398. Multicenter Evaluation of Outcomes of SARS-CoV-2 Positive Patients Treated at Rural vs Urban Hospitals in the United States

Abstract Background The SARS-CoV-2 pandemic has revealed socioeconomic and healthcare inequities in the US. With approximately 20% of the population living in rural areas, there are limitations to healthcare access due to economic constraints, geographical distances, and provider shortages. There is limited data evaluating outcomes associated with SARS-CoV-2 positive patients treated at rural vs. urban hospitals. The aim of the study was to evaluate characteristics and outcomes of SARS-CoV-2 positive patients treated at rural vs. urban hospitals in the US. Methods This was a multicenter, retrospective cohort analysis of adult (≥ 18 years) hospitalized patients from 241 US acute care facilities with >1 day inpatient admission with a discharge or death between 3/6/20-5/15/21 (BD Insights Research Database [Becton, Dickinson & Company, Franklin Lakes, NJ]), which includes both small and large hospitals in rural and urban areas. SARS-CoV-2 infection was identified by a positive PCR or antigen during or < 7 days prior to hospital admission. Descriptive statistics were completed. P value of ≤0.05 was considered statistically significant. Results Overall, 42 (17.4%) and 199 (82.6%) of hospitals were classified as rural and urban, respectively. A total of 304,073 patients were admitted to a rural hospital with 12,644 (4.2%) SARS-CoV-2 positive. In comparison, a total of 2,844,100 patients were treated at an urban hospital with 132,678 (4.7%) SARS-CoV-2 positive. Patients admitted to rural hospitals were older compared to those treated at an urban hospital (65.2 ± 17.3 vs. 61.5 ± 18.7, P=0.001) (Table 1). Patients treated at an urban facility had significantly higher rates of ICU admission, severe sepsis, and mechanical ventilation. ICU length of stay was significantly longer for patients admitted to an urban hospital compared to a rural hospital (8.1 ± 9.9 vs. 6.1 ±7.2 days, P=0.001) (Table 2). No difference in mortality was observed. Table 1. Characteristics of SARS-CoV-2 positive patients treated at rural vs. urban hospitals. Table 2. Outcomes of SARS-CoV-2 patients treated at rural vs. urban hospitals. *Patients with available data. Conclusion In this large multicenter evaluation of hospitalized patients positive for SARS-CoV-2, there were significant differences in patient characteristics. There was no observed difference in mortality. These findings are important in evaluating the pandemic’s impact on patients in rural and urban healthcare settings. Disclosures Karri A. Bauer, PharmD, Merck & Co., Inc. (Employee, Shareholder) Kalvin Yu, MD, BD (Employee) Vikas Gupta, PharmD, BCPS, Becton, Dickinson and Company (Employee, Shareholder) Laura A. Puzniak, PhD, Merck & Co., Inc. (Employee)

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1485. Trends in Important-Resistant Gram-Negative (GN) and Gram-Positive (GP) Urine Bacterial Pathogens in Hospitalized Patients in the United States: A Multicenter Evaluation from 2013 to 2018

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1349 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S541-S541

Author(s):

Thomas Lodise ◽

Steven P Gelone ◽

Kalvin Yu ◽

Kalpana Gupta ◽

Maureen Early ◽

...

Keyword(s):

The United States ◽

Generation Cephalosporin ◽

Hospitalized Patients ◽

Research Database ◽

Becton Dickinson ◽

Antibiotic Resistant ◽

Carbapenem Resistant ◽

Time Period ◽

Positive Urine ◽

Notable Increase

Abstract Background The US CDC has identified a number of antibiotic-resistant (AR) bacteria as urgent or serious public health threats. This study sought to quantify the prevalence and incidence of extended-spectrum β-lactamase (ESBL) Enterobacteriaceae (ENT), Carbapenem-resistant ENT (CRE), P. aeruginosa (Carb NS-PsA), vancomycin-resistant enterococci (VRE), and methicillin-resistant S. aureus (MRSA) in the urine of adult hospitalized patients. Methods All hospitalized adult patients with a positive urine culture (first urine isolate of a species per 30-day period) were evaluated from over 400 US hospitals (2013–2018; BD Insights Research Database, Becton, Dickinson and Company). The following five groups of AR bacteria were examined: (1) ESBL ENT if ESBL-positive per commercial panels or intermediate/resistant (non-susceptible [NS]) to a third-generation cephalosporin; (2) CRE ENT if NS to imipenem (IPM), meropenem (MEM), doripenem (DOR) or ertapenem; (3) Carb-NS PsA if NS to IPM, MEM or DOR; (4) VRE if resistant to vancomycin; and (5) MRSA as resistant to methicillin/oxacillin. For each AR grouping, % NS and rates of NS per 100 admissions were calculated and trends were examined using Logistic regression and Poisson models. Results Across the 6-year study period, there were 24,558,856 admissions, accounting for 2,285,971 non-duplicate urine isolates; 1,016,642 were ENT, 87,450 were PSA, 203,231 were enterococci, and 41,979 were S. aureus. The % of NS for ESBL, CRE ENT, Carb-NS PsA, VRE, and MRSA were 12%, 0.9%, 13%, 19%, and 55%, respectively. The % of NS for ESBL increased from 2013 to 2018 (P < 0.001) whereas % NS for PsA and % MRSA decreased during the same time period (P < 0.001) (Figure 1). The rates of NS per 100 admissions for ESBL, CRE ENT, Carb-NS PsA, VRE, and MRSA were 0.44, 0.04, 0.05, 0.16, and 0.09, respectively. The annual NS rates per 100 admission trends for ESBL and CRE ENT were increasing (all P < 0.0001) while the trends for Carb-NS PsA, VRE, and MRSA were decreasing (all P < 0.0001). Conclusion While the percent of ESBL, CRE ENT, Carb-NS PsA, VRE, and MRSA have remained relatively constant over the past 6 years, there has been a notable increase in the rates of ESBL and CRE ENT per 100 admissions among adult hospitalized patients with positive urine cultures. Disclosures All authors: No reported disclosures.

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642. Facility Reported vs. CLSI MIC Breakpoint Comparison of Carbapenem Non-susceptible (Carb-NS) Enterobacteriaceae (ENT) from 2016-2019: A Multicenter Evaluation

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.839 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S423-S423

Author(s):

Vikas Gupta ◽

Kalvin Yu ◽

Jason M Pogue ◽

Janet Weeks ◽

Cornelius J Clancy

Keyword(s):

Inhibitory Concentration ◽

The United States ◽

Skin Wound ◽

Research Database ◽

Research Support ◽

Becton Dickinson ◽

Minimal Impact ◽

Systematic Application ◽

The Us ◽

Inpatient Settings

Abstract Background Carbapenem (Carb) minimum inhibitory concentration (MIC) breakpoints were lowered by CLSI in 2010 and recognized by FDA in 2012. Adoption of revised breakpoints is often slow, which may lead to under-reporting of Carb non-susceptibility (NS) by facilities. We compare facility-reported rates of Carb-NS ENT to the CLSI MIC breakpoints for a large nationwide collection of isolates in the United States (US) from 2016-2019. Methods All adults with a positive non-contaminant ENT culture (first isolate of a species per 30-day period from blood, respiratory, urine, skin/wound, intra-abdominal, or other) in ambulatory/inpatient settings from up to 300 US hospitals from 2016-2019 were evaluated (BD Insights Research Database). Facility-reported Carb-NS was defined as: susceptible (S), intermediate (I) or R to ertapenem (ETP), imipenem (IPM), meropenem (MEM) and/or doripenem (DOR) per commercial panels. Where available, MICs were interpreted using CLSI 2010 MIC breakpoints (µg/ml): ≤ 0.5 (S), 1 (I), ≥ 2 (R) for ETP and ≤1 (S), 2 (I), and ≥ 4 (R) for IPM/MEM/DOR. For evaluable ENT isolates we compared susceptibility results as reported by the facility to CLSI MIC breakpoints. Results Overall, 77.4% (937,926/1,211,845) and 90.6% (2,157,785/2,381,824) non-duplicate ENT isolates with facility-reported susceptibility results also had interpretable MIC results for ETP and IPM/MEM/DOR, respectively (Tables). ETP S rates were 99.3% and 99.1% as reported by facilities and using CLSI criteria, respectively. S rates of other Carbs were 98.9% and 98.4% by facility reporting and CLSI criteria, respectively. Systematic application of CLSI breakpoints under-reported EPT-I and –R isolates by 24.2% and 16.4%, respectively, and identification of IPM/MEM/DOR-I and –R isolates by 31.3% and 22.7%, respectively. Conclusion Systematic application of CLSI breakpoints in 2016-19 would have had minimal impact on ENT S rates in the US. However, facility reporting failed to identify 18.8% of ETP I or R and 26.5% of IPM/MEM/DOR I or R isolates. The clinical implications of this observation are unknown. Facilities should know their local epidemiology, decide if under-reporting might be an issue, and assess if there is any impact on their patients. Disclosures Vikas Gupta, PharmD, BCPS, Becton, Dickinson and Company (Employee, Shareholder) Kalvin Yu, MD, BD (Employee) Jason M Pogue, PharmD, BCPS, BCIDP, Merck (Consultant)QPex (Consultant)Shionogi (Consultant)Utility Therapeutics (Consultant)VenatoRX (Consultant) Janet Weeks, PhD, Becton, Dickinson and Company (Employee) Cornelius J. Clancy, MD, Merck (Grant/Research Support)

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221. Evaluation of Rates of Culture Positive Blood Stream Pathogens Prior to and During the SARS-CoV-2 Pandemic: A Multicenter Evaluation

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.423 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S218-S219

Author(s):

Laura A Puzniak ◽

Karri A Bauer ◽

Kalvin Yu ◽

Pamela Moise ◽

Vikas Gupta

Keyword(s):

Viral Infections ◽

Cohort Analysis ◽

Blood Stream ◽

Hospitalized Patients ◽

Research Database ◽

Becton Dickinson ◽

Candida Spp ◽

Blood Source ◽

Acute Care Facilities ◽

Culture Positive

Abstract Background Bacterial co-infections or super-infections are well-characterized complications of viral infections, further increasing morbidity and mortality of global viral pandemics. We evaluated trends in the incidence of culture positive gram-negative (GN), gram-positive (GP), and fungal/yeast pathogens from a blood source in hospitalized patients at US hospitals before and during the SARS-CoV-2 pandemic. Table: Incidence and rate of blood pathogens in the pre and post SARS-CoV-2 period. Gray indicates significantly lower rate compared to pre-pandemic time period, black indicates significantly higher rates compared to pre-pandemic. Methods: This was a multi-center, retrospective cohort analysis of all hospitalized patients from 267 US acute care facilities with >1-day inpatient admission between 7/1/19-5/19/21 (BD Insights Research Database [Becton, Dickinson and Company, Franklin Lakes, NJ]). SARS-CoV-2 infection was identified by a positive PCR during or ≤7 days prior to hospitalization. All admissions with a non-contaminant culture positive GN, GP, and fungal/yeast pathogen from a blood source were evaluated prior to and during the SARS-CoV-2 pandemic as rates per 1,000 admissions (p< .05 for significance). Results There were 2,001,793 admissions in the pre-SARS-CoV-2 period (7/2019-2/2020) and 2,875,219 admissions during the SARS-CoV-2 pandemic. Incidence of GN/GP blood stream pathogens was significantly higher prior to the SARS-CoV-2 pandemic than during the pandemic. Higher rates of blood stream pathogens occurred in those who were tested for SARS-CoV-2, but all non-tested patients had significantly lower rates than pre-pandemic. Rates of Candida spp., Enterococcus spp., Serratia marcescens, and Enterobacter cloacae were higher in SARS-CoV-2 positive patients compared to pre-pandemic patients. Compared to the prior pandemic period, the incidence of B. fragilis, Streptococcus, Enterococcus and Candida were higher among those tested for SARS-CoV-2 but were negative. Conclusion In general, rates of positive blood cultures for bacterial pathogens were either lower or similar during the SARS-CoV-2 period compared to the pre-SARS-CoV-2 pandemic period. The patients that were tested for SARS-CoV-2 but were positive who had higher rates of infection than prior may indicate the similarity in viral and bacterial clinical presentation. Further evaluation of higher rates of Enterococcus and Candida in the pandemic period are warranted. Disclosures Laura A. Puzniak, PhD, Merck & Co., Inc. (Employee) Karri A. Bauer, PharmD, Merck & Co., Inc. (Employee, Shareholder) Kalvin Yu, MD, BD (Employee) Pamela Moise, PharmD, Merck (Employee) Vikas Gupta, PharmD, BCPS, Becton, Dickinson and Company (Employee, Shareholder)

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515. Evolution of Treatment Patterns for Patients Hospitalized with COVID-19 in the United States

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.714 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S359-S360

Author(s):

Kelly Zalocusky ◽

Shemra Rizzo ◽

Devika Chawla ◽

Yifeng Chia ◽

Tripthi Kamath ◽

...

Keyword(s):

Treatment Guidelines ◽

The United States ◽

Hospitalized Patients ◽

Invasive Ventilation ◽

Data Set ◽

Diagnostic Codes ◽

Dramatic Decline ◽

The Us ◽

Optimal Patient Care ◽

Procedure Codes

Abstract Background COVID-19 remains a threat to public health, with over 30 million cases in the US alone. As understanding of optimal patient care has improved, treatment guidelines have continued to evolve. This study characterized real-world trends in treatment for US patients hospitalized with COVID-19, stratified by whether patients required invasive ventilation. Methods US patients diagnosed and hospitalized with COVID-19 between March 23 and December 31, 2020, in the Optum de-identified COVID-19 electronic health record (EHR) data set were identified. Both drug and procedure codes were used to ascertain medications, and both procedure and diagnostic codes were used to detect invasive ventilation during hospitalization. Medication trends were estimated by computing proportions of hospitalized patients receiving each drug weekly during the study period. Results In this cohort of 71,366 hospitalized patients, the largest observed change in care was related to chloroquine/hydroxychloroquine (HCQ) (Figure). HCQ usage peaked at 87% of patients receiving invasive ventilation (54% without ventilation) in the first week of this study (March 23-29), but declined to < 5% of patients, regardless of ventilation status, by the end of May. In contrast, dexamethasone usage was 10% at baseline in patients receiving ventilation (1% without ventilation) and increased to a steady state of >85% of patients receiving ventilation ( >50% without ventilation) by the end of June. Similarly, remdesivir usage increased sharply from a baseline of 2% of patients and continued to rise to a peak of 79% of patients receiving invasive ventilation (44% without ventilation) in November before declining. Conclusion Meaningful shifts in treatments for US patients hospitalized with COVID-19 were observed from March through December 2020. A dramatic decline was observed for HCQ use, likely owing to safety concerns, while usage of dexamethasone and remdesivir increased as evidence of their efficacy mounted. Across medications, usage was substantially more prevalent among patients requiring invasive ventilation compared with patients with less severe cases. Disclosures Kelly Zalocusky, PhD, F. Hoffmann-La Roche Ltd. (Shareholder)Genentech, Inc. (Employee) Shemra Rizzo, PhD, F. Hoffmann-La Roche Ltd. (Shareholder)Genentech, Inc. (Employee) Devika Chawla, PhD MSPH, F. Hoffmann-La Roche Ltd. (Shareholder)Genentech, Inc. (Employee) Yifeng Chia, PhD, F. Hoffmann-La Roche Ltd (Shareholder)Genentech, Inc. (Employee) Tripthi Kamath, PhD, F. Hoffmann-La Roche Ltd (Shareholder)Genentech, Inc. (Employee) Larry Tsai, MD, F. Hoffmann-La Roche Ltd (Shareholder)Genentech, Inc. (Employee)

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786. Facility Reported vs. CLSI MIC Breakpoint Comparison of Carbapenem Non-susceptible (Carb-NS) Pseudomonas aeruginosa (PSA) From 2016-2019: A Multicenter Evaluation

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.983 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S490-S490

Author(s):

Vikas Gupta ◽

Kalvin Yu ◽

Jason M Pogue ◽

Janet Weeks ◽

Cornelius J Clancy

Keyword(s):

Pseudomonas Aeruginosa ◽

Skin Wound ◽

Clinical Implications ◽

Research Database ◽

Research Support ◽

Becton Dickinson ◽

Minimal Impact ◽

Commercial Test ◽

The Us ◽

Inpatient Settings

Abstract Background CLSI lowered Pseudomonas aeruginosa (PSA) Carbapenem (Carb) interpretive breakpoint minimum inhibitory concentrations (MICs) in 2012. It often takes several years for commercial test manufacturers and microbiology labs to incorporate revised breakpoints. We compare facility-reported rates of Carb-NS PSA to the 2012 CLSI MIC breakpoints, using a large nationwide database for isolates tested in 2016-2020 at United States (US) facilities. Table. Imipenem (IPM)/meropenem (MEM)/doripenem (DOR) interpretation (evaluable isolates) results for PSA. Methods All adults with a positive non-contaminant PSA culture (first isolate per 30-day period from blood, respiratory, urine, skin/wound, intra-abdominal, or other) in ambulatory and inpatient settings from 298 US hospitals from Q1 2016-Q4 2020 were evaluated (BD Insights Research Database, Becton, Dickinson & Company). Facility-reported Carb-non susceptible (NS) was defined as lab information system feed designations of susceptible (S), intermediate (I) or resistant (R) to imipenem (IPM), meropenem (MEM) and/or doripenem (DOR) per commercial panels. Where available, MICs were interpreted using CLSI 2012 Carb breakpoints (µg/ml) of ≤2 (S), 4 (I), ≥8 (R) for IPM/MEM/DOR. For evaluable PSA isolates we compared susceptibility results as reported by the facility to those using CLSI MIC breakpoints. Results Overall, 86.9% (255,844/294,426) of non-duplicate PSA isolates with facility-reported IPM/MEM/DOR susceptibility interpretations also had interpretable MIC results. S rates were 84.9% and 83.3% as reported by facilities and determined by CLSI criteria, respectively (Table). Facilities under-reported Carb-NS by 9.8%, using CLSI criteria as the standard (10.4% and 7.7% of R and I isolates, respectively, were missed by facility reporting). Conclusion Systematic application of CLSI breakpoints in 2016-20 would have had minimal impact on PSA S rates in the US. However, facility reporting failed to identify ~10% of Carb-NS isolates. The clinical implications of this observation are unknown. Facilities should know their local epidemiology, decide if under-reporting might be an issue, and assess if there is any impact on their patients. Disclosures Vikas Gupta, PharmD, BCPS, Becton, Dickinson and Company (Employee, Shareholder) Kalvin Yu, MD, BD (Employee) Jason M Pogue, PharmD, BCPS, BCIDP, Merck (Consultant)QPex (Consultant)Shionogi (Consultant)Utility Therapeutics (Consultant)VenatoRX (Consultant) Janet Weeks, PhD, Becton, Dickinson and Company (Employee) Cornelius J. Clancy, MD, Merck (Grant/Research Support)

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Higher Hospitalization and Mortality Rates Among SARS-CoV-2 infected Persons in Rural America

10.1101/2021.10.05.21264543 ◽

2021 ◽

Author(s):

Alfred Jerrod Anzalone ◽

Ronald Horswell ◽

Brian Hendricks ◽

San Chu ◽

William Hillegass ◽

...

Keyword(s):

Rural Communities ◽

Urban Areas ◽

The United States ◽

Hospitalized Patients ◽

Rural America ◽

Inpatient Mortality ◽

Rural And Urban Areas ◽

Rural And Urban ◽

All Cause Mortality ◽

Hospital Systems

IMPORTANCE: Rural communities are among the most underserved and resource-scarce populations in the United States (US), yet there are limited data on COVID-19 mortality in rural America. Furthermore, rural data are rarely centralized, precluding comparability across urban and rural regions. OBJECTIVE: The purpose of this study is to assess hospitalization rates and all-cause inpatient mortality among persons with definitive COVID-19 diagnoses residing in rural and urban areas. DESIGN, SETTINGS, AND PARTICIPANTS: This retrospective cohort study from the National COVID Cohort Collaborative (N3C) examines a cohort of 573,018 patients from 27 US hospital systems presenting with SARS-CoV-2 infection between January 2020 and March 2021, of whom 117,897 were hospitalized. A sample of 450,725 hospitalized persons without COVID-19 diagnoses was identified for comparison. EXPOSURES: ZIP Codes provided by source hospital systems were classified by urban-rural gradient through a crosswalk to the US Department of Agriculture Rural-Urban Commuting Area Codes. MAIN OUTCOMES AND MEASURES: Primary outcomes were hospitalization and all-cause mortality among hospitalized patients. Kaplan-Meier analysis and mixed effects logistic regression were used to estimate 30-day survival in hospitalized patients and associations between rurality, hospitalization, and inpatient mortality while controlling for major risk factors. RESULTS: Rural patients were more likely to be older, white, have higher body mass index, and diagnosed with SARS-CoV-2 later in the pandemic compared with their urban counterparts. Rural compared with urban inhabitants had higher rates of hospitalization (23% vs. 19%) and all-cause mortality among hospitalized patients (16% vs. 11%). After adjustment for demographic and baseline differences, rural residents (both urban adjacent and non-adjacent) with COVID-19 were more likely to be hospitalized (Adjusted Odds Ratio (AOR) 1.41, 95% Confidence Interval (CI), 1.37-1.45 and AOR 1.42, CI 1.35-1.50) and to die or be transferred to hospice (AOR 1.62, CI 1.30-1.49 and 1.38, CI 1.30-1.49), respectively. Similar differences in mortality were noted for hospitalized patients without SARS-CoV-2 infection. CONCLUSIONS: Hospitalization and inpatient mortality are higher among rural compared with urban persons with COVID-19, even after adjusting for several factors, including age and comorbidities. Further research is needed to understand the factors that drive health disparities in rural populations.

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The Shortage of Trauma Surgeons in the US

The American Surgeon ◽

10.1177/0003134820988808 ◽

2021 ◽

pp. 000313482098880

Author(s):

Adel Elkbuli ◽

Mason Sutherland ◽

Carol Sanchez ◽

Huazhi Liu ◽

Darwin Ang ◽

...

Keyword(s):

Trauma Patient ◽

Cohort Analysis ◽

State Level ◽

Educational Interventions ◽

The United States ◽

Census Bureau ◽

The Us ◽

Control And Prevention ◽

Trauma Surgeons ◽

Us Census

Background As the United States (US) population increases, the demand for more trauma surgeons (TSs) will increase. There are no recent studies comparing the TS density temporally and geographically. We aim to evaluate the density and distribution of TSs by state and region and its impact on trauma patient mortality. Methods A retrospective cohort analysis of the American Medical Association Physician Masterfile (PM), 2016 US Census Bureau, and Centers for Disease Control and Prevention (CDC’s) Web-based Injury Statistics Query and Reporting System (WISQARS) to determine TS density. TS density was calculated by dividing the number of TSs per 1 000 000 population at the state level, and divided by 500 admissions at the regional level. Trauma-related mortality by state was obtained through the CDC’s WISQARS database, which allowed us to estimate trauma mortality per 100 000 population. Results From 2007 to 2014, the net increase of TS was 3160 but only a net increase of 124 TSs from 2014 to 2020. Overall, the US has 12.58 TSs/1 000 000 population. TS density plateaued from 2014 to 2020. 33% of states have a TS density of 6-10/1 000 000 population, 43% have a density of 10-15, 12% have 15-20, and 12% have a density >20. The Northeast has the highest density of TSs per region (2.95/500 admissions), while the Midwest had the lowest (1.93/500 admissions). Conclusion The density of TSs in the US varies geographically, has plateaued nationally, and has implications on trauma patient mortality. Future studies should further investigate causes of the TS shortage and implement institutional and educational interventions to properly distribute TSs across the US and reduce geographic disparities.

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Development of a 51-hospital Chicagoland regional antibiogram and comparison to local hospital and national surveillance data

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.334 ◽

2020 ◽

Vol 41 (12) ◽

pp. 1409-1418

Author(s):

David A. Butler ◽

Mark Biagi ◽

Vikas Gupta ◽

Sarah Wieczorkiewicz ◽

Lisa Young ◽

...

Keyword(s):

The United States ◽

Surveillance Data ◽

Metropolitan Statistical Area ◽

Research Database ◽

National Surveillance ◽

Local Institutions ◽

Becton Dickinson ◽

Gram Positive ◽

Gram Negative ◽

Susceptibility Data

AbstractObjective:To develop a regional antibiogram within the Chicagoland metropolitan area and to compare regional susceptibilities against individual hospitals within the area and national surveillance data.Design:Multicenter retrospective analysis of antimicrobial susceptibility data from 2017 and comparison to local institutions and national surveillance data.Setting and participants:The analysis included 51 hospitals from the Chicago–Naperville–Elgin Metropolitan Statistical Area within the state of Illinois. Overall, 18 individual collaborator hospitals provided antibiograms for analysis, and data from 33 hospitals were provided in aggregate by the Becton Dickinson Insights Research Database.Methods:All available antibiogram data from calendar year 2017 were combined to generate the regional antibiogram. The final Chicagoland antibiogram was then compared internally to collaborators and externally to national surveillance data to assess its applicability and utility.Results:In total, 167,394 gram-positive, gram-negative, fungal, and mycobacterial isolates were collated to create a composite regional antibiogram. The regional data represented the local institutions well, with 96% of the collaborating institutions falling within ±2 standard deviations of the regional mean. The regional antibiogram was able to include 4–5-fold more gram-positive and -negative species with ≥30 isolates than the median reported by local institutions. Against national surveillance data, 18.6% of assessed pathogen–antibiotic combinations crossed prespecified clinical thresholds for disparity in susceptibility rates, with notable trends for resistant gram-positive and gram-negative bacteria.Conclusions:Developing an accurate, reliable regional antibiogram is feasible, even in one of the largest metropolitan areas in the United States. The biogram is useful in assessing susceptibilities to less commonly encountered organisms and providing clinicians a more accurate representation of local antimicrobial resistance rates compared to national surveillance databases.

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Prostate Cancer Incidence 5 Years After US Preventive Services Task Force Recommendations Against Screening

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djaa068 ◽

2020 ◽

Vol 113 (1) ◽

pp. 64-71 ◽

Cited By ~ 10

Author(s):

Ahmedin Jemal ◽

MaryBeth B Culp ◽

Jiemin Ma ◽

Farhad Islami ◽

Stacey A Fedewa

Keyword(s):

Prostate Cancer ◽

United States ◽

Cancer Incidence ◽

Task Force ◽

Preventive Services ◽

The United States ◽

Research Database ◽

Prostate Cancer Incidence ◽

Stage Disease ◽

The Us

Abstract Background Previous studies reported that prostate cancer incidence rates in the United States declined for local-stage disease and increased for regional- and distant-stage disease following the US Preventive Services Task Force recommendations against prostate-specific antigen-based screening for men aged 75 years and older in 2008 and for all men in 2012. It is unknown, however, whether these patterns persisted through 2016. Methods Based on the US Cancer Statistics Public Use Research Database, we examined temporal trends in invasive prostate cancer incidence from 2005 to 2016 in men aged 50 years and older stratified by stage (local, regional, and distant), age group (50-74 years and 75 years and older), and race and ethnicity (all races and ethnicities, non-Hispanic Whites, and non-Hispanic Blacks) with joinpoint regression models to estimate annual percent changes. Tests of statistical significance are 2-sided (P < .05). Results For all races and ethnicities combined, incidence for local-stage disease declined beginning in 2007 in men aged 50-74 years and 75 years and older, although the decline stabilized during 2013-2016 in men aged 75 years and older. Incidence decreased by 6.4% (95% CI = 4.9%-9% to 7.9%) per year from 2007 to 2016 in men aged 50-74 years and by 10.7% (95% CI = 6.2% to 15.0%) per year from 2007 to 2013 in men aged 75 years and older. In contrast, incidence for regional- and distant-stage disease increased in both age groups during the study period. For example, distant-stage incidence in men aged 75 years and older increased by 5.2% (95% CI = 4.2% to 6.1%) per year from 2010 to 2016. Conclusions Regional- and distant-stage prostate cancer incidence continue to increase in the United States in men aged 50 years and older, and future studies are needed to identify reasons for the rising trends.

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1440. Prevalence and Regional Variation of in ESBLs and CRE Enterobacteriaceae (ENT) among Adult, Hospitalized Patients with ENT on a Urine Culture: A Multicenter Evaluation

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1304 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S525-S526

Author(s):

Thomas Lodise ◽

Vikas Gupta ◽

Kalvin Yu ◽

Kalpana Gupta ◽

Maureen Early ◽

...

Keyword(s):

Urine Culture ◽

Generation Cephalosporin ◽

Geographic Region ◽

Hospitalized Patients ◽

Resistant Bacteria ◽

Research Database ◽

Geographic Variations ◽

Becton Dickinson ◽

Empiric Antibiotic ◽

True Frequency

Abstract Background Despite increased public health awareness of ESBLs and CRE, limited data exist regarding the true frequency of these resistant bacteria in urine cultures collected from adult patients in US hospitals. This study sought to quantify the prevalence and rates of ESBLs and CRE from urine cultures in adult hospitalized patients with ENT. Methods All hospitalized adults with a urine culture (first urine isolate of a species per 30-day period) from 377 hospitals in 2018 were evaluated (BD Insights Research Database, Becton, Dickinson & Company). ESBL was defined as an ENT that was ESBL-positive per commercial panels or intermediate or resistant (non-susceptible, [NS]) to a third-generation cephalosporin; CRE was defined as an ENT that was NS to imipenem, meropenem, doripenem or ertapenem. Urine isolates were classified as community-onset (CO: < 3 days of an inpatient admission and no previous admission within 14 days) or hospital-onset (HO: ≥ 3 days post-admission or within 14 days of discharge) period. Prevalence and rates per 100 admissions were calculated overall, by onset location (CO vs. HO), and by US Department of Health and Human Services (HHS) geographic region. Results In 2018, there were 193,476 non-duplicate ENT urine isolates across 4,623,333 admissions; 63.6% were E. coli (EC), 19.5% were K. pneumoniae/oxytoca (KPO), and 8.7% were P. mirabilis (PM). Overall, 12.6% were ESBL and 0.9% were CRE. Rate per 100 admissions was 0.484 and 0.037 for ESBL and CRE, respectively. Among CO, 11.8% were ESBLs and ESBL rates per 100 admissions were 0.358; 0.7% were CRE and CRE rates per 100 admissions was 0.024. Among HO, 15.7% were ESBLs and ESBL rates per 100 admissions was 0.126; 1.5% were CRE and CRE rates per 100 admissions was 0.013. Regional differences in both ESBL and CRE ENT were noted (table). Conclusion The prevalence of ESBLs/CRE among adult hospitalized patients with ENT in a urine culture was 13% and 1%, respectively. The % ESBL/CRE was higher among patients HO urine isolates whereas ESBL/CRE rates per 100 admissions were higher among patients with CO urine isolates. Considerable geographic variations were observed. Region and site of onset differences in ESBL/CRE epidemiology should be considered when making empiric antibiotic treatment decisions. Disclosures All authors: No reported disclosures.

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