Hospital-acquired Respiratory Infections Research Articles

Decreased hospital-acquired respiratory infections among older inpatients during the COVID-19 pandemic: a retrospective observational study in a general hospital in China

BackgroundTo mitigate hospital-acquired transmission of coronavirus disease 2019 (COVID-19), various prevention and control measures have been strictly implemented in medical institutions. These stringent measures can potentially reduce the incidence of hospital-acquired respiratory infections. This study aimed to assess if there were changes in the prevalence of hospital-acquired respiratory infections during a period of national attention focused on COVID-19 prevention.MethodsA retrospective analysis of the clinical data from adult patients with hospital-acquired respiratory infections admitted between October and December 2019 and during the same period in 2020 was performed. All patients were referred from a general hospital in Beijing China and COVID-19 patients were not treated at the hospital. Hospital-acquired respiratory infections were diagnosed based on the criteria of the Centers for Disease Control and Prevention/National Healthcare Safety Network (CDC/NHSN). A comparison of the incidence and mortality rate of hospital-acquired respiratory infections between the two selected time periods was conducted. Additionally, multivariate logistics regression analysis was used to identify mortality-associated risk factors.ResultsThis study included 2,211 patients from October to December 2019 (pre-COVID-19 pandemic) and 2,921 patients from October to December 2020 (during the COVID-19 pandemic). The incidence of hospital-acquired respiratory infections in 2019 and 2020 was 4.7% and 2.9%, respectively, with odds ratio (OR): 0.61, 95% confidence interval (CI): 0.46–0.81, and P = 0.001. In-hospital mortality of hospital-acquired respiratory infections in 2019 and 2020 was 30.5% and 38.4%, respectively, with OR: 1.42, 95%CI: 0.78–2.59, and P = 0.25. Multivariate logistics regression analysis revealed that a history of previous malignancy (OR: 2.50, 95%CI: 1.16–5.35, P = 0.02), was associated with in-hospital mortality.ConclusionsThe incidence of hospital-acquired respiratory infections was significantly decreased following the implementation of various prevention and control measures during the COVID-19 pandemic. A history of previous malignancy was associated with higher in-hospital mortality in older inpatients with hospital-acquired respiratory infections.

Hospital-acquired respiratory viral infections while applying droplet precautions on-site (DroPS) - prospective observation during the 2019/20 influenza season, Bern, Switzerland

Single room isolation for respiratory viral infections (RVI), like influenza, puts hospitals under pressure. During the influenza season 2019/20, we implemented Droplet precautions on-site (DroPS) for RVI in two acute care hospitals and prospectively assessed the rate of hospital-acquired RVI (HARVI). 318 patients were admitted with RVI, 85 had Influenza or RSV, 75 stayed in multi-bed rooms with DroPS. From 764 patients at risk, hospitalised ≥ three days in a multi-bed room, 11 (1.4%) developed a clinical HARVI, and three tested positive (3/764, 0.4%; 2x RSV, 1x influenza). DroPS may represent an alternative strategy to deal with respiratory viral infections.

Ventilator-Associated Pneumonia, Ventilator-Associated Events, and Nosocomial Respiratory Viral Infections on the Leeside of the Pandemic.

The COVID-19 pandemic has had an unprecedented impact on population health and hospital operations. Over 7 million patients have been hospitalized for COVID-19 thus far in the United States alone. Mortality rates for hospitalized patients during the first wave of the pandemic were > 30%, but as we enter the fifth year of the pandemic hospitalizations have fallen and mortality rates for hospitalized patients with COVID-19 have plummeted to 5% or less. These gains reflect lessons learned about how to optimize respiratory support for different kinds of patients, targeted use of therapeutics for patients with different manifestations of COVID-19 including immunosuppressants and antivirals as appropriate, and high levels of population immunity acquired through vaccines and natural infections. At the same time, the pandemic has helped highlight some longstanding sources of harm for hospitalized patients including hospital-acquired pneumonia, ventilator-associated events (VAEs), and hospital-acquired respiratory viral infections. We are, thankfully, on the leeside of the pandemic at present; but the large increases in ventilator-associated pneumonia (VAP), VAEs, bacterial superinfections, and nosocomial respiratory viral infections associated with the pandemic beg the question of how best to prevent these complications moving forward. This paper reviews the burden of hospitalization for COVID-19, the intersection between COVID-19 and both VAP and VAEs, the frequency and impact of hospital-acquired respiratory viral infections, new recommendations on how best to prevent VAP and VAEs, and current insights into effective strategies to prevent nosocomial spread of respiratory viruses.

Routine, molecular point-of-care testing for SARS-CoV-2 and other respiratory viruses within an acute oncology service improves patient care

COVID-19 has caused significant challenges for infection prevention measures and patient flow in hospital admission pathways. We aimed to assess the impact of replacing laboratory PCR with molecular point-of-care testing (mPOCT) for respiratory viruses including SARS-CoV-2, within an Acute Oncology Service (AOS). This pre- and post-implementation study took place in the AOS of a large teaching hospital, in Southampton, UK. We collected data from two periods: November 25th, 2019 to November 24th, 2020, when respiratory virus testing utilised laboratory PCR, and December 1st, 2020 to May 31st, 2021 following the introduction of mPOCT. The primary outcome was the time to results. 2189 patients were tested in the pre-implementation period and 1540 in the post implementation period. Median (IQR) time to results was 5.8h (4.2-10.6) pre-implementation and 1.9h (1.5-3.0) post-implementation (difference -3.6h [95%CI to -3.8 to -3.5]; p<0.0001). Median time spent in assessment areas was 6.0h (4.1-7.9) pre-implementation and 5.5h (3.8-7.4) post-implementation (p<0.0001). 20 (0.9%) patients admitted via AOS assessment unit developed hospital-acquired respiratory virus infection pre-implementation versus 0 (0%) post-implementation (p=0.031). Routine mPOCT for respiratory viruses, including SARS-CoV-2, was associated with a reduced time to results, reduced time in assessment areas, and a reduction in the rates of hospital-acquired respiratory virus infection in an acute oncology assessment unit.

Incidence, risk factors, and outcomes of hospital-acquired infections with common respiratory viruses

Background: We estimated the incidence of hospital-acquired respiratory virus infections (HARVIs) by viral species, and we identified risk factors for and outcomes of HARVIs. Methods: We identified a cohort of all inpatient admissions of ≥24 hours duration to University of Michigan hospitals during 3 study years (2017–2018, 2018–2019, and 2019–2020). HARVIs were defined as initial respiratory virus detection (adenovirus, coronaviruses, human metapneumovirus, influenza A and B, parainfluenza viruses, respiratory syncytial virus, or rhinovirus-enterovirus) in a clinical test ordered after the 95th percentile of the virus-specific incubation period. Incidence was calculated as the number of HARVIs per 10,000 patient admission days. Patient demographic and clinical characteristics were assessed as risk factors for HARVI in Cox proportional hazards models of the competing outcomes of HARVIs and hospital discharge. The association between time-varying HARVI status and the competing outcomes of discharge and in-hospital death was estimated in covariate-adjusted Cox-proportional hazards models. All analyses were performed separately for adult patients (aged ≥18 years) and pediatric patients (aged &lt;18 years). Results: The overall incidences of HARVI were 8.5 and 3.0 per 10,000 admission days for pediatric and adult patients, respectively. Rhinovirus was the most common HARVI in both pediatric and adult patients, with incidences of 5.1 and 1.1 infections per 10,000 admission days, respectively. With the exception of influenza A, the incidence of HARVI was higher in pediatric patients than adult patients for all viral species. For adults, congestive heart failure, renal disease, and cancer all increased HARVI risk independent of their associations with extended hospital stays. Risk of HARVI was also elevated for patients admitted September through June relative to July admissions. For pediatric patients, chronic cardiovascular and respiratory conditions, cancer, medical-device dependence, and December admission increased risk of HARVI. Age, sex, and race were not associated with risk of HARVI for children or adults. Inpatient lengths of stay were longer for adults with HARVI compared to those without (range of virus-specific hazard ratios, 0.48– 0.77). However, estimated effects were not statistically significant for human metapneuomovirus, parainfluenza, or adenovirus. Only influenza A was associated with an increased risk of in-hospital death within 30 days of infection for adults. No HARVIs were associated with increased length of stay or risk of death for pediatric patients. Conclusions: The incidence of HARVI varied by viral species and was higher among pediatric patients. HARVIs increased the length of hospital stays for adults but not for pediatric patients.Disclosures: None

Microbiology and Clinical Outcome of Hospital-Acquired Respiratory Infections in an Italian Teaching Hospital: A Retrospective Study.

The burden, microbial etiology and clinical impact of hospital-acquired respiratory infections (HARIs) were determined at an Italian teaching hospital over a 12-month period. For this purpose, overall ordinary hospitalizations ≥ 2 days of subjects over 18 years old with discharge from 1 January 2018 to 31 December 2018 were examined by cross-referencing demographic and clinical data from hospital discharge forms with microbiological data from the computer system of the Microbiology Unit. We identified 329 individuals with HARIs (96 females and 233 males; median age 70 years, range 18-93), who represented ¼ of the total hospital-acquired infections (HAIs) in the period. The inpatient setting was medical and surgical in similar proportions (169 vs. 160, respectively) and the mean hospital stay was 38.9 ± 33.6 days. One hundred and forty patients (42.6% of the total sample) were suffering from one or more chronic diseases. A total of 581 microorganisms (82 antibiotic-resistant and 499 non-resistant) were detected in HARI patients. The most common isolated species were Staphylococcus aureus (16.7%), Klebsiella pneumoniae (13.3%), Pseudomonas spp. (12.6%) and Acinetobacter baumannii (10.5%), followed by Enterobacter spp. (5.3%), Escherichia coli (5.2%) and Enterococcus spp. (4.8%). One hundred and sixty-seven individuals (49.0% of the total) had polymicrobial infections. One hundred thirty-one patients (39.8% of the total) underwent endotracheal intubation and mechanical ventilation and 62.6% of them died, compared to 17.7% of the non-intubated patients. Multivariable analysis confirmed a positive correlation between death and increased age (p = 0.05), surgical MDC (p = 0.007), number of microorganisms over the sample mean (p = 0.001), the presence of chronic diseases (p = 0.046), and intubation and mechanical ventilation (p &lt; 0.0001). A positive correlation between intubation and antibiotic-resistant organisms (p = 0.003) was also found. HARIs are still a major public health problem and require constant surveillance due to their severe clinical outcome.

The impact of a comprehensive coronavirus disease 2019 (COVID-19) infection prevention bundle on non-COVID-19 hospital-acquired respiratory viral infection (HA-RVI) rates.

After implementing a coronavirus disease 2019 (COVID-19) infection prevention bundle, the incidence rate ratio (IRR) of non-severe acute respiratory coronavirus virus 2 (non-SARS-CoV-2) hospital-acquired respiratory viral infection (HA-RVI) was significantly lower than the IRR from the pre-COVID-19 period (IRR, 0.322; 95% CI, 0.266-0.393; P < .01). However, HA-RVIs incidence rates mirrored community RVI trends, suggesting that hospital interventions alone did not significantly affect HA-RVI incidence.

Characterisation of Bacteriophage vB_SmaM_Ps15 Infective to Stenotrophomonas maltophilia Clinical Ocular Isolates.

Recent acknowledgment that multidrug resistant Stenotrophomonas maltophilia strains can cause severe infections has led to increasing global interest in addressing its pathogenicity. While being primarily associated with hospital-acquired respiratory tract infections, this bacterial species is also relevant to ophthalmology, particularly to contact lens-related diseases. In the current study, the capacity of Stenotrophomonas phage vB_SmaM_Ps15 to infect ocular S. maltophilia strains was investigated to explore its future potential as a phage therapeutic. The phage proved to be lytic to a range of clinical isolates collected in Australia from eye swabs, contact lenses and contact lens cases that had previously shown to be resistant to several antibiotics and multipurpose contact lenses disinfectant solutions. Morphological analysis by transmission electron microscopy placed the phage into the Myoviridae family. Its genome size was 161,350 bp with a G + C content of 54.2%, containing 276 putative protein-encoding genes and 24 tRNAs. A detailed comparative genomic analysis positioned vB_SmaM_Ps15 as a new species of the Menderavirus genus, which currently contains six very similar globally distributed members. It was confirmed as a virulent phage, free of known lysogenic and pathogenicity determinants, which supports its potential use for the treatment of S. maltophilia eye infections.

Droplet precautions on-site (DroPS) during the influenza season 2018/2019: a possible alternative to single room isolation for respiratory viral infections

BackgroundThe guideline-driven and widely implemented single room isolation strategy for respiratory viral infections (RVI) such as influenza or respiratory syncytial virus (RSV) can lead to a shortage of available hospital beds. We discuss our experience with the introduction of droplet precautions on-site (DroPS) as a possible alternative.MethodsDuring the 2018/19 influenza season we introduced DroPS on several wards of a single tertiary care center, while other wards maintained the traditional single room isolation strategy. On a daily basis, we evaluated patients for the development of respiratory symptoms and screened those with a clinical diagnosis of hospital-acquired respiratory viral infection (HARVI) for influenza/RSV by molecular rapid test. If negative, it was followed by a multiplex respiratory virus PCR. We report the concept of DroPS, the feasibility of the strategy and the rate of microbiologically confirmed HARVI with influenza or RSV infection on the DroPS wards compared to wards using the traditional single room isolation strategy.ResultsWe evaluated all hospitalised patients at risk for a HARVI, 741 (72%) on the DroPS wards and 293 (28%) on the regular wards. The hospital-acquired infection rate with influenza or RSV was 2/741 (0.3%; 1× influenza A, 1× RSV) on the DroPS wards and 2/293 (0.7%; 2× influenza A) on the regular wards.ConclusionsDroplet precautions on-site (DroPS) may be a simple and potentially resource-saving alternative to the standard single room isolation strategy for respiratory viral infections. Further studies in a larger clinical context are needed to document its safety.

PGN-004 - Antimicrobial susceptibility and co-resistance among Pseudomonas aeruginosa isolates from hospital-acquired respiratory-tract infections: SMART 2017–2019 Malaysia

PGN-004 - Antimicrobial susceptibility and co-resistance among Pseudomonas aeruginosa isolates from hospital-acquired respiratory-tract infections: SMART 2017–2019 Malaysia

Hospital-acquired Respiratory-Tract Infections in the Teaching Hospitals of Sfax

Hospital-acquired Respiratory-Tract Infections (HARTIs) are identified as the most frequent type of hospital-acquired infections. They can engender significant morbidity and mortality rates, generating a heavy economic burden, especially in the limited resources countries. In this perspective, this study aimed to determine the prevalence of HARTIs in the University Hospitals (UHs) of Southern Tunisia and to identify their main associated factors. It was a cross-sectional study conducted in the two UHs of Sfax governorate, Tunisia, from July 10 to 24th, 2017, including all hospitalized patients for at least 48 hours. It was a 1-day pass per department and a 1-week survey per UH. In total, 34 cases of HARTIs were notified among 752 surveyed patients, accounting for an overall prevalence of 4.5%. The prevalence of HARTIs in the Intensive Care Units (ICU) was 20.6%. Multivariate logistic regression analysis showed that developing a HARTI in non-ICU was independently associated with tobacco use [Adjusted Odds Ratio (AOR) = 2.83; 95% Confidence Interval (95% CI) = [1.10–7.27]; p = 0.03], central vascular catheter (AOR = 5.70; 95% CI = [1.29–25.15];p = 0.022) and McCabe Index ≥1 (AOR = 7.38; 95% CI = [2.73–19.97];p < 0.001). In ICU, only endotracheal tube was independently associated with HARTIs (AOR = 42.5; 95% CI = [4.97–64.13]; p = 0.001). This study illustrated the extent of HARTIs problem threatening the quality of care in Southern Tunisia. Identifying the risk factors of HARTIs in both ICUs and non-ICUs may help healthcare workers to ascertain the avoidability of these infections.

Impact of a Comprehensive SARS-CoV-2 Infection Prevention Bundle on Rates of Hospital-Acquired Respiratory Viral Infections

Background: We evaluated the impact of a comprehensive SARS-CoV-2 (COVID-19) infection prevention (IP) bundle on rates of non–COVID-19 healthcare-acquired respiratory viral infection (HA-RVI). Methods: We performed a retrospective analysis of prospectively collected respiratory viral data using an infection prevention database from April 2017 to January 2021. We defined HA-RVI as identification of a respiratory virus via nasal or nasopharyngeal swabs collected on or after hospital day 7 for COVID-19 and non–COVID-19 RVI. We compared incident rate ratios (IRRs) of HA-RVI for each of the 3 years (April 2017 to March 2020) prior to and 10 months (April 2020 to January 2021) following full implementation of a comprehensive COVID-19 IP bundle at Duke University Health System. The COVID-19 IP bundle consists of the following elements: universal masking; eye protection; employee, patient, and visitor symptom screening; contact tracing; admission and preprocedure testing; visitor restrictions; discouraging presenteeism; population density control and/or physical distancing; and ongoing attention to basic horizontal IP strategies including hand hygiene, PPE compliance, and environmental cleaning. Results: During the study period, we identified 715 HA-RVIs over 1,899,700 inpatient days, for an overall incidence rate of 0.38 HA-RVI per 1,000 inpatient days. The HA-RVI IRR was significantly higher during each of the 3 years prior to implementing the COVID-19 IP bundle (Table 1). The incidence rate of HA-RVI decreased by 60% after bundle implementation. COVID-19 became the dominant HA-RVI, and no cases of HA-influenza occurred in the postimplementation period (Figure 1). Conclusions: Implementation of a comprehensive COVID-19 IP bundle likely contributed to a reduction in HA-RVI for hospitalized patients in our healthcare system. Augmenting traditional IP interventions in place during the annual respiratory virus season may be a future strategy to reduce rates of HA-RVI for inpatients.

Community-acquired and hospital-acquired respiratory tract infection and bloodstream infection in patients hospitalized with COVID-19 pneumonia

ObjectivesSARS-CoV-2 may cause acute lung injury, and secondary infections are thus relevant complications in patients with COVID-19 pneumonia. However, detailed information on community- and hospital-acquired infections among patients with COVID-19 pneumonia is scarce.MethodsWe identified 220 SARS-CoV-2-positive patients hospitalized at the University Hospital Basel, Switzerland (between 25 February and 31 May 2020). We excluded patients who declined the general consent (n = 12), patients without clinical evidence of pneumonia (n = 29), and patients hospitalized for < 24 h (n = 17). We evaluated the frequency of community- and hospital-acquired infections using respiratory and blood culture materials with antigen, culture-based, and molecular diagnostics. For ICU patients, all clinical and microbial findings were re-evaluated interdisciplinary (intensive care, infectious disease, and clinical microbiology), and agreement reached to classify patients with infections.ResultsIn the final cohort of 162 hospitalized patients (median age 64.4 years (IQR, 50.4–74.2); 61.1% male), 41 (25.3%) patients were admitted to the intensive care unit, 34/41 (82.9%) required mechanical ventilation, and 17 (10.5%) of all hospitalized patients died. In total, 31 infections were diagnosed including five viral co-infections, 24 bacterial infections, and three fungal infections (ventilator-associated pneumonia, n = 5; tracheobronchitis, n = 13; pneumonia, n = 1; and bloodstream infection, n = 6). Median time to respiratory tract infection was 12.5 days (IQR, 8–18) and time to bloodstream infection 14 days (IQR, 6–30). Hospital-acquired bacterial and fungal infections were more frequent among ICU patients than other patients (36.6% vs. 1.7%). Antibiotic or antifungal treatment was administered in 71 (43.8%) patients.ConclusionsCommunity-acquired viral and bacterial infections were rare among COVID-19 pneumonia patients. By contrast, hospital-acquired bacterial or fungal infections were frequently complicating the course among ICU patients.

1417. Clinical Features and Outcomes of raoultella terrigena Infections. A Single-Center Experience from Karachi, Pakistan

Background Raoultella terrigena (formerly Klebsiella terrigena) is an environmental gram-negative rod, occasionally causing infections in humans, especially in elderly, immunosuppressed patients. Moreover, this organism tends to be multi-drug resistant, limiting treatment options. Evidence on clinical presentation and outcomes of this infection is limited; we conducted a cross-sectional study to get a better insight into these infections.MethodsWe conducted a cross-sectional study on all adult patients with clinical specimen positive for Raoultella terrigena at a 700-bedded tertiary care hospital in Karachi, Pakistan, between January 2013 to December 2018.ResultsA total of 58 patients with R. terrigena were identified. The median age was 61.5 years, and the male to female ratio was (60.9% vs. 39.1%). The most common site of infection was respiratory tract 28.3%, followed by urinary tract infections 26%, and central line-associated infections 15.2%. In 12 patients 22.6%, R. terrigena was a colonizer. Amongst infected cases, 23.6% were in shock, and of which 18.1% required vasopressors. 29.2% had respiratory failure requiring non-invasive ventilation in 13.9%, and mechanical ventilation in 15.3%. The previous history of multidrug-resistant organisms was present in 67.4% cases and the history of prior antibiotics use within the last six months was present in 78.3%. 91.3% of isolates were resistant to piperacillin-tazobactam and meropenem, 65.2% were resistant to colistimethate. However, tigecycline susceptibility maintained in 30.4% checked in n=31, 67.4% and fosfomycin sensitivity in 15.2% cases, checked in n=29, 63% cases. Eight patients lost to follow up. Majority of patients were treated with combination therapy n=31, 81.6% and meropenem plus colistemethate was the most commonly used combination n=11, 44%. The overall mortality rate was 44.7%. Among all recorded co-morbid conditions, chronic kidney disease was strongly associated with mortality (p= .029), as also the use of vasopressors (p= .005).Persons who had high (greater or equal to three) Charlson comorbidity index had high mortality (p=0.002).Conclusion R.terrigena is a highly drug-resistant organism with high mortality rate, and causes hospital-acquired respiratory tract infections in majority of patients.Disclosures All Authors: No reported disclosures

Etiologic Features of Respiratory Tract Infections Seen in Children with Primary Nephrotic Syndrome: A Cross-Sectional Retrospective Study

Background: Respiratory tract infections (RTI) are common complications of primary nephrotic syndrome (PNS) and influence the outcomes of PNS. The pathogenic spectrum and their susceptibility to antibiotics in RTI change over time, which increases the difficulty of treatment. Objectives: To improve the curative effect of RTI in children with PNS, we conducted a cross-sectional retrospective study in 2740 children with PNS to study the etiologic features of RTI seen in PNS children. Methods: Totally 2740 children with PNS hospitalized during 2010 - 2014 were enrolled in this study. Respiratory specimens were collected for the detection of pathogens using current laboratory diagnostic tests. The cases were divided into community-acquired respiratory tract infection (CARTI) and hospital-acquired respiratory tract infection (HARTI) as well as upper respiratory tract infection (URTI) and lower respiratory tract infection (LRTI) to analyse the etiologic features. Results: Among 2162 cases of PNS with RTI, 2095 cases were CARTI (96.90%), and 67 cases were HARTI (3.10%). The most common pathogen in CARTI was Coxsackie virus, followed by Mycoplasma pneumoniae, respiratory syncytial virus, and Streptococcus pneumoniae, while the most common pathogen in HARTI also was Coxsackie virus, followed by respiratory syncytial virus, Mycoplasma pneumoniae, and Streptococcus pneumoniae. There was significant difference in the positive rates of Pseudomonas aeruginosa and Candida albicans between CARTI and HARTI. The distribution of pathogens differed between URTI and LRTI in children with PNS. The positive rates of most pathogens were lower in URTI than LRTI. Generally, the isolation rate of extended-spectrum β-lactamase (ESBL) producing bacteria was relatively low. In CARTI, the sensitive rates of Gram-negative ESBL producing bacteria to carbapenems, amoxicillin/clavulanate potassium, ampicillin/sulbactam, and ciprofloxacin were more than 90.00%, while Gram-positive ESBL producing bacteria were sensitive to glycopeptides, linezolid, macrodantin, mupirocin-HL, and amoxicillin/clavulanate potassium. Conclusions: In children with PNS, the etiology differed between CARTI and HARTI as well as URTI and LRTI. Therefore, it is necessary to differentiate these features for empirical therapy. If the pathogen is bacterial, amoxicillin/clavulanate potassium could be the first choice before sputum culture results are available.

Prevention of hospital-acquired respiratory viral infections: Assessment of a multimodal intervention program.

A multimodal program focused on preventing nosocomial respiratory viral infections. Definite cases per 1,000 discharges increased 1.3-fold in hospital units screening visitors for respiratory viral symptoms during the 2017-2018 respiratory virus season but not during the 2016-2017 season. Definite cases per 1,000 discharges increased 3.1-fold in hospital units that did not screen visitors either season.

M. pneumoniae and C. pneumoniae are no relevant pathogens in critically ill patients with hospital-acquired respiratory tract infections.

To assess the incidence of Mycoplasma pneumoniae and Chlamydia pneumoniae in the pathogenesis of hospital-acquired respiratory tract infections (RTIs) in critically ill patients. This is a retrospective cohort study of all ICU-patients ≥18 years with RTI who underwent conventional culture techniques and PCR testing for both M. pneumoniae and C. pneumoniae from respiratory tract specimens (bronchoalveolar lavage or tracheobronchial aspirates) between January 2013 to May 2017 at the Jena University Hospital. In total, 314 patients were included in the analysis. Of these, 210 (66.9%) patients were diagnosed with HAP, 65 (20.7%) with VAP and 39 (12.4%) with VAT. Overall, 73 (30.7%) patients were on mechanical ventilation on the day of microbiological examination. PCR-testing for M. pneumoniae was positive in two patients (0.6%) and for C. pneumoniae in zero patients. Our study shows that the incidence of M. pneumoniae and C. pneumoniae in the pathogenesis of hospital-acquired RTIs in critically ill patients is negligible. The results support the recommendations of the guidelines not to perform empiric therapy covering these pathogens.

A Nosocomial Respiratory Infection Outbreak of Carbapenem-Non-Susceptible &lt;i&gt;Escherichia coli&lt;/i&gt; ST131 with Multiple Transmissible &lt;i&gt;blaKPC-2&lt;/i&gt; Carrying Plasmids

Background: Escherichia coli sequence type (ST) ST131 is one of the most widespread and successful opportunistic pathogenic E. coli clones known as multiple-resistance. It can cause community- and hospital-acquired urinary tract infection, abdominal and pelvic infection, and bacteraemia with high morbidity and mortality. Currently, carbapenems have been considered the treatment of choice for E. coli ST131 infections. Although carbapenem resistance is still rare, the resistance rate to carbapenems is growing slowly mainly due to the acquisition of β-lactamase and carbapenemase. In this study, we report a nosocomial outbreak of predominantly respiratory infections caused by blaKPC-2 carrying E. coli ST131 in a Chinese hospital and revealed the transmission of carbapenem-non-susceptible E. coli, as well as the acquisition and spread of blaKPC-2 by E. coli ST131. Methods: A total of 45 carbapenem-non-susceptible E.coli strains were collected in one Beijing hospital from July 2012 to December 2013. The characteristic of these strains including antimicrobial susceptibility, carbapenem resistance mechanism, plasmid profiles and genetic background were determined by two-fold broth microdilution method, PCR, PFGE-S1 southern blot hybridization and whole genome sequencing respectively. Phylogenetic relationships between these strains were inferred. The genetic context of blaKPC-2 was analyzed to trace the spread of blaKPC-2. Findings: 45 carbapenem-non-susceptible E. coli strains were isolated from patients mainly with respiratory infections in this nosocomial outbreak. These strains carried blaKPC-2 and belonged to ST131. These strains are closely related and divided into multiple lineages in the phylogenetic tree. It was initially prevalent only in the ward E02, then spread to other wards and multiple lineages co-evolved, resulting in a nosocomial respiratory infection outbreak of carbapenem-non-susceptible E. coli ST131 in these geriatric wards. The blaKPC-2 positive plasmid profiles suggested that the carbapenem resistance was due to the acquisition of multiple transmissible plasmids carrying blaKPC-2 by E. coli ST131. These plasmids with different backbone sequence exhibit wealthy multidrug resistance (MDR) regions and cointegrate structure at the mediate of IS26. Diverse multidrug resistance elements were transferred and rearranged between these plasmids with different backbone sequence at the mediate of IS26, resulting in the rapid spread of antibiotic-resistant genes and blaKPC-2 between these strains. Interpretation: E. coli ST131 has become a multidrug epidemic clone that can cause hospital-acquired respiratory infections that have been less aware. Our research indicates that clinical attention should be paid to the importance of E. coli ST131 in respiratory infections. The emergence of blaKPC in E. coli ST131 may herald the beginning for transmission of blaKPC with high prevalence in communities and hospitals. Close monitoring of blaKPC-2 positive ST131 in hospitals and communities are necessary for control and proper treatment of ST131 infections. Funding Statement: This work was supported by the National Natural Science Foundation of China (81861138053，31761133004 and 81861138004) and the Ministry of Science and Technology (2018ZX10733-402). Declaration of Interests: All authors declare that there are no conflicts of interest. Ethics Approval Statement: Not needed.

Laboratory-based surveillance of hospital-acquired respiratory virus infection in a tertiary care hospital.

Of 7,772 laboratory-confirmed cases of respiratory viral infection among hospitalized patients, 22.8% were categorized as having hospital-acquired infection. The overall incidence of hospital-acquired respiratory viral infection was 3.9 (95% confidence interval, 3.7-4.1) cases per 1,000 admitted patients. Rhinovirus was the most common virus (30.3%), followed by influenza virus (17.6%) and parainfluenza virus (15.6%).

Adherence to Institutional Guidelines for Community and Nosocomial Pneumonia and Its Impact on In-hospital Mortality and 30-day Readmission in a Community Health System

BackgroundAntimicrobial stewardship committee at Kennedy Health created novel pneumonia guidelines in 2016 which were based on local antibiogram and multi-drug resistant organism risk factors. The purpose of this study was to measure adherence to institutional treatment guidelines (ITG) and its impact on mortality and 30-day readmissions.MethodsAn IRB approved retrospective chart review was conducted on patients admitted for > 24 hours with a confirmed diagnosis of bacterial pneumonia. Patients were included if they were ≥18 years old and diagnosed with community-acquired pneumonia (CAP) or hospital-acquired pneumonia (HAP) between April and September 2016. The primary objective of the study was to measure the adherence to ITG for CAP and HAP. The secondary objectives were to measure the in-hospital mortality and 30-day readmission rate between the adherent and non-adherent groups. A pre and post implementation analysis was performed focusing on rates of hospital acquired respiratory infection (HARI) rates, and overall antibiotic utilization.ResultsThere were 216 patients included in the study with CAP (n = 128) and HAP (n = 88). The rate of adherence to ITG was higher in CAP vs.. HAP (73.4% vs. 45.5%, P < 0.001). Although there was no difference observed in mortality between CAP and HAP (0.8% vs. 0.0%, P = 1.0), the rate of 30-day readmissions was lower in CAP vs. HAP (4.7% vs. 29.5%, P < 0.001). When comparing adherent and non-adherent groups, there was no difference in 30-day readmissions in patients with CAP (4.3% vs. 5.9%, P = 0.656) and HAP (30.9% vs. 26.1%, P = 0.613). There was a 32.1% decrease in anti-pseudomonal β-lactam usage in 2016 vs. 2015 (53.6 vs. 79 DOT/1000PD, P = 0.008). Fluoroquinolone utilization was decreased by 55.8% in 2016 vs. 2015 (39.6 vs. 89.6 DOT/1000PD, P < 0.001). Vancomycin utilization decreased by 28.4% in 2016 compared with 2015 (67.9 vs. 94.9, DOT/1000PD, P = 0.009). Comparing 2016 vs. 2015, we noticed a decrease in pseudomonas HARI rates (2% vs. 3%) however, an increase in MRSA HARI rates (1% vs. 0.2%).ConclusionAdherence to ITG was shown to be higher for CAP compared with HAP. Although there was no difference seen in mortality between CAP and HAP, there was significantly lower 30-day readmissions in patients with CAP compared with HAP. Overall, antipseudomonal and anti-MRSA antibiotic utilization was decreased after ITG implementation.Disclosures All authors: No reported disclosures.