The Growing Importance of Non-Device-Associated Healthcare-Associated Infections: A Relative Proportion and Incidence Study at an Academic Medical Center, 2008-2012

Abstract Background Hospital-onset (HO) sepsis is associated with substantial mortality but is not tracked or reported by most hospitals. CDC’s Adult Sepsis Event (ASE) definition may facilitate standardized surveillance but little is known about the clinical correlates of HO-ASEs and their association with currently reportable healthcare-associated infections (HAIs). Methods In this retrospective study of all adult patients admitted to an academic medical center between June 2015–2018, we assessed the overlap between HO-ASEs and HAIs reported to the National Healthcare Safety Network (NHSN) and reviewed a random subset of 110 HO-ASE cases to determine their clinical correlates. Results The cohort included 168,249 hospitalized patients, including 2,139 (1.3%) with HO-ASE and 2,133 (1.3%) with NHSN HAIs. Amongst the 2,139 HO-ASE patients, 480 (22.4%) had ≥1 HAI: 8.1% VAE, 6.2% CLABSI, 6.1% C.difficile, 3.1% CAUTI, 1.3% MRSA bacteremia, and 0.8% SSI. HO-ASE was associated with higher in-hospital mortality rates than HAIs (28.6% vs 14.6%, p< 0.001). HO-ASE associated mortality was high even when NHSN-reportable HAIs were absent (26.5%) whereas NHSN-reportable HAI mortality was relatively low when HO-ASE was absent (8.4%). Amongst the 110 reviewed HO-ASE cases, 102 (93%) were possible or confirmed infections, most commonly pneumonia (39%, of which 35% were ventilator-associated), non-C.difficile intra-abdominal infections (15%), febrile neutropenia (14%), urinary tract infection (7%, of which 88% were catheter-associated), and skin/soft tissue infection (7%). Most (86%) infections flagged by HO-ASEs were acquired in the hospital rather than the community. The most common non-infectious events flagged by HO-ASE were pulmonary edema and periprocedural blood loss associated with blood cultures and empiric antibiotics. Conclusion CDC’s hospital-onset ASE definition accurately identifies patients with nosocomial sepsis who have very high mortality rates and are generally not captured by currently reportable HAI metrics. Routine hospital-onset ASE surveillance could provide a broader window into serious nosocomial infections, identify new targets for prevention, and further improve outcomes for hospitalized patients. Disclosures All Authors: No reported disclosures

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2424. Shedding of Viable Clostridiodes difficile in Patients Admitted to a Medical Intensive Care Unit

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.2102 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S837-S838

Author(s):

Vincent B Young ◽

Micah Keidan ◽

Rachel D Yelin ◽

Thelma E Dangana ◽

Pamela B Bell ◽

...

Keyword(s):

Intensive Care ◽

Medical Center ◽

Academic Medical Center ◽

Secondary Analysis ◽

Icu Patients ◽

Specific Pcr ◽

Patient Admissions ◽

Academic Medical ◽

Healthcare Associated ◽

Record Review

Abstract Background Hospitalized patients are at risk of colonization with a range of healthcare-associated bacterial pathogens, including C. difficile. In patients admitted to intensive care units (ICUs), in whom C. difficile infection (CDI) is associated with increased morbidity and mortality. To understand the risk for acquisition of C. difficile and development of CDI, we monitored ICU patients daily for shedding of C. difficile by culture. Methods We conducted a secondary analysis of daily rectal/fecal swab samples collected from medical ICU patients of a 720-bed academic medical center in Chicago, IL. Selective culture for C. difficile was performed on swab samples from patients who had 2 or more samples obtained using selective media. Confirmation of putative C. difficile isolates was done by specific PCR assays for the 16S rRNA-encoding gene and the toxin genes tcdA, tcdB, cdtA and cdtB. Clinical testing for CDI was performed using the Xpert® C. difficile PCR assay (Cepheid). Clinical and demographic metadata were collected at bedside and by electronic medical record review. Results Culture was attempted on 2106 swab samples from 451 patients (486 ICU admissions) (Figure 1). A mean of 4.33 samples was obtained from each patient. C. difficile was isolated from 211 (10%) samples from 79 patients (Table 1). The first sample was positive by culture for 48 (9.9%) of patient admissions to the ICU. 31 (6.4%) patients who were initially negative by culture had a subsequent sample from which C. difficile was isolated. Persistence of culture-positivity varied from patient to patient (Figure 2). Of 80 patients who were tested for CDI based on physician suspicion, 12 patients had a positive Cepheid PCR test; 9 had diarrhea and were treated for CDI. Conclusion Surveillance for shedding of C. difficile by daily culture reveals that patients admitted to the ICU can shed the pathogen intermittently without attributable disease. This can be in the form patients who are admitted carrying the organism as well as those who appear to acquire the organism during their stay. It is unclear whether patient or microbiome factors underlie the differences seen in patterns of shedding. Furthermore, intermittent shedding may reflect multiple episodes of exposure to C. difficile spores and asymptomatic shedding without stable colonization. Disclosures All authors: No reported disclosures.

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482. Time Series Analysis of Antimicrobial Consumption and Pseudomonas aeruginosa Resistance in an Academic Medical Center in the United States (2013–2018)

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.555 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S236-S236

Author(s):

Courtney M Dewart ◽

Courtney Hebert ◽

Preeti Pancholi ◽

Kurt Stevenson

Keyword(s):

Antimicrobial Stewardship ◽

Transfer Functions ◽

Medical Center ◽

Academic Medical Center ◽

The United States ◽

Antimicrobial Use ◽

Antimicrobial Consumption ◽

Academic Medical ◽

Days Of Therapy ◽

Healthcare Associated

Abstract Background Monitoring antimicrobial use and resistance are key components of initiatives to promote antimicrobial stewardship and prevent antimicrobial-resistant infections. In this surveillance study, we evaluated trends in resistance among healthcare-associated P. aeruginosa isolates and potential associations with antimicrobial consumption. Methods We established a retrospective cohort of P. aeruginosa isolates collected ≥48 hours after inpatient admission at a 1,300-bed academic medical center from July 1, 2013 to July 31, 2018. We included isolates from all clinical cultures and retained the first isolate for a patient encounter. We defined the multidrug-resistant (MDR) status in accordance with the phenotype definitions established by the Centers for Disease Control and Prevention. We calculated the monthly percentage of class-specific resistance and MDR status among isolates. We measured monthly antimicrobial consumption as days of therapy per 1,000 patient-days. To evaluate potential associations between identified trends in resistance and antimicrobial use, we constructed autoregressive integrated moving average models (ARIMA) with transfer functions. Results Of 1,897 isolates included in the analysis, 303 (16.0%) were classified as MDR P. aeruginosa. The rate of healthcare-associated P. aeruginosa infections and percent of MDR isolates remained stable over the five-year study period. However, we identified trends in resistance to specific antimicrobial classes: there was a significant increase in resistance to antipseudomonal carbapenems, while resistance to aminoglycosides and extended-spectrum cephalosporins decreased. Using the ARIMA modeling strategy, bivariable analyses of resistance and antimicrobial use revealed that carbapenem-resistant P. aeruginosa was positively correlated with the use of antipseudomonal carbapenems at a 1-month lag and ertapenem at a 5-month lag. Conclusion Risk assessments that only measure rates of MDR organisms may miss underlying trends in class resistance. Increasing carbapenem resistance despite a stable proportion of MDR isolates highlights a critical area for continued monitoring and antimicrobial stewardship initiatives targeted at carbapenem use in our hospital. Disclosures All authors: No reported disclosures.

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Healthcare-associated COVID-19: The experience of an academic medical center

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1357 ◽

2020 ◽

pp. 1-3

Author(s):

Rachel J. Pryor ◽

Michelle Doll ◽

Michael P. Stevens ◽

Kaila Cooper ◽

Emily J. Godbout ◽

...

Keyword(s):

Medical Center ◽

Academic Medical Center ◽

Academic Medical ◽

Healthcare Associated

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Effect of Hospital-Wide Chlorhexidine Patient Bathing on Healthcare-Associated Infections

Infection Control and Hospital Epidemiology ◽

10.1086/668024 ◽

2012 ◽

Vol 33 (11) ◽

pp. 1094-1100 ◽

Cited By ~ 39

Author(s):

Mark E. Rupp ◽

R. Jennifer Cavalieri ◽

Elizabeth Lyden ◽

Jennifer Kucera ◽

MaryAnn Martin ◽

...

Keyword(s):

Critical Care ◽

Relative Risk ◽

Washout Period ◽

Medical Center ◽

Academic Medical Center ◽

Bloodstream Infections ◽

Significant Rise ◽

Healthcare Associated Infections ◽

Dose Escalation Study ◽

Healthcare Associated

Background.Chlorhexidine gluconate (CHG) bathing has been used primarily in critical care to prevent central line-associated bloodstream infections and infections due to multidrug-resistant organisms. The objective was to determine the effect of hospital-wide CHG patient bathing on healthcare-associated infections (HAIs).Design.Quasi-experimental, staged, dose-escalation study for 19 months followed by a 4-month washout period, in 3 cohorts.Setting.Academic medical center.Patients.All patients except neonates and infants.Intervention and Measurements.CHG bathing in the form of bed basin baths or showers administered 3 days per week or daily. CHG bathing compliance was monitored, and the rate of HAIs was measured.Results.Over 188,859 patient-days, 68,302 CHG baths were administered. Adherence to CHG bathing in the adult critical care units (90%) was better than that observed in other units (57.7%, P< .001). A significant decrease in infections due to Clostridium difficile was observed in all cohorts of patients during the intervention period, followed by a significant rise during the washout period. For all cohorts, the relative risk of C. difficile infection compared to baseline was 0.71 (95% confidence interval [CI], 0.57–0.89; P = .003) for 3-days-per-week CHG bathing and 0.41 (95% CI, 0.29–0.59; P < .001) for daily CHG bathing. During the washout period, the relative risk of infection was 1.85 (95% CI, 1.38–2.53; P =< .001), compared to that with daily CHG bathing. A consistent effect of CHG bathing on other HAIs was not observed. No adverse events related to CHG bathing were reported.Conclusions.CHG bathing was well tolerated and was associated with a significant decrease in C. difficile infections in hospitalized patients.

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