bluuebunny/crossref_metadata_2025_split huggingface dataset:
Identifying symptoms/illnesses and situations that predispose outpatients to use antibiotics in two healthcare systems
Authors: Laytner Lindsey , Grigoryan Larissa , Trautner Barbara , Alquicira Osvaldo , Salinas Juanita , Hansen Michael , Zoorob Roger , Khan Fareed M. 
Published: May 2022

Background: Taking antibiotics outside the guidance of a clinician (nonprescription use) is a potential safety issue and runs counter to antibiotic stewardship efforts. We identified the symptoms and illnesses and situations that may predispose patients to take antibiotics, and we compared these findings between patients attending public primary care clinics and private emergency departments. Methods: A cross-sectional survey was conducted between January 2020 and March 2021 in 6 primary care clinics and 2 emergency departments in the United States. We queried patients about 5 symptoms and illnesses (Fig. 1) and 14 situations (Fig. 2) to investigate whether these would lead the patients to take antibiotics without a prescription. We used the χ2 test to compare the symptoms and illnesses and situations between the respondents from public and private healthcare systems. We set the P value for significance at <.025. Results: In total, the survey had 564 respondents (median age, 49.7 years; range, 19–92), and 72% were female. Most respondents identified as either Hispanic or Latina/Latino (46.6%) or African American or Black (33%), followed by White (15.8%), and other (4.6%). Most respondents had visited public clinics (72%). The most common insurance status for our respondents included Medicaid or county financial assistance program (56.6%), followed by private insurance or Medicare (36.7%) and self-pay (6.7%). In public primary care clinics, only 23% had private insurance or Medicare compared to 72.9% in private emergency departments. Of those surveyed, 69% agreed that antibiotics would improve the recovery from sinus infections, followed by bronchitis (64%), sore throat (64%), cold/flu (61.4%), and diarrhea (31.5%). The proportions of respondents who believed that antibiotics would improve the recovery from diarrhea (36.2% vs 19.4%; P = .004) and sore throat (59.9% vs 48.4%; P < .001) were significantly higher among public versus private outpatient respondents. We did not find significant differences for cold/flu, sinus infection, or bronchitis between these 2 healthcare systems (Fig. 1). In 11 of the 14 situations, patients in public clinics were more likely to report a likelihood of using nonprescription antibiotics than the patients visiting the private emergency rooms (Fig. 2). Conclusions: Future stewardship interventions should be aware of the symptoms and illnesses and situations that may influence outpatients to take nonprescription antibiotics. Addressing modifiable factors (eg, leftover antibiotics, antibiotics given by friends or family, and antibiotics available without a prescription in stores or markets) may also curtail these unsafe practices and reduce antibiotic resistance.Funding: NoneDisclosures: None
Evaluation of periprocedure antibiotics and infection-related hospitalizations after transrectal prostate biopsies
Authors: Ryan Tenley , Thomas-Gosain Neena , Eason Jane , Akalu Hanna , Sharif Navila , Bennett Jessica 
Published: May 2022

Background: Prostate cancer is the leading cancer diagnosis and the second leading cause of cancer deaths in men. Definitive diagnosis is made by prostate biopsy. This procedure poses a risk of infection and, rarely, sepsis. Studies have found the incidence of symptomatic urinary tract infection (UTI) after biopsy to be 2%–3%, and the rate of infection-related hospitalization (IRH) to be 0.6%–4.1%. An initial review at our facility found the IRH rate to be 3.7%. The primary purpose of this study was to determine the incidence of IRH following prostate biopsy in patients at the Memphis VA Medical Center (VAMC) after initial review and education. Methods: All transrectal prostate biopsies performed at the Memphis VAMC from October 2017 through May 2021 were analyzed. Patients were excluded if they had a spinal cord injury or concomitant procedure. The primary outcome was IRH occurring within 30 days of the procedure. Variables collected included risk factors, antibiotic choice and duration, and details of postprocedural infections. Analyses were performed on a per-procedure basis. Results: Overall, 601 procedures were identified; 13 were excluded, for a total of 588 transrectal prostate biopsies on 533 patients. All patients were given antibiotics. Oral antibiotics alone were provided for 306 procedures (52%) for an average duration of 3 days. A combination of both oral and intramuscular antibiotics were provided for 282 (48%) procedures. The most common oral antibiotics used were cefuroxime (538, 91.4%), ciprofloxacin (17, 2.9%), amoxicillin–clavulanate (16, 2.7%), and sulfamethoxazole–trimethoprim (12, 2%). Intramuscular antibiotics included ceftriaxone (263, 93.3%) and gentamicin (19, 6.7%). An infectious complication occurred in 29 patients (4.9%): 26 (3.4%) were urogenital and 5 (0.8%) required hospitalization. Of the procedures complicated by a postprocedure infection, 22 (75.9%) received an oral antibiotic alone, 21 (95.4%) of which were cefuroxime, and 7 (24.1%) received both an intramuscular and an oral agent. Conclusions: In our initial review, the most common antibiotics used were fluroquinolones, with an average duration of 3 days periprocedure and an IRH rate of 3.7%. These findings were used to reinforce practices compliant with American Urological Association (AUA) guidelines. This follow-up review reveals that the first-line choice changed from fluroquinolones to cephalosporins, with average duration remaining at 3 days. Although the overall infection rate was 4.9%, the IRH rate decreased from 3.7% to 0.8%.Funding: NoneDisclosures: None
Central-line associated bloodstream infections secondary to strict anaerobes: Time for A definition change?
Authors: Seidelman Jessica , Lewis Sarah , Kalu Ibukun , Gettler Erin , Advani Sonali , Anderson Deverick , Smith Becky 
Published: May 2022

Background: Central-line–associated bloodstream infections (CLABSIs) arise from bacteria migrating from the skin along the catheter, by direct inoculation, or from pathogens that form biofilms on the interior surface of the catheter. However, given the oxygen-poor environments that obligate anaerobes require, these organisms are unlikely to survive long enough on the skin or on the catheter after direct inoculation to be the true cause of a CLABSI. Although some anaerobic CLABSIs may meet the definition for a mucosal-barrier-injury, laboratory-confirmed, bloodstream infection (MBI-LCBI), some may be not. We sought to determine the proportion of CLABSIs attributed to obligate anaerobic bacteria, and we sought to determine the pathophysiologic source of these infections. Methods: We performed a retrospective analysis of prospectively collected CLABSI data at 54 hospitals (academic and community) in the southeastern United States from January 2015 to December 2020. We performed chart reviews on a convenient sample for which medical records were available. We calculated the proportion of CLABSIs due to obligate anaerobes, and we have described a subset of anaerobic CLABSI cases. Results: We identified 60 anaerobic CLABSIs of 2,430 CLABSIs (2.5%). Of the 60 anaerobic CLABSIs, 7 were polymicrobial with nonanaerobic bacteria. The most common species we identified were Bacteroides, Clostridium, and Lactobacillus (Table 1). The proportion of anaerobic CLABSIs per year varied from 1.2% to 3.7% (Fig. 1). Of 60 anaerobic CLABSIs, 29 (48%) occurred in the only quaternary-care academic medical center in the database. In contrast, an average of 0.6 (SD, 0.6) anaerobic CLABSIs occurred in the 53 community hospitals over the 6-year study period. Of these 29 anaerobic CLABSIs, 23 (79%) were clinically consistent with secondary bloodstream infections (BSIs) due to gastrointestinal or genitourinary source, but they lacked appropriate documentation to meet NHSN criteria for secondary BSI or MBI-LCBI based on case reviews by infection prevention physicians. The other 6 anaerobic CLABSIs did not have a clear clinical etiology and did not meet MBI-LCBI criteria. In addition, 27 (93%) of 29 anaerobic CLABSIs occurred in patients who were either solid-organ transplant recipients, were stem-cell transplant recipients, or were receiving chemotherapy. Lastly, 27 (93%) of 29 anaerobic CLABSIs were treated with antibiotics. Conclusions: Anaerobic CLABSIs are uncommon events, but CLABSI may disproportionately affect large, academic hospitals caring for a high proportion of medically complex patients. Additional criteria could be added to the MBI-LCBI to better classify anaerobic BSI.Funding: NoneDisclosures: None
COVID-19 vaccine knowledge, beliefs and attitudes among Oregon healthcare provider types
Authors: Stampke Lisa Corley , Osborn Jessica , Guzman-Cottrill Judith 
Published: May 2022

Background: During this pandemic, the public has struggled to navigate the abundance of COVID-19 vaccine misinformation, and it is unclear how this misinformation has affected medical providers and their recommendations for patients. We sought to understand differences in COVID-19 vaccine knowledge, beliefs, and attitudes among Oregon healthcare provider types and regions of practice (rural, suburban, urban). Methods: A 36-question survey was constructed using Qualtrics with consultation from a survey methodologist. The survey was reviewed and approved by OHSU IRB and distributed via listserv or social media posting to provider societies in Oregon, including nurse practitioners (NPs), naturopathic doctors (NDs), physician assistants (PAs), doctors of medicine (MDs), doctors of osteopathic medicine (DOs), or practioners with a bachelor of medicine–bachelor of surgery (MBBS), and via the Oregon Health Authority (OHA) immunization practice listserv. The survey accepted responses from July 9 to August 12, 2021. Participants were volunteers and responses were anonymous. Results: We collected 101 responses. Among them, 87 participants completed 100% of survey questions. Survey respondents were predominantly White females aged 41–50 years with an MD, DO, or MBBS. The overall COVID-19 vaccination rate of respondents was 94.6%. The vaccination rate was highest among the 4 NDs and 7 PAs at 100%, followed by 78 MDs, DOs, and MBBSs at 96.2%, and 12 NPs at 75%. Of NP respondents, 67% practiced rurally; 25.6% of MDs, DOs, and MBBSs practiced rurally; and 25% of NDs and 28.6% of PAs practiced rurally. In total, 22% of NPs did not feel comfortable recommending the COVID-19 vaccine to patients, compared to 1% of MDs, DOs, and MBBSs and 0% of NDs or PAs. All provider types had high rates of disagreement with the statement that the COVID-19 pandemic had increased their trust in vaccine safety: 44% of NPs; 29% of PAs; 25% of NDs; and 7% of MDs, DOs, and MBBSs. Among 19 rural providers, 19% indicated mistrust in public health to ensure that vaccines are safe versus 3% in suburban areas and 0% in urban areas. Conclusions: COVID-19 vaccine hesitancy is prevalent among healthcare providers and may be higher in NPs and those practicing rurally. Unfortunately, the response rate of NPs was low. Future research should focus on these providers to better understand their knowledge, beliefs, and attitudes about COVID-19 vaccines. These results can also inform future targeted vaccine education to healthcare providers during public health crises.Funding: NoneDisclosures: None
RNA and viable SARS-CoV-2 contamination of emergency department surfaces and association with patient COVID-19 status and aerosol procedures
Authors: Tanner Windy , Roberts Scott , Barber Douglas , Barbell Elliana , Heimer Robert , Jubanyik Karen , Parwani Vivek , Tanner Jason , Ulrich Andrew , Wade Martina , Wiley Anne , Yolda-Carr Devyn , Martinello Richard 
Published: May 2022

Background: Aerosol-generating procedures (AGPs) performed on COVID-19–positive patients raise concerns about the dissemination of SARS-CoV-2 via aerosols and droplets. Infectious aerosols and droplets generated by SARS-CoV-2–positive patient AGPs or through direct COVID-19 patient coughing or exhalation could potentially contaminate surfaces, leading to the indirect spread of SARS-CoV-2 via fomites within the emergency department (ED). We sampled surfaces of ED patient rooms occupied by known SARS-CoV-2–positive patients or patients under investigation for COVID-19 and undergoing an AGP to determine the frequency of room contamination with SARS-CoV-2 RNA. Methods: Swabs were collected from 5 room surfaces in the ED following AGPs performed on patients under investigation for COVID-19 or positive for SARS-CoV-2. High- and low-touch surfaces 6 feet (2 m) from the patient (door handle and return vent, respectively) and reusable medical equipment were swabbed. Swabs were tested for SARS-CoV-2 RNA by RT-qPCR; positive samples were cultured in Vero E6 cells. Patient COVID-19 results were confirmed through the electronic medical record. Results: In total, 203 rooms were sampled: 43 SARS-CoV-2–positive patients with an AGP, 44 SARS-CoV-2–positive patients who did not have an AGP, and 116 SARS-CoV-2–negative patients with an AGP, for a total of 1,015 swabs. Overall, SARS-CoV-2 RNA was detected on 36 (3.5%) surfaces from 29 rooms (14.3%) (Table 1). RNA contamination was detected more frequently in rooms occupied by SARS-CoV-2–positive patients who did not have an AGP than rooms occupied by COVID-19 patients (30% vs 14%). SARS-CoV-2 RNA was also detected in rooms occupied by SARS-CoV-2–negative patients undergoing an AGP (9%). SARS-CoV-2 RNA was most frequently detected on air vents (n = 15), bedrails (n = 10), equipment and vital signs monitors (n = 4 each), and door handles (n = 3). One bedrail was positive by culture and confirmed by an RT-qPCR cycle threshold reduction from >40 to 13. Conclusions: We detected SARS-CoV-2 RNA contamination on room surfaces in the ED, regardless of patient AGP or COVID-19 status; however, RNA contamination of room surfaces was most common in rooms occupied by SARS-CoV-2–positive patients who did not have an AGP, which may be attributable to stage of disease and viral shedding. SARS-CoV-2 RNA contamination was also present in rooms where APGs were performed on SARS-CoV-2–negative patients, suggesting carryover from previous patients. SARS-CoV-2 RNA was found most often on room air-return vents, further emphasizing the importance of aerosols in the spread of SARS-CoV-2.Funding: NoneDisclosures: None
Candidemia before and after the COVID-19 pandemic: An analysis of risk factors and outcomes in patients with candidemia
Authors: Colburn Nora , Nichols Courtney , Lustberg Mark , Day Shandra , Haden Michael , Liscynesky Christina 
Published: May 2022

Background: An increase in candidemia has been observed throughout the world since the start of the COVID-19 pandemic. Patients with COVID-19 may have different risk factors, clinical presentations, and outcomes compared to patients without COVID-19. Methods: We conducted a retrospective chart review of all inpatients with candidemia at a large, academic medical center from April 30, 2019, to February 19, 2021. The first case of COVID-19 was detected at our institution March 2020 and patients were sorted into pre– versus post–COVID-19 pandemic groups. Data regarding clinical characteristics, risk factors, and outcomes were collected. The rate of candidemia per 10,000 patient days was calculated from January 2013 through February 2021. Results: In total, 202 patients were identified with candidemia: 92 cases were identified before the pandemic and 110 cases were identified after the pandemic began. Moreover, 33 (16.3%) patients were diagnosed with COVID-19 during the admission and 169 (83.7%) did not have COVID-19. Patients with COVID-19 were significantly more likely to be older (median, 64.5 vs 54.8 years; P = .0006) and to have a higher body mass index (32.8 vs 29.1; P = .03) than patients without COVID-19. Patients with COVID-19 were less likely have some of the traditional risk factors (eg, abdominal surgery, total parenteral nutrition, history of injecting drugs) for candidemia compared to patients without COVID-19. Patients with COVID-19 were significantly more likely to require ICU care (97.0% vs 67.5%; P < .001) and to require mechanical ventilation (90.9% vs 53.9%; P < .001), and they had higher mortality at 30 days (66.7% vs 31.4%; P < .001). A multivariate logistic regression model showed that COVID-19 (OR, 2.53; 95% CI, 1.09–5.90) and higher age (OR 1.45, 95% CI, 1.11–1.91) were significant predictors of 30 day mortality. Using a Poisson regression model, the incidence rate ratio for candidemia per month after the start of the COVID-19 pandemic was 2.09 (95% CI, 1.85–2.36; P < .0001) compared to the years prior. Conclusions: Rates of candidemia significantly increased after the start of the COVID-19 pandemic. Patients with candidemia in the post–COVID-19 era tend to have nontraditional risk factors, to be more critically ill, and to have increased mortality compared to patients in the pre–COVID-19 era. COVID-19 and higher age were independent predictors of mortality. More studies are needed to further define risk factors for candidemia in patients with COVID-19.Funding: NoneDisclosures: None
Diversity and persistence of MRSA and VRE in nursing homes: Environmental screening and whole-genome sequencing
Authors: Cassone Marco , Wang Joyce , Lansing Bonnie , Mantey Julia , Gibson Kristen , Gontjes Kyle , Mody Lona 
Published: May 2022

Background: Transmission of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) is of special concern among frail patients in nursing homes. To understand environmental contamination patterns in this setting, we screened a suitable section of a nursing home over time and assessed MRSA and VRE prevalence in patients and their rooms. We were especially interested in assessing whether MRSA and VRE strains persist in rooms during changes of occupancy after patient discharge. Methods: We conducted a prospective cohort study of MRSA and VRE colonization and contamination among successive patients in a cluster of 9 single-occupancy rooms. Using flocked swabs, 5 high-touch surfaces were screened 3 times a week for 34 weeks. Patients were also screened (ie, nares, groin, and hands), if they agreed to participate. Whole-genome sequencing was performed on 67 nonredundant MRSA and VRE strains. Single-nucleotide polymorphism heatmaps and similarity trees were generated to evaluate strain diversity and persistence the facility. Results: Overall, 146 distinct occupancy events were captured during the study (16.5 average per room; range, 11–22), with 387 study visits and 4,670 total swabs collected. All rooms were contaminated with VRE, and 8 of 9 were contaminated with MRSA at least once during the study period. New contamination of a room with MRSA or VRE was observed in 43 (23%) of 185 opportunities, with potential persistence during occupancy changes in 25 (32.9%) of 76 opportunities. Sequencing of 67 nonredundant isolates identified at least 6 enterococcal clades and 10 MRSA clades (6 USA100 and 4 USA300), indicating a high degree of diversity and probably multiple introductions in the facility during the study time. In 3 separate cases, whole-genome sequencing confirmed persistence of a specific MRSA strain during a change of room occupancy, including 1 case of a MRSA strain persisting in a clean room before admission of the next patient. For VRE, 2 cases of persistence during room occupancy changes were confirmed, along with 6 cases of possible persistence (contamination across noncontiguous room occupancy events). Conclusions: Active surveillance screening and a recurring evaluation of terminal cleaning procedures should be considered due to high levels of circulation and persistence of MRSA and VRE in the nursing home setting.Funding: NoneDisclosures: None
Research and implementation of a whole-genome sequencing surveillance system for outbreak detection
Authors: Sundermann Alexander , Griffith Marissa , Srinivasa Vatsala Rangachar , Waggle Kady , Saul Melissa , Ayres Ashley , Snyder Graham , Marsh Jane , Harrison Lee 
Published: May 2022

Background: Traditional infection prevention (IP) methods for outbreak detection often rely on geotemporal clustering confined to single locations. We recently developed the Enhanced Detection System for Healthcare-Associated Transmission (EDS-HAT), which combines whole-genome sequencing (WGS) surveillance and machine learning of the electronic health record (EHR). Our retrospective research findings show potential transmissions averted and cost savings using EDS-HAT in real time. Here, we describe the process and initial findings from EDS-HAT real-time implementation. Methods: Real-time whole-genome sequencing surveillance began on November 1, 2021. Patient cultures positive for select bacterial pathogens who were hospitalized for ≥3 days or had a recent healthcare exposure in the prior 30-days were collected. Isolates were deemed genetically related if ≤15 single-nucleotide polymorphisms (SNPs) were identified for all organisms except Clostridioides difficile (≤2 SNPs). Clusters were manually investigated by both research and IP teams, and interventions were performed by the IP team. Data on collection, analysis, notification, and intervention dates were gathered. Results: As of January 11, 2022, 413 isolates had undergone whole-genome sequencing. Among them, 18 unique patient isolates were genetically related to ≥1 other isolate, comprising 7 clusters (range, 2–6 patients). Notable findings include a Pseudomonas aeruginosa cluster possibly related to a shared bronchoscope, a pseudo-outbreak of Serratia marcescens related to autopsy blood culture practice, and a cluster of vancomycin-resistant Enterococcus faecium on a shared transplant unit. Only 1 cluster of 2 isolates of Klebsiella pneumoniae had no known possible transmission routes. The median turnaround time from patient’s culture date to IP notification was 19 days (range, 13–28), with noted delays over the winter holiday. Concusions: Real-time WGS can identify small clusters including potentially interruptible transmission routes. Rapid turnaround time, coordination between clinical and genomic laboratories, and a robust IP team are key factors in implementing a WGS surveillance program. Real-time WGS surveillance has the potential to reduce costs for hospitals, improve patient safety, and save lives.Funding: NoneDisclosures: None