457. Cutibacterium (Propionibacterium) acnes Infection Rate and Optimization of Surgical Culture Duration

Abstract Background Cutibacterium acnes is part of the normal skin and gastrointestinal tract flora that is increasingly recognized as a causative organism of surgical infections. Distinguishing between infection and contamination is difficult. The standard culture duration for C. acnes has not been determined. As a slow-growing organism, a prolonged incubation of 10–14 days is adopted in many laboratories. Ideally, only samples with high pretest probability for infection should be worked up this way, otherwise resources are overutilized with likely no benefits and potential harms to patients. We conduct a study to assess the optimal incubation duration for C. acnes. Methods We retrospectively reviewed microbiologic and clinical data of patients who underwent surgical procedures at the Veterans Affairs (VA) Hospital and the University of Utah Hospital in Salt Lake City, Utah, between 2015 and 2018 for which prolonged incubation of surgical samples was requested. Samples that grew C. acnes were divided into three groups (infection, contaminant, indeterminate) based on the quantity of growth and the number of positive samples (Figure 1). Samples in the “indeterminate” group were re-classified into the other two groups based on clinical criteria (Figure 2). Time to culture positivity (TTP) was calculated for each group. Results 741 patients contributed to a total of 909 surgical cases. There were 2,401 samples collected resulting in 4,408 bacterial cultures. C. acnes grew in 131 cases (14.41%). Fifty-five cases (44%) fulfilled the criteria for true infections and 70 cases (56%) were contaminants. 6 cases were lost to follow-up. The mean TTP of the infection and the contamination groups were 5.60 + 0.76 days and 8.67 + 0.81 days, respectively. The TTP of C. acnes from specimens of true surgical infections was significantly shorter than that of contaminants by the mean of 3.07 days (95% CI: -4.22 to -1.92); P < 0.001. Conclusion Using our microbiological and clinical criteria to differentiate infections and contaminations, this study provides evidence that surgical sample cultures should be held no longer than 7 days to limit the effect of contaminated C. acnes on cultures and reduce unnecessary antimicrobial use. Disclosures All authors: No reported disclosures.

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The Wake-Effect—Emergency Vehicle-Related Collisions

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00037791 ◽

1997 ◽

Vol 12 (4) ◽

pp. 41-44 ◽

Cited By ~ 39

Author(s):

Jeff J. Clawson ◽

Robert L. Martin ◽

Geoff A. Cady ◽

Ronald F. Maio

Keyword(s):

Salt Lake ◽

Salt Lake City ◽

Fire Department ◽

Geographic Area ◽

Emergency Vehicle ◽

Survey Analysis ◽

Wake Effect ◽

Mean Values ◽

Emergency Medical ◽

The Mean

AbstractIntroduction:Emergency medical vehicle collisions (EMVCs) occurring during initia response and with patient transport have been a long-standing problem for emergency medical services (EMS) systems. Experience suggests “wake-effect” collision occur as a result of an EMS vehicle's transit, but do not involve the emergency medical vehicle (EMV). Substantiating the existence and magnitude of wake-effect collisions may have major implications regarding the manner of EMV response.Hypothesis:Paramedics will report that wake-effect collisions do occur and that the occur more frequently than do EMVCs.Methods:Design: Survey analysis. Participants: Thirty paramedics employed by the Salt Lake City (Utah) Fire Department and 45 paramedics employed by Salt Lake County Fire Department. Geographic Area: Service area has population of 650,000 and is urban, suburban, and rural. Measurements: The survey consisted of three openended questions concerning years on the job, EMVCs, and wake-effect collisions. Analysis: The mean value for the number of EMVCs and wake-effect EMVCs, along with the 0.95 confidence intervals (0.95 CI) were determined.Results:Seventy-three surveys were analyzed. Sixty EMVCs and 255 wake-effect collisions were reported. Overall, the mea value for the number EMVCs per respondent was 0.82 (0.60–1.05) and for wake-effect collisions 3.49 (2.42–4.55). The mean values for EMVC's for each service were 0.86 (0.50–1.38); 0.80 (0.50–11.0). For wake-effect collisions the mean values were 4.59 (2.83–6.35); and 2.76 (1.46–4.06) respectively.Conclusion:This study suggests that the wake-effect collision is real and may occur with greater frequency than do EMVCs. Significant limitations of this study are recall bias and misclassiftcation bias. Future studies are needed to define more precisely wake-effect collision prevalence and the resulting “cost” in regards to injury and vehicle/property damage.

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BioFire Film Array Blood Culture Identification Panel for Rapid Detection of Pathogens from Sterile Sites - A Diagnostic Accuracy Study

The Open Infectious Diseases Journal ◽

10.2174/1874279301810010015 ◽

2018 ◽

Vol 10 (1) ◽

pp. 15-22

Author(s):

Ailbhe Comyn ◽

Aoife Ronayne ◽

Maryke J. Nielsen ◽

Jennifer Cleary ◽

Robert Cunney ◽

...

Keyword(s):

Blood Culture ◽

Diagnostic Accuracy ◽

Salt Lake ◽

Salt Lake City ◽

Causative Organism ◽

Diagnostic Accuracy Study ◽

Tertiary Referral Hospital ◽

Accuracy Study ◽

Lake City ◽

Culture Identification

Background: Rapid diagnosis of the causative organism of invasive infections is critical to the improved care of patients. A new platform, FilmArray (BioFire Diagnostics, LLC, Salt Lake City, UT) allows for rapid PCR to be performed in less than two hours on positive blood cultures Objective: The aim was to perform a retrospective diagnostic accuracy study in a paediatric tertiary referral hospital comparing results from culture, our gold standard, against those obtained when the samples were tested directly using the FilmArray Blood Culture Identification (BCID) Panel (BioFire Diagnostics, LLC, Salt Lake City, UT). Method: Samples from sterile site infections were tested using traditional culture based methods as well as PCR testing, and these results were then compared to testing which was done directly on the FilmArray BC-ID panel. Results: Ninety-four samples were tested in total and concordant results were observed in 71 samples (76%). Correlation between detection of pathogens such as Staphylococcus aureus and Streptococcus pyogenes by PCR and culture result was high (94% and 88% respectively). Discordant results could be explained by the cultured organism not having a target on the panel (n=8) or PCR detection of potentially non-viable bacteria in the sample (n=8); the remaining samples (n=9) were negative by PCR despite culturing an organism with a target present on the panel for that organism. We have demonstrated an overall correlation of 76% and that in some instances the PCR detected non-viable yet clinically significant bacteria. Conclusion: Use of the FilmArray BCID panel directly for samples from sterile sites should be considered when there is a high index of suspicion of a single-organism infection at that site prior to sampling.

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Use of Salt Lake City URBAN 2000 Field Data to Evaluate the Urban Hazard Prediction Assessment Capability (HPAC) Dispersion Model

Journal of Applied Meteorology ◽

10.1175/jam2205.1 ◽

2005 ◽

Vol 44 (4) ◽

pp. 485-501 ◽

Cited By ~ 20

Author(s):

Joseph C. Chang ◽

Steven R. Hanna ◽

Zafer Boybeyi ◽

Pasquale Franzese

Keyword(s):

Urban Areas ◽

Salt Lake ◽

Dispersion Model ◽

Salt Lake City ◽

Model Configuration ◽

Meteorological Input ◽

The Mean ◽

Lake City ◽

Urban Hazard ◽

Random Scatter

Abstract After the terrorist incidents on 11 September 2001, there is a greatly heightened concern about the potential impacts of acts of terrorism involving the atmospheric release of chemical, biological, radiological, and nuclear (CBRN) materials in urban areas. In response to the need for an urban CBRN model, the Urban Hazard Prediction Assessment Capability (Urban HPAC) transport and dispersion model has been developed. Because HPAC is widely used by the Department of Defense community for planning, training, and operational and tactical purposes, it is of great importance that the new model be adequately evaluated with urban datasets to demonstrate its accuracy. This paper describes evaluations of Urban HPAC using the “URBAN 2000” urban tracer and meteorological field experiment data from Salt Lake City, Utah. Four Urban HPAC model configuration options and five plausible meteorological input data options—ranging from data-sparse to data-rich scenarios—were considered in the study, thus leading to a total of 20 possible model combinations. For the maximum concentrations along each sampling arc for each intensive operating period (IOP), the 20 Urban HPAC model combinations gave consistent mean overpredictions of about 50%, with a range over the 20 model combinations from no overprediction to a factor-of-4 overprediction in the mean. The median of the random scatter for the 20 model combinations was about a factor of 3 of the mean, with a range over the 20 model combinations between a factor of about 2 and 9. These performance measures satisfy previously established acceptance criteria for dispersion models.

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Flow diversion of tandem cerebral aneurysms: a multi-institutional retrospective study

Neurosurgical FOCUS ◽

10.3171/2017.2.focus1731 ◽

2017 ◽

Vol 42 (6) ◽

pp. E10 ◽

Cited By ~ 4

Author(s):

Al-Wala Awad ◽

Karam Moon ◽

Nam Yoon ◽

Marcus D. Mazur ◽

M. Yashar S. Kalani ◽

...

Keyword(s):

Salt Lake ◽

Demographic Data ◽

Salt Lake City ◽

Cerebral Aneurysms ◽

Flow Diversion ◽

Single Session ◽

Anterior Circulation ◽

The Mean ◽

Lake City

OBJECTIVEFlow diversion has proven to be an efficacious means of treating cerebral aneurysms that are refractory to other therapeutic means. Patients with tandem aneurysms treated with flow diversion have been included in larger, previously reported series; however, there are no dedicated reports on using this technique during a single session to treat this unique subset of patients. Therefore, the authors analyzed the outcomes of patients who had undergone single-session flow diversion for the treatment of tandem aneurysms.METHODSThe authors conducted a retrospective review of flow diversion with the Pipeline embolization device (PED) for the treatment of tandem aneurysms in a single session at 2 participating medical centers: University of Utah, Salt Lake City, Utah, and Barrow Neurological Institute, Phoenix, Arizona. Patient demographic data, aneurysm characteristics, treatment strategy and results, complications, and follow-up data were collected from the medical record and analyzed.RESULTSBetween January 2011 and December 2015, 17 patients (12 female, 5 male) with a total of 38 aneurysms (mean size 4.7 ± 2.7 mm, mean ± SD) were treated. Sixteen patients had aneurysms in the anterior circulation, and 1 patient had tandem aneurysms in the posterior circulation. Twelve patients underwent only placement of a PED, whereas 5 underwent adjunctive coil embolization of at least 1 aneurysm. One PED was used in each of 9 patients, and 2 PEDs were required in each of 8 patients. There were 2 intraprocedural complications; however, in both instances, the patients were asymptomatic at the last follow-up. The follow-up imaging studies were available for 15 patients at a mean of 7 months after treatment (216 days, range 0–540 days). The mean initial Raymond score after treatment was 2.7 ± 0.7, and the mean final score was 1.3 ± 0.7.CONCLUSIONSIn this series, the use of flow diversion for the treatment of tandem cerebral aneurysms had an acceptable safety profile, indicating that it should be considered as an effective therapy for this complicated subset of patients. Further prospective studies must be performed before more definitive conclusions can be made.

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