Background Currently, publicly reported infections include a few types of events, and do not provide a comprehensive picture on overall infection prevention practices. Hospital onset bloodstream infection (HOBSI), regardless of source, reflects invasive infection from an at risk patient population in inpatient healthcare settings.Methods Using one infection prevention surveillance system, we identified all positives blood cultures for 5 organisms commonly associated with healthcare infections (Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Candida species) over the 12 months of 2016, across 51 acute care hospitals. Each HOBSI was counted once per patient and was classified based on the NHSN definition. Validation was performed comparing individual site laboratory microbiology data to the surveillance system report.ResultsA total of 1,053 HOBSI events occurred over 2,797,568 patient-days at an aggregate rate of 3.76 per 10,000 patient-days. Small (<100 beds) hospitals had very low event rates. There were significant differences between medium (100–300 beds) size and large (>300 beds) hospitals, specifically candidemia and Gram-negative bacteremia (table). S. Aureus and Candida species represented 57% of all HOBSIs. Facility and system events were trended monthly over time based on individual and all organisms combined and provided an objective assessment of invasive infections over time (figure).Conclusion Automated reporting of HOBSI for common organisms associated with invasive disease provides an objective method to evaluate infection prevention in medium and large hospitals and potentially benchmarking based on hospital characteristics in the future.Disclosures
All authors: No reported disclosures.
Background Hospital Onset (HO) Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is publicly reported and tied to the Hospital-Acquired Conditions Reduction program. It reflects a surrogate of risk of infection of MRSA invasive disease in the hospital setting, and reported as a standardized infection ratio that adjusts for admission MRSA prevalence, hospital size and medical school affiliation. However, it may not adequately represent all HO S. Aureus bacteremia, which is unaffected by the prevalence of resistance to methicillin.Methods We compared the rates of NHSN-defined laboratory ID events for HO methicillin susceptible S. Aureus (MSSA) and MRSA bacteremia in 51 hospitals (small, <100 beds, n = 15; medium, 100–300 beds, n = 15; large, >300 beds, n = 21) from a single health system over a 12-month period abstracting data from one clinical decision support system. We also compared the rates of HO S. Aureus bacteremia based on hospital size.Results340 HO S. Aureus bacteremia events (1.22 per 10,000 patient-days) occurred during calendar year 2016 (MSSA n = 218, 64%; MRSA n = 122, 36%). 14/15 small hospitals did not have any HO S. Aureus bacteremia events during the study period. HO MSSA bacteremia rates were 0.58 and 0.77 per 10,000 patient-days for medium size and large-size hospitals respectively (P = 0.094). In contrast, HO MRSA bacteremia rates were 0.71 and 0.47 per 10,000 patient-days for medium size and large-size hospitals respectively (P = 0.045). There was no correlation between HO MSSA and MRSA bacteremia for large and medium size hospitals (Figure).Conclusion By measuring only HO MRSA, a significant portion of patients with increased morbidity and mortality are overlooked. HO S. Aureus bacteremia may provide a better measure to use to evaluate invasive S. Aureus risk in the hospital setting, and would mitigate the MRSA prevalence factor. These findings are important when we evaluate policy related to what is considered a hospital acquired condition.Figure:Relation between HO MSSA and MRSA Bacteremia for Based on Hospital Size.Disclosures
All authors: No reported disclosures.
Background. Differences in clinical characteristics and outcomes between community-acquired (CA) and healthcare-associated (HCA) Bacteroides bacteremia cases are not well known.Methods. We evaluated all positive blood cultures between March 2012 and December 2016 in a Japanese 781-bed acute hospital. Identification and susceptibility was performed based on CLSI criteria, and MALDI-TOF has been used since January 2015 in addition to conventional methods.Results.
5%]). After introducing MALDI-TOF, the number of unidentifiedBacteroides species fell from 12 (18.5%) to 5 (7.7%). Sensitivity to ampicillin/sulbactam, cefmetazole, and clindamycin was 85.2%, 92.6%, and 59.3%, respectively. Most bacteremia (51 [78.5%]) were of intra-abdominal origin. Baseline characteristics and immunocompromised status of HCA and CA Bacteroides bacteremia patients were similar, except for diabetes, which was more frequent in HCA cases (Table). There was significantly higher 7-and 30-day mortality in HCA than in CA cases (P = 0.03).Conclusion. The higher mortality in HCA Bacteroides bacteremia suggests the need for appropriate multidisciplinary management of these cases.
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