bluuebunny/crossref_metadata_2025_split huggingface dataset:
1212. Whole Genome Sequencing for High-Resolution Methicillin-Resistant Staphylococcus aureus Outbreaks Tracing in Neonatal Intensive Care Units and In silico Resistance and Virulence Markers Detection
Authors: Durand Geraldine , Javerliat Fabien , Bes Michele , Laurent Frédéric , Vandenesch Francois , Tristan Anne 
Published: November 2018

Abstract

Background
The French National Reference Center for Staphylococci used whole genome sequencing (WGS) to investigate outbreaks due to a virulent MRSA clone containing the toxic shock syndrome toxin-1 (TSST-1+, sequence type 5, Geraldine clone) increasingly reported in neonatal intensive care units (ICUs).

Methods
We analyzed 48 isolates previously characterized by spa typing: 31 isolates from outbreak 1 (infected or colonized patients, healthcare workers carriage and environment), 12 isolates from four distinct outbreaks (2, 3, 4, and 5) that occurred in geographically independent neonatal ICUs, and five sporadic strains. We performed WGS using a de novo assembly approach to perform comparisons between isolates (EpiSeq®, bioMérieux). A phylogenetic analysis was constructed by comparing single nucleotide variations (SNVs) in 2020 core-genes using a cutoff of 40 SNVs for defining isolates belonging to the same transmission cluster. We detected in silico resistance and virulence markers using the same bioinformatic pipeline.

Results
For outbreak 1, 25/31 isolates with two distinct but related spa types t002 and t111 were highly related (&lt;13 SNVs), suggesting the transmission of the same strain; 6/31 isolates were genetically distinct (&gt;80 SNVs) from the previous cluster of 25 isolates suggesting their origin from separate sources. Interestingly the three isolates of outbreak 2 with a spa t111 differed by less than 22 SNVs from the main cluster of the 25 isolates of outbreak 1. This suggested origin from the same transmission cluster. The other three outbreaks showing respectively a spa t002 for outbreak 3 and outbreak 4 and a spa t045 for outbreak 5 were not affiliated to the main cluster of outbreak 1. The isolates carry numerous virulence factors (including TSST-1) and resistance markers confering a peculiar antibiotic resistance profile to the Geraldine clone.

Conclusion
WGS provides the resolution power to reveal unsuspected transmission events not indicated by conventional methods (different spa type). Based on its high resolution WGS is an all in one tool for epidemiology, virulence and resistance analysis. It really transforms outbreak management and infection control practice for an early response and should replace conventional methods for detection of MRSA transmission.

Disclosures
G. Durand, bioMérieux: Employee, Salary. F. Javerliat, bioMérieux: Employee, Salary.
1221. Genetic Characteristics of Healthcare-Associated Methicillin-Resistant Staphylococcus aureus (HA-MRSA) Belonging to Clonal Complex 5 (CC5) in Latin-America
Authors: Reyes Jinnethe , Carvajal Lina P , Rios Rafael , Echeverri Aura , Rincon Sandra , Munita Jose M , Tran Truc , Panesso Diana , Arias Cesar , Diaz Lorena 
Published: November 2018

Abstract

Background
MRSA are responsible for a high proportion of healthcare-associated infections. HA-MRSA is multidrug resistant, and infections occur most frequently among inpatients, for example, those who have undergone invasive medical procedures or those aged 50 to 60 years and older. Dominance of multidrug-resistant CC5 (Chilean and New York/Japan clones) was prevalent in infections in Latin America with the notable exception of Colombia and Ecuador where USA300-LV isolates dominate. We performed genetic characterization of HA-MRSA-CC5 isolates recovered from infections in nine countries (12 hospitals).

Methods
Species identification of S. aureus and presence of mecA were performed by PCR. We determined MICs to common anti-MRSA antibiotics and performed screening for VISA phenotype. Molecular characterization included detection of lukSF-PV and SCCmec typing. PFGE and MLST were performed in selected MRSA isolates with susceptibility patterns typical of the Chilean (ST5-MRSA-I) and USA300-LV (ST8-MRSA-IV) lineages.

Results
A total of 665 S. aureus isolates were prospectively recovered from 592 patients. A high frequency of methicillin resistance (&gt;40%) was observed in all countries (62%, 55%, 44%, and 40% in BRA, PER, CHI and ARG, respectively). Decreased susceptibility to VAN was not observed and VAN MIC90 was 1 µg/mL. In PER and CHI, the overwhelming majority of isolates (89%) belonged to the Chilean/Cordobes clone (CC5) with susceptibility patterns typical of this lineage (Resistance to β-lactams, MLSB-type, quinolones, and aminoglycosides). The New York/Japan clone (ST5-MRSA-II) was predominant in Brazil, replacing the prevalent hospital-associated Brazilian (ST239-MRSA-III) lineage. Most Argentinian MRSA isolates exhibiting a CA (ST5-IV) pattern, previously described in this country.

Conclusion
A variety of MRSA genetic lineages are circulating in Latin America with geographic clustering and clonal replacement. Dissemination of the CA-USA300-LV has not occurred beyond the northern region of the subcontinent.

Disclosures
J. M. Munita, Pfizer: Grant Investigator, Research grant. C. Arias, Merck & Co., Inc.: Grant Investigator, Research support. MeMed: Grant Investigator, Research support. Allergan: Grant Investigator, Research support.
1224. Drug-Resistance Dynamics of Staphylococcus aureus at a Tertiary Hospital, Beijing, China: 2013–2017
Authors: Zhang Yuzheng , Johnston Janice Mary , Fu Qiang 
Published: November 2018

Abstract

Background
To understand the drug-resistance dynamics of Staphylococcus aureus and provide references for effective control of methicillin-resistant Staphylococcus aureus (MRSA) infection.

Methods
All data were obtained from the healthcare-associated infection surveillance system. Different strains of S. aureus were identified using the VITEK-2 automated system, the drug susceptibility results of resistance and intermediate were classified into resistance. Chi-square test and variation analyses of S. aureus drug-resistant rate were performed.

Results
From 2013 to 2017, 2,289 strains of S. aureus were isolated, and the specimen were mostly collected from sputum (721, 31.50%), wound secretion (211, 9.22%), and blood (210, 9.17%). The resistance rate of S. aureus was highest for tigecycline (94.43% in 2013, 100% in 2017) and penicillin (96.49% in 2013, 95.60% in 2017) (P = 0.028). The resistance rates among other drugs such as clindamycin (65.28% in 2013, 71.39% in 2017) and erythromycin (69.62% in 2013, 62.59% in 2017) were more stable (P = 0.056). However, oxacillin (from 73.68% to 34.47%), gentamicin (from 51.51% to 24.13%), and tetracycline (from 46.78% to 30.81%) showed a declining trend (P = 0.017). Meanwhile, there were almost no S. aureus resistance to linezolid, vancomycin, and nitrofurantoin. During the previous 5-year period, MRSA rates decreased sharply and in 2017 rate was 34.47%. In 2017, MRSA was most frequently isolated in orthopedics, emergency ICU, and respiratory.

Conclusion
The reduction in drug-resistant MRSA may be evidence of effective antibiotic administration practice. Whereas more comprehensive infection control measures are needed to prevent the transmission of S. aureus and MRSA.

Disclosures
All authors: No reported disclosures.
1228. Incidence of Staphylococcus aureus Infection after Elective Surgeries Among Adults in US Hospitals
Authors: Dreyfus Jill , Begier Elizabeth , Yu Holly , Quintana Alvaro , Gayle Julie , Olsen Margaret A 
Published: November 2018

Abstract

Background
Staphylococcus aureus is a leading cause of postsurgical infections. National estimates of these infections after elective surgeries based on microbiology data are limited. This study assessed 180-day postsurgical S. aureus incidence in real-world hospital settings.

Methods
Adults (≥18 years) who underwent elective surgery during a hospital-based outpatient or inpatient encounter from July 1, 2010–June 30, 2015 at one of 181 hospitals reporting microbiology results in the Premier Healthcare Database (PHD). Eighty-seven surgical categories were defined using ICD-9-CM and CPT procedure codes according to National Hospital Surveillance Network groupings plus additional categories. Microbiology results and ICD-9-CM diagnosis codes were used to identify invasive (e.g., deep incisional and organ-space SSI, bloodstream) and overall (i.e., invasive, superficial incisional, urinary tract, respiratory) S. aureus infections. Cumulative 180-day S. aureus infection rates were calculated as number of infections divided by number of discharges with elective surgeries. National infection volumes were calculated by multiplying infection rates by national inpatient elective surgery estimates using surgery counts in the entire PHD (665 hospitals) and weights based on hospital characteristics.

Results
Following 1,116,994 hospital-based outpatient elective surgeries, 180-day S. aureus incidence was 1.19% overall, with 0.38% complicated by invasive S. aureus infections. Among 884,803 inpatient elective surgeries, overall and invasive 180-day S. aureus infection incidence was 1.35% and 0.53%, respectively. This translated to an estimated 57,200 S. aureus infections (22,400 invasive) among an estimated 4.2 million elective inpatient surgeries annually in the US methicillin-resistance (MRSA) was observed in 45% and 46% of S. aureus infections after inpatient and outpatient surgeries, respectively. Figure 1 shows cumulative S. aureus incidence rates at each time point after outpatient and inpatient elective surgeries. Figure 2 delineates the incidence rates for each type of S. aureus infection.

Conclusion
Our study indicated similar S. aureus infection rates after inpatient and outpatient elective surgeries. The results highlight the much larger burden of disease of S. aureus infection in the United States beyond inpatient surgeries.

Disclosures
J. Dreyfus, Premier, Inc.: Employee and Shareholder, Salary. E. Begier, Pfizer, Inc.: Employee and Shareholder, Salary. H. Yu, Pfizer, Inc.: Employee and Shareholder, Salary. A. Quintana, Pfizer, Inc.: Employee and Shareholder, Salary. J. Gayle, Premier, Inc.: Employee, Salary. M. A. Olsen, Pfizer: Consultant, Consulting fee.
1233. An Automated E-mail Notification Systemic to Infectious Disease Specialists and Effect on the Management of Staphylococcal aureus Bacteremia in a Community Hospital setting
Authors: Roe Nicole , Wang Michael , Douce Richard 
Published: November 2018

Abstract

Background
Staphylococcus aureus is the leading cause of community and healthcare-associated bacteremia and carries a high burden with a substantial mortality, ranging from 20 to 40 %. Evidence suggests infectious disease (ID) consultation improves mortality and adherence to the Infectious Diseases Society of America (IDSA) guidelines. Due to complications from a lack of ID consultation, a notification system consisting of automated e-mails to ID providers was implemented. The objective of this study was to review the impact of the automatic notification to ID consultants with positive blood culture results in a community hospital system.

Methods
Cases of staphylococcus aureus bacteremia were identified from the microbiology database by at least one positive blood culture. The automated e-mail notification system was implemented in December 2014. ID providers were encouraged to verbally contact primary providers for positive results. Cases of bacteremia prior to implementation of the automated notification system were compared with those post-intervention. Patients under age 18 were excluded. Data gathered included mortality, re-admission rates, and compliance with IDSA guidelines.

Results
There were no significant differences in inpatient mortality (9 vs. 18%, P = 0.180). 30-day mortality between the two groups (18 vs. 20%, P = 0.815). The 30-day readmission rate among surviving patients was reduced by 50% (40% vs. 19%, P = 0.014). Compliance with antibiotic duration in complicated bacteremia increased post-intervention (57% vs. 85%, P = 0.04).

Conclusion
An automatic notification to ID specialists reporting patients with Staphylococcus aureus bacteremia led to improved compliance with IDSA guidelines regarding antibiotic duration and reduced re-admission rates. There was no effect on overall mortality.
All authors: No reported disclosures.
1236. Infection Control Risk Mitigation and Implementation of Best Practice Recommendations in Long-Term Care Facilities
Authors: Fitzgerald Teresa , Nailon Regina , Tyner Kate , Beach Sue , Drake Margaret , Micheels Teresa , Rupp Mark E , Schwedhelm Michelle , Tierney Maureen , Ashraf Muhammad Salman 
Published: November 2018

Abstract

Background
Nebraska (NE) Infection Control Assessment and Promotion Program (ICAP) is a quality improvement initiative supported by the NE Department of Health and Human Services. This initiative utilizes subject matter experts (SMEs) including infectious diseases physicians and certified infection preventionists (IP) to assess and improve infection prevention and control programs (IPCP) in various healthcare settings. NE ICAP conducted on-site surveys and observations of IPCP in many volunteer facilities to include long-term care facilities (LTCF) between November 2015 and July 2017. SMEs provided on-site coaching and made best practice recommendations (BPR) for priority implementation. Impact of this intervention on LTCF IPCP was examined.

Methods
Using a standardized questionnaire, follow-up phone calls were made with LTCF to evaluate implementation of the BPR one-year post-assessment. Descriptive analyses were performed to examine BPR implementation in LTCF that had follow-up between 4/4/17 to 4/17/18 and to identify factors that promoted or impeded BPR implementation.

Results
Overall, 45 LTCF were assessed. The top 5 IC categories requiring improvement were audit and feedback practices (28 of 45, 62%), PPE supplies at point of use (62%), IC risk assessments (58%), TB risk assessments (56%), and supply and linen storage practices (56%). Follow-up assessments were completed for 270 recommendations in 25 LTCF. Recommendations reviewed ranged from three to 26 per LTCF (median = 15). The majority of the 270 recommendations (n = 162, 60%) had been either completely (35%) or partially (25%) implemented by the time of the follow-up calls. The ICAP visit itself was reported as the most helpful resource for BPR implementation (77 of 162). Lack of staffing was the most commonly mentioned barrier to implementation when LTCF implemented BPR partially or implementation was not planned (37 of 85). BPR Implementation most frequently involved additional staff training (64 of 162), review of policies and procedures (38 of 162), and implementing audit (34 of 162) and/or feedback (23 of 162) programs.

Conclusion
Numerous IC gaps exist in LTCF. Peer-to-peer feedback and coaching by SMEs facilitated implementation of many BPR directed toward mitigating identified IC gaps.

Disclosures
All authors: No reported disclosures.
1243. Comparative Analysis of Antimicrobial-related Adverse Events in the Outpatient Treatment of Staphylococcal Infections
Authors: Smith Bradley , Rivera Christina , Dierkhising Ross , Estes Lynn , O’Horo John , Tande Aaron , Zeuli John , Virk Abinash 
Published: November 2018

Abstract

Background
Limited data exist to evaluate safety-related outcomes in Outpatient Parenteral Antimicrobial Therapy (OPAT) patients treated with antimicrobial agents for Gram-positive infections.

Methods
This retrospective, single-center study enrolled Mayo Clinic OPAT patients between 2013 and 2017. The primary objective of the study compared rates of therapy modification due to drug-related toxicity for staphylococcal infections treated with ceftriaxone, cefazolin, nafcillin, oxacillin, vancomycin, daptomycin, ceftaroline, linezolid, or ertapenem. Secondary objectives included determination of the frequency and type of adverse drug events (ADEs) attributed to OPAT and rate of readmission due to ADEs attributed to OPAT.

Results
One hundred seventy-two patients were identified (cefazolin n = 54, ceftriaxone n = 49, vancomycin n = 30, daptomycin n = 16, nafcillin n = 9, ertapenem n = 6, ceftaroline n = 4, oxacillin n = 3, linezolid n = 1). The overall treatment completion rates were high (153/172, 89.0%). Patients completed an average of 35.3 days (7 to 95) of therapy with their original antibiotic. Fourteen patients required change to a different antibiotic due to antimicrobial toxicity (ceftriaxone=5; vancomycin=2; cefazolin = 2; daptomycin = 2; ceftaroline = 1; nafcillin = 1; oxacillin = 1) and five patients experienced treatment failure required an additional agent (ceftriaxone = 2; nafcillin = 2; linezolid = 1). Adverse drug events (ADEs) were the most common reason for antimicrobial adjustment (14/19, 73.7%). The most common ADEs were hypokalemia (28/172, 16.3%) and diarrhea (25/172, 14.5%). There were only two cases of Clostridium difficile. Thirty-day readmissions due to antimicrobial therapy were low with 11 patients.

Conclusion
OPAT with Gram-positive agents used for staphylococcal infections is effective, but antimicrobial modifications still occur. Clinicians should be aware of the risk of ADEs and readmissions in OPAT patients. A multidisciplinary approach may enhance management of ADEs and possibly preventing readmissions

Disclosures
All authors: No reported disclosures.
1251. Contaminated Sinks May be an Environmental Source for Serial Transmission of Carbapenem-Resistant Enterobacteriaceae (CRE) to ICU Patients
Authors: Lewis Sarah S , Seidelman Jessica , Huslage Kirk , Carriker Charlene , Hnat Amy , Lobaugh-Jin Erica , Sova Christopher , Taylor Bonnie , Strittholt Nancy , Vereen Sheila , Willis Robbie , Campbell Christy , Addison Rachel , Hazen Kevin , Mathers Amy , Vegesana Kasi , Carroll Joanne , Kotay Shireen , Baker Arthur W , Sexton Daniel , Anderson Deverick J , Smith Becky 
Published: November 2018

Abstract

Background
We performed an investigation after noting an increase in hospital-onset (HO) KPC-producing Enterobacteriaceae (KPC-E) infections in patients admitted to a tertiary referral hospital in North Carolina.

Methods
We defined pre-outbreak (January 1, 2017–June 30, 2017), outbreak (July 1, 2017–October 31, 2017), and post-outbreak (November 1, 2017–March 31, 2018) phases. A clinical case was defined as any positive clinical culture for KPC-E. HO was defined as a positive clinical or surveillance culture collected on hospital day ≥3. Patients were mapped in space and time to inform targeted environmental sampling. Whole-genome sequencing (WGS) was performed on selected KPC K. pneumoniae environmental and patient isolates to determine relatedness.
In October 2017, a CRE prevention bundle was implemented that included daily communication of CRE patient movement, increased audits/feedback of HCW compliance with hand hygiene, enhanced cleaning and disinfection in CRE rooms and high-risk units with bleach and UVC disinfection, and weekly rectal surveillance screens in four adult ICUs.

Results
0.67 clinical cases of KPC-E per month were observed during the pre-outbreak period compared with 3.75 clinical cases of KPC-E per month during the outbreak period. K. pneumoniae was the most common species (Figure 1). Mapping of patients revealed probable direct and indirect transmission between patients in multiple hospital units (Figure 2). three patients who were non-sequentially admitted to the same ICU room over a 12-week span acquired KPC K. pneumoniae (Figure 2). Environmental cultures from the in-room sink drain and P-trap grew KPC K. pneumoniae that was related to the patient isolates by WGS; the sink was removed. Although no additional clinical cases of KPC-E occurred after full implementation of the bundle and sink removal, we continued to observe acquisition of KPC-E rectal colonization in all four ICUs (Figure 3).

Conclusion
We describe a multispecies outbreak of KPC-E that was mitigated through evidence-based CRE control measures and removal of a colonized sink. However, ongoing low-level presumed transmission of KPC points to persistent environmental sources. Additional study is needed to understand the prevalence of CRE in hospital sinks, factors that drive drain colonization, and contribution of CRE in a sink to nosocomial transmission.

Disclosures
All authors: No reported disclosures.
1253. Healthcare-Associated Transmission of Burkholderia cepacia Complex Associated With Extrinsically Contaminated Nasal Spray
Authors: Tran Dat , Cassidy Maureen , Buehring Tara , Pierce Rebecca 
Published: November 2018

Abstract

Background
Burkholderia cepacia complex (Bcc) species can contaminate medical devices and water-based products, resulting in outbreaks of healthcare-associated infections. In March 2018, we investigated a cluster of 20 patients with a sinus culture positive for Bcc seen at two affiliated ENT clinics in Oregon over a 2-month period, based on reporting by a laboratorian in a central laboratory external to the clinics.

Methods
We conducted an epidemiologic investigation to identify potential causes for an apparent outbreak of Bcc, including review of health records and microbiologic reports, site visits, staff interviews, and cultures of common equipment and products.

Results
20 patients (9 were female; age range 10 to 72 years, median age 54.5 years) had new positive Bcc cultures from the sinus. The absence of cystic fibrosis, immunosuppression or sinonasal polyposis in all patients, scant growth of Bcc in most cases with isolation of another organism in some, and the use of Bcc-directed antibiotics in a minority of patients suggested the presence of a contamination source. All patients had received lidocaine/phenylephrine (L/P) via multidose nasal spray atomizers prior to endoscopically-directed sinus cultures. Site visits revealed improper medication dispensing and storage practices (e.g., no expiration date for L/P stock, storage of L/P-containing atomizers at room temperature), and inadequate instrument reprocessing and environmental cleaning. Cultures of L/P in 2/2 in-use atomizers and 1/1 opened stock bottle, as well as swabs of 3/3 spray mechanisms, grew Bcc. Cultures of L/P from the unopened, refrigerated stock bottle, a flexible endoscope and a rigid endoscope did not yield Bcc. No negative clinical sequelae in these patients were reported.

Conclusion
Contaminated multidose L/P nasal spray with Bcc resulted in nosocomial transmission at these clinics. This investigation highlights the important role of laboratorians in detecting Bcc contamination events that lead to colonization, and suboptimal reporting by clinicians in the outpatient setting. It also raises the question of how often such contamination events go undetected. Injection safety training needs to be broadened to “medication administration safety” training as one and only principles could have prevented this incident.

Disclosures
All authors: No reported disclosures.