bluuebunny/crossref_metadata_2025_split huggingface dataset:
Investigation of the Effects of Environmental Fatigue on the Mechanical Properties of GFRP Composite Constituents Using Nanoindentation
Authors: Gonabadi H. , Oila A. , Yadav A. , Bull S. 
Published: November 2021

Abstract
Background
Fatigue failure criteria for fibre reinforced polymer composites used in the design of marine structures are based on the micromechanical behaviour (e.g. stiffness properties) of their constituents. In the literature, there is a lack of information regarding the stiffness degradation of fibres, polymer matrix and fibre/matrix interface regions affected by environmental fatigue.

Objective
The aim of present study is to characterize the stiffness properties of composite constituents using the nanoindentation technique when fatigue failure of composites is due to the combined effect of sea water exposure and cyclic mechanical loads.

Methods
In the present study, the nanoindentation technique was used to characterize the stiffness properties of composite constituents where the effects of neighbouring phases, material pile up and viscoplasticity properties of the polymer matrix are corrected by finite element simulation.

Results
The use of finite element simulation in conjunction with nanoindentation test data, results in more accurate estimation of projected indented area which is required for measuring the properties of composite constituents. In addition, finite element simulation provides a greater understanding of the stress transfer between composite constituents during the nanoindentation process.

Conclusions
Results of nanoindentation testing on the composite microstructure of environmentally fatigue failed composite test coupons establish a strong link to the stiffness degradation of the fiber/matrix interface regions, verifying the degradation of composite constituents identified by scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDX) analysis.
The Impact of Coronavirus Disease 2019 (COVID-19) Pandemic on Device-Associated Healthcare-Associated Infection
Authors: Kang Minji , Henry Sharen , Thomas Elizabeth , Arocha Doramarie , Trivedi Julie 
Published: November 2021

Background: The impact of the coronavirus disease 2019 (COVID-19) pandemic on healthcare-associated infection (HAI) is not yet known. Diversion of resources from traditional HAI surveillance and prevention efforts toward institutional COVID-19 response, along with decrease in patient contact due to fear or required quarantine or isolation, may have increased HAI rates. In contrast, increased compliance with hand hygiene and personal protective equipment may have decreased HAI rates. Methods: We sought to determine the impact of COVID-19 pandemic on healthcare-associated central-line–associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI). CLABSI and CAUTI rates and standardized infection ratios (SIRs) reported to the NHSN from the first quarter of 2015 to the fourth quarter of 2020 were obtained for the entire facility and for the medical intensive care unit (MICU), which was converted during the pandemic to an intensive care unit solely for critically ill patients with COVID-19. Changes in CLABSI and CAUTI rates and SIRs before the pandemic (Q1 2015 to Q4 2019) and during the pandemic (Q1 2020 to Q4 2020) were assessed using an independent-sample t test. Results: The CLABSI rate was unchanged, with a mean (SD) of 0.64 (±0.34) CLABSIs per 1,000 central-line days before the pandemic and 0.72 (±0.22) during the pandemic (P = .62) (Figure 1). The SIR remained stable at 0.54 (±0.29) before and 0.96 (±0.59) during the COVID-19 pandemic (P = .25). However, CLABSI rate in MICU increased significantly from 0.92 (±1.00) to 2.75 (±1.00) (p < 0.01), along with SIR from 0.81 ± 0.89 to 2.53 ± 1.07 (p < 0.01) (Figure 1). CAUTI rate was unchanged with 1.17 ± 0.38 CAUTI per 1000 catheter days per quarter before, and 1.04 ± 0.87 during COVID-19 pandemic (p = 0.64). CAUTI SIR remained stable at 0.82 ± 0.31 before and 0.83 ± 0.86 during COVID-19 pandemic (p = 0.96). CAUTI rate in MICU was 0.78 ± 1.20 before and 2.17 ± 3.24 after COVID-19 pandemic (p = 0.45) (Figure 2). Conclusions: Although our institutional CLABSI and CAUTI rates and SIRs remained unchanged, our medical intensive care unit, which housed our critically ill patients with COVID-19, experienced significant increases in CLABSI rate and SIR. This finding is likely multifactorial in the setting of overextended nursing staff, use of prone position, and challenges of infection prevention efforts under isolation precautions.Funding: NoDisclosures: None
Impact of CLSI Break Point Changes Over the Past Decade on Antimicrobial Susceptibility in Gram-Negative Bacteria
Authors: Johnson Wesley , Burgess David , Burgess Donna , Cotner Sarah , VanHoose Jeremy , Clark Justin , Wallace Katie 
Published: November 2021

Background: Over the past decade, the CLSI has updated susceptibility break points for several antimicrobial agents. The purpose of this study was to evaluate the impact of these changes against gram-negative bacteria at our academic medical center. Methods: In this retrospective, IRB-approved study, we collected consecutive, nonduplicate clinical isolates of Enterobacter cloacae, Escherichia coli, Klebsiella aerogenes, K. oxytoca, K. pneumoniae, and Pseudomonas aeruginosa for the past decade (2010–2019) at our academic medical center and 3 adult ICUs. Susceptibility testing was performed using the BD Phoenix automated system. For these isolates, susceptibilities for 7 β-lactams (aztreonam, ceftriaxone, ceftazidime, cefepime, piperacillin/tazobactam, ertapenem, and meropenem) and 2 fluoroquinolones (levofloxacin, ciprofloxacin) were calculated based upon CLSI break points in 2010 and current CLSI break points in 2020. Any change >5% in susceptibility was deemed significant for this analysis. Results: In 17.5% of Enterobacteriales isolates tested, at least 1 antimicrobial demonstrated significant decline. Ertapenem was the most commonly affected antimicrobial (45% of the isolates) followed by ceftriaxone (35%) and cefepime (25%). Susceptibilities of aztreonam, ceftazidime, and meropenem were not affected for any of the Enterobacteriales. The most common organism demonstrating a significant impact on change in susceptibility among the Enterobacteriales was E. cloacae (41.7% of the time) followed by E. aerogenes (20.8%), K. oxytoca (12.5%), K. pneumoniae (8.3%) and E. coli (4.2%). Most of the impact was observed hospital-wide (33.3%), followed closely by the MICU (28.6%), the NSICU (23.8%) and the CVICU (14.3%). For P. aeruginosa, the impact of the antimicrobial break-point changes on susceptibility was more pronounced than the Enterobacteriales. Overall, 93.8% of the time there was a significant decline in antimicrobial susceptibility. Each antimicrobial (ciprofloxacin, levofloxacin, meropenem, and piperacillin/tazobactam) demonstrated a significant decline in susceptibility hospital-wide and in each ICU except for the susceptibility of meropenem in the NSICU. Conclusions: Changes in break points had a significant impact on the susceptibility of all antimicrobials for P. aeruginosa at our institution, both hospital-wide and in the adult ICUs. Although the impact was less for the Enterobacteriales, ertapenem, ceftriaxone, and cefepime demonstrated significant susceptibility changes, especially with E. cloacae. Understanding and evaluating the impact of the break-point changes may lead to changes in empiric therapy in other institutions.Funding: NoDisclosures: None
Microbiological Identification and Susceptibility Testing Using an Automated Method in a Tertiary-Care Public Hospital in Brazil
Authors: Midori Valeria , Yuki Gutoski , Rocha Patricia , Decarli Ariadne , Esteves Larissa , Nascimento Laís , Tuon Felipe , Ribeiro Victoria , Cieslinski Juliette 
Published: November 2021

Background: The use of the automated system for identification and susceptibility tests can improve antimicrobial stewardship. The reduction in the time of identification of the pathogen and the correct dose of antibiotic are factors that contribute significantly to institutional programs and patient outcomes. Objective: We identified and evaluated the susceptibility tests of microorganisms for common pathogens through antibiograms that accounted for the minimum inhibitory concentration (MIC), in a tertiary-care public hospital in Brazil. Methods: This retrospective, cross-sectional study was performed to identify microbiologic profiles after the implementation of a VITEK 2 system at a tertiary-care public hospital in Curitiba, Brazil. Based on data from the medical records, patients with positive cultures of clinical samples from August to December 2017 were included in this study. The analysis included culture results, susceptibility profiles, and MICs of 5 antibiotics: amikacin, cefepime, ciprofloxacin, meropenem and vancomycin. Results: In total, 545 antibiograms were evaluated using VITEK 2. The following microorganisms were isolated: 345 gram-negative bacilli (63.3%), 187 gram- positive cocci (34.3%), 9 unidentified microorganisms (1.7%), and 4 yeasts (0.7%). Among the analyzed antibiograms, amikacin was tested in 371 isolates (68.1%), with an MIC of 2 mg/L being the most prevalent value, with a frequency of 224 results (41.1%). Cefepime was tested in 319 isolates (58.5%), with an MIC of 1 mg/L being the most prevalent, with a frequency of 177 results (32.5%). Ciprofloxacin was tested in 470 isolates (86.2%), with an MIC of 0.25 mg/L being the most prevalent value, with frequency of 189 results (34.7%). Meropenem was tested in 318 isolates (58.3%), with an MIC of 0.25 mg/L being the most prevalent value, with a frequency of 223 results (40.9%). Vancomycin was tested in 157 isolates (28.8%), with an MIC of 1 mg/L being the most prevalent value, with frequency of 87 results (16%). Conclusions: When analyzing the most frequently isolated microorganisms and their predominant sensitivity profiles in our institution, amikacin proved to be a good therapeutic option, considering the epidemiological profile, as gram-negative bacilli showed greater sensitivity. Furthermore, VITEK 2 systems provided early access to appropriate antimicrobial therapy for patients, which is a known factor for reducing bacterial resistance.Funding: NoDisclosures: None
Differences in the Clinical Outcome of Community-Acquired APN According to the Appropriateness of Antibiotic Use
Authors: Kim Bongyoung , Yoon Choseok , Park Se Yoon , Kwon Ki Tae , Ryu Seong-yeol , Wie Seong-Heon , Jo Hyun-uk , Kim Jieun , Hong Kyung-Wook , In Kim Hye , Kim Hyun ah , Kim Mi-Hee , Bae Mi-Hyun , Sohn Yong-Hak , Kim Jieun , Lee Yangsoon , Pai Hyunjoo 
Published: November 2021

Background: The purpose of this study was to find out the relationship between appropriateness of antibiotic prescription and clinical outcomes in patients with community-acquired acute pyelonephritis (CA-APN). Methods: A multicenter prospective cohort study was performed in 8 Korean hospitals from September 2017 to August 2018. All hospitalized patients aged ≥19 years diagnosed with CA-APN at admission were recruited. Pregnant women and patients with insufficient data were excluded. In addition, patients with prolonged hospitalization due to medical problems that were not associated with APN treatment were excluded. The appropriateness of empirical and definitive antibiotics was divided into “optimal,” “suboptimal,” and “inappropriate,” and optimal and suboptimal were regarded as appropriate antibiotic use. The standard for the classification of empirical antibiotics was defined reflecting the Korean national guideline for the antibiotic use in urinary tract infection 2018. The standards for the classification of definitive antibiotics were defined according to the result of in vitro susceptibility tests of causative organisms. Clinical outcomes including clinical failure (mortality or recurrence) rate, hospitalization days, and medical costs were compared between patients who were prescribed antibiotics appropriately and those who were prescribed them inappropriately. Results: In total, 397 and 318 patients were eligible for the analysis of the appropriateness of empirical and definitive antibiotics, respectively. Of these, 10 (2.5%) and 18 (5.7%) were inappropriately prescribed empirical and definitive antibiotics, respectively, and 28 (8.8%) were prescribed either empirical or definitive antibiotics inappropriately. Patients who were prescribed empirical antibiotics appropriately showed a lower mortality rate (0 vs 10%; P = .025), shorter hospitalization days (9 vs 12.5 days; P = .014), and lower medical costs (US$2,333 vs US$4,531; P = .007) compared to those who were prescribed empirical antibiotics “inappropriately.” In comparison, we detected no significant differences in clinical outcomes between patients who were prescribed definitive antibiotics appropriately and those who were prescribed definitive antibiotics inappropriately. Patients who were prescribed both empirical and definitive antibiotics appropriately showed a lower clinical failure rate (0.3 vs 7.1%; P = .021) and shorter hospitalization days (9 vs 10.5 days; P = .041) compared to those who were prescribed either empirical or definitive antibiotics inappropriately. Conclusions: Appropriate use of antibiotics leads patients with CA-APN to better clinical outcomes including fewer hospitalization days and lower medical costs.Funding: NoDisclosures: None
Engaging Veterans in Identifying Key Elements of Environmental Cleaning: The Patient Perspective
Authors: Baubie Kelsey , McKinley Linda , Keating Julie , Bartel Rosemary 
Published: November 2021

Background: Contaminated surfaces in healthcare settings contribute to the transmission of pathogens. Environmental cleaning and disinfection are important for preventing pathogen transmission and reducing healthcare-associated infections (HAIs). Hospital cleanliness plays a large role in patient perception of the healthcare setting and, consequently, of patient satisfaction. However, patient perceptions of environmental cleaning remain unclear. To engage patients as part of achieving patient-centered care, we undertook a qualitative study to examine patient perspectives on environmental cleaning and disinfection in healthcare settings. Methods: We conducted semistructured qualitative interviews with 14 hospitalized patients at a large midwestern Veterans’ Administration hospital. Interviews were audio recorded, professionally transcribed verbatim, summarized in a “key domains” template developed by the research team, then coded for emerging themes. Results: Patients reported feeling satisfied with hospital cleanliness and especially the daily cleaning they observed while hospitalized. Cleaning activities highlighted included mopping and disinfecting high-touch surfaces, bathrooms, and floors. Despite this overall positive response, some patients expressed worries of being “in the way” or burdensome if they were in their rooms while staff were cleaning. One interviewee stated, “It’s easier for them if there isn’t a patient in [the room] … it’s hard to do any endeavor when you’ve got a complete stranger watching you.” Patients also acknowledged the importance of careful cleaning, especially during the COVID-19 crisis; “It’s got to be something you take seriously, especially during this pandemic.” Some patients spoke of the relationship which can develop between environmental services staff during daily hospital room cleaning. Conclusions: Patient perceptions of environmental cleaning are important to understand and incorporate into clinical practice. Overall, patients felt that their environments were clean, and they expressed confidence in the staff’s work. Interviewees additionally spoke of their own self-efficacy, saying they try to clean up after themselves and would feel comfortable speaking up if something needed to be cleaned. However, some patients acknowledged feeling burdensome to the environmental services staff if patients were present in rooms while staff cleaned. Cleaning activities may become more patient-centric if they are better planned (eg, while patient is out of the room) or based on patient preferences on time of day.Funding: NoDisclosures: None
Prevalence of Healthcare-Associated Infections at the National Hospital During the COVID-19 Pandemic in Peru
Authors: Huamani Jussara , Prudencio Walter 
Published: November 2021

Background: Healthcare-associated infections are important because they constitute a public health problem due to the increase in morbidity and mortality that they produce in hospitalized patients, increased hospitalization costs due to prolonged stay, expensive antibiotic treatments and surgical reinterventions, not counting the social costs due to loss of wages and production, among others. Methods: We report the specific prevalence of healthcare-associated infections (HCAIs) in Edgardo Rebagliati Martin National Hospital, Perú, in 2020. We performed a descriptive cross-sectional study from July 27 to July 31, 2020. The medical records of hospitalized patients were reviewed according to the inclusion criteria. STATA software was used for descriptive statistical analyses. Results: In total, 1,217 hospitalized patients were included in the study. The prevalence of HCAI was 12.2% (149 patients). The prevalence of HCAI in areas where patients with the diagnosis of COVID-19 were hospitalized was higher (8.1%) than in common hospitalization areas (4.1%). Men represented 92% of the total number of patients with HCAIs. The most frequent infections were clinically defined pneumonia (30.9%) and bloodstream infections (20.1%). The most frequently isolated microorganism was Pseudomonas aeruginosa. Conclusions: The prevalence of HCAI was 12.2%. The most frequent HCAIs were pneumonia and bloodstream infection.Funding: NoDisclosures: None
Evaluation of Electronic Health Record and Long-Term Care Pharmacy Data for Tracking and Reporting Antibiotic Use in the United States
Authors: Hudson Matthew , Gouin Katryna , Wang Stanley , Kulkarni Manjiri , Beckerson Mary , Ditz Laura , Creasy Stephen , Wdowicki Marti , Chi Nancy , Hicks Lauri , Kabbani Sarah 
Published: November 2021

Background: Antibiotics are frequently prescribed in nursing homes, often inappropriately. Data sources are needed to facilitate measurement and reporting of antibiotic use to inform antibiotic stewardship efforts. Previous analyses have shown that the type of nursing-home stay, that is, short stay (<100 days), is a strong predictor of high antibiotic use compared to longer nursing-home stays. The study objective was to compare 2 different data sources, electronic health record (EHR) and long-term care (LTC) pharmacy data, for surveillance of antibiotic use and type of nursing-home stay. Methods: EHR and pharmacy data during 2017 were included from 1,933 and 1,348 US-based nursing homes, respectively. We compared data elements available in each data source for antibiotic use reporting. In each data set, we attempted to describe antibiotic use as the proportion of residents on an antibiotic, days-of-therapy (DOT) per 1,000 resident days (RD), and distribution of antibiotic course duration, overall and at the facility level. Facility proportion of short-stay and long-stay (>100 days) nursing-home residents were calculated using admission dates and census data in the EHR data set and a payor variable in the pharmacy data set (Figure 1). The 2 data sources also provided antibiotic characteristics, including antibiotic class, agent, and route of administration. The deidentified nature of facility data prevented direct comparison of antibiotic use measures between facilities. Results: The EHR and pharmacy data sets contained 381,382 and 326,713 residents, respectively (Table 1). Within the EHR, 51% of residents were prescribed an antibiotic in 2017, at a median rate of 77 DOT per 1,000 RD. In the LTC pharmacy, 46% of residents were prescribed an antibiotic at a median rate of 79 DOT per 1,000 RD (Table 1). Short-stay residents contributed a smaller proportion of total RDs in the EHR relative to the pharmacy cohort (21% vs 50%, respectively). Conclusions: Nursing-home antibiotic use data obtained from EHR and pharmacy vendors can be used for calculating antibiotic use measures, which is important for antibiotic use reporting and facility-level tracking to identify opportunities for improving prescribing practices and provide facility-level benchmarks. Further validation of both data sources in the same facilities is needed to compare antibiotic use rates and to determine the most appropriate proxy for type of nursing-home stay for facility-level risk adjustment of antibiotic use rates.Funding: NoDisclosures: None
Impact of COVID-19 on Antimicrobial Use and Resistance in an Urban Safety-Net Community Hospital
Authors: Lora Alfredo Mena , Li Ella , Herald Fischer , Simpkins Nichelle , Krill Candice , Takhsh Eden , Burgos Rodrigo , Marchionne John , Ali Mirza , Spencer Sherrie , Bleasdale Susan , Borgetti Scott 
Published: November 2021

Background: The disease caused by SARS-CoV-2, COVID-19, has caused a pandemic leading to strained healthcare systems worldwide and an unprecedented public health crisis. Lower respiratory tract infections (LRTIs) and hypoxia caused by COVID-19 has led to an increase in hospitalizations. We sought to define the impact of COVID-19 on antimicrobial use and antimicrobial resistance (AMR) in an urban safety-net community hospital. Methods: Retrospective review of antimicrobial use and AMR in a 151-bed urban community hospital. Antimicrobial use was calculated in days of therapy per 1,000 patient days (DOT/1,000 PD) for ceftriaxone, piperacillin-tazobactam and meropenem during 2019 and 2020. Ceftriaxone, piperacillin-tazobactam and meropenem were reviewed for calendar year 2019 and 2020. AMR was assessed by comparing the carbapenem resistant Enterobacteriaceae (CRE) infection incidence rate per 1,000 patient days between 2019 and 2020. Results: The average quarterly DOT/1,000 PD increased from 359.5 in 2019 to 394.25 in 2020, with the highest increase in the second and fourth quarters of 2020, which temporarily correspond to the first and second waves of COVID-19. Ceftriaxone and meropenem use increased during the first and second waves of COVID-19. Piperacillin-tazobactam use increased during the first wave and declined thereafter (Figure 1). Rates of CRE increased from a quarterly average of 0.57 to 0.68 (Figure 2). Conclusions: Antimicrobial pressure increased during the first and second waves of COVID-19. Ceftriaxone was the most commonly used antimicrobial, reflecting internal guidelines and ASP interventions. CRE rates increased during COVID-19. This finding may be due to an overall increase in antimicrobial pressure in the community and in critically ill patients. Antibiotics are a precious resource, and antimicrobial stewardship remains important during the COVID-19 pandemic. Appropriate use of antimicrobials is critical to preventing AMR.Funding: NoDisclosures: None