Unknown Source Of Infection Research Articles

Comparatively analyzed pattern of Delta and Omicron SARS-CoV-2 genovariant dominated COVID-19 incidence in the population of the Saratov region

Despite the stable decline in SARS-CoV-2 virus-caused COVID-19 incidence in most countries worldwide by the end of 2023, spreading of this infection on a global scale remains relevant. Among all known SARS-CoV-2 genovariants, within the last about two years Omicron remains dominant. The distinctive properties of this genovariant are presented by short incubation period (1–5 days), high contagiousness, and a relatively mild disease course due to largest number of genomic mutations among all SARS-CoV-2 genovariants. The first case of Omicron genovariant-caused infection in Russia was recorded in early December 2021. Over many month-monitoring after active spread of the genovariant in Russia, it is obvious that in a number of key characteristics it differs profoundly from previous SARS-CoV-2 genovariants. Analyzing major patterns inherent in COVID-19 epidemic process particularly uncovering geographic features is one of the most crucial activities in COVID-19 surveillance. Here, we provide a comparatively analyzed pattern of Delta and Omicron SARS-CoV-2 genovariant dominated COVID-19 incidence in the population of the Saratov region. For this, there was used statistical reporting from the Office of Rospotrebnadzor for the Saratov Region. The main research method is based on epidemiological analysis. The study data showed that upon Omicron genovariant dominance, an increased percentage in COVID-19 cases among children of varying age, increased rate of infected subjects with unknown source of infection as well as improved clinical disease course were recorded. Regardless of the circulating genovariant, elderly people remain to be in risk group. Thus, after three years of the COVID-19 pandemic, the mutual adaptation for SARS-CoV-2 and human population can be observed, which is accompanied by altered biological properties of the former and the accumulation of herd immunity. Alleviated disease symptoms and decreased mortality rate among Omicron genovariant-infected individuals evidence in favor of further COVID-19 transformation into a seasonal infection.

Clinical and microbiological characteristics of Ruminococcus gnavus bacteremia and intra-abdominal infection

ObjectivesRuminococcus gnavus is a rare human pathogen, and clinical data on R. gnavus infection are insufficient. This retrospective study aimed to investigate the clinical characteristics of R. gnavus infections. MethodsThis study included 13 cases of bacteremia and three cases of non-bacteremia infections caused by R. gnavus. We evaluated the patient data, infection source, clinical outcomes, and antimicrobial susceptibility of R. gnavus isolates for these cases. ResultsThe median age of patients was 75 years (range 47–95), and eight patients were female. Twelve cases were presumed to have an intra-abdominal infection source, and the remaining four cases had an unknown infection source. The most common underlying conditions were immunosuppression (seven cases), solid tumors (seven cases), and history of gastrointestinal surgery (five cases). Thirteen patients exhibited gastrointestinal problems (dysfunction, bleeding, intra-abdominal infection, or inflammation). Multiple pathogens were observed in six cases, and fatal outcomes were recorded in three cases. Antimicrobial susceptibility data were available for eight isolates, all of which exhibited low minimum inhibitory concentrations to penicillin (≤0.03 μg/mL), ampicillin–sulbactam (≤0.5 μg/mL), piperacillin–tazobactam (≤4 μg/mL), and metronidazole (≤0.5–1 μg/mL). ConclusionRuminococcus gnavus is frequently associated with an intra-abdominal infection source, and treatment strategies should consider the possibility of multiple pathogens.

Factors Related to the Transmission of COVID-19 within Households from Pediatric Initial Cases

Objectives: This study aims to identify pediatric COVID-19 transmission the general and epidemiological characteristics within households and determine odds ratios (OR) of transmission based on these characteristics. Methods: This study analyzed all laboratory-confirmed (PCR +) initial pediatric COVID-19 cases aged 0 to 18 years reported in Daegu, Republic of Korea, between February 18, 2020, and December 31, 2021 (n = 1,348). Household transmission was defined as households where at least one secondary case occurs within 1 to 14 days after the pediatric initial case. The study excluded cases that were known as the index case in the household but were identified as a secondary case through epidemiological investigation. Additionally, if the source of infection was unknown, they were excluded, provided at least one family member confirmed positive on the laboratory-contact test, including cases with incomplete epidemiological investigation. Results: 469 cases (34.8%) experienced household transmission. Male, symptomatic and cases with unknown source of infection had higher OR of transmitting COVID-19 to the household compared to the opposite scenarios (Male: OR, 1.36; 95% CI, 1.07-1.74; Symptomatic: OR, 1.93; 95% CI, 1.36-2.73; unknown source of infection: OR, 2.26; 95% CI, 1.59-3.21). Moreover, the age group of 4-6 years had the highest OR of transmitting COVID-19 to household contacts compared to the age group of 13-18 years (OR, 3.59; 95% CI, 2.55-5.05), and the age groups of 7-12 years (OR, 2.62; 95% CI, 1.94-3.53) and 0-3 years (OR, 2.25; 95% CI, 1.22-4.15) also showed higher ORs. However, the OR for the Ct value was 0.98 (95% CI, 0.96-0.99). Conclusions: This study suggests that male, symptomatic and cases with unknown sources in pediatric COVID-19 patients are more likely to transmit COVID-19 within households. Younger pediatric patients have higher OR for COVID-19 households transmission than older ones. However, the high Ct value indicated a lower likelihood of transmission.

Interdisciplinary perspectives on computed tomography in sepsis: survey among medical doctors at a large university medical center

ObjectivesThis study aims to describe physicians’ perspectives on the use of computed tomography (CT) in patients with sepsis.MethodsIn January 2022, physicians of a large European university medical center were surveyed using a web-based questionnaire asking about their views on the role of CT in sepsis. A total of 371 questionnaires met the inclusion criteria and were analyzed using work experience, workplace, and medical specialty of physicians as variables. Chi-square tests were performed.ResultsPhysicians considered the ability to detect an unknown focus as the greatest benefit of CT scans in sepsis (70.9%, n = 263/371). Two clinical criteria — “signs of decreased vigilance” (89.2%, n = 331/371) and “increased catecholamine demand” (84.7%, n = 314/371) — were considered highly relevant for a CT request. Elevated procalcitonin (82.7%, n = 307/371) and lactate levels (83.6%, n = 310/371) were consistently found to be critical laboratory values to request a CT. As long as there is evidence of infection in one organ region, most physicians (42.6%, n = 158/371) would order a CT scan based on clinical assessment. Combined examination of the chest, abdomen, and pelvis was favored (34.8%, n = 129/371) in cases without clinical clues of an infection source. A time window of ≥ 1–6 h was preferred for both CT examinations (53.9%, n = 200/371) and CT-guided interventions (59.3%, n = 220/371) in patients with sepsis.ConclusionDespite much consensus, there are significant differences in attitudes towards the use of CT in septic patients among physicians from different workplaces and medical specialties. Knowledge of these perspectives may improve patient management and interprofessional communication.Key PointsDespite interdisciplinary consensus on the use of CT in sepsis, statistically significant differences in the responses are apparent among physicians from different workplaces and medical specialties.The detection of a previously unknown source of infection and the ability to plan interventions and/or surgery based on CT findings are considered key advantages of CT in septic patients.Timing of CT reflects the requirements of specific disciplines.

Concordance Between Initial Presumptive and Final Adjudicated Diagnoses of Infection Among Patients Meeting Sepsis-3 Criteria in the Emergency Department.

Guidelines emphasize rapid antibiotic treatment for sepsis, but infection presence is often uncertain at initial presentation. We investigated the incidence and drivers of false-positive presumptive infection diagnosis among emergency department (ED) patients meeting Sepsis-3 criteria. For a retrospective cohort of patients hospitalized after meeting Sepsis-3 criteria (acute organ failure and suspected infection including blood cultures drawn and intravenous antimicrobials administered) in 1 of 4 EDs from 2013 to 2017, trained reviewers first identified the ED-diagnosed source of infection and adjudicated the presence and source of infection on final assessment. Reviewers subsequently adjudicated final infection probability for a randomly selected 10% subset of subjects. Risk factors for false-positive infection diagnosis and its association with 30-day mortality were evaluated using multivariable regression. Of 8267 patients meeting Sepsis-3 criteria in the ED, 699 (8.5%) did not have an infection on final adjudication and 1488 (18.0%) patients with confirmed infections had a different source of infection diagnosed in the ED versus final adjudication (ie, initial/final source diagnosis discordance). Among the subset of patients whose final infection probability was adjudicated (n = 812), 79 (9.7%) had only "possible" infection and 77 (9.5%) were not infected. Factors associated with false-positive infection diagnosis included hypothermia, altered mental status, comorbidity burden, and an "unknown infection source" diagnosis in the ED (odds ratio: 6.39; 95% confidence interval: 5.14-7.94). False-positive infection diagnosis was not associated with 30-day mortality. In this large multihospital study, <20% of ED patients meeting Sepsis-3 criteria had no infection or only possible infection on retrospective adjudication.

1985. Infective Endocarditis in Enterococcus faecalis Bloodstream Infection: Prevalence, Risk Factors, and Patient Outcomes

Abstract Background A substantial proportion of gram-positive infective endocarditis (IE) is caused by Enterococcus species, which renders significant mortality risk. Recent European studies have attempted to identify clinical variables beyond Duke’s criteria and develop risk assessment tools. This study aimed to evaluate the prevalence of IE in our patient population with E. faecalis bloodstream infection (BSI), risk factors predictive of IE, and clinical outcomes. Methods This retrospective cohort study included adult, hospitalized patients with E. faecalis BSI in 1 tertiary and 3 community Michigan hospitals from January 1, 2018 through December 31, 2020. The primary objective was evaluation of comorbidities, clinical variables, and a previously validated NOVA (N-number of positive blood cultures, O-origin unknown, V-valvular heart disease, A-auscultation of cardiac murmur) scoring system for their association with IE using bivariate analysis and logistic regression. The secondary aim was to describe the mortality and readmissions rates with E. faecalis BSI and IE. Results We identified 167 patients with E. faecalis BSI, 65% were female, and the mean age was 71.6 (standard deviation +/- 14.8). Echocardiography was done in 68.2% of patients. There was evidence of IE in 11.9% of cases. The origin of infection was community acquired in 93.4%, an unknown source in 5.4%, and monomicrobial infections in 73.6% of patients. The comorbidities of valvular heart disease (50% with IE vs. 20.4% without IE, p=0.01) and a cardiac implantable electronic device (CIED) (35% with IE vs. 11.5% without IE, p=0.01) were associated with IE. Community acquired origin, an unknown source of infection, and NOVA scores were not associated with IE status. Patients with a CIED were more likely to have IE, with an odds ratio of 3.45 (95% confidence interval 1.06 to 11.17; p=0.04). The 30- and 60-day mortality rates were 16.7% and 19.7% with E. faecalis BSI. The 30- and 60-day readmission rates were 19.1% and 28.1%. Mortality and readmission rates did not differ among patients based on IE status. Conclusion This study revealed a significant IE prevalence of 11.9% in patients with E. faecalis BSI. Of the many previously identified risk factors for IE, patients with valvular heart disease and a CIED had the greatest risk for IE. Disclosures All Authors: No reported disclosures.

1848. Predictors of 6-Month Mortality in Staphylococcus aureus Bacteremia: A Population-Based Study in Olmsted County, Minnesota, from 2006 to 2020

Abstract Background Staphylococcus aureus has high mortality rates, which is influenced by several factors related to the host-pathogen interaction. The current study aims to provide a contemporary evaluation of predictors of 6-month mortality rate in a population-based cohort of incident Staphylococcus aureus bacteremia (SAB) cases. Methods Retrospective population-based study of 541 adult residents of Olmsted County, MN with monomicrobial SAB from January 1, 2006 through December 31, 2020. The study’s primary outcome was 6-month mortality rate, and a survival analysis was prepared by the Kaplan-Meier method. Multivariable Cox regression was used to investigate risk factors associated with 6-month mortality. Results The median (IQR) age of 541 patients with SAB was 66.8 (54.4-78.5) years and 39.6% were female. The median Charlson Comorbidity Index (CCI) was 2 (1-4). SAB cases were healthcare-associated in 49.2% and 56.2% were methicillin-susceptible. Twenty percent of SAB cases had an unknown infection source and 38.3% had complicated bacteremia. There were 7 relapses within the first 12 weeks of follow-up, corresponding to a cumulative incidence rate of 1.3%. There were no re-infections through the remainder of the 6-month follow-up, although there were 2 recurrences after 7 months. Eighty-nine (16.5%) patients died within 1 month of SAB diagnosis and 144 (26.7%) patients died during the 6-month follow-up period. In a multivariable analysis, older age, elevated CCI, unknown source of SAB, and intensive care unit (ICU) admission were significant predictors of an increased 6-month mortality rate. In contrast, presence of diabetes mellitus was significantly associated with a decreased 6-month mortality rate; also, undergoing infectious diseases consultation was associated with reduced mortality in the first 2 weeks, but not for the remainder of the 6-month follow-up period. Conclusion To our knowledge, the current investigation represents the only contemporary population-based study determining significant predictors of mortality in SAB patients, namely, older age, higher CCI, unknown source of SAB, and ICU admission. This study also described one of the lowest 30-day mortality rates reported over the past 2 decades. Figure 1.Survival and reinfection rates of patients with SAB over 6 months. Abbreviations: SAB, Staphylococcus aureus bacteremia. Foot notes: The overall survival curve was derived by the Kaplan-Meier estimator, while the curve for reinfection was estimated by the cumulative incidence function taking into account the competing risk of death. Disclosures Larry M. Baddour, M.D., Boston Scientific: Advisor/Consultant|Botanix Pharmaceuticals: Advisor/Consultant|Roivant Sciences: Advisor/Consultant|UpToDate, Inc.: Royalty payments - authorship duties.

Staphylococcus aureus bacteraemia and mortality: a population-based study in Olmsted County, Minnesota, from 2006 to 2020

Objectives To provide an evaluation of predictors of 6-month mortality in incident Staphylococcus aureus bacteraemia cases. Methods A retrospective population-based study of 541 adult residents of Olmsted County, MN with monomicrobial S. aureus bacteraemia from 1 January 2006 through 31 December 2020. Multivariable Cox regression was used to investigate risk factors of 6-month mortality. Results The median (interquartile range [IQR]) age of 541 patients with S. aureus bacteraemia was 66.8 (54.4–78.5) years and 39.6% were female. The median (IQR) Charlson Comorbidity Index was 6 (3–9). Overall, 144 patients died during the six-month period following their initial episode (30-day and 6-month mortality = 16.5% and 26.7%, respectively). In a multivariable analysis, older age, ICU admission, and unknown source of infection were significant predictors of increased 6-month mortality. In contrast, having an infectious diseases (ID) consultation was associated with reduced mortality in the first 2 weeks of follow-up. Secondary analyses revealed an early benefit of ID consultation during the first 30 days of follow-up and that infective endocarditis was an additional predictor of 6-month mortality. Conclusions To our knowledge, this investigation represents the only US population-based study evaluating predictors of mortality in patients with S. aureus bacteraemia. The finding of a short-term survival benefit associated with early ID consultation may be due to more extensive diagnostic efforts.

Epidemiological Characteristics, Disease Knowledge of COVID-19 Patients in Dong Thap

Abstract: A cross-sectional descriptive study was conducted from August 2021 to September 2021 to describe the epidemiological characteristics of COVID-19 patients at the field hospital in Dong Thap Community College. The study collected epidemiological data from 240 subjects. The results show that the male/female ratio is 1.2/1; the mean age was 29.2±15.1(1-65) years old; the proportion of subjects having contact with the pandemic area is 90%. The percentage of patients who caught Covid-19 from their family is the highest (62.1%), followed by the number of patients with an unknown source of infection (24.6%) and the number of patients who caught Covid-19 from community transmission (13.3%). The mean time between infection to hospitalization was 4.8 days. The percentage of subjects having 1st dose of vaccine is 12.5%. Most patients acknowledge the COVID-19 pandemic and know the modes of transmission of the SARS-CoV-2 virus. Most of the sick people practiced adequately or inadequately 5K measures in the community and did not practice disease prevention measures at home. The goals of this study are: i) Contributing to a general assessment of epidemiological factors and the accumulated understanding of the disease of COVID-19 patients in general, and COVID-19 subjects at the field hospital of Dong Thap Community College in particular; and ii) Contributing to the development of better disease prevention measures.&#x0D; Keywords: COVID-19, SARS-CoV-2, epidemiological characteristics.

Monkeypox: Considerations as a New Pandemic Looms

Monkeypox: Considerations as a New Pandemic Looms

Risk of cardiac device-related infection in patients with late-onset bloodstream infection. Analysis on a National Cohort

To determine the incidence of cardiac device-related infection (CDRI) among patients with cardiac device (CD) during late-onset bloodstream infection (BSI) and to identify the risk factors associated with CDRI. Patients with a CD (cardiac implantable electronic devices -CIED- and/or prosthetic heart valve -PHV-) and late-onset-BSI (>1 year after the CD implantation/last manipulation) were selected from the PROBAC project, a prospective, observational cohort study including adult patients with bacteraemia consecutively admitted to 26 Spanish hospitals from October 2016 to March 2017. Multivariate analyses using logistic regression were performed to identify the risk factors associated with CDRI. 317 BSI from patients carrying a CD were registered, 187 (56.2%) were late-onset-BSI. A total of 40 (21.4%) CDRI were identified during late-onset-BSI. The CDRI cumulative incidence in Gram-positive-BSI was 41.8% (38/91), with S. aureus, Enterococcus spp. and viridans streptococci showing the greatest percentages: 40% (12/30), 42% (11/26) and 75% (6/8), respectively. Independent predictors of CDRI were an unknown source of infection (OR: 2.88[CI 95%:1.18-7.06], p =0.02), Gram-positive-aetiology (23.1 [5.23-102.1], p<0.001) and persistent bacteraemia (4.81 [1.21-19], p=0.03). In an exploratory analysis, S. aureus (3.99 [1.37-11.65], p=0.011), Enterococcus spp. (5.21 [1.76-15.4], p=0.003) and viridans streptococci (28.7 [4.71-173.5], p<0.001) aetiology were also found to be risk factors for CDRI. CDRI during late-onset-BSI is a frequent phenomenon. Risk of CDRI differs among species, happening in almost half of the Gram-positive-BSI. An unknown source of the primary infection, Gram-positive-aetiology -especially S. aureus, Enterococcus spp. and viridans streptococci-, and persistent bacteraemia were identified as risk factors for CDRI.

Clinical Characteristics, Laboratory Findings, Management, and Outcome of Severe Coronavirus Disease 2019 in Children at a Tertiary Care Center in Riyadh, Saudi Arabia: A Retrospective Study.

BackgroundNumerous studies worldwide have reported COVID-19 in children; however, the clinical symptoms and consequences of COVID-19 in children have only been reported in a few studies in Saudi and gulf region. Therefore, we aimed to investigate the clinical features and outcomes of COVID-19 infection in children and the therapeutic interventions used.MethodsThis retrospective cohort study included 96 patients with confirmed severe acute respiratory syndrome coronavirus 2 infection aged ≤14 years who were admitted to a tertiary governmental care hospital in Riyadh, Saudi Arabia between March 2020 and November 2020. Data on children with COVID-19, including demographics, comorbidities, symptoms, imaging and laboratory results, therapies, and clinical outcomes, were analyzed.ResultsOf 96 children admitted with a confirmed diagnosis of COVID-19, 63.8% were aged ≤ 3 years, 52.1% were male, 56.2% had an unknown source of infection, and 51% had no comorbidities. Most cases had severe infection (71.88%) as they required oxygen, 10.42% of whom were critical. The most common symptoms were respiratory-related (98%), and the common physical sign was fever (49%). High D-dimer (90.7%) and C-reactive protein (72.09%) levels were found in most cases. Oxygen (71.88%) was the most commonly used treatment. Most patients were discharged home and fully recovered (97.92%). We reported two deaths (2.08%).ConclusionsOur findings showed that the majority of the admitted children with COVID-19 were ≤3 years of age (52.1%) and infected with an unknown source (56.2%). Moreover, the majority of the cases had severe COVID-19 infection as they required oxygen (71.88%), although they had favorable outcomes. However, some cases were critical and resulted in death. Future studies will be crucial to better understand the disease spectrum and potential therapeutic options for COVID-19 in children.

Prevalence of and Associations With Avascular Necrosis After Pediatric Sepsis: A Single-Center Retrospective Study.

Avascular necrosis (AVN) is a rare, but serious, complication after sepsis in adults. We sought to determine if sepsis is associated with postillness diagnosis of AVN, as well as potential-associated risk factors for AVN in children with sepsis. Retrospective observational study. Single academic children's hospital. Patients less than 18 years treated for sepsis or suspected bacterial infection from 2011 to 2017. Patients who developed AVN within 3 years after sepsis were compared with patients who developed AVN after suspected bacterial infection and with patients with sepsis who did not develop AVN. None. AVN was determined using International Classification of Diseases, 9th Edition/10th Edition codes and confirmed by chart review. The prevalence of AVN after sepsis was 0.73% (21/2,883) and after suspected bacterial infection was 0.43% (53/12,276; risk difference, 0.30; 95% CI, 0.0-0.63; p = 0.05). Compared with 43 sepsis controls without AVN, AVN in the 21 sepsis cases was associated with being older, having sickle cell disease and malignancy, higher body mass index, unknown source of infection, and low platelet count in the first 7 days of sepsis. Half of sepsis patients were treated with corticosteroids, and higher median cumulative dose of steroids was associated with AVN (23.2 vs 5.4 mg/kg; p < 0.01). Older age at infection (odds ratio [OR], 1.3; 95% CI, 1.1-1.4), malignancy (OR, 8.8; 95% CI, 2.6-32.9), unknown site of infection (OR, 12.7; 95% CI, 3.3-48.6), and minimal platelet count less than 100,000/µL in first 7 days of sepsis (OR, 5.0; 95% CI, 1.6-15.4) were identified as potential risk factors for AVN after sepsis following adjustment for multiple comparisons. Although rare, sepsis was associated with a higher risk of subsequent AVN than suspected bacterial infection in children. Older age, malignancy, unknown site of infection, and minimum platelet count were potential risk factors for AVN after sepsis.

Sources of Infection Among Confirmed Cases of COVID-19 in Jeju Province, Korea.

ObjectivesJeju Province in Korea reported 627 coronavirus disease 2019 (COVID-19) cases between January 20, 2020, and March 31, 2021. This study analyzed the sources of infection among confirmed cases in Jeju Province, a self-governed island.MethodsThe sources of infection were broadly categorized as follows: (1) infections from overseas (confirmed patients who reported travel overseas or contact with overseas travelers); (2) infections from outside Jeju Province (confirmed patients who had visited other provinces or had contact with individuals who had traveled to other provinces in Korea); and (3) unknown sources of infection (confirmed patients who were infected following contact with an infected person whose source of infection was unknown). The chi-square test was used to analyze the differences in the distributions of related variables for each source of infection.ResultsOf the 627 confirmed cases, 38 (6.1%) were infections from overseas sources, 199 (31.7%) were from outside of Jeju Province, and 390 (62.2%) were from unknown sources. Jeju Province had no cases with an unknown source of infection during the first and second waves of the nationwide outbreak.ConclusionsInfections from overseas sources could be blocked from spreading to local communities in Jeju Province by conducting screening at the airport, along with the preemptive suspension of visa-free entry. In addition, considering the scale of the nationwide outbreak, measures must be established to delay outbreaks from unknown sources of infection caused by sources outside Jeju Province.

Independent Risk Factors for Sepsis-Associated Cardiac Arrest in Patients with Septic Shock.

The clinical characteristics and laboratory values of patients with septic shock who experience in-hospital cardiac arrest (IHCA) have not been well studied. This study aimed to evaluate the prevalence of IHCA after admission into the emergency department and to identify the factors that increase the risk of IHCA in septic shock patients. This observational cohort study used a prospective registry of septic shock patients and was conducted at the emergency department of a university-affiliated hospital. The data of 887 adult (age ≥ 18 years) septic shock (defined using the Sepsis-3 criteria) patients who were treated with a protocol-driven resuscitation bundle therapy and were admitted to the intensive care unit between January 2010 and September 2018 were analyzed. The primary endpoint was the occurrence of sepsis-associated cardiac arrest. The patient mean age was 65 years, and 61.8% were men. Sepsis-associated cardiac arrest occurred in 25.3% of patients (n = 224). The 28-day survival rate after cardiac arrest was 6.7%. Multivariate logistic regression identified chronic pulmonary disease (odds ratio (OR) 2.06), hypertension (OR 0.48), unknown infection source (OR 1.82), a hepatobiliary infection source (OR 0.25), C-reactive protein (OR 1.03), and serum lactate level 6 h from shock (OR 1.34). Considering the high mortality rate of sepsis-associated cardiac arrest after cardiopulmonary resuscitation, appropriate monitoring is required in septic shock patients with major risk factors for IHCA.

Study on presentation and predisposing factors for pediatric deep neck space infection

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Aim were to study the clinical presentation and predisposing factors in children with deep neck space infections and to study the effective mode of management of pediatric deep neck space infections and its complications. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This prospective study was done in a tertiary care hospital on 163 pediatric patients with deep neck space infections who were thoroughly examined to know the source of the infection. Ultrasonography of neck and Radiological investigations were done to determine the location and extent of the abscesses. All patients were started on empirical antibiotic therapy of amoxicillin and clavulanic acid and metronidazole. Patients with small abscess were blindly aspirated with wide bore needle, while incision and drainage were done for large abscess. The pus samples from both were sent for culture and sensitivity. Patients presenting with complications, underwent incision and drainage. Patients, who failed empirical antibiotic therapy and needle aspiration, then underwent incision and drainage. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The most common symptom and sign was neck swelling (85%). The next most common symptom was neck pain (70%). Most of the patients had unknown source of infection and others had history of recurrent sore throat, dental infections, acute cervical lymphadenopathy, parotitis and furuncle over neck. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Deep neck space infections (DNI’s) in pediatric population constitutes of medical emergency as it could lead to life threatening complications in a short time. Though with changing times of new diagnostic and therapeutic tools have drastically reduced the incidence of complications.&lt;/p&gt;

Long-Term Sustainability and Acceptance of Antimicrobial Stewardship in Intensive Care: A Retrospective Cohort Study.

To evaluate long-term uptake of an antimicrobial stewardship audit-and-feedback program along with potential predictors of stewardship suggestions and acceptance across a diverse ICU population. A retrospective cohort study. An urban, academic medical institution. Patients admitted to an ICU who received an antimicrobial stewardship program suggestion between June 2010 and September 2019. None. The antimicrobial stewardship program provided 7,749 antibiotic assessments over the study period and made a suggestion to alter therapy in 2,826 (36%). Factors associated with a higher likelihood of receiving a suggestion to alter therapy included shorter hospital length of stay prior to antimicrobial stewardship program review (odds ratio 1.15 for ≤ 5 d; 95% CI 1.00-1.32), admission to cardiovascular (1.37; 1.06-1.76) or burn surgery (1.88; 1.50-2.36) versus general medicine, and preceding duration of antibiotic use greater than 5 days (1.33; 1.10-1.60). Assessment of aminoglycosides (2.91; 1.85-4.89), carbapenems (1.93; 1.54-2.41), and vancomycin (2.71; 2.19-3.36) versus ceftriaxone was more likely to result in suggestions to alter therapy. The suggestion acceptance rate was 67% (1,895/2,826), which was stable throughout the study period. Admission to a level 3 ICU was associated with higher likelihood of acceptance of suggestions (1.50; 1.14-1.97). Factors associated with lower acceptance rates were admission to burn surgery (0.64; 0.45-0.91), treatment of pneumonia (0.64; 0.42-0.97 for community-acquired and 0.65; 0.44-0.94 for ventilator-acquired), unknown source of infection (0.66; 0.48-0.92), and suggestion types of "narrow spectrum" (0.65; 0.45-0.94), "change formulation of antibiotic" (0.42; 0.27-0.64), or "change agent of therapy" (0.63; 0.40-0.97) versus "change of dose". An antimicrobial stewardship program implemented over a decade resulted in sustained suggestion and acceptance rates. These findings support the need for a persistent presence of audit-and-feedback over time with more frequent suggestions to alter potentially nephrotoxic agents, increased efforts toward specialized care units, and further work approaching infectious sources that are typically treated without pathogen confirmation and identification.

2087. Electronic Capture and Feedback of Standardized Antibiotic Clinical Indications Data Among Community Hospitals

BackgroundAntibiotic clinical indications allow stewardship programs to assess therapy appropriateness; however, many hospitals that require antibiotic indications upon order entry lack standardized mapping of indications leading to variability in entered values. Electronic capture and feedback of standardized antibiotic clinical indications data may allow hospitals to more effectively compare indication-specific prescribing trends among facilities.MethodsWe collected antibiotic indications from electronic medication orders for 6 DASON hospitals. These indications were mapped to a list of 15 standardized indication categories created by consensus of the DASON stewardship team. To demonstrate the feasibility and utility of standardized clinical indications mapping, we evaluated agents given for the indication C. difficile infection (CDI) in 2018. Differences between the hospitals were compared with highlight the added benefit of standardized indication data in evaluating antibiotic use and adoption of local guidelines.ResultsFor 249,916 antibiotic days of therapy (DOT) with an indication available, a total of 125 unique indications were reported. Of note, 3 facilities allowed more than one indication to be entered at prescriber discretion. The distribution of antibiotic DOT mapped to the standardized indication list can be seen in Figure 1. The most common indication was the other category (19.5%). These were primarily other, no additional information (47%) or empiric therapy for an unknown source of infection (17%). Additional indications in the other category included chronic obstructive pulmonary disease exacerbations and sexually transmitted infections (< 5% each). Figure 2 depicts the agents used for CDI indication between facilities. Despite universal adoption of local guidelines where oral vancomycin is the drug of choice for treating CDI, there was variability seen in vancomycin CDI DOT (range: 60 – 80% of CDI DOT).ConclusionStewardship programs can implement standardized antimicrobial indications to facilitate electronic capture, feedback, and comparison and efficiently identify stewardship targets. Additionally, hospitals may use these data to explore the appropriateness of antibiotic use. Disclosures All authors: No reported disclosures.

Hepatitis E virus genotype 3 strains and a plethora of other viruses detected in raw and still in tap water

In this study, next generation sequencing was used to explore the virome in 20L up to 10,000L water from different purification steps at two Swedish drinking water treatment plants (DWTPs), and in tap water. One DWTP used ultrafiltration (UF) with 20 nm pores, the other UV light treatment after conventional treatment of the water. Viruses belonging to 26 different families were detected in raw water, in which 6–9 times more sequence reads were found for phages than for known environmental, plant or vertebrate viruses. The total number of viral reads was reduced more than 4-log10 after UF and 3-log10 over UV treatment. However, for some viruses the reduction was 3.5-log10 after UF, as for hepatitis E virus (HEV), which was also detected in tap water, with sequences similar to those in raw water and after treatment. This indicates that HEV had passed through the treatment and entered into the supply network. However, the viability of the viruses is unknown. In tap water 10–130 International Units of HEV RNA/mL were identified, which is a comparable low amount of virus. The risk of getting infected through consumption of tap water is probably negligible, but needs to be investigated. The HEV strains in the waters belonged to subtypes HEV3a and HEV3c/i, which is associated with unknown source of infection in humans infected in Sweden. None of these subtypes are common among pigs or wild boar, the major reservoirs for HEV, indicating that water may play a role in transmitting this virus. The results indicate that monitoring small fecal/oral transmitted viruses in DWTPs may be considered, especially during community outbreaks, to prevent potential transmission by tap water.

Genetically similar hepatitis E virus strains infect both humans and wild boars in the Barcelona area, Spain, and Sweden.

Hepatitis E virus (HEV) is a hepatotropic virus, endemic in Europe where it infects humans and animals, with domestic pigs and wild boars as main reservoirs. The number of HEV-infected cases with unknown source of infection increases in Europe. There are human HEV strains genetically similar to viruses from domestic pigs, and zoonotic transmission via consumption of uncooked pork meat has been shown. Due to continuous growth of the wild boar populations in Europe, another route may be through direct or indirect contacts with wild boars. In the Collserola Natural Park near Barcelona, Spain, the wild boars have spread into Barcelona city. In Sweden, they are entering into farmlands and villages. To investigate the prevalence of HEV and the risk for zoonotic transmissions, the presence of antibodies against HEV and HEV RNA were analysed in serum and faecal samples from 398 wild boars, 264 from Spain and 134 from Sweden and in sera from 48 Swedish patients with HEV infection without known source of infection. Anti-HEV was more commonly found in Spanish wild boars (59% vs. 8%; p<0.0001) while HEV RNA had similar prevalence (20% in Spanish vs. 15% in Swedish wild boars). Seven Swedish and three Spanish wild boars were infected with subtype 3f, and nine Spanish with subtype 3c/i. There were three clades in the phylogenetic tree formed by strains from wild boars and domestic pigs; another four clades were formed by strains from humans and wild boars. One strain from a Spanish wild boar was similar to strains from chronically infected humans. The high prevalence of HEV infections among wild boars and the similarity between wild boar HEV strains and those from humans and domestic pigs indicate that zoonotic transmission from wild boar may be more common than previously anticipated, which may develop into public health concern.