bluuebunny/crossref_metadata_2025_split huggingface dataset:
Feasibility of Developing Traditional Facility-Specific Nursing Home Antibiograms
Authors: Taylor Lindsay , Howe Michael , Osman Fauzia , Crnich Christopher 
Published: November 2020

Background: An antibiogram is a tool for tracking and reporting antimicrobial resistance; the CDC has endorsed as part of a comprehensive antimicrobial stewardship program in nursing homes. We have previously shown that antibiogram utilization has increased in nursing homes, but most facilities employ tools that are not based on facility-specific data. In this study, we investigate the feasibility to develop antibiograms using facility-specific data and compare these results with antibiograms developed using data from multiple facilities that share the same lab and geographic region. Methods: Raw, de-identified culture results from January 1 through December 31st, 2018 were collected from participating nursing homes and their consulting microbiology laboratories under an IRB-exempt protocol. Culture results were entered and stored in REDCap. Number of isolates per species was examined based on nursing home, nursing home laboratory network, and region. Percentage sensitivities of the most frequently isolated species to commonly used antibiotics were calculated at the nursing home and regional level and compared. T tests of the absolute difference between nursing home- and regional level percentage sensitivities were performed. All data analyses were performed in R software. Results: The mean annual cultures per nursing home was 23.5 (SE, ±3.29). Grouping cultures by lab and region increased the mean culture count 6-fold and 12-fold, respectively. The most commonly isolated species were Escherichia coli (29.7%), Enterococcus spp (11.6%), Proteus spp (10%), Klebsiella spp (8.5%). None of the nursing homes had >30 isolates of a single species (Fig. 1). Escherichia coli was the only species that exceeded the 30-isolate threshold when aggregated at the laboratory network level (Fig. 2). Grouping nursing home cultures by region provided the greatest average isolate count across the most common species. The greatest differences in percentage sensitivity between nursing homes and their region were noted for Escherichia coli and Proteus spp to fluoroquinolones (>20% difference; P < .01). The difference in sensitivity was <5% for Escherichia coli to nitrofurantoin. Conclusions: Nursing homes do not generate enough annual isolates to create antibiograms compliant with Clinical Laboratory Standard Institute guidelines. Grouping isolates from multiple nursing homes at the regional level does reliably exceed the 30-isolate threshold for multiple bacterial species but leads to susceptibility estimates that may vary substantially from those observed at the facility level. Alternative tools for tracking antibiotic resistance and guiding antibiotic prescribing decisions at the local level are needed.Funding: NoneDisclosures: None
First-Time Use of Clinical Pharmacists to Improve Appropriate Antibiotic Prescribing in a Medical ICU in Viet Nam
Authors: Van Tuan Mai , Pham Nhu Hiep , Hoang Thi Lan Huong , Dang Nhat Tan , Pham Thi Ngoc Anh , Nguyen Thanh Huy , Cao Quoc Tuan , Pham Vu Thuy Hang , Nguyen Nga , Vasquez Amber , Phong Lan Nguyen Thi , Bui Hien , Bui Manh Hung 
Published: November 2020

Background: Antibiotic overuse has led to increasing rates of antibiotic resistant infections and unnecessary antibiotic costs. Clinical pharmacists can play a key role in optimizing appropriate use of antimicrobials and reducing antimicrobial resistance. However, the role of clinical pharmacists in antimicrobial stewardship is new and not well established in Viet Nam. Objective: We evaluated the use of clinical pharmacists for improved antimicrobial prescribing. Methods: We assembled an antibiotic stewardship program (ASP) team consisting of a clinical pharmacist and a specialist in infection prevention and control in a 60-bed medical intensive care unit (MICU) at Hue Central Hospital in central Viet Nam. During January–September 2018, the ASP team collected baseline antibiotic prescribing days of therapy (DOT) for all antibiotics administered in the MICU. Then, from October 2018 through June 2019, the ASP team reviewed daily positive clinical bacterial cultures and susceptibility results for all patients present in the MICU. They reviewed medical charts, including antimicrobial prescriptions, during week days and only if patient was still in the ICU at the time of ASP rounds. The team recommended changes to antibiotic therapy verbally to physicians and left the decision to change antibiotic therapy to their discretion. The ASP team documented whether their recommendations were accepted or rejected. Statistical significance was determined using the Student t test. Results: The ASP team reviewed 160 medical charts and made 169 ASP recommendations: 122 (72%) to continue current treatment; 24 (14%) to monitor drug levels or obtain diagnostic tests; 10 (6%) to discontinue therapy; 6 (4%) to de-escalate therapy; 5 (3%) to adjust doses; and 2 (1%) to broaden therapy. Only 8 of the recommended changes (5%) were declined by the clinicians. The average monthly DOT for all types of antibiotics declined significantly from 2,213 to 1,681 (24% decrease; P = .04). Reductions in DOT for the most common broad-spectrum antibiotics included colistin from 303 to 276 (P = .75); imipenem-cilastatin 434 to 248 (P = .06); doripenem 150 to 144 (P = .85). Piperacillin-tazobactam increased from 122 to 142 (P = 0.75). Conclusions: We demonstrated that daily review of cultures and antibiotic use decreased overall antibiotic prescribing. Given that few recommendations included discontinuation of therapy, ASP rounds likely raised awareness for clinicians to optimize antibiotic use.Funding: NoneDisclosures: None
Genomic Epidemiology of Clostridioides difficile Sequence Types 1 and 2 Across Three US Medical Centers
Authors: Miles-Jay Arianna , Young Vincent , Pamer Eric , Savidge Tor , Kamboj Mini , Garey Kevin , Snitkin Evan 
Published: November 2020

Background:Clostridioides difficile is a toxin-producing bacterium that is the foremost cause of healthcare-associated diarrhea in the United States. Recent epidemiologic and genomic evidence indicates that divergent C. difficile strains have varying propensities for transmission within healthcare settings. We investigated whether and how these differences are reflected in the genomic epidemiology of 2 common C. difficile strains—sequence type (ST) 1 (analogous to Ribotype 027) and ST2 (associated with Ribotypes 014/020)—across 3 geographically distinct US medical centers. Methods: Between 2011 and 2017, a convenience sample of ST1 and ST2 C. difficile clinical isolates were collected from 3 US sites: The University of Michigan Medical Center, Texas Medical Center Hospitals, and Memorial Sloan Kettering Cancer Center. Isolates underwent whole-genome sequencing and in silico multilocus sequence typing to verify strain types. Sequences were mapped to ST1 and ST2 reference genomes and single nucleotide variants (SNVs) were identified, filtered, and used to construct pairwise SNV distance matrices. A range of pairwise SNV distance thresholds were applied to assess genetic linkages consistent with recent transmission within ST1 compared to within ST2. Proportions of genetically linked isolates were compared using 2 tests. Results: We identified 200 ST1 and 188 ST2 isolates across the 3 collection sites. Overall, ST2 was more genetically diverse than ST1 (pairwise SNV distance range, 0–156 SNVs and 0–78 SNVs, respectively). ST2 isolates displayed significantly less evidence of recent transmission: 10 ST2 isolates (5.3%) were within 2 SNVs of another isolate compared to 88 (44%) ST1 isolates (P .001) (Fig. 1). As the SNV threshold increased to 5 and 10 SNVs, this trend was maintained (all P < .001). ST2 isolates were also more likely to be genetically linked to an isolate from a different collection site than ST1 isolates. Among isolates with genetic links to at least 1 other isolate at the 5 SNV and 10 SNV thresholds, 21 of 37 and 74 of 89 ST2 isolates (57%, 83%) were linked to an isolate from a different collection site, compared to 2 of 88 and 48 of 157 ST1 isolates (2% and 31%, respectively; both P < .001). Conclusions: Compared to C. difficile ST1 isolates, ST2 isolates displayed less evidence of recent healthcare transmission and were more likely to be genetically linked to isolates from divergent collection sites. Interpreting genetic linkages among C. difficile isolates requires an understanding of regional and strain-specific genetic diversity to avoid misattribution of genetic linkages to recent transmission.Funding: NoneDisclosures: None
Healthcare-Associated Infections: Enterobacteriaceae Bloodstream Infections in the ICU Settings
Authors: KŁOS Marta , Pomorska-Wesołowska Monika , Romaniszyn Dorota , Chmielarczyk Agnieszka , Wojkowska-Mach Jadwiga 
Published: November 2020

Background: Bloodstream infections (BSIs) are one of the most frequently observed hospital-acquired infections (HAIs). Objectives: We aimed to describe the epidemiology and drug resistance of hospital-acquired Enterobacteriaceae BSIs and to check for any correlation with the type of hospital care. Methods: In 2015–2018, 333 Enterobacteriaceae isolates were collected from hospitalized internal medicine and surgical patients. The drug-resistance testing was conducted according to the EUCAST recommendations, using the disc-diffusion method to determine resistance to penicillin, cephalosporins, carbapenems, aminoglycosides, fluoroquinolones, and sulfamethoxazole with trimethoprim. Tests confirming the presence of extended-spectrum β-lactamases (ESBLs) and KPC, NDM, and OXA-48 carbapenemases were performed. We determined the minimum inhibitory concentration (MIC) values (mg/L) for selected antibiotics. To detect the resistance genes, a single PCR reaction, a multiplex PCR, and a real-time PCR were conducted. Results: The prevalence rate of Enterobacteriaceae bacilli in BSIs was 23.5%. Penicillin resistance remained at a very high level of almost 100%, with only the piperacillin-tazobactam resistance remaining at 19%–22%. The same was true for cephalosporins: the bacilli have only shown a high susceptibility to cefoperazone with sulbactam (4%–14% of them were resistant). Ciprofloxacin (53%–62%) and sulfamethoxazole with trimethoprim (48–55%) have proven highly resistant. Carbapenems were the only antibiotics with susceptibility at 98%–99%. No difference was found between the types of hospital care (surgical vs nonsurgical) and the levels of antimicrobial resistance in the studied Enterobacteriaceae isolates (Table 1). Conclusions: The high prevalence of Enterobacteriaceae bacilli in BSI is particularly worrying, as is the high rate of resistance to cephalosporins and aminoglycosides, which are often used in the empirical therapy. Unfortunately, our results indicate the need to base the empirical therapy on carbapenems.Funding: This work was supported by a grant from Jagiellonian Univerity Medical School (No. N41/DBS/000053)Disclosures: None
High Burden of Resistant Gram-Negative Pathogens Causing Device-Associated Healthcare Infections in Saudi Arabia, 2008–2016
Authors: Balkhy Hanan , Ramadan Aiman , Alshamrani Majid , Alsaedi Asim , Al Nasser Wafa , Gammal Ayman El , Aljohani Sameera , Arabi Yassen , Alqahtani Saad , Baffoe-Bonnie Henry , Alothman Adel , AlMohrij Saad 
Published: November 2020

Objectives: There is local and regional deficiency in the data examining the contribution of resistant pathogens to device-associated healthcare-associated infections (DA-HAIs). We examined such data in a multihospital system in Saudi Arabia in comparison with the US NHSN reports. Methods: Surveillance of DA-HAIs was prospectively conducted between 2008 and 2016 in 4 hospitals of Ministry of National Guard Health Affairs. Consecutive NHSN reports were used for comparison. Definitions and methodology of DA-HAIs and bacterial resistance were based on the NHSN reports. Results: In total, 1,260 pathogens causing 1,141 DA-HAI events were included. Gram-negative pathogens (GNPs) were responsible for 62.5% of DA-HAIs, with significantly higher Klebsiella, Pseudomonas, Acinetobacter, and Enterobacter than NHSN hospitals. Approximately 28.3% of GNPs and 23.5% of gram-positive pathogens (GPPs) exhibited some type of resistance. Nearly 34.3% of Klebsiella were cephalosporin-resistant; 4.8% of Enterobacteriaceae were carbapenem-resistant (CRE); 24.4% of Staphylococcus aureus were methicillin-resistant (MRSA; and 21.9% of Enterococci were Vancomycin-resistant (VRE). The multidrug resistance (MDR) rates were 65.0% for Acinetobacter, 26.4% for Escherichia coli, 23.0% for Klebsiella, and 14.9% for Pseudomonas. Resistant GNPs including cephalosporin-resistant Klebsiella, MDR Klebsiella, and MDR Escherichia coli were significantly more frequent than in NHSN hospitals, whereas resistant GPPs including MRSA and VRE were significantly less frequent than in NHSN hospitals. Conclusion: Compared with American hospitals, GNPs that contribute to DA-HAIs in Saudi hospitals show more resistance. The higher resistance rates in Klebsiella and Escherichia coli are alarming and call for effective antimicrobial stewardship programs.Funding: NoneDisclosures: None
Hospital Preparedness for a Community Measles Outbreak in Ribeirao Preto, Brazil
Authors: Fonseca Silvia , Lucca Ivana , Sgobi Franceliana , Fioravante Andre , Celia Alexandre , Diniz Rafael , Souza Maysa , Lima Luciana , Marani Ronaldo , Ustulin Deise , Sarria Gabrielly , Vegas Viviane , Chan Woe 
Published: November 2020

Background: Measles was considered eradicated in Brazil in 2016, but the virus reemerged in the country in 2018, causing large outbreaks. Ribeirao Preto has been measles free since 1997, but the outbreak in Sao Paulo City, 180 miles away in June 2019, alerted us to the possibility of measles patients coming to our emergency room (ER). The preparedness challenge was considerable: most healthcare workers (HCWs) had never seen a measles case before, and confirmatory measles laboratory tests were not readily available to us. Objective: To describe the hospital preparedness for the coming community measles outbreak. Methods: Hospital So Francisco is a 170-bed, general, tertiary-care hospital with 10,000 ER visits monthly. Measles preparedness consisted of measles training classes for HCWs, and flow charts with pictures and measles information in every ER office, also sent to HCW cell phones. We also designated areas for suspected measles patients for prompt medical evaluation; and we implemented mass measles vaccination for all hospital HCWs regardless of vaccination status, excluding pregnant or immunosuppressed HCWs. We considered a measles suspected case any person with fever, 1 of 3 symptoms (cough, coryza or conjunctivitis), and a generalized maculopapular rash with head-to-toe distribution. All contacts for suspected cases were recommended to obtain a measles vaccination. Detection of viral RNA in a biological sample and or a positive IgM result in serum was used to confirm a clinically suspected case. The study period spanned July 2019 to September 2019. Results: Measles training occurred for 3 weeks in July–August and reached 200 HCWs. The measles vaccination was offered July 23 to August 15; 1,362 HCWs were already vaccinated (93% of target population). In total, 35 clinical suspected measles cases were seen in the ER, and 3 of these were HCWs who had received the measles vaccine in their incubation period. Also, 3 patients were admitted to the hospital and 1 to the intensive care unit; there were no deaths. Overall, 8 patients had laboratory-confirmed measles, and 1,343 community contacts of these patients were vaccinated. We did not detect measles transmission to inpatients or to other HCWs after mass vaccination began. In the same period, Sao Paulo state had >7,000 laboratory-confirmed measles cases and 12 deaths. Conclusions: Community measles outbreaks are a challenge for the hospital infection control team, and they can potentially disrupt the daily activities in the hospital. We were able to adequately prepare for the largest state outbreak in 20 years without secondary cases or deaths.Funding: NoneDisclosures: None
Hospital-Acquired Bloodstream Infections With MRSA and VRE: Standardized Admission Screening Did Not Impact Rates
Authors: Ellison Jennifer , Chow Blanda , Howatt Andrea , Pfister Ted , Bush Kathryn 
Published: November 2020

Background: Bloodstream infections (BSIs) are an important cause of morbidity and mortality in severely ill patients, contributing to increased length of stay and a higher cost of care. Surveillance of hospital-acquired (HA) BSI is considered a measure of quality of care and has been performed provincially in Alberta since 2011. Prior to October 2015, a nonstandardized, risk-factor–based VRE screening process was used. Screening practices for antibiotic-resistant organisms (AROs) were aligned in October 2015 with a provincially standardized admission screening tool to allow for early initiation of contact precautions for patients colonized or infected with MRSA or VRE. In this data review, we sought to determine whether this admission screening change influenced ARO infections through review of HA-BSI rates. Methods: Prospectively, we reviewed reports of all patients admitted to Alberta Health Services/Covenant Health acute-care and acute-/tertiary-care rehabilitation facilities who met inclusion criteria: (1) positive blood culture identified with MRSA or VRE; (2) new episode for the patient; and (3) positive result occurred on or after calendar day 3 of admission. Data are presented as quarterly rates. Screening practices for MRSA and VRE were standardized provincially in October 2015 to include screening for MRSA on admission for patients who had an inpatient admission, received hemodialysis, or was an inmate in a correctional facility in the past 6 months. We also screened for VRE patients admitted to a solid-organ transplant unit or a hematology unit, regardless of risk factors. Results: We detected no changes in the quarterly rates of HA-BSI with MRSA or VRE after admission screening was standardized. Prior to standardized screening, MRSA BSI rates ranged from 0.12 to 0.25 per 10,000 patient days, with an overall rate of 0.18 per 10,000 patient days. After standardization, rates ranged from 0.09 to 0.30 per 10,000 patient days, with an overall rate of 0.17 per 10,000 patient days (P = .46). VRE BSI rates prior to standardization ranged from 0.03 to 0.13 per 10,000 patient days, with an overall rate of 0.08 per 10,000 patient days, which increased slightly to 0.09 per 10,000 patient days after standardized screening, ranging between 0.04 and 0.16 per 10,000 patient days (P = .61). Conclusions: Following the implementation of standardized admission screening and the early initiation of contact precautions, no significant changes were observed in rates of either HA-BSI with MRSA or VRE. Further investigation is required to identify the most effective strategies to reduce HA-BSIs caused by MRSA and VRE.Funding: NoneDisclosures: None
Impact of FilmArray Pneumonia Panel on Early Targeted Antibiotic Therapy
Authors: Hou Cindy , Ali Shereef , Vyas Nikunj 
Published: November 2020

Background:
Patients with pneumonia are frequently recipients of broad-spectrum antibiotics while awaiting maturation of respiratory cultures. FilmArray pneumonia panel (FPP) is an option for more expeditious identification of pathogen(s). We evaluated the utility of FPP in early de-escalation or escalation of antibiotics. Methods: FPP tests were performed on adults hospitalized with pneumonia. The microbiologist directly communicated the organisms, colony counts, and resistance patterns to the infectious disease physician or pharmacist. These results were also compared with pathogen identification and resistance patterns from a VITEK-2 system. The primary objective of this analysis was to evaluate the rates of de-escalation, escalation, and discontinuation of therapy and their impact on inpatient mortality. The secondary objective of the analysis was to evaluate the confirmation of detected organisms and resistance patterns by FPP. Results: In total, 26 patients included in the analysis. The median age was 70 years and 62% of patients were men; 50% of these patients were critically ill. In the cohort, the most commonly identified organisms were Pseudomonas aeruginosa (31%) and Staphylococcus aureus (30%). Other common organisms were Moraxella catarrhalis (23%) and influenza A (15%). The CTX-M resistance gene was seen in 30% of Enterobacteriaceae cultures, and the MecA/C and MREJ genes were detected in 75% of Staphylococcus aureus cultures. As a result of FPP, de-escalation occurred at a rate of 62%; discontinuation occurred at 42%; and escalation occurred 23%. Inpatient mortality was similar among the 3 groups: de-escalation, 37.5%; discontinuation, 45.5%; escalation, 50%. Notably, 82% of patients received comfort care. Organisms and resistance rates were confirmed with respiratory cultures in 54% of patients. Conclusions: Utilizing FPP yielded high rates of de-escalation, discontinuation, and escalation of antibiotics. No impact noted on inpatient mortality was noted; most of these patients were managed by comfort care. Culture confirmation rates were low due to the variety of sample types. We believe that the use of FPP for bronchoscopy and endotracheal cultures would have the highest impact on antibiotic stewardship efforts.Funding: NoneDisclosures: None
Impact of Rapid PCR Influenza Testing on the Rate of Inpatient Admissions During Influenza Season at a Tertiary-Care Center
Authors: Polistico Jordan , Sandhu Avnish , Chopra Teena , Goldman Erin , LeRose Jennifer , Ganesan Ashwin 
Published: November 2020

Background: Influenza causes a high burden of disease in the United States, with an estimate of 960,000 hospitalizations in the 2017–2018 flu season. Traditional flu diagnostic polymerase chain reaction (PCR) tests have a longer (24 hours or more) turnaround time that may lead to an increase in unnecessary inpatient admissions during peak influenza season. A new point-of-care rapid PCR assays, Xpert Flu, is an FDA-approved PCR test that has a significant decrease in turnaround time (2 hours). The present study sought to understand the impact of implementing a new Xpert Flu test on the rate of inpatient admissions. Methods: A retrospective study was conducted to compare rates of inpatient admissions in patients tested with traditional flu PCR during the 2017–2018 flu season and the rapid flu PCR during the 2018–2019 flu season in a tertiary-care center in greater Detroit area. The center has 1 pediatric hospital (hospital A) and 3 adult hospitals (hospital B, C, D). Patients with influenza-like illness who presented to all 4 hospitals during 2 consecutive influenza seasons were analyzed. Results: In total, 20,923 patients were tested with either the rapid flu PCR or the traditional flu PCR. Among these, 14,124 patients (67.2%) were discharged from the emergency department and 6,844 (32.7%) were admitted. There was a significant decrease in inpatient admissions in the traditional flu PCR group compared to the rapid flu PCR group across all hospitals (49.56% vs 26.6% respectively; P < .001). As expected, a significant proportion of influenza testing was performed in the pediatric hospital, 10,513 (50.2%). A greater reduction (30% decrease in the rapid flu PCR group compared to the traditional flu PCR group) was observed in inpatient admissions in the pediatric hospital (Table 1) Conclusions: Rapid molecular influenza testing can significantly decrease inpatient admissions in a busy tertiary-care hospital, which can indirectly lead to improved patient quality with easy bed availability and less time spent in a private room with droplet precautions. Last but not the least, this testing method can certainly lead to lower healthcare costs.Funding: NoneDisclosures: None