bluuebunny/crossref_metadata_2025_split huggingface dataset:
817. Exploring Microbial Community Alterations during Hospital Animal-Assisted Intervention Programs
Authors: Dalton Kathryn R , Carroll Karen C , Carroll Karen C , Grice Elizabeth A , Davis Meghan F 
Published: January 2021

Abstract

Background
Animal-assisted interventions, or pet therapy, is increasingly used by healthcare facilities given the numerous benefits in various settings. However, therapy animals may serve as vectors of hospital-associated pathogens. Yet, both pathogenic and protective commensal microbes could be transferred between patients and therapy animals. This pilot study aims to quantify the microbial sharing between patients and therapy dogs, and determine if contact level and a decolonization intervention modifies this sharing.

Methods
We collected pediatric patient and therapy dog nasal samples before and after each group therapy visit. Contact level was based on interaction time and key behaviors. Therapy dog handlers performed normal practices for two control visits, then switched to a decolonization protocol (chlorhexidine shampoo prior to the visit, and chlorhexidine wipes during the visit) for two intervention visits. Sample DNA was sequenced for the 16S rRNA gene V1-3 region to assess microbiota composition and diversity.

Results
We collected 105 samples (79 from patients and 26 from dogs) over 13 study visits. There was an increase in within-sample (alpha) diversity levels after the visits in patients and dogs in control visits, and an overall decrease in intervention visits. Patients were more similar in their microbial composition (beta diversity) to other patients and to dogs after visits. Patients with higher dog contact were more similar to other patients in control and intervention visits using the unweighted metric, but only in control visits for the weighted metric.

Conclusion
These findings indicate that microbes are shared between patients and therapy dogs during animal-assisted interventions, shown by the increase in alpha diversity levels and microbial community shifts. High contact increased interactions in all pathways, resulting in greater microbial sharing. With the dog pathway blocked, the intervention reduced spread of unique dog taxa, but sharing still occurred in high contact patients.
This shows that, while there is potential for the dog to be a vector, other potential pathways are important for microbial sharing during group therapy visits. Infection control efforts should reflect all possible pathways of microbial transmission.

Disclosures
All Authors: No reported disclosures
822. Structural Damage and Biofilm Accumulation on Patient-Ready Orthopaedic Implant (Least Used Cortical Screws), Acquired through Loaner System
Authors: Pereira Luiz Antônio , Lopes Lillian Kelly O , Costa Dayane M , Santos Michelle A , Boff Isabella M , Leão-Vasconcelos Lara Stefânia N , Vickery Karen , Tipple Anaclara F 
Published: January 2021

Abstract

Background
The acquisition of reusable medical devices through loaner system is a worldwide phenomenon. Single-use implants, such as orthopaedic screws, that remain in the surgical tray are subjected to multiple handling and reprocessing until they are implanted. Exposure to physical, chemical and biological agents may compromise their quality/safety and favor biofilm formation. The aim of this study was to assess the surface integrity and microbiological conditions of patient-ready orthopaedic surgical implants (least used cortical screws), provided through loaner system.

Methods
After full reprocessing, clinical trays used for small fragment surgery (3,5) provided through loaner system to a large Brazilian teaching hospital were randomly selected between August to November 2019. Trays were opened in a biological safety cabinet and the least frequently used cortical screws (numbers 10 and 38), therefore, the ones most exposed to biological, chemical and physical agents, were randomly removed and subjected to bacterial culture (n = 3 screws/tray, 9 trays) and Scanning Electron Microscopy (SEM) (n= 1 screw/tray, 5 trays). The 27 screws were individually cultured in Tryptic Soy Broth (TSB), sonicated and vortexed, and incubated at 35oC for up to 28 days (screws were left in TSB). Positive cultures were plate out for automated bacteria identification.

Results
Bacterial growth was identified in 2/27 screws. Three bacterial species were isolated, Staphylococcus hominis resistant to rifampicin and Kocuria rhizophila (screw A), and Micrococcus luteus (Screw B). Structural damage and soil were visualized on all screws subjected to SEM (5/5). Extensive biofilms were detected on three screws (3/5) (Figure 1).
Figure 1. Scanning electron micrographs of patient-ready orthopaedic implants (screws), acquired through loaner system showing extensive biofilm, with incorporated bacilli/rods and/or cocci shape bacteria.

Conclusion
Recovery of bacteria, biofilm accumulation and structural damage were detected on patient-ready least frequently used orthopaedic cortical screws. Screws frequently remain in surgical trays for multiple reprocessing, thus, they are repeatedly exposed to contamination and possible damage. These findings point to the need to discuss and review the way these single-use implants are currently made available for surgery.

Disclosures
All Authors: No reported disclosures
823. How to Compare standardized Healthcare-associated Infection (HAI) Rates? Benchmark 2D and 3D
Authors: Couto Braulio Roberto Gonçalves Marinho , Starling Carlos Ernesto Ferreira 
Published: January 2021

Abstract

Background
External benchmarking involves comparing standardized data on HAI rates in one hospital or healthcare facility in relation to others. Here we present two epidemiological graphical tools, 2D and 3D benchmarks, which summarize the efficiency in preventing main infections in a Medical/Surgical Intensive Care Unit (MSICU).

Methods
The 3D benchmark graph considers the incidence density rate of ventilator-associated pneumonias (VAP cases per 1,000 ventilator-days) as the X-Axis, the incidence density rate of central line-associated primary bloodstream infections (CLABSI cases per 1,000 central line-days) as the Y-Axis, and the incidence density rate of urinary catheter-associated urinary tract infections (CAUTI per 1,000 urinary catheter-days) as the Z-Axis. Efficiency in preventing infection (e) considers the zero rate to be 100% efficient (e=100%) and the highest available benchmark rate to be “zero” efficiency (RMax: e=0%). From this definition, the efficiency of any MSICU (0% ≤ e ≤ 100%) is obtained using a linear interpolation function, from the rate observed in the MSICU under evaluation (Rx): e = 100x(RMax – Rx)/RMax. If Rx &gt; RMax, then RMax = Rx. The 3D benchmark is build by calculating the preventing infection (e) for each infection (VAP, CLABSI, and CAUTI) for all benchmarks and for the MSICU under evaluation. In the 3D Benchmark, three control volumes are created: “Infection Control Urgency” volume, “Infection Control Excellence” volume, “Infection Prevention Opportunity” volume. Benchmark 2D considers only the VAP density rate as X-Axis, and the CLABSI density rate as Y-Axis. In this graph, five control regions are created: 1=excellence in the control of VAP+CLABSI; 2=excellence in VAP control and opportunity for CLABSI prevention; 3=excellence in CLABSI control and opportunity to prevent VAP; 4=opportunity to prevent VAP+CLABSI; 5=urgency in infection control.

Results
Graph parameters were based on NHSN data from the device-associated module, NOIS Project, Anahp, CQH, and GVIMS/GGTES/ANVISA (Brazilian benchmarks), and El-Saed et al. benchmarks. We applied the 2D/3D benchmarks to several Brazilian ICUs.
2D benchmark for the MSICUs from Lifecenter Hospital, Brazil, Jan-Dez/2019: UCO & UTI 19 =excellence in CLABSI control and opportunity to prevent VAP; UTI 20=excellence in VAP control and opportunity for CLABSI prevention; UTI 18=opportunity to prevent VAP+CLABSI.

3D benchmark for the MSICUs from Lifecenter Hospital, Brazil, Jan-Dez/2019

2D benchmark for the MSICUs from Vera Cruz Hospital, Brazil, Jan-Dez/2019: CTI 3.o Andar =excellence in the control of VAP+CLABSI; CTI 1.o Andar=excellence in VAP control and opportunity for CLABSI prevention.

Conclusion
2D and 3D benchmarks are easy to understand and summarize the efficiency in prevention the mains infections of MSICU.

Disclosures
All Authors: No reported disclosures
829. Identification of Congenital Cytomegalovirus Infection Using Real-World Healthcare Data
Authors: Weil Clara , Marks Morgan , Wang Wei , Chodick Gabriel , Bilavsky Efraim , Sinha Anushua 
Published: January 2021

Abstract

Background
Infants with congenital cytomegalovirus infection (cCMVi) may present with symptoms such as sensorineural hearing loss (SNHL) during the neonatal period and/or develop permanent disability. This study aims to identify infants with cCMVi using information available in an electronic healthcare database in Israel.

Methods
We performed a retrospective study in Maccabi Healthcare Services (MHS, 2.4-million-member healthcare system) among infants with ≥30 days’ continuous enrolment since birth and linked maternal data of women aged 18-44 years in 2013-2017. Data were obtained on diagnosis codes (‘Dx’; ICD-9-CM) of CMV and SNHL and dispensed valgancivlovir treatment (‘Tx’) within 90 days after birth. To help inform the timing of the CMV infection (congenital vs. postnatal) data on maternal CMV testing history were also obtained among infants whose earliest CMV Dx was at age 22-90 days.

Results
The study included 171,952 infants linked to 128,264 mothers (167,879 pregnancies). A total of 461 infants (0.3%) had a CMV Dx within 90 days, 81.3% of which (n=375) were diagnosed within 21 days. Among all infants with a CMV Dx within 90 days, 105 also had dispensed Tx (n=101) and/or SNHL Dx (n=16). Among infants diagnosed at age 22-90 days without evidence of prior Tx or SNHL (n=69), 12 had a record of primary maternal CMV infection in pregnancy, 8 had mothers who were CMV seronegative at the start of pregnancy without follow-up test results, and 49 did not have any maternal laboratory data available. A medical record review is being conducted to validate each cCMV case definition in the MHS database.

Conclusion
In large Israeli healthcare system, 0.3% of infants had a CMV Dx in their electronic health records suggestive of potential cCMVi. Case review is ongoing to validate these codes and help inform analyses on the clinical and economic burden of cCMVi in this population where awareness of CMV is high but newborn screening is not universal.

Disclosures
Morgan Marks, PhD, ScM, Merck and Co. Inc. (Employee, Shareholder) Wei Wang, PhD, Merck (Employee) Anushua Sinha, MD, MPH, Merck & Co. (Employee)Merck & Co. (Shareholder)Merck & Co. (Consultant)
832. Assessment of Risk Factors Associated with Wide-resistance Gram-negative Bacteria Infections
Authors: Reis Henry Pablo Lopes Campos e , Rodrigues Ana Beatriz Ferreira , Silva Julio César Castro , de Lima Lia Pinheiro , Quinaher Talita Lima , de Freitas Thaynara Carvalho , Pereira Carla Mônica Porto , de Araujo Breno Queiroz , Da Silva Abel Brasil Ramos , Amaral Germana Perdigão , de Souza Geovania Maciel , Fragoso Luciana Vladia Carvalhedo , Girão Evelyne Santana , Pontes Licia Borges , Junior Arnaldo Aires Peixoto , Araujo Vitor Nogueira , Duarte Fernando Barroso , Barroso Karine Sampaio Nunes , Rodrigues Jorge Luiz Nobre 
Published: January 2021

Abstract

Background
Enterobacteria and multidrug-resistant non-fermenting Gram-negative bacilli present a challenge in the management of invasive infections, leading to mortality rates due to their limited therapeutic arsenal. The objective of this work was to analyze risk factors that may be associated with these infections, for a better situational mapping and assertive decision-making in a university hospital in Brazil.

Methods
The study was conducted between January and September 2019, with 167 patients in contact isolation at a university hospital in Brazil. Potential outcome-related variables for wide-resistance Gram-negative bacteria (BGN) infections were evaluated. Risk factors were identified from univariate statistical analysis using Fisher’s test.

Results
51 (30.5%) out of 167 patients in contact isolation evolved with wide-resistance BGN infection. Risk factors in univariate analysis were age, hospital unit and previous use of invasive devices. Patients aged up to 59 years were more likely to progress to infection than those aged over 60 years (p 0.0274, OR 2.2, 95% CI 1.1-4.5). Those admitted to the oncohematology (p &lt; 0.001, OR 32.5, Cl 9.1-116.3) and intensive care unit (p &lt; 0.001, OR 28.0, Cl 3.5-225.9) units were more likely to develop this type of infection. The least likely were those admitted to a kidney transplant unit (p 0.0034, OR 15.33, Cl 1.8-131.0). Prior use of mechanical ventilation (p 0.0058, OR 12.2, Cl 2.0-76.1) and delayed bladder catheter (p 0.0266, OR 5.0, Cl 1.2-20.1) in patients with respiratory and urinary tract infection, respectively, were also reported as risk factors related to these infections. The gender of the patients was not significant for the study.

Conclusion
This study determined that variables such as age, hospitalization unit, use of mechanical ventilation and delayed bladder catheter could be considered important risk factors in triggering the infectious process by wide-resistant gram-negative bacteria. Thus, the analysis of these factors becomes a great foundation to prevent the development of multiresistant pathogens through prevention strategies, prophylaxis management and more targeted empirical therapies.

Disclosures
All Authors: No reported disclosures
835. Comparison of the outcomes of patients with KPC and NDM-1-producing Enterobacteriaceae
Authors: Seo Hyeonji , Kim Min Jae , Chong Yong Pil , Kim Sung-Han , Lee Sang-Oh , Choi Sang-Ho , Kim Yang Soo , Woo Jun Hee , Jung Jiwon 
Published: January 2021

Abstract

Background
Carbapenemase-producing Enterobacteriaceae infections are associated with high mortality. We aimed to compare the clinical outcomes of patients with Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae and those with New-Delhi-Metallo-beta-lactamase-1 (NDM-1)-producing Enterobacteriaceae.

Methods
We performed a retrospective cohort study of all adult patients (&gt; 16 years old) with KPC or NDM-1-producing Enterobacteriaceae isolates in a 2,700-bed tertiary referral hospital in Seoul, South Korea between 2010 and 2019. Primary outcomes were infection within 30 days and 30-day mortality after the first isolation of KPC or NDM-1-producing Enterobacteriaceae.

Results
A total of 859 patients were identified during the study period. Of them, 475 (55%) were KPC group and 384 (45%) were NDM-1 group. KPC group tended to develop infection within 30 days after first isolation more frequently than NDM-1 group (31% vs. 26%; P = 0.07). Thirty-day mortality was significantly higher in KPC group compared to NDM-1 group (KPC, 17% (81/475) versus NDM-1, 9% (33/384), P &lt; 0.001). Multivariate analysis revealed that APACHE II score (adjusted odds ratio [aOR], 1.12; P &lt; 0.001), solid cancer (aOR, 2.56; P &lt; 0.001), previous carbapenem therapy (aOR, 1.93; P = 0.004), development of infection of KPC or NDM-1-producing Enterobacteriaceae within 30 days (aOR, 2.63; P &lt; 0.001), and KPC-producing Enterobacteriaceae (aOR, 1.62; P = 0.045) were independent risk factors for 30-day mortality.
Table 1. Results of analyses of risk factors for 30-day mortality from initial positive culture date in patients with KPC or NDM-1- producing Enterobacteriaceae

Figure 1. Kaplan–Meier survival estimates of patients with KPC or NDM-1-producing Enterobacteriaceae for 30-day mortality after first isolation: KPC (continuous line) versus NDM (dotted line). (log-rank test).

Conclusion
Our study suggests that KPC-producing Enterobacteriaceae is associated with poorer outcome compared to NDM-1-producing Enterobacteriaceae. Therefore, patients with KPC-producing Enterobacteriaceae colonization should be monitored carefully for development of infection, and appropriate antibiotics should be initiated as soon as possible.

Disclosures
All Authors: No reported disclosures
837. Contamination of Hospital Drains by Carbapenemase-Producing Enterobacterales (CPE) in Ontario, Canada
Authors: Jamal Alainna J , Mataseje Laura , Brown Kevin , Katz Kevin , Johnstone Jennie , Muller Matthew , Allen Vanessa , Borgia Sergio , Boyd David , Ciccotelli William , Delibasic Kornelija , Fisman David , Leis Jerome A , Li Angel , Mehta Mamta , Ng Wil , Pantelidis Rajni , Paterson Aimee , Pikula Gordana , Sawicki Rachel , Schmidt Shelley , Souto Renata , Tang Lin , Thomas Cameron , McGeer Allison , Mulvey Michael 
Published: January 2021

Abstract

Background
The hospital water environment is a CPE reservoir, and transmission of CPE from drains to patients is a risk.

Methods
We cultured sink and shower drains in patient rooms and communal shower rooms that were exposed to inpatients with CPE colonization/infection from October 2007 to December 2017 at 10 hospitals. We compared patient room drain CPE to prior room occupant CPE using Illumina and MinION whole-genome sequencing.

Results
Three-hundred and ten inpatients exposed 1,209 drains, of which 53 (4%) yielded 62 CPE isolates at 7 (70%) hospitals. Compared to room occupant CPE isolates, drain CPE isolates were more likely Enterobacter spp. (6, 10% vs. 25, 51%, p&lt; 0.0001) or KPC-producers (9, 15% vs. 23, 47%, p=0.0002). Of the 49 CPE isolates in patient room drains, 4 (8%) were linked to a prior room occupant (Table), 24 (49%) had the same carbapenemase as a prior room occupant but isolates/carbapenemase gene-containing plasmids that were unrelated, and 21 (43%) did not share a carbapenemase with a prior room occupant. The 4 drains linked to prior room occupants were likely contaminated by these room occupants, who were CPE-colonized prior to drain exposure. Despite few links between drain and room occupant CPE, there were 10 isolates harbouring related blaNDM-1-containing IncHI2A/HI2-type plasmids in 8 rooms on two units at one hospital. Nine of these were Enterobacter hormaechei ST66 isolates that were 0 to 6 SNVs apart and one was a Klebsiella oxytoca STnovel isolate.
Table. Four patient room drain CPE isolates (D1b, D4, D5, D12) and isolates from prior room occupants that they were related to by whole-genome sequencing.

Conclusion
It was uncommon for drain CPE to be linked to prior patient exposure. This suggests contamination of most drains by undetected colonized patients and a need for more aggressive patient screening in our hospitals. This may also suggest retrograde (drain-to-drain) transmission, especially considering the 10 isolate drain cluster at one hospital. Reasons for the preponderance of Enterobacter spp. in drains requires further study.

Disclosures
Allison McGeer, MD, FRCPC, GlaxoSmithKline (Advisor or Review Panel member, Research Grant or Support)Merck (Advisor or Review Panel member, Research Grant or Support)Pfizer (Research Grant or Support)
58. Evaluation of a Disease State Stewardship Intervention for Urinary Tract Infections at an Academic Medical Center
Authors: Xhemali Xhilda , Forster Derek W , Clemons Bryant , Cotner Sarah , VanHoose Jeremy , Burgess Donna R , Burgess David , Myint Thein , Maskey Mitu , Wallace Katie 
Published: January 2021

Abstract

Background
Urinary tract infections (UTIs) are often misdiagnosed and mismanaged. Disease state stewardship initiatives targeting UTIs may have a significant impact on the overuse of antimicrobials (ABX). The purpose of our study is to evaluate the effectiveness of a UTI focused disease state stewardship intervention.

Methods
This retrospective study was conducted at a tertiary care academic medical center. Patients &gt; 18 years of age with a collected urinalysis (UA) and receiving ABX for a UTI were included. Retrospective review of UTI management from 9–11/2017 was performed and used as the baseline. In the post-intervention period, 9–11/2018, the UTI management guideline had been published and service lines educated. A prospective audit and feedback (PAAF) initiative was started 6/2019, whereby the antimicrobial stewardship team performed daily reviews of patients on ABX for UTIs. Patients reviewed 9–11/2019 were included in the PAAF cohort. Exclusion criteria included: pregnancy, undergoing a urologic procedure, treatment of a concomitant infection, receiving therapy based on outside recommendations, or left AMA/expired during treatment. The primary outcome of this study was to evaluate overall guideline adherence.

Results
600 patients (200 in each group) were included, with 419 (69.8%) female and an overall median age of 61.4 years. Altered mental status (24.8%) and dysuria (21.5%) were the two main diagnostic testing indications. Treatment of asymptomatic presentations decreased between the three periods, 74.0% vs 48.5% vs 36.0%. Appropriate ordering of UA (33.5% vs 55.0% vs 68.5%, p&lt; 0.001) and urine cultures (29.0% vs 57.1% vs 64.8%, p&lt; 0.001) improved following guideline implementation and PAAF. Interventions by the stewardship team were made in 21% of patients during PAAF, namely therapy discontinuation (78.6%). Overall guideline adherence significantly improved over time, 13.0% vs 27.0% vs 36.5%, p&lt; 0.001.

Conclusion
UTI disease state intervention was associated with a reduction in the treatment of asymptomatic presentations, increase in appropriate diagnostic ordering, and improvement in overall guideline adherence. PAAF can be a powerful stewardship strategy for promoting consistency in UTI treatment and decreasing unnecessary ABX use.

Disclosures
All Authors: No reported disclosures