and clinical practice, we suggest a framework for the investigation of suspected recurrence cases (Fig. 1). However, the challenge of this detailed investigation lies in the high resource load required to allow truly robust conclusions, especially considering complicating factors in a postvaccination setting.Nonetheless, we propose that studies that employ such techniques must be undertaken to appropriately answer the multitude of pressing questions that pertain to COVID-19 recurrence. These investigations are particularly significant considering recent reports of reinfection by novel SARS-CoV-2 variants, which may lead to a more severe second episode of disease. 8 Thus, only when we comprehend the complex interplay between COVID-19 recurrence and the other components of the pandemic will we be able to quantify and react to its impact on both the patient and population levels.
Background: Resin-containing blood culture bottles (RBB) are used to increase the isolation of microorganisms by binding antimicrobials in sampled blood. Since RBB implementation in April 2018, our infection preventionists noted an increase in positive blood cultures on routine surveillance. Objective: To describe the change in bacterial isolation post-RBB implementation. Methods: All positive blood culture sets drawn in adult inpatient units or the emergency room between October 2017 and September 2018 and their associated organisms were obtained from the hospital laboratory database. Then, regardless of central-line placement or “present on admission” designation, the 2019 NHSN surveillance definitions for laboratory-confirmed bloodstream infection (LCBI-1 and LCBI-2) were applied to categorize all positive cultures as “common commensals” (CCs) or pathogens. A univariate analysis was performed using the Mantel-Haenszel χ2 test (OpenEpi version 3.01). Results: Although the number of monthly blood cultures drawn remained effectively stable before and after implementation (pre-RBB median, 3,512.5; post-RBB median, 3,626), the rate ratio of positive cultures increased by 1.36 times: pre-RBB median, 127 sets per month and post-RBB median, 172.5 sets per month (χ2 = 5.785; P = .008). The rate ratio of pathogen-containing cultures increased by 1.40 times (pre-RBB median, 98 sets per month and post-RBB median, 137.5 sets per month; χ² = 5.615; P = .009) with only a 1.24 increase in CCs (pre-RBB median, 29 and post-RBB median, 36; χ² = 0.553; P = .229) (Fig. 1). Conclusions: After RBB implementation, the monthly incidence rate of pathogen-containing sets increased. Additionally, the increase in these sets as well as of overall positive blood cultures was statistically significant. Current literature on RBBs does not suggest preferential increased isolation of pathogens. Further study is needed to determine whether our findings are related to blood-culturing practices or the RBBs themselves.Funding: NoneDisclosures: None
Background: Despite introduction of mandatory vaccination of healthcare workers (HCWs) in 2011, we continued to see occasional cases of nosocomial influenza. We sought to understand the characteristics of patients who acquired nosocomial influenza to better target prevention efforts. Methods: The study population was a retrospective cohort of all patients aged ≥18 years admitted to an academic medical center between September 2012 and August 2018. Patient data obtained included age, admission/discharge date, service line, influenza vaccination status on admission, and virus serotype. Nosocomial influenza was defined as positive polymerase chain reaction (PCR) or antigen testing for influenza A/B >3 days after admission. Each influenza season, patients with nosocomial influenza or community-acquired influenza (CA-I) were censored after the positive test. Means with standard deviations are reported (SAS version 9.4). Results: Overall, 223,005 patient admissions occurred during the study period: 222,154 (99.6%) were without confirmed influenza infection, 788 (0.35%) had CA-I, and 63 (0.03%) had nosocomial influenza (Fig. 1). The mean age of patients without influenza infection was 57.6 ± 19.3 years compared to 66.5 ± 18.8 years for those with CA-I and 67.1 ± 13.5 with nosocomial influenza. Influenza A accounted for 630 cases (80%) of CA-I, and 58 cases (92%) of nosocomial influenza. Also, 31 (48%) with nosocomial influenza had been vaccinated against influenza prior to admission (Table 1). Most nosocomial influenza cases (78%) occurred on medicine and oncology units. Conclusions: Influenza A represented a larger percentage of nosocomial influenza compared to CA-I. The proportion of nosocomial influenza cases remained stable during the study period, even after introduction of PCR tests in the 2014–2015 season. The mean age of the nosocomial influenza group was greater compared to the CA-I and no influenza groups. More than half of nosocomial influenza cases were unvaccinated at the time of admission, demonstrating the importance of improving vaccine uptake among vulnerable populations.Funding: NoneDisclosures: None
Background: Deep and organ-space surgical site infections (SSIs) are serious complications of coronary artery bypass graft (CABG) procedures. It is unclear whether the use of bilateral versus single internal mammary artery (BIMA vs SIMA) and surgical approach to internal mammary artery (IMA) harvest (pedicled vs skeletonized) are independent risk factors for SSI. The use of BIMA grafting redirects blood flow away from the sternum to the heart and may increase SSI risk due to lower tissue perfusion. A skeletonized approach to graft harvest, wherein the IMA is dissected free of surrounding tissue to preserve collateral sternal blood flow, may decrease SSI risk as compared to a pedicled approach in which the IMA is mobilized within a tissue pedicle. We describe the incidence and potential risk factors for post-CABG SSI in an academic tertiary-care center performing ~500 IMA procedures annually. Methods: Data were abstracted on adult patients who underwent a CABG procedure using at least 1 IMA graft between July 2017 and June 2020. Additional data on potential risk factors for SSI were obtained electronically from hospital data marts and the Division of Cardiac Surgery database, including demographics, comorbidities, number of arterial grafts, surgical approach, surgeon, and discharge location. Using standard NHSN definitions, infection control practitioners identified post-CABG deep and organ-space SSIs. Patient and procedure characteristics were evaluated as potential risk factors for deep and organ-space SSI using the Fisher exact test. Results: Of 1,591 CABG procedures performed during the study period, 1,244 (78.2%) were performed using a SIMA technique and 347 (21.8%) were performed using a BIMA technique. The overall post-CABG SSI incidence was 1.2 per 100 procedures, with 1.0 SSIs per 100 SIMA procedures and 1.7 SSIs per 100 BIMA procedures. Table 1 demonstrates an increase over time in proportion of CABG procedures performed using SIMA and skeletonized IMA grafts. We also observed a decrease in overall SSI incidence over this period. See Table 2 for univariate predictors of post-CABG SSI. Conclusions: Female sex, BMI ≥40, age ≥75 years, diabetes, and discharge to a rehabilitation setting were associated with development of post-CABG SSI. Although the overall incidence of deep and organ-space SSI in our cohort was very low, making it difficult to draw conclusions about potentially modifiable risk factors, an increase in the use of SIMA and skeletonized grafts appears to be accompanied by a decrease in SSI incidence. More data from our institution and others are needed to determine the significance of this trend.Funding: NoDisclosures: None
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