Background: In 2024, US hospitals were affected by the Becton Dickinson (BD) BACTEC blood culture bottle shortage with little time to respond and conserve supply. The extent of the impact of this shortage on clinical practice has not been explored. Methods: We developed a 7-question online poll with the Emerging Infections Network (EIN) exploring the extent to which facilities were impacted by the shortage, geographic distribution and facility type of institutions affected, actions taken to mitigate the shortage, and the impact on clinical management of fever and Staphylococcus aureus bacteremia. The link was sent to >3100 EIN listserv members 3 times during September 2024. Descriptive and thematic analyses were performed on quantitative and qualitative responses. Results: Of 202 respondents from 39 states, 129(64%) responded their hospital had limited blood cultures available, 8(4%) were unsure how their hospitals were affected, and 65(32%) indicated their hospitals were not affected (Fig1). The most affected hospital facility types with >10 respondents were Community (27/39, 69%), University (48/72, 67%), Children’s (7/11, 67%), Non-university teaching (33/52, 65%), and the VA/DOD was least affected facility type (3/11, 27%). Respondents not affected by the shortage most commonly used alternate blood culture media. Top mitigation strategies included publishing algorithms for best practice use (103/202, 51%), restricting follow-up blood cultures (88/202, 44%), using single blood culture sets (86/202, 43%), and implementing EMR-based alerts on blood culture orders (71/202, 36%). Important clinical themes identified by affected respondents included limitations on blood culture use (147 responses), concerns with overall treatment and care including delays and disruptions in discharges or prolonged antibiotic use (15 responses), concerns with bacteremia management (15 responses), and increased diagnostic stewardship opportunities (21 responses) (Fig2). The most prevalent theme in S. aureus bacteremia management was limitations in repeat blood cultures (61/163, 37%) with concerns about confirming bacteremia clearance, while the most common theme in inpatient/ER management of fever was limitations in initial blood cultures (64/159, 40%), with common comments about reducing inappropriate blood cultures. 61/202 respondents commented in the open-ended question with the most common theme highlighting increased diagnostic stewardship as a positive outcome of the shortage (19/61, 31%). Conclusion: The BD BACTEC blood culture bottle shortage caused widespread clinical impact. The themes identified highlight the challenges placed on healthcare systems during times of shortage as well as the effects on patient care. Mitigation strategies implemented during the shortage may create future opportunities for diagnostic stewardship.

Background: Candida auris is an emerging multidrug-resistant pathogen that presents significant infection control challenges due to its ability to cause invasive infections and outbreaks. Despite its increasing prevalence in healthcare settings, there is limited guidance or data related to perioperative infection prevention in patients colonized with C.auris.(1-4) CDC guidelines do not address perioperative screening or management of C.auris in surgical patients, including solid organ transplant recipients.(5)

This study examines the reported experiences and approaches infectious diseases professionals take in managing C.auris colonization perioperatively. Methods: An online “Quick Query” poll was distributed to members of the Emerging Infections Network (EIN). EIN Quick Queries are a unique tool that utilize focused rapidly-deployable polls to ascertain members’ opinions/approaches to emerging infectious diseases with limited data, allowing for hypothesis generation or identifying areas of need. Our poll included 6 questions assessing perioperative prevention of C.auris infection. Descriptive analysis was used to evaluate responses. Results: Eighty-four EIN members completed the poll, representing 29 U.S. states and three other countries/territories. California accounted for the largest share of responses (17%), followed by Massachusetts (7%), and Florida (6%). Institutional protocols for C.auris prevention/management in surgical patients existed in 17% (14/84) of facilities, with only one facility reporting transplant-specific guidelines (Figure 1). Preoperative screening for C. auris was reported by 8% (7/84) of respondents, predominantly from California (5/7). Among the 44 respondents who encountered colonized surgical patients, only four (9%) used perioperative antifungal prophylaxis, with micafungin as the preferred agent. Notably, none of the seven sites utilizing preoperative screening reported using perioperative anti-fungal prophylaxis for C. auris colonization. Three of the four respondents who used perioperative antifungal prophylaxis also reported encountering postoperative C.auris infections in colonized surgical patients, suggesting evolving practices influenced by clinical outcomes. C.auris colonization in transplant recipients prior to transplantation was reported by 11 respondents (13%), while only two (2%) reported encounters involving transplants from colonized donors. In total,19% of respondents (16/84) reported postoperative invasive C.auris infections in previously colonized patients, including 13 surgical patients and 3 transplant recipients. Three other cases were described among transplant recipients without known donor or recipient colonization pre-transplant. Conclusion: The survey highlights the lack of institutional guidelines for Candida auris prevention in perioperative settings, including among solid-organ transplant patients. Postoperative C.auris infections are being encountered, although uncommon, underscoring the need for further research and standardized guidelines to address perioperative prevention of this emerging pathogen.

We surveyed members of the Emerging Infections Network about Candida auris screening practices at US healthcare facilities. Only 37% of respondents reported conducting screening; among these, 75% reported detection of at least 1 C. auris case in the last year. Increased screening could improve C. auris detection and prevent spread.

This survey of infectious disease providers on long COVID care revealed a lack of familiarity with existing resources, a sentiment of missing guidelines, and scarcity of dedicated care centers. The low response rate suggests that infectious disease specialists do not consider themselves as the primary providers of long COVID care.

Background: The CDC recommends routine use of contact precautions for patients infected or colonized with multidrug-resistant organisms (MDROs). There is variability in implementation of and adherence to this recommendation, which we hypothesized may have been exacerbated by the COVID-19 pandemic. Methods: In September 2022, we emailed an 8-question survey to Emerging Infections Network (EIN) physician members with infection prevention and hospital epidemiology responsibilities. The survey asked about the respondent’s primary hospital’s recommendations on transmission-based precautions, adjunctive measures to reduce MDRO transmission, and changes that occurred during the COVID-19 pandemic. We sent 2 reminder emails over a 1-month period. We used descriptive statistics to summarize the data and to compare results to a similar EIN survey (n = 336) administered in 2014 (Russell D, et al. doi:10.1017/ice.2015.246). Results: Of 708 EIN members, 283 (40%) responded to the survey, and 201 were involved in infection prevention. Most respondents were adult infectious diseases physicians (n = 228, 80%) with at least 15 years of experience (n = 174, 63%). Respondents were well distributed among community, academic, and nonuniversity teaching facilities (Table 1). Most respondents reported that their facility routinely used CP for methicillin-resistant Staphylococcus aureus (MRSA, 66%) and vancomycin-resistant Enterococcus (VRE, 69%), compared to 93% and 92% respectively, in the 2014 survey. Nearly all (>90%) reported using contact precautions for Candida auris, carbapenem-resistant Enterobacterales (CRE), and carbapenem-resistant Acinetobacter spp, but there was variability in the use of contact precautions for carbapenem-resistant Pseudomonas aeruginosa and extended-spectrum β-lactamase–producing gram-negative organisms. In 2014, 81% reported that their hospital performed active surveillance testing for MRSA, and in 2022 this rate fell to 54% (Table 2). The duration of contact precautions varied by MDRO (Table 3). Compared to 2014, in 2022 facilities were less likely to use contact precautions indefinitely for MRSA (18% vs 6%) and VRE (31% vs 11%). Also, 180 facilities (90%) performed chlorhexidine bathing in at least some inpatients and 106 facilities (53%) used ultraviolet light or hydrogen peroxide vapor disinfection at discharge in some rooms. Furthermore, 89 facilities (44%) reported institutional changes to contact precautions policies after the start of the COVID-19 pandemic that remain in place. Conclusions: Use of contact precautions for patients with MDROs is heterogenous, and policies vary based on the organism. Although most hospitals still routinely use contact precautions for MRSA and VRE, this practice has declined substantially since 2014. Changes in contact-precaution policies may have been influenced by the COVID-19 pandemic, and more specifically, contemporary public health guidance is needed to define who requires contact precautions and for what duration.

Disclosures: None

Background: Candida auris, an emerging fungal pathogen, is frequently drug resistant and spreads rapidly in healthcare facilities. Screening to identify patients colonized with C. auris can prevent further spread by prompting aggressive infection prevention and control measures. The CDC recommends C. auris screening based on local epidemiological conditions, patient characteristics, and facility-level risk factors; such screening might help facilities in higher burden areas to mitigate transmission and those in lower-burden areas to detect new introductions before spread begins. To describe US screening practices and challenges, we surveyed a network of infection disease practitioners, comparing responses by local C. auris case burdens. Methods: In August 2022, we emailed a survey about C. auris screening practices to ~3,000 members of the IDSA Emerging Infection Network. We describe survey results, stratifying findings by whether the healthcare facility was in a region where C. auris is frequently identified (tier 3 facility) or not frequently identified (tier 2 facility), based on CDC assessment using existing multidrug-resistant organism containment guidance (https://www.cdc.gov/hai/containment/guidelines.html). Results: We received 253 responses (tier 3 facilities: 119, tier 2 facilities: 134); overall, 37% performed screening. Tier 3 facilities more frequently performed screening than tier 2 facilities (59% vs 17%). Among facilities that performed screening, tier 3 facilities, compared with tier 2 facilities, more frequently screened patients on admission (84% vs 55%) and used an in-house laboratory for testing (68% vs 29%), most often with culture-based methods. Tier 2 facilities more frequently screened patients already admitted in the facility (eg, in response to cases or as part of point-prevalence surveys) compared with tier 3 facilities (59% vs 49%). Among facilities performing screening, 72% had identified ≥1 case in the previous year (tier 3 facilities, 85%; tier 2 facilities, 33%). Barriers to screening included limited laboratory capacity, long testing turnaround times, and the perception that screening was not useful. Conclusions: Most facilities surveyed did not perform C. auris screening. However, most facilities that performed screening, including those in regions of higher and lower C. auris burden, detected cases during the previous year. Admission screening, which might help detect new introductions before spread begins, was uncommon in facilities in lower-burden areas. Improving ease of C. auris screening through access to in-house laboratory testing with rapid turnaround times might increase the adoption of C. auris screening by facilities, thereby increasing detection and preventing spread.

Disclosures: None

Pediatric antimicrobial stewardship programs (ASPs) improve antibiotic use for hospitalized children. Prescriber surveys indicate acceptance of ASPs, but data on infectious diseases (ID) physician opinions of ASPs are lacking. We conducted a survey of pediatric ID physicians, ASP and non-ASP, and their perceptions of ASP practices and outcomes.

We performed a survey of adult infectious diseases (ID) physicians to explore unintended consequences of antimicrobial stewardship programs (ASP). ID physicians worried about disagreement with colleagues, provider autonomy, and remote recommendations. Non-ASP ID physicians expressed more concern regarding ASPs focus on costs, provider efficiency, and unintended consequences of ASP guidance.

We surveyed infectious disease specialists about early coronavirus disease 2019 (COVID-19) vaccination preparedness. Almost all responding institutions rated their facility’s preparedness plan as either excellent or adequate. Vaccine hesitancy and concern about adverse reactions were the most commonly anticipated barriers to COVID-19 vaccination. Only 60% believed that COVID-19 vaccination should be mandatory.

A nationwide survey indicated that screening for asymptomatic carriers of C. difficile is an uncommon practice in US healthcare settings. Better understanding of the role of asymptomatic carriage in C. difficile transmission, and of the measures available to reduce that risk, are needed to inform best practices regarding the management of carriers.