bluuebunny/crossref_metadata_2025_split huggingface dataset:
Retail Meat as a Potential Transmission Source of Community-Acquired Urinary Tract Infection
Authors: Yamaji Reina , Rubin Julia , Friedman Cindy , McDermott Patrick , Hung-Fan Melody , Riley Lee 
Published: October 2017

Abstract

Background
Escherichia coli causes approximately 80% of community-acquired UTI (CA-UTI), but the sources of these uropathogenic E. coli infections are not well established. Recent studies have suggested that food, especially poultry, may serve as a source of UPEC. Here we prospectively examined E. coli isolates from patients with CA-UTI and retail meat concurrently available from the same geographic region to determine the frequency of shared genotypes.

Methods
Between September 2016 and May 2017, we collected urine samples from patients with UTI examined at a university-affiliated healthcare center. During the same time, we recovered E.coli from retail meat products (chicken breast, ground turkey, ground beef, and pork chops) collected as part of the National Antimicrobial Resistance Monitoring System (NARMS) FDA retail meat sampling program in Northern California. Urine samples and buffered peptone water containing meat samples were cultured on MacConkey agar. Lactose-positive and indole-positive colonies were presumptively identified as E coli. Bacterial DNA was extracted by a freeze-boil method. E. coli isolates were genotyped by multilocus sequence typing (MLST).

Results
Of 1020 urine samples, E. coli was isolated from 210 (21%). Five pandemic MLST genotypes (ST95, ST127, ST69, ST73, and ST131) accounted for 126 (60%) isolates. Of 200 meat samples, E. coli was isolated from 76 (38%). E. coli was isolated from 29 (73%) of 40 ground turkey samples, 34 (43%) of 80 chicken breast, 7 (18%) of 40 ground beef, and 6 (15%) of 40 pork chop. ST69 and ST131 were isolated from 3 chicken samples. Other genotypes of E. coli isolates from meat samples and CA-UTI included ST10 (3), ST38 (2), ST88 (1), ST117 (5), ST906 (1), and ST1844 (1). Eleven (32%) of 34 chicken samples contained UPEC strains, compared with 4 (14%) of 29 ground turkey samples, and 1 (17%) of 6 pork chop samples; no beef samples contained UPEC strains.

Conclusion
Overall, we found that nearly one-quarter of retail poultry products that we tested contained UPEC strains with the same MLST genotypes found in CA-UTI patients. Foodborne transmission may account for a substantial proportion of CA-UTI. Additional studies are needed to demonstrate transmission of these genotypes from poultry to patients and to target possible prevention measures.

Disclosures
All authors: No reported disclosures.
Pharmacodynamic Target Attainment for Meropenem and Piperacillin/Tazobactam Using a PK/PD-based Dosing Calculator in Critically Ill Patients
Authors: Heil Emily , Nicolau David P , Robinson Gwen , Farkas Andras , Thom Kerri 
Published: October 2017

Abstract

Background
Unbound plasma concentrations of β-lactam antibiotics vary widely and attainment of PK/PD targets is highly variable in critically ill patients, which may affect microbiologic cure or contribute to toxicity. PK/PD-based antibiotic dosing programs may provide more accurate doses that achieve predicted targets for a cultured organism.

Methods
This was a single center, prospective study of critically ill patients with culture positive gram-negative infections treated with meropenem (MEM) or piperacillin/tazobactam (TZP). A PK/PD-based antibiotic dosing app was used to select doses that had a probability of target attainment (PTA) of 90% or greater for time above MIC (fT&gt;MIC) of at least 40% for MEM and 50% for TZP. Total meropenem, piperacillin and tazobactam mid-point and trough concentrations were obtained at steady-state and adjusted for protein binding, to assess target attainment.

Results
Thirty-six patients were enrolled; 20 received MEM and 16 TZP. Antibiotic concentrations varied widely amongst patients, particularly with TZP. MEM and TZP concentrations are displayed in Table 1 and Figure 1. Doses evaluated for &gt;90% probability of target attainment in the dosing calculator differed from standard package labeled doses for 25% (5/20) of MEM and 18.8% (3/16) of TZP patients. All (20/20) MEM and 94% (15/16) TZP patients maintained fT&gt;MIC for the entire dosing interval.

Conclusion
A PK/PD based antibiotic dosing calculator that provides individualized β-lactam doses can lead to altered doses that may increase probability of target attainment in critically ill patients. Future research is needed to review the relevance of PK/PD-based dose adjustments on clinical outcomes.

Disclosures
D. P. Nicolau, Shionogi & Co.: Research Contractor, Research support; A. Farkas, Optimum Dosing Strategies: Employee, Salary.
Communicating Microbiology Results. It’s Not Just What You Say, But How You Say It
Authors: Musgrove Mary , Kenney Rachel M , Kendall Ronald , Tibbetts Robert , Samuel Linoj , Peters Mike , Davis Susan 
Published: October 2017

Abstract

Background
Gaps in microbiology communication can lead to suboptimal antibiotic prescribing. In May 2016, our laboratory modified reporting of respiratory cultures growing commensal flora only to specify “no methicillin-resistant Staphylococcus aureus/MRSA or Pseudomonas aeruginosa” (PA). The purpose of this study was to compare MRSA and PA antibiotic therapy utilization before and after the change.

Methods
IRB approved, quasi-experiment at four hospitals with an antimicrobial stewardship program. Dates: August 1, 2015–January 31, 2016 and August 1, 2016–January 31, 2017. Included: ≥18 years, commensal flora only respiratory culture, empiric MRSA and PA antibiotic for treatment of lower respiratory infection. Excluded: non-respiratory infection. Primary outcome: MRSA or PA therapy de-escalated. Secondary outcomes: time to culture result, MRSA and PA antibiotic days of therapy, length of stay. Safety outcomes: acute kidney injury (AKI), C. difficile (CDI), subsequent multi-drug-resistant organism (MDRO), in-hospital all-cause mortality.

Results
Two hundred and ten patients included, 105 per group. Median age 64 and 61 years, male sex 52% and 56% in pre- and post-group, respectively. Empiric antibiotics, pre vs. post: vancomycin 94% vs. 95%; cefepime 66% vs. 36%; piperacillin–tazobactam 10% vs. 46%. MRSA or PA antibiotics de-escalated: 39% pre and 73% post (P &lt; 0.001). See Table 1 for variables associated with antibiotic de-escalation. Days of therapy: 7 vs. 5 days (P &lt; 0.001). AKI 31% vs. 14% (P = 0.003). Eight subsequent MDRO in pre and one in post (P = 0.035). No differences: time to culture result, length of stay, mortality, CDI.

Conclusion
Improved microbiology communication to assist prescriber interpretation of commensal respiratory flora was associated with a reduction in the proportion of patients that received antibiotics targeting MRSA and PA.

Disclosures
S. Davis, Merck: Received grant through college that I’m faculty for, Grant recipient; Allergan: Speaker’s Bureau, Consulting fee; Allergan: Consultant and Scientific Advisor, Consulting fee; Medicines Company: Consultant and Scientific Advisor, Consulting fee; Zavante: Consultant and Scientific Advisor, Consulting fee.
Can antibiotic De-escalation Be Measured Without Chart Review? A Proposed Electronic Definition
Authors: Moehring Rebekah W , Ren Xinru , Anderson Deverick J , Davis Angelina , Dyer April , Lokhnygina Yuliya , Hicks Lauri , Srinivasan Arjun , Ashley Elizabeth Dodds 
Published: October 2017

Abstract

Background
Antimicrobial stewardship programs promote de-escalation: moving from broad to narrow spectrum agents and/or stopping antibiotics as more clinical data return. A standard definition of de-escalation objectively applied to electronic data could provide a means to assess stewardship improvement opportunities.

Methods
We performed a retrospective cohort study of de-escalation events among five hospitals from the Duke Health System and the Duke Antimicrobial Stewardship Outreach Network using 2016 electronic medication administration record data. Antibiotics were ranked into four categories: narrow spectrum (e.g., cefazolin), broad spectrum, extended spectrum, and agents typically targeted for protection (e.g., meropenem). Included patients were cared for on inpatient units, had antibiotic therapy for at least 2 days, and had at least 3 days of hospitalization after starting antibiotics. De-escalation was defined as reduction in either the number of antibiotics or rank measured at two time points: day 1 of initiation of antibiotic therapy and day 5 (or day of discharge if occurring on day 3 or 4). Escalation was an increase in either number or rank of agents. Unchanged was either no change or discordant directions of change in number and rank. For all categories, the outcome was percent among qualifying admissions. Descriptive statistics were used to describe de-escalation among hospitals, unit type, and ICD-10 diagnoses.

Results
Among 39,226 included admissions, de-escalation occurred in 14,138 (36%), escalation in 5,129 (13%), and antibiotics were unchanged in 19,959 (51%) (Figure). Percent de-escalation was significantly different among hospitals (median 37%, range 31–39%, P &lt; .001). Infectious diagnoses with lower rates of de-escalation included intra-abdominal infection (23%), skin and soft-tissue infection (28%), and ENT/upper respiratory tract infection (19%). Intensive care units had higher rates of both de-escalation and escalation (43% and 16%) when compared with non-ICU wards (35% and 13%, P &lt; .001).

Conclusion
We provided an objective, electronic definition of de-escalation and demonstrated variation among hospitals, units, and diagnoses. This metric may be useful for assessing stewardship opportunities.

Disclosures
All authors: No reported disclosures.
The Role of Negative Methicillin-Resistant Staphylococcus aureus Nasal Surveillance Swabs in Predicting the Need for Empiric Vancomycin Therapy
Authors: Chotiprasitsakul Darunee , Tamma Pranita D , Gadala Avinash , Cosgrove Sara E 
Published: October 2017

Abstract

Background
The role of MRSA nasal surveillance swabs in guiding decisions about need for subsequent vancomycin therapy is unclear. Our objectives were to (1) determine the likelihood that patients with negative MRSA nasal swabs went on to develop MRSA infections during the same hospitalizations to assess if vancomycin therapy could be avoided once the nasal swab result returns negative, (2) assess days of vancomycin that potentially could be avoided, and (3) identify risk factors for having a negative MRSA nasal swab and developing an MRSA infection during the hospital stay.

Methods
This retrospective cohort study was conducted at six intensive care units (ICUs) at a tertiary care hospital in Baltimore from December 2013 to June 2015. MRSA nasal swabs are obtained at the time of admission and weekly thereafter for all ICU patients. The negative predictive value (NPV), defined as the ability of a negative MRSA nasal screening test to correctly predict no subsequent MRSA infection during the hospital stay, was calculated, accounting for the 3-day turnaround time of MRSA nasal surveillance swabs. Days of vancomycin therapy started or continued after 3 days from the first negative MRSA nasal swab were determined by chart review. A matched case–control study was performed to identify risk factors for patients with negative MRSA surveillance cultures who subsequently developed MRSA infections.

Results
Of 11,441 MRSA-nasal swab negative patients, the proportion of subsequent incident MRSA infections was 0.2%. Negative MRSA surveillance swabs had an NPV of 99.4% (95% CI 99.1–99.6%). Among 4,091 MRSA-negative patients receiving vancomycin, vancomycin was started or continued after 3 days since the first MRSA-negative nasal swab in 1,434 patients (35%), translating to 7,377 potentially avoidable vancomycin days. The matched case–control analysis did not identify risk factors associated with subsequent MRSA infection.

Conclusion
At our institution with robust infection control practices and low nosocomial MRSA transmission rates, patients with negative MRSA nasal swabs have a very low likelihood of subsequent MRSA infection during hospitalizations. MRSA nasal swabs can provide useful information when determining whether to initiate or stop empiric vancomycin.

Disclosures
All authors: No reported disclosures.
Doing the Same with Less: A Randomized, Multinational, Open-Label, Adjudicator-Blinded Trial of an Algorithm vs. Standard of Care to Determine Treatment Duration for Staphylococcal Bacteremia
Authors: Holland Thomas L , Boucher Helen W , Raad Issam , Anderson Deverick J , Cosgrove Sara E , Aycock Suzanne , Baddley John W , Chow Shein-Chung , Chu Vivian H , Cook Paul P , Corey G Ralph , Daly Jennifer S , Hachem Ray Y , Chaftari Anne-Marie , Horton James M , Jenkins Timothy C , Gu Jiezhun , Levine Donald P , Miro Jose M , Riska Paul , Rubin Zachary A , Rupp Mark E , Schrank John , Sims Matthew , Wray Dannah , Zervos Marcus J , Fowler Vance 
Published: October 2017

Abstract

Background
The appropriate duration of antibiotics for staphylococcal bloodstream infection (BSI) is unknown. An algorithm to identify patients with staphylococcal BSI who can be safely treated with shorter courses of therapy would improve care and reduce total antibiotic use.

Methods
Adult patients with staphylococcal BSI were randomized to treatment based on algorithm-based therapy (ABT) or to standard of care (SOC). Co-primary outcomes were clinical success, as determined by a blinded Adjudication Committee, and serious adverse event (SAE) rates. The prespecified secondary outcome measure was antibiotic days by treatment group, among patients without complicated BSI. Prespecified durations of therapy in ABT were: S. aureus BSI (SAB): uncomplicated: 14 days; complicated: 4–6 weeks. Coagulase-negative staphylococci BSI (CoNSB): simple (1 positive blood culture) (0–3 days), uncomplicated (&gt;1 positive blood culture) (5 days), complicated (7–28 days). Outcomes were compared using intention-to-treat principles. The target sample size was 500 patients, to ensure 90% power for establishing noninferiority within a margin of 15%.

Results
Between April 2011 and March 2017, 509 adults with suspected staphylococcal BSI at 16 sites in the US and Spain were randomized to ABT (N = 255) or SOC (N = 254). There were 116 patients with SAB (23%) and 385 (76%) with CoNSB (Figure 1). Overall success rate in the ABT group was 82.0% vs. 81.5% in the SOC group, difference 0.5%, 95% CI −5.2% to 6.1%. SAEs were reported in 32.9% of ABT vs. 28.3% of SOC patients (OR 1.2, 95% CI 0.9 to 1.8). Among evaluable patients without complicated BSI, mean duration of therapy was 4.4 days in the ABT group vs. 6.4 days in the SOC group (difference −2.0 days, 95% CI −3.3 to −-0.7, P = 0.003). Among patients with uncomplicated SAB, treatment durations were similar (15.3 days in ABT vs. 16.3 days in SOC, difference −1 day, 95% CI −3.89 to 1.91, P = 0.497), whereas for uncomplicated CoNSB, duration was shorter in the ABT group (5.3 days in ABT vs. 8.4 days in SOC, difference −3 days, 95% CI −4.87 to −1.34, P &lt; 0.001).

Conclusion
The use of a treatment algorithm for staphylococcal BSI was associated with significant reductions in duration of antibiotic therapy in patients without complicated BSI, without significant differences in overall success or SAEs.

Disclosures
V. Fowler Jr., NIH: Investigator, Contract HHSN272200900023C
Tracking an Unusual Carbapenemase-producing Organism from Drains to Patient Using Whole Genome Sequencing
Authors: Ramsburg Amanda M , Weingarten Rebecca A , Conlan Sean P , Dekker John P , Michelin Angela V , Odom Robin T , Bordner MaryAnn , Zellmer Caroline J , Henderson David K , Segre Julia A , Frank Karen M , Palmore Tara N 
Published: October 2017

Abstract

Background
The NIH Clinical Center conducts patient and environmental surveillance for carbapenemase-producing organisms (CPO). Previous investigation revealed that sink drains can become colonized with CPO. Subsequent surveillance targets included potential aqueous reservoirs, such as floor drains of environmental services (EVS) closets.

Methods
Premoistened swabs were used to culture sink drains, floor drains, and equipment for CPO. Perirectal swabs were ordered monthly for all patients in non-behavioral health wards. Specimens were plated to CRE- and ESBL-selective media, and colonies identified by MALDI-TOF. The presence of the blaKPC gene was confirmed by PCR. When environmental CPO isolates were detected, EVS procedures and practices were reviewed.

Results
In June 2016, blaKPC+ Leclercia adecarboxylata was isolated from an EVS closet floor drain, and in August 2016, from drains in four additional closets. In the previous 10 years, Leclercia sp. was isolated just once from a clinical culture. In September 2016, routine surveillance revealed new-onset blaKPC+ L. adecarboxylata colonization in a stem cell transplant recipient. Investigation included 33 cultures collected from sink and floor drains, EVS equipment, and other items. EVS equipment, especially mop buckets, were identified as a likely point source due to their use in patient care areas and closets with contaminated floor drains. Among seven mop buckets sampled, one grew blaKPC+ L. adecarboxylata. Whole genome sequencing demonstrated genetic relatedness of the Leclercia isolates. Floor cleaner was changed to a disinfectant solution. Extensive decontamination of 67 EVS closets and equipment was performed urgently. No further patient or environmental cultures have grown blaKPC+ L. adecarboxylata.

Conclusion
The recovery of a highly unusual organism, rarely found in clinical specimens, that was also carrying a blaKPC+ plasmid, allowed us to detect environmental spread of this organism in the hospital. The ability to track this organism using genome sequencing provided strong evidence of the mode of spread, leading to effective remediation. No evidence-based methods exist for remediating drain contamination, which can serve as a potential reservoir for transmission.

Disclosures
All authors: No reported disclosures.
Utility of Routine Genomic Sequencing for Infection Control Surveillance
Authors: Ellison Richard T , Hoss Andrew , Mathew Jomol , Halperin Jeff , Gross Brian , Ward Doyle V 
Published: October 2017

Abstract

Background
Recent work indicates that comprehensive genomic sequencing can be a highly effective tool in defining the transmission of microbial pathogens. We have studied the utility of the routine use of genomic sequencing for infection control surveillance in an academic medical center.

Methods
The genomes of inpatient and emergency department isolates of Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Enterococcus faecium were sequenced. Within each species, single-nucleotide polymorphisms (SNP) were identified in the core genome for all isolates using alignment-based methods. The number of SNP differences between isolate pairs was determined and used, in combination with the patient’s electronic medical records to identify potential transmission events.

Results
Between September 2016 and March 2017, 388 S. aureus, 66 P. aeruginosa, 48 K. pneumoniae, and 29 E. faecium isolates were sequenced from 373 patients. There was variation in the distribution of SNP differences between intrapatient isolates for the four pathogens; with the least variability for E. faecium and greatest for P. aeruginosa. The majority of the bacterial isolates from separate patients appeared to be genetically unique exhibiting marked SNP differences from other isolates. There were 19 sets of isolates where the SNP variation between interpatient isolates was either comparable to that of intrapatient variation (12) and suggestive of recent transmission events, or with SNP variation somewhat greater than the intrapatient SNP variation (7) suggesting relative relatedness. Only one of the highly related sets had been previously identified by standard infection control surveillance. Likely transmissions appeared to have occurred both in the inpatient and outpatient settings, and the transmission routes were not always apparent.

Conclusion
The routine use of genomic sequencing analysis identified previously unrecognized likely transmission events within the institution’s patient population that are of relevance to infection control surveillance. This capacity should significantly enhance our understanding of the epidemiology of hospital acquired infections, and assist in developing and implementing new prevention strategies.

Disclosures
R. T. Ellison III, Philips Healthcare: Consultant and Grant Investigator, Consulting fee and Research grant; A. Hoss, Philips: Employee, Salary; J. Mathew, Philips Healthcare: Investigator, Research grant; J. Halperin, Philips Healthcare: Employee and Shareholder, Salary; B. Gross, Philips: Employee and Shareholder, Salary; D. V. Ward, Philips Healthcare: Consultant, Investigator and Research Contractor, Consulting fee, Research support and Salary
Invasive Mycobacterium abscessus Infection after Cardiac Surgery: Epidemiology and Clinical Outcomes
Authors: Baker Arthur W , Maziarz Eileen K , Lewis Sarah S , Stout Jason E , Anderson Deverick J , Smith Peter K , Schroder Jacob N , Daneshmand Mani A , Alexander Barbara D , Sexton Daniel J , Wolfe Cameron R 
Published: October 2017

Abstract

Background
We recently mitigated a clonal outbreak of Mycobacterium abscessus, including a large cluster of patients who developed invasive infection after exposure to heater-cooler units (HCU) during cardiac surgery. Recent studies have described a small number of Mycobacterium chimera infections linked to open-heart surgery; however, little is known about the epidemiology and clinical courses of cardiac surgery patients with invasive infection from rapidly-growing mycobacteria, such as M. abscessus.

Methods
We retrospectively collected clinical data from all patients who underwent cardiac surgery at our hospital and had positive cultures for M. abscessus from 2013 to 2016. We excluded heart transplant recipients and patients who at time of diagnosis had ventricular assist devices. We analyzed patient characteristics, antibiotic treatment courses, surgical interventions, and clinical outcomes.

Results
Nine cardiac surgery patients who met the case definition developed culture-proven invasive infection from M. abscessus (Figure 1). Seven (78%) infections occurred after surgeries that included valve replacement. Median time from suspected inoculation in the operating room to first positive culture was 49 days (interquartile range, 38–115 days). Seven (78%) patients had bloodstream infections, and six (67%) patients had sternal wound infections. Six (67%) patients developed disseminated disease with infection at multiple sites. All patients received combination antimicrobial therapy. The most common majority regimen (n = 6) was imipenem, amikacin, and tigecycline. Four (44%) patients experienced therapy-limiting antibiotic toxicities (Figure 2). Seven (78%) patients were well enough to undergo at least one surgical debridement. Five (56%) patients stopped therapy due to presumed cure, but four (44%) patients had deaths attributable to M. abscessus infection.

Conclusion
Invasive M. abscessus infection after cardiac surgery was associated with high morbidity and mortality. Most patients underwent surgical debridement and received prolonged three-drug antimicrobial therapy, which was complicated by numerous antibiotic toxicities. Treatment cured five patients, but four patients died from mycobacterial disease.

Disclosures
All authors: No reported disclosures.