Surveillance Cultures Research Articles

Modelling interventions and contact networks to reduce the spread of carbapenem-resistant organisms between individuals in the ICU

Contact precautions are widely used to prevent the transmission of carbapenem-resistant organisms (CROs) in hospital wards. However, evidence for their effectiveness in natural hospital environments is limited. To determine which contact precautions, healthcare worker (HCW)-patient interactions, and patient and ward characteristics are associated with greater risk of CRO infection or colonization. CRO clinical and surveillance cultures from two high-acuity wards were assessed through probabilistic modelling to characterize a susceptible patient's risk of CRO infection or colonization during a ward stay. User- and time-stamped electronic health records were used to build HCW-mediated contact networks between patients. Probabilistic models were adjusted for patient (e.g. antibiotic administration) and ward (e.g. hand hygiene compliance, environmental cleaning) characteristics. The effects of risk factors were assessed by adjusted odds ratio (aOR) and 95% Bayesian credible intervals (CrI). The degree of interaction with CRO-positive patients, stratified by whether CRO-positive patients were on contact precautions. The prevalence of CROs and number of new carriers (i.e. incident CRO aquisition). Among 2193 ward visits, 126 (5.8%) patients became colonized or infected with CROs. Susceptible patients had 4.8 daily interactions with CRO-positive individuals on contact precautions (vs 1.9 interactions with those not on contact precautions). The use of contact precautions for CRO-positive patients was associated with a reduced rate (7.4 vs 93.5 per 1000 patient-days at risk) and odds (aOR 0.03, 95% CrI 0.01-0.17) of CRO acquisition among susceptible patients, resulting in an estimated absolute risk reduction of 9.0% (95% CrI 7.6-9.2%). Also, carbapenem administration to susceptible patients was associated with increased odds of CRO acquisition (aOR 2.38, 95% CrI 1.70-3.29). In this population-based cohort study, the use of contact precautions for patients colonized or infected with CROs was associated with lower risk of CRO acquisition among susceptible patients, even after adjusting for antibiotic exposure. Further studies that include organism genotyping are needed to confirm these findings.

Multi-drug resistant (MDR) and extensively drug-resistant (XDR) bacteraemia rates among cancer patients in an oncology hospital in eastern India: an 11-year retrospective observational study

Trend analysis of bacteraemias caused by multi-drug resistant (MDR) and extensively drug resistant (XDR) bacteria helps to assess efficacy of infection prevention and control (IPC) practices. Data on the trends of MDR and XDR bacteraemias are lacking from cancer patients in India. To report antibiotic resistance rates over time in bacteraemias and to assess the effect of IPC practices where patient isolation facilities were limited on the rates and trends of MDR and XDR bacteraemias from a cancer centre in eastern India. A retrospective observational study was conducted in a specialist cancer hospital in India from 2011 to 2021. The study included both patients with haematological and solid organ malignancy. Data on blood cultures and surveillance culture samples were analysed. Blood cultures were processed using BACT/ALERT® (bioMérieux, Marcy-l'Étoile, France) and the identification and antibiotic susceptibilities of bacteria were performed using VITEK® 2 (bioMérieux, Marcy-l'Étoile, France). Surveillance cultures for MDR/XDR bacteria were performed on a subset of patients and processed based on a modified method described previously. 3rd-generation cephalosporin-resistant Gram negative bacilli were the commonest cause of MDR bacteraemia (57.6%) followed by carbapenem resistant organisms (CRO) (35.7%). Bacteraemias caused by vancomycin-resistant enterococci (VRE), meticillin-resistant Staphylococcus aureus (MRSA) and colistin-resistant Gram negative bacilli were responsible for 1.3%, 2.3% and 3.0% of laboratory confirmed bloodstream infections (BSI) respectively. The ranges of the rates of MDR/XDR BSI per 1000 in-patients during the study period were: MRSA (1-1.18), VRE (0-0.88), 3rd generation cephalosporin-resistant Gram negative bacilli (10.10-20.32), CRO (5.05-13.07) and colistin-resistant Gram negative bacilli (E.coli, Klebsiella, Pseudomonas aeruginosa, Acinetobacter spp (0-1.3). Surveillance cultures collected from a subset of patients showed ranges of MRSA detection in 0-2.11%, VRE in 1.67%-7.49%, 3rd generation cephalosporin-resistant Gram negative bacilli in 55%-89.91% and carbapenem resistant Gram negative bacilli in 18.33%-31.11% of patients. This is one of few studies providing trend data for MDR/XDR bacteraemia rates among cancer patients in India over a decade. In a high prevalence setting it was possible to keep the rates of MDR/XDR bacteraemia controlled with IPC strategies and without adequate isolation facilities. The results are of potential interest to policy makers, IPC specialists and clinicians.

SG-APSIC1097: The impact of COVID-19 on the incidence of carbapenem-resistant Enterobacterales (CRE) in Singapore: An interrupted time-series analysis

Objectives: Over the past 2 years, many infection prevention and control (IPC) resources have been diverted to manage the COVID-19 pandemic. Its impact on the incidence of antimicrobial-resistant organisms has not been adequately studied. We investigated the impact of the pandemic on the incidence of carbapenem-resistant Enterobacterales (CRE) in Singapore. Methods: We extracted data on unique CRE isolates (clinical and/or surveillance cultures) and patient days for 6 public hospitals in Singapore from the carbapenemase-producing Enterobacteriaceae (CaPES) study group database, and we calculated the monthly incidence of CRE (per 10,000 patient days). Interrupted time-series (ITS) analysis was conducted with the pre–COVID-19 period defined as before February 2020, and the COVID-19 period defined as after February 2020. Statistical analyses were performed using Stata version 15 software. Results: From January 2017 to March 2021, 6,770 CRE isolates and 9,126,704 patient days were documented. The trend in CRE monthly incidence increased significantly during the pre–COVID-19 period (0.060; 95% CI, 0.033–0.094; P < .001) but decreased during the COVID-19 period (−0.183; 95% CI, −0.390 to 0.023; P = .080) without stepwise change in the incidence (−1.496; 95% CI, −3.477 to 0.485; P = .135). The trend in monthly incidence rate of CRE clinical cultures increased significantly during the pre–COVID-19 period (0.046; 95% CI, 0.028–0.064; P < .001) and decreased significantly during COVID-19 period (−0.148; 95% CI, −0.249 to −0.048; P = .048) with no stepwise change in the incidence (−0.063; 95% CI, −0.803 to 0.677; P = .864). The trend in monthly incidence rate of CRE surveillance cultures decreased during the pre–COVID-19 period (−0.020; 95% CI, −0.062 to 0.022; P = .341) and the COVID-19 period (−0.067; 95% CI, −0.291to 0.158; P = .552) without stepwise change in the incidence (−1.327; 95% CI, −3.535 to 0.881; P = .233). Conclusions: The rate of CRE in clinical cultures decreased during COVID-19 but not the rate in surveillance cultures. Further studies are warranted to study the impact of COVID-19 on CREs.(DUPLICATE DELETED)

Predicting infection risk from surveillance cultures: frustrating or foretelling?

The global burden of morbidity and mortality due to multidrug-resistant infections is high, and in-vitro inactive empirical antibiotic therapy is a well known risk factor for poor outcomes. 1 Antimicrobial Resistance CollaboratorsGlobal burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022; 399: 629-655 Summary Full Text Full Text PDF PubMed Scopus (1171) Google Scholar , 2 Kadri SS Lai YL Warner S et al. Inappropriate empirical antibiotic therapy for bloodstream infections based on discordant in-vitro susceptibilities: a retrospective cohort analysis of prevalence, predictors, and mortality risk in US hospitals. Lancet Infect Dis. 2021; 21: 241-251 Summary Full Text Full Text PDF PubMed Scopus (57) Google Scholar Studies have shown that colonisation with resistant pathogens increases the subsequent risk of infection by those same strains. However, when operationalising this principle, deciding how often to use specific broad-spectrum antibiotics if the patient is colonised with a particular pathogen warrants an improved understanding of the relative size of infection risks across different pathogens, host types, and time. 3 Denkel LA Maechler F Schwab F et al. Infections caused by extended-spectrum beta-lactamase-producing Enterobacterales after rectal colonization with ESBL-producing Escherichia coli or Klebsiella pneumoniae. Clin Microbiol Infect. 2020; 26: 1046-1051 Summary Full Text Full Text PDF PubMed Scopus (18) Google Scholar , 4 Tseng W-P Chen Y-C Chen S-Y Chen S-Y Chang S-C Risk for subsequent infection and mortality after hospitalization among patients with multidrug-resistant Gram-negative bacteria colonization or infection. Antimicrob Resist Infect Control. 2018; 7: 93 Crossref PubMed Scopus (33) Google Scholar , 5 Giannella M Bartoletti M Conti M Righi E Carbapenemase-producing Enterobacteriaceae in transplant patients. J Antimicrob Chemother. 2021; 76: i27-i39 Crossref Scopus (6) Google Scholar , 6 Tischendorf J de Avila RA Safdar N Risk of infection following colonization with carbapenem-resistant Enterobactericeae: a systematic review. Am J Infect Control. 2016; 44: 539-543 Summary Full Text Full Text PDF PubMed Scopus (143) Google Scholar Roel P J Willems and colleagues should be congratulated for their systematic review and meta-analysis establishing the cumulative incidence risk and the incidence density of infection in patients with multidrug-resistant Gram-negative bacteria (MDR-GNB) or vancomycin-resistant enterococci (VRE) colonisation of the gastrointestinal or urinary tract. 7 Willems RPJ van Dijk K Vehreschild MJGT et al. Incidence of infection with multidrug-resistant Gram-negative bacteria and vancomycin-resistant enterococci in carriers: a systematic review and meta-regression analysis. Lancet Infect Dis. 2022; (published online Jan 30.)https://doi.org/10.1016/S1473-3099(22)00811-8 Google Scholar Willems and colleagues pool aggregate results from 40 observational studies contributing 5015 VRE carriers and 9034 MDR-GNB carriers with a median study duration of 45 days (IQR 28–140). 7 Willems RPJ van Dijk K Vehreschild MJGT et al. Incidence of infection with multidrug-resistant Gram-negative bacteria and vancomycin-resistant enterococci in carriers: a systematic review and meta-regression analysis. Lancet Infect Dis. 2022; (published online Jan 30.)https://doi.org/10.1016/S1473-3099(22)00811-8 Google Scholar Infection and colonisation were as defined by the authors of each respective study and varied across studies. Incidence of infection with multidrug-resistant Gram-negative bacteria and vancomycin-resistant enterococci in carriers: a systematic review and meta-regression analysisThe risk of infection was substantial, with the highest risk for patients colonised with carbapenem-resistant Gram-negative bacteria and the lowest in patients with VRE. These data might help to guide prophylactic and treatment decisions and form a valuable resource for planning clinical trials on targeted prevention. Full-Text PDF

Socio-cultural drivers of Saudi tourists’ outbound destination decisions

This study examines key socio-cultural factors that influence Saudi tourists’ decisions to travel abroad. The paper utilises qualitative data collected through semi-structured interviews with males and females, whose views remain under-researched. It explores how Saudi Arabia's deeply embedded religious and tribal value systems and structures shape tourists’ destination choices and travel behaviours. The findings show that social norms and cultures of surveillance, alongside social obligations, act as push factors, decreasing the appeal of domestic tourism. Moreover, data suggest that seeking personal space and freedom, and the ability to engage in norm-breaking practices, are pull factors that make international destinations, especially those with fewer co-nationals, appealing. Practically, the study helps to identify marketing strategies that domestic and international destinations can adopt to target and accommodate Saudi tourists more effectively. Theoretically, the findings help to conceptualise a middle ground between what we call ‘extensionist’ and ‘rejectionist’ views of cultural influence and to appreciate the cumulative, intersecting impacts of socio-cultural imperatives.

An onion with layers of hope and fear: A cross‐case analysis of the media representation of Tor Network reflecting theoretical perspectives of new technologies

AbstractThe Onion Router (Tor) is a sophisticated web browser accompanied by an encrypted network that enables online anonymity, protecting people's privacy. Adopted by many as a counter‐surveillance mitigation around the world, legitimate users of Tor include the military, journalists, whistle‐blowers, and citizens from authoritarian regimes. This article shows that the data protection offered by Tor is consistently associated to criminal and anti‐social uses by the media. This research looks at the British press representation of Tor conducting a thematic analysis of articles published by six newspapers between 2008 and 2017. This analysis connects the press coverage to three theoretical approaches: moral panics, technological ambivalence, and liberation technology. This research demonstrates through three case studies that the media reproduces theoretical discussions about new technologies on Tor's portrayal, presenting cases with only positive, only negatives and both positive and negative uses. However, examples of optimistic views of Tor are rare, and the press coverage focuses mainly on the criminal uses, especially crypto markets and child pornography. Overall, the British press ignores a culture of surveillance and spreads a discourse of fear through a recurrent connection of Tor to horrifying uses, undermining any potential positive outcomes.

Limiting the Spread of Multidrug-Resistant Bacteria in Low-to-Middle-Income Countries: One Size Does Not Fit All.

The spread of multidrug-resistant organisms (MDRO) is associated with additional costs as well as higher morbidity and mortality rates. Risk factors related to the spread of MDRO can be classified into four categories: bacterial, host-related, organizational, and epidemiological. Faced with the severity of the MDRO predicament and its individual and collective consequences, many scientific societies have developed recommendations to help healthcare teams control the spread of MDROs. These international recommendations include a series of control measures based on surveillance cultures and the application of barrier measures, ranging from patients' being isolated in single rooms, to the reinforcement of hand hygiene and implementation of additional contact precautions, to the cohorting of colonized patients in a dedicated unit with or without a dedicated staff. In addition, most policies include the application of an antimicrobial stewardship program. Applying international policies to control the spread of MDROs presents several challenges, particularly in low-to-middle-income countries (LMICs). Through a review of the literature, this work evaluates the real risks of dissemination linked to MDROs and proposes an alternative policy that caters to the means of LMICs. Indeed, sufficient evidence exists to support the theory that high compliance with hand hygiene and antimicrobial stewardship reduces the risk of MDRO transmission. LMICs would therefore be better off adopting such low-cost policies without necessarily having to implement costly isolation protocols or impose additional contact precautions.

Role of short-dwell daily ethanol-lock therapy in the management of hemodialysis tunneled cuffed catheter-related bloodstream infection.

Catheter-Related Blood Stream Infection (CRBSI) is the major limitation of using Tunneled cuffed catheter (TCC) for long-term Hemodialysis. The standard therapy of CRBSI involves systemic antibiotics with catheter replacement/removal. As antibiotic alone is rarely effective therapy for CRBSI, biofilm eradication using antimicrobial locking solutions is a promising modality for CRBSI treatment, hence catheter salvage. The present study evaluated the efficacy and safety of Ethanol-lock therapy (ELT) in combination with systemic antibiotics for the management of CRBSI associated with hemodialysis TCC. 56 patients with CRBSI were treated with 70% ELT (1 h daily for 5 days) along with systemic antibiotics. Seventeen patients with CRBSI who didn't consent to ELT were treated with antibiotics alone. The effect of ELT was evaluated as clinical cure (fever resolution and negative surveillance cultures), infection-free TCC survival duration and adverse events of ELT among patients with CRBSI. The parameters were compared with 17 patients treated with antibiotics alone. ELT was successful in 50 out of 56 patients (89.28%); compared to 41.17% (seven out of 17) with antibiotics alone (p < 0.001). Mean TCC survival was also significantly higher with ELT combined with systemic antibiotics (126.23 ± 18.67 days) compared to antibiotics alone (38.76 ± 9.91) (p = 0.006). No systemic adverse effects were noted with ELT; two patients receiving ELT had catheter breakage during the study period. We conclude that short-dwell daily ELT with systemic antibiotics is an effective therapy for CRBSI in hemodialysis patients with TCC.

Microbial Epidemiology of the Cystic Fibrosis Airways: Past, Present, and Future.

Progressive obstructive lung disease secondary to chronic airway infection, coupled with impaired host immunity, is the leading cause of morbidity and mortality in cystic fibrosis (CF). Classical pathogens found in the airways of persons with CF (pwCF) include Pseudomonas aeruginosa, Staphylococcus aureus, the Burkholderia cepacia complex, Achromobacter species, and Haemophilus influenzae. While traditional respiratory-tract surveillance culturing has focused on this limited range of pathogens, the use of both comprehensive culture and culture-independent molecular approaches have demonstrated complex highly personalized microbial communities. Loss of bacterial community diversity and richness, counteracted with relative increases in dominant taxa by traditional CF pathogens such as Burkholderia or Pseudomonas, have long been considered the hallmark of disease progression. Acquisition of these classic pathogens is viewed as a harbinger of advanced disease and postulated to be driven in part by recurrent and frequent antibiotic exposure driven by frequent acute pulmonary exacerbations. Recently, CF transmembrane conductance regulator (CFTR) modulators, small molecules designed to potentiate or restore diminished protein levels/function, have been successfully developed and have profoundly influenced disease course. Despite the multitude of clinical benefits, structural lung damage and consequent chronic airway infection persist in pwCF. In this article, we review the microbial epidemiology of pwCF, focus on our evolving understanding of these infections in the era of modulators, and identify future challenges in infection surveillance and clinical management.

Mitigating Endoscope-Associated Infections: Revised ANSI/AAMI Standards and New Duodenoscope Surveillance Antimicrobial Sampling and Culturing Protocols

Article| January 2023 Mitigating Endoscope-Associated Infections: Revised ANSI/AAMI Standards and New Duodenoscope Surveillance Antimicrobial Sampling and Culturing Protocols Uday Jain, BSEE, MD, PhD, FASA Uday Jain, BSEE, MD, PhD, FASA Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor January 2023, Vol. 87, 29. https://doi.org/10.1097/01.ASM.0000911792.39689.52 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation Uday Jain; Mitigating Endoscope-Associated Infections: Revised ANSI/AAMI Standards and New Duodenoscope Surveillance Antimicrobial Sampling and Culturing Protocols. ASA Monitor 2023; 87:29 doi: https://doi.org/10.1097/01.ASM.0000911792.39689.52 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: age-related cognitive decline, american national standards institute, antimicrobials, duodenoscopes, endoscopes, infections, surveillance, medical Anesthesiologists provide anesthesia for numerous endoscopy procedures. They also perform bronchoscopy and other endoscopies. There are recent developments in mitigating endoscopy-associated infections. Carbapenem-resistant Enterobacteriaceae (CRE) infections, which are resistant to multiple antibiotics, have been traced to duodenal endoscopy, cystoscopy, and ureteroscopy (Am J Infect Control 2016;44:1032-6). These cases had all followed standard disinfection protocols. The outbreaks were traced to difficulty sterilizing complex shapes or materials, such as the hinge of side-viewing duodenoscopes. As a result of these outbreaks, new sterilization standards have been published by the American National Standards Institute (ANSI)/Association for the Advancement of Medical Instrumentation (AAMI) (ANSI/AAMI ST91:2021; asamonitor.pub/3DEYQnI). Additionally, the FDA and the CDC published new surveillance antimicrobial surveillance guidelines (asamonitor.pub/3Qgqiwq). The FDA recommends transitioning to fully disposable duodenoscopes (Clin Gastroenterol Hepatol 2020;18:2108-2117) or using endoscopes with disposable components. This guidance includes developing schedules for routine inspection and... You do not currently have access to this content.

Supporting victims of domestic violence in rural and island communities during COVID-19: the impact of the pandemic on service providers in North East Scotland and Orkney

We investigate the impact of the COVID-19 pandemic on domestic violence service providers in rural and island communities in North East Scotland and Orkney. Domestic abuse and violence in rural areas is typically underestimated and might be more hidden due to stigma, a surveillance culture, and the practical difficulties of accessing services. The geographical challenges of rural and remote areas in relation to domestic violence are, to some extent, further amplified in small island locations, given population sizes, terrain and separation by sea. In such communities, visits to a service organisation’s offices, or a visit by one of their staff, might publicly mark a service user out as a domestic abuse survivor. This article focuses on the move to digital and telephone provision of support in areas where broadband internet access is inconsistent and service users may live many miles from sources of support. At the same time, the move to online modes of communication was welcomed by staff in relation to offering opportunities for training and networking. There was also use of social and local media to raise awareness of the prevalence of domestic violence in these locations and to counter the myth of idyllic and abuse-free rural and island communities.

Impact of COVID-19 pandemic on carbapenem-resistant Enterobacterales incidence in the South-East Asia region: an observational study.

The COVID-19 pandemic led to an initial increase in the incidence of carbapenem-resistant Enterobacterales (CRE) from clinical cultures in South-East Asia hospitals, which was unsustained as the pandemic progressed. Conversely, there was a decrease in CRE incidence from surveillance cultures and overall combined incidence. Further studies are needed for future pandemic preparedness.

The Evaluation of Risk Factors for Vancomycin-Resistant Enterococcus Colonization and Infection Among Mixed Adult Intensive Care Unit Patients.

Background and objective Despite the adherence to strict infection control measures, vancomycin-resistant enterococcus (VRE) colonization and VRE infections are still important problems nowadays. However, there are only a limited number of studies examining the factors causing the transformation of VRE colonization to VRE infection in the intensive care unit (ICU). The aim of this study is to delineate the prevalence of VRE colonization and its transformation into infection and the risk factors leading to infection. Methods Patients admitted to the third-level mixed-type ICU from 2012 to 2015 for at least 24 hoursand acquired VRE colonization and VRE infection, both during and after their admission, were included in the study, and their medical records were examined retrospectively. VRE rectal swabs were taken weekly from each patient on admission and discharge from the ICU. If the VRE-positive patient was detected negative for VRE on the rectal swap taken three times in total as a surveillance culture successively, this patient was accepted as VRE negative. Demographic data, Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores, invasive procedures, treatments (corticosteroid, antibiotic, etc.), nutrition types, laboratory results, and ICU results were recorded. Results Among 1730 patients admitted to ICU, 101 (5.8%) were found to carry VRE colonization. Twelve (11.8%) out of 101 patients colonized with VRE developed VRE infection. About 56.4% had urinary tract infections, 68.3% had pneumonia, 15.8% had surgical site infections, and 24.8% had catheter-associated infections among these infected patients. The most prevalent factor was Enterococcus faecium in patients with VRE colonization (64.3%) and infection (91%). VRE turned negative in 67% of patients with VRE colonization during their stay in ICU. Renal replacement therapy was statistically significant (p < 0.05) in the group with VRE infection (66.7%) compared to the VRE-colonized group (26.1%). Infection development risk among carriers of VRE for more than one week was again found statistically significant (p = 0.025). Demographic data, APACHE-II scores, treatments, nutrition type, previous antibiotic usage and types, invasive procedures, laboratory results, and ICU results were similar among the patients with VRE colonization and infection. Conclusion A longer duration of ICU stay in patients with colonization and previous renal replacement therapy increases the transformation of VRE colonization to VRE infection. Strategies towarddecreasing VRE-colonized patients' period of stay in ICU is the main objective to control the rate of VRE infection.

NDM-producing Enterobacterales prevalence associated to COVID-19 in a tertiary hospital

Colonizations/Infections caused by carbapenem-resistant Enterobacterales are of great clinical and epidemiological importance due to their rapid dissemination and high mortality rates. In this scenario, the use of antibiotics intensified by the COVID-19 pandemic has brought about a great warning on the real impact that this pandemic could have on antimicrobial management programs and long-term antimicrobial resistance rates. The objective of this study was to evaluate the increase of New Delhi Metallo β-Lactamase (NDM)-producing Enterobacterales cases in COVID-19 units of a complex Brazilian tertiary hospital. This retrospective observational study included all patients admitted to the hospital identified as colonized or infected by NDM-producing Gram negative bacilli (GNB), from January 2017 to April 2021. Forty-two NDM-producing Enterobacterales were identified in 39 patients. The rate of NDM cases per total surveillance cultures increased progressively between 2017 and 2021 (chi-2 for trend, p < 0.0001) and was associated with a higher occurrence specifically in COVID units (Fisher exact, p < 0.0001). The molecular investigation of the NDM-producing Klebsiella pneumoniae strains revealed the emergence of diverse clones during the COVID-19 period, also with possible evidence of horizontal transmission among patients within COVID units. NDM-producing Enterobacterales with multiple and different clonalities in the COVID-19 units also raised questions about the importance of other factors besides horizontal clonal transfer, including the increase of antimicrobial consumption by these patients.

What We Learn from Surveillance of Microbial Colonization in Recipients of Pediatric Hematopoietic Stem Cell Transplantation.

Infections in hematopoietic stem cell transplant (HSCT) remain one of the major causes for morbidity and mortality, and it is still unclear whether knowledge of microbial colonization is important. In this single-center study, we collected weekly surveillance cultures in pediatric recipients of allogenic HSCT from five different body regions and tested for bacteria and fungi. Between January 2010 and December 2021, we collected 1095 swabs from 57 recipients of allogeneic HSCTs (median age: 7.5 years, IQR 1-3: 2.5-11.9). The incidence of positive microbiological cultures (n = 220; 20.1%) differed according to the anatomic localization (p &lt; 0.001) and was most frequent in the anal region (n = 98), followed by the genital, pharyngeal and nasal regions (n = 55, n = 37 and n = 16, respectively). Gram-positive bacteria (70.4%) were the most commonly isolated organisms, followed by fungi (18.6%), Gram-negative (5.5%), non-fermenting bacteria (1.4%), and other flora (4.1%). No association with increased risk of infection (n = 32) or septicemia (n = 7) was noted. Over time, we did not observe any increase in bacterial resistance. We conclude that there is no benefit to surveillance of microbial colonization by culture-based techniques in pediatric HSCT. Sequencing methods might enhance the detection of pathogens, but its role is still to be defined.

Surveillance of multi-resistant microrganisms and epidemiological investigation of intensive care unit patients

It is of great importance to detect the presence of microorganisms in healthcare services. On this basis, strategies should be developed to maintain safety inside the hospital environment by preventing the transmission of microorganisms, thus preventing healthcare-associated infections (HAI). In the Intensive Care Unit (ICU), the precocious detection of infection and/or colonization by multidrug-resistant (MDR) microorganisms is key. For this reason, the routine monitoring of patients that are infected or colonized by MDR microorganisms is mandatory. In this context, this study aimed to evaluate the performance of epidemiological surveillance swabs and microbiological cultures in ICU patients in a university public hospital in Belo Horizonte, Minas Gerais State, Brazil. Medical records of patients admitted to the ICU from January 1st, 2018 to December 31st, 2020, submitted to epidemiological surveillance cultures, and presenting factors correlated to the development of HAI were evaluated. This was a descriptive, retrospective and observational, non-interventional study. The study population was composed mainly of male patients (66.3%), with a mean age of 59 years, coming from the Medical Clinic department, and septicemia was the main cause of hospitalization in the ICU. The analyses showed that 9.5% of the patients were colonized by MDR microorganisms. The samples were collected at the ICU, and a higher frequency of gram-negative bacteria was observed, including A. baumannii, P. aeruginosa, K. pneumoniae, and carbapenem-resistant Enterobacteriaceae. The most frequently prescribed antimicrobials were β-lactams and glycopeptides, and the same patient was treated using more than one class of antimicrobials. The surveillance culture is key to understanding the microbiological profile of the institution. The collection of swabs and microbiological cultures from different sites could be used to adopt routines and recommend measures aimed at controlling and reducing the HAI rates as well as the emergence of MDR outbreaks. These procedures could contribute to the creation and maintenance of a safe and effective healthcare service.

Guidance of empirical antimicrobial therapy by surveillance cultures in high-risk neutropenic patients: a retrospective cohort study

BackgroundIn neutropenic patients, bloodstream infections (BSI) significantly contribute to morbidity and mortality. Appropriate empirical antibiotic therapy (EAT) of BSI is essential, at the same time overconsumption of very broad-spectrum antibiotics should be avoided. We investigated: (1) whether surveillance cultures can predict BSI with third-generation cephalosporin –resistant Enterobacterales and Pseudomonas aeruginosa (3GC-R), (2) the effect of inappropriate empirical antimicrobial therapy (IEAT) on clinical outcome and (3) the potential reduction of carbapenem use when using surveillance cultures to guide therapy.MethodsRetrospective study of adult patients with haematological malignancies with febrile episodes during chemotherapy-induced high-risk neutropenia in whom surveillance cultures were collected weekly. IEAT was defined as the absence of in vitro susceptibility of blood-isolates to the administered EAT. Clinical outcome (ICU admission and death) was evaluated within 30 days.ResultsA total of 673 febrile episodes occurred among 372 high-risk neutropenic patients. BSI was present in 20.1% (135/673), of which 25.9% (35/135) were due to Enterobacterales and P. aeruginosa. Of these, 17/35 were 3GC-R and 70.6% (12/17) were preceded by 3GC-R colonization. Negative predictive value of surveillance cultures for 3GC-R BSI was 99.1%. IEAT due to (3GC-R) BSI was not significantly associated with clinical outcome. Using surveillance cultures to guide EAT could potentially reduce carbapenem use by 82.8%, when compared to standard EAT with carbapenem.ConclusionsThis retrospective analysis shows that in patients with high-risk neutropenia, surveillance cultures can potentially reduce the use of carbapenems with infrequent IEAT for 3GC-R BSI and no negative impact on clinical outcome.

Surveillant assemblage: Overt, covert, movement and social surveillance in domestic and family violence in Singapore

This paper explores the role of surveillance technologies in domestic and family violence in Singapore. To do so, it outlines findings from a pilot research project which focused on technology and violence against women in Singapore and involved fourteen semi-structured interviews with frontline workers in the fields of domestic and family violence, sexual violence and LGBT support. Drawing from Dragiewicz et al.'s (2018) work on technology facilitated coercive control, this paper outlines how overt, covert, social and movement surveillance via digital, internet and communication technologies was used to control and constrain survivors. This article explores how the dynamics of domestic and family violence shaped the use of the surveillance technologies reported in these accounts. It also argues that wider gendered, global and local surveillance cultures generated important permissions which legitimated surveillance as a technology of control and reproduced women and girls as normalised surveillance subjects.

420. ­­Impact of Intensified Prevention Measures On Rates of Hospital-Acquired Carbapenem-Resistant Acinetobacter baumannii In Endemic Setting

Abstract Background During the last decade, hospital-acquired carbapenem-resistant Acinetobacter baumannii (HA-CRAB) have become endemic in acute care facilities in Israel. Despite the increasing rates CRAB carriage among hospitalized patients in endemic settings, the role of active surveillance cultures (ASC) is still debated. The aim of the study was to evaluate the impact of different components of control measures conducted in an endemic acute care hospital Methods The study consisted of a 12-month baseline period (1 January 2019–31 December 2019; period 1), 12-month 1st intervention period (1 January 2020- December 2020; period 2); 6-month 2nd intervention period (1 January 2021-30 June 2021; period 3) and a 9-month follow-up period (1 June 2021–31 March 2022; period 4). During period 1, basic infection-control measures were implemented including contact precautions for CRAB carriers. During period 2, all CRAB carries were cohorted in a single ward and managed by dedicated health care workers. Enhanced environmental cleaning was conducted by a dedicated team. During periods 3 and 4, high-risk patients were screened on admission; weekly cultures were obtained in high-risk units. The incidence density rate (IDR) of HA-CRAB was defined as the per-patient number of first CRAB isolate from clinical specimens. Incidence rates ratios (IRR) were compared between the study periods. Results During the baseline period, IDR of HA-CRAB was 4.9/10,000 patient days (PD). During period 2, no significant decrease was observed (IDR 3.9/10,000 PD, IRR 0.7 95% CI 0.49-1.16, p=0.15). In response to ongoing transmission in several wards, ASC program was initiated in January 2021. IDR during period 3 was 5.3/10,000 PD (IRR 1.1, 95% CI 0.74- 1.56, p=0.64). Since January 2021, 2.1% (78/3799) were found to be colonized on admission and 5.5% (100/1809) were detected by weekly screening. Among the 291 patients who were detected with CRAB during this period, 70.9% were identified by ASC. During period 4, IDR was 3.1/10,000 PD (IRR 0.60, 95% CI 0.40-0.88, p=0.007). Conclusion The comprehensive intervention that combined intensified control measures with routine ASC was effective in reducing the incidence of HA-CRAB in endemic setting. Disclosures Yasmin Maor, MD, MSD: Advisor/Consultant|MSD: Honoraria|Pfizer: Honoraria.

Reservoir of Carbapenem-Resistant Acinetobacter baumannii in the Hospital Environment and Colonization Pressure: A Surveillance-Based Study in Indian Intensive Care Unit.

The endemicity of Acinetobacter baumannii in intensive care units (ICUs) is a serious concern. We studied the reservoirs of A. baumannii in the ICU and their effects on colonization pressure and transmission. A prospective surveillance (6 months) was conducted. Screening culture (rectal and axillary) swabs were collected within 48 hours admission and in 120 hours. Surveillance cultures from patients' surroundings, health care workers (HCWs), and hospital sewage were collected. A. baumannii was identified by phenotypic and genotypic methods. Carbapenem resistance and insertion sequence element were detected. Typing was done by repetitive extragenic palindromic-polymerase chain reaction and multilocus sequence typing. Colonization pressure was calculated and compared with environment colonizers. Of the 87 patients, 21.83% (19) were colonized with A. baumannii, 73.68% (14/19) were imported, and 26.31% (5/19) acquired carriers. Axilla was the commonest site. From the environment (15), bed rails 33.33% (5/15) and suction tubes 26.66% (4/15) were the common sites. HCWs showed 7.5% (3/40) carriage. Carbapenem resistance with blaOXA-51, blaOXA-23, and ISAba1 were 91.89% (34/37). Strong correlation between colonization pressures and environmental colonizers was seen (r2 = 0.719, p = 0.032). Carbapenem and polymyxin B were (p ≤ 0.05) significant exposures. Sequence type 623 was the predominant cluster with isolates from carriers, HCWs, and environment. Colonization pressure of carbapenem-resistant A. baumannii depends on their presence in the hospital. Hands of HCWs were an important vehicle for transmission. Infection control measure should consider reducing the environmental reservoir.