Microbiological Factors Research Articles

Temporal space infection secondary to recurrent buccal space infection from mandibular deciduous molar in 7-year-old child: a case report

Head and neck space infections are usually secondary to odontogenic infections due to translocation of oral microbes to fascial space via odontogenic route resulting in progression by enzymatic degradation of connective tissue. Various factors like microbiological, host, nutritional and socioeconomic factors are responsible for progression of fascial space infection that might take fatal course if not treated in time. The present case report describes a child with fascial space infection of oral and maxillofacial region who was treated by incision and drainage in department of oral and maxillofacial surgery of this hospital. Fascial space infections are one of the surgical emergencies and need to be addressed in early stage as it has rapid regional and systemic progression leading to fatal outcome. It is multifactorial and all need to be addressed. Incision and drainage with removal of cause with antimicrobial therapy is treatment modality of space infection. Inadequate drainage might lead to recurrence of infection and progression to distant secondary spaces.

Isolation of pathogenic Candida species from oral cavity of postpartum females, and its association with obstetric and dental problems

ObjectiveThe aim of the current study was to investigate pathogenic Candida spp. Colonization in oral cavity of postpartum females and its association with adverse pregnancy outcomes (APOs) and dental issues. MethodsSaliva samples and clinico-demographic data were collected from 267 postpartum females along with 54 non-pregnant females (Jan 2016–March 2018). Isolation of Candida was carried out by using standard microbiological methods and different virulence factors (Esterase activity, phospholipase activity and biofilm formation) were evaluated. ResultsCandidacolonization was high in postpartum females (p<0.001, OR = 4.28). This colonization was not significant among females with APOs, however, one to three folds risk was seen with different obstetric and dental factors. High esterase activity was seen among Candida isolates from postpartum females in comparison to control group (p = 0.01). Phospholipase activity of C.albicans isolates from this group was also high (p = 0.001). Majority of the Candida isolates (66.87%) from postpartum females were biofilm formers. Increase in antifungal activity was seen among isolates from postpartum females, with 85% isolates resistant to Fluconazole and Voriconazole (p<0.001) and Amphotericin B resistance was present in 64.38% isolates (p<0.001). ConclusionPostpartum females are more susceptible to oral Candida colonization, which exhibit enhanced virulence characteristics and its carriage are associated with increased risk for development of APOs and dental problems.

Risk Factors for Delayed Isolation of Patients with Active Pulmonary Tuberculosis in an Acute-care Hospital

The objective of the current study was to determine the factors associated with delayed isolation of pulmonary tuberculosis (TB). In this retrospective study, data of patients newly diagnosed with pulmonary TB from January 2015 through December 2017 at a referral hospital were reviewed. Delayed recognition of pulmonary TB was defined as failure to initiate airborne isolation within the first 3 days of admission. We analyzed the clinical, microbiological, and radiological factors associated with delayed isolation of pulmonary TB. A total of 134 patients with positive sputum acid-fast bacilli (AFB) cultures were analyzed, of which 44 (33%) were isolated within 3 days after admission. In multivariate logistic regression analysis, older age (p = 0.01), admission to departments other than Infectious Disease or Pulmonology (p = 0.005), and presence of malignancy (p = 0.02) were associated with delayed isolation. Patients with a radiologic diagnosis of active pulmonary TB were likely to be isolated early (p = 0.01). Better awareness of pulmonary TB among attending practitioners in hospital settings is required. Delay in isolation is associated with older age, malignancy, hospitalization to departments other than Infectious Disease or Pulmonology, and non-confident radiologic diagnosis of active pulmonary TB.

Soil quality assessment of wheat-maize cropping system with different productivities in China: Establishing a minimum data set

The double-cropping of winter wheat and summer maize is a major grain production system in China which occupies more than half the double-cropping systems of the country’s dryland area. This cropping system has experienced a decreased crop yield and soil quality and the limiting factors are poorly known. The goal of this study was to conduct a systematic evaluation of wheat yield and soil quality from 132 fields along a regional scale in China. The specific objectives were (i) to establish a minimum data set (MDS) in wheat phase under the wheat-maize cropping system (ii) to evaluate soil quality of the wheat field and determine the factors limiting wheat productivity. The wheat-maize cropping system was partitioned into three productivity levels (high, medium and low) according to the wheat yield. Twenty-six soil indicators, including soil microbiological, chemical and physical factors were measured and analyzed. Using Pearson correlation analysis we identified eight key soil indicators that determine wheat yield. We then used principal component analysis to determine an MDS, which included soil organic matter, alkali-hydrolyzable nitrogen, the ratio of microbial biomass nitrogen to total nitrogen, and available zinc. One-way analysis of variance based on the individual contribution of each MDS indicators under three productivity, revealed available nitrogen, soil organic matter and the ratio of microbial biomass nitrogen to total nitrogen was the most important indicators on limiting wheat yield. A soil quality index (SQI) based on scoring and weighting of MDS indicators was integrated as a tool for assessing farmland soil quality. Based on the MDS, high (HP), medium (MP) and low (LP) productivity received mean SQI of 0.55, 0.48 and 0.39, respectively. The significant positive correlation between SQI and wheat yield suggests that this is a good representative of the MDS for the wheat-maize cropping system in China. We conclude that our SQI may be an effective and practical tool to guide a strategic, regional goal with respect to sustainable high yields.

Microbiological profile and risk factors for in-hospital mortality of infective endocarditis intertiary care hospitals of south Vietnam

Objectives We aimed to evaluate the microbiological characteristics and risk factors for mortality of infective endocarditis in two tertiary hospitals in Ho Chi Minh City, south Vietnam. Materials and methods A retrospective study of 189 patients (120 men, 69 women; mean age 38±18 years) with the diagnosis of probable or definite infective endocarditis (IE) according to the modified Duke Criteria admitted to The Heart Institute or Tam Duc Hospital between January 2005 and December 2014. Results IE was related to a native valve in 165 patients (87.3%), and prosthetic valve in 24 (12.7 %). Of the 189 patients in our series, the culture positive rate was 70.4 %. The most common isolated pathogens were Streptococci (75.2%), Staphylococci (9.8%) followed by gram negative organism (4.5%). The sensitivity rate of Streptococci to ampicillin, ceftriaxone or vancomycin was 100 %. The rate of methicillin resistant Staphylococcus aureus was 40 %. There was a decrease in penicillin sensitivity for Streptococci over three eras: 2005 ± 2007 (100 %), 2008 ± 2010 (94 %) and 2010 ± 2014 (84 %). The in-hospital mortality rate was 6.9 %. Logistic regression analysis found prosthetic valve and NYHA grade 3 or 4 heart failure and vegetation size of more than 15 mm as strong predictors of in-hospital mortality. Conclusion Streptococcal species were the major pathogen of IE in the recent years with low rates of antimicrobial resistance. Prosthetic valve involvement, moderate or severe heart failure and vegetation size of more than 15 mm were independent predictors for in-hospital mortality in IE.

Farmakoterapia skóry. Cz. 1. Budowa i fizjologia skóry

The study presents the structure and physiology of the skin in terms of transport and ways of permeation of medicinal and cosmetic substances of plant origin through the skin. Human skin structure is composed of three layers: the epidermis, true skin and subcutaneous tissue. The skin is composed also of appendages: sudoriferous and sebaceous glands, hair and nails. In addition, we distinguish blood and lymphatic vessels as well as sensory nerves. The paper also discusses the role of the horny barrier, the reaction and water-lipid layer of the skin and its microflora. The most important functions of the skin are: protective role in relation to mechanical, physical, chemical and microbiological factors, thermoregulation of the body, the role in the secretory and water management, participation in the synthesis of some compounds (e.g. vitamin D) and protein, lipid and carbohydrate metabolism, complicity in the body’s immune response and in the conductivity of sensory impulses.

Central line-associated bloodstream infection among children with biliary atresia listed for liver transplantation.

BACKGROUNDPre-transplant nutrition is a key driver of outcomes following liver transplantation in children. Patients with biliary atresia (BA) may have difficulty achieving satisfactory weight gain with enteral nutrition alone, and parenteral nutrition (PN) may be indicated. While PN has been shown to improve anthropometric parameters of children with BA listed for liver transplantation, less is known about the risks, particularly infectious, associated with this therapy among this specific group of patients.AIMTo describe the incidence, microbiology, and risk factors of central line-associated bloodstream infection (CLABSI) among children with BA listed for liver transplantation.METHODSRetrospective review of children aged ≤ 2-years of age with BA who were listed for primary liver transplantation at Texas Children’s Hospital from 2008 through 2015 (n = 96). Patients with a central line for administration of PN (n = 63) were identified and details of each CLABSI event were abstracted. We compared the group of patients who experienced CLABSI to the group who did not, to determine whether demographic, clinical, or laboratory factors correlated with development of CLABSI.RESULTSNineteen of 63 patients (30%, 95%CI: 19, 43) experienced 29 episodes of CLABSI during 4800 line days (6.04 CLABSI per 1000 line days). CLABSI was predominantly associated with Gram-negative organisms (14/29 episodes, 48%) including Klebsiella spp., Enterobacter spp., and Escherichia coli. The sole polymicrobial infection grew Enterobacter cloacae and Klebsiella pneumoniae. Gram-positive organisms (all Staphylococcus spp.) and fungus (all Candida spp.) comprised 9/29 (31%) and 6/29 (21%) episodes, respectively. No demographic, clinical, or laboratory factors were significantly associated with an increased risk for the first CLABSI event in Cox proportional hazards regression analysisCONCLUSIONThere is substantial risk for CLABSI among children with BA listed for liver transplantation. No clinical, demographic, or laboratory factor we tested emerged as an independent predictor of CLABSI. While our data did not show an impact of CLABSI on the short-term clinical outcome, it would seem prudent to implement CLABSI reduction strategies in this population to the extent that each CLABSI event represents potentially preventable hospitalization, unnecessary healthcare dollar expenditures, and may exact an opportunity cost, in terms of missed allograft offers.

Utility of sequential organ failure assessment score in predicting outcome for patients with peritoneal sepsis

Background: Severe complicated intra-abdominal sepsis (SCIAS) is a worldwide challenge with increasing incidence. The sequential organ failure assessment (SOFA) score numerically quantifies the number and severity of failed organs. We examined the utility of the SOFA score for assessing outcome of patients with severe peritoneal sepsis.Methods: This is a prospective observational study. A total of 100 patients who presented to emergency department of Victoria hospital with features suggestive of peritoneal sepsis from January 2018 to August 2018 were included in the study. The presence of organ dysfunction was assessed using a sequential organ failure assessment (SOFA). Clinical, microbiologic, and laboratory factors were considered for assessing the outcome.Results: Forty-two patients had two or more sites of infection on admission. Bacteraemia was confirmed in 20 patients. 88 patients were surgical. The median age of patients was 69 years. Males being more commonly affected than females. Twenty-eight days survival rate was 41%. The incidence of organ dysfunction on day 1 was noted more frequently for renal, cardiovascular, and neurological systems. SOFA score on day 1 and day 3 were significantly higher in non-survivors than those in survivors. Patients with three and higher number of organ systems with dysfunction had a lower survival rate than the subgroups of patients with one or two organ systems with dysfunction.Conclusions: The SOFA score provides potentially valuable prognostic information on in hospital survival when applied to patients with severe peritoneal sepsis.

Predicting tuberculosis relapse in patients treated with the standard 6-month regimen: an individual patient data meta-analysis

BackgroundRelapse continues to place significant burden on patients and tuberculosis (TB) programmes worldwide. We aimed to determine clinical and microbiological factors associated with relapse in patients treated with the WHO...

Electromagnetic Pollution of the Environment and its Effects on the Materials from the Built up Media

In built up media (complex built environment), the materials are simultaneously exposed to a series of physical, chemical and microbiological stress factors that act synergistically with disturbing electromagnetic fields and cause material degradation - with consequences on the durability and safety in exploitation of buildings and installations. The main generative sources of disturbing fields (stray current generators) on built up media are railroads with DC or AC traction with various operating voltage and frequency, medium and high voltage overhead power lines and unbalanced currents from a three-phase power system. The generated stray currents cause destruction both in metallic elements of built structures (railroads, power installations) and in neighbouring constructions and installations (belonging to other administrations) with negative environmental implications.

TB sequel: incidence, pathogenesis and risk factors of long-term medical and social sequelae of pulmonary TB \u2013 a study protocol

BackgroundUp to fifty percent of microbiologically cured tuberculosis (TB) patients may be left with permanent, moderate or severe pulmonary function impairment. Very few studies have systematically examined pulmonary outcomes in patients to understand the pathophysiologic basis and long-term socio-economic consequences of this injury. The planned multi-country, multi-centre observational TB cohort study, aims to advance the understanding of the clinical, microbiological, immunological and socio-economic risk factors affecting long-term outcome of pulmonary TB. It will also determine the occurrence of reversible and irreversible socio-economic consequences to patients, their households and the health sector related to pulmonary TB disease and its treatment.MethodsWe will enrol up to 1.600 patients with drug sensitive and multidrug-resistant pulmonary TB who are treated according to the local standard of care by the respective National TB Program. Recruitment is taking place at the time of TB diagnosis at four African study clinics located in The Gambia, Mozambique, South Africa and Tanzania. The primary outcome is the proportion of TB patients with severe lung impairment measured by spirometry at 24 months after TB treatment initiation. Biological samples, including sputum, urine and blood, for studying host- and pathogenic risk factors will be collected longitudinally and examined in a nested case-control fashion. A standardized quality of life questionnaire will be used together with a novel version of WHO’s generic patient cost instrument which has been adapted for the longitudinal study design.DiscussionThis study is an integral part of an overall strategy to fill a knowledge gap needed to improve TB treatment outcomes globally. The main scientific goal is to identify the major pathogenic mechanisms associated with poor TB treatment outcomes, so that such pathways can be interrupted to avert long term TB sequelae. National as well as supra-national stakeholders and decision makers have been integrated early in the study planning process to inform future treatment guidelines and national health policies.Trial registrationClinicalTrials.gov: NCT03251196, August 16, 2017.

Technological and microbiological factors affecting the polyphenolic profile of Montenegrin red wines

The main objective of this study was to determine the impact of three commercial yeasts (BDX, ICVD21 and BM4x4) and lactic acid bacteria (VP41 and ALPHA) on the phenolic profile of Montenegrin red wines. Wines made of two autochthonous grape varieties (Vranac and Kratosija) and international grape variety (Cabernet Sauvignon) were examined. The research was performed during the 2012 and 2013 vintage and twenty-one phenolic compounds, including stilbenes, hydroxycinnamic and hydroxybenzoic acids, and flavonols have been identified in the wine after alcoholic and malolactic fermentation, using the liquid chromatography-mass spectrophotometry method. The influence of different commercial yeasts on all analysed phenolic compounds was statistically significant (p ??0.05) for all examined wines, and there were also statistically significant differences between varietal wines. After alcoholic and malolactic fermentation, the highest average content of p-coumaric acid was determined in Vranac wines. Additional analysis of stilbenes after alcoholic fermentation of varietal wines of the 2013 vintage revealed that the total content of stilbenes was the highest in Vranac wines, where a significant increase of their concentration was observed in wines inoculated with commercial yeast. A similar trend was observed in all studied wine varieties.

A rare agent of continuous ambulatory peritoneal dialysis peritonitis: Rhizobium Radiobacter

Peritonitis is a common clinical problem in patients treated by continuous ambulatory peritoneal dialysis (CAPD). The most common microbiological factors causing peritonitis are Gram-positive (especially Staphylococcus spp.). Peritonitis with Rhizobium radiobacter (Agrobacterium radiobacter) is a rare infection in CAPD patients. Peritonitis due to R. radiobacter has been reported in our patient's dialysate culture who underwent CAPD for three years. We report the case of a 26-year-old female PD patient who had CAPD peritonitis due to R. radiobacter and successfully treated with intraperitoneal vancomycin and oral ciprofloxacin without relapses or removing the PD catheter.

Evidence of secondary sulfate production in the mineral soil of a temperate forested catchment in southern Québec, Canada

The analysis of sulfate stable isotope ratios (δ18O-SO4 and δ34S-SO4) in different hydrological compartments of forested catchments has revealed the major role of the humus layer in recycling atmospherically derived sulfur (S). The contribution of the mineral soil to S recycling is still uncertain and may vary among forest types. Here, seasonal variations in SO4 concentration, δ18O-SO4 and δ34S-SO4 were investigated over a period of two and a half years in precipitation and at various depths in the soil solutions in a temperate forest catchment dominated by sugar maple in southern Québec, Canada. δ18O-SO4 declined from precipitation (11.8‰) to the humus solution (4.8‰) and to the soil solution beneath the upper B-horizon (1.2‰). No decline was observed below the upper B-horizon. This decline from precipitation to the humus layer reflected a production of secondary sulfate through chemical oxidation of SO2 in the canopy, while the decline in the soil resulted from microbial mineralization of organic S. In contrast with findings at other boreal and temperate forest sites, lower δ18O-SO4 in the upper mineral soil than in the humus layer was indicative of microbial transformations of S not only in the humus layer but also deeper in the upper part of the mineral soil. Significant seasonal variations were found for δ18O-SO4 in precipitation and in soil solutions beneath the humus and the top mineral horizon, reflecting the influence of both hydrological and microbiological factors. Higher δ18O-SO4 in the soil solution in fall than in spring and summer resulted from the release of primary sulfate from snow cover in early spring, which was subsequently recycled by soil microorganisms during the growth season, resulting in a higher proportion of secondary sulfate in fall than in spring and summer.

Risk factors, microbiological findings and outcomes of necrotizing fasciitis at a tertiary care centre

Background: Necrotizing fasciitis (NF) is a uncommon and serious infection involving the skin and subcutaneous tissues of lower and upper limbs, perineal area (Fournier’s gangrene), and the abdominal wall with high morbidity and mortality. Early diagnosis and aggressive treatment can reduce the mortality rate of NF. The objectives of this study are to study the etiolopathological, microbiological factors determining the outcome of necrotizing fasciitis.Methods: It is prospective study and was conducted in JSS Medical College and Hospital in October 2008 to October 2010. Total 50 patients diagnosed with necrotizing fasciitis were admitted to JSS Medical College and Hospital. Demographic data, type of co morbidities, site of infection, clinical features with microbiology and laboratory results, and outcomes of patients were analyzed.Results: Out of 50 patients there were 42 males and 8 females. Highest number of cases was found in the age group of 65-74 years among males, 55-64 years among females. The commonest site in the present study is lower limbs (74%). Diabetes mellitus was the commonest (76%) co morbidity. Beta hemolytic streptococci 22 (44%) was the highest to be isolated. In type I and Coagulase positive staphylococci 18 (36%) was the commonest organism isolated in type II necrotizing fasciitis. The significant risk factors were gender, comorbidties, hospital length of stay, and albumin level, leucocytosis, anemia, hypoalbumenia, low serum ferritin levels increase blood sugar levels. The mortality was 12% (8 patients).Conclusions: Patients with advance age, co-morbid conditions like diabetes mellitus, hypertension, peripheral vascular disease, osteomyelitis had high unexplained susceptibility to the disease and with a higher incidence in males. Thus, early recognition with a high index of clinical suspicion would definitely reduce both morbidity and mortality. It has gross morbidity and mortality if not treated in its early stages. Leucocytosis, anemia, hypoalbumenia, low serum ferritin levels, increase blood sugar levels were consistent findings seen in majority of the patients which resulted in increased morbidity.

Antimicrobial Resistance in Fecal Escherichia coli and Salmonella enterica from Dairy Calves: A Systematic Review.

The discovery of antibiotics brought with it many advances in the health and well-being of humans and animals; however, in recent years development of antimicrobial resistance (AMR) has increasingly become a concern. Much of the antibiotic use on dairy farms is for disease management in mature cattle, and AMR in fecal organisms is relatively rare in this group. However, young dairy calves often carry high levels of AMR in their fecal Escherichia coli and Salmonella enterica, which could provide a potential reservoir of AMR genes on dairy farms. To develop practical and effective antibiotic stewardship policies for dairy calf rearing, it is vital to have a solid understanding of the current state of knowledge regarding AMR in these animals. A systematic review process was used to summarize the current scientific literature regarding AMR in fecal S. enterica and E. coli and associations between management practices and AMR prevalence in dairy calves in the United States and Canada. Seven online databases were searched for literature published from 1997 to 2018. Multiple studies indicated an association between preweaned calves and increased risk of fecal shedding of resistant bacteria, compared to other animal groups on dairy farms. There also was evidence, although less consistent, of an impact of antibiotic treatment, antibiotic-containing milk replacer feeding, and feeding nonsalable or waste milk (WM) on the presence of AMR bacteria. Overall, the research summarized in this systematic review highlights the need for continued research on the impact of management practices, including antibiotic use, WM feeding, and disease prevention practices in reducing AMR in E. coli and S. enterica in dairy calves. In addition, few data were available on physiological and microbiological factors that may contribute to the high relative populations of resistant bacteria in young calves, suggesting another valuable area of future research.

772. Factors Associated With Healthcare Delay of Active Pulmonary Tuberculosis After Hospitalization

BackgroundHospitals are undesirable reservoirs for a respiratory outbreak. Active pulmonary tuberculosis (TB) can be readily transmitted among hospitalized patients. Early recognition of pulmonary TB is an essential priority against transmission. The aim of this study was to evaluate factors associated with delayed identification of pulmonary TB in hospital settings.MethodsMedical records of newly diagnosed TB patients admitted to a referral hospital from January 2015 through December 2017 were reviewed. Delayed recognition of pulmonary TB was defined as failure to initiate airborne isolation within the first 3 days after admission. We analyzed clinical, microbiological, radiological, and healthcare factors associated with delayed recognition of pulmonary TB. Patients who were not suspected of having active pulmonary TB had no remarks about TB on their initial chest radiograph interpretation by radiologists. Multivariate logistic regression analysis was performed with significant factors included.ResultsA total of 136 patients were analyzed who had positive sputum acid-fast bacilli (AFB) cultures. Of these, 45 (33%) patients were isolated 3 days after admission and had longer days of exposure before isolation (median 9, interquartile range [IQR] 6–14, P < 0.001) in comparison to others (median 0, IQR 0–1). Patients with older age (odds ratio [OR] = 1.04, 95% confidence interval [CI] 1.01–1.08, P = 0.01), patients who were admitted to departments other than infectious diseases or pulmonology (OR = 6.23, 95% CI 2.17–17.89, P = 0.001) and patients who were not suspected of having active pulmonary TB by radiologists (OR = 11.36, 95% CI 4.11–31.39, P < 0.001) were more likely to have delayed recognition of pulmonary TB.ConclusionIn a country with intermediate TB prevalence, better awareness for pulmonary TB is required for all hospitalized patients who are admitted to departments other than infectious diseases or pulmonology. Although active pulmonary TB is not suspected by a radiologist, sputum AFB smear, and culture are necessary when new lesions are present in chest radiographs.Disclosures All authors: No reported disclosures.

1053. Biofilm Production and Clinical Characteristics of S. maltophilia Causing Persistent or Relapsing Bacteremia

BackgroundThis study aimed to identify clinical or microbiological factors related to persistence or recurrence of Stenotrophomonas maltophilia bacteremia in adult patients.Methods S. maltophilia isolated from blood in two tertiary hospitals between 2011 and 2017 were investigated. Persistent bacteremia was defined as the consecutive blood culture positive for ≥5 days after initiation of appropriate antibiotics therapy. Relapse was defined as isolation of S. maltophilia from blood after completion of antibiotics treatment for the first episode of bacteremia. Biofilm formation was assessed in 96-well polystyrene plate with Trypticase Soy Broth using 0.5% crystal violet staining. The presence of smf-1 gene was detected by polymerase chain reaction.ResultsOf total 100 patients with S. maltophilia bacteremia, 10 of persistent, 8 of relapsing, and 46 of nonpersistent, nonrelapsing cases were investigated. The presence of indwelling urinary catheter (P = 0.011), nasogastric tube (P = 0.003), mechanical ventilator treatment (P = 0.001), and previous colonization of S. maltophilia (P = 0.016) were more frequently observed in patients with persistent bacteremia compared with nonpersistent, nonrelapsing bacteremia cases. In patients with relapsing bacteremia, hematologic malignancy (P = 0.022), neutropenia (P = 0.001), and concomitant isolation of S. maltophilia in clinical samples other than blood (P = 0.041) were more common than nonpersistent, nonrelapsing bacteremia patients. Catheter-related infection (37.0%) followed by pneumonia (28.3%) was the most common primary focus of nonpersistent, nonrelapsing bacteremia whereas pneumonia was the most frequent cause of bacteremia in both of persistent and relapsing cases (40.0% and 50.0%). Most of isolates (63 of 64) were susceptible to cotrimoxazole. The resistance to levofloxacin were comparable among isolates from persistent, relapsing and nonpersistent, nonrelapsing cases (10.0% vs. 12.5% vs. 15.2%, P = 0.988). Biofilm formation ability was not significantly different between three groups (optical density at 595, mean ± SD, 0.69 ± 0.34 vs. 0.78 ± 0.33 vs. 0.70 ± 0.33, P = 0.529). The smf-1 gene was found in all isolates.ConclusionMore careful treatment approaches to patients with risk factors for S.maltophilia treatment failure should be warranted.Disclosures All authors: No reported disclosures.

1009. Venous 1: A Prospective Multicenter Cohort Study of Enterococcal Bacteremia

BackgroundEnterococci often cause hospital-associated bloodstream infections in critically ill and immunocompromised patients. Prospective studies to assess the clinical impact of enterococcal bacteremia (EB) are lacking. We conducted a prospective study to investigate the clinical and microbiological factors associated with mortality in EB.MethodsAdults with EB were prospectively followed in three US tertiary hospitals from September 2016 to March 2018. Individuals with EB for whom follow-up blood culture data within 7 days of index culture were available were included. Microbiologic failure (MF) was defined as clearance of bacteremia ≥4 days after the first blood culture. The main outcome was hospital mortality.ResultsA total of 282 patients were included with 69 (24%) infected with vancomycin-resistant enterococci (VRE). The majority of patients were male (60%) with a median age of 63 years. Median length of hospitalization for VRE patients was longer (25 d) than non-VRE (13 days, P < 0.001). E. faecium corresponded to 77% of VRE isolates, whereas E. faecalis comprised 72% of non-VRE. The average time to first blood culture was 16 days for VRE vs. 4 days for non-VRE (P < 0.001). Patients with VRE were more likely to have hematological malignancy or bone marrow transplant (P < 0.003), whereas patients infected non-VRE were more likely to have solid tumors (P = 0.02). The most common antibiotic used was daptomycin as monotherapy for both VRE and non-VRE with a median dose of 8 mg/kg for both groups. Overall mortality was 25% (43% vs. 20% in VRE vs. non-VRE patients, respectively; P < 0.0001). Factors significantly associated with mortality in univariate analyses included ICU admission, prolonged hospitalization, hematological malignancy, use of immunosuppressive therapy, hemodialysis, neutropenia (<500 cell/mL), Pitt bacteremia score >3, infection with VRE and MF. ICU admission (RR 3.3; 95% CI 1.7–7.5, neutropenia (RR 4.1; 95% CI 1.3–12.9), Pitt bacteremia score >3 (RR 6.8; 95% CI 2.6–18.0), MF (RR 4.7; 95% CI 2.2–10.3) and infection with VRE (RR 4.1; 95% CI 1.1–16.6) remained significantly associated with mortality in multivariate analyses.ConclusionThe presence of VRE in EB and MF are associated with increased mortality. EB represent a major burden of disease in hospital settings.Disclosures C. Arias, Merck & Co., Inc.: Grant Investigator, Research support. MeMed: Grant Investigator, Research support. Allergan: Grant Investigator, Research support.

Prospective study evaluating post-operative central nervous system infections following cranial surgery

Aims: To evaluate the efficacy of our methods for decreasing the incidence of post-operative central nervous system infections (PCNSI) and to assess the type of microbiology and risk factors associated with PCNSI.Methods: This prospective study was performed at First Affiliated Hospital, College of Medicine, Zhejiang University, which is a major medical centre in eastern China. The study included adult patients who underwent cranial surgery from January 2014 to October 2015 at this institution and survived for more than 7 days . The demographic information and clinical data of the patients were recorded for every operation and the incidence of PCNSI and the type of microbiology were analysed separately for patients undergoing craniotomy and those undergoing cranial burr-hole surgery. Prior to initiation of the study, our research team had developed and implemented a series of methods for reducing infection rates in our department.Results: A total of 1,616 cranial surgery procedures were assessed in the present study; 1,236 craniotomy/craniectomy operations and 380 cranial burr-hole surgery operations. Of these procedures, 29 were complicated by PCNSI (27 cases with meningitis/ventriculitis and two with intracranial abscess/empyema). The overall incidence of PCNSI was 1.8%, while the incidence of craniotomy/craniectomy operations was 2.0% (25 cases) and that of burr-hole surgery operations was 1.1% (four cases); the most common microorganism was Staphylococcus. Of the patients who underwent cranial burr-hole surgery, the only independent risk factor for PCNSI was the absence of prophylactic antibiotics. There were no independent risk factors for craniotomy/craniectomy operations.Conclusions: In the present large-sample study, the incidence of PCNSI was 1.8%, which was dramatically lower than that of a previous study performed by our research group.