bluuebunny/crossref_metadata_2025_split huggingface dataset:
1223. Increasing Incidence of Methicillin-Resistant Staphylococcus aureus in Greenland
Authors: Kjerulf Anne , Holt Jette , Jensen Anne Birgitte , Poulsen Peter , Petersen Andreas 
Published: November 2018

Abstract

Background
The first case of methicillin-resistant Staphylococcus aureus (MRSA) in Greenland was diagnosed in 2000 and led to the first guideline on screening and treatment for MRSA. Up to 2015 there were only 13 patients with MRSA but since then a nearly 4-fold increase in incidence has been seen. The objectives of this study were to analyze the reasons for this increase.

Methods
MRSA data were collected from the laboratory surveillance database at Dronning Ingrids Hospital, typing results from the Reference Laboratory for Antimicrobial Resistance and Staphylococci at SSI, and the patient records.

Results
From 2000 to 2017, 48 patients (15 children and 33 adults) have been diagnosed with MRSA. Thirty patients were colonized with MRSA, predominantly in the nose and throat. Eighteen patients had infections: conjunctivitis, middle ear infections, wounds, skin abscesses, mastitis, surgical site infections, for example.
The increase since 2015 was mainly due to three large outbreaks in three different cities: Aasiaat in 2014/2015 (seven persons with MRSA; three children and four adults), the capital Nuuk in 2016 (six persons with MRSA; two children and four adults) and Tasiilaq in 2017 (13 persons with MRSA; three children and ten adults). The first two outbreaks were community-acquired with transmission in families and the last one was community-acquired or community-onset hospital acquired. Each outbreak was caused by a specific MRSA-type: t902 CC22 in Aasiaat (unknown epidemiology), t3979 CC5 in Nuuk (probably from Australia), and t304 CC6 in Tasiilaq (probably from Denmark).
MRSA was mainly imported from Denmark or abroad due to admission to hospital or due to traveling to high-endemic countries like Australia, but in some cases the epidemiology was unknown. Transmission occurred mainly in families with close contact.

Conclusion
The increasing number of patients with MRSA in Greenland can be explained by factors such as import from Denmark or abroad due to admission to hospital or traveling, and transmission in Greenland. An ongoing surveillance, compliance to screening procedures (especially patients admitted to hospitals abroad) and guidelines for infection prevention and control are necessary in order to combat MRSA in Greenland in the future.

Disclosures
All authors: No reported disclosures.
1230. Epidemiology and Risk Factors for Recurrent Invasive Methicillin-Resistant Staphylococcus aureus Infection: nine US States, 2006–2013
Authors: Kracalik Ian , Jackson Kelly , Nadle Joelle , Bamberg Wendy , Petit Susan , Ray Susan M , Lynfield Ruth , Harrison Lee H , Townes John M , Dumyati Ghinwa , Schaffner William , Lake Jason , See Isaac 
Published: November 2018

Abstract

Background
Methicillin-resistant Staphylococcus aureus (MRSA) causes &gt;70,000 invasive infections annually in the United States, and recurrent infections pose a major clinical challenge. We examined risk factors for recurrent MRSA infections.

Methods
We identified patients with an initial invasive MRSA infection (isolation from a normally sterile body site) from 2006 to 2013, through active, population-based surveillance in selected counties in nine states through the Emerging Infections Program. Recurrence was defined as invasive MRSA isolation &gt;30 days after initial isolation. We used logistic regression with backwards selection to evaluate adjusted odds ratios (aOR) associated with recurrence within 180 days, prior healthcare exposures, and initial infection type, controlling for patient demographics and comorbidities.

Results
Among 24,478 patients with invasive MRSA, 3,976 (16%) experienced a recurrence, including 61% (2,438) within 180 days. Risk factors for recurrence were: injection drug use (IDU) (aOR; 1.38, 95% confidence interval [CI]: 1.15–1.65), central venous catheters (aOR; 1.35, 95% CI: 1.22–1.51), dialysis (aOR; 2.00, 95% CI: 1.74–2.31), and history of MRSA colonization (aOR; 1.35, 95% CI: 1.22–1.51) (figure). Recurrence was more likely for bloodstream infections (BSI) without another infection (aOR; 2.08, 95% CI: 1.74–2.48), endocarditis (aOR; 1.46, 95% CI: 1.16–1.55), and bone/joint infections (aOR; 1.38, 95% CI: 1.20–1.59), and less likely for pneumonia (aOR: 0.75, 95% CI: 0.64–0.89), compared with other initial infection types. When assessed separately, the presence of a secondary BSI with another infection increased the odds of recurrence over that infection without a BSI (aOR: 1.96, 95% CI: 1.68–2.30).

Conclusion
Approximately one in six persons with invasive MRSA infection had recurrence. We identified potential opportunities to prevent recurrence through infection control (e.g., management and early removal of central catheters). Other possible areas for preventing recurrence include improving the management of patients with BSI and bone/joint infections (including both during and after antibiotic treatment) and mitigating risk of infection from IDU.

Disclosures
All authors: No reported disclosures.
1235. Transmission of Genetically Related, Multidrug Resistant, and Invasive Vancomycin-Resistant Enterococci (VRE) Between Patients and Rooms on the Stem Cell Transplant (SCT) and Leukemia (LKM) Units
Authors: El Haddad Lynn , Hanson Blake , Arias Cesar , Otero Glen , Harb Cynthia , Ghantoji Shashank S , Stibich Marc , Chemaly Roy F 
Published: November 2018

Abstract

Background
VRE are a major cause of morbidity and mortality in immunocompromised patients. Tracking the dissemination of VRE strains is crucial to understand the dynamics of infections, emergence, and spread of VRE in the hospital setting.

Methods
Whole-genome sequencing (WGS) and phylogenetic analyses were performed to identify dominant VRE strains and potential transmission networks between patients and their rooms on the leukemia (LKM) and the stem cell transplant (SCT) units, located on two consecutive floors. We included 35 VRE-positive rectal swabs from SCT and LKM patients, and 55 environmental swabs from the patients’ main rooms and bathrooms. Sequence types, drug resistance genes, virulence genes, and patients’ outcomes were also determined.

Results
We identified VRE strains with newly described sequence types (ST) such as ST736, ST494, and ST772 which were isolated from both floors. One VRE genetic lineage belonged to ST494 (only previously isolated in Peru and was the only VanB-type strain). All other strains harbored the vanA gene. We observed highly genetically related strains transmitted between distinct rooms, floors, and time periods within the hospital in a period of 1 month (figure). Of five VRE bacteremia events, three strains were lacking the pili operon fms14-17-13 (ST203) and the remaining two were resistant to daptomycin (ST736, ST664) (figure). Of 10 patients harboring daptomycin-resistant strains, only 3 (30%) were exposed to daptomycin within 18 months before strain recovery.

Conclusion
Our findings confirmed horizontal transfer of highly related genetic lineages of multidrug resistant and invasive VRE strains between SCT and LKM patients and their room environment. New STs were identified and some correlated with bacteremia events. The use of a routine real-time WGS can characterize VRE strains and identify potential reservoirs of transmission in the healthcare setting in order to design interventions to prevent and control the spread of opportunistic and highly resistant organisms.

Disclosures
C. Arias, Merck & Co., Inc.: Grant Investigator, Research support. MeMed: Grant Investigator, Research support. Allergan: Grant Investigator, Research support. M. Stibich, Xenex Services: Employee, Salary. R. F. Chemaly, Xenex Services: Consultant and Grant Investigator, Research grant.
1237. New York State Outpatient Regional Antibiogram for Urinary Pathogens: Have We Reached a Post Antibiotic Era for the Treatment of UTIs?
Authors: Rank Elliot , Lodise Thomas P , Avery Lisa , Bankert Eve , Dobson Erica , Dumyati Ghinwa , Hassett Stephen , Keller Marina , Lubowski Theresa , Pearsall Matthew , Carreno Joseph 
Published: November 2018

Abstract

Background
Outpatient prescribing for acute uncomplicated cystitis is a significant driver of antimicrobial use. Empiric therapy should be based on local susceptibility data. However, there is limited guidance on regional susceptibility trends in outpatient settings. This study describes the epidemiology and prevalence of antimicrobial resistance in uropathogens in New York State outpatient settings to help inform empiric treatment decisions.

Methods
Retrospective analysis of positive urine cultures sent to Quest Diagnostics in 2016 from outpatient settings. Cultures that grew ≥105 CFU/mL were included from 17 NYS counties. Bacterial identification and antimicrobial sensitivities were determined on the Vitek-2 using CLSI M-100 S-25 breakpoints. Data were summarized as proportions and stratified by age (&lt;17, 18–64, ≥65) and sex.

Results
Over 78,000 isolates were included (Table 1). The most prevalent isolates were Escherichia coli (65.2%), Enterococcus spp. (11.9%), and Klebsiella pneumoniae (9.9%). E. coli was highly susceptible to nitrofurantoin (NTF, 97.2%) and cefazolin (CFZ, 89.9%) and less susceptible to trimethoprim–sulfamethoxazole (TMP-SMX, 72.9%) and ciprofloxacin (CIP, 78.0%). Enterococcus spp. was highly susceptible to NTF (99.0%) and ampicillin (99.8%). K. pneumoniae was highly susceptible to TMP-SMX (90.0%) and CIP (95.2%) and markedly less susceptible to NTF (42.0%). E. coli was more prevalent in females (69.7% vs. 39.6%, P &lt; 0.001). Enterococcus was more prevalent in males (39.6% vs. 10.1%, P &lt; 0.001). The prevalence of K. pneumoniae was similar in men and women (9.6% vs. 10.1%, P = 0.08). Resistance was more prevalent in males (NTF: 6.3% vs. 4.2%; TMP-SMX: 26.3% vs. 22.7%; CIP: 35% vs. 17.3%) and for adults ≥65 (NTF: 6.2% vs. 3.6%; TMP-SMX: 25.1% vs. 22.1%; CIP: 30.0% vs. 14.0%) P &lt; 0.001 for all comparisons.

Conclusion
NTF appears to be the best empiric choice for outpatient treatment of acute uncomplicated cystitis in New York State. TMP-SMX and ciprofloxacin should be avoided empirically. These data also highlight the necessity to obtain uropathogen sensitivity data to confirm empiric therapy or make appropriate adjustments in the outpatient setting.
Table 1. Summary of Antimicrobial Susceptibilities

Disclosures
T. P. Lodise Jr., Motif BioSciences: Board Member, Consulting fee.
1239. Frequently Identified Infection Control Gaps in Outpatient Hemodialysis Centers
Authors: Tyner Kate , Nailon Regina , Drake Margaret , Fitzgerald Teresa , Beach Sue , Lyden Elizabeth , Rupp Mark E , Schwedhelm Michelle , Tierney Maureen , Ashraf Muhammad Salman 
Published: November 2018

Abstract

Background
Little is known about infection control (IC) practice gaps in outpatient hemodialysis centers (OHDC). Hence, we examined the frequency of IC gaps and the factors associated with them.

Methods
The Nebraska (NE) Infection Control Assessment and Promotion Program (ICAP) in collaboration with NE Department of Health and Human Services conducted on-site visits to assess infection prevention and control programs (IPCP) in 15 OHDC between June 2016 and March 2018. The CDC Infection Prevention and Control Assessment Tool for Hemodialysis Facilities was used for IPCP evaluation. A total of 124 questions, 76 of which represented best practice recommendations (BPR) were analyzed in 10 IC domains. Gap frequencies were calculated for each BPR. Fisher’s exact test was used to study the association of the identified gaps with typical patient census of the facilities and chain affiliation (CA).

Results
Of the 15 OHDC, seven were large centers (typically following &gt;50 patients) and 11 were part of national chains. Important IC gaps exist in all OHDC. A median of 64 (range 57–70) of 76 BPR were being followed by OHDC or were nonapplicable to them. The IC Program and Infrastructure domain had the highest frequency of IC gaps (Figure 1). Figure 2 describes the top 5 IC gaps. Smaller OHDC (sODHC) and those without CA performed better in a few areas. For example, a higher proportion of sODHC had work exclusion policies that encourage reporting of illness without any penalty when compared with larger OHDC (75% vs. 0, P = 0.01). Similarly, a higher proportion of sOHDC provided space and encouraged persons with symptoms of respiratory infection to sit as far away from others as possible in nonclinical areas (63% vs. 0, P &lt; 0.05). None of the nonchain OHDC had shared computer charting terminals when compared with 64% of OHDC with CA (P = 0.08) and a majority of nonchain OHDC provided space and encouraged persons to maintain distance with others when having respiratory symptoms as opposed to a minority of OHDC with CA (75% vs. 18%, 0.08).

Conclusion
Important IC gaps exist in OHDC and require mitigation. Informing OHDC of existing IC gaps may help in BPR implementation. Larger scale studies should focus on identifying factors promoting certain BPR implementation in smaller and nonchain OHDC.

Disclosures
All authors: No reported disclosures.
1245. Infection Prevention and Control (IP&C) and Antibiotic Stewardship (AS) Practices in Pediatric Long-Term Care Facilities
Authors: Johnson Candace L , Hill-Ricciuti Alexandra , Saiman Lisa 
Published: November 2018

Abstract

Background
In November 2017, the Centers for Medicare and Medicaid (CMS) implemented a requirement for long-term care facilities (LTCFs) to incorporate AS into their IP&C programs. The purpose of this study was to describe baseline IP&C and AS practices in pediatric LTCFs.

Methods
We modified a survey from the CDC to assess IP&C in pediatric LTCFs. The internet-based survey was distributed to the 41 pLTCFs in the Pediatric Complex Care Association from May to June 2017. The 67-question survey included questions to assess IP&C domains and infrastructure such as written policies, hand and respiratory hygiene (HH), personal protective equipment (PPE) use, environmental cleaning, and AS practices. Responses to questions were summarized using frequencies and analyzed using χ2 or Fisher’s exact tests, as appropriate. The characteristics of sites with ≥90% compliance with the CMS rule, as assessed by 14 relevant survey questions, were compared with those of sites with &lt;90% compliance.

Results
Overall, 25 (61%) facilities nationwide completed the survey. All sites reported having written IP&C policies and most had a person responsible for IP&C (96%); fewer reported reviewing/updating these policies annually (72%). Few sites provided feedback to staff on HH adherence (44%), PPE use (40%), and cleaning/disinfection procedures (44%). Few had written policies on antibiotic prescribing (48%) or provided prescribers with feedback about their prescribing practices (40%). Sites with ≥90% compliance with the CMS rule were more likely to report providing prescribers with feedback (70% vs. 20%, P = 0.03), to have provided AS training to clinical (60% vs. 0%, P &lt; 0.01) and nursing staff (70% vs. 7%, P &lt; 0.01) in the past 12 months, and to provide feedback regarding HH (70% vs. 27%, P = 0.05).

Conclusion
While most facilities had implemented some IP&C and AS strategies pertaining to the CMS rule before its enforcement, this survey identified several gaps, especially pertaining to staff feedback for IP&C practices and antibiotic prescribing. Facilities should develop feedback strategies and regularly reinforce the importance of IP&C at employment and during regular trainings.

Disclosures
All authors: No reported disclosures.
1260. Decreasing Hospital Acquired Blood Stream Infections Through Self-Investigation by Hospital Wards
Authors: Shitrit Pnina , Chowers Michal , Gerber Beatriz , Lederman Hanni , Maram Mira 
Published: November 2018

Abstract

Background
Data on the incidence of hospital-wide acquired bloodstream infection (BSI) and the best ways to reduce it are lacking. Our aim was to increase hospital-wide awareness and decrease incidence of hospital-acquired (HA)-BSI through self-investigation.

Methods
Meir Medical Center is a 740-bed hospital. Beginning in January 2016, reports of HA-BSI events were sent daily to the wards with requests to investigate the source of infection, and preventability using a structured questionnaire. The infection control staff gave immediate feedback to the wards regarding their investigation. A summary of the results was sent to all wards and to hospital management quarterly. Interrupted time series analysis was used to compare the monthly rate of HA-BSI before and after the intervention. We estimated the number of cases prevented by the intervention by applying the HA-BSI rate in 2015 to the number of admissions in 2016–2017 and comparing the observed number of cases to the expected if the rate had not changed.

Results
In 2016, 64% of HA-BSI underwent investigation by the wards; this increased to 78% in 2017. As illustrated in the figure, before the intervention, the HA-BSI rate per 1,000 admissions increased by 0.11 per month (not significant P = 0.15). In the first month of the intervention, the HA-BSI rate decreased significantly by 0.43 (P = 0.04, 95% CI: −0.84 to −0.02). The HA-BSI rate continued to decrease (relative to the pre-intervention period) by 0.045 per month (P = 0.05, 95% CI: −0.09 to 0.00). During these 3 years, there was no significant change in the rate of community-acquired BSI (8.46, 8,88, 8,58, P for trend = 0.83) or in the rate of blood cultures drawn. During the intervention, the rate of HA-BSI decreased in both ICU units and in non-ICU wards. The number of HA-BSI caused by Enterobacteriaceae decreased from 170 in 2015 to 116 in 2017. S. aureus decreased from 51 to 30 and Candida from 11 to 0. The most common sources of BSI were urinary tract infection (31.4%) and central line associated BSI (16.4%). All-cause 30-day mortality for patients with HA-BSI was 30%. We estimated that in 2016–2017, 200 cases of HA-BSI and 60 deaths were prevented.

Conclusion
Increase awareness to HA BSI through self-investigation by the wards led to hospital-wide significant reduction in HA-BSI.

Disclosures
M. Chowers, GSK: Grant Investigator, Research grant
1261. Utility of a Multiplex Molecular Gastrointestinal Panel in Rapid Identification and Control of a Norovirus Outbreak in a Pediatric Tertiary Care Center
Authors: Comeau Jeannette L , Ivany Allana M , Romeo Terry , Maxwell Bridget S , Nymark Natalie , MacKinnon Belinda , Doon Erin , Mailman Tim 
Published: November 2018

Abstract

Background
Norovirus is one of the most common viral pathogens implicated in gastroenteritis outbreaks in community and healthcare settings. The virus’ short incubation period and high attack rate allow its rapid spread through inpatient wards to patients (Patients), staff and visitors. Early identification and appropriate implementation of infection prevention and control measures is essential to interrupt transmission.

Methods
The IWK Health Centre is a 250-bed tertiary care Pediatric and Women’s hospital serving the Maritime Provinces, Canada. We describe a norovirus outbreak in our Pediatric Medical Unit, a 24-bed, single room ward with individual bathrooms for patients and families. Hospital-acquired norovirus definition: Patients admitted ≥48 hours with lab-confirmed norovirus AND ≥ 1 of: (1) acute onset diarrhea (no noninfectious cause) or (2) ≥2 of: nausea, vomiting, abdominal pain, fever, or headache. In 2017 the FilmArray Gastrointestinal (GI) Panel was introduced in the Clinical Microbiology Laboratory as part of a prospective post-implementation study. Since then, stool samples sent for viral, bacterial, or parasitic testing are evaluated by PCR. The panel tests for 22 GI analytes, including five viruses, with a 2-hour turnaround time. Previously, in-house stool viral testing was limited to adeno- and rotavirus antigen. Patient characteristics were collected and analyzed for this study.

Results
Patients 1, 2, and 3 had new onset diarrhea and emesis; Pt 1 on day 0, and Patients 2 and 3 on day 1. Patient 3’s parents (likely source) had had diarrhea and emesis on days 3 and 2, and used the ward kitchen. Two care-givers of Patient 2, and 1 medical resident developed diarrhea and emesis over days 0 to 2. The outbreak was declared over on day 7. Patients 1, 2, and 3 all tested positive for norovirus in stool on day 1. On days 2–3, six other patients with diarrhea tested norovirus negative. All symptomatic patients were immediately placed on contact precautions, room/ward cleaning frequency increased and proper hand hygiene was reinforced. Common areas (playroom/kitchen) were closed until the outbreak was over. All patients with loose stool were tested during the outbreak.

Conclusion
FilmArrayGI panel enabled same-day identification of norovirus in this single-ward outbreak and permitted real-time identification of the termination of the outbreak.

Disclosures
All authors: No reported disclosures.
1262. Investigation and Mitigation of a Multi-Species Outbreak of Invasive Fungal Infections on Two Oncology Wards
Authors: Huslage Kirk , Stiegel Matthew , Lobaugh-Jin Erica , Hnat Amy , Strittholt Nancy , Lewis Sarah S , Baker Arthur W , Thomann Wayne R , Smith Becky 
Published: November 2018

Abstract

Background
We investigated an increase in hospital-acquired invasive fungal infections (HA-IFI) among patients admitted to adjacent hematopoietic stem cell transplant (HSCT) and hematologic malignancy (HM) wards in the setting of a large construction project adjacent to the hospital.

Methods
We defined cases of HA-IFI as HSCT or HM patients who met criteria for probable or proven IFI with suspected inpatient acquisition. We hypothesized that outside construction increased internal particle/spore counts despite preconstruction prevention efforts. The environmental investigation included an evaluation of storage/distribution of supplies, air handler inspections, air particulate counts, and bioaerosol sampling of airborne fungal spores.

Results
From October 2017 to January 2018, 11 cases of probable/proven HA-IFI occurred (Figure 1). Infections caused by multiple pathogens (Figure 2) ranged from pneumonia and sinusitis to disseminated disease. Bioaerosol sampling and particulate counts were taken from unit corridors and rooms on both wards. Fungal species identified via bioaerosol sampling were primarily Penicillium and Cladosporium species, with rare Aspergillus identified. Geometric mean particulate counts of 1 μm aerodynamic size were reduced by 88% and 75% on the HM and HSCT wards, respectively (Figure 3). Interventions on these units occurred from January to February 2018 and included: limiting the frequency of outdoor air exchanges on air handler units, reinforcing seals around entrance doors, adjusting room pressurizations to be positive or neutral on HM ward (HSCT ward is already a positive pressure environment), eliminating cardboard associated with supplies, and requiring N95 respirators for HSCT patients when off unit. After implementing these environmental control measures, we have not identified additional cases of HA-IFI on these wards.

Conclusion
We describe a multispecies outbreak of IFI in HM and HSCT patients potentially associated with new building construction that occurred despite implementation of multiple pre-construction control efforts. A multifaceted strategy to improve air quality and protect patients on and off high-risk units was needed to mitigate the outbreak.

Disclosures
All authors: No reported disclosures.