bluuebunny/crossref_metadata_2025 huggingface dataset:
Outcomes of Extended-Spectrum Beta-Lactamase Gram-Negative Bacteremia Cases Treated With Carbapenem Versus Noncarbapenem Antibiotics
Authors: Chen Tara , Manogna Dharmini , Lenka Jyotirmayee , Hanna John , Lesho Emil , Laguio-Vila Maryrose
Published: November 2020

Background: The rising prevalence of infections caused by extended-spectrum β-lactamase (ESBL)–producing bacteria increases reliance on carbapenems, which intensifies selection pressure for the emergence of carbapenem-resistant Enterobacteriaceae (CRE). Whether noncarbapenem (nC) antibiotics can be safely used in this setting remains incompletely understood. Objective: To examine the safety of carbapenem stewardship in this population, we compared outcomes of uncomplicated ESBL bacteremia treated with a carbapenem to those treated with a noncarbapenem regimen. Methods: A retrospective chart review of patients with ESBL bacteremia from 2014 to 2018 in a 5-hospital regional health system was conducted. Patients aged <18 years, with polymicrobial bacteremia, whose infections required a prolonged length of antibiotic therapy (LOT), or who died on antibiotic treatment or transitioned to hospice, were excluded. Groups were stratified based on the antibiotic regimen with the highest number of treatment days during the treatment course. Outcome measures included empiric and definitive length of therapy (LOT), 30-day all-cause mortality, 90-day readmission, recurrence of ESBL bacteremia, hospital length of stay (LOS), incidence of Clostridioides difficile infection (CDI) and adverse drug events, obtained by Wilcoxon rank-sum testing, χ2 test, and Fisher exact test, as applicable. Results: In total, 112 unique patients had ESBL bacteremia; 42 were excluded, leaving 70 for analysis. Of these, 57 were treated with a carbapenem regimen and 13 patients were treated with a noncarbapenem regimen: 9 ciprofloxacin, 3 gentamicin, 1 TMP-SMX. Patient baseline and antibiotic regimen characteristics were similar (Table 1). The most common organism was E. coli, and the most common source was urinary. A similar proportion of each group received ESBL-active empiric antibiotics. There were no significant differences in total effective antibiotic LOT, 30-day all-cause mortality, 90-day readmission, or recurrence of ESBL bacteremia (Table 2). A nonsignificant trend in hospital LOS was observed in the noncarbapenem group (11 vs 6 days; P = .055). Conclusions: Although the sample size was small, these multicenter data suggest that noncarbapenem treatment of ESBL bacteremia may be safe and effective. Pending confirmatory studies, ESBL bacteremia may be an important target for carbapenem stewardship.

Funding: None

Disclosures: None
Outcomes of Patients With Hospital-Acquired Influenza
Authors: Campbell Melissa , James Amber , Fairweather Iyanna , Rivera-Vinas Jose , Kaslow Richard , Landry Marie-Louise , Peaper David , Martinello Richard
Published: November 2020

Background: Hospital-acquired influenza (HA flu) lacks a consensus definition. However, it is known to be associated with increased inpatient morbidity and mortality. Objective: To describe the clinical course of HA flu in a cohort population. Methods: A retrospective cohort study was conducted at a tertiary-care adult and pediatric teaching hospital. Patients with HA flu during 3 seasons, 2016 through 2019, were identified from medical record information based on timing of the onset of signs and symptoms and positive virologic testing >72 hours after admission. Influenza infection was confirmed by multiplex respiratory PCR, influenza A/B PCR, or direct fluorescent antibody tests. Chart review was performed to abstract patient demographics and comorbidities, length of stay, testing, and timing to antiviral administration as well as diagnosis of pneumonia, coinfections, and 30-day mortality. Escalation of care during hospitalization was defined as a new requirement of supplemental oxygen, invasive or noninvasive ventilation, and transfer to an intensive care unit. Results: During the 3 flu seasons, 132 patients were identified with HA flu; 76 (58%) were women, 6 (4.6%) were aged <18 years, and 126 (95.4%) were adults. Annually, HA-flu patients accounted for 5%–7.8% of all patients hospitalized with laboratory-proven influenza. The median duration between hospitalization and positive flu test was 15 days, and the median length of stay after influenza diagnosis was 6 days. Antiviral treatment was received by 96% of the patients. In total, 41 patients (31%) showed radiographic evidence for pneumonia. Coinfection with either a viral or bacterial pathogen was identified in 25% of the cases. In addition, 26% of the patients experienced an escalation of care, and 20 patients (15%) were transferred to the intensive care unit after HA flu diagnosis. Furthermore, 4 deaths (3%) were attributed to influenza during their hospitalization. Conclusions: HA flu was a frequent cause for escalation in care and was associated with a mortality rate substantially higher than is typically seen in community-based populations with influenza. Coinfection was mostly related to bacteremia and pneumonia, yet not all pneumonias had an associated microbiological diagnosis other than influenza, and there was no significant association between coinfection and mortality. Future work should explore more precise definitions for HA flu as well as its complications.

Funding: None

Disclosures: None
Outcomes of Rapid Identification of Bacteremia in Combination with Antimicrobial Stewardship Intervention
Authors: Bernardes Marilia , Formosa Julieth , Viotti Julia Bini , Febres-Aldana Anthony , Ratzan Kenneth
Published: November 2020

Background: Rapid diagnostic tests designed to provide bacterial identification and detection of resistance genes directly from positive blood cultures can significantly reduce the time to definitive results, ensuring appropriate and timely antibiotic administration while simultaneously decreasing antibiotic overuse and development of antimicrobial resistance. However, their impact on in-hospital mortality and length of stay (LOS) is yet to be fully assessed. Methods: We retrospectively reviewed bacteremia cases in patients hospitalized over a 6-month period before (n = 78) and after (n = 93) the implementation of Verigene bacterial nanoparticle testing. Exclusion criteria included age >90 years, bacteremia thought to be a contaminant, polymicrobial bacteremia, or hospice admission. Verigene was performed at a central laboratory from 6 a.m. to 11 p.m. Pharmacists notified physicians of results and assisted with antibiotic modifications. Patient demographics, time to organism identification, time to effective antimicrobial therapy, and other key clinical parameters were compared. The primary outcomes were in-hospital LOS, 14-day mortality, and 30-day mortality. Secondary outcomes included time to effective antibiotic therapy and intensive care unit (ICU) LOS. Results: Organism identification was achieved more quickly (4.9 hours vs 44.5 hours; P < .001) and effective antibiotic therapy was started earlier after Verigene implementation. The mean in-hospital LOS decreased from 13.15 days to 10.02 days (P = .0071) after the Verigene intervention, despite a higher mean Charlson comorbidity index among the cases. Mortality was similar between groups. Conclusions: Rapid identification of gram-positive and gram-negative bacteremia with an antimicrobial stewardship intervention can decrease time to effective antibiotic therapy and total LOS.

Funding: None

Disclosures: None
Passive Engineering Controls Result in Sustained 66% Reduction in Blood Culture Contamination
Authors: Baxter Monica , Cook Carolyn , James Angie
Published: November 2020

Background: Blood culture testing is an important diagnostic tool in identifying the presence of microbes in the bloodstream. Tests are frequently contaminated, leading to false-positive results. Blood culture contamination can result in unnecessary antibiotic treatment, extended hospital length of stay, and patient exposure to hospital-acquired conditions. Methods: St. Mary’s Regional Medical Center (SMRMC) in Russellville, Arkansas, struggled with blood-culture contamination rates, with an average of 6.8% from 2014 to 2018. Ongoing staff education yielded a reduction to an average of 5%. In an effort to reduce the contamination rates, our facility elected to try a novel specimen diversion device. Laboratory and emergency department (ED) staff were educated on the diversion device prior to the initiation of the trial period. Compliance with the diversion device averaged 70%–75% during the trial period. Monitoring of contaminations was added to our daily safety huddle to provide a quick turnaround time for false-positive education to specific clinical staff. Results: The results were significant, with a decrease in contamination rates from 4.93% to 1.66%—a 66% reduction. Improved blood culture testing has several advantages: best practice for patient care is first and foremost, along with other financial benefits for the facility. Several articles have estimated the cost of a contaminated culture to be $3,000–$10,000 per event; SMRMC has adopting an estimated cost of $4,000. The number of cultures at our hospital averages ~4,400 per year, and these results suggest a savings of >$500,000 per year (as contaminations on an annual basis fell from 217 to 73). With this intervention, 144 patients were spared from receiving unnecessary antibiotics as a result of a false-positive blood culture testing. Conclusions: We conducted a brief analysis to determine whether there was any obvious change in length of stay for patients with a false-positive blood culture compared to those with true negative results. In analyzing data for 3 different months, patients with contaminated cultures spent an average of 3.97 additional days in the facility. In conclusion, the implementation of this specimen diversion device significantly lowered our contamination rates, was integrated into practice, and has provided clinical and financial benefits.

Funding: None

Disclosures: None
Patients with Positive Glutamine Dehydrogenase (GDH) Antigen/Toxin and Toxin Negative/PCR Positive Patients: A Comparison
Authors: Chinn Raymond , Mabalot Shannon
Published: November 2020

Background: A multistep algorithm using GDH antigen plus toxin with a reflex PCR is an acceptable method for detecting CDI. The use of the PCR in discordant cases can identify those patients who are colonized from those patients who have nontoxogenic strains of C. difficile. Identification of discordant patients has infection prevention implications. Treatment is not recommended for patients colonized with C. difficile. Methods: A line listing of patients with positive hospital-onset antigen/toxin positive and discordant PCR positive was created. Demographic information was extracted from medical records and the 2 cohorts were compared. Results: There were 59 discordant and 44 positive cases HO CDI cases from October 2017 through September 2019: (1) There was no difference in age and sex between the 2 groups. (2) Positive patients tended to have 3 loose stools before and after testing (57% vs 27%; P = .026). (3) Overall, 82% of positive patients had 1 of 3 signs or symptoms (leukocytosis, abdominal pain, and temperature >38°C) consistent with CDI compared to 66% of discordant patients (P = .038), and 55% of positive patients were more likely to have 2 of 3 signs or symptoms of CDI compared to 17% of discordant patients (P = .00003). (4) Also, 46% of discordant patients were either on the oncology ward or ICU compared to 32% of positive patients (P = .764). (5) There was no difference between in discordant compared to positive patients in non-CDI antimicrobial therapy within 7 days of CDI test submission (81% vs 84%, respectively). Conclusions: (1) Screening for CDI testing should include 3 loose stools and at least 2 of 3 signs or symptoms of CDI. (2) Discordant cases most likely represents colonization because only 17% of discordant patients had 2 of 3 CDI signs or symptoms at presentation. (3) Discordant cases without clinical features of CDI should not receive treatment to minimize antibiotic exposure. (4) Identification of discordant patients have infection prevention ramifications because CD can be indirectly transmitted by colonized patients; therefore, using PCR in addition to toxin testing is favored. (5) Antimicrobial therapy highly associated with CDI should be avoided, should antimicrobial therapy be necessary in PCR-positive discordant patients.

Funding: None

Disclosures: None
Pattern Recognition Algorithms for Predicting Surgical Site Infection in Abdominal Hysterectomy
Authors: Souza Flávio , Couto Braulio , da Conceição Felipe Leandro Andrade , da Silva Gabriel Henrique Silvestre , Dias Igor Gonçalves , Rigueira Rafael Vieira Magno , Pimenta Gustavo Maciel , Martins Maurilio , Mendes Julio Cesar , Fagundes Amanda Martins , Escalda Beatriz Viana Ferreira , de Souza Isabela Marques , de Vasconcelos Laura Ferraz , Medeiros Maria Eduarda Rodrigues , de Almeida Thais Azevedo
Published: November 2020

Background: This research represents an experiment based in surgical site infection (SSI) to patients undergoing abdominal hysterectomy surgery procedures in hospitals in Belo Horizonte, (population, 3 million). We statistically evaluated such incidences and studied the SSI prediction power of pattern recognition algorithms, the artificial neural networks based in multilayer perceptron (MLP). Methods: Between July 2016 and June 2018, data on SSI were collected by the hospital infection control committees (CCIH) of the 3 hospitals involved in the research. They collected all data used in the analysis during their routine SSI surveillance procedures. The information was forwarded to the NOIS (Nosocomial Infection Study) Project, which used SACIH (ie, automated hospital infection control system software) to collect data from a sample of hospitals participating voluntarily in the project. After data collection, 3 procedures were performed for SSI prediction: (1) a treatment of the database collected for the use of intact samples; (2) a statistical analysis on the profile of the hospitals collected; and (3) an assessment of the predictive power of 5 types of MLP (ie, backpropagation standard, momentum, resilient propagation, weight decay, and quick propagation). MLPs were tested with 3, 5, 7, and 10 hidden-layer neurons and a database split for the resampling process (65% or 75% for testing, 35% or 25% for validation). They were compared by measuring area under the curve (AUC; range, 0–1) presented for each of the configurations. Results: From 1,166 records collected, only 665 records were enabled for analysis. Regarding statistical data: the average duration of surgery was 100 minutes (range, 31–180); patients were aged 41–49 years; the SSI rate was low (only 10 cases); the average length of stay was 2 days; and there were no deaths among the cases. Moreover, 29% of the operative sites were contaminated and 57% were potentially contaminated, revealing a high rate of potential contamination in the operative sites. The prediction process achieved 0.995. Conclusions: Despite the noise in the database, it was possible to obtain a relevant sampling to evaluate the profile of hospitals in Belo Horizonte. In addition, for the predictive process, although some settings achieved AUC results of 0.5, others achieved and AUC of 0.995, indicating the promise of the automated SSI monitoring framework for abdominal hysterectomy surgery (available in www.sacihweb.com). To optimize data collection and to enable other hospitals to use the SSI prediction tool, a mobile application was developed.

Funding: None

Disclosures: None
Perceptions of Antimicrobial Stewardship among Infectious Disease Physicians at Two Affiliated Teaching Hospitals
Authors: Rynkiewich Katharina , Schwartz David , Won Sarah , Stoner Brad
Published: November 2020

Background: Two affiliated teaching hospitals in Chicago, Illinois, participated in an ethnographic study of hospital-based inpatient antimicrobial stewardship programs and interventions between 2017 and 2018. Although antimicrobial stewardship is now a requirement in medical practice, it is not clear how infectious disease physicians perceive and understand antimicrobial stewardship. Over a period of 18 months, we directly observed infectious disease practice to better understand how antimicrobial stewardship is conducted among physicians within the same specialty. Methods: A doctoral candidate medical anthropologist conducted semistructured interviews with infectious disease attending physicians and fellow physicians (N = 18) at 2 affiliated teaching hospitals in Chicago, IL, between July 2017 and March 2018 as part of an ethnographic study involving direct observation of inpatient care. Interview questions focused on 3 key domains: (1) descriptions of antimicrobial use among hospital-based physicians, (2) solicited definitions of antimicrobial stewardship, and (3) experiences practicing as an infectious disease consultant. Physicians who were directly involved with the antimicrobial stewardship program were excluded from this analysis. Transcriptions of the data were analyzed using thematic coding aided by MAXQDA qualitative analysis software. Results: Infectious disease physicians have a robust understanding of antimicrobial stewardship (Table 1). Infectious disease physicians described other hospital-based physicians as regularly overusing and misusing antimicrobials, compared with their practice, which they described as “thoughtful.” Definitions in response to the question “What is antimicrobial stewardship?” centered on guiding the prescribing behavior of others. Infectious disease physicians valued stewardship and were concerned with lack of adherence to antimicrobial prescribing recommendations among other hospital-based physicians, behaviors which infectious disease physicians viewed as perpetuating antibiotic resistance. Finally, infectious disease physicians found serving as antimicrobial stewards during their everyday practice to be challenging based on their role as consultants to the primary service. Conclusions: Our qualitative analysis revealed that infectious disease physicians not regularly involved in antimicrobial stewardship are highly motivated stewards who perceive their hospital-based colleagues to be less effective at appropriately prescribing antimicrobials. As consultants, infectious disease physicians are not autonomous decision makers. However, as antimicrobial stewardship programs search for champions, infectious disease physicians could be better utilized as knowledgeable and motivated individuals who can make the case for stewardship.

Funding: None

Disclosures: None
Phylogenetic Analysis of Candida auris Isolates From Clinical Samples of Surgical Intensive Care Units
Authors: Warrier Anup , Wilson Arun
Published: November 2020

Background: Between January and September of 2019, 15 patients acquired Candida auris infection in our surgical intensive care unit (SICU). Although the outbreak was controlled by enhancing horizontal measures and a change of the environmental disinfectant from a quaternary ammonium compound to a peroxide-based product; we wanted to understand whether patient-to-patient spread was occurring or the environment was the major contributor. Methods: We submitted all the 15 isolates from clinical samples for WGS and phylogenetic analysis; along with operation theater (OT) and ICU environment random swabs for metagenomic analysis. DNA sample QC DNA extraction was done using a Qiagen QiAmp DNA mini kit (cat. no. 51306). The DNA samples were subjected to QIAXPERT and Qubit for quantifying the amount of DNA in the extracted sample. Also, the 260/280-nm ratio was examined for the purity of the same. They were also subjected for agarose gel electrophoresis. For the DNA library prep protocol, whole-genome libraries were prepared from 21 samples using NEBNext Ultra IITM DNA Library Prep Kit (Cat. No: E7645L). The adapter sequences were added to the ends of DNA fragments to generate paired-end libraries. The resulting adaptor-ligated libraries were purified and index tags were added by amplification, followed by purification. Libraries were assessed to check the quality and quantity using Agilent 2200 Tape station (cat. no. 3-PM 863NA). For the sequencing protocol, prepared libraries were quantified using Qubit High Sensitivity reagent. The obtained libraries were diluted to final concentration of 2 nm in 10 µL and were subjected to cluster amplification. Once the cluster generation was completed, the flow cells were loaded on to the sequencer. Sequencing was carried out in Hi Seq X10 to generate 2X150-bp sequence reads at >100X sequencing depth (~1.5 Gb). A minimum of 75% of the sequenced bases were of Q30 value. Sequenced data were processed to generate FASTQ files and were uploaded on the FTP server for download and secondary data analysis. Results: Overall, 2% of the DNA from the OT and SICU environment showed Candida auris. The phylogenetic analysis confirmed 2 different clusters. Furthermore, 13 of the clinical isolates belonged to the same cluster, confirming that patient-to-patient transmission had occurred, which was subsequently confirmed by line listing the patients. Conclusions:Candida auris can efficiently spread from patient to patient, resulting in outbreaks. It can also persist in the healthcare environment causing ongoing propagation of these outbreaks.

Funding: None

Disclosures: None
Practice Variation in Validation of Device Denominator Data for National Healthcare Safety Network Reporting
Authors: Challener Douglas , Sampathkumar Priya , O’Horo John O
Published: November 2020

Background: The NHSN is a widely used CDC program for tracking healthcare-associated infections (HAIs). The goal of the NHSN is to help healthcare organizations to identify and track the incidence of HAI and to prevent adverse events as well as to simplify mandatory quality reporting to the CMS. Healthcare organizations provide both event data for HAIs and information about the population at risk. For device-related infections, device denominator data (eg, data related to urinary or intravascular catheters, and ventilators) must be collected and reported. NHSN guidelines require that electronic reporting of device denominator numbers be validated to be within 5% of manually collected counts over a period of 3 consecutive months. Little is known about current practical application of validation practices. Methods: We surveyed members of the SHEA Research Network (SRN) to assess awareness of and compliance with the current NHSN requirements for device denominator data validation. Results: The survey was sent to 89 member institutions of the SRN from November 20, 2018, to December 12, 2018. The response rate was 35.7%, and 90% of respondents are currently using an electronic system for device denominator count reporting. All except 1 institution manually validated the data. Of the facilities that had completed validation, 31% used <90 days of manual data. Moreover, 82% of these facilities found a difference of <5% between the electronic data and manual data without a statistically significant difference between those with at least 90 days of validation data and those with <90 days. Also, 21% of facilities validated data based on a subset of units. Conclusions: Although most respondents to the survey validate electronically collected device denominator data in accordance with NHSN’s requirements, nearly one-third reported using shorter validation periods than NHSN requires. However, shorter periods were not associated with worse concordance. The NHSN should evaluate whether the burden of a 3-month validation period is justified.

Funding: None

Disclosures: None
Prescribing Pattern of Antibiotics among Children in a Tertiary-Care Hospital, Bangladesh
Authors: Chowdhury Sukanta , Sarker Rajib , Khan Md. Shafiqul Islam , Ghosh Probir Kumar , Tareq Md. Abu , Begum Musammet Rasheda
Published: November 2020

Background: The inappropriate and irrational use of antibiotics both in humans and animals causes bacterial resistance. Bacterial resistance is common in low- and middle-income countries, including Bangladesh. Bangladesh has very limited information on antibiotic use and associated resistance. We sought to better understand antibiotic use in low-resource settings for the development of effective strategies to address inappropriate antibiotic use. Methods: We conducted a cross-sectional study among hospitalized children <5 years of age in a tertiary-care hospital in Barishal, Bangladesh, to collect data on antibiotic use. We collected data from 400 children during February–April 2019. Results: Among these 400 children, >50% were aged <1 year, and >60% of these children were boys. The average hospital stay was 3 days (range, 1–14). Most of the children had history of diarrhea and 18% had pneumonia. Most children (82%) were prescribed antibiotics. A combined form of antibiotics was prescribed for 17% of these children. In total, 14 different antibiotics were used. The most commonly used antibiotic was ceftriaxone (57%) followed by azithromycin (14%). The parental route was mostly preferred (75%) for antibiotic administration. Conclusions: Antibiotic prescription was common in children aged <5 years visiting a tertiary-care hospital. Most of the prescribed antibiotics were broad spectrum, which can promote bacterial resistance. Further studies are needed to identify the factors associated with overuse of antibiotics and bacterial resistance in low-resource settings.

Funding: None

Disclosures: None
Preventing Transmission of Vaccine-Associated Viral Infections from a Patient With Severe Combined Immune Deficiency
Authors: Kamhuka Linda , Tremblay Isabelle , Lam-Li Debbie , LeMay Mireille , Favela Luis Murguia , Wright Nicola , Vayalumkal Joseph
Published: November 2020

Background: The transmissibility of vaccine-strain viruses from immunocompromised patients, such as those with severe combined immune deficiency (SCID) is unknown. The infection control management of a patient diagnosed with SCID and infected with vaccine-strain varicella zoster virus (VZV) and measles virus is described below. A previously healthy, full-term boy was vaccinated at 14 months with measles mumps rubella varicella (MMR) vaccine. He had received prior vaccinations, including rotavirus, without adverse effects. During the 6 weeks after vaccination, the patient developed signs and symptoms clinically consistent with chicken pox and measles. An immune work-up revealed SCID. Methods: The Alberta Health Services (AHS) SCID protocol was followed to manage the patient upon admission at 17 months of age. Multiple meetings with various stakeholders were held to ensure appropriate precautions were followed to minimize the risk of pathogen transmission. Results: The patient was placed on airborne and contact precautions in a negative-pressure room. The pressure differential of the room to the corridor was continually monitored and displayed at the entry to the room. Staff known to be immune to VZV or measles were not required to wear an N95 respirator. All intrahospital movement of the patient was coordinated with the respective care teams and departments, including infection prevention and control, facilities maintenance and engineering, respiratory therapy, and diagnostic imaging. A mask was placed on the patient when movement outside the room was required. VZV testing was positive for the Oka/vaccine strain on all samples tested (ie, nasopharyngeal, skin, blood, and cerebrospinal fluid). Nasopharyngeal swabs and blood were PCR positive for measles genotype A/vaccine strain virus. Both viruses were persistently positive in spite of treatment with acyclovir, valganciclovir, varicella zoster immune globulin, and intravenous immune globulin. Conclusions: There is currently no documented transmission of measles vaccine-strain virus, and transmission of VZV vaccine-strain virus is rare. According to the AHS SCID protocol, the use of airborne and contact precautions for a patient identified with measles and/or VZV supersedes the use of a positive-pressure room for patients identified with SCID. Newborn screening for SCID was implemented in Alberta in June 2019. As a result, more SCID patients will be diagnosed earlier in their course, and therefore prior to most routine vaccinations. However, newborn screening will not pick up some types of combined immune deficiencies. Some children may still be at risk of vaccine-associated illnesses due to undiagnosed underlying immune deficiencies.

Funding: None

Disclosures: None
Quality Improvement Measures to Reduce Central-Line–Associated Bloodstream Infections (CLABSIs) in a Neonatal Intensive Care Unit (NICU)
Authors: Anderson Tamika , Flood Michelle , Kelley Susan , Pugh Lea Ann , Casabar Renato , Sharma Mamta , Battjes Rebecca
Published: November 2020

Background: Central-line–associated bloodstream infections (CLABSIs) are a significant contributor to morbidity and mortality for neonates; they also increased healthcare costs and duration of hospitalization. This population is susceptible to infections because of their undeveloped immune systems, and they require intravenous access until they can tolerate enteral feedings, which for extremely premature infants can take several weeks (if not months) to achieve. Our hospital is a regional-referral teaching hospital with 772 licensed beds. The neonatal intensive care unit (NICU) is a level 3, 35-bed unit where the most critically ill neonates receive care. After a sustained 3-year period of zero CLABSIs, we identified 10 infections between September 2016 through April 2018. Methods: A multidisciplinary team known as the neonatal infection prevention team (NIPT) was reinstated. This team included members from nursing and infection prevention (IP) and from NICU Shared Governance, as well as a neonatal nurse practitioner (NNP) and a neonatologist to review these CLABSIs. Evidence-based practices, policies, and procedures were implemented to help reduce CLABSIs. Nurse educators provided education and training. The infection prevention team reinstated and modified the central-line maintenance and insertion tools to document compliance and to identify any gaps in care. Nurses were expected to document line maintenance once per shift (a.m. and p.m.). All CLABSIs were entered into the CDC NHSN and the hospital’s safety event reporting system, which required follow-up by a clinical manager. The infection prevention team monitored NHSN standardized infection ratios (SIRs) monthly. The SIR is the number of observed events divided by the number predicted (calculated based on national aggregate data). Results: The highest reported quarterly SIR was 1.423, which occurred in the third quarter of 2018 (Fig. 1). Overall compliance with line maintenance protocols was 86% on the morning shift and 89% on the afternoon shift. With implementation of an evidence-based bundle, the NICU had a rolling 12-month SIR of 0.00 as of October 2019. Conclusions: Multidisciplinary team development, implementation of evidence-based bundle elements, and education on catheter care contributed to the long-term success in decreasing CLABSI rates in our NICU. Although this implementation achieved a zero CLABSI rate, we experienced some barriers, including compliance issues with staff not completing the audit tools, staff turnover, and high patient census.

Funding: None

Disclosures: None
Quantitative Characterization of High-Touch Surfaces in Emergency Departments and Hemodialysis Facilities
Authors: Wang Tina , Barofsky Alana , Simon Matthew , Saiman Lisa , Furuya E. Yoko , Calfee David
Published: November 2020

Background: The healthcare environment can serve as a reservoir for many microorganisms and, in the absence of appropriate cleaning and disinfection, can contribute to pathogen transmission. Identification of high-touch surfaces (HTS) in hospital patient rooms has allowed the recognition of surfaces that represent the greatest transmission risk and prioritization of cleaning and disinfection resources for infection prevention. HTS in other healthcare settings, including high-volume and high-risk settings such as emergency departments (EDs) and hemodialysis facilities (HDFs), have not been well studied or defined. Methods: Observations were conducted in 2 EDs and 3 HDFs using structured observation tools. All touch episodes, defined as hand-to-surface contact regardless of hand hygiene and/or glove use, were recorded. Touches by healthcare personnel, patients, and visitors were included. Surfaces were classified as being allocated to individual patients or shared among multiple patients. The number of touch episodes per hour was calculated for each surface to rank surfaces by frequency of touch. Results: In total, 28 hours of observation (14 hours each in EDs and HDFs) were conducted. 1,976 touch episodes were observed among 62 surfaces. On average, more touch episodes were observed per hour in HDFs than in EDs (89 vs 52, respectively). The most frequently touched surfaces in EDs included stretcher rails, privacy curtains, visitor chair arm rests and seats, and patient bedside tables, which together accounted for 68.8% of all touch episodes in EDs (Fig. 1). Frequently touched surfaces in HDFs included both shared and single-patient surfaces: 27.8% and 72.2% of HDF touch episodes, respectively. The most frequently touched surfaces in HDFs were supply cart drawers, dialysis machine control panels and keyboards, handwashing faucet handles, bedside work tables, and bed rail or dialysis chair armrests, which accounted for 68.4% of all touch-episodes recorded. Conclusions: To our knowledge, this is the first quantitative study to identify HTSs in EDs and HDFs. Our observations reveal that certain surfaces within these environments are subject to a substantially greater frequency of hand contact than others and that a relatively small number of surfaces account for most touch episodes. Notably, whereas HTSs in EDs were primarily single-patient surfaces, HTSs in HDFs included surfaces shared in the care of multiple patients, which may represent an even greater risk of patient-to-patient pathogen transmission than single-patient surfaces. The identification of HTSs in EDs and HDFs contributes to a better understanding of the risk of environment-related pathogen transmission in these settings and may allow prioritization and optimization of cleaning and disinfection resources within facilities.

Funding: None

Disclosures: None
Real-Time Identification of Patients Included in the CMS Bundled Payment Care Improvement (BPCI) Program
Authors: Korvink Michael , Martin John , Long Michael
Published: November 2020

Background:
The Bundled Payment Care Improvement Program is a CMS initiative designed to encourage greater collaboration across settings of care, especially as it relates to an initial set of targeted clinical episodes, which include sepsis and pneumonia. As with many CMS incentive programs, performance evaluation is retrospective in nature, resulting in after-the-fact changes in operational processes to improve both efficiency and quality. Although retrospective performance evaluation is informative, care providers would ideally identify a patient’s potential clinical cohort during the index stay and implement care management procedures as necessary to prevent or reduce the severity of the condition. The primary challenges for real-time identification of a patient’s clinical cohort are CMS-targeted cohorts are based on either MS-DRG (grouping of ICD-10 codes) or HCPCS coding—coding that occurs after discharge by clinical abstractors. Additionally, many informative data elements in the EHR lack standardization and no simple and reliable heuristic rules can be employed to meaningfully identify those cohorts without human review. Objective: To share the results of an ensemble statistical model to predict patient risks of sepsis and pneumonia during their hospital (ie, index) stay. Methods: The predictive model uses a combination of Bernoulli Naïve Bayes natural language processing (NLP) classifiers, to reduce text dimensionality into a single probability value, and an eXtreme Gradient Boosting (XGBoost) algorithm as a meta-model to collectively evaluate both standardized clinical elements alongside the NLP-based text probabilities. Results: Bernoulli Naïve Bayes classifiers have proven to perform well on short text strings and allow for highly explanatory unstructured or semistructured text fields (eg, reason for visit, culture results), to be used in a both comparative and generalizable way within the larger XGBoost model. Conclusions: The choice of XGBoost as the meta-model has the benefits of mitigating concerns of nonlinearity among clinical features, reducing potential of overfitting, while allowing missing values to exist within the data. Both the Bayesian classifier and meta-model were trained using a patient-level integrated dataset extracted from both a patient-billing and EHR data warehouse maintained by Premier. The data set, joined by patient admission-date, medical record number, date of birth, and hospital entity code, allows the presence of both the coded clinical cohort (derived from the MS-DRG) and the explanatory features in the EHR to exist within a single patient encounter record. The resulting model produced F1 performance scores of .65 for the sepsis population and .61 for the pneumonia population.

Funding: None

Disclosures: None
Reduction in Methicillin-Resistant Staphylococcus aureus (MRSA) Surveillance in a Low-Prevalence Neonatal Intensive Care Unit Does Not Lead to Increase in Vancomycin Utilization
Authors: Shapiro Craig , Ravin Karen , Chan Shannon , Gable Maura , Gupta Ashish
Published: November 2020

Background:
Methicillin-resistant Staphylococcus aureus (MRSA) infection in neonates is associated with significant morbidity, mortality, and hospital cost. Multiple studies have shown that these infections are often preceded by colonization, but no consensus has been established for MRSA surveillance. The impact of changing the surveillance strategy on vancomycin utilization has not been evaluated previously. Methods: Retrospective chart review of infants who underwent MRSA screening in a level IV NICU with all outborn neonates. A weekly surveillance PCR was obtained from the nares between July 2016 and June 2017 (phase 1) and only on admission and discharge between July 2017 and June 2018 (phase 2). Patients with a positive PCR were placed on contact precautions without decolonization. The χ2 test was performed to compare the 2 phases of screening, and the Student t test and the Fisher exact test were used to compare the characteristics of MRSA colonized infants. Vancomycin utilization was measured in days of therapy (DOT) per 1,000 NICU patient days. Results: In total, 689 infants underwent MRSA screening during the study period; 324 infants had weekly MRSA surveillance and 365 infants had screening at admission and discharge. There was no statistically significant difference in MRSA colonization rates (4.3% vs 3.0%) or MRSA colonization acquisition (negative to positive, 1.8% vs 1.0%) between the phases. Among MRSA-colonized patients, nearly 60% were colonized on admission. Nearly 40% of the infants became colonized with MRSA during their hospitalization, none of whom developed MRSA infections prior to discharge. Mean vancomycin utilization decreased from 38.55 to 30.16 DOT per 1,000 NICU patient days between the 2 study periods. Conclusions: In a level IV NICU with relatively low MRSA prevalence, the change in MRSA screening practice from weekly surveillance to surveillance upon admission and discharge demonstrated no difference in MRSA acquisition or infection. Overall vancomycin utilization also decreased during this period, suggesting a culture shift around antibiotic utilization. Further study is needed to evaluate the utility of MRSA screening, decolonization, and isolation practices in low-prevalence NICUs and to identify additional drivers of vancomycin utilization.

Funding: None

Disclosures: None
Reduction of Central-Line–Associated Bloodstream Infections in a Spinal Cord Injury Unit
Authors: Baer Stephanie L. , Larsh Amy Halcyon , Prunier Annalise , Thurmond Victoria , Goins Donna , Hickox Nancy , Gardenhire Mary , Walker Tiffany , Bernal Sarah , Nowacki Maryea , Griffin Lenora , Hunter-Watson Heather
Published: November 2020

Background: Central-line–associated bloodstream infections (CLABSIs) are a complication of indwelling central venous catheters, which increase morbidity, mortality, and cost to patients. Objective: Due to increased rates in a spinal cord injury unit (SCIU), a performance improvement project was started to reduce CLABSI in the patient population. Methods: To reduce the incidence of CLABSI, a prevention bundle was adopted, and a peer-surveillance tool was developed to monitor compliance with the bundle. Staff were trained to monitor their peers and submit weekly surveillance. Audits were conducted by the clinical nurse leader with accuracy feedback. Bundle peer-surveillance was implemented in February of 2018 with data being fed back to leadership, peer monitors, and stakeholders. Gaps in compliance were addressed with peer-to-peer education, changes in documentation requirements, and meetings to improve communication and reduce line days. In addition, the use of an antiseptic-impregnated disc for vascular accesses was implemented for dressing changes. Further quality improvement cycles during the first 2 quarters of fiscal year 2019 included service-wide education reinforcement, identification in variance of practice, and reporting to staff and stakeholders. Results: CLABSI bundle compliance increased from 67% to 98% between February and October 2018. The weekly audit reporting accuracy improved from 33% to 100% during the same period. Bundle compliance was sustained through the fourth quarter of 2019 at 98%, and audit accuracy was 99%. The initial CLABSI rates the quarter prior to the intervention were 6.10 infections per 1,000 line days for 1 of the 3 SCIUs and 2.68 infections per 1,000 line days for the service overall. After the action plan was initiated, no CLABSIs occurred for the next 3 quarters in all SCIUs despite unchanged use of central lines (5,726 line days in 2018). The improvement was sustained, and the line days decreased slightly for 2019, with a fiscal year rate of 0.61 per 1,000 line days (ie, 3 CLABSIs in 4,927 central-line days). Conclusions: The incidence of CLABSI in the SCIU was reduced by an intensive surveillance intervention to perform accurate peer monitoring of bundle compliance with weekly feedback, communication, and education strategies, improvement of the documentation, and the use of antiseptic-impregnated discs for dressings. Despite the complexity of the patient population requiring long-term central lines, the CLABSI rate was greatly impacted by evidence-based interventions coupled with reinforcement of adherence to the bundle.

Funding: None

Disclosures: None
Macroporosity and Grain Density of Rubble Pile Asteroid (162173) Ryugu
Authors: Grott Matthias , Biele Jens , Michel Patrick , Sugita Seiji , Schröder Stefan , Sakatani Naoya , Neumann Wladimir , Kameda Shingo , Michikami Tatsuhiro , Honda Chikatoshi
Published: November 2020

Rubble pile asteroids such as (162173) Ryugu have large bulk porosities, which are believed to result from void spaces in between the constituent boulders (macroporosity) as well as void spaces within the boulders themselves (microporosity). In general, both macroporosity and microporosity are estimated based on comparisons between the asteroid bulk density and both the bulk and grain density of meteorite analogs, and relatively large macroporosities are usually obtained. Here we use semiempirical models for the macroporosity of multicomponent mixtures to determine Ryugu's macroporosity based on the observed size‐frequency distribution (SFD) of boulders on the surface. We find that Ryugu's macroporosity can be significantly smaller than usually assumed, as the observed SFD allows for an efficient packing of boulders, resulting in a macroporosity of 16% ± 3%. Therefore, we confirm that Ryugu's high bulk porosity is a direct consequence of a very large boulder microporosity. Furthermore, using estimates of boulder microporosity of around 50% as derived from in situ measurements, the average grain density in boulders is 2,848 ± 152 kg m–3, similar to values obtained for CM and the Tagish lake meteorites. Ryugu's bulk porosity corresponding to the above values is 58%. Thus, the macroporosity of rubble pile asteroids may have been systematically overestimated in the past.
Food or just a free ride? A meta-analysis reveals the global diversity of the Plastisphere
Authors: Wright Robyn J , Langille Morgan G I , Walker Tony R
Published: November 2020

It is now indisputable that plastics are ubiquitous and problematic in ecosystems globally. Many suggestions have been made about the role that biofilms colonizing plastics in the environment—termed the “Plastisphere”—may play in the transportation and ecological impact of these plastics. By collecting and re-analyzing all raw 16S rRNA gene sequencing and metadata from 2,229 samples within 35 studies, we have performed the first meta-analysis of the Plastisphere in marine, freshwater, other aquatic (e.g., brackish or aquaculture) and terrestrial environments. We show that random forest models can be trained to differentiate between groupings of environmental factors as well as aspects of study design, but—crucially—also between plastics when compared with control biofilms and between different plastic types and community successional stages. Our meta-analysis confirms that potentially biodegrading Plastisphere members, the hydrocarbonoclastic Oceanospirillales and Alteromonadales are consistently more abundant in plastic than control biofilm samples across multiple studies and environments. This indicates the predilection of these organisms for plastics and confirms the urgent need for their ability to biodegrade plastics to be comprehensively tested. We also identified key knowledge gaps that should be addressed by future studies.
Genomics and metatranscriptomics of biogeochemical cycling and degradation of lignin-derived aromatic compounds in thermal swamp sediment
Authors: Levy-Booth David J , Hashimi Ameena , Roccor Raphael , Liu Li-Yang , Renneckar Scott , Eltis Lindsay D , Mohn William W
Published: November 2020

Thermal swamps are unique ecosystems where geothermally warmed waters mix with decomposing woody biomass, hosting novel biogeochemical-cycling and lignin-degrading microbial consortia. Assembly of shotgun metagenome libraries resolved 351 distinct genomes from hot-spring (30–45 °C) and mesophilic (17 °C) sediments. Annotation of 39 refined draft genomes revealed metabolism consistent with oligotrophy, including pathways for degradation of aromatic compounds, such as syringate, vanillate, p-hydroxybenzoate, and phenol. Thermotolerant Burkholderiales, including Rubrivivax ssp., were implicated in diverse biogeochemical and aromatic transformations, highlighting their broad metabolic capacity. Lignin catabolism was further investigated using metatranscriptomics of sediment incubated with milled or Kraft lignin at 45 °C. Aromatic compounds were depleted from lignin-amended sediment over 148 h. The metatranscriptomic data revealed upregulation of des/lig genes predicted to specify the catabolism of syringate, vanillate, and phenolic oligomers in the sphingomonads Altererythrobacter ssp. and Novosphingobium ssp., as well as in the Burkholderiales genus, Rubrivivax. This study demonstrates how temperature structures biogeochemical cycling populations in a unique ecosystem, and combines community-level metagenomics with targeted metatranscriptomics to identify pathways with potential for bio-refinement of lignin-derived aromatic compounds. In addition, the diverse aromatic catabolic pathways of Altererythrobacter ssp. may serve as a source of thermotolerant enzymes for lignin valorization.