Number Of Positive Blood Cultures Research Articles

Gastrointestinal endoscopy 30-day-associated bacteremia: Nonoutbreak 5-year review in an inner-city, tertiary-care hospital

Gastrointestinal endoscopic procedures (GIEP's) are an essential part of patient care both diagnostically and therapeutically. Post-GIEP infections may be higher than previously reported and may not have been accurately captured in the past. The aim of this study was to determine the incidence and associated factors of bacteremia associated with GIEP's. This is retrospective study of GIEPs performed over a five-year period (2018-2022) at an academic medical center. Electronic health records (EHR) identified GIEPs and positive blood cultures within 30 days of procedure. Statistical analysis was performed using non-parametric testing to compare variables due to the small number of positive blood cultures. EHR identified 18,986 GIEP's and 52 true and unique bacteremia out of 17,093 blood cultures during the five-year study period. The highest rate of positive blood culture of 2.84% (18/ 634) was associated with ERCP and the lowest 0.08% (7/ 9029) was associated with colonoscopy. Our study showed a reflection of the endemic rate of bacteremia post GIEP's. Our study cannot differentiate endogenous infection versus contaminated (exogenous) endoscopes. ERCP procedures are disproportionately associated with higher incidence of bacteremia. Clinical surveillance in non-outbreak settings is essential for estimating GIEP related infections. It should be combined with endoscopic reprocessing audits for appropriate prevention of GIEP associated infections.

The impact of levofloxacin prophylaxis on empiric intravenous antibiotic use in pediatric hematopoietic stem cell transplant recipients.

Levofloxacin prophylaxis during periods of neutropenia in pediatric hematopoietic stem cell transplant (HSCT) may reduce the number of febrile episodes and use of empiric intravenous antibiotics (EIA); however, the literature is conflicting. This retrospective review compared EIA use before and after implementation of levofloxacin prophylaxis at a children's hospital. Levofloxacin prophylaxis was associated with reduced use of certain EIA; however, did not reduce the number of positive blood cultures or clinical deteriorations. Therefore, levofloxacin prophylaxis may have implications for the stewardship of broad-spectrum intravenous antibiotics used in pediatric HSCT.

Review of Blood Cultures Taken From Arterial Lines in James Cook University Hospital: Contamination Analysis And Comparison With Venous Samples

BACKGROUND: Blood cultures are crucial diagnostic tools for identifying and treating bloodstream infections. Traditionally, venous blood is the preferred source for sample acquisition, but arterial lines offer an alternative. However, concerns regarding contamination and diagnostic accuracy have been raised, questioning the reliability of arterial line blood cultures. This study aimed to evaluate the contamination rates of arterial line blood cultures at James-Cook University Hospital (JCUH), UK and compare them with venous samples to understand their clinical utility better. METHODS: A comprehensive retrospective review analysed 17,643 blood culture samples collected between September 2022 and March 2023 at JCUH. Among these, 109 arterial line blood cultures and 785 venous peripheral adult samples were included for data analysis. Contamination rates were calculated as the number of positive blood cultures with contaminants per total positive samples (arterial or venous). The incidence of contamination was defined as the number of total blood cultures reported with contaminants per total samples (arterial or venous). No discrimination was made based on the number of contaminants found. Clinical information accompanying the blood cultures, such as the specification of arterial lines as 'new' samples, was also considered. RESULTS: The overall contamination rate at JCUH was found to be 4.99%. Specifically, the contamination rate for venous samples was 49.26%, while arterial samples had a higher contamination rate of 56.52%. The incidence of contamination from arterial samples was 11.92%, significantly higher than the incidence rate for venous samples at 3.18%. Most arterial samples were requested from intensive care units (ICUs) and highly dependent wards (HDUs), indicating potential areas for targeted interventions to improve blood culture collection practices. CONCLUSION: Arterial blood cultures demonstrated higher contamination rates compared to venous samples, raising concerns about their reliability. Contamination in arterial samples, particularly when collected from critically ill patients in ICUs and HDUs, can lead to inappropriate use of antibiotics, delayed, or missed diagnosis, and suboptimal patient outcomes. The study recommends targeted interventions to improve arterial blood culture collection practices and further training for healthcare workers involved in arterial line care. Encouraging the use of only 'new' arterial lines and implementing standardized protocols can help reduce contamination rates. Furthermore, the study identified certain limitations, such as potential human errors in data analysis and the need for a larger dataset of arterial line cultures. Extending the analysis to compare different sample sources like CVCs, Hickman lines, and central lines could provide a more comprehensive understanding of contamination rates across various culture collection methods. In conclusion, venous samples showed higher clinical favourability with a lower contamination rate, providing increased dependability for accurate diagnosis and management. Although some studies have not shown clear superiority of arterial samples over venous samples, this analysis highlights considerable differences in contamination rates, suggesting a potential inferiority of arterial blood culture samples. While efforts can be made to optimize the consistency of arterial samples and reduce contamination rates, their use should be approached with caution. Implementing the recommended measures is essential for accurate diagnosis, improved patient outcomes, and effective antibiotic management in clinical practice.

Diagnostic performance of the time to positivity of blood cultures to distinguish true bacteremia from contaminants based on an automated system.

To determine the diagnostic performance of blood culture positivity times for distinguishing true bacteremia from contaminants in the automated "BACT/ALERT®" system. A cross-sectional, diagnostic test-type study was conducted from a database of blood culture samples processed between January 2016 and August 2021. All blood culture samples from patients with suspected bacteremia were included; blood culture samples were entered into the "BACT/ALERT®" system to differentiate true bacteremia from contaminants. We obtained 33,951 blood cultures samples, of which 3875 were positive. Of the total number of positive blood cultures, 75.2% (n=2913) were true bacteremia and 24.8% (n=962) were contaminants. The median time to positivity in blood cultures with true bacteremia was significantly shorter (16.3 hours; IQR: 11.2 - 24.9) than the median time to positivity of blood cultures with contaminants (22.5 hours; IQR: 18.4 - 31.8; p<0.001). The positivity time showed the capacity to differentiate true bacteremia from contaminants, with an AUC-ROC of 0.73 (95%CI: 0.71 - 0.75), with 85% and 63% sensitivity and specificity respectively for the diagnosis of contaminants when the positivity time exceeds 16.5 hours. The use of antibiotics prior to sampling delayed the time to positivity, while having fever before sampling shortened the time to positivity. Our results show good diagnostic performance of blood culture positivity times to differentiate true bacteremia from contaminants using the "BACT/ALERT®" system when the positivity time was longer than 16.5 hours.

235. Investigation of the relationship between the number of positive blood cultures and patient prognosis

Abstract Background The relationship between the number of positive blood cultures (NPBCs) and clinical outcomes has not been well-studied. The purpose of this study was to assess the impact of NPBCs (one set or two) on clinical outcomes. Methods We conducted a retrospective study comparing the clinical features of two sets of positive blood cultures (NPBCs=2) and one set of positive blood culture (NPBCs=1) in adult patients with bacteremia and fungemia from 2004 to 2021 at a tertiary hospital in Tokyo, Japan. We focused on four pathogens commonly encountered in clinical practice, including Staphylococcus aureus (S. aureus), Streptococci, gram-negative rods (GNR) (Enterobacterales and Pseudomonas aeruginosa), and Candida species, as the true causative pathogens in bacteremia and fungemia. The primary outcome was in-hospital mortality, and secondary outcomes were ICU admission and use of vasopressor drugs. Results In univariate analysis, NPBCs=2 for S. aureus was associated with vasopressor use, and NPBCs=2 for Streptococci was linked to a higher rate of ICU admission. However, these differences were not significant in multivariate analysis. Interestingly, NPBCs=2 for S. aureus had a positive impact on in-hospital mortality compared with NPBCs=1 (OR 0.574, 95%CI 0.376–0.877, p &amp;lt; 0.05). NPBCs for Candida species did not affect clinical outcomes. Furthermore, NPBCs=2 for GNR was associated with vasopressor use (OR 1.62, 95%CI 1.27–2.07, p &amp;lt; 0.05) in both univariate and multivariate analysis. We performed logistic regression analysis using the five items with the highest clinical significance: NPBCs=2, serum Cr &amp;gt; 1.2 mg/dL, Hb &amp;lt; 12 g/dL, heart rate &amp;gt; 90 beats/min, and platelet count &amp;lt; 150,000/μL. Based on the β coefficient, we assigned scores to each item and created a STAT-2 (S: Serum Cr, T: Thrombocytopenia, A: Anemia, T: Tachycardia, 2: NPBCs=2) score for the use of hypertensive drugs for GNR. The receiver operating characteristic (ROC) curve for the STAT-2 score with a cutoff of 6 points or higher had an area under the curve (AUC) of 0.763. The specificity was 90.8%, with a positive likelihood ratio of 4.13 (95% CI 3.40-5.02). Conclusion Our study suggests that NPBCs can predict clinical outcomes in patients with certain pathogenic infections. Disclosures All Authors: No reported disclosures

1664. The Impact of Levofloxacin Prophylaxis on Empiric Intravenous Antibiotic Use in Pediatric Hematopoietic Stem Cell Transplant Recipients

Abstract Background Clinical trials have demonstrated that levofloxacin prophylaxis during periods of neutropenia in hematopoietic stem cell transplantation (HSCT) reduces the frequency of bacteremia in adults and febrile episodes in children. Therefore, levofloxacin prophylaxis may also have a role in reducing empiric intravenous antibiotic (EIA) use. Methods This retrospective review assessed the impact of levofloxacin prophylaxis for patients &amp;lt; 18 years undergoing HSCT at a Canadian children’s hospital. The primary outcome was antibiotic days of therapy (DOT) during the pre-engraftment period comparing the pre-levofloxacin era (Jan 1, 2019–Jun 30, 2020) to the levofloxacin era (Jul 1, 2020–Dec 31, 2021). Patients were excluded if they were receiving EIA at the time of transplant, received chimeric antigen receptor T-cell therapy, or if levofloxacin use was discordant with their era. Secondary outcomes included the number of positive blood cultures and clinical deterioration episodes (clinical change resulting in blood culture draw and initiation/change of EIA). Results Fifty-four of 152 patients (36.5%) and 55 of 147 patients (37.4%) were included in the pre-levofloxacin and levofloxacin eras respectively. The most common reasons for exclusion were EIA use at the time of transplant and levofloxacin use discordant with the patient's era (Figure 1). Baseline characteristics were not significantly different between groups (Table 1). Mean DOT/pre-engraftment days (%) were significantly lower in the levofloxacin era for piperacillin-tazobactam (53.3 vs. 38.3, p=0.004) and amikacin (1.7 vs. 0.1, p=0.03), while there was no significant difference for meropenem, vancomycin, or all other antibiotics combined. There was also no significant difference in the number of positive blood cultures (11 vs. 7, p=0.35) or clinical deterioration episodes (55 vs. 66, p=0.1). Conclusion Levofloxacin prophylaxis in children undergoing HSCT reduced percent pre-engraftment days on piperacillin-tazobactam and amikacin, with no significant impact on the number of positive blood cultures or clinical deterioration episodes. Therefore, levofloxacin prophylaxis may facilitate antimicrobial stewardship activities through reduced use of certain broad-spectrum antibiotics. Disclosures Kathryn E. Timberlake, PharmD, Avir Pharma: Advisor/Consultant

Abstract 16120: Efficacy of an Electronic Medical Record Alert System in Identifying Cardiac Implantable Electronic Device Infection

Introduction: Cardiac Implantable Electronic Device infection (CIED-I) is common, morbid, and frequently under recognized. Electronic Medical Record (EMR) based alerts have been proposed as a solution to improve detection of CIED-I. Hypothesis: Development of a real-time EMR algorithm to identify CIED-I can improve recognition of patients with CIED-I. Methods: An EMR (Epic, Verona, WI) alert system to identify inpatients with CIED-I was developed based on the presence of CIED and positive blood cultures. The presence of CIED was determined using patient problem list, structured data elements describing device implantation, and prior device interrogation. Alerts were generated each time a patient with CIED had a positive blood culture. We examined patients admitted between January 2020 - March 2023. Identified patients were adjudicated manually to confirm: (1) the presence of CIED and (2) true bacteremia versus contaminant based on patient and microbiological characteristics. Results: The algorithm generated 255 alerts, corresponding to 100 unique patients over 142 hospitalizations. Of these alerts, 213 appropriately identified 88 unique patients with positive blood cultures and CIEDs, resulting in an alert specificity of 84% and patient specificity of 88%. The remaining 42 (16.6%) alerts occurred in 10 patients who no longer had CIED due to prior CIED extraction (6 at the time of heart transplant and 4 with extraction without reimplantation) as well as 2 patients with erroneous blood culture identification (one positive syphilis antibody test and one lab documentation error). In patients with appropriate alerts, 27 patients had 4/4 positive blood culture bottles, 5 patients had 3/4, 10 patients had 2/4, 41 patients had 1/4, 2 patients had 2/2, and 1 patient had 1/2. The positive predictive value of the algorithm to identify true bacteremia was 0.65 (138/213). Conclusions: The algorithm has high specificity to identify patients with possible CIED infection. Improving the accuracy of device detection, by incorporating radiology imaging or history of extraction, could further improve specificity. Positive predictive value and alert fatigue could be improved by stratifying alerts by blood culture species and total number of positive blood cultures.

Vancomycin use for haemodialysis patients-Development of a new dosing protocol.

To develop a dosing and monitoring protocol to achieve therapeutic vancomycin levels on intermittent haemodialysis. We identified 15 vancomycin treatment courses received by patients on intermittent haemodialysis at a district health board in Auckland, New Zealand. Demographic, biochemical and clinical parameters were gathered from their health records. We subsequently devised and implemented a new vancomycin protocol consisting of weight-based loading dose, and subsequent dose titration according to same-day measured pre-dialysis levels. We then re-audited 16 vancomycin treatment courses to assess the performance of the protocol. A significantly higher proportion of vancomycin levels were within the target range (15-20 mg/L) following the implementation of protocol, from 23% to 46% (p< .005). Additionally, a greater proportion of treatment courses had >50% of pre-dialysis levels within the target range, rising from 13% to 56% (p< .01). In the pre-protocol group, 19 out of 117 doses of vancomycin were withheld during treatment, compared to 1 out of 118 doses in the post-protocol group. A total of 62% of total maintenance doses were administered in adherence to protocol. Length of hospital stay and number of positive blood cultures while on treatment were reduced. Our initial audit revealed deficiencies in our clinical practice in the absence of a local vancomycin protocol for patients receiving intermittent haemodialysis. Following the implementation of our novel protocol, there was an improvement in therapeutic levels and fewer doses were withheld. Our sample size was too small to allow for interpretation of clinical outcome data.

Epidemiology of bacteremia in a pediatric population – A 10-year study

IntroductionWith the widespread introduction of conjugate meningococcal and pneumococcal vaccines, the prevalence and etiology of invasive bacterial infections have changed. We aimed to review all cases of bacteremia in a level II pediatric department over a ten-year period in the post-pneumococcal conjugate vaccine era. MethodsWe reviewed all positive blood cultures (BC) obtained in our department between 2007 and 2016. Results were classified as contaminants, potential pathogens or confirmed pathogens, based on species, number of positive BC in the episode and the patients’ medical history. Demographic and clinical data were collected for patients with identified pathogens. ResultsA total of 638 positive BC were identified (6.6% of total BC); 120 (1.2%) were considered to represent true bacteremia. The most frequently identified microorganism was Streptococcus pneumoniae (29.2%), with a decrease in the number of cases between 2008 and 2015. Staphylococcus aureus was the second most common organism (19.2%) being 21.7% of these methicillin-resistant. Escherichia coli was the most common isolate in children aged less than three months. ConclusionWe found a rate of true bacteremia in children similar to recent studies. Although Streptococcus pneumoniae remains the most common microorganism, its prevalence may be declining. Monitoring microbiological data in children has implications in practice, particularly in local antibiotic prescription.

Clinical characteristics and prognosis of Staphylococcus aureus bacteremia

Staphylococcus aureus bacteremia patients characteristics at a tertiary hospital are described, and complications, mortality and associated factors are analyzed. Data from patients with S. aureus bacteremia admitted between March 2020 and February2021 at Miguel Servet university hospital in Zaragoza were retrospectively analyzed. Results showed a 14 days mortality of 24.2% and an 30 days mortality of 40%. Overall survival decreased with complications appearance [HR 3.1 (1.2-8.05)] and age over 65 years [HR 3.1 (1.4-6.6)]. The adjusted analysis showed correlation between a higher mortality at 14 and 30 days with age over 65 years [OR 6.3 (1.7-23.1)], sepsis presence [OR 19.3 (5.4-68.7)] and number of positive (+) blood cultures ≥3 [OR 5.4 (0.8-34.1)]. Mortality at 14 days was associated with sepsis presence [OR 58.2 (5.7-592.9)], number of positive (+) blood cultures ≥3 [OR 14.1 (1.1-173.7)] and an older age [OR 1.1 (1.03-1.1)]. Analyzing time to positive blood cultures ≤12 hours and number of positive blood cultures ≥ 3 at the same time, frequency of sepsis increased [30 patients (66.6%) vs 15 patients (33.3%); OR 3.4 (IC95% 1.5-8)]. High 14- and 30-days mortality were found, as well as a worse evolution in older age patients, with sepsis presence, and with greater number of positive blood cultures and times to positive blood cultures ≤12 h.

Evaluation of Procalcitonin Diagnostic Accuracy with Comparison to Blood Culture

Background: Procalcitonin has been used globally as indicator marker of sepsis to define bacteremia or blood stream infection for early patient management or antibiotic therapy. Blood culture refers to a microbiological culture of a peripheral blood sample. The blood cultures help to determine the presence of systemic infections, such as septicaemia. If the culture is positive, the causative micro-organism can usually be identified, and antibiotic sensitivity testing performed. On the other hand, the sensitivity of procalcitonin in comparison to its specificity to certain bacterial infections is still in question. Methodology: In this study, we selected 309 patients without restriction of age gender with pre-diagnosed sepsis or septic shock syndrome. Blood culture samples were collected in bactAlert media plus culture bottles and were incubated in BactAlert 3D semi-automated blood culture system; blood sample was collected for serum procalcitonin on immunoassay principle. Results: Out of 309, a total 87 blood cultures were positive and PCT was positive in 134 whereas 179 were PCT negative. In positive PCT, 63 were having bacterial growth in their blood culture while 71 were with negative blood culture. Although in total, 179 PCT were negative, only 16 were having bacterial growth in blood culture samples whereas all others revealed no growth that showed maximum number of positive blood cultures were having PCT positive but not all PCT positive demonstrated bacterial growth in blood culture suggesting that the bacteremia or sepsis can only be suspected with positive PCT. In addition, blood culture positive or negative results cannot be predicted by PCT value to make diagnostic confirmation of sepsis. Keywords: Procalcitonin (PCT), Blood culture, Sepsis, 95%CI; confidence interval, IQR; Interquartile range

Infections in a Tertiary Care Pediatric Center in Southern Poland during the SARS-CoV-2 Pandemic

The worldwide surge of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a global pandemic and led governments to control spread of the virus and provide care for the population affected by the infection. Although, in children, COVID-19 is usually asymptomatic or mild (except PIMS), the pandemic affected the whole socioeconomic system and led to the overwhelming of healthcare facilities. We report retrospective observations of the prevalence of various infectious diseases during the SARS-CoV-2 pandemic in a tertiary multidisciplinary pediatric center in Southern Poland. We retrospectively evaluated the impact of the SARS-CoV-2 pandemic on the number of other infections diagnosed in a pediatric tertiary care referral center. Our analysis included the period from the beginning of February to the end of April 2020 (spring pandemic wave), and from the beginning of September to the end of November 2020 (autumn pandemic wave). We compared them to the appropriate periods of 2019. The evaluation included blood, urine, stool and lover respiratory tract cultures as well as virological investigations. Additionally, the costs of antibiotics and antifungal drugs in selected departments were assessed. Our analysis showed considerable reduction in the majority of common infections except for influenza A and B. The microbiological data correspond with economical summary of antibiotic costs, which were significantly lower during the pandemic. One exception was the number of positive blood cultures, which increased even though the overall number of tests was lower. A general reduction of the number of infections diagnosed in children could result from the implemented preventative measures associated with the pandemic and the generally increased awareness of the risk of infection among parents and guardians. The treatment of the most serious diseases continued as it did before the pandemic. To our knowledge, this study is the first attempt to assess the impact of the COVID-19 pandemic on the prevalence of infections in a large pediatric center. Further research on the impact of the COVID-19 pandemic on the healthcare systems is necessary.

Surging bloodstream infections and antimicrobial resistance during the first wave of COVID–19: a study in a large multihospital institution in the Paris region

ObjectivesThis study measured the impact of the first wave of COVID-19 pandemic (COVID-19) (March–April 2020) on the incidence of bloodstream infections (BSIs) at Assistance Publique – Hôpitaux de Paris (APHP), the largest multisite public healthcare institution in France. MethodsThe number of patient admission blood cultures (BCs) collected, number of positive BCs, and antibiotic resistance and consumption were analysed retrospectively for the first quarter of 2020, and also for the first quarter of 2019 for comparison, in 25 APHP hospitals (ca. 14 000 beds). ResultsUp to a fourth of patients admitted in March–April 2020 in these hospitals had COVID-19. The BSI rate per 100 admissions increased overall by 24% in March 2020 and 115% in April 2020, and separately for the major pathogens (Escherichia coli, Klebsiella pneumoniae, enterococci, Staphylococcus aureus, Pseudomonas aeruginosa, yeasts). A sharp increase in the rate of BSIs caused by microorganisms resistant to third-generation cephalosporins (3GC) was also observed in March–April 2020, particularly in K. pneumoniae, enterobacterial species naturally producing inducible AmpC (Enterobacter cloacae...), and P. aeruginosa. A concomitant increase in 3GC consumption occurred. ConclusionsThe COVID-19 pandemic had a strong impact on hospital management and also unfavourable effects on severe infections, antimicrobial resistance, and laboratory work diagnostics.

Epidemiology of bacteremia in a pediatric population – A 10-year study

IntroductionWith the widespread introduction of conjugate meningococcal and pneumococcal vaccines, the prevalence and etiology of invasive bacterial infections have changed. We aimed to review all cases of bacteremia in a level II pediatric department over a ten-year period in the post-pneumococcal conjugate vaccine era. MethodsWe reviewed all positive blood cultures (BC) obtained in our department between 2007 and 2016. Results were classified as contaminants, potential pathogens or confirmed pathogens, based on species, number of positive BC in the episode and the patients’ medical history. Demographic and clinical data were collected for patients with identified pathogens. ResultsA total of 638 positive BC were identified (6.6% of total BC); 120 (1.2%) were considered to represent true bacteremia. The most frequently identified microorganism was Streptococcus pneumoniae (29.2%), with a decrease in the number of cases between 2008 and 2015. Staphylococcus aureus was the second most common organism (19.2%) being 21.7% of these methicillin-resistant. Escherichia coli was the most common isolate in children aged less than three months. ConclusionWe found a rate of true bacteremia in children similar to recent studies. Although Streptococcus pneumoniae remains the most common microorganism, its prevalence may be declining. Monitoring microbiological data in children has implications in practice, particularly in local antibiotic prescription.

Community-acquired bacteraemia in COVID-19 in comparison to influenza A and influenza B: a retrospective cohort study

BackgroundDuring the coronavirus disease 2019 (COVID-19) pandemic in the Netherlands it was noticed that very few blood cultures from COVID-19 patients turned positive with clinically relevant bacteria. This was particularly evident in comparison to the number of positive blood cultures during previous seasonal epidemics of influenza. This observation raised questions about the occurrence and causative microorganisms of bacteraemia in COVID-19 patients, especially in the perspective of the widely reported overuse of antibiotics and the rising rate of antibiotic resistance.MethodsWe conducted a retrospective cohort study on blood culture results in influenza A, influenza B and COVID-19 patients presenting to two hospitals in the Netherlands. Our main outcome consisted of the percentage of positive blood cultures. The percentage of clinically relevant blood cultures, isolated bacteria and 30-day all-cause mortality served as our secondary outcomes.ResultsA total of 1331 viral episodes were analysed in 1324 patients. There was no statistically significant difference (p = 0.47) in overall occurrence of blood culture positivity in COVID-19 patients (9.0, 95% CI 6.8–11.1) in comparison to influenza A (11.4, 95% CI 7.9–14.8) and influenza B patients (10.4, 95% CI 7.1–13.7,). After correcting for the high rate of contamination, the occurrence of clinically relevant bacteraemia in COVID-19 patients amounted to 1.0% (95% CI 0.3–1.8), which was statistically significantly lower (p = 0.04) compared to influenza A patients (4.0, 95% CI 1.9–6.1) and influenza B patients (3.0, 95% CI 1.2–4.9). The most frequently identified bacterial isolates in COVID-19 patients were Escherichia coli (n = 2) and Streptococcus pneumoniae (n = 2). The overall 30-day all-cause mortality for COVID-19 patients was 28.3% (95% CI 24.9–31.7), which was statistically significantly higher (p = <.001) when compared to patients with influenza A (7.1, 95% CI 4.3–9.9) and patients with influenza B (6.4, 95% CI 3.8–9.1).ConclusionsWe report a very low occurrence of community-acquired bacteraemia amongst COVID-19 patients in comparison to influenza patients. These results reinforce current clinical guidelines on antibiotic management in COVID-19, which only advise utilization of antibiotics when a bacterial co-infection is suspected.

394. Pseudo-outbreak of Coagulase-negative Staphylococcus Species from Blood Cultures Highlights Unique Challenges in Care of Critically Ill Patients With COVID-19

BackgroundIn response to the COVID-19 pandemic, a dedicated intensive care unit for patients infected with SARS-CoV-2 was created at our institution. We noticed a marked increase in the number of blood cultures positive for coagulase-negative Staphylococcus species (CoNS) that highlights unique challenges that arise with the creation of new units and workflows.MethodsWe reviewed all blood culture results from the COVID-19 intensive care unit (CoVICU) from April 15 to May 29. We reviewed all blood cultures taken from the oncology ward, medical intensive care unit (MICU), and emergency department (ED) for the same time frame as a comparison. We calculated contamination rates, using the clinical microbiology laboratory criteria for possible contaminants based on species and number of positive blood cultures.ResultsThere were 324 total blood cultures collected from the CoVICU with 27/324 (8.3%) positive for organisms deemed contaminant, 10/324 (3.1%) were positive considered bloodstream infections (BSI); the ratio of BSI:contaminant was 1:2.7. For the MICU, ED, and oncology units contamination rates were 2/197 (1%), 33/747 (4.4%), and 2/334 (0.6%), respectively; and the ratio of BSI:contaminant was 5:1, 2.2:1, and 17.5:1, respectively. There was a significant relationship between contamination rates and unit, X2(3, N = 1602) = 30.85, p < 0.001.ConclusionUpon investigation, peripheral blood draw kits were not stocked in the CoVICU. Additionally, certain components of standard work for blood culture collection (e.g. glove exchange) could not be performed per usual practice due to isolation precautions. Peripheral blood draws were routinely performed by nurses in CoVICU and MICU while phlebotomy performed these in other comparison units. We suspect that lack of availability of blood draw kits and disruption of typical workflow in isolation rooms contributed to an unusually high number of contaminated blood cultures among patients admitted to the CoVICU. Notably, the CoVICU and MICU providers were the same pool of caregivers, further supporting a process issue related to isolation precautions. Institutions should be aware of the need for extra attention to supply chain management and examination of disruption to standard work that arise in the management of COVID-19 patients.Disclosures All Authors: No reported disclosures

908. Evaluation of Blood Culture Submission Rates in Japan

BackgroundBlood culture tests are useful for accurate diagnosis of bacteremia and selection of antimicrobial treatment, and they are essential for instituting antimicrobial resistance (AMR) countermeasures. This study investigated blood culture submission rates in Japan and their association with the incidence of bloodstream infections.MethodsBlood culture data recorded in the Japan Surveillance for Infection Prevention and Healthcare Epidemiology (J-SIPHE) database from January to December 2019 and data submitted for consecutive 12 months from acute care hospitals (hospitals with a mean length of patient stay of ≤19 days) were included for analysis. Samples comprised 1 set of blood culture samples (aerobic and anaerobic bottles) defined as one submission. The annual blood culture submission rate was calculated as the total number of submitted blood cultures per 1000 patients/day. The incidence of bloodstream infections was calculated as the number of positive blood cultures excluding contaminated specimens per 1000 patients/day. The blood culture submission rate was then divided into four categories, respectively: category 1: 0–15; category 2: 15–30; category 3: 30–45; and category 4: 45–80.The Kruskal-Wallis test was performed to determine overall difference among 4 submission rate categories and the Dunn test with Bonferroni correction was used to compare pairs of submission rate categories.Filtering of facilities for data analysis ResultsA total of 117 hospitals were included in the analysis. The median number of beds was 415.0 (interquartile ratio [IQR]: 274.5–549.5). The median incidence of bloodstream infection was 2.78 (2.17–3.87). The median blood culture submission rate was 26.18 (17.20–35.76). The median incidence of bloodstream infection by category of blood culture submission rate was 1.39, 2.53, 3.61, and 4.48, respectively; with a significant difference observed among the four categories overall (p< 0.01). Significant differences were observed between categories 1 and 2 and between categories 2 and 3 (both p< 0.01) but not between categories 3 and 4 (p=0.758).Characteristics of the acute hospitals by category of blood culture submission rate Incidence of bloodstream infections by category of blood culture submission rate ConclusionThe blood culture submission rate is considered to be around 45 in the acute hospital setting in Japan. The incidence of bloodstream infections is greatly affected by submission rates.Disclosures All Authors: No reported disclosures

C-reactive protein- and clinical symptoms-guided strategy in term neonates with early-onset sepsis reduced antibiotic use and hospital stay: a quality improvement initiative

BackgroundEarly-onset sepsis (EOS) is a potentially life-threatening complication of birth. Clinical symptoms are often unspecific and biomarkers have low predictive values for EOS. Therefore, clinical suspicion often leads to antibiotic therapy in neonates with a negative blood culture. In the study we evaluated if a quality improvement initiative could reduce unwarranted antibiotic use in a safe way in term neonates with culture-negative sepsis.MethodsThe quality improvement initiative included new treatment guidelines and were introduced on 11 June 2018. The guidelines included C-reactive protein- and clinical symptoms-guided decision-making and shorter intravenous antibiotic therapy. All term neonates treated for EOS at Ryhov Hospital, Jönköping, Sweden were studied before (period 1: 2016–2017) and after the introduction of the new guidelines (period 2: 11 June 2018 to 30 Sept 2019).Laboratory and clinical data were analysed.ResultsThere were 7618 term neonates in period 1 and 5005 term neonates in period 2. We identified 140 (1.8%) EOS in period 1 and 97 (1.9%) EOS in period 2. During period 1 and 2, there were 61 (61/140, 44%) and 59 (59/97, 61%) EOS neonates, respectively, who met the criteria for shorter antibiotic treatment. The number of positive blood cultures were seven (0.92/1000 live births) and five (1.0/1000 live births) in period 1 and 2. The median C-reactive protein were 52 mg/L (37–62) in period 1 and 42 mg/L (31–56) in period 2 in the group who met the criteria of the guidelines. The duration of antibiotic therapy (Median: seven vs. five days, p < 0.001) and hospital stay (Median: seven vs. five days, p < 0.001) as well as healthcare costs (decreased by €122,000/year) was reduced in the group who met the criteria after the introduction of the guidelines.ConclusionC-reactive protein- and clinical symptoms-guided decision-making for EOS significantly decreased the duration of antibiotic therapy and hospital stay, and hence reduced healthcare costs, with no reinfection in a cohort of term infants.Trial registrationTrial registration number: ISRCTN29535824. Date of registration: 28 May 2020. Retrospectively registered.

Optimization of microbial diagnostics by introduction of ablood culture standard operating procedure in the emergency department

EinleitungZentrale Notaufnahmen stellen die Eintrittspforte für viele stationär aufzunehmende Patienten in einem Krankenhaus dar und sind häufig der Ausgangspunkt für die antiinfektive Diagnostik und Therapie von Notfallpatienten. In dieser retrospektiven Untersuchung soll der Frage nachgegangen werden, wie die Etablierung einer Standard Operating Procedure (SOP) „Blutkulturen“ und deren Schulung die mikrobielle Diagnostik in einer zentralen Notaufnahme verbessern kann.MethodikIn einer Vorher-und-nachher-Untersuchung wurde über einen jeweils 3‑monatigen Zeitraum (11/2017 bis 01/2018 und 11/2018 bis 01/2019) die Anzahl der abgenommenen Blutkulturen, die Rate an Blutkulturen/1000 Fälle, die Anzahl positiver Blutkulturen und die Häufigkeit typischer Hautkeime analysiert. Im Zeitraum zwischen den evaluierten Zeitabschnitten wurde eine SOP „Blutkulturen“ in Zusammenarbeit mit dem Antibiotic-Stewardship(ABS)-Teams und der zentrale Notaufnahme entwickelt, implementiert und geschult. Ein positives Votum der Ethikkommission der Heinrich-Heine-Universität (2019-392-RetroDEuA) lag vor.ErgebnisseDie pflegerischen und ärztlichen Mitarbeiter wurden zu 92 % bzw. 93 % geschult. Die Anzahl der abgenommenen Blutkulturen stieg von 1757 auf 2872 um 64 % ebenso wie die Anzahl der Blutkulturen/1000 Fälle von 287 auf 481 (68 %). Die Anzahl der positiven Blutkulturen reduzierte sich von 18,6 auf 13,7 % (p < 0,05). Typische Hautkeime fanden sich in 34,4 % und 26,4 % der Fälle (p < 0,05).InterpretationDie durch Schulungen begleitete Einführung einer SOP „Blutkulturen“ in der zentralen Notaufnahme kann einen relevanten Beitrag zur antimikrobiellen Diagnostik leisten und sowohl die Quantität als auch die Qualität erhöhen.

Prevalence of multidrug-resistant Gram-negative bacteria cases at admission in a multispeciality hospital

ObjectivesThe prevalence of drug-resistant cases is increasing globally. The present study aimed to investigate the prevalence of cases of blood culture positive for multidrug-resistant Gram-negative bacteria (MDR-GNB) at the time of admission, i.e. within 24h of admission to hospital from primary or secondary care centres. MethodsThis record-based retrospective cross-sectional study was designed to analyze MDR-GNB-positive cases at Fortis Hospital, Mumbai, India. Fortis Hospital is a 500-bed referral tertiary care centre. An increase of MDR-GNB was seen from January 2012 to June 2014 in the hospital. A retrospective analysis of blood culture GNB-positive samples was performed to evaluate MDR-GNB-positive cases at admission. ResultsThe total number of positive blood cultures in January to December 2012, January to December 2013 and January to June 2014 were 221, 236 and 116, respectively, with 77.83%, 79.66% and 69.83% GNB-positive. Total MDR-GNB-positive cases were 26.16%, 32.98% and 33.33%, respectively, and amongst these MDR-GNB, 22%, 32% and 37% where positive at time of admission to the hospital. The MDR-GNB were Escherichia coli, Klebsiella, Acinetobacter, Pseudomonas and Enterobacter. ConclusionMDR-GNB blood cultures positive at admission rose from January 2012 to June 2014 and hence there is an urgent need for possible contact isolation of all patients coming from primary and secondary to tertiary health care centres which should be made compulsory until screening rules out MDR-GNB to prevent spread of MDR organisms in the hospital.