Multidrug-resistant Organism Infection Research Articles

A Linguistic Model of Communication Types in Palliative Medicine: Effects of Multidrug-Resistant Organisms Colonization or Infection and Isolation Measures in End of Life on Family Caregivers' Knowledge, Attitude, and Practices.

Background: This study examines communication profiles and associated attitudes toward health care professionals in interviews with family caregivers of hospitalized patients with confirmed multidrug-resistant organisms (e.g., methicillin-resistant Staphylococcus aureus or multiresistant gram-negative bacteria) diagnosis at the end of life. Objectives: This study aims to replicate and complement findings from a previous investigation using a different methodological framework. The benefits of linguistic research in medical contexts are highlighted. Design: Fifty interviews with family caregivers were analyzed linguistically. The considered parameters include lexical choices such as evaluative wording, metaphors, and specialized terminology, as well as higher level categories-turn-taking, sentence-length, and personal deixis. These characteristics serve to assess attitudes toward medical staff, hygiene measures, knowledge, and its transfer and general emotional states. Conclusions: Linguistic expertise adds benefits to the classical analysis of language data as used in social sciences. Family caregivers' linguistic and attitudinal profiles vary depending on whether their involvement in the overall situation is active or passive, and whether their relationship toward staff and hospital is cooperative or confrontative. Depending on the four possible combinations of those characteristics, different recommendations for communication strategies on the staff's side can be given. In all cases, clear and patient/family centeredness are considered beneficial.

Prognostic factors of critical acute pancreatitis: A prospective cohort study

BackgroundPatients with critical acute pancreatitis (CAP) have the highest risk of mortality. However, there have been no studies specifically designed to evaluate the prognostic factors of CAP. Aims & methodsThis was a prospective observational cohort study involving patients with CAP. Three aspects including organ failure, (peri)pancreatic necrotic fluid cultures and surgical interventions were analyzed specifically to identify prognostic factors. ResultsOf the 102 consecutive patients with CAP, 83 patients (81.4%) received step-up surgical treatment, the mortality of the step-up group was 25.3% (21/83). 19 patients (18.6%) underwent step-down surgical treatment, the mortality of the step-down group was 57.9% (11/19). Overall mortality in the whole cohort was 31.4% (32/102). Multivariate analysis of death predictors indicated that multiple organ failure (MOF) (OR = 5.3; 95% CI, 1.5–18.2; p = 0.008), long duration (≥5 days) of organ failure (OR = 6.4; 95% CI, 1.2–54.3; p = 0.029), multidrug-resistant organisms (MDROs) infection (OR = 4.6; 95% CI, 1.3–15.8; p = 0.013), OPN (OR = 3.7; 95% CI, 1.5–8.8; p = 0.004) and step-down surgical treatment (OR = 3.5; 95% CI, 1.2–10.1; p = 0.019) were significant factors. ConclusionAmong patients with CAP, MOF, long duration (≥5 days) of organ failure, MDROs infection, OPN and step-down surgical treatment were identified as the predictors of mortality.

A Multi-Centered Case-Case-Control Study of Factors Associated With Klebsiella pneumoniae Carbapenemase-Producing Enterobacteriaceae Infections in Children and Young Adults.

Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae (KPC-CRE) are multidrug-resistant organisms causing morbidity and mortality worldwide. KPC-CRE prevalence is increasing in pediatric populations, though multi-centered data are lacking. Identifying risk factors for KPC-CRE infection in children and classifying genotypes is a priority in this vulnerable population. A case-case-control study of patients (0-22 years) at 3 tertiary-care Chicago-area medical centers, 2008-2015, was conducted. Case group 1 children possessed KPC-CRE infections; case group 2 harbored carbapenem-susceptible Enterobacteriaceae (CSE) infections; controls had negative cultures. Case-control matching was 1:1:3 by age, infection site and hospital. Statistical and molecular analyses were performed. Eighteen KPC-CRE infections were identified; median patient age was 16.5 years. Of 4 available KPC-CRE, 2 were unrelated, non-ST258 KP strains harboring blaKPC-2, one was a ST258 KP harboring blaKPC-3, and the last was an E. coli containing blaKPC-2. KPC-CRE and CSE-infected patients had more multidrug-resistant organisms infections, long-term care facility admissions and lengths of stay (LOS) > 7 days before culture. KPC-CRE and CSE patients had more gastrointestinal comorbidities (odds ratios [Ors], 28.0 and 6.4) and ≥ 3 comorbidities (Or 15.4 and 3.5) compared with controls; KPC-CRE patients had significantly more pulmonary and neurologic comorbidities (both ORs 4.4) or GI and pulmonary devices (ORs, 11.4 and 6.1). Compared with controls, CSE patients had more prior fluoroquinolone use (OR, 7.4); KPC-CRE patients had more carbapenem or aminoglycoside use (ORs, 10.0 and 8.0). Race, gender, LOS and mortality differences were insignificant. Pediatric patients with KPC-CRE infection suffer from high multi-system disease/device burdens and exposures to carbapenems and aminoglycosides. Different from adult reports, non-ST258 KP strains were more common, and LOS and mortality rates were similar in all groups. Pediatric CRE control in should focus on modifiable risk factors including antibiotic and device utilization.

Manipulation of the microbiota to eradicate multidrug-resistant Enterobacteriaceae from the human intestinal tract

Manipulation of the microbiota to eradicate multidrug-resistant Enterobacteriaceae from the human intestinal tract

Differences in microbial etiology between hospital-acquired pneumonia and ventilator-associated pneumonia: a single-center retrospective study in Guang Zhou.

Purpose: Nosocomial pneumonia is a common nosocomial infection that includes hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia(VAP). It is an important cause of morbidity and mortality in hospitalized patients. This study aimed to evaluate the differences in microbial etiology and outcomes between HAP and VAP, particularly in related risk factors of multidrug-resistant organism (MDRO) causing HAP and VAP.Patients and methods: This single-center retrospective, observational study included patients with HAP/VAP. Clinical and epidemiological data of nosocomial pneumonia confirmed by microbial etiology that occurred in the Third Affiliated Hospital of Sun Yat-sen University, China, from January 2014 to December 2017 were obtained.Results: A total of 313 HAP cases and 106 VAP cases were included. The leading pathogens of HAP and VAP were similar, including Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae. Antimicrobial susceptibility of the pathogens was low, and P. aeruginosa in VAP was less susceptible. In the multivariate logistic regression analysis, the risk factors associated with MDRO-HAP were chronic obstructive pulmonary disease, antibiotic therapy in the preceding 90 days, and prior endotracheal tracheostomy. The risk factor of MDRO-VAP was ≥5 days of hospitalization. The 30-day mortality rates of HAP and VAP were 18.5% and 42.5%.Conclusion: The leading pathogens were similar in both HAP and VAP, and antimicrobial susceptibility of the pathogens was low. The risk factors associated with MDRO infection in HAP and VAP have significant variability; hence, attention should be paid to improve prognosis. VAP was associated with poorer outcomes compared with HAP.

Pola Sensitivitas Isolat Klinis Bakteri Gram Negatif Multiresisten Obat Terhadap Fosfomisin dari Beberapa Rumah Sakit Kota Pekanbaru

Over the last few years, there has been a decrease in amount of effective antibiotics, coincide with the lack of newantibiotics relevant for the treatment of Gram negative multi-drug resistant organisms infections. This problem can beovercome by the assessment and re-introduction of old antibiotics such as fosfomycin. Fosfomycin is a broad spectrumantibiotic that is bactericidal. This study aimed to find out the sensitivity pattern of clinical isolate multi-drug resistantGram negative bacteria to fosfomycin with descriptive cross sectional method. The sample used in this study wasclinical isolates collection of Microbiology Laboratory Faculty of Medicine, University of Riau from Hospitals inPekanbaru. The result showedsensitivity to fosfomycin Escherichia coli producing ESBL (88%), Klebsiella pneumoniaeproducing ESBL (95%), Acinotobacter baumannii resistant meropenem (27%), Pseudomonas aeruginosa resistantmeropenem (36%) and K.pneumoniae resistant meropenem (70%). Fosfomycin can be used as alternative therapy forinfections caused by Gram-negative Multi-drug resistant organisms.

Multidrug-Resistant Bacterial Infection in Patients with Cirrhosis. A Review

The burden of multidrug resistance has become one of the world’s most urgent public health problems. Patients with infection caused by multidrug-resistant organisms (MDROs) have an increased risk for worse outcomes and death. Cirrhotic patients, mostly decompensated, are prone to developing infections caused by MDROs, particularly because they are in close contact with healthcare settings. During the last two decades, the first-line therapies recommended to treat infections in cirrhotic patients have become progressively less effective. Early identification of patients at high risk of MDRO infection is essential. Considering the emergence and spread of MDROs, empirical first-line antibiotic treatment must be tailored according to the local prevalence of MDROs and risk factors for MDRO infection. New empirical strategies must include antibiotics that are active against MDROs followed by a well-standardized early de-escalation policy. Appropriate use of broad-spectrum antibiotics, restriction of antibiotic prophylaxis to high-risk populations, promotion of infection-control measures, and support of research into the development of new antibiotics are needed to control the worrisome spread of MDROs.

The cost of keeping a hospital clean: Insights from a cancer hospital in East India

CONTEXT: Assessment of cleaning cost of hospitals is important for hospital administrators, infection control experts and housekeeping managers. Such data are lacking in the medical literature. AIMS: The aim of this study was to determine the cleaning cost of a tertiary care not-for-profit private cancer hospital. SETTINGS: This study was conducted in Tata Medical Center, Kolkata, India, which has 183 inpatient beds. DESIGN: This was a retrospective observational study. MATERIALS AND METHODS: Cleaning cost assessment was done from financial records over one financial year (April 2015–March 2016). The methodology involved taking into account the cost of various types of wastes (general, biomedical and microbiological), human resource cost (housekeeping staff salary), laundry cost, costs of cleaning equipment, cost of consumables (personal protective equipment, soap solutions, disinfectants, cleaning mops etc.) and the cost of water consumption. STATISTICAL ANALYSIS: No special statistical tests were used. RESULTS: The cost of keeping the hospital clean was INR Rs. 49,206,015 ($745,546 USD/€668,854). This comprised 4% of the total operational expenditure of the hospital. The maximum proportion of cost for cleaning hospitals was due to housekeeping staff salaries (66%), followed by cost of laundry (17%) and cost of cleaning consumables (13%). The trend analysis of the multidrug-resistant organism (MDRO)-related bacteraemia rate during the study period (calendar year of 2015 and 2016) showed a slight reduction of Methicillin- resistant Staphylococcus aureus, Vancomycin- resistant Enterococci and extended-spectrum beta-lactamase and AmpC beta-lactamase bacteraemia rates. CONCLUSION: Keeping hospital clean is resource intensive. This is an essential strategy to keep MDRO infection rates under control.

Antibiotic Resistance Policy and the Stewardship Role of the Nurse.

Government policy, at all levels, should reflect current scientific evidence to curb the spread of multidrug-resistant organisms (MDROs) and to promote healthier lives for citizens and the global community. The World Health Organization estimates that approximately 63,000 Americans die annually of infections from MDROs. Annual spending in the United States used to combat MDRO infections surpassed $35 billion in 2015. This article is a review of U.S. policy regarding MDROs and focuses on several means with which nurses can implement antibiotic stewardship within their practices to stall the creation and global spread of antibiotic-resistant organisms. Nurses are vital to successfully implementing methods of antibiotic stewardship as they are at the center of multidisciplinary health care teams and have the greatest direct patient contact of all members within the team. Methods of antibiotic stewardship include limiting the use of antibiotics within animal husbandry industries, promotion of health care policy in line with antibiotic stewardship standards, and adopting more stringent clinical prescribing practices of antibiotics used in human therapies. Application of these improvements to U.S. federal, state, and local facility policies is in line with current scientific evidence and will provide a framework for cohesive partnerships with nations and institutions abroad that also struggle with the spread of MDROs in their own communities.

Weekly Screening for Multidrug-Resistant Organisms Identifies High Number of Colonizations in Patients Undergoing Stem Cell Transplantation

Introduction:Multidrug-resistant organisms (MDRO) are a challenge in patients undergoing stem cell transplant (SCT) which often result in an increase in mortality. To our knowledge, current literature defines only screening at the time of work-up for SCT-patients. The aims of the study were to assess the rate of MDRO colonization with weekly screening, rate of infection and the associated mortality in patients undergoing SCT.Patients and methods:Consecutive patients admitted at the SCT unit between January-18 to July-18 were reviewed in our institution. Screening consisted of rectal and perineal swab on admission and weekly until the date of discharge. In case of detection of MDRO , patients were isolated and infection control strategies were applied.Results:41 patients were analysed, with 47 admissions, 6 patients had 2 admissions. The median duration of hospitalization was 27 days/patient (range 8-100). 168 rectal-and perineal swab were performed with a median of 3 swabs/patient (range 1-7). Patient characteristics are shown in Table 1. 36 patients (87%) spiked fever in a median of 8,5 days after admission (1-38days). 24,4% (n=10) had a positive screening: 2/10 patients at baseline and 8/10 patients (80%) were detected for the first time beyond baseline screen. Rate of MDRO colonization was 3% per week (95%CI 1.4-5.4). MDRO identified were : 4 patients with Extended-spectrum beta-lactamases producing E. Coli (ESBL-EC), Multidrug-resistant (MR) Pseudomonas aeruginosa (n=3), Vancomycin-resistant Enterococci (n=2) and 1 patient with carbapenem-resistant Citrobacter freundii. 6/10 patients developed MDRO infection (60%), all with previous MDRO positive detection: MR-Pseudomonas aeruginosa in urine culture (n=3) 2 treated with ceftolozane/tazobactam, 1 with meropenem+amikacin; ESBL-EC in urine culture (n=2) both treated with meropenem and 1 with Klebsiella pneumoniae carbapenemase in urine culture treated with ceftazidime/avibactam. The infection rate was 4,6% (95% CI 3.9-5.2). In 80% patients (n=8) antibiotic treatment was guided by positive screening, 3 patients were admitted to intensive care unit for sepsis. No mortality was associated to MDRO.In 76%of patients (n=28) screening was negative for MDRO. 24/28 (85%) spiked fever with a median of 10 days after admission (1-38days). None MDRO-infections in negative-screened patients were detected.Conclusions :Weekly screening for MDRO identified a high number of MDRO colonizations allowing to apply early strategies of infection control in high risk patients . Besides, MDRO infection occurred only in patients previously colonized, therefore, 80% of our cohort could benefit from guided treatment by the time of the febrile episode. Early identification of MDRO colonization might have helped to reduce MDRO related mortality. However, these findings should be confirmed with further studies, comparing baseline with weekly MDRO screening strategies. DisclosuresNo relevant conflicts of interest to declare.

462. “All Eyes on You”: A Covert Observational Study on Contact Precaution Compliance in Six Hospitals at the Detroit Medical Center

BackgroundThe Center for Disease Control and Prevention recommends strict contact isolation precautions (CP) that include hand hygiene (HH) and barrier (gloves and gown) precautions upon entering and leaving the rooms of patients diagnosed with multidrug-resistant organism or Clostridium difficile infections. Although this policy has been in place for several years, compliance rate among HCW is rarely studied. The aim of our study was to covertly monitor, analyze, and compare the overall bundle compliance (OBC) and individual (HH, glove and gown) component compliance (ICC) among HCWs during routine patient care.MethodsA prospective observational study was done in six Detroit Medical Centers (July 2017 to February 2018). Trained observers audited both inpatient and intensive care units on random days and time. Components audited (1) HH before donning and after doffing (2) gowning and gloving techniques before entering and after existing the patient room. A mobile application (speedy audit) was used to record all data. A pilot targeted education program (TEP) was also conducted in one of the hospitals where education was focused only on strict HH practice before donning.ResultsA total of 6,274 observations were collected. The OBC was 38%. Common HCWs observed included nurses (registered nurse and nursing student) 47%; physicians (attending’s, residents, fellows) 28%; service workers including Environmental Service, Food service, Patient transporter, Social worker, Pastoral care- 14%; Allied Health Professions including Dietician, Blood Collection, Physiotherapist, Radiology Tech, Respiratory Therapist 4%; The OBC among all HCW were below 50%. For the ICC, HH (49%) was way below the gloving (80%,) and gowning (62%) compliance. HH compliance before donning was strikingly lower (40%) than the compliance after doffing (62%). This trend was similar in all HCW. Within a month of TEP, a drastic increase in both HH [↑ to 75% from 26% (P < 0.001)] and OBC [↑ to 68% from 16% (P < 0.001)] was seen.ConclusionCommon misconception that gloves are substitute to HH could explain the low HH rates before donning. Recognition of this gap and focused education on HH before donning has led to improved compliance in all HCW.Disclosures All authors: No reported disclosures.

1199. Epidemiology of Carbapenem-Resistant Klebsiella pneumoniae: A Comparative Study Between Facilities in the United States and the Dominican Republic

BackgroundThe prevalence of multi-drug-resistant organisms (MDRO) is on the rise globally. MDRO infections carry high morbidity and mortality. There is a paucity of data on Carbapenem-resistant Klebsiella pneumoniae (CRKp) in the Dominican Republic (DR). Evaluating CRKp in various settings will provide data on contrasting epidemiologic risk factors. We evaluated the epidemiology of CKRp in three contrasting settings, a 495-bed urban academic center (AC), a 151-bed urban community hospital (CH) and a 200 bed teaching hospital in the DR (DRH).MethodsWe performed a retrospective cohort study of patients with CRKp cultures from 2014 to 2016 from AC, CH and DRH. A comparative evaluation of the epidemiology of CRKp between the cohorts was performed. Demographics, co-morbid conditions, antibiotic sensitivity, and outcomes were compared between hospital cohorts.ResultsCohort AC had 64 patients, compared with eight from CH and eight from DRH. AC (59%) and CH (62%) cohorts included more men than the DRH cohort (25%). Average age was 62, 66, and 51, respectively. History of MDRO, antibiotic use in the past 6 months and hospitalization within the past year were common risk factors (Figure 1). Diabetes and end-stage renal disease were common comorbidities at all facilities (Figure 2). Charleston Comorbidity Index (CCI) score was highest at AC (6.6) and DRH (6.4) compared with CH (4). Mortality was highest in DRH (63%, 6/8) and AC (11%, 7/64) while CH had no deaths. Urine was the most common source at AC (67%) and CH (75%) while blood was most common at DRH (62.5%). CRKp isolates were susceptible to colistin at varying rates (AC=85%, CH = 63%, DRH = 80%).Figure 1.Common risk factors for CRKp between facilities.Figure 2.Common patient comorbidities for CRKp between facilities.ConclusionPrior antibiotic use and hospitalization were common risk factors in all settings. Mortality and CCI scores for CRKp was highest at AC and DRH, which are tertiary referral centers. CH had less overall mortality and higher rates of colistin resistance. Further studies are needed to understand these risk factors. Strengthening antimicrobial stewardship and infection control practices in the United States and abroad may help curb the spread of resistance in different clinical settings.Disclosures All authors: No reported disclosures.

1961. A Randomized Controlled Trial of the Effect of Accelerated Copper Textiles on Healthcare-Associated Infections and Multidrug-Resistant Organisms: The “Investigating Microbial Pathogen Activity of Copper Textiles” (IMPACT) Study

BackgroundHealthcare-associated infections (HAIs) and multidrug-resistant organisms (MDROs) remain critically important problems. Although copper has well-described antimicrobial properties, the impact of copper-impregnated linens on HAIs and MDROs in healthcare settings remains undefined.MethodsThis study was conducted in a 24-bed medical ICU and a 24-bed surgical ICU from 1/12/16 to 7/31/16. Six beds in each ICU were randomized to CottonX™ accelerated copper linens (flat sheet, fitted sheet, pillow cover, gown) (Argaman Technologies Ltd.) and 18 beds to regular linens. Patients were enrolled if they were in the ICU for ≥3 days and were followed prospectively for development of an HAI (including C. difficile infection) and/or MDRO from ICU day 3 through 2 days after ICU discharge. MDROs were defined as a new clinical culture (i.e., no culture with the same organism in the prior year) with methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, or ceftriaxone-resistant or carbapenem-resistant Enterobacteriaceae. A patient could be included more than once for distinct ICU stays (“episodes”).ResultsAmong 1,021 subjects, the median age was 61 and 448 (44%) were female. Of 1,205 total episodes, 678 (56%) were in the MICU, 527 (44%) were in the SICU, and 351 (29%) were randomized to copper rooms. There were no significant differences between study groups with regard to demographics, comorbidities, indwelling devices, or antibiotic use. The overall rate (per 1,000 patient-days) of the composite outcome (HAI or MDRO) was 11.66 and 15.44 in copper and non-copper episodes, respectively, [incidence rate ratio (IRR) = 0.76 (95% CI, 0.46, 1.19); P = 0.22]. Rates of HAIs were 10.26 and 10.41 for copper and non-copper episodes, respectively ([IRR (95% CI) = 0.99 (0.57, 1.64); P = 0.97]. Rates of MDROs were 3.73 and 6.51 for copper and non-copper episodes, respectively [IRR (95% CI) = 0.57 (0.23, 1.26); P = 0.15]. Results were consistent when stratified by type of ICU.ConclusionWhile not statistically significant, there was a nearly 50% lower rate of MDRO infection and colonization with use of CottonX™ accelerated copper linens, possibly in part due to decreases in environmental contamination. Future work should further explore the role of copper linens in reducing MDROs.Disclosures D. Pegues, DaVita / Total Renal Care: Consultant, Consulting fee.

Impact of Amoxicillin-Clavulanate followed by Autologous Fecal Microbiota Transplantation on Fecal Microbiome Structure and Metabolic Potential.

Strategies to prevent multidrug-resistant organism (MDRO) infections are scarce, but autologous fecal microbiota transplantation (autoFMT) may limit gastrointestinal MDRO expansion. AutoFMT involves banking one's feces during a healthy state for later use in restoring gut microbiota following perturbation. This pilot study evaluated the effect of autoFMT on gastrointestinal microbiome taxonomic composition, resistance gene content, and metabolic capacity after exposure to amoxicillin-clavulanic acid (Amox-Clav). Ten healthy participants were enrolled. All received 5 days of Amox-Clav. Half were randomized to autoFMT, derived from stool collected pre-antimicrobial exposure, by enema, and half to saline enema. Participants submitted stool samples pre- and post-Amox-Clav and enema and during a 90-day follow-up period. Shotgun metagenomic sequencing revealed taxonomic composition, resistance gene content, and metabolic capacity. Amox-Clav significantly altered gut taxonomic composition in all participants (n = 10, P < 0.01); however, only three participants exhibited major changes at the phylum level following exposure. In the cohort as a whole, beta-lactamase genes were enriched following Amox-Clav (P < 0.05), and predicted metabolic capacity was significantly altered (P < 0.01). Species composition, metabolic capacity, and beta-lactamase abundance returned to pre-antimicrobial exposure state 7 days after either autoFMT or saline enema (P > 0.05, compared to enrollment). Alterations to microbial metabolic capacity occurred following antimicrobial exposure even in participants without substantial taxonomic disruption, potentially creating open niches for pathogen colonization. Our findings suggest that metabolic potential is an important consideration for complete assessment of antimicrobial impact on the microbiome. AutoFMT was well tolerated and may have contributed to phylogenetic recovery. (This study has been registered at ClinicalTrials.gov under identifier NCT02046525.)IMPORTANCE The spread of multidrug resistance among pathogenic organisms threatens the efficacy of antimicrobial treatment options. The human gut serves as a reservoir for many drug-resistant organisms and their resistance genes, and perturbation of the gut microbiome by antimicrobial exposure can open metabolic niches to resistant pathogens. Once established in the gut, antimicrobial-resistant bacteria can persist even after antimicrobial exposure ceases. Strategies to prevent multidrug-resistant organism (MDRO) infections are scarce, but autologous fecal microbiota transplantation (autoFMT) may limit gastrointestinal MDRO expansion. AutoFMT involves banking one's feces during a healthy state for later use in restoring gut microbiota following perturbation. This pilot study evaluated the effect of amoxicillin-clavulanic acid (Amox-Clav) exposure and autoFMT on gastrointestinal microbiome taxonomic composition, resistance gene content, and metabolic capacity. Importantly, we found that metabolic capacity was perturbed even in cases where gross phylogeny remained unchanged and that autoFMT was safe and well tolerated.

A Systematic and Critical Review of Bacteriophage Therapy Against Multidrug-resistant ESKAPE Organisms in Humans.

Bacteriophages (phages) may constitute a natural, safe, and effective strategy to prevent and control multidrug-resistant organisms (MDROs), and ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) pathogens in particular. Few clinical studies have assessed the safety and efficacy of phages in patients infected with MDROs. This systematic review summarizes and critically evaluates published studies of phages in clinical practice and presents the appropriate phage selection criteria, as well as recommendations for clinicians and scientists for a successful therapy. Articles were identified through a search of the PubMed, Ovid, EMBASE, and Cochrane Library databases. Among 1102 articles and abstracts, 30 studies were selected and evaluated using selective inclusion criteria, phage criteria, and study characteristics. Most studies showed efficacy (87%) and safety (67%) of the tested phages, but few studies examined phage resistance (35%). Clinical studies and regulatory changes are needed to determine the safety and efficacy of phages and to advance their use in patients with MDRO infections.

A Multicenter, Prospective, Observational Study to Determine Predictive Factors for Multidrug-Resistant Pneumonia in Critically Ill Adults: The DEFINE Study.

This study was conducted to describe the prevalence, epidemiology, and clinical outcomes of multidrug-resistant (MDR) organism (MDRO) pneumonia in critically ill patients. A multicenter, prospective, observational study of patients admitted to 60 intensive care units (ICUs), from 34 hospitals, in the United States from November to December 2016. Adults (> 18 yrs) receiving antimicrobial therapy at least 5 days for pneumonia were included. Patients were classified into two categories, with or without MDRO, and subcategorized by pneumonia type. Demographics, medication histories, and health care exposure were collected during ICU admission and compared using t test and chi-square tests. Multivariate logistic regression was used to determine predictive factors for MDRO pneumonia and hospital mortality. Of 652 patients, 92 patients (14.1%) developed MDR pneumonia. Predictors of MDRO pneumonia were acid suppression therapy within the previous 90 days (odds ratio [OR] 1.88 [1.14-3.09]; p=0.013), mechanical ventilation (OR 1.96 [1.14-3.35]; p<0.001), and history of MDRO infection (OR 4.74 [2.21-10.18]; p<0.001). Appropriate initial antimicrobial selection occurred in 58 patients (63%) with MDRO pneumonia compared to 464 patients (82.7%) in patients without MDRO pneumonia (p<0.001). MDRO pneumonia was not associated with hospital mortality (18.5% vs 17.6%, p=0.087). In a broad cohort of critically ill patients, MDRO pneumonia is infrequent, and associated with factors describing the intensity of health care provided. Presence of MDRO pneumonia is not associated with hospital mortality. Further study is needed to clarify risk factors for multidrug-resistant pneumonia in critically ill patients.

Infection in Solid Organ Transplant Recipients: Focus on Multi drug-resistant organisms

Background: Infection in transplantation is still an important cause of morbimortality. In the era of multidrug-resistant organisms (MDRO) this condition gets even worse. Methods & Materials: We analyzed all organ transplants (Tx) performed in our center, during 2015 and 2016. Data were prospectively obtained. We described incidence and type of infections, percentage of MDRO, risk factors for MDRO infection, and mortality. Patients who died or had the organ explanted within 72 hs were excluded. Results: 264 Tx were included: 118 kidney (KT), 62 heart (HT), 52 liver(LT), 15 kidney-pancreas (KPT) and 17 lung (LT). 173 (65.5%) presented infectious episodes (ep.),138 pat. (52%) presented 292 ep. of bacterial infection (BI). HT and LT had lower incidence of BI. 109 pat. presented MDRO infections. 210/292 (72%) BI were caused by MDRO. The lowest incidence of MDRO was observed in HT.Tabled 1Organismn°MDROResistanceTransplantKlebsiella pn.132112 (83.5%)KPC 12 (11%)all TxE. coli4825 (48%)Ps. ae4117 (41%)MBL 3 (7%)LTOther enterobacteria2928 (96.5%)Acinetobacter1917 (89%)Enterococcus182 (12%)S. aureus54 (80%)Other377 (19%) Open table in a new tab The most frequent localization in KT and KPT was urinary tract (66 and 67%), in LT was abdominal (46%), In HT respiratory and urinary (32 and 34%) and in LT respiratory (78%). Thirty-four of 292 ep. were surgical site infections.(11.5%), this type of infection was more frequent in KPT and LT. MDRO infection did not correlate with mortality, except in LT: 60% in pat. with MDRO vs 21% in pat. without MDRO infection: p = 0.019. MDRO infection did not correlate either with age, localization of infection, or retransplantation. In KT infection with MDRO correlated with type of donor: living-donor 13/47 and deceased donor 45/71 p = 0.00012 Conclusion: MDRO infections are very frequent in our population. These infections correlated with mortality in LT recipients. It is relevant to learn about resistance of microorganisms in transplant recipients, so as to indicate adequate empirical antibiotic treatment

Impact of discontinuing contact precautions against vancomycin resistant Enterococcus: Multicenter study in Argentina

Background: Contact precautions (CP) are widely recommended to prevent multidrug-resistant organism (MDRO) transmission avoiding colonization and infection. However, conflicting data exist regarding their effectiveness. Recent studies suggest that for endemic methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin resistant Enterococcus (VRE), standard measures and decolonization for MRSA could be effective. In Argentina there is no formal recommendation, however, most centers implement CP and only a few discontinue them. Our purpose is to evaluate the impact on the EVR infections after discontinuing CP in centers located in Buenos Aires. Methods & Materials: Multicenter, retrospective, quasi-experimental study of patients admitted to acute care facilities in Buenos Aires. We included centers that perform health care associated infections surveillance according to NHSN definitions and discontinued CP for more than 1 year. The CP included the use of gloves, gowns, personnel items or their subsequent disinfection and individual or cohort rooms. EVR infection was defined as the presence of signs and symptoms associated with EVR isolation in clinical samples 48 hours after admission. We compared the number of cases of VRE infections/1000 discharges 1 year before and after discontinuing CP. P 0 .05 was considered statistically significant. During the study, CP were continued for other MDRO (MRSA, multidrug resistant gram-negative bacilli and Clostridium difficile) in addition with the hand hygiene program. Results: Five institutions were included (4 tertiary acute care University Private - 1 Public), 4 polyvalent. Total beds 1308, only 2 centers have shared rooms. One institution reported UCI data. In the preintervention period occurred 27 infections / 61099 discharges (rate 0.44 / 1000 discharges), after CP discontinuation there were 32 infections / 61668 discharges (rate 0.52 / 1000 discharges) (p0.62). The average adherence to hand hygiene in the initial period was 58% and post-intervention 66%. Conclusion: This experience, in different centers, shows that discontinuation of CP was not associated with a significant increase of VRE infections and should be accompanied by cross-sectional measures such as Hand Hygiene. The prevalence of different MDRO infections should be considered to evaluate the cost effectiveness of CP.

Commentary

Commentary

Abstract O-34: MULTI-DRUG RESISTANT ORGANISM SEPSIS IN PEDIATRIC MULTI-VISCERAL AND ISOLATED BOWEL TRANSPLANT RECIPIENTS: AN INTRODUCTORY, PILOT STUDY

Aims & Objectives: Infections are the leading cause of death in transplant recipients, but there is a paucity of pediatric data. Recently, we demonstrated that 47% of bacterial infections in septic pediatric liver transplant recipients could be attributed to multi-drug resistant organisms (MDROs). We now aim to describe the epidemiological landscape of multi-visceral (MVTx) and isolated bowel transplant (BTx) patients admitted with severe sepsis (PSS) to the pediatric intensive care unit (PICU). Methods IRB-approved, retrospective analysis of MV & BTx transplanted between 7/2011 and 12/2015 with subsequent PSS admissions until 1/2017. PSS defined by international pediatric sepsis consensus conference criteria. MDROs defined as bacteria resistant to greater than one class of antimicrobial agents. Results 24 patients received an MV or BTx during the study period (16 MVTx, 8 BTx). 54.2% (n=13) were subsequently admitted with PSS for a total of 24 episodes. Table 1 shows demographics for PSS patients. Figure 1 identifies etiology of infections. Overall 47.8% of infections were bacterial, with 81.8% of those infections secondary to MDROs (vancomycin-resistant Enterococcus and extended-spectrum beta-lactamase producing organisms most common). Bloodstream infections were most common site for bacterial infections (45.5%) with the remainder peritonitis/cholangitis or wound infections. Outcome measures shown in Table 2. Mortality was 7.7% (n=1). Median PICU and hospital LOS was 5.5 days (IQR: 2–16.25) and 63.5 days (IQR: 21.75–131). Conclusions Despite a high prevalence of MDRO infections resulting in sepsis, mortality rates are comparable to non-transplant patients. Multi-center studies are needed to better understand the impact of these infections and identify pathways for risk mitigation.