bluuebunny/crossref_metadata_2025 huggingface dataset:
18. Association Between State-level Voting Patterns and Prior Receipt of the HPV Vaccine, an Analysis Using Data from the Behavioral Risk Factor Surveillance System 2016 – 2018
Authors: Corcorran Maria A , Valinetz Ethan , Hussein Abir , Littman Alyson J , Hawes Stephen E
Published: January 2021

Background

Human papillomavirus (HPV) is the main cause of cervical, anal and oro-pharyngeal cancer worldwide. The HPV vaccine can prevent over 90% of HPV-related malignancies but vaccination rates in the United State (US) vary significantly by region. In this study, we assessed whether state-level politics is associated with receipt of HPV vaccination in the US, and if the association is modified by sex and age.

Methods

This study analyzed data from the Center for Disease Control and Prevention’s (CDC) Behavioral Risk Factors Surveillance System (BRFSS) survey. Persons ages 18 to 36 years of age, who lived in 17 states that included the supplementary “Adult Human Papillomavirus (HPV)” module questionnaire in 2016, 2017 or 2018, were included. We compared self-reported receipt of HPV vaccination among persons living in Republican versus Democratic states, based on state electoral college votes in the 2016 US presidential election. Mantel-Haenszel stratified analysis was used to estimate prevalence ratios and to assess for effect modification and control for confounding.

Results

Overall, 36,334 survey respondents were included in the analysis, 22.7% of whom reported prior receipt of the HPV vaccine, 28.1% in Democratic states and 20.4% in Republican states. When adjusted for race, living in a Democratic state was associated with a higher prevalence of prior receipt of the HPV vaccine in comparison to living in a Republican state. This association was strongest for men less than 26 years of age (PR 1.77, 95% CI: 1.58, 1.98) but remained significant for men ages 26 – 36 years (PR 1.51, 95% CI: 1.24, 1.85), women less than 26 years of age (PR 1.20, 95% CI: 1.13, 1.27), and women ages 26 – 36 years (PR 1.69, 95% CI: 1.57, 1.83).

Conclusion

Overall HPV vaccine coverage was low in adults 18–36 years of age. The strong association between state-level voting patterns and prior receipt of the HPV vaccine suggests that HPV vaccine coverage is lower in Republican states when compared to Democratic states. Further public health efforts are needed to promote HPV vaccine uptake among young men and women, particularly in Republican voting states.

Disclosures

All Authors: No reported disclosures
30. Impact of Pharmacist Assertiveness Training in Recommending Pneumococcal Vaccination among High-Risk Adults
Authors: Gatwood Justin , Renfro Chelsea , Chiu Chi-Yang , Kapan Shiyar , Hagemann Tracy , Hohmeier Kenneth
Published: January 2021

Background

Community pharmacies have become vital access points to provide a range of vaccines to adults, including pneumococcal; however, despite growth in vaccines given at these sites, the most recent rates of adults being immunized against pneumococcal disease remain below goals set by Health People 2020. A lack of patient awareness is a leading reason for low vaccination rates, suggesting that a need exists to improve provider communication in recommending pneumococcal vaccination in high-risk adults.

Methods

A multi-phase, pharmacy-based intervention was launched in west and middle Tennessee locations of a nationwide community pharmacy chain focusing on improving evidence-based, presumptive recommendations related to pneumococcal vaccination. All locations were randomized to one of three arms based on training intensity: 1) no training; 2) online training only; and 3) online and live simulation training. The program focused on providing assertive recommendations and managing potential hesitancy guided by multiple health communication theories and community-based hesitancy data provided to each pharmacy by the study team. Primary endpoints included changes in pneumococcal vaccinations (counts over 6-month periods [July-December] in 2018 and 2019) and provider vaccine-related self-efficacy and were evaluated by generalized linear models.

Results

A total of 100 pharmacies were enrolled and 50 pharmacists completed their assigned training element. Completing the full training program (i.e., online and live) led to improvements in pharmacist self-efficacy related to being influential in vaccine-related decisions and not being helpless in managing resistance (both p< 0.05). Overall counts of all pneumococcal vaccines were lower (-11.3%) across all stores in the period following training; however, a small increase (2.1%, P=0.084) was observed in the stores that underwent the full training, versus decreases of 22.0% and 9.4% in control and online-only training comparisons, respectively.

Conclusion

Results suggest that provider vaccine self-efficacy can be improved through an evidence-based communication training program but substantial improvements in specific vaccinations may need to leverage a more holistic focus on all recommended adult vaccines.

Disclosures

Justin Gatwood, PhD,MPH, AstraZeneca (Grant/Research Support)GlaxoSmithKline (Grant/Research Support)Merck & Co. (Grant/Research Support) Tracy Hagemann, PharmD, GSK (Grant/Research Support)Merck (Grant/Research Support)
32. Influenza Vaccination Prevalence Among Adults with and without HIV by Race, Age, and Sex
Authors: Levine-Hall Tory , Hood Nicole , Alexeeff Stacey , Anderson Alexandra , Hojilla J Carlo , Horberg Michael A , Horberg Michael A , Lam Jennifer , Satre Derek , Silverberg Michael
Published: January 2021

Background

People with HIV (PWH) may be more likely than people without HIV (HIV-) to receive influenza vaccinations. However, it is unknown if there are demographic differences in vaccination rates and whether this varies by HIV status.

Methods

We identified all adult PWH (≥18 years) and 20:1 race-, age- and sex-matched HIV- adults enrolled in Kaiser Permanente Northern California between 2013 - 2017. We evaluated prevalence of influenza vaccinations during the 2013 – 2016 flu seasons (September 1 to March 31). We used Poisson regression models with repeated measures (subjects contributed to multiple flu seasons) to estimate the relative risk [RR] of influenza vaccinations by race, age, and sex within HIV status strata. Multivariable models included terms for HIV status, race, age, sex, unhealthy alcohol use, smoking status, calendar year, alcohol use disorder, census-based education/income, depression, insurance type, and outpatient visits, and interaction terms for HIV*race, HIV*age group, and HIV*sex.

Results

The study sample included 7,422 PWH and 152,305 HIV-. 90% of PWH and 91% of HIV- were men; mean age at baseline was 49.4 (PWH) and 50.6 (HIV-) years; and 45% of PWH and 44% of HIV- were non-White. In adjusted models, PWH were more likely to receive the influenza vaccine compared with HIV- (RR 1.51; 95% CI 1.50–1.54). Among HIV-, Blacks were less likely to receive the vaccine compared with Whites (RR 0.77; 0.76–0.78); this effect was attenuated in PWH (RR 0.88; 0.84–0.92) (Figure, panel a). Among HIV-, older age groups were more likely to receive the vaccine compared with the 18 – 29 age group, with attenuated RRs among PWH (Figure, panel b). Among HIV-, females were more likely to receive the vaccine compared to males (RR 1.11; 1.09–1.13) while among PWH, females were less likely compared to males (RR 0.94; 0.89–1.00; p=0.04) (Figure, panel c).

Adjusted relative risk of influenza vaccination by race, age, and sex

Conclusion

PWH were more likely to be vaccinated against influenza than HIV-. In both PWH and HIV-, Blacks and younger age groups were less likely to be vaccinated, although these associations were attenuated in PWH. The effect of sex varied by HIV status with increased vaccination rates for female HIV- but reduced rates for female PWH. Targeted efforts are needed to continue to close the gap in demographic disparities regarding influenza vaccination rates among PWH.

Disclosures

Michael Silverberg, PhD, MPH, Gilead Sciences, Inc. (Grant/Research Support)
41. Impact of the Development of a Perioperative Antibiotic Pathway on Antibiotic Duration of Therapy, C.difficile Infection Rates and Surgical Site Infection Rates in the Adult Facial Reconstruction Population
Authors: McDonnell Lindsay , Kennedy Leigh A
Published: January 2021

Background

There is variability in the duration of peri-operative antibiotic prophylaxis for free flap reconstructions (FFRs) of the head and neck. Complications of FFRs such as surgical site infections (SSIs), can be devastating and lead to vessel thrombosis and flap loss. Infection rates for head and neck free flap reconstructions have been reported to be as high as 20–50% of cases.1

Despite recommendations from ASHP, IDSA and CDC, postoperative antibiotics are often prolonged at the clinician’s discretion, with many clinicians administering >24 hours of prophylactic antibiotics in cases of FFRs.

Methods

The departments of infectious disease, otorhinolaryngology and antimicrobial stewardship, developed a pathway for perioperative antibiotics for adult patients undergoing FFRs. Patients with criteria that put them at high risk for SSIs post-operatively, were given up to 72 hours of antibiotics. Patients without these risk factors, were allowed a maximum of 24 hours of antibiotics post-operatively.

Next, dissemination and education of the pathway occurred. Our group then collected post –intervention data on antibiotic duration of therapy, C. difficile infections and SSIs in these patients. We collected data over a 6 month period (10/1/2018 to 3/31/2019) for patients undergoing FFRs who received ampicillin/sulbactam (n=33) and compared it to our baseline/pre-intervention data.

Perioperative Antibiotic Recommendations for Adult Facial Reconstructive Surgery Pathway

Results

The mean duration of ampicillin-sulbactam usage decreased from 6.82 days to 4.24 days (p=0.0039). The hospital acquired C.difficile rate decreased from 6.06% to 0% (p=0.4923). The rate of SSIs increased from 3.13% pre-intervention to 9.09%, but this did not reach statistical significance (p=0.6132). One patient in the pre- intervention group and one patient in the post intervention group required a return to the operating room due to SSIs.

Conclusion

In conclusion, through the development of a pathway for perioperative antibiotics for adult patients undergoing FFRs, the duration of postoperative antibiotic therapy decreased significantly. The rates of SSIs increased after the pathway was introduced, but this was not statistically significant. The rates of C.difficile infections decreased, but this did not reach statistical significance.

Disclosures

All Authors: No reported disclosures
44. Antibiotic Class-Based Distribution and Analysis of Reported Beta-Lactam Allergies amongst Hospitalized Patients
Authors: Hornak Joseph Patrik , Reynoso David
Published: January 2021

Background

Reported β-lactam allergy (BLA) is very common, yet less than 10% of these patients exhibit true hypersensitivity. When faced with reported BLAs, physicians often choose alternative antibiotics which can be associated with C. difficile infection, drug-resistance development, poorer outcomes, & increased costs. Effective identification of these patients is necessary for subsequent, appropriate BLA “de-labeling.” Here, we conducted a single-center analysis of alternative antibiotic utilization amongst patients reporting BLA and compare the frequency of drug-resistant infections and C. difficile infection in allergic & non-allergic patients.

Methods

This is a retrospective review of adult patients hospitalized at The University of Texas Medical Branch from 1/1/2015 to 12/31/2019. Pooled electronic medical records were filtered by antibiotic orders and reported allergies to penicillins or cephalosporins. Patients with drug-resistant and/or C. difficile infection (CDI) were identified by ICD-10 codes. Microsoft Excel & MedCalc were used for statistical calculations.

Results

Data were available for 118,326 patients and 9.3% (11,982) reported a BLA, with the highest rates seen in those receiving aztreonam (85.9%, 530/617) & clindamycin (33.7%, 3949/11718). Amongst patients reporting BLA, high ratios-of-consumption (relative to all patients receiving antibiotics) were seen with aztreonam (7.0), clindamycin (2.7), cephalosporin/β-lactamase inhibitors (2.4), & daptomycin (2.1). Compared to the non-BLA population, BLA patients more frequently experienced MRSA infection (3.0% vs 1.5%, OR 1.99, 95% CI 1.79–2.23, p< 0.0001), β-lactam resistance (1.2% vs 0.6%, OR 2.07, 95% CI 1.72–2.49, p< 0.0001), and CDI (1.2% vs 0.7%, OR 1.85, 95% CI 1.54–2.23, p< 0.0001).

Conclusion

Our measured BLA rate matches approximate expectations near 10%. Moreover, these patients experienced significantly higher frequencies of drug-resistant bacterial infections and CDI. Targeted inpatient penicillin allergy testing stands to be particularly effective in those patients receiving disproportionately utilized alternative agents (e.g. aztreonam, clindamycin, daptomycin). β-lactam allergy “de-labeling” in these patients is likely a valuable antimicrobial stewardship target.

Disclosures

All Authors: No reported disclosures
48. Association of Rapid Pathogen Identification and Pharmacist Intervention on Time to Optimal Antimicrobial Therapy for Bloodstream Infections at Two Community Hospitals
Authors: Froberg Bryant M , Torney Nicholas
Published: January 2021

Background

As many as 1 in 3 patients with bloodstream infections at community hospitals receive inappropriate empiric antimicrobial therapy. Studies have shown that the coupling of real-time intervention with rapid pathogen identification improves patient outcomes and decreases health-system costs at large, tertiary academic centers. The aim of this study was to assess if similar outcomes could be obtained with the implementation of real-time pharmacist intervention to rapid pathogen identification at two smaller, rural community hospitals.

Methods

This was a pre-post implementation study that occurred from September of 2019 to March 2020. This study included patients ≥18 years of age admitted with one positive blood culture. Patients were excluded if they were pregnant, had a polymicrobial blood culture, known culture prior to admission, hospice consulted prior to admission, expired prior to positive blood culture, or transferred to another hospital within 24 hours of a positive blood culture. Endpoints of patients prior to intervention were compared to patients post-implementation. The primary endpoint was time to optimal antimicrobial therapy. Secondary endpoints included time to effective antimicrobial therapy, in-hospital mortality, length of hospital stay, and overall cost of hospitalization.

Results

Of 212 patients screened, 88 patients were included with 44 patients in each group. Both groups were similar in terms of comorbidities, infection source, and causative microbial. No significant difference was seen in the mean time to optimal antimicrobial therapy (27.3±35.5 hr vs 19.4± 30 hr, p=0.265). Patients in the post-implementation group had a significantly higher mean hospitalization cost ($24,638.87± $11,080.91 vs $32,722.07±$13,076.73, p=0.013). There was no significant difference in time to effective antimicrobial therapy, in-hospital mortality, or length of hospital stay.

Conclusion

There were no between-group differences in the primary outcome of time to optimal therapy, with a higher mean hospitalization cost after implementation. These results suggest further antimicrobial stewardship interventions are needed, along with larger studies conducted in the community hospital settings.

Disclosures

All Authors: No reported disclosures
49. Clinical Utility of Oseltamivir Restriction Policy
Authors: Kale-Pradhan Pramodini , Manuel Martin , Johnson Leonard B
Published: January 2021

Background

Inappropriate use of oseltamivir and antibiotics for upper respiratory tract infections may increase risk of microbial resistance. Restriction policies have been used to curtail inappropriate use of oseltamivir and antimicrobials in suspected or confirmed influenza patients. We assessed the impact of Infectious Diseases (ID) consult on the management of oseltamivir and concomitant antibiotics.

Methods

A single-center, retrospective study of patients ≥ 17 years, admitted for greater than 24 hours who received oseltamivir from October 1, 2018 to May 1, 2019 were evaluated. Demographics, Charlson Weighted Index of Comorbidity (CWIC), length of hospital stay (LOS), discharge disposition, rapid flu test, respiratory viral panel, sputum and blood cultures, antibiotic regimen and duration were collected. Continuous variables were analyzed using Students t-test and categorical variables with Chi square test.

Results

298 patients were screened and 182 patients met the inclusion criteria. Please see table below for results. Oseltamivir was appropriately continued in 92.9% in the ID consult group compared to 89.3% in the non-ID consult group (p = 0.51). Antibiotic interventions were appropriate in 63.2% of the ID consult group compared to 40% in non-ID group (p = 0.36).

Results Summary

Conclusion

Oseltamivir interventions were appropriate and similar in between groups. Further, there was higher percentage of appropriate antibiotic interventions in the ID physician group. Duration of antibiotics was longer in the ID physicians consulted group which may be due to higher severity of illness in the group.

Disclosures

All Authors: No reported disclosures
52. Development and Implementation of a Short Duration of Antibiotic Therapy Algorithm for Uncomplicated Gram-Negative Bacteremia
Authors: Bae Esther Y , Bernice Fidelia , Dzintars Kathryn , Cosgrove Sara E , Tamma Pranita D , Avdic Edina
Published: January 2021

Background

Recent literature suggests no difference in clinical outcomes between short (7 days) and prolonged course (14 days) antibiotic therapy for the treatment of uncomplicated Gram-negative bacteremia (GNB).

Methods

The objectives of the study were to develop and implement a treatment algorithm that identifies patients who are eligible for 7-day therapy for uncomplicated GNB and evaluate its impact on patient outcomes at The Johns Hopkins Hospital (JHH) in Baltimore. The algorithm was developed and implemented at JHH on 11/11/2019. From 11/11/2019 to 3/31/2020, the Infectious Diseases (ID) Pharmacy Resident and ID pharmacists reviewed cases of GNB on weekdays and contacted teams to provide algorithm-compliant treatment recommendations. To quantify the impact of the intervention on clinical outcomes, data from the same time period during the previous year (baseline) were collected and compared to those collected during the intervention. The primary outcome was duration of antibiotic therapy for GNB. Secondary outcomes included: duration of intravenous (IV) antibiotics, length of hospital stay (LOS), and recurrent bacteremia.

Results

A total of 345 patients with GNB were identified (142 baseline; 203 intervention) of which 59 and 55 patients met criteria for 7-day therapy, respectively. The Pitt bacteremia score (median 1), bacteremia source [urinary (43%), abdominal (23%)], and organisms [E. coli (48%) and Klebsiella spp. (33%)] were similar between the periods. More patients in the intervention period were treated for ≤8 days (60.0% vs. 37.3%; p=0.015), and the median duration of therapy was 2 days shorter (8 vs. 10 days; p=0.04). Median duration of IV antibiotic therapy (4 vs. 7 days; p=0.004) and median LOS (4 vs. 7 days; p=0.029) were also shorter in the intervention period. There were no differences in the rate of 30-day recurrent bacteremia between the periods (3.4% baseline vs. 1.8% intervention; p=0.60).

Conclusion

Our pharmacist-led intervention successfully shortened the duration of therapy, increased conversion from IV to PO therapy, and reduced LOS, without negatively impacting the number of patients with recurrent GNB.

Disclosures

All Authors: No reported disclosures
813. The Reduction of the acquisition rate of carbapenem resistant Acinetobacter baumannii after room privatization in the intensive care unit
Authors: Jung Jongtak , Choe Pyoeng Gyun , Kang Chang Kyung , Song Kyung Ho , Park Wan Beom , Bang Ji-Hwan , Kim Eu Suk , Park Sang Won , Kim Hong Bin , Kim Nam-Joong , Oh Myoung-don
Published: January 2021

Background

Acinetobacter baumannii is one of the major pathogens of hospital-acquired infection recently and hospital outbreaks have been reported worldwide. On September 2017, New intensive care unit(ICU) with only single rooms, remodeling from old ICU with multibed bay rooms, was opened in an acute-care tertiary hospital in Seoul, Korea. We investigated the effect of room privatization in the ICU on the acquisition of carbapenem-resistant Acinetobacter baumannii(CRAB).

Methods

We retrospectively reviewed medical records of patients who admitted to the medical ICU in a tertiary care university-affiliated 1,800-bed hospital from 1 January 2015 to 1 January 2019. Patients admitted to the medical ICU before the remodeling of the ICU were designated as the control group, and those who admitted to the medical ICU after the remodeling were designated as the intervention group. Then we compared the acquisition rate of CRAB between the control and intervention groups. Patients colonized with CRAB or patients with CRAB identified in screening tests were excluded from the study population. The multivariable Cox regression model was performed using variables with p-values of less than 0.1 in the univariate analysis.

Results

A total of 1,105 cases admitted to the ICU during the study period were analyzed. CRAB was isolated from 110 cases in the control group(n=687), and 16 cases in the intervention group(n=418). In univariate analysis, room privatization, prior exposure to antibiotics (carbapenem, vancomycin, fluoroquinolone), mechanical ventilation, central venous catheter, tracheostomy, the presence of feeding tube(Levin tube or percutaneous gastrostomy) and the length of ICU stay were significant risk factors for the acquisition of CRAB (p< 0.05). In the multivariable Cox regression model, the presence of feeding tube(Hazard ratio(HR) 4.815, 95% Confidence interval(CI) 1.94-11.96, p=0.001) and room privatization(HR 0.024, 95% CI 0.127-0.396, p=0.000) were independent risk factors.

Table 1. Univariate analysis of Carbapenem-resistant Acinetobacter baumannii

Table 2. Multivariable Cox regression model of the acquisition of Carbapenem-resistant Acinetobacter baumannii

Conclusion

In the present study, room privatization of the ICU was correlated with the reduction of CRAB acquisition independently. Remodeling of the ICU to the single room would be an efficient strategy for preventing the spreading of multidrug-resistant organisms and hospital-acquired infection.

Disclosures

All Authors: No reported disclosures
814. A Quasi-Experimental Study on Stethoscopes Contamination with Multidrug-Resistant Bacteria: Its Role as a Vehicle of Transmission
Authors: Lee Raeseok , Choi Su-Mi , Jo Sung Jin , Han Songyi , Park Yun Jeong , Choi Min A
Published: January 2021

Background

Stethoscopes have been suggested to be a possible vector of contact transmission. However, only a few studies have focused on the prevalence of contamination by multidrug-resistant (MDR) bacteria and the effectiveness of disinfection training to reduce. The aim of this study is to investigate the burden of stethoscope contamination with nosocomial pathogens and multidrug-resistant (MDR) bacteria and to analyze habit changes in the disinfection of stethoscopes before and after education and training.

Methods

We performed a prospective pre and post quasi-experimental study. All participants were surveyed on their disinfection behavior and stethoscopes were cultured by pressing the diaphragm directly onto a blood agar plate before and after education on disinfection. Pulsed-field gel electrophoresis (PFGE) was performed to determine the relatedness of MDR bacteria.

Fig. 1. Study flow for pre and post quasi-experimental study. Abbreviations. PFGE, Pulsed-field gel electrophoresis

Results

Most of the stethoscopes were contaminated with microorganisms, 97.9% before and 91.5% even after intervention. The contamination rate of nosocomial pathogens before and after education was 20.8 % and 19.2%, respectively. Stethoscope disinfection habits were improved (55.1% vs 31%; p< 0.001), and the overall bacterial loads of contamination were reduced (median CFUs 15 vs 10; p=0.019) after the intervention. However, the contamination rate by nosocomial pathogens and MDR bacteria did not decrease significantly. A carbapenemase-producing Klebsiella pneumoniae from the stethoscope was closely related to isolates from the patients admitted at the same ward where the stethoscope was used.

Fig. 2. Changes in colony forming units of bacteria isolated from stethoscopes between pre and post intervention period. Abbreviations. CFUs, colony forming units; ns, non-specific

Fig. 3. Result of PFGE and dendrogram of carbapenemase-producing K. pneumoniae from the stethoscope and the patients where the stethoscope was used. Percentage similarities are shown above the dendrogram. Note. ST_7W, K. pneumoniae from the stethoscope; SM 01 to 03, K. pneumoniae isolates form the patients; PFGE, Pulsed-field gel electrophoresis

Table 1. Contamination rates caused by nosocomial pathogens and proportion of MDR bacteria

Conclusion

Stethoscopes were contaminated with various nosocomial pathogens including MDR bacteria and were very likely to be a vehicle of MDR bacteria. Healthcare workers feel the need for education and think it helps, but continuous, consistent education and training should be done in multifaceted approach to reduce the nosocomial transmission via stethoscopes.

Disclosures

All Authors: No reported disclosures
816. Effectiveness of Aseptic Stethoscope Barriers in Allowing Clean Contact for Clostridioides Difficile-Contaminated Stethoscopes
Authors: Vasudevan Rajiv S , Kalra Sarathi , Torriani Francesca J , Peacock William F
Published: January 2021

Background

Healthcare-associated infections (HAIs), such as C. difficile colitis, pose a significant health risk. C. difficile is a spore-forming gram-positive anaerobic bacillus capable of surviving on various surfaces. While a strong emphasis has been placed on hand-washing and environmental cleaning with bleach products to limit the spread of C. difficile, stethoscope contamination has been poorly addressed. Studies have demonstrated that the stethoscope diaphragm harbors similar levels and type of contamination to one’s hands. While a non-alcohol-based solution is recommended for stethoscope hygiene in settings at risk for C. difficile, the use of an aseptic stethoscope diaphragm barrier has not been evaluated. Our purpose is to evaluate whether C. difficile-contaminated stethoscope diaphragms remain aseptic by the placement of an aseptic diaphragm barrier.

Methods

Fresh cultures of C. difficile were diluted to 107 CFU/mL. After inoculating 16 stethoscope diaphragms with C. difficile, 8 had an aseptic diaphragm barrier applied, and 8 served as non-barrier controls. Contaminated stethoscopes were placed in an anaerobic incubator, then swabbed at 15 and 30 minutes, 2 and 4 hours, and 1, 2, 3, and 7 days after inoculation, and subsequently plated onto blood, chocolate, and cycloserine-cefoxitin fructose agar. These plates were incubated for 48 hours, and resulting colonies were manually counted. Statistical analysis was performed (RStudio version 1.0.153) by ANOVA (Analysis of Variance) with post-hoc Tukey HSD (Honestly Significant Difference).

Results

Overall, mean colony count was 33 CFU on the 8 stethoscope diaphragms without barriers, vs zero on those with barriers (p≤ 0.05). Growth rates were greatest at 48 hours, with colony counts as high as 160. While stethoscope diaphragms without barriers had increasing rates of C. difficile culture growth, the presence of the barrier resulted in no growth in 100% of stethoscope diaphragms for up to 1 week after contamination (Figure 1).

C. difficile colony counts from stethoscope diaphragms at time-points up to 1 week.

Conclusion

Aseptic barriers allow C. difficile-contaminated stethoscope diaphragms to remain without bacterial growth for up to a week. Disposable aseptic diaphragm barriers may be effective in preventing the spread of C. difficile.

Disclosures

William F. Peacock, MD, AseptiScope Inc. (Board Member)
817. Exploring Microbial Community Alterations during Hospital Animal-Assisted Intervention Programs
Authors: Dalton Kathryn R , Carroll Karen C , Carroll Karen C , Grice Elizabeth A , Davis Meghan F
Published: January 2021

Background

Animal-assisted interventions, or pet therapy, is increasingly used by healthcare facilities given the numerous benefits in various settings. However, therapy animals may serve as vectors of hospital-associated pathogens. Yet, both pathogenic and protective commensal microbes could be transferred between patients and therapy animals. This pilot study aims to quantify the microbial sharing between patients and therapy dogs, and determine if contact level and a decolonization intervention modifies this sharing.

Methods

We collected pediatric patient and therapy dog nasal samples before and after each group therapy visit. Contact level was based on interaction time and key behaviors. Therapy dog handlers performed normal practices for two control visits, then switched to a decolonization protocol (chlorhexidine shampoo prior to the visit, and chlorhexidine wipes during the visit) for two intervention visits. Sample DNA was sequenced for the 16S rRNA gene V1-3 region to assess microbiota composition and diversity.

Results

We collected 105 samples (79 from patients and 26 from dogs) over 13 study visits. There was an increase in within-sample (alpha) diversity levels after the visits in patients and dogs in control visits, and an overall decrease in intervention visits. Patients were more similar in their microbial composition (beta diversity) to other patients and to dogs after visits. Patients with higher dog contact were more similar to other patients in control and intervention visits using the unweighted metric, but only in control visits for the weighted metric.

Conclusion

These findings indicate that microbes are shared between patients and therapy dogs during animal-assisted interventions, shown by the increase in alpha diversity levels and microbial community shifts. High contact increased interactions in all pathways, resulting in greater microbial sharing. With the dog pathway blocked, the intervention reduced spread of unique dog taxa, but sharing still occurred in high contact patients.

This shows that, while there is potential for the dog to be a vector, other potential pathways are important for microbial sharing during group therapy visits. Infection control efforts should reflect all possible pathways of microbial transmission.

Disclosures

All Authors: No reported disclosures
822. Structural Damage and Biofilm Accumulation on Patient-Ready Orthopaedic Implant (Least Used Cortical Screws), Acquired through Loaner System
Authors: Pereira Luiz Antônio , Lopes Lillian Kelly O , Costa Dayane M , Santos Michelle A , Boff Isabella M , Leão-Vasconcelos Lara Stefânia N , Vickery Karen , Tipple Anaclara F
Published: January 2021

Background

The acquisition of reusable medical devices through loaner system is a worldwide phenomenon. Single-use implants, such as orthopaedic screws, that remain in the surgical tray are subjected to multiple handling and reprocessing until they are implanted. Exposure to physical, chemical and biological agents may compromise their quality/safety and favor biofilm formation. The aim of this study was to assess the surface integrity and microbiological conditions of patient-ready orthopaedic surgical implants (least used cortical screws), provided through loaner system.

Methods

After full reprocessing, clinical trays used for small fragment surgery (3,5) provided through loaner system to a large Brazilian teaching hospital were randomly selected between August to November 2019. Trays were opened in a biological safety cabinet and the least frequently used cortical screws (numbers 10 and 38), therefore, the ones most exposed to biological, chemical and physical agents, were randomly removed and subjected to bacterial culture (n = 3 screws/tray, 9 trays) and Scanning Electron Microscopy (SEM) (n= 1 screw/tray, 5 trays). The 27 screws were individually cultured in Tryptic Soy Broth (TSB), sonicated and vortexed, and incubated at 35oC for up to 28 days (screws were left in TSB). Positive cultures were plate out for automated bacteria identification.

Results

Bacterial growth was identified in 2/27 screws. Three bacterial species were isolated, Staphylococcus hominis resistant to rifampicin and Kocuria rhizophila (screw A), and Micrococcus luteus (Screw B). Structural damage and soil were visualized on all screws subjected to SEM (5/5). Extensive biofilms were detected on three screws (3/5) (Figure 1).

Figure 1. Scanning electron micrographs of patient-ready orthopaedic implants (screws), acquired through loaner system showing extensive biofilm, with incorporated bacilli/rods and/or cocci shape bacteria.

Conclusion

Recovery of bacteria, biofilm accumulation and structural damage were detected on patient-ready least frequently used orthopaedic cortical screws. Screws frequently remain in surgical trays for multiple reprocessing, thus, they are repeatedly exposed to contamination and possible damage. These findings point to the need to discuss and review the way these single-use implants are currently made available for surgery.

Disclosures

All Authors: No reported disclosures
823. How to Compare standardized Healthcare-associated Infection (HAI) Rates? Benchmark 2D and 3D
Authors: Couto Braulio Roberto Gonçalves Marinho , Starling Carlos Ernesto Ferreira
Published: January 2021

Background

External benchmarking involves comparing standardized data on HAI rates in one hospital or healthcare facility in relation to others. Here we present two epidemiological graphical tools, 2D and 3D benchmarks, which summarize the efficiency in preventing main infections in a Medical/Surgical Intensive Care Unit (MSICU).

Methods

The 3D benchmark graph considers the incidence density rate of ventilator-associated pneumonias (VAP cases per 1,000 ventilator-days) as the X-Axis, the incidence density rate of central line-associated primary bloodstream infections (CLABSI cases per 1,000 central line-days) as the Y-Axis, and the incidence density rate of urinary catheter-associated urinary tract infections (CAUTI per 1,000 urinary catheter-days) as the Z-Axis. Efficiency in preventing infection (e) considers the zero rate to be 100% efficient (e=100%) and the highest available benchmark rate to be “zero” efficiency (RMax: e=0%). From this definition, the efficiency of any MSICU (0% ≤ e ≤ 100%) is obtained using a linear interpolation function, from the rate observed in the MSICU under evaluation (Rx): e = 100x(RMax – Rx)/RMax. If Rx > RMax, then RMax = Rx. The 3D benchmark is build by calculating the preventing infection (e) for each infection (VAP, CLABSI, and CAUTI) for all benchmarks and for the MSICU under evaluation. In the 3D Benchmark, three control volumes are created: “Infection Control Urgency” volume, “Infection Control Excellence” volume, “Infection Prevention Opportunity” volume. Benchmark 2D considers only the VAP density rate as X-Axis, and the CLABSI density rate as Y-Axis. In this graph, five control regions are created: 1=excellence in the control of VAP+CLABSI; 2=excellence in VAP control and opportunity for CLABSI prevention; 3=excellence in CLABSI control and opportunity to prevent VAP; 4=opportunity to prevent VAP+CLABSI; 5=urgency in infection control.

Results

Graph parameters were based on NHSN data from the device-associated module, NOIS Project, Anahp, CQH, and GVIMS/GGTES/ANVISA (Brazilian benchmarks), and El-Saed et al. benchmarks. We applied the 2D/3D benchmarks to several Brazilian ICUs.

2D benchmark for the MSICUs from Lifecenter Hospital, Brazil, Jan-Dez/2019: UCO & UTI 19 =excellence in CLABSI control and opportunity to prevent VAP; UTI 20=excellence in VAP control and opportunity for CLABSI prevention; UTI 18=opportunity to prevent VAP+CLABSI.

3D benchmark for the MSICUs from Lifecenter Hospital, Brazil, Jan-Dez/2019

2D benchmark for the MSICUs from Vera Cruz Hospital, Brazil, Jan-Dez/2019: CTI 3.o Andar =excellence in the control of VAP+CLABSI; CTI 1.o Andar=excellence in VAP control and opportunity for CLABSI prevention.

Conclusion

2D and 3D benchmarks are easy to understand and summarize the efficiency in prevention the mains infections of MSICU.

Disclosures

All Authors: No reported disclosures
829. Identification of Congenital Cytomegalovirus Infection Using Real-World Healthcare Data
Authors: Weil Clara , Marks Morgan , Wang Wei , Chodick Gabriel , Bilavsky Efraim , Sinha Anushua
Published: January 2021

Background

Infants with congenital cytomegalovirus infection (cCMVi) may present with symptoms such as sensorineural hearing loss (SNHL) during the neonatal period and/or develop permanent disability. This study aims to identify infants with cCMVi using information available in an electronic healthcare database in Israel.

Methods

We performed a retrospective study in Maccabi Healthcare Services (MHS, 2.4-million-member healthcare system) among infants with ≥30 days’ continuous enrolment since birth and linked maternal data of women aged 18-44 years in 2013-2017. Data were obtained on diagnosis codes (‘Dx’; ICD-9-CM) of CMV and SNHL and dispensed valgancivlovir treatment (‘Tx’) within 90 days after birth. To help inform the timing of the CMV infection (congenital vs. postnatal) data on maternal CMV testing history were also obtained among infants whose earliest CMV Dx was at age 22-90 days.

Results

The study included 171,952 infants linked to 128,264 mothers (167,879 pregnancies). A total of 461 infants (0.3%) had a CMV Dx within 90 days, 81.3% of which (n=375) were diagnosed within 21 days. Among all infants with a CMV Dx within 90 days, 105 also had dispensed Tx (n=101) and/or SNHL Dx (n=16). Among infants diagnosed at age 22-90 days without evidence of prior Tx or SNHL (n=69), 12 had a record of primary maternal CMV infection in pregnancy, 8 had mothers who were CMV seronegative at the start of pregnancy without follow-up test results, and 49 did not have any maternal laboratory data available. A medical record review is being conducted to validate each cCMV case definition in the MHS database.

Conclusion

In large Israeli healthcare system, 0.3% of infants had a CMV Dx in their electronic health records suggestive of potential cCMVi. Case review is ongoing to validate these codes and help inform analyses on the clinical and economic burden of cCMVi in this population where awareness of CMV is high but newborn screening is not universal.

Disclosures

Morgan Marks, PhD, ScM, Merck and Co. Inc. (Employee, Shareholder) Wei Wang, PhD, Merck (Employee) Anushua Sinha, MD, MPH, Merck & Co. (Employee)Merck & Co. (Shareholder)Merck & Co. (Consultant)
832. Assessment of Risk Factors Associated with Wide-resistance Gram-negative Bacteria Infections
Authors: Reis Henry Pablo Lopes Campos e , Rodrigues Ana Beatriz Ferreira , Silva Julio César Castro , de Lima Lia Pinheiro , Quinaher Talita Lima , de Freitas Thaynara Carvalho , Pereira Carla Mônica Porto , de Araujo Breno Queiroz , Da Silva Abel Brasil Ramos , Amaral Germana Perdigão , de Souza Geovania Maciel , Fragoso Luciana Vladia Carvalhedo , Girão Evelyne Santana , Pontes Licia Borges , Junior Arnaldo Aires Peixoto , Araujo Vitor Nogueira , Duarte Fernando Barroso , Barroso Karine Sampaio Nunes , Rodrigues Jorge Luiz Nobre
Published: January 2021

Background

Enterobacteria and multidrug-resistant non-fermenting Gram-negative bacilli present a challenge in the management of invasive infections, leading to mortality rates due to their limited therapeutic arsenal. The objective of this work was to analyze risk factors that may be associated with these infections, for a better situational mapping and assertive decision-making in a university hospital in Brazil.

Methods

The study was conducted between January and September 2019, with 167 patients in contact isolation at a university hospital in Brazil. Potential outcome-related variables for wide-resistance Gram-negative bacteria (BGN) infections were evaluated. Risk factors were identified from univariate statistical analysis using Fisher’s test.

Results

51 (30.5%) out of 167 patients in contact isolation evolved with wide-resistance BGN infection. Risk factors in univariate analysis were age, hospital unit and previous use of invasive devices. Patients aged up to 59 years were more likely to progress to infection than those aged over 60 years (p 0.0274, OR 2.2, 95% CI 1.1-4.5). Those admitted to the oncohematology (p < 0.001, OR 32.5, Cl 9.1-116.3) and intensive care unit (p < 0.001, OR 28.0, Cl 3.5-225.9) units were more likely to develop this type of infection. The least likely were those admitted to a kidney transplant unit (p 0.0034, OR 15.33, Cl 1.8-131.0). Prior use of mechanical ventilation (p 0.0058, OR 12.2, Cl 2.0-76.1) and delayed bladder catheter (p 0.0266, OR 5.0, Cl 1.2-20.1) in patients with respiratory and urinary tract infection, respectively, were also reported as risk factors related to these infections. The gender of the patients was not significant for the study.

Conclusion

This study determined that variables such as age, hospitalization unit, use of mechanical ventilation and delayed bladder catheter could be considered important risk factors in triggering the infectious process by wide-resistant gram-negative bacteria. Thus, the analysis of these factors becomes a great foundation to prevent the development of multiresistant pathogens through prevention strategies, prophylaxis management and more targeted empirical therapies.

Disclosures

All Authors: No reported disclosures
835. Comparison of the outcomes of patients with KPC and NDM-1-producing Enterobacteriaceae
Authors: Seo Hyeonji , Kim Min Jae , Chong Yong Pil , Kim Sung-Han , Lee Sang-Oh , Choi Sang-Ho , Kim Yang Soo , Woo Jun Hee , Jung Jiwon
Published: January 2021

Background

Carbapenemase-producing Enterobacteriaceae infections are associated with high mortality. We aimed to compare the clinical outcomes of patients with Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae and those with New-Delhi-Metallo-beta-lactamase-1 (NDM-1)-producing Enterobacteriaceae.

Methods

We performed a retrospective cohort study of all adult patients (> 16 years old) with KPC or NDM-1-producing Enterobacteriaceae isolates in a 2,700-bed tertiary referral hospital in Seoul, South Korea between 2010 and 2019. Primary outcomes were infection within 30 days and 30-day mortality after the first isolation of KPC or NDM-1-producing Enterobacteriaceae.

Results

A total of 859 patients were identified during the study period. Of them, 475 (55%) were KPC group and 384 (45%) were NDM-1 group. KPC group tended to develop infection within 30 days after first isolation more frequently than NDM-1 group (31% vs. 26%; P = 0.07). Thirty-day mortality was significantly higher in KPC group compared to NDM-1 group (KPC, 17% (81/475) versus NDM-1, 9% (33/384), P < 0.001). Multivariate analysis revealed that APACHE II score (adjusted odds ratio [aOR], 1.12; P < 0.001), solid cancer (aOR, 2.56; P < 0.001), previous carbapenem therapy (aOR, 1.93; P = 0.004), development of infection of KPC or NDM-1-producing Enterobacteriaceae within 30 days (aOR, 2.63; P < 0.001), and KPC-producing Enterobacteriaceae (aOR, 1.62; P = 0.045) were independent risk factors for 30-day mortality.

Table 1. Results of analyses of risk factors for 30-day mortality from initial positive culture date in patients with KPC or NDM-1- producing Enterobacteriaceae

Figure 1. Kaplan–Meier survival estimates of patients with KPC or NDM-1-producing Enterobacteriaceae for 30-day mortality after first isolation: KPC (continuous line) versus NDM (dotted line). (log-rank test).

Conclusion

Our study suggests that KPC-producing Enterobacteriaceae is associated with poorer outcome compared to NDM-1-producing Enterobacteriaceae. Therefore, patients with KPC-producing Enterobacteriaceae colonization should be monitored carefully for development of infection, and appropriate antibiotics should be initiated as soon as possible.

Disclosures

All Authors: No reported disclosures
837. Contamination of Hospital Drains by Carbapenemase-Producing Enterobacterales (CPE) in Ontario, Canada
Authors: Jamal Alainna J , Mataseje Laura , Brown Kevin , Katz Kevin , Johnstone Jennie , Muller Matthew , Allen Vanessa , Borgia Sergio , Boyd David , Ciccotelli William , Delibasic Kornelija , Fisman David , Leis Jerome A , Li Angel , Mehta Mamta , Ng Wil , Pantelidis Rajni , Paterson Aimee , Pikula Gordana , Sawicki Rachel , Schmidt Shelley , Souto Renata , Tang Lin , Thomas Cameron , McGeer Allison , Mulvey Michael
Published: January 2021

Background

The hospital water environment is a CPE reservoir, and transmission of CPE from drains to patients is a risk.

Methods

We cultured sink and shower drains in patient rooms and communal shower rooms that were exposed to inpatients with CPE colonization/infection from October 2007 to December 2017 at 10 hospitals. We compared patient room drain CPE to prior room occupant CPE using Illumina and MinION whole-genome sequencing.

Results

Three-hundred and ten inpatients exposed 1,209 drains, of which 53 (4%) yielded 62 CPE isolates at 7 (70%) hospitals. Compared to room occupant CPE isolates, drain CPE isolates were more likely Enterobacter spp. (6, 10% vs. 25, 51%, p< 0.0001) or KPC-producers (9, 15% vs. 23, 47%, p=0.0002). Of the 49 CPE isolates in patient room drains, 4 (8%) were linked to a prior room occupant (Table), 24 (49%) had the same carbapenemase as a prior room occupant but isolates/carbapenemase gene-containing plasmids that were unrelated, and 21 (43%) did not share a carbapenemase with a prior room occupant. The 4 drains linked to prior room occupants were likely contaminated by these room occupants, who were CPE-colonized prior to drain exposure. Despite few links between drain and room occupant CPE, there were 10 isolates harbouring related blaNDM-1-containing IncHI2A/HI2-type plasmids in 8 rooms on two units at one hospital. Nine of these were Enterobacter hormaechei ST66 isolates that were 0 to 6 SNVs apart and one was a Klebsiella oxytoca STnovel isolate.

Table. Four patient room drain CPE isolates (D1b, D4, D5, D12) and isolates from prior room occupants that they were related to by whole-genome sequencing.

Conclusion

It was uncommon for drain CPE to be linked to prior patient exposure. This suggests contamination of most drains by undetected colonized patients and a need for more aggressive patient screening in our hospitals. This may also suggest retrograde (drain-to-drain) transmission, especially considering the 10 isolate drain cluster at one hospital. Reasons for the preponderance of Enterobacter spp. in drains requires further study.

Disclosures

Allison McGeer, MD, FRCPC, GlaxoSmithKline (Advisor or Review Panel member, Research Grant or Support)Merck (Advisor or Review Panel member, Research Grant or Support)Pfizer (Research Grant or Support)