bluuebunny/crossref_metadata_2025_split huggingface dataset:
Identification of Risk Factors for Invasive Extraintestinal Pathogenic Escherichia coli (ExPEC) Disease
Authors: Clarke Erik , Geurtsen Jeroen , Spiessens Bart , Chehoud Christel 
Published: November 2021

Background: A pathogenic group of invasive extraintestinal pathogenic (ExPEC) Escherichia coli possess the ability to infect normally sterile body sites and cause severe invasive ExPEC disease (IED). ExPEC is a leading cause of bacteremia and sepsis worldwide and is associated with older age and multidrug-resistant infections. Janssen Vaccines & Prevention is developing a novel multivalent glycoconjugate vaccine to prevent IED. We aimed to use an unbiased approach, with no prespecified potential risk factors, using machine-learning models, to screen for and identify IED risk factors for further validation. Methods: We used a patient-level prediction study design to model the probability of a patient developing IED within 14 days to 1 year from a given date based on their prior 2 years of health records. We used the Optum EHR database (~98 million subjects) in the common data model (CDM) format, with health features encoded in the following categories: conditions, procedures, drugs, healthcare visits, recent laboratory measurements, and age and gender. A gradient boosting model (XGBoost) was used with Shapley additive explanation (SHAP) values to identify which features were most important to the model’s decisions and to characterize precisely the relationship between features and outcomes (binary or continuous). Results: Study participants were aged ≥60 years at index with no previously recorded IED. Of ~6,500,000 cases included, ~8,000 had IED during the prediction window. We found that having ≥1 urinary tract infection (UTI) in the retrospective period increased the model’s probability of predicting IED for that patient, with more frequent or more recent UTIs increasing IED prediction chance (Figure 1). Higher age linearly increased the model’s likelihood of predicting that a patient would develop IED. The model also identified ≥1 inpatient or ER visit and laboratory values indicative of renal or immune dysfunction to be correlated with increased IED risk. This methodology is a generalizable approach to screening for potential risk factors for an outcome using EHR databases; it requires little to no prespecification of the health factors or precise relationship between the factors and outcome. Conclusions: Using a new, impartial methodology (with no prespecification), older age and a history of UTIs were key predictive features for IED, factors previously identified through traditional analysis, confirming the validity of the methodology. Novel features, including recent hospitalization, were shown to increase IED risk relative to existing criteria. Our findings may be used to inform the clinical development of preventive strategies.Funding: Janssen Research and DevelopmentDisclosures: None
A Cluster of Coronavirus Disease 2019 (COVID-19) Cases on an Inpatient Hospital Unit Involving Multiple Modes of Transmission
Authors: Witherspoon Kelsey , Haden Michael , Smyer Justin , Flaherty Jennifer , Smith Heather , Colburn Nora , Liscynesky Christina , Allen James , Day Shandra 
Published: November 2021

Background: The Ohio State University Wexner Medical Center identified a cluster of coronavirus disease 2019 (COVID-19) cases on an inpatient geriatric stroke care unit involving both patients and staff. The period of suspected severe acute respiratory coronavirus virus 2 (SARS-CoV-2) transmission and exposure on the unit was December 20, 2020, to January 1, 2021, with some patients and staff developing symptoms and testing positive within the 14 days thereafter. Methods: An epidemiologic investigation was conducted via chart review, staff interviews, and contact tracing to identify potential patient and staff linkages. All staff who worked on the unit were offered testing regardless of the presence of symptoms as well as all patients admitted during the outbreak period. Results: In total, 6 patients likely acquired COVID-19 in the hospital (HCA). An additional 6 patients admitted to the unit during the outbreak period subsequently tested positive but had other possible exposures outside the hospital (Fig. 1). One patient failed to undergo COVID-19 testing on admission but tested positive early in the cluster and is suspected to have contributed to patient to employee transmission. Moreover, 32 employees who worked on the unit in some capacity during this period tested positive, many of whom became symptomatic during their shifts. In addition, 18 employees elected for asymptomatic testing with 3 testing positive; these were included in the total. Some staff also identified potential community exposures. Additionally, staff reported an employee who was working while symptomatic with inconsistent mask use (index employee) early in the outbreak period. The index employee likely contributed to employee transmission but had no direct patient contact. Our epidemiologic investigation ultimately identified 12 employees felt to be linked to transmission based on significant, direct patient care provided to the patients within the outbreak period (Fig. 1). In addition, 3 employees had an exposure outside the hospital indicating likely community transmission. Conclusions: Transmission was felt to be multidirectional and included employee-to-employee, employee-to-patient, and patient-to-employee transmission in the setting of widespread community transmission. Interventions to stop transmission included widespread staff testing, staff auditing regarding temperature and symptom monitoring, and re-education on infection prevention practices. Particular focus was placed on appropriate PPE use including masking and eye protection, hand hygiene, and cleaning and disinfection practices throughout the unit. SARS-CoV-2 admission testing and limited visitation remain important strategies to minimize transmission in the hospital.Funding: NoDisclosures: None
Adherence to Antibiotic Stewardship Program Associated with Shorter Course of Treatment and Fewer Adverse Events
Authors: Mulligan Patrick , Shah Nirav , Acree Mary , Grant Jennfer , Ravichandran Urmila , Ismail Nader 
Published: November 2021

Group Name: NorthShore University HealthSystemBackground: Prolonged antibiotic use has been attributed to an increased incidence of adverse drug events (ADEs). Cessation of unnecessary antibiotics would decrease length of treatment and may help prevent these adverse events. We evaluated whether an antibiotic stewardship intervention aimed at stopping unnecessary antibiotic usage would both shorten the duration of treatment and reduce ADEs. Methods: At NorthShore University HealthSystem, a 4-hospital, 832-bed system, we identified patients who were started on empiric antibiotics during a hospital admission between May 2, 2016, and June 30, 2018. Within 24 hours of antibiotic initiation, an infectious disease (ID) physician reviewed each patient chart. If the patient was unlikely to have a symptomatic bacterial infection, the ID physician left a note in the electronic medical record (EMR) recommending antibiotic cessation. Two physician reviewers retrospectively reviewed whether the treatment team accepted these recommendations and assessed potential ADEs for 30 days after the recommendation through inpatient and outpatient notes in the EMR. These ADEs were defined using previously published criteria. If the 2 reviewers disagreed on the presence of an ADE, an ID physician acted as the tie breaker. We compared the number of antibiotic days and the number of ADEs between cases in which the recommendations were followed and cases in which they were not. Results: We reviewed 168 cases: 78 (46.43%) followed recommendations and 90 (53.57%) did not. There were no significant differences in baseline patient characteristics between the 2 groups. There was a significant difference in total ADEs between the 2 groups: in 6 cases (7.69%) the recommendations were followed, and 21 (23.33%) they were not followed (P = .011). There was also a significant difference in antibiotic days between cases in which recommendations were followed (1.40 days) versus those in which they were not followed (1.99 days) (p < 0.001). Conclusions: Antibiotic-associated adverse events can cause harm to patients and increase healthcare costs, particularly when used for patients who are unlikely to have a bacterial infection. An antibiotic stewardship program to identify patients in an EMR who are unlikely to benefit from antibiotic use can decrease the length of total antibiotic usage and help prevent adverse events.Funding: NoDisclosures: None
Automation of Healthcare-Associated Infections (HAIs) Areas for Opportunity Through the Use of Technology
Authors: Pearson Meri 
Published: November 2021

Background: A large healthcare system in Georgia implemented an enhanced electronic infection surveillance system that is incorporated into the electronic medical record (EMR). Prior to the implementation of this electronic infection surveillance system, the infection prevention (IP) team performed healthcare-associated infection (HAI) surveillance through a locally created system that did not interface with their EMR. Each HAI identified undergoes a robust analysis for opportunities depending on the infection type by manual abstraction from the EMR, which is stored in a spreadsheet. One disadvantage of this spreadsheet is that only 1 person can enter data at a time. The coronavirus disease 2019 (COVID-19) pandemic has presented many challenges for healthcare facilities including shifting resources from HAI prevention programs. These programs include the investigations performed to identify risk factors that can aid in preventing future infections. Due to the necessity to increase efficiency in the current pandemic, the IP team proposed using technology to automate our HAI investigation process. Method: The IP team and the business intelligence (BI) team met to determine whether data completed in the electronic infection surveillance system could flow into an interactive data visualization software that is currently used for other HAI prevention dashboards. The existing spreadsheet was reviewed to select variables essential for HAI investigations and for which the data existed in the EMR. The BI team worked to find the correct data tables within the EMR so that the data could automatically refresh daily in the data visualization software. Result: The BI team was able to correctly identify variables used in the previously manual HAI investigation process within the EMR to interface with the data visualization software. This automation of investigations allows quick analysis of trends and areas of opportunity to prevent future HAIs. Conclusion: This utilization of technology can be applied to other healthcare facilities with similar software systems to streamline IP workflows. The automation of quickly and efficiently recognizing areas of opportunity allows IPs more time to facilitate the prevention of HAIs in other ways.Funding: NoDisclosures: None
Antimicrobial Stewardship Standards and Patient Safety: A Case Study in Blood Culture Contamination
Authors: Schaefer Connie 
Published: November 2021

Background: Blood culture is a crucial diagnostic tool for healthcare systems, but false-positive results drain clinical resources, imperil patients with an increased length of stay (and associated hospital-acquired infection risk), and undermine global health initiatives when broad-spectrum antibiotics are administered unnecessarily. Considering emerging technologies that mitigate human error factors, we questioned historically acceptable rates of blood culture contamination, which prompted a need to promote and trial these technologies further. In a 3-month trial, 3 emergency departments in a midwestern healthcare system utilized an initial specimen diversion device (ISDD) to draw blood cultures to bring their blood culture contamination rate (4.4% prior to intervention) below the 3% benchmark recommended by the Clinical & Laboratory Standards Institute. Methods: All emergency department nursing staff received operational training on the ISDD for blood culture sample acquisition. From June through August 2019, 1,847 blood cultures were drawn via the ISDD, and 862 were drawn via the standard method. Results: In total, 16 contamination events occurred when utilizing the ISDD (0.9%) and 37 contamination events occurred when utilizing the standard method (4.3%). ISDD utilization resulted in an 80% reduction in blood culture contamination from the rate of 4.4% rate held prior to intervention. Conclusions: A midwestern healthcare system experienced a dramatic reduction in blood culture contamination across 3 emergency departments while pilot testing an ISDD, conserving laboratory and therapeutic resources while minimizing patient exposure to unnecessary risks and procedures. If the results obtained here were sustained and the ISDD utilized for all blood culture draws, nearly 400 contamination events could be avoided annually in this system. Reducing unnecessary antibiotic use in this manner will lower rates of associated adverse events such as acute kidney injury and allergic reaction, which are possible topics for further investigation. The COVID-19 pandemic has recently highlighted both the importance of keeping hospital beds available and the rampant carelessness with which broad-spectrum antibiotics are administered (escalating the threat posed by multidrug-resistant organisms). As more ambitious healthcare benchmarks become attainable, promoting and adhering to higher standards for patient care will be critical to furthering an antimicrobial stewardship agenda and to reducing treatment inequity in the field.Funding: NoDisclosures: None
Clostridioides difficile Is Not Difficult to Predict in Hospital Settings
Authors: Alexander Kinta , Petersen Frances , Brown Sean 
Published: November 2021

Background:Clostridioides difficile is a gram-positive bacteria that is the most common cause of hospital-associated infectious diarrhea among traditional and nontraditional high-risk populations. Excess healthcare costs associate with C. difficile infection (CDI) prevalence, morbidity, and mortality is shown to economically impact the US healthcare system with at least an additional $1 billion in annual cost. Exposure to antimicrobial agents resulted in increased risk for hospital-onset CDI (HO-CDI) at an inner-city hospital during 2010 and 2011. Methods: A retrospective case-control study of all persons with HO-CDI in the MICU was conducted at an inner-city hospital between January 1, 2010, and December 31, 2011. A patient was considered to have developed HO-CDI if diarrhea developed after 72 hours of admission into the MICU and a confirmed laboratory stool specimen for Clostridioides difficile infection (CDI) was obtained. A non–HO-CDI person was randomly selected using “risk set sampling.” After the application of inclusion and exclusion criteria, 88 cases were eligible for the study. Of these cases, 29 met the definition for HO-CDI, and 59 met the definition for non–HO-CDI. The relationship between antimicrobial use and the development of HO-CDI in patients in the MICU at an inner-city hospital was investigated using a logistic regression model in which the variable of total antibiotics was used as a possible predictor for predicting a positive HO-CDI. Results: Logistic regression was utilized to determine the relationships between selected study variables and presence or absence of HO-CDI. Total antibiotics was significantly related to HO-CDI. The results of this analysis showed that total antibiotics was a significant predictor for HO-CDI. The total value of the coefficient B for this predictor was 0.47, and the exponentiated value (exp[B]) of this coefficient was 1.60 (95% CI, 1.08–2.35). In this sample, patients who had 1 or more antibiotics were at a 60% greater risk of having a positive HO-CDI culture. There was a significant association between the use of metronidazole and HO-CDI (p < .001). Conclusions: Antimicrobial stewardship is an integral part of patient safety. The findings from this study were instrumental in the implementation of a fledging antimicrobial stewardship program and the use of evidence-based practices at this inner-city hospital.Funding: NoDisclosures: None
Inequities in CLABSI Rates in a Children’s Hospital by Race, Ethnicity, and Language Preference
Authors: McGrath Caitlin , Kronman Matthew , Zerr Danielle , Bettinger Brendan , Coker Tumaini , Bell Shaquita 
Published: November 2021

Background: Systemic racism results in health inequities based on patient race, ethnicity, and language preference. Whether these inequities exist in pediatric central-line–associated bloodstream infections (CLABSIs) is unknown. Methods: This retrospective cohort study included patients with central lines hospitalized from October 2012 to June 2019 at our tertiary-care children’s hospital. Self-reported race, ethnicity, language preference, demographic, and clinical factors were extracted from the electronic health record. The primary outcome was non–mucosal barrier injury (non-MBI) CLABSI episodes as defined by the NHSN. CLABSI rates between groups were compared using χ2 tests and Cox proportional hazard regression. We adjusted for care unit, age, immunosuppressed status, diapered status, central-line type, line insertion within 7 days, daily CLABSI maintenance bundle compliance, number of blood draws and IV medication doses, and need for total parental nutrition, extracorporeal membrane oxygenation, and renal replacement therapy. In mid-2019, we engaged stakeholders in each care unit to describe preliminary findings and to identify and address potential drivers of observed inequities. Results: We included 337 non-MBI CLABSI events over 230,699 central-line days (CLDs). The overall non-MBI CLABSI rate during the study period was 1.46 per 1,000 CLDs. Unadjusted CLABSI rates for black or African American (henceforth, “black”), Hispanic, non-Hispanic white, and Asian (the 4 largest race or ethnicity groups by CLDs) patients were 2.74, 1.53, 1.42, 1.24 per 1,000 CLDs, respectively (P < .001) (Table 1). Unadjusted CLABSI rates for patients with limited-English proficiency (LEP) and English-language preference were 1.98 and 1.38 per 1,000 CLDs, respectively (P = .014). After adjusting for covariates, the hazard ratio (HR) point estimate for CLABSI rate remained higher for black patients (HR, 1.50; 95% CI, 0.99–2.28) and patients with LEP (HR, 1.33; 95% CI, 0.87–2.05), compared to the reference group based on largest CLD. The differences in CLABSI rate by race or ethnicity and language were more pronounced in 2 of our 6 care units. Stakeholder engagement and analysis of hospital data revealed opportunities on those units for improved (1) interpreter utilization and (2) line maintenance observation practices by race/ethnicity and language preference (data not shown). These findings and CLABSI rates over time by race/ethnicity and language preference (Figures 1 and 2) were shared with frontline staff. Conclusions: In our children’s hospital, CLABSI rates differed based on patients’ self-reported race, ethnicity, and language preference, despite controlling for factors commonly associated with CLABSI. Identifying inequities in CLABSI rates and mitigating their determinants are both essential to the goal of achieving equitable care.Funding: NoDisclosures: None
Using a Quality-Driven Approach to Maintain an N-95 Respirator Supply During a Pandemic-Driven Global Shortage
Authors: Selimos Amy , Buchanan Mark , DiBiase Lauren , Dean Stephen , Boone Pat , Shaheen Nicholas , Sickbert-Bennett Vavalle Emily , Willis Beth 
Published: November 2021

Background: Reports of hospitals overwhelmed by COVID-19 patients created severe shortages of personal protective equipment (PPE). In this large academic medical system, we used a systematic team approach to proactively maintain an adequate PPE supply. The team consisted of staff from multiple departments including infection prevention, environmental health and safety, operational efficiency, and supply chain. The healthcare system solicited donations of PPE, and our team was tasked with developing a sustainable method to provide healthcare workers with safe and effective N-95 respirators. Respirators are normally fitted to our 6,000+ healthcare workers through a fit-testing process using 4 models of N-95s. We received >60 models, many in small quantities, posing a new level of complexity that prevented use of our typical fit-testing method. Methods: Donated respirators were manually verified on the CDC/NIOSH website to validate approval or approved alternative. A categorization system was developed, and respirators were sorted based on quality, style, and condition. User seal checks replaced qualitative fit testing due to the uncertain and quickly changing respirator supply. Staff were educated about the importance of performing a seal check to evaluate respirator fit and were provided instructions for what to do if they failed a seal check. We performed limited quantitative fit testing on a small group previously fit tested to 1 of the 4 models of N-95s normally stocked to identify the most effective alternative respirators to serve as substitute N-95s. Results: We were able to provide staff with new N-95s and delay the release of reprocessed N-95s. Overall, 18 models of respirators were tested on staff for filtration effectiveness and fit. We deemed 61% masks to be of last resort, and these were not released. We determined that 39% were acceptable as an alternative for at least 1 of our usual respirator models. However, only 3 models (17%) available in small quantities fit wearers whose size was in shortest supply. This scarcity led to the evaluation and purchase of a new respirator prototype for small N-95 wearers, which was an important success of our team’s work and for staff safety. Conclusions: Collaboration between teams from a variety of backgrounds, using both qualitative and quantitative data, resulted in a sustainable method for receiving, sorting, and evaluating donated N-95 respirators, ensuring the delivery of a steady supply of effective N-95 respirators to our staff. This quality-driven approach was an efficient and effective strategy to maintain our N-95 respirator supply during a pandemic driven global shortage.Funding: NoDisclosures: None