scholarly journals 163. MIC Shifts in Response to Increased Antibiotic Utilization During COVID-19 Pandemic

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S191-S192
Author(s):  
Jonathan Byrd ◽  
Neena Thomas-Gosain ◽  
Jane V Eason ◽  
Jessica Bennett ◽  
Jarred Bowden
Keyword(s):  
Antibiotic Use ◽  
Time Frame ◽  
Klebsiella Pneumonia ◽  
Short Term ◽  
Gram Negative ◽  
Emergency Department Data ◽  
Antibiotic Utilization ◽  
The Impact ◽  
Similar Decrease ◽  
Sustained Increase

Abstract Background Multiple studies have shown that antibiotic utilization increased during the COVID-19 pandemic. However, the impact of this increased utilization has not been well established. The aim of this study is to describe the trends in minimum inhibitory concentrations for various antibiotics against common gram-negative pathogens observed since the start of the COVID-19 pandemic as compared to previous years. Methods This retrospective study was conducted at the Memphis VA. All respiratory, urine, and blood culture MicroScan results run from October 2017-March 2021 were analyzed. Only inpatient and emergency department data was included. The MIC50 and MIC90 of seven antibiotics for four of the most common pathogens were trended by quarterly intervals. Results MIC50 and MIC90 were compared using standardized breakpoints. As compared to previous years, Pseudomonas aeruginosa was noted to have the most sustained increase in MIC90 across various antibiotics. In the last 3 quarters of the study time frame, piperacillin-tazobactam mean MIC90 increased from 32 to 64, cefepime from 8 to > 16, and meropenem from 4 to > 8. Escherichia coli had a sustained increase in ceftriaxone MIC90 from < 1 to > 8 in the final quarter of 2020 and beginning of 2021. Klebsiella pneumonia was also found to have a sustained increase in cefepime mean MIC90 from < 1 to > 16 during the year of 2020, with return to previous MIC90 the following quarters. Conclusion Previous studies have clearly demonstrated a widespread increase in antibiotic utilization during the COVID era. Our study demonstrates how even short-term increases in antibiotic use can lead to shifts in MIC, if not outright resistance. This was demonstrated across multiple common gram-negative pathogens and to various broad-spectrum antibiotics which were commonly used more frequently during COVID-19. Further analysis will be needed to determine whether these trends continue or whether the decrease in antibiotic utilization in the recent months will lead to similar decrease in MIC. Disclosures All Authors: No reported disclosures

scholarly journals 1017. Scratching the Surface with NHSN Data: Defining High Impact Stewardship Targets in Critical Care

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S357-S358
Author(s):  
Kelsie Cowman ◽  
Victor Chen ◽  
Nidhi Saraiya ◽  
Yi Guo ◽  
Rachel Bartash ◽  
...  
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Antibiotic Use ◽  
Time Frame ◽  
High Impact ◽  
Chart Audit ◽  
Surgical Intensive Care ◽  
Patient Level ◽  
Clostridioides Difficile ◽  
The Impact

Abstract Background The National Healthcare Safety Network (NHSN) provides risk-adjusted Standardized Antimicrobial Administration Ratios (SAAR) as a benchmark for medical and surgical intensive care units (ICU). Antibiotic use (AU) data does not provide patient-level information (e.g., antibiotic appropriateness, indications, durations, etc.). However, we hypothesize that AU data can help define high impact stewardship targets, particularly in the context of critical care Clostridioides difficile rates. Methods Units with high rates of AU and hospital-onset (HO) C. difficile were selected for review. A monthly AU and C. difficile dashboard was created for ICU providers, inclusive of data from May 2018 onwards. We also performed chart audits for indication, duration, and location of initiation for all medical intensive care unit (MICU) patients receiving piperacillin/tazobactam (P/T) or vancomycin (Van) during February 2019 per request of ICU stakeholders. Data were used to obtain stewardship buy-in from local MICU champions. Results AU data indicated that (1) all 3 MICUs consistently had SAARs >1 for broad-spectrum categories and (2) Van and P/T were the highest volume agents on these units (Figure 1). Chart audit of 135 MICU patients showed that 17 patients received P/T, 34 Van, and 84 (62%) both agents; median duration was 2 days for Van and 3 days for P/T (Figure 2). Approximately half of initiations occurred in the emergency department (ED) (50% Van, 47% P/T); most common indications were “respiratory tract infection” and “severe sepsis/septic shock” for both P/T (77%) and Van (74%) (Figure 2). HO C. difficile in MICUs accounted for 6%, 13%, and 16% of total HO C. difficile cases in campuses A, B, and C, respectively during the time frame (Figure 1). Conclusion We feel that NHSN data scratches the surface of the deep-rooted challenges of ICU stewardship. However, it can identify AU trends and most frequently prescribed antibiotics in the context of unit-specific C. difficile rates. Intensive stewardship audit can further uncover areas for intervention, such as ED Van and P/T overprescribing. We suggest presenting clinical stakeholders with a quarterly “stewardship dashboard” combining AU rates, patient-level data, and C. difficile rates to maximize the impact of stewardship endeavors. Disclosures All authors: No reported disclosures.

scholarly journals 283. Population-Based Co-infection of Carbapenem-Resistant Organisms and SARS-CoV-2 in Massachusetts

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S247-S248
Author(s):  
Ashley Geoghegan ◽  
Jessica Leaf ◽  
Monina Klevens ◽  
Scott Troppy
Keyword(s):  
Average Length ◽  
Klebsiella Oxytoca ◽  
Antibiotic Use ◽  
Hospital Staff ◽  
Time Frame ◽  
Population Based ◽  
Case Definition ◽  
Average Length Of Stay ◽  
Carbapenem Resistant ◽  
The Impact

Abstract Background Concerns about antibiotic resistance are exacerbated in COVID-19 patients due to frequent antibiotic use, increase in mechanical ventilation and reusable equipment, conservation of PPE, and strain on hospital staff. We described cases with co-infection of carbapenem-resistant organisms (CRO) and SARS-CoV-2 and compared rates in the Massachusetts population. Methods All providers and hospitals are required to report CROs and SARS-CoV-2 to the Massachusetts Virtual Epidemiologic Network (MAVEN). We selected cases with both a positive SARS-CoV-2 test and a laboratory confirmed CRO from January through July 2020. We classified by which result occurred first and described demographic and clinical characteristics. We standardized the CRO case definition by excluding CR-Pseudomonas aeruginosa and calculated rates per 100,000 to assess the impact of SARS-CoV-2 on the population-based frequency of CROs. Analyses were conducted in SAS 9.4. Results 28 confirmed cases of SARS-CoV-2 infection were also diagnosed with a CRO. They were an average age of 71.8, 60.7% male, 67.9% white, and 64.3% were in congregate care prior to their diagnoses. Mortality was 5/28 (17.9%). The 23 (82.1%) with a positive SARS-CoV-2 result first were all hospitalized at least once compared to 40% in the CRO first group (p=0.003). 11 (47.8%) of the SARS-CoV-2 first were already admitted when they tested CRO positive; 7 (30.4%) were admitted for the CRO separately from COVID-19 treatment. None of the CRO first group were admitted for CRO infection. Average length of stay for the SARS-CoV-2 first group was higher than the CRO first group (62.3 days vs 11.0 days; p=0.049). Cases positive for CRO first were all infected with CR-Escherichia coli whereas those positive for SARS-CoV-2 first were infected with CRAB, CRPA, or a CRE (Klebsiella oxytoca or Klebsiella pneumoniae) (p< 0.0001). The rate of CRO/COVID coinfection was 0.203 per 100,000 population; the rates for January through July of CRO alone were 2.5 per 100,000 in 2020 and 2.4 per 100,000 in 2019. Conclusion Characteristics of individuals co-infected with CRO and SARS-CoV-2 differed by which diagnosis was made first; however, the SARS-CoV-2 pandemic did not impact the CRO population rate during the time frame studied. Disclosures All Authors: No reported disclosures

scholarly journals 1985. Impact of Suppressing Ciprofloxacin Susceptibility Results on Antibiotic Utilization and Hospital-acquired Clostridioides difficile Infection

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S664-S665
Author(s):  
Bryan P White ◽  
Daniel B Chastain ◽  
Karen Kinney ◽  
Katie Thompson ◽  
Jerry Kelley ◽  
...  
Keyword(s):  
Antibiotic Use ◽  
Interrupted Time Series Analysis ◽  
E Coli ◽  
Clostridioides Difficile ◽  
Antibiotic Utilization ◽  
Increased Risk ◽  
Days Of Therapy ◽  
Before And After ◽  
Hospital Acquired ◽  
The Impact

Abstract Background Fluoroquinolones (FQs) are broad-spectrum antibiotics associated with multiple adverse effects and an increased risk of Clostridioides difficile infections (CDI). Previous data suggest that suppression of FQ susceptibility results decreased FQ use. The purpose of this study was to examine the impact of suppressing ciprofloxacin susceptibility on antibiotic use, susceptibility, and CDI. Methods This was a single-center quasi-experimental study of the effect of the suppression of ciprofloxacin susceptibility on pan susceptible urine isolates for Klebsiella sp. and E. coli starting in March 2018 in the 11 months before and after the intervention. Monthly antibiotic utilization in days of therapy (DOT)/1,000 patient-days for levofloxacin, ciprofloxacin, ceftriaxone, trimethoprim/sulfamethoxazole (TMP/SMZ), fosfomycin, and nitrofurantoin, hospital-acquired CDI (HA-CDI) rates as defined by CDC, and Pseudomonas aeruginosa susceptibility was compared with interrupted time series analysis using Stata MP 12.1 before and after the intervention to compare the level, intercept, and rate, slope, of a trend line. Results There was no change in the level or rate of ciprofloxacin DOT (0.27, 95% CI: −0.94 to 1.48–3.49; 95% CI: −10.89 to 3.90) and levofloxacin DOT (−5.87, 95% CI: −17.79 to 6.06; −0.98, 95% CI −2.86 to 0.90) with the intervention, respectively. Level of P. aeruginosa susceptibility to ciprofloxacin level (8.13, 95% CI: 0.00 to 16.26) had a trend toward increasing and rate (1.65, 95% CI: 0.44 to 2.87) increased after the intervention. Ceftriaxone DOT level decreased after the intervention (P = 0.01), but the rate did not change. Cephalexin (P = 0.01) and nitrofurantoin (P = 0.01) DOT levels increased after the intervention without changes in rates. There was no change in the level or rate of HA-CDI, fosfomycin, or TMP/SMZ DOTs. Conclusion Suppressing ciprofloxacin susceptibility results on pan susceptible Klebsiella sp. and E. coli urine isolates was associated with increased P. aeruginosa susceptibility to ciprofloxacin and increased cephalexin and nitrofurantoin DOTs. No changes were seen in FQ use or HA-CDI rates. Disclosures All authors: No reported disclosures.

scholarly journals Use of a laboratory model hospital sink system to investigate fluctuation of Gram-negative bacteria in sink waste traps

2020 ◽  
Vol 2 (7A) ◽  
Author(s):  
Harry Ferguson ◽  
Paz Aranega Bou ◽  
Ginny Moore
Keyword(s):  
Klebsiella Oxytoca ◽  
Time Frame ◽  
Laboratory Model ◽  
Gram Negative Bacteria ◽  
Clinical Environment ◽  
Experimental Conditions ◽  
Gram Negative ◽  
The Uk ◽  
Enterobacter Asburiae ◽  
The Impact

Hospital sinks in the UK have recently been under scrutiny as possible reservoirs for Gram-negative bacteria, especially carbapenem resistant Enterobacterales (CRE). These strains have been found in intensive care wards across the country and can re-enter the clinical environment, representing a risk to vulnerable patients. Two sink waste traps known to be colonized with CRE were collected from a hospital and fitted to a vertical-draining and rear-draining handwash sink installed within a laboratory model sink system. Sinks were automatically flushed four times a day and, as per usual in the model, TSB was provided once daily to maintain microbial populations. Gram-negative bacteria were regularly monitored using selective culture, MALDI-TOF and antibiotic disk diffusion. The short-term effect of adding simulated IV fluids (5% glucose or 0.9% NaCl) and the impact of sink design on Gram-negative proliferation were investigated. Communities included Enterobacter asburiae; Klebsiella oxytoca; Pseudomonas aeruginosa and Citrobacter freundii, among others, including CRE. The addition of simulated IV fluids did not induce Gram-negative bacterial proliferation in the time frame of the experiment. Differences were observed in the fluctuation of Gram-negative levels after flushing between the different sink designs. Gram-negative numbers in vertical-draining sinks decreased immediately after the tap was flushed and subsequently increased between flushes. However, in rear-draining sinks, little fluctuation was observed. Hospital sink waste traps can harbour Gram-negative bacteria resistant to antibiotics. In our experimental conditions, the type of sink was the determining factor in the magnitude of fluctuation in Gram-negative populations while simulated IV fluids had little effect.

scholarly journals Impact of an Antibiotic Stewardship Program on the Incidence of Resistant Escherichia coli: A Quasi-Experimental Study

Antibiotics ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 179
Author(s):  
Elad Ziv-On ◽  
Michael D Friger ◽  
Lisa Saidel-Odes ◽  
Abraham Borer ◽  
Orly Shimoni ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Antibiotic Use ◽  
Defined Daily Dose ◽  
Interrupted Time Series Analysis ◽  
Gram Negative ◽  
E Coli ◽  
Stewardship Program ◽  
Resistance Rates ◽  
The Impact ◽  
Over Time

Infections caused by multidrug-resistant Gram-negative bacteria increase hospitalizations and mortality rates; antibiotic pressure increases resistance rates. We evaluated the impact of the antibiotics stewardship program (ASP) on Escherichia coli resistance rates, evaluating all antibiotic use and patients with positive cultures hospitalized between 2011 and 2018. Data on antibiotics were collected quarterly as the defined daily dose (DDD)/100 days hospitalization. In 2014, an intervention was introduced, targeting the reduction of overall antibiotic use as well as specifically targeting quinolones and other broad-spectrum antibiotics. Using interrupted time series analysis (ITS), we compared the rates and trends of antibiotic use and resistant E. coli. We included 6001 patients, 3182 pre-ASP and 2819 post-ASP. We observed significant changes in absolute numbers as well as in trends for use of DDD/100 days of all antibiotics by 31% from 76 to 52, and by 52% from 10.4 to 4.9 for quinolones. ITS demonstrated that before the ASP intervention, there was a slope pattern for increased E. coli resistance to antibiotics. This slope was reversed following the intervention for quinolones −1.52, aminoglycosides −2.04, and amoxicillin clavulanate (amox/clav) −1.76; the effect of the intervention was observed as early as three months after the intervention and continued to decrease over time until the end of the study, at 48 months. We conclude that the ASP can positively impact the resistance rate of Gram-negative infections over time, regardless of the targeted combination of antibiotics, if the overall use is reduced.

A Newspaper’s Effect on the Strength of Automatic Associations in Memory

2012 ◽  
Vol 24 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Florian Arendt
Keyword(s):  
Treatment Group ◽  
Term Effect ◽  
Control Group ◽  
Implicit Measure ◽  
Short Term ◽  
Short Term Treatment ◽  
Short Term Effect ◽  
Automatic Associations ◽  
Foreign Nationality ◽  
The Impact

A test was done to see if reading a newspaper which consistently overrepresents foreigners as criminals strengthens the automatic association between foreign country and criminal in memory (i.e., implicit cultivation). Further, an investigation was done to find out if reading articles from the same newspaper produces a short-term effect on the same measure and if (1) emotionalization of the newspaper texts, (2) emotional reactions of the reader (indicated by arousal), and (3) attributed text credibility moderate the short-term treatment effect. Eighty-five participants were assigned to one of three experimental conditions. Participants in the control group received short factual crime texts, where the nationality of the offender was not mentioned. Participants in the factual treatment group received the same texts, but the foreign nationality was mentioned. Participants in the emotionalized treatment group received emotionalized articles (i.e., texts which are high in vividness and frequency) covering the same crimes, with the foreign nationality mentioned. Supporting empirical evidence for implicit cultivation and a short-term effect was found. However, only emotionalized articles produced a short-term effect on the strength of the automatic association, indicating that newspaper texts must have a minimum of stimulus intensity to overcome an effect threshold. There were no moderating effects of arousal or credibility pertaining to the impact on the implicit measure. However, credibility moderated the short-term effect on a first-order judgment (i.e., estimated frequency of foreigners of all criminals). This indicates that a newspaper’s effect on the strength of automatic associations is relatively independent from processes of propositional reasoning.

Diatoms in the Amur Bay sediments (Sea of Japan) and the impact of typhoons on their accumulation over the last 2000 years

2019 ◽  
pp. 252-256
Author(s):  
Irina A. Prushkovskaya ◽  
Ira B. Tsoy
Keyword(s):  
Sea Of Japan ◽  
Short Term ◽  
Catastrophic Events ◽  
Bromine Content ◽  
Amur Bay ◽  
The Impact

The study of diatoms in the sediments of the Amur Bay (Sea of Japan), formed over the last 2000 years, showed that the sharp short-term drops in the concentration of diatoms coincide with the minima of bromine content, which can be explained by the influence of typhoons or other catastrophic events leading to floods and used later in paleoreconstructions.

Coming-of-Age Cinema in New Zealand

2017 ◽  
Author(s):  
Alistair Fox
Keyword(s):  
Coming Of Age ◽  
Belief Systems ◽  
Time Frame ◽  
New Wave ◽  
Art Cinema ◽  
Literary Sources ◽  
French New Wave ◽  
Significant Phenomenon ◽  
The Impact ◽  
New Zealanders

This book investigates the coming-of-age genre as a significant phenomenon in New Zealand’s national cinema, tracing its development from the 1970s to the present day. A preliminary chapter identifies the characteristics of the coming-of-age film as a genre, tracing its evolution and the influence of the French New Wave and European Art Cinema, and speculating on the role of the genre in the output of national cinemas. Through case studies of fifteen significant films, including The God Boy, Sleeping Dogs, The Scarecrow, Vigil, Mauri, An Angel at My Table, Heavenly Creatures, Once Were Warriors, Rain, Whale Rider, In My Father’s Den, 50 Ways of Saying Fabulous, Boy, Mahana, and Hunt for the Wilderpeople, subsequent chapters examine thematic preoccupations of filmmakers such as the impact of repressive belief systems and social codes, the experience of cultural dislocation, the expression of a Māori perspective through an indigenous “Fourth Cinema,” bicultural relationships, and issues of sexual identity, arguing that these films provide a unique insight into the cultural formation of New Zealanders. Given that the majority of films are adaptations of literary sources, the book also explores the dialogue each film conducts with the nation’s literature, showing how the time frame of each film is updated in a way that allows these films to be considered as a register of important cultural shifts that have occurred as New Zealanders have sought to discover their emerging national identity.

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