Lauren Richey

Acute human immunodeficiency virus infection.

Abstract:The clinical spectrum of acute human immunodeficiency virus (HIV) infection, a common clinical syndrome, may range from asymptomatic to a severe illness. The purpose of this review is to increase awareness of this syndrome, which is rarely suspected and often missed in clinical care settings, and provide an informative reference for primary care providers. The diagnosis of acute HIV infection is important for both patient care and public health concerns. In this article, the epidemiology, pathophysiology, clinical presentation, diagnosis and treatment of acute HIV infection are reviewed.

314When Should Contact Precautions be Discontinued for Patients with Methicillin-Resistant Staphylococcus aureus (MRSA)

Background. When to discontinue contact precautions (CP) for patients (pts) with MRSA remains unresolved and policies vary between hospitals. Our facility considers an MRSA patient positive (+) (and thus remaining in CP) until they have had two active surveillance cultures (ASC) return negative (-) or have undergone successful decolonization therapy. Methods. From October 2010-March 2014 we prospectively performed admission ASC (and weekly for those with (-) results) on pts known to have been MRSA (+) for at least 1 year to determine the proportion who remained MRSA (+). Characteristics (age, sex, race, hospitalization within the year, presence of a wound or foreign body, receipt of antibiotics, hemodialysis, and residence in a group setting) were collected from a chart review to determine factors associated with persistent carriage. Results. Over the study period 408 pts with MRSA had an admission ASC done a mean of 1671 days from their first known (+) MRSA culture (range 416 5668 days). Ultimately, 82 (20.1%) pts in the cohort had MRSA detected during the study. 68 (16.7%) of 408 had a (+) admission ASC. Of the 339 pts who had a (-) admission ASC, 181 (53.4%) had a second ASC culture and 8 (4.4%) were (+) for MRSA. Of the 173 pts who had two (-) ASC, 6 (3.5%) went on to have a future culture (+) for MRSA. Increased number of days between first known (+) MRSA culture to admission ASC was associated with a lower risk for having MRSA detected during the study (p= 0.04) and having the ASC performed more than 5 years since the first known (+) MRSA culture was associated with the lowest risk (OR 0.45, [0.25-0.79], p = 0.005). For example, 18 (12.5%) of 144 pts with an ASC done more than 5 years from their first known (+)MRSAvs 64 (24.2%) of 264 pts with an ASC done 5 years or less from their first known (+) MRSA culture had MRSA detected during the study. Presence of a foreign body significantly increased the risk for having a (+) MRSA culture (OR 1.36 [1.02-1.82], p= 0.05) and female sex significantly reduced the risk (OR 0.78 [0.60-1.00], p = 0.05). Conclusion. The proportion of pts with MRSA documented more than a year ago who remained (+) was 20.1% however this significantly decreased over time, particularly after 5 years. Our data also suggest that in the absence of a foreign body and especially among females, CP can be discontinued after one (-) admission ASC. Disclosures. C. Salgado, Wolters Kluwer Health: Editorial Assistance, Licensing agreement or royalty

359Epidemiology of Carbapenem-Resistant Enterobacteriaceae (CRE) at an Academic Medical Center

359. Epidemiology of Carbapenem-Resistant Enterobacteriaceae (CRE) at an Academic Medical Center Charles Leiner, BS; Lisa Steed, PhD; Cassandra Salgado, MD, MS; Lauren Richey, MD, MPH; Medical University of South Carolina, Charleston, SC; Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC; Infectious Diseases, Medical University of South Carolina, Charleston, SC