Outcome in bacteremia associated with nosocomial pneumonia and the impact of pathogen prediction by tracheal surveillance cultures

Introduction: Infection is a devasting complication after primary and revision arthroplasty. Therefore, identifying potential sources of infection can help to reduce infection rates. The aim of this study was to identify the impact and potential risk of contamination for glows and surgical helmets during arthroplasty procedures. Methods: Surveillance cultures were used to detect contamination of the glow interface during the surgery and the surgical helmets immediately at the end of the surgery. The cultures were taken from 49 arthroplasty procedures from the surgeon as well as the assisting surgeon. Results: In total, 196 cultures were taken. 31 (15.8%) of them showed a contamination. 12 (13.5%) of 98 cultures taken from the surgical helmets were positive, while 18 (18.3%) of 96 cultures taken from the gloves showed a contamination. Discussion: The study showed that during arthroplasty procedures, surgical helmets and gloves were frequently contaminated with bacteria. In 20 of 49 (40.8%) arthroplasty surgeries, either the surgical helmet or the gloves showed a contamination. Surgeons should be aware that they might be a source for infection during arthroplasty surgeries.

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PIN11 THE IMPACT OF MECHANICAL VENTILATION ON OUTCOMES AND COSTS IN NOSOCOMIAL PNEUMONIA

Value in Health ◽

10.1016/s1098-3015(10)64787-0 ◽

2006 ◽

Vol 9 (3) ◽

pp. A156-A157

Author(s):

C Neslusan ◽

G Nuyts ◽

R Stellhorn

Keyword(s):

Mechanical Ventilation ◽

Nosocomial Pneumonia ◽

The Impact

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Reduction of Methicillin-ResistantStaphylococcus aureusInfection among Veterans in Atlanta

Infection Control and Hospital Epidemiology ◽

10.1086/668776 ◽

2013 ◽

Vol 34 (1) ◽

pp. 62-68 ◽

Cited By ~ 10

Author(s):

Edward Stenehjem ◽

Cortney Stafford ◽

David Rimland

Keyword(s):

Active Surveillance ◽

Medical Center ◽

Veterans Health ◽

Health Administration ◽

Healthcare Settings ◽

Surveillance Cultures ◽

Mrsa Infection ◽

The Impact ◽

Mrsa Colonization ◽

Community Onset

Objective.Describe local changes in the incidence of community-onset and hospital-onset methicillin-resistantStaphylococcus aureus(MRSA) infection and evaluate the impact of MRSA active surveillance on hospital-onset infection.Design.Observational study using prospectively collected data.Setting.Atlanta Veterans Affairs Medical Center (AVAMC).Patients.All patients seen at the AVAMC over an 8-year period with clinically and microbiologically proven MRSA infection.Methods.All clinical cultures positive for MRSA were prospectively identified, and corresponding clinical data were reviewed. MRSA infections were classified into standard clinical and epidemiologic categories. The Veterans Health Administration implemented the MRSA directive in October 2007, which required active surveillance cultures in acute care settings.Results.The incidence of community-onset MRSA infection peaked in 2007 at 5.45 MRSA infections per 1,000 veterans and decreased to 3.14 infections per 1,000 veterans in 2011 (P< .001 for trend). Clinical and epidemiologic categories of MRSA infections did not change throughout the study period. The prevalence of nasal MRSA colonization among veterans admitted to AVAMC decreased from 15.8% in 2007 to 11.2% in 2011 (P<.001 for trend). The rate of intensive care unit (ICU)-related hospital-onset MRSA infection decreased from October 2005 through March 2007, before the MRSA directive. Rates of ICU-related hospital-onset MRSA infection remained stable after the implementation of active surveillance cultures. No change was observed in rates of non-ICU-related hospital-onset MRSA infection.Conclusions.Our study of the AVAMC population over an 8-year period shows a consistent trend of reduction in the incidence of MRSA infection in both the community and healthcare settings. The etiology of this reduction is most likely multifactorial.

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Impact of Surveillance for Vancomycin-Resistant Enterococci on Controlling a Bloodstream Outbreak Among Patients With Hematologic Malignancy

Infection Control and Hospital Epidemiology ◽

10.1086/502411 ◽

2004 ◽

Vol 25 (5) ◽

pp. 391-394 ◽

Cited By ~ 35

Author(s):

Ray Hachem ◽

Linda Graviss ◽

Hend Hanna ◽

Rebecca Arbuckle ◽

Tanya Dvorak ◽

...

Keyword(s):

Critically Ill ◽

Hematologic Malignancy ◽

Incidence Density ◽

Fiscal Year ◽

Surveillance Program ◽

Complete Control ◽

Vancomycin Resistant Enterococci ◽

Surveillance Cultures ◽

Vancomycin Resistant ◽

The Impact

AbstractObjective:To determine the impact of stool surveillance cultures of critically ill patients on controlling vancomycin-resistant enterococci (VRE) outbreak bacteremia.Design:Stool surveillance cultures were performed on patients who had hematologic malignancy or were critically ill at the time of hospital admission to identify those colonized with VRE. Hence, contact isolation was initiated.Setting:A tertiary-care cancer center with a high prevalence of VRE.Participants:All patients with hematologic malignancy who were admitted to the hospital as well as all of those admitted to the intensive care unit were eligible.Results:Active stool surveillance cultures performed between 1997 and 2001 decreased the incidence density of VRE bacteremias eightfold while vancomycin use remained constant. In fiscal year (FY) 1997 and FY 1998, there were five and three VRE outbreak bacteremias, respectively. The outbreak clones were responsible for infection in 69% of those patients with VRE bacteremia. However, the stool surveillance program resulted in the complete control of VRE bacteremia by FY 1999 until the end of the study.Conclusion:Despite the steady use of vancomycin, the active surveillance program among high-risk patients with hematologic malignancy and those who were critically ill resulted in the complete control of VRE outbreak bacteremia at our institution.

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1035. Implementation of an Antimicrobial Stewardship Program-Led, Multifactorial Pneumonia Diagnosis and Treatment Bundle

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.899 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S364-S364

Author(s):

Jefferson L Cua ◽

Ryan L Crass ◽

Vince Marshall ◽

Mohammad Ateya ◽

Jerod Nagel ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Antibiotic Use ◽

Surveillance Culture ◽

Antimicrobial Stewardship Program ◽

Intervention Period ◽

Surveillance Cultures ◽

Stewardship Program ◽

The Impact ◽

Suspected Pneumonia ◽

Pneumonia Diagnosis

Abstract Background Pneumonia remains a leading cause of hospitalization and accounts for significant antibiotic use. This study aims to evaluate the impact of bundled antimicrobial stewardship program (ASP) interventions, including procalcitonin and surveillance cultures, on broad-spectrum antimicrobial use in patients with suspected pneumonia. Methods This is a pre-post, quasi-experimental study conducted at Michigan Medicine. During the intervention period, an ASP member reviewed adult patients admitted to 3-floor medical services with antibiotics initiated for suspected pneumonia. The ASP member (1) recommended the use of procalcitonin when clinically appropriate, (2) used institutional guidelines to guide empiric antibiotic selection based on risk for drug-resistant pathogens, and (3) ordered a methicillin-resistant Staphylococcus aureus (MRSA) surveillance culture in patients receiving empiric anti-MRSA therapy. The primary endpoint was anti-MRSA and anti-pseudomonal (PSA) antibiotic use measured as days of therapy (DOT) per 1000 days-present on the services of interest. Antibiotic use and clinical data were extracted from an electronic database. Pneumonia diagnosis codes were used to identify the study population. Results A total of 549 patients were included: 310 in the pre-intervention (December 1/2017 - 3/31/2018) and 239 in the intervention (December 1/2018 - 3/31/2019) periods. Baseline demographics were similar between groups (Table 1). Less than 15% of patients had a microbiological diagnosis via respiratory culture in both study periods (Table 2). Respiratory cultures were ordered less commonly in the intervention period; however, the rate of culture positivity was higher (28% vs. 48%, P < 0.01). Process measures improved in the intervention period with an increase in the proportion of patients with MRSA surveillance cultures (13% vs. 39%, P < 0.01) and procalcitonin monitoring (77% vs. 83%, P = 0.07). Compared with the pre-intervention period, anti-MRSA antibiotic use decreased from 172 to 158 DOT per 1000 days-present (Δ -8%) and the use of anti-PSA antibiotics decreased from 348 to 316 DOT per 1000 days present (Δ -9%). Conclusion The implementation of an ASP-led pneumonia bundle led to reductions in anti-MRSA and anti-PSA antibiotic use. Disclosures All authors: No reported disclosures.

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Comparison of surveillance and clinical cultures to measure the impact of infection control interventions on the incidence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus in the hospital

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2019.322 ◽

2020 ◽

pp. 1-5

Author(s):

Surbhi Leekha ◽

Lyndsay M. O’Hara ◽

Alyssa Sbarra ◽

Shanshan Li ◽

Anthony D. Harris

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Infection Control ◽

The United States ◽

Incidence Density ◽

Surgical Intensive Care Unit ◽

Care Hospital ◽

Convenience Sample ◽

Surveillance Cultures ◽

The Impact

Abstract Objective: To evaluate whether clinical cultures are an appropriate surrogate for surveillance cultures to measure the effect of interventions on the incidence of MRSA and VRE in the hospital. Design: Cross-sectional and quasi-experimental, retrospective analysis Setting and population: Convenience sample of patients admitted between January 1, 2002, and June 31, 2011, to the medical intensive care unit (MICU) and surgical intensive care unit (SICU) of an acute-care hospital in the United States. Interventions: Asynchronously in the MICU and SICU, we introduced (1) universal glove and gown use, (2) bundled intervention to prevent central-line–associated bloodstream infection, and (3) daily chlorhexidine gluconate bathing. Results: We observed a statistically significant correlation between surveillance and clinical culture-based incidence rates of MRSA in the MICU (0.32; P < .001) and the SICU (0.37; P < .001) but not for VRE in either the MICU (0.16, P = .11) or the SICU (0.15; P = .12). For VRE, but not for MRSA, incidence density rates based on surveillance cultures were 2- to 4-fold higher than for clinical cultures. When evaluating the impacts of the interventions, different effect estimates were noted for universal glove and gown use on MRSA acquisition in MICU, and for VRE acquisition in both the MICU and the SICU based on surveillance versus clinical cultures. Conclusions: For multidrug-resistant organism acquisition, surveillance cultures should be used when feasible because clinical cultures may not be an appropriate surrogate. Clinical or surveillance-based end points for infection control interventions should reflect the conceptual model from colonization to infection and where an intervention might have an effect, rather than considering them interchangeable.

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