Browsing by Author "Wilson, Lucy"
Now showing 1 - 20 of 29
Results Per Page
Sort Options
Item Antibiotic Resistance in Maryland: The Statewide Antibiogram Initiative(Oxford University Press, 2016-10-25) Vaeth, Elisabeth; Reid, Molly; Richards, Katherine; Wilson, Lucy; Blythe, DavidBackground. Antimicrobial resistance is among the greatest current threats to human health. Both the White House and the Centers for Disease Control and Prevention have recently emphasized the need for awareness of resistance trends at the local and regional levels. Methods. In 2014 the Maryland Department of Health and Mental Hygiene requested that all acute care microbiology laboratories submit an antibiogram for calendar year 2013. Forty-one of 44 laboratories submitted an antibiogram. Isolate data from all units/wards and all body sites were aggregated to calculate a percent susceptible for each combination of organism and antimicrobial. Isolates were also stratified by region and hospital size to identify trends. It is unknown how closely each laboratory adhered to current Clinical Laboratory Standards Institute guidelines for antibiograms. Results. Statewide, Acinetobacter baumannii and Pseudomonas aeruginosa were the most resistant gram-negative organisms. Acinetobacter baumannii was only 33%–57% susceptible to the third- and fourth-generation cephalosporins, 44%–51% susceptible to quinolones, and 53%–57% susceptible to carbapenems. Pseudomonas aeruginosa was 74% susceptible to ciprofloxacin and levofloxacin and 87%–89% susceptible to carbapenems. The Enterobacteriaceae species also showed considerable resistance to penicillins, cephalosporins, and quinolones. Among gram-positive organisms, methicillin-resistant Staphylococcus aureus represented 50% of the total S. aureus isolates collected in Maryland hospitals in 2013. No significant vancomycin resistance was identified in this species, however. Only 26% of Enterococcus faecium isolates statewide were susceptible to vancomycin. Streptococcus pneumoniae showed significant resistance to macrolides. Differences in resistance trends by region and hospital size were also detected. Conclusion. Maryland faces significant threats from antibiotic resistance in some of the most commonly encountered pathogens in inpatient hospital populations. Differences in testing practices and adherence to current guidelines for antibiogram creation create challenges for interpretation of aggregate data and suggest the need for specific requirements when antibiograms are submitted for regional analyses. Disclosures. All authors: No reported disclosures.Item Assessing the Burden of Acinetobacter baumannii in Maryland: A Statewide Cross-Sectional Period Prevalence Survey(Cambridge University Press, 2015-01-02) Thorn, Kerri A.; Maragakis, Lisa L.; Richards, Katie; Johnson, J. Kristie; Roup, Brenda; Lawson, Patricia; Harris, Anthony D.; Fuss, Elizabeth P.; Pass, Margaret A.; Blythe, David; Perencevich, Eli N.; Wilson, Lucy; Maryland MDRO Prevention CollaborativeObjective. To determine the prevalence of Acinetobacter baumannii, an important healthcare-associated pathogen, among mechanically ventilated patients in Maryland. Design. The Maryland MDRO Prevention Collaborative performed a statewide cross-sectional active surveillance survey of mechanically ventilated patients residing in acute care and long-term care (LTC) facilities. Surveillance cultures (sputum and perianal) were obtained from all mechanically ventilated inpatients at participating facilities during a 2-week period. Setting. All healthcare facilities in Maryland that provide care for mechanically ventilated patients were invited to participate. Patients. Mechanically ventilated patients, known to be at high risk for colonization and infection with A. baumannii, were included. Results. Seventy percent (40/57) of all eligible healthcare facilities participated in the survey, representing both acute care (n = 30) and LTC (n = 10) facilities in all geographic regions of Maryland. Surveillance cultures were obtained from 92% (358/390) of eligible Patients. A. baumannii was identified in 34% of all mechanically ventilated patients in Maryland; multidrug-resistant A. baumannii was found in 27% of all Patients. A. baumannii was detected in at least 1 patient in 49% of participating facilities; 100% of LTC facilities had at least 1 patient with A. baumannii, compared with 31% of acute care facilities. A. baumannii was identified from all facilities in which 10 or more patients were sampled. Conclusions. A. baumannii is common among mechanically ventilated patients in both acute care and LTC facilities throughout Maryland, with a high proportion of isolates demonstrating multidrug resistance.Item Association Between Outpatient Antibiotic Prescribing Practices and Community-Associated Clostridium difficile Infection(Oxford University Press, 2015-08-11) Dantes, Raymund; Mu, Yi; Hicks, Lauri A.; Cohen, Jessica; Bamberg, Wendy; Beldavs, Zintars G.; Dumyati, Ghinwa; Farley, Monica M.; Holzbauer, Stacy; Meek, James; Phipps, Erin; Wilson, Lucy; Winston, Lisa G.; McDonald, L. Clifford; Lessa, Fernanda C.Background. Antibiotic use predisposes patients to Clostridium difficile infections (CDI), and approximately 32% of these infections are community-associated (CA) CDI. The population-level impact of antibiotic use on adult CA-CDI rates is not well described. Methods. We used 2011 active population- and laboratory-based surveillance data from 9 US geographic locations to identify adult CA-CDI cases, defined as C difficile-positive stool specimens (by toxin or molecular assay) collected from outpatients or from patients ≤3 days after hospital admission. All patients were surveillance area residents and aged ≥20 years with no positive test ≤8 weeks prior and no overnight stay in a healthcare facility ≤12 weeks prior. Outpatient oral antibiotic prescriptions dispensed in 2010 were obtained from the IMS Health Xponent database. Regression models examined the association between outpatient antibiotic prescribing and adult CA-CDI rates. Methods. Healthcare providers prescribed 5.2 million courses of antibiotics among adults in the surveillance population in 2010, for an average of 0.73 per person. Across surveillance sites, antibiotic prescription rates (0.50–0.88 prescriptions per capita) and unadjusted CA-CDI rates (40.7–139.3 cases per 100 000 persons) varied. In regression modeling, reducing antibiotic prescribing rates by 10% among persons ≥20 years old was associated with a 17% (95% confidence interval, 6.0%–26.3%; P = .032) decrease in CA-CDI rates after adjusting for age, gender, race, and type of diagnostic assay. Reductions in prescribing penicillins and amoxicillin/clavulanic acid were associated with the greatest decreases in CA-CDI rates. Conclusions and Relevance. Community-associated CDI prevention should include reducing unnecessary outpatient antibiotic use. A modest reduction of 10% in outpatient antibiotic prescribing can have a disproportionate impact on reducing CA-CDI rates.Item Carbapenem-Nonsusceptible Acinetobacter baumannii, 8 US Metropolitan Areas, 2012–2015(CDC, 2018-04) Bulens, Sandra N.; Yi, Sarah H.; Walters, Maroya S.; Jacob, Jesse T.; Wilson, Lucy; et alIn healthcare settings, Acinetobacter spp. bacteria commonly demonstrate antimicrobial resistance, making them a major treatment challenge. Nearly half of Acinetobacter organisms from clinical cultures in the United States are nonsusceptible to carbapenem antimicrobial drugs. During 2012–2015, we conducted laboratory- and population-based surveillance in selected metropolitan areas in Colorado, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, and Tennessee to determine the incidence of carbapenem-nonsusceptible A. baumannii cultured from urine or normally sterile sites and to describe the demographic and clinical characteristics of patients and cases. We identified 621 cases in 537 patients; crude annual incidence was 1.2 cases/100,000 persons. Among 598 cases for which complete data were available, 528 (88.3%) occurred among patients with exposure to a healthcare facility during the preceding year; 506 (84.6%) patients had an indwelling device. Although incidence was lower than for other healthcare-associated pathogens, cases were associated with substantial illness and death.Item Carbapenem-Resistant enterobacterales in individuals with and without health care risk factors —Emerging infections program, United States, 2012-2015(Elsevier, 2023-01-03) Bulens, Sandra N.; Reses, Hannah E.; Ansari, Uzma A.; Grass, Julian E.; Wilson, Lucy; et al.Background. Carbapenem-resistant Enterobacterales (CRE) are usually healthcare-associated but are also emerging in the community. Methods. Active, population-based surveillance was conducted to identify case-patients with cultures positive for Enterobacterales not susceptible to a carbapenem (excluding ertapenem) and resistant to all third-generation cephalosporins tested at 8 US sites from January 2012 to December 2015. Medical records were used to classify cases as health care-associated, or as community-associated (CA) if a patient had no known health care risk factors and a culture was collected <3 days after hospital admission. Enterobacterales isolates from selected cases were submitted to CDC for whole genome sequencing. Results. We identified 1499 CRE cases in 1194 case-patients; 149 cases (10%) in 139 case-patients were CA. The incidence of CRE cases per 100,000 population was 2.96 (95% CI: 2.81, 3.11) overall and 0.29 (95% CI: 0.25, 0.35) for CA-CRE. Most CA-CRE cases were in White persons (73%), females (84%) and identified from urine cultures (98%). Among the 12 sequenced CA-CRE isolates, 5 (42%) harbored a carbapenemase gene. Conclusions. Ten percent of CRE cases were CA; some isolates from CA-CRE cases harbored carbapenemase genes. Continued CRE surveillance in the community is critical to monitor emergence outside of traditional health care settings.Item Comparison of the Risk of Recurrent Clostridioides Difficile Infections Among Patients in 2018 Versus 2013(Oxford University Press, 2022-08-17) Guh, Alice Y.; Yi, Sarah H.; Baggs, James; Winston, Lisa; Wilson, Lucy; et al.Among persons with an initial Clostridioides difficile infection (CDI) across 10 US sites in 2018 compared with 2013, 18.3% versus 21.1% had ≥1 recurrent CDI (rCDI) within 180 days. We observed a 16% lower adjusted risk of rCDI in 2018 versus 2013 (P < .0001).Item Effect of Nucleic Acid Amplification Testing on Population-Based Incidence Rates of Clostridium difficile Infection(Oxford University Press, 2013-07-29) Gould, Carolyn V.; Edwards, Jonathan R.; Cohen, Jessica; Bamberg, Wendy M.; Clark, Leigh Ann; Farley, Monica M.; Johnston, Helen; Nadle, Joelle; Winston, Lisa; Gerding, Dale N.; McDonald, L. Clifford; Lessa, Fernanda C.; Beldavs, Zintars; Hanna, Samir; Hollick, Gary; Holzbauer, Stacy; Lyons, Carol; Phipps, Erin; Wilson, Lucy; Clostridium difficile Infection Surveillance Investigators; Centers for Disease Control and PreventionNucleic acid amplification testing (NAAT) is increasingly being adopted for diagnosis of Clostridium difficile infection (CDI). Data from 3 states conducting population-based CDI surveillance showed increases ranging from 43% to 67% in CDI incidence attributable to changing from toxin enzyme immunoassays to NAAT. CDI surveillance requires adjustment for testing methods.Item Emerging Infectious Diseases Videos for Prehospital Providers(Cambridge University Press, 2019-05-06) Jenkins, J. Lee; Bissell, Richard; Wilson, Lucy; University of Maryland, Baltimore County; Department of Emergency Health Services: Maryland Department of HealthIntroduction: The prehospital disaster and emergency medical services community stands on the front-line in the response to events such as novel influenza, multi-drug resistant tuberculosis, and other high consequence diseases such as the Ebola Virus Disease. Aim: To address provider and community safety, we developed an online educational program utilizing a Multi-Pathogen Approach to infectious disease personal protective equipment (PPE) deployment by prehospital providers. Such vigilance starts with syndromic recognition and quickly transcends to include operational issues, clinical interventions, and public health integration. Methods: The University of Maryland, Baltimore County (Maryland, USA), Department of Emergency Health Services partnered with the Maryland State Department of Health (USA), to develop an online educational curriculum. The curriculum was developed through an expert panel consensus group including prehospital providers and is hybrid in design and includes awareness level training and procedural guidance. Results: Currently deployed online, this educational content demonstrating the use of the Multi-Pathogen Approach is accessible open-access via YouTube worldwide on computers, tablets, and smartphones. This curriculum is also accessible for continuing medical education to over 50,000 prehospital, hospital, and clinic personnel throughout Maryland and the National Capital Region of the United States. The curriculum consists of twelve modules of didactic and live videotaped demonstrations. Discussion: The development of the Multi-Pathogen Approach for the deployment of PPE and the use of online education modules has given prehospital providers an easily accessible open-access tool for high consequence disease management. The development of educational efforts such as these can help ensure better patient care and prehospital EMS system readiness.Item Estimating central line–associated bloodstream infection incidence rates by sampling of denominator data: A prospective, multicenter evaluation(Elsevier, 2015-07-30) Thompson, Nicola D.; Edwards, Jonathan R.; Bamberg, Wendy; Beldavs, Zintars G.; Dumyati, Ghinwa; Godine, Deborah; Maloney, Meghan; Kainer, Marion; Ray, Susan; Thompson, Deborah; Wilson, Lucy; Magill, Shelley S.Background: Large-scale, prospective, evaluation of sampling for central lineeassociated bloodstream infection (CLABSI) denominator data was necessary prior to National Healthcare Safety Network (NHSN) implementation. Methods: In a sample of volunteer hospitals from states in the Emerging Infections Program, prospective collection of CLABSI denominators (patient days, central line days [CLDs]) was performed in eligible locations for 6 and 12 consecutive months using the current NHSN method (daily collection) and also by a second data collector who sampled the denominator data 1 d/wk. The quality of the sampled data was evaluated and used to calculate estimated CLDs and CLABSI rates, which were compared with actual CLDs and CLABSI rates (daily counts). Results: In total, 89 locations in 66 acute care hospitals participated. Sampled data were collected as intended 88% of the time; the quality of the data was comparable with the data collected daily. In locations with higher CLDs per month ( 75), estimated CLDs and CLABSI rates were similar to actual CLDs and CLABSI rates; however, there were significant differences in actual and estimated values among locations with lower (74) CLDs per month.Sampling was successfully implemented, but significant differences in the accuracy of estimated CLDs and CLABSI rates, based on the actual number of CLDs per month, were noted. Conclusion: For locations with a higher number of CLDs per month, sampling 1 d/wk is a valid and accurate alternative to daily collection of CLABSI denominator data.Item Evaluating the Accuracy of Sampling to Estimate Central Line–Days Simplification of the National Healthcare Safety Network Surveillance Methods(Cambridge University Press, 2015-01-02) Thompson, Nicola D.; Edwards, Jonathan R.; Bamberg, Wendy; Beldavs, Zintars G.; Dumyati, Ghinwa; Godine, Deborah; Maloney, Meghan; Kainer, Marion; Ray, Susan; Thompson, Deborah; Wilson, Lucy; Magill, Shelley S.OBJECTIVE. To evaluate the accuracy of weekly sampling of central line-associated bloodstream infection (CLABSI) denominator data to estimate central line-days (CLDs). DESIGN. Obtained CLABSI denominator logs showing daily counts of patient-days and CLD for 6-12 consecutive months from participants and CLABSI numerators and facility and location characteristics from the National Healthcare Safety Network (NHSN). SETTING AND PARTICIPANTS. Convenience sample of 119 inpatient locations in 63 acute care facilities within 9 states participating in the Emerging Infections Program. METHODS. Actual CLD and estimated CLD obtained from sampling denominator data on all single-day and 2-day (day-pair) samples were compared by assessing the distributions of the CLD percentage error. Facility and location characteristics associated with increased precision of estimated CLD were assessed. The impact of using estimated CLD to calculate CLABSI rates was evaluated by measuring the change in CLABSI decile ranking. RESULTS. The distribution of CLD percentage error varied by the day and number of days sampled. On average, day-pair samples provided more accurate estimates than did single-day samples. For several day-pair samples, approximately 90% of locations had CLD percentage error of less than or equal to ± 5%. A lower number of CLD per month was most significantly associated with poor precision in estimated CLD. Most locations experienced no change in CLABSI decile ranking, and no location's CLABSI ranking changed by more than 2 deciles. CONCLUSIONS. Sampling to obtain estimated CLD is a valid alternative to daily data collection for a large proportion of locations. Development of a sampling guideline for NHSN users is underway.Item Health care worker perceptions toward computerized clinical decision support tools for Clostridium difficile infection reduction: A qualitative study at 2 hospitals(Elsevier, 2018-09-27) Blanco, Natalia; O'Hara, Lyndsay M.; Robinson, Gwen L.; Brown, Jeanine; Heil, Emily; Brown, Clayton H.; Stump, Brian D.; Sigler, Bryant W.; Belani, Anusha; Miller, Heidi L.; Chiplinski, Amber N.; Perlmutter, Rebecca; Wilson, Lucy; Morgan, Daniel J.; Leekha, SurbhiBackground Clostridium difficile infection (CDI) is associated with significant morbidity and mortality. Computerized clinical decision support (CCDS) tools can aid process improvement in infection prevention and antibiotic stewardship, but implementation and health care workers (HCWs) uptake of these tools is often variable. The objective of this study was to describe HCWs' perceptions of barriers and facilitators related to uptake of CCDS tools as part of a CDI reduction bundle. Methods We conducted a qualitative study among HCWs at 2 acute care hospitals in Maryland. Semi-structured interviews and structured surveys were completed by HCWs to evaluate their perception to CCDS tools at 2 different stages: predevelopment and preimplementation. Emergent themes and patterns in the data were identified and condensed. Results Gaps in CDI-related knowledge and in communication between HCWs were identified throughout the evaluation. HCWs agreed on the potential of the tools to improve CDI diagnosis, prevention, and control. An important barrier for uptake was the perceived loss of autonomy and clinical judgment, whereas standardization and error reduction were perceived advantages. Conclusions These observations shaped the development and implementation of the CDI reduction bundle. Qualitative findings can provide valuable contextual information during the development stages of CCDS tools in infection prevention and antibiotic stewardship.Item Impact of COVID-19 Pandemic on Clostridioides difficile Infection Rates and Risk Factors in Maryland(Oxford University Press, 2023-11-27) Marceaux-Galli, Kaytlynn; Perlmutter, Rebecca; Blythe, David; Wilson, LucyWhile many Healthcare Associated Infection (HAI) rates increased during the pandemic, inpatient C. difficile infection (CDI) rates declined. We compared pre-pandemic (2018-2019) to interpandemic (2020-2021) data, using Maryland’s population-based surveillance data collected through the Emerging Infections Program’s CDI HAIC project, to quantify the impact of COVID-19 on decreases in CDI within different epidemiologic classes (epi classes): HCFO, CO-HCFA, CA (Tables 1 & 2).Item Improved Phenotype-Based Definition for Identifying Carbapenemase Producers among Carbapenem-Resistant Enterobacteriaceae(CDC, 2015-09) Chea, Nora; Bulens, Sandra N.; Kongphet-Tran, Thiphasone; Lynfield, Ruth; Shaw, Kristin; Vagnone, Paula Snippes; Kainer, Marion; Muleta, Daniel; Wilson, Lucy; Vaeth, Elisabeth; Dumyati, Ghinwa; Concannon, Cathleen; Phipps, Erin C.; Culbreath, Karissa; Janelle, Sarah J.; Bamberg, Wendy; Guh, Alice Y.; Limbago, Brandi M.; Kallen, Alexander J.Preventing transmission of carbapenemase-producing, carbapenem-resistant Enterobacteriaceae (CP-CRE) is a public health priority. A phenotype-based definition that reliably identifies CP-CRE while minimizing misclassification of non–CP-CRE could help prevention efforts. To assess possible definitions, we evaluated enterobacterial isolates that had been tested and deemed nonsusceptible to >1 carbapenem at US Emerging Infections Program sites. We determined the number of non-CP isolates that met (false positives) and CP isolates that did not meet (false negatives) the Centers for Disease Control and Prevention CRE definition in use during our study: 30% (94/312) of CRE had carbapenemase genes, and 21% (14/67) of Klebsiella pneumoniae carbapenemase–producing Klebsiella isolates had been misclassified as non-CP. A new definition requiring resistance to 1 carbapenem rarely missed CP strains, but 55% of results were false positive; adding the modified Hodge test to the definition decreased false positives to 12%. This definition should be considered for use in carbapenemase-producing CRE surveillance and prevention.Item Incidence of, Risk Factors for, Clinical Presentation, and 1-Year Outcomes of Infective Endocarditis in an Urban HIV Cohort(Wolters Kluwer, 2006-08-25) Gebo, Kelly A; Burkey, Matthew D; Lucas, Gregory M; Moore, Richard D; Wilson, LucyBackground: Previous studies described infective endocarditis (IE) in the era before highly active antiretroviral therapy (HAART); however, IE has not been well studied in the current HAART era. We evaluated the incidence of, risk factors for, clinical presentation, and 1-year outcomes of IE in HIV-infected patients. Methods: We evaluated all cases of IE diagnosed between 1990 and 2002 in patients followed at the Johns Hopkins Hospital outpatient HIV clinic. To identify factors associated with IE in the current era of HAART, a nested case-control analysis was employed for all initial episodes of IE occurring between 1996 and 2002. Logistic regression analyses were used to assess risk factors for IE and factors associated with 1-year mortality. Results: IE incidence decreased from 20.5 to 6.6 per 1000 person-years (PY) between 1990 and 1995 and 1996 and 2002. The majority of IE cases were male (66%), African American (90%), and injection drug users (IDUs) (85%). In multivariate regression, an increased risk of IE occurred in IDUs (AOR, 8.71), those with CD4 counts <50 cells/mm3, and those with HIV-1 RNA >100,000 copies/mL (AOR, 3.88). Common presenting symptoms included fever (62%), chills (31%), and shortness of breath (26%). The most common etiologic organism was Staphylococcus aureus (69%; of these 11 [28%] were methicillin resistant). Within 1 year, 16% had IE recurrence, and 52% died. Age over 40 years was associated with increased mortality. Conclusions: IE rates have decreased in the current HAART era. IDUs and those with advanced immunosuppression are more likely to develop IE. In addition, there is significant morbidity and 1-year mortality in HIV-infected patients with IE, indicating the need for more aggressive follow-up, especially in those over 40 years of age. Future studies investigating the utility of IE prophylaxis in HIV patients with a history of IE may be warranted.Item Invasive Group A Streptococcus Infections Associated With Liposuction Surgery at Outpatient Facilities Not Subject to State or Federal Regulation(AMA, 2014-07) Beaudoin, Amanda L.; Torso, Lauren; Richards, Katherine; Said, Maria; Beneden, Chris Van; Longenberger, Allison; Ostroff, Stephen; Wendt, Joyanna; Dooling, Kathleen; Wise, Matthew; Blythe, David; Wilson, Lucy; Moll, Mària; Perz, Joseph F.Importance Liposuction is one of the most common cosmetic surgery procedures in the United States. Tumescent liposuction, in which crystalloid fluids, lidocaine, and epinephrine are infused subcutaneously before cannula-assisted aspiration of fat, can be performed without intravenous or general anesthesia, often at outpatient facilities. However, some of these facilities are not subject to state or federal regulation and may not adhere to appropriate infection control practices. Objective To describe an outbreak of severe group A Streptococcus (GAS) infections among persons undergoing tumescent liposuction at 2 outpatient cosmetic surgery facilities not subject to state or federal regulation. Design Outbreak investigation (including cohort analysis of at-risk patients), interviews using a standardized questionnaire, medical record review, facility assessment, and laboratory analysis of GAS isolates. Setting and Participants Patients undergoing liposuction at 2 outpatient facilities, one in Maryland and the other in Pennsylvania, between July 1 and September 14, 2012. Main Outcomes and Measures Confirmed invasive GAS infections (isolation of GAS from a normally sterile site or wound of a patient with necrotizing fasciitis or streptococcal toxic shock syndrome), suspected GAS infections (inflamed surgical site and either purulent discharge or fever and chills in a patient with no alternative diagnosis), postsurgical symptoms and patient-reported experiences related to his or her procedure, and emm types, T-antigen types, and antimicrobial susceptibility of GAS isolates. Results We identified 4 confirmed cases and 9 suspected cases, including 1 death (overall attack rate, 20% [13 of 66]). One instance of likely secondary GAS transmission to a household member occurred. All confirmed case patients had necrotizing fasciitis and had undergone surgical debridement. Procedures linked to illness were performed by a single surgical team that traveled between the 2 locations; 2 team members (1 of whom reported recent cellulitis) were colonized with a GAS strain that was indistinguishable by laboratory analysis of the isolates from the case patients. Facility assessments and patient reports indicated substandard infection control, including errors in equipment sterilization and infection prevention training. Conclusions and Relevance This outbreak of severe GAS infections was likely caused by transmission from colonized health care workers to patients during liposuction procedures. Additional oversight of outpatient cosmetic surgery facilities is needed to assure that they maintain appropriate infection control practices and other patient protections.Item Long-Term Outcomes of Clostridium difficile Infection Among Medicare Beneficiaries(Oxford University Press, 2018-11-26) Hatfield, Kelly M; Baggs, James; Winston, Lisa G; Parker, Erin; Wilson, Lucy; et alBackground Clostridium difficile infection (CDI) is a common healthcare-associated infection, particularly among older adults. We used laboratory-confirmed CDI surveillance data from 8 states participating in the Centers for Disease Control and Prevention’s Emerging Infections Program linked to claims data for Centers for Medicare and Medicaid Services (CMS) beneficiaries to measure variation in 1-year outcomes associated with CDI. Methods A CDI case was defined as a positive C. difficile stool test in 2014 in a person without a positive test in the prior 8 weeks. Cases aged ≥65 years were linked to their CMS beneficiary ID using unique combinations of date of birth, sex, and zip code. Each case was matched to five control beneficiaries who did not link to any case and were residents of the same catchment area. Inclusion criteria were continuous fee-for-service Medicare for the entire study period (1 year before and after event date), and no hospitalization or skilled nursing facility stay with an ICD-9-CM code for CDI in the year prior to their match date. Multivariable logistic regression models were used to compare mortality and hospitalization for 1 year following the event date between beneficiaries with and without CDI, adjusting for age, sex, race, catchment area, chronic conditions, number of hospitalizations in the prior year, and hospitalization status at the time of and 7 days preceding the event date. Results Of 5,097 cases aged ≥65, 3,082 (60%) were linked to a CMS ID, and 1,832 (59%) met inclusion criteria. In crude analysis, 34% of beneficiaries with CDI died within 1 year, compared with 5% of beneficiaries without CDI. Beneficiaries with CDI were also more likely to be hospitalized in the subsequent year (54% vs. 17%). Beneficiaries with CDI had a higher adjusted odds of death (adjusted OR 3.01, 95% CI: 2.46, 3.69) and hospitalization within 1 year (adjusted OR 1.93, 95% CI: 1.65, 2.25) than those without CDI. Conclusion Older adults with CDI were three times more likely to die in the year following infection and nearly two times more likely to be hospitalized compared with those without CDI, revealing independent long-term risk of poor outcomes. This excess morbidity and mortality supports the need to develop novel CDI prevention strategies for this population. Disclosures All authors: No reported disclosures.Item Molecular Characterization of Carbapenem-Resistant Enterobacterales Collected in the United States(Mary Ann Liebert, Inc, 2022-04-18) Karlsson, Maria; Lutgring, Joseph D.; Ansari, Uzma; Lawsin, Adrian; Wilson, Lucy; et alCarbapenem-resistant Enterobacterales (CRE) are a growing public health concern due to resistance to multiple antibiotics and potential to cause health care-associated infections with high mortality. Carbapenemase-producing CRE are of particular concern given that carbapenemase-encoding genes often are located on mobile genetic elements that may spread between different organisms and species. In this study, we performed phenotypic and genotypic characterization of CRE collected at eight U.S. sites participating in active population- and laboratory-based surveillance of carbapenem-resistant organisms. Among 421 CRE tested, the majority were isolated from urine (n = 349, 83%). Klebsiella pneumoniae was the most common organism (n = 265, 63%), followed by Enterobacter cloacae complex (n = 77, 18%) and Escherichia coli (n = 50, 12%). Of 419 isolates analyzed by whole genome sequencing, 307 (73%) harbored a carbapenemase gene; variants of blaKPC predominated (n = 299, 97%). The occurrence of carbapenemase-producing K. pneumoniae, E. cloacae complex, and E. coli varied by region; the predominant sequence type within each genus was ST258, ST171, and ST131, respectively. None of the carbapenemase-producing CRE isolates displayed resistance to all antimicrobials tested; susceptibility to amikacin and tigecycline was generally retained.Item Phenotypic Definitions for Identifying Carbapenemase-Producing Carbapenem-resistant Enterobacteriaceae(Oxford University Press, 2014-12-01) Chea, Nora; Bulens, Sandra N.; Kongphet-Tran, Thiphasone; Albrecht, Valerie; Lynfield, Ruth; Shaw, Kristin M; Kainer, Marion; Muleta, Daniel; Wilson, Lucy; Vaeth, Elisabeth; Dumyati, Ghinwa; Concannon, Cathleen; Phipps, Erin C.; Culbreath, Karissa; Janelle, Sarah Jackson; Bamberg, Wendy; Kallen, AlexanderBackground. Evidence suggests that much of the increase in carbapenem-resistant Enterobacteriaceae (CRE) in the U.S. is due to the spread of carbapenemase-producing (CP) strains. However, resistance mechanism testing is not widely used. A phenotypic definition that reliably identifies CP-CRE could help target prevention. Methods. Escherichia coli, Enterobacter spp., and Klebsiella spp. isolates that were nonsusceptible to any carbapenem based on local laboratory results were collected from six Emerging Infections Program sites. Isolates underwent susceptibility testing and PCR for the most common U.S. carbapenemases (KPC, NDM, IMP, VIM, OXA-48). The proportion of false positives (FP) (i.e., met phenotypic definition but not CP-CRE), and false negatives (FN) (i.e., did not meet phenotypic definition but was CP-CRE) were calculated for ten phenotypic CRE definitions that included a variety of carbapenem and 3rd and 4thgeneration cephalosporin susceptibility patterns. Phenotypic definitions with FP ≤ 35% and FN ≤ 6% were considered acceptable and further stratified by organism. Results. Overall, 212 isolates were included, of which 50 (24%), 84 (40%), and 78 (36%) were E. coli, Klebsiella spp. and Enterobacter spp., respectively. Seventy-four (35%) were KPC-CRE (5 E. coli, 57 Klebsiella spp., 12 Enterobacter) and five (2%) were NDM-CRE (5 Klebsiella spp.). The proportion of FP and FN for the ten phenotypic definitions ranged from 17% to 48% and 1% to 11% respectively. Two phenotypic definitions met criteria for further evaluation including: 1). Current CDC phenotypic definition – nonsusceptible to any carbapenem (excluding ertapenem) and resistant to all 3rd generation cephalosporins tested (FN = 4%, FP = 31%) and 2). Resistant to any carbapenem (excluding ertapenem) (FN = 6%, FP =18%). Klebsiella had a higher proportion of FN and lower proportion of FP than E. coli or Enterobacter Conclusion. No phenotypic definition perfectly identifies CP-CRE; the proportion of FP and FN also might vary by organism. Two phenotypic definitions appeared to have a potentially acceptable proportion of FP and FN and might be useful to target CRE surveillance and prevention efforts; however, testing across a broader group of sites and carbapenemases is needed. Disclosures. All authors: No reported disclosures.Item Prior Hospitalizations Among Cases of Community-Associated Clostridioides difficile Infection—10 US States, 2014–2015(Oxford University Press, 2019-10-23) Hatfield, Kelly M; Baggs, James; Winston, Lisa Gail; Parker, Erin; Johnston, Helen; Brousseau, Geoff; Olson, Danyel M; Fridkin, Scott; Wilson, Lucy; Perlmuter, Rebecca; Holzbauer, Stacy; Phipps, Erin C; Hancock, Emily B; Dumyati, Ghinwa; Ocampo, Valerie; Kainer, Marion A; Korhonen, Lauren C; Jernigan, John A; McDonald, L Clifford; Guh, AliceBackground Despite overall progress in preventing Clostridioides difficile Infection (CDI), community-associated (CA) infections have been steadily increasing. Although the incubation period of CDI is thought to be relatively short, gastrointestinal microbial disruption from remote healthcare exposures (e.g., inpatient antibiotic use) may be associated with CA-CDI. To assess this potential association, we linked CA-CDI infections identified through CDC’s Emerging Infections Program (EIP) to Medicare claims data to describe prior healthcare utilization. Methods We defined an EIP CA-CDI case as a positive C. difficile test collected in 2014–2015 from an outpatient or inpatient within 3 days of hospital admission, provided there was no positive test in the prior 8 weeks and no admission to a healthcare facility in the prior 12 weeks. We linked EIP CA-CDI cases aged ≥65 years to a Medicare beneficiary using unique combinations of birthdate, sex, and zip code. Cases were included if they maintained continuous fee-for-service coverage for 1 year prior to the event date. To calculate exposure odds ratios for previous hospitalizations, each case was matched to 5 control beneficiaries on age, sex, and county of residence. We used logistic regression to calculate adjusted matched odds ratios (amOR) that controlled for chronic conditions. Results We successfully linked 2,287/3,367 (68%) EIP CA-CDI cases. Of these, 1,236 cases met inclusion criteria; the median age was 77 years and 63% were female. We identified 69 (5.6%) cases with misclassification of prior healthcare exposures, most of whom (48, 70%) were hospitalized in the 12 weeks prior to their event. Among the 1,167 true CA-CDI cases, 33% were hospitalized in the prior 12 weeks to 1 year. The median number of weeks from prior hospitalization to CDI was 27 (IQR 18–38, Figure 1). Cases had a higher risk of hospitalization than matched controls in the prior 3–6 months (amOR: 2.33, 95% CI: 1.87, 2.90) and 6–12 months (amOR: 1.43 95% CI: 1.18, 1.74). Conclusion Remote hospitalization in the previous year was a significant risk factor for CA-CDI, especially in the 3–6 months prior to CA-CDI. Long-lasting prevention strategies implemented at hospital discharge and enhanced inpatient antibiotic stewardship may prevent CA-CDI among older adults.Item Resolution of a fungal mycotic aneurysm after a contaminated steroid injection: a case report(Springer, 2014-05-31) Nelson, George; Fermo, Olga; Thakur, Kiran; Felton, Elizabeth; Bang, Jee; Wilson, Lucy; Rhee, Susan; Llinas, Rafael; Johnson, Kristine; Sullivan, DavidBackground In the past ten years there have been three separate outbreaks of fungal contaminated steroid injections from compounding pharmacies. The 2012 outbreak of central nervous system fungal infections associated with contaminated methylprednisolone produced by a United States compounding pharmacy has led to 750 infections (151 with meningitis and paraspinal infections and 325 cases with paraspinal infections without meningitis) and 64 deaths as of October 23, 2013. Exserohilum rostratum has been the predominant pathogen identified by culture, polymerase chain reaction or antibody tests. According to previous reports, cerebral involvement with phaeohyphomycosis has a high risk of morbidity and mortality. Case presentation We report a 41 year-old Caucasian woman who received a lumbar methylprednisolone injection from a contaminated lot in August 2012. She was diagnosed with fungal meningitis by cerebrospinal fluid pleocytosis and positive (1, 3) beta-D-glucan after cultures and polymerase chain reaction were negative. Two weeks after onset of therapy, she developed a 4.1 mm superior cerebellar artery mycotic aneurysm associated with new stroke symptoms, which resolved with thirty-two weeks of antifungal treatment. Conclusions This is the rare case report of successful medical management of a cerebral mycotic aneurysm with stroke symptoms related to a presumed phaeohyphomycosis in an immunocompetent individual. Further studies are needed to determine the utility of cerebrospinal fluid (1, 3) beta-D-glucan in diagnosing and monitoring patients with meningitis thought to be related to fungal infection.