bluuebunny/crossref_metadata_2025_split huggingface dataset:
806. Decreasing Central Line-associated Bloodstream Infections Through Quality Improvement Initiative on a High Acuity Transplant Unit
Authors: Ip Katie , Shayer Leah M , lerner susan m , Kim-Schluger Leona , Moon Jang 
Published: January 2021

Abstract

Background
Central line-associated blood stream infections (CLABSI) have a significant impact on mortality, morbidity and length of stay. Data collected by the Infection Prevention Department revealed progressive increases in the rate of CLABSI on an Abdominal Transplant Unit. Recognizing a drift from best practice, front line staff, the IP team and vascular access specialists, collaborated to identify opportunities for improving care of patients with vascular access devices.

Methods
An increase in CLABSI rate was observed on the Abdominal Transplant Unit beginning in 2016. An initiative began in 2017 to evaluate whether CLABSI rate reduction was sustainable for at least 1 year and to identify key determinants of this sustainability. Interventions were aimed at infection prevention best practices, care standardization, and team-based monitoring. Interventions included (1) re-education on CLABSI reduction, (2) two RN dressing changes to validate practice during central line dressing change, (3) blood draws from central lines (during non-emergent situations) had to be approved by nurse manager, physician lead and transplant quality physician, (4) CLABSI prevention nurses were chosen as designated phlebotomists for patients with prior approval, (5) daily line review was performed to address line days, indication of line (remove latent lines) and plan of care (transition to permanent access) and this information was shared with the unit physician lead and transplant quality team. Assuring compliance with audits and timely feedback with clinician accountability were vital with compliance with best practices.

Results

Conclusion
During the intervention, CLABSI infection rates dropped from 4.825 to 1.533 in 1,000 CVC days. The sustainability plan for this program is to continue line audits, assessing line necessity and review the effectiveness of the initiatives, review all new CLABSI data with staff and implement new changes as necessary. Joint, ongoing multidisciplinary collaboration is essential to reduce CLABSIs and optimize quality in a challenging, high-acuity patient population.

Disclosures
All Authors: No reported disclosures
809. Modified Laboratory Reporting to Prevent Catheter-Associated Urinary Tract Infections (CAUTIs)
Authors: Monsalud Cherie Faith , Singh Kamaljit , McElvania Erin , Schora Donna , Grant Jennifer , Lavin Mary Alice , Lim Rachel , Zelencik Shane 
Published: January 2021

Abstract

Background
Catheter-associated urinary tract infections (CAUTIs) are among the most common healthcare-associated infections. Many patients at our institution with a CAUTI do not have signs or symptoms of infection and bacterial growth likely represents asymptomatic bacteriuria (ASB). As a result, we implemented a Modified Lab Workflow (MLW) focused on diagnostic stewardship to improve urine culture (UCx) reporting and prevent misclassification and unnecessary treatment of CAUTIs.

Methods
On Sep. 1, 2019, laboratory reporting of Foley UCx was modified according to the protocol in Figure 1. UCx results were divided into 3 groups: (1) no growth, (2) mixed bacterial flora (≥3 organisms) not consistent with infection or (3) growth of ≤2 organisms with at least 1 organism ≥105 cfu/ml per National Healthcare Safety Network (NSHN) CAUTI definition. Group 3 UCx were resulted with instructions to the clinician (see Figure 1.). When requested, group 3 results were reviewed by Infection Prevention and released with organism identification and antibiotic susceptibility if it met Infectious Diseases Society of America (IDSA) CAUTI criteria. Otherwise they were resulted as: “Bacterial growth indicative of contamination or colonization.”
Figure 1. Modified Laboratory Workflow for Reporting Urine Cultures from Foley Catheters

Results
Between Sep. 1, 2019 to Mar. 1, 2020, a total of 134 UCx from catheterized patients were reviewed. Forty-two (31%) of UCx were from patients with a Foley in-situ ≥48 hours and processed through MLW; 92 UCx were from a Foley in place &lt; 48 hours and excluded from the study. Of the 42 UCx processed via MLW, 16 (38%) were no growth and 7 (17%) had bacterial growth suggestive of contamination. For group 3, 19/42 (45%) had growth of significant bacteria but only 1(5%) met IDSA criteria for reporting. During the study, 6 additional CAUTIs were reported due to incorrect specimen labeling causing Foley urine specimens to subvert MLW.

Conclusion
During our study, we identified 1 CAUTI through apt MLW use. Seven total CAUTIs occurred (SIR=0.66); a majority due to incorrect UCx source labeling, resulting in missed MLW screening. Ten CAUTIs (SIR=0.97) were reported in the preceding 6 months. As part of a comprehensive CAUTI prevention program, a MLW can help reduce classification of ASB as a CAUTI. Education to providers on precise labeling of UCx source is a key component of a successful MLW.

Disclosures
All Authors: No reported disclosures
LB-4. Cefepime-Enmetazobactam Demonstrates Superiority to Piperacillin-Tazobactam in a Subgroup of Patients with Complicated Urinary Tract Infections/Acute Pyelonephritis Caused by Extended Spectrum β-Lactamase-Producing Enterobacterales
Authors: Belley Adam , Barth Philip , Kashyap Shikhar , Lahlou Omar , Motta Paola , Knechtle Philipp , Velicitat Patrick 
Published: January 2021

Abstract

Background
There is a critical need for carbapenem-sparing therapies for infections caused by extended spectrum β-lactamase (ESBL)-producing Enterobacterales. Enmetazobactam is a novel ESBL inhibitor combined with the cephalosporin cefepime. Treatment outcomes of cefepime-enmetazobactam (FPE) versus piperacillin-tazobactam (PTZ) were assessed in subgroups of patients with ESBL-producing baseline uropathogens (ESBL-BU) in the ALLIUM phase 3 trial of complicated urinary tract infections (cUTI)/acute pyelonephritis (AP).

Methods
1034 cUTI/AP patients randomized 1:1 in a double-blind, multicenter trial received either 2 g cefepime/0.5 g enmetazobactam or 4 g piperacillin/0.5 g tazobactam q8h by 2h infusion for 7 to 14 days. Enterobacterales with MICs ≥1 µg/ml to ceftazidime, ceftriaxone, cefepime, meropenem, or FPE were genotyped for β-lactamases. In addition to the primary analysis (by stratified Newcombe) of overall success (combination of clinical cure and microbiological eradication) in the microbiological modified intent to treat population (mMITT) at test-of-cure (TOC), subgroup analyses were performed on patients with ESBL-BU non-resistant to FPE (MIC≤8 µg/ml) and PTZ (MIC≤64 µg/ml) and a subgroup (mMITT+R) that also included the ESBL-BU resistant to either agent (FPE MIC ≥16 µg/ml or PTZ MIC≥128 µg/ml).

Results
In mMITT, FPE (273/345, 79.1%) demonstrated superiority to PTZ (196/333, 58.9%) at TOC (difference, 21.2%; 95% CI: 14.3, 27.9). The prevalence rate of ESBL-BU was 20.9% (142/678), with 99.3% (141/142) expressing a CTX-M-type (-1, -3, -9, -14, -15, -27, -55, -91, -169) and 3.5% (5/142) co-expressing AmpC (CMY-2/-59). FPE (56/76, 73.7%) demonstrated superiority to PTZ (34/66, 51.5%) in this subgroup at TOC (difference 30.2%; 95% CI: 13.4, 45.1; Table). In mMITT+R, the ESBL-BU prevalence rate was 22.3% (172/771), with 6.4% (11/172) co-expressing AmpC (CMY-2/-4/-59/-99), 4.7% (8/172) co-expressing a metallo-β-lactamase (VIM-1, NDM-1), and 2.3% (4/172) co-expressing OXA-48. Superiority of FPE (67/91, 73.6%) compared to PTZ (41/81, 50.6%) was also observed at TOC despite inclusion of ESBL-BU resistant to either agent (difference 30.0%; 95% CI: 14.9, 43.3).
Table

Conclusion
FPE may represent a new empiric carbapenem-sparing option in settings where ESBL are endemic.

Disclosures
Adam Belley, PHD, Allecra Therapeutics SAS (Consultant) Philip Barth, MD, Allecra Therapeutics SAS (Consultant) Shikhar Kashyap, n/a, Allecra Therapeutics SAS (Consultant)Allecra Therapeutics SAS (Consultant) Omar Lahlou, PhD, Allecra Therapeutics SAS (Employee) Paola Motta, PhD, Allecra Therapeutics SAS (Employee) Patrick Velicitat, MD, Allecra Therapeutics SAS (Employee)
LB-13. Economic and workload impact of COVID-19 pandemic on physicians in the United States: results of a national survey
Authors: Long Dustin , Long Dustin , Turner Wesli , Chapman Lambert Crystal , Creger Thomas , Mugavero Michael J , Burkholder Greer A 
Published: January 2021

Abstract

Background
The United States (US) healthcare system has experienced enormous economic impact due to the COVID-19 pandemic, driven by both loss of revenue related to shutdowns and increased strain on resources. These factors have impacted the workload and finances of physicians.

Methods
A 31-item anonymous survey evaluating the psychological impact of the COVID-19 pandemic on physicians was developed at the University of Alabama at Birmingham using QualtricsXM software and included questions on adverse economic impact (defined as selecting job loss, furlough or reduced income as a stressor), workload, and compensation. It was distributed via physician professional and social networks including email, Facebook groups, and #MedicalTwitter May 14-July 31, 2020.

Results
Among 597 respondents, 295 (49%) reported adverse economic impact, with the highest proportions among emergency medicine (71%), anesthesiologists (63%), and surgeons (60%) and lowest among infectious diseases (ID) (25%). In multivariable analysis (Table), physicians practicing in the Northeastern US saw the lowest economic impact versus the South (OR 3.44, 95% CI: 2.03–5.84), Midwest (2.62, 1.36–5.05) or West (1.98, 1.06–3.71). Physicians practicing in federal or academic settings experienced less economic impact than those in community settings (0.09, 0.03–0.30 and 0.61, 0.41–0.93 respectively). Increased work hours were identified by 185 (31%) of respondents as a stressor, with 169 (92%) reporting additional hours were partially or completely uncompensated. Among 584 respondents, 212 (36%) had new roles and responsibilities (Figure), with the highest proportion among ID physicians (75%).
Table 1: Characteristics and factors associated with reporting adverse economic impact of the COVID-19 pandemic among 597 physicians in the United States

Figure: New roles and responsbilities assumed by 212 physicians during the COVID-19 pandemic

Conclusion
The COVID-19 pandemic has increased physician workload, with approximately one-third of physicians taking on new responsibilities and a similar proportion reporting increased work hours. Much of this additional work is uncompensated due to the economic impact of the pandemic on the healthcare system. Simultaneously, many physicians across the US have suffered adverse economic consequences, especially in the South. ID physicians have experienced higher workload but less economic impact, related to increased need for their expertise and new roles and responsibilities.

Disclosures
Dustin Long, PhD, Nothing to disclose
LB-14. CovidIQ- a Text Message-Based Symptom Surveillance Tracker that Predicts New Areas of Increased Incidence of Covid-19 Disease
Authors: Reza Mohammed , Magen Eran , Vora Naheed , Rogers Katherine , Moll Debbie , Warren Elaine , Suryaprasad Anil , Armas-Kolostroubis Laura , Cheung Alice 
Published: January 2021

Abstract

Background
Testing for SARS-CoV-2 is limited, making it difficult to estimate the true prevalence of disease and control the spread of new cases. Therefore, finding other ways to diagnose new cases of Covid-19 early is essential for preventing further spread of SARS-CoV-2 to other people in the community and prevent further outbreaks from occurring.

Methods
CovidIQ is a confidential and secure text messaging platform that works by collecting participants’ self-reported symptoms. Upon agreeing to participate, users are asked some basic demographic questions including gender, age range, ethnic background, and zip code. Participants are then queried via text message on a weekly or biweekly basis as to what symptoms they are experiencing: none, temperature &gt;99.6F, cough, shortness of breath, headache, fatigue, loss of appetite, loss of sense of smell or taste, diarrhea, body ache, sore throat, and/or chills. The symptoms are further broken down into major and minor criteria, allowing presumptive cases to be identified with more accuracy. The major criteria include elevated body temperature, cough, and shortness of breath. If a participant has any 2 major criteria, 1 major or 2 minor, or 3 minor criteria, they are considered a presumptive positive case.
While CovidIQ cannot be used to diagnose individuals, the combined results from many individuals show real-time changes in rates of infection for entire counties. Not all people who develop Covid-19 will need hospitalization. They may remain out in the community unaware of the risk they pose to others. And, because the official count of confirmed cases is delayed by 2–4 weeks from the time of actual infection, CovidIQ can sound the alarm much earlier when rates of infection begin to spike. Advanced warning can help communities and individuals make informed decisions about how they should conduct themselves.

Results
CovidIQ identified the spike in COVID-19 cases in Jacksonville/Duval County, Florida a full two weeks before it was reported by the Florida Department of Health and Johns Hopkins University.
Prevalence of Suspected COVID-19 Cases Through the Use of the CovidIQ Platform in Relation to Dates of OfficiallyReported Cases, Duval County, FL

Conclusion
CovidIQ is a novel tool developed to augment the public health response to this ongoing crisis by informing the public sector of potential new hot spots before areas experience a surge as compared to the current reporting structure.

Disclosures
All Authors: No reported disclosures
LB-16. Association Between Universal Face Shield in a Quaternary Care Center and Reduction of SARS-COV2 Infections Among Healthcare Personnel and Hospitalized Patients
Authors: Hemmige Vagesh , Winterer Becky , Lasco Todd , Lembcke Bradley 
Published: January 2021

Abstract

Background
SARS-COV2 transmission to healthcare personnel (HCP) and hospitalized patients is a significant challenge. Our hospital is a quaternary healthcare system with more than 500 beds and 8,000 HCP. Between April 1 and April 17, 2020, we instituted several infection prevention strategies to limit transmission of SARS-COV2 including universal masking of HCP and patients, surveillance testing every two weeks for high-risk HCP and every week for cluster units, and surveillance testing for all patients on admission and prior to invasive procedures. On July 6, 2020, we implemented universal face shield for all healthcare personnel upon entry to facility. The aim of this study is to assess the impact of face shield policy on SARS-COV2 infection among HCP and hospitalized patients.
Figure 1- Interrupted time series

Methods
The preintervention period (April 17, 2020-July 5, 2020) included implementation of universal face masks and surveillance testing of HCP and patients. The intervention period (July 6, 2020-July 26, 2020) included the addition of face shield to all HCP (for patient encounters and staff-to-staff encounters). We used interrupted time series analysis with segmented regression to examine the effect of our intervention on the difference in proportion of HCP positive for SARS-COV2 (using logistic regression) and HAI (using Poisson regression). We defined significance as p values &lt; 0.05.

Results
Of 4731 HCP tested, 192 tested positive for SARS-COV2 (4.1%). In the preintervention period, the weekly positivity rate among HCP increased from 0% to 12.9%. During the intervention period, the weekly positivity rate among HCP decreased to 2.3%, with segmented regression showing a change in predicted proportion positive in week 13 (18.0% to 3.7%, p&lt; 0.001) and change in the post-intervention slope on the log odds scale (p&lt; 0.001). A total of 14 HAI cases were identified. In the preintervention period, HAI cases increased from 0 to 5. During the intervention period, HAI cases decreased to 0. There was a change between pre-intervention and post-intervention slope on the log scale was significant (p&lt; 0.01).

Conclusion
Our study showed that the universal use of face shield was associated with significant reduction in SARS-COV2 infection among HCP and hospitalized patients.

Disclosures
All Authors: No reported disclosures
Impact of isolating COVID-19 patients in a supervised community facility on transmission reduction among household members
Authors: López Mercé , Gallego Claudia , Abós-Herrándiz Rafael , Tobella Ana , Turmo Nuria , Monclús Alba , Martinez Alba , Rami Artur , Navas Elena , Muñoz Miguel-Angel 
Published: January 2021

AbstractBackgroundIsolation of COVID-19 patients has been universally implemented to control transmission of the outbreak. Hotels and other facilities have been adapted to help appropriate isolation be achieved. Our study tested the efficacy of isolating patients in a reconditioned hotel versus isolation in their domiciles to reduce infection transmission.MethodsObservational cohort study based on a survey to COVID-19 patients between April and June 2020. One cohort had been isolated in a hotel and the other in their domiciles. Multivariate regression models analyzed the factors related to the occurrence of COVID-19 infection among the household members.ResultsA total of 229 household members of COVID-19 patients were analyzed, 139 of them belonging to the group of hotel-isolated patients and 90 in the group of domicile-isolated ones. More than half of the household members became infected (53.7%). Higher risk of infection was found in the household members of domicile-isolated patients isolated and in those reporting overcrowding at home, (odds ratio [OR] 1.67, 95% confidence interval [CI] 0.89–3.12) and (OR 1.44, 95% CI 0.81; 2.56), respectively.ConclusionsThe isolation of COVID-19 patients in community-supervised facilities may protect their household members from transmission of the disease. Overcrowded homes may contribute to the transmission of the infection.
Black pepper and piperine induce anticancer effects on leukemia cell line
Authors: Banerjee Somesh , Katiyar Parul , Kumar Vijay , Saini Shashank Sagar , Varshney Ritu , Krishnan Vengadesan , Sircar Debabrata , Roy Partha 
Published: January 2021

Abstract
The black pepper, most commonly used in Indian cuisines for ages, is considered as “king of spices.” The present study evaluates the anticancer potential of black pepper and its main constituent, i.e. alkaloid piperine, against human leukemia cell line, K-562 cells. Gas chromatography–mass spectrometry (GC–MS) analysis confirmed the presence of piperine in black pepper extract. The methanolic extract of black pepper (BP-M) and pure piperine (PIP) showed a strong cytotoxic effect against this cell line. Both BP-M and PIP generated apoptotic bodies in K-562 cells and caused nuclear condensation as visualized by fluorescent microscopy, which was further confirmed by flow cytometry analysis. BP-M and PIP also generated reactive oxygen species in K-562 cells as established by flow cytometry. The translation of Bax, caspase-3 and caspase-9 genes was found to be upregulated with subsequent downregulation of Bcl-2 gene. The anti-proliferative effect of both BP-M and PIP was also observed by trypan blue staining and was further confirmed by the downregulated expression of proliferating cell nuclear antigen (PCNA). The molecular docking studies showed the binding of PIP with PCNA and Bcl-2 and supported the in vitro findings. The docking studies also proposed the binding of PIP to ADP binding pocket of Apaf-1 protein. Taken together, these findings signify the anticancer potential of both black pepper and PIP, thus proposing black pepper as a potent nutraceutical for preventing the progression of chronic myeloid leukemia.
Structure of African Populations of Pyricularia oryzae from Rice
Authors: Odjo Théophile , Diagne Diariatou , Adreit Henri , Milazzo Joëlle , Raveloson Harinjaka , Andriantsimialona Dodelys , Kassankogno Abalo Itolou , Ravel Sébastien , Gumedzoé Yawovi Mawuéna Dieudonné , Ouedraogo Ibrahima , Koita Ousmane , Silué Drissa , Tharreau Didier 
Published: January 2021

Rice blast, caused by the filamentous ascomycete Pyricularia oryzae, is one of the most devastating diseases of rice. Four genetic clusters were previously identified, and three have a large geographic distribution. Asia is the center of diversity and the origin of most migrations to other continents, and sexual reproduction persisted only in the South China–Laos–North Thailand region, which was identified as the putative center of origin of all P. oryzae populations on rice. Despite the importance of rice blast disease, little is known about the diversity and the population structure of the pathogen in Africa (including Madagascar). The present study was intended to describe the structure of African populations of P. oryzae and identify the relationship between African and worldwide genetic clusters. A set of 2,057 strains (937 African and 1,120 Madagascan strains) were genotyped with 12 simple sequence repeat markers to assess the diversity and the population structure of P. oryzae. Four genetic clusters were identified in Africa and Madagascar. All four clusters previously identified are present in Africa. Populations from West Africa, East Africa, and Madagascar are highly differentiated. The geographic structure is consistent with limited dispersion and with some migration events between neighboring countries. The two mating types are present in Africa with a dominance of Mat1.2, but no female-fertile strain was detected, supporting the absence of sexual reproduction on this continent. This study showed an unsuspected high level of genetic diversity of P. oryzae in Africa and suggested several independent introductions. [Formula: see text] Copyright © 2021 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .