bluuebunny/crossref_metadata_2025_split huggingface dataset:
Extended-Spectrum Β-Lactamases in E. coli Isolates From Hospitalized Patients: A Single-Center Snapshot From Croatia
Authors: Mestrovic Tomislav , Bedenic Branka , Tomic-Paradzik Maja , Drenjancevic Domagoj 
Published: November 2021

Background: A significant increasing trend in the prevalence of Escherichia coli strains that produce extended-spectrum β-lactamases (ESBLs) has been observed in recent years, both in the community setting and in the healthcare arena. We aimed to provide a snapshot of the current situation with E. coli β-lactamase–producing strains in a single general hospital by appraising their β-lactamase content and plasmid types, which will inform further clinical and research efforts. Methods: Our study population consisted of all hospitalized patients in different clinical units of the General Hospital in Slavonski Brod during a 1-year period: internal medicine, infectious disease, surgery, urology and ICU. Phenotypic tests for the detection of ESBLs and plasmid-mediated AmpC β-lactamases were initially pursued, followed by the molecular detection (polymerase chain reaction, PCR) of resistance genes using primers for blaTEM, blaCTX-M, and blaSHV. PCR-based replicon typing (PBRT) was conducted to type resistance plasmids carrying ESBL genes. Results: During the study period, 30 E. coli isolates with reduced susceptibility to third-generation cephalosporins (ie, ceftazidime, cefotaxime, and ceftriaxone) were detected in hospitalized patients. These isolates stemmed from blood culture (66.7%), wound swabs (13.3%), urine (13.3%), and drainage content (6.7%). Alongside complete resistance to β-lactam antimicrobial agents, they were also characterized by high resistance to gentamicin (93.3%) and ciprofloxacin (96.7%), whereas 23.3% of isolates were also resistant to ertapenem. Most isolates harbored both blaCTX-M and blaTEM genes concurrently (46.7%), while solitary blaTEM and blaCTX-M genes were found in 33.3% and 20% of these isolates, respectively. The presence of SHV β-lactamases was not found in any of the isolates. PBRT revealed a wide array of diverse plasmid groups, with most of the isolates harboring different combinations; however, 80% of isolates were characterized by plasmid incompatibility group B/O (IncB/O). Conclusions: We detected increased frequency of both TEM and CTX-M type β-lactamases in E. coli isolates from a single-hospital setting, with significant consequences for further treatment approaches. The high prevalence of broad- and extended-spectrum β-lactamase producers tends to prompt an increased carbapenem use (potentially resulting in increased resistance to carbapenems); thus, this type of analytical work should become a standard approach (where possible) in hospital centers in our country and worldwide.Funding: NoDisclosures: None
Sustainable Neonatal CLABSI Surveillance: Consensus Toward New Criteria in the Netherlands
Authors: Heijting Ilja , Hopman Joost , Hogeveen Marije , de Boode Willem , Tostmann Alma , Antonius Tim 
Published: November 2021

Group Name: Working Group on Neonatal Infectious Diseases of the Section of Neonatology of the Dutch Paediatric SocietyBackground: Central-line–associated bloodstream infections (CLABSIs) are a main focus of infection prevention and control initiatives in neonatal care. Standardized surveillance of neonatal CLABSI enables intra- and interfacility comparisons, which can contribute to quality improvement. To date, there is no national registration system for CLABSI in neonatal care in the Netherlands. Across neonatal intensive care units (NICUs), several different sets of CLABSI criteria and surveillance methods are used for local monitoring of CLABSI incidence rates. To achieve standardized CLABSI surveillance, we conducted a consensus procedure with regard to nationwide neonatal CLABSI surveillance criteria. Method: A modified Delphi consensus procedure for the development of nationwide neonatal CLABSI surveillance criteria was performed between January 2016 and January 2017 in the Netherlands. An expert panel was formed by members of the Working Group on Neonatal Infectious Diseases of the Section of Neonatology of the Dutch Paediatric Society. The consensus procedure consisted of 3 expert panel rounds. Figure 1 shows a detailed description of the consensus procedure. Result: The expert panel achieved consensus on Dutch neonatal CLABSI surveillance criteria, which are summarized in Figure 2. Neonatal CLABSI is defined as a bloodstream infection occurring >72 hours after birth, associated with an indwelling central venous or arterial line and laboratory confirmed by 1 or more blood cultures. In addition, the blood culture finding should not be related to an infection at another site and one of the following criteria can be applied: (1) a bacterial or fungal pathogen is identified from 1 or more blood cultures; (2) the patient has clinical symptoms of sepsis and (2A) a common commensal is identified in 2 separate blood cultures or (2B) a common commensal is identified by 1 blood culture and C-reactive protein (CRP) level is >10 mg/L in the first 36 hours following blood culture collection. Conclusion: The newly developed Dutch neonatal CLABSI surveillance criteria are concise, are specific to the neonatal population, and comply with a single blood-culture policy in actual neonatal clinical practice. International agreement upon neonatal CLABSI surveillance criteria is needed to identify best practices for infection prevention and control.Funding: NoDisclosures: None
Hospital Onset Vancomycin-Resistant Enterococci Infections in a Northern California Tertiary-Care Center From 2019 to 2020
Authors: Rasmussen Stephanie , Waldman Sarah 
Published: November 2021

Background: Understanding the epidemiology and risk factors for nosocomial infections with vancomycin-resistant enterococci (VRE) is necessary for the prevention and control of VRE infections in the hospital setting. We sought to determine the incidence of nosocomial infections of VRE and to ascertain predictors associated with nosocomial infection. Methods: In this retrospective cohort study, data were collected from patients with VRE infection from January 2019 to December 2020 at a tertiary-care center in northern California. VRE infections were designated as hospital onset (HO) if the specimen was collected >3 days after hospital admission or community onset (CO) if the specimen was collected ≤3 days after admission. Associations between HO infections with time, unit, and specimen were identified. Results: Over the 2-year period, 214 unique VRE infections were identified in hospitalized patients; 115 infections were CO and 99 were HO. HO-VRE were associated most frequently with stay in medical/telemetry units (68%), followed by oncology–transplant units (15%) and ICUs (12%). There were ~4.7 and ~3.6 HO-VRE infections per month in 2019 and 2020, respectively. No differences were identified between HO-VRE infections in 2 medical units regarding glycopeptide and cephalosporin use in those units. The sources of VRE infections were urinary 45%, bloodstream 15%, stool 10%, and other 30%. Of the 45 infections in urine, 51% were identified from catheters (Foley and straight) and 27% were identified from clean-catch urine. Interestingly, 71% of patients with VRE identified from urine did not report urinary tract infection (UTI) symptoms at the time of collection. Urine was most often collected for urinalysis and culture from patients with nonspecific symptoms such as fever, leukocytosis, hypotension, tachycardia, or altered mental status. All urine collected from patients who reported UTI symptoms grew >100,000 CFU/mL in culture, while only 75% of cultures from patients without symptoms grew >100,000 CFU/mL. The most common antibiogram was resistance to ampicillin, cefazolin, levofloxacin, minocycline, penicillin, tetracycline, and/or vancomycin (42% of cases) and susceptibility to both daptomycin and linezolid (60% of cases). Conclusions: HO-VRE infections were frequently identified with urinary sources and were often associated with catheter use. However, the frequent lack of concurrent UTI symptoms suggests VRE colonization rather than infection in many cases. Understanding the epidemiology and risk factors for HO-VRE infections is essential for developing infection prevention protocols to reduce the incidence of those infections.Funding: NoDisclosures: None
Klebsiella pneumoniae Carbapenemase (KPC)–Producing K. pneumoniae Contamination of an In-Room Sink in a New Bed Tower
Authors: Warren Bobby , Smith Becky , Lewis Sarah , Anderson Deverick , Addison Bechtler 
Published: November 2021

Group Name: Duke Center for Antimicrobial Stewardship and Infection PreventionBackground: Wastewater drains in hospital patient rooms have been identified as environmental reservoirs for multidrug-resistant organisms, and they have been linked to outbreaks of carbapenem-resistant Enterobacteriaceae (CRE). We studied the colonization of wastewater drains in a new hospital bed tower. Methods: A patient care unit in a new bed tower opened on July 18, 2020. In-room sinks were located in each hospital room opposite the patient head wall. Patients admitted to this unit underwent weekly rectal cultures to survey for carbapenemase-producing CRE. Additionally, infection preventionists performed routine surveillance of all clinical cultures for CRE. Cultures were performed from all patient room sinks in this unit monthly beginning September 14, 2020. Samples were obtained from the drain cover, handles, and top of bowl using sponges soaked in neutralizing buffer and processed using the stomacher technique. The tail-pipe was sampled using a flocked mini-tip swab soaked in neutralizing buffer; the P-trap water was sampled with sterile tubing attached to a 50-mL syringe. All samples were plated on HARDYCHROM-ESBL and KPC Colorex media and were incubated at 37°C for 24 hours. Results: The first identified CRE-positive patient was admitted to the new unit on December 4, 2020; urine culture obtained at the time of admission grew KPC–producing Klebsiella pneumoniae (KPC-KP). The sink in this patient’s room had been sampled 3 prior times (most recently on November 9, 2020) and was negative for CRE. On December 7, 2020, KPC-KP was found on the drain cover (6,750 colony-forming units, CFU) and in the sink’s P-trap (1,840 CFU) of the index patient’s room during routine sink surveillance. Additional samples from other room surfaces were taken on December 9, 2020, and KPC-KP was recovered from the computer keyboard (452 CFU) and patient bedrails (880 CFU). The patient was discharged from this room December 13, 2020, and the room underwent enhanced terminal room cleaning including UV-C light. On the next routine sink sampling on January 4, 2021, KPC-KP was recovered again in the index room sink P-trap (9,800 CFU) but at no additional sites. MLST was performed, and all isolates were ST-258. Conclusions: In a new bed tower with no prior evidence of CRE-positive patients, the first identified case of a CRE (KPC-KP) in a patient resulted in widespread environmental contamination of the room after only 3 days of hospitalization and contamination of the in-room sink drain that persisted after 1 month. Given the ease with which CRE colonizes wastewater drains, new strategies are needed to mitigate drain colonization and to prevent CRE transmission to subsequent patients.Funding: NoDisclosures: None
Risk of Methicillin-Resistant Staphylococcus aureus (MRSA) and Vancomycin-Resistant Enterococcus (VRE) Acquisition in Ambulances: A Retrospective Propensity Score-Matched Cohort Analysis
Authors: Schaps Diego , Anderson Deverick , Godfrey Andrew 
Published: November 2021

Background: Infection following ambulance transport, or medical-transport–associated infection (MTAI), is understudied. Although medical-transport vehicles are routinely contaminated with methicillin-resistant Staphylococcus aureus (MRSA) and/or vancomycin-resistant Enterococcus (VRE), an association between vehicle exposure and disease development has not been identified. We estimated the relative risk (RR) of developing MRSA or VRE colonization or infection within 30 days of ambulance exposure. Methods: We performed a retrospective cohort study of patients with a principal diagnosis of chest pain presenting to our emergency department (ED) from January 1, 2016, through December 31, 2019. To control for confounding by healthcare exposure, patients were included if they presented from and were discharged to nonhealthcare locations without being admitted to the hospital. Encounters were stratified by whether the patient arrived at the ED via ambulance or private vehicle. Propensity scores were calculated using multivariable logistic regression with ambulance exposure as the dependent variable. Age, smoking status, history of myocardial infarction, congestive heart failure, peripheral vascular disease, cerebrovascular disease, dementia, diabetes mellitus, and chronic kidney disease were included as covariates because their standard differences were >0.10. Propensity score matching was performed in a 2:1 ratio, but not all exposed patients received 2 matching unexposed patients due to a low sample size. A multivariable logistic regression was performed on the matched cohort to estimate the RR of newly diagnosed MRSA or VRE infection or colonization within 30 days following ambulance exposure. Results: In total, 321,229 patients had ED encounters during the study period. After applying inclusion criteria and propensity score-matching there were 11,324 patients: 3,903 in the ambulance group and 7,421 in the unexposed group. Moreover, 12 patients (0.11%) had the outcome of interest, including 9 (0.08%) with MRSA and 3 (0.03%) with VRE. The 30-day prevalences of MRSA and VRE were larger in the ambulance group than in the unexposed group: 8 (0.20%) and 4 (0.05%), respectively (P = .02). Patients who presented to the ED via ambulance were almost 4 times more likely to have MRSA or VRE within 30 days of their encounter (RR, 3.72; 95% CI, 1.09–12.71; P = .04). The RRs for MRSA and VRE alone were 3.33 (95% CI, 0.79–13.94; P = .10) and 4.14 (95% CI, 0.37–46; P = .25), respectively. Conclusions: To our knowledge, our cohort study is the first to demonstrate an association between ambulance exposure and the development of disease. These results represent the first step in evaluating MTAI burden to eventually develop targeted interventions with the purpose of reducing it.Funding: NoDisclosures: None
Respiratory Syncytial Virus: An Underrecognized Healthcare-Associated Infection
Authors: Gettler Erin , Talbot Thomas , Talbot H. Keipp , Ndi Danielle , Mitchel Edward , Markus Tiffanie , Harris Bryan , Schaffner William 
Published: November 2021

Background: Despite significant morbidity and mortality, estimates of the burden of healthcare-associated viral respiratory infections (HA-VRI) for noninfluenza infections are limited. Of the studies assessing the burden of respiratory syncytial virus (RSV), cases are typically classified as healthcare associated if a positive test result occurred after the first 3 days following admission, which may miss healthcare exposures prior to admission. Utilizing an expanded definition of healthcare-associated RSV, we assessed the estimates of disease prevalence. Methods: This study included laboratory-confirmed cases of RSV in adult and pediatric patients admitted to acute-care hospitals in a catchment area of 8 counties in Tennessee identified between October 1, 2016, and April 30, 2019. Surveillance information was abstracted from hospital and state laboratory databases, hospital infection control databases, reportable condition databases, and electronic health records as a part of the Influenza Hospitalization Surveillance Network by the Emerging Infections Program. Cases were defined as healthcare-associated RSV if laboratory confirmation of infection occurred (1) on or after hospital day 4 (ie, “traditional definition”) or (2) between hospital day 0 and 3 in patients transferred from a chronic care facility or with a recent discharge from another acute-care facility in the 7 days preceding the current index admission (ie, “enhanced definition”). The proportion of laboratory-confirmed RSV designated as HA-VRI using both the traditional definition as well as with the added enhanced definition were compared. Results: We identified 900 cases of RSV in hospitalized patients over the study period. Using the traditional definition for HA-VRI, only 41 (4.6%) were deemed healthcare associated. Adding the cases identified using the enhanced definition, an additional 12 cases (1.3%) were noted in patients transferred from a chronic care facility for the current acute-care admission and 17 cases (1.9%) were noted in patients with a prior acute-care admission in the preceding 7 days. Using our expanded definition, the total proportion of healthcare-associated RSV in this cohort was 69 (7.7%) of 900 compared to 13.1% of cases for influenza (Figure 1). Although the burden of HA-VRI due to RSV was less than that of influenza, when stratified by age, the rate increased to 11.7% for those aged 50–64 years and to 10.1% for those aged ≥65 years (Figure 2). Conclusions: RSV infections are often not included in estimates of HA-VRI, but the proportion of cases that are healthcare associated are substantial. Typical surveillance methods likely underestimate the burden of disease related to RSV, especially for those aged ≥50 years.Funding: NoDisclosures: None
Facemasks for Source Control: Testing Influenza Transfer to Bedside Tables
Authors: Biggio Adriane , Nagy-Agren Stephanie 
Published: November 2021

Background: Research testing human study participants regarding the effectiveness of face masks in preventing influenza transfer or transmission is limited. In this pilot study, we investigated the following question: In influenza-positive veterans, what is the effect of face-mask wearing in comparison to not wearing a face mask on influenza transfer to bedside tables measured for 2 hours per condition over a 10-week period during the 2019–2020 influenza season Methods: Influenza-positive veterans with influenza symptom onset ≤ 120 hours admitted to the Salem Veterans Affairs Medical Center were recruited to participate in this study. Exclusion criteria included critical illness requiring an oxygen mask or intubation. The Precept® FluidGard® 160 Procedure Mask 15300, Precept Medical Products, Inc., Arden, NC was worn by all participants during the two-hour intervention period. Surface swabs were used to measure the presence of influenza on bedside tables. CDC/NIOSH tested for influenza A and B from surface samples and facemasks using real-time polymerase chain reaction (PCR) assay (TaqMan ThermoFisher Scientific). Demographic information was collected (Table 1). A study questionnaire collected qualitative data on tolerability and feasibility of wearing a facemask when hospitalized with influenza. Institutional Review Board approval was granted. Results: From January 2, 2020, to March 11, 2020, 8 participants completed the study. Mean age was 67 years, all were male. Of these 8 participants, 6 had influenza A and 2 had influenza B. Half were diabetic; all received oseltamivir. Relative room humidity ranged from 15.6% to 39.8%. Neither influenza A nor B was detected by qPCR on bedside tables for any of the 8 participants under either face-mask–wearing condition. All participants reported that wearing the face mask was easy or very easy; of these, 5 reported experiencing warmth from the mask. Also, 50% of participants selected 2 hours as the time they could tolerate wearing a mask; the other 25% specified they could wear the face mask for 3 hours or 5 hours or more, respectively. Conclusions: In this pilot study, we demonstrated that wearing face masks is a tolerable infection control practice for providing source control for inpatients with influenza and will guide future research. Because a major limitation was the small size of the study, associated with lack of viral capture, a larger study is planned. Using face masks for source control among inpatients with influenza and other respiratory virus infections should be considered a standard infection control practice.Funding: NoDisclosures: None
The Impact of Narrowing Perioperative Antibiotic Prophylaxis for Left-Ventricular-Assist Device Implantation
Authors: Allen Lauren , Bartash Rachel , Cowman Kelsie , Guo Yi , Minamoto Grace , Patel Snehal , Vukelic Sasha , Nnani Daryl , Fauvel Daphenie 
Published: November 2021

Background: Left-ventricular-assist device (LVAD)–related infections occur in 20%–40% of LVAD recipients and may result in up to 10% of LVAD-related deaths. Optimal surgical infection prophylaxis for LVAD implantation is not well defined. Our institution historically used a 4-drug surgical infection prophylaxis regimen of fluconazole, ciprofloxacin, rifampin, and vancomycin as recommended by the device manufacturer. In January 2020, a 2-drug surgical infection prophylaxis regimen of vancomycin and cefazolin was implemented to reduce broad-spectrum antibiotic use while preserving gram-positive coverage. The primary objective of this study was to compare LVAD-associated infection rates before and after changing surgical infection prophylaxis. Methods: A retrospective review of patients who underwent LVAD implantation between January 2018 and January 1, 2021, was performed. Definitions of LVAD-associated infections and non-LVAD infections were based on the International Society for Heart and Lung Transplantation guidelines. Infection rates at 2 weeks and 30 days after implantation and 30-day mortality were compared between the 4-drug surgical infection prophylaxis regimen (January 2018–December 2019) and the 2-drug regimen (January 2020–January 2021). Additional data collected included demographics, cause of cardiomyopathy, type of infection, and causative organism. Results: In total, 51 patients were in the 4-drug surgical infection prophylaxis group and 23 patients were in the 2-drug surgical infection prophylaxis group. Baseline characteristics between the groups were similar. The cause of cardiomyopathy in both groups was predominantly nonischemic (67% vs 70%, = .81), and most patients received a Heartmate III device (84% vs 100%, P = .06). There was no statistical difference between infection rates in the 4-drug and 2-drug prophylaxis groups at 2 weeks or 30 days (Table 1). The 30-day mortality rate was 4% in the 4-drug group versus 13% in the 2-drug group (P = .17). No deaths were due to infections. Gram-negative and fungal LVAD–associated infections were rare: 4% versus 4% (P = .99) for gram-negative infections and 2% versus 0% (P = .99) for fungal infections. The most commonly isolated organisms were Staphylococcus aureus and coagulase-negative Staphylococcus in both groups. Pneumonia was the most common infection in both groups (Figure 1). Conclusions: We did not observe a significant increase in infection or mortality with narrowing of perioperative antibiotics. However, these results should be interpreted cautiously given the small sample size. Larger studies are needed to confirm these findings.Funding: NoDisclosures: None