bluuebunny/crossref_metadata_2025_split huggingface dataset:
UTI Symptomatology and Antibiotic Prescribing among US Veterans Seen in Outpatient Clinics
Authors: Wilson Geneva , Jackson Ravyn , Abdelrahim Sara , Bej Taissa , Jump Robin , Evans Charlesnika 
Published: September 2024

Background: Infectious Diseases Society of America guidelines recommend antibiotic prescribing for urinary tract infections (UTIs) when there is a positive culture and signs and symptoms of infection. Despite these guidelines, prescribing for asymptomatic bacteriuria remains prevalent. We conducted a chart review of UTI outpatient encounters to determine the prevalence of antibiotic prescribing as well as patient and provider factors associated with inappropriate prescribing for UTIs. Methods: Patients who were seen at any Department of Veterans Affairs (VA) outpatient clinic with a positive urine culture from 1/1/2019-12/31/2022 were evaluated for inclusion. Exclusion criteria were pregnancy, neutropenia, neurogenic bladder, spinal cord injury/disorder, chronic kidney disease stage III and above, and those undergoing urologic surgical procedures within 7 days. Inappropriate prescribing was defined as an antibiotic prescription given for UTI treatment when no signs or symptoms of infection were recorded during the patient encounter. Chi-square, Fisher’s exact and t-tests were used to evaluate the association between patient and provider characteristics and antibiotic prescribing. Results: Among 341 visits, most patients were male (70%), White (40%), older (mean age of 65.8 ± 15.9 years) and treated at an urban facility (57%). Antibiotics were prescribed for 67% (229/341) of visits. Of the 229 antibiotic courses prescribed, 119 (52%) were appropriate; issued to patients with > = 1 sign or symptom consistent with a urinary tract infection. The most common symptom recorded was dysuria, followed by frequency, urgency, and hematuria (Figure 1). The remaining 110 (48%) antibiotic prescriptions were inappropriate; given to patients without documented UTI-related signs or symptoms. The proportion of inappropriate prescribing was higher among advanced practice practitioners (39/56; 69%) compared to physicians (68/113; 60%; P < 0 .0001). Prescribing of an antibiotic did not differ by gender (p-value=0.3779), race (p-value=0.3972), age (p-value=0.7461) or urban versus rural geography (p-value=0.3647). Discussion: In outpatient clinics, nearly half of antibiotics prescribed to patients with a positive urine culture occurred in the absence of documented of signs or symptoms of a UTI. These results suggest that interventions to improve antibiotic use for UTI-related concerns in the outpatient setting should address UTI-related signs and symptoms as well as asymptomatic bacteriuria. Advanced practice practitioners were more likely to prescribe without documentation of relevant signs or symptoms than physicians. Improving meaningful documentation about the presence or absence of signs and symptoms of a UTI may help reduce inappropriate antibiotic prescriptions in the outpatient setting.Disclosure: Robin Jump: Research support to my institution from Merck and Pfizer; Advisory boards for Pfizer
Reduction in IUSS (Immediate Use Steam Sterilization) Associated with Reduction in Surgical Site Infections
Authors: Jaffe Jennifer , Merz Linda , McMullen Kathleen 
Published: September 2024

Background: Immediate use steam sterilization (IUSS) is a potential risk factor for surgical site infection (SSI). During a regulatory survey, it was discovered that IUSS rates for a 767-bed hospital exceeded what had been reported to Infection Prevention (IP) and surgery leaders (estimated at an average of 60 instances per month, with approximately 40 of those in orthopedic cases). A Quality Improvement (QI) project to reduce IUSS was implemented. Methods: The QI project started with the requirement of three signatures for every cycle of IUSS (surgery management, sterilization management, and IP). Additional trays were ordered to provide an ample supply for cases. Surgery personnel were no longer allowed to perform IUSS, and the number of sterilizers available for IUSS was reduced from 8 to 1. The project was fully implemented as of December 2019. To evaluate the impact, SSI rates for hip and knee prothesis were compared using chi square analysis (Epi Info, CDC); before QI project rates were measured from 2017-2019 and after QI project rates were measured for 2020-2022. No other changes were made that were anticipated to impact orthopedic SSI rates. Results: There were no instruments or implants processed by IUSS after December 2019. Prior to the project, there were 9 hip SSI (rate = 0.54 per 100 procedures) and 14 knee SSI (rate = 0.49 per 100 procedures). After the project, hip SSI decreased by 76% (2 SSI, rate = 0.13 per 100 procedures, p = < 0 .05) and knee SSI decreased by 18% (7 SSI, rate = 0.41 per 100 procedures, p=0.67). Conclusion: A multidisciplinary QI project was successful at drastically reducing the use of IUSS, and a correlating statistically significant decrease in hip SSI and clinically significant decrease in knee SSI was seen for 3 years after the project was completed.Disclosure: Kathleen McMullen: Speaker - 3M
Creation of a Multi-Year Pediatric Candidemia Antibiogram in Georgia Identifies Changing Epidemiology and Resistance Trends
Authors: Saint-Victor Diane , Gonzalez Mark , Dubick Collin , Linam Matt 
Published: September 2024

Background: Invasive candidiasis, including candidemia, is a significant cause of morbidity and mortality in medically complex and immunocompromised children. Understanding the epidemiology and antifungal susceptibility patterns of Candida infections could help guide empiric antifungal therapy. Methods: This fungal antibiogram was created at a large quaternary children’s health system in Georgia. Blood isolates positive for Candida spp. from 2019 through 2023 were included. The number and percentage of isolates for each Candida spp was recorded by year and then as the combined 5-year total. The Clinical and Laboratory Standards Institute (CLSI) antifungal interpretative criteria were used, and we only included one unique Candida spp isolate per patient. Due to the limited number of isolates, the combined 5 years of isolates were used to create the fungal antibiogram. Data are shown as percent susceptible using CLSI interpretative criteria and number of isolates. Results: Between 2019 and 2023 there were 124 unique blood isolates of Candida spp identified. The most common isolates were C. albicans (33%), C. parapsilosis (27%), C. glabrata (14%) and C. tropicalis (11%). Over the 5 years of the study, the percentage of C. albicans isolates decreased from 47% to 21%. The change in epidemiology was not driven by a single Candida species but varied from year to year. For C. albicans, susceptibility was 100% for fluconazole and micafungin. For C. parapsilosis, susceptibility to fluconazole and micafungin was 97% and 94%, respectively. Fluconazole susceptibility was lowest for C. glabrata (88%) and C. krusei (0%). Using CLSI epidemiological cutoff values (ECV) to evaluate the amphotericin B results, none of the isolates had results greater than the CLSI ECVs. Comparing 2019 and 2023, the percentage of Candida blood isolates resistant to fluconazole increased from 5% to 18.5%. Conclusion: C. albicans was the most frequently identified cause of candidemia in children, but there was a gradual increase in fungemia caused by other Candida spp. over the past 5 years including Candida with fluconazole resistance. Overall, our findings demonstrate high susceptibility rates to fluconazole and echinocandins in Candida spp. blood isolates. Further research is needed to identify risk factors for antifungal resistant candidemia in pediatric patients.Disclosure: Mark Gonzalez: Honoria for a one time consulation with NaviDx consulting in May of 2022. Honoria from the American Society for Microbiology for writing of a chapter in the Clinical Microbiology Procedures Handbook.
Does Patient Perception of Cleanliness Still Matter? The Relationship between HCAHPS and HAC During the COVID-19 Pandemic
Authors: Crews-Stowe Caitlin 
Published: September 2024

Background: Environmental contamination of surfaces is known to be one of the most common causes of healthcare associated infections (HAIs), with cleaning and disinfection of surfaces shown to reduce the incidence of HAIs and contribute to overall hospital cleanliness. Prior research showed that there was a relationship between a hospital’s performance on the Hospital Consumer Assessment of Healthcare Providers and Systems survey question on patient perception of cleanliness and their HAC score. However, this research was done prior to the COVID-19 pandemic. This study looked to examine if the pandemic changed the relationship between patient perception of cleanliness and HAC score performance. Method: A retrospective correlational study was performed to examine if the relationship between patient perception of cleanliness and the incidence of Clostridioides difficile (CDI) and Methicillin-Resistant Staphylococcus aureus (MRSA) HAIs, as defined by the facility’s HAC score, were affected by the COVID-19 pandemic. Multiple Center for Medicare and Medicaid Services (CMS) datasets were utilized for the study. There were approximately 2700 acute care facilities that reported data on the HCAHPS perception of cleanliness question and either a MRSA or CDI HAC score for the period of January 1, 2021, to December 31st, 2021. Basic descriptive statistics and Spearman’s rho correlation analyses were performed to examine the potential associations between the two scores. Result: For MRSA, the study found that as the percentage of patients who reported that their room was “always” clean increased, the hospital’s HAC score decreased (r= −0.141, p = < 0.001). Additionally, as the percentage of patients who reported their room was “never” clean increased, the hospital’s HAC score increased (r= 0.175, p = <0.001) For C. difficile, the analysis also revealed that as the percentage of patients who reported their room was “always” clean increased, there was not a significant change in the hospital’s HAC score (r= −0.023, p = 0.237). There was also not a significant change in the HAC score when the percentage of patients who reported their room as “never” clean increased (r= −0.012, p = 0.527).Conclusion: The study found that for MRSA, a hospital’s performance on the HCAHPS performance on patient perception of cleanliness is related to their performance on their HAC score. This did not hold true when looking at C. difficile infections, which is in contrast to the prior evidence. Further research is needed to determine if there are specific factors that may have influenced this change.Disclosure: Caitlin Crews-Stowe: Employee- ActivePure Medical
Automated Discontinuation of Isolation Precautions with the Use of Electronic Health Record Tools
Authors: Cantu Sherry , Spallone Amy , Chemaly Roy , Powell Jane , Bui Ha , Prasla Nadeem 
Published: September 2024

Background: At a comprehensive cancer center, hundreds of patients are screened daily for infections requiring the implementation of isolation precautions. Discontinuation of precautions is determined by negative testing, resolution of infection, or other criteria. Determining appropriate discontinuation of isolation precautions is labor intensive for Infection Preventionists (IPs). An unintended consequence of manual discontinuation is that numerous patients remain on isolation indefinitely. This was amplified during the COVID-19 pandemic when thousands of patients were placed on isolation precautions. Using electronic health record (EHR) tools, opportunities for process improvements were developed. Our goal was to establish an automated method to resolve isolation precautions. We aimed to decrease the number of manually resolved precautions by 25% each fiscal year (FY), compared to our baseline of activity in FY 2019 (FY19). Our secondary aim was to automate adding and resolving precautions when testing is initiated for suspected transmissible conditions (rule-out testing features).Methods: Infection Control (IC) collaborated with EHR analysts to build tools to automate a process for appropriate isolation discontinuation. We reviewed our internal data in conjunction with evidence-based guidelines and started with acute, short-term infections that do not require repeat testing or cultures. Expiration dates were established for these infections to resolve automatically after meeting criteria. A secondary review determined that additional infections could be added safely to this process. The secondary aim of establishing rule-out testing was implemented for respiratory viral panels (including SARS-COV-2) and C. difficile testing. When testing was ordered for these conditions, a suspect-infection status and alert for precautions were automatically added to patients’ EHR banners. If the assay resulted negative, the suspect-infection status was automatically removed from their chart. Results: Our baseline of active infections in FY19 was approximately 2,700 cases. From FY19 through FY23, 123,115 infections were added to our patients, and 128,422 infections were resolved. In the first year of implementation, there was a 58% decrease in the number of manually resolved cases. From the initiation of our project through the end of FY23, manual discontinuation of precautions has decreased by 88%. Conclusions: We successfully implemented a process improvement project to appropriately remove patients from isolation precautions automatically using EHR tools, which resulted in reduced labor on our IPs and patient time spent on isolation restrictions. Additional benefits from this process improvement extend to decreasing unnecessary costs to the patient and the organization, better stewardship of supply/resources, and improving patient satisfaction.
Impact of Universal Masking by Healthcare Personnel on Non-SARS-CoV-2 Healthcare-Associated Viral Respiratory Infections
Authors: Rosenthal Ayelet , Moore Riley , Fishbein Joseph , Kociolek Larry 
Published: September 2024

Background: The impact of universal masking on transmission of endemic respiratory viruses in children’s hospitals is unknown. Our objective was to measure the association between universal masking by healthcare personnel and the incidence of non-SARS-CoV-2 healthcare-associated viral respiratory infections (HA-VRIs) in a free-standing academic pediatric medical center during the COVID-19 pandemic. Methods: In this quasi-experimental study, we measured the incidence rate of non-SARS-CoV-2 HA-VRIs (VRI diagnosed on or after hospital day 3 by one of several molecular assays) during three time periods: prior to the COVID-19 pandemic (pre-intervention: September 2013 - February 2020); during universal masking (intervention: May 2021 - March 2023); and after universal masking was lifted (post-intervention: April 2023 - November 2023). Although universal masking was implemented in late March 2020, we exclude the lockdown period of strict COVID-19-related public health mitigations (i.e., school closures and shelter-in-place advisories) during which community prevalence of non-SARS-CoV-2 respiratory viruses was minimal in our region (March 2020 to April 2021). By negative binomial regression analysis, we compared the level and trend of HA-VRIs between the pre-intervention and intervention periods. Results: Figure 1 illustrates the incidence rate of non-SARS-CoV-2 HA-VRI during the pre-intervention, lockdown, intervention, and post-intervention periods. The aggregate non-SARS-CoV-2 HA-VRI incidence rate during the pre-intervention, intervention, and post-intervention periods was 1.25, 1.84, and 1.96 HA-VRIs per 1000 patient days, respectively. There was no significant difference in the level (p = 0.96) or trend (p = 0.67) of HA-VRI incidence rate between the pre-intervention and intervention periods. Conclusion: Universal masking was not associated with a decrease in the incidence rate of non-SARS-CoV-2 HA-VRIs at our children’s hospital during the COVID-19 pandemic. These findings suggest that universal masking may not be an effective infection prevention measure in children’s hospitals during periods of increased endemic respiratory viral transmission in the community.Disclosure: Larry Kociolek: Research Support - Merck
Trends and outcomes in community-onset and hospital-onset Staphylococcus bacteremia among hospitals in the United States from 2015 to 2020
Authors: Kobayashi Takaaki , Ai ChinEn , Jung Molly , Salinas Jorge L. , Yu Kalvin C. 
Published: September 2024

Abstract

Background:
We investigated trends in Staphylococcus aureus (staph) bacteremia incidence stratified by methicillin susceptibility (methicillin-susceptible S. aureus [MSSA] vs. methicillin-resistant S. aureus [MRSA]) and onset designation (community-onset [CO] vs. hospital-onset [HO]).

Methods:
We evaluated the microbiological data among adult patients who were admitted to 267 acute-care hospitals during October 1, 2015, to February 28, 2020. Using a subset of data from 41 acute-care hospitals, we conducted a retrospective cohort study to assess patient demographics, characteristics, mortality, length of stay, and costs. We also conducted a case-control study between those with and without staph bacteremia.

Results:
The incidence of MSSA bacteremia significantly increased from 2.43 per 1,000 admissions to 2.87 per 1,000 admissions (estimate=0.0047, P-value=.0006). The incidence of MRSA significantly increased from 2.11 per 1,000 admissions to 2.42 per 1,000 admissions (estimate=0.0126, P-value <.0001). While the incidence of CO MSSA and CO MRSA demonstrated a significant increase (p=0.0023, and p < 0.0001), the incidence of HO MSSA and HO MRSA did not significantly change (p=0.2795 and p < 0.4464). Compared to those without staph bacteremia, mortality, length of stay, and total cost were significantly higher in those with staph bacteremia, regardless of methicillin susceptibility or onset designation.

Conclusion:
The increasing incidence of CO MSSA and MRSA bacteremia might suggest the necessity for dedicated infection control measures and interventions for community members colonized with or at risk of acquiring Staphylococcus aureus.
Association between hospital-onset SARS-CoV-2 and ending universal admission testing and masking at five US hospitals
Authors: Pak Theodore , Kanjilal Sanjat , McKenna Cara , Rhee Chanu , Klompas Michael 
Published: September 2024

Background: Many US hospitals have stopped universal masking and testing all patients on admission for SARS-CoV-2. We assessed the association of ending universal masking and admission testing with the incidence of hospital-onset SARS-CoV-2 infections in five Massachusetts hospitals. Method: We conducted a retrospective study of all patients admitted between March 6, 2020 and December 14, 2023 and identified hospital-onset SARS-CoV-2 infections (newly positive SARS-CoV-2 PCR tests >4d after arrival) and community-onset infections (newly positive ≤4d after arrival). We excluded cases if local infection control teams discontinued precautions within 4d (suggesting a false positive or remote/resolved infection). We calculated weekly ratios between hospital-onset and community-onset SARS-CoV-2 cases to account for changes in community SARS-CoV-2 incidence over time. We then performed interrupted time series analysis, looking for changes in the ratio of hospital-onset to community-onset cases across three periods: pre-Omicron period with universal testing and masking in place (March 6, 2020–Dec 16, 2021); Omicron period with universal testing and masking in place (Dec 17, 2021–May 11, 2023); and Omicron period without universal testing and masking (May 12, 2023–Dec 14, 2023). We performed medical record reviews on 100 randomly selected hospital-onset cases after May 12, 2023 to examine if community-onset cases were being misclassified as hospital-onset cases. Result: During the study period, there were 626,908 patient admissions, including 24,980 with community-onset and 1,510 with hospital-onset SARS-CoV-2 infections. The mean weekly ratio of new hospital-onset to community-onset SARS-CoV-2 infections rose from 2.6% before Omicron, to 8.5% (95% CI, 7.0–9.9%) during Omicron, to 17% (95% CI, 15–19%) after universal admission testing and masking ended (Figure 1). There was a significant immediate level change after the pre-Omicron-to-Omicron transition (140% relative increase; 95% CI, 40–240%) and after universal admission testing and masking ended (110% relative increase; 95% CI, 73–150%). On medical record review of 100 randomly selected hospital-onset SARS-CoV-2 cases after universal admission testing had ended, 89% had new symptoms at the time of testing, 80% had PCR cycle thresholds ≤30, 27% had a known COVID-19 exposure, and 97% met at least one of these criteria. In-hospital mortality occurred in 8% of the 100 reviewed cases. Conclusion: Stopping universal masking and admission testing of all hospitalized patients at five Massachusetts hospitals was associated with a significant increase in hospital-onset COVID-19. Nosocomial COVID-19 remains a common complication of hospital care. Preventing nosocomial infections in this vulnerable population remains an important safety goal.Disclosure: Theodore Pak: Founder/CEO - The East Harlem Software Company, Inc.
Exploring canyons beneath Devon Ice Cap for sub-glacial drainage using radar and thermodynamic modeling
Authors: Pierce Chris , Skidmore Mark , Beem Lucas , Blankenship Don , Adams Ed , Gerekos Christopher 
Published: September 2024

Abstract
Sub-glacial canyon features up to 580 m deep between flat terraces were identified beneath Devon Ice Cap during a 2023 radar echo sounding (RES) survey. The largest canyon connects a hypothesized brine network near the Devon Ice Cap summit with the marine-terminating Sverdrup outlet glacier. This canyon represents a probable drainage route for the hypothesized water system. Radar bed reflectivity is consistently 30 dB lower along the canyon floor than on the terraces, contradicting the signature expected for sub-glacial water. We compare these data with backscattering simulations to demonstrate that the reflectivity pattern may be topographically induced. Our simulated results indicated a 10 m wide canal-like water feature is unlikely along the canyon floor, but smaller features may be difficult to detect via RES. We calculated basal temperature profiles using a 2D finite difference method and found the floor may be up to 18°C warmer than the terraces. However, temperatures remain below the pressure melting point, and there is limited evidence that the canyon floor supports a connected drainage system between the DIC summit and Sverdrup Glacier. The terrain beneath Devon Ice Cap demonstrates limitations for RES. Future studies should evaluate additional correction methods near complex terrain, such as RES simulation as we demonstrate here.