bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effectiveness of Twenty Germicides Against Five Strains of C. difficile spores, With and Without Calf Serum, at Several Exposure Times
Authors: Rutala William , Gergen Maria , Gerding Dale , Weber David Jay 
Published: November 2020

Background:Clostridioides difficile is a major cause of antibiotic-associated colitis and the most common healthcare-associated pathogen in the United States. Interrupting the known transmission mechanisms of C. difficile in hospitals requires appropriate hand hygiene, disinfection of potentially contaminated surfaces, and patient equipment. However, only limited data are available on the effectiveness of germicides against various strains of C. difficile, with and without fetal calf serum, and at multiple exposure times. For this reason, we undertook the following evaluation to determine the effectiveness of germicides. Methods: The effectiveness of the sporicidal activity of the germicides against 5 strains of C. difficile was evaluated using a quantitative carrier test, a standard of ASTM International developed by Sattar et al. In this protocol, metal carriers (1 cm diameter 0.7 mm thick) were inoculated with 10 L spore suspension, containing ~103 or 106 C. difficile spores, and we then exposed them to 50 L germicide for 1, 5, 10, or 20 minutes. The following C. difficile strains were used in these studies: ATCC strains 9689; J9; BI-9; 630; and CF-4. To determine whether C. difficile spore susceptibility was similar to other spores, we also tested Bacillus atrophaeus spores, ATCC strain 19659. Fetal calf serum (FCS) was used to simulate organic matter. Results: In general, high-level disinfectants (eg, OPA, glutaraldehyde), chemical sterilants (eg, peracetic acid), and high concentrations of chlorine (>5,000 ppm) were generally sporicidal (>3 log10 reduction) in 5–10 minutes (and sometimes 1 minute). This level of sporicidal activity was demonstrated for the various strains of C. difficile spores and B. atrophaeus spores (Table 1). There did not appear to be any significant differences in inactivation of C. difficile spores (BI-9 strain) in the presence or absence of FCS (Table 2). Discussion: The sporicidal activity of disinfectants is critical because such formulations are routinely used to eliminate the risk associated with noncritical and semicritical instruments and environmental surfaces. Our data suggest that immersion in most (but not all) high-level disinfectants for 10 minutes is likely to be successful in eradicating C. difficile spores (>4 log10 reduction) from semicritical equipment (eg, endoscopes). Additionally, high concentrations of chlorine and some high-level disinfectants will kill C. difficile spores in 1 or 2 minutes.Funding: NoneDisclosures: Drs. Rutala and Weber are consultants to PDI (Professional Disposable International)
Effectiveness of Standard Daptomycin Dose in Treatment of Methicillin-Resistant Staphylococcus aureus Bacteremia
Authors: Nair Rajeshwari , Richardson Kelly , Livorsi Daniel , Goto Michihiko , Perencevich Eli , Schweizer Marin 
Published: November 2020

Background: Daptomycin is considered an effective alternative to vancomycin in patients with methicillin-resistant Staphylococcus aureus bloodstream infection (MRSA BSI). Objective: We investigated the real-world effectiveness of recommended daptomycin doses compared with vancomycin. Methods: This nationwide retrospective cohort study included patients from 124 Veterans’ Affairs hospitals who had a MRSA BSI and were initially treated with vancomycin during 2007–2014. Patients were categorized into 3 groups by daptomycin dose calculated using adjusted body weight: low (>6 mg/kg/day), standard (6–8 mg/kg/day), and high (≥8 mg/kg/day). International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes were used to identify other prior or concurrent infections and comorbidities. Multivariate cox regression was used to compare 30-day all-cause mortality as the primary outcome comparing patients on either low-dose, standard-dose, or high-dose daptomycin with vancomycin. Hazard ratio (HR) and 95% confidence intervals (CIs) were reported. Results: Of the 7,518 patients in the cohort, 683 (9.1%) were switched to daptomycin after initial treatment with vancomycin for their MRSA BSI episode. A low dose of daptyomycin was administered to 181 patients (26.5%), a standard dose was given to 377 patients (55.2%), and a high dose was administered to 125 patients (18.3%). Dose groups differed significantly in body mass index (BMI), presence of an osteomyelitis diagnosis, and diagnosis of diabetes. Thirty-day mortality was significantly lower in daptomycin patients than in those given vancomycin (11.3% vs 17.6%; P < .0001). Treatment with daptomycin was associated with improved 30-day survival compared with vancomycin (HR, 0.66; 95% CI, 0.53–0.84), after adjusting for age, BMI, diagnosis of endovascular infection, skin and soft-tissue infection and osteomyelitis, hospitalization in the prior year, immunosuppression, diagnosis of diabetes, and vancomycin minimum inhibitory concentration (MIC). Treatment with a standard dose of daptomycin was associated with lower mortality compared with vancomycin (HR, 0.63; 95% CI, 0.46–0.86). High and low daptomycin dose groups had a trend toward improved 30-day survival compared with vancomycin (Fig. 1). In 2 separate sensitivity analyses excluding vancomycin patients, there was no difference in 30-day mortality between a standard dose and a high dose (HR, 1.01; 95% CI, 0.51–1.97). However, we detected a trend toward poor survival with a low dose compared with a standard dose (HR, 1.21; 95% CI, 0.73–2.02). Conclusions: A standard dose of daptomycin was significantly associated with lower 30-day mortality compared with continued vancomycin treatment. Accurate dosage of daptomycin and avoidance of low-dose daptomycin should be a part of good antibiotic stewardship practice.Funding: NoneDisclosures: None
Effects of Irregularities in the Microstructure of Surgical Instruments on Microbial Adherence and Challenges for Processing
Authors: Evangelista Sintia , Oliveira Adriana 
Published: November 2020

Background: A surgical instrument can have areas that pose different challenges to cleaning, hindering the removal of dirt. This can directly impact the effectiveness of its processing while potentially promoting cross contamination. Moreover, structural changes (ie, cracks or fissures) on the instrument surface, although rarely addressed, can act as reservoirs for microorganisms, contributing to organic matter retention, microbial growth, and biofilm formation. Our aim was to determine the effect of irregularities in the microstructure of surgical instruments on microbial adherence. Methods: We analyzed 18 fragments of 3 distinct areas of new crile forceps: the ratchet, shank, and jaw. Of these fragments, 15 were artificially contaminated by immersion in tryptic soy broth containing 10 6 CFU/mL of Escherichia coli (ATCC 25922), for 4, 6, 8, and 12 hours of incubation at 37C with agitation at 100 rpm. The other 3 fragments were used as controls. All fragments were subjected to scanning electron microscopy to evaluate the adhesion of the microorganism. Results: An irregular surface was found in 3 of 6 shank fragments (50%) (Fig. 1) and in all the jaw and ratchet fragments, grooves, and cracks. Initially, there was less adherence of E. coli to the smooth shank surface after contamination, but the concentration of the microorganism increased progressively over time in relation to that in the jaw or ratchet at the same time, and a higher concentration occurred in the cracks and grooves. Conclusions: Structural damage was observed in all fragments, especially in the ratchet and jaw areas, favoring microbial accumulation. Microorganisms housed in the cracks and grooves were better protected from removal by scrubbing with a brush (being unlikely to reach them), making these areas a microbial reservoir and source of contamination. Prolonged contact of the instrument with the contaminating microorganism allowed for greater adherence, even on the smooth areas. The results support the relevance of the early onset of cleaning, considering that even microscopic changes on the surface of the instrument may represent an additional challenge to its effective processing.Funding: NoneDisclosures: None
Efficacy of a Sink Tailpiece Heating Device to Decrease Microbial Colonization of Sink Drains
Authors: Park Stacy , Steinberg Limor , Carroll Joanne , Mathers Amy , Attai April 
Published: November 2020

Background: Many institutions have reported transmission of multidrug-resistant organisms to patients from colonized sinks. Prior data have shown that bacterial colonization of the sink drain, which can occur via biofilm from a colonized p-trap or via seeding from above, results in dispersion of bacteria in the area of the sink when water from the faucet comes in contact with the drain. Heat disruption of biofilm formation between the p-trap and sink drain is a potential strategy in preventing colonization of sink drains. Methods: In an academic center hospital, 54 tail-piece heaters were installed in 3 intensive care units and 2 acute-care units in an associated regional hospital. Half of the installed devices were sham (no heat). The devices were programmed to heat the tail piece to 72C for 1 hour every fourth hour. Rooms were randomized to heating or sham devices on a 1:1 basis within each unit. Sink drains and p-traps were sampled biweekly. Samples were assessed for semiquantitative growth of gram-negative bacteria on MacConkey agar, looking especially for Pseudomonas aeruginosa and Stenotrophomonas maltophilia. Carbapenemase-producing Enterobacterales (CPE) was detected by broth enrichment followed by growth on Colorex KPC agar. Frontline personnel were blinded to device assignment. Results: Linear mixed modeling revealed reduced risk of detectable gram-negative bacteria (OR, 0.16; 95% CI, 0.037–0.536) and Enterobacterales (OR, 0.17; 95% CI, 0.368–0.668) in sink drains with a heating device (Fig. 1), but no difference in risk of detectable P. aeruginosa or S. maltophilia (Table 1). We detected a trend toward reduction in CPE that did not reach statistical significance, and there was no difference in risk for detection of any bacteria in the p-trap between heating and sham devices. Audits of devices demonstrated that few reached the target heating temperature of 72C (median, 65.9C; range, 50.1–73.7C). Conclusions: Disruption of biofilm between the p-trap and the sink drain is a promising strategy for the prevention of sink-drain colonization with clinically important bacteria. The presence of a heating device was associated with reduced risk of detectable gram-negative organisms, specifically Enterobacterales, in sink drains. The limitations of this study included low overall rates of positivity for certain pathogens, including CPE, and suboptimal, inconsistent performance across heating devices. Further work with a larger sample size and more consistent heating devices is warranted, as are data regarding patient outcomes as a result of such interventions.Funding: NoneDisclosures: None
Epidemiology of NDM-Producing Enterobacteriaceae in Michigan
Authors: Gill Gurmat , Sandhu Avnish , Polistico Jordan , Awali Reda , McNamara Sara , Chopra Teena 
Published: November 2020

Background: Carbapenem-resistant Enterobacteriaceae (CRE) are classified as an urgent antibiotic-resistant threat by the CDC, and they are listed on the critical priority list by the World Health Organization due to the lack of antibiotic treatment options. New-Delhi metallo-β-lactamase (NDM) is an emerging mechanism of carbapenem resistance in the United States. We sought to understand the risk factors and clinical characteristics of patients with NDM CRE in Michigan to improve surveillance. Methods:A retrospective descriptive study was conducted in collaboration with the Michigan Department of Health and Human Services (MDHHS). CRE isolates submitted to MDHHS between April 2014 and July 2019 were tested for the presence of NDM using CDC PCR protocols. Additional information on case demographics, laboratory results, healthcare and antibiotic exposure history, and travel history were collected. Results: In total, 30 NDM cases were identified in Michigan during the study period. Of these 30 cases, 15 (50%) were men, and the median age was 73.5 years (range, 20–88 20). Also, 2 of these patients (6.6%) were immunocompromised; 2 patients (6.6%) had had extensive abdominal surgery, and 2 patients (6.6%) had recurrent hospitalization. Furthermore, 12 case isolates (40%) were collected in outpatient settings, whereas 16 (53%) were collected from inpatient settings. In addition, 13 (43%) patients were admitted from home and 4 (13%) presented from an extended-care facility. Urine was the most common site of isolation in 19 of 30 (63%) cases, followed by blood and tissue culture in 4 of 30 (13%) each. Escherichia coli was the most common organism (17 of 30, 57%), followed by Klebsiella pneumoniae (9 of 30, 30%). Also, 15 of 30 cases (50%) had a recent history of international travel, and of these, 9 of 15 (60%) reported travel to India. Among these 15 cases, 12 (80%) sought medical care in the countries they visited. Two cases (6.6%) had a documented history of multidrug-resistant organism colonization or infection. The mortality rate was 6.6% (2 of 30). The mean time from admission to implementation of contact precautions was 7.3 days (range, 0–20). Conclusions: Suspicion of NDM CRE strains should remain high in patients with a travel history from areas known as major reservoirs of NDM. Delay in implementing contact precautions, as noted in the present study, can lead to a greater risk of transmission. Early detection and subsequent isolation of NDM patients are essential strategies for preventing transmission within healthcare facilities. Future efforts include performing whole-genome sequencing of these isolates to assist in identifying potential epidemiological links among the affected patients.Funding: NoneDisclosures: None
European Union One Health Country Visits as Driver to Combat on Antimicrobial Resistance
Authors: Spruijt Pita , Bergervoet Paul , Westerhof Robbin , Langelaar Merel , Ploy Marie-Cécile 
Published: November 2020

Background: In 2016, the European Union adopted unanimously Council Conclusions on the next steps to combat antimicrobial resistance under a One Health approach. To implement some of the provisions laid down in the Council Conclusions, a European Joint Action on Antimicrobial Resistance (AMR) and Healthcare-Associated Infections (HCAI) or EU-JAMRAI was set up, gathering 44 partners. Methods: As part of EU-JAMRAI, 13 participating European countries set up a country-to-country peer review system to evaluate each other’s national action plans (NAPs). This review system entailed a self-assessment, strengths–weaknesses–opportunities–threats (SWOT) analysis, and country visits. All steps were executed with representatives from both the human and the veterinary domains (One Health approach). Special attention was given to supervision and the way supervision can enhance the implementation of guidelines on AMR, both at the policy level and within healthcare institutions. Results: Despite differences in the stage of developing and implementing NAPs, all 13 countries are working on NAPs. In this process, country visits function as a moment to exchange best practices and to provide an outsider’s point of view. At the end of 2019, 13 country-to-country visits had taken place, resulting in tailor-made recommendations for each country. These recommendations were shared with the competent authority. An example is a country that used the recommendation to improve infection prevention as an immediate reason to get the topic on the agenda of the Ministry of Health. During the country visits, intersectoral participation was perceived as desirable, but in some cases it was challenging to arrange. For some highly relevant topics, it has been recognized that discussion should take place on a European level. Examples of such topics include supervision, infection prevention guidelines, funding, surveillance, and regular audits of antibiotic prescriptions for physicians including feedback loops. Conclusions: Peer review is a cooperative and friendly working method compared to common audits. The country visits function as an agenda setting tool to get or to keep AMR on the political agenda and presenting the most relevant topic(s) to address for each country.Funding: NoneDisclosures: None
Evaluating Healthcare Worker Movements and Patient Interactions Within ICU Rooms
Authors: Khader Karim , Leecaster Molly , Ray William , Haroldsen Candace , Keegan Lindsay , Samore Matthew , Rubin Michael 
Published: November 2020

Background: Contamination of healthcare workers and patient environments likely play a role in the spread of antibiotic-resistant organisms. The mechanisms that contribute to the distribution of organisms within and between patient rooms are not well understood, but they may include movement patterns and patient interactions of healthcare workers. We used an innovative technology for tracking healthcare worker movement and patient interactions in ICUs. Methods: The Kinect system, a device developed by Microsoft, was used to detect the location of a person’s hands and head over time, each represented with 3-dimensional coordinates. The Kinects were deployed in 2 intensive care units (ICUs), at 2 different hospitals, and they collected data from 5 rooms in a high-acuity 20-bed cardiovascular ICU (unit 1) and 3 rooms in a 10-bed medical-surgical ICU (unit 2). The length of the Kinect deployment varied by room (range, 15–48 days). The Kinect data were processed to included date, time, and location of head and hands for all individuals. Based on the coordinates of the bed, we defined events indicating bed touch, distance 30 cm (1 foot) from the bed, and distance 1 m (3 feet) from the bed. The processed Kinect data were then used to generate heat maps showing density of person locations within a room and summarizing bed touches and time spent in different locations within the room. Results: The Kinect systems captured In total, 2,090 hours of room occupancy by at least 1 person within ~1 m of the bed (Table 1). Approximately half of the time spent within ~1 m from the bed was at the bedside (within ~30 cm). The estimated number of bed touches per hour when within ~1 m was 13–23. Patients spent more time on one side of the bed, which varied by room and facility (Fig. 1A, 1B). Additionally, we observed temporal variation in intensity measured by person time in the room (Fig. 1C, 1D). Conclusions: High occupancy tends to be on the far side (away from the door) of the patient bed where the computers are, and the bed touch rate is relatively high. These results can be used to help us understand the potential for room contamination, which can contribute to both transmission and infection, and they highlight critical times and locations in the room, with a potential for focused deep cleaning.Funding: NoneDisclosures: None
Evaluating Metagenomic Analysis for Pathogen Transmission in Healthcare Settings
Authors: Hewitt Curt , Weber Katharina , LeSassier Danielle , Kappell Anthony , Schulte Kathleen , Westfall Nicole , Albright Nicolette , Godbold Gene , Palsikar Veena , Acevedo Carlos , Ternus Krista 
Published: November 2020

Background: The prevalence of healthcare-acquired infections (HAIs) and rising levels of antimicrobial resistance place a significant burden on modern healthcare systems. Cultures are typically used to track HAIs; however, culture methods provide limited information and are not applicable to all pathogens. Next-generation sequencing (NGS) can detect and characterize pathogens present within a sample, but few research studies have explored how NGS could be used to detect pathogen transmission events under HAI-relevant scenarios. The objective of this CDC-funded project was to evaluate and correlate sequencing approaches for pathogen transmission with standard culture-based analysis. Methods: We modeled pathogen transfer via hand contact using synthetic skin. These skin coupons were seeded with a community of commensal organisms to mimic the human skin microbiome. Pathogens were added at physiologically relevant high or low levels prior to skin-to-skin contact. The ESKAPE pathogens: E. faecium, S. aureus, K. pneumoniae, A. baumannii, P. aeruginosa, and Enterobacter spp plus C. difficile were employed because they are the most common antibiotic resistant HAIs. Pathogen transfer between skin coupons was measured following direct skin contact and fomite surface transmission. The effects of handwashing or fomite decontamination were also evaluated. Transferred pathogens were enumerated via culture to establish a robust data set against which DNA and RNA sequence analyses of the same samples could be compared. These data also provide a quantitative assessment of individual ESKAPE+C pathogen transfer rates in skin contact scenarios. Results: Metagenomic and metatranscriptomic analysis using custom analysis pipelines and reference databases successfully identified the commensal and pathogenic organisms present in each sample at the species level. This analysis also identified antibiotic resistance genes and plasmids. Metatranscriptomic analysis permitted not only gene identification but also confirmation of gene expression, a critical factor in the evaluation of antibiotic resistance. DNA analysis does not require cell viability, a key differentiator between sequencing and culturing reflected in simulated handwashing data. Sensitivity remains a key limitation of metagenomic analysis, as shown by the poor species identification and gene content characterization of pathogens present at low abundance within the simulated microbial community. Species level identification typically failed as ratios fell below 1:1,000 pathogen CFU:total community CFU. Conclusions: These findings demonstrate the strengths and weaknesses of NGS for molecular epidemiology. The data sets produced for this study are publicly available so they can be employed for future metagenomic benchmarking studies.Funding: NoneDisclosures: None