bluuebunny/crossref_metadata_2025_split huggingface dataset:
Detection of carbapenem-resistant Enterobacterales from nursing home wastewater effluent from September 2021 to November 2021
Authors: Lenz Susanna , Franco Lauren , Coulliette-Salmond Angela 
Published: September 2023

Background: Surveillance and early detection of antibiotic resistance genes and multidrug-resistant organisms (MDROs), such as carbapenem-resistant Enterobacterales (CRE), are important to quell outbreaks early, as antibiotic resistance continues to be an increasing threat. Wastewater surveillance in general has gained attention in the United States, but scientific evidence demonstrating the feasibility to assess antibiotic resistance genes and MDROs is limited. In this study, wastewater effluent was used to screen a nursing home facility, which housed a population at increased risk for colonization with MDROs, for the presence of β-lactam–resistant genes.Methods: Wastewater effluent samples (24-hour composite, n = 19; grab samples, n = 6) collected from a skilled nursing home facility from September 2021 to November 2021 in DeKalb County, Georgia, were screened for carbapenem-resistant and extended-spectrum β-lactam (ESBL)–resistant Enterobacterales using 2 selective chromogenic media: mSuperCARBA (mSC) for selection of CRE and CHROMagar ESBL for selection of gram-negative bacteria producing extended-spectrum β-lactamases. Colilert-18 (IDEXX) was applied to detect and quantify total coliforms and Escherichia coli, serving as an enrichment approach for potential gram-negative organisms (Enterobacterales) containing antibiotic resistance genes. E. coli–positive Colilert-18 (IDEXX) samples (n = 24) had a composite of 1.0 mL total from 5 positive wells or 20% per plate collected and stored at −80°C in 25% glycerol. The E. coli–positive Colilert-18 samples were later thawed and plated on mSC and CHROMagar ESBL, where a random subset of all the colonies (ie, mixture of typical and atypical colonies; n = 28) were selected for matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) to confirm identification. Additionally, a non-enrichment approach, filtered wastewater samples (10 mL, n = 23) were frozen (−80°C) until DNA extraction, followed by multiplex real-time PCR for the blaKPC, blaNDM, blaVIM, and blaOXA-48–like carbapenemase genes. Results: Among 24 E. coli–positive Colilert-18 samples, 16 (67%) of 24 contained carbapenem-resistant Klebsiella, Enterobacter, or Citrobacter (KEC), 88% contained ESBL-resistant KEC (21 of 24), 4% (1 of 24) contained carbapenem-resistant E. coli, and 67% contained ESBL-resistant E.coli (16 of 24). In the 28 colonies picked from mSC or ESBL, 10 different genera were confirmed using MALDI-TOF: Aeromonas, Citrobacter, Enterobacter, Escherichia, Klebsiella, Providencia, and Raoultella. Of 23 filtered samples, 18 (78%) were positive for the blaKPC gene, whereas all samples were negative for blaNDM, blaVIM, and blaOXA-48–like genes. In this nursing home, these findings suggest a concerning frequency of bacteria resistant to last-line antibiotics. Wastewater surveillance can potentially serve as an approach to identify antibiotic resistance and track its presence over time.Disclosure: None
Ambulatory antibiotic prescribing for children in a practice research network
Authors: Mitchell Lauren , Kronman Matthew , Cole Allison , Poole Nicole 
Published: September 2023

Background: Most antibiotic use occurs in ambulatory settings. Antibiotic prescribing for children living in the United States in medically underserved areas or in populations is not well understood.Objective: To characterize antibiotic prescribing for children in a practice-based research network (PBRN).Design and Methods: In this retrospective cohort study, we characterized oral antibiotic prescribing in a large PBRN. Patients aged 0–17 years with at least 1 in-person visit between January 1, 2014, and December 31, 2018, at 1 of 25 primary-care clinics located within the WWAMI (Washington, Wyoming, Alaska, Montana, and Idaho) region of the Practice and Research Network (WPRN) were included. Data were extracted from DataQUEST, a centralized data repository from included primary-care clinics. Encounters for wellness visits or those lacking a diagnosis code and patients with complex chronic conditions were excluded. Diagnoses were categorized using International Classification of Disease, Ninth Revision (ICD-9) and ICD-10 codes. Oral antibiotics prescribed within 3 days of an encounter were associated with that encounter. Demographic data included age, sex, race, and ethnicity. Antibiotic appropriateness was determined using a previously published 3-tiered classification system using diagnosis codes as always, sometimes, or never appropriate. Patient-level data (ZIP codes) were used to designate medically underserved areas (MUAs) and medically underserved populations (MUPs). Antibiotic prescribing was then analyzed within these groups. Results: In total, 37,314 patients across 206,845 encounters were included, of which 34,601 encounters (17%) resulted in antibiotic prescription (Table 1). Of those, appropriateness data were available for 34,286 (99%). Of the antibiotics prescribed, 14% were always appropriate, 57% were sometimes appropriate, and 27% were never appropriate (1% missing). In total, 64% and 35% of encounters occurred with patients from an MUA and MUP, respectively. Conclusions: Targets to improve oral antibiotic prescribing for children in a large PBRN include antibiotic prescribing for diagnoses that never require an antibiotic. Larger comparative studies may focus on the role (if any) that MUA/MUP has on antibiotic prescribing.Disclosures: None
In-depth assessment of critical access hospital stewardship program adherence to the CDC Core elements in Iowa and Nebraska
Authors: Ryder Jonathan , Tigh Jeremy , Watkins Andrew , Preusker Jenna , Schroeder Daniel , Ashraf Muhammad Salman , Schooneveld Trevor Van 
Published: September 2023

Background: Critical-access hospitals (CAHs) are required to meet the CDC 7 Core Elements of antimicrobial stewardship programs (ASPs). CAHs have lower adherence to the core elements than larger acute-care hospitals, and literature defining which core-element deficiencies exist within CAHs as well as barriers to adherence is lacking. Methods: We evaluated 21 CAH ASPs (5 in Nebraska and 15 in Iowa) that self-identified as potentially deficient in the Core Elements, via self-assessment followed by in-depth interviews with local ASP team members to assess adherence to the CDC Core Elements for ASPs. Core-element compliance was rated as either full (1 point), partial (0.5), or deficient (0), with a maximum score of 7 per ASP. High-priority recommendations to ensure core-element compliance were provided to facilities as written feedback. Self-reported barriers to implementation were thematically categorized. Results: Among the 21 CAH ASPs, none fully met all 7 core elements (range, 2.5–6.5), with a median of 5 full core elements met (Fig. 1). Only 6 ASPs (28.6%) had at least partial adherence to each of the 7 core elements. Action (21 of 21, 100%) and leadership commitment (16 of 21, 76.2%) were the core elements with the highest adherence, and accountability (4 of 21, 19%) and education (9 of 21, 42.9%) were the lowest. The most frequent high-priority recommendations were to provide physician and pharmacist leader ASP training (19 of 21, 90.5%), to track antimicrobial stewardship interventions (12 of 21, 57.1%), and to provide or track educational activities (12 of 21, 57.1%) (Fig. 2). One-third of programs were recommended to establish a physician leader. The most commonly self-identified barriers to establishing and maintaining an ASP were a lack of dedicated resources such as time of personnel (15 of 20, 75%), lack of infectious diseases expertise and training (8 of 20, 40%), and electronic medical record limitations (5 of 20, 25%) (Fig. 3). Conclusions: CAH ASPs demonstrate several critical gaps in achieving adherence to the CDC Core Elements, primarily in training for physician and pharmacist leaders and providing stewardship-focused education. Further resources and training customized to the issues present in CAH ASPs should be developed.Disclosures: None
Investigating potential drivers of increased central-line–associated bloodstream infections during the SARS-CoV-2 omicron-variant surge
Authors: Kang HeeEun , Stewart Kathleen O. , Khan Asif , Casale Stephanie C. , Barker Caitlin Adams , Kim Justin 
Published: September 2023

Background: Central-line–associated bloodstream infection (CLABSI) rates increased nationally during COVID-19, the drivers of which are still being characterized in the literature. CLABSI rates doubled during the SARS-CoV-2 omicron-variant surge at our rural academic medical center. We sought to identify potential drivers of CLABSIs by comparing period- and patient-specific characteristics of this COVID-19 surge to a historical control period. Methods: We defined the study period as the time of highest COVID-19 burden at our hospital (July 2021–June 2022) and the control period as the previous 2 years (July 2019–June 2021). We compared NHSN CLABSI standardized infection ratios (SIRs), central-line standardized utilization ratios (SURs), completion of practice evaluation tools (PETs) for monitoring of central-line bundle compliance, and proportions of traveling nurses. We performed chart reviews to determine patient-specific characteristics of NHSN CLABSIs during these periods, including demographics, comorbidities, central-line characteristics and care, and microbiology. Results: The CLABSI SIR was significantly higher during the study period than the control period (0.89 vs 0.52; P = .03); the SUR was significantly higher during the study period (1.08 vs 1.02; P < .01); the PET completion per 100 central-line days was significantly lower during the study period (23.0 vs 31.5; P < .01); and the proportion of traveling nurses was significantly higher during the study period (0.20 vs 0.08; P < .01) (Fig. 1). Patients with NHSN CLABSIs during the study period were more likely to have a history of COVID-19 (27% vs 3%; P = .01) and were more likely to receive a higher level of care (60% vs 27%; P = .02). During the study period, more patients had multilumen catheters (87% vs 61%; P = .04). The type of catheter, catheter care (ie, dressing changes and chlorhexidine bathing), catheter duration before CLABSI, and associated microbiology were similar between the study and control periods (Table 1). Conclusions: During the SARS-CoV-2 omicron-variant surge, the increase in CLABSIs at our hospital was significantly associated with increased central-line utilization, decreased PET completion, and increased proportion of traveling nurses. Critical illness and multilumen catheters were significant patient-specific factors that differed between CLABSIs from the study and control periods. We did not observe differences in catheter type, duration, or catheter care. Our study highlights key modifiable risk factors for CLABSI reduction. These findings may be surrogates for other difficult-to-measure challenges related to the culture of safety during a global pandemic, such as staff education related to infection prevention and daily review of central-line necessity.Disclosures: None
Multidrug-resistant ventilator-associated pneumonia (VAP) before and during the COVID-19 pandemic among hospitalized patients in a tertiary-care private hospital
Authors: Aligui Alec Ann Alissa , Abad Cybele Lara 
Published: September 2023

Background: Data on the incidence and outcome of ventilator-associated pneumonia (VAP) and multidrug-resistant VAP (MDR-VAP) among COVID-19 patients are limited. We compared the incidence and incidence density (ie, number of VAP per 1,000 ventilatory days) of MDR-VAP prior to and during the COVID-19 period in an urban, tertiary-care hospital. Methods: A retrospective study was conducted to compare the incidence, profile, and outcomes of patients with MDR-VAP during the pre–COVID-19 period (2018–2019) and during the COVID-19 pandemic (2020–2021). Results: In total, 80 (22%) of 362 patients developed VAP and were included in the cohort: 27 (33.75%) from the pre–COVID-19 period and 53 (66.25%) from the COVID-19 period, respectively. Most were male [20 (74%) of 27 vs 34 (64%) of 53], with median ages of 66 years (range, 35–90) and 67 years (range, 32–92) in the pre–COVID-19 and COVID-19 periods, respectively. Comorbidities were similar between the 2 periods, except for cardiovascular disease (14 vs 11; P = .005) and chronic lung disease (14 vs 9; P = .0012), which decreased significantly from the pre–COVID-19 period to the COVID-19 period. Only 15 (56%) of 27 versus 37 (70%) of 53 patients developed MDR-VAP during the pre–COVID-19 and COVID-19 period, with incidence densities of 19.3 of 1,000 and 27.8 of 1,000 ventilator days (P = .0371), respectively. The median length of stay prior to VAP for the pre–COVID-19 and COVID-19 periods were 17 and 10 days, respectively (P < .0001). Extended-spectrum β-lactamase (ESBL) resistance increased significantly from 1 (3.7%) of 27 before COVID-19 to 15 (28.3%) of 53 during the COVID-19 period. Carbapenem-resistant Enterobacteriaceae (CRE) resistance was higher before COVID-19 than during the COVID-19 period: 15 (56%) of 27 versus 10 (19%) of 53. In both periods, Klebsiella pneumoniae and Acinetobacter baumannii were the most common pathogens isolated. Mortality was high in both periods at 93% and 83%, respectively. Only female sex was associated with MDR-VAP in the COVID-19 period on multivariate analysis (OR, 3.47; 95% CI, 1.019–11.824; P < .047). Conclusions: The frequency of VAP and MDR-VAP increased during the COVID-19 period, despite a shorter median hospital stay. Mechanisms of resistance differed in the pre–COVID-19 and COVID-19 periods. Mortality with VAP was extremely high. The factors associated with increased risk of VAP and COVID-19 need to be studied further, and measures to prevent VAP should be prioritized.Disclosures: None
Characterizing healthcare worker attitudes toward the bivalent COVID-19 booster
Authors: Willebrand Kathryn , Fredrick Jacqueline , Pischel Lauren , Patel Kavin , Roberts Scott , Murray Thomas , Martinello Richard 
Published: September 2023

Background: Recent evidence has shown that the updated COVID-19 bivalent booster is effective in preventing COVID-19 compared with no previous vaccination and prior monovalent vaccination. Despite its effectiveness, uptake has been poor, and a minority of eligible recipients have received the booster. Understanding healthcare worker (HCW) attitudes for and against voluntary uptake of the bivalent booster dose against COVID-19 can help guide communication strategy to maximize uptake. In this survey study, we investigated attitudes toward updated and/or bivalent booster uptake in a behavioral health hospital shortly after a COVID-19 outbreak. Methods: A survey tool was developed and sent to all HCWs at the Yale New Haven Psychiatric Hospital in December 2022. The survey queried demographic data, job category, history of COVID-19, prior COVID-19 vaccinations, perception of COVID-19 exposure, and updated and/or bivalent booster doses. The survey was administered several weeks after a COVID-19 outbreak on multiple inpatient behavioral health units. Receipt of the COVID-19 primary vaccination series and the first booster dose were mandated for HCWs; however, receipt of the bivalent booster was voluntary. Results: The survey was sent to 664 HCWs with primary assignments in behavioral health settings. In total, 182 (27.4%) provided complete responses to the survey and are included in these data. Moreover, 91 HCWs (50.0%) reported previously having COVID-19 at least once. Overall, 100 HCWs (55.0%) received the bivalent booster. The most identified reasons for receiving the bivalent booster were wanting to protect family and friends (n = 113), importance of staying healthy (n = 112), and protecting colleagues and patients (n = 103). The most identified reasons for not wanting to receive the bivalent booster dose were not thinking it provides additional protection (n = 33), “too many” shots already received (n = 31), and concern about side effects (n = 30). Discussion: Bivalent booster dose uptake in HCWs on behavioral health units shortly after a COVID-19 outbreak was greater than the general population. HCWs reported varying reasons for and against receipt of the bivalent booster dose, with the most common being protection of family and friends and perceptions of no additional protection, respectively. A limitation of this study was voluntary response bias, in which results are biased toward individuals more likely to receive a bivalent booster vaccine. It is unclear whether reasons for declining the vaccine are representative of HCWs who did not complete the survey. Assessing attitudes for the bivalent booster dose can assist in guiding communication and outreach strategies to increase vaccine uptake by HCWs.Disclosures: None
Measuring the efficacy of routine disinfection methods on frequently used physical therapy equipment
Authors: Barrett Aaron , Graves Amanda , Jesus Elaine De , Edelschick Jennifer , McCotter Diandrea , Anderson Deverick , Turner Nicholas , Warren Bobby 
Published: September 2023

Background: Frequently used physical therapy (PT) equipment is notably difficult to disinfect due to equipment material and shape, however, the efficacy of standard disinfection of PT equipment is poorly understood. Methods: We completed a prospective observational microbiological analysis of fomites used in adult or pediatric PT at Duke University Health System, Durham, North Carolina, from September to December 2022. Predetermined study fomites were obtained after being used during a clinical shift and standard disinfection had been completed by clinical service staff. Fomites were split into 2 halves, left and right, for sampling. Samples were taken with premoistened cellulose sponges processed using the stomacher technique and were incubated on appropriate selective and general medias. We defined antimicrobial-resistant, clinically important pathogens (AMR-CIP) as MRSA, VRE, and MDR-gram-negative isolates, and non–AMR-CIP as MSSA, VSE, and gram-negative species. Study fomites were grouped as follows: (1) pediatric pig toy, (2) walking aids (walkers or canes), (3) balls (medicine, dodge, etc), and (4) other (foam roller, sliding board, etc). Results: In total, 47 patients, 61 fomites, and 122 were analyzed. Of the study patients, 24 (51%) were female, 13 (27%) had active infections, and 15 (32%) were on contact precautions. Because fomites were split in half, patients in the left and right study arms were identical. Overall, the median total colony-forming-units (CFU) of study fomites was 1,348 (IQR, 398–2,365): 468 (IQR, 161–1,230) for the left side study arm and 540 (IQR, 102–1,221) for the right study arm (P = .45). At the sample level, 52 (43%), 15 (12%), and 37 (30%) of 122 samples harbored any CIPs, AMR CIPs, or non-AMR CIPs, respectively. At the fomite level, 27 (44%), 5 (8%), 15(25%), and 7 (11%) of 61 fomites harbored any CIPs, only AMR-CIPs, only non-AMR CIPs, or both AMR and non-AMR CIPs, respectively. Generally, therapy balls were the most contaminated study fomites (n = 2,237; IQR, 1,425–2,658), and walking aids were most frequently contaminated with any CIPs (n = 26, 72%), AMR CIPs (n = 8, 22%), and non-AMR CIPs (n = 15, 47%). Discussion: Following routine disinfection, frequently used PT equipment remained heavily contaminated and harbored AMR and non-AMR CIPs, supporting the notion that PT equipment is difficult to disinfect via standard disinfection. Additionally, left-, and right-side fomite divisions had similar pathogens, suggesting that this sampling model of intrapatient comparisons may be helpful for resolving case-mix issues in future studies. Future work should focus on PT-specific enhanced disinfection strategies to improve the disinfection of PT equipment.Financial support: This study was funded by PURioLABS.Disclosures: None
Decontamination of bedding reduces the risk for contamination of personnel changing bedding: A simulation study
Authors: Cadnum Jennifer , Osborne Andrew , Memic Samir , Donskey Curtis , Torres-Teran Maria 
Published: September 2023

Background: The recent worldwide outbreak of Mpox virus infections has raised concern about the potential for nosocomial acquisition during handling of contaminated bedding or clothing. We conducted simulations to test the hypothesis that decontamination of bedding prior to handling could reduce the risk for contamination of personnel. Methods: We conducted a crossover trial to test the effectiveness of spraying contaminated bedding with a hydrogen peroxide disinfectant in reducing contamination of personnel during handling of the contaminated bedding. Bedding was contaminated on top and bottom surfaces with aerosolized bacteriophage MS2. Personnel (N = 10) wearing a cover gown and gloves removed the bedding from a patient bed and placed it into a hamper both with and without prior hydrogen peroxide spray decontamination. After handling the bedding, samples were collected to assess viral contamination of gloves, cover gown, neck or chest, and hands or wrists. Results: Contamination of the gloves and cover gown of personnel occurred frequently during handling of bedding and 20% of participants had contamination of their hands or wrists and neck after the simulation (Fig.). Decontamination of the bedding reduced contamination of the gloves and eliminated contamination of the cover gown, hands or wrists, or neck. Conclusion: Decontamination of bedding prior to handling could be an effective strategy to reduce the risk for nosocomial acquisition of Mpox by healthcare personnel.Disclosures: None
Genetic relatedness among Neisseria gonorrhoeae isolates in southeastern Michigan
Authors: Shallal Anita , Tibbets Robert , Gurdziel Katherine , Vager Dora , Zervos Marcus , Suleyman Geehan 
Published: September 2023

Background: Antimicrobial resistance (AMR) in Neisseria gonorrhoeae (NG) is an emerging public health crisis. Whole-genome sequencing (WGS) is an efficient way of predicting AMR determinants and their spread in the population. In a previous study, genotype–phenotype correlation analyses among NG isolates to determine antimicrobial resistance revealed discordance for azithromycin (AZM) and ceftriaxone (CRO) compared to other antibiotics. We investigated the evolutionary relatedness of NG isolated from patients with sexually transmitted infection (STI) using WGS in southeastern Michigan. Methods: Isolates, corresponding demographic data, and minimum inhibitory concentrations (MIC) via E-test (CRO) and broth microdilution (AZM) were obtained from the Michigan Department of Health and Human Services. Whole-genome libraries were prepared using the QIAseq FX kit followed by sequencing on a NovaSeq6000 (>200X Coverage); samples were aligned to NG reference strain TUM19854 (NZ_AP023069.1) using Snippy before phylogenetic tree generation using Neighbor-joining clustering on the core.aln files. Phylogenetic trees were visualized using ATGC:PRESTO. Results: In total, 38 isolates were analyzed. Demographic data and susceptibility testing results are noted in Table 1. Most isolates were from males (63%), Blacks (44.7%), individuals living in Detroit City proper (47.3%), and those with unknown HIV status (55.2%). More than one-third had prior STI, including NG. All isolates were susceptible to CRO (CLSI susceptible breakpoint MIC, 1). Within the phylogenetic tree, 8 main branches were identified (Fig. 1). Moreover, 1 branch contained a cluster with 12 closely related isolates, which included the 9 isolates with nonsusceptible AZM. Nearly all isolates in that cluster had been collected from Detroit City proper and Wayne County, suggesting epidemiological overlap and potential spread of resistant strains in those counties.Conclusions: Comparative whole-genome and phylogenetic analyses among a subset of NG isolates revealed clustering of AZM resistance strains, suggesting a genomic component to AMR. Further studies are needed to determine the utility of WGS in diagnosis, outbreak investigations, and management of NG infections.Disclosures: None