bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Antimicrobial Stewardship Programs in Latin American Adult Intensive Care Units: PROA-LATAM Project
Authors: Quirós Rodolfo , Angeleri Patricia , Zurita Jeannete , Aleman Washington , Carneiro Marcelo , Guerra Silvia , Medina Julio , Luquerna Ximena Castañda , Guerra Alexander , Vega Silvio , Cuéllar Luis , Munita Jose , Maki Gina , Prentiss Tyler , Escobar Elvio , Foianini Ángel , Zervos Marcus , Bardossy Ana 
Published: November 2020

Background: Antimicrobial stewardship programs (ASPs) are useful in improving clinical outcomes in a cost-effective way and in reducing antimicrobial resistance. Objective: We sought to determine the impact of ASP in adult medical-surgical intensive care units (MS-ICUs). Methods: A multicenter study, in 77 MS-ICUs of 9 Latin-American countries, was conducted along 12 months (July 2018–June 2019). A self-assessment survey using a tool based on CDC recommendations (0–100 scale) was performed at the beginning, after 6 months, and at the end of the study. The impact of ASP was evaluated monthly using the following indicators: antimicrobial consumption (defined daily doses [DDD] per 100 patient days), appropriateness of antimicrobial prescriptions (percentage of total prescriptions), crude mortality rate (events per 100 discharges), and hospital-acquired multidrug-resistant microorganisms (MDRs) and Clostridioides difficile infections (CDI events per 1,000 patient days). These indicators were compared between MS-ICUs that reached the 75th percentile and those that maintained the 25th percentile at the final self-assessment. Results: Of all indicators evaluated, only surgical prophylaxis ≤24 hours, vancomycin therapeutic monitoring, and aminoglycosides (1 dose per day) did not show significant differences between MS-ICUs at the 75th percentile and the 25th percentile. CDI events were significantly higher at the 75th percentile MS-ICUs, probably related to better detection of C. difficile (Table 1). Conclusions: This study confirmed that MS-ICUs with more comprehensive ASPs had significantly better indicators.Funding: Proprietary Organization: MERCKDisclosures: None
Quality Initiative to Reduce Catheter-Associated Urinary Tract Infections Using Cleansing Cloths With a Standardized Method
Authors: Droske Lauren , Patel Parul , Schora Donna , Patel Jignesh , Barza Ruby , Monsalud Cherie Faith , Fisher Adrienne , Lim Rachel , Shah Mona , Kufner Bridget , Zelencik Shane , Lavin Mary Alice , Singh Kamaljit 
Published: November 2020

Background: Catheter-associated urinary tract infections (CAUTIs) account for >15% of hospital-acquired infections, resulting in increased length of stay and costs. Consequently, methods to improve indwelling urinary catheter (IUC) care and maintenance are warranted to reduce the risk of hospital-acquired CAUTIs. This study was a prospective quality improvement (QI) project to reduce CAUTIs using prepackaged cloths (ReadyCleanse by Medline Industries) and a simple, standardized cleaning process for care and maintenance of IUCs. Methods: This study is an ongoing QI project at NorthShore University HealthSystem, a 4-hospital system located north of Chicago, Illinois, with 750 beds and ∼64,000 annual admissions. The study consists of a 1.5-month staff training on proper product use (phase 1), followed by an intervention using the cloths for IUC care (phase 2). Each package contains 5 individual cloths corresponding to a simple, 5-step, cleansing protocol. IUC care and maintenance are performed twice daily on a routine basis and after each incontinent episode. Beginning July 2018, current practice (soap and wash cloth) was replaced with the ReadyCleanse cloths, and on August 1, 2018, data collection began. Adult patients admitted at all 4 NorthShore Hospitals with an IUC for >24 hours are enrolled in the study. From patient electronic health records, we collected patient demographics, reason for IUC insertion, days of catheter use, and development of CAUTI (according to the NHSN definition). During the intervention, observations of compliance and performance of catheter care were also performed. For the analysis described here, results for the first 14 months of the study were compared to CAUTI numbers from the 14-month period prior to the start of the study (February 2017–March 2018); the data presented represent ∼50% of the planned data collection. Results: As of September 30, 2019, 4,969 patients were prospectively enrolled in the study: 1,491 patients from hospital A, 1,451 from hospital B, 1,091 from hospital C, and 936 from hospital D. Patient demographics for the study cohort were 47% female, with a median age of 77 years and an average of 3.9 catheter days per patient. Systemwide, observational audits for compliance using the cloths averaged 95%. Upon completion of study month 14, 22 CAUTIs had been identified, compared to 26 CAUTIs for the comparison period, indicating a 15% reduction. Conclusion: Implementation of this simple, standardized alternative for IUC care is feasible on a large scale and may have potential for reducing CAUTI rates.Funding: Medline Industries supported this study.Disclosures: None
Tube Feeding: A Risk Factor for Clostridioides difficile Infection Among Long-Term Care Facility Residents Hospitalized at a Tertiary-Care Hospital in Detroit
Authors: Polistico Jordan , Awali Reda , Chopra Teena , Virdi Parminder kaur , Zaher Nathan , Baidoun Mohammad , Oring Justin , Gonzalez Elisa , Zhang Pingping , Heinrich Kirstin 
Published: November 2020

Objective: We investigated the epidemiology of Clostridioides difficile infection (CDI) in long-term care facility (LTCF) patients admitted to a tertiary-care center in Detroit. Methods: A retrospective case-control study was conducted of LTCF residents who were hospitalized with CDI at the Detroit Medical Center between January 1, 2009, and December 31, 2016. Case patients (LTCF residents admitted with CDI) were compared to 2 sets of inpatient controls. The first set of controls included inpatients presenting from the same LTCFs without CDI (control A). Second set included inpatients admitted from non-LTCF (home, community, hospital) who acquired CDI > 48 hours after admission or those who acquired CDI within 48 hours of admission but were exposed to an acute-care hospital within 4 weeks prior to admission (control B). Cases were matched (1:3 ratio) to the 2 sets of controls (control A and control B) based on year of admission. Matched multivariable analyses using conditional logistic regression were performed to identify independent predictors of CDI. Results: In total, 85 cases were matched to 2 sets of controls. For the first multivariate logistic regression model performed on cases and control A (n1 = 255), significant risk factors identified included tube feeding (OR, 3.60; 95% CI, 1.43–9.02; P = .006) and albumin ≤2.5 g/dL (OR, 4.98; 95% CI, 2.02–12.31; P < .001). For the second multivariate logistic regression model performed on cases and control B (n2 = 255), significant risk factors identified included Charlson comorbidity index score (OR, 1.25; 95% CI, 1.12–1.40; P < .001), tube feeding (OR, 3.63; 95% CI, 1.81–7.25; P < .001), prior use of PPI (OR, 0.37; 95% CI, 0.20–0.68; P = .001), prior use of H2 blockers (OR, 0.34; 95% CI, 0.16–0.69; P = .003), and prior use of antibiotics (OR, 0.12; 95% CI, 0.06–0.24; P < .001). Cases were more likely to have complicated CDI (OR, 7.02; P < .001) and recurrent CDI (OR, 2.63; P =.02) when compared to control B. Conclusions: Patients who acquired CDI at LTCFs experienced more severe CDI and were at greater risk for recurrent CDI than patients with other healthcare-associated CDI. For the regression model performed on cases and control A as well as that performed on cases and control B, tube feeding was the only variable that consistently predicted CDI among LTCF patients.Funding: This study was supported by Pfizer Inc (Collegeville, PA).Disclosures: None
A Ten-Year Review of Carbapenemase Producing Enterobacterales (CPE) in London, United Kingdom
Authors: Patel Bharatkumar , Hopkins Katie , Meunier Daniele , Staves Peter , Hopkins Susan , Woodford Neil 
Published: November 2020

Background: To determine the pattern of CPE observed in a single region in the United Kingdom. Methods: From 2009 to 2018, clinical laboratories in England were requested to send suspected CPE from all sites to the national reference laboratory for confirmation and investigation of carbapenem resistance mechanism(s). Isolates of Enterobacterales from London laboratories and confirmed to have 1 or more carbapenemase genes were included in the analysis. Result: Between 2009 and 2018, 5,133 isolates were confirmed to produce a carbapenemase; at least 1 CPE was identified in every London Laboratory and hospital. Confirmations increased from 28 isolates in 2009 to 1857 in 2018 and with a sharp rise after the introduction of the ‘PHE toolkit’ in 2013 (Fig. 1). Most CPE (2655, 51.7%) were from rectal screens (the 3 most frequently identified carbapenemase families were OXA-48–like in 1,263 isolates, NDM in 971 and IMP in 128), 631 (12.3%) were from urine samples, 180 (3.5%) from blood cultures, 103 (2.0%) from sputum specimens and the remainder (1564, 30.5%) were swabs, fluids and tissues from various body sites. Moreover, 51 CPE (1%) were identified from environmental swabs. Isolates were predominantly Klebsiella spp (2,525, 49%; 2,088 were K. pneumoniae), followed by Escherichia coli (1,434, 27.9%), Enterobacter spp (746, 14.5%; 605 were E. cloacae complex), and Citrobacter spp (349, 6.8%); 10 other species contributed smaller numbers. Within the carbapenemase families, OXA-48-like enzymes predominated overall (2303, 44.9%), followed by NDM (1822, 35.5%), IMP (313, 6.1%), VIM (207, 4.0%), NDM+OXA-48-like (205, 4.0%), and KPC (196, 3.8%). The first detection of a CPE with 2 distinct enzymes occurred in 2012 (OXA-48-like and NDM) and since then 235 co-detections have been identified; 233 related to OXA-48-like with another gene. Conclusion: The first CPE isolate in London was identified in 2003, a Klebsiella spp with a VIM enzyme. The number of isolates submitted to the national reference laboratory has continued to increase year on year. VIM and NDM carbapenemases predominated in the early years, because of their association with several outbreaks; these have now been overwhelmed by OXA-48-like detections and outbreaks. The increasing numbers of CPE with a combination of a metallo- and a non-metallo carbapenemase increases the therapeutic challenges to treat infected patients. Bacteremia caused by CPE remains rare, suggesting that infection prevention and control efforts are having some impact. However, as colonization prevalence increases, the number of clinical infections will rise in the future unless control measures to limit transmission and spread are improved.Funding: NoneDisclosures: None
Clinical Metrics for a Large Healthcare System’s Antimicrobial Management Program
Authors: Burgess Hayley , Kramer Joan , Hofammann Elizabeth , Cooper Mandelin 
Published: November 2020

Background: Clinical metrics and outcomes for evaluation of antimicrobial management programs (AMP) are challenging and inconsistent throughout the United States. Here, we present the results of the development of clinical metrics to measure and trend AMP outcomes within 161 acute-care facilities affiliated with a large healthcare system. Methods: Key AMP metrics were implemented in 2018 using 2017 as baseline: use of fluoroquinolones in UTIs, dosing of vancomycin, de-escalation, and intravenous (IV)-to-oral conversion of targeted drugs. Fluoroquinolone (FQ) and UTI metric evaluated all inpatients who received at least 1 dose of a FQ based on barcoded medication administration (BCMA) data and urinary tract infections were based on cystitis ICD-10 coding. Vancomycin dosing metric evaluated inpatient vancomycin troughs within therapeutic range during the admission. De-escalation metric evaluated for patients on a broad-spectrum antibiotic with a positive culture and sensitivity to narrower antibiotics. The IV-to-oral ratio was used to monitor targeted medications. Nonantimicrobial medications appropriate for IV-to- oral conversion were included in the ratio. Goals were established for each metric using the 75th percentile and ranges for “at goal,” “close to goal,” and “not at goal” were established using green–yellow–red color coding. Metrics were monitored via a systemwide dashboard that included all affiliated facilities. Data were shared monthly to key stakeholders including physicians, pharmacists, and senior leadership. Results: From 2017 to the third quarter of 2019, the FQ and UTI metric decreased 55%. This reduction in the FQ usage in UTI metric correlated with a reduction of 26.7 days of therapy (DOT) per 1,000 days present for FQ and a 50% reduction in FQ DOT for all affiliated facilities. The vancomycin dosing metric improved 2.9% from 75.2% of patients to 78.1% of patients with at least 1 vancomycin trough within range during the admission, which represents ~2,000 more patients with dosing in the target range over baseline. The de-escalation metric improved by 7% overall from 2018 to the third quarter of 2019, which translates to ~1,600 more patients with therapy de-escalated. The IV-to-oral ratio metric improved 5.5%, which means that ~180,000 more oral dosages were administered. Conclusions: Implementing AMP program clinical metrics in a large health system positively influenced antimicrobial medication therapy management for patients. Monitoring of process metrics should be considered for all AMP programs to advance antibiotic stewardship.Funding: NoneDisclosures: None
Potential Impact of CDC’s Enhanced Barrier Precautions Recommendations on Veterans’ Affairs Long-Term Care Facilities
Authors: Evans Martin , Kralovic Stephen , Roselle Gary , Lipscomb Karen , Flarida Linda 
Published: November 2020

Background: We previously showed that ~25% of Veterans’ Affairs (VA) long-term care facility (LTCF) residents had 1 or more indwelling medical devices. Of these devices, 36% were indwelling urinary catheters, 18% were percutaneous gastrostomy tubes, 12% were peripherally inserted central catheters, 8% were suprapubic urinary catheters, and 6% were peripheral intravenous catheters. Approximately 11% of those with an indwelling device developed an LTCF-acquired infection, compared to 3.5% of those without a device. Methicillin-resistant Staphylococcus aureus (MRSA) is a targeted multidrug-resistant organism (MDRO) in all VA LTCFs nationwide. All admissions to VA LTCFs are screened for MRSA carriage upon admission and, since 2013, those that screen positive (~21%) are placed in VA enhanced barrier precautions (EBPs). VA EBPs require that all healthcare workers entering a resident’s bedroom don gowns and gloves for specific activities likely to be associated with contamination of the worker’s hands and clothes. With proper hand hygiene and clean clothing, the colonized resident is encouraged to leave their bedroom and participate fully in all LTCF activities. In July 2019, the US Centers for Disease Control and Prevention (CDC) recommended the use of EBPs for all residents in LTCFs with a wound or device regardless of their colonization status if a resident is identified within the facility with novel or targeted MDROs including panresistant organisms, carbapenemase-producing gram-negative bacteria, and Candida auris. Methods: We assessed the potential impact of this recommendation on VA LTCFs by asking our 133 LTCFs to do a 1-day point-prevalence survey. Results: In total, 63 sites (47%) responded. On the survey day, there were 4,777 residents in the participating facilities, of whom 891 (18.7%) were under EBPs or contact precautions (CPs) for MRSA or other MDROs. Moreover, 963 (20.2%) residents (not already in EBP or CP) had a wound or an indwelling device such as central venous catheter, urinary catheter, feeding tube, tracheostomy or were on a ventilator (if >1 device, resident counted only once). If newly published CDC recommendations were implemented for novel or targeted MDRO precautions in VA LTCFs nationwide, 1,854 residents (38.8%) in VA LTCFs would be placed under EBPs or CPs. Conclusions: In VA LTCFs, adopting the CDC recommendation to place all patients with wounds or indwelling devices under EBPs regardless of colonization status would increase the percentage of residents on transmission-based precautions to ~40% (nearly doubling those in an isolation precaution status).Funding: NoneDisclosures: None
An Outbreak of New Delhi Metallo--Lactamase-5 (blaNDM-5)–Producing Escherichia coli in Companion Animals in the United States
Authors: Rankin Shelley C. , Cole Stephen D. 
Published: November 2020

Background: The emergence of carbapenem-resistant Enterobacteriaceae (CRE) in companion animals will be a game changer for infection prevention and control strategies in veterinary and human healthcare facilities. CRE have emerged as an important cause of human healthcare-associated infections and are a major clinical and public health problem. Although reports of CRE from animals are still very rare, they have been documented in China, Europe, and the United States. Methods: In April 2019, a passive veterinary surveillance system identified the blaNDM-5 gene in an E. coli isolated from a dog in Philadelphia in July 2018. CRE are reportable to the Philadelphia Department of Public Health (PDPH), and in May 2019, the Matthew J. Ryan Veterinary Hospital at the University of Pennsylvania (MJRVH) reported a cluster of carbapenem-resistant E. coli (CR-E. coli) isolated from 14 animals to the PDHP. This cluster of 17 isolates, that all contained a blaNDM-5 gene, was the first report of a CR-E. coli outbreak at a US veterinary facility. The first isolate, E. coli 24213-18, was sequenced on the Pacific Biosciences (PacBio) Sequel Sequencer and has been uploaded to GenBank. Whole genome sequencing was performed on all 17 isolates using the Illumina MiSeq platform. Antimicrobial resistance genes were identified from the National Center for Biotechnology Information Pathogen Detection Isolates Browser using AMRFinder. Results: PacBio sequencing confirmed E. coli ST167 and identified a circular IncFII plasmid of 139,547 bp that contained the blaNDM-5 gene, along with many additional resistance genes. In June 2019, a retrospective review of hospital records was completed and showed that, from July 2018, 17 CR- E. coli were isolated from 14 animals. Conclusions: Control of CRE infections in human healthcare settings is challenging because the organisms colonize the gastrointestinal tract and can go undetected. The same issue is to be expected with companion animals. Healthcare-associated spread of CRE E. coli in a veterinary facility emphasizes the importance of rapidly identifying and characterizing carbapenem-resistant isolates from animals. Methods to control the spread of CRE in veterinary medical settings have not yet been studied, and related investigations will be critically important to limit the transmission of these pathogens in animal populations. The risk of transmission of CRE from animals to people is currently poorly understood. CRE will be a major challenge across all health fields as these organisms become more prevalent in the community. It is likely that a ‘One Health’ approach to surveillance, infection prevention, and antimicrobial stewardship will be required to limit the spread and potential global dominance of CRE.Funding: NoneDisclosures: None
Chlorhexidine MICs Remain Stable Among Antibiotic-Resistant Bacterial Isolates Collected from 2005 to 2019 at Three US Sites
Authors: Lutgring Joseph , Grass Julian , Lonsway David , Yoo Brian , Epson Erin , Crumpler Megan , Galliher Karen , Zahn Matthew , Evans Eric , Jacob Jesse , Page Alexander , Satola Sarah , Smith Gillian , Kainer Marion , Hayden Mary , Reddy Sujan , Elkins Christopher , Magill Shelley , Guh Alice 
Published: November 2020

Background: Chlorhexidine bathing reduces bacterial skin colonization and prevents infections in specific patient populations. As chlorhexidine use becomes more widespread, concerns about bacterial tolerance to chlorhexidine have increased; however, testing for chlorhexidine minimum inhibitory concentrations (MICs) is challenging. We adapted a broth microdilution (BMD) method to determine whether chlorhexidine MICs changed over time among 4 important healthcare-associated pathogens. Methods: Antibiotic-resistant bacterial isolates (Staphylococcus aureus from 2005 to 2019 and Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae complex from 2011 to 2019) were collected through Emerging Infections Program surveillance in 2 sites (Georgia and Tennessee) or through public health reporting in 1 site (Orange County, California). A convenience sample of isolates were collected from facilities with varying amounts of chlorhexidine use. We performed BMD testing using laboratory-developed panels with chlorhexidine digluconate concentrations ranging from 0.125 to 64 μg/mL. After successfully establishing reproducibility with quality control organisms, 3 laboratories performed MIC testing. For each organism, epidemiological cutoff values (ECVs) were established using ECOFFinder. Results: Among 538 isolates tested (129 S. aureus, 158 E. coli, 142 K. pneumoniae, and 109 E. cloacae complex), S. aureus, E. coli, K. pneumoniae, and E. cloacae complex ECVs were 8, 4, 64, and 64 µg/mL, respectively (Table 1). Moreover, 14 isolates had an MIC above the ECV (12 E. coli and 2 E. cloacae complex). The MIC50 of each species is reported over time (Table 2). Conclusions: Using an adapted BMD method, we found that chlorhexidine MICs did not increase over time among a limited sample of S. aureus, E. coli, K. pneumoniae, and E. cloacae complex isolates. Although these results are reassuring, continued surveillance for elevated chlorhexidine MICs in isolates from patients with well-characterized chlorhexidine exposure is needed as chlorhexidine use increases.Funding: NoneDisclosures: None