bluuebunny/crossref_metadata_2025 huggingface dataset:
1113. Real-Time Evolution of Extensively Drug-Resistant Vibrio cholerae
Authors: Das Bhabatosh
Published: November 2018

Background

Bay of Bengal is known as the epicenter of a number of distinct waves of global transmission of cholera. Vibrio cholerae, the etiological agent of acute diarrhoeal disease cholera, has extraordinary competency to acquire exogenous DNA by horizontal gene transfer (HGT) and acclimatize them into their genome for structuring metabolic process, developing drug resistance and disease. Antimicrobial resistance (AMR) in V. cholerae is a global concern. However, little is known about the identity, source, acquisition process, and stability of the resistance traits in the genome of cholera pathogen.

Methods

Antibiotic susceptibility testing of V. cholerae isolated from different parts of India during 2001–2017 was performed using Discs and E-strips. Whole-genome sequencing of resistant (R), multidrug resistant (MDR), extensively drug resistant (XDR), and pandrug (PDR) resistant V. cholerae was done by next-generation DNA sequencing. Mobile genetic elements (MGEs) linked with AMR genes were tagged by allelic exchange methods. Whole-cell proteome analysis was done by iTRAQ analysis.

Results

Almost 99% of V. cholerae isolates (n = 438) are resistant against ≥2 antibiotics, 17.2% isolates (n = 76) are resistant against ≥10 antibiotics, and 7.5% isolates (n = 33) are resistant against ≥14 antibiotics. Highest resistance was detected against sulfamethaxozole (99.8%, n = 442). In addition, resistance to nalidixic acid (n = 429), trimethoprim (n = 421), and streptomycin (n = 409) are also very high. All the sequenced resistant isolates carrying multiple resistance genes and are linked with MGEs like integrating conjugative elements, transposons etc. Most of the resistance traits are functional and expressed even in the absence of antibiotics.

Conclusion

Our comprehensive analysis of 443 clinical V. cholerae isolates show that the cholera pathogen is continuously evolving to counterbalance the antimicrobial effects of antibiotics. Several MGEs linked with AMR genes and other fitness factors potentially propagate to other bacterial species through HGTs. Knowledge of the present study would be useful to understand the evolution of cholera pathogens and management of cholera by helping selection of specific drug regimen against the pathogens.

Disclosures

All authors: No reported disclosures.
1114. Utility of a Bedside Diagnostic Testing Algorithm to Screen for Hospital-Onset Clostridium difficile Infection
Authors: Nathan Ramesh V , Lenz Amy , Davis Genevieve
Published: November 2018

Background

Molecular assays have improved C. difficile detection in hospitalized patients. However, asymptomatic carriers have been misclassified as hospital onset C. difficile infection (HO-CDI), which has implications for management and infection prevention programs. At our facility, we implemented robust antibiotic stewardship policies in 2016 and had an SIR for HO-CDI of 0.73 for the year. In Q1 2017, this increased to 1.88. These cases revealed that nearly all tests, found positive for C. difficile, did not meet the standard definition of clinically significant diarrhea (CSD). Moreover, many patients did not have a clinical change in condition that supported a diagnosis of C. difficile. We reasoned that an algorithm for appropriate testing for C. difficile would significantly reduce our perceived rates of HO-CDI. We also reasoned that this tool could efficiently be used at the bedside during a clinical assessment.

Methods

To determine which patients had CSD, we designed, educated on and implemented an algorithm to screen for appropriate testing. It required three major elements: three or more loose stools in 24 hours, no gastric motility agents 48 hours prior, and a clinical change in condition (e.g., leukocytosis, fever, abdominal cramping). The completed algorithm accompanied the stool specimen and was required for testing. We evaluated each submitted algorithm for method validation. From this, we determined testing appropriateness and algorithm tool selectivity.

Results

One year pre- and post-algorithm periods (PR-A and PO-A, respectively) were defined. Following its introduction, we noted a 57% decline in rates of HO-CDI (23 cases PR-A vs. 10 cases PO-A), and a 44% reduction in tests sent for C. difficile (average of 41 tests/month PR-A vs. 23 tests/month PO-A). We only used NAAT testing. We also noted a marked rise in adherence to the algorithm as time elapsed. The PDSA tool was used to refine the algorithm, with improved utilization by providers.

Conclusion

A simple bedside algorithm leads to more appropriate testing of patients for HO-CDI. A significant decline in reported rates of HO-CDI was noted. There is an additional benefit of diagnostic stewardship, as fewer tests are sent. This tool can be used immediately and independent of an electronic health record, is very cost effective, and is applicable to hospitals with low rates of HO-CDI.

Disclosures

R. V. Nathan, Merck, Allergan, The Medicines Co.: Speaker’s Bureau, Speaker honorarium.
1116. Comparison of Short-Course vs. Prolonged-Course Antimicrobial Therapy in the Management of Intra-Abdominal Infections
Authors: Phlamon Mina , Petite Sarah , Cole Kelli
Published: November 2018

Background

When managing complicated intra-abdominal infections (IAIs), the current Infectious Diseases Society of America (IDSA) guidelines recommend an antimicrobial treatment duration of 4–7 days. Although recent evidence supports this shorter course of therapy, antimicrobials are still often administered for 10–14 days due to concern for subsequent complications. The purpose of this study was to compare clinical outcomes of short-course (SC) vs. prolonged-course (PC) antimicrobial therapy in the management of IAI at our institution.

Methods

IRB-approved, single-center, retrospective cohort including all patients at the University of Toledo Medical Center who were admitted between January 1, 2012–June 30, 2017 with an IAI, received antimicrobials for ≥48 hours, and had at least one sign of IAI. Patients with concomitant infections at sites other than the abdomen, primary peritonitis or pancreatitis, immunocompromising conditions, or bacteremia were excluded. Primary outcome of clinical cure was compared between SC (≤7 days of antimicrobial treatment) and PC (>7 days) groups. Secondary outcomes included hospital length of stay (LOS), ICU LOS, 28-day all-cause mortality, and 30-day readmission. Multivariable logistic regression was performed to assess for factors associated with clinical cure.

Results

One hundred seventy-five patients were included, 73 SC and 102 PC. Baseline characteristics were similar between groups. Rate of clinical cure for SC vs. PC was 74.0% vs. 67.6% (P = 0.367). Secondary outcomes including hospital LOS (5.5 days vs. 5.8 days, P = 0.372), ICU LOS (3.0 days vs. 5.0 days, P = 0.117), 28-day all-cause mortality (4.1% vs. 2.0%, P = 0.651), and 30-day readmission (19.2% vs. 20.6%, P = 0.818) were also not significantly different. After multivariable logistic regression, the only variable independently associated with clinical cure was diverticulitis (adjusted odds ratio 0.337, 95% CI 0.133 – 0.853).

Conclusion

In patients with IAI, there was no significant difference observed in rates of clinical cure between SC and PC antimicrobial therapy. These results further support the IDSA recommendations for a shorter duration of therapy for patients with IAI.

Disclosures

All authors: No reported disclosures.
1118. Viral Species Richness and Composition in Young Children With Loose or Watery Stool in Ethiopia
Authors: Aiemjoy Kristen , Altan Eda , Aragie Solomon , Fry Dionna , Phan Tung , Deng Xutao , Chanyalew Melsew , Tadesse Zerihun , Callahan Kelly , Delwart Eric , Keenan Jeremy
Published: November 2018

Background

Stool consistency is an important diagnostic criterion in both research and clinical medicine and is often used to define diarrheal disease.

Methods

We examine the pediatric enteric virome across stool consistency to evaluate differences in richness and community composition using fecal samples collected from children participating in a clinical trial in the Amhara region of Ethiopia. The consistency of each sample was graded according to the modified Bristol Stool Form Scale for children (mBSFS-C) before a portion of stool was preserved for viral metagenomic analysis. Stool samples were grouped into 29 pools according to stool consistency type. Differential abundance was determined using negative-binomial modeling.

Results

Of 446 censused children who were eligible to participate, 317 presented for the study visit examination and 269 provided stool samples. The mean age of children with stool samples was 2.7 years old. Species richness was highest in watery-consistency stool and decreased as stool consistency became firmer (Spearman’s r = −0.45, P = 0.013).The greatest differential abundance comparing loose or watery to formed stool was for norovirus GII (7.64, 95% CI 5.8, 9.5) followed by aichivirus A (5.93, 95% CI 4.0, 7.89) and adeno-associated virus 2 (5.81, 95% CI 3.9, 7.7).

Conclusion

We documented a difference in pediatric enteric viromes according to mBSFS-C stool consistency category, both in species richness and composition. Our results suggest that loose or watery stool, as measured by the mBSFS-C, may signal enteric viral infection in young children. Additional studies are warranted to confirm these findings.

Disclosures

All authors: No reported disclosures.
1119. Risk Factors for Clostridium difficile Acquisition and Persistence among Guatemalan Children
Authors: Gaensbauer James , Lamb Molly , Melgar Mario , Calvimontes Diva M , Contreras-Roldan Ingrid , Asturias Edwin , Dominguez Samuel
Published: November 2018

Background

Little is known about the epidemiology and risk factors for Clostridium difficile infection (CDI) among children in low and middle-income countries (LMICs). We sought to characterize the clinical, demographic, and environmental factors associated with C.difficile acquisition and persistence over time, and assess the relationship between CDI and additional diarrheal pathogens among rural and urban Guatemalan children.

Methods

Children 6–35 months old with acute nonbloody diarrhea (<72 hours) were enrolled in an acute diarrhea clinical trial between March 2015 and January 2016 at two sites (one rural and one urban) in Guatemala. Stool samples collected at baseline and 30 days later were analyzed by multiplex PCR (FilmArray™ GI-Panel, BioFire, USA) that identifies 22 viral, parasitic and bacterial diarrheal pathogens including C. difficile. Subjects were characterized by combination of baseline and 30-day C.difficile sample results: −/+ (new acquisition), +/− (clearance), and +/+ (persistence). Associations between these categorizations and demographic, epidemiologic, and co-infecting pathogenic organisms were assessed using multivariable generalized linear models.

Results

CDI was present in 26 of 298 subjects at baseline; 13 (50%) had persistence at 30 days and 13 (50%) cleared. New acquisition at day 30 occurred in 23 subjects. In multivariable analysis adjusted for age, recent hospitalization was marginally significantly associated with C. difficile presence in stool at baseline (prevalence ratio [PR] 2.65, P = 0.07). In subjects with either new C. difficile acquisition or persistence between baseline and day 30, residence in the rural site (PR 0.33, P = 0.003)) and presence of E. coli pathotypes: enteropathogenic (EPEC), enteroaggregative (EAEC), and enterotoxigenic (ETEC) (PR 0.43, P = 0.01)) were associated with reduced risk of CDI.

Conclusion

In an LMIC pediatric population, the presence of E. coli pathotypes appeared protective against C. difficile persistence/new acquisition. These findings add to our current understanding that CDI occurs in part as a result of competition within the intestinal microbiota, which may be independent of the potential pathogenicity of competing microbes. We hypothesize that this phenomenon could be suppressing the C. difficile burden among children in LMICs.

Disclosures

All authors: No reported disclosures.
1121. Epidemiology and Risks for Infection Following Cytoreductive Surgery and Hyperthermic Intra-Peritoneal Chemotherapy at an Australian Centre
Authors: Smibert Olivia , Slavin Monica , Thursky Karin , Teh Ben , Penno Janelle , Ismail Hilmy , Worth Leon
Published: November 2018

Background

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is associated with improved cancer survival but increased risk of infection in patients with abdominal-pelvic malignancy. We evaluated risks and characteristics of infectious outcomes at an Australian cancer centre.

Methods

Patients undergoing CRS-HIPEC between January 2016 and November 2017 at Peter MacCallum Cancer Centre were retrospectively reviewed. Malignancy type, comorbidities, perioperative risk factors, and infectious complications were captured, using standardized definitions for surgical site infection. Association between risk factors and infection outcomes was evaluated by logistic regression modeling.

Results

Sixty-nine patients underwent CRS-HIPEC, predominantly for colorectal cancer and pseudomyxoma peritonei. Overall, 32 (46.3%) experienced an infectious complication, including infections at surgical site (16), respiratory tract (6), urinary tract (5), Clostridium difficile (2), and post-operative sepsis (10). In most, infection onset was within 7 days post-operatively. Median length of hospitalisation was 20 days for patients with infection, compared with 8 days for those without (P = 0.000). Of variables potentially associated with infection at surgical site, small bowel resection (OR 5.56, 95% confidence interval [CI] 1.09–28.19; P = 0.039) and number of resected viscera (OR 1.71, 95% CI 1.05–2.76; P = 0.029) were significantly associated with infection on univariate analysis.

Conclusion

We demonstrate a significant burden of early infective complications in patients undergoing CRS-HIPEC, including surgical and non-surgical site infections. Findings support the need for multimodal programs to reduce the risk of a broad range of infections in this population. Higher risk subgroups, including those with small bowel resection and increased number of resected viscera, may benefit from enhanced monitoring.

Disclosures

All authors: No reported disclosures.
1123. Individual and Household Risk Factors for Symptomatic Cholera Infection: A Systematic Review and Meta-Analysis
Authors: Richterman Aaron , Sainvilien Duarxy Rodcnel , Eberly Lauren , Ivers Louise C
Published: November 2018

Background

Cholera has caused seven global pandemics, including the current one which has been ongoing since 1961. A systematic review of risk factors for symptomatic cholera infection has not been previously published.

Methods

In accordance with PRISMA guidelines, we performed a systematic review and meta-analysis of individual and household risk factors for symptomatic cholera infection.

Results

We identified 110 studies eligible for inclusion in qualitative synthesis. Factors associated with symptomatic cholera that were eligible for meta-analysis included education less than secondary level (summary OR 2.64, 95% CI 1.41–4.92, I2 = 8%), unimproved water source (summary OR 4.78, 95% CI 3.02–7.57, I2 = 49%), open container water storage (summary OR 2.51, 95% CI 1.57–4.01, I2 = 33%), consumption of food outside the home (summary OR 5.02, 95% CI 2.34–10.76, I2 = 61%), household contact with cholera (summary OR 3.99, 95% CI 2.03–7.87, I2 = 89%), water treatment (summary OR 0.22, 95% CI 0.13–0.36, I2 = 37%), and handwashing (summary OR 0.17, 95% CI 0.10–0.30, I2 = 37%). Other notable associations with symptomatic infection included income/wealth, blood group, gastric acidity, infant breastfeeding status, and HIV infection.

Conclusion

We identified potential risk factors for symptomatic cholera infection including environmental characteristics, socioeconomic factors, and intrinsic patient factors. Ultimately, a combination of interventional approaches targeting various groups with risk-adapted intensities may prove to be the optimal strategy for cholera control.

Disclosures

All authors: No reported disclosures.
1125. Reduced Time to Pathogen Identification and Antibiotic Prescription Using Multiplex Molecular Testing for Gastrointestinal Infections
Authors: Kardasheva Aleksandra , Yount Evan , Rose Tracie , Verma Punam , Chihara Shingo
Published: November 2018

Background

A variety of microbial pathogens causes diarrhea which remains a significant global concern. The ability to rapidly identify the pathogen impacts the decision to treat, promotes antimicrobial stewardship, and assists with infection control and prevention. The objective of the study was to compare the time it took for rapid identification of microbial pathogens via a stool-culture based testing vs. real-time PCR using a Verigene Enteric Pathogens (EP) test.

Methods

The study was performed at Virginia Mason Medical Center, a tertiary medical center in Seattle. A retrospective chart review included the diagnosis of microbial pathogen, antibiotics prescribed (if any), time of prescription, duration of antibiotics course and patients’ outcome if they were hospitalized. Stool specimens from 136 patients in 2015 were analyzed via a stool-culture based method. The results were compared with a molecular-based method used to study specimens from 225 patients in 2017. Years 2015 and 2017 were chosen as in 2016 the culture-dependent testing was replaced by culture independent. T-test was used to examine the difference in time to identification of the pathogen and time to prescription between 2015 and 2017. SAS 9.4 was used for the analysis.

Results

In 2015, 2,194 stool specimens were tested and 136 (6.2%) were positive. In 2017, 2,037 stool specimens were examined and 225 (11%) returned positive. The median time to prescription in 2015 was 53.84 hours in comparison to 21.96 hours in 2017 (P < 0.0001). The time to identification of the pathogen was 60.05 hours in 2015 vs. 22.53 hours in 2017 (P < 0.0001). The TAT (turnaround time), defined as the time from the specimen being received in the laboratory to the finalized result, was 167.92 hours vs. 156.35 hours, respectively (P = 0.75).

Conclusion

Multiplex PCR assays for enteric pathogens showed higher sensitivity when compared with standard culture-based methods. When the clinician felt antibiotics were indicated, there was a significantly shorter time to antibiotics prescription. Aside from a shorter time to microbial identification, molecular assays detect an increased number of pathogens from a single specimen that has an important impact on infection prevention and appropriate treatment.

Disclosures

All authors: No reported disclosures.
1129. Targeted Voriconazole Prophylaxis in Heart Transplantation Recipients
Authors: Lin Michael , Echenique Ignacio , Angarone Michael , Anderson Allen , Stosor Valentina
Published: November 2018

Background

The use of antifungal prophylaxis, targeted or universal, remains controversial and unstudied. The goal of this study is to determine the role of targeted voriconazole prophylaxis (VORI) in prevention of invasive fungal infections (IFI) after heart transplantation (HT).

Methods

We conducted a single-center, prospective, observational cohort study of 276 HT recipients from June 2005 to April 2017 to characterize the incidence and outcome of IFI following targeted VORI. Starting in June 2013, HT recipients with thymoglobulin (ATG) treatment received VORI for 3 months. Probable/proven IFI were defined by EORTC/MSG criteria. Descriptive frequencies and univariate analyses were performed.

Results

Mean duration of follow-up post-HT was 1,165 days (0–3,152 days). 149 (54%) and 70 (25%) received basiliximab and thymoglobulin induction, respectively. Thirty-one (11%) received VORI, following use of ATG in the setting of induction (68%) or rejection (32%). VORI was started at median of 6 days (0–1,008 days) post-HT for a mean duration of 97 days (5–251 days). Overall, 23 IFIs occurred in 23 recipients (8%) at mean 283 days post-HT (range 2–1,579 days), including seven Aspergillus (one occurring after VORI completion), seven invasive Candida (five with candidemia), two Rhizopus, one Cunninghamella, two histoplasma, two blastomyces, one Cryptococcus, and one multifocal cutaneous Alternaria.

Conclusion

Targeted VORI resulted in reduced incidences of both early and overall IFI after HT although this did not reach statistical significance. Since instituting this strategy, we have observed a single case of aspergillosis following VORI discontinuation. Overall and 1-year mortality were not impacted. The use of antifungal prophylaxis following HT requires continued investigation both to determine efficacy and toxicity in this patient population.

Disclosures

All authors: No reported disclosures.
1134. Novel T2Candida Panel Assay Compared With Blood Cultures for Detection of Candidemia in Transplant and Non-Transplant Patients
Authors: Hussain Noman , Chaudhry Zohra , Rizvi Hira , Abreu-Lanfranco Odaliz , Ramesh Mayur , Busto Ramon Del , Osborn Zachary , Alangaden George
Published: November 2018

Background

Blood culture (BC) the current “gold” standard for detection of candidemia has a sensitivity of ~50% and turnaround time (TAT) of 2–5 days. T2Candida Panel (T2) a magnetic resonance nano-diagnostic test done directly on blood samples detects C. albicans/C. tropicalis, C. krusei/C. glabrata, and C. parapsilosis. Clinical trials of T2 showed good sensitivity, specificity, NPV 99% and TAT of 3–5 hours. The performance of T2 in high-risk transplant (Tx) population is unknown. T2 was implemented at our institution in October 2015. We evaluated the performance characteristics of T2 and BC in our Tx and non-transplant (non-Tx) patient populations.

Methods

This was an observational, retrospective, cross-sectional evaluation of patients with suspected candidemia that had T2 done from October 2015 to October 2017 at a multihospital healthcare system in Detroit, MI. Performance characteristics of the T2 and BC in Tx and non-Tx patients were compared. BC obtained within 7 days before or after the T2 test were included in the analysis. TAT, sensitivity, specificity, PPV and NPV were calculated using positive BC as the standard. Differences between groups were assessed using two sample proportions testing at α = 0.05.

Results

A total of 1,272 patients with suspected candidemia had T2 done: 1,162 (91%) non-Tx and 110 (9%) Tx patients. Average TAT for T2 was 13 hours (5–41) vs. 34 hours (21–109) to initial positive BC result and 4 days (3–13) to species-specific BC result. In four non-Tx patients with negative T2, C. lusitaniae, C. dubliniensis, and C. kefyr were isolated in BC. Performance characteristics of T2 and BC in the two groups is shown (Table 1). Of the T2+/BC− cases (n = 102), 9% had retinitis and 9% had invasive candidiasis.

Conclusion

The rapid TAT, good sensitivity, and high NPV of T2 in Tx patients has clinical implications and can help support antifungal stewardship efforts in this population. The clinical significance of T2 positivity in the presence of negative BC needs further investigation.

Disclosures

G. Alangaden, T2 Biosystems: Speaker’s Bureau, Educational grant and Speaker honorarium.
1140. GATA2 Mutations Are Frequently Identified Among Patients With Myeloid Malignancies Who Develop Invasive Aspergillosis
Authors: Bold Tyler D , Cheng Matthew P , Vedula Rahul S , Marty Francisco M , Lindsley R Coleman
Published: November 2018

Background

Patients with myeloid malignancies are at risk of invasive aspergillosis (IA), a cause of significant morbidity and mortality. Identification of patients at higher risk for IA may help optimize prophylactic or preemptive treatment decisions. Molecular genetic testing used to risk-stratify and guide therapy for hematologic malignancies may also have applicability toward predicting infectious outcomes. The purpose of this study was to identify mutations that may increase risk for IA among patients with myeloid malignancies.

Methods

We identified patients cared for at Dana-Farber/Brigham and Women’s Cancer Center between March 1, 2015 and January 31, 2018 who were diagnosed with probable or proven IA during the treatment of myeloid malignancies including acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS). We reviewed pathogenic mutations detected by the Rapid Heme Panel (RHP), a clinical targeted next-generation sequencing panel of 95 recurrently mutated genes in hematologic malignancies.

Results

Twenty-four patients with myeloid malignancy (AML 20, MDS 4) were diagnosed with IA, 20 of whom (AML 17, MDS 3) had undergone genetic testing with the RHP at the time of their cancer diagnosis. We found that three of 20 patients (15%) had a pathogenic mutation in GATA2. All were missense mutations within the functional zinc-finger domains, including one resulting in an R398W amino acid change, one of the spectrum of germline mutations known to cause the primary immunodeficiency MonoMAC. Patients with GATA2 mutations in our cohort were ages 35–68 and variant allele fraction ranged from 16.3% to 49.7%, raising the possibility that both inherited and acquired GATA2 dysfunction could incur a similar infectious risk.

Conclusion

Mutations in GATA2, a gene associated with MonoMAC syndrome, were common among patients with myeloid malignancy who developed IA. These data suggest that personalized genetic analyses of patients with underlying hematologic malignancy may also be useful for assessment of infectious risk.

Disclosures

All authors: No reported disclosures.
1141. Microbial Assessment of Healthcare-Associated Pathogens on Various Environmental Sites in Patient Rooms After Terminal Room Disinfection
Authors: Kanamori Hajime , Rutala William , Gergen Maria , Sickbert-Bennett Emily , Anderson Deverick J , Sexton Daniel , Weber David ,   the CDC Prevention Epicenters Program
Published: November 2018

Background

Hospital room environmental surfaces can be contaminated with healthcare-associated pathogens even if terminal room cleaning/disinfection is implemented. We examined the microbiological burden on hospital room environmental sites after standard or enhanced terminal room disinfection.

Methods

Microbial data from the Benefits of Enhanced Terminal Room Disinfection Study were utilized. All patient rooms were randomly assigned to standard disinfection (Quaternary ammonium [Quat]) or an enhanced disinfection (Quat/ultraviolet light [UV-C], Bleach, or Bleach/UV-C). Microbiological samples were obtained using Rodac plates (25 cm2/plate) from 8 of 10 hospital room sites, including bed rail, over-bed table, supply/medicine cart, chair, side counter, linen hamper lid, sink, toilet seat, shower floor, and bathroom floor. The number of colony forming units (CFU) of four target epidemiologically important pathogens (EIP), including multidrug-resistant Acinetobacter, Clostridium difficile, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant enterococci, was counted. A total of 3,680 samples from 736 environmental sites in all 92 patient rooms (21 standard rooms and 71 enhanced rooms) were analyzed.

Results

Overall, the frequency of all environmental sites positive for EIP was 11% (84/736) in all rooms, 21% (36/168) in standard rooms, and 8% (48/568) in enhanced rooms (P < 0.001) (Figure 1). Environmental sites, other than the toilet seat, in standard rooms were likely to be more frequently contaminated with EIP than in enhanced rooms (P = 0.013 for overbed table, P = 0.010 for bed rail, and P > 0.05 for other sites each). Mean CFU of EIP per room was 19.2 in all rooms, 60.8 in standard rooms, and 6.9 in enhanced rooms (P = 0.006) (Figure 2). All sites in standard rooms tended to have higher mean counts than in enhanced rooms (P = 0.001 for overbed table, P = 0.001 for bed rail, P = 0.012 for side counter, and P > 0.05 for other sites each).

Conclusion

Our results demonstrate that an enhanced terminal room disinfection reduced microbial burden of healthcare-associated pathogens on environmental sites better than standard room disinfection. Environmental hygiene of touchable surfaces after terminal room cleaning using Quat needs to be improved.

Disclosures

W. Rutala, PDI: Consultant and Speaker’s Bureau, Consulting fee and Speaker honorarium. D. Weber, PDI: Consultant, Consulting fee.
1151. A Safer, More Effective Method for Cleaning and Disinfecting GI Endoscopic Procedure Rooms
Authors: Overholt Bergein , Reynolds Karen , Wheeler Donald
Published: November 2018

Background

Healthcare acquired infections are increasing. Current cleaning and disinfecting (C&D) methods subject staff to toxic chemicals and can be damaging to the facility. Hypochlorous acid (HOCl) is a disinfecting solution that is 80–200 times more effective than bleach in surface disinfection of bacteria yet is nontoxic to humans. The aim of this study was to determine whether HOCl is as effective as standard cleaning methods for C&D GI ambulatory surgery center (ASC) rooms as determined by ATP (adenosine triphosphate) measurements over a 2-week period.

Methods

Two similar GI ASCs, each with two procedure rooms, were studied. One ASC received postprocedure STANDARD C&D with quaternary ammonium compounds in nonwoven fabric for surface wiping of high touch areas followed by terminal benzalkonium chloride foam/spray on these areas. The second ASC received HOCl C&D using on-site freshly prepared HOCl, 1,000 ppm. Microfiber cloths semi-wet with HOCl were used for wiping surfaces for both C&D. In the HOCl rooms, after terminal manual wiping, misting with HOCl of the entire room was performed. Selected high touch area ATP testing was performed in all rooms before procedures in the AM and 10 minutes after terminal manual cleaning. In the HOCL rooms, testing was also performed 10 minutes after misting. High touch areas tested in each room included: endoscopic cart (three locations/cart), both gurney bed rails, computer mouse (two), working counters (two areas), light switch, door knob. ATP scores were compared within each site using analysis of means (ANOM).

Results

After terminal cleaning, the average ATP score in the HOCl CLEANING and DISINFECTING study arm was significantly lower than that for the STANDARD CLEANING and DISINFECTING rooms (P < 0.0017) (Figure 1). In evaluating the effect of the HOCl misting, the ATP scores in the HOCl rooms had a post cleaning, pre-misting average score of 2.7. The post misting average score was 1.7, showing that misting produced a further significant reduction (improvement) in ATP scores (P = 0.01).

Conclusion

HOCl cleaning and disinfection in GI ASCs is more effective than standard procedures in lowering ATP scores following endoscopic procedures in procedure rooms. HOCl terminal misting of the rooms further improves the cleaning and disinfecting results.

Disclosures

B. Overholt, HOCl Solutions: Shareholder, none to date.
1153. UV-C Technology Is an Effective Adjunct to Terminal Cleaning in Environmental Pathogen Reduction in a Tertiary Pediatric Hospital
Authors: Singh Prachi , Lucas Amanda , Singer Monica Nayakwadi
Published: November 2018

Background

Effective environmental surface cleaning plays a vital role in reducing transmission of hospital-acquired infections. There remains a paucity of data in the pediatric literature regarding environmental pathogen reduction utilizing UV-C light. The objective of this study was to evaluate the reduction of environmental pathogens using UV-C light (Clorox Optimum-UV) as an adjunct to terminal cleaning in a free-standing tertiary pediatric hospital.

Methods

Upon patient discharge, a subset of patient rooms were tested for pathogens. Surface swabs were collected from high touch surfaces (call button, telemetry monitor, door handle, flush handle of toilet, faucet, bed rail, phone, keyboard pad, mouse, side table, dresser, and light switch). After terminal cleaning of the room, per hospital protocol the Clorox Optimum-UV completed one or two cycles of 5 minutes each depending on the dimensions of the room. Post-UV-C surface swabs were obtained from the same high touch areas in the room. Total colony count was reported from each of the surfaces swabbed. Swabs were streaked onto non-selective agar and incubated at 30-35oC for 72–96 hours. Mean plate colony count was determined manually and reported as CFU/swab. Data analysis was performed in Minitab 18.1. Fisher least significant difference (LSD) test was used to describe the difference between total bacterial counts at each time point (Pre-clean: dirty room, Post-clean: pre-UV-C/post-terminal clean, Post-UV: post UV-C light cycle).

Results

Mean total colony counts prior to cleaning the room was 92.3 CFU (33 surfaces), Pre-UV-C light 45.6 CFU and post-UV-C light 5.8 CFU (64 surfaces). Total bacterial counts are represented in Graphs 1 and 2. Upon multivariate analysis, the time the sample was taken (preclean, postclean, or post-UV) was the single explanatory variable for the differences seen in the means of total bacterial counts (P = 0).

Conclusion

Our study demonstrates that UV-C disinfection is a highly effective adjunctive cleaning method with standard terminal cleaning to reduce bacterial burden from environmental surfaces.

Disclosures

A. Lucas, Clorox: Research Contractor, Grant recipient. M. Nayakwadi Singer, Clorox: Grant Investigator, Grant recipient.
1154. Comparison of Five Testing Modalities for the Assessment of Patient Environment Cleanliness
Authors: Salsgiver Elizabeth , Martin Elena , Callan Katrina , O’Hara Niamh B , Ounit Rachid , Westblade Lars F , Mason Christopher E , Simon Matthew S , Saiman Lisa , Furuya E Yoko , Calfee David P
Published: November 2018

Background

Microbial contamination of the patient environment has been associated with healthcare-associated infections. Objective assessment of environmental cleanliness is recommended by the CDC to identify improvement opportunities. Methods currently used to assess cleanliness and microbial dynamics differ in their sensitivity, specificity, cost, ease of use, and turnaround time. We compared five assessment methods to examine these characteristics.

Methods

The bedrail, overbed table, remote control, and toilet seat in occupied patient rooms were sampled and assessed with: adenosine triphosphate (ATP) luminescence technology (LT), Replicate Organism Detection And Counting (RODAC) plates, C diff Banana Broth™ (CDBB), conventional aerobic culture (CC) and antimicrobial susceptibility testing, and shotgun next-generation sequencing (NGS) and analysis using metagenomic software.

Results

One hundred forty surfaces from 35 rooms were sampled. Of 70 surfaces sampled by both ATP LT and RODAC, 42 (60%) had concordant “pass” or “fail” results. Of 28 discordant samples, 26 (93%) passed by RODAC but failed by ATP LT. CDBB testing identified Clostridioides difficile on two surfaces in one room; C. difficile was also identified by NGS in this room. NGS had 100% concordance with organisms identified by CC, and identified approximately 20 additional organisms not identified by CC per surface. 38% of organisms identified by NGS were potential pathogens, compared with 13% through CC. No correlations were found between the primary quantitative assessments (RODAC bacterial concentrations and ATP LT ATP concentrations) and quantitative components of CC (presence/absence of organisms) and NGS (read numbers).

Conclusion

ATP LT and RODAC plates both provide useful quantitative cleanliness data, although high ATP values did not always indicate the The presence of viable aerobic bacteria. CDBB may be a useful method for identifying C. difficile in the environment, but larger studies of the performance characteristics of CDBB are needed. CC and NGS provided useful organism identification information, but NGS had higher sensitivity for detecting potentially pathogenic organisms. The clinical implications of NGS results must be further studied and cost and technical expertise are important considerations.

Disclosures

N. B. O’Hara, Biotia: Board Member, Employee and Shareholder, Salary. L. F. Westblade, Accelerate Diagnostics: Grant Investigator, Grant recipient. Biomerieux: Grant Investigator, Grant recipient. Allergan: Grant Investigator, Grant recipient. Merck: Grant Investigator, Grant recipient.
1155. Excessive Movement, Unnecessary Contamination: Clostridium difficile Patients in the Hospital
Authors: Reese Sara , Knepper Bryan , Miller Amber , Young Heather
Published: November 2018

Background

The environmental contamination of Clostridium difficile in acute care hospital rooms is associated with increased risk of infection for subsequent patients. Patients that stay in a room following a patient with a C. difficile infection (CDI) have an increased risk of CDI compared with patients whose previous resident did not have CDI. The objective of this study was characterize the room movement of CDI patients in a Level 1 Trauma Medical Center.

Methods

A patient with CDI was defined as an inpatient with a positive C. difficile test through rapid serology, C. difficile polymerase chain reaction (PCR) or multiplex-stool PCR from March 2017 to March 2018. Patients were classified as either community-onset (CO, positive test <4 days after admission) or hospital-onset (HO, positive test ≥4 days after admission). Additionally, the number of rooms each CDI patient resided in during one admission following a positive C. difficile test was determined and the proportion of patients who stayed in one to two rooms or at least three rooms per visit was calculated.

Results

There were a total of 244 CDI patients identified (172: CO, 72: HO) between March 2017 and March 2018. The mean time from admission to positive test was 12.4 hours post-admission for CO-CDI patients and 251.1 hours for HO-CDI patients. Almost 40% of HO-CDI patients (36.1%, n = 72) stayed in at least three rooms during their hospital admission compared with <30% of CO-CDI patients (28.4%, n = 172).

Conclusion

The current state of room movement with CDI patients is suboptimal, resulting in increased infection risk for subsequent patients. A multi-faceted intervention to address this problem is essential to achieve an optimal goal of 1–2 rooms per hospital stay for a CDI patient. Quality improvement projects include (1) notification of patient movement to nursing leadership, (2) alerts to nursing supervisors of potential CDI patients before room transfer, and (3) earlier diagnosis of community-onset C. difficile.

Disclosures

All authors: No reported disclosures.
1159. Influenza Symptoms in Vaccinated Healthcare Workers in an H3N2-Dominant Season
Authors: Bartlett Allison , Ridgway Jessica P , Marrs Rachel , Henson Amanda M , Chu Vera , Enriquez Aurea , Murillo Cynthia , Runjo Demetria , Seguin Alexandra , Beavis Kathleen G , Guenette Caroline , Landon Emily
Published: November 2018

Background

Influenza vaccination of healthcare workers is an important component of keeping patients safe, but must be paired with exclusion of ill healthcare workers (HCW) from work. CDC recommends exclusion from work until afebrile for 24 hours, but not all HCW with influenza develop fever and may still be a risk for spreading. Half of HCW with influenza in an H1N1-dominant season (2013–2014) at our institution were afebrile.

Methods

From 1/31–4/24/18 (H3N2-dominant season), HCW with fever or cough were screened for influenza and respiratory syncytial virus by polymerase chain reaction of flocked nasopharyngeal swabs. Additional HCW were tested by their primary care providers. We collected influenza vaccination status and symptoms and calculated the proportion of influenza-positive HCWs with fever or cough. Infection control practitioners (ICPs) contacted each influenza-positive HCW to identify potential patient or HCW exposures 24 hours prior to symptom onset and offered oseltamivir prophylaxis to exposed patients and HCW.

Results

Of 186 HCW tested by UCM, 49 (26%) tested positive for influenza (35 with influenza A; 14 with influenza B) and 11 (6%) tested positive for RSV. Forty-eight HCW (98%) received influenza vaccination. Fever was reported in only 19 (54%) HCW with influenza A and three (21%) HCW with influenza B. Cough was present in the majority of HCW (34 (97%) with influenza A and 12 (86%) with influenza B). An additional 55 HCW were diagnosed with influenza by their primary care providers. ICPs performed contact investigations for 43 HCW who reported exposure to patients or other HCW between 24 hours before symptom onset through the time of diagnosis. Occupational medicine provided 138 courses of prophylactic oseltamivir to HCW.

Conclusion

Afebrile influenza illness is common; current workforce guidelines are insufficient to prevent exposure in the healthcare setting. Expanding employee influenza screening to include fever OR cough doubled the number influenza positive HCW identified. Despite excellent influenza vaccination rates, vigilance is critical to prevent influenza transmission in the hospital. HCW screening for influenza based on fever OR cough, exclusion from work, and identification of potential exposures can help keep patients and colleagues safe.

Disclosures

All authors: No reported disclosures.
1161. Infection Control After Debridement of Brucella melitensis Hardware Infection
Authors: Novack Amanda
Published: November 2018

Background

Brucellosis is the most common laboratory-acquired bacterial infection, according to the Centers for Disease Control and Prevention (CDC), despite the rare incidence of Brucellosis in the population at large. A 34-year-old man presented with pain and swelling of the left leg, where he had previously sustained an open tibia fracture 1 year prior. After the initial injury, he underwent four corrective surgeries (including bone graft and internal-fixation) and was asymptomatic for 6 months before these new symptoms developed. MRI revealed a 6.5 × 5.1 × 2.7 cm abscess and tibial osteomyelitis. Surgical staff performed an aggressive incision and drainage (I&D) with saucerization of the tibia, to treat what seemed to be a routine hardware infection. Five days later, tissue cultures grew Brucella melitensis. Upon further questioning, the patient described butchering a wild boar 10 days prior to symptom onset.

Methods

The CDC provides guidance on serological testing and post-exposure prophylaxis (PEP) for persons exposed to Brucella in the laboratory setting. Upon identification of this patient’s Brucella isolates, infection control staff identified all laboratory workers that met CDC criteria for “high risk” exposure, as well as other healthcare workers (HCW) exposed to aerosolized infectious material (including those workers in the operating room during pulse lavage of the abscess).

Results

Staff identified 34 HCW with presumed high-risk exposure, including 19 laboratory personnel, 13 operating room personnel, and two patient care technicians. Baseline serology was obtained on all 34 HCW, and PEP with rifampin and doxycycline was prescribed for each. Nine of the exposed employees changed PEP therapy due to intolerance, and follow-up serology was obtained on 32 of the 34 healthcare workers, with zero seroconversions found.

Conclusion

Brucellosis is a rare disease in clinical practice, so a high index of suspicion is necessary to enact appropriate precautions before widespread exposures. When exposure is identified after the fact, efficient protocols should be in place to identify all susceptible individuals. Due to the low infectious dose of Brucella melitensis, CDC guidance should be expanded to include aerosolizing procedures outside of the laboratory.

Disclosures

All authors: No reported disclosures.
LB14. Safety and Immunogenicity of High-Dose Quadrivalent Influenza Vaccine Administered by Intramuscular Route in Subjects Aged 65 Years and Older
Authors: Chang Lee-Jah , Meng Ya , Janosczyk Helene , Landolfi Victoria , Talbot H Keipp ,   QHD00013 Study Team
Published: November 2018

Background

Older adults (≥65 years of age) remain at increased risk of influenza because they do not respond to standard dose influenza vaccines as well as younger adults. A high dose, inactivated trivalent influenza vaccine, IIV3-HD, containing four times the antigen content (60 µg hemagglutinin per influenza strain) of standard-dose influenza vaccines has been available in the United States since 2010. Two distinct B influenza lineages (Victoria and Yamagata) have co-circulated for over a decade, making it difficult to predict which will predominate the next season. IIV4-HD has been developed to address the frequent influenza B strain mismatches by incorporating a strain from each B lineage. This pivotal Phase III study evaluated the safety and immunogenicity of IIV4-HD as compared with two IIV3-HD vaccines.

Method

A randomized, modified double-blind, multicenter study (NCT03282240) was conducted in 2670 healthy subjects in the United States, who were randomly assigned to receive IIV4-HD, a licensed IIV3-HD, or an IIV3-HD with the alternate B influenza strain. Using the hemagglutinin inhibition (HAI) assay at baseline and 28 days after vaccination, post-vaccination geometric mean titers and seroconversion rates were measured. Safety data were collected through 6 months post-vaccination.

Result

IIV4-HD was noninferior to the licensed IIV3-HD and the investigational IIV3-HD (containing the alternate B strain) for all four influenza strains as assessed by HAI GMTs and seroconversion rates. Moreover, IIV4-HD induced a superior immune response (HAI GMTs and seroconversion rates) compared with the immune response induced by the IIV3-HD that does not contain the corresponding B strain. Reactogenicity profiles were comparable across all study groups. Most unsolicited adverse events were of Grade 1 or Grade 2 intensity. One serious adverse event considered related by the Investigator was reported in the IIV4-HD group.

Conclusion

Vaccination of adults 65 years of age and older with IIV4-HD was found to be noninferior to two IIV3-HD vaccines with a similar safety profile. The addition of a second B lineage strain does not adversely affect the safety or immunogenicity profile of IIV4-HD compared with IIV3-HD.

Disclosures

L. J. Chang, Sanofi Pasteur: Employee, Salary. Y. Meng, Sanofi Pasteur: Employee, Salary. H. Janosczyk, Sanofi Pasteur: Employee, Salary. V. Landolfi, Sanofi Pasteur: Employee, Salary. H. K. Talbot, Sanofi Pasteur: Investigator, Research grant. Gilead: Investigator, Research grant. MedImmune: Investigator, Research grant. Vaxinnate: Safety Board, none. Seqirus: Safety Board, none.