Point Prevalence Survey Research Articles

802. Corynebacterium striatum Outbreak Among Ventilated COVID-19 Patients in an Acute Care Hospital – California, 2021

Background Corynebacterium striatum (CS), a common human commensal colonizing the skin and nasopharynx, has been associated with nosocomial infections in immunocompromised and chronically ill patients. During the winter 2020-2021 COVID-19 surge, a 420-bed California hospital reported a marked increase in CS respiratory cultures among ventilated COVID-19 patients. We conducted a public health investigation to assess and mitigate nosocomial transmission and contributing infection prevention and control (IPC) practices. MethodsA case was defined as a patient with CS in respiratory cultures from January 1, 2020 - February 28, 2021. We reviewed clinical characteristics on a subset of cases in 2021 and IPC practices in affected hospital locations. CS respiratory isolates collected on different dates and locations were assessed for relatedness by whole genome sequencing (WGS) on MiSeq.ResultsEighty-three cases were identified, including 75 among COVID-19 patients (Figure 1). Among 62 patients identified in 2021, all were ventilated; 58 also had COVID-19, including 4 cases identified on point prevalence survey (PPS). The median time from admission to CS culture was 19 days (range, 0-60). Patients were critically ill; often it was unclear whether CS cultures represented colonization or infection. During the COVID-19 surge, two hospital wings (7W and 7S) were converted to negative-pressure COVID-19 units. Staff donned and doffed personal protective equipment in anterooms outside the units; extended use of gowns was practiced, and lapses in glove changes and hand hygiene (HH) between patients likely occurred. In response to the CS outbreak, patients were placed in Contact precautions and cohorted. Staff were re-educated on IPC for COVID-19 patients. Gowns were changed between CS patients. Subsequent PPS were negative. Two CS clusters were identified by WGS: cluster 1 (5 cases) in unit 7W, and cluster 2 (2 cases) in unit 7S (Figure 2). Figure 1. Corynebacterium striatum Respiratory Cultures January 2020-February 2021 Figure 2. Phylogenetic Tree Corynebacterium striatum Isolates ConclusionA surge in patients, extended use of gowns and lapses in core IPC practices including HH and environmental cleaning and disinfection during the winter 2020-2021 COVID-19 surge likely contributed to this CS outbreak. WGS provides supportive evidence for nosocomial CS transmission among critically ill COVID-19 patients. Disclosures All Authors: No reported disclosures

169. The Resurgence of Candida auris in California during the Novel Coronavirus (COVID-19) Pandemic, May 2020–May 2021

BackgroundIn February 2019, California (CA) experienced its first C. auris outbreak in Orange County (OC). The CA Department of Public Health (CDPH) and OC with the Centers for Disease Control and Prevention (CDC), mounted a successful containment response; by November 2019, cases were limited to low-level spread in OC long-term acute care hospitals (LTACH).In May 2020, C. auris cases began to surge in OC, followed by extensive spread in six other southern CA local health jurisdictions (LHJ). CDPH with LHJ and CDC, initiated an aggressive, interjurisdictional containment response.MethodsWe carried out response and preventive point prevalence surveys (PPS), onsite infection prevention and control (IPC) assessments, and in-service trainings at outbreak and interconnected hospitals and skilled nursing facilities in six LHJ. Other regional activities included: epidemiologic investigation, contact and discharge tracking and screening; increasing laboratory testing capacity; screening patients admitted to and from LTACH; statewide healthcare facility (HCF) education and outreach; sending regional outbreak HCF lists to all HCF; and biweekly state-LHJ coordination calls. The Antibiotic Resistance (AR) Lab Network supported testing.ResultsFrom May 2020—May 2021, we conducted screening at 226 HCF, and identified 1192 cases at 93 HCF, mostly through screening (n=1109, 93%) and at LTACH (n=906, 76%); we identified 113 (10%) cases at ACH, including 35 (31%) in COVID-19-burdened units. Cases peaked in August 2020 (n=93) and February 2021 (n=191) and have since declined, with C. auris resurgence mirroring COVID-19 incidence.We conducted 98 onsite IPC assessments, and identified multiple, improper IPC practices which had been implemented in response to COVID-19, including double-gloving and -gowning, extended use of gowns and gloves outside patient rooms, and cohorting according to COVID-19 status only.Figure 1. C. auris and COVID-19 Cases in California through May 2021, and C. auris Cases by Local Health Jurisdiction (LHJ) May 2020–May 2021 Table 1. By Facility Type: Colonization Testing May 2020–May 2021, and Total Case Counts before and from May 2020 Table 2. COVID-19-related Infection Control Practices Affecting C. auris Spread, and Associated Public Health Recommendations ConclusionThe C. auris resurgence in CA was likely a result of COVID-19-related practices and conditions. An aggressive, coordinated, interjurisdictional C. auris containment response, including proactive prevention activities at HCF interconnected with outbreak HCF, can help mitigate spread of C. auris and potentially other novel AR pathogens.Disclosures All Authors: No reported disclosures

803. The Impact of Bundled Interventions to Decrease Transmission of Drug-Resistant Pseudomonas aeruginosa from Wastewater Drain Sites on a Hematologic Malignancy/Hematopoietic Stem Cell Transplant Unit

BackgroundWastewater drain (WWD) sites are an important reservoir for amplification, propagation and transmission of multidrug resistant organisms. We observed an increase in the incidence of carbapenem and fluoroquinolone non-susceptible (CP-NS and FQ-NS) P. aeruginosa bloodstream infections (BSI) among patients on our hematologic malignancies (HM) and hematopoietic cell transplant (HCT) unit. The incidence of CP-NS/FQ-NS P. aeruginosa BSI from 2012 through May 2021 is represented in Figure 1. We sought to determine the impact of low-cost, low-barrier interventions targeting WWD sites on the prevalence of patient and environmental P. aeruginosa colonization and incidence of BSI.Figure 1. Incidence of P. aeruginosa BSI, 2012 through May 2021 MethodsBehavioral and structural interventions to limit acquisition from WWD sites were informed by an environmental analysis and rolled out in staged fashion beginning in September 2019. Pre- and post-intervention colonization surveys were performed on the unit to assess for patient and WWD site P. aeruginosa colonization. Whole genome sequencing (WGS) was performed on select isolates. A sensitivity analysis performed accounted for the unconfirmed patient isolates. BSI data was collected retrospectively. ResultsCharacteristics of the pre- and post-intervention groups are presented in Table 1. Five of 27 (18.5%) and 1 of 26 (3.8%) patients in the pre- and post-intervention point prevalence survey, respectively, were confirmed to be colonized with P. aeruginosa (Figure 2), corresponding to a prevalence rate ratio of 0.21 (0.03,1.66). If the two indeterminate samples in the pre-intervention period were positive, the prevalence rate ratio would instead be 0.15 (0.02,1.12). The most frequent P. aeruginosa strains identified by WGS from the patients and environment were 111, 308 and 446. At least 87% of rooms were colonized with P. aeruginosa from at least one WWD site, from pre- and post-intervention periods (Table 2). Table 1. Demographic and clinical characteristics of patients in each epoch. Results are given as percent (frequency) unless otherwise noted. Chi square test was used unless otherwise noted. Figure 2. Proportion of patients colonized with P. aeruginosa Positive: Colonized with P. aeruginosa, confirmed by WGS; Unknown: Phenotype of isolate suggestive of P. aeruginosa, WGS not performed; Negative: No growth on selective agar or non-P aeruginosa identification on WGS Table 2. WWD site colonization, by phenotypic and WGS determination. Fisher’s exact test was used unless otherwise noted. Conclusion P. aeruginosa WWD colonization on our HM/HCT unit may predispose patients to colonization and BSI. The prevalence of patient colonization decreased following implementation of the interventions, despite persistent environmental colonization. We will follow the incidence of P. aeruginosa BSI to determine the long-term impact of these interventions. Disclosures All Authors: No reported disclosures

Antimicrobial use among hospitalized patients: A multi-center, point prevalence survey across public healthcare facilities, Osun State, Nigeria.

In order to inform sub-national action plan for control of antimicrobial resistance (AMR) and benchmark interventions to improve antibiotic use, it is essential to define situations on antibiotic use using standardized tools. We sought to assess quality of antimicrobial prescription across all government healthcare facilities with capacities for in-patient care in the first of the 36 states in Nigeria as part of ongoing state-wide situation analysis on AMR. A survey was conducted between 10-27 June 2019 using the WHO methodology for point prevalence survey on antibiotic use in hospitals. Data was collected from hospital administrators and records of hospitalized patients. Data analysis was done using Microsoft Excel 2010 (Redmond Washington). Prevalence of antibiotic use amongst all 321 included patients was 76.6% (246/321). Of all indications recorded, the highest was surgical prophylaxis (96/260, 36.9%) for which there were multiple doses beyond 24 hours in almost all cases (91/96, 94.8%). The largest volume of prescribing took place in the surgical wards, and the most common prescriptions were metronidazole (142/564, 25.2%), cefuroxime (104/564, 18.4%), and ceftriaxone (77/564, 13.7%). Overall, 46.3% of the antibiotics used belong to Access group, 53.5% to watch and only 0.2% to Reserve. Treatment in almost all instances 544/563 (96.6%) was empiric. The majority of patients received multiple antibiotics mostly without compliance to guidelines. There was low prescribing of Access antibiotics and excessive use of antibiotics in the Watch group. Antibiotics were used most commonly for surgical prophylaxis but inappropriately. Inappropriate use of antibiotics in this study underscores the crucial need for an action plan incorporating antimicrobial stewardship.

Using Self-Determination Theory to Drive an Evidence-Based Medicine Curriculum for Pediatric Residents: A Mixed Methods Study.

The ability to incorporate evidence-based medicine (EBM) into clinical practice is an Accreditation Council for Graduate Medical Education competency, yet many pediatric residents have limited knowledge in this area. The objective of this study is to describe the effect of an EBM curriculum on resident attitudes and clinical use of EBM. We implemented a longitudinal EBM curriculum to review key literature and guidelines and teach EBM principles. In this Institutional Review Board-exempt mixed methods study, we surveyed residents, fellows, and faculty about resident use of EBM at baseline, 6 months, and 12 months after the beginning of the intervention. We conducted point prevalence surveys of faculty about residents' EBM use on rounds. Residents participated in focus groups, which were audio-recorded, transcribed, and coded using conventional content analysis to develop themes. Residents (N=61 pre- and 70 post-curriculum) reported an increased appreciation for the importance of EBM and comfort generating a search question. Faculty reported that residents cited EBM on rounds, with an average of 2.4 citations/week. Cited evidence reinforced faculty's plans 79% of the time, taught faculty something new 57% of the time, and changed management 21% of the time. Focus groups with 22 trainees yielded 4 themes: 1) increased competence in understanding methodology and evidence quality; 2) greater autonomy in application of EBM; 3) a call for relatedness from faculty role models and a culture that promotes EBM; and 4) several barriers to successful use of EBM. After implementation of a longitudinal EBM curriculum, trainees described increased use of EBM in clinical practice.

Parent Attitudes about Childhood Vaccines: Point Prevalence Survey of Vaccine Hesitancy in an Irish Population.

Understanding parental attitudes to their children’s vaccination is critical to developing and implementing interventions that address parents’ hesitancy and improve vaccine uptake. The Parent Attitudes about Childhood Vaccines (PACV) survey is a validated tool for identifying vaccine hesitancy in parents. We evaluated the rate of vaccine hesitancy and areas of concern regarding childhood vaccinations using an adapted version of the PACV survey, in a convenience sample of parents attending a STEM (Science, Technology, Engineering and Mathematics) outreach event in Ireland, in 2018. A score ≥ 50 identified vaccine hesitant parents. Of 105 parents who completed the survey, the prevalence of vaccine hesitancy was 6.7%, (7/105). Parents had concerns around vaccine side effects (36.2%, n = 38), vaccine safety (20%, n = 21) and the number of vaccines administered (13.3%, n = 14). Parents trusted the vaccine information they received (85.6%, n = 90) and 81.9% (n = 86) believed that the vaccine schedule was good for their child. The findings indicate the presence of vaccine hesitancy in parents in Ireland regarding paediatric vaccines with further research necessary to address parents’ vaccine concerns. Future research should explore further, by qualitative methods, parents’ vaccine concerns. There is also potential to identify vaccine hesitant parents with the PACV survey as a surveillance method in healthcare settings; for example, in community pharmacies, family doctor clinics and out-patient clinics.

Serial point-prevalence surveys to estimate antibiotic use in a small animal veterinary teaching hospital, November 2018 to October 2019.

BackgroundThere is no standardized methodology to measure antibiotic drug use (AU) in small animal veterinary hospitals.ObjectivesTo estimate AU prevalence in a small animal veterinary teaching hospital and characterize usage by indication and evidence of infection. To establish an AU measurement methodology for veterinary settings.AnimalsElectronic medical records of cats and dogs seen by primary care, urgent care, emergency and critical care, internal medicine, and surgery services during November 2018 to October 2019.MethodsOn 1 day each month, data (signalment, visit reason, diagnostics, and antibiotic details, including indication) were collected for all animals seen on study services.ResultsOf 168 inpatient dogs and 452 outpatient dogs, 98 (58.3%) and 107 (23.7%,) were receiving at least 1 antibiotic on the day of data collection, respectively. For cats 15/49 (30.6%) inpatients and 29/187 (15.5%) outpatients were receiving at least 1 antibiotic. Common drug classes prescribed for dogs were potentiated penicillins (28.7%), first‐generation cephalosporins (22.1%), and nitroimidazoles (14.7%), and for cats, common drug classes administered were potentiated penicillins (26.9%), fluoroquinolones (13.5%), and penicillins (11.5%). Common indications for antibiotics included skin, respiratory, gastrointestinal, perioperative, aural, and urinary conditions.Conclusions and Clinical ImportanceSerial point‐prevalence surveys (PPS) can estimate AU in a large specialty hospital setting and identify targets for antimicrobial stewardship. The methodology developed during this study can be adapted for use in private practice, including large animal practice. Mirroring methods used in human healthcare, the data collection tool can also be used to describe AU nationally through completion of national PPS.

Point prevalence survey is useful for introducing effective surveillance of healthcare-associated infections

SummaryBackgroundIn Finland, the surveillance of healthcare-associated infections (HAI) became obligatory by the renewed Communicable Diseases Act on the 1st March 2017.AimTo introduce HAI surveillance protocol (HALT-2 by ECDC) in primary care hospitals in the largest hospital district in Finland, and to measure the burden of HAIs and antimicrobial use patterns for improvement.MethodsTwo identical point prevalence surveys (PPS) were organized in autumn 2015 and in spring 2017. The infection control persons (ICP) in the hospitals were inducted to the HAI definitions and the study protocol to collect the data with questionnaires on the study days. The data were checked and analyzed by the areal infection control unit. The hospitals were provided feedback of the results and HAI prevention methods.FindingsIn 2015, 2218 patients from 22 hospitals and in 2017, 2343 patients from 25 hospitals were studied. The prevalence of HAI was 11% in both surveys (ranges per hospital 4–24% and 4–31%, respectively). Of all HAIs, 37% originated from referring hospitals. Respiratory tract, urinary tract and skin were the most frequent sites of infection. One fourth of all patients received at least one systemic antimicrobial. The process showed that recognition of HAIs may be difficult for non-experienced ICPs.ConclusionsThe HALT-2 protocol proved useful in introducing HAI surveillance and prevention in primary care hospitals with active patient transfer from other hospitals and relatively high prevalence of HAI and antimicrobial use. For annually repeated surveys, slightly shorter electronic questionnaires are essential.

Pediatric Antifungal Prescribing Patterns Identify Significant Opportunities to Rationalize Antifungal Use in Children.

Objective:The need for pediatric antifungal stewardship programs has been driven by an increasing consumption of antifungals for prophylactic and empirical use. Drivers and rational of antifungal prescribing need to be identified to optimize prescription behaviors.Methods:A prospective modified weekly Point Prevalence Survey capturing antifungal prescriptions for children (> 90 days to < 18 years of age) in 12 centers in England during 26 consecutive weeks was performed. Demographic, diagnostic and treatment information was collected for each patient. Data were entered into an online REDCap database.Results:One thousand two hundred fifty-eight prescriptions were included for 656 pediatric patients, 44.9% were girls, with a median age of 6.4 years (interquartile range, 2.5–11.3). Most common underlying condition was malignancy (55.5%). Four hundred nineteen (63.9%) received antifungals for prophylaxis, and 237 (36.1%) for treatment. Among patients receiving antifungal prophylaxis, 40.2% did not belong to a high-risk group. In those receiving antifungal treatment, 45.9%, 29.4%, 5.1% and 19.6% had a diagnosis of suspected, possible, probable of proven invasive fungal disease (IFD), respectively. Proven IFD was diagnosed in 78 patients, 84.6% (n = 66) suffered from invasive candidiasis and 15.4% (n = 12) from an invasive mold infection. Liposomal amphotericin B was the most commonly prescribed antifungal for both prophylaxis (36.6%) and empiric and preemptive treatment (47.9%). Throughout the duration of the study, 72 (11.0%) patients received combination antifungal therapy.Conclusions:Antifungal use in pediatric patients is dominated by liposomal amphotericin B and often without evidence for the presence of IFD. A significant proportion of prophylactic and empiric antifungal use was seen in pediatric patients not at high-risk for IFD.

Burden of Healthcare-Associated Infections in Sicily, Italy: Estimates from the Regional Point Prevalence Surveys 2016-2018.

An assessment of the burden of healthcare-associated infections (HAIs) in terms of disability-adjusted life years (DALYs) is useful for comparing and ranking HAIs and to support infection prevention and control strategies. We estimated the burden of healthcare-associated pneumoniae (HAP), bloodstream infection (HA BSI), urinary tract infection (HA UTI), and surgical site infection (SSI) in Sicily, Italy. We used data from 15,642 patients aged 45 years and above, identified during three repeated point prevalence surveys (PPSs) conducted from 2016 to 2018 according to the European Centre for Disease Prevention and Control protocol. The methodology of the Burden of Communicable Diseases in Europe project was employed. The selected HAIs accounted for 8424 DALYs (95% uncertainty interval (UI): 7394–9605) annually in Sicily, corresponding to 344 DALYs per 100,000 inhabitants aged 45 years and above (95% UI: 302–392). Notably, more than 60% of the burden was attributable to HAP, followed by HA BSI, SSI, and HA UTI. The latter had the lowest burden despite a relatively high incidence, whereas HA BSI generated a high burden even through a relatively low incidence. Differences between our estimates and those of European and Italian PPSs encourage the estimation of the burden of HAIs region by region.

Point Prevalence Survey of Antimicrobial Use in Four Tertiary Care Hospitals in Mexico.

PurposeTo describe the antimicrobial use in four tertiary care hospitals in Mexico.Patients and MethodsPoint prevalence surveys (PPSs) were conducted on medical records of hospitalized patients with prescribed antimicrobials (AMs) in four tertiary care hospitals in Mexico in 2019. Prevalence estimates and descriptive statistics were used to present the collected data on antimicrobial prescribing and microbiological studies.ResultsThe prevalence of patients with prescribed AMs among the hospitals ranged from 47.1% to 91.3%. Antibiotics for systemic use (J01s) were the most prescribed (84.6%, [95% CI: 81.5–87.3]), mainly extended-spectrum J01s: third-generation cephalosporins 19.8% [95% CI: 16.8–23.1], and carbapenems 17.0% [95% CI: 14.2–20.2]. Antibiotic treatments were largely empirical, with no planned duration or review dates. The ceftriaxone use was excessive and prolonged. No formal reference guidelines for antimicrobial prescribing were available in the hospitals. Multidrug-resistant Escherichia coli and ESKAPE pathogens were identified in all hospitals.ConclusionThis study describes the extensive use of antimicrobials and broad-spectrum antibiotics for systemic use in Mexican hospitals, along with the presence of resistant pathogens to the antibiotics frequently used in the hospitals surveyed.

Point prevalence survey of health-care associated infections and their risk factors in the tertiary-care referral hospitals of Southern Tunisia.

Health-care associated infections (HAI) are considered a public health problem and have substantial effect on mortality and morbidity. This study aimed to determine the prevalence of HAI in South Tunisian University Hospitals (UH) and to identify their risk factors. We performed a point prevalence study, in the UH of Southern Tunisia in February 2019, including all hospitalized patients for at least 48 hours. Overall, 898 patients were included in this survey, among whom 480 participants (53.5%) were males. There were 81 HAIs, accounting for a prevalence of HAI of 9.02%. Urinary tract infections (28.4%) were the most common HAI, followed by respiratory tract infections (22.2%). The main identified microorganisms among HAI patients were Klebsiella pneumonia (22.7%) and Escherichia coli (20.7%). Independent intrinsic risk factors of high prevalence of HAI were diabetes (Adjusted Odds Ratio (AOR)=3.5;p=0.016) having a rapidly fatal disease (AOR=4;p=0.024) and an ASA scores ≥2 (AOR=2.8;p=0.045). As for extrinsic risk factors, admission in ICU (AOR=11.1;p= 0.04), a length of hospital stay ≥ 7 days (AOR=4.1;p=0.04), previous hospitalization within 90 days prior to the admission (AOR=4.2;p=0.01) and having a peripheral vascular catheter (AOR=6.7; p=0.039) were independently associated with higher prevalence of HAI. Lower prevalence of HAI was independently associated with prescription of antimicrobial preoperative prophylaxis (AOR= 0.1; p=0.02). Our findings illustrated high prevalence of HAI in South Tunisian Hospitals, affecting principally fragilized patients who may require special needs. Therefore, promoting hygiene programs for health professionals to establish patient safety's culture is urgently needed.

Point Prevalence Survey of Antibiotic Prescribing in the Hospital Sector in Albania

Point Prevalence Survey of Antibiotic Prescribing in the Hospital Sector in Albania

Antibiotic consumption in long-term care facilities in Poland and other European countries in 2017

IntroductionThe aim of this research study was to compare the situation concerning the use of microbiology testing, the epidemiology of healthcare-associated infection (HAI) and antimicrobial consumption (AMC) in Polish long-term care facilities (LTCFs) with other European countries, using the most recent findings available in the European databases. Furthermore, this study aimed to highlight several basic factors that contribute to the observable differences in AMC between countries participating in the HALT-3 study, especially the relationship with demographic indicators, as well as the health care resources utilization rates.Patients and methodsThe most recent HAIs in Long-Term care facilities Point Prevalence Survey (HALT PPS) was carried out in EU/EEA countries in 2016–2017, and in Poland it was carried out in April–June 2017 in 24 LTCFs. AMC data was collected with use of methodology of the Anatomical Therapeutic Chemical (ATC) classification system of the WHO.ResultsIn total total in HALT-3 study on the day of the PPS, 5035 out of the 102,301 eligible residents received at least one antimicrobial agent, with prevalence of 4.9%, and in Poland 3.2%. The most common HAIs in the countries included into the study was urinary tract infection with relative frequency of 32%, in Poland it was skin infection, 30.4%. The respiratory tract infections, excluding pneumonia (PNU) were observed in 29.5% of residents in total, in Poland 17.4%, the prevalence rate of PNU were 1.4% and 5.4%, respectively. The lack of microbiological results of HAIs testing concerned the vast majority of all HAIs, 75.8% in total and 81.5% in Poland. The most frequently used antibacterial for systemic use were beta-lactams and the most frequently prescribed antimicrobial agent was ‘amoxicillin and enzyme inhibitor’. AMC was closely correlated with the age of the general population (65 years of age and more) and the availability of doctors in general population.ConclusionsA significant problem observed in LTCFs was the empirical use of antibiotics and the scarcity of microbiological testing. In the studied Polish LTCFs, where the age of residents was low, also the AMC was found to be lower.

Hospital-level risk factors for healthcare-associated infections: insight from the Italian PPS Study

Abstract Background In 2016-2017, a Point Prevalence Survey (PPS) was conducted by the European Centre for Disease Prevention and Control (ECDC) in 29 European countries to investigate healthcare-associated infections (HAIs) and antimicrobial use. The aim of this study was to identify significant determinants of HAIs at a hospital level according to Italian data. Methods Among variables considered by the ECDC Protocol for the PPS, those with most plausible relationship with HAI occurrence according to the literature were a priori selected. Hence, conceptual causal models were built for each reference variable, by adjusting for an established set of confounders (geographical region, hospital type and number of beds), and also considering the possible interaction of the number of blood cultures per 100 patient-days (a proxy of how thoroughly HAIs are searched). Direct effects were estimated in the form of risk ratios through multivariable log-binomial regression models. Results Data were available for 135 Italian hospitals participating in the survey. Factors with significant impact on HAIs resulted to be: percentage of single rooms (RR = 0.91 for every 5% increase, p = 0.013), presence of a plan for infection prevention and control (IPC, RR = 0.51, p = 0.007), routine production of an IPC report (RR = 0.50, p = 0.001), adoption of measures for HAI prevention (RR = 0.21, p = 0.002) and antimicrobial stewardship (RR = 0.50, p = 0.015). The interaction of the number of blood cultures was significant for the effect of IPC report (p = 0.038), number of measures for HAI prevention (p = 0.037) and antimicrobial stewardship (p = 0.02). Conclusions The results confirm the importance of HAI prevention and antimicrobial stewardship as means of lowering the occurrence of HAIs. Therefore, investigating, testing and correctly reporting the onset and evolution of HAIs is paramount to ensure better understanding of the phenomenon and to provide useful insights to create a safer background for clinical practice. Key messages Adopting preventive measures and antimicrobial stewardship is crucial in lowering the occurrence of HAIs and ensuring safer care. Investigating, testing and correctly reporting the onset and evolution of HAIs is paramount to ensure better understanding of the phenomenon and to enable effective HAI prevention.

Prevalence survey on antimicrobial use &amp; multidrug resistance in tertiary level university hospital

Abstract Introduction Excessive and inappropriate use of antibiotics is highly associated with the emergence of antibiotic resistance. Antibiotic resistance reduces the effectiveness and number of options for antibiotic treatment, leading to increased morbidity, mortality, and health care expenditures. This study aimed to characterize antimicrobial prescriptions and to determine multidrug resistance (MDR prevalence in tertiary-level university hospitals (TLUH). Methods It was a point-prevalence survey of antimicrobial use in the two TLUH of Southern Tunisia, in 2019. For inpatients receiving antimicrobials, detailed information was collected. Results Totally, 1047 inpatients were included in our study. The sex ratio (male/female) was 1.1. The mean age was 50 ± 12 years. Overall, 410 cases (39.2%) were on antimicrobials. A significant association was noted between receiving antimicrobial drugs and admission in intensive care units (ICU) (65.% vs 30.2%; p &amp;lt; 0.001), having a surgical history, notably minimal invasive (81.9% vs 30.7%; p &amp;lt; 0.001)and indwelling invasive medical devices such as urinary (17.6% vs 3.9%; p &amp;lt; 0.001). and central vascular catheters (8.6% vs 2.2%; p &amp;lt; 0.001). Main antimicrobials were penicillin (26.7%), fluoroquinolones (20%) and third-generation cephalosporins (16.5%). Prophylactic indication constituted 24.9% (102 cases) of prescriptions, among which 81.3% were judged inappropriate for dose or timing while health-care associated infections accounted for 46.4% of all prescriptions. Parenteral route was prescribed in 302 cases (73%). Antibiotic indications were documented 221 cases (53.9%). Of 78 isolates, 50% were multidrug resistant strains, among which the commonest pathogen was extending-spectrum-beta lactamase producing Escherichia Coli (10 cases,25.6%). Conclusions This study demonstrated a high prevalence of antimicrobial use and MDR which needs addressing especially for surgical prophylaxis and empirical broad-spectrum antimicrobial prescriptions. Key messages High prevalence of multidrug resistance. The needs to addressing especially for surgical prophylaxis and empirical broad-spectrum antimicrobial prescriptions.

Impact of an Anti-Microbial Stewardship Program on Targeted Antimicrobial Therapy in a Tertiary Care Health Care Institute in Central India.

IntroductionAntimicrobial resistance (AMR) has become a global pandemic. In order to identify this menace, World Health Organisation (WHO) has developed the Global Action Plan on AMR (GAP AMR). Antimicrobial stewardship programs (AMSP) have been identified as a decisive tool for combating AMR. One of the most efficient measures of these programs has been the implementation of point prevalence surveys (PPS) of antibiotic usage and subsequent audit feedback. The present study was undertaken to identify the impact of AMSP on curtailing of empirical usage of antibiotics and the augmentation of targeted therapy. MethodsIt is an observational, cross-sectional study comprising 1396 patients. The microbiology culture details and anti-microbial-sensitivity results were recorded. Antibiotic prescriptions were recorded in each patient during their hospital stay.ResultOut of 1396 patients treated over four quarters (Q1-Q4), 711 (50.9%) patients were on antibiotics, and among them, only 415 patients were subjected to any microbiological cultures with an overall bacterial culture rate (BCR) of 58.3%, and 296 patients (41.6%) were treated with antibiotics empirically without sending any samples for bacterial culture. There was a statistically significant rise in BCR from 47.3% in the first quarter to 77.6% in the fourth quarter. Sending specimens for blood culture increased significantly from 29.2% in Q1 to 37.6% in Q4. After receiving culture reports, 72.3% of cases continued with the same antibiotic, the antibiotic was changed in 19.9% of cases, and the antibiotic was stopped in 7.8% of cases.ConclusionThere was a strong positive impact of AMSP in curtailment of empirical usage of antibiotics and augmenting targeted therapy as evidenced by the significant rise in BCR over Q1-Q4 PPS as well as a significant rise in ordering for blood culture over the same time period.

Antibiotic Prescribing Pattern in Primary Care Practice in Federal Territory Kuala Lumpur and Putrajaya, Malaysia

Introduction: The emerging of antibiotic resistance has become a challenge to global health and there is a strong association between antibiotic consumption and incidence of resistance. One of the tools to monitor and identify antibiotic prescribing pattern is Point Prevalence Survey (PPS). Objectives: To determine the pattern of antibiotic prescribing in Primary Health Clinics (PHC) in Federal Territory Kuala Lumpur and Putrajaya (FTKLP). Methods: A cross-sectional study was conducted at 17 PHCs in FTKLP using universal sampling. Data from prescriptions received were recorded in PPS-PC data collection form. The compliance of the antibiotics prescribed were determined via cross-referencing with the Malaysian National Antibiotic Guideline (NAG) 2014 and/or Clinical Pathway for Antimicrobial Stewardship Program in PHCs (CP) 2019. Results: A total of 338 prescriptions with antibiotics were received and the prescribing rate of antibiotics at the PHCs in FTKLP 2019 was 5.94%.Only 128 (37.9%) prescriptions with antibiotics prescribed were compliant with either the NAG or the CP while 33 (9.8%) prescriptions were found non-compliant with either guideline. Compliance of the remaining 177 prescriptions could not be determined due to non-specific diagnoses. The most commonly prescribed drug class was penicillin (n=198, 58.4%), followed by cephalosporins (n=80, 23.6%) and macrolides (n=41, 12%). Conclusion: This PPS study showed a low compliance of antibiotic prescribing to guidelines compared to recent studies and indicate the need for further action to be taken in order to improve antimicrobial prescribing in PHCs. KEYWORDS: Point prevalence survey, antibiotic, primary care

The 2018 Global Point Prevalence Survey of antimicrobial consumption and resistance in 47 Canadian hospitals: a cross-sectional survey.

Background:Patient-level surveillance of antimicrobial use (AMU) in Canadian hospitals empowers the reduction of inappropriate AMU and was piloted in 2017 among 14 hospitals in Canada. We aimed to describe AMU on the basis of patient-level data in Canadian hospitals in 2018 in terms of antimicrobial prescribing prevalence and proportions, antimicrobial indications, and agent selection in medical, surgical and intensive care wards.Methods:Canadian adult, pediatric and neonatal hospitals were invited to participate in the standardized web-based cross-sectional Global Point Prevalence Survey of Antimicrobial Consumption and Resistance (Global-PPS) conducted in 2018. An identified site administrator assigned all wards admitting inpatients to specific surveyors. A physician, pharmacist or nurse with infectious disease training performed the survey. The primary outcomes were point prevalence rates for AMU over the study period regarding prescriptions, indications and agent selection in medical, surgical and intensive care wards. The secondary outcomes were AMU for resistant organisms and practice appropriateness evaluated on the basis of quality indicators. Antimicrobial consumption is presented in terms of prevalence and proportions.Results:Forty-seven of 118 (39.8%) hospitals participated in the survey; 9 hospitals were primary care centres, 15 were secondary care centres and 23 were tertiary or specialized care centres. Of 13 272 patients included, 33.5% (n = 4447) received a total of 6525 antimicrobials. Overall, 74.1% (4832/6525) of antimicrobials were for therapeutic use, 12.6% (n = 825) were for medical prophylaxis, 8.9% (n = 578) were for surgical prophylaxis, 2.2% (n = 143) were for other use and 2.3% (n = 147) were for unidentified reasons. A diagnosis or indication was documented in the patient’s file at the initiation for 87.3% (n = 5699) of antimicrobials; 62.9% (n = 4106) of antimicrobials had a stop or review date; and 72.0% (n = 4697) of prescriptions were guided by local guidelines.Interpretation:Overall, three-quarters of AMU was for therapeutic use across participating hospitals. Canadian hospitals should be further incentivized to create and adapt local guidelines on the basis of recent antimicrobial resistance data.

Integration of Specialist Palliative Care into Tertiary Hospitals: A Multicenter Point Prevalence Survey from Thailand.

Background: Accessibility and quality of hospital-based palliative care in Thailand have received scant attention.Objective: To determine the prevalence of inpatients who require in-hospital palliative care, to identify the proportion with access to specialist palliative care, and to define the factors associated with accessibility to specialist palliative care.Design: A cross-sectional analysis of a multicenter survey.Setting/Subjects: We surveyed all hospitalized patients from Thailand's four regions admitted to 14 tertiary care hospitals.Measurements: We used the Supportive and Palliative Care Indicators Tool to identify palliative care patients then reviewed their medical records. We categorized hospitalized palliative care patients into a palliative care consultation group and a nonconsultation group. The odds ratio (OR) between patient characteristics and patient groups was estimated using binary logistic regression.Results: One-fifth (18.7%) of hospitalized patients were palliative care patients, whereas only 17.3% received a specialist palliative care consult. Of these, one-third (28.4%) received advance care planning (ACP) documentation. One-quarter of patients in pain were not prescribed analgesics. The logistic regression analysis revealed that palliative care consultations were associated with patients >65 years (OR = 1.830, 95% confidence interval [CI]: 1.122−2.987), a cancer diagnosis (OR = 2.640, 95% CI: 1.478−4.718), strong opioids prescription (OR = 5.519, 95% CI: 3.217−9.469), and ACP documentation (OR = 50.149, 95% CI: 28.239−89.059).Conclusions: The prevalence of hospitalized palliative care patients in Thailand is comparable with that in developed countries; however, accessibility remains a significant gap, as specialist palliative care is associated with the quality of palliative care service.