MDRO Infection Research Articles

Sequential use of capsular typing and whole-genome sequencing-based analysis for transmission of carbapenem-resistant Acinetobacter baumannii in a tertiary medical center

BackgroundDuring the COVID-19 pandemic, there has been an increasing trend in healthcare-associated infections (HAIs) caused by carbapenem-resistant Acinetobacter baumannii (CRAB), posting a global public health concern. The heightened sensitivity of whole-genome sequencing (WGS) renders it an optimal and potent tool for monitoring outbreaks and tracing the transmission routes of nosocomial pathogens. MethodWe collected CRAB isolates from March 1, 2023, to April 6, 2023 in Chang Gung Memorial Hospital Lin Kou branch, a tertiary medical center in northern Taiwan. Any two or more isolates with the same identifiable capsular K-locus (KL) types were selected, and analyzed via WGS to identify putative transmission clusters, combined with epidemiologic and retrospective analysis on medical records to confirm risk factors and hidden transmission chains. ResultA total of 48 non-redundant CRAB isolates were collected, belonging to ST2 of Pasteur MLST scheme and identifiable KL types of KL2, KL3, KL9, KL10, KL22, KL52. Excluding the KL types that was only found in 1 case, KL2 (n = 9, 22.5 %), KL3 (n = 24, 60 %), KL9 (n = 3, 7.5 %), and KL10 (n = 4, 10 %) were selected for further WGS analysis. Four distinct transmission clusters comprised of 2, 3, 10, and 23 cases were identified on a basis of phylogenetic status. 12 probable transmission chains were revealed, and 2 hidden transmission routes can be speculated. ConclusionThis study referred to some hidden transmission chains that may be missed from traditional surveillance measures. Despite its low prevalence and high cost currently, implementing WGS could be a efficient, prompt, and unequivocal option for future MDRO infection control.

Development and external validation of a model to predict multidrug-resistant bacterial infections in patients with cirrhosis.

We included patients with cirrhosis and bacterial infections from two prospective studies: a transcontinental study was used for model development and internal validation (n = 1302), and a study from Argentina and Uruguay was used for external validation (n = 472). All predictors were measured at the time of infection. Both culture-positive and culture-negative infections were included. The model was developed using logistic regression with backward stepwise predictor selection. We externally validated the optimism-adjusted model using calibration and discrimination statistics and evaluated its clinical utility. The prevalence of MDRO infections was 19% and 22% in the development and external validation datasets, respectively. The model's predictors were sex, prior antibiotic use, type and site of infection, MELD-Na, use of vasopressors, acute-on-chronic liver failure, and interaction terms. Upon external validation, the calibration slope was 77 (95% CI .48-1.05), and the area under the ROC curve was .68 (95% CI .61-.73). The application of the model significantly changed the post-test probability of having an MDRO infection, identifying patients with nosocomial infection at very low risk (8%) and patients with community-acquired infections at significant risk (36%). This model achieved adequate performance and could be used to improve the selection of empiric antibiotics, aligning with other antibiotic stewardship program strategies.

Development and validation of machine learning models to predict MDRO colonization or infection on ICU admission by using electronic health record data

BackgroundMultidrug-resistant organisms (MDRO) pose a significant threat to public health. Intensive Care Units (ICU), characterized by the extensive use of antimicrobial agents and a high prevalence of bacterial resistance, are hotspots for MDRO proliferation. Timely identification of patients at high risk for MDRO can aid in curbing transmission, enhancing patient outcomes, and maintaining the cleanliness of the ICU environment. This study focused on developing a machine learning (ML) model to identify patients at risk of MDRO during the initial phase of their ICU stay.MethodsUtilizing patient data from the First Medical Center of the People’s Liberation Army General Hospital (PLAGH-ICU) and the Medical Information Mart for Intensive Care (MIMIC-IV), the study analyzed variables within 24 h of ICU admission. Machine learning algorithms were applied to these datasets, emphasizing the early detection of MDRO colonization or infection. Model efficacy was evaluated by the area under the receiver operating characteristics curve (AUROC), alongside internal and external validation sets.ResultsThe study evaluated 3,536 patients in PLAGH-ICU and 34,923 in MIMIC-IV, revealing MDRO prevalence of 11.96% and 8.81%, respectively. Significant differences in ICU and hospital stays, along with mortality rates, were observed between MDRO positive and negative patients. In the temporal validation, the PLAGH-ICU model achieved an AUROC of 0.786 [0.748, 0.825], while the MIMIC-IV model reached 0.744 [0.723, 0.766]. External validation demonstrated reduced model performance across different datasets. Key predictors included biochemical markers and the duration of pre-ICU hospital stay.ConclusionsThe ML models developed in this study demonstrated their capability in early identification of MDRO risks in ICU patients. Continuous refinement and validation in varied clinical contexts remain essential for future applications.

Early Intra-Abdominal Bacterial Infections after Orthotopic Liver Transplantation: A Narrative Review for Clinicians.

Despite recent advances in the transplant field, infectious complications after orthotopic liver transplantation (OLT) are major causes of morbidity and mortality. Bacterial intra-abdominal infections (IAIs) are predominant during the first month post-transplantation and affect patient and graft survival. Recently, the emergence of multidrug resistant bacteria has generated great concern in OLT patients. We performed this narrative review of the literature in order to propose a "ready-to-use" flowchart for reasoned empirical antibiotic therapy in the case of suspected post-OLT IAIs. The review was ultimately organized into four sections: "Epidemiology and predisposing factors for IAI"; "Surgical-site infections and perioperative prophylaxis"; "MDRO colonization and infections"; and "Reasoned-empirical antibiotic therapy in early intra-abdominal infections post OLT and source control". Multidisciplinary teamwork is warranted to individualize strategies for the prevention and treatment of IAIs in OLT recipients, taking into account each patient's risk factors, the surgical characteristics, and the local bacterial epidemiology.

Microbiological analysis of nosocomial pneumonia at Tanta University Chest Hospital

BackgroundHospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) represent a major health problem among hospitalized patients leading to consequent morbidity and mortality specially after Covid-19 era and spread of multidrug-resistance organisms)MDRO) in hospitals.AimThis study aimed to analyze the commonest microorganisms responsible for HAP and VAP at Tanta University Chest Hospital.MethodsThis prospective observational study was done at Chest Department, Faculty of Medicine, started from June 2022 to February 2023. Fifty HAP patients’ sputum samples and 50 VAP patients (25 endotracheal aspirates and 25 bronchoalveolar lavages) were included. All collected samples were submitted to standard microbiological tests at Microbiology Department, Tanta Faculty of Medicine.ResultsA total number of 50 HAP and 50 VAP cases were included. Microbial isolates were relatively the same in both groups, where Klebsiella pneumoniae was the predominant isolates (56) followed by Staphylococcus aureus (25), Escherichia coli (14), Pseudomonas aeruginosa (13), Acinetobacter baumannii (5), Streptococcus pneumoniae (4), Enterococci (3), Stenotrophomonas maltophilia (2), Citrobacter freundii (2), Streptococcus pyogenes (2), Providencia stuartii (1), and 7 isolates of Candida. Antimicrobial susceptibility showed predominance of drug-resistance organisms in VAP (78%) versus HAP (28%), P-value: < 0.001. Klebsiella pneumonia showed higher rates of resistance (37 out of 56 isolates, P-value = 0.020). Four out of 5 Acinetobacter baumannii isolates were multidrug resistant, and 2 isolates of Stenotrophomonas maltophilia were polydrug resistant. Multivariate logistic regression analysis showed that intravenous antibiotic administration within last 3 months was associated with risk for MDR-HAP, while univariate regression analysis showed that intravenous antibiotic administration within the last 3 months was the strongest predictor for MDR-VAP. A higher mortality rate was recorded in VAP group (66%), versus (14%) in HAP group (P-value: < 0.001).ConclusionMicrobial isolates were relatively the same in both HAP and VAP, but VAP showed significant predominance of drug-resistant organisms. The most significant predictor for risk of MDRO infection in HAP and VAP was intravenous antibiotic administration within last 3 months; so, raising attention towards antibiotic choice may improve the outcome. Finally, VAP was associated with higher mortality compared to HAP.

Appropriateness of Empirical Antibiotic Therapy in Hospitalized Patients with Bacterial Infection: A Retrospective Cohort Study.

The incidence of inappropriate and excessive empirical antibiotic therapy is unclear. The aim of this study was to determine the prevalence of different empirical antibiotic therapy prescriptions, related factors, and outcomes in hospitalized patients with bacterial infection. A retrospective cohort study was performed and patients with bacterial infection who were admitted between October 1, 2019, and September 30, 2020, were included. Multivariable analysis was performed by the logistic regression model. A total of 536 (42.6%) of the 1257 included patients received inappropriate empirical antibiotic therapy (IEAT), and 368 (29.3%) patients received appropriate but unnecessarily broad-spectrum empirical antibiotic therapy (AUEAT). MDRO (adjusted OR 2.932 [95% CI 2.201~3.905]; p < 0.001) and fever on admission (adjusted OR 0.592 [95% CI 0.415~0.844]; p = 0.004) were correlates of IEAT; sepsis (adjusted OR 2.342 [95% CI 1.371~3.999]; p = 0.002), age (adjusted OR 1.019 [95% CI 1.008~1.030]; p < 0.001), MDRO (adjusted OR 0.664 [95% CI 0.469~0.941]; p = 0.021), and urinary tract infection (adjusted OR 0.352 [95% CI 0.203~0.611]; p < 0.001) were correlates of AUEAT. Patients who received AUEAT were more likely to have a poor prognosis (63 [17.8%] vs 101 [27.4%]; p = 0.002). Both IEAT (median [IQR], 24,971 [13,135-70,155] vs 31,489 [14,894-101,082] CNY; p = 0.007) and AUEAT (median [IQR], 24,971 [13,135-70,155] vs 30,960 [16,475-90,881] CNY; p = 0.002) increased hospital costs. 45.3% (570/1257) of patients were infected with MDRO and 62.9% of them received IEAT. Inappropriate and excessive empirical antibiotic use was widely prevalent among hospitalized patients. Either inappropriate or excessive use of antibiotics may increase the burden of healthcare costs, the latter of which may be associated with poor prognosis. Clinicians need to be more judicious in choosing antibiotic(s). The MDRO epidemic was severe, especially in patients who received IEAT. It is imperative to take effective measures to improve the current situation of antibiotic abuse and antimicrobial resistance.

Multidrug-Resistant Bacteria on Critically Ill Patients with Sepsis at Hospital Admission: Risk Factors and Effects on Hospital Mortality.

To evaluate the effect of MDRO infection on hospital mortality and the risk factors among critically ill patients with sepsis at hospital admission. A cross-sectional study was performed between April 2019 and May 2020, followed by a cohort to evaluate hospital mortality that prospectively included all consecutive patients 18 years or older with sepsis admitted within 48 hours of hospital admission to an adult ICU in Brazil. Patients' characteristics, blood samples within one hour of ICU admission, and microbiological results within 48h of hospital admission were collected. In addition, descriptive statistics, binary logistic regression, and propensity score matching were performed. At least one MDRO was isolated in 85 patients (9.8%). The extended-spectrum beta-lactamase-producing Enterobacterales are the most frequent organism (56.1%). Hypoxemic acute respiratory failure (OR 1.87, 95% CI 1.02-3.40, p = 0.04), Glasgow Coma Score below 15 (OR 2.57, 95% CI 1.38-4.80, p < 0.01), neoplasm (OR 2.66, 95% CI 1.04-6.82, p = 0.04) and hemoglobin below 10.0 g/dL (OR 1.82, 95% CI 1.05-3.16, p = 0.03) were associated with increased MDRO. Admission from the Emergency Department (OR 0.25, 95% CI 0.14-0.43, p < 0.01) was associated with decreased MDRO. In the multivariate analysis, MDRO at hospital admission increased hospital mortality (OR 2.80, 95% CI 1.05-7.42, p = 0.04). After propensity score-matching adjusted to age, APACHE II, SOFA, and dementia, MDRO at hospital admission was associated with significantly high hospital mortality (OR 2.80, 95% CI 1.05-7.42, p = 0.04). The E-value of adjusted OR for the effect of MDRO infection on hospital mortality was 3.41, with a 95% CI of 1.31, suggesting that unmeasured confounders were unlikely to explain the entirety of the effect. MDRO infection increased hospital mortality, and MDRO risk factors should be accessed even in patients admitted to ICU within 48 hours of hospital admission.

Clinical prediction models for multidrug-resistant organism colonisation or infection in critically ill patients: a systematic review protocol

IntroductionMultidrug-resistant organisms (MDROs) are pathogenic bacteria that are the leading cause of hospital-acquired infection which is associated with high morbidity and mortality rates in intensive care units, increasing hospitalisation duration...

114 Long Term Impact of Hospital Acquired Multi-drug Resistant Organisms on Health-related Quality of Life

IntroductionMDROs colonize wounds and cause infections for hospitalized burn patients, which may lead to increased infection risk, wound complications, longer (LOS) and more cost. Little is known about the long-term impacts of MDRO colonization and infection on burn survivors. We aimed to describe the impacts of colonization on long-term health-related quality of life (HRQoL), itch, and pain.MethodsData from adult participants in a multicenter longitudinal outcome study were used. Data was described and χ 2 and Kruskal-Wallis testing was applied to determine differences between the two groups. Outcomes included Veterans RAND 12 (VR-12) physical component summary score (PCS), and PROMIS 29 domains for pain intensity, fatigue, pain interference, physical function, and sleep disturbance. Pruritus was assessed using the 4-D Itch scale for total itch. Multilevel, multiple linear regressions were used for outcome measures at 6 m post-injury. Random effects regression with robust standard errors (SE) were used to evaluate the impacts over time.ResultsThe study included 704 individuals and 92 were MDRO colonized (13%). Colonized patients had larger burns (25% TBSA, IQR 9-45 vs. 8% TBSA, IQR 3–20; p < .001), more operations (4, IQR 2-7 vs. 1, IQR 1-3; p < .001), more grafting (17% TBSA, IQR 3-46 vs. 3% TBSA, IQR 1- 9; p < .001), more ventilator days (2, IQR 0–8 vs. 0 IQR 0-0; p < .001), and longer LOS (34 days, IQR 17 – 64 vs. 16, IQR 9 - 27; p < .001). Adjusting for confounding covariables, such as demographics, colonization was associated with a lower PCS score (OR -0.33, 95% CI -0.68, -0.06; p=.018); a higher fatigue score (OR 0.46, 95% CI 0.13, 0.79; p = .007) and worse itch (OR 0.4, 95% CI -0.01, 0.75; p = .036). There was no association with pain intensity, pain interference, or sleep disturbance. Random effects regression indicated that colonization was associated with lower PCS (OR -5.0, 95% CI -8.60, -1.39; p = .007).ConclusionsImpact of colonization extends beyond the immediate hospitalization and likely has long-term effects on HRQoL. Given our observation of lower physical function after MDRO, more granular research on taxa-specific effects, timing of colonization, and interventions are indicated to elucidate the impact on HRQoL.

Stopping Hospital Infections With Environmental Services (SHINE): A Cluster-randomized Trial of Intensive Monitoring Methods for Terminal Room Cleaning on Rates of Multidrug-resistant Organisms in the Intensive Care Unit.

Multidrug-resistant organisms (MDROs) frequently contaminate hospital environments. We performed a multicenter, cluster-randomized, crossover trial of 2 methods for monitoring of terminal cleaning effectiveness. Six intensive care units (ICUs) at 3 medical centers received both interventions sequentially, in randomized order. Ten surfaces were surveyed each in 5 rooms weekly, after terminal cleaning, with adenosine triphosphate (ATP) monitoring or an ultraviolet fluorescent marker (UV/F). Results were delivered to environmental services staff in real time with failing surfaces recleaned. We measured monthly rates of MDRO infection or colonization, including methicillin-resistant Staphylococcus aureus, Clostridioides difficile, vancomycin-resistant Enterococcus, and MDR gram-negative bacilli (MDR-GNB) during a 12-month baseline period and sequential 6-month intervention periods, separated by a 2-month washout. Primary analysis compared only the randomized intervention periods, whereas secondary analysis included the baseline. The ATP method was associated with a reduction in incidence rate of MDRO infection or colonization compared with the UV/F period (incidence rate ratio [IRR] 0.876; 95% confidence interval [CI], 0.807-0.951; P = .002). Including the baseline period, the ATP method was associated with reduced infection with MDROs (IRR 0.924; 95% CI, 0.855-0.998; P = .04), and MDR-GNB infection or colonization (IRR 0.856; 95% CI, 0.825-0.887; P < .001). The UV/F intervention was not associated with a statistically significant impact on these outcomes. Room turnaround time increased by a median of 1 minute with the ATP intervention and 4.5 minutes with UV/F compared with baseline. Intensive monitoring of ICU terminal room cleaning with an ATP modality is associated with a reduction of MDRO infection and colonization.

Analysis of Influencing Factors and Predictive Models of Multidrug-resistant Bacterial Infection in Severe Patients

Objective: To investigate the influencing factors of multi-drug resistant bacterial infections in patients with severe disease and establish a predictive model. Methods: 207 infected patients in our hospital from 2018 to May 2020 were selected for the study, of which 73 carried drug-resistant bacteria. Results: The risk factor network of people infected with multi-drug resistant bacteria is higher than that of people infected with non-multidrug resistant bacteria, and the interaction between risk factors of the former is stronger. Conclusion: Antibiotics must be used appropriately after surgery. When the elderly was abnormal in indicators such as fever and procalcitonin in the ward, they should be considered as high-risk groups of MDRO infection. They need special care and preventive measures.

237. Inpatient and Discharge Antibiotic Use for Hospitalized Patients Growing Multi-Drug Resistant Bacteria in Urine Cultures

BackgroundMultidrug resistant organism (MDRO) infections are a threat to public health. Urinary tract infections (UTIs) are the most common MDRO infection and are responsible for a significant proportion of antibiotic use. Studies demonstrate both duration and type of antibiotics prescribed to patients with MDRO UTI are inappropriate, and that asymptomatic MDRO bacteriuria is inappropriately treated. In addition, antibiotics prescribed at hospital discharge are inappropriate in ~70% of patients. We sought to characterize inpatient and outpatient antibiotic durations to describe burden of antibiotic use for patients with an MDRO isolated from a urine specimen during a hospitalization.MethodsThis retrospective study was conducted at Barnes-Jewish Hospital, a 1266-bed academic medical center in St. Louis, Missouri from 11/7/12-11/7/17. Patients ≥ 18 years of age were included if they had an MDRO isolated from a urine specimen and no other positive bacterial cultures during their hospitalization. Demographics, comorbidities, cultures, and antibiotics were collected via data pulls and chart review. MDROs were defined according to European and US Center for Disease Control and Prevention guidelines. Antibiotic use was described as percentages of all antibiotics used.ResultsA total of 1052 patients had MDROs in urine cultures. Of these patients, 747 (71.0%) were discharged on oral antibiotics for a mean duration of 6.7 days, while 135 (12.8%) were discharged on IV antibiotics for a mean of 10.9 days. The five most commonly administered inpatient antibiotics after urine culture results were available (% prescribed) were IV ceftriaxone (43.0%), IV vancomycin (26.0%), PO ciprofloxacin (25.6%), IV cefepime (24.5%), and PO trimethoprim-sulfamethoxazole (17.6%). The five most commonly prescribed antibiotics at discharge were PO ciprofloxacin (22.3%), PO trimethoprim-sulfamethoxazole (17.8%), PO nitrofurantoin (8.4%), PO cephalexin (6.2%), and PO doxycycline (5.0%).ConclusionPatients with MDROs in urine cultures receive prolonged durations of inpatient and outpatient antibiotics, longer than what is recommended by current evidence and guidelines.Disclosures Dustin Stwalley, MA, AbbVie Inc (Shareholder)Bristol-Myers Squibb (Shareholder) Margaret A. Olsen, PhD, MPH, Merck (Grant/Research Support)Pfizer (Consultant, Grant/Research Support)

Total antibiotic use in a state-wide area and resistance patterns in Brazilian hospitals: an ecologic study

IntroductionUse of antibiotic and bacterial resistance is the result of a complex interaction not completely understood. ObjectivesTo evaluate the impact of entire antimicrobial use (community plus hospitals) on the incidence of bloodstream infections in intensive care units adjusted by socioeconomic factors, quality of healthcare, and access to the healthcare system. DesignEcologic study using a hierarchical spatial model. SettingData obtained from 309 hospitals located in the state of São Paulo, Brazil from 2008 to 2011. ParticipantsIntensive care units located at participant hospitals. OutcomeHospital acquired bloodstream infection caused by MDRO in ICU patients was our primary outcome and data were retrieved from São Paulo Health State Department. Socioeconomic and healthcare indexes data were obtained from IBGE (Brazilian Foundation in charge of national decennial census) and SEADE (São Paulo Planning and Development Department). Information on antimicrobial sales were obtained from IMS Brazil. We divided antibiotics into four different groups (1–4). ResultsWe observed a direct association between the use of group 1 of antibiotics and the incidences of bloodstream infections caused by MRSA (1.12; 1.04–1.20), and CR-Acinetobacter sp. (1.19; 1.10–1.29). Groups 2 and 4 were directly associated to VRE (1.72; 1.13–2.39 and 2.22; 1.62–2.98, respectively). Group 2 was inversely associated to MRSA (0.87; 0.78–0.96) and CR-Acinetobacter sp. (0.79; 0.62–0.97). Group 3 was inversely associated to Pseudomonas aeruginosa (0.69; 0.45–0.98), MRSA (0.85; 0.72–0.97) and VRE (0.48; 0.21–0.84). No association was observed for third generation cephalosporin-resistant Klebsiella pneumoniae and Escherichia coli. ConclusionsThe association between entire antibiotic use and resistance in ICU was poor and not consistent for all combinations of antimicrobial groups and pathogens even after adjusted by socioeconomic indexes. Selective pressure exerted at the community level seemed not to affect the incidences of MDRO infection observed in intensive care setting.

Predicting the occurrence of multidrug-resistant organism colonization or infection in ICU patients: development and validation of a novel multivariate prediction model

BackgroundMultidrug-resistant organisms (MDROs) have emerged as an important cause of poor prognoses of patients in the intensive care unit (ICU). This study aimed to establish an easy-to-use nomogram for predicting the occurrence of MDRO colonization or infection in ICU patients.MethodsIn this study, we developed a nomogram based on predictors in patients admitted to the ICU in the First Affiliated Hospital of Xiamen University from 2016 to 2018 using univariate and multivariate logistic regression analysis. We externally validated this nomogram in patients from another hospital over a similar period, and assessed its performance by calculating the area under the receiver operating characteristic (ROC) curve (AUC) and performing a decision curve analysis.Results331 patients in the primary cohort and 181 patients in the validation cohort were included in the statistical analysis. Independent factors derived from the primary cohort to predict MDRO colonization or infection were male sex, higher C-reactive protein (CRP) levels and higher Pitt bacteremia scores (Pitt scores), which were all assembled in the nomogram. The nomogram yielded good discrimination with an AUC of 0.77 (95% CI 0.70–0.84), and the range of threshold probabilities of decision curves was approximately 30–95%.ConclusionThis easy-to-use nomogram is potentially useful for predicting the occurrence of MDRO colonization or infection in ICU patients.

Risk Factors for Fungal Infection in a Ventricular Assist Device Cohort

Ventricular assist device (VAD) infections are an important cause of morbidity and mortality. Fungal infections are associated with poor outcomes and risk factors to predict infection warrant characterization. A retrospective cohort study of continuous-flow 2nd or 3rd generation VAD devices placed at Northwestern Memorial Hospital from July 2008 to September 2018 was performed. VAD-specific and VAD-related infections were characterized according to 2013 ISHLT definitions. Early infections were defined as occurring less than or equal to 60 days from the date of VAD implantation, late infections were defined as greater than 60 days. Binary logistic regression analysis comparing fungal to non-fungal bacterial infections identified significant risk factors. Summary and comparative statistics were performed using IBM® SPSS Statistics version 25.0. 86 infections occurred in 433 VAD implantations. 93.0% (n = 80) were non-fungal and 7.0% (n = 6) were fungal. Independent risk factors for fungal infection when compared to bacterial infections were early VAD infection (66.6% vs 11.3%, p = 0.000), ischemic cardiomyopathy as an underlying diagnosis (83.3% vs 38.7%, p = 0.033), 3rd generation VAD device (100% vs 53.7%, p = 0.027), polymicrobial infection (83.3% vs 28.8%, p = 0.006), concurrent infection with a multi-drug resistant organism in the same device (66.6% vs 21.2%, p = 0.013) as shown in Table 1. Patients with fungal infections had a higher mortality rate (66.6% vs 27.5%, p = 0.044). Risk factors for fungal infection compared to bacterial infections in VADs are ICM, 3rd generation devices, polymicrobial infection, and concurrent MDRO infections. Mortality is higher in VAD patients with fungal infections.

Analysis on risk factors for multidrug-resistant bacterial infections in patients in neurosurgical intensive care unit

Objective To analyze the risk factors of multidrug-resistant bacteria (MDRO) infection in patients in Neurosurgical intensive care unit (NSICU), and to provide reference for clinical prevention and treatment. Methods 1 251 patients with NSICU in our hospital from January 2012 to March 2018 were selected as the study subjects. The bacterial specimens were extracted. 380 patients with MDRO infection were the observation group, and 871 patients with non-MDRO infection in NSICU were the control group. The patients' medical records and clinical information were retrospectively analyzed, and multivariate logistic regression analysis was used to analyze the risk factors of MDRO infection in NSICU patients. Results There was no significant difference in the gender, age and body mass index (BMI) between the observation group and the control group (P>0.05). There was statistical significance in the proportion of hospitalization time, operation, use of urethra tube, mechanical ventilation, serious basic diseases and rational use of antibiotics between the observation group and the control group (P<0.05). According to the analysis on proportion of colony samples, the highest proportion in the observation group was sputum samples, accounted for 45.00%, followed by urine samples (21.58%), and the lowest proportion was other types of samples, accounted for 1.84%. The results of MDRO test showed that the highest proportion of pathogens was methicillin-resistant staphylococcus aureus (MRSA), accounted for 33.69%, followed by pseudomonas aeruginosa (PA), carbapenem-resistant acinetobacter baumannii (CR-AB), and the lowest proportion was stenotrophomonas maltophilia (SM), accounted for 1.58%. Logistic regression analysis showed that surgery, catheterization, mechanical ventilation, serious basic diseases and abuse of antibiotics were risk factors for MDRO infection in NSICU patients (P<0.05). Conclusions Invasive manipulation and antimicrobial abuse are the main risk factors for MDRO infection in NSICU patients, among which respiratory tract infection is the most serious and MRSA strain infection is the most common. The management of drugs and therapeutic devices should be scientific, rational and standardized in order to reduce the infection rate of MDRO. Key words: Intensive care units; Neurosurgery; Drug resistance, multiple, bacterial; Factor analysis, statistical

Impact of Healthcare-Associated Infections on Length of Stay: A Study in 68 Hospitals in China.

Healthcare-associated infections (HAIs) not only bring additional medical cost to the patients but also prolong the length of stay (LOS). 2119 HAI case-patients and 2119 matched control-patients were identified in 68 hospitals in 14 primary sampling provinces of 7 major regions of China. The HAI caused an increase in stay of 10.4 days. The LOS due to HAI increased from 9.7 to 10.9 days in different levels of hospitals. There was no statistically significant difference in the increased LOS between different hospital levels. The increased LOS due to HAI in different regions was 8.2 to 12.6 days. Comparing between regions, we found that the increased LOS due to HAI in South China is longer than other regions except the Northeast. The gastrointestinal infection (GI) caused the shortest extra LOS of 6.7 days while the BSI caused the longest extra LOS of 12.8 days. The increased LOS for GI was significantly shorter than that of other sites. Among 2119 case-patients, the non-multidrug-resistant pathogens were detected in 365 cases. The average increased LOS due to these bacterial infections was 12.2 days. E. coli infection caused significantly shorter LOS. The studied MDROs, namely, MRSA, VRE, ESBLs-E. coli, ESBLs-KP, CR-E. coli, CR-KP, CR-AB, and CR-PA were detected in 381 cases (18.0%). The average increased LOS due to these MDRO infections was 14 days. Comparing between different MDRO infections, we found that the increased LOS due to HAI caused by CR-PA (26.5 days) is longer than other MDRO infections (shorter than 19.8 days).

Evaluation of the Impact of Antimicrobial Stewardship Program (ASP) on Unrestricted Use of Meropenem at an Academic Medical Center

Objective The primary objectives were to evaluate the prescriber acceptance rate of Antimicrobial Stewardship Program (ASP) pharmacist recommendation to de-escalate/discontinue meropenem, and estimate the difference in duration of meropenem therapy. The secondary objective was to determine incidence of adverse events in the two groups. Methods It was a retrospective study. All patients admitted to Gwinnett Medical Center and receiving meropenem from January–November 2015 were included in the study. Exclusion criteria were: patients admitted to intensive care unit, one-time dose, infectious disease consultation, and age &lt;18 years. Electronic medical records were reviewed for data collection. The control group consisted of patients from January–July 2015 when there was no ASP pharmacist. The intervention group consisted of patients from August–November 2015 during which period the ASP pharmacist recommended de-escalation/discontinuation of meropenem based on culture and sensitivity results. Results A total of 41 patients were studied, 21 in the control group and 20 in the intervention group. There was no significant difference in baseline characteristics in the two groups and in terms of prior hospitalization or antibiotic use (within 90 days) and documented or suspected MDRO infection at the time of admission. De-escalation/discontinuation was suggested in 16/20 patients in the intervention group (80%), and intervention was accepted in 68%. The mean duration of therapy was significantly decreased in the intervention group (5.6 days vs. 8.1 days, p =0.0175). Two patients had thrombocytopenia (unrelated to meropenem), and none of the patients had seizure. Conclusion Targeted antibiotic review is an effective ASP strategy, which significantly decreases the duration of meropenem therapy.

1204. The MDR Upon Admission Score for Shortening Time to Initiation of Appropriate Antimicrobial Therapy in the Era of Widespread Resistance to Antimicrobials

BackgroundMulti-drug-resistant organisms (MDRO) pose a growing burden, including in non-hospital settings. Delay in initiation of appropriate antimicrobial therapy (DAAT) upon admission to an acute care hospital is common and is associated with worse outcomes. The aim of this study was to develop a prediction score for MDRO infection upon admission, in order to improve patients’ outcomes and avoid misuse of broad-spectrum antimicrobials.MethodsA retrospective case–control analysis was conducted at Assaf Harofeh Medical Center, Israel, comparing adult patients with MDRO infections diagnosed in the first 48 hours of hospitalization to patients presenting with non-MDRO sepsis (i.e., patients with microbiologically confirmed non-MDRO infection, or patients with non-microbiologically confirmed sepsis). MDROs were determined by clinical laboratory testing. Patients were identified over four consecutive months (August–December 2016). A multivariable logistic regression of predictors for MDRO infection upon admission was used to develop the prediction score.ResultsNinety-five of 818 total patients (11.6%) had MDRO infection. The final score included 10 parameters: (1) home therapy (IV therapy, wound care, or specialized nursing care, 16 points), (2) routine (at least weekly) outpatient clinic visits in the past 3 months (15 points), (3) history (2 years) of past MDRO colonization (14 points), (4) any antibiotics in the preceding 3 months (12 points), (5) invasive procedure in the past 6 months (11 points), (6) elderly (≥65 years old, 10 points), (7) hemiplegia or paraplegia (8 points), (8) resident of long-term care facility (7 points), (9) severe sepsis (i.e., severe sepsis, septic shock, or multi-organ failure, 6 points), and (10) acute kidney injury (5 points). A cutoff of ≥24 points had a sensitivity of 90%, a specificity of 73% and an ROC AUC = 0.88 (figure).ConclusionThis study presents the development of a new prediction score for MDRO infection upon admission, based on parameters that could easily be extracted at bedside for patients admitted with sepsis. A future prospective interventional study is needed in order to validate the score, captured at bedside electronically, in terms of improving patients’ outcomes. Disclosures All authors: No reported disclosures.

Infectious Diseases Consultation Reduces 30-Day and 1-Year All-Cause Mortality for Multidrug-Resistant Organism Infections.

BackgroundMultidrug-resistant organism (MDRO) infections are associated with high mortality and readmission rates. Infectious diseases (ID) consultation improves clinical outcomes for drug-resistant Staphylococcus aureus bloodstream infections. Our goal was to determine the association between ID consultation and mortality following various MDRO infections.MethodsThis study was conducted with a retrospective cohort (January 1, 2006–October 1, 2015) at an academic tertiary referral center. We identified patients with MDROs in a sterile site or bronchoalveolar lavage/bronchial wash culture. Mortality and readmissions within 1 year of index culture were identified, and the association of ID consultation with these outcomes was determined using Cox proportional hazards models with inverse weighting by the propensity score for ID consultation.ResultsA total of 4214 patients with MDRO infections were identified. ID consultation was significantly associated with reductions in 30-day and 1-year mortality for resistant S. aureus (hazard ratio [HR], 0.48; 95% confidence interval [CI], 0.36–0.63; and HR, 0.73, 95% CI, 0.61–0.86) and Enterobacteriaceae (HR, 0.41; 95% CI, 0.27–0.64; and HR, 0.74; 95% CI, 0.59–0.94), and 30-day mortality for polymicrobial infections (HR, 0.51; 95% CI, 0.31–0.86) but not Acinetobacter or Pseudomonas. For resistant Enterococcus, ID consultation was marginally associated with decreased 30-day mortality (HR, 0.81; 95% CI, 0.62–1.06). ID consultation was associated with reduced 30-day readmission for resistant Enterobacteriaceae.ConclusionsID consultation was associated with significant reductions in 30-day and 1-year mortality for resistant S. aureus and Enterobacteriaceae, and 30-day mortality for polymicrobial infections. There was no association between ID consultation and mortality for patients with resistant Pseudomonas, Acinetobacter, or Enterococcus, possibly due to small sample sizes. Our results suggest that ID consultation may be beneficial for patients with some MDRO infections.