bluuebunny/crossref_metadata_2025_split huggingface dataset:
890. Incidence and Microbiology of Surgical Site Infection (SSI) after Breast Surgery
Authors: Tanveer Farah , Youssef Dima , Youssef Mamta , Szpunar Susanna , Flood Michelle 
Published: January 2021

Abstract

Background
Surgical site infection (SSI) after breast surgery is much more common than expected after a clean surgical procedure. Although
breast SSIs are primarily Gram-positive; recent literature shows an increase in Gram-negative infections. We assessed the risk factors and microbiology of SSI following breast surgery at our institution.

Methods
We conducted a historical cohort study of all (³ 18 y) females who had surgery from 1/1/2014-3/31/2019 and subsequent SSI within 90 days of the procedure. Two controls, matched for surgery type, were selected per case. Data were collected on demographic and clinical characteristics, surgery type, microbiology and antibiotics. Data were analyzed using the χ 2 test, Student’s t-test and multivariable logistic regression with a forward likelihood ratio algorithm.

Results
After excluding patients with limited data, we reviewed 284 charts: 95 of 132 cases and 189 controls. The 90-day incidence of SSI was 3.5 % (132/3755). Cases were younger than controls: 53.9 ± 12.4 years vs. 58.3± 13.7 years, respectively, p=0.02. Controls had more comorbidities: 1.8 ± 1.3 vs. 1.4 ± 0.7,respectively, p=0.001. Tissue expanders were placed in 65 (70%) cases versus 11 (5.8%) controls (p &lt; 0.0001). After controlling for age, BMI, comorbidities and post-operative antibiotics, only tissue expanders were associated with infection (OR=35.1, p&lt; 0.0001, 95% CI: 16.6, 74.0).
Microbiological data were available for 84 cases. Gram-positive organisms accounted for 45 (53.6%) infections and Gram-negative organisms accounted for 39 (46.4%) infections. Over 72% of African Americans (p= 0.014), 76.5% of patients with diabetes (p=0.005) and 57.1 % with tissue expanders (p= 0.02) had Gram-negative infections. The table shows the multivariable predictors of Gram-negative infection. Tissue expander removal was required in 61.5% of patients with Gram-negative infections compared to 39% with Gram-positive infections.
Predictors of Gram-negative SSI after breast surgery

Conclusion
Patients with tissue expanders had a higher incidence of SSI after breast surgery; removal was often required in Gram-negative infections. Diabetes and post-operative antibiotics were significant predictors of Gram-negative infection. Knowledge of local epidemiology is a key factor in deciding empiric therapy for SSI.

Disclosures
All Authors: No reported disclosures
63. Frequency and Outcomes of Patients Prescribed Antibiotics for Extended Durations on Discharge from the Hospital to Nursing Homes
Authors: Molina Kaitlyn E , Noble Brie N , Crnich Christopher J , McGregor Jessina C , Bearden David T , Chan Dominic , Furuno Jon P , Furuno Jon P 
Published: January 2021

Abstract

Background
Nursing home (NH) residents are at increased risk of being prescribed antibiotic for extended durations and experiencing antibiotic-associated adverse events. However, many of these antibiotics are prescribed in the hospital prior to NH admission. We quantified the frequency, characteristics and outcomes of patients receiving antibiotic treatment in the hospital and discharged to NHs with an antibiotic prescription for greater than 7 days.

Methods
This was a retrospective cohort study of adult (age &gt;18 years) patients with a prescription for an antibiotic on discharge from Oregon Health & Science University Hospital (OHSU) to a NH between January 1, 2016 and December 31, 2018. Study data were collected from an electronic repository of patients’ electronic health record data. Outcomes of interest included having an emergency department (ED) visit, inpatient hospital admission, or inpatient admission for Clostridioides difficile infection (CDI) at the index facility within 30 days of discharge.

Results
Among 2969 antibiotic prescriptions on discharge, 1267 (42.7%) were prescribed for greater than 7 days to a total of 1059 patients. A diagnosis of a bacterial infection was present for 902 (85.2%) patients. The most frequent diagnoses were bloodstream/endocarditis (21.8%), osteomyelitis (11.6%), and skin and soft tissue infections (10.6%). The most frequently prescribed antibiotics were cephalosporins (24.2%), penicillins (14.1%), glycopeptides (12.9%), and fluoroquinolones (12.6%). Of the 1059 identified patients, 126 (11.9%) had an ED visit, 216 (20.4%) inpatient admission, and 16 (1.5%) had an admission for CDI within 30 days of discharge.

Conclusion
More than 40% of antibiotic prescriptions on discharge to a NH were for greater than 7 days. This frequency and associated poor outcomes suggest extended antibiotic duration are a high-value target to improve antibiotic prescribing on discharge to NHs.

Disclosures
All Authors: No reported disclosures
892. Meningitis after Ventricular Shunt Operations: Multicenter Study to Identify Etiology, Incidence and Risk Factors
Authors: Giarola Lucca G , de Carvalho Handerson Dias Duarte , Couto Braulio Roberto Gonçalves Marinho , Starling Carlos Ernesto Ferreira 
Published: January 2021

Abstract

Background
A Ventriculoperitoneal shunt is the main treatment for communicating hydrocephalus. Surgical site infection associated with the shunt device is the most common complication and an expressive cause of morbidity and mortality of the treatment.
The objective of our study is to answer three questions: a)What is the risk of meningitis after ventricular shunt operations? b) What are the risk factors for meningitis? c) What are the main microorganisms causing meningitis?

Methods
A retrospective cohort study assessed meningitis and risk factors in patients undergoing ventricular shunt operations between 2015/Jul and 2018/Jun from 12 hospitals at Belo Horizonte, Brazil. Data were gathered by standardized methods defined by the National Healthcare Safety Network (NHSN)/CDC procedure-associated protocols for routine SSI surveillance. Sample size = 926.
26 variables were evaluated by univariate and multivariate analysis (logistic regression).

Results
71 patients were diagnosed with meningitis which represent a risk of 7.7% (C.I.95%= 6.1%; 9.6%). From the 26 variables, three were acknoleged as risk factors: age &lt; two years old (OR = 3.20; p &lt; 0.001), preoperative hospital length of stay &gt; four days (OR = 2.02; p = 0.007) and more than one surgical procedure (OR = 3.23; p = 0.043). Patients two or more years old, who had surgery four days after hospital admission, had increased risk of meningitis from 4% to 6% (p = 0.140). If a patient &lt; two years had surgery four days post hospital admission, the risk is increased from 9% to 18% (p = 0.026). 71 meningitis = &gt; 45 (63%) the etiologic agent identified: Staphylococcus aureus (33%), Staphylococcus epidermidis (22%), Acinetobacter sp (7%), Enterococcus sp (7%), Pseudomonas sp (7%), and other (18%). Hospital length of stay in non-infected patients (days): mean = 21 (sd = 28), median = 9; hospital stay in infected patients: mean = 34 (sd = 37), median = 27 (p=0.025). Mortality rate in patients without infection was 10% while hospital death of infected patients was 13% (p=0.544).

Conclusion
Two intrinsic risk factors for meningitis post ventricular shunt, age under two years old and multiple surgeries, and one extrinsic risk factor, preoperative length of hospital stay, were identified. Incidence of meningitis post VP shunt decreases with urgent surgical treatment.

Disclosures
All Authors: No reported disclosures
896. Prediction of Surgical Site Infection Risk in Patients Undergoing Bariatric Surgery
Authors: de Souza Flávio Henrique Batista , Couto Braulio Roberto Gonçalves Marinho , da Conceição Felipe Leandro Andrade , da Silva Gabriel Henrique Silvestre , Dias Igor Gonçalves , Rigueira Rafael Vieira Magno , Pimenta Gustavo Maciel , Martins Maurilio B , Mendes Júlio César O , Januário Guilherme Brangioni , Oliveira Rayane Thamires , de Vasconcelos Laura Ferraz , de Araújo Laís L , Rodrigues Ana Clara Resende , Silva Camila Morais Oliveira E , De Souza Eduarda Viana , Melo Júlia Faria , De Sá Maria Cláudia Assunção , Silva Walquíria Magalhães , Barbosa Alicy Verônica Alves , Talim Amanda Torres , Alcasar Laura Daldegan , Avelar Luiza Magalhaes , Neto Marcella Brito Pinheiro Oliveira , Santos Paula Araújo Pessoa , Porto Vitoria Sturzeneker 
Published: January 2021

Abstract

Background
In the hospitals of Belo Horizonte (a city with more than 3,000,000 inhabitants), a survey was conducted between July 2016 and June 2018, focused on surgical site infection (SSI) in patients undergoing bariatric surgery procedures. The main objective is to statistically evaluate such incidences and enable a study of the prediction power of SSI through MLPs (Multilayer Perceptron), a pattern recognition algorithm.

Methods
Data were collected on SSI by the Hospital Infection Control Committees (CCIH) of the hospitals involved in the research. After data collection, three procedures were performed: a treatment of the database collected for the use of intact samples; a statistical analysis on the profile of the hospitals collected and; an assessment of the predictive power of five types of MLP (Backpropagation Standard, Momentum, Resilient Propagation, Weight Decay, and Quick Propagation) for SSI prediction. MLPs were tested with 3, 5, 7, and 10 hidden layer neurons and a database split for the resampling process (65% or 75% for testing, 35% or 25% for validation). They were compared by measuring AUC (Area Under the Curve - ranging from 0 to 1) presented for each of the configurations.

Results
From 3473 initial data, only 2491 were intact for analysis. Statistically, it was found that: the average age of the patients was 39 years (ranging from 16 to 65); the average duration of surgery was 138 minutes; and 0.8% of patients had SSI. Regarding the predictive power of SSI, the experiments have a minimum value of 0.350 and a maximum of 0.756.

Conclusion
Despite the loss rate of almost 30% of the database samples due to the presence of noise, it was possible to have a relevant sampling for the profile evaluation of Belo Horizonte hospitals. Moreover, for the predictive process, although some configurations have results that reached 0.755, which makes promising the use of the structure for automated SSI monitoring for patients undergoing bariatric surgery. To optimize data collection and enable other hospitals to use the SSI prediction tool (available in www.sacihweb.com), two mobile application were developed: one for monitoring the patient in the hospital and the other for monitoring after hospital discharge.

Disclosures
All Authors: No reported disclosures
64. Impact of a Duration Bundle on Antimicrobial Use in a Pediatric Hospital
Authors: Weslander Erin , Li Diana , Wang Xuanqing 
Published: January 2021

Abstract

Background
Limiting antibiotic durations to the shortest effective duration is a strong recommendation with moderate-quality evidence in the 2016 IDSA Antimicrobial Stewardship Program (ASP) guidelines. An ASP bundle including a decrease in antimicrobial automatic stop dates from 14 days to 10 days along with a guideline for standard durations for 48 specific indications was implemented at a tertiary pediatric hospital in November 2019. The purpose of this review and was to assess the impact of this ASP initiative on patient outcomes and hospital cost-savings by comparison of pre-intervention and post-intervention data.

Methods
A set of antimicrobial duration recommendations for pediatric patients was created by the Antimicrobial Stewardship Program, Pediatric Hospital Medicine providers, and Infectious Disease providers specific to indication, agent, or pathogen. After education of medical care providers and distribution of the recommendations, automatic stop dates in the Electronic Medical Record (EMR) were updated from 14 days to 10 days for all antimicrobials. Concomitant advertising campaigns were shown on all hospital screensavers. Data were collected for a one month pre-intervention period of Nov.15 - Dec.15, 2018 including 133 patients and a one month intervention period of Nov.15 - Dec.15, 2019 including 125 patients.

Results
The average length of stay decreased from an average of 8.3 days pre-implementation to 6.7 days (p=0.043) post implementation. The ratio of actual to recommended duration also decreased from 1.56 to 1.30 (p&lt; 0.001) when comparing pre vs. post initiative. Balancing measures did not change for restarting treatment within 48 hours of stopping or readmission within 30 days for the same infection. The decrease in inpatient therapy translated to more than $10,000 per year in direct drug cost.

Conclusion
This intervention lead to a significant reduction in average length of stay per admission and significantly reduced the secondary outcomes of the total duration of antimicrobial therapy and the ratio of actual duration compared to recommended duration. This lead to cost savings and decreased inappropriate antibiotic exposure.

Disclosures
All Authors: No reported disclosures
902. Selection of Antibiotics for Prophylaxis of Left Ventricular Assist Device Surgical Infections: More is Not More
Authors: Nguyen Peter T , Sam Teena , Colley Peter , Van Zyl Johanna , Berhe Mezgebe , Meyer Dan 
Published: January 2021

Abstract

Background
Surgical site infections (SSI) for implantation of left ventricular assist devices (LVADs) are associated with high mortality. Updated guidance from the International Society for Heart and Lung Transplant recommends that SSI prophylaxis regimens target Staphylococcus spp and recommend against broad regimens targeting gram-negatives and fungi. The purpose of this study was to compare outcomes between patients that received broad or narrow antimicrobial prophylaxis regimens after a change in institutional protocol.

Methods
This single center retrospective study included adult patients who underwent LVAD implantation between January 2015 and September 2019. Patients were excluded if post-surgical care was managed at an outside facility, were treated for an active infection at the time of implantation, or underwent re-implantation within 90 days. The narrow spectrum group consisted of patients that received cefazolin, vancomycin or both, while the broad spectrum group consisted of patients that received an anti-pseudomonal beta-lactam plus vancomycin ± other antibiotics. Data was compared using t-test or Wilcoxon rank sum test, Chi-Square test, or Fisher’s Exact. Cox-proportional hazards models and log-rank tests were used for survival analysis.

Results
A total of 104 patients were included, with 39 and 65 patients receiving narrow and broad spectrum prophylaxis, respectively. There was no difference in the primary outcome of SSI rate between the narrow and broad antimicrobial prophylaxis groups at 30 days (7.7% vs 7.7%, p=1.00) and 1 year (18.0% vs 18.5%, p=1.00) respectively. Secondary outcomes of time to mortality (HR 0.45, 95% CI 0.15-1.36, logrank P=0.15), time to first infection (HR 0.68, 95% CI 0.26-1.8, logrank P=0.44), or the composite outcome of mortality or infection (HR 0.55, 95% CI 0.24-1.23, logrank P=0.14) were not different between the groups. The majority of infections were due to gram-positive bacteria (73%), most commonly methicillin susceptible S. aureus (36%).
Time to Mortality

Time to First Infection

Composite Outcome (Time to First Infection or Death)

Conclusion
This study supports the use of narrow spectrum antimicrobial prophylaxis in LVAD implantation. These results highlight an opportunity to improve antibiotic use in LVAD implantation.

Disclosures
All Authors: No reported disclosures
903. SSI Trends in Community Hospitals from 2013 to 2018
Authors: Seidelman Jessica L , Baker Arthur W , Lewis Sarah S , Advani Sonali D , Smith Becky , Anderson Deverick J 
Published: January 2021

Abstract

Background
Surgical site infections (SSIs) are common causes of hospital-acquired infection. However, only sparse data are available on the recent epidemiology of SSIs in community hospitals.

Methods
We performed a retrospective analysis of prospectively collected SSI data at 32 community hospitals in the southeastern United States from 2013 to 2018. We calculated the annual prevalence rates (PRs) of SSI for 26 commonly performed procedures and stratified results by causative pathogen. We used log-binomial regression models to examine trends of SSI prevalence over time.

Results
Over the 6-year study period, 3,561 complex (i.e., deep incisional or organ space) SSIs occurred following 669,467 total procedures (PR, 0.53 infections per 100 procedures). The complex SSI PR did not change significantly during the study period (0.58/100 procedures in 2013 versus 0.53/100 procedures in 2018; PR ratio [PRR], 0.84; 95% CI 0.66–1.08, p=0.16). For commonly performed procedures, rates of SSI in community hospitals were higher than 2018 National Healthcare Safety Network (NHSN) benchmark SSI rates for colon surgery, hip arthroplasty, knee arthroplasty, and spinal fusion. (Table 1). Staphylococcus aureus was the most common pathogen to cause SSI each year and was responsible for 23.7% (n=843) of all complex SSIs. Methicillin-susceptible S. aureus (MSSA) complex SSIs [13.5%, n=480] were more common than complex SSIs caused by methicillin-resistant S. aureus (MRSA) [10.2%, n=363] (Figure 1). Compared to the 2013, the only significant decrease in S. aureus SSI PR occurred in 2017 (PRR 0.67 95% CI 0.49-0.90, p=0.01), which was primarily driven by the significant decrease in MRSA SSI PR in 2017 compared to 2013 (PRR 0.61 95% CI 0.42-0.89, p-value=0.01). The Escherichia coli SSI PRs did not change significantly during the study period, but E. coli became the second most prevalent pathogen in 2018, surpassing MRSA.
Table 1. Community Hospital SSI Prevalence Rates for Commonly Performed Procedures

Figure 1: Prevalence Rates of Community Hospital Complex SSIs by Causative Pathogen from 2013 to 2018

Conclusion
The complex SSI rate did not significantly decline in our cohort of community hospitals from 2013 to 2018. Baseline SSI rates were low, and statistically significant decreases in SSI rates may be difficult to achieve. However, the epidemiology of community hospital SSIs may be changing with a shift away from MRSA SSIs.

Disclosures
All Authors: No reported disclosures
904. Surgical Site Infection After Bariatric Surgery: a Small Risk that Defines Life and Death of Patients
Authors: Giarola Lucca G , Starling Carlos Ernesto Ferreira , Couto Braulio Roberto Gonçalves Marinho , de Carvalho Handerson Dias Duarte 
Published: January 2021

Abstract

Background
Surgical site infection (SSI) in bariatric surgery can lead to devastating outcomes such as peritonitis, sepsis, septic shock and organ space infection. The objective of our study is to answer four questions: a) What is the SSI risk after bariatric surgery? b) What are the risk factors for SSI after bariatric surgery? c) What are the main outcomes to SSI in bariatric surgery? d) What are the main bacteria responsible for SSI in bariatric surgery?

Methods
A retrospective cohort study assessed 8,672 patients undergoing bariatric surgery between 2014/Jan and 2018/Dec from two hospitals at Belo Horizonte, Brazil. Data were gathered by standardized methods defined by the National Healthcare Safety Network (NHSN)/CDC procedure-associated protocols for routine SSI surveillance. Outcome: SSI, hospital death and total length of hospital stay. 20 preoperative and operative variables were evaluated by univariate and multivariate analysis (logistic regression).

Results
77 SSI were diagnosed (risk = 0.9% [C.I.95% = 0.7%;1.1%]). Mortality rate in patients, without infection was only 0.03% (3/8,589) while hospital death of infected patients was 4% (3/77; RR = 112; p&lt; 0.001). Hospital length of stay in non-infected patients (days): mean = 2, std.dev.= 0.9; hospital stay in infected patients: mean = 7, std. dev. = 15.6 (p&lt; 0.001). Two main factors associated with SSI after bariatric surgery were identified by logistic regression: duration of procedure (hours), OR = 1.4;p=0.001, and laparoscopy procedure, OR = 0.3;p=0.020. From 77 SSIs, in 28 (36%) we identified 34 etiologic agents. The majority of SSI (59%) was caused by species of Streptococcus (32%), Klebsiella (15%), and Enterobacter (12%).

Conclusion
SSI is rare after bariatric surgery, however, when it happens, it’s a disaster for the patient. The incidence of SSI can be reduced significantly when laparoscopy procedure is used and the surgeon is able to perform a rapid surgery.

Disclosures
All Authors: No reported disclosures
905. Surgical Site Infections Following Colon Surgery in a Large Network of Community Hospitals
Authors: Seidelman Jessica L , Baker Arthur W , Ge Maojun , Lewis Sarah S , Advani Sonali D , Smith Becky , Anderson Deverick J 
Published: January 2021

Abstract

Background
Colon surgeries are commonly performed, and surgical site infections (SSIs) following these procedures are routinely reported to the National Healthcare Safety Network (NHSN). However, the impact of infections present at the time of surgery (PATOS) and emergent surgeries on the epidemiology of colon surgery SSIs has not been well described.

Methods
We retrospectively analyzed prospectively collected data on complex (i.e., deep incisional or organ space) SSIs following colon surgery performed at 34 community hospitals in the southeastern United States from January 2015 to June 2019. We excluded SSIs categorized as PATOS. We then stratified colon surgery SSI rates according to age, sex, body mass index (BMI), operation duration, diabetes diagnosis, American Society of Anesthesiologists (ASA) physical status, wound class, emergent procedure, endoscopic procedure, and hospital colon surgery volume. Finally, we explored effect measure modification of emergent surgery and open surgery on hospital volume using log-binomial modeling and tests of homogeneity.

Results
A total of 722 complex SSIs occurred following 28,642 colon surgeries (prevalence rate [PR], 2.52 per 100 procedures). After PATOS SSIs were excluded, 545 complex SSIs remained (PR 1.90 per 100 procedures). Risk factor analysis revealed that age &lt; 75 years and operation time &gt; 75th percentile (188 minutes) during the 5-year study period) significantly increased risk of SSI (Table 1). The most common pathogens that caused SSIs in this study cohort were Escherichia coli, Enterococcus, and Klebsiella. (Table 2) 105 (19%) SSIs were culture-negative and 378 (69%) of the SSIs were polymicrobial. We defined hospital volume as high (&gt;500 procedures in the 5-year period) based on the median hospital volume in the dataset. No significant effect measure modification occurred between hospital volume and either laparoscopic surgery or emergent surgery (Table 3).
Table 1: Characteristics of patients who underwent colon surgery from January 2015 to June 2018 in 34 community hospitals.

Table 2: Count and frequency of pathogens that caused complex surgical site infections after colon surgery

Table 3: Colon surgery complex surgical site infection rates, stratified by emergent, elective, open, and laparoscopic procedures and hospital colon surgery volume

Conclusion
In our cohort, we found that one-fourth of colon surgery SSIs were categorized as PATOS, which are no longer publicly reported to the Centers for Medicare & Medicaid Services. While most SSI literature describes higher volume hospitals having lower SSI rates, high colon surgery volume was associated with increased SSI rates in our community hospital cohort.

Disclosures
All Authors: No reported disclosures