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antibioticuse, immunosuppression, and antifungal use. Bivariate conditional
logisticregression modelswere used to study the association of individualfac-
tors with candidemia. Multivariable conditional logistic regression models
were performed using factorswith a P Results: Overall,101 patients with can-
didemia and 505 matched controls were included. In the bivariate analysis,
associations were detected between candidemia and TPN, CVA, pancreatic
disease,invasive procedures,H
2
blockeruse, antibiotic use,and antifungal use
(all Ps Conclusions: Associations of candidemia with recent antifungal use
and pancreatic disease were relatively novel findings. Neutropenia was not
an independent risk factor for candidemia in this study. Future directions
include further evaluations of previousantifungaluse in patients with candi-
demia to identify opportunities for possible intervention and antifungal
stewardship.
Funding: None
Disclosures: None
Antimicrobial Stewardship & Healthcare Epidemiology 2022;2(Suppl. S1):s56–s57
doi:10.1017/ash.2022.164
Presentation Type:
Poster Presentation - Poster Presentation
Subject Category: Outbreaks
Management of a large tuberculosis contact investigation related to a
contaminated bone graft product used in spinal surgery
Marci Drees; Lija Gireesh; Carol Briody; Charlotte Miller; Emily Hanlin;
Ruoran Li; William Wilson; Noah Schwartz; Isaac Benowitz;
Janet Glowicz and Tabe Mase
Background: In March–April 2021, 23 patients at a 906-bed hospital in
Delaware had surgical implantation of a bone graft product contaminated
with Mycobacterium tuberculosis; 17 patients were rehospitalized for sur-
gical site infections and 6 developed pulmonary tuberculosis. In May 2021,
we investigated this tuberculosis outbreak and conducted a large, multidis-
ciplinary, contact investigation among healthcare personnel (HCP) and
patients potentially exposed over an extended period in multiple depart-
ments. Methods: Exposed HCP were those identified by their managers
as present, without the use of airborne precautions, in operating rooms
(ORs) during index spine surgeries or subsequent procedures, the posta-
nesthesia care unit (PACU) when patients had draining wounds, inpatient
rooms when wound care was performed, and the sterile processing depart-
ment (SPD) on the days repeated surgeries were performed. We created
and assigned an online education module and symptom screening ques-
tionnaire to exposed HCP. Employee health services (EHS) instituted a
dedicated phlebotomy station to provide interferon-γrelease assay
(IGRA) testing for HCP at ≥8 weeks after last known exposure. EHS man-
aged all exposed HCP, including nonemployees (eg, private surgeons) via
automated e-mail reminders, which were escalated through supervisory
chains as needed until follow-up completion. The infection prevention
team notified exposed patients, defined as those who shared semiprivate
rooms with case patients with transmissible tuberculosis. The Delaware
Division of Public Health performed IGRA testing. Results: There were
506 exposed HCP in ORs (n = 100), the PACU (n = 87), inpatient units
(n = 140), the SPD (n = 54), and other locations (n = 122); 83% were
employed by the health system. Surgical masks and eye protection were
routinely used during patient care. All exposed HCP completed screening
by December 17, 2021. Furthermore, 2 HCP had positive IGRAs without
symptoms or chest radiograph abnormalities, indicating latent
tuberculosis infection, but after further review of records and interviews,
we discovered that they had previously tested positive and had been treated
for latent tuberculosis infection. In addition, 5 exposed patients tested neg-
ative and 2 remain pending. Conclusions: This large investigation demon-
strated the need for a systematic process that encompassed all exposed
HCP including nonemployees and incorporated administrative controls
to ensure complete follow-up. We did not identify any conversions related
to this outbreak despite high burden of disease in case patients and multiple
exposures to contaminated bone-graft material and infectious bodily fluids
without respirator use. Transmission risk was likely reduced by baseline
surgical mask use and rapid institution of airborne precautions after out-
break recognition.
Funding: None
Disclosures: None
Antimicrobial Stewardship & Healthcare Epidemiology 2022;2(Suppl. S1):s57
doi:10.1017/ash.2022.165
Presentation Type:
Poster Presentation - Poster Presentation
Subject Category: Outbreaks
Learnings from a Cutibacterium acnes pseudo-outbreak in pediatric
neurosurgical patients
Felicia Scaggs Huang; Andrea Ankrum; Cincinnati Hospital; Zheyi Teoh;
Joshua Courter; ; Mangano and Karin Bierbrauer, Josh
Background: Cutibacterium acnes is normal skin flora as well as a common
culture contaminant. It can cause infections in the setting of sterile
implants, although clinical presentations can be subtle. Differentiating true
infection from sample contamination is challenging and has implications
for patient care. We describe an investigation of a cluster of 7 hospitalized
pediatric patients with C. acnes isolated from anaerobic cultures of cerebro-
spinal fluid (CSF) over 3 weeks at a quaternary-care children’s hospital.
Methods: An outbreak response was coordinated between the infection
prevention and control (IPC), microbiology, and neurosurgery teams.
We defined a case as a hospitalized patient with C. acnes isolated from
a CSF culture beginning in November 2020. We reviewed charts of all cases
and CSF culture collection on all case units, transport to and processing at
the microbiology laboratory, and the IPC team measured adherence for all
processes. Results: There were 8 positive cultures in 7 cases from
November 10 to 27, 2020. The median case age was 2 months (range,
0–119). Cases occurred on 4 different units. All positive patients had at
least 1 implanted neurosurgical device used for CSF drainage. There were
no clear commonalities in surgeon responsible for device placement, hard-
ware type placed, or staff collecting CSF samples. A standard protocol for
CSF collection was followed for all cases. Overall, 3 patients cleared cul-
tures without intervention, 2 received oral antibiotics, and 2 underwent
surgical removal of their device. Specimen processing was unchanged,
although due to supply issues, an alternative anaerobic culture media
(Anaerobic Systems, Morgan Hills, CA) was used for 6 weeks, during
which all cases were identified. Compared to routine media, the alternative
is known to enhance organism detection. The company reported no con-
cerns for media contamination or C. acnes outbreaks. Once routine media
Fig. 1.
SHEA Spring 2022 Abstracts
2022;2 Suppl 1 S57
https://doi.org/10.1017/ash.2022.165 Published online by Cambridge University Press