bluuebunny/crossref_metadata_2025 huggingface dataset:
693. Performance of ICD Code Versus Discharge Summary based Query for Endocarditis Cohort Identification
Authors: Nina Kim H , Gupta Ayushi , Lan Kristine F , Stewart Jenell C , Dhanireddy Shireesha , Corcorran Maria A
Published: December 2021

Background

Studies on infective endocarditis (IE) have relied on International Classification of Diseases (ICD) codes to identify cases but few have validated this method which may be prone to misclassification. Examination of clinical narrative data could offer greater accuracy and richness.

Methods

We evaluated two algorithms for IE identification from 7/1/2015 to 7/31/2019: (1) a standard query of ICD codes for IE (ICD-9: 424.9, 424.91, 424.99, 421.0, 421.1, 421.9, 112.81, 036.42 and ICD-10: I38, I39, I33, I33.9, B37.6 and A39.51) with or without procedure codes for echocardiogram (93303-93356) and (2) a key word, pattern-based text query of discharge summaries (DS) that selected on the term “endocarditis” in fields headed by “Discharge Diagnosis” or “Admission Diagnosis” or similar. Further coding extracted the nature and type of valve and the organism responsible for the IE if present in DS. All identified cases were chart reviewed using pre-specified criteria for true IE. Positive predictive value (PPV) was calculated as the total number of verified cases over the algorithm-selected cases. Sensitivity was the total number of algorithm-matched cases over a final list of 166 independently identified true IE cases from ID and Cardiology services. Specificity was defined using 119 pre-adjudicated non-cases minus the number of algorithm-matched cases over 119.

Results

The ICD-based query identified 612 individuals from July 2015 to July 2019 who had a hospital billing code for infective endocarditis; of these, 534 also had an echocardiogram. The DS query identified 387 cases. PPV for the DS query was 84.5% (95% confidence interval [CI] 80.6%, 87.8%) compared with 72.4% (95% CI 68.7%, 75.8%) for ICD only and 75.8% (95% CI 72.0%, 79.3%) for ICD + echo queries. Sensitivity was 75.9% for the DS query and 86.8-93.4% for the ICD queries. Specificity was high for all queries >94%. The DS query also yielded valve data (prosthetic, tricuspid, pulmonic, aortic or mitral) in 60% and microbiologic data in 73% of identified cases with an accuracy of 94% and 90% respectively when assessed by chart review.

Table 1. Test Characteristics of Three Electronic Health Record Queries for Infective Endocarditis

Conclusion

Compared to traditional ICD-based queries, text-based queries of discharge summaries have the potential to improve precision of IE case ascertainment and extract key clinical variables.

Disclosures

All Authors: No reported disclosures
702. Risk Factors for Acute Gastroenteritis Among Patients Hospitalized in 5 Veterans Affairs Medical Centers, 2016–19
Authors: Balachandran Neha , Cates Jordan , Kambhampati Anita , Marconi Vincent , Brown Sheldon T , Rodriguez–Barradas Maria C , Beenhouwer David , Holodniy Mark , Lucero-Obusan Cynthia A , Cardemil Cristina , Parashar Umesh D , Mirza Sara
Published: December 2021

Background

In the United States, an estimated 179 million acute gastroenteritis (AGE) episodes occur each year. Identifying factors contributing to AGE susceptibility and severity is important to address the high disease burden of AGE among adults. The primary objective of this analysis was to identify risk factors for all-cause AGE, norovirus-associated AGE and severe AGE among hospitalized adults.

Methods

We analyzed data from 1029 inpatient AGE cases and 624 non-AGE controls enrolled prospectively from December 1, 2016 – November 30, 2019 from 5 Veterans Affairs Medical Centers (Atlanta, Bronx, Houston, Los Angeles, Palo Alto). Standardized patient interviews and medical chart abstractions were conducted to collect demographics, exposure history, and underlying medical conditions. Stool samples from participants were tested for 22 pathogens using the BioFire Gastrointestinal Panel. Severity of AGE was determined using a 20-point modified Vesikari score (MVS) and severe AGE was defined as a MVS score of ≥ 11. Multivariate logistic regression was performed to assess associations between potential risk factors and outcomes.

Results

Of the total AGE cases, 551 (54%) had severe AGE; 44 (4%) were norovirus positive. Risk factors for all-cause AGE vs. non-AGE controls included household contact with a person with AGE in the past 7 days (aOR=2.9, 95% CI:1.3-6.7), severe renal disease (aOR=3.1, 95% CI:1.8-5.2), human immunodeficiency virus (HIV) (aOR=3.9, 95% CI:1.8-8.5), and immunosuppressive therapy (aOR=5.6, 95% CI:2.7-11.7). Factors associated with norovirus positivity by univariate analysis were contact with a person with AGE outside (OR=4.4, 95% CI:1.6-12.0) and within (OR=5.0, 95% CI:2.2-11.5) the household in the past 7 days. Detection of any viral pathogen (aOR=4.0, 95% CI:1.7-9.5) was a risk factor for severe AGE.

Conclusion

Our findings suggest that inpatients with HIV or severe renal disease, on immunosuppressive therapy, or in contact with a person with AGE within household are at higher risk for all-cause AGE. Patients with these medical conditions should be monitored for AGE related hospitalizations and may benefit from targeted AGE prevention messaging.

Disclosures

Vincent Marconi, MD, Bayer (Consultant, Scientific Research Study Investigator)Eli Lilly (Consultant, Scientific Research Study Investigator)Gilead Sciences (Consultant, Scientific Research Study Investigator)ViiV (Consultant, Scientific Research Study Investigator)
706. Effect of the Covid-19 Pandemic on Rates of Recurrent Clostridiodes difficile Infection in the Veterans Affairs System
Authors: Drekonja Dimitri M , Zhang Jane , Reinink Andrew R , Anway Ruth , Nugent Sean , Shaukat Aasma
Published: December 2021

Background

Clostridiodes difficile infection (CDI) is common and classified as an urgent threat by the US Centers for Disease Control and Prevention. Recurrence (rCDI) occurs in 30% of cases and increases with subsequent episodes. As part of a trial of fecal microbiota transplantation vs. placebo for the prevention of rCDI, rCDI is identified using a case-finding algorithm that screens for potential cases across all Veterans Affairs facilities, a key component of which is a stool test confirming the presence of C. difficile. With the emergence of Covid-19 in the Unites States in early 2020, study personnel observed a decreasing number of rCDI cases. We hypothesized that Covid restrictions and fear of transmission prevented patients from coming to a VA facility to submit a confirmatory stool sample, the standard method of diagnosing rCDI. Accordingly, the algorithm was modified to also identify cases where rCDI was empirically treated, without confirmatory testing. Here we report on the prevalence of empiric treatment of rCDI during the Covid pandemic and changes in lab-conformed cases over time.

Methods

Cases of potentially rCDI are identified by a weekly query of VA data, using an algorithm that includes laboratory testing results, diagnostic codes, and prescriptions. The ource database is updated daily from every VA facility, encompassing over 8 million Veterans. Potential cases are reviewed by research coordinators using the medical record to determine study eligibility. Beginning June 2020, the algorithm was adjusted to also identify patients with lab confirmation of their first CDI episode but none for their recurrence and identified those who were prescribed treatment for rCDI.

Results

We observed a reduction in both the number of weekly cases (22.2 vs. 17.4; P < 0.001) which is a 22% decrease after the Covid-19 emergency declaration (figure). Post-declaration, empiric treatment was prescribed to 159 Veterans (mean, 3.3/week).

Potential cases of rCDI/week pre- and post Covid-19 pandemic declaration

Conclusion

There was a significant drop in laboratory-confirmed rCDI associated with Covid-19. Recurrent CDI was frequently empirically treated during the Covid-19 pandemic, potentially exposing many patients with non-CDI diarrhea to unnecessary antimicrobial use and its attendant risks.

Disclosures

All Authors: No reported disclosures
711. A Unique Breath Secondary Metabolite Volatile Signature for the Diagnosis of Histoplasmosis
Authors: Leon Armando R , Koshy Seena , Perez Pablo , Garcia Sucely , Sandoval Nancy , Marty Francisco M , Samayoa Johanna , Koo Sophia
Published: December 2021

Background

Histoplasmosis is a common endemic fungal infection in the Americas, causing significant morbidity and mortality, particularly in immunocompromised patients. Existing diagnostic methods are limited in their sensitivity (especially in pulmonary histoplasmosis) and turnaround time.

Methods

We examined prospectively collected breath samples from 84 patients with suspected histoplasmosis 3/2019 - 2/2020 at Hospital Roosevelt (HR; Guatemala City, Guatemala, n = 56) and suspected invasive fungal disease 1/2018 - 10/2019 at Brigham and Women’s Hospital (BWH; Boston, MA, USA, n = 28) using thermal desorption gas chromatography-tandem mass spectrometry (TDU-GC-MS/MS). Patients were evaluated for histoplasmosis and other infections according to the local standard of care – of note, 18/56 patients at HR did not have Histoplasma urine antigen testing.

Results

Median age was 44 years, 60 (71%) were male, 23 (27%) had HIV, 15 (18%) had hematologic malignancy. 7 patients were diagnosed with histoplasmosis over the study period (4 at HR, 5 at BWH), with a clinical syndrome + positive Histoplasma urine or serum antigen test, with some patients also having yeast forms on tissue biopsy. 3 patients had disseminated and 4 pulmonary histoplasmosis. 4 patients with histoplasmosis had co-infections – 2 tuberculosis (TB), 1 influenza, and 1 Pneumocystis jirovecii (PJP) pneumonia. 4 patients were receiving antifungal therapy active against Histoplasma at the time of their first breath sample. We found 3 sesquiterpenes: (A) cyperene, (B) 1R,4aR,8aR)-2,5,5,8a-Tetramethyl-4,5,6,7,8,8a-hexahydro-1H-1,4a-methanonaphthalene, and (C) viridiflorol in patients with histoplasmosis, that distinguished these patients from those with other pneumonia (TB, coccidioidomycosis, invasive aspergillosis, mucormycosis, PJP, bacterial pneumonia) with 100% sensitivity and 70% (95% CI 59, 80) specificity.

Figure 1. TDU GC-MS/MS spectral comparison in histoplasmosis vs. the other invasive mycoses aspergillosis or mucormycosis. A: Cyperene; B: (1R,4aR,8aR)-2,5,5,8a Tetramethyl-4,5,6,7,8,8a-hexahydro-1H-1,4a-methanonaphthalene; C: viridiflorol; D: 1H-Indene, 2,3,3a,4-tetrahydro-3,3a,6-trimethyl-1-(1-methylethyl)-; E: β-funebrene; F: trans-α-bergamotene; G: eremophilene; H: spathulenol; I: cedrene; J: cedranoxide, 8,14-

Conclusion

Conclusion: Patients with histoplasmosis have a unique secondary metabolite breath signature that can be used for the noninvasive diagnosis of pulmonary and disseminated histoplasmosis. Many patients in this cohort did not undergo urine antigen testing or other diagnostic workup for histoplasmosis, which may have affected our specificity estimates.

Disclosures

Francisco M. Marty, MD, SCYNEXIS, Inc. (Scientific Research Study Investigator)
727. Predictors of Depressive Symptoms in Pregnant Partners in Seroconcordant Couples Living with HIV in Zambézia Province, Mozambique
Authors: Sack Daniel , Matino Ariano , Erin Graves , Emilio Almiro , Shepherd Bryan , DeSchacht Caroline , Audet Carolyn
Published: December 2021

Background

Depression contributes to HIV treatment outcomes in sub-Saharan Africa, where approximately 15% of people living with HIV have comorbid depression. HoPS+, a cluster randomized trial among seroconcordant couples living with HIV, assesses male partner involvement during antenatal HIV care and HIV outcomes. We describe predictors of depressive symptoms among pregnant partners living with HIV in Zambézia Province, Mozambique.

Methods

This baseline cross-sectional analysis includes 1079 female HoPS+ participants. We show demographic (age, enrollment date, relationship status, education, and occupation) and clinical (WHO HIV stage, body mass index [BMI], and antiretroviral therapy [ART] use history) factors. We model females’ depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]) using proportional odds models with continuous covariates as restricted cubic splines (enrollment date, age, BMI, partner’s PHQ-9 score), categorical covariates (district, relationship status, education, occupation, WHO stage), and ART use history. Missing covariates were imputed 20 times.

Results

Participants’ median age was 23 (interquartile range [IQR] 20-28). Most women reported no or < 7 years of education (84.1%), were farmers (61.3%), and were WHO stage I (81.9%). They had a median PHQ-9 score of 3 (IQR 0-5) and 47 (43.6%) had moderately severe or severe depressive symptoms, with 19.6% missing PHQ-9 scores. Among 867 pregnant partners with PHQ-9s, demographic and clinical covariates were not meaningful predictors of PHQ-9 score. Male partner’s PHQ-9 score, however, was associated with (covariate-adjusted Spearman’s rho 0.58, 95% Confidence Interval [CI]: 0.51-0.65) and strongly predictive of a pregnant partner’s score (Figure). An increase in a male partner’s PHQ-9 score from 9 to 10 was associated with 1.47 times increased odds (95% CI: 1.37-1.58) of a ≥1-point increase in a woman’s PHQ-9 score

Figure: Female Partner's Depressive Symptoms

Conclusion

Depressive symptoms are highly correlated among pregnant people and their partners, which may have implications for pregnancy care. Interventions aimed to reduce depressive symptoms and improve HIV-related outcomes during pregnancy may have greater success when focused on addressing both partners’ depressive symptoms.

Disclosures

All Authors: No reported disclosures
747. Association of Clostridiodes difficile Infection Incidence With Renewed Vigor in Infection Prevention Practices With the Onset of the COVID-19 Pandemic
Authors: Khan Ahmed A , Waqar Sana
Published: December 2021

Background

Clostridioides difficile is the leading cause of hospital associated infections. In 2017 it lead to an estimated 223,900 cases, 12,800 deaths and &1 billion in attributable healthcare costs.[1] Judicious use of antibiotics and good hand hygiene practices form the cornerstone of prevention. During the COVID-19 pandemic there has been a focus on infection control practices such as hand hygiene, which would also lead to decreased incidence of other contagious infections such as C. difficile diarrhea.

Methods

We looked at the incidence of C. difficile infection in a tertiary care hospital, 1 year before and 1 year after the start of the COVID-19 pandemic. We looked at the absolute number of hospital associated C. difficile infections and the rate per 1000 patient days. The testing methodology changed during the time of the study. Initially it included NAAT for C. difficile, however in March of 2020 the testing strategy included testing for GDH antigen and toxin A/B to differentiate between infection and asymptomatic colonization.

Results

From January 1st and December 31st 2019 there were a total of 182 C. difficile infections with a rate of 1.29% per 1000 patient days. Between January 1st and December 31st 2020 there were a total of 51 C. difficile infections with a rate of 0.39% per 1000 patient days. There was an absolute risk reduction of 0.9% and relative risk reduction of 69.7%. Hand hygiene audits did not show a difference in adherence between the two periods, with a compliance rate of 98% for both.

Conclusion

Our data suggests that there was a substantial reduction in C. difficile infection rate after widespread knowledge of COVID-19 and implementation of enhanced infection prevention strategies. These included frequent reminders of hand washing, gowning and social distancing to name some. This information was conveyed in the form of widely disseminated signs in highly visible areas, frequent reminders electronically and in person between staff and providers. There are limitations in our study, which include difficulty in longitudinally assessing the extent to which patient care providers adhered to infection prevention strategies and a change in testing strategy for C. difficile diagnosis during this time.

Disclosures

All Authors: No reported disclosures
753. Impact of COVID-19 on Healthcare Facility-Onset Clostridiodes difficile Infection
Authors: Suleyman Geehan , Khansa Rafa , Mayur Ramesh , Brar Indira , Kenney Rachel
Published: December 2021

Background

It is estimated that the majority of hospitalized COVID-19 patients around the world received antibiotics despite the fact that bacterial co-infections are rare. This can lead to increased antimicrobial resistance and Clostridioides difficile infections (CDI). Gastrointestinal symptoms of COVID-19 may also contribute to increased testing. The objective of this study was to assess the impact of the COVID-19 pandemic on our healthcare facility-onset (HO) CDI rates.

Methods

This was a retrospective cross-sectional study comparing CDI rate per 1,000 patient days, C. diff order rate per 1,000 patient days, Standardized Antimicrobial Administration Ratio (SAAR), and Standardized Infection Ratio (SIR) in the pre-COVID-19 period from January 1, 2019 to December 31, 2019 to the COVID-19 period from April 1, 2020 to March 31, 2021 at a 877-bed tertiary care hospital in Detroit, Michigan. CDI and order rates were extracted from the electronic medical record (Epic™ Bugsy). SAAR and SIR data were extracted from National Healthcare Safety Network (NHSN).

Results

The average CDI rate per 1,000 patient days was 4.29 pre-COVID-19 compared to 1.98 during COVID-19 with a 54% reduction, and the C. diff order rate per 1,000 patient days also decreased from 130.89 to 93.03, resulting in a 29% reduction (Figure 1). The SIR was 0.383 compared to 0.308 during COVID-19 (P-value 0.404). SAAR decreased from 1.095 to 0.945 (P-value < 0.001). However, our institution experienced three COVID-19 waves, with peaks in April 2020, November 2020 and March 2021, that correlated with high risk CDI antibiotic utilization in intensive care unit (ICU) (Figure 2). The average hand hygiene rate increased from 82% to 92%.

Figure 1. Clostridioides difficile order and infection rates pre-and during COVID-19 pandemic.

Figure 2. Standardized Antimicrobial Administration Ratio (SAAR) pre-and during COVID-19 pandemic.

Conclusion

Despite the COVID-19 pandemic, the HO-CDI and C. diff order rates and overall SAAR decreased; however, antibiotic utilization increased in the ICU during the COVID-19 waves. The overall decrease may be multifactorial and related to increased hand hygiene compliance, isolation and personal protective equipment use and overall decreased antibiotic use and C. diff orders.

Disclosures

Rachel Kenney, PharmD, Medtronic, Inc. (Other Financial or Material Support, spouse is an employee and shareholder)
758. Increased Prevalence of Clostridioides difficile Infection During the COVID-19 Pandemic Among Hospitalized Veterans in South Texas, USA
Authors: Young Eric H , Beck Erica , Ford Delvina , Madrid-Morales Julieta , Hoffman Ann , Cadena-Zuluaga Jose , Frei Alexa , Reveles Kelly R
Published: December 2021

Background

Clostridioides difficile infection (CDI) continues to be a major global public health concern, particularly during the ongoing SARS-CoV-2 coronavirus disease 2019 (COVID-19) pandemic. Despite new social distancing guidelines and enhanced infection control procedures (e.g., masking, hand hygiene) being implemented since the beginning of COVID-19, little evidence indicates whether these changes have influenced the prevalence of CDI hospitalizations. This study aims to measure CDI prevalence before and during the COVID-19 pandemic in a local cohort of U.S. Veterans.

Methods

This was a cross-sectional study of all Veterans presenting to the South Texas Veterans Health Care System in San Antonio, Texas from Jan 1, 2019 to Apr 30, 2021. Monthly laboratory confirmed CDI events were collected overall and categorized as the following: hospital-onset, healthcare facility-associated (HO-HCFA-CDI), community-onset, healthcare facility-associated CDI (CO-HCFA-CDI), and community-associated CDI (CA-CDI). Monthly confirmed COVID-19 cases were also collected. CDI prevalence was calculated as CDI events per 10,000 bed days of care (BDOC) and was compared between pre-pandemic (Jan 2019-Feb 2020) and pandemic (Mar 2020-Apr 2021) periods.

Results

A total of 285 CDI events, 920 COVID-19 cases, and 104,220 BDOC were included in this study. The overall CDI rate increased from 20.33 per 10,000 BDOC pre-pandemic to 34.51 per 10,000 during the pandemic (p< 0.0001). This was driven primarily by a rise in CO-HCFA-CDI rates (0.95 vs 2.52 per 10,000 BDOC; p< 0.0001) during the pandemic, followed by increases in CA-CDI (15.58 vs. 18.61 per 10,000 BDOC; p< 0.0001) and HO-HCFA-CDI (2.66 vs. 5.43 per 10,000 BDOC; p< 0.0001). Lastly, CDI rates have tripled since the start of the pandemic (March-Apr 2020) compared to the current year (March-Apr 2021) (14.69 vs. 43.76 per 10,000 BDOC).

Conclusion

Overall, CDI prevalence increased during the COVID-19 pandemic, driven mostly by an increase in CO-HCFA-CDI. As COVID-19 rates increased, CDI rates also increased, likely due to greater healthcare exposures and antibiotic use. Continued surveillance of COVID-19 and CDI is warranted to further decrease infection rates

Disclosures

All Authors: No reported disclosures
768. Gaining Compliance-Getting Results
Authors: Staton Sharon , Dejean Janet
Published: December 2021

Background

Compliance with the chlorhexidine gluconate (CHG) daily application component of the CLABSI prevention bundle potentially could negatively affect infection rates. In an attempt to increase CHG compliance, a 3-month trial for soap based CHG bathing was undertaken on two pediatric oncology units with long term central line patients.

Methods

The current bathing process involved 2 steps, a soap and water bath followed one hour later by a CHG wipe. It was time consuming and received complaints from staff and parents resulting in lower documented compliance rates. A one step process was implemented combining skin cleansing and CHG application with one product.

Staff, parents and patients were educated on proper bathing technique. Instruction brochures printed in multiple languages were employed and discussed for education. An electronic survey was developed to collect parent feedback.

Results

The trial was from October - December 2020 and included 25 select patients in the cancer center. Patients and parents provided positive feedback with the new process.

Audits measured both line maintenance and bathing. If one step was missed-than non- compliance with the bundle was noted . Bundle adherence increased with auditors noting that this was due entirely to an increase in bathing compliance. From April to September 2020 prior to implementation of the soap based CHG bathing, CHG compliance on the Stem Cell Transplant Unit (SCTU) averaged 48%. During the three month period after the trial, CHG compliance has averaged 64%. CHG monthly compliance reached 85% by April 2021. In addition, patients compliant with CHG bathing demonstrated a significant reduction in coagulase negative staphylococcus (CoNS ) blood stream infections due to the reduction of CoNS skin colonization. Cost analysis for the one week in the 15 bed BMT unit and 10 HemONC patients showed that the one step soap based CHG was &161.50 and the CHG wipe cost &960,75; a difference of &799.25per week or &41,561.00 annually.

Conclusion

Any infection prevention strategy needs to involve staff and parents for compliance and outcome success.

Disclosures

All Authors: No reported disclosures
792. Outbreak of Multidrug-resistant Pseudomonas aeruginosa in a Tertiary Healthcare System in Detroit
Authors: Evans Kenisha J , Cruz Angela Beatriz , Meyer Monica , Jabbo Lavina , Cranis Mara , Cullen Lori , Moshos Judy , Chopra Teena , Chopra Teena
Published: December 2021

Background

Pseudomonas aeruginosa is one of the most common causes of healthcare-associated infections in critically ill patients and those with suboptimal immunity. However, the development of multidrug resistant Pseudomonas aeruginosa (MDR Pa) creates an even great disease burden and threat to both the hospital and local community health. The purpose of this study is to illustrate a descriptive analysis of a cluster of MDR Pseudomonas, during a local surge of SARS-CoV-2 (COVID 19) pandemic. The goal is to shed more light on the troublesome parallel during outbreaks, such as COVID-19 and consequential secondary outcomes.

Methods

From November 2020 through February 2021, 16 patients exposed to the intensive care units of a tertiary healthcare system were infected or colonized with a multidrug-resistant strain of P. aeruginosa (Figure 1). Outbreak investigation was conducted via retrospective chart review of the first eight cases and prospective analysis of the latter eight cases. The isolates collected prospectively were analyzed for taxonomic identification, antimicrobial resistance profile, and phylogenetic analysis. Clinical characteristics of all patients were collected, and epidemiological investigation was carried out. MDR is defined as resistance to at least four classes of antibiotics: third-generation cephalosporins, fluoroquinolones, aminoglycosides, and carbapenems.

Figure 1. Epidemiological Curve of Cases of Multidrug-resistant Pseudomonas aeruginosa in the Detroit Medical Center from November 2020-February 2021

Results

Of the 16 cases of MDR Pa infections, seven died within five months (Table 1). Antimicrobial resistance gene profiling detected blaOXA and blaPAO betalactamase genes in all the samples. One sample contained an additional blaVIM resistance gene, although this patient was colonized and not actively infected. The analysis suggests existence of two clusters demonstrating relatedness and possible horizontal transmission. Timing of this cluster of cases coincides with surge of COVID-19 cases. This highlights the importance of infection control measures and antimicrobial stewardship.

Table 1. Characteristics of patients infected with multidrug-resistant Pseudomonas aeruginosa (MDR-Pa) at Detroit Medical Center, November 2020 to February 2021

Conclusion

Since early 2017 studies show there is a growing prevalence worldwide in transferable resistance, particularly for β-lactamases and carbapenemases, MDR Pseudomonas. This study emphasizes an irony paralleled during a pandemic, the needed efforts to prevent unintentional lapses in patient safety.

Disclosures

All Authors: No reported disclosures
795. A Bayesian Spatial-temporal Modelling Approach for Prevalence Estimation of a VRE Outbreak in a Tertiary Care Hospital
Authors: Atkinson Andrew , Ellenberger Benjamin , Endrich Olga , Kaspar Tanja , Hardegger Maria , Steiger Walter , Piezzi Vanja , Leichtle Alexandra , Marschall Jonas
Published: December 2021

Background

There was a nosocomial outbreak of vancomycin-resistant enterococci (VRE) in our hospital group from 2018-19. The goals of the study were to describe the prevalence trajectory and explore risk factors associated with putative room colonization during the outbreak.

Methods

We performed a room centric analysis of 12 floors (floors F to R, 264 rooms) of the main bed tower of the hospital, including data on 37’458 patients (23’050 person weeks) over the 104 week period. Patients were assumed to be colonized in the week prior to their first positive test, and thereafter throughout the remainder of their stay until discharge. Poisson Bayesian Hierarchical models were fitted to estimate prevalence per room, including both spatial (conditional autoregressive) and temporal (random walk) random effects terms. Model M1 estimated prevalence for each floor and then used meta-analysis to combine the estimates, whereas model M2 estimated prevalence for “all-floors” simultaneously.

Results

The oncology department, where the outbreak was thought to have started, experienced slightly higher prevalence (floors O and R; adjusted incidence rate ratio (aIRR) 4.8 [2.6, 8.9], p< 0.001; reference is general medicine; see Figure Panel A), as did both the cardiac surgery (floors G, N, O; aIRR 3.8 [2.0, 7.3], p< 0.001) and abdominal surgery departments (floors H and Q; 3.7 [1.8, 7.6], p< 0.001). There was no discernible difference in prevalence between floors with single and multiple department occupancy. Furthermore, departments spread across multiple floors had similar prevalence on all constituent floors – perhaps indicating transmission by people or devices moving between floors.

The “single floor meta-analysis” model (M1) more closely followed the estimated trajectory for the crude prevalence, whereas the “all floors” model (M2) dampened the amplitude of the peaks somewhat, but better estimated periods of low prevalence (Figure Panel B).

Figure: Estimates from the Bayesian Hierarchical Models

Panel A. Random effect prevalence estimates for each floor (from model M2). Panel B. Crude prevalence (black) and estimates from the “single floor meta-analysis” approach (M1, dashed red) with 95% credible intervals shaded (shaded red), and “all-floors” model (M2, blue ).

Conclusion

We applied a room centric approach that took into account spatial and temporal dependencies apparent in the nosocomial VRE outbreak. Despite additional complexity, Bayesian Hierarchical Models provide a more flexible platform for studying transmission dynamics and performing hypothesis testing, compared to more traditional methods.

Disclosures

All Authors: No reported disclosures
797. Infection Prevention and Control Training Needs and Preferences Among Frontline Health Professionals
Authors: Stream Sarah , Salman Ashraf M , Fadul Nada , German Dan K , Soma Mounica , Tyner Kate , Cortes-Penfield Nicolas W , Cortes-Penfield Nicolas W
Published: December 2021

Background

In 2020, the Nebraska Infection Control Assessment and Promotion program began collaborating with the Nebraska Department of Health and Human Services (NE DHHS) and the CDC to distribute infection prevention and control (IPC) training to frontline healthcare professionals (HCPs), focusing on nursing assistants (NAs), dentists, and other groups not traditionally targeted by IPC training. We conducted a learning needs assessment of these workers to plan high-yield curricula for each group.

Methods

We distributed an online survey to Nebraska’s frontline HCPs via local professional society email lists and the NE DHHS’s weekly newsletter. The survey asked respondents to identify their professional role, practice setting (urban vs suburban vs rural), preferred sources and formats of training, and perceived need for additional training across multiple IPC topics.

Results

456 HCPs completed our survey, including 177 NAs, 72 nurses, and 59 dentists; most HCPs practiced in a rural setting (62%). HCPs viewed the CDC as the most trustworthy source of IPC training (92% trusted, vs 71% for local health authorities, 64% for professional societies, and 43% for academic institutions); versus other respondents, NAs had substantially lower trust in all groups except the CDC. Respondents were more often interested in self-paced learning (63%) or interactive discussion with experts (53%) versus peer discussions (40%) or lectures (34%). Compared with other respondents, dentists were least interested in peer discussions (27%) and NAs in lectures (15%). Triage and screening was the only IPC training topic a majority of all respondents (51%) requested, though majorities of nurses (58%) and dentists (51%) also wanted training on environmental cleaning. Hand hygiene (12%) and personal protective equipment use (27%) were the least requested IPC topics, especially among NAs (5% and 18%).

Conclusion

Nebraska’s frontline healthcare workers express high confidence in the CDC as a source of IPC training and prefer self-paced and expert discussion learning modalities. Key between-group differences indicate that individualizing curricula for NAs, dentists, and other HCPs may improve IPC training quality.

Disclosures

M. Salman Ashraf, MBBS, Merck & Co. Inc (Grant/Research Support, I have recieved grant funding for an investigator initiated research project from Merck & Con. Inc. However, I do not see any direct conflict of interest related to the submitted abstract) Nicolas W. Cortes-Penfield, MD, Nothing to disclose
A Randomized, Placebo-Controlled Trial Assessing the Effect of VISBIOME ES Probiotic in People With HIV on Antiretroviral Therapy
Authors: Presti Rachel M , Yeh Eunice , Williams Brett , Landay Alan , Jacobson Jeffrey M , Wilson Cara , Fichtenbaum Carl J , Utay Netanya S , Dube Michael P , Klingman Karin L , Estes Jacob D , Flynn Jacob K , Loftin Amanda , Brenchley Jason M , Andrade Adriana , Kitch Douglas W , Overton Edgar T
Published: December 2021

Background

A5350, a phase II, randomized, double-blind study, evaluated the safety and tolerability of the probiotic Visbiome Extra Strength (ES) over 24 weeks and measured effects on inflammation and intestinal barrier function.

Methods

The primary outcome was change in soluble CD14 (sCD14) levels; secondary outcomes included safety and tolerability, markers of inflammation and cellular activation, and microbiome. In a substudy, gut permeability was assessed by paired colonic biopsies measuring the area of lamina propria occupied by CD4+ cells, interleukin (IL)-17+ cells, and myeloperoxidase (MPO). Changes between arms were compared with the 2-sample t test with equal variance or the Wilcoxon rank-sum test. For safety, the highest graded adverse events (AEs) were compared between arms using the Fisher exact test.

Results

Overall, 93 participants enrolled: 86% male, median age 51 years, median CD4 count 712 cells/mm3. Visbiome ES was safe and well tolerated. There was no difference in mean change in sCD14 from baseline to week 25/26 between placebo (mean change, 92.3 µg/L; 95% CI, –48.5 to 233 µg/L) and Visbiome ES (mean change, 41.0 µg/L; 95% CI, –94.1 to 176.2 µg/L; P=.60). Similarly, no statistically significant differences between arms in inflammatory marker changes were identified. In substudy participants, no statistical differences between arms for change in cellular marker expression or gut permeability were observed (P>.05 for all). The microbiome demonstrated increased probiotic species and a significant decrease in Gammaproteobacteria (P=.044) in the Visbiome ES arm.

Conclusions

Visbiome ES was safe and altered the microbiome but demonstrated no effect on systemic inflammatory markers, pathology, or gut permeability in antiretroviral therapy–treated people with HIV.
The Chlamydomonas bZIP transcription factor BLZ8 confers oxidative stress tolerance by inducing the carbon-concentrating mechanism
Authors: Choi Bae Young , Kim Hanul , Shim Donghwan , Jang Sunghoon , Yamaoka Yasuyo , Shin Seungjun , Yamano Takashi , Kajikawa Masataka , Jin EonSeon , Fukuzawa Hideya , Lee Youngsook
Published: December 2021

Photosynthetic organisms are exposed to various environmental sources of oxidative stress. Land plants have diverse mechanisms to withstand oxidative stress, but how microalgae do so remains unclear. Here, we characterized the Chlamydomonas reinhardtii basic leucine zipper (bZIP) transcription factor BLZ8, which is highly induced by oxidative stress. Oxidative stress tolerance increased with increasing BLZ8 expression levels. BLZ8 regulated the expression of genes likely involved in the carbon-concentrating mechanism (CCM): HIGH-LIGHT ACTIVATED 3 (HLA3), CARBONIC ANHYDRASE 7 (CAH7), and CARBONIC ANHYDRASE 8 (CAH8). BLZ8 expression increased the photosynthetic affinity for inorganic carbon under alkaline stress conditions, suggesting that BLZ8 induces the CCM. BLZ8 expression also increased the photosynthetic linear electron transfer rate, reducing the excitation pressure of the photosynthetic electron transport chain and in turn suppressing reactive oxygen species (ROS) production under oxidative stress conditions. A carbonic anhydrase inhibitor, ethoxzolamide, abolished the enhanced tolerance to alkaline stress conferred by BLZ8 overexpression. BLZ8 directly regulated the expression of the three target genes and required bZIP2 as a dimerization partner in activating CAH8 and HLA3. Our results suggest that a CCM-mediated increase in the CO2 supply for photosynthesis is critical to minimize oxidative damage in microalgae, since slow gas diffusion in aqueous environments limits CO2 availability for photosynthesis, which can trigger ROS formation.
Study of the Unit-3 nuclear reactor of Fukushima Daiichi by cosmic muon radiography
Authors: Fujii Hirofumi , Hara Kazuhiko , Hayashi Kohei , Kakuno Hidekazu , Kodama Hideyo , Nagamine Kanetada , Sato Kotaro , Kim Shin-Hong , Suzuki Atsuto , Sumiyoshi Takayuki , Takasaki Fumihiko , Tanaka Shuji , Yamashita Satoru , Mizokami Shinya , Yamada Daichi
Published: December 2021

We have investigated the status of the nuclear debris in the Unit-3 nuclear reactor of the Fukushima Daiichi nuclear power plant by the method called cosmic muon radiography. We used the same telescope system which was used to study the Unit-2 reactor. As in the previous studies, we succeeded in identifying the inner structure of the reactor, such as the containment vessel and other structures of the reactor complex, through the thick concrete wall of the reactor building. We evaluated the amount of material remaining in the fuel loading zone, and conclude that most of the original fuel materials have melted and dropped from the loading zone.
Diagonal reflection symmetries, four-zero texture, and trimaximal mixing with predicted θ13 in an A4 symmetric model
Authors: Yang Masaki J S
Published: December 2021

In this paper, we impose a magic symmetry on the neutrino mass matrix mν with universal four-zero texture and diagonal reflection symmetries. Due to the magic symmetry, the Maki–Nakagawa–Sakata matrix inevitably has trimaximal mixing. Since the lepton sector has only six free parameters, the physical observables of leptons are all determined from the charged lepton masses mei, the neutrino mass differences $\Delta m_{i1}^{2}$, and the mixing angle θ23. This scheme predicts sin θ13 = 0.149, which is almost equal to the latest best fit, as a function of the lepton masses me, μ and the mass differences $\Delta m_{i1}^{2}$. Moreover, even if the mass matrix has perturbations that break the magic symmetry, the prediction of sin θ13 is retained with good accuracy for the four-zero texture with diagonal reflection symmetries.
Role and Regulation of Poly-3-Hydroxybutyrate in Nitrogen Fixation in Azorhizobium caulinodans
Authors: Crang Nick , Borah Khushboo , James Euan K. , Jorrín Beatriz , Green Patrick , Tkacz Andrzej , East Alison K. , Poole Philip S.
Published: December 2021

An Azorhizobium caulinodans phaC mutant (OPS0865) unable to make poly-3-hydroxybutyrate (PHB), grows poorly on many carbon sources and cannot fix nitrogen in laboratory culture. However, when inoculated onto its host plant, Sesbania rostrata, the phaC mutant consistently fixed nitrogen. Upon reisolation from S. rostrata root nodules, a suppressor strain (OPS0921) was isolated that has significantly improved growth on a variety of carbon sources and also fixes nitrogen in laboratory culture. The suppressor retains the original mutation and is unable to synthesize PHB. Genome sequencing revealed a suppressor transition mutation, G to A (position 357,354), 13 bases upstream of the ATG start codon of phaR in its putative ribosome binding site (RBS). PhaR is the global regulator of PHB synthesis but also has other roles in regulation within the cell. In comparison with the wild type, translation from the phaR native RBS is increased approximately sixfold in the phaC mutant background, suggesting that the level of PhaR is controlled by PHB. Translation from the phaR mutated RBS (RBS*) of the suppressor mutant strain (OPS0921) is locked at a low basal rate and unaffected by the phaC mutation, suggesting that RBS* renders the level of PhaR insensitive to regulation by PHB. In the original phaC mutant (OPS0865), the lack of nitrogen fixation and poor growth on many carbon sources is likely to be due to increased levels of PhaR causing dysregulation of its complex regulon, because PHB formation, per se, is not required for effective nitrogen fixation in A. caulinodans.

[Formula: see text] Copyright © 2021 The Author(s). This is an open access article distributed under the CC BY 4.0 International license .
Best practices for CVAD care
Authors: Alspach Jennie R.
Published: December 2021

Following evidence-based guidelines for catheter maintenance is essential to promote positive patient outcomes.
Orthoplastic Reconstruction of Type IIIB Open Tibial Shaft Fractures Using Debrided, Devitalized Cortical Segments: Health-Related Quality-of-Life Outcomes
Authors: Al-Hourani Khalid , Pearce Oliver , Stoddart Michael , Riddick Andrew , Khan Umraz , Kelly Michael B.
Published: December 2021

Objective:

To determine health-related quality of life (HRQoL) in patients who sustained type IIIB open tibial diaphyseal (OTA/AO-42) fractures and underwent orthoplastic reconstruction using mechanically relevant devitalized bone (ORDB) versus those who did not require the use of devitalized bone as part of their orthoplastic reconstruction.

Design:

Consecutive cohort study.

Patients/Participants:

The study included 74 patients who sustained a type IIIB open tibial diaphyseal fracture requiring orthoplastic reconstruction over a 4-year period in a major trauma center. All patients underwent a two-stage orthoplastic reconstruction protocol, with the second stage consisting of definitive fixation and flap coverage (free fascial anterolateral thigh flap) in a single sitting. Patients were contacted at a minimum of 30 months to measure HRQoL.

Intervention:

Patients requiring ORDB versus those who did not require the use of devitalized bone as part of their orthoplastic reconstruction.

Main Outcome Measurements:

The primary outcome measure was HRQoL ascertained using Euro-Qol (EQ)-5D and Short-Form (SF)-36 scores.

Results:

Thirty (n = 30) patients underwent ORDB with the remaining 44 not requiring devitalized bone as part of their reconstruction. The median age was 46.5 years [interquartile range (IQR) 29.0], with a median follow-up of 3.8 years (IQR 1.5). The median cohort EQ-5D was 0.743 (IQR 0.222), ORDB 0.743 (IQR 0.195) versus non-ORDB 0.748 (IQR 0.285), P = 0.71. The median physical component SF-36 score was 80 (IQR 50), ORDB 80 (IQR 34.5) versus non-ORDB 77.5 (IQR 58.75), P = 0.72. The median mental component SF-36 score was 80 (IQR 28), ORDB 80 (IQR 21) versus non-ORDB 80 (IQR 36), P = 0.29.

Conclusions:

In patients who sustained a type IIIB open tibial shaft fracture and who underwent a 2-stage orthoplastic reconstruction, ORDB does not seem to be associated with inferior health-related quality of life based on EQ-5D or SF-36 scores. The results of this approach should be considered within the strict combined orthoplastic approach in the study unit.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
A Comparison of the Prevalence of, Demographics of, and Effects on Outcomes of Bilateral Versus Unilateral Femoral Shaft Fractures: A Retrospective Cohort Analysis From the National Trauma Data Bank
Authors: Cosgrove Christopher T. , Wolinsky Philip R. , Berkes Marschall B. , McAndrew Christopher M. , Stwalley Dustin L. , Miller Anna N.
Published: December 2021

Objectives:

To document the prevalence of, and the effect on outcomes, operatively treated bilateral femur fractures treated using contemporary treatments.

Design:

A retrospective cohort using data from the National Trauma Data Bank.

Participants:

In total, 119,213 patients in the National Trauma Data Bank between the years 2007 and 2015 who had operatively treated femoral shaft fractures.

Main Outcome Measurements:

Complication rates, hospital length of stay (LOS), days in the intensive care unit (ICU LOS), days on a ventilator, and mortality rates.

Results:

Patients with bilateral femur fractures had increased overall complications (0.74 vs. 0.50, P < 0.0001), a longer LOS (14.3 vs. 9.2, P < 0.0001), an increased ICU LOS (5.3 vs. 2.4, P < 0.0001), and more days on a ventilator (3.1 vs. 1.3, P < 0.0001), when compared with unilateral fractures. Bilateral femoral shaft fractures were independently associated with worse outcomes in all primary domains when adjusted by Injury Severity Score (P < 0.0001), apart from mortality rates. Age-adjusted bilateral injuries were independently associated with worse outcomes in all primary domains (P < 0.0001) except for the overall complication rate. A delay in fracture fixation beyond 24 hours was associated with increased mortality (P < 0.0001) and worse outcomes for all other primary measures (P < 0.0001 to P = 0.0278) for all patients.

Conclusions:

Bilateral femoral shaft fractures are an independent marker for increased hospital and ICU LOS, number of days on a ventilator, and increased complication rates, when compared with unilateral injuries and adjusted for age and Injury Severity Score. Timely definitive fixation, in a physiologically appropriate patient, is critical because a delay is associated with worse inpatient outcome measures and higher mortality rates.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Serum metabolomic profiling reveals potential biomarkers in assessing the management of women with polycystic ovary syndrome: a randomized controlled trial
Authors: Ding Xuesong , Deng Yan , Wang Yanfang , Xue Wei , Zhu Shiyang , Ma Xiao , Ma Ruilin , Sun Aijun
Published: December 2021

Background:

As one of the most common endocrinal disorders for women at childbearing age, the diagnostic criteria of polycystic ovary syndrome (PCOS) have been defined differently among different international health organizations. Phenotypic heterogeneity of PCOS also brings about difficulties for its diagnosis and management assessment. Therefore, more efficient biomarkers representing the progression of PCOS are expected to be integrated into the monitoring of management process using metabolomic approaches.

Methods:

In this prospective randomized controlled trial, 117 PCOS patients were enrolled from December 2016 to September 2017. Classical diagnostic parameters, blood glucose, and metabolome were measured in these patients before and at 2 months and 3 months of different medical interventions. The receiver operating characteristic (ROC) curves were built based on multivariate statistical analysis using data at baseline and 3 months’ management, and combinational biomarkers with appreciable sensitivity and specificity were selected, which then validated with data collected at 2 months.

Results:

A set of metabolites including glutamic acid, aspartic acid, 1-methylnicotinamide, acetylcarnitine, glycerophosphocholine, and oleamide were filtered out with high performance in representing the improvement through 3-month management of PCOS with high sensitivity and specificity in ROC analysis and validation with other two groups showed an appreciable area under the curve over 0.96.

Conclusions:

The six metabolites were representative of the remission of PCOS through medical intervention, making them a set of potential biomarkers for assessing the outcome of PCOS management.

Trial Registration:

ClinicalTrials.gov, NCT03264638.