110. MRSA nasal swab as a stewardship tool to guide IV Vancomycin in diabetic foot infections

Background The Infectious Disease Society of America (IDSA) guidelines suggest empiric Methicillin-Resistant Staphylococcus Aureus (MRSA) coverage for Diabetic Foot Infection (DFI) with a history of MRSA infection, if local prevalence is high, or if the infection is severe. However, data suggests that there is overutilization of vancomycin in this population and this medication is associated with toxicity. MRSA nasal screen has a high negative predictive value (NPV) for ruling out MRSA in pneumonia and other sites. We performed a medication utilization evaluation (MUE) for Vancomycin IV in DFI patients who had an MRSA nares screen to determine our own NPV of this test and feasibility to use it as an antibiotic stewardship program (ASP) tool to guide vancomycin use in this population. Methods We retrospectively reviewed 224 patients from January 2015 to January 2020 who had a diagnosis of DFI and an MRSA nasal screen. 139 patients had cultures done. For the NPV, we excluded patients who had any MRSA positive culture or screen up to a year from admission (Figure 1). Figure 1. Flowchart from our medication utilization evaluation showing patient’s distribution by MRSA-screen result Results We found 148 (66%) patients with DFI who had received IV vancomycin empirically during the admission and 196 of them were MRSA-nares negative (Figure 2). The average days of therapy (DOT) in the MRSA-nares negative patients was 5.2 days vs 4.8 in the MRSA-nares positive patients. Out of the 139 patients with a negative MRSA nasal swab, 124 had no MRSA in cultures, yielding an NPV of 89%. If we considered only the deep cultures, the NPV increased to 90%. Figure 2. Number of patients who received IV vancomycin grouped by MRSA-screen result Conclusion We identified overutilization of IV vancomycin in patients with a diagnosis of DFI in our institution. Also, our NPV of the MRSA-nasal screening to rule out MRSA infection in DFI was high at 89% similar to previous studies. Based on these findings, we plan to implement a local ASP protocol (Figure 3) using MRSA nasal swab screen to decrease the empiric use of vancomycin. The results of these efforts will be analyzed and published in future iterations with the hopes to share this knowledge to reduce the use of IV vancomycin in this population in other centers. Figure 3. Protocol draft to be used as an ASP tool to guide IV vancomycin de-escalation based on MRSA-nasal screen for DFI patients Disclosures All Authors: No reported disclosures

Misinterpretation of Hereditary Breast Cancer Risk and Its Association with Information Sharing Motives among Women at Low Likelihood of Carrying a BRCA1/2 Mutation

<b><i>Purpose:</i></b> In this brief report, we ask whether women’s interpretation of breast cancer risk based on their low likelihood of carrying a <i>BRCA1/2</i> mutation is associated with their information-sharing behavior, and whether misinterpretation is associated with motives for sharing the result. <b><i>Methods:</i></b> Women in mammography clinics who completed a brief family history assessment and deemed to be at low likelihood of carrying a <i>BRCA1/2</i> mutation were asked to complete a 1-time online survey between June 2016 and January 2017. <b><i>Results:</i></b> One-third (44/148) of women shared their family history screen result with someone in their social network. Result information was shared largely with a first-degree female relative to express feelings of relief (77%, 33/43). There were no differences in likelihood of sharing based on breast cancer risk interpretation. However, women who misinterpreted the implications of the result for general breast cancer risk reported more motives to share the result with their social network than those who accurately interpreted their breast cancer risk. <b><i>Conclusions:</i></b> As family history-based screening for hereditary breast cancer is broadly implemented, the communication needs of the majority of women who will be unlikely of carrying a <i>BRCA1/2</i> mutation must be considered. The motives of women who misinterpreted the implications of this result for breast cancer risk suggest the possibility that miscommunication could be spread to the broader family network.

Impact of Positive Vancomycin-Resistant Enterococcus (VRE) Screen Result on Appropriateness of Definitive Antibiotic Therapy

Background: Vancomycin-resistant Enterococcus (VRE) screening has been utilized to identify colonized patients to prevent transmission. However, little is known about the utility of screening to guide antibiotic therapy. We assessed the appropriateness of definitive therapy in patients with a VRE screen and evaluate the predictive value of screening for the development of a VRE infection. Methods: In this retrospective study, we evaluated VRE screening of patients aged 18 years admitted between June 1, 2015, and May 31, 2018, to a 280-bed, academic, tertiary-care hospital. Rectal swabs were tested using Cepheid Xpert. Screening was performed routinely on admission for hematologic malignancy and liver transplantation patients. Only the first screen result was included for patients who had multiple VRE screens. The patient was classified as having a VRE infection if any Enterococcus isolates were vancomycin resistant. The primary outcome was appropriateness of antibiotic therapy in patients who had a VRE screen. Appropriateness of VRE-directed therapy was defined as therapy with linezolid or daptomycin for patients who had a positive VRE culture and an identifiable source of infection, or who had no clinical improvement on alternative therapy, or who had a documented β-lactam allergy. If appropriateness was unclear, 2 infectious diseases specialists determined appropriateness. Results: In total, 1,374 patients who had a rectal VRE screen met inclusion criteria. Of these, 1,053 (88%) had a negative screen. We detected no difference in the appropriateness of VRE-directed therapy between patients with a positive screen and those with a negative screen (59.3% vs 61.0%; P = .8657). The VRE screen had a sensitivity of 60% (95% CI, 43%–74%), specificity of 90% (95% CI, 88%–92%), positive predictive value of 18% (95% CI, 12%–25%), and negative predictive value of 98% (95% CI, 97%–99%) for VRE infection. Conclusions: Although VRE screening may have utility to detect colonization in high-risk patients, a positive VRE screen is of limited value in determining the need for VRE-directed therapy. Patients with a negative VRE screen have a low likelihood of developing a VRE infection, and a negative screen could be used to identify patients who may not require empiric coverage for VRE. Further research is needed to determine optimal utilization of VRE screening for prediction and treatment of VRE infections.Funding: NoneDisclosures: None

Prevalence of Social Risks on Inpatient Screening and Their Impact on Pediatric Care Use

OBJECTIVES: Screening for social determinants of health in the inpatient setting is uncommon. However, social risk factors documented in billing and electronic medical record data are associated with increased pediatric care use. We sought to describe (1) the epidemiology of social risks and referral acceptance and (2) association between social risks identified through routine inpatient screening and care use. METHODS: Parents of children ages 0 to 18 admitted to a general pediatric floor at an academic children’s hospital completed a psychosocial screening survey from October 2017 to June 2019. The survey covered the following domains: finances, housing, food security, medications, and benefits. Patient characteristics and care use outcomes were abstracted from the electronic medical record and compared by using Pearson’s χ2 or the Wilcoxon rank test and logistic regression analyses. RESULTS: Of 374 screened families, 141 (38%) had a positive screen result, of whom 78 (55%) reported &gt;1 need and 64 (45%) accepted a community resource. In bivariate analyses, patients with a positive screen result had higher 30-day readmission (10% vs 5%; P = .05), lower median household income ($62 321 vs $71 460; P &lt; .01), lower parental education (P &lt; .01), public insurance (57% vs 43%; P &lt; .01), lived in a 1-parent household (30 vs 12%; P &lt; .01), and had a complex chronic condition (35% vs 23%; P = .01) compared with those with a negative screen result. There was no difference in care reuse by screening status in adjusted analyses. CONCLUSIONS: Social risks are common in the pediatric inpatient setting. Children with medical complexity offer a good target for initial screening efforts.

Newborn Screening: Current Status in Alberta, Canada

Newborn screening (NBS) in Alberta is delivered by a number of government and health service entities who work together to provide newborn screening to infants born in Alberta, the Northwest Territories, and the Kitikmeot region of the Nunavut territory. The Alberta panel screens for 21 disorders (16 metabolic, two endocrine, cystic fibrosis, severe combined immunodeficiency, and sickle cell disease). NBS is a standard of care, but is not mandatory. NBS performance is monitored by the Alberta Newborn Metabolic Screening (NMS) Program and NMS Laboratory, who strive for continuous quality improvement. Performance analysis found that over 99% of registered infants in Alberta received a newborn screen and over 98% of these infants received a screen result within 10 days of age.

2020 The clinical implications of a positive prostate cancer screen in patients undergoing a cardiac transplant evaluation

OBJECTIVES/SPECIFIC AIMS: Screening the general population for prostate cancer with prostate specific antigen (PSA) continues to be controversial. Patients with advanced heart failure undergoing evaluation for suitability for cardiac transplantation are often requested to undergo prostate cancer screening, with guiding evidence generated from the general population. The objective of this study is to determine the clinical implications of a positive prostate cancer screen result in this patient population. METHODS/STUDY POPULATION: A retrospective cohort study was performed on all men that were referred to a tertiary care cardiac transplant center between January 2000 and December 2015. Patients were classified as having either a “positive screen” (PSA≥4 ng/mL) or a “negative screen” (PSA<4 ng/mL) at the point of evaluation. The primary outcome of time to listing for cardiac transplant (days) was calculated from the date of referral to the date of listing. A multivariable Cox proportional hazards model was developed to assess the association between a positive prostate cancer test result and listing for cardiac transplantation. RESULTS/ANTICIPATED RESULTS: Among the 704 patients included in this study, 66 men (9.4%) had a positive prostate cancer screen result. Men with a positive prostate cancer screen were approximately 4 year older (mean 58.5 vs. 54.1 years), more likely to have a diagnosis of Ischemic Cardiomyopathy (74% vs. 53%) and require continuous mechanical support (61% vs. 16%) at the point of transplant evaluation. The median time for listing for cardiac transplant was greater in patients with a positive PSA (119 vs. 48 days, p<0.05). After adjusting for age, renal function, clinical status at evaluation, history of COPD, and year of referral, patients with a positive prostate cancer screen had a reduced hazards ratio (HR) for progressing to cardiac transplant listing compared with those with a negative screen (HR 0.58, 95%CI: 0.38–0.91). DISCUSSION/SIGNIFICANCE OF IMPACT: Screening patients undergoing cardiac transplant evaluation for prostate cancer with PSA has a low diagnostic yield. An individual’s PSA value is influenced by their age and clinical status at the time of screening, with a positive screen being associated with a reduced likelihood for progressing to listing for cardiac transplant.

Human papillomavirus tumour status is not associated with a positive depression screen for patients with oropharyngeal cancer

Background:Several risk factors for depression in patients with oropharyngeal cancer have been determined. However, it is unknown whether human papillomavirus associated oropharyngeal cancer, which has a distinct clinico-demographic profile, modulates this risk.Methods:A retrospective analysis was conducted of patients with oropharyngeal cancer. These patients had completed a 10-item depression screening questionnaire before receiving treatment for their disease from 2011 to 2014. Associations between patient or disease characteristics and depression screening questionnaire results were investigated.Results:The study comprised 69 patients, 31 (44.9 per cent) of whom screened positive for depression. There were no significant differences in distributions of clinico-demographic or histopathological characteristics, including human papillomavirus tumour status, by depression screen result.Conclusion:This population has a high risk for depression, but no obvious risk factors, including human papillomavirus tumour status, were associated with an elevated risk. This inability to risk-stratify patients by clinico-demographic or disease characteristics emphasises the importance of regular depression screening for all patients in this population.

InstantLabs®E. coli O157 Food Safety Kit

The InstantLabs®E. coli O157 Food Safety Kit was validated against the International Organization for Standardizationreference method 16654 for the detection of Escherichia coli O157. The matrixes, raw ground beef, raw beef trim, Romaine lettuce, pasteurized apple juice, and raw ground chicken, were inoculated with appropriate CFU/test portion of E. coli O157 to generate fractional positives (5–15) in 20 inoculated samples. The matrixeswere co-inoculated with Salmonella at 2–5 times the level of E. coli O157 to demonstrate the potential for using the same enrichment culture for the detection of multiple organisms. Samples were enriched in prewarmed FASTGRO SE broth at 42 ± 1°C for 10–20 h. All samples were confirmed using the ISO reference method, regardless of initial screen result. The InstantLabs test method performed as well as or better than the reference method for the detection of E. coli O157 in all tested samples. Inclusivity and exclusivity testing revealed no false negatives and no false positives among the 50 E. coli O157 serovars and 30 non-E. coli O157 species examined. Finally, the method was shown to be robust when variations were applied to enrichment time, volume for DNA extraction, and heat block time.

InstantLabs®Salmonella Species Detection Method: Matrix Extension

The performance of InstantLabs®Salmonella Species Food Safety Kit to detect Salmonella in four food matrixes was validated against the International Organization for Standardization (ISO) reference method 6579:2002. The matrixes (raw ground beef, raw chicken breast, raw ground chicken, and lettuce) were inoculated with low levels of Salmonella (&lt;1 CFU/test portion) to generate fractional positives (5–15) in 20 inoculated samples. These matrixes were co-inoculated with Escherichia coli O157:H7 at two to five times the level of Salmonella. Samples were validated using 375 g (meat) or 25 g (lettuce and poultry) test portions enriched in FASTGRO™ SE at 42 ± 1°C for 12 h and 10 h, respectively. All samples were confirmed using the ISO reference method, regardless of initial screen result. The InstantLabs test method was shown to perform as well as or better than the reference method for the detection of Salmonella species in ground beef, chicken breast, ground chicken, and lettuce. Inclusivity and exclusivity testing revealed no false negatives among the 100 Salmonella serovars and no false positives among the 30 non-Salmonella species examined, respectively.