bluuebunny/crossref_metadata_2025_split huggingface dataset:
772. Effect of Selective Digestive Decontamination Using Oral Colistin on HAI Rates and All-Cause Mortality Among Cardiovascular Surgery Patients - A Single Centre Experience from India
Authors: R Sneha , Wilson Arun , Warrier Anup R , Prakash Shilpa , Elizabeth Reima , Nair Suresh 
Published: December 2021

Abstract

Background
Hospital acquired infections affect the morbidity and mortality of ICU patients considerably. Selective digestive decontamination (SDD) is defined as the prophylactic application of topical, non-absorbable antimicrobials in the oropharynx and stomach, with the goal of eradicating potentially pathogenic microorganisms but preserving the protective anaerobic microbiota. SDD has been applied in trials among critically ill patients and found to be effective in reducing HAI.

Methods
This cohort study was conducted in our cardiothoracic vascular surgery ICU of a tertiary care hospital, where patients were given oral colistin syrup (100mg 6th hourly for 5 days) in the immediate post op during the intervention period. We compared the clinical and microbiological outcomes of patients before (5 months, pre-intervention arm) and after (5 months, intervention arm) the implementation of SDD (Oral colistin syrup).

Results
A total of 78 patients were included in the interventional arm with a mean age of 58.7 years whereas the pre-interventional group consisted of 94 study participants with a median age of 57.5 years. 11 out of 94 had positive respiratory sample culture (11.7%) in the preintervention group which mandated antibiotic therapy for HAP compared to one culture positive in the interventional period (OR 0.0980, 95% CI: 0.0124 to 0.777 and P=0.0279). One patient had blood stream infection in the pre-intervention period compared to none in the intervention phase. All-cause mortality in the pre-interventional group was 7.44% (7 in 94) vs 1.28% (1 in 78) in the interventional group (OR 0.1614, 95% CI: 0.0194 to 1.3416, P= 0.0914). Adverse events (nausea, vomiting & loose stools) were observed in a total of 24 study patients, but necessitated withdrawal of regimen only in nine patients.

Conclusion
An SDD regimen of Colistin alone in Cardiac Surgery patients resulted in statistically significant reduction in incidence of Hospital Acquired Pneumonia, along with a reduction in all-cause mortality (though not statistically significant).

Disclosures
All Authors: No reported disclosures
779. COVID-19 Pandemic and Catheter-associated Urinary Tract Infection Trends
Authors: Suleyman Geehan , Kassab Rita , Gudipati Smitha , Mayur Ramesh , Brar Indira 
Published: December 2021

Abstract

Background
It has been postulated that the COVID-19 pandemic would increase the overall catheter-associated urinary tract infections (CAUTI) risk in part due to higher acuity, increased indwelling urinary catheter (IUC) utilization, longer length of stay, changes in infection prevention practices due to staffing shortages. However, reported data are limited. The goal of this study was to evaluate the impact of the COVID-19 pandemic on our CAUTI rates.

Methods
This was a retrospective cross-sectional study comparing CAUTI rate per 1,000 indwelling urinary catheter (IUC) days, urine culture (UC) utilization rate per 1,000 IUC days, IUC utilization rate per 1,000 patient days, Standardized Infection Ratio (SIR) and Standardized Utilization Ratio (SUR) in the pre-COVID-19 period from January 1, 2019 to December 31, 2019 to the COVID-19 period from April 1, 2020 to March 31, 2021 at an 877-bed tertiary care hospital in Detroit, Michigan. CAUTI, UC utilization and IUC utilization rate were extracted from the electronic medical record (Epic™ Bugsy). SIR and SUR data were extracted from National Healthcare Safety Network (NHSN).

Results
The average CAUTI rate per 1,000 IUC days decreased from 0.99 pre-COVID-19 to 0.64 during COVID-19, yielding a 35% reduction. The UC order rate per 1,000 IUC days decreased from 19.19 to 18.83 with only 2% reduction. However, IUC utilization rate increased by 55% from 0.184 to 0.286. The SIR decreased from 0.483 to 0.337 with a 30% reduction, although this was not statistically significant ((P-value 0.283). The overall SUR decreased significantly from 0.806 to 0.762 (P-value &lt; 0.001). Figure 2 is a control chart of the CAUTI rate from July 2019 to April 2021.

Figure 1. CAUTI, indwelling urinary catheter and urine culture utilization rates pre-and during COVID-19 pandemic.

Figure 2. CAUTI control chart pre-and during COVID-19 pandemic.

Conclusion
Although the IUC utilization increased during the COVID-19 pandemic, CAUTI rate, SIR and SUR decreased and UC orders remained unchanged. Thus, the pandemic did not have a negative impact on our CAUTI rates.

Disclosures
All Authors: No reported disclosures
786. Facility Reported vs. CLSI MIC Breakpoint Comparison of Carbapenem Non-susceptible (Carb-NS) Pseudomonas aeruginosa (PSA) From 2016-2019: A Multicenter Evaluation
Authors: Gupta Vikas , Yu Kalvin , Pogue Jason M , Weeks Janet , Clancy Cornelius J 
Published: December 2021

Abstract

Background
CLSI lowered Pseudomonas aeruginosa (PSA) Carbapenem (Carb) interpretive breakpoint minimum inhibitory concentrations (MICs) in 2012. It often takes several years for commercial test manufacturers and microbiology labs to incorporate revised breakpoints. We compare facility-reported rates of Carb-NS PSA to the 2012 CLSI MIC breakpoints, using a large nationwide database for isolates tested in 2016-2020 at United States (US) facilities.
Table. Imipenem (IPM)/meropenem (MEM)/doripenem (DOR) interpretation (evaluable isolates) results for PSA.

Methods
All adults with a positive non-contaminant PSA culture (first isolate per 30-day period from blood, respiratory, urine, skin/wound, intra-abdominal, or other) in ambulatory and inpatient settings from 298 US hospitals from Q1 2016-Q4 2020 were evaluated (BD Insights Research Database, Becton, Dickinson & Company). Facility-reported Carb-non susceptible (NS) was defined as lab information system feed designations of susceptible (S), intermediate (I) or resistant (R) to imipenem (IPM), meropenem (MEM) and/or doripenem (DOR) per commercial panels. Where available, MICs were interpreted using CLSI 2012 Carb breakpoints (µg/ml) of ≤2 (S), 4 (I), ≥8 (R) for IPM/MEM/DOR. For evaluable PSA isolates we compared susceptibility results as reported by the facility to those using CLSI MIC breakpoints.

Results
Overall, 86.9% (255,844/294,426) of non-duplicate PSA isolates with facility-reported IPM/MEM/DOR susceptibility interpretations also had interpretable MIC results. S rates were 84.9% and 83.3% as reported by facilities and determined by CLSI criteria, respectively (Table). Facilities under-reported Carb-NS by 9.8%, using CLSI criteria as the standard (10.4% and 7.7% of R and I isolates, respectively, were missed by facility reporting).

Conclusion
Systematic application of CLSI breakpoints in 2016-20 would have had minimal impact on PSA S rates in the US. However, facility reporting failed to identify ~10% of Carb-NS isolates. The clinical implications of this observation are unknown. Facilities should know their local epidemiology, decide if under-reporting might be an issue, and assess if there is any impact on their patients.

Disclosures
Vikas Gupta, PharmD, BCPS, Becton, Dickinson and Company (Employee, Shareholder) Kalvin Yu, MD, BD (Employee) Jason M Pogue, PharmD, BCPS, BCIDP, Merck (Consultant)QPex (Consultant)Shionogi (Consultant)Utility Therapeutics (Consultant)VenatoRX (Consultant) Janet Weeks, PhD, Becton, Dickinson and Company (Employee) Cornelius J. Clancy, MD, Merck (Grant/Research Support)
789. Susceptibility of Phenotypic Subsets of Pseudomonas aeruginosa Isolates to Cefiderocol and Comparator Agents from SIDERO-WT 2014-2019
Authors: Nguyen Sean , Fam David , Sahm Daniel F , Hackel Meredith , Echols Roger , Yamano Yoshinori 
Published: December 2021

Abstract

Background
Multidrug-resistant (MDR) phenotypes are frequently observed among P. aeruginosa (PsA) isolated from hospitalized patients. This study describes the in vitro activities of cefiderocol (CFDC) and comparator agents against various non-susceptible (NS) phenotypic subsets of MDR PsA isolates from the SIDERO-WT multi-national surveillance program.

Methods
Clinical PsA isolates were collected from North America (NA) and Europe in 2014-2019 and tested for susceptibility at a central laboratory. MICs (μg/ml) were determined for CFDC, ceftazidime-avibactam (CZA), ceftolozane-tazobactam (C/T), colistin, cefepime, meropenem (MEM), and ciprofloxacin by broth microdilution according to CLSI guidelines. Aztreonam-avibactam (avibactam fixed concentration of 4 µg/ml) and imipenem/relebactam (I/R) were only tested during SIDERO-WT Year 5 (i.e. 2019). Susceptibility was interpreted according to current FDA and 2021 CLSI breakpoints.

Results
The different phenotypic subsets and susceptibility of tested compounds are shown in the table. Among 7700 PsA isolates, 47.7% and 23% were from respiratory and gastrointestinal sources of infection. CFDC inhibited 97.5% and 99.9% of all PsA at its FDA-S and CLSI-S MIC breakpoint of ≤1 and ≤4, respectively. CFDC had the lowest MIC90 of all tested agents and &gt;99% S at an MIC ≤4 for all phenotypic subsets. At a MIC ≤1, CFDC displayed high susceptibility rates against all subsets including ≥88% S against CZA-NS, C/T-NS, I/R-NS, and MEM+I/R-NS isolates. Against MDR subsets, comparator agents consistently demonstrated lower activity than CFDC; 88% of MEM+C/T-NS and MEM+CZA-NS isolates had a CFDC MIC≤1 while 15.6% and 20.3% were S to I/R, respectively. 86% of MEM+CZA+C/T-NS and 80.4% CZA+C/T+I/R-NS isolates were S to CFDC. CFDC inhibited 98.1% and 99.4% of PsA isolates from NA (n = 3548) at a MIC of ≤1 and ≤4, respectively. In NA isolates that were MEM+C/T-NS; 85.7% of PsA isolates had a MIC ≤1 to CFDC and 33.3% and 28.6% were S to CZA and I/R, respectively.

MEM: Meropenem; NS: Non-susceptible; CZA: Ceftazidime/avibactam; C/T: Ceftolozane/tazobactam; I/R: Imipenem/relebactam

Conclusion
CFDC demonstrated potent in vitro activity against a variety of phenotypic subsets of MDR P. aeruginosa isolates as compared to agents that are commonly used to treat MDR PsA infections including strains NS to other agents. These data support the use of CFDC as an important treatment option for MDR PsA.

Disclosures
Sean Nguyen, PharmD, Shionogi Inc (Employee) David Fam, PharmD, Shionogi (Employee) Daniel F. Sahm, PhD, IHMA (Employee)Pfizer, Inc. (Independent Contractor) Meredith Hackel, PhD MPH, IHMA (Employee)Pfizer, Inc. (Independent Contractor) Roger Echols, MD, Shionogi (Consultant) Yoshinori Yamano, PhD, Shionogi (Employee)
802. Corynebacterium striatum Outbreak Among Ventilated COVID-19 Patients in an Acute Care Hospital – California, 2021
Authors: Kim Janice J , Turner Nancy E , Holman Emily , Lefrak Linda , Youssef Fady A , Richardson Patrizia , Mukhopadhyay Rituparna , Crandall John , Su Henry , Epson Erin 
Published: December 2021

Abstract

Background
Corynebacterium striatum (CS), a common human commensal colonizing the skin and nasopharynx, has been associated with nosocomial infections in immunocompromised and chronically ill patients. During the winter 2020-2021 COVID-19 surge, a 420-bed California hospital reported a marked increase in CS respiratory cultures among ventilated COVID-19 patients. We conducted a public health investigation to assess and mitigate nosocomial transmission and contributing infection prevention and control (IPC) practices.

Methods
A case was defined as a patient with CS in respiratory cultures from January 1, 2020 - February 28, 2021. We reviewed clinical characteristics on a subset of cases in 2021 and IPC practices in affected hospital locations. CS respiratory isolates collected on different dates and locations were assessed for relatedness by whole genome sequencing (WGS) on MiSeq.

Results
Eighty-three cases were identified, including 75 among COVID-19 patients (Figure 1). Among 62 patients identified in 2021, all were ventilated; 58 also had COVID-19, including 4 cases identified on point prevalence survey (PPS). The median time from admission to CS culture was 19 days (range, 0-60). Patients were critically ill; often it was unclear whether CS cultures represented colonization or infection. During the COVID-19 surge, two hospital wings (7W and 7S) were converted to negative-pressure COVID-19 units. Staff donned and doffed personal protective equipment in anterooms outside the units; extended use of gowns was practiced, and lapses in glove changes and hand hygiene (HH) between patients likely occurred. In response to the CS outbreak, patients were placed in Contact precautions and cohorted. Staff were re-educated on IPC for COVID-19 patients. Gowns were changed between CS patients. Subsequent PPS were negative. Two CS clusters were identified by WGS: cluster 1 (5 cases) in unit 7W, and cluster 2 (2 cases) in unit 7S (Figure 2).
Figure 1. Corynebacterium striatum Respiratory Cultures January 2020-February 2021

Figure 2. Phylogenetic Tree Corynebacterium striatum Isolates

Conclusion
A surge in patients, extended use of gowns and lapses in core IPC practices including HH and environmental cleaning and disinfection during the winter 2020-2021 COVID-19 surge likely contributed to this CS outbreak. WGS provides supportive evidence for nosocomial CS transmission among critically ill COVID-19 patients.

Disclosures
All Authors: No reported disclosures
Immunotherapy in non-small cell lung cancer: rationale, recent advances and future perspectives
Authors: Luo Wenxin , Wang Zhoufeng , Zhang Ting , Yang Lan , Xian Jinghong , Li Yalun , Li Weimin 
Published: December 2021

Abstract
Lung cancer, with non-small cell lung cancer (NSCLC) being the major type, is the second most common malignancy and the leading cause of cancer-related death globally. Immunotherapy, represented by immune checkpoint inhibitors (ICIs), has been one of the greatest advances in recent years for the treatment of solid tumors including NSCLC. However, not all NSCLC patients experience an effective response to immunotherapy with the established selection criteria of programmed death ligand 1 (PD-L1) and tumor mutational burden (TMB). Furthermore, a considerable proportion of patients experience unconventional responses, including pseudoprogression or hyperprogressive disease (HPD), immune-related toxicities, and primary or acquired resistance during the immunotherapy process. To better understand the immune response in NSCLC and provide reference for clinical decision-making, we herein review the rationale and recent advances in using immunotherapy to treat NSCLC. Moreover, we discuss the current challenges and future strategies of this approach to improve its efficacy and safety in treating NSCLC.
CALCULATION OF THE DOSE CONVERSION COEFFICIENTS FOR CHINESE EYE LENS UNDER PHOTON EXPOSURE
Authors: Teng Zhongbin , Song Mingzhe , Liu Senlin , Wei Kexin , Liu Yuntao 
Published: December 2021

Abstract
In this work, the conversion coefficients from air kerma to the eye lens dose were calculated for photon exposures using the detailed eye and head Monte-Carlo (MC) model with the Chinese adult parameters. To verify the MC model and the simulation method, the conversion coefficients from fluence to the eye lens dose for mono-energy electrons (0.7–12 MeV) were calculated and compared with other studies. Then the conversion coefficients from air kerma to the doses in the entire lens and in the sensitive volume were calculated, respectively, for mono-energy photons (0.01–50 MeV) at different incidence angles (0–90°, in step of 15°). A small difference was found between the calculated conversion coefficient and the ICRP recommended value. The difference could be mainly due to the difference in their geometry characteristic of the eye and head models. In addition, the uncertainty analysis of the calculated conversion coefficients was performed in detail. The calculated dose conversion coefficient of the eye lens can be used to evaluate the eye lens dose for Chinese occupational staffs in external photon fields. And it can be used to determine the personal absorbed dose in the eye lens Dp lens in photon reference radiation fields.
Between Online Autonomy and Local Constraints: Spaces of Roman Catholic Women’s Activity in Poland
Authors: Szwed Anna 
Published: December 2021

AbstractThe analysis presented in this article shows how a hybrid community combining online and offline activity generates a semi-autonomous space of women's activity, neither fully independent of the religious institution, nor entirely controlled by it. Based on results obtained over 15 months of qualitative research conducted in the Captivating (Urzekająca), conservative community of Roman Catholic women in Poland, I show that digital environments are conducive to building a community of women, a creative approach to practices, renegotiating power relations, and building a sense of agency among women, while also recognizing the authority of the Church as an institution. At the same time, I argue that relative autonomy in practising religion online is limited by the pressures experienced by women in the offline space as a result of the nature of the local Church. The article discusses the question of the relations between the online and offline space, as well as the role of the broader context for understanding conservative women's practice of religion.
Effect of protein source and nonroughage NDF content in finishing diets of feedlot cattle fed free-choice hay on growth performance and carcass characteristics
Authors: Pittaluga Alejandro M , Clark Chris , Relling Alejandro E 
Published: December 2021

Abstract
One-hundred twenty crossbreed steers (initial body weight (BW) 566 ± 42 kg) were used to evaluate the interaction of protein source (PS) and nonroughage NDF content (NRFC) in finishing diets of feedlot cattle fed free-choice hay on performance and carcass characteristics. Steers were stratified by BW and randomly assigned to 8 pens (2 × 2 factorial) and fed for 104 ± 10 d. Four dietary treatments were investigated: (1) distillers’ dry grains with solubles (DDGS) and a low NRFC (DLF), (2) DDGS and a high NRFC (DHF), (3) soybean meal (SBM) and a low NRFC (SLF), (4) SBM and a high NRFC (SHF). Free-choice grass hay and concentrates were offered in a different bunk. Data were analyzed as a randomized complete block design. Do to the confounded effect of PS and protein intake, a linear regression was used to evaluate the effect of protein intake in growth performance. For gain to feed ratio (G:F) an interaction tended to occur (P = 0.10) between PS and NRFC. Steers on the DHF treatment had a lower G:F compared with SLF and SHF. Feeding SBM increased (P = 0.05) final BW, tended to increase (P = 0.06) average daily gain (ADG), and decreased (P = 0.05) hay intake (HI) compared with steers fed DDGS. There was a positive association (P ˂ 0.01) of crude protein intake with ADG and FBW. Dietary NRFC did not change (P ≥ 0.3) final BW, ADG, DMI, and HI. Protein source did not affect (P ≥ 0.16) hot carcass weight (HCW), longissimus muscle (LM) area, dressing, 12th rib fat thickness, or marbling score (MS). No differences were detected between NRFC for dressing, HCW, LM area, or MS (P ≥ 0.18); but diets with greater NRFC decreased (P = 0.03) the 12th rib fat thickness. Steers in the SHF treatment presented the lesser kidney-pelvic-heart fat compared with the remaining treatments (PS × NRFC interaction, P = 0.04). Soybean meal inclusion/increase in protein intake improved growth performance of feedlot steers compared with DDGS, despite protein intake meet the protein requirement. Increasing the NRFC did not affect growth or HI but decreased feed efficiency of steers fed DDGS.
Relationship between mask wearing, testing, and vaccine willingness among Los Angeles County adults during the peak of the COVID-19 pandemic
Authors: Lam Chun Nok , Kaplan Cameron , Saluja Sonali 
Published: December 2021

Abstract

Background
Mask wearing mitigates the spread of COVID-19; however, many individuals have not adopted the protective behavior.

Purpose
We examine mask wearing behavior during the height of the pandemic in Los Angeles County, and its association with COVID-19 testing and willingness to get vaccinated.

Methods
We conducted a cross-sectional survey using representative sampling between December 2020 and January 2021, through an online platform targeting Los Angeles County residents. Survey items include demographic characteristics, health conditions, access to health care, mask wearing, COVID-19 testing, exposure risk factors, and willingness to receive COVID-19 vaccine. We performed logistic regression models to examine factors associated with always mask wearing.

Results
Of the analytic sample (n = 1,984), 75.3% reported always wearing a face mask when leaving home. Being a female, Asian or African American, or non-Republican resident, or having higher education, having poor or fair health, having a regular doctor, knowing someone hospitalized for COVID-19, and being willing to receive the COVID-19 vaccine were associated with always wearing a mask. Residents who were younger, had a highest risk health condition, and had ≥2 COVID-19 tests had lower odds of always mask wearing.

Conclusion
Mask wearing guidelines are easing; however, as vaccination rates plateau and new virus variants emerge, mask wearing remains an important tool to protect vulnerable populations. Encouraging protective measures among younger adults, those with less education, republicans, men, and White residents—groups that are least likely to be vaccinated or wear a mask—may be critical to reducing transmission.
A low aldosterone/renin ratio and high soluble ACE2 associate with COVID-19 severity
Authors: Akin Sakir , Schriek Paula , van Nieuwkoop Cees , Neuman Rugina I. , Meynaar Iwan , van Helden Erik J. , Bouazzaoui Hassan El , Baak Remon , Veuger Marjan , Mairuhu Ronne A.T.A. , van den Berg Lettie , van Driel Vincent , Visser Loes E. , de Jonge Evert , Garrelds Ingrid M. , Duynstee Johannes F.A.B. , van Rooden Jan Kees , Ludikhuize Jeroen , Verdonk Koen , Caliskan Kadir , Jansen Tim , van Schaik Ron H.N. , Danser A.H. Jan 
Published: December 2021

Background:
The severity of COVID-19 after SARS-CoV-2 infection is unpredictable. Angiotensin-converting enzyme-2 (ACE2) is the receptor responsible for coronavirus binding, while subsequent cell entry relies on priming by the serine protease TMPRSS2 (transmembrane protease, serine 2). Although renin-angiotensin-aldosterone-system (RAAS) blockers have been suggested to upregulate ACE2, their use in COVID-19 patients is now considered well tolerated. The aim of our study was to investigate parameters that determine COVID-19 severity, focusing on RAAS-components and variation in the genes encoding for ACE2 and TMPRSS2.

Methods:
Adult patients hospitalized due to SARS-CoV-2 infection between May 2020 and October 2020 in the Haga Teaching Hospital were included, and soluble ACE2 (sACE2), renin, aldosterone (in heparin plasma) and polymorphisms in the ACE2 and TMPRSS2 genes (in DNA obtained from EDTA blood) were determined.

Measurements and main results:
Out of the 188 patients who were included, 60 were defined as severe COVID-19 (ICU and/or death). These patients more often used antidiabetic drugs, were older, had higher renin and sACE2 levels, lower aldosterone levels and a lower aldosterone/renin ratio. In addition, they displayed the TMPRSS2-rs2070788 AA genotype less frequently. No ACE2 polymorphism-related differences were observed. Multivariate regression analysis revealed independent significance for age, sACE2, the aldosterone/renin ratio, and the TMPRSS2 rs2070788 non-AA genotype as predictors of COVID-19 severity, together yielding a C-index of 0.79. Findings were independent of the use of RAAS blockers.

Conclusion:
High sACE2, a low aldosterone/renin ratio and having the TMPRSS2 rs2070788 non-AA genotype are novel independent determinants that may help to predict COVID-19 disease severity.

Trial registration:
retrospectively registered.