bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Meropenem Restriction on Time Between Order and Administration in a Medical Intensive Care Unit
Authors: Le Aline , Kang Le , Noda Andrew , Godbout Emily , Markley John Daniel , Lee Kimberly , Pakyz Amy , Kim Jihye , Doll Michelle Elizabeth , Bearman Gonzalo , Stevens Michael 
Published: November 2020

Background:
In this study, we assessed whether meropenem restriction led to delays in administration for patients in a medical intensive care unit (MICU) at a large tertiary-care urban teaching hospital. Methods: The antimicrobial stewardship program (ASP) at Virginia Commonwealth University Health System (VCUHS) requires approval for restricted antimicrobial orders placed between 8 a.m. and 9 p.m. Between 8 a.m. and 5 p.m. (daytime), authorized approvers include ASP and infectious diseases (ID) physicians. From 5 p.m. to 9 p.m. (evening) orders are approved by ID fellows. Orders were entered as Stat, Now, and Routine. Between 9 p.m. and 8 a.m. (night), patients receive doses without approval. Meropenem restriction began in mid-January 2018. Pre- and postmeropenem restriction periods were defined as February–December 2017 and February–December 2018. Meropenem use data were compared for adult patients in the MICU. A multivariable Cox regression model was implemented to compare (1) time from order entry to approval; (2) time from order approval to patient administration; (3) total time from order entry to patient administration, adjusting for order priority, approver (ASP, ID consult, ID fellow, pharmacy); and (4) time of day of order placement (day, eve, night). The analyses were performed using SAS version 9.4 software (SAS Institute, Cary, NC). Result: Time from order approval to patient administration was significantly decreased in the postrestriction period (HR, 1.840; P < .001) (Table 1). Stat orders were faster compared to routine orders for order entry to approval (HR, 1.735; P < .001), approval to administration (HR, 2.610; P < .001), and total time from order entry to administration (HR, 2.812; P < .001). No significant differences were found in time to approval by approving service. Time from order entry to approval was faster for nighttime orders than for daytime orders (HR, 1.399; P = .037). Conclusions: Our data indicate that the time from order entry to administration decreased following meropenem restriction in our MICU. More research is needed to identify the reason for this finding, but we postulate that this is due to an effect on drug administration prioritization within nursing workflow. These data will inform our local meropenem restriction efforts.Funding: NoneDisclosures: Michelle Doll reports a research grant from Molnlycke Healthcare.
Effectiveness of Methicillin-Resistant Staphylococcus aureus (MRSA) Nasal Screening for Reduction of Vancomycin Use for Pneumonia
Authors: Snellgrove Shannon , Brown Matthew , Edwards Seth , Leal Sixto , Bryan Allen , Pappas Peter , Lee Rachael 
Published: November 2020

Background: Methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization has been a well-established risk for developing MRSA pneumonia. In previous studies, the MRSA nasal screening test has shown an excellent negative predictive value (NPV) for MRSA pneumonia in patients without exclusion criteria such as mechanical ventilation, hemodynamic instability, cavitary lesions, and underlying pulmonary disease. MRSA nasal screening can be used as a stewardship tool to de-escalate broad antibiotic coverage, such as vancomycin. Objective: The purpose of this study was to determine whether implementation of a MRSA nasal screening questionnaire improves de-escalation of vancomycin for patients with pneumonia. Methods: A retrospective review was performed on 250 patients from October 2018 to January 2019 who received MRSA nasal screening due to their prescriber choosing only “respiratory” on the vancomycin dosing consult form. Data obtained included demographics and clinical outcomes. Statistical analyses were performed, and P < .05 was considered significant. Results: Of the 250 patients screened, only 19 patients (8%) were positive for MRSA. Moreover, 40% of patients met exclusion criteria. In 149 patients without exclusion criteria, the MRSA nasal swab had a 98% NPV. Although not statistically significant, vancomycin days of therapy (DOT) based on MRSA nasal swab result was 1 day shorter in those with negative swabs (3.49 days negative vs 4.58 days positive; P = .22). Vancomycin DOT was significantly reduced in pneumonia patients without exclusion criteria (3.17 days “no” vs 4.17 days “yes”; P = .037). Conclusions: The implementation of an electronic MRSA nasal screening questionnaire resulted in reduced vancomycin DOT in pneumonia patients at UAB Hospital. The MRSA nasal swab is an effective screening tool for antibiotic de-escalation based on its 98% NPV for MRSA pneumonia if utilized in the correct patient population.Funding: NoneDisclosures: Rachael Anne Lee reports a speaker honoraria from Prime Education, LLC.
Improvement of Adequacy of Empirical Antimicrobial Therapy in Escherichia coli Bacteremia of Urinary Source in Catalonia (VINCat-PROA)
Authors: Horcajada Juan P. , Hernández Sergi , Padullés Ariadna , Gimenez Montserrat , Lucía Boix-Palop , Ferrer Ricard , Melendo Susana , Badia Josep Maria , Oliva Glòria , Calbo Esther , Grau Santiago 
Published: November 2020

Background: The antibiotic use optimization program (PROA) in Catalonia (Spain) is part of the surveillance program for nosocomial infections in hospitals in Catalonia (VINCat). Despite the existence of guidelines for the treatment of urinary tract infections in hospitals, adherence to them is not guaranteed. Objective: Our objective was to evaluate the adequacy of empirical antimicrobial therapy to local guidelines in bacteremia caused by Escherichia coli of urinary source within the PROA-VINCat program during a 3-year period. The impact of a voluntary survey asking for evaluating local results and implementing correction measures was also analyzed. Methods: Multicentric prospective observational study including all episodes of E. coli bacteremia of urinary source between May 2017 and September 2019, in adult hospitalized patients in 45 Catalan hospitals. Adequacy of the empirical therapy to local guidelines was one of the prospectively recorded items. A survey evaluating local results of 2017–2018 and asking for possible correcting measures was sent to the participating centers at the end of 2018. Percentages of adequacy of empirical antimicrobial therapy in 2017, 2018, and 2019 were compared by means of χ2 test. Results: Overall, 3,804 episodes of bacteremia were recorded: 845 in 2017, 1,861 in 2018 and 1,098 until September 30, 2019. Globally, adequacy of empirical therapy to guidelines increased from 73.7% in 2017 to 78.2% in 2019 (P = .06). Interestingly, in the 24 hospitals that responded to the voluntary survey, the adequacy of empirical therapy increased significantly from 72.9% in 2017 to 79.9% in 2019 (P = .009). In hospitals that did not respond, adequacy remained the same over the years (76.7% in 2017, 75.1% in 2019; P = .90). Correction measures applied were: meeting with the antimicrobial stewardship team to evaluate the results (100%), review of local resistance rates (62%), review of local guidelines (58.3%), improving guidelines dissemination (75%), sessions for improving guidelines adherence (58%), and analysis of adherence to guidelines after education (65%). Conclusions: In the empirical treatment of E. coli bacteremia of urinary source, adequacy to local antimicrobial therapy guidelines improved from 2017 to 2019, but only in hospitals answering a voluntary survey regarding correcting measures for improving adequacy. Adherence to antimicrobial stewardship proposals improves indicators at local and regional level.Funding: NoneDisclosures: Juan Pablo Horcajada reports consulting fees from MSD, Pfizer, and Menarini and speaker honoraria from MSD, Pfizer, and Zambon.
Infection Control, Antimicrobial Consumption, and Hospital-Acquired Clostridioides difficile Infection in Acute-Care Hospitals in Catalonia
Authors: Calbo Esther , Castellà Laia , Hornero Ana , Larrosa Nieves , Sopena Nieves , Grau Santiago , Hernández Sergi , Gimenez Montserrat , Melendo Susana , Boix-Palop Lucía , Horcajada Juan P. 
Published: November 2020

Background: Hospital-acquired Clostridioides difficile infection (HA-CDI) is a major infection control challenge. Using whole-genome sequencing, <40% of HA-CDI cases have been estimated to have been acquired from other inpatient cases. Huge regional variations have been described depending on the prevalence of epidemic ribotypes. We hypothesized that, according to the geographical area, variations in HA-CDI rates between hospitals could be attributable either to differences in infection control policies or to antimicrobial consumption. Objectives: To assess the association of HA-MRSA rates (a surrogate marker of infection control policies) and antimicrobial consumption with HA-CDI incidence from 2011 to 2018 in hospitals reporting at the VINCat-program (Infection Control and Antimicrobial Stewardship Catalan Program). Methods: Data on 45 hospitals in Catalonia (with 70.5% of all adult acute-care hospital beds) reporting antimicrobial consumption, HA-MRSA, and HA-CDI new cases to the VINCat-program since 2011 to 2018 were analyzed. To report antimicrobial consumption, the Anatomical Therapeutic Chemical Classification (ATC) defined daily dose (DDD) index 2018 was used. Participating hospitals were classified into 3 groups according to size: group 1 (>500 beds), 9 hospitals; group 2 (500–200 beds), 15 hospitals; and group 3 (<200 beds), 21 hospitals. The number of hospitalization days recorded at the participating hospitals increased from 2,828,101 in 2011 to 3,201,680 in 2018. To analyze the association between HA-MRSA rate, antimicrobial consumption and the rate of CDI-HA, a Poisson regression model was used. HA-CDI annually new cases have been defined as a dependent variable, the stays as an offset of the model and the HA-MRSA rates and antimicrobial consumption (measured in DDD) as independent factors. The exponents of model coefficients are equal to incidence rate ratios (IRR). Results: The regression model showed an association of with antimicrobial consumption with HA-CDI (IRR,1.05; 95% CI, 1.03–1.07; P < .001) and a lack of association with HA-MRSA (IRR, 0.83; 95% CI, 0.46–1.48; P = .52). Conclusions: The HA-CDI incidence rate grew annually by 5% for an increase of 1 DDD in annual antibiotic consumption. No association HA-MRSA rates was detected, suggesting that antimicrobial stewardship programs are urgently needed to improve the control of HA-CDI in Catalonia, a geographical area with a low prevalence of epidemic ribotypes.Funding: NoneDisclosures: Juan Pablo Horcajada reports consulting fees from MSD, Pfizer, and Menarini and speaker honoraria from MSD, Pfizer, and Zambon.
Patient Involvement in Infection Prevention and Control (IPC) Practice: Knowledge and Perception Study
Authors: Fofanah Bobson Derrick , Conteh Christiana 
Published: November 2020

Background: Patient involvement is increasingly recognized as critical component for improved care, and patients has been identified of as having a potentially important role for better health outcome as a result of their involvement in their care plan. A usual saying that infection prevention and control is “everyone’s business” is frequently understood to include not only healthcare workers but also patients and their relatives, all of whom are seen as stakeholders with a part to play in ensuring a better patient outcome. There is limited evidence about knowledge and perception about involving patient and/or relatives in IPC implementation in a post–Ebola-outbreak country. Objectives: We aimed to ascertain the knowledge and perception of patient involvement in infection prevention and control (IPC) practice. Methods: We used a qualitative approach comprising interviews with patients and/or relatives and health workers sampled from 5 hospitals. Participants (n = 60) included 25 nurses, 25 patients and/or relatives, 5 IPC focal persons, and 5 hospital administrators. Interviews used a structured questionnaire to explore staff views on patient involvement. A separate questionnaire was used to survey patient perspectives and knowledge about basic hospital IPC practices. Results: Of 60 interviews, 64% of nurses supported involving patient in hospital IPC practice, saying that the patient can serve as a reminder during the time of care, whereas 36% disagreed with involving the patient because of fear of having confrontations with the patient. Also, 92% of patients and/or relatives agreed to their involvement because they viewed it as their right; only 8% did not accept involvement because they thought it was a burden and not their responsibility. All 5 IPC focal persons (100%) supported patient involvement; they thought it would enhance overall IPC compliance and keep healthcare workers reminded of IPC practice, most especially hand hygiene. Also, 100% of hospital administrators supported involving patients because they felt that patient should be involved in their care plan. Conclusions: From this study, it is evident that patient involvement is key in optimizing IPC compliance in hospitals. The study findings indicate that most patients have knowledge of the importance of hand washing since the Ebola outbreak; however, they lack knowledge on other practices such as waste disposal, cough etiquette, etc. There is need for IPC orientation on admission and continuous patient education.Funding: NoneDisclosures: NoneIf I am discussing specific healthcare products or services, I will use generic names to extent possible. If I need to use trade names, I will use trade names from several companies when available, and not just trade names from any single company.DisagreeChristiana Kallon
Prevalence of Carbapenem-Resistant Enterobacteriaceae (CRE) at a Tertiary-Care Center in the United States
Authors: Heipel Diane , Major Yvette , Viola-Luqa Carli , Doll Michelle Elizabeth , Stevens Michael , Cooper Kaila , Godbout Emily , Bearman Gonzalo 
Published: November 2020

Background: Quantification of the magnitude of CRE both within a facility and regionally poses a challenge to healthcare institutions. Periodic point-prevalence surveys are recommended by the CDC CRE tool kit as a facility-level prevention strategy. A 2016 point-prevalence survey of 2 high-risk units at a tertiary-care center in the United States for CRE colonization found that all patients surveyed were negative for CRE. The infection prevention (IP) team repeated the study in 2019 to reassess the prevalence of CRE in the healthcare facility. Methods: A point-prevalence survey was performed in November 2019 on the same 2 high-risk units surveyed in 2016. A perirectal flocked swab was collected from all patients unless a patient refused and/or a contraindication to rectal swab was present. Swabs were inoculated onto HardyChrom TM CRE agar for incubation in ambient air at 35°C for 24 hours. Organism identification was performed using MALDI-TOF mass spectrometry on a MBT Smart by Bruker. Results: None of the patients on either high-risk unit was known to be colonized or infected with CRE at the time of the point-prevalence survey. Of 41 perirectal swabs collected, 4 (9.8%) were positive for CRE. None (0 of 20) were surgical ICU patients and 4 of 21 (19%) were medical ICU patients. All positive swabs revealed different organisms identified as follows: Escherichia coli, Enterobacter cloacae, Enterobacter kobai, and Enterobacter aerogenes. All 4 positive patients had had recent contact with multiple acute-care hospitals. Also, 2 had been transferred for liver transplant evaluation. None of these patients had received a carbapenem during their admission to the facility. Conclusion: CRE are increasingly identified in healthcare centers in the United States. Centers previously classified as low prevalence will need to maintain preventive strategies to limit transmission risks as colonized patients arrive in the facility for care. Adoption of a robust horizontal infection prevention program may be an effective strategy to avoid the spread of CRE.Funding: NoneDisclosures: Michelle Doll reports a research grant from Molnlycke Healthcare.
Using Whole-Genome Sequencing to Improve Surveillance Measures: Case Study of Methicillin-Resistant Staphylococcus aureus (MRSA) in a Florida Hospital
Authors: Lamers Susanna , Nolan David , McCarter Yvette Simone , Neilsen Chad , Rose Rebecca , Rodriguez Christopher , Cross Stephanie 
Published: November 2020

Background: The CDC considers methicillin-resistant Staphylococcus aureus (MRSA) one of the most important hospital-acquired infections (HAIs) in the United States. However, infection control departments (ICDs) often rely on subjective data to determine whether multiple MRSA cases are a true outbreak and whether the hospital is responsible (community- vs hospital-acquired). Objective: Our objective was to determine whether whole-genome sequencing (WGS) of MRSA provided new insights into on transmission dynamics at large, inner-city hospital in Jacksonville, Florida. Methods: Over a 4-month period, MRSA samples were obtained from 44 infected patients at 3 campuses within a single hospital system. Limited nonpatient identifying information was obtained, including date of collection, campus, unit, reason for admission, and days post admission (DPA) of MRSA diagnosis. Whole-genome sequences were generated using the Illumina platform. Raw reads were processed, and genetic distances were calculated and used to identify genetically linked bacterial infections using FoxSeq version 1.0 software. Results: Based on their length of stay, 10 patients were reported by the ICD as obtaining an HAI. Three distinct “episodes” were evident in which >5 MRSA cases were observed within a 3–5-day period. Genomic analysis identified 5 clusters of linked infections: 4 clusters contained 2 patients and another contained 3. Of these clusters, only 1 contained multiple cases that were reported as HAIs; however, because these case were separated by 2 weeks, it is unlikely that they came from a source in the hospital. The results suggest that HAIs were overreported and that most MRSA present in the hospital likely came from community sources. Conclusions: WGS provided clear evidence that temporally clustered MRSA cases do not imply an outbreak is occurring. Furthermore, ongoing detection of the same community-acquired infections over several months is indicative of a shared source outside of the hospital, which could be uncovered through examination of clinical records. Considering the implications of HAIs, best approaches to combat them should include identifying their sources. As molecular surveillance approaches to infection control are rapidly becoming easier and less expensive, the methods can be used to bring objective clarity to the ICD.Funding: NoneDisclosures: Susanna L. Lamers reports salary from BioInfoExperts and contract research for the NIH, the University of California - San Francisco, and UMASS Medical School.
Variation in Measures of Antimicrobial Use Across Four Nursing Homes, Atlanta, Georgia, 2019
Authors: Dube William , Saiyed Sahebi , Comer Patricia , Hanichen Michael , Klinczar Christie , Price Crystal , Fridkin Scott 
Published: November 2020

Background: Although antibiotic stewardship programs (ASP) are now required in nursing homes, assimilating and responding to data to improve prescribing in nursing homes is novel. Four Atlanta-based skilled nursing facilities (SNFs) began collaborating (EASIL: Emory Antibiotic Stewardship in Long-Term Care) to share standardized prescribing data to allow interfacility comparisons and action. Methods: After SNF ASPs were evaluated and trained, standardized prescribing logs were submitted (January 2019 to June 2019) including the following data: start date, treatment site, prescriber attribution of order (ie, SNF order vs hospital order) and monthly resident days. SNF-specific point estimates of usage rates were calculated as pooled means for all antibiotic starts, SNF-order starts, and days of therapy (DOT), by treatment site per 1,000 resident days. Duration of urinary tract infection (UTI) therapy was assessed by calculating percentage of SNF-UTI starts over recommended duration defined by the local treatment guideline. Rate ratios (RRs) of use were calculated to compare SNF-specific rates to the largest SNF. The 95% CIs were calculated using normal approximation. Results: Monthly starts ranged from 124 to 177, with a pooled mean of 7.8 antibiotic starts (any type), 4.5 SNF-order starts, and 1.2 SNF-UTI starts per 1,000 resident days. Approximately half of all starts were SNF starts (range, 43%–53%), and less than half of DOT were attributed to SNF starts (range, 35%–45%). Overall, SNF-order treatment sites were most often UTIs (29%), lower respiratory infections (17%), and skin and soft-tissue infections (17%). SNF-order UTI starts per 1,000 patient days varied at 1 SNF (SNF B RR, 1.57; 95% CI, 1.04–2.36). SNF-order UTI DOT per 1,000 patient days was more variable, with SNFs B and C having significantly higher rates (B RR, 1.49, 1.24, and 1.82; C RR, 5.42; 95% CI, 4.65–6.34) than SNF A (Fig. 1). The percentage of SNF-order UTI starts that were over recommended duration ranged from 8% (nitrofurantoin, SNF A) to 100% (fluoroquinolones, SNF C) (Fig. 1). Conclusions: Although UTIs are the single most common reason to prescribe antibiotics after arriving in a SNF, they account for a small fraction of overall starts and an even smaller fraction of DOT. We identified outlier prescribing by different SNFs using 3 metrics, suggesting that distinct corrective actions are necessary to target distinct prescribing challenges (starts, duration, and transitions of care).Funding: NoneDisclosures: Scott Fridkin reports that his spouse receives consulting fees from the vaccine industry.