bluuebunny/crossref_metadata_2025_split huggingface dataset:
2903. Post PCV13 Dynamics of NonVaccine Serotype (NVT): Disproportionate Increase of the Additional PCV20 Candidate Serotypes in Respiratory and Invasive Disease in Young Children
Authors: Ben-Shimol Shalom , Givon-Lavi Noga , Kotler Leore , Greenberg David , Dagan Ron 
Published: October 2019

Abstract

Background
PCV13 implementation in children resulted in a substantial decline in carriage of and disease by vaccine serotypes (VT13). However, disease caused by non-PCV13 serotypes (NVT) is still relatively prevalent and even increasing, leading to an effort to develop a 20-valent vaccine (PCV20), containing the additional 7 serotypes: 8, 10A, 11A, 12F, 15B/C, 22F, 33F (VT20-13). We assessed dynamics of VT13, VT20-13, and non-PCV20 (NVT20) in nasopharyngeal carriage, respiratory infections, and IPD in children < 2 years following PCV13 implementation.

Methods
Multiple prospective, population-based surveillance projects, conducted in Israel between 2009 and 2017 were used. We studied isolates from IPD; otitis media (OM); conjunctivitis; carriage in healthy children; carriage during lower respiratory tract infections with chest radiography examination (LRI); and carriage during non-LRI illnesses. We added data from healthy children in the community since 2011. Prevalence rate ratios were calculated, comparing VT13, VT20-13 and NVT20 rates in late-PCV13 (2015–2017) vs. early-PCV (2009–2011) periods.

Results
Overall, 9,089 episodes were recorded. VT13 declined significantly in all 6 groups by 75–86% (Figures 1 and 2). Proportions of VT20-13 significantly increased in all groups, excluding conjunctivitis. The highest increases were observed in IPD, OM, and carriage during LRI. In 2015–2017, VT20-13 consisted 24%, 23%, and 19% of carriage in healthy children, carriage in non-LRI illness, and conjunctivitis, respectively, vs. 51%, 33%, and 32% in IPD, OM, and carriage during LRI. VT20-13 rapidly became the leading fraction in IPD. NVT20 proportions increased in all groups.

Conclusion
(1) PCV13 implementation resulted in a substantial increase in NVT carriage and disease; (2) In IPD, VT20-13 became the dominant group; (3) The increases in the proportion of VT20-13 seen in OM and carriage during LRI was significantly higher than in conjunctivitis and in carriage without LRI.

Disclosures
All Authors: No reported Disclosures.
1138. Script for Pediatrics: Creating a Smartphone Application to Improve Antimicrobial Prescribing
Authors: Primhak Sarah , Pool Natasha , Humphrey Gayl , Voss Lesley , Webb Rachel H , Wilson Elizabeth M , Ritchie Stephen , Duffy Eamon , Best Emma 
Published: October 2019

Abstract

Background
When considering antimicrobial stewardship (AMS) interventions, pediatrics is an important and often overlooked group. By 5 years of age, 97% of New Zealand (NZ) children have received antibiotics (median 8 antibiotic courses/child). Prescribing is complex due to age and weight-based adjustments, unpalatable oral preparations and inappropriate allergy labeling. Our tertiary Children’s Hospital has >250 web-based nationally utilized guidelines, 15% including antimicrobials. A point prevalence audit showed only 63% guideline adherence for inpatient antimicrobial prescriptions. We designed an accessible app to bring antibiotic prescribing and antibiotic allergy decision-making to prescribers at point of care.

Methods
Using local hospital and community guidelines, the national formulary and in consultation with subspecialist teams, 31 algorithms were developed. Each algorithm asked questions including diagnosis, age, antibiotic allergy history and known colonization with-resistant organisms.

Results
The smartphone app (Script) uses the algorithms to advise on appropriate antimicrobial, dose, route and duration of treatment. Advice regarding IV-oral switch parameters and oral antibiotic choice is provided. If allergy is suspected symptom-based decision-making enables the user to choose an alternative agent or encourages allergy de-labeling. Further AMS occurs in some algorithms when advice is given not to prescribe antimicrobials.

Conclusion
Script for Pediatrics launched in NZ in March 2019 with >1000 users in the first 6 weeks. The most frequently accessed guidelines are otitis media, pneumonia and meningitis.
Smartphone applications with local relevance and the ability to update in real-time may prove important tools, by providing easily accessible and intuitive advice to help support antimicrobial stewardship activities. This intervention has been rapidly adopted by pediatric hospital prescribers. The impact on prescribing in concordance with guidelines, timely intravenous to oral antibiotic switch and allergy de-labeling will be assessed.

Disclosures
All authors: No reported disclosures.
1163. Minocycline EDTA Ethanol (MEDTA+EtOH) Lock Is Highly Efficacious in Rapidly Eradicating Candida auris Biofilm
Authors: Reitzel Ruth A , Rosenblatt Joel , Gerges Bahgat , Vargas-Cruz Nylev , Hachem Ray Y , Kontoyiannis Dimitrios P , Raad Issam I 
Published: October 2019

Abstract

Background
Bloodstream infections due to Candida auris are an emerging public health concern due to high prevalence of antifungal resistance and significant rates of patient mortality. C. auris is typically azole-resistant; however, several strains have been identified with elevated MICs to all major classes of antifungals. Previously we reported that a synergistic combination of MEDTA+EtOH was highly effective in a clinical trial that evaluated salvage of catheters in patients with bacterial CLABSI. We have also previously reported in vitro studies that demonstrated this combination was capable of eradicating ordinary yeast CLABSI pathogens. In this study we evaluated the ability MEDTA+EtOH lock to rapidly eradicate C. auris biofilms.

Methods
Biofilm eradication of C. auris was evaluated in 10 strains. Candida auris biofilm was grown on silicone discs for 24 hours. Discs were then washed to remove any nonadherent organisms and exposed for 60 minutes to 1 mg/mL Minocycline + 30 mg/mL EDTA + 25% Ethanol (MEDTA+EtOH) lock solution. 1.35% Taurolidine + 3.5% Citrate + 1000U Heparin (TCH) lock solution was used as a comparator. Discs were exposed to Muller–Hinton broth as a control. Subsequently discs were sonicated for 15 minutes in 5 mL of saline and quantitatively cultured onto sabouraud dextrose agar. Plates were incubated at 37°C for 48 hours and counted for growth. All testing was conducted with 6 replicates.

Results
Median and range of recovered viable colonies are presented below. MEDTA+EtOH was significantly more efficacious compared with control (P = 0.002 for all strains) in completely eradicating all replicates in all 10 strains of C. auris tested. MEDTA+EtOH was also superior compared with TCH lock solution (P = 0.002) for all strains.

Conclusion
MEDTA+EtOH is highly effective and was superior to TCH and positive control in the rapid in vitro eradication of all 10 strains of C. auris biofilms tested.

Disclosures
All authors: No reported disclosures.
1184. Making Pneumonia Surveillance Easy: Automation of Pneumonia Case Detection
Authors: Ding Dan , Stachel Anna , Iturrate Eduardo , Phillips Michael 
Published: October 2019

Abstract

Background
Pneumonia (PNU) is the second most common nosocomial infection in the United States and is associated with substantial morbidity and mortality. While definitions from CDC were developed to increase the reliability of surveillance data, reduce the burden of surveillance in healthcare facilities, and enhance the utility of surveillance data for improving patient safety - the algorithm is still laborious. We propose an implementation of a refined algorithm script which combines two CDC definitions with the use of natural language processing (NLP), a tool which relies on pattern matching to determine whether a condition of interest is reported as present or absent in a report, to automate PNU surveillance.

Methods
Using SAS v9.4 to write a query, we used a combination of National Healthcare Safety Network’s (NHSN) PNU and ventilator-associated event (VAE) definitions that use discrete fields found in electronic medical records (EMR) and trained an NLP tool to determine whether chest x-ray report was indicative of PNU (Fig1). To validate, we assessed sensitivity/specificity of NLP tool results compared with clinicians’ interpretations.

Results
The NLP tool was highly accurate in classifying the presence of PNU in chest x-rays. After training the NLP tool, there were only 4% discrepancies between NLP tool and clinicians interpretations of 223 x-ray reports - sensitivity 92.2% (81.1–97.8), specificity 97.1% (93.4–99.1), PPV 90.4% (79.0–96.8), NPV 97.7% (94.1–99.4). Combining the automated use of discrete EMR fields with NLP tool significantly reduces the time spent manually reviewing EMRs. A manual review for PNU without automation requires approximately 10 minutes each day per admission. With a monthly average of 2,350 adult admissions at our hospital and 16,170 patient-days for admissions with at least 2 days, the algorithm saves approximately 2,695 review hours.

Conclusion
The use of discrete EMR fields with an NLP tool proves to be a timelier, cost-effective yet accurate alternative to manual PNU surveillance review. By allowing an automated algorithm to review PNU, timely reports can be sent to units about individual cases. Compared with traditional CDC surveillance definitions, an automated tool allows real-time critical review for infection and prevention activities.

Disclosures
All authors: No reported disclosures.
1208. Preventing Transmission of Bloodborne Viruses from-Infected Healthcare Workers to Patients in Canadian Healthcare Settings: A National Guideline
Authors: Ogunremi Toju , Defalco Katherine , Lynn Johnston B , Boucoiran Isabelle , Cividino Maureen , Cleghorn Blaine , Ann Isinger Melody , Mark Joffe A , Mazzulli Tony , Robert Yves , Vearncombe Mary , Wong David K , Wong Jason , Dunn Kathy , Henry Bonnie 
Published: October 2019

Abstract

Background
Infectious agents, such as bloodborne viruses (BBVs), can potentially be transmitted from healthcare workers (HCWs) to patients. In an effort to reduce this risk to patients, this guideline, which provides a framework for policies on the management of HCWs infected with BBVs in Canada, was developed.

Methods
A total of six systematic reviews (1995–2016) were conducted to inform the risk of transmission of human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV) from infected HCWs to patients and the infectivity of each virus related to source serum viral load. Three environmental scans were conducted to inform sections on disclosure of HCW’s serologic status, Expert Review Panels, and lookback investigations. Government partners and key stakeholder organizations were consulted and a Task Group provided technical expertise.

Results
The risk of HCW-to-patient BBV transmission is negligible, except during exposure-prone procedures where there is a risk of HCW injury and possible exposure of a patient’s open tissues to the HCW’s blood. Transmission rates were lowest with HIV and highest with HBV (Table 1). Rates varied with several factors including source viral load, nature of potential exposure, infection prevention and control breaches, susceptibility of exposed patient, and use of post-exposure prophylaxis where relevant. The extent of reporting bias for exposure incidents where transmission did not occur is unknown. Current antiviral therapy informed guideline recommendations, with viral load thresholds provided to assist treating physician, Expert Review Panels and regulatory authorities in determining a HCW’s fitness for practice.

Conclusion
Routine Practices (or Standard Precautions) are critical to prevent HCW-to-patient transmission of infections; including BBVs. Recommendations provided in this guideline aim to further reduce the already minimal risk of HCW-to-patient transmission. The guideline provides a pan-Canadian approach for managing HCWs infected with a BBV, with recommendations directly impacting clinical practice related to preventing and controlling healthcare-associated infections.

Disclosures
All authors: No reported disclosures.
1212. Environmental Contamination Characterization of Two Outpatient Clinics
Authors: Warren Bobby G , Turner Nicholas A , Smith Becky A , Addison Rachel , Marden Samantha , Weber David J , Rutala William , Anderson Deverick J 
Published: October 2019

Abstract

Background
Environmental contamination in outpatient clinics is poorly understood.

Methods
We performed a microbiological analysis of surfaces in wound and pulmonary outpatient clinics at a tertiary care center. Cultures were obtained with pre-moistened cellulose sponges from three locations (Exam bed/chair, patient chair, physician area/chair) before and after clinic days. Sponges were combined with 1% Tween20-PBS and mixed in the Seward Stomacher. The homogenate was centrifuged and all but 5 mL of the supernatant was discarded. Samples were plated on Sheep’s blood agar and selective media for S. aureus, Enterococcus spp. and Gram-negative bacteria. CFU was determined by counting the number of colonies on each plate and using dilution calculations to calculate the CFU of the original ~5 mL homogenate. The total sample areas in the wound and pulmonary clinic were 12,735 cm2 and 16,400 cm2, respectively.

Results
A total of 300 samples were obtained over 90-days. Median total room CFU was 7,918 (IQR 2,939–18,855) (Figure 1). Median CFU for the examination area, patient area and physician areas were 2090 (537–10508), 1524 (573–4605) and 960 (371–2183), respectively (Figure 2). The proportions of samples positive for S. aureus, Enterococcus spp. and Gram-negative bacteria were 5.0, 3.3 and 7.7%, respectively (Table 1). In general, median total CFU increased during the clinic day (median CFU before the clinic day 6883 (2937–14983) vs. median after clinic day=10351 (3484–21263) (Figure 3). Environmental bioburden was higher in the wound clinic than the pulmonary clinic (median 18206 CFU [IQR 10048–25037) vs. 3764 [IQR 1452–6671], P < 0.001) (Figure 1). The average number of patients seen in the wound clinic per clinic day was greater than the pulmonary clinic (3.8 vs. 2.2, P < 0.001).

Conclusion
Outpatient clinic rooms were contaminated with clinically important pathogens. Contamination varied by environmental location and increased as the clinic day progressed. Higher contamination was seen in the wound clinic possibly due to higher patient volume vs. increased environmental contamination that occurs while giving wound care. Wound care clinics may need to focus on more detailed cleaning to reduce environmental contamination and the risk of pathogen transmission in at-risk patients.

Disclosures
All authors: No reported disclosures.
1216. A Novel Antimicrobial Surface Coating Demonstrates Persistent Reduction of both Microbial Burden and Healthcare-Associated Infections at Two High-acuity Hospitals
Authors: Elliott Sean P , Ellingson Katherine , Pogebra-Brown Kristen , Gerba Charles P 
Published: October 2019

Abstract

Background
Healthcare-Associated Infections (HAIs) pose substantial risks to patients and hospitals. Surface disinfection practices in hospitals have limited efficacy because surfaces are frequently and easily re-contaminated. A need for innovative technologies to address these challenges exists. One such innovation is a novel antimicrobial surface coating with potential to persistently reduce environmental bacterial load. Here, we use a multicenter, nonrandomized, controlled, pre-post study design to assess the impact of an antimicrobial surface coating on environmental bioburden and HAIs at two high acuity hospitals.

Methods
An antimicrobial surface coating was applied via electrostatic spray to patient rooms and common areas in three selected units at each hospital. Quantitative surface cultures were sent to an independent microbiology laboratory pre- and 11-weeks post-application to identify total bacterial colony-forming units (CFU). HAI outcomes from treatment and contemporaneous control units were assessed using National Healthcare Safety Network protocols for multidrug-resistant organism bloodstream infections (MDRO-BSI) and Clostridium difficile infections (CDI). We used Poisson regression models to compare HAI rates for treated and untreated units for 12-months before and after application of surface coating.

Results
Both hospitals showed statistically significant decreases in total bacterial CFU following application of the antimicrobial surface coating (64% and 75% decreases in Hospitals A and B, respectively, P < 0.0001). Across both hospitals, there was a 36% decline in pooled HAIs (hospital-onset MDRO-BSI + CDI) following application of surface coating in treated units (IRR = 0.64, 95% CI = 0.44–0.91), and no decline in HAIs over the same period in nontreated units (IRR = 1.20, 95% CI = 0.92–1.55).

Conclusion
Significant and persistent reductions in both microbial burden and associated HAIs occurred in units where surfaces were treated with antimicrobial surface coating, suggesting the potential for improved patient outcomes and reduced healthcare costs. Optimal implementation methods and long-term impact should be assessed with further study of this novel environmental control intervention.

Disclosures
All authors: No reported disclosures.
1228. Risk Factors for Contamination with Carbapenemase-Producing Enterobacteriales (CPE) in Exposed Hospital Drains in Ontario, Canada
Authors: Jamal Alainna , Brown Kevin A , Katz Kevin , Johnstone Jennie , Muller Matthew P , Allen Vanessa , Borgia Sergio , Boyd David A , Ciccotelli William , Delibasic Kornelija , Fisman David , Leis Jerome , Li Angel , Mataseje Laura , Mehta Mamta , Mulvey Michael , Ng Wil , Pantelidis Rajni , Paterson Aimee , McGeer Allison 
Published: October 2019

Abstract

Background
Hospital drains may be a source of CPE in patients. We determined prevalence of and risk factors for CPE contamination of hospital drains exposed to patients with CPE colonization/infection.

Methods
We cultured hand hygiene and patient use sink as well as tub/shower drains exposed to 310 inpatients colonized/infected with CPE in 10 Ontario hospitals. A multi-level logistic regression model was fitted to determine whether type of drain/room/unit was associated with CPE drain contamination. Drain and room occupant CPE isolates underwent Illumina whole-genome and MinION sequencing. Single nucleotide variant (SNV) phlogenomic analyses and plasmid characterization were performed.

Results
53/ Of the 1,209 drains, 53 (4%) at 7 (70%) hospitals yielded CPE. Patient room shower drains were significantly more likely to yield CPE than hand hygiene sink (OR 3.35, 95% CI 1.61–6.97) and patient use sink (OR 10.89, 95% CI 3.62–32.80) drains. Hand hygiene sink drains were significantly more likely to yield CPE than patient use sink drains (OR 3.26, 95% CI 1.05–10.13). 8 (15%) drain isolates matched the room occupant CPE gene/species; 24 (44%) matched the gene but not species, and 23 (42%) matched neither gene nor species. Among 13 drain/11 room occupant pairs with molecular comparisons to date, only 1/13 (8%) drain isolates matched the respective room occupant carbapenemase allele and replicon harboring the carbapenemase gene (IncN replicon harboring blaKPC-3). In addition, one drain isolate had a plasmid highly related to plasmids of 2 isolates from a patient occupying a room in an adjacent unit (IncN3 replicons harboring blaKPC-2). At another hospital, all 6 drain isolates were located on one unit and had an IncHI2A/HI2/TrfA replicon harboring blaNDM-1; 5 of these were E. cloacae ST66, with 0–3 SNV differences observed between isolates.

Conclusion
Different drain types have different risks of CPE contamination. In our setting, most drain contamination was not caused by recognized room occupants. Further investigation is needed to understand the sources of hospital drain CPE contamination.

Disclosures
All authors: No reported disclosures.
1257. Mental Health, Quality of Life, and Accessibility to Care Among Virally Suppressed People Living with HIV in the United States
Authors: Evans Tammeka , Cutts Katelyn , Swinburn Paul , Lykopoulos Konstantinos , Ferrer Pedro A 
Published: October 2019

Abstract

Background
Life expectancy of people living with HIV (PLHIV) in the United States has improved dramatically in the last 25 years, and more than ever are virally suppressed (VS). However, HIV is a complex chronic condition associated with a myriad of concurrent conditions. The “Real-world Insights of PLHIV Shared through Electronic devices” (RISE) study was a cross-sectional survey designed to obtain an up-to-date understanding of the unmet needs in virally suppressed PLHIV.

Methods
Participants completed the survey on a mobile application downloaded directly to their device. The survey included a sociodemographic and clinical section, and seven validated patient-reported outcome measures. The current analysis was limited to Functional Assessment of HIV Infection (FAHI) total and domain scores as well as the Patient Satisfaction Questionnaire (PSQ-18) accessibility and convenience domain. A two-point difference in the FAHI domain scores and a five-point difference in the total score are generally considered clinically meaningful and were used as benchmarks for comparisons.

Results
Most of the sample (n = 1,226) were virally suppressed (VS) (92%), male (81%), White (53%), homosexual (77%), and reported some type of mental health condition (90%). On average participants were 46±11 years old and had been diagnosed with HIV 14.3±9.6 years ago. VS participants with a mental health condition reported significantly lower quality of life (QoL) than participants without a mental health condition, except on the FAHI social well-being and cognitive functioning scores (Table 1). VS participants with depression reported lower QoL even when controlling for key demographic variables (F= 278.3; P < 0.0001; R2=.77).

Conclusion
While treatment and care for PLHIV has improved in recent years, there remain significant unmet needs. Although achieving VS significantly improves the QoL of PLHIV, additional attention should be placed on the role of mental health and well-being, especially as individuals age while living with HIV. These results highlight the need to understand factors contributing to decreased HRQoL in PLHIV, and the importance of addressing these factors in clinical care.

Disclosures
All authors: No reported disclosures.