bluuebunny/crossref_metadata_2025 huggingface dataset:
SG-APSIC1049: Immunogenicity of Gam-COVID-Vac and Sinopharm BBIBP-CorV vaccines in seropositive and seronegative adults
Authors: Stoma Igor , Korsak Katsiaryna , Voropaev Evgenii , Osipkina Olga , Kovalev Aleksey
Published: March 2023

Objectives: Data comparing the immunogenicity of Sputnik-V and Sinopharm vaccines in seropositive and seronegative groups are lacking. We compared the immunogenicity of Sputnik-V (Gam-COVID-Vac) and Sinopharm (BBIBP-CorV) vaccines in seronegative and seropositive groups. Methods: In total, 60 adults participated the study. The immune response after vaccination was assessed using enzyme immunoassay. IgG levels were measured in all participants at 3 time points: before vaccination, 42 days after the first vaccine dose, and 6 months after the first vaccine dose. The results of the SARS-CoV-2 antibody test were quantified according to the WHO First International Standard and expressed in international units (BAU per mL). Results: The study participants were divided into 2 groups: 30 people (50%) were vaccinated with Sputnik-V (Gam-COVID-Vac) and 30 people (50%) were vaccinated with Sinopharm (BBIBP-CorV). The groups had no difference in sex composition. The highest antibody levels were observed 42 days after vaccination in both the seronegative group (P = .006) and the seropositive group (P < .001). At 6 months after vaccination, the IgG value declined much farther among the seronegative group (P = .003) compared to those who had recovered from COVID-19 before vaccination. However, the “hybrid immunity” generated by the Sputnik-V vaccine had greater strength and duration (P < .001). Conclusions: This study showed that IgG levels in vaccinated individuals who previously recovered from SARS-CoV-2 infection (“hybrid immunity”) were higher than in SARS-CoV-2–naïve individuals. In a comparative part of the study, the Sputnik-V vaccine had greater strength and duration of immune response across the 6-month observation period (P < .001).
SG-APSIC1126: Controlling SARS-CoV-2 infection in inpatients through a grouping system at Ho Chi Minh Children’s Hospital 1 in Vietnam
Authors: Minh Chau Nguyen Ngoc , Thuy Le Thi Thanh , Nguye Thanh Hung , Ngo Ngoc Quang Minh , Do Van Niem , Nguyen Thi Thanh Huong
Published: March 2023

Objectives: At the onset of COVID-19, whenever SARS-CoV-2 was detected at Children’s Hospital 1 (CH1), the related department or building was closed for extensive tracing, testing, and medical isolation. This process disrupted hospital activities, reduced the efficiency of patient care, and used medical resources. To address this problem, CH1 implemented a system of grouping inpatients to color-coded areas from June to December 2021. Methods: In this retrospective study, we describe the system of grouping inpatients to color-coded areas based on SARS-CoV-2 test result at a 1,600-bed, national pediatric hospital in Ho Chi Minh City. Results: Inpatients were first separated into those with or without respiratory symptoms, and secondly to different color-coded areas based on SARS-CoV-2 test result and hospitalization length: red zone (days 1–3), orange zone (days 3–7), and green zone (day 7 onward). Prior to admission, all patients were tested with a SARS-CoV-2 rapid diagnostic test. If negative, the patient was admitted to the red zone. On days 3 and 7 of hospitalization, the patient was tested using a pooled RT-PCR method. Patients negative on day 3 were relocated to the orange zone; patients negative on day 7 were relocated to the green zone. A patient with a positive test result at any time point was transferred to a COVID-19 zone. One caregiver was allowed to stay with 1 patient with similar testing regimen. A mobile transportation team was set up to deliver food and other necessities; thus, movement was restricted and interaction was prevented among zones. After this system was implemented, COVID-19 cases were detected early, with most positive cases in the red zone (19.6%) and the orange zone (2.8%), with only 1 case in the green zone (0.7%). Conclusions: The system of grouping patients to color-coded areas helped prevent SARS-CoV-2 transmission within the hospital, allowing undisrupted operation.
SG-APSIC1098: Impact of the COVID-19 pandemic on influenza vaccination uptake among healthcare workers
Authors: Gwee Min Yi , Wah Lim John , Venkatachalam Indumathi , Ying Jean Sim Xiang , Aung May Kyawt , Yong Yang , Philip Conceicao Edwin , Arora Shalvi , Oo Aung Myat , Jin Shawn See Wee
Published: March 2023

Objectives: Influenza vaccination is encouraged for all healthcare workers (HCWs) to reduce the risk of acquiring the infection and onward transmission to colleagues and patients during the influenza season. Thus, vaccination was introduced at Singapore General Hospital (SGH) in 2007 and has been offered to all HCWs at no cost. The HCW influenza vaccination program is conducted annually in October and biannually during years with vaccine mismatch. However, influenza vaccine uptake remained low among HCWs. We sought to determine the impact of the coronavirus disease 2019 (COVID-19) pandemic on influenza vaccine uptake among HCWs. Methods: At SGH, 2 methods of vaccine delivery are offered: centralized (1-month drop-in system during office hours) and decentralized (administered by vaccination teams in offices or ward staff in inpatient locations). In the 4-year study period between 2018 and 2021, 6 influenza vaccination exercise campaigns were conducted during 8 influenza seasons. During each exercise, ~9,000 HCWs were eligible for vaccination. Results: Prior to the COVID-19 pandemic, vaccine uptake in the Southern Hemisphere was 77.6% (6,964 of 8,977) in 2018 and 84.2% (7,296 of 8,670) in 2019. During the COVID-19 pandemic in 2020, vaccine uptake in the Southern Hemisphere increased by 10% to 94.1% (8,361 of 8,889). In the Northern Hemisphere, vaccine uptake was 79.2% (7,114 of 8,977) in 2018, and this increased by 17.9% to 97.1% (8,926 of 9,194) during the COVID-19 pandemic in 2020. During the 2021 Southern Hemisphere influenza season, no vaccination program was conducted because the risk of influenza was considered low due to the closure of international borders and the implementation of public health measures. In addition, priority was given to COVID-19 vaccination efforts. Conclusions: Increased uptake of the influenza vaccination was observed during the COVID-19 pandemic. Anxiety created by the respiratory disease pandemic and debate surrounding vaccines likely contributed to increased awareness and uptake in influenza vaccine among HCWs.
SG-APSIC1062: The role of active surveillance in the primary-care setting during a pandemic in Singapore
Authors: Yan Chau Chain , Li Giselle , Wei Lim Min
Published: March 2023

Objectives: In response to the COVID-19 pandemic, primary care swiftly transformed and re-established patient flow in clinics to red, orange, and green zones based on a set of screening criteria. To further manage the influx of suspected COVID-19 patients and their needs safely, a list of surveillance audit criteria was developed to ensure good infection control standards. Methods: The infection control team prepared the surveillance audit criteria based on recommended CDC/WHO guidelines for pandemic preparedness. These criteria were contextualized to the primary-care polyclinic setting. The surveillance audit criteria were grouped according to their category: screening, triage, early recognition and source control, inventory management of personal protective equipment (PPE), infection control measures in the red zone, precautionary measures during collection of nasopharyngeal swabs and environmental cleaning and disinfection for premises in the red, orange, and green zones, respectively. The infection control liaison nurses in each polyclinic were trained to use the checklist to ensure consistency in interpretation of the criteria. Results: Surveillance audits were conducted biweekly in the first 3 months then monthly once the compliance rate was steady at 90%–100% for all categories. The overall average compliance rate since commencing in March 2020 for all polyclinics was sustained at 90%–100%. Common findings included inappropriate use of PPE (eg, self-contamination during removal of gown or wrong sequence of doffing), inadequate ventilation, and inadequate cleaning processes. All findings were corrected immediately, and staff education was provided. Conclusions: Primary care plays an important role during a pandemic. It is essential that both patients and healthcare workers in the primary care setting are protected from infection risk during a pandemic. Having a good surveillance audit process helps ensure that primary care services can continue for the general population. Surveillance is an essential component of the health system’s response to a pandemic.
SG-APSIC1065: The effectiveness of an ultraviolet-C device for terminal room disinfection in an intensive care unit
Authors: Shi Zhi-Yuan , Huang Pei-Hsuan , Tai Chun-Hsi , Hung Hsin-Yi , Chen Yuh-Feng , Chen Ying-chun , Huang Hui-Mei
Published: March 2023

Objectives: Medical devices and the hospital environment can be contaminated easily by multidrug-resistant bacteria. The effectiveness of cleaning practices is often suboptimal because environmental cleaning in hospitals is complex and depends on human factors, the physical and chemical characteristics of environment, and the viability of the microorganisms. Ultraviolet-C (UV-C) lamps can be used to reduce the spread of microorganisms. We evaluated the effectiveness of an ultraviolet-C (UV-C) device on terminal room cleaning and disinfection. Methods: The study was conducted at an ICU of a medical center in Taiwan. We performed a 3-stage evaluation for the effectiveness of UV-C radiation, including pre–UV-C radiation, UV-C radiation, and a bleaching procedure. The 3 stages of evaluation were implemented in the ICU rooms from which a patient had been discharged or transferred. We collected the data from adenosine triphosphate (ATP) bioluminescence testing, colonized strains, and their corresponding colony counts by sampling from the environmental surfaces and air. We tested 8 high-touch surfaces, including 2 sides of bed rails, headboards, footboards, bedside tables, monitors, pumping devices, IV stands, and oxygen flow meters. Results: In total, 1,696 environmental surfaces and 72 air samples were analyzed. The levels of ATP bioluminescence and colony counts of isolated bacteria decreased significantly after UV-C radiation and bleaching disinfection for both the environmental and air samples (P < .001). Resistant bacteria (vancomycin-resistant Enterococcus, VRE) were commonly isolated on the hard-to-clean surfaces of monitors, oxygen flow meters, and IV pumps. However, they were also eradicated (P < .001). Conclusions: UV-C can significantly reduce environmental contamination by multidrug-resistant microorganisms. UV-C is an effective device to assist staff in cleaning the hospital environment.
SG-APSIC1050: Personal care formulations prove effective against evolving variants of SARS-CoV-2: Implications for public health and hygiene
Authors: Mukherjee Sayandip , Vincent Carol K , Jayasekera Harshinie W , Yekhe Ashish S
Published: March 2023

Objectives: Early in the COVID-19 pandemic, global health authorities identified and emphasized the importance of practicing proper hand hygiene to reduce the transmission of SARS-CoV-2 and to diminish the chances of becoming infected. It is well established in the scientific literature that surfactants and alcohols are capable of inactivating enveloped viruses such as SARS-CoV-2. However, given the novel nature of the virus, Unilever adopted an evidence-based approach to demonstrate virucidal efficacy of marketed bar soaps, liquid handwashes, and alcohol-based hand sanitizers against the original and selected variants of SARS-CoV-2. Methods: High titers of clinically isolated and laboratory-propagated SARS-CoV-2 strains were subjected to a range of selected proprietary formulations from Unilever at end-user–relevant dilutions, temperature, and contact duration, and were tested according to the internationally recognized ASTM E-1052 test protocol. Results: All tested personal-care formulations were effective against the parental SARS-CoV-2 strain as well as the β (beta) and δ (delta) variants of concern. More specifically, bar soaps with a varying concentration of total fatty matter content and liquid handwashes with varying levels of total surfactants reduced the viral titer by >99.9% within 20 seconds. Alcohol-based hand sanitizers demonstrated >99.99% reduction of input viral load within 15 seconds of contact with the viral inoculum. Conclusions: In conclusion, we have provided empirical proof that well-designed personal-care formulations that act through generic physicochemical mechanism against the basic structure of the virus particle have high virucidal efficacy against the original and evolved SARS-CoV-2 variants. Furthermore, we argue that due to the broad-spectrum mode of action of these tested formulations, the continued practice of good hand hygiene practices with everyday products holds significant promise as an easily accessible, economic, and effective nontherapeutic public health intervention toward reducing the transmission of present and future variants of SARS-CoV-2 across communities and populations.
SG-APSIC1100: Healthcare-associated infections in COVID-19 patients in Vietnam: Are we able to respond better?
Authors: Anh Thu Truong , Co Dao Xuan , Son Do Ngoc , Thach Pham The , Chinh Luong Quoc , Nghiem Huynh Xuan , Vinh Nguyen Dai , Phuong Truong Thai , Nhung Pham Hong , Nhan Le Duc , Dung Tran Thi , Nga Tran Thi , Tuan Nguyen Quang
Published: March 2023

Objectives: Studies have revealed that a relatively high incidence of severe infection and mortality in COVID-19 patients is attributed to healthcare-associated infections (HAIs). We implemented a study in 2 field hospitals dedicated to COVID-19 treatment in Da Nang, Vietnam (July–August 2020), and Ho Chi Minh City, Vietnam (August–October 2021), to identify pathogens, risk factors, and outcomes associated with HAIs. Methods: We applied a prospective study tool to estimate HAI incidence among 1,454 patients. HAIs are diagnosed and ascertained using surveillance criteria established by the US Centers for Disease Control and Prevention. All patients hospitalized for COVID-19 for at least 2 days were enrolled in this assessment of HAI risks, pathogens, and outcomes. Results: Among 1,454 sampled patients, 391 patients had 423 HAIs (27.1%). The highest proportion occurred in ICUs, with 422 HAI patients (34.1%). Pneumonia (n = 331, 78.3%) and bloodstream infections (n = 55, 13.1%) were the most common HAIs. Multidrug-resistant (MDR) bacteria, such as Klebsiella pneumonia (27.9%) and Acinetobacter baumannii (25.3%), were the most commonly isolated organisms. Ventilators and central venous catheters were independently associated with HAIs. Regarding the mortality rates, 55% of deaths occurred in intensive care units. Patients with HAIs (70.3%) were twice as likely to die compared to patients without HAIs (38.8%). HAIs leading to septic shock caused almost triple mortality (n = 58, 90.6%) compared with non-HAI patients (n = 412, 38.8%). HAIs prolonged hospital stay: 24.7 days for patients with HAIs and 19.1 days for patients without HAIs (P < .001). Conclusions: Patients with COVID-19–related critical illnesses are at high risk of HAIs from multidrug-resistant (MDR) bacteria. HAIs prolong hospitalization, whereas HAIs with septic shock almost tripled mortality. Guidelines and procedures to prevent and control HAIs caused by MDR bacteria as well as training and monitoring on aseptic-compliant techniques during invasive clinical procedures are needed.
SG-APSIC1064: The role of infection control activities on healthcare-associated infections during 2017-2021 at intensive care units in Cho Ray Hospital
Authors: Phan Dung Tien , Dung Phan Tien , Ven Le Thi , Ly Nguyen Anh , My Tran Thi , Dung Truong Anh , Thuy Vu Thi
Published: March 2023

Objectives: Healthcare-associated infections (HAIs) are one of the greatest challenges and concerns in Vietnam and around the world. Many studies have shown that HAIs may result in an increase in hospital length of stay, antibiotic use, multidrug-resistant organism (MDROs) infections, treatment costs, and mortality. Therefore, in the past 5 years, the Department of Infection Control of Cho Ray Hospital has carried out many infection and prevention control (IPC) activities to reduce the rates of HAI and MDRO infection. We evaluated IPC activities and results achieved in these efforts at Cho Ray Hospital during 2017–2021. Methods: We described the implemented IPC activities and retrospectively collected data from HAIs surveillance reports during 2017–2021 for 3 intensive care units (ICUs): ICU-B, ICU-D, and the NICU. Results: In the past 5 years, we implemented synchronous IPC activities, including promoting hand hygiene training and surveillance, environmental cleaning surveillance, carrying out improvement projects such as a ventilator-associated pneumonia (VAP) prevention bundle, an MDRO prevention bundle, and an environmental cleaning quality improvement project. Many positive results were achieved, although a slight increase in the HAI incidence occurred in 2021 due to the COVID-19 pandemic. Overall, the hand hygiene compliance rate increased from 49.7% to 83.8%. The rate of HAIs per 1,000 patient days decreased steadily from 5.4 to 2.4. The VAP rate fell from 30.5 to 17.2 per 1,000 patient days, and the central-line–associated bloodstream infection (CLABSI) rate decreased gradually from 5.4 to 2.4 per 1,000 patient days. The catheter-associated urinary tract infection (CAUTI) rate decreased from 2.9 to 0.9 per 1,000 patient days, and the MDRO infection rate decreased significantly from 32.7 to 11.3 per 1,000 patient days. Conclusions: The synchronous implementation of HAI prevention bundles promoting hand hygiene and environmental cleaning achieved significant effects in the efforts to decrease HAIs and MDROs in the ICUs of Cho Ray Hospital.
SG-APSIC1163: A five-year review and analysis of sharp injuries in an acute-care hospital in Singapore
Authors: Oh Helen , Mak Mervis , Wu Tuodi
Published: March 2023

Objectives: Sharp injuries are frequent occurrences in healthcare settings. According to the World Health Organization, >2 million occupational exposures to sharp injuries occur among 35 million healthcare workers (HCWs) annually. We report the 5-year incidence and trends of sharp injuries in an acute-care hospital. We compared the rates of injury, the distribution of injuries, and the type of exposure of HCWs during the prepandemic and pandemic eras. Methods: We conducted a retrospective analysis of a 5-year surveillance on self-reported sharp injuries in Changi General Hospital, a 1,000-bed acute-care hospital. The occupational groups, the type of sharps, and the incident activity involved were reviewed. The bloodborne pathogen statuses of the identified source patients were studied. Results: In total, 441 sharp injuries were reported from 2017 to 2021. Among the occupational groups, doctors reported the highest number of sharp injuries (N = 272, 61.7%), followed by nurses (N = 129, 29.3%) and other allied health professionals (N = 29, 6.4%). An increasing proportion of doctors reported sharp injuries from 2017 to 2019 (prepandemic era) and the proportion declined from 2020 to 2021 (pandemic era); 52 doctors (58.4%) reported sharp injuries in 2017, 61 (61.1%) in 2018, 72 (67.9%) in 2019, 47 (61%) in 2020, and 40 (57.1%) in 2021. Most sharp injuries were caused by solid sharps (212 of 441, 48.1%) and hollow-bore needles (205 of 441, 46.5%). Source patients were identified in 407 sharp injuries. From the known sources, 51 were seropositive: 20 for hepatitis B (HBV), 27 for hepatitis C (HCV), and 4 for human immunodeficiency virus (HIV). No seroconversion occurred. Overall, 198 sharp injuries (44.9%) were sustained during surgical procedures, 83 (18.8%) occurred during blood taking, and 44 (9.9%) occurred during injection administration. Also, 37.5% of sharp injuries among doctors occurred during surgical procedures, and 69.6% of sharp injuries in OT occurred among junior surgical doctors. Conclusions: The overall incidence of sharp injuries has decreased during the pandemic. Fewer elective surgical procedures were performed during the pandemic period. OT suturing training workshops and awareness programs on strategies for preventing sharps injuries in the operating theatre, targeted at surgical residents during the past 2 years, could have contributed to the decrease in the incidence of sharp injuries in our hospital. Sharp injuries pose a significant exposure to blood and body fluids and should be subject to continued epidemiological surveillance.
SG-APSIC1063: Building and application of e-learning software for infection control, Cho Ray Hospital
Authors: Duy Nguyen Xuan Nhat , Duy Nguyen Xuan Nhat , Thuy Phan Thi Hong
Published: March 2023

Objectives: In the context of the COVID-19 pandemic over the past 2 years, training regarding infection and prevention control (IPC) has become essential in responding promptly to the pandemic. Many healthcare workers from Cho Ray Hospital and provincial hospitals need IPC training; however, human resources and facilities for continuous education and training are lacking. Therefore, IPC e-learning has become necessary for medical staff, and we designed IPC e-learning courses to meet healthcare workers’ needs for efficient, time and cost-saving training to ensure safety during the COVID-19 pandemic. Methods: All medical staff of Cho Ray Hospital were invited to participate in the infection control e-learning study. The software was developed based on the existing lectures from practical infection control protocols. Healthcare workers were asked to study the software and take a test on the their training. Results: We built the e-learning course of IPC for 5,000 participants as well as management software to manage lessons, member data, and test results. After implementation for 2 months in the hospital, 207 participants had taken the exam 2,234 times. Overall, 70.5% of participants were nurses and 14.9% were doctors. Moreover, 66.4% of participants passed the test the first time they took it, and 33.6% took the test a second time. After the second test, the percentage of members who passed the exam was 100%. Conclusions: Building and applying e-learning software for IPC training has brought about efficiency and quality of training, has reduced the use of human resources for training, and has decreased costs. The software application is being expanded to all hospitals in Vietnam.
SG-APSIC1105: The effectiveness of the infection control interventions in decreasing multidrug-resistant organism transmission in the Department of Neonatology of Hung Vuong Hospital
Authors: Nhung Ngo , Hang Tran Thi Thuy , Nhung Ngo My , Nhung Ngo My , Tham Ngo Thi Thanh , Tien Bui Thi Thuy , Hang Phan Thi
Published: March 2023

Objectives: Infection control and prevention (IPC) is one of the most important factors in decreasing multidrug-resistant organism (MRDO) transmission. We evaluated the effectiveness of the IPC program in reducing the spread of MDROs at the Department of Neonatology of Hung Vuong Hospital. Methods: This research was conducted from April 2020 to September 2020 in the neonatology department in 3 phases: (1) We determined the compliance rate of hand hygiene and high-touch surfaces cleaning (via camera monitoring). (2) We conducted the following interventions: We developed specific cleaning protocols for the neonatology department. We provided training regarding MRDO transmission control and prevention for healthcare workers. We implemented a counseling program for active screening and isolation for hospitalized children; added isolation rooms for children with MRDO asymptomatic infections. And we improved feedback efficiency through an online group between the infection control and prevention team and the department of neonatology. (3) We re-evaluated compliance with hand hygiene practices and cleaning of high-touch surfaces, then we compared the rates of positive MRDO cultures before and after these interventions. Results: Before the interventions, 453 hand hygiene observations were recorded and 322 high-touch-surface cleaning observations were recorded. The hand hygiene compliance rate improved significantly from 33.2% to 85.5% (PR, 11.9; 95% CI, 7.4–19.3; P< .01). The high-touch-surface cleaning rate increased from 82.4% to 93.5% (PR, 3.1, 95% CI, 1.5–6.4; P < .01). The rate of high-touch surfaces being cleaned with proper technique increased from 38.5% to 87.9% (PR, 11.6; 95% CI, 6.3–21.3; P < .01). In total, 103 swab samples were positive for MRDOs by culture before and after the intervention. The rate of positive MRDO cultures decreased from 80.8% to 64.7% (P = .017). Conclusions: Enhancing hand hygiene and high-touch-surface cleaning compliance helped reduce MRDO transmission in the Department Neonatology of Hung Vuong Hospital.
SG-APSIC1061: First-response infection prevention and control during COVID-19 outbreaks in residential aged-care facilities
Authors: Dawson Elizabeth , Campbell Elise
Published: March 2023

Objectives: COVID-19 has highlighted the importance of the hierarchy of controls and early implementation of transmission-based precautions during outbreaks in residential aged-care facilities (RACFs). The RACF outreach team is a service provided by the Sydney Local Health District (SLHD) that provides RACFs with expert clinical care and advice, along with outbreak management and infection control and prevention education. Methods: The RACF outreach team developed 2 unique IPC management tools designed to assist RACFs during the COVID-19 pandemic: (1) the comprehensive initial review and (2) first-responder assessment tool designed to assist the team in identifying high-risk issues during afterhours shifts. The tool reviews 5 key components in outbreak management: screening, PPE usage, resident care, communication and signage, and infection control and prevention. The outreach team provides an IPC report of the comprehensive initial review, which provides site-specific advice regarding zoning, cohorting, implementation of donning and doffing stations, safe staffing and workflows, ventilation, personal protective equipment (PPE) use, and PPE safety. The recommendations supplied in the SLHD IPC report are provided to facilities and are implemented at the facility level. These reviews are followed up in meetings of the outbreak management team conducted virtually via Zoom videoconferencing. These meetings include an RACF senior manager and a representative from the local PHU, the outreach service, the Australian Commonwealth, the Aged Care Commission, an SLHD executive manager, and an infectious diseases practitioner. Results: Since the outbreak of the SARS-CoV-2 ο (omicron) variant began in Sydney, Australia, in November 2021, 58 facilities with >2,500 residents have been reviewed, and 57 of these facilities had a COVID-19 outbreak at some point during the pandemic. Conclusions: The RACFs in SLHD continue to report death rates <5% among all SARS-COV-2–positive residents.
SG-APSIC1080: Surveillance and control efforts for carbapenemase-producing gram-negative bacteria at a high-burden tertiary-care healthcare facility in Ho Chi Minh City, Vietnam
Authors: Huynh Tuan , Pham Lan , Luong Loan , Le Tuan , Lě Khanh , Bui Duyen , Ta Truc , Trinh Thoa , Nguyen Yen , Bui Diep , Vo Nga , Nguyen Nga , Nguyen Bao , Truong Binh
Published: March 2023

Objectives: In Vietnam, although surveillance and control of multidrug-resistant organisms is a national priority, information on the burden of these pathogens remains scarce. At the University Medical Center in Ho Chi Minh City, we assessed the proportion of carbapanemase-producing carbapenem-resistant organisms (CP-CRO) and evaluated an intervention package to prevent transmission of carbapenemase-producing carbapenem-resistant Enterobacterieacea (CP-CRE) in the intensive care unit (ICU). Methods: All gram-negative isolates collected between November 2018 to April 2019 were tested for carbapenem resistance using the disc-diffusion method. Carbapenem-resistant bacteria, defined as meropenem resistant, were tested for phenotypic carbapenemase-production using the Becton Dickinson Phoenix CPO Detect assay. An intervention package, including placement of patients in cohorts, enhanced barrier precautions, enhanced discharge environmental cleaning, and CP-CRE rectal screening, was implemented from July 2019 through December 2020. During this period, all ICU patients were screened on admission, and negative patients were rescreened every 2 days or 7 days until discharge, death, or CRE-positive result. Admission prevalence and incidence of CP-CRE transmission was calculated among CP-CRE infected or colonized patients. Results: Among 599 gram-negative isolates collected, 108 were carbapenem-resistant isolates, of which 107 (99%) were CP-CRO by the phenotypic method. Most CP-CRO were Acinetobacter baumannii (42%) and Klebsiella pneumoniae (36%). Of 1,206 patients, 433 (35.9%) were already colonized or infected with CP-CRE before admission to the ICU. The incidence rate (cases per 100 risk days) of CP-CRE colonization or infection during ICU treatment decreased from 11.5 before the intervention to 2.9 after the implementation of the intervention package. The average number of days to change from a negative to positive screening result in the intervention phase was 7.4, compared with 4.9 days during preintervention phase. Conclusions: Nearly all CROs isolated from our ICU are carbapenemase-producing CROs, with high presence on admission as well as new acquisition during an ICU stay. An intervention package containing enhanced infection control measures was effective in reducing CP-CRE transmission.
SG-APSIC1074: Trend of ‘ESKAPE’ and their susceptibility changes for meropenem and levofloxacin during the pandemic at Sardjito Hospital Yogyakarta Indonesia
Authors: Dahesihdew Andaru , Fanani Yunan Nadhif
Published: March 2023

Objectives: The bacteria in the ‘ESKAPE’ group are monitored due to their ability to resist antibiotic action. During the COVID-19 pandemic at our hospital, the usage of meropenem and levofloxacin as the empirical treatment for bacterial pneumonia increased and might have contributed to the antimicrobial resistance problem. In this study, we evaluated the ESKAPE group infection rates and their susceptibility to antibiotics in Dr. Sardjito Hospital, a referral and academic hospital in Yogyakarta, Indonesia. Methods: Data for ESKAPE pathogens in 2019–2021 were taken from the microbiology laboratory of Dr. Sardjito Hospital and were evaluated. Results: The proportion of ESKAPE isolates among positive cultures during 2019–2021 slightly increased from 49.4% to 48.4% to 50.7% each year (P > .05). The dominant ESKAPE infections were pneumonia, bloodstream infection, and urinary tract infection by K. pneumoniae, and wound infection by P. aeruginosa. The susceptibility pattern of ESKAPE to meropenem decreased from 72% in 2019 to 68% in 2020 but increased to 84% in 2021. To levofloxacin, the susceptibility pattern was decreased in a fluctuating trend from 68% in 2019 to 33% in 2020 and to 39% in 2021. During the COVID-19 pandemic (2020–2021), the pattern of ESKAPE infections was similar to that of 2019. In descending order, the frequency rank was K. pneumoniae, P. aeruginosa, A. baumannii, Enterobacter spp, and S. aureus. The proportions of MDR isolates increased from the prepandemic period to the COVID-19 pandemic era for E. faecium (from 5% to 24.4%), for A. baumannii (from 9.6% to 38.5%), and for P. aeruginosa (from 7.4% to 13.5%) (P < .05). These patterns did not differ between non–COVID-19 patients and COVID-19 patients. These results highlight the general impact of overused antibiotics beyond COVID-19 patients. Usage of watched and restricted antibiotics must be more controlled because bacterial coinfection and superinfection in COVID-19 patients was relatively low. Conclusions: During the COVID-19 pandemic, ESKAPE infections increased and their susceptibility to meropenem and levofloxacin decreased. Tight control of antibiotic usage is needed.
SG-APSIC1095: Acquisition rate of carbapenemase-producing organisms (CPOs) among hospital contacts of CPO patients: An interim subgroup analysis of a cohort study
Authors: Husen Sharifah Farhanah Syed , Linn Kyaw Zaw , Ong Clara Chong Hui , Huan Xiaowei , Loo Liang Hui , Sazali Ismail Bin , Vasoo Shawn , Foo Meow Ling , Ooi Say Tat , Tan Thean Yen , Smitasin Nares , Ling Moi Lin , Tambyah Paul Anantharajah , Tan Seow Yen , Ng Oon Tek , Marimuthu Kalisvar
Published: March 2023

Objectives: The increase in carbapenemase-producing organism (CPO) transmission among hospitalized patients is a growing concern. Studies investigating the transmission of CPO to epidemiologically linked contacts are scarce. We conducted an interim subgroup analysis of the ongoing multicenter household transmission of CPO in Singapore (CaPES-C) study to identify the acquisition rate of CPO among epidemiologically linked contacts of hospitalized CPO patients. Methods: This multicenter prospective cohort study was conducted between January and December 2021. We recruited CPO-positive patients and their epidemiologically linked contacts. Stool samples were collected from the patients at baseline, day 3, day 7, and at weeks 2, 3, 4, 5, 6, 12, 24, 36, and 48. Additionally, a sample was collected at the time of discharge from the hospital. Xpert Carba-R test was used to detect CPO genotypes in the stool samples. In this interim analysis, we calculated the acquisition rate of CPO among the epidemiologically linked hospital contacts of CPO positive patients using Stata version 15 software. Results: We recruited 22 (56.4%) CPO-positive index patients [blaNDM, n = 7 (31.8%); blaIMP, n = 3 (13.6%); blaOXA-48, n = 10 (45.5%), others, n = 2 (9.1%)] and 14 (35.9%) epidemiologically linked hospital contacts. The median age of CPO-positive patients was 72.5 years (IQR, 62–82) and 15 (68.2%) were female. The median age for the epidemiologically linked contacts was 82.5 years (IQR, 70–85) and 4 (28.6%) were female. After 1,082 patient days, 2 (14.3%) epidemiologically linked contacts tested positive for CPO giving an acquisition rate of 1.85 per 1,000 patient days (95% CI, 0.46 – 7.39). One of these participants acquired a concordant genotype (blaOXA-48) at day 7 and the other acquired a discordant genotype (CPO positive index, blaIMP; epidemiologically linked contact, blaNDM) at week 12 of follow-up. Conclusions: This small interim analysis revealed a high conversion rate among epidemiologically linked hospital contacts. A larger study is needed to understand the influence of genotypes, hospital environment, and human behavior on the transmission of CPO in hospitals.
SG-APSIC1073: Incidence and predictors of Escherichia coli–producing extended-spectrum beta-lactamase (ESBL-Ec) in Queensland, Australia, from 2010 to 2019: A population-based spatial analysis
Authors: Ling Weiping , Cadavid-Restrepo Angela , Furuya-Kanamori Luis , Harris Patrick N.A. , Paterson David L.
Published: March 2023

Objectives: The dissemination of Escherichia coli–producing extended-spectrum β-lactamase (ESBL-Ec) is evident in the community. In this population-based spatial analysis, we sought to describe the distribution of ESBL-Ec and to identify predictors of incidence in the community. Methods: The study population was defined as individuals with the ESBL-Ec isolate in Queensland, Australia, from 2010 to 2019. Annual choropleth maps and a global Moran index were constructed to describe ESBL-Ec distribution. Getis-Ord Gi* was performed to identify “hot spots” of statistical significance. Using demographic factors and incidence per postal area from 2016, multivariable analyses with or without spatially structured random effects were performed. Results: In total, 12,786 individuals with ESBL-Ec isolate were identified. The incidence rate increased annually from 9.1 per 100,000 residents in 2010 to 49.8 per 100,000 residents in 2019. The geographical distribution changed from random to clustered in 2014. Hot spots were more frequently identified in the Outback and Far North Queensland, where remote communities and hotter weather are prevalent. Multivariable spatial analysis suggests that communities with higher socioeconomic status (RR, 0.66; 95% CI, 0.55–0.79 per 100 units) and employment in the agricultural industry (RR, 0.79; 95% CI, 0.67–0.95 per 10%) were protective of lower ESBL-Ec incidence. After accounting for multiple demographic factors, the residual, structured, random-effects model indicated that hot spots were still detected in more remote communities but also in several city regions. Conclusions: The change in distribution of ESBL-Ec across Queensland suggests the presence of area-level specific risk factors that enhance spread in the community. Risk factors for spread appear different between remote and city settings, and future research should be tailored to understand the respective area-level risk factors. Factors such as local temperature, antibiotic consumption, and access to services should be validated. Future public health measures to reduce transmission should be focused on the identified hot spots.
SG-APSIC1123: Diagnostic and infection prevention and control (IPC) performance of rapid polymerase chain reaction (PCR) compared to conventional culture PCR methods for detecting carbapenemase-producing organisms (CPOs)
Authors: Huan Xiaowei , Linn Kyaw Zaw , Farhanah Sharifah , Ong Clara Chong Hui , Hon Pei Yun , Sun Yan , Lian Weixiang , Loh Janis Wanning , Chow Angela , Ang Benda Sze Peng , Leong Janice Wai Yeng , De Partha P , Ng Oon Tek , Kalisvar Marimuthu , Vasoo Shawn
Published: March 2023

Objectives: In this study, we compared the performance of a rapid polymerase chain reaction (PCR) method in detecting carbapenemase-producing organisms (CPOs) and its impact on infection prevention and control (IPC) measures compared with a culture PCR method. Methods: All patients requiring CPO screening were included. Rectal swabs were collected with double rayon swabs (Copan 139C). They were simultaneously analyzed for the presence of CPOs using rapid PCR assay (Xpert Carba-R assay, Cepheid, Sunnyvale, CA) and a culture–PCR method (ChromID CARBA-SMART, bioMerieux, Marcy-l’Etoile, France). For CARBA-SMART, only colored colonies (ie, Enterobacterales) were evaluated for CPOs according to the prevailing institutional protocol. We tracked time to CPO detection. Using CPO positivity from either the rapid PCR or the culture PCR method as the gold standard, we calculated the sensitivity and specificity of both tests. We calculated the number of epidemiologically linked contacts generated when the first test results were known. We prospectively followed the ward census to identify the putative additional number of contacts generated by the later known result. Contacts were patients who shared the same ward (with overlapping time) as the CPO patients. Results: Between April 2019 and June 2020, culture PCR method detected CPOs in 316 (1.3%) of 24,514 samples (blaOXA48, N = 211; blaNDM, N = 51; blaIMI, N = 21; blaIMP, N = 10; blaKPC, N = 9; mixed genotypes, N = 14). The rapid PCR test detected CPOs in 605(2.5%) of 24,514 samples (blaOXA48, N = 266; blaNDM, N = 161; blaIMP, N = 99; blaVIM, N = 29; blaKPC, N = 15; mixed genotypes, N = 35). The sensitivity of direct PCR and culture PCR methods were 94.2% (95% CI, 92.1%–95.8%) and 43.5% (95% CI, 39.6%–47.4%), respectively. Both tests had 100% specificity. The median times to detection for the rapid PCR and culture PCR methods were 3–4 hours and 4 days, respectively. Compared with rapid PCR, the culture PCR method generated additional 7,415 contacts when it also tested positive for CPOs and an additional 23,135 contacts when it tested negative for CPOs. Conclusions: In our study, the rapid PCR test was more sensitive, identified CPO faster, and generated fewer epidemiologically linked contacts than the culture PCR method.
SG-APSIC1199: Evaluation of a pooling strategy using Xpert Carba-R assay for screening for carbapenemase-producing organisms in rectal swabs
Authors: Zhang Peng , Wang Qi , Zhou Chaoe , Gao Xinghui , Tang Yi-wei , Wang Hui
Published: March 2023

Objectives: Rapid and accurate screening for carbapenemase-producing organism (CPOs) in hospitalized patients is critical for infection control and prevention. The Xpert Carba-R assay is designed for rapid detection of CPOs, but 1 assay is usually conducted for only 1 sample. We evaluated a pooling strategy for CPO screening using the Xpert Carba-R assay. Methods: Swab sets containing 2 swabs were collected from 415 unique patients at Peking University People’s Hospital. One swab was used for the pooling test, in which 5 swabs from different patients were mixed in 1 sample treatment solution. The prevalence of CPOs in the hospital (5.3%) predicted that 5:1 pooling was most economical. As the reference method, the other swab was tested by culture using sequencing. Results: Of 415 samples, 383 were CPO negative using the pooling test strategy and 31 were positive. All samples that were negative by pooling were negative by culture and sequencing. Among the 31 positive samples identified by the pooling strategy, 26 were positive by culture and sequencing (including 24 samples with 1 targeted gene and 2 samples with double targeted genes, 1 NDM+/IMP+ and 1 VIM+/IMP+), and 5 were negative. Overall, 198 tests were conducted in the study, and 217 were saved compared with testing individually. The efficiency of the pooling strategy was 215%. The overall sensitivity was 1 (95% CI, 0.840–1), the specificity was 0.987 (95% CI, 0.968–0.995), the accuracy was 0.987 (95% CI, 0.970–0.996), positive predictive value was 0.838 (95% CI, 0.655–0.939), and the negative predictive value was 1 (95% CI, 0.988–1). Conclusions: The pooling strategy using the Xpert Carba-R assay showed good potential in screening CPO with good sensitivity and a significantly lower cost.
SG-APSIC1081: Healthcare cost of antibiotic resistant infections: A hospital-based study in Vietnam
Authors: LanPham Thi , Pham Lan
Published: March 2023

Objectives: Antimicrobial resistance is a serious threat to health and economic well-being worldwide. The impact of antibiotic-resistant infections is reflected by higher mortality, increased lengths of hospital stay (LOS), and increased healthcare costs. We analyzed the direct healthcare costs attributable to treating patients infected with methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Enterobacterales (CRE) in a tertiary-care referral hospital in Vietnam. Methods: A retrospective descriptive cross-sectional study was conducted in an intensive care unit (ICU) in the University Medical Center in Ho Chi Minh City from June 2018 to September 2019. Participants were ICU patients diagnosed with either MRSA or CRE infection, and patients infected with non–multidrug-resistant organisms (non-MDROs) were used as the comparison group. Medical records were obtained to collect data on medical services expenditures such as medications, diagnostic testing, medical procedures, and hospital rooms. Statistical significance was determined using the Mann-Whitney and Kruskal-Wallis tests for comparing the average costs and the χ2 test for comparing the proportions. Results: In total, 227 patients, including 37 MRSA-infected patients, 97 CRE-infected patients, and 93 non–MDRO-infected patients, were included in the study. The additional average healthcare costs for a treatment episode of a CRE infection case (367.7 million VND or ~US $16,000) and of a MRSA infection case (139.1 million VND or ~US $6,043) were 3.8 times higher (P < .001) and 1.5 times higher (P < .001), respectively, than the average cost for a non-MDRO case (94.8 million VND or ~US $4,121). Resource use for a CRE infection was higher than that for MRSA infection, with longer antibiotic treatment (13.4 additional days), greater LOS (15.8 additional days), and higher costs (additional 228.6 million VND or ~US $9,939). Conclusions: Multidrug-resistant infections create a heavy economic burden in a low- to middle-income country like Vietnam. The elevated cost was mainly due to longer antibiotic treatment and increased LOS.
SG-APSIC1083: Prevalence and classification of carbapenemase-producing gram-negative bacilli at a medical center in Ho Chi Minh City, Vietnam
Authors: Huynh Tuan , Luong Loan
Published: March 2023

Objectives: The identification and classification of carbapenemases are meaningful in clinical treatment, epidemiology, and multidrug-resistant bacteria control. We sought to identify the proportion of carbapenemase-producing and carbapenemase classifications in gram-negative bacilli in our hospital. Methods: Isolates of gram-negative bacilli were extracted from sputum, blood, and urine samples in a medical center in Ho Chi Minh City. The identification of gram-negative bacilli was performed using the Phoenix M50 automated system (Becton Dickinson, Franklin Lakes, NJ). An antibiogram was conducted using the disk-diffusion method to detect meropenem-resistant gram-negative bacteria. Carbapenemase confirmation and classification of isolates resistant or intermediately resistant to meropenem were performed using the NMIC500 CPO kit on the Phoenix M50 system. Results: Among 599 isolates of gram-negative bacilli, 108 isolates were resistant or intermediately resistant to carbapenem (meropenem). Of these108 isolates, 107 (99.1%) were resistant due to the carbapenemase-producing mechanism. The proportions of resistant or intermediately resistant isolates to carbapenem were as follows: 73.8% for Acinetobacter baumannii, 26.4% for Klebsiella pneumoniae, 25.9% for Pseudomonas aeruginosa, and 2.8% for Escherichia coli. Class D carbapenemase accounted for the highest proportion, with 53 (49.5%) of 107 isolates, followed by class B with 31 isolates (29%), and class A with the lowest proportion of 2 isolates (1.9%). Also, 44.4% of Acinetobacter baumannii isolates and 74.4% of Klebsiella pneumoniae isolates produced class D carbapenemase. Conclusions: Gram-negative bacilli are resistant to carbapenem primarily due to the carbapenemase-secreting mechanism. D-class carbapenemase accounted for the highest percentage, followed by B-class type, and A-class carbapenemase in gram-negative bacilli.