bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Statewide Assessment of Antifungal Stewardship Activities in Acute-Care Hospitals in Connecticut
Authors: Bromberg Romina , Leung Vivian , Maloney Meghan , Paranandi Anu , Banach David 
Published: November 2020

Background: Morbidity and mortality associated with invasive fungal infections and concerns of emerging antifungal resistance have highlighted the importance of optimizing antifungal therapy among hospitalized patients. Little is known about antifungal stewardship (AFS) practices among acute-care hospitals. We sought to assess AFS activities within Connecticut and to identify opportunities for improvement. Methods: An electronic survey assessing AFS practices was distributed to infectious disease physicians or pharmacy antibiotic stewardship program leaders in Connecticut hospitals. Survey questions evaluated AFS activities based on antibiotic stewardship principles, including several CDC Core Elements. Questions assessed antifungal restriction, prospective audit and feedback practices, antifungal utilization measurements, and the perceived utility of a local or statewide antifungal antibiogram. Results: Responses were received from 15 respondents, which represented 20 of 31 hospitals (65%); these hospitals made up the majority of the acute-care hospitals in Connecticut. Furthermore, 18 of these hospitals (58%) include antifungals in their stewardship programs. Also, 16 hospitals (52%) conduct routine review of antifungal ordering and provide feedback to providers for some antifungals, most commonly for amphotericin B, voriconazole, micafungin, isavuconazole, and flucytosine. All hospitals include guidance on intravenous (IV) to oral (PO) conversions, when appropriate. Only 14 of hospitals (45%) require practitioners to document indication(s) for systemic antifungal use. Most hospitals (17, 55%) provide recommendations for de-escalation of therapy in candidemia, though only 4 (13%) have institutional guidelines for candidemia treatment, and only 11 hospital mandates an infectious diseases consultation for candidemia. Assessing outcomes pertaining to antifungal utilization is uncommon; only 8 hospitals (26%) monitor days of therapy and 5 (16%) monitor antifungal expenditures. Antifungal susceptibility testing on Candida bloodstream isolates is performed routinely at 6 of the hospitals (19%). Most respondents (19, 95%) support developing an antibiogram for Candida bloodstream isolates at the statewide level. Conclusions: Although AFS interventions occur in Connecticut hospitals, there are opportunities for enhancement, such as providing institutional guidelines for candidemia treatment and mandating infectious diseases consultation for candidemia. The Connecticut Department of Public Health implemented statewide Candida bloodstream isolate surveillance in 2019, which includes antifungal susceptibility testing. The creation of a statewide antibiogram for Candida bloodstream infections is underway to support empiric antifungal therapy.Funding: NoneDisclosures: None
Alcohol Hand Rub Significantly Reduces Overall Bacterial Bioburden on Stethoscopes in a Real-World Clinical Setting
Authors: Johnson Alexandra , Warren Bobby , Anderson Deverick John , Johnson Melissa , Gamez Isabella , Smith Becky 
Published: November 2020

Background: Stethoscopes are a known vector for microbial transmission; however, common strategies used to clean stethoscopes pose certain barriers that prevent routine cleaning after every use. We aimed to determine whether using readily available alcohol-based hand rub (ABHR) would effectively reduce bacterial bioburden on stethoscopes in a real-world setting. Methods: We performed a randomized study on inpatient wards of an academic medical center to assess the impact of using ABHR (AlcareExtra; ethyl alcohol, 80%) on the bacterial bioburden of stethoscopes. Stethoscopes were obtained from healthcare providers after routine use during an inpatient examination and were randomized to control (no intervention) or ABHR disinfection (2 pumps applied to tubing and bell or diaphragm by study personnel, then allowed to dry). Cultures of the tubing and bell or diaphragm were obtained with premoistened cellulose sponges. 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 clinically important pathogens (CIPs) including S. aureus, Enterococcus spp, and gram-negative bacteria (GNB). CFU count 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. Results: In total, 80 stethoscopes (40 disinfection, 40 control) were sampled from 46 physicians (MDs) and MD students (57.5%), 13 advanced practice providers (16.3%), and 21 nurses (RNs) and RN students (26.3%). The median CFU count was ~30-fold lower in the disinfection arm compared to control (106 [IQR, 50–381] vs 3,320 [986–4,834]; P < .0001). The effect was consistent across provider type, frequency of recent usual stethoscope cleaning, age, and status of pet ownership (Fig. 1). Overall, 26 of 80 (33%) of stethoscopes harbored CIP. The presence of CIP was lower but not significantly different for stethoscopes that underwent disinfection versus controls: S. aureus (25% vs 32.5%), Enterococcus (2.5% vs 10%), and GNB (2.5% vs 5%). Conclusions: Stethoscopes may serve as vectors for clean hands to become recontaminated immediately prior to performing patient care activities. Using ABHR to clean stethoscopes after every use is a practical and effective strategy to reduce overall bacterial contamination that can be easily incorporated into clinical workflow. Larger studies are needed to determine the efficacy of ABHR at removing CIP from stethoscopes as stethoscopes in both arms were frequently contaminated with CIP. Prior cleaning of stethoscopes on the study day did not seem to impact contamination rates, suggesting the impact of alcohol foam disinfection is short-lived and may need to be repeated frequently (ie, after each use).Funding: NoneDisclosures: NoneDisclosures: NoneFunding: None
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: NoneFunding: 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: NoneDisclosures: 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: NoneDisclosures: 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: NoneDisclosures: 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: NoneDisclosures: 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: NoneFunding: None