bluuebunny/crossref_metadata_2025 huggingface dataset:
Antimicrobial Resistance and Biofilm Formation by Staphylococcus aureus Isolated From Ocular Infections
Authors: KŁOS Marta , Pomorska-Wesołowska Monika , Romaniszyn Dorota , Chmielarczyk Agnieszka , Wojkowska-Mach Jadwiga
Published: November 2020

Background: Untreated staphylococcal ocular infections may cause injuries in the ocular structure and lead to visual impairments, lesions in the anatomical ocular surface, and blindness. The aim of the study was to describe the characteristic of 90 Staphylococcus aureus (SA) strains from hospital and community treated ocular infections with a special emphasis on ability of biofilm formation and drug resistance. The biofilm formation was carried out using the Congo red agar (CRA) method applying Congo red dye. Studies have demonstrated that the CRA method is simple, fast, and repeatable and that modifications of some components can easily increase its accuracy. Methods: Biofilm formation was examined by the method with CRA test. On CRA, slime-producing strains formed black colonies, whereas nonproducing strains developed red colonies in 6 kinds of colors, from very red to very black: very red, red, burgundy, almost black, black, and very black. Antimicrobial susceptibility testing was performed by disc diffusion or the E-test method according to the current guidelines of the EUCAST. The MRSA, and MLSB phenotypes were detected. Polymerase chain reaction (PCR) was used to detect the mecA, and mupA genes. Erythromycin resistance genes (ermA, ermB, ermC, and msr) were detected by multiplex PCR. Results: A positive result of the CRA test was accomplished in 66.2% cases; significantly more often in hospital strains (73.4% vs 45.4%; OR, 3.3; 55% CI, 1.2–9.3). Moreover, 73.4% isolates were fully susceptible. In hospitalized patients, the level of resistance to at least 1 antimicrobial category has been identified as 40.9%, and this rate was 27.2% in outpatients. Among the tested strains, 5 (6.0%) had the resistance phenotype MRSA and 22 (26.5%) the resistance phenotype MLSB; 4 strains manifested both mechanisms; erythromycin resistance was 25.3% in those resistant to fluoroquinolones. Resistance to fluoroquinolones was 5 times more often found in ambulatory patients. All of the tested isolates were vancomycin sensitive. Conclusions: Biofilm formation is an important risk factor for developmental staphylococcal hospital-acquired ocular infections. Our results prove that hospital strains have demonstrated much greater biofilm-forming ability than nonhospital strains. Studies indicate the high efficacy of chloramphenicol and fluoroquinolones treatments, as well as the need to implement new solutions due to the aforementioned bacteria’s high resistance to neomycin and anatomic barriers difficulties.

Disclosures: None

Funding: None
Antimicrobial Stewardship Approach: Strategy to Enhance Antimicrobial Stewardship Programs in Arizona Long-Term Care
Authors: Villanueva Juan , Nix David , Bhattarai Rachana , Komatsu Kenneth , Kim Elizabeth
Published: November 2020

Background: Implementing robust antimicrobial stewardship programs within long-term care facilities (LTCFs) presents unique challenges not typically seen in other healthcare settings. These facilities tend to care for older adults, rely on limited on-site clinician availability and experience higher-than-normal staff turnover. Many LTCFs lack the resources and expertise to track and analyze antibiotics usage. Through a collaborative effort between the Arizona Department of Health Services and the University of Arizona College of Pharmacy, support for carrying out stewardship activities was provided to these healthcare facilities. Our objective was to assess the viability of using pharmacy prescribing data to evaluate antibiotics usage among LTCFs throughout Arizona to assist in development of antimicrobial stewardship interventions. Methods: We invited interested LTCFs to participate in the development and enhancement of antimicrobial stewardship programs. We analyzed antibiotic prescribing data from November 2017 through November 2018 to assess the types and quantities of antibiotics prescribed. We worked with pharmacies to obtain a deidentified dataset that included unique patient identifiers, transaction (start) date, agent name, directions for use, route of administration, quantity dispensed, and stop dates. We estimated duration of treatment by assessing antibiotic starts using the number of transaction dates and unique patient identifiers for repeat prescriptions. Each agent was evaluated individually and assigned to an antibiotic category to better assess cumulative prescribing. Results: Through assistance from our community partners, we recruited 11 facilities to participate and worked with 5 servicing pharmacies to obtain a complete dataset for 6 LTCFs. For the facilities evaluated, there were a total of 4,654 antibiotic prescriptions. The most commonly prescribed antibiotic categories were fluroquinolones (24.3% of prescriptions) and oral β-lactams (17.8% of prescriptions). The third most commonly prescribed antibiotics were agents utilized against methicillin-resistant Staphylococcus aureus (MRSA) (13.7% of prescriptions). Antibiotic duration ranged from 1 to 304 days of therapy. Conclusions: Working directly with servicing pharmacies is an efficient way to obtain antibiotic prescribing data for LTCFs. During the 1-year period evaluated, antibiotic prescription rates varied between LTCFs. Despite numerous warnings, the fluroquinolone class continue to be among the most commonly prescribed antibiotics. Visualizing trends in LTCFs antibiotic data is an optimal way to develop and enhance antimicrobial stewardship programs in LTCFs. This fundamental information can help identify areas in which a facility can focus their stewardship efforts and provide a baseline for monitoring progress over time.

Funding: None

Disclosures: None
Antimicrobial Stewardship Programs and Antibiotic Usage and Resistance in Department of Veterans’ Affairs Medical Centers
Authors: Palalay Hope , Kelly Allison , Simbartl Loretta , Gamage Shantini , Jones Makoto , Roselle Gary
Published: November 2020

Background: Implementation of antimicrobial stewardship programs (ASPs) in acute-care facilities may optimize antibiotic use and decrease antibiotic resistance. To explore the relationship between ASPs and clinical outcomes, we reviewed bivariate relationships between VA Medical Center (VAMC) complexity level and presence of an ASP, presence of an ASP and inpatient antibiotic use, and antibiotic use and antibiotic resistance or Clostridioides difficile infection (CDI). Methods: We conducted a cross-sectional study of national data using the following elements: a detailed survey of antimicrobial stewardship practices at VAMCs in 2012 which included facility complexity designations; data from the VA national Electronic Health Record (EHR) for inpatient antibiotic use (2009–2012 in days of therapy per 1,000 bed days of care); EHR laboratory data in 2013 for antibiotic resistance in E. coli isolates; and 2013 CDI rate data from the VA Inpatient Evaluation Center. These data were reviewed for assessment of the presence of ASPs and for antibiotic use and resistance. We assessed 4 groups of antibiotics for use and resistance: total antibiotics, fluoroquinolones, cephalosporins, and carbapenems. Categorical, t test, or nonparametric analyses were performed, as appropriate. Results: 120 VAMCs were evaluated; 71% had ASPs. Proportions of VAMCs with ASPs were not significantly different by facility complexity level. Differences were observed between presence or absence of ASP and some antibiotic use groups (Table). Presence or absence of an ASP was not statistically associated with a difference in E. coli resistance (any antibiotic group examined) or CDI rates. In addition, antibiotic use (any group) did not statistically associate with E. coli resistance rates, and this result remained unchanged when stratified by presence or absence of an ASP. Conclusions: Total antibiotic use and fluroquinolone use were lower among facilities with ASPs than without, a finding consistent with ASP implementation reducing the amount of antibiotics prescribed. Although we did not find an association between facilities with an ASP and antibiotic resistance or CDI rates in this preliminary review, it sets the stage for future multivariate analyses. Furthermore, given the years of antibiotic use needed for development of resistance, the limited years evaluated may not have been sufficient to determine an impact, highlighting the need for further research into understanding clinical outcomes.

Funding: None

Disclosures: None
Antimicrobial Susceptibility of Bordetella pertussis Isolates in Southern Vietnam During 2015–2017
Authors: Pham Hoan T. , Nguyen Anh H. V. , Nghia Cao Huu
Published: November 2020

Background: Pertussis continues to be an important health issue in Vietnam despite infant vaccination programs. In Vietnam, the incidence rates of pertussis per 100,000 population rose from 0.09 in 2014 to 0.33 in 2015 and to 0.58 in 2017. Macrolides, especially erythromycin, are the treatment of choice. However, erythromycin-resistant cases, caused by transition at A2047G position in 23S rRNA, have been reported in the region. Few data are available on antimicrobial resistance in Bordetella pertussis to guide treatment in Vietnam. We report antimicrobial susceptibility of the circulating strains in southern Vietnam during 2015–2017. Methods: Tracheal aspirates from 263 suspected pertussis cases were subject to multiplex real-time PCR to identify B. pertussis and Bordetella spp. Samples were cultured on Regan Lowe agar with 10% sheep blood containing cephalexin (40 µg/mL) and incubated at 37°C for 10 days. The antimicrobial susceptibilities to erythromycin, azithromycin, clarithromycin, and trimethoprim/sulfamethoxazole were determined using the disc diffusion method (CLSI-2017) on Regan Lowe and Mueller Hinton agar. Erythromycin minimum inhibitory concentrations (MICs) were determined using an E-test. The results were recorded after days 3 and 7 of incubation. Sequencing of the 23S rRNA gene was performed to detect mutations conferring macrolide resistance. Results: Of 263 cases, 119 were positive for B. pertussis (45.2%) by real-time PCR, and 15 of 263 strains (5.7%) were successfully cultured. All 15 isolates were susceptible to macrolides and no heterogeneous phenotype was recorded after 7 days; erythromycin MICs were ≤0.094 µg/mL (Fig. 1). We observed no difference in results generated on Regan Lowe and Mueller Hinton media. However, for testing trimethoprim/sulfamethoxazole, results on were superior, as those on Regan Lowe media were unclear. Sequencing of 23S rRNA identified no mutations known to confer macrolide resistance. Conclusions: None of 15 B. pertussis isolates tested were nonsusceptible to erythromycin and macrolides. Similarly, no mutation at the erythromycin-binding site in the 23S rRNA gene was identified. The low isolation rate of B. pertussis by culture means that few positive specimens were tested for antimicrobial susceptibility. To overcome this limitation, detection of resistance directly from clinical specimens needs to be investigated. Ongoing screening for B. pertussis and antimicrobial susceptibility is recommended to support efforts to control the spread of this respiratory tract infection agent.

Funding: None

Disclosures: None
Assessing Effectiveness of Antibiotic Therapy Against Gram-Negative Bacteria in a Saudi Hospital Using a Drug Resistance Index
Authors: Yaseen Muhammad , Althaqafi Abdulhakeem , Alshamrani Majid , Alsaedi Asim , Fayssal Farahat , Hameed Fahad Al , Mowallad Abdulfattah , Tseng Katie , Essack Sabiha
Published: November 2020

Background: Assessing the effectiveness of antibiotics and communicating the problem of resistance is essential when devising antimicrobial stewardship programs in hospital settings. The drug resistance index (DRI) is a useful tool that combines antibiotic consumption and bacterial resistance into a single measure. In this study, we used the DRI to assess the impact of introducing a new antibiotic restriction form on antibiotic effectiveness for the treatment of gram-negative infections in the intensive care unit (ICU). Methods: We conducted a before-and-after intervention study from 2015 to 2017 at King Abdulaziz Medical City, a tertiary-care facility in Jeddah, Saudi Arabia. The antibiotic susceptibility of gram-negative bacteria and antibiotic prescribing rates for antibiotics indicated for gram-negative bacteria were assessed to evaluate the impact of a new antibiotic restriction form introduced in the ICU in July 2016. Changes in antibiotic effectiveness before and after the intervention were evaluated by calculating the DRI for 4 of the most common gram-negative pathogens and 8 commonly used antibiotic classes. Results: The overall DRI for the adult ICU (59.45) was higher than the hospital-wide DRI (47.96). A higher DRI was evident for carbapenems and antipseudomonal penicillins + β-lactamase inhibitors. A. baumannii had the highest DRI, followed by K. pneumoniae in both the adult ICU and hospital-wide. After implementation of antibiotic restriction in the adult ICU, the DRI for carbapenems was significantly lower in the postintervention phase, from 31.61 to 26.05 (P = 0.031). Conclusions: DRI is a useful tool for tracking the effectiveness of antibiotics over time. The results highlight the importance of having effective antibiotic stewardship program in healthcare settings as well as regular feedback of antibiotic consumption data to the stakeholders to keep the antibiotic prescriptions in check, thereby ensuring their sustained effectiveness.

Funding: None

Disclosures: None
Assessment of Potential Clostridioides difficile Public Health Notification Thresholds in Acute-Care Hospitals
Authors: Dale Ariella , Parikh Meghana , Bamberg Wendy , Kainer Marion
Published: November 2020

Background:Clostridioides difficile remains a pervasive issue throughout healthcare facilities in the United States. Currently, no national guidelines exist for healthcare facilities to notify public health about suspected C. difficile transmission. Identification of a threshold for public health notification is needed to improve efforts to target prevention in facilities and to contain the spread of C. difficile.Methods: We analyzed C. difficile data reported by acute-care hospitals (ACHs) during October 2017–September 2018 via the CDC NHSN in Colorado and Tennessee. Threshold levels of ≥2, ≥3, and ≥4 C. difficile infections per calendar month per unit were assessed to identify ACH units that would trigger facility reporting to public health. Values meeting thresholds were defined as “alerts.” Facilities were further stratified by size and medical teaching status. Recurrent alerts were defined as meeting the threshold at least twice within 12 months. Presence and recurrence of facility alerts were compared to facility-specific standardized infection ratios (SIRs) and cumulative attributable differences (CADs). Results: Of 105 ACHs in Tennessee and 50 in Colorado, 46 in Tennessee (44%) and 28 in Colorado (56%) had alerts with a threshold of ≥2 cases per calendar month per unit; 20 in Tennessee (19%) and 19 in Colorado (38%) had ≥3 cases per calendar month per unit; and 7 in Tennessee (7%) and 10 in Colorado (20%) had ≥4 cases per calendar month per unit. Most alerts with each threshold were in facilities with ≥400 beds and in major teaching hospitals. Using a threshold of ≥2, 64% of Tennessee and 79% of Colorado alerts were associated with recurrent alerting units. Using an alert threshold of ≥3, 85% of Tennessee facilities (17 of 20) and 75% of Colorado facilities (15 of 20) with the highest CAD values had at least 1 alert. Using state-based CAD values, 79% of the CAD value for Tennessee (356 of 449) and 91% of the CAD value for Colorado (309 of 340) were attributable to facilities with at least 1 alert. Facilities above a threshold of ≥3 had a pooled SIR of 0.92 in Tennessee (range, 0.46–7.94) and 1.07 in Colorado (range, 0.74–1.74). Conclusions: Using alert threshold levels identified ACHs with higher levels of C. difficile. Recurrent alerts account for a substantial proportion of the total alerts in ACHs, even as thresholds increased. Alerts were strongly correlated with high CAD values. Because NHSN C. difficile data are not available to public health departments until several months after cases are identified, public health departments should consider working with ACHs to implement a threshold model for public health notification, enabling earlier intervention than those prompted by SIR and CAD calculations.

Disclosures: None

Funding: None
Association Between Infection Control Resource Use and the Number of Penalties Under Medicare’s Hospital-Acquired Condition Reduction Program
Authors: Scott Robert , Baggs James , Culler Steven , Jernigan John
Published: November 2020

Background: The Hospital-Acquired Condition Reduction Program (HACRP) is a pay-for-performance Medicare program that promotes reducing patient harm, particularly healthcare-associated infections (HAIs). We examined the association between infection-control–related activities and the number of penalties a hospital received between fiscal years 2015 and 2018. Methods: We used logistic regression with ordered categories to assess infection control resource use and the number of penalties, an ordered categorical dependent variable with 5 categories ranging from 0 to 4, as of 2018. Data sources included National Healthcare Safety Network, American Hospital Association Annual Survey, Medicare Impact and Cost Report files, and Data.Medicare.gov. We excluded hospitals lacking data to calculate any HACRP score or component score for HAI and hospitals missing observations for model variables (301 hospitals). We assessed the following model variables: teaching hospital status, infection preventionists (IP) per 1,000 beds, surveillance hours per week per bed, other infection control activities per week per bed, nurse-to-bed ratio, housekeeping expenditure per 10,000 beds, nursing position vacancies per bed, bed size, electronic health record (EHR) implementation, number of skilled nursing beds, rural or urban location, and Medicare patient case-mix (cmi_quartiles). Results: In our model, negative logit model point estimates indicated that increased values of the variable are associated with a lower odds of having a higher number of penalties. The final data set consisted of 3,004 US hospitals. Lower penalties were significantly associated with higher IP-to-bed ratio. Although the point estimates were <1, an association between lower penalties and higher nurse-to-bed ratios or electronic health records was not demonstrated (Table 1). Conclusions: Our results suggest that after controlling for selected hospital structural factors, incremental resources related to infection control have a protective association with HCARP penalties.

Funding: None

Disclosures: None
Automated Risk Analysis of Surgical Site Infection in Hip Arthroplasty Surgeries
Authors: Souza Flávio , Couto Braulio , Conceição Felipe Leandro Andrade da , Silva Gabriel Henrique Silvestre da , Dias Igor Gonçalves , Rigueira Rafael Vieira Magno , Pimenta Gustavo Maciel , Martins Maurilio , Mendes Julio Cesar , Quintão Ana Flavia Viana , Brandão Camila Vieira , Borges Débora Martins , Lage Eduarda Muzzi Torres , Sabadini Luiza da Conceição , Lopes Sabrina de Almeida
Published: November 2020

Background: In 7 hospitals in Belo Horizonte, a city with >3,000,000 inhabitants, a survey was conducted between July 2016 and June 2018, focused on surgical site infection (SSI) in patients undergoing arthroplasty surgery procedures. The main objective is to statistically evaluate such incidences and enable a study of the prediction power of SSI through pattern recognition algorithms, the MLPs (multilayer perceptron). Methods: Data were collected on SSI by the hospital infection control committees (CCIHs) of the hospitals involved in the research. All data used in the analysis during their routine SSI surveillance procedures were collected. The information was forwarded to the NOIS (Nosocomial Infection Study) Project, which used SACIH automated hospital infection control system software to collect data from a sample of hospitals participating voluntarily in the project. After data collection, 3 procedures were performed: (1) a treatment of the database collected for the use of intact samples; (2) a statistical analysis on the profile of the hospitals collected; and (3) an assessment of the predictive power of 5 types of MLP (backpropagation standard, momentum, resilient propagation, weight decay, and quick propagation) for SSI prediction. MLPs were tested with 3, 5, 7, and 10 hidden layer neurons and a database split for the resampling process (65% or 75% for testing and 35% or 25% for validation). The results were compared by measuring AUC (area under the curve; range, 0–1) presented for each of the configurations. Results: Of 1,246 records, 535 were intact for analysis. We obtained the following statistics: the average surgery time was 190 minutes (range, 145–217 minutes); the average age of the patients was 67 years (range, 9–103); the prosthetic implant index was 98.13%; the SSI rate was 1.49%, and the death rate was 1.21%. Regarding the prediction power, the maximum prediction power was 0.744. Conclusions: Despite the considerable loss rate of almost 60% of the database samples due to the presence of noise, it was possible to perform relevant sampling for the profile evaluation of hospitals in Belo Horizonte. For the predictive process, some configurations have results that reached 0.744, which indicates the usefulness of the structure for automated SSI monitoring for patients undergoing hip arthroplasty surgery. To optimize data collection and to enable other hospitals to use the SSI prediction tool (available in www.sacihweb.com ), a mobile application was developed.

Funding: None

Disclosures: None
Candida auris Infection Among Patients With Cancer in an Oncology Center in Eastern India
Authors: Bhattacharya Sanjay , Das Parijat , Goel Gaurav , Mukherjee Sudipta , Ghosh Pralay Shankar , Singh Rohit , Sinha Subir , Chandy Mammen , Walia Kamini , Chakrabarti Arunaloke
Published: November 2020

Background: The multidrug-resistant fungus Candida auris is emerging as a major cause of healthcare-associated infection globally. Understanding the epidemiology of these infections in vulnerable groups such as cancer patients is important for hospital infection control and their effective management. In this report we present diagnostic, clinical, antifungal resistance and outcome data of 11 cases of C. auris infection from an oncology center in India. Methods:C. auris strains were identified by Sanger-based DNA sequencing of the internal transcriber spacer (ITS) gene. Antifungal susceptibility testing (AFST) was performed using the broth dilution method. Identification and AFST were checked by the WHO Collaborating Center for Reference & Research on Fungi of Medical Importance. Patients had both empirical as well as directed therapy with antifungal agents based on AFST results and clinical assessment. Results: Between November 2018 and March 2019, 11 cases of C. auris (8 from patients with solid-organ tumors and 3 from hematological malignancy) were detected. Two distinct genetic clusters were identified by ITS gene sequencing; one of these clusters showed 100% homology with a previously unknown C. auris isolate (GenBank accession no. MK881076) and the other cluster had a 100% identity score with isolates from Japan and South Korea (GenBank accession nos. MH071441, KY657027, and EU884189). All 11 strains were resistant to fluconazole. With voriconazole, 1 isolate was susceptible, 3 were resistant, and 7 showed dose-dependent susceptibility. Two isolates were resistant to amphotericin B. Resistance to caspofungin or anidulafungin was noted in 1 of 11 isolates (9%); most showed intermediate susceptibility (63% to caspofungin). Among all of the patients, 72% were from the intensive care unit (ICU) or the high-dependency unit. The 30-day all-cause mortality was 5 of 11 (45%) in the C. auris group and 4 of 11 (36%) the control group (ie, infections with other Candida spp during same period). Duration of ICU stay in the C. auris group was 12 days and in the control group it was 6 days. The median cost (in terms of hospital bill at the time of discharge or death) for management of Candida auris infection and the primary medical condition was US$10,121 for the C. auris groups and US$8,608 for the control group. Most cases (10 of 11) were detected in wards without isolation rooms, and 8 of the 11 C. auris cases (73%) were detected in patients in the intensive care unit. Conclusions: Morbidity, mortality, ICU stay, and healthcare costs are significant in C. auris infection.

Funding: None

Disclosures: None
Carbapenemase-Producing, Carbapenem-Resistant Acinetobacter baumannii: Summary of CDC Consultations, 2017–2019
Authors: Epstein Lauren , Shugart Alicia , Ham David , Vallabhaneni Snigdha , Brooks Richard , McAllister Gillian , Halpin Alison , Gilbert Sarah , Walters Maroya
Published: November 2020

Background: Carbapenemase-producing carbapenem-resistant Acinetobacter baumannii (CP-CRAB) are a public health threat due to potential for widespread dissemination and limited treatment options. We describe CDC consultations for CP-CRAB to better understand transmission and identify prevention opportunities. Methods: We defined CP-CRAB as CRAB isolates with a molecular test detecting KPC, NDM, VIM, or IMP carbapenemases or a plasmid-mediated oxacillinase (OXA-23, OXA-24/40, OXA-48, OXA-58, OXA-235/237). We reviewed the CDC database of CP-CRAB consultations with health departments from January 1, 2017, through June 1, 2019. Consultations were grouped into 3 categories: multifacility clusters, single-facility clusters, and single cases. We reviewed the size, setting, environmental culturing results, and identified infection control gaps for each consultation. Results: We identified 29 consultations involving 294 patients across 19 states. Among 9 multifacility clusters, the median number of patients was 12 (range, 2–87) and the median number of facilities was 2 (range, 2–6). Among 9 single-facility clusters, the median number of patients was 5 (range, 2–50). The most common carbapenemase was OXA-23 (Table 1). Moreover, 16 consultations involved short-stay acute-care hospitals, and 6 clusters involved ICUs and/or burn units. Also, 8 consultations involved skilled nursing facilities. Environmental sampling was performed in 3 consultations; CP-CRAB was recovered from surfaces of portable, shared equipment (3 consultations), inside patient rooms (3 consultations) and nursing stations (2 consultations). Lapses in environmental cleaning and interfacility communication were common across consultations. Among 11 consultations for single CP-CRAB cases, contact screening was performed in 7 consultations and no additional CP-CRAB was identified. All 4 patients with NDM-producing CRAB reported recent international travel. Conclusions: Consultations for clusters of oxacillinase-producing CP-CRAB were most often requested in hospitals and skilled nursing facilities. Healthcare facilities and public health authorities should be vigilant for possible spread of CP-CRAB via shared equipment and the potential for CP-CRAB spread to connected healthcare facilities.

Funding: None

Disclosures: None
Chlorhexidine Dressings to Prevent Catheter-Related Bloodstream Infections: A Systematic Literature Review and Meta-analysis
Authors: Puig-Asensio Mireia , Marra Alexandre R. , Childs Christopher A , Perencevich Eli N. , Schweizer Marin L.
Published: November 2020

Background: Catheter-related bloodstream infections (CRBSIs) are associated with significant morbidity and mortality. We aimed to determine the effectiveness of chlorhexidine (CHG) dressings in preventing incident CRBSI in different settings and types of catheters. Methods: We searched PubMed, Cochrane Library, CINAHL, Embase, and ClinicalTrials.gov through March 2019 for studies with the following inclusion criteria: (1) population consisted of patients requiring short or long-term catheters; (2) CHG dressing was used in the intervention group and a nonantimicrobial impregnated dressing was used in the control group; (3) CRBSI was reported as an outcome. Randomized controlled trials (RCTs) and quasi-experimental studies were included. We used a random-effect models to obtain pooled OR estimates. Heterogeneity was evaluated with I 2 test and the Cochran Q statistic. Results: The review included 21 studies (17 RCTs). The use of CHG dressings was associated with a lower incidence of CRBSI (pooled RR, 0.63; 95% CI, 0.53–0.76). There was no evidence of publication bias. In stratified analyses, CHG dressing reduced CRBSI in ICU adult patients (9 studies, pRR, 0.52; 95% CI, 0.38–0.72) and adults with oncohematological disease (3 studies, pRR, 0.53; 95% CI, 0.35–0.81) but not in neonates and pediatric populations (6 studies, pRR, 0.90; 95% CI, 0.57–1.40). When stratified by type of catheter, CHG dressing remained protective against CRBSI in short-term venous catheters (11 studies, pRR, 0.65; 95% CI, 0.48–0.88) but not in long-term catheters (3 studies, pRR, 0.76:; 95% CI, 0.19–3.06). Other subgroup analyses are shown in Table 1. Conclusions: CHG dressings reduce the incidence of CRBSI, particularly in adult ICU patients and adults with an onco-hematological disease. Future studies need to evaluate the benefit of CHG in non-ICU settings, in neonates and pediatric populations, and in long-term catheters.

Funding: None

Disclosures: None
Cobweb Chart for Infection Rates, Infectometer, and Outbreak Alert System: Real-Time Systems for Summarizing Nosocomial Data
Authors: Couto Braulio , Starling Carlos
Published: November 2020

Background: Reporting nosocomial surveillance data can be difficult because the quantity of statistics, graphics, tables, and numeric data may confuse people. Another issue related to feedback regarding healthcare infections rate is that gaps exist between collecting data, the analysis, and implementation of actions based on the information produced. Even when a statistical process control chart (SPC) is used, it is interpreted retrospectively. Here, we present 3 epidemiological tools: (1) a cobweb chart for infection rates, (2) the infectometer, and (3) an outbreak alert system. Methods: For the cobweb chart, the first step is to choose how many and which infection rates will be summarized. Thereafter, all infection rates, respective benchmarks, endemic level, and actual values are placed in a spreadsheet. Although each infection rate has different units (eg, %, rates per 100 discharges, and/or rates per 1,000 denominator days), when we compare the respective endemic level and actual rate with the benchmark, dimensionless quantities are generated for each indicator, making it possible to build the cobweb graph. Using the infectometer for calculations, we (1) built an SPC chart for each infection or microorganism; (2) estimated the average month and standard deviation of the infection cases, excluding outlier data, and (3) calculated the monthly expected incidence, assuming that nosocomial infection occurrence follows a normal distribution. If the supposition of normal distribution fails, a percentile method is used. The outbreak alert system predicts outbreaks using the infectometer parameters, the last month’s observed infection cases, and a Poisson model for predicting the chance of new cases of each infection above monthly expected incidence. Results: With the adapted radar chart, we can report many infection rates in only 1 chart (Fig. 1). The SPC charts for infection rates, stratified by all the types of healthcare infections or by microorganism, can be built, and the infectometer can then be produced, showing weekly and monthly expected cases of an endemic condition. The outbreak alert system is presented as a speedometer that is analyzed at the beginning of each month (Fig. 2). Conclusions: The idea behind the cobweb chart for infection rate method is to report all infection rates in only 1 graph. With the infectometer, it is not necessary to wait until the end of the month to analyze the surveillance data; the analysis becomes prospective and timely. The outbreak alert system brings the future to the present, showing the risk of an outbreak.

Funding: None

Disclosures: None
Colonization of Resistant Microorganisms in Renal Transplants
Authors: Taminato Monica , Fram Dayana , Rezende Thaís Freitas Teles , Grothe Cibele , Pignatari Antonio Carlos , Barbosa Dulce Aparecida
Published: November 2020

Background: Kidney transplant recipients are a group of patients at risk for healthcare-related infections. The results of this study make an important clinical contribution and contribute to findings options to decrease the infection-related morbidity and mortality that affects this patient population. Objectives: We evaluated the prevalence of colonization by multidrug-resistant bacteria, Klebsiella pneumoniae carbapenemase (KPC)–producing bacteria, vancomycin-resistant enterococci (VRE), and methicillin-resistant Staphylococcus aureus (MRSA) in renal transplant patients; we identified the infection rate, morbidity, and mortality in this population. Methods: Prospective cohort study was conducted at the Kidney and Hypertension Hospital from 2012 to 2015. This project was approved by the Unifesp Research Ethics Committee (no. 1630/11) and an informed consent form was obtained from patients included in the study. Study protocol: Data collection was performed in 2 phases: within the first 24 hours after transplantation and 7 days after transplantation. For all included patients, the following data were collected: identification data, clinical data, and laboratory tests of the first day in the study. All included patients (colonized or not) were followed prospectively for 6 months or until treatment change or death. Results: The study included 200 renal transplant patients in accordance with the inclusion and exclusion criteria. We observed that 76 (38%) patients included in our sample were colonized; 8% S. aureus, 11% Enterococcus, and 19% K. pneumoniae. We verified the presence of concomitant colonization of 1 or more of these pathogens. The most prevalent concomitance identified in our population was E. coli and K. pneumoniae. We identified the presence of diabetes and diabetes associated with hypertension as risk factor for colonization. Thus, patients with more systemic complications may be at risk for colonization by multidrug-resistant bacteria. Another risk factor for colonization was antibiotic use in the 6 months prior to transplantation. Transplant-related outcomes were length of stay after transplantation, delayed graft function (ie, dialysis after the transplantation) and postoperative care in an intensive care unit. At the 6-month follow-up, we identified urinary infection and surgical site infection as risk factors. One death occurred due to stroke in the group of colonized patients, unrelated to infectious causes. Conclusions: These results show fundamental aspects for health professionals for bacterial characterization, transmission, and resistance mechanisms and, mainly, tools for prevention and control of multidrug-resistant bacteria from patients colonized under conservative treatment before the complexity of high-risk procedures begins, such as dialysis and transplantation to reduce morbidity and mortality.

Funding: FAPESP São Paulo Research Support Foundation

Disclosures: None
Compliance with Standard Precautions Among University Nursing Students From Croatia: A Cross-Sectional Study
Authors: Mestrovic Tomislav , Neuberg Marijana , Kozina Goran
Published: November 2020

Background: Stringent compliance with standard precautions is of utmost importance for reducing the spread of healthcare-associated infections (HAIs); however, the role of medical and nursing students is often underappreciated. Because undergraduate and graduate nursing programs combine classroom education and clinical training, nursing students are already important stakeholders in HAI risk reduction and patient safety endeavors. Objectives: In this study, we appraised self-reported adherence to standard precautions among university nursing students, and we examined factors that may influence their level of compliance. Methods: In total, 362 undergraduate and graduate university nursing students form the University North in Croatia (Europe), enrolled in courses or modules with clinical placement, were surveyed in this self-reported cross-sectional study. A 2-part self-administered questionnaire was used, consisting of a demographic survey and a globally applicable 20-item Compliance with Standard Precautions Scale (CSPS). Differences were examined by an independent t test and analysis of variance (ANOVA), and factors influencing compliance were further appraised by a standard multiple linear regression analysis. Significance was set at P <.05 (2-sided). Results: The overall compliance rate in this study was 58.4%. The highest compliance rate was observed for wearing gloves when exposed to body fluids, blood products, and any excretion of patients (82.8%); conversely, the lowest compliance rate was reported for disposing a sharps box before it was full (27.2%). Higher rates of compliance were seen in female nursing students compared with their male counterparts (P = 0.039). Even though age was not a significant predictor, there was an increase in compliance rates according to the academic year level (P < .001). Conclusions: Our results indicate that the overall compliance rate of the Croatian nursing students was moderate, although there was a trend toward more rigorous standard precaution adherence with more education and clinical experience. These findings highlight the need to improve the nursing curriculum to integrate more material on infection control practices early in the program, consequently bridging the gap between theory and practice. Finally, a supportive culture of infection control adherence in quotidian clinical practice must be continuously fostered.

Funding: None

Disclosures: None
Core Elements of a State HAI/AR Program With Emphasis on Partnership Networks
Authors: Joshi Cecilia , Mothershed Elizabeth , Vance Wendy , McLees Anita , Paek Margaret , Coteau Adina de , Paragini Salina , Shah Rhea , Meka Sruthi
Published: November 2020

Background: There is a critical need for comprehensive and effective healthcare- associated infection and antibiotic resistance (HAI/AR) programs in the United States. Since 2009, the CDC has funded and engaged public health, healthcare, academic, community, corporate, federal, and other stakeholders to develop effective HAI programs that rely upon such these stakeholders for success. State and local public health programs play a central role in these programs because they bridge healthcare and the community. They may regulate and assess facilities, collect and validate data on infections, and implement prevention programs. Myriad other state, federal, and privately supported stakeholders play essential roles. CDC is developing a framework for highly effective state HAI/AR programs that describes core program elements and can be used as a strategic tool, both in day to day processes and in a public health crisis, such the COVID-19 response. Program elements may include engaged leaders and champions, reliable data for action, effective policies, evaluation, program innovation, communications, and partner networks. This presentation describes a success framework for developing and leveraging HAI/AR partner networks to achieve and sustain their capacities and impact.

Methods: CDC collected qualitative data in select states and combined with expert opinion to draft core elements for success among a network of partners working to achieve HAI/AR and COVID-19 response and prevention in states. The core elements serve as a foundation for the framework. Ongoing analyses will inform refinement of the core elements and framework. The CDC is gathering stakeholders’ input on the framework for applicability and usability in states, with the goal of national implementation. Results: Currently, data indicate the following core elements for partner networks: leadership, strategy and structure; policies; innovation and adaptability; implementation; expertise and resources; communications; and monitoring and evaluation. The framework includes a process for partner network development and sustenance, maturity levels, and supporting tools. States have reported support for core elements and agreed that a success framework is beneficial to achieving core elements. Multiple states have reported support for a process that includes building partner networks and clearly defining roles, as a critical step toward full implementation of Program core elements. Conclusions: A framework for building high-level strategy and competency in partner networks has never been developed for HAI/AR programs. Effective partner networks represent an essential core element of a comprehensive state HAI/AR program. This framework could be applied to a variety of programs and public health contexts, increasing the effectiveness of partner networks.

Funding: None

Disclosures: None
Creating an Outpatient-Specific Antibiogram to Guide Treatment for Urinary Tract Infections
Authors: Grigoryan Larissa , Goebel Melanie , Willis Samuel , Danek Lisa , Matas Jennifer , Kachalia Neal , Katta Anna , Muldrew Kenneth , Zare Mohammad , Hudson Forrest , Atmar Robert , Trautner Barbara
Published: November 2020

Background: Outpatients with uncomplicated urinary tract infections (UTIs) are often treated empirically without culture, whereas urine cultures are typically collected from patients with complicated UTI. Susceptibilities for fosfomycin (a first-line agent) are not routinely performed or reported in the antibiogram. Understanding the prevalence of antibiotic resistance for UTI is critical for empiric treatment and antibiotic stewardship in primary care. Methods: We developed a UTI-focused antibiogram from a prospective sample of outpatients (women and men) with UTIs from 2 public family medicine clinics in an urban area with a diverse, international population (November 2018 to present). During the study period, providers ordered a urine culture for any adult patient presenting with UTI symptoms, including uncomplicated and complicated infections. We estimated the prevalence of resistance to UTI-relevant antibiotics in the overall study population and compared it between patients born in the United States and other countries. Results: We collected 678 urine cultures from 644 unique patients (79% female). Of these cultures, 158 (23.3%) had no growth, 330 (48.7%) grew mixed urogenital flora, and 190 (28.0%) were positive (>10,000 CFU/mL). Patients with positive cultures were mostly female (88.2%), and their mean age was 46.6 ± 14.8 years. Among patients with positive cultures, 42.7% were born in the United States and 57.3% were born Mexico or Central America. Escherichia coli was the most commonly isolated organism (Fig. 1). Susceptibility results for E. coli and all gram-negative organisms combined are presented in Fig. 2. Susceptibility of uropathogens to TMP-SMX was significantly higher in patients born in the United States compared to patients from Mexico or Central America (82% vs 61%; P = .03). Susceptibility to ciprofloxacin was similar in patients born in the United States and other countries (79% vs 72%; P = .50). Of 77 E. coli isolates, 11 (14%) were positive for extended-spectrum β-lactamase production, including 8 isolates from patients whose country of origin was Mexico or a Central American country. Conclusions: More than 20% of outpatients presenting with UTI symptoms had a negative urine culture. Among outpatients with uncomplicated and complicated UTI, uropathogens had a high prevalence of resistance to ciprofloxacin and TMP-SMX, but susceptibility to fosfomycin (restricted in our system) was 100%. Resistance rates for TMP-SMX were higher in patients from Mexico and Central America. Our findings question whether TMP-SMX should remain a first-line agent in US primary-care settings.

Funding: This project was supported by the National Institute of Allergy and Infectious Diseases of the National Institutes of Health under Award Number UM1AI104681.

Disclosures: None
De-escalation of Antibiotics in Severe Sepsis and Septic Shock at a Large Municipal Hospital
Authors: Kondo Maiko , Uppal Amit , Horowitz Harold
Published: November 2020

Background: Early de-escalation of antibiotics in sepsis may be safe and effective. In our study, we performed a retrospective chart review of patients admitted to a large municipal hospital who were treated for severe sepsis or septic shock to compare outcomes in patients who experienced early de-escalation (DEG) with outcomes of those who did not (NDG).

Methods: The observational study was conducted at Bellevue Hospital Center (an 850-bed municipal hospital affiliated with New York University School of Medicine, New York, NY). Patients admitted from January 1 to December 31, 2015, who were treated for severe sepsis or septic shock during any time of their hospital stay were reviewed for the study. De-escalation was defined as narrowing or discontinuation of 1 or more antimicrobial therapies < 3 days after sepsis onset. Results: Overall, 277 patients were included (DEG, 90 patients, 32%; NDG, 187 patients, 68%). The groups were similar in terms of sex, comorbidities, length of stay, and severity of illness: septic shock (47% DEG vs 49% NDG; P = .693) and ICU stay (27% DEG vs 32% NDG; P = .406). DEG patients were slightly older than NDG patients: (DEG age, 63+16 years vs NDE age, 58+16 years; P = .028). There was no difference in hospital mortality (8% DEG vs 12% NDE; P = .257). Nearly half of the patients in both groups (46% DEG and 47% NDG) had no causative microorganisms identified using conventional microbiology culture. The common sources of primary infection were respiratory, urinary tract, and gastrointestinal infections, and these were not different between groups. Also, 69% of DEG patients and 79% of NDG patients received antibiotics for >7 days (P = .002). Empiric intravenous vancomycin was initiated in 83% in DEG patients and 74% in NDG patients at sepsis diagnosis. Although organisms covered by intravenous vancomycin were isolated from only 17% of patients in DEG and 23% in NDG, vancomycin was continued for >5 days in 34% of DEG patients and 50.3% of NDG patients (P < .001). 60% of patients in DEG and 61% in NDG were seen by infectious diseases specialists (ID). Patients with infectious diseases consultations had significantly more comorbidities, were more frequently in the ICU, had higher MDRO isolation and longer hospital stays, but they were still de-escalated without a difference in mortality. Conclusions: Microbiology data did not contribute to early de-escalation of antibiotics in this study. This finding may be related to the high percentage of negative culture and unavailability of rapid molecular diagnostic tests. Shorter duration of antibiotics (including vancomycin) was not associated with worse outcome in these severely ill patients.

Funding: None

Disclosures: None