bluuebunny/crossref_metadata_2025_split huggingface dataset:
Repeated Prevalence Surveys and Admission Screening for Candida auris at One Long-Term Acute-Care Hospital, Chicago, 2016–2019
Authors: Pacilli Massimo , Walblay Kelly , Adil Hira , Xydis Shannon , Kerins Janna , Valley Ann , Black Stephanie 
Published: November 2020

Background: Since the initial identification of Candida auris in 2016 in Chicago, ongoing spread has been documented in the Chicago area, primarily among older adults with complex medical issues admitted to high-acuity long-term care facilities, including long-term acute-care hospitals (LTACHs). As of October 2019, 790 cases have been reported in Illinois. Knowing C. auris colonization status on admission is important for prompt implementation of infection control precautions. We describe periodic facility point-prevalence surveys (PPSs) and admission screening at LTACH A. Methods: Beginning September 2016, we conducted repeated PPSs for C. auris colonization at LTACH A. After a baseline PPS, we initiated admission screening in May 2019 for patients without prior evidence of C. auris colonization or infection. C. auris screening specimens consisted of composite bilateral axillary/inguinal swabs tested at public health laboratories. We compared a limited set of patient characteristics based on admission screening results. Results: From September 2016 through October 2019, 277 unique patients were screened at LTACH A during 10 PPSs. Overall, 36 patients (13%) were identified to be colonized. The median facility C. auris prevalence increased from 2.8% in 2016 to 37% in 2019 (Fig. 1). During May–September 2019, among 174 unique patients admitted, 151 (87%) were screened for C. auris colonization on admission, of whom 18 (12%) were found to be colonized. Overall, 14 patients were known to have C. auris colonization on admission and were not rescreened, and 9 patients were discharged before screening specimens could be collected. A significantly higher proportion of patients testing positive for C. auris on admission had a central venous catheter or a peripherally inserted central catheter or were already on contact precautions (Table 1). The PPS conducted on October 1, 2019, revealed 5 new C. auris colonized patients who had screened negative on admission. Conclusions: Repeated PPSs at LTACH A indicated control of C. auris transmission in 2016–2017, followed by increasing prevalence beginning in May 2018, likely from patients admitted with unrecognized C. auris colonization and subsequent facility spread. Admission screening allowed for early detection of C. auris colonization. However, identification during subsequent PPS of additional colonized patients indicates that facility transmission is ongoing. Both admission screening and periodic PPSs are needed for timely detection of colonized patients. Given the high C. auris prevalence in LTACHs and challenges in identifying readily apparent differences between C. auris positive and negative patients on admission, we recommend that all patients being admitted to an LTACH in endemic areas should be screened for C. auris.Funding: NoneDisclosures: None
Performance of Mumps PCR and Serologic Testing During a University-Associated Mumps Outbreak in Charleston, SC
Authors: Stoltz Kristen , Puri Shruti , Curry Scott 
Published: November 2020

Background: Sensitive diagnostic testing is critical in responses to mumps outbreaks. PCR testing of buccal swabs is the most sensitive diagnostic test, but IgM serology remains standard in much of the United States. We provided testing guidance stressing use of mumps PCR to ambulatory clinics and emergency departments in addition to the standard serologic testing for acute mumps beginning in 2018. We compared the performance of PCR and IgM serology to assess cases of parotitis presenting during a community outbreak of mumps in fall 2019 associated with a university in Charleston, SC. Methods: All patients tested for mumps who presented to our facility (ER and ambulatory clinics) with mumps PCR and/or mumps IgM ordered between September 2019 and January 2020 were included. Mumps PCRs were sent to a commercial reference laboratory (ARUP). Confirmed cases were defined as having a positive mumps PCR and/or IgM with parotitis. Clinical characteristics of mumps patients including age, duration of symptoms, MMR history, and association with the university were obtained by chart review. Results: Mumps was confirmed in 15 of 44 tested patients (34%), with 15 of 15 mumps patients (100%) having positive PCR and 1 of 15 patients (7%) and 1 of 15 patients (7%) having positive and equivocal mumps IgM serologies, respectively. Only 1 patient who did not meet our mumps case definition (no CT imaging evidence of parotitis, no fevers, chronic sinus symptoms) had a positive PCR and had recent receipt of a third MMR dose in response to the ongoing outbreak. Median age for mumps patients was 22 years (range, 15–48) with 8 of 15 cases (53%) detected among university students and an additional 2 cases having close connections to the university associated with the outbreak. Only 1 of 15 mumps patients (6.7%) was febrile at presentation (median temperature, 37.2°C) and mumps cases presented for testing ≤3 days for 7 of 15 cases (47%) (range, 0–13 days from symptom onset). No cases were diagnosed by IgM only, and 10 of 15 mumps cases had some recollection of remote MMR immunization, whereas 6 of 15 (40%) had 2 documented MMR doses at <5 years of age. Conclusion: Serologic IgM testing for diagnosis of mumps appears insensitive for detection of cases in outbreaks within highly immunized adult patients. Although our recommended shift to PCR likely enhanced case finding during this outbreak, the potential for false-positive PCRs due to vaccine strain shedding following third-dose MMR immunization may also be considered a threat to the specificity of the test during outbreak situations.Funding: NoneDisclosures: None
Surgical Antibiotic Prophylaxis in Hysterectomy: Is Cefazolin Still the Best?
Authors: Valentyne Alyssa , Osman Fauzia , Al-Niaimi Ahmed , Pop-Vicas Aurora 
Published: November 2020

Background: Prior studies suggest that cefazolin, widely used for antibiotic prophylaxis in hysterectomy, might not prevent surgical site infections (SSIs) as well as antibiotics with a broader antianaerobic antimicrobial spectrum. We compared the effectiveness of cefazolin versus antibiotic regimens with a broader antimicrobial spectrum in a ≥500-bed regional referral center. Methods: Study design: retrospective cohort. Population and setting: patients ≥18 years old who underwent hysterectomy between 1998 and 2018 at the University of Wisconsin Hospital. Analysis: propensity score matching with a caliper of 0.2 to select controls for cefazolin treatment, matching on: age, body mass index (BMI), diabetes, length of stay, duration of surgery, and preoperative renal function. We conducted a crude SSI incidence analysis and adjusted for additional covariates (malignancy, intraoperative temperature, and preoperative glucose level) using a Cox proportional hazards model. All analyses were conducted using STATA SE v15 software. Results: We had 4,087 hysterectomy patients, with 123 SSIs (3%). Among these SSIs, 46%, 11%, and 42% were superficial, deep, and organ-space, respectively. Malignancies were present in 83% of SSI patients, with 30% being ovarian cancer. Risk factors for SSI in the unmatched sample multivariable analysis (MV) were length of stay (aHR, 1.1; 95% CI, 1.05–1.1; P < .001), duration of surgery (aHR, 1.2; 95% CI, 1.1–1.32; P < .001), and BMI (aHR, 1.04; 95% CI, 1.02–1.06; P < .001). After propensity matching, 2,282 hysterectomies remained. In the crude incidence analysis, cefazolin (IR, 6.0) had a protective SSI effect compared to cefoxitin (IR, 7.1), ciprofloxacin/metronidazole (IR, 27.2), clindamycin/gentamicin (IR, 14.1), any antianaerobic regimen (IR, 8.0), and regimens not guideline recommended (IR, 11.7). In our MV analyses of cefazolin versus comparator antibiotic regimens, we found that hypothermia was consistently associated with a higher SSI risk (P ≤ .03). Receipt of a β-lactam antibiotic regimen was associated with a significantly lower SSI risk (aHR, 0.31; 95% CI, 0.11–0.89, P = .03), but cefazolin’s protective SSI effect was no longer statistically significant. Conclusions: We found that cefazolin had a lower SSI risk compared to other antibiotic regimens, including those with better antianaerobic spectrum, in our tertiary-care hospital’s 11-year high-risk cohort. Our analysis suggests that maintaining intraoperative normothermia and administering β-lactam antibiotic prophylaxis are important modifiable risk factors for SSI prevention.Funding: NoneDisclosures: None
Observed Time Burden With Isolation Precautions at Three University-Affiliated Hospitals in Korea
Authors: Kang JaHyun , Karlsson Omar , Yeon Bock-hui , Han Si-Hyeon , Kim Jae Yeun 
Published: November 2020

Background: Isolation precautions (IPs; ie, patient isolation with transmission-based precautions) are essential in hospital infection control interventions to prevent the transmission of healthcare-associated infections. Because IPs require healthcare personnel (HCP) to use personal protective equipment (PPE; eg, gown, gloves, and mask) to enter patient isolation rooms and perform hand hygiene (HH) frequently, IPs are often regarded as cumbersome tasks and may lead to fewer HCP visits. This observation study examined the time burden of IPs (ie, PPE use and HH) from time spent on HCP tasks, including patient treatment and care, in patient isolation rooms. Methods: With institutional review board approval, participating hospitals were recruited. At each hospital, assigned infection control nurses observed HCP tasks at patient isolation rooms of interest and recorded each task’s duration, using a stopwatch or timer and an observation form. For each observation block (ie, a duty period at 1 observation unit, regardless of the number of observed isolation rooms), unit-related information was collected, including the numbers of hospitalized patients, admission patients, discharge patients, isolation patients, and nurses. For each block, IP proportions were calculated by total time spent on IP divided by the total time spent on all tasks. Descriptive statistics, t test, ANOVA, and regression analyses were conducted using STATA version 16.0 software. Results: Three university-affiliated hospitals (838 average hospital beds, range 811–855) participated from April 2 to May 18, 2019 (for 7–9 days). In total, 2,901 tasks were monitored and the total time spent was 164,973 seconds; most tasks were done by nurses (89.2%) and females (86.8%). Although the most time-intensive task was procedures (eg, intravenous infusion) followed by medication, PPE use was the most frequent task followed by HH (Table 1). Regarding IP proportions, an overall average of 23.6% of total task time was spent on IPs (16.1% for PPE use and 7.5% for HH) in patient isolation rooms (Table 2). Notably, tasks in the tuberculosis isolation room of hospital B showed a greater HH proportion (13.7%) than PPE proportion (13.5%) because HCP usually use N95 masks only. Wards, compared to intensive care units (ICUs), showed higher PPE proportions (19.2%), potentially due to PPE stock in the nurse station and less PPE education compared to ICUs. Conclusions: Our study results demonstrated the substantial amount of time spent on IP compliance among all task durations in patient isolation rooms. To improve IP compliance, this time burden needs to be considered with greater system support, such as more nursing staff.Funding: This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (Grant no. 2017R1D1A1B03036377).Disclosures: None
A Descriptive Analysis of Infection Present at Time of Surgery (PATOS) in NHSN Surgical Site Infection (SSI) Data, 2015–2018
Authors: Konnor Rebecca , Russo Victoria , Dudeck Margaret A. , Allen-Bridson Katherine 
Published: November 2020

Background: In 2015, the CDC NHSN introduced infection present at time of surgery (PATOS) as a required data element for reporting surgical site infections (SSIs). PATOS is the documented observation that infection was visualized during the operative procedure and at the same tissue level of subsequent SSI. PATOS SSIs are excluded from CDC calculations of SSI summary measures, the standardized infection ratios (SIRs), including the SSI SIRs used by CMS public reporting and payment programs. The characteristics of PATOS SSIs have not been assessed since its introduction, prompting interest in the review of these SSIs. This study describes PATOS SSI surveillance for 2015–2018, with specific focus on infections following colon surgery (COLO), the NHSN operative procedure category with highest reported incidence of PATOS. Methods: We analyzed all procedures and SSIs reported to the NHSN. Using measures of frequency, we quantified the proportion of SSI and PATOS SSI attributed to all procedures and to COLO specifically. The mid-p method was used for proportion comparison. Procedure and SSI data were described by year and characteristics. Results: Between 2015 and 2018, 12,046,033 procedures and 188,770 SSIs (2%) were reported. Of these SSIs, 22,096 (12%) were PATOS SSIs (Fig. 1). COLO accounted for 11% of all procedures reported, for a total of 1,328,852 procedures with 72,891 (5%) resulting in SSI. COLO accounted for 64% of PATOS SSIs. The proportion of SSIs reported as PATOS SSIs resulting from COLO increased from 18% in 2015 to 22% by 2018 (Fig. 2). The proportion of COLO PATOS SSIs was statistically different from the proportion of PATOS SSIs for all other procedures each year (P < .0001). Organ-space (OS) SSIs accounted for 76% of COLO PATOS SSIs (10,558 of 13,911), and most of these SSIs were SSI intra-abdominal infections (IABs) (91%). The proportion of COLO PATOS SSI superficial incisional primary (SIP) was statistically different from non-COLO PATOS SSI SIP (P = .0105) (Fig. 2). Of COLOs linked to PATOS SSIs, 53% were assigned dirty or infected wound classification. Conclusions: The increase in PATOS SSIs linked to COLO procedures underscores the importance of monitoring PATOS SSIs at the facility level. Focused validation of PATOS data is needed to identify reasons for this increase, which may include misapplication or misunderstanding of PATOS determinations. Validation may highlight the potential need for prevention strategies or interventions related to PATOS.Funding: NoneDisclosures: None
Admission Screening for Candida auris Among High-Risk Patient Populations
Authors: Spalding Christine D. , Adrian Zelazny , Kenosky Christina M. , Shallom Shamira J. , Syedmoussavi Seyedmojtaba , Segre Julia A. , Palmore Tara 
Published: November 2020

Background:Candida auris is a highly transmissible healthcare-associated pathogen that can cause severe infection as well as long-lasting colonization. C. auris is often resistant to the antifungals that are commonly used to treat Candida infections, which may lead to clinical failure. Therefore, healthcare facilities must identify the organism quickly and implement strict precautions to prevent its spread. In 2019, the NIH Clinical Center instituted C. auris admission screening among its high-risk patient populations. Methods: Patients admitted to the NIH Clinical Center, a 200-bed research hospital, were identified on admission as having been hospitalized outside the United States in the prior 6 months. Admission screening began in August 2019. In September 2019, due to evolving regional epidemiology, we expanded surveillance criteria to include patients housed in any healthcare facility in the District of Columbia, Maryland, and Virginia metro area in the previous 6 months. Screening was performed as routine clinical care, and therefore did not require written informed consent. Swabs were obtained from nares, axilla and groin, with subsequent addition of mouth and toe web (BD ESwabs). Patients were placed on empiric contact isolation for at least 48 hours and concurrently screened for carbapenemase-producing organisms. Swabs were cultured on CHROMagar Candida and in Sabouraud dextrose broth with 10% NaCL and 50 mg/L chloramphenicol and gentamicin, and incubated for 14 days at 30°C and 40°C, respectively. Positive broth tubes were subcultured onto CHROMagar Candida. C. auris was identified by MALDI-TOF MS and ITS sequence analysis. Susceptibility testing was performed using Sensititre YeastOne Colorimetric assay. Whole-genome sequencing was used to identify clonal designations and genetic relatedness of isolates. Results: Since August 2019, 1 to 2 patients per week have been screened for C. auris. As of November 2019, 1 of 15 patients screened on admission grew C. auris from a groin swab. The patient, who had been hospitalized abroad, was found to be cocolonized with blaNDM-1+ E. coli and K. pneumoniae. Subsequent screening of other patients on the same ward identified no evidence of spread. Admission surveillance is ongoing. Conclusions: Healthcare-associated outbreaks can originate from C. auris–colonized patients. Admission surveillance of high-risk patients is intended to prevent transmission from undetected reservoirs. Our sampling of multiple sites, though laborious, may add to the data on C. auris colonization. Future plans include incorporating molecular testing and streamlining geographic criteria. C. auris admission screening has already identified one colonized patient, and will continue as a new and important patient safety measure at our hospital.Funding: NoneDisclosures: None
Admission Screening for Clostridium difficile Infection (CDI) in Bone Marrow Transplant Populations
Authors: Tarabay Jessica , Ayers Marie , Soni Tanushree , Langston Amelia , Bracewell Emily , Bell Christina , Crain Maria , Hutcherson Don , Smiley Mitzy 
Published: November 2020

Background:Clostridium difficile infection (CDI) is the most common healthcare-associated infection (HAI) and is often associated with increased medical costs and longer lengths of hospital stay. Previous studies have highlighted that hematopoietic stem cell transplant (HSCT) recipients are at an increased risk for CDI of up to 33% from other hospitalized patients. Studies have also supported the prevalence of asymptomatic colonization with C. difficile among HSCT patients. Asymptomatic colonization with C. difficile is a significant risk factor for transmission of infection to other patients developing hospital onset (HO-CDI). Therefore, targeted infection prevention efforts, such as early identification of patients with community-onset (CO-CDI) and patients with asymptomatic colonization with CDI in HSCT patients, may be effective in reducing the occurrence of HO-CDI. We discuss the CDI admission screening protocol in Emory University Hospital’s (EUH) bone marrow transplant (BMT) unit. Methods: As part of an infection prevention initiative, a CDI screening protocol was implemented in December 2018 for all patients that admitted to the EUH inpatient BMT unit. Upon admission, patients were screened for CO-CDI symptoms, specifically loose or unformed stools. A C. difficile toxin assay PCR would be collected within the first 3 calendar days of admission for all patients screened. Patients with symptoms were placed on isolation precautions pending results of the C. difficile toxin assay. If a patient had a positive C. difficile toxin assay result, isolation precautions would be maintained for the duration of hospitalization regardless of symptoms. Patients who are were unable to produce a stool specimen on the first 3 days of admission were excluded from the screening protocol. Patients with positive C. difficile toxin assay PCRs were classified as CO-CDI and were treated. Results: Since implementation of the CDI screening protocol, 109 CDI events were identified from January 2019 to October 2019. Moreover, 79% of positive C. difficile toxin assays were collected within the first 3 calendar days of admission. HO-CDI has decreased from 78% in 2018 to 21% during the designated time frame. Conclusions: CDI screening upon admission of BMT populations has shown a decrease among HO-CDI by early identification of CO-CDI and CO asymptomatic colonization with C. difficile. This early identification has allowed rapid implementation of infection preventions precautions, thus reducing risk of unit-based transmission.Funding: NoneDisclosures: None
Antibiotic Use at the End-of-Life in Patients with Advanced Dementia: A Systematic Literature Review
Authors: Marra Alexandre , Puig-Asensio Mireia , Perencevich Eli 
Published: November 2020

Background: Improving the use of antibiotics across the care continuum will be necessary as we strive to protect our patients from antimicrobial resistance. One potential target for antimicrobial stewardship is during end-of-life care of patients with advanced dementia. We aimed to perform a systematic literature review measuring the burden of antibiotic use during end-of-life care in patients with dementia. Methods: We searched PubMed, CINAHL, and Embase through July 2019 for studies with the following inclusion criteria in the initial analysis: (1) end-of-life patients (ie, dementia, cancer, organ failure, frailty or multi-morbidity); (2) antibiotic use in the end-of-life care; with the final analysis restricted to (3) patients with advanced dementia. Only randomized controlled trials (RCTs) and cohort studies were included. Results: Of the 93 full-text articles, 17 studies (18.3%) met the selection criteria for further analysis. Most of the included studies were retrospective (n = 8) or prospective (n = 8) cohort studies. These studies in combination included 2,501 patients with advanced dementia. Also, 5 studies (698 patients, [27.9%]) were restricted to patients with Alzheimer’s disease. In 5 studies in which data were available, fewer than one-quarter of patients (19.9%, 498) with advanced dementia were referred to palliative care. In 12 studies >50% of patients received antibiotics during the end-of-life period. Also, 15 studies did not report the duration of antimicrobial therapy. Only 2 studies reported the antimicrobial consumption in days of therapy per 1,000 resident days. Only 6 studies studied whether the use of antibiotics was associated with beneficial outcomes (survival or comfort), and none of them evaluated potential adverse effects associated with antibiotic use. Conclusions: There are significant gaps in the literature surrounding antimicrobial use at the end of life in patients with advanced dementia. Future studies are needed to evaluate the benefits and harms of using antibiotics for patients during end-of-life care in this patient population.Acknowledgement. We thank Jennifer Deberg from Hardin Library for the Health Sciences, University of Iowa Libraries on the search methods.Disclosures: NoneFunding: None