scholarly journals 790. Evaluation of an Enhanced CPE Screening Program in an Acute Care Hospital in South Korea

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S491-S492
Author(s):  
Sun Hee Park ◽  
Yunmi Yi ◽  
Seul Ki Ji ◽  
Seung Beom Han ◽  
Soyoung Shin
Keyword(s):  
South Korea ◽  
Screening Program ◽  
Bacterial Species ◽  
Acute Care Hospital ◽  
Clinical Samples ◽  
Screening Methods ◽  
Care Hospital ◽  
Healthcare Facilities ◽  
Study Results ◽  
Chromogenic Agar

Abstract Background Carbapenemase-producing Enterobacteriaceae (CPE) poses a great challenge in infection control in healthcare settings. A screening and contact precautions are recommended to prevent the spread of CPE among patients. However, screening strategies differ among countries and healthcare facilities. Methods In September 2018, we launched a CPE screening program at a 660-bed hospital in South Korea, which targeted previously colonized patients, patients with history of admission < 1 month or transferred patients or ICU-admitted patients. Once patients were identified to have CPE, they were isolated in a single room. After a CPE outbreak in July-Aug 2019, the enhanced screening program was implemented, which included patients with additional risk factors (exposure to hospitals in the past 6 months, receipt of hemodialysis or invasive procedures or rehabilitation) combined with weekly screening in ICU-admitted patients. Screening methods changed from two consecutive rectal screening swabs with chromogenic agar to initial screening with Xpert-Carba-R PCR, followed by one or two consecutive tests with chromogenic agar. We compared the CPE incidence in screening and clinical cultures before and after the enhanced screening program introduction (Sep 2018-Nov 2020). Results A total of 14,318 (2,178 vs. 12,140) were screened among 49,980 admitted patients and screening compliance increased from 18.6% to 94.5%. The number of CPE detection increased from 44 to 154 cases and the proportion of CPE-positive screening per 1000 admissions increased 0.6 to 2.2. However, the number of clinical CPE cultures decreased from 11 to 3 (Figure). Among screened patients, time-to-positivity was markedly reduced by 1.9 days (2.96 vs. 1.02 days) during the post-period. Additional 70 patients were detected: 36 due to serial screening in the ICUs and 34 due to enhanced on-admission screening. Factors significantly associated with positive screening were previous exposure to hospital (OR 3.5; 95% CI 1.7-7.1) and receipt of hemodialysis (OR 4.3; 95%CI 1.9-9.2). CPE isolates and carbapenemase genes were diverse (Figure). Trends in CPE detection in screening and clinical samples (upper), and bacterial species with detected carbapenemase genes (lower). Conclusion The study results showed that the enhanced screening program enabled us to identify the previously undetected CPE colonized patients and to decrease clinical CPE cultures. Disclosures All Authors: No reported disclosures

scholarly journals 2440. Using a geospatially explicit agent-based model of a regional healthcare network to assess varied antibiotic risk on Clostridioides difficile infection incidence

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S843-S844
Author(s):  
Sarah Rhea ◽  
Kasey Jones ◽  
Georgiy Bobashev ◽  
Breda Munoz ◽  
James Rineer ◽  
...  
Keyword(s):  
Acute Care ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Healthcare Facilities ◽  
Agent Based ◽  
Healthcare Network ◽  
Clostridioides Difficile ◽  
Unit Increase ◽  
Clostridioides Difficile Infection ◽  
The Impact

Abstract Background Different antibiotic classes are associated with different Clostridioides difficile infection (CDI) risk. The impact of varied antibiotic risk on CDI incidence can be explored using agent-based models (ABMs). ABMs can simulate complete systems (e.g., regional healthcare networks) comprised of discrete, unique agents (e.g., patients) which can be represented using a synthetic population, or model-generated representation of the population. We used an ABM of a North Carolina (NC) regional healthcare network to assess the impact of increasing antibiotic risk ratios (RRs) across network locations on healthcare-associated (HA) and community-associated (CA) CDI incidence. Methods The ABM describes CDI acquisition and patient movement across 14 network locations (i.e., nodes) (11 short-term acute care hospitals, 1 long-term acute care hospital, 1 nursing home, and the community). We used a sample of 2 million synthetic NC residents as ABM microdata. We updated agent states (i.e., location, antibiotic exposure, C. difficile colonization, CDI status) daily. We applied antibiotic RRs of 1, 5, 8.9 (original model RR), 15, and 20 to agents across the network to simulate varied risk corresponding to different antibiotic classes. We determined network HA-CDI and CA-CDI incidence and percent mean change for each RR. Results In this simulation study, HA-CDI incidence increased with increasing antibiotic risk, ranging from 11.3 to 81.4 HA-CDI cases/100,000 person-years for antibiotic RRs of 1 to 20, respectively. On average, the per unit increase in antibiotic RR was 33% for HA-CDI and 6% for CA-CDI (figure). Conclusion We used a geospatially explicit ABM to simulate increasing antibiotic risk, corresponding to different antibiotic classes, and to explore the impact on CDI incidence. The per unit increase in antibiotic risk was greater for HA-CDI than CA-CDI due to the higher probability of receiving antibiotics and higher concentration of agents with other CDI risk factors in the healthcare facilities of the ABM. These types of analyses, which demonstrate the interconnectedness of network healthcare facilities and the associated community served by the network, might help inform targeted antibiotic stewardship efforts in certain network locations. Disclosures All authors: No reported disclosures.

scholarly journals High clonal diversity of ESBL-producing Klebsiella pneumoniae isolates from clinical samples in a non-outbreak situation. A cohort study

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Mariona Xercavins ◽  
Elena Jiménez ◽  
Emma Padilla ◽  
Montserrat Riera ◽  
Núria Freixas ◽  
...  
Keyword(s):  
Cohort Study ◽  
Klebsiella Pneumoniae ◽  
Time Window ◽  
Acute Care Hospital ◽  
Diffusion Method ◽  
Clinical Samples ◽  
Care Hospital ◽  
Disk Diffusion Method ◽  
High Genetic Diversity ◽  
Cross Transmission

Abstract Background Klebsiella pneumoniae has been responsible for a large number of clonal hospital outbreaks. However, some epidemiological changes have been observed since the emergence of CTX-M enzymes in K. pneumoniae. Aim To analyse the transmission dynamics of Extended Spectrum β-Lactamase-producing Klebsiella pneumoniae (ESBL-Kp) in an acute care hospital. Methods In 2015 a prospective cohort study was conducted. All new consecutive adult patients with ESBL-Kp isolates in all clinical samples were included. Patients with a previous known infection/colonization by ESBL-Kp and patients in high risk areas (e.g., intensive care units) were excluded. Cross-transmission was defined as the carriage of a clonally-related ESBL-Kp between newly diagnosed patients who shared the same ward for ≥48 h with another case, within a maximum time window of 4 weeks. ESBL-production was confirmed using the double-disk diffusion method and PCR. Clonal relationships were investigated by rep-PCR and multilocus sequence typing (MLST). Results Sixty ESBL-Kp isolates from 60 patients were included and analysed. Infections and colonizations were classified as hospital-acquired (52%), healthcare-related (40%) or community-acquired (8%). High genetic diversity was detected. When epidemiological clinical data were combined with the rep-PCR, the patterns identified did not show any cases of cross-transmission. ESBL-Kp were detected in 12.5% of environmental samples. No clonal relationship could be established between environmental reservoirs and patients. The genetic mechanism detected in all strains was associated with blaCTX-M genes, and 97% were CTX-M-15. Conclusions The dynamics of ESBL-K. pneumoniae isolated in our setting could not be explained by clonal transmission from an index patient. A polyclonal spread of ESBL-Kp was identified.

scholarly journals Seroprevalence of Measles in Healthcare Workers in South Korea

2020 ◽  
Vol 41 (S1) ◽  
pp. s386-s387
Author(s):  
Sun Kyung Kim ◽  
Jiwon Jung ◽  
Sun Hee Kwak ◽  
Min Jee Hong ◽  
Eun Ok Kim ◽  
...  
Keyword(s):  
South Korea ◽  
Birth Cohort ◽  
Healthcare Workers ◽  
Medical Center ◽  
Adult Population ◽  
Care Hospital ◽  
Healthcare Facilities ◽  
Asan Medical ◽  
Measles Vaccination ◽  
Antibody Tests

Background: Measles is a highly contagious disease that is transmissible by airborne particles but is preventable by vaccination. South Korea has maintained a highly immunized adult population; however, small local outbreaks of measles continued to occur, and there have been some reports of pockets of underimmunity among the young adult population. It is important to know the seroepidemiology of healthcare workers (HCWs) for policy-making process, but data on the seroprevalence of measles in HCWs in South Korea are limited. Methods: We investigated the seroprevalence of HCWs at Asan Medical Center, a 2,705-bed tertiary-care hospital in Seoul, South Korea, with 8,329 HCWs. In 2014, after an outbreak of measles occurred in a university in Seoul, Asan Medical Center required measles IgG tests for all HCWs born in and after 1967 for point-prevalence surveillance. In addition, we have routinely performed measles antibody test for new HCWs since 2014. In 2018, antibody tests were administered to HCWs who were born before 1967 or who had taken a leave of absence in 2014. We provided MMR vaccination to all HCWs whose antibody tests yielded negative results. Results: In total, 7,411 HCWs (89%) underwent measles antibody tests from 2014 to 2018. The overall seropositivity was 73% (95% CI, 72%–74%); seroprevalence was 73% in HCWs born in of after 1967, whereas the seroprevalence in HCWs born before 1967 was 98%. The seroprevalence sharply decreased from 85% in the 1986 birth cohort to 42% in the 1995 birth cohort. Conclusions: In conclusion, the proportion of measles-susceptible individuals was substantially high in HCWs, especially in young adults. Because the impact of measles outbreak in healthcare facilities would be critical, a policy regarding routine serologic screening followed by measles vaccination or routine measles vaccination in healthcare facilities should be considered, especially for young Korean HCWs.Funding: NoneDisclosures: None

scholarly journals Impact of an antimicrobial stewardship programme on antimicrobial utilization and the prevalence of MDR Pseudomonas aeruginosa in an acute care hospital in Qatar

2020 ◽  
Vol 2 (3) ◽  
Author(s):  
Mazen A Sid Ahmed ◽  
Hamad Abdel Hadi ◽  
Sulieman Abu Jarir ◽  
Abdul Latif Al Khal ◽  
Muna A Al-Maslamani ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Acute Care ◽  
Antimicrobial Stewardship ◽  
Acute Care Hospital ◽  
Antibiotic Use ◽  
Significant Rise ◽  
Successful Implementation ◽  
Care Hospital ◽  
Antimicrobial Consumption ◽  
Healthcare Facilities

Abstract Background The excessive and inappropriate use of antibiotics is universal across all healthcare facilities. In Qatar there has been a substantial increase in antimicrobial consumption coupled with a significant rise in antimicrobial resistance (AMR). Antimicrobial stewardship programmes (ASPs) have become a standard intervention for effective optimization of antimicrobial prescribing. Methods A before–after study was conducted in Hamad General Hospital (603 bed acute care hospital): 1 year before implementation of a comprehensive ASP compared with the following 2 years. The ASP included a hospital-wide pre-authorization requirement by infectious diseases physicians for all broad-spectrum antibiotics. Prevalence of MDR Pseudomonas aeruginosa was compared with antimicrobial consumption, calculated as DDD per 1000 patient-days (DDD/1000 PD). Susceptibility was determined using broth microdilution, as per CLSI guidelines. Antibiotic use was restricted through the ASP, as defined in the hospital’s antibiotic policy. Results A total of 6501 clinical isolates of P. aeruginosa were collected prospectively over 3 years (2014–17). Susceptibility to certain antimicrobials improved after the ASP was implemented in August 2015. The prevalence of MDR P. aeruginosa showed a sustained decrease from 2014 (9%) to 2017 (5.46%) (P = 0.019). There was a significant 23.9% reduction in studied antimicrobial consumption following ASP implementation (P = 0.008). The yearly consumption of meropenem significantly decreased from 47.32 to 31.90 DDD/1000 PD (P = 0.012), piperacillin/tazobactam from 45.35 to 32.67 DDD/1000 PD (P < 0.001) and ciprofloxacin from 9.71 to 5.63 DDD/1000 PD (P = 0.015) (from 2014 to 2017). Conclusions The successful implementation of the ASP led to a significant reduction in rates of MDR P. aeruginosa, pointing towards the efficacy of the ASP in reducing AMR.

scholarly journals 1268. Transmissibility of Candida auris by Type of Inpatient Healthcare Facility

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S386-S387
Author(s):  
Prabasaj Paul ◽  
Kaitlin Forsberg ◽  
Snigdha Vallabhaneni ◽  
Shawn R Lockhart ◽  
Anastasia P Litvintseva ◽  
...  
Keyword(s):  
Acute Care ◽  
Reproduction Number ◽  
Acute Care Hospital ◽  
Healthcare Facility ◽  
Control Measures ◽  
Care Hospital ◽  
Candida Auris ◽  
Healthcare Facilities ◽  
Colonization Pressure ◽  
Facility Type

Abstract Background Candida auris is a multidrug-resistant yeast causing outbreaks in healthcare settings. Stopping the spread of C. auris requires rapid identification of healthcare facilities at risk of higher transmission to help targeted implementation of infection control measures. We used data collected during public health investigations to quantify transmissibility of C. auris by type of healthcare facility. Methods In two states, 3,159 patient swabs were collected during 96 C. auris point prevalence surveys conducted at 36 inpatient healthcare facilities in November 2016 and April 2018. We estimated facility transmissibility and facility reproduction number (number infected by one index colonized patient per day, and per stay, respectively, at the facility) of C. auris based on estimated colonization pressure, a count of newly colonized patients between successive surveys at the same facility, and mean lengths of stay at facilities (estimated from CMS administrative data). The results were summarized by facility type: acute care hospital (ACH), long-term acute care hospital (LTACH) or ventilator unit at skilled nursing facility (VSNF), and were compared with previous estimates for transmissibility of carbapenem-resistant Enterobacteriaceae (CRE). Results Swabs were collected from 13 ACHs, 12 LTACHs, and 11 VSNFs. The C. auris facility reproduction number may exceed the critical value of 1 in both ACHs and VSNFs, and may exceed that for CRE in ACHs (table). Conclusion Transmissibility of C. auris is comparable to that of CRE. The transmissibility within VSNFs emphasizes their potential role as amplifiers in the outbreak. Understanding transmissibility by facility type helps evaluate the potential impact of interventions in various settings. Disclosures All authors: No reported disclosures.

scholarly journals Outbreak of Carbapenem-Resistant Enterobacteriaceae at a Long-Term Acute Care Hospital: Sustained Reductions in Transmission through Active Surveillance and Targeted Interventions

2012 ◽  
Vol 33 (10) ◽  
pp. 984-992 ◽  
Author(s):  
Amit S. Chitnis ◽  
Pam S. Caruthers ◽  
Agam K. Rao ◽  
JoAnne Lamb ◽  
Robert Lurvey ◽  
...  
Keyword(s):  
Acute Care ◽  
Genetic Relatedness ◽  
Acute Care Hospital ◽  
Public Health Approach ◽  
Care Hospital ◽  
Healthcare Facilities ◽  
Targeted Interventions ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

Objective.To describe a Klebsiella pneumoniae carbapenemase (KPC)–producing carbapenem-resistant Enterobacteriaceae (CRE) outbreak and interventions to prevent transmission.Design, Setting, and Patients.Epidemiologic investigation of a CRE outbreak among patients at a long-term acute care hospital (LTACH).Methods.Microbiology records at LTACH A from March 2009 through February 2011 were reviewed to identify CRE transmission cases and cases admitted with CRE. CRE bacteremia episodes were identified during March 2009–July 2011. Biweekly CRE prevalence surveys were conducted during July 2010–July 2011, and interventions to prevent transmission were implemented, including education and auditin? of staff and isolation and cohorting of CRE patients with dedicated nursing staff and shared medical equipment. Trends were evaluated using weighted linear or Poisson regression. CRE transmission cases were included in a case-control study to evaluate risk factors for acquisition. A real-time polymerase chain reaction assay was used to detect the blaKPC gene, and pulsed-field gel electrophoresis was performed to assess the genetic relatedness of isolates.Results.Ninety-nine CRE transmission cases, 16 admission cases (from 7 acute care hospitals), and 29 CRE bacteremia episodes were identified. Significant reductions were observed in CRE prevalence (49% vs 8%), percentage of patients screened with newly detected CRE (44% vs 0%), and CRE bacteremia episodes (2.5 vs 0.0 per 1,000 patient-days). Cases were more likely to have received β-lactams, have diabetes, and require mechanical ventilation. All tested isolates were KPC-producing K. pneumoniae, and nearly all isolates were genetically related.Conclusion.CRE transmission can be reduced in LTACHs through surveillance testing and targeted interventions. Sustainable reductions within and across healthcare facilities may require a regional public health approach.Infect Control Hosp Epidemiol 2012;33(10):984-992

scholarly journals Interfacility Spread of OXA-23–Producing Carbapenem-Resistant Acinetobacter—Connecticut, 2018–2019

2020 ◽  
Vol 41 (S1) ◽  
pp. s304-s304
Author(s):  
Sydney Jones ◽  
Meghan Maloney ◽  
Anu Paranandi ◽  
Dana Pepe ◽  
Elizabeth Nazarian ◽  
...  
Keyword(s):  
Public Health ◽  
Acute Care Hospital ◽  
Care Facility ◽  
Care Hospital ◽  
Term Care ◽  
Environmental Cleaning ◽  
Healthcare Facilities ◽  
Contact Precautions ◽  
Carbapenem Resistant ◽  
Carbapenemase Gene

Background: Carbapenem-resistant Acinetobacter baumannii (CRAB), a multidrug-resistant gram-negative bacterium, can cause difficult-to-treat infections with mortality in approximately half of CRAB cases. CRAB can spread among healthcare facilities after transfer of an infected or colonized patient. Strategies to limit CRAB spread include adherence to contact precautions, environmental cleaning with bleach, and screening to identify colonized patients. During July–September 2018, the Connecticut Department of Public Health (DPH) worked with an acute-care hospital (hospital A) to contain an outbreak of OXA-23–producing CRAB (OXA-23 is an enzyme that confers resistance to carbapenems). During November 2018–March 2019, statewide CRAB surveillance identified additional cases of related OXA-23–producing CRAB at other healthcare facilities. DPH, Connecticut State Public Health Laboratory (SPHL), and the Antibiotic Resistance Laboratory Network (ARLN) investigated to prevent additional cases. Methods: Since January 2017, CRAB isolates have been routinely sent to SPHL and ARLN for carbapenemase gene detection and whole-genome sequencing (WGS) to determine isolate relatedness. During November 2018–March 2019, DPH collected patient healthcare history for patients with CRAB isolates to identify outbreaks and provide assistance in infection control and prevention to healthcare facilities reporting CRAB cases. Beginning May 2019, DPH and ARLN offered facilities screening to identify patients colonized with OXA-23–producing CRAB. Results: Of 10 OXA-23–producing CRAB isolates reported to DPH during November 2018–March 2019, 3 were closely related to the 9 isolates from hospital A’s outbreak by WGS (single-nucleotide polymorphism difference range, 1–16). One isolate was from a patient who had been admitted to hospital A during July 2018. All 3 patients with CRAB isolates shared a history of residence at long-term–care facility A (LTCF A). Two patients received a CRAB infection diagnosis upon admission to hospital B after transfer from LTCF A. Both LTCF A and hospital B performed environmental cleaning with bleach and placed CRAB-identified patients on contact precautions. LTCF A declined screening patients for CRAB, whereas hospitals B and C, which receive frequent transfers from LTCF A, screened all patients on admission from LTCF A. During May–September 2019, among 6 patients screened, 1 was colonized with OXA-23–producing CRAB and was placed on contact precautions. Conclusions: Transfer of patients who are infected or colonized with CRAB among hospitals and LTCFs can facilitate the regional spread of CRAB. Strategies for containing the spread of carbapenemase-producing organisms include adherence to contact precautions, colonization screening, interfacility communication, and collaboration with public health.Funding: NoneDisclosures: None

Isolation of Stenotrophomonas maltophilia from Clinical Samples in Some Hospitals in Shiraz, Iran

2020 ◽  
pp. 1-3
Author(s):  
Majid Baserisalehi ◽  
Samira Zarezadeh ◽  
Majid Baserisalehi ◽  
Saeed Shoa
Keyword(s):  
Stenotrophomonas Maltophilia ◽  
Enterobacter Aerogenes ◽  
Late Summer ◽  
Early Spring ◽  
Clinical Samples ◽  
Bacillus Species ◽  
Microbiological Analysis ◽  
Blood Samples ◽  
Healthcare Facilities ◽  
Phenotypic Methods

Stenotrophomonas maltophilia is an emerging pathogenic non-fermentative Gram-negative Bacillus species. It has caused many nosocomial infections and can be isolated from various hospital wards and healthcare facilities. Research has shown that most of its strains are inherently resistant to many antibiotics and have multidrug resistance. This research intended to determine its occurrence frequency at some Hospitals in shiraz, Iran. The present study was conducted in six months (from early spring to late summer 2019). Clinical samples (Blood, Urine and cerebrospinal fluid (CSF)) collected from 120 patients afflicted with various infections. The samples were transferred to the Laboratory and subjected to microbiological analysis. Identification of the isolates was carried out by phenotypic methods and Stenotrophomonas maltophilia isolates verified using molecular methods. In total, various bacteria were isolated from 84 clinical samples. The isolates were Escherichia coli, Enterobacter aerogenes, Klebsiella pneumoniae, Stenotrophomonas maltophilia, Staphylococcus aureus and Pseudomonas aeruginosa. Stenotrophomonas maltophilia was isolated from 17 (20.2%) positive samples and most of them were isolated from blood samples. Our finding indicated that Stenotrophomonas maltophilia isolated more from blood samples follow by CSF sample. In addition, our finding illustrated that Stenotrophomonas maltophilia can be considered as the common nosocomial agent at hospitals in Shiraz, Iran.

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