Pseudo-Outbreak ofMycobacterium chelonaeandMethtlobactertum mesophilicumCaused by Contamination of an Automated Endoscopy Washer

AbstractObjective:To evaluate an unusual number of rapidly growing acid-fast bacilli, later identified asMycobacterium chelonae,and pink bacteria, later identified asMethylo-bacterium mesophilicum,from fungal cultures obtained by bronchoscopy.Design:Outbreak investigation.Setting:An academic medical center performing approximately 500 bronchoscopies and 4,000 gastrointestinal endoscopies in 1998.Patients:Patients undergoing bronchoscopy July 21 to October 2, 1998.Methods:The infection control department reviewed patient charts and bronchoscopy logs; obtained cultures of source water, faucets, washers, unopened glutaraldehyde, glutaraldehyde from the washers, and endoscopes; observed endoscope and bronchoscope cleaning and disinfecting procedures; reviewed glutaraldehyde monitoring records; and sentM chelonaeisolates for DNA fingerprinting.Results:M chelonae, M mesophilicum,gram-negative bacteria, and various molds grew from endoscopes, automated washers, and glutaraldehyde from the washers but not from unopened glutaraldehyde. The endoscopy unit regularly monitored the pH of glutaraldehyde, and the logs contained no deficiencies. The above sources remained positive for the same organisms after a glutaraldehyde cleaning cycle of the automated washers. DNA fingerprinting of theM chelonaerevealed that they were clonally related.Conclusions:The automated washers were contaminated with a biofilm that rendered them resistant to decontamination. The washers then contaminated the endoscopes and bronchoscopes they were used to disinfect. Our institution purchased new endoscopes and a new paracetic acid sterilization system.

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Impact of CLSI Break Point Changes Over the Past Decade on Antimicrobial Susceptibility in Gram-Negative Bacteria

Antimicrobial Stewardship & Healthcare Epidemiology ◽

10.1017/ash.2021.115 ◽

2021 ◽

Vol 1 (S1) ◽

pp. s60-s60

Author(s):

Wesley Johnson ◽

David Burgess ◽

Donna Burgess ◽

Sarah Cotner ◽

Jeremy VanHoose ◽

...

Keyword(s):

Medical Center ◽

Academic Medical Center ◽

Break Point ◽

Significant Decline ◽

Gram Negative Bacteria ◽

Gram Negative ◽

The Past ◽

Academic Medical ◽

Break Points ◽

The Impact

Background: Over the past decade, the CLSI has updated susceptibility break points for several antimicrobial agents. The purpose of this study was to evaluate the impact of these changes against gram-negative bacteria at our academic medical center. Methods: In this retrospective, IRB-approved study, we collected consecutive, nonduplicate clinical isolates of Enterobacter cloacae, Escherichia coli, Klebsiella aerogenes, K. oxytoca, K. pneumoniae, and Pseudomonas aeruginosa for the past decade (2010–2019) at our academic medical center and 3 adult ICUs. Susceptibility testing was performed using the BD Phoenix automated system. For these isolates, susceptibilities for 7 β-lactams (aztreonam, ceftriaxone, ceftazidime, cefepime, piperacillin/tazobactam, ertapenem, and meropenem) and 2 fluoroquinolones (levofloxacin, ciprofloxacin) were calculated based upon CLSI break points in 2010 and current CLSI break points in 2020. Any change >5% in susceptibility was deemed significant for this analysis. Results: In 17.5% of Enterobacteriales isolates tested, at least 1 antimicrobial demonstrated significant decline. Ertapenem was the most commonly affected antimicrobial (45% of the isolates) followed by ceftriaxone (35%) and cefepime (25%). Susceptibilities of aztreonam, ceftazidime, and meropenem were not affected for any of the Enterobacteriales. The most common organism demonstrating a significant impact on change in susceptibility among the Enterobacteriales was E. cloacae (41.7% of the time) followed by E. aerogenes (20.8%), K. oxytoca (12.5%), K. pneumoniae (8.3%) and E. coli (4.2%). Most of the impact was observed hospital-wide (33.3%), followed closely by the MICU (28.6%), the NSICU (23.8%) and the CVICU (14.3%). For P. aeruginosa, the impact of the antimicrobial break-point changes on susceptibility was more pronounced than the Enterobacteriales. Overall, 93.8% of the time there was a significant decline in antimicrobial susceptibility. Each antimicrobial (ciprofloxacin, levofloxacin, meropenem, and piperacillin/tazobactam) demonstrated a significant decline in susceptibility hospital-wide and in each ICU except for the susceptibility of meropenem in the NSICU. Conclusions: Changes in break points had a significant impact on the susceptibility of all antimicrobials for P. aeruginosa at our institution, both hospital-wide and in the adult ICUs. Although the impact was less for the Enterobacteriales, ertapenem, ceftriaxone, and cefepime demonstrated significant susceptibility changes, especially with E. cloacae. Understanding and evaluating the impact of the break-point changes may lead to changes in empiric therapy in other institutions.Funding: NoDisclosures: None

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Adequacy of empiric gram-negative coverage for septic patients at an academic medical center

American Journal of Infection Control ◽

10.1016/j.ajic.2019.03.037 ◽

2019 ◽

Vol 47 (10) ◽

pp. 1194-1199 ◽

Cited By ~ 1

Author(s):

DaleMarie Vaughan ◽

Amy Pakyz ◽

Michael Stevens ◽

Kimberly Lee ◽

Shaina Bernard

Keyword(s):

Medical Center ◽

Academic Medical Center ◽

Gram Negative ◽

Academic Medical

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Improvement of gram-negative susceptibility to fluoroquinolones after implementation of a pre-authorization policy for fluoroquinolone use: A decade-long experience

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2018.245 ◽

2018 ◽

Vol 39 (12) ◽

pp. 1419-1424 ◽

Cited By ~ 5

Author(s):

Rachael A. Lee ◽

Morgan C. Scully ◽

Bernard C. Camins ◽

Russell L. Griffin ◽

Danielle F. Kunz ◽

...

Keyword(s):

Medical Center ◽

Academic Medical Center ◽

Rate Of Change ◽

Gram Negative ◽

E Coli ◽

Stewardship Program ◽

Restriction Policy ◽

Academic Medical ◽

Days Of Therapy ◽

Gram Negative Organisms

AbstractObjectiveDue to concerns over increasing fluoroquinolone (FQ) resistance among gram-negative organisms, our stewardship program implemented a preauthorization use policy. The goal of this study was to assess the relationship between hospital FQ use and antibiotic resistance.DesignRetrospective cohort.SettingLarge academic medical center.MethodsWe performed a retrospective analysis of FQ susceptibility of hospital isolates for 5 common gram-negative bacteria: Acinetobacter spp., Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Primary endpoint was the change of FQ susceptibility. A Poisson regression model was used to calculate the rate of change between the preintervention period (1998–2005) and the postimplementation period (2006–2016).ResultsLarge rates of decline of FQ susceptibility began in 1998, particularly among P. aeruginosa, Acinetobacter spp., and E. cloacae. Our FQ restriction policy improved FQ use from 173 days of therapy (DOT) per 1,000 patient days to <60 DOT per 1,000 patient days. Fluoroquinolone susceptibility increased for Acinetobacter spp. (rate ratio [RR], 1.038; 95% confidence interval [CI], 1.005–1.072), E. cloacae (RR, 1.028; 95% CI, 1.013–1.044), and P. aeruginosa (RR, 1.013; 95% CI, 1.006–1.020). No significant change in susceptibility was detected for K. pneumoniae (RR, 1.002; 95% CI, 0.996–1.008), and the susceptibility for E. coli continued to decline, although the decline was not as steep (RR, 0.981; 95% CI, 0.975–0.987).ConclusionsA stewardship-driven FQ restriction program stopped overall declining FQ susceptibility rates for all species except E. coli. For 3 species (ie, Acinetobacter spp, E. cloacae, and P. aeruginosa), susceptibility rates improved after implementation, and this improvement has been sustained over a 10-year period.

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Risk of Acquiring Extended-Spectrumβ-Lactamase–ProducingKlebsiellaSpecies andEscherichia colifrom Prior Room Occupants in the Intensive Care Unit

Infection Control and Hospital Epidemiology ◽

10.1086/670216 ◽

2013 ◽

Vol 34 (5) ◽

pp. 453-458 ◽

Cited By ~ 30

Author(s):

Adebola O. Ajao ◽

J. Kristie Johnson ◽

Anthony D. Harris ◽

Min Zhan ◽

Jessina C. McGregor ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Medical Center ◽

Bacterial Species ◽

Academic Medical Center ◽

Gram Negative Bacteria ◽

Icu Patients ◽

Gram Negative ◽

Colonization Pressure ◽

Icu Length Of Stay

Objective.To quantify the association between admission to an intensive care unit (ICU) room most recently occupied by a patient positive for extended-spectrumβ-lactamase (EBSL)-producing gram-negative bacteria and acquisition of infection or colonization with that pathogen.Design.Retrospective cohort study.Setting and Patients.The study included patients admitted to medical and surgical ICUs of an academic medical center between September 1, 2001, and June 30, 2009.Methods.Perianal surveillance cultures were obtained at admission to the ICU, weekly, and at discharge from the ICU. Patients were included if they had culture results that were negative for ESBL-producing gram-negative bacteria at ICU admission and had an ICU length of stay longer than 48 hours. Pulsed-field gel electrophoresis (PFGE) was performed on ESBL-positive isolates from patients who acquired the same bacterial species (eg,Klebsiellaspecies orEscherichia coli) as the previous room occupant.Results.Among 9, 371 eligible admissions (7, 651 unique patients), 267 (3%) involved patients who acquired an ESBL-producing pathogen in the ICU; of these patients, 32 (12%) were hospitalized in a room in which the prior occupant had been positive for ESBL. Logistic regression results suggested that the prior occupant's ESBL status was not significantly associated with acquisition of an ESBL-producing pathogen (adjusted odds ratio, 1.39 [95% confidence interval, 0.94-2.08]) after adjusting for colonization pressure and antibiotic exposure in the ICU. PFGE results suggested that 6 (18%) of 32 patients acquired a bacterial strain that was the same as or closely related to the strain obtained from the prior occupant.Conclusions.These data suggest that environmental contamination may not play a substantial role in the transmission of ESBL-producing pathogens among ICU patients. Intensifying environmental decontamination may be less effective than other interventions in preventing transmission of ESBL-producing pathogens.

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Re-Organization of an Infection Prevention and Control Department by Service Lines at a Large Academic Medical Center

American Journal of Infection Control ◽

10.1016/j.ajic.2009.04.112 ◽

2009 ◽

Vol 37 (5) ◽

pp. E86-E87

Keyword(s):

Prevention And Control ◽

Infection Prevention ◽

Medical Center ◽

Academic Medical Center ◽

Infection Prevention And Control ◽

Academic Medical ◽

Control Department ◽

And Control

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1050. Oral Antibiotics for the Treatment of Gram-Negative Bloodstream Infections: Prescribing Practices and Outcomes at a Large Academic Medical Center

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.887 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S313-S314

Author(s):

Kimberly Claeys ◽

Nora Loughry ◽

Sanjay Chainani ◽

Surbhi Leekha ◽

Emily Heil

Keyword(s):

Antibiotic Therapy ◽

Medical Center ◽

Academic Medical Center ◽

Bloodstream Infections ◽

Antibiotic Use ◽

Optimal Time ◽

Oral Antibiotics ◽

Prescribing Practices ◽

Gram Negative ◽

Academic Medical

Abstract Background There is limited data to guide the use of oral (PO) antibiotics for the treatment of Gram-negative (GN) bloodstream infection (BSI). The objective of this study was to describe the characteristics and outcomes at a large academic medical center. Methods Retrospective observational cohort of adult patients (age ≥18 years) with at least one blood culture positive for aerobic Gram-negative organism(s) treated with antibiotic therapy (IV or oral [PO]) at University of Medical Center from November 2015 to May 2017. Oral antibiotics were described based on bioavailability. The primary outcome of interest was 30-day infection-related readmission. Secondary objectives included evaluation of patient characteristics associated with PO antibiotic use. Results During the defined study period 310 patients met inclusion; 113 (36.5%) were switched to PO antibiotic therapy for the treatment of GN BSI within a median of 5 (IQR 3–11) days. Oral antibiotics were initiated at discharge for 50 (44%) of patients switched. Patients switched to PO were less likely to have has a stay in the ICU (24.8% vs. 47.7%, P < 0.0001) and were less likely to have an ID consult (57.5% vs. 71.1%, P = 0.034). There was no difference in median Charlson Comorbidity Score (2, IQR 0–4). The most common sources of infection among those switched to PO agents were urinary (50, 44.2%) and intra-abdominal (25, 22.1%). The majority of patients were placed on a PO agent with high bioavailability (61, 54%), which included levofloxacin and moxifloxacin. There was a slightly higher proportion of use of high (vs. low) bioavailable antibiotics in patients with ID consult compared with those without (59% vs. 41%, P = 0.053). PO antibiotics were more frequently prescribed for patients discharged home (78, 69%) compared with patients discharged to Rehab/Short-term facility (28, 24.8%). Thirty-day hospital readmission was more common among the patients treated with PO antibiotics (18.6 vs. 8.1%, P = 0.006); however, ID-related readmission was rare (0.9% vs. 1%, P = 0.91). Conclusion Urinary and intra-abdominal sources and home discharge were common among those with PO antibiotic use. ID-related outcomes were similar among those treated with IV vs. PO agents. More research is necessary to determine optimal time to PO antibiotic switch. Disclosures K. Claeys, Nabriva: Scientific Advisor, Consulting fee. Melinta: Scientific Advisor, Consulting fee. E. Heil, ALK-Abelló: Grant Investigator, Research grant.

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