bluuebunny/crossref_metadata_2025_split huggingface dataset:
845. Trends and Regional Differences in Community-Onset Fluoroquinolone-Resistant E. coli in Hospitalized Adults in the United States
Authors: Wolford Hannah , Baggs James , Hatfield Kelly M , Olubajo Babatunde , Preston Leigh Ellyn , Kourtis Athena P , McDonald Clifford , Jernigan John A , Reddy Sujan 
Published: January 2021

Abstract

Background
Escherichia coli is a common cause of community-onset (CO) infections, including urinary tract and abdominal infections, and CO sepsis. Fluoroquinolones (FQ) are used in the empiric treatment of E. coli infections, but FQ-resistance may limit their effectiveness. We examined trends and regional differences in FQ-resistant E. coli clinical cultures among hospitalized adult patients in the U.S.

Methods
We measured the incidence of E. coli clinical cultures among hospitalized adults in a cohort of hospitals in the Premier Healthcare Database and Cerner Health Facts from 2012 through 2017. FQ resistance was defined as resistance to ciprofloxacin, levofloxacin, or moxifloxacin. Only cultures collected prior to day 4 of hospitalization, defined as CO, were considered. We extrapolated national estimates using a raking procedure to generate weighted adjustments matching the American Hospital Association distribution for U.S. acute care hospitals. Weights were based on U.S. census division, bed size category, teaching status, and urban/rural designation. We used a weighted means survey procedure to calculate national estimates and weighted multivariable logistic regression to examine trends and regional differences.

Results
In 2017, we estimated 949,393 CO E. coli infections with FQ susceptibility testing; 312,304 (33%) were due to E. coli resistant to FQ. Of FQ-resistant E. coli isolates, 76% were isolated from urine. We did not observe a significant trend in FQ-resistant E. coli from 2012 to 2017 (p = 0.85). Percent FQ-resistant varied significantly by region (p &lt; 0.0001) with an estimated range of 19% (Mountain) to 42% (Southeast Central) in 2017. We also found variability by hospital (2017 Q1: 26% and Q3: 39%). FQ-resistance rates were higher in urine (36%: 95% CI 34-38%) than blood isolates (27%: 95% CI 26-29%) and higher for males (40%: 95% CI 38-42%) than females (33%: 95% CI 31-35%).

Conclusion
FQ-resistance is common in CO E. coli infections with significant variability by region and hospital. Empiric FQ treatment for infectious syndromes commonly caused by E. coli may need to be reconsidered. Clinicians should consult with local antibiograms and antibiotic stewardship programs to determine the most appropriate empiric treatment of E. coli infections in hospitalized adults.

Disclosures
All Authors: No reported disclosures
848. Trends of Carbapenem Resistance in Enterobacterales in the US Between 2015 and 2019
Authors: Marcella Stephen , Kanakamedala Hemanth , Zhou Yun , Cai Bin , Pogue Jason M 
Published: January 2021

Abstract

Background
Carbapenem-resistant Enterobacterales (CRE) are considered an urgent threat to human health by the CDC. Tracking resistance over time is of importance to understand trends and patterns. Tracking carbapenem resistance is complicated by definitions which include resistance to ertapenem only which can differ in epidemiology, mechanism, and treatment options. This study examines trends of CRE from 2015 to 2019 and the impact of carbapenem resistance on outcomes.

Methods
Enterobacterales infections identified in the Premiere HealthCare database from 2015 to 2019 were categorized into 3 groups: ertapenem only resistant (Erta-R); isolates resistant to ertapenem and class 2 carbapenems (CR-1/2); and carbapenem susceptible (CS). Trends in resistance over the study period were assessed. Furthermore, patient characteristics and outcomes were compared between groups.

Results
Among 225,457 unique cultures 692 were Erta-R, 2,397 were CRE-1/2, and 222,368 were CS. Overall rates of CRE-1/2 slightly increased from 0.9% to 1.2% over the study period (P for trend of &lt; 0.0001) while there was a slight negative trend for Erta-R rates (P for trend =0.006). Rates of CR by pathogen (Figures 1 and 2) were relatively stable over the study period. Enterobacter cloacae was the most common organism in the Erta-R group and K. pneumoniae was the most common CRE-1/2 pathogen. Differences in patient characteristics were seen between the three groups for race, gender, and comorbidities (Table). Both mortality (Erta-R: 10%, CRE-1/2: 9% vs CS: 4%, respectively) and infection-associated length of stay (Erta-R: 8 days; CRE-1/2: 8 days vs CS: 6 days, respectively) were higher in both Erta-R and CRE 1/2 when compared to CS (P&lt; 0.001). There were no differences in outcomes between patients with Erta-R and CRE 1/2.
Figure 1. Annual rates of CRE (resistance to both classes) by pathogen over the study period

Figure 2. Annual rates of CRE (ertapenem R only) by pathogen over the study period

Table. Patient demographics and outcomes

Conclusion
CRE rates were relatively stable over the study period. Despite low incidence, CRE continue to have significant associations with morbidity and mortality. Interestingly, outcomes were similar in patients with isolates resistant to ertapenem only when compared to isolates resistant to both classes of carbapenems. This might be reflective of novel treatment options available over the study period.

Disclosures
Stephen Marcella, MD, Shionogi Inc. (Employee) Hemanth Kanakamedala, BS, Shionogi Inc. (Independent Contractor) Yun Zhou, MS, Shionogi Inc. (Independent Contractor) Bin Cai, MD, PhD, Shionogi Inc. (Employee) Jason M Pogue, PharmD, BCPS, BCIDP, Shionogi Inc. (Advisor or Review Panel member)
850. External Validation of the Methicillin-Resistant Staphylococcus aureus Bacteremia Score
Authors: Boyle Ellen , Dorgan Emily , Lunowa Cali , Molina Kyle C , Johnson Tanner M , miller matthew , Huang Misha , Fish Douglas 
Published: January 2021

Abstract

Background
Predictive scoring systems, such as the Pitt Bacteremia Score (PBS) and Acute Physiology and Chronic Health Evaluation II (APACHE-II), can optimize clinical decisions and provide adjustment for confounding among patients with Methicillin-Resistant Staphylococcus aureus bacteremia (MRSAB). The recently introduced MRSAB score demonstrated superior discriminatory ability in mortality prediction compared to APACHE-II and PBS, however external validation is lacking.

Methods
Single center, retrospective cohort study of adult patients admitted to University of Colorado Hospital from 2013–2020 with initial episode of MRSAB were included. Patients transferred from an outside hospital, left against medical advice, or died/pursued comfort care within 24 hours of index culture were excluded. The primary outcome was discrimination of 30-day all-cause mortality. The discriminatory abilities of APACHE-II, PBS and MRSAB were compared using receiver operating characteristic (ROC) analysis. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were analyzed, and optimal MRSAB score was identified by Youden Index.

Results
Overall, 170 patients met study inclusion. The median (IQR) age was 57 (47-66) years, 69% were male, and 19% were in an ICU during blood culture collection. The most common infection sites were skin and soft tissue (41%), musculoskeletal (23%), and line-related (19%), whereas endovascular (14%) infections were less common. The median (IQR) PBS, APACHE-II and MRSAB scores were 2 (0-4),17 (12-23), and 6.5 (3-11), respectively. Thirty-day all-cause mortality was 12.9%. ROC curve analysis revealed an area (95% CI) for the APACHE-II, PBS, and MRSAB scores of 0.84 (0.77-0.92), 0.71 (0.57-0.85), 0.79 (0.68-0.90), respectively. A threshold MRSAB score of ≥10 was identified, whereby mortality was 3.6% with MRSAB &lt; 10, and 30% with MRSAB ≥10. A MRSAB ≥10 had a sensitivity, specificity, PPV and NPV with corresponding 95% CIs of 0.82 (0.63-0.94), 0.72 (0.68-0.79), 0.30(0.19-0.42) and 0.96(0.92-0.99), respectively.
Receiver operator characteristic (ROC) curves for the prediction of 30-day mortality

Conclusion
The MRSAB score is a useful predictive scoring model, with discriminatory ability comparable to APACHE-II, and excellent NPV at ≥10. Our findings support routine clinical and research application.

Disclosures
matthew miller, PharmD, Allergan (Speaker’s Bureau)Tetraphase (Speaker’s Bureau)
59. Evaluation of Drug-Bug Mismatch Alerts and Their Value in an Antimicrobial Stewardship Program
Authors: Whittaker Cristen A , Nhan Ethan , Storb Marc , Szymborski Shana , Trivedi Manish , Reilly Joseph 
Published: January 2021

Abstract

Background
Antimicrobial stewardship is a priority for hospitals and utilizing generated reports can enhance stewardship activities. At our institution, a software program was used to help optimize antimicrobial therapy by providing a drug-bug mismatch (DBM) alert which identifies patients with culture susceptibilities not covered by their current antimicrobial therapy. The purpose of this study was to evaluate the utility of this alert feature and determine whether or not an intervention was needed for patients identified.

Methods
From August 2019 to March 2020 the DBM alerts were reviewed by a pharmacist and interventions pursued when appropriate. Data collection included the patient’s culture results and source, indication for current antibiotics, and potential for intervention. Alerts were stratified into different groups based on the type of culture, including urine, blood, sputum, bone or bodily fluid, wound or tissues, and stool. Those mismatches not resulting in an intervention were categorized as a contamination, colonization, or inappropriate. This study was approved by the institutional review board.

Results
A total of 105 DBM alerts were analyzed from various sources, including 51 (47.6%) urine, 17 (16.2%) sputum, 16 (15.2%) wound or tissue, 14 (13.3%) blood, 6 (5.7%) bone or bodily fluid, and 1 stool culture. Overall, 48 of 105 (45.7%) of alerts resulted in an intervention. Urine and sputum culture alerts required interventions at the lowest rate with treatment interventions in 12 of 51 (23.5%) and 5 of 17 (29.4%) of those cases respectively. Blood culture alerts were the most successful as 9 of 14 (64.3%) alerts required an intervention. Alerts with wound or tissue cultures identified gaps in therapy as 9 of 16 (56.3%) cases required intervention. Colonization or contamination appeared to be the major cause of alerts that did not result in intervention.

Conclusion
The DBM alert can be a beneficial tool for pharmacists participating in antimicrobial stewardship activities. However, the alerts had varying value depending on the culture source. The DBM alert can identify real-time patient issues regarding appropriate antimicrobial therapy. Further modifications to our process in utilizing this DBM report are warranted to enhance value and allocate time accordingly.

Disclosures
All Authors: No reported disclosures
854. Infection Prevention vs. Antimicrobial Stewardship: Does Nasal Povidone-Iodine Interfere with Methicillin Resistant Staphylococcus aureus (MRSA) Screening?
Authors: Harrison Cecelia K , Zent Robie , Schneck Elyse , Flynn Cynthia E , Drees Marci 
Published: January 2021

Abstract

Background
As part of universal decolonization, intensive care unit (ICU) patients may receive intranasal mupirocin to reduce MRSA infections. However, due to concerns about widespread use of mupirocin promoting resistance, some have proposed a bactericidal antiseptic, povidone-iodine (P-I), as an alternative. There are few data as to whether either agent reduces the sensitivity of MRSA nares screening. This study aimed to discern whether intranasal P-I interferes with MRSA screening via polymerase chain reaction (PCR) and/or culture.

Methods
We performed a prospective proof-of-concept cohort study at our &gt;1200-bed, community-based academic health care system, enrolling 20 patients who screened MRSA-positive by PCR on admission to a medical ICU, medical-surgical ICU, or medical stepdown unit. All patients received twice-daily intranasal P-I (7.5%) for 5 days or until unit discharge. We obtained follow-up nasal MRSA PCR tests after 4-6 days, and confirmed all PCR results with MRSA cultures using CHROMagar™. We calculated sensitivity of MRSA PCR at follow-up using culture as the gold standard.

Results
Twenty patients were enrolled, with a median age of 72 years (range, 53-91). Most (75%) were admitted with active infection, and 40% had known MRSA history. All baseline PCRs were confirmed by positive culture. Patients underwent a mean of 8.1 (range, 4-13) nasal P-I applications prior to follow-up testing. At follow up, 16/20 (80%) remained MRSA-positive via both PCR and culture. Of the 4 patients with negative follow-up results, 1 was both PCR-/culture-, 2 were PCR+/culture- and 1 was PCR-/culture+. All 4 had received ≥1 doses of vancomycin, and one person had received ≥1 doses of linezolid. The sensitivity of MRSA PCR at follow-up was 94%.

Conclusion
MRSA PCR remains highly sensitive even after multiple applications of P-I, and may be more sensitive than culture. If clinicians wish to screen for MRSA for stewardship or other purposes, receipt of nasal P-I should not be a deterrent. However, the fact that most patients remained culture-positive after 4-13 applications raises concerns that P-I is less effective than mupirocin for clearing nasal colonization. We recommend using quantitative cultures to further investigate the effectiveness of nasal P-I.

Disclosures
All Authors: No reported disclosures
860. A Proposed Standard for Hospital Bioaerosol Monitoring in Avoiding Nosocomial Mould Infections
Authors: Seiler Garret T , Ostrosky-Zeichner Luis , Ferguson Lance , Boston Kelly , Grant Mike , Koehn Jan 
Published: January 2021

Abstract

Background
Recent nosocomial outbreaks of mould infections have been linked to bioaerosols. Active and passive environmental sampling is a primary method of quantifying airborne contamination in the hospital, but currently there are no standardized Occupational Exposure Limits (OELs) for the avoidance of nosocomial infections.

Methods
Between March 2016 and December 2019, 186 post-construction/post-cleaning air samples were collected to measure particle counts based on defined size criteria Lighthouse handheld Particle Counter) and viable air fungal cultures (Anderson single stage N6 Viable Particulate Sampler) across wards of a 1,082 bed hospital in Houston, Texas, and compared with outdoor controls. Areas were cleared for occupancy if the ≤ 0.3micron particle counts were reduced by the expected efficacy of the HVAC unit and if indoor fungi airborne concentrations in CFU/m³ were also reduced or did not exceed the outdoor ambient reference levels for each separate day of site assessment.

Results
The mean counts of particles ≤ 0.3microns were as follows: floors 37,427.50 (-32% reduction), operating rooms 8,163.88 (95% reduction), OR sterile core 15,001.31 (89% reduction), ICU 7,640.15 (93% reduction), radiology suites 1,046.25 (97% reduction), and outpatient areas 17,891.58 (82% reduction). The table indicates the reported mean density (CFU/m³) data and species of fungi isolated in viable bioaerosol samples, 13 of which matched outdoor reference isolates. The mean density of outdoor cultures was 292.37 compared to all indoor units 24.53 (91.61% reduction), floors 25.44 (91.3% reduction), ICUs 28.19 (90.4% reduction), radiology suites 22.5 (92.3% reduction), and ORs 12.79 (95.6% reduction). During this time, no nosocomial fungal infections or outbreaks were documented for the institution.
Table 1: Mean Density (cfu/mm3) of Fungal Species per Location

Conclusion
An indoor air quality standard comprised of particle count data reduced by the expected efficacy of the operating HVAC unit and also existing indoor viable fungi in units of CFU/m³ that did not exceed the outdoor reference could potentially be correlated with avoidance of nosocomial mould infections.

Disclosures
Luis Ostrosky-Zeichner, MD, Amplyx (Scientific Research Study Investigator)Astellas (Consultant, Scientific Research Study Investigator, Other Financial or Material Support, Non-branded educational speaking)Biotoscana (Consultant, Other Financial or Material Support, Non-branded educational speaking)Cidara (Consultant, Scientific Research Study Investigator)F2G (Consultant)Gilead (Consultant)Mayne (Consultant)Octapharma (Consultant)Pfizer (Other Financial or Material Support, Non-branded educational speaking)Scynexis (Consultant, Grant/Research Support, Scientific Research Study Investigator)Stendhal (Consultant)Viracor (Consultant)
864. Whole Genome Sequencing is Unable to Track Candida auris Transmission
Authors: Roberts Scott C , Ozer Egon A , Zembower Teresa , Qi Chao 
Published: January 2021

Abstract

Background
Candida auris (C. auris), an emerging yeast species, is often drug-resistant and has caused outbreaks in healthcare settings. Surging C. auris cases at our institution prompted whole genome sequencing (WGS) of patient and environmental specimens and comparison to local and international isolates.

Methods
WGS was performed on clinical and environmental isolates obtained from Northwestern Memorial Hospital (NMH) from June 2018 to December 2019. Genome sequences were compared against isolates from other institutions in the Chicagoland area obtained from a reference lab (ACL) and from the CDC. Two isolates underwent long-read sequencing on the Oxford Nanopore GridION platform to obtain closed genomes. WGS was performed on the remaining isolates with the Illumina MiSeq platform.

Results
Twenty isolates from NMH, five from ACL, and two from the CDC underwent WGS to yield 12.6 Mb genomes. Any two NMH isolates differed from each other by a maximum of 36 single nucleotide variants (SNV) (Figure 1). Two patients thought to be part of a transmission cluster (isolates CA06 and CA07), differed by 7 SNVs. No phylogenetic grouping between hospital systems across Chicagoland was observed. Isolates from room surfaces from a C. auris patient differed by 1-6 SNVs from each other and from 7-8 SNVs from the patient isolate. Samples taken from different body sites of another patient differed by 4-9 SNVs. Average SNV counts were lower among nosocomially acquired cases when compared to C. auris isolates present on admission (Figure 2). All NMH isolates were fluconazole sensitive, but a fluconazole resistant ACL isolate differed from a sensitive NMH isolate by only 4 SNVs.
Figure 1: Phylogenetic tree of all NMH and ACL isolates with fluconazole sensitivities

Figure 2: Observed pairwise SNP differences between nosocomial and POA strains

Conclusion
WGS of C. auris did not reveal identical isolates in any instance, even from the same patient or the patients and their environment. Generally, lower numbers of SNVs were observed for intra- versus inter-institutional isolates. More work is needed to determine the use, if any, of WGS in outbreak investigations.

Disclosures
All Authors: No reported disclosures
865. Methicillin-resistant Staphylococcus aureus (MRSA) prevalence among healthcare workers (HCW) in contact tracings in a Dutch teaching hospital, 2010-2018
Authors: Weterings veronica , Kievits Heidi , van Rijen Miranda , kluytmans Jan 
Published: January 2021

Abstract

Background
In The Netherlands, the national guidelines on MRSA prevention and control advocate screening of HCW after unprotected exposure to MRSA carriers. Although this strategy at large is successful, contact tracing of staff is a time consuming and costly component. We evaluated our contact tracing policy for HCW over the years 2010 – 2018.
MRSA prevalence among samples in contact tracing

Methods
A retrospective, observational study was performed in a Dutch teaching hospital. All HCW who had unprotected contact with an MRSA carrier were included in contact tracing. When there had been a long period of unprotected admission prior to an MRSA finding, or when the index case was a HCW, than the entire (nursing) team was tested. All samples of HCWs who were tested for MRSA carriage as part of contact tracing from 2010 until 2018 were included. A pooled nose, throat and perineum swab was collected using the eSwab medium (Copan) and inoculated on chromID MRSA agar plates (bioMérieux) after enrichment in a broth.

Results
In total, we included 8,849 samples (range: 677 – 1,448 samples per year) from a total of 287 contact tracings (range: 26 – 55 contact tracings per year). Thirty two HCWs were colonized with MRSA (0.36%; 95%CI 0.26 – 0.51). None of them developed a clinical infection.
Eight HCWs (0.10%; 95%CI 0.05% – 0.19%) were colonized with the same MLVA type as the index case, and were detected in 6/287 contact tracings (2%). In 4/8 of these cases, a positive HCW was the index for undertaking contact tracing. In 3/8 cases it was clear that the HCW who was identified in the contact tracing was the source of the outbreak and was the cause of invasive MRSA infections in patients.
Notably, a different MLVA type as the index case was found in 24 HCWs (0,27%; 95%CI 0,18 – 0,40) of which 7/24 HCW (29,2%) were intermittent carriers.

Conclusion
This study revealed a sustained low MRSA prevalence among samples in contact tracing of healthcare workers, over nine years. Furthermore, it shows that when MRSA contact tracing is performed according to the national guideline only 1 out 1000 samples results in a secondary case. This is similar to the population carriage rate of MRSA in The Netherlands. More frequently, an unrelated strain is found. These findings raise question marks regarding the efficacy of the current strategy to perform contact tracing after unprotected exposure.

Disclosures
All Authors: No reported disclosures