Microbiology Reports Research Articles

How to manipulate friends and influence practice: Application of complexity science leads to quality improvement in laboratory sample submissions.

We sought to reduce healthcare-associated infections (HCAIs) through the application of complexity science. To confirm incidental findings that altering the structure of microbiology reports with targeted education led to better utilisation of laboratory resources, while participating in efforts to reduce HCAI. We adopted a different approach to laboratory result authorisation, using narrative to engage the clinicians and induce behavioural change. Subsequent educational opportunities emphasised key messages. Positive urine means calculated by the analysis tool numbered 2179/month throughout the study period. Negative urines started at 5576/month, reduced to 5134/month in November 2014 and to 4602/month in April 2016, coinciding with our changes. Opportunity costs were saved. The changes in both policy and reporting were contemporaneous with a decline in negative samples. There were no significant changes in the number of positive specimens. The efficiency and effectiveness of the laboratory was improved and resources released: £145,000 ($182,000) for a resident population of 384,000. This suggests an annual release of about £25 million ($31 million) may be possible in the UK and £122 million ($155 million) in the USA.

Incidence of invasive Haemophilus influenzae infections in children with sickle cell disease

Children with sickle cell disease (SCD) are at increased risk for invasive infection with encapsulated bacteria. Antibiotic prophylaxis and immunizations against Streptococcus pneumoniae and Haemophilus influenzae type b (Hib) have decreased the overall incidence of invasive infections and have shifted distribution of serotypes causing disease toward those not covered by immunizations. We sought to determine the current incidence of invasive H.influenzae infections in children with SCD and to describe the clinical features and management of these infections. Microbiology reports of a large pediatric tertiary care center were reviewed to identify all isolates of H.influenzae detected in sterile body fluid cultures from January 1, 2010 to December 31, 2017. Results were compared with the center's comprehensive clinical database of all children with SCD to identify all cases of children ages 0 to18 years with SCD with invasive H.influenzae disease for the same time period. We captured 2444 patients with SCD, with 14,336 person-years. There were eight episodes of H.influenzae bacteremia in seven children with SCD (five type f, two non-typable, one type a). Most episodes (7 of 8) were in children<5 years. The incidence rate of invasive H.influenzae in SCD was 0.58/1000 person-years for ages 0 to 18 years and 1.60/1000 person-years for children age<5 years. There were no deaths from H.influenzae infection. In the era of universal antibiotic prophylaxis and immunization against Hib, invasive H.influenzae disease due to nonvaccine serotypes remains a risk for children with SCD, particularly those under five years of age.

Bloodstream Infections in Children Undergoing Allogeneic, Autologous Hematopoietic Stem Cell Transplantation or Chimeric Antigen Receptor T Cell Therapy

Topic Significance & Study Purpose/Background/Rationale Bloodstream infections (BSI) are a major source of morbidity in children receiving hematopoietic stem cell transplantation (HSCT) or chimeric antigen receptor (CAR) T cell therapy. An in-depth understanding of BSIs in this population is crucial to identify targets for prevention. The purpose of this study was to describe patient risk factors and characteristics of BSIs in children and adolescents undergoing HSCT and CAR T cell therapy. Methods, Intervention, & Analysis Patients were enrolled consecutively beginning on November 1, 2017. Male and female children, with any underlying diagnosis, ages 0 to 25 years were eligible and followed prospectively from the time of initiation of conditioning for autologous, allogeneic or CAR T cell therapy through October 1, 2018. Microbiology reports were tracked daily and positive blood culture results reviewed. Corresponding patient data was extracted from the electronic medical record in real time. Bloodstream infections were classified based on current Centers for Disease Control Guidelines. Descriptive, Chi-square and logistic regression analyses were done to elucidate risk factors and associations. Findings & Interpretation During the 11 month study period, 89 patients received 109 cell infusions. The mean age was 10.5 years with 38% Hispanic (n=34), 29% non-Hispanic (n=26) and 32% other (n=29) ethnicity. Mean length of stay (LOS) was 37.7 days. Thirty-two positive cultures were identified. Of the positive cultures, 19 gram-positive and 13 gram-negative organisms were isolated (Table 1). Figure 1 displays BSI classification by therapy type. The majority of BSIs were mucosal barrier injury-laboratory confirmed bloodstream infections, and occurred in patients receiving allogeneic HSCT. Hispanic ethnicity was associated with BSI incidence when compared to patients of non-Hispanic and unknown ethnicity (p Discussion & Implications Meticulous nursing assessment of oral and peri-rectal mucosa is necessary, along with evidence-based strategies to prevent central-line associated bloodstream infections. Future research is critical to develop and test MBI-LCBI prevention strategies and understand why patients of certain ethnic backgrounds may be at increased risk for BSI.

Spectrum of mycotic keratitis in north India: Sixteen years study from a tertiary care ophthalmic centre

IntroductionTo analyse the fungal culture results of patients with fungal keratitis over sixteen years and look for variations in the trends over years and distribution across ages, gender and seasons. Materials and methodsClinical and demographic records and microbiology reports of 18,898 patients of fungal keratitis from 2001 to 2016 were analysed. ResultsOverall fungal culture positivity was 21.5%. 67.3% were males and 32.7% were females. Maximum numbers of samples (17.9%) were received from age group 41–50 years, and maximum fungal culture positivity was seen in age group 31–40 years (30.8%). Most common fungus was Aspergillus species (31.1%), followed by Fusarium species (24.5%), Alternaria (10.5%), Curvularia (10.2%), Helminthosporium (5.7%), Bipolaris (5.4%), Penicillium (4.5%), Candida (4.4%), Acremonium (1.2%), Rhizopus (1.0%), Paecilomyces (0.8%), Rhodotorula (0.5%) and Mucor (0.2%). Fungal culture positivity and relative frequency of fungi remained almost stable over the study duration, except Rhodotorula spp, which showed a rise 2014 onwards. Highest numbers of culture proven fungal keratitis cases were seen in monsoon season. ConclusionsTo the best of our knowledge, our study is the largest compilation of epidemiological and microbiological features of fungal keratitis, throwing light on important attributes relevant to management of mycotic keratitis patients.

Hepatitis A surveillance: sensitivity of two information sources

BackgroundThe frequency of mild forms of hepatitis A, especially in children, could lead to underreporting. The objective of the study was to investigate the sensitivity of two surveillance systems, mandatory Statutory Disease Reports and the Microbiological Reporting System of Catalonia, using capture-recapture techniques.MethodsThe study was conducted in Catalonia between 2011 and 2015. Hepatitis A cases reported to two independent surveillance systems were included: Statutory Disease Reports (SDR) and Microbiological Reporting System of Catalonia (MRS). The variables collected were: age, sex, year of declaration, size of municipality (< 10,000 and ≥ 10,000), country of birth (Spain or abroad), reporting centre (primary care/hospital) and notification method (electronic or paper). The capture-recapture analysis and the estimate of 95% confidence intervals were made using the Chapman formula for comparison of two sources, both for the estimate of the total number of cases and the stratification according to variables. Multinomial logistic regression was performed to obtain an adjusted estimate.ResultsThe SDR had a greater overall sensitivity than the MRS (48.8%; 43.5–55.6 vs. 19.3%; 17.2–21.9). In cases aged < 15 years the sensitivity of both systems was higher (76.6%; 72.7–81 vs. 25.2%; 20.9–29.5) than in cases aged > 15 years (25.5%; 22.8–28.3 vs. 12.1%; 10–14.2). For those born in Spain, the sensitivity was 57.2% (49.6–67.4) in the SDR and 27.1% (23.5–31.9) in the MRS, lower than that for foreign-born patients (58%; 51.2–66.8 vs. 49.1%; 43.4–56.6). In electronically-reported cases, the sensitivity was much higher in the SDR than in the MRS (47.2%; 42.3–52.1 vs. 9.4%; 6.5–12.3). No differences were observed according to sex, size of municipality, and year of declaration or reporting centre. The estimated total number of cases using the Chapman formula was very similar to the adjusted estimate (1121; 985–1258 vs. 1120; 876–1525), indicating the robustness of the results.ConclusionsThe sensitivity of the SDR was greater than that of MRS, especially in patients aged < 15 years, although for patients born abroad the difference in sensitivity was lower. Reinforced surveillance combining the SDR and MRS improves the efficiency in the detection of cases.

No Demonstrable Benefit of Penicillin in a Vaccinated Population of Children with Sickle Cell Disorder

UK and many National guidelines advise on the use of prophylactic antibiotics, immunisation and patient education to minimise the risk of severe infections by encapsulated organisms in patients with Sickle Cell Disorder. The UK vaccination schedule for sickle cell anaemia patients includes Pneumococcal, Meningococcal and Haemophilus influenzae type B (Hib) immunisation. Prophylactic Penicillin V is recommended as additional protection against Streptococcus pneumoniae (S.pneumoniae).In light of the findings in the papers by Oligbu et al, 2017, and Martin et al 2018, we aimed to retrospectively compare compliance with prophylactic Penicillin V against infection rates by S.pneumoniae,Neisseria meningitidis (N.meningitidis) and Hib . We hypothesised that the incidence of infections with IPD and other encapsulated organisms would be greater in patients who were not adherent with Penicillin V. Patients were considered compliant with prophylactic Penicillin V if 75% or more of their urine samples gave positive results.The study population consisted of 52 Sickle Cell patients, ranging from age 3 to 20years.Three patients were excluded as no urine samples had been collected from them in the 5 year period. Of the remaining 49 patients only 9 patients (18%) were had good adherence with Penicillin V over a 5 year period.100% of patients received prevenar vaccination (PCV-7 or PCV 13).73% received additional pneumovax.We retrospectively reviewed microbiology culture reports over a five year period. All microbiology reports were reviewed from the period, with the virulent encapsulated organisms of S.pneumoniae,N.meningitidis and Hib recorded, alongside any other bacterial infections.No patients had microbiological evidence of infection by virulent encapsulated bacteria. Six patients had cultures positive for other organisms: two Staphylococcus aureus positive sputum cultures, one Salmonella positive stool culture, two urine cultures positive for Escherichia coli, and one skin wound swab positive for Streptococcus pyogenes.Of the 6 organisms identified, 3 occurred in patients compliant with Penicillin V, and 3 occurred in patients who were non-compliant. Patients compliant with Penicillin V formed a small cohort (n=9), resulting in an apparently high incidence of infection (33%). In the non-compliant cohort (n=40), 8% had shown infection. Analysis by Fisher's Exact Test confirmed no significant difference in the incidence of infection between the two groups (p= 0.06).In a sickle cell disorder population where 82% of the patients were not 100% compliant with prophylactic Penicillin V, no significant encapsulated bacteria (S.pneumoniae,N.meningitidis or Hib) were cultured in a 5 year period in our cohort. Non-compliance with prophylactic Penicillin V was not associated with an increased incidence of infections by encapsulated organisms.The UK study (Oligbu et al) on IPD was performed in the PCV13 era and states a 49x increased risk of developing IPD and a 5x increase in mortality in children with sickle cell compared to their peers. However, most IPD cases were due to non-vaccine serotypes. A similar study from the US (Martin et al) found deaths only in the PCV7 cohort, it does not state if the patients were vaccinated with pneumovax 23.In conclusion 82% of children did not adhere to penicillin. We have not demonstrated any benefit in adhering to prophylactic penicillin. Adherence is poor and alternative approaches of standby antibiotics should be considered. We suggest focusing on vaccination as a preventative strategy is of more benefit. Martin OO, Moquist KL, Hennessy,JM, Nelson SC. Invasive pneumococcal disease in children with sickle cell disease in the pneumococcal conjugate vaccine era. Pediatr Blood Cancer. 2018;65:e26713. https://doi.org/10.1002/pbc.26713Oligbu G, Collins S , Streetly A, Dick, M, Ladhany, S. Risk of invasive pneumococcal disease in children with sickle cell disease in England: National observational cohort study, 2010 - 2015. Arch Dis Child 2017;102(Suppl1):A4-A4 DisclosuresNo relevant conflicts of interest to declare.

514. The Effect of Probiotics on the Incidence of Clostridium difficile

BackgroundCurrently there is conflicting evidence regarding probiotics affecting the incidence and/or severity of Clostridium difficile infection (CDI). According to the IDSA guidelines, there are insufficient data to support the use of probiotics as primary prophylaxis of CDI. The primary objective of this study was to evaluate whether the administration of probiotics is efficacious for CDI prophylaxis in patients who are on antibiotics making them at increased risk for contracting CDI.MethodsThe study is an Institutional Review Board approved retrospective cohort study looking at patients who were admitted to NYU Winthrop University Hospital and received at least one dose of antibiotics considered high-risk of inducing CDI. Patients were grouped according to concurrent probiotic use and the association between probiotic use and incident CDI was examined. A model for incident CDI adjusting for number of concurrent antibiotics, patient age, proton pump inhibitors, histamine receptor antagonists, presence of colitis, and chemotherapy was also estimated. Microbiology reports were analyzed for up to 12 weeks post initial administration of antibiotics to determine whether patient acquired CDI. If no CDI occurred during the admission or post discharge, data was censored at 12 weeks.ResultsOf 2,208 patients, 1,502 (68%) were included in the interim analysis. Ninety-six out of 1,502 patients (6.39%) had CDI within 12 weeks of antibiotics initiation. One hundred thirty-five (9%) were on probiotics during antibiotic use and 1,367 (91%) were not. Of those taking probiotics, 11.1% had an incident of CDI and of those not taking probiotics, 5.9% had an incident of CDI with a relative risk of 1.88 (1.11, 3.16) and a P = 0.02. After adjustment, although a positive association between probiotics and CDI was still observed, it was not statistically significant (P = 0.24)ConclusionBased on the interim analysis, probiotics were associated with a higher risk of CDI in univariate analysis, however, when adjusted for several confounding factors this association, while still positive, was no longer statistically significant.Further data collection is ongoing to corroborate these results. Disclosures All authors: No reported disclosures.

1253. Healthcare-Associated Transmission of Burkholderia cepacia Complex Associated With Extrinsically Contaminated Nasal Spray

Background Burkholderia cepacia complex (Bcc) species can contaminate medical devices and water-based products, resulting in outbreaks of healthcare-associated infections. In March 2018, we investigated a cluster of 20 patients with a sinus culture positive for Bcc seen at two affiliated ENT clinics in Oregon over a 2-month period, based on reporting by a laboratorian in a central laboratory external to the clinics.MethodsWe conducted an epidemiologic investigation to identify potential causes for an apparent outbreak of Bcc, including review of health records and microbiologic reports, site visits, staff interviews, and cultures of common equipment and products.Results20 patients (9 were female; age range 10 to 72 years, median age 54.5 years) had new positive Bcc cultures from the sinus. The absence of cystic fibrosis, immunosuppression or sinonasal polyposis in all patients, scant growth of Bcc in most cases with isolation of another organism in some, and the use of Bcc-directed antibiotics in a minority of patients suggested the presence of a contamination source. All patients had received lidocaine/phenylephrine (L/P) via multidose nasal spray atomizers prior to endoscopically-directed sinus cultures. Site visits revealed improper medication dispensing and storage practices (e.g., no expiration date for L/P stock, storage of L/P-containing atomizers at room temperature), and inadequate instrument reprocessing and environmental cleaning. Cultures of L/P in 2/2 in-use atomizers and 1/1 opened stock bottle, as well as swabs of 3/3 spray mechanisms, grew Bcc. Cultures of L/P from the unopened, refrigerated stock bottle, a flexible endoscope and a rigid endoscope did not yield Bcc. No negative clinical sequelae in these patients were reported.ConclusionContaminated multidose L/P nasal spray with Bcc resulted in nosocomial transmission at these clinics. This investigation highlights the important role of laboratorians in detecting Bcc contamination events that lead to colonization, and suboptimal reporting by clinicians in the outpatient setting. It also raises the question of how often such contamination events go undetected. Injection safety training needs to be broadened to “medication administration safety” training as one and only principles could have prevented this incident.Disclosures All authors: No reported disclosures.

The Effect of Catheterization on Susceptibility of Uropathogens After Pelvic Reconstructive Surgery.

The aim of this study was to determine whether bacterial uropathogens from positive urine cultures and uropathogen antibiotic susceptibility differ between catheterized (C) and noncatheterized (NC) patients after pelvic reconstructive surgery. This is a retrospective cohort study of patients with a positive urine culture within 1 year of pelvic reconstructive surgery. Patients were categorized as having an indwelling catheter placed for urinary retention or voiding dysfunction within 48 hours of specimen collection versus no catheter. Microbiology reports provided uropathogens and antibiotic susceptibility for each culture. Student t test, χ, and logistic regression were used to compare rates of non-Escherichia coli uropathogens and susceptibility to first-line antibiotics between C and NC groups. A total of 427 positive urine cultures from 317 unique patients were identified. Positive urine cultures from C patients were less likely to contain E. coli (47.1% NC vs 29.2% C; P = 0.0009), with enterococcus being the most common non-E. coli uropathogen. The odds of non-E. coli uropathogens increased with age (adjusted odds ratio, 4.25; 95% confidence interval, 1.95-9.28; P = 0.0003 for the oldest patients). Cultures from C patients were more likely to have a uropathogen not susceptible to sulfamethoxazole/trimethoprim (20.5% NC vs 32.1% C; P = 0.03), nitrofurantoin (19.2% NC vs 34.6% C; P = 0.002), and cefazolin (18.1% NC vs 49.4% C; P < 0.0001). After pelvic reconstructive surgery, patients with a positive urine culture who have undergone catheterization within 48 hours of specimen collection are more likely to have non-E. coli uropathogens, with 1 in 3 cultures being not susceptible to common first-line antibiotics. This highlights the importance of performing susceptibility testing rather than treating empirically after pelvic reconstructive surgery.

CHRONIC MUCOCUTANEOUS CANDIDIASIS: IS NOT WHAT WE HAVE THOUGHT

Introduction Chronic mucocutaneous candidiasis is only treated symptomatically, most cases do not have a diagnosis of certainty, however, at least half of the cases are caused by transducer and activator of transcription 1 (STAT1) mutations. Case Description Female of 12 years; mother with systemic lupus erythematosus, oral and vaginal candidiasis. Medical history: refers to 8 cases of urinary tract infection from 3 years of age with a microbiological report of Candida spp., from birth vulvovaginal infections of recurrence, aphthae and oral candiadiasis rebellious to treatment with frequent recurrences. Starts study protocol in 2015 with profile of immunoglobulins and immunoglobulin G subclasses normal, subpopulations of lymphocytes normal, initiates prophylactic treatment with itraconazole, presenting recurrences. Lymphocyte function tests were performed with normality report, initiate immunomodulation with transfer factor, partial response. Start treatment with intravenous immunoglobulin at a dose of 400 mg/kg/dose with a decrease in infectious processes; 2016 molecular study were performed with diagnosis of STAT1 mutation with gain of function. Discussion In patients with chronic mucocutaneous candidiasis the presence of STAT1 mutations with gain of function must be considered, responsible for the regulation of the Th17 response, which is characterized by the production of interleukin 17 and 22, crucial for the epithelial defense; the use of the transfer factor confers an immunoregulation factor, which is why it was granted to the patient. In our country, the report of these entities will help to increase the index of suspicion, favor the detection and grant the early treatment of this entity.

Utilization of a Dual Surveillance Program to Reduce Surgical-site Infections.

Background:Surveillance plays a pivotal role in the surgical-site infections (SSIs) prevention through identifying infections, monitoring changes in infection rates, and evaluating the effectiveness of intervention strategies.Methods:This retrospective study reviewed SSI surveillance systems implemented at the Children’s National Health System in 3 phases between 2007 and 2016 including all surgical procedures. The targeted surveillance was conducted in cardiovascular, spinal fusion, and ventricular shunt surgeries and required an infection preventionist (IP) to review all procedures, to identify SSIs that meet the CDC’s National Healthcare Safety Network definition. SSIs in the remaining surgical procedures were identified through the review of positive microbiology reports daily and followed by full chart review if the specimen type and/or patient location were suggestive of a surgical history. Timely feedback of SSI to stakeholders was the primary mode of intervention, with additional interventions implemented for the 3 targeted surveillance procedures. Data collected between 2013 and 2016 were analyzed to account for a definition change in 2013.Results:For the 3 targeted surveillance procedures, IP reviewed 2,255 procedures and identified 43 SSIs. For the remaining procedures, IPs identified 123 SSIs confirmed by one or more pathogens. The overall SSI rate had a 31% decrease. The cardiovascular and spinal fusion SSI rate had a 61% and 84% decrease, respectively. The ventricular shunt SSI rate increased 29% due to 2 episodes of recurrent infections in 2 patients.Conclusions:It is prudent for hospitals to continue monitoring SSI by establishing surveillance programs with optimal approaches.

PhyMet2: a database and toolkit for phylogenetic and metabolic analyses of methanogens

Environmental Microbiology ReportsVolume 10, Issue 5 p. 605-605 CorrigendumFree Access PhyMet2: a database and toolkit for phylogenetic and metabolic analyses of methanogens This article corrects the following: PhyMet2: a database and toolkit for phylogenetic and metabolic analyses of methanogens Burdukiewicz Michał, Przemysław Gagat, Sławomir Jabłoński, Jarosław Chilimoniuk, Michał Gaworski, Paweł Mackiewicz, Łukaszewicz Marcin, Volume 10Issue 3Environmental Microbiology Reports pages: 378-382 First Published online: May 17, 2018 First published: 10 October 2018 https://doi.org/10.1111/1758-2229.12676Citations: 1AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Following the publication of the above article in Environmental Microbiology Reports 10(3): 378–382, the authors recognized that there were errors in the name of the first author and the corresponding author. The correct first author's name should be Michał Burdukiewicz. The correct corresponding author's name should be Marcin Lukaszewicz. The authors would like to apologize for the confusion caused by this error. Reference Burdukiewicz, M., Gagat, P., Jabłoński, S., Chilimoniuk, J., Gaworski, M., Mackiewicz, P., and Łukaszewicz, M. (2018) PhyMet2: a database and toolkit for phylogenetic and metabolic analyses of methanogens. Environ Microbiol Rep 10(3): 378– 382. Citing Literature Volume10, Issue5Special Issue: Special Issue on Pathogen and resistance ecologyOctober 2018Pages 605-605 ReferencesRelatedInformation

Skull pathology in 10 cats with patellar fracture and dental anomaly syndrome.

The aim of this case series is to describe the clinical and radiological features of mandibular and maxillary abnormalities in cats diagnosed with patellar fractures and dental anomalies, a condition that we have named 'patellar fracture and dental anomaly syndrome' (PADS), also known previously as 'knees and teeth syndrome'. Where available, clinical records, skull and/or intraoral dental radiographs, head CT images, microbiology and histopathology reports were collected, and follow-up was obtained. Ten cats with mandibular or maxillary abnormalities were identified. Common clinical features included multiple persistent deciduous teeth, gingivitis and swellings of the jaw. Skull radiographs were available for 7/10 cats and head CT images were available for one cat. Findings included marked bony and periosteal proliferation, hypodontia, root resorption, root malformation and unerupted permanent teeth. Where available, microbiology and histopathology results were consistent with osteomyelitis. Mandibular and maxillary abnormalities are an additional unreported clinical feature of the rare condition that we have termed PADS. Radiologically, these lesions can have an aggressive appearance, which can mimic neoplasia. Medical management with antibiotic and anti-inflammatory therapy improves clinical signs in the short term; however, surgical extraction of persistent deciduous and unerupted permanent teeth, and debridement of proliferative and necrotic bone appear to be necessary for an improved outcome. Additional information on long-term outcome is required.

PUK4 - Urinary Tract Infections:Incidence in Patients with Type 2 Diabetes Mellitus

The incessantly increasing prevalence of Diabetes Mellitus globally, necessitates the assessment of UTI. This study was conducted to compare the incidence of UTI amongst patients with and without type 2 diabetes mellitus in a tertiary care hospital. This prospective observational study was conducted in all inpatients diagnosed with UTI above 18 years of age in General Medicine department. Data such as patient demographics, symptomatology, laboratory investigations and microbiology reports were recorded in a suitably designed data collection form. Multi-nomial regression was applied to obtain relative risks of factors that contribute to the development of UTI using SPSS software 20.0. A total of 180 patients were included wherein female preponderance was observed to be 113 (62.8%). Of the total 106 patients, 98 (92.5%) had a previous history of Diabetes Mellitus, 8 (7.5%) were newly diagnosed and the incidence was found to be higher in females 65 (61.3%) and geriatrics 59 (55.6%). The estimated odds for developing UTI in the age groups 30-39 years was 2.661 (95% CI 0.246 – 28.745) when compared to those > 60 years with a significance of 0.42 whilst those with diabetes were 3.267 (95% CI 0.745 – 14.331) times more likely to develop UTI than those without diabetes. Although the odds for baseline characteristics were statistically insignificant, these factors should be considered in the assessment of UTI patients with Diabetes Mellitus. In these patients, UTIs are more severe, caused by more resistant pathogens, and is associated with poor outcomes than in patients without diabetes.

Ventilator-Associated Pneumonia (VAP): Are we ready to let go of the old definitions

Background: In 2013 the NHSH implemented major changes in the VAP definition. Reviewing episodes became easier and faster and it eliminated most of the subjective interpretation of data. We started implementing this new definition in January 2017 but continued to use the old definition as well. Objectives: Assess the impact of the new NHSN definitions to calculate the VAP rates in our hospital. Analyze whether the changes in the VAP rates trends are reflected in antibiotic consumption. Methods & Materials: Descriptive Study. Retrospective analysis of the VAP rates in Intensive Care Unit (ICU) and Coronary Care Unit (CCU). Daily data from active surveillance, microbiology reports and electronic medical records review. Antibiotic consumption in ICU and CCU: DDD Defined Daily Dose. D/P: every 100 days/patient Results: VAP Rates (per1000 days ventilator) 2013-2016 old definition and 2017 old and new definition. ICU: 2013: 4.02, 2014 6.27 2015 3.42, 2016 4.12 2017 old 2.65, new:0. CCU: 2013: 12.41, 2014 9.9, 2015 10.23, 2016: 8, 2017 old: 2.8 new: 0. Antibiotic consumption: CCU DDD 2016 D/P 27.4, 2017 39.09. ICU DDD 2016 D/P 91,39 2017 95.43. We observed a statistically significant increase in antibiotic consumption in the ICC from 2016 to 2017(p ≤ 0.001). In the ICU there was there was no significant decrease in antibiotic consumption, with a tendency to rise for this period. Conclusion: Although we observed a decreasing tendency in VAP these years, the abrupt fall in VAP rates after the introduction of the new NHSN definitions seems to reflect a definition biass more than an improvement in the care provided to our patients.We have observed no significant change in antibiotic use to match the changes in VAP rates.It can be a big risk to use a definition that gives us a false sense of security, leading us to more relaxed behaviour in terms of prevention. For the time being, we consider useful to use both definitions to calculate VAP rates and dentify this risk.

The changing epidemiology of invasive pneumococcal disease after PCV13 vaccination in a country with intermediate vaccination coverage

BackgroundWe studied the impact of 13-valent pneumococcal conjugate vaccine (PCV13) on the incidence of invasive pneumococcal disease (IPD) and serotype distribution in a region with intermediate levels of vaccination (around 64% in children aged <2 years). MethodsSurveillance data on IPD cases reported by microbiologists participating in the Microbiological Reporting System of Catalonia during 2006–2014 were analysed. We compared estimated incidence rate (IR) ratios for serotypes included in PCV7, PCV10non7, PCV13non10 and non-PCV13 between the PCV7 (2006–2009) and PCV13 periods (2010–2014). IR were corrected for missing serotypes according to year and age groups: <2 years, 2–4 years, 5–64 years and ≥65 years. ResultsA total of 9338 IPD cases were reported. Overall IPD incidence declined by 26.2% (from 16.4 to 12.1) in the PCV13 period. The largest decrease was observed in children aged 2–4 years (44.5%, from 37.4 to 20.8). Pneumonia fell in all age groups with the largest reduction in children aged 2–4 years (49.3%) and <2 years (42%). PCV13 serotypes decreased significantly in all age groups, from 52% (31.6 to 15.1) in children aged 2–4 years to 35% (22.8 to 14.8) in adults aged ≥65 years. Non-PCV13 serotypes rose by 13% (14.8 to 16.8) in people aged ≥65 years. ConclusionsIn a region with intermediate vaccination coverage, the introduction of PCV13 has reduced the overall incidence of IPD, mainly due to the decrease in PCV13 serotypes in all age groups, suggesting herd immunity. Non-PCV13 serotypes have increased in adults aged ≥65 years, suggesting serotype replacement. Higher PCV13 vaccination coverage in children will further reduce IPD incidence in all age groups.

Risk of infection following semi-invasive ultrasound procedures in Scotland, 2010 to 2016: A retrospective cohort study using linked national datasets.

Outbreak reports indicate a risk of cross-infection following medical procedures using semi-invasive ultrasound probes. This study aimed to evaluate the risk of infection, using microbiological reports and antibiotic prescriptions as proxy measures, associated with semi-invasive ultrasound probe procedures, including transoesophageal echocardiography, transvaginal and transrectal ultrasound. Patient records from the Electronic Communication of Surveillance in Scotland and the Prescribing Information System were linked with the Scottish Morbidity Records for cases in Scotland between 2010 and 2016. Three retrospective cohorts were created to include inpatients/day-cases and outpatients in the following specialties: Cardiology, Gynaecology and Urology. Cox regression was used to quantify the association between semi-invasive ultrasound probe procedures and the risk of positive microbiological reports and community antibiotic prescriptions in the 30-day period following the procedure. There was a greater hazard ratio of microbiological reports for patients who had undergone transoesophageal echocardiography (HR: 4.92; 95% CI: 3.17-7.63), transvaginal (HR: 1.41; 95% CI: 1.21-1.64) and transrectal ultrasound (HR: 3.40; 95% CI: 2.90-3.99), compared with unexposed cohort members after adjustment for age, co-morbidities, previous hospital admissions and past care home residence. Similarly, there was a greater hazard ratio of antibiotic prescribing for those who had received transvaginal (HR: 1.26; 95% CI: 1.20-1.32) and transrectal (HR: 1.75; 95% CI: 1.66-1.84) ultrasound, compared with unexposed patients. Analysis of linked national datasets demonstrated a greater risk of infection within 30 days of undergoing semi-invasive ultrasound probe procedures, using microbiological reports and antibiotic prescriptions as proxy measures of infection.

P080: Clinical lead nurse practitioner Strathcona Community Hospital

Introduction: Prior to opening Strathcona Community Hospital (STCH) site leadership were tasked to develop an innovative care model. The central aim was quality improvement and patient safety optimization in the emergency department (ED) utilizing a nurse practitioner (NP) model. They developed 3 pillars: collaboration, multidisciplinary approach, and integration with the plan of improving patient satisfaction and ensuring no patient gets lost to follow up. NPs work in the STCH ED and the NP led Emergency Department Transition (EDT) Clinic in Ambulatory Care. In the ED NPs provide direct clinical care, judicious review of DI and microbiology reports, and care coordination for patients at risk of lost to follow up. The EDT clinic is an innovative NP lead clinic with the purpose of providing timely, high-quality follow up care for ED patients. Methods: Data for the service delivery indicators came from data repository and manual data collection looking at the following outcomes: timely review of DI/micro results; decreased ED visits for non-urgent/emergent issues; safe transitions in care and improved patient satisfaction. Quantitative data from service delivery, patient and surveys were analyzed using Microsoft Excel and SPSS 19. Results: From June 2016 to January 2017 ED NPs at STCH reviewed 3000 positive microbiology reports and made 517 f/u calls to those patients, and reviewed 3181 DI results. This has freed up approximately 2 hrs per day of ED physician time. When NPs were working in the ED, the number of patients who left without treatment (LWT) was approximately 50% less, and improved STCH ED wait times to be among the lowest in the Edmonton Zone. From June 2016 to January 2017, EDT NPs completed 837 patient visits; 371 letters to family physicians (FPs); 215 referrals; and connected 520 patients to a new FP. Patient satisfaction survey show 88-90% of the patients were satisfied with their care. Conclusion: NPs are integral members of the ED team at STCH, providing direct clinical care and several valuable follow up services for ED patients. The EDT clinic provides urgent follow up for ED patients unable to get a timely appointment with their FP or no access to primary care. The clinic also prevents unnecessary returns to ED, and aids to bridge ED services to family physicians or specialist. NPs are the common thread through all departments at STCH, contributing to quality improvement and high patient satisfaction.

An Introduction to Current Trends in Foodborne Pathogens and Diseases

Purpose of Review This editorial review aims to provide readers with an introduction to the Current Clinical Microbiology Report Special Issue “Foodborne Pathogens” and to point out overarching novel trends and developments in this field. Recent Findings The first global burden of foodborne disease study by the WHO estimated that foodborne diseases annually cause illness in 1 in 10 people, resulting in 420,000 deaths per year. In recent years, the threat of foodborne antimicrobial-resistant pathogens has intensified, facing researchers and authorities with major challenges. Whole genome sequencing, MALDI-TOF mass spectrometry, and Fourier transform infrared spectroscopy enable improved detection and typing of foodborne pathogens. Summary Foodborne diseases remain a major risk to global health. At the same time, crucial advances in the development of technological platforms have led to unprecedented opportunities in detection, typing, and source attribution of foodborne pathogens.

Prevalence of Methicillin-resistant Staphylococcus aureus in the Surgical Wards of the Port-of-Spain General Hospital, Trinidad and Tobago

Objective: Methicillin-resistant Staphylococcus aureus (MRSA) is associated with soft tissue infections in surgical patients. In severe cases, it may result in pneumonia, septicaemia and osteomyelitis. Limited data are available with regard to its prevalence and associations in the Caribbean. This study aimed to assess the prevalence of MRSA in patients hospitalized in the surgical wards of the Port-of-Spain General Hospital (POSGH), Trinidad and Tobago, and determine associated risk factors. Methods: Over the period of April 1 to August 1, 2013, all patients from the surgical wards of the POSGH who had had wound swabs taken were identified. Demographic data included duration of hospital stay, surgical and medical history, antibiotic use and type of wound swab. Microbiological reports were then retrieved and analyses done. Results: A total of 153 patients had wound swabs taken. There were 38 patients (24%) infected with Staphylococcus aureus, with 15 (39.5%) growing MRSA. Increased susceptibility to MRSA was associated with age, gender, ethnicity, duration of hospital stay, co-morbidities, previous antibiotic use, previous surgery and the type of wound (p &lt; 0.05). Conclusion: The prevalence of MRSA in the surgical wards of the POSGH was 39.5% of Staphylococcus aureus isolates. Risk factors included the age range of 60–69 years, patients with co-morbidities, hospital stays of longer than one week, previous surgery and prior use of antibiotics. We recommend more awareness of this problem in the practice of Caribbean medicine to improve infection rates.