bluuebunny/crossref_metadata_2025_split huggingface dataset:
Computer-Assisted Avatar-Based Treatment for Dysfunctional Beliefs and Eating-Disorder Symptomatology: A Randomized Control Pilot Study
Authors: Fey Marius , Peperkorn Nicolina , Borchert Thomas , Meyer Marie Lisa , Raacke Jan , Shiban Youssef 
Published: September 2023

AbstractDysfunctional beliefs influence the pathogenesis and maintenance of eating disorders. Cognitive-behavioral therapy (CBT) aims to modify these specific beliefs and mediate functional patterns of appraisal and thinking. The present pilot study aims to experimentally validate a computer-assisted avatar-based treatment (CAT-DB) to reduce dysfunctional body-related cognitions and symptom severity in a sample with subclinical eating disorder symptomatology. In a randomized controlled trial, 48 participants were assigned to either the control group or CAT-DB. The conviction of individual body-related cognitions and eating disorder-specific symptom expression was measured shortly before the beginning of the intervention (pre-measurement), directly after the intervention (post-measurement), and 14 days later (follow-up). There was a significant interaction effect for symptom severity, as reductions in eating disorder-specific symptomatology were significantly greater in the CAT-DB group compared to the control group at follow-up. Compared to the control group, CAT-DB resulted in non-significant but expected improvements in individual body-related automatic thoughts. The present study offers preliminary evidence suggesting that CAT-DB could be efficacious in addressing certain symptoms associated with eating disorders. Further studies with representative clinical samples diagnosed with eating disorders are needed to provide more evidence of the efficacy of CAT-DB as a support for classical CBT in a variety of therapeutic and research contexts.
Evaluation of four environmental sampling methods for the recovery of multidrug-resistant organisms
Authors: Babiker Ahmed , Page Alex , Riel Julia Van , Wilber Eli , Strudwick Amanda , Bower Chris , Woodworth Michael , Satola Sarah 
Published: September 2023

Background: Environmental contamination is a major risk factor for multidrug-resistant organism (MDRO) exposure and transmission in the healthcare setting. Sponge-stick sampling methods have been developed and validated for MDRO epidemiological investigations, leading to their recommendation by public health agencies. However, similar bacteriological yields with more readily available methods that require less processing time or specialized equipment have also been reported. We compared the ability of 4 sampling methods to recover a variety of MDRO taxa from a simulated contaminated surface. Methods: We assessed the ability of (1) cotton swabs moistened with phosphate buffer solution (PBS), (2) e-swabs moistened with e-swab solution, (3) cellulose-containing sponge sticks (CSS), and (4) non–cellulose-containing sponge sticks (NCS) to recover extended-spectrum β-lactamase (ESBL)–producing Escherichia coli, carbapenem-resistant Pseudomonas aeruginosa (CRPA), carbapenem-resistant Acinetobacter baumannii (CRAB), methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus faecium (VRE), and a mixture that contained VRE, MRSA, and ESBL organisms. A solution of known bacterial inoculum (~105 CFU/mL) was made for each MDRO. Then, 1 mL solution was pipetted on a stainless-steel surface (8 × 12 inch) in 5 µL dots and allowed to dry for 1 hour. All samples were collected by 1 individual to minimize variation in technique. Sponge sticks were expressed in PBS containing 0.02% Tween 80 using a stomacher, were centrifuged, and were then resuspended in PBS. Cotton and e-swabs were spun in a vortexer. Then, 1 mL of fluid from each method was plated to selective and nonselective media in duplicate and incubated at 35°C for 24 hours (MRSA plates, 48 hours) (Fig. 1). CFU per square inch and percentage recovery were calculated. Results: Table 1 shows the CFU per square inch and percentage recovery for each sampling method–MDRO taxa combination. The percentage recovery varied across MDRO taxa. Across all methods, the lowest rate of recovery was for CRPA and the highest was for VRE. Regardless of MDRO taxa, the percentage recovery was highest for the sponge stick (CSS and NCS) compared to swab (cotton and E-swab) methods across all taxa (Table 1 and Fig. 2).Conclusions: These findings support the preferential use of sponge sticks for the recovery of MDROs from the healthcare environment, despite the additional processing and equipment time needed for sponge sticks. Further studies are needed to assess the robustness of these findings in noncontrived specimens as well as the comparative effectiveness of different sampling methods for non–culture-based MDRO detection.Disclosure: None
Identifying nonprescription antibiotic users with screening questions in a primary care setting
Authors: Amenta Eva , Valentine-King Marissa , Laytner Lindsey , Paasche-Orlow Michael , Street Richard , Barning Kenneth , Porter Thomas , Mahmood Hammad , Trautner Barbara , Grigoryan Larissa 
Published: September 2023

Background: Antibiotic use without a prescription (nonprescription use) leads to antibiotic overuse, with negative consequences for patient and public health. We studied whether screening patients for prior nonprescription antibiotic use in the past 12 months predicted their intentions to use them in the future. Methods: A survey asking respondents about prior and intended nonprescription antibiotic use was performed between January 2020 and June 2021 among patients in waiting rooms of 6 public clinics and 2 private emergency departments in economically and socially diverse urban and suburban areas. Respondents were classified as prior nonprescription users if they reported previously taking oral antibiotics without contacting a doctor, dentist, or nurse. Intended use was defined as answering “yes” or “maybe” to the question, “Would you use antibiotics without contacting a doctor, nurse, or dentist?” We calculated the sensitivity, specificity, and positive and negative predictive value (PPV and NPV) of prior nonprescription antibiotic use in the past 12 months for future intended nonprescription use. Bayes PPV and NPV were also calculated, considering the prevalence of nonprescription antibiotic use (24.8%) in our study. Results: Of the 564 patients surveyed, the median age was 51 years (SD, 19–92), with 72% of patients identifying as female. Most were from the public healthcare system (72.5%). Most respondents identified as Hispanic or Latino(a) (47%) or African American (33%), and 57% received Medicaid or the county financial assistance program. Prior nonprescription use was reported by 246 (43%) of 564 individuals, with 91 (16%) reporting nonprescription use within the previous 12 months. Intention to use nonprescription antibiotics was reported by 140 participants (25%). The sensitivity and specificity of prior nonprescription use in the past 12 months to predict the intention to use nonprescription antibiotics in the future were 75.9% (95% CI, 65.3–84.6) and 91.4% (95% CI, 87.8–94.2), respectively. After the Bayes’ adjustment, the PPV and NPV of prior use to predict future intention were 74.5% (95% CI, 66.7–80.9) and 92.0% (95% CI, 88.7–94.4) (Table 1). Conclusions: These results show that prior nonprescription antibiotic use in the past 12 months predicted the intention to use nonprescription antibiotics in the future (PPV of 75%). As a stewardship effort, we suggest clinicians use a simple question about prior nonprescription antibiotic use in primary-care settings as a screening question for patients at high risk for future nonprescription antibiotic use.Financial support: HSQR-R 5R01HS026901-04Disclosure: None
Patient and facility characteristics of an NDM-producing Acinetobacter baumannii outbreak in California, 2020–2022
Authors: Hsiao Lian , Horwich-Scholefield Sam , Mitsunaga Tisha , Holden Diana , Epson Erin 
Published: September 2023

Background: Carbapenem-resistant Acinetobacter baumannii (CRAB) are bacteria that cause healthcare-associated infections and outbreaks. Most produce carbapenemases like New Delhi metallo-β-lactamase (NDM), which are more commonly found in carbapenem-resistant Enterobacterales but rarely in CRAB. In 2018, selected laboratories began participating in a public health sentinel surveillance program by routinely submitting CRAB and other antimicrobial-resistant isolates to the AR Laboratory Network for specialized testing. In May 2020, the Antimicrobial Resistance Laboratory Network detected the first NDM-CRAB case in California, triggering an investigation. Initial whole-genome sequencing of subsequent isolates indicated high relatedness. Methods: We defined confirmed cases as patients with NDM detected in CRAB isolates and probable cases as NDM detected in a screening swab from a patient epidemiologically linked to a known case(s) with specimens collected during May 2020–September 2022. We defined outbreak facilities as having (1) 1 or more newly identified cases during a point-prevalence survey in response to a known case or (2) at least 2 cases identified within 4 weeks of each other that were epidemiologically linked. We analyzed demographic and specimen characteristics, as well as healthcare exposure history using R Studio version 1.3.959 software. Results: Of 230 total patients, 176 (77%) were confirmed and 54 (23%) were probable cases; 150 (65%) were identified through colonization screening. Among 176 NDM-CRAB isolates, the most common specimen sources were respiratory (n = 29), wound (n = 28), and urine (n = 24), and 87 (49%) of 176 isolates were nonsusceptible to all antimicrobials tested. Among patients, median age was 65 years (range, 24–97), 127 (55%) were male, 37 (15%) were Hispanic or Latino, and 100 (43%) were White. We identified 37 outbreak facilities across 13 counties, including 25 acute-care hospitals (ACHs), 6 skilled nursing facilities (SNFs), 5 ventilator-equipped SNFs (vSNFs), and 1 long-term ACH. We identified 125 cases (54%) in SNFs and vSNFs and 93 cases (40%) in ACHs; among ACH patients, 43 (46%) had been SNF or vSNF residents within the prior year. No patients reported international exposure. Conclusions: The first known case of NDM-CRAB in California was detected by sentinel surveillance. In this extensive regional outbreak, most cases were identified by screening at public health and clinical laboratories. Transmission occurred across healthcare settings connected by patient sharing, underscoring the importance of communication, active surveillance, and implementation of infection prevention and control practices to mitigate spread within and between facilities. Expanding these efforts, with support and resources from public health departments, is key to detecting, characterizing, and containing future outbreaks of antimicrobial-resistant pathogens.Disclosure: None
Sex differences in knowledge and practices regarding antibiotics and antibiotic resistance in the Puerto Rican population
Authors: Toro-Garay Yiana , Rivera-Santiago Tanialy , Ortiz-Bonilla Vilmarie 
Published: September 2023

Background: Antibiotic resistance is one of the biggest threats to global health, and by 2050 it is expected to cause 10 million deaths per year globally. Sex differences depend on context and sociodemographic factors; therefore, studies addressing sex differences have been inconclusive. Furthermore, to our knowledge, sex differences in the Puerto Rican population have not been analyzed. We sought to understand whether knowledge and practices regarding antibiotic use and antibiotic resistance in the Puerto Rican population differ by sex. Methods: A convenience sampling was performed at outpatient clinics across Puerto Rico. Those who agreed to participate completed a self-report questionnaire aimed to address demographics, antibiotic knowledge, and experiences. Bivariate analyses were performed using Stata version 17.0 software. Results: In total, 252 participants received the questionnaire, and 250 completed it. Most of the participants were female (71.2%), aged >56 years (40.0%), and had a high school diploma (40.4%). Women had 2.71 (95% CI, 1.1–6.8, P). Conclusions: Women perceived themselves to be more knowledgeable regarding antibiotic use and resistance than men. However, no difference in actual knowledge could be identified. Similarly, antibiotic-related practices did not differ by sex except for using previously saved antibiotic treatment, and men had higher odds of conducting this practice. Further studies should be conducted to understand the factors that influence these behavioral practices, and educational interventions should focus on addressing misconceptions regarding antibiotics and antibiotic resistance.Disclosures: None
Determining trends of respiratory tract infections in a long-term care facility pilot surveillance project
Authors: Adre Cullen , Patel Dipen , Reed Vicky , Velrajan Srilakshmi , Evans Christopher , Wilson Christopher 
Published: September 2023

Background: Respiratory tract infections (RTIs) in long-term care facilities (LTCFs) are particularly burdensome among residents, the COVID-19 pandemic highlighted the devastating consequences of RTIs in LTCFs. This situation has prompted the need for LTCFs to have a robust, active surveillance system to assist LTCFs with RTI identification. Such a system could assist with faster implementation of appropriate antimicrobial therapy and critical infection prevention and control. The TN Emerging Infections Program worked with CDC EIP to implement a pilot project to test the feasibility of performing RTI surveillance to inform future changes to NHSN. Methods: We recruited 6 LTCFs to collect prospective RTI surveillance for 6 consecutive months from October 2021 through March 2022. Data were collected for all residents meeting the RTI surveillance definitions: pneumonia, lower respiratory tract infection, influenza-like illness (including influenza), and COVID-19. These data were entered by facility workers into a REDCap database with a prospective RTI LTCF event form. Monthly data collection summaries were submitted using a designated denominator form. Descriptive statistics were used to analyze RTI data, and analyses were performed using SAS version 9.4 software. Results: In total, 6 facilities participated in the pilot project during the capture period. The total number of RTI cases across all facilities was 195. December had the most cases (n = 50). The most common first triggers were new RTI signs or symptoms (67.69%), laboratory results (17.44%), imaging findings (6.67%), and clinician-diagnosed RTI (8.21%). The most reported symptom was new or increased cough (57.44%). Chest radiographs were performed for 50.77% of patients. Positive viral laboratory test results were documented 29.74% of the time. Antibiotic treatments were given to 70.77% of residents. The most commonly prescribed antibiotics were cephalosporins (22.56%), macrolides (17.95%), fluoroquinolones (12.31%), and doxycycline (9.23%). Also, 17.4% of cases with antibiotic regimens had cephalosporins as monotherapy. Vaccine documentation was as follows: influenza 2020–2021 (40.51%), influenza 2021–2022 (64.1%), complete COVID-19 vaccine series (82.56%), PPSV-23 vaccine (33.85%), and PCV-13 (23.59%). Conclusions: RTI surveillance was incorporated smoothly into the daily workflow for facilities; the biggest barrier to effective implementation was staff turnover. A scheduled weekly time to collect data and fill out forms proved most effective. A high percentage of cases was treated with cephalosporins as monotherapy, which, based on the latest guidelines, may be suboptimal. Individual reports were sent back to facilities with a comparison to the aggregated data. These data will be used to evaluate antibiotic appropriateness and to guide future RTI surveillance efforts in the LTCF setting.Disclosures: None
Effect of antifungal stewardship on micafungin prescribing practices in intensive care units at a tertiary-care hospital
Authors: Arya Radhika , Norman Sarah , Daas Farah , Ramdeen Sheena 
Published: September 2023

Background: Fungal diseases are associated with substantial global mortality and economic burden, especially in critically ill or immunocompromised patients. Antifungal resistance has emerged as a barrier to treating invasive fungal infections, but antifungal stewardship is still a developing effort due to limited data. Here, we describe the antifungal prescribing practices and the impact of antifungal stewardship on micafungin days of therapy (DOTs) in critical care units. Methods: This retrospective study included patients who were admitted to the intensive care unit (ICU) at a tertiary-care hospital in Washington, DC. The preintervention group included baseline micafungin use data between January 1, 2021, and May 31, 2021. The postintervention group included prospective audits, feedback on micafungin orders by a clinical pharmacist, and education on the appropriateness of the antifungal agents. The postintervention group included patients admitted between June 1, 2021, and December 31, 2021. Approval was obtained from the institutional review board. Results: The overall average of micafungin days of therapy (DOT) per 1,000 patient days present in the preintervention group versus the postintervention group was 33 versus 24 days, respectively. Moreover, 121 patients were randomly selected for a more detailed retrospective review to define micafungin prescribing practices further. Of these, 73 patients (60.3%) were male; the median age was 63 years. The most common cause for prescribing micafungin in both groups was empiric antifungal coverage (62.8%), followed by fungemia (12.4%). The most common organism isolated was Candida albicans. For other sources of infection and organisms isolated, refer to Table 1. In-hospital mortality occurred in 63 (52.06%) patients in both groups. Conclusions: Antifungal stewardship through prospective audit and feedback and education by clinical pharmacists decreased micafungin DOTs in critical care units. Empiric prescribing of micafungin is highly prevalent in the ICU despite the low incidence of invasive fungal infections. Although periodic drug utilization reviews and pharmaceutical surveillance can help reduce the prolonged duration of micafungin therapy in the ICU, more robust and routine antifungal stewardship is key to the appropriate use of micafungin to avoid the emergence of antifungal resistance.Disclosures: None
Serotonergic agents and linezolid: Impact of exposure to more than one agent concomitantly on risk of adverse effects
Authors: Yan Xuping , McCoy Christopher , Chapin Ryan , Lee Matthew , Gold Howard , Donohoe Kendall 
Published: September 2023

Background: The off-target effects linezolid have the potential to cause serotonin syndrome when given in conjunction with serotonergic agents. Despite package insert labeling as a contraindication, several postmarketing studies have demonstrated a low incidence of serotonin syndrome with the concomitant use of linezolid and other serotonergic agents. Linezolid provides a convenient oral option for gram-positive infections. However, due to concerns for serotonin syndrome, the use of linezolid is sometimes avoided. Methods: We performed a single-center, retrospective, medical record review of all adult inpatients from September 2021 to September 2022. Patients included had 1 administration of linezolid and 1 inpatient administration of a selective serotonin reuptake inhibitor (SSRI) or serotonin and norepinephrine reuptake inhibitor (SNRI) within 14 days. The primary outcome was the incidence of serotonin syndrome as defined by the Hunter serotonin toxicity criteria, which were retrospectively applied to each patient based on medical-record documentation. We compared patients receiving 1 versus multiple serotonergic agents. Secondary outcomes included duration of hospitalization and adverse outcomes based on concerns for serotonin syndrome such as need for rescue, ICU admission, or change in medication. Results: Of the 50 included patients from a convenience sample, 27 (54%) were on linezolid and >1 serotonergic agent. Patients had similar baseline characteristics (Table 1). The most common concomitant agent used was an SSRI. Other agents that predispose patients to serotonin syndrome included opioid analgesics and other classes of antidepressants (Fig. 1). Serotonin syndrome occurred within 48 hours in 1 patient on an SNRI and a continuous fentanyl drip. There was no need for rescue or ICU admission due to serotonin syndrome. No patients were readmitted due to serotonin syndrome, and no differences were observed in hospital lengths of stay. Conclusions: Exposure to a single serotonergic agent combined with receipt of linezolid was not associated with any cases of serotonin syndrome. Exposure to multiple serotonergic agents was not associated with a high incidence of serotonin syndrome. This small series supports previous reports demonstrating relative safety of linezolid given with serotonergic agents and encourages review of interruptive drug–drug interaction alerts for linezolid within the electronic ordering system.Disclosures: None
Identifying the relationship between hospital rurality and antibiotic overuse
Authors: Hardin Hannah , Vaughn Valerie , White Andrea , Horowitz Jennifer , McLaughlin Elizabeth , Szymczak Julia , Petty Lindsay , Malani Anurag , Flanders Scott , Gandhi Tejal 
Published: September 2023

Background: Antibiotic overuse and the resulting patient outcomes span all hospitals. However, although antibiotic stewardship can improve antibiotic use, effective stewardship programs require expertise and an infrastructure that are not present in all hospitals. Rural hospitals have less access to resources, infectious disease expertise, and participation in academic research. Thus, we compared antibiotic overuse at discharge between rural and nonrural hospitals for patients diagnosed with community-associated pneumonia (CAP) or urinary tract infection (UTI)—the 2 most common hospital infections. Methods: To determine whether antibiotic overuse at discharge was higher among rural versus nonrural hospitals, we analyzed data from a 41-hospital prospective cohort of patients treated for CAP or UTI between July 1, 2017, and July 30, 2019, in Michigan. Antibiotic overuse was defined as treatment that was unnecessary (ie, patient did not have an infection), excessive (ie, duration >4 days for CAP), or included suboptimal fluoroquinolone use (ie, safer alternative available). Overuse was determined based on patient risk factors, symptoms, allergies, diagnostic results, and time to stability. Hospital rurality was defined using the Rural–Urban Continuum Codes (RUCC) score. We defined rural as a score ≥4 and very rural as a score of 7–9. We used t tests to compare the mean percentage of patients with antibiotic overuse at discharge between nonrural and rural (and very rural) hospitals. Results: Across 41 hospitals, we included 23,449 patients with CAP or UTI. There were 5 rural (and 3 very rural) hospitals with 2,039 (and 1,082) patients. Antibiotic overuse at discharge was present in 43.1% of patient cases in nonrural hospitals, 52.5% in rural hospitals (P = .04 vs nonrural) and 58.1% in very rural hospitals (P = .007 vs nonrural). Compared to nonrural hospitals, the mean percentage of cases with antibiotic overuse at discharge in rural hospitals was 9.4% higher (15.1% higher in very rural hospitals). Results were similar in a subgroup analysis of only patients with UTI (47.0% in rural vs 37.5% in nonrural, mean difference, 9.5%; P = .03) but were not statistically significant in patients with CAP (53.8% vs 48.0%, respectively; mean difference, 5.8%; P = 0.23). Conclusions: In this retrospective study, rural hospitals—especially very rural hospitals, had higher rates of antibiotic overuse at discharge than nonrural hospitals. Our findings suggest that antibiotic stewardship interventions tailored toward the unique differences in infrastructure, resources, and needs of rural hospitals are essential to community health.Disclosures: None