bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patients with Positive Glutamine Dehydrogenase (GDH) Antigen/Toxin and Toxin Negative/PCR Positive Patients: A Comparison
Authors: Chinn Raymond , Mabalot Shannon 
Published: November 2020

Background: A multistep algorithm using GDH antigen plus toxin with a reflex PCR is an acceptable method for detecting CDI. The use of the PCR in discordant cases can identify those patients who are colonized from those patients who have nontoxogenic strains of C. difficile. Identification of discordant patients has infection prevention implications. Treatment is not recommended for patients colonized with C. difficile. Methods: A line listing of patients with positive hospital-onset antigen/toxin positive and discordant PCR positive was created. Demographic information was extracted from medical records and the 2 cohorts were compared. Results: There were 59 discordant and 44 positive cases HO CDI cases from October 2017 through September 2019: (1) There was no difference in age and sex between the 2 groups. (2) Positive patients tended to have 3 loose stools before and after testing (57% vs 27%; P = .026). (3) Overall, 82% of positive patients had 1 of 3 signs or symptoms (leukocytosis, abdominal pain, and temperature >38°C) consistent with CDI compared to 66% of discordant patients (P = .038), and 55% of positive patients were more likely to have 2 of 3 signs or symptoms of CDI compared to 17% of discordant patients (P = .00003). (4) Also, 46% of discordant patients were either on the oncology ward or ICU compared to 32% of positive patients (P = .764). (5) There was no difference between in discordant compared to positive patients in non-CDI antimicrobial therapy within 7 days of CDI test submission (81% vs 84%, respectively). Conclusions: (1) Screening for CDI testing should include 3 loose stools and at least 2 of 3 signs or symptoms of CDI. (2) Discordant cases most likely represents colonization because only 17% of discordant patients had 2 of 3 CDI signs or symptoms at presentation. (3) Discordant cases without clinical features of CDI should not receive treatment to minimize antibiotic exposure. (4) Identification of discordant patients have infection prevention ramifications because CD can be indirectly transmitted by colonized patients; therefore, using PCR in addition to toxin testing is favored. (5) Antimicrobial therapy highly associated with CDI should be avoided, should antimicrobial therapy be necessary in PCR-positive discordant patients.Funding: NoneDisclosures: None
Pattern Recognition Algorithms for Predicting Surgical Site Infection in Abdominal Hysterectomy
Authors: Souza Flávio , Couto Braulio , da Conceição Felipe Leandro Andrade , da Silva Gabriel Henrique Silvestre , Dias Igor Gonçalves , Rigueira Rafael Vieira Magno , Pimenta Gustavo Maciel , Martins Maurilio , Mendes Julio Cesar , Fagundes Amanda Martins , Escalda Beatriz Viana Ferreira , de Souza Isabela Marques , de Vasconcelos Laura Ferraz , Medeiros Maria Eduarda Rodrigues , de Almeida Thais Azevedo 
Published: November 2020

Background: This research represents an experiment based in surgical site infection (SSI) to patients undergoing abdominal hysterectomy surgery procedures in hospitals in Belo Horizonte, (population, 3 million). We statistically evaluated such incidences and studied the SSI prediction power of pattern recognition algorithms, the artificial neural networks based in multilayer perceptron (MLP). Methods: Between July 2016 and June 2018, data on SSI were collected by the hospital infection control committees (CCIH) of the 3 hospitals involved in the research. They collected all data used in the analysis during their routine SSI surveillance procedures. The information was forwarded to the NOIS (Nosocomial Infection Study) Project, which used SACIH (ie, automated hospital infection control system software) to collect data from a sample of hospitals participating voluntarily in the project. After data collection, 3 procedures were performed for SSI prediction: (1) a treatment of the database collected for the use of intact samples; (2) a statistical analysis on the profile of the hospitals collected; and (3) an assessment of the predictive power of 5 types of MLP (ie, backpropagation standard, momentum, resilient propagation, weight decay, and quick propagation). MLPs were tested with 3, 5, 7, and 10 hidden-layer neurons and a database split for the resampling process (65% or 75% for testing, 35% or 25% for validation). They were compared by measuring area under the curve (AUC; range, 0–1) presented for each of the configurations. Results: From 1,166 records collected, only 665 records were enabled for analysis. Regarding statistical data: the average duration of surgery was 100 minutes (range, 31–180); patients were aged 41–49 years; the SSI rate was low (only 10 cases); the average length of stay was 2 days; and there were no deaths among the cases. Moreover, 29% of the operative sites were contaminated and 57% were potentially contaminated, revealing a high rate of potential contamination in the operative sites. The prediction process achieved 0.995. Conclusions: Despite the noise in the database, it was possible to obtain a relevant sampling to evaluate the profile of hospitals in Belo Horizonte. In addition, for the predictive process, although some settings achieved AUC results of 0.5, others achieved and AUC of 0.995, indicating the promise of the automated SSI monitoring framework for abdominal hysterectomy surgery (available in www.sacihweb.com). To optimize data collection and to enable other hospitals to use the SSI prediction tool, a mobile application was developed.Funding: NoneDisclosures: None
Perceptions of Antimicrobial Stewardship among Infectious Disease Physicians at Two Affiliated Teaching Hospitals
Authors: Rynkiewich Katharina , Schwartz David , Won Sarah , Stoner Brad 
Published: November 2020

Background: Two affiliated teaching hospitals in Chicago, Illinois, participated in an ethnographic study of hospital-based inpatient antimicrobial stewardship programs and interventions between 2017 and 2018. Although antimicrobial stewardship is now a requirement in medical practice, it is not clear how infectious disease physicians perceive and understand antimicrobial stewardship. Over a period of 18 months, we directly observed infectious disease practice to better understand how antimicrobial stewardship is conducted among physicians within the same specialty. Methods: A doctoral candidate medical anthropologist conducted semistructured interviews with infectious disease attending physicians and fellow physicians (N = 18) at 2 affiliated teaching hospitals in Chicago, IL, between July 2017 and March 2018 as part of an ethnographic study involving direct observation of inpatient care. Interview questions focused on 3 key domains: (1) descriptions of antimicrobial use among hospital-based physicians, (2) solicited definitions of antimicrobial stewardship, and (3) experiences practicing as an infectious disease consultant. Physicians who were directly involved with the antimicrobial stewardship program were excluded from this analysis. Transcriptions of the data were analyzed using thematic coding aided by MAXQDA qualitative analysis software. Results: Infectious disease physicians have a robust understanding of antimicrobial stewardship (Table 1). Infectious disease physicians described other hospital-based physicians as regularly overusing and misusing antimicrobials, compared with their practice, which they described as “thoughtful.” Definitions in response to the question “What is antimicrobial stewardship?” centered on guiding the prescribing behavior of others. Infectious disease physicians valued stewardship and were concerned with lack of adherence to antimicrobial prescribing recommendations among other hospital-based physicians, behaviors which infectious disease physicians viewed as perpetuating antibiotic resistance. Finally, infectious disease physicians found serving as antimicrobial stewards during their everyday practice to be challenging based on their role as consultants to the primary service. Conclusions: Our qualitative analysis revealed that infectious disease physicians not regularly involved in antimicrobial stewardship are highly motivated stewards who perceive their hospital-based colleagues to be less effective at appropriately prescribing antimicrobials. As consultants, infectious disease physicians are not autonomous decision makers. However, as antimicrobial stewardship programs search for champions, infectious disease physicians could be better utilized as knowledgeable and motivated individuals who can make the case for stewardship.Funding: NoneDisclosures: None
Phylogenetic Analysis of Candida auris Isolates From Clinical Samples of Surgical Intensive Care Units
Authors: Warrier Anup , Wilson Arun 
Published: November 2020

Background: Between January and September of 2019, 15 patients acquired Candida auris infection in our surgical intensive care unit (SICU). Although the outbreak was controlled by enhancing horizontal measures and a change of the environmental disinfectant from a quaternary ammonium compound to a peroxide-based product; we wanted to understand whether patient-to-patient spread was occurring or the environment was the major contributor. Methods: We submitted all the 15 isolates from clinical samples for WGS and phylogenetic analysis; along with operation theater (OT) and ICU environment random swabs for metagenomic analysis. DNA sample QC DNA extraction was done using a Qiagen QiAmp DNA mini kit (cat. no. 51306). The DNA samples were subjected to QIAXPERT and Qubit for quantifying the amount of DNA in the extracted sample. Also, the 260/280-nm ratio was examined for the purity of the same. They were also subjected for agarose gel electrophoresis. For the DNA library prep protocol, whole-genome libraries were prepared from 21 samples using NEBNext Ultra IITM DNA Library Prep Kit (Cat. No: E7645L). The adapter sequences were added to the ends of DNA fragments to generate paired-end libraries. The resulting adaptor-ligated libraries were purified and index tags were added by amplification, followed by purification. Libraries were assessed to check the quality and quantity using Agilent 2200 Tape station (cat. no. 3-PM 863NA). For the sequencing protocol, prepared libraries were quantified using Qubit High Sensitivity reagent. The obtained libraries were diluted to final concentration of 2 nm in 10 µL and were subjected to cluster amplification. Once the cluster generation was completed, the flow cells were loaded on to the sequencer. Sequencing was carried out in Hi Seq X10 to generate 2X150-bp sequence reads at >100X sequencing depth (~1.5 Gb). A minimum of 75% of the sequenced bases were of Q30 value. Sequenced data were processed to generate FASTQ files and were uploaded on the FTP server for download and secondary data analysis. Results: Overall, 2% of the DNA from the OT and SICU environment showed Candida auris. The phylogenetic analysis confirmed 2 different clusters. Furthermore, 13 of the clinical isolates belonged to the same cluster, confirming that patient-to-patient transmission had occurred, which was subsequently confirmed by line listing the patients. Conclusions:Candida auris can efficiently spread from patient to patient, resulting in outbreaks. It can also persist in the healthcare environment causing ongoing propagation of these outbreaks.Funding: NoneDisclosures: None
Practice Variation in Validation of Device Denominator Data for National Healthcare Safety Network Reporting
Authors: Challener Douglas , Sampathkumar Priya , O’Horo John O 
Published: November 2020

Background: The NHSN is a widely used CDC program for tracking healthcare-associated infections (HAIs). The goal of the NHSN is to help healthcare organizations to identify and track the incidence of HAI and to prevent adverse events as well as to simplify mandatory quality reporting to the CMS. Healthcare organizations provide both event data for HAIs and information about the population at risk. For device-related infections, device denominator data (eg, data related to urinary or intravascular catheters, and ventilators) must be collected and reported. NHSN guidelines require that electronic reporting of device denominator numbers be validated to be within 5% of manually collected counts over a period of 3 consecutive months. Little is known about current practical application of validation practices. Methods: We surveyed members of the SHEA Research Network (SRN) to assess awareness of and compliance with the current NHSN requirements for device denominator data validation. Results: The survey was sent to 89 member institutions of the SRN from November 20, 2018, to December 12, 2018. The response rate was 35.7%, and 90% of respondents are currently using an electronic system for device denominator count reporting. All except 1 institution manually validated the data. Of the facilities that had completed validation, 31% used <90 days of manual data. Moreover, 82% of these facilities found a difference of <5% between the electronic data and manual data without a statistically significant difference between those with at least 90 days of validation data and those with <90 days. Also, 21% of facilities validated data based on a subset of units. Conclusions: Although most respondents to the survey validate electronically collected device denominator data in accordance with NHSN’s requirements, nearly one-third reported using shorter validation periods than NHSN requires. However, shorter periods were not associated with worse concordance. The NHSN should evaluate whether the burden of a 3-month validation period is justified.Funding: NoneDisclosures: None
Prescribing Pattern of Antibiotics among Children in a Tertiary-Care Hospital, Bangladesh
Authors: Chowdhury Sukanta , Sarker Rajib , Khan Md. Shafiqul Islam , Ghosh Probir Kumar , Tareq Md. Abu , Begum Musammet Rasheda 
Published: November 2020

Background: The inappropriate and irrational use of antibiotics both in humans and animals causes bacterial resistance. Bacterial resistance is common in low- and middle-income countries, including Bangladesh. Bangladesh has very limited information on antibiotic use and associated resistance. We sought to better understand antibiotic use in low-resource settings for the development of effective strategies to address inappropriate antibiotic use. Methods: We conducted a cross-sectional study among hospitalized children <5 years of age in a tertiary-care hospital in Barishal, Bangladesh, to collect data on antibiotic use. We collected data from 400 children during February–April 2019. Results: Among these 400 children, >50% were aged <1 year, and >60% of these children were boys. The average hospital stay was 3 days (range, 1–14). Most of the children had history of diarrhea and 18% had pneumonia. Most children (82%) were prescribed antibiotics. A combined form of antibiotics was prescribed for 17% of these children. In total, 14 different antibiotics were used. The most commonly used antibiotic was ceftriaxone (57%) followed by azithromycin (14%). The parental route was mostly preferred (75%) for antibiotic administration. Conclusions: Antibiotic prescription was common in children aged <5 years visiting a tertiary-care hospital. Most of the prescribed antibiotics were broad spectrum, which can promote bacterial resistance. Further studies are needed to identify the factors associated with overuse of antibiotics and bacterial resistance in low-resource settings.Funding: NoneDisclosures: None
Preventing Transmission of Vaccine-Associated Viral Infections from a Patient With Severe Combined Immune Deficiency
Authors: Kamhuka Linda , Tremblay Isabelle , Lam-Li Debbie , LeMay Mireille , Favela Luis Murguia , Wright Nicola , Vayalumkal Joseph 
Published: November 2020

Background: The transmissibility of vaccine-strain viruses from immunocompromised patients, such as those with severe combined immune deficiency (SCID) is unknown. The infection control management of a patient diagnosed with SCID and infected with vaccine-strain varicella zoster virus (VZV) and measles virus is described below. A previously healthy, full-term boy was vaccinated at 14 months with measles mumps rubella varicella (MMR) vaccine. He had received prior vaccinations, including rotavirus, without adverse effects. During the 6 weeks after vaccination, the patient developed signs and symptoms clinically consistent with chicken pox and measles. An immune work-up revealed SCID. Methods: The Alberta Health Services (AHS) SCID protocol was followed to manage the patient upon admission at 17 months of age. Multiple meetings with various stakeholders were held to ensure appropriate precautions were followed to minimize the risk of pathogen transmission. Results: The patient was placed on airborne and contact precautions in a negative-pressure room. The pressure differential of the room to the corridor was continually monitored and displayed at the entry to the room. Staff known to be immune to VZV or measles were not required to wear an N95 respirator. All intrahospital movement of the patient was coordinated with the respective care teams and departments, including infection prevention and control, facilities maintenance and engineering, respiratory therapy, and diagnostic imaging. A mask was placed on the patient when movement outside the room was required. VZV testing was positive for the Oka/vaccine strain on all samples tested (ie, nasopharyngeal, skin, blood, and cerebrospinal fluid). Nasopharyngeal swabs and blood were PCR positive for measles genotype A/vaccine strain virus. Both viruses were persistently positive in spite of treatment with acyclovir, valganciclovir, varicella zoster immune globulin, and intravenous immune globulin. Conclusions: There is currently no documented transmission of measles vaccine-strain virus, and transmission of VZV vaccine-strain virus is rare. According to the AHS SCID protocol, the use of airborne and contact precautions for a patient identified with measles and/or VZV supersedes the use of a positive-pressure room for patients identified with SCID. Newborn screening for SCID was implemented in Alberta in June 2019. As a result, more SCID patients will be diagnosed earlier in their course, and therefore prior to most routine vaccinations. However, newborn screening will not pick up some types of combined immune deficiencies. Some children may still be at risk of vaccine-associated illnesses due to undiagnosed underlying immune deficiencies.Funding: NoneDisclosures: None
Quality Improvement Measures to Reduce Central-Line–Associated Bloodstream Infections (CLABSIs) in a Neonatal Intensive Care Unit (NICU)
Authors: Anderson Tamika , Flood Michelle , Kelley Susan , Pugh Lea Ann , Casabar Renato , Sharma Mamta , Battjes Rebecca 
Published: November 2020

Background: Central-line–associated bloodstream infections (CLABSIs) are a significant contributor to morbidity and mortality for neonates; they also increased healthcare costs and duration of hospitalization. This population is susceptible to infections because of their undeveloped immune systems, and they require intravenous access until they can tolerate enteral feedings, which for extremely premature infants can take several weeks (if not months) to achieve. Our hospital is a regional-referral teaching hospital with 772 licensed beds. The neonatal intensive care unit (NICU) is a level 3, 35-bed unit where the most critically ill neonates receive care. After a sustained 3-year period of zero CLABSIs, we identified 10 infections between September 2016 through April 2018. Methods: A multidisciplinary team known as the neonatal infection prevention team (NIPT) was reinstated. This team included members from nursing and infection prevention (IP) and from NICU Shared Governance, as well as a neonatal nurse practitioner (NNP) and a neonatologist to review these CLABSIs. Evidence-based practices, policies, and procedures were implemented to help reduce CLABSIs. Nurse educators provided education and training. The infection prevention team reinstated and modified the central-line maintenance and insertion tools to document compliance and to identify any gaps in care. Nurses were expected to document line maintenance once per shift (a.m. and p.m.). All CLABSIs were entered into the CDC NHSN and the hospital’s safety event reporting system, which required follow-up by a clinical manager. The infection prevention team monitored NHSN standardized infection ratios (SIRs) monthly. The SIR is the number of observed events divided by the number predicted (calculated based on national aggregate data). Results: The highest reported quarterly SIR was 1.423, which occurred in the third quarter of 2018 (Fig. 1). Overall compliance with line maintenance protocols was 86% on the morning shift and 89% on the afternoon shift. With implementation of an evidence-based bundle, the NICU had a rolling 12-month SIR of 0.00 as of October 2019. Conclusions: Multidisciplinary team development, implementation of evidence-based bundle elements, and education on catheter care contributed to the long-term success in decreasing CLABSI rates in our NICU. Although this implementation achieved a zero CLABSI rate, we experienced some barriers, including compliance issues with staff not completing the audit tools, staff turnover, and high patient census.Funding: NoneDisclosures: None