Background: Mie Prefecture in Japan established a Cluster Response Team within the Headquarters for COVID-19 and registered prefectural staff as well as certified Nurse in Infection Control (CNICs) and other experts, who were promptly dispatched to the site of the cluster and provided other support. However, the extent to which they were dispatched, what activities they performed, and what contributions they made have not been analyzed. Method: The Mie prefectural government officials who were responsible for coordinating the dispatch were interviewees regarding the cluster response situation from November 2020 to August 2022. In addition, a questionnaire survey was conducted with CNICs on the supporting side and facility managers on the receiving side regarding the activities and roles of CNICs. Result: Of the 275 cluster cases, cluster response teams were dispatched in 59 cases (64% to nursing facilities, 34% to medical institutions). Nineteen of the 46 CNICs registered in Mie Prefecture were dispatched. The number of days CNICs were dispatched ranged from 1 to 4 days, with 1 day being the most common (69.5%). The dispatch coordinators commented that the CNICs they requested were biased, but that they would have liked to request all CNICs to be dispatched. In a survey of CNICs, 36 of 46 (78.3%) responded to the survey. Support was provided for zoning (92%), PPE donning and doffing instruction (92%), infection control evaluation and instruction (85%), cleaning and disinfection services (54%), and training sessions (54%). The tasks that CNIC believed should be performed were generally consistent with the tasks that were actually performed. However, cleaning and disinfection tasks and nursing tasks that were not indicated as tasks to be performed were actually performed. In a questionnaire targeting recipients, 31 of 67 facilities (46.3%) responded to the survey. Respondents indicated that the dispatch of staff improved their knowledge of infection control measures (90.3%), reduced anxiety (87.1%), ensured thorough hand disinfection (61.3%), and standardized the PPE donning and doffing method (58.1%). Requests to the CNIC included regular on-site guidance, sharing and disseminating information, and holding training sessions. Conclusion: Administrative staff and infection control staff, mainly CNICs, paired up to provide effective cluster response. However, the uneven distribution of the dispatched CNICs and the unexpected tasks they had to perform indicated the need to re-establish a community-wide infection control system in preparation for the next pandemic.

Background: Pediatric urinary tract infections represent the most common pediatric infection with increasing gram-negative antibiotic resistance. Overutilization of antimicrobials including third generation cephalosporins are known drivers of this resistance. Antimicrobial stewardship (AS) efforts have recently shown that antibiotic selection may be influenced by patient race. Implementation science (IS) can provide frameworks and strategies to improve antimicrobial utilization and equity. Methods: This was a pre/post study of 2 geographically different children’s hospitals general pediatric floors assessing the impact of a set of implementation strategies developed to improve provider knowledge of best practice antimicrobials (based on local susceptibilities for treatment of UTI’s) and influence uptake of best practice prescribing. IS strategies included provider education, local clinical champion and opinion leader involvement, leadership involvement, local policy changes, and stakeholder co-design of decision support tools (a clinical pathway, a specific ITI antibiogram, and a dynamic order set). No education was provided regarding racial differences in prescribing habits. Outcomes were measured utilizing a portion of the RE-AIM Framework of assessing adoption of “Right” antibiotic, order set adoption, and equitable reach (racial differences in prescribing). Results: Hospital A and B had a first-generation cephalosporin prescription rate of 29.7% (n=441) and 20.6% (n-557) pre implementation and 44.6% (n=84) and 47.5% (n=118) post (p < 0 .001). Both hospitals also saw a significant reduction in third-generation cephalosporins. In Hospital A, APRN’s were more likely to prescribe a first generation cephalosporin (52.4%) than a DO (42.1%) or MD (26.4%) pre-implementation (p=0.004). In Hospital B, APRN’s were less likely to prescribe first generation cephalosporins (5.4%) than a DO (28.9%) or MD (19.4%) pre-implementation (p=0.004). No statistical significance was seen post implementation for antimicrobial selection by provider type for either hospital. Based on race, both hospitals had Black and Other patients receiving more first-generation cephalosporins while white patients were more likely to receive third-generation cephalosporins (p=0.033) pre implementation. No statistical significance was seen post implementation for antimicrobial selection based on race. No improvement was seen in order set utilization. Conclusion: With order set utilization not improving with implementation of new dynamic order set, other strategies such as education, clinical champion and opinion leader involvement, and provision of a local UTI antibiogram were likely contributors to the improvement in best antimicrobial for treatment of UTI’s. Further mixed method research is warranted to improve understanding of the relative performance of our strategies, especially the lack of provider adoption of the novel dynamic order set.

Disclosure: Jessica Snowden: Advisory board - Pfizer

Background: Group A Streptococcus (GAS; Streptococcus pyogenes) is an important human pathogen that can cause life-threatening invasive disease, ranging from skin/soft tissue infections to infective endocarditis. In the fall of 2022, the Center for Disease Control & Prevention (CDC) issued an alert due to a global increase in invasive GAS infections, particularly among children and adults with co-morbidities. An increase in invasive disease was observed at our five-hospital healthcare system in Southeast Michigan. The objective of this study was to describe characteristics of patients with invasive GAS and characterize treatment and outcomes of disease. Methods: This was a retrospective cross-sectional study of patients from June 2013 to August 2023 with positive blood cultures for GAS. Patients were identified using a data query for positive blood cultures for GAS through Microsoft SQL Server. Patients with age < 1 8 years, polymicrobial bacteremia, incomplete data, or who were enrolled in hospice and/or died within 48-hours of admission were excluded. Collected variables included: demographics, infection characteristics (syndrome, duration of bacteremia), microbiological characteristics (antimicrobial susceptibility testing; AST), antimicrobial treatment (empiric and final, antitoxin therapy), and clinical outcomes (length of hospital stay [LOS], treatment-associated adverse events, 30-day mortality and infection-related readmission). Results: 250 patients were included (Table 1). More than half were male with median age of 57.5 years. Diabetes mellitus (38%) and chronic kidney disease (23%) were common comorbidities [Table 1]. Persons experiencing homelessness and persons who use injection drugs accounted for 9% and 13% of the cases, respectively. The most common infective syndrome accompanying bacteremia was cellulitis (57%). The majority of patients received vancomycin for empiric therapy (81%) and penicillin (38%) or cephalosporin (36%) for final regimen [Table 2]. A total of 79 GAS isolates (32%) were clindamycin resistant. Clindamycin was included in the empiric regimen of 20 (8%) patients, the final regimen in 44 (18%) of patients, and as antitoxin adjunct therapy in 135 (54%) of patients. A third (33%) of patients received no antitoxin. The average duration of antitoxin therapy was 3.6 days and antimicrobial therapy 19.9 days. The mean LOS was 11.4 days (Table 3). Thirty nine (16%) patients had treatment failure and 8 (3%) experienced C. difficile infection within 30 days of antimicrobial treatment. Thirty-day mortality was 11%; of these, 9% had in-hospital mortality. Conclusions: Invasive GAS infection confers significant morbidity and mortality, and ongoing research is needed to determine the best treatment regimens in the era of increasing clindamycin resistance.

Among the greatest challenges facing scholars of public opinion are the potential biases associated with survey item nonresponse and preference falsification. This difficulty has led researchers to utilize nonresponse rates to gauge the degree of preference falsification across regimes. This article addresses the use of survey nonresponse rates to proxy for preference falsification. A simulation analysis exploring the expression of preferences under varying degrees of repression was conducted to examine the viability of using nonresponse rates to regime assessment questions. The simulation demonstrates that nonresponse rates to regime assessment questions and indices based on nonresponse rates are not viable proxies for preference falsification. An empirical examination of survey data supports the results of the simulation analysis.

Dyads can be challenging to recruit for research studies, but detailed reporting on strategies employed to recruit adult–adolescent dyads is rare. We describe experiences recruiting adult–youth dyads for a hypertension education intervention comparing recruitment in an emergency department (ED) setting with a school-based community setting. We found more success in recruiting dyads through a school-based model that started with adolescent youth (19 dyads in 7 weeks with < 1 hour recruitment) compared to an ED-based model that started with adults (2 dyads in 17 weeks with 350 hours of recruitment). These findings can benefit future adult–youth dyad recruitment for research studies.

Background: Infection Prevention (IP) practices in ambulatory care are often reactive and many communicable diseases in the community often do not fall onto IP’s radar until the patient becomes ill enough to seek inpatient services. The gap between ambulatory and inpatient care can lead to increased transmission and illness severity. Early identification has substantial impacts on timely implementation of IP mitigation strategies, appropriate handoff upon entry into other care settings, and timely reporting to public health organizations. Current IP processes underutilize electronic health record (EHR) capabilities by relying upon lab driven notifications. This project sought to redesign the IP’s workflows, advancing the health system beyond the acute care setting and into the ambulatory care setting by adding the power of diagnosis codes to close a practice gap. Method: Infection Prevention and Information Technology collaborated to build silent best practice advisories (BPAs) in the EHR that utilized diagnosis codes related to Varicella zoster (VZV) infection charted by ambulatory care providers. These BPAs function by triggering infection statuses that populate the patient chart and include instructions to front line staff on personal protective equipment (PPE) requirements. These BPAs also trigger real-time notifications to the IP team to determine the validity of the infection status and exposure work-up necessity. Chart reviews of diagnosis codes utilized in pre and post intervention timeframes were completed to understand the impact of the silent BPAs. Percentages of patients captured, and Healthcare Worker (HCW) exposure reviews reported were evaluated to demonstrate effectiveness. Plan, Do, Study, Act (PDSA) was utilized to respond to gaps, increase efficiency, and limit erroneous infection statuses. Result: The one-year pre-intervention period revealed 36 total diagnosis codes used for Varicella zoster (VZV) infection; 3% of these infection cases were captured and 4% of eligible cases were reported for HCW exposure review. The one-year post intervention period revealed 40 total diagnosis codes used for VZV infection; 80% of these infection cases were captured and 70% of eligible cases were reported for HCW exposure review. PDSA quality improvement cycles allowed for refinement of the BPA logic that further increased infection cases captured to 100% with 100% of eligible cases reported for HCW exposure review. Conclusion: Utilizing the EHR, the organization appreciated enhanced identification of patients in real-time with VZV infection that allowed for appropriate mitigation strategies to be implemented. This proactive workflow design helps minimize the risk of transmission between ambulatory and acute settings and facilitated HCW exposure reviews.

Background: The BioFire FilmArray Blood Culture Identification 2 (BCID2) Panel is used to identify organisms present in positive blood cultures within hours of detection at Virginia Commonwealth University Health System (VCUHS). BCID2 is also able to detect common resistance mechanisms including CTX-M, the most common extended-spectrum beta-lactamase (ESBL) in the United States, and several carbapenemases. The Antimicrobial Stewardship Program (ASP) at VCUHS established optimal treatment recommendations for each organism identified by BCID2 based on the detection of a resistance mechanism and local resistance patterns. The recommendation for the majority of Enterobacterales without a detected resistance mechanism is ceftriaxone. However, providers are often reluctant to de-escalate antibiotics without confirmed susceptibility testing, as there may be other mechanisms of antibiotic resistance in Gram-negative organisms. The objective of this evaluation was to measure the degree of congruence between BCID2 resistance mechanism detection and susceptibility testing by disk diffusion, and to validate the adequacy of the VCUHS ASP BCID2 treatment recommendations for Enterobacterales bacteremia. Methods: Patients with positive Enterobacterales BCID2 results from March 12 to June 19, 2023 were retrospectively identified. Organisms identified by BCID2 that were considered high-risk for clinically significant AmpC production due to an inducible AmpC gene (i.e., K. aerogenes, E. cloacae complex) were excluded. Results: A total of 270 results were included. The most commonly identified organism was E. coli (n = 139, 51.5%), followed by K. pneumoniae (n = 74, 27.4%). There were 27 (10%) isolates positive for CTX-M and 1 (0.4%) isolate positive for KPC. All CTX-M isolates were ceftriaxone resistant, and the KPC isolate was meropenem resistant. The remaining 242 isolates were negative for all resistance markers detected by BCID2. Of these, only 3 (1.2%) were resistant to ceftriaxone and notably, 8 (3.3%) were resistant to piperacillin/tazobactam. Overall, BCID2 CTX-M detection was 90% sensitive and 100% specific for predicting ceftriaxone resistance in Enterobacterales. Conclusion: CTX-M detection by BCID2 is highly sensitive and specific for predicting ceftriaxone resistance in Enterobacterales. CTX-M negative isolates were more often susceptible to ceftriaxone than to piperacillin/tazobactam, which is commonly used as empiric therapy for Gram-negative organisms at our institution. This highlights an excellent opportunity for safe and effective early de-escalation of antibiotics for treatment of Enterobacterales bacteremia.

Background: Antimicrobial resistance (AMR) remains a crucial, healthcare issue for which many countries have devised a national action plan. In Japan as well, antimicrobial stewardship programs (ASP) are being implemented in acute care hospitals under this policy framework. Clinical pharmacists play a central role in ASP, often jointly with infectious disease (ID) physicians. However, in Japan, a shortage of ID physicians has resulted in some ASP being led solely by pharmacists. While reports of the short-term effects of this situation are emerging, the long-term impact of pharmacist-led ASP is still largely unknown in Japan. The present study retrospectively examined the long-term effects of pharmacist-led ASP in a small, Japanese, acute care hospital. Method: The present study examined a pharmacist-led ASP in an acute care hospital (287 beds) in Japan which was launched in August 2015 and assessed the duration of therapy per 1000 patient-days (DOT) as the primary outcome by comparing the pre-intervention period (April 2013-July 2015) with the intervention period (August 2015-March 2023) using linear regression analysis. Additionally, segmented time-series analysis was conducted for each, additional intervention, and the impact of reduced activity due to the coronavirus disease 2019 (COVID-19) pandemic during the intervention. The DOT at the study center were compared with the national average of facilities implementing ASP. Result: While the DOT for all intravenous antimicrobials showed a slight increase on linear regression (r=0.01; P=0.1), the DOT of antipseudomonal intravenous antimicrobials significantly decreased (r=-0.027; P < 0 .01). Moreover, a significant reduction in DOT was observed immediately after the initiation of prospective review and feedback for carbapenems and daily prospective review and feedback for all intravenous antimicrobials (-3.2 and -2.4; P < 0 .001 for the intercept). An increase in DOT was observed during the COVID-19 pandemic-related reduction in activity time, and a rapid decline was observed upon the resumption of activities. Conversely, the average, nationwide DOT significantly increased for all intravenous antimicrobials as well as for antipseudomonal intravenous antimicrobials (r=0.02 and r=0.004; P < 0 .01) Conclusion: Sustaining an effective, pharmacist-led antimicrobial stewardship program led to a continual decrease in the DOT of antipseudomonal intravenous antimicrobials in a small, Japanese, acute care hospital despite a nationwide increase in their use following implementation of the national AMR action plan. Detailed analysis of pharmacists’ activities across multiple facilities is necessary to verify these effects.

Introduction: The obesity pandemic presents numerous challenges in radiography, including patients exceeding the weight limits of imaging equipment, difficulties in palpating anatomical landmarks and inadequate penetration resulting in inaccurate diagnoses and need for repeat imaging resulting in increased radiation exposure. Pneumonia is a common reason for hospitalization, but identifying an infiltrate on the chest radiograph (CXR) in obese patients can be challenging. Conversely, motion artefacts may be misinterpreted as areas of pneumonia resulting in over-diagnosis and consequently the overuse of antibiotics. This study evaluated the diagnostic utility of CXR for identifying pneumonia in obese patients by comparing it with computed tomography (CT scan) performed within 72 hours. We also evaluated the impact on initiation or discontinuation of antibiotics – a very important aspect of antibiotic stewardship. Methods: All patients admitted between July 2020 and 2022 with a diagnosis of pneumonia who underwent both CXR and chest CT scan within a 72-hour window were included. Patients were divided into two groups obese and non-obese based on BMI. The results were evaluated to determine the concordance between the two modalities in diagnosing pneumonia, as well as its influence on antibiotic therapy. Results: A total of 320 patients were included, with a mean age of 65.3 years. 146 (45.6%) were male, and 174 (54.4%) were female. 202 (63.1%) were classified as obese (BMI > 30). CXR was performed as first modality in 313 (97.8%) cases, while 7 (2.2%) underwent CT scan first. In the obese group the overall concordance between the 2 modalities for diagnosing pneumonia was 67.5%. In the non-obese group the concordance was 80.2% (p < 0 .001). Among the obese patients who underwent CXR first, 11 (5%) had antibiotics discontinued after the CT scan results, while the number was 4 (3%) in the non-obese group. Additionally, 3 patients in the obese group had antibiotics initiated after the CT scan. Conclusions: Obesity poses unique challenges to healthcare facilities and imaging equipment. Diagnosing pneumonia in obese patients using CXR alone may result in over-diagnosis. This may lead to unnecessary antibiotic use and delayed diagnosis of alternate disease, or in some cases, missing a pneumonia and under-treatment. A chest CT scan is more sensitive and may be more helpful to identify a pneumonia accurately in these patients and thus facilitate appropriate antibiotic use.

Background: Clostridioides difficile infection (CDI) is associated with 500,000 infections and 30,000 deaths per year. Inappropriate testing and treatment of patients with asymptomatic colonization occurs frequently (between 15% and 41%). The VA CDI guidelines emphasize avoidance of CDI testing in patients with laxative use within the previous 48 hours due to the high likelihood of non-infectious diarrhea. The objective of this study was to assess laxative administration among inpatients tested for CDI in VA hospitals and identify factors associated with guideline discordance. Methods: Adults hospitalized in Illinois, Wisconsin, and Michigan VA Medical Centers from January 2019-December 2022 with a CDI test performed during the admission were included. CDI tests included Toxin B gene Polymerase Chain Reaction or Toxin Enzyme Immunoassay. Tests were defined as positive, negative, or cancelled according to the diagnostic protocols of the VA testing laboratories. Laxative use, patient demographics, admission data, and comorbidities were collected from the VA Corporate Data Warehouse. Guideline discordant testing was defined as a diagnostic test for CDI ordered within 48 hours of a recorded laxative dose. Factors associated with discordant testing were analyzed using clustered binomial logistic regression models. Analyses were completed using SAS 9.4. Results: There were 7,326 tests ordered for 4,888 patients during the study. Patients were predominantly White (61.8%), male (95.6%), and elderly (mean age=70.0 standard deviation=12.1). Most (59.0%) patients had received at least one dose of laxative in the 48 hours preceding their CDI test. Being Black (Odds Ratio (OR)=0.86 (95%Confidence Interval (95%CI) =0.76,0.98) or Hispanic (OR (95%CI) =0.62(0.48,0.82) vs White) was associated with a decreased likelihood of inappropriate testing due to recent laxative use. Being tested at a rural facility (OR (95%CI) =1.23 (1.07,1.41) vs urban), within a long-term care (LTC) unit (OR (95%CI) =1.67 (1.41,1.97) vs inpatient), or within an intensive care unit (ICU) (OR (95%CI) =1.40 (1.24,1.59)) were all associated with an increased likelihood of being inappropriately tested. Guideline discordant tests were more likely to have negative results (OR (95%CI) =1.25 (1.05,1.49)) compared to guideline concordant tests. Discussion: Laxative administration in the 48 hours preceding CDI testing was common among hospitalized Veterans and associated with a lower likelihood of positive Results: This echoes non-VA studies where laxative use was reported at 44%. An increased likelihood of guideline discordant testing in ICU and LTC settings suggests the need for greater diagnostic stewardship interventions. Additionally, further work to determine negative outcomes associated with inappropriate testing are needed.

Background: Patients infected or colonized with Candida auris can serve as a transmission source for other patients. Screening patients for Candida auris colonization allows facilities to implement infection prevention and control measures and minimize the risk of transmission. The Centers for Disease Control and Prevention (CDC) recommends healthcare facilities perform three types of screening; admission screening in patients with specific risks, close contact screening of patients who overlap a confirmed positive case for 3 or more days or point prevalence surveillance if there is evidence of ongoing transmission within the facility. The CDC further recommends that patients being screened for Candida auris be maintained in transmission-based precautions while awaiting Results: In 2022-2023 there was ongoing transmission of Candida auris occurring in a community served by a large multi-state healthcare system. Close contact and point prevalence surveillance screening for both acute and non-acute healthcare facilities were implemented by the local health jurisdiction. Methods: A composite swab of the bilateral axilla and groin was used to screen close contacts of patients confirmed to be infected or colonized with Candida auris. Close contact was defined as having been on the same unit as the positive patient for 3 or more days while the patient was not in transmission-based precautions. Point prevalence surveillance was performed on all patients currently housed on units where close contact screen-positive patients resided. Potentially exposed patients who had been discharged were not screened. Patients were placed in contact transmission-based precautions until results were received. In 1657 patients in six acute care facilities were identified for Candida auris screening. 161 patients refused or were unable to be screened. Of the 1496 patients screened, 40 screened positive, demonstrating a 2.67% secondary attack rate. Of the 40 screen-positive patients, 5 were identified through point prevalence and 35 through close contact screening. Conclusion: Performing point prevalence surveillance in acute care facilities is operationally challenging and costly with little benefit in the prevention of Candida auris transmission. More robust collection and reporting of screening data is needed to inform surveillance protocols and prevention strategies specific to different healthcare settings. Limitations of this study include the lack of screening completion in discharged patients identified as close contact or point prevalence surveillance eligible. Additionally, some patients had a history of contact with healthcare facilities outside of this healthcare system, with unknown exposure risks or prevention strategies.

This article studies how Illapu, a prominent Chilean New Song band, deals with Mapuche culture and sound. Through the analysis of four songs, I argue that by first incorporating Mapuche instruments and rhythms (1970s), and then adding engaged lyrics dealing with Mapuche history (1980s), and finally engaging with Mapuche listeners and artists (1990s–2000s), Illapu participates in the transformation of the way in which indigeneity is conceived. I assert that the transformation of their creative processes takes place in parallel with the emergence of a public political Mapuche subject distinctly identified as such. By positioning themselves as ‘brown’ exemplary agents, the members of Illapu get to voice current Mapuche political demands without resorting to supplantation.

This article focuses on the circulation of knowledge about epilepsy in Sweden between 1915 and 1940. During the period medical research on epilepsy increased, which simultaneously brought a new degree of specialisation and distinction between branches of medicine. The aim of this article is to study the impact of new medical knowledge about epilepsy on the treatment and education of children with epilepsy in Sweden. In order to concretise the aim, the study focuses on the asylum Margarethahemmet. The key source material consists of Margarethahemmet’s annual reports and yearbooks. The minutes of the meetings of the Swedish General Association for the Care of the Feebleminded and Epileptic for the period 1915–1938 have been used as supplementary material. In order to trace the impact of medical discoveries on Margarethahemmet’s operations, contemporary scientific articles, mostly from Germany, have also been used. The article demonstrates how new research and new knowledge was sought internationally and nationally, to provide doctors and special teachers at the asylum with a proper knowledge about education, care and treatment for children with epilepsy. The increased understanding of the disease directly impacted the ability of a stigmatized group – people with epileptic disorder – to actively participate in society on the same terms as others.

Background: Our institution utilizes a two-step algorithm consisting of an initial polymerase chain reaction (PCR) test with positive results reflexed to an enzyme immunoassay (EIA) for toxin. Institutional guidelines implemented during the COVID-19 pandemic recommended applying clinical judgment to patients with PCR+/Toxin- (discordant) results when determining if treatment is indicated. Pre-pandemic, we found that clinicians continued CDI-directed therapy in 56% of patients following the Toxin- result. Our study aims to identify how clinicians interpret PCR+/Toxin- results and reasons for management decisions post-pandemic. Methods: At an academic medical center, we conducted a retrospective cohort study of the first 50 inpatient charts with PCR+/Toxin- results from August to October 2022. Data was abstracted from clinical, pharmacy, and microbiology databases. The primary outcome was the proportion of patients continued on CDI-directed therapy for ≥24 hours after the Toxin- result became available. Secondary outcomes included the proportion of patients prescribed a full treatment course for CDI and the reasons for continuing treatment. Results: There were 37 patients (74%) who started CDI-directed treatment after initial PCR+ Results: Of these patients, 59% (22/37) were continued on treatment for ≥24 hours after the Toxin- result (primary outcome). 77% (17/22) of these patients who met the primary outcome completed full treatment courses. Three patients were transitioned to prophylaxis dosing after the Toxin- result. The most common reason for continuing treatment after discordant results was high clinical suspicion for CDI (Figure). There were no CDI-related complications in this 50-patient cohort. In immunocompromised patients, 70% (16/23) started treatment after initial PCR+ results and 81% (13/16) met the primary outcome. In patients admitted specifically to immunocompromised inpatient services, 90% (9/10) started treatment after initial PCR+ results and 100% (9/9) met the primary outcome. Conclusion: The majority of patients started on treatment after the PCR+ result were continued on treatment following the Toxin- result, though several of these patients did not complete full treatment courses. Treatment rates were similar to our pre-pandemic baseline. When patients were continued on treatment after discordant results, clinicians cited appropriate high clinical suspicion. Notably, every patient admitted to an immunocompromised service was continued on treatment after Toxin- Results: Overall, clinicians are following institutional guidelines by applying clinical judgement when interpreting discordant Results: Further research will help identify what variables affect clinician interpretation and management practices for discordant results, which will help shape institutional guideline updates, clinician education, and additional stewardship interventions.

Understanding the impact of mpox-related hospitalizations for medical versus infection control indications in New York City Background: New York City (NYC) accounted for 15-20% of new mpox infections at the peak of the 2022-2023 United States outbreak. Globally, 8% of mpox patients required hospitalization. We investigated the proportion of mpox hospitalizations for medical versus infection control indications at two large healthcare systems in the New York metropolitan area. Methods: We included all patients admitted to NYU Langone Health or NYC Health + Hospitals for laboratory-confirmed mpox between May 1, 2022, and April 28, 2023. We analyzed demographic information, reasons for hospitalization, length of stay, number and type of co-infections, healthcare encounters, complications, and treatments received. Results: Sixty-five patients were hospitalized for mpox, with 8 (12%) admitted primarily for infection control isolation (Table 1). Median age was 35 years (IQR=31-40), 69% were cisgender men, and 38% were Black. Those hospitalized primarily for isolation were more likely to reside in a homeless shelter (50% vs. 9%, p < 0 .01) and less likely to have a private residence (25% vs. 81%, p < 0 .01) than those hospitalized for medical indications. Those hospitalized for medical indications were more likely to have HIV (63% vs. 25%, p=0.04), secondary bacterial infections (67% vs. 25%, p=0.02), and to receive antibiotics (82% vs. 25%, p < 0 .01) (Tables 2 and 3). There was no significant difference in median cumulative length of stay per patient (p=0.69) between those hospitalized for medical versus isolation purposes. Most admissions for medical indications were for soft tissue superinfection (40%), severe pharyngitis and/or proctitis (28%) and pain management (20%). There was no significant difference in the proportion of tecovirimat receipt (65% vs. 38%, p=0.14) between those hospitalized for medical versus isolation purposes. Conclusion: Infection control isolation accounted for a significant proportion (12%) of mpox hospitalizations and was associated with a similar median length of stay per patient as hospitalization for medical indications. Our small cohort limits statistical power for comparison between groups. However, our findings argue for increased community-based isolation capacity. This may reduce unnecessary hospitalizations during future outbreaks, particularly amongst unsheltered individuals or those living in congregate settings.

Disclosure: Madeline DiLorenzo: Stocks - Abbvie, Amgen Inc., Becton Dickinson, Biogen Inc., Bristol Myers and Squibb, CVS Health, Davita Inc., Elevance Health, Gilead, Henry Schein, Hologic Inc., Humana Inc., Jazz Pharmaceuticals, Laboratory Corp, Merck and Co., Quest Diagnostics, ResMed Inc., Teladoc Health, Vertex Pharmaceuticals, West Pharmaceuticals