- associated blood stream infections (CLABSI). Methods We conducted a retrospective study in acute care unit hospitalizations in a Veterans Affairs (VA) hospital in San Antonio, Texas from October 2017 to December 2021. Individuals over 18 years of age admitted with a new diagnosis of COVID-19, determined by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) polymerase chain reaction (PCR) were included in the study. CLABSIs were defined by the National Healthcare Safety Network (NHSN) criteria for laboratory confirmed bloodstream infections. Pearson correlation was used to determine correlation of CLABSI and COVID-19 disease hospitalization rates. CLABSI rates were also compared pre-COVID-19 (Oct 2017-Feb 2020) to COVID-19 (Mar 2020-Dec 2021) periods using the chi-square test. Results During the study period, a total of 0.69 CLABSIs per 1,000 central line days occurred in the pre-COVID-19 period compared to 1.98 per 1,000 in the COVID-19 period (p=0.004). There was a significant correlation between CLABSI and ICU COVID-19 hospitalization rates (R=0.459; p=0.001) as well as CLABSI and acute care COVID-19 hospitalization rates (R=0.341; p=0.014). During the COVID-19 period only, there continued to be a significant correlation between CLABSI and COVID-19 ICU hospitalization rates (R=0.426; p=0.048). Conclusion CLABSI rates significantly increased during the COVID-19 period compared to the pre-COVID-19 period and CLABSI rates were significantly correlated with COVID-19 ICU and acute care hospitalizations. Accounting for this variable allows us to factor in impact of post-COVID-19 related complications and association with CLABSI rate. We urge for careful implementation of HAI prevention strategies during the pandemic. Awareness of anticipated increase is important in allocating resources essential for prevention of HAIs. Disclosures All Authors: No reported disclosures.
Abstract Background RSV infections, known for their respiratory complications, present a unique challenge in healthcare settings. Respiratory syncytial virus (RSV) causes substantial morbidity and mortality in older adults, resulting in approximately 60,000–160,000 hospitalizations and 6,000–10,000 deaths annually among adults aged ≥65 years Methods Retrospective review of the RSV cases from January 1, 2022 to October 27, 2023, at the South Texas Veterans healthcare system. We collected data(age and outcome of patients) from Theradoc (infection control surveillance tool used for surveillance) on positive RSV patients seeking care at South Texas Veterans Health Care System including the age of the positives, whether they had respiratory symptoms, were admitted to the hospital, and whether this admission was related to the respiratory symptoms. Results 130 patients with positive RSV( by Biofire or Fluvid RSV PCR) were studied. The mean age of the population was 61.7 years, with a standard deviation of 15.8 and a median of 63. Out of these, 73.8%(96/130) had only upper respiratory symptoms( Per CDC definition includes: rhinorrhea, cough, sneezing, nasal congestion) and 17.6% (23/130) had lower +/- upper respiratory symptoms.( Lower respiratory symptoms were defined as Tracheobronchitis, pneumonia, exacerbation of COPD, asthma, exacerbation of cardiac or neurological illness) 21.5%(28/130) of them were admitted due to some other reason but were found to be positive for RSV and 10.7%(14/130) of them were admitted due to RSV. Almost 61% (79/130)of them were aged 60 and above and out of those, RSV was the reason to seek care in 83.5%(66/79) of them. 83.3% (55/66) of them had upper respiratory symptoms and almost 26% of them had lower +/-upper respiratory symptoms. Almost 30%(23/79) of the patients over the age of 60 were admitted and RSV was the reason for admission in 53% (14/23) of them. Variables included the age of the positives, whether they had respiratory symptoms, were admitted to the hospital, and whether this admission was related to the respiratory symptoms Conclusion This project's findings will contribute to promoting the vaccination against RSV in patients older than 60 years of age and improving patient outcomes. Disclosures All Authors: No reported disclosures
