bluuebunny/crossref_metadata_2025_split huggingface dataset:
Characteristics of antibiotic exposures for surgical procedures prior to Clostridioides difficile diagnosis—Minnesota, 2018
Authors: D’Heilly Paige , Beaudoin Amanda , Melin Davis , Holzbauer Stacy 
Published: May 2022

Background:Clostridioides difficile infection (CDI) is the leading cause of healthcare-associated diarrhea. Significant risk factors for CDI include antibiotic use and healthcare exposure. Antibiotics are often administered before, during and/or after surgery to prevent postsurgical infection. The contribution of surgery-related antibiotics to the overall CDI burden has not been well described, and assessment of the appropriateness of surgical antibiotic use is complicated by complex clinical guidelines. We have described surgical antibiotic prophylaxis history among adult with CDI in Minnesota in 2018. Method: The Minnesota Department of Health (MDH) performs 5-county active population- and laboratory-based CDI surveillance as a CDC Emerging Infections Program site. Incident CDI was defined as stool positive for C. difficile by toxin or molecular assay from a person aged ≥18 years with no positive test in the preceding 8 weeks. History of CDI was defined as having had a previous CDI episode in the 2009–2018 surveillance data set. Medical records were reviewed for 12 weeks prior to incident CDI test date to identify antibiotic prescriptions. Antibiotics with documented indication for surgical-site infection prevention or surgical prophylaxis were classified as “surgical antibiotic prophylaxis” (SPPX). SPPX type (eg, intraoperative, postoperative), appropriateness of SPPX, and clinical guideline adherence were not assessed. Results: During 2018, 812 incident CDIs were reported to MDH among 736 patients. SPPX preceded 84 (10.3%) cases, non-SPPX antibiotic use preceded 465 cases (57.3%), and 263 cases (32.4%) had no documented prior antibiotic use. The median age of incident CDIs with preceding SPPX was 68 years (IQR, 54–79.5). In 25 incident CDI cases with preceding SPPX (29.8%), there were no other antibiotic exposures. Among incident CDIs with preceding SPPX, 11 (13.1%) had >1 surgery event with SPPX. Prior CDI was identified for 13 (15.7%) with SPPX. Among 99 procedures with preceding SPPX, orthopedic surgeries (n = 27, 27.3%), gastrointestinal surgeries (n = 26, 26.3%), and cardiovascular surgeries (n = 22, 22.2%) were most common. In total 18 SPPX prescriptions (18.2%) originated in outpatient settings. SPPX drugs included cefazolin (n = 67, 67.7%), ceftriaxone (n = 7, 7.1%), ertapenem (n = 6, 6.1%), and clindamycin (n = 6, 6.1%). Median SPPX duration was 1 day (IQR, 1–2), and the median number days between surgery and specimen collection date was 19 (IQR, 7–49). Conclusions: Antibiotic stewardship programs should assess surgical prescribing, including in outpatient centers. Even short antibiotic duration for surgery could put patients at risk for CDI. More data are needed to evaluate the appropriateness of SPPX prescribing and to describe the impact of SPPX on CDI.Funding: NoneDisclosures: None
Clostridioides difficile: A diagnostic intervention
Authors: Alsoubani Majd , Khuvis Joshua , Rodday Angie , Doron Shira 
Published: May 2022

Background:Clostridioides difficile infection (CDI) is a leading cause of healthcare-associated infection and is associated with increased morbidity and mortality. Multiple strategies have been implemented to optimize the diagnostic accuracy of CDI testing algorithms. However, overdiagnosis of C. difficile colonization remains a challenge especially in the era of highly sensitive Nucleic acid amplification testing (NAAT). We implemented 2 interventions to reduce the rates of inappropriate C. difficile orders and tests. Methods: We performed a quasi-experimental retrospective study to examine the rates of all inpatient C. difficile test orders and results relative to 2 interventions between January 2018 and February 2021. We defined 3 periods: preintervention, after the first intervention, and after the second intervention. The first intervention, implemented May 2019, was a clinical decision support system (CDSS) tool to guide clinicians to order testing only if CDI criteria were met. The second intervention, implemented July 2020, was the requirement of mandatory antimicrobial team approval of PCR reflex testing for indeterminate toxin or antigen test results. This intervention included a discussion between clinicians and members of stewardship team prior to approval. To evaluate the impact of interventions on ordering appropriateness, chart review was conducted on a random subsample of 100 orders from each period. Hospital-onset CDI (HO-CDI) was calculated using CDC criteria. Results: In total, 3,004 C. difficile test orders were placed during the study period. The rates of reportable HO-CDI were significantly reduced by 57.1% (P = .003). We detected a significant reduction in the number of tests ordered over time from 11.6 to 7.51 per 1,000 patient days. (p Conclusions: CDSS tools target patients at high pretest probability of CDI. The restriction of PCR-reflex testing to the antimicrobial stewardship team is a novel effective measure to minimize the misdiagnosis of CDI. The incorporation of multiple strategies is necessary to improve the diagnostic accuracy of C. difficile testing.Funding: NoneDisclosures: None
Peripheral intravascular catheter-associated bloodstream infection in the medical–surgical ICU
Authors: Hogle Nancy , Burke Patrick , Fraser Thomas 
Published: May 2022

Background: Prompt removal of unnecessary central venous catheters (CVC) may reduce central-line–associated bloodstream infection (CLABSI). Primary non–central-line–associated hospital-acquired bloodstream infection (BSI), including peripheral intravascular (PIV) catheter-associated bloodstream infection (PIVABSI) remains a problem. Hospitals use CLABSI surveillance data to measure patient safety, yet this measure alone fails to describe the burden of total intravascular device-related infection. We described non-CLABSI primary BSI due to PIV in our medical–surgical ICU population. Methods: Hospital-wide surveillance for primary hospital-acquired BSI, including CLABSI, was conducted in accordance with NHSN protocol. We measured PIV catheter days and central-line days using a database including nursing device documentation and patient census data to count the number of patients with 1 or more devices in place in each location, counted at the same time each day. By substituting the role of the CVC with short or midline PIV in NHSN CLABSI surveillance protocols, we performed surveillance for PIVABSI. We defined PIVABSI as a patient without CVC and either a short or midline catheter in place for >2 calendar days on the date of BSI. Patients with BSI and both CVC and PIV were counted as CLABSI. We compared CVC and PIV utilization and the incidence density of CLABSI and PIVABSI in 8 medical and surgical ICUs at our large teaching hospital. We used OpenEpi version 3.01 software to test the hypothesis that the incidence density of CLABSI would be significantly different from that of PIVABSI. Results: From January to September 2021, there were 16 CLABSIs and 12 primary non–central-line–associated hospital-acquired BSIs, all 12 were PIVABSIs. Of these 12, 8 had >1 PIV in place and none were midlines. There were 13,418 central-line days, 10,897 short and midline peripheral IV days, and 22,415 patient days, resulting in device utilization ratios of 0.60 and 0.49, respectively. The incidence density of CLABSI was 1.2 per 1,000 central-line days, although the incidence density of PIVABSI was 1.1 per 1,000 peripheral IV days (P = .84). There was no difference in pathogens between the 2 groups. Conclusions: PIVABSI represented more than one-third of the total primary hospital-acquired BSIs in our medical and surgical ICUs. Total BSI surveillance is feasible. Efforts to reduce CLABSI should be part of a broader strategy to decrease total hospital-acquired BSI from all vascular access devices.Funding: NoneDisclosures: None
The effectiveness of a dedicated central venous access care team to prevent catheter-related bloodstream infections
Authors: Charles Fil de Lara Fortune , Mano Maria Jesusa , Henson Karl Evans , Bello Jia An , Abad Cybele Lara 
Published: May 2022

Background: Catheter-related bloodstream infection (CRBSI) rates remain high despite the use of an insertion bundle. We hypothesized that line care and maintenance by a dedicated team would help decrease CRBSI rates. This study was conducted in The Medical City (TMC), is a 526-bed, private, tertiary-care center in Pasig City, Philippines. Methods: All adult hospitalized patients from October 1, 2020, to October 31, 2021, with a newly inserted temporary central venous catheter (CVC) were eligible for inclusion. CRBSI rates before the intervention (October 2019 to March 2020) and after the intervention (April to October 2021) were compared. The intervention arm consisted of a dedicated central venous access team (CVAT) who provided education and performed daily line care and dressing changes per protocol. A series of χ2 and Wilcoxon rank-sum tests were performed to compare characteristics between exposure groups. Incidence rates of CRBSI before and after the intervention were compared using an incidence rate ratio approach. Results: In total, 209 CVCs were enrolled in the study, with 103 CVCs (49.28%) in the preintervention arm and 106 CVCs (50.72%) in the postintervention arm. Baseline patient characteristics were similar. CRBSIs were more frequent in the preintervention arm than the postintervention arm (39 of 103 vs 28 of 106; P = .08). The CRBSI incidence density rate was higher in the preintervention arm than the postintervention arm, but the difference was not statistically significant (37.46 per 1,000 patient days vs 25.97 per 1,000 patient days; P = .14). Median time to CRBSI was similar in both groups (9 vs 8 days). Conclusions: Baseline CRBSI rates were high and risk of infection increased by day 8 after line insertion. We detected a decreasing trend in rates of CRBSI with a dedicated CVAT, but multiple interventions are likely needed to influence overall rates.Funding: NoneDisclosures: None
Hospital-acquired bloodstream infections in patients with and without hepatic failure
Authors: Bosco Jordan , Burke Patrick , Canosa Francisco Marco , Wilson Stephen , Gordon Steven , Fraser Thomas 
Published: May 2022

Background: The NHSN parameter estimate for predicted number of central-line–associated bloodstream infection (CLABSI) is the same for gastroenterology wards as other specialty wards, such as behavioral health and gerontology. We conducted this study to contribute to the body of knowledge surrounding the risk for hospital-acquired bloodstream infection (HABSI) in patients with and without hepatic failure. The Cleveland Clinic is a 1,200-bed, multispecialty hospital with a solid-organ transplant service. Patients with hepatic failure who do not require critical care are housed on 36-bed unit A. On unit A, 43% of patients are under hepatology or gastroenterology service, although 51% of patients are under general internal medicine. Overall, unit A has a high incidence of HABSI. Methods: Surveillance for HABSI and CLABSI is performed at the Cleveland Clinic per NHSN protocol. All patients with a midnight stay on unit A from January 2019 through September 2021 were dichotomized as having hepatic failure (yes or no) if they ever received the International Classification of Diseases Tenth Revision code for “hepatic failure, not elsewhere classified.” We joined the diagnostic code to patient days and central-line-days databases and summarized the data using Microsoft Excel software. We stratified the number of patients, patient days, device days, infection classification, and hospital length of stay by whether the patient had hepatic failure, and we compared the incidence of HABSI and CLABSI between the 2 groups using OpenEpi version 3.01 software. Results: We identified 72 HABSIs among 4,285 patients who stayed on unit A for 30,910 patient days during the study period. The incidences of HABSI in patients with and without hepatic failure were 39.0 and 13.9 per 10,000 patient days, respectively (P < .001). The incidence of CLABSI was 5.4 and 1.9 per 1,000 line days, respectively (P = .01). Patients with hepatic failure stayed longer (11.5 vs 5.9 days), yet the central-line utilization ratios were not substantially different (0.25 vs 0.24). Enterococcus was the most common pathogen involved in CLABSI in both groups (Table 2). Conclusions: Patients with hepatic failure experienced CLABSI more frequently than patients without hepatic failure, stayed longer in the hospital, and were less likely have HABSI attributed to another primary focus of infection according to NHSN definitions. Although hepatic failure may be among the most severe conditions among patients in a gastroenterology ward, we have demonstrated that these units house a population uniquely susceptible to HABSI and CLABSI.Funding: NoneDisclosures: None
Perceptions and emotions of infection control team member during the COVID-19 pandemic in Germany
Authors: Schulz-Stubner Sebastian 
Published: May 2022

Background: We conducted an anonymous survey in compliance with German data protections regulations among participants of the annual infectious disease and control meeting in Freiburg, Germany, in October 2021. Methods: In total, 391 surveys were returned: 188 from nurse infection control practitioners (ICPs) and 66 from specially infection control trained physicians (STPs). We report the results of these 2 subgroups regarding their perceptions and emotions during the pandemic. Descriptive statistics and χ2 test with P < .05 were used when applicable. Results: Shortages of medical masks or FFP2 masks during the first pandemic wave in 2020 were reported by 48.5% STPs and 57.4% ICPs. STPs and ICPs relied equally on information provided by the Robert Koch Institute, the WHO, the ECDC and the CDC. Occupational health information was sought significantly more often by ICPs; only 17% of ICPs never used this source versus 51.5% of STPs (P < .001). Most ICPs (58%) and STPs (51%) described their relationship to local authorities as good as well as communication with institutional leaders (69.7%). Fewer ICPs (36.1%) felt frequently appreciated during the pandemic compared to 45.5% of STPs and more ICPs (25%) reported frustration than STPs (18.2%). However, the differences were not statistically significant. Rarely, ICPs (2.1%) or STPs (1.5%) felt unsafe at work and only 1.6% of ICPs and no STPs reported loss of motivation. In addition, 13.8% of ICPs and 12.1% of STPs often felt overwhelmed, but only 3.2% of ICPs and no STPs felt hopeless. Their self-reported competency was rated as high by 75% of ICPs and 69.7% of STPs. The 5 most frequent free-text comments regarding “lessons learned” pertained to better crisis communication, better supply chain management, precise regulations, “less talking more doing,” and mandatory vaccination. The most frequent free-text general comments pertained to maintain basic hygiene measures in private and public life because of the pandemic. Conclusions: Our survey results indicate a high level of resilience among members of infections control teams in German medical institutions despite obvious shortcomings in supplies during the first wave of the pandemic. There were no significant differences between physician and nurse members of infection control teams regarding their perceptions and emotions, indicating a homogenous situation within the teams. The high level of self-perceived competency has likely helped deal with the pandemic and prevented the feeling of loss of control implied in the question items “feeling overwhelmed” and “hopeless.”Funding: NoneDisclosures: None
Epidemiologic risk factors and occupation analysis of COVID-19 cases, hospitalizations, and deaths–southern California, 2020
Authors: Cummings Patricia , Perez Theresa Ubano , Sidana Megan , Peters Charmaine 
Published: May 2022

Background: COVID-19 occupational exposures have been examined using death certificates and employment data from the Bureau of Labor Statistics and the O*Net database in the United States. However, no studies have examined cases, hospitalizations, and deaths by occupation using hospital records.1 We analyzed COVID-19 cases using hospitalization data from a large, rural community hospital to fill this gap in the evidence base. Methods: A retrospective cross-sectional study design was used to examine patients with COVID-19 from March 1 through July 31, 2020. We examined demographic characteristics, such as age, sex, race or ethnicity, and length of stay (LOS), among those who tested positive for SARS-CoV-2. Epidemiological risk factors were also analyzed, including smoking status, body mass index (BMI), alcohol use, and occupation. Occupational data were processed using the National Institute for Occupational Safety and Health Industry and Occupation Computerized Coding System. Homemakers, disabled persons or retirees, students or minors, and listed occupations with insufficient information were excluded from the analysis. Occupations were categorized into 23 major occupation groups based on the 2018 Standard Occupational Classification System. To examine whether certain occupations are at a higher risk due to COVID-19, we stratified the analysis by overall cases, hospitalizations, and deaths. Microsoft Power BI Desktop and IBM SPSS version 28.0.0.0 software were used to analyze the data. This study was reviewed and approved by the local institutional review board. Results: In total, 2,132 COVID-19 diagnoses with 1,049 total hospitalizations were identified during the study period. Most cases were in the group aged 50–64 years, white race, and/or Hispanic ethnicity (Table 1). Most cases never or rarely drank alcohol, were nonsmokers, and had a BMI ≥30 (Table 2). The average LOS among those hospitalized for COVID-19 was 6.46 days. The occupational analysis revealed a higher frequency of cases among those in management (n = 95, 14%) and healthcare (n = 83, 12%), with those in management (n = 40, 14%) and sales (n = 29, 10%) having the highest frequency of being hospitalized. However, the highest frequency of deaths occurred among those in building and grounds cleaning and maintenance occupations (13%) (Table 3). Conclusions: This study describes the burden of COVID-19 in a rural area with a large aging population and highlights potential health disparities among severe cases and deaths in different occupational groups.1. Baker MG, Peckham TK, Seixas NS. Estimating the burden of United States workers exposed to infection or disease: a key factor in containing risk of COVID-19 infection. PLoS One 2020;15:e0232452.Funding: NoneDisclosures: None
Absence of racial and ethnic disparities in COVID-19 survival among residents of US Veterans’ Affairs community living centers
Authors: Alabdely Mayyadah , Kothadia Sonya , Bej Taissa , Wilson Brigid , Song Sunah , Akpoji Ukwen , Perez Federico , Jump Robin 
Published: May 2022

Background: COVID-19 has had a disproportionate effect on nursing homes residents as well as people from racial and ethnic minorities. Whether differences in mortality due to COVID-19 exists for nursing-home residents from racial and ethnic minorities is less clear, with some previous studies reporting systems-level disparities. The Department of Veterans’ Affairs (VA) has nursing homes, termed community living centers (CLCs), across the United States. We hypothesized that differences in COVID-19–related mortality among racial and ethnic minorities would be less pronounced among residents of CLCs. Methods: Using data from the VA Corporate Data Warehouse, we conducted a retrospective cohort study from April 14, 2020 (implementation of population-based testing) to December 10, 2020 (availability of a COVID-19 vaccine). Inclusion criteria were residents with a positive SARS-CoV-2 test while residing in or <48 hours before admission to a CLC. Positive tests <180 days after a prior positive test were excluded. We assessed the cohort for demographics, including self-reported race or ethnicity, clinical characteristics, and survival probability including all-cause 30-day mortality. A multivariable logistic regression model was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for all-cause 30-day mortality that included race, ethnicity, age, and Charlson comorbidity index (CCI). Results: Among 14,759 CLC residents, 651 (4.4%) had a positive SARS-COV-2 test. Their mean age was 75.7 ± 11.3 years, and self-reported race or ethnicity was 68% White (445 of 651), 23% Black (152 of 651), and 4% Hispanic/Latinx (27 of 651). The mean CCI was lower among White residents than Black residents (4.15 ± 2.6 vs 4.61 ± 3.1, respectively). All-cause 30-day mortality for CLC residents following positive SARS-COV-2 test was 25% for White patients, 14% for Black patients, and 15% for Hispanic/Latinx patients (Fig. 1). Age (in years), but neither race or ethnicity nor CCI, was independently associated with all-cause 30-day mortality (OR, 1.07; 95% CI, 1.05–1.09) in CLC residents with COVID-19. Conclusions: Among VA CLC residents with a positive COVID-19 test, minority CLC residents did not have worse outcomes than white residents, suggesting that users of the VA healthcare system may enjoy abrogation of some aspects of health disparities.Funding: NoneDisclosures: None