Background:
Clinical antibiotic susceptibility testing (AST) interpretations based on minimum inhibitory concentrations (MIC) breakpoints are important for both clinical decision making and some ...reportable condition criteria. Standardization of MIC breakpoints across clinical laboratories is lacking; AST instruments are often validated for outdated Clinical and Laboratory Standards Institute (CLSI) MIC breakpoint guidelines. In this study, we analyzed the agreement between the reported clinical laboratory AST interpretations and the guideline CLSI interpretation.
Methods:
Clinical laboratory AST data collected from the Multisite Gram-Negative Surveillance Initiative (MuGSI) carbapenem-resistant Enterobacterales (CRE) surveillance program in Tennessee between 2019 and 2021 were utilized. MIC values from the clinical instrument were used to calculate CLSI standard interpretations following the 2019–2021 CLSI M100 guidelines. Agreement between the clinical laboratory and CLSI interpretations of the reported MIC values were measured using a weighted Cohen κ calculated in SAS version 9.4 software. Total matches were isolates with identical CLSI and clinical laboratory interpretations.
Results:
In total, 14 antibiotics were assessed. Of those, 9 antibiotics had at least moderate agreement (κ > 0.41) between interpretations. Agreement between the clinical laboratory and the CLSI interpretations were near perfect (κ > 0.81) for 3 antibiotics. Agreement between the clinical laboratory and the CLSI interpretations were poor for cefazolin (0.06) and ertapenem (0.14). Cefotaxime (−0.07) was the only antibiotic that suggested no agreement.
Conclusions:
Of the antibiotics included in the analysis, 36% had less than moderate agreement between clinical laboratory and CLSI AST interpretations. Given the increases in antimicrobial resistance globally and the emphasis placed on antibiotic stewardship, standardization across clinical AST panels should be prioritized. Inconsistencies have the potential to contribute to inappropriate antibiotic use in addition to under- or overidentification of reportable conditions, including CRE.
Disclosures:
None
Background:
In September 2021, the CMS mandated that long-term care facility (LTCF) healthcare workers be vaccinated for COVID-19 unless medically or religiously exempt. Vaccinating healthcare ...workers reduces transmission of COVID-19 among patients and workers, reducing the risk of illness among residents and patients. We examined the relationship between COVID-19 clusters and staff vaccination rates in Tennessee LTCFs.
Methods:
COVID-19 cluster data were collected using REDCap from January 3, 2021, to September 25, 2022, and LTCF vaccination rates were collected from the NHSN. Clusters were identified in facilities with 2 or more cases. The staff vaccination rate 2 weeks prior to the cluster was used, accounting for the lag time between vaccination dose and reaching full immunity. We selected 75% as the critical immunization threshold. The facility case rate was calculated per 100 beds. A test was performed to determine whether reaching the critical vaccination threshold was associated with cluster occurrence. The relationship between vaccination rate and case number was tested using Pearson correlation. Statistical analyses were conducted using SAS version 9.4 software.
Results:
The average staff vaccination rate when NHSN first required long-term care facilities to report rates rose from 47% in June 2021 to 83% in September 2022. In total, 806 clusters were identified with 20,868 combined weeks from all facilities being reported after merging facilities’ weekly vaccine percentage rates with cluster data. Most weeks from all facilities did not identify a cluster (n = 20,064, 96.15%) and did not meet the critical immunization threshold (n = 11,050, 52.95%). The association between a cluster occurring and a facility meeting the threshold was significant (χ
2
= 5.41; df = 1;
P
95% CI, .7327–.9740). The Pearson correlation coefficient between vaccination rate and case number was 0.05560 (
P
= .2894).
Conclusions:
There was a significant association between facilities not reaching the immunization threshold and presence of a COVID-19 cluster. The facility case rate was not correlated with staff vaccination rate; however, a limitation of this analysis was that resident vaccination was not tested. Another limitation was that medical and religious exemptions could not be differentiated. Healthcare staff should consider getting vaccinated, if able, to reduce the risk of COVID-19 and to keep staff and residents safe from COVID-19.
Disclosures:
None
Background:
Healthcare workers (HCWs) are at increased risk of influenza exposure and represent a potential transmission source. The Department of Health and Human Services (HHS) set a goal for 2020 ...to have 90% of all HCWs in acute-care hospitals (ACHs) vaccinated. Vaccination against influenza decreases symptomatic illness and absenteeism and protects HCWs and their contacts. We assessed characteristics of facility intervention programs based on their success in meeting this benchmark.
Methods:
Data from the NHSN were utilized, including answers to the Annual Flu Survey for 2014–2022 and the rate of vaccine compliance by facility. Flu surveys detail facility-specific programs implemented for each influenza season, from October to March. We used SAS version 9.4 software for univariate analyses to determine factors significantly associated with meeting the HHS benchmark target of ≥90% vaccination among all HCWs, split into categories for employees, students or volunteers, and licensed independent practitioners. Facilities were excluded if they were not ACHs or Critical Access Hospitals (CAH), did not complete the Annual Flu Survey for at least 1 year, or required vaccination as a condition of employment.
Results:
From 2014 to 2022, 745 surveys were completed. Overall, 48.58% of respondents succeeded in meeting the HHS benchmark. Also, 306 surveys completed noted that their facility did not require influenza vaccination. Among those, only 19.93% respondents succeeded. Moreover, 80.33% of successful respondents for all HCWs required personal protective equipment (PPE) upon vaccination refusal compared to 34.29% of unsuccessful respondents (
P
< .0001). Furthermore, 98.36% successful respondents required documentation of offsite vaccination, compared to 89.39% of unsuccessful respondents (
P
= .027). For employees, 64.56% of successful respondents tracked vaccination rates in some or all units compared to 45.81% of unsuccessful respondents (
P
= .004). Also, 63.29% successful respondents had visible vaccination of leadership, compared to 43.61% of unsuccessful respondents (
P
= .003). Furthermore, 86.08% of successful respondents had mobile vaccination carts, compared to 73.57% unsuccessful respondents (
P
= .023). For the student- or volunteer-specific benchmark, 24.59% of successful respondents provided vaccination incentives compared to 14.63% of unsuccessful respondents (
P
= .035).
Conclusions:
Facilities with ≥90% vaccination among HCWs were more likely to require PPE after vaccination refusal and documentation for offsite vaccination. Other strategies for vaccination were differentially associated by employee type for Tennessee facilities. For future outreach, a multipronged approach is more likely to be successful in addressing vaccine uptake among employees with lagging rates. Strategies for influenza vaccine uptake could also improve other occupational vaccinations. More research is needed on the barriers to vaccination among HCWs specifically.
Disclosures:
None
Measles elimination hinges on vaccination coverage remaining above 95% to retain sufficient community protection. Recent declines in routine measles vaccinations due to the COVID-19 pandemic coupled ...with prior models indicating the country was close to the 92% herd immunity benchmark are a cause for concern. We evaluated population-level measles susceptibility in the US, including sensitivity analyses accounting for pandemic-related impacts on immunization. We estimated the number of children aged 0–18 currently susceptible to measles and modeled susceptibility proportions in decreased vaccination scenarios. Participants were respondents to the NIS-Teen survey between 2008 and 2017 that also had provider-verified vaccination documentation. The exposure of interest was vaccination with a measles-containing vaccine (MCV), and the age at which they were vaccinated for all doses given. Using age at vaccination, we estimated age-based probabilities of vaccination and modeled population levels of MCV immunization and immunity vs. susceptibility. Currently, 9,145,026 children (13.1%) are estimated to be susceptible to measles. With pandemic level vaccination rates, 15,165,221 children (21.7%) will be susceptible to measles if no attempt at catch-up is made, or 9,454,436 children (13.5%) if catch-up vaccinations mitigate the decline by 2–3%. Models based on increased vaccine hesitancy also show increased susceptibility at national levels, with a 10% increase in hesitancy nationally resulting in 14,925,481 children (21.37%) susceptible to measles, irrespective of pandemic vaccination levels. Current levels of measles immunity remain below herd immunity thresholds. If pandemic-era reductions in childhood immunization are not rectified, population-level immunity to measles is likely to decline further.
Abstract
Background
The spread of Carbapenem-resistant pathogens is a growing global public health concern. Tennessee conducts surveillance of Carbapenem-resistant Enterobacterales (CRE) since 2011 ...and participates in Multi-site Gram-negative Surveillance Initiative (MuGSI) in Davidson County and seven surrounding counties since 2014.
Methods
We analyzed the CRE and Carbapenem-resistant Acinetobacter baumannii complex (CRAB) incident cases reported to the MuGSI project from 2016–2021. A CRE case is defined as the isolation of Escherichia coli, Enterobacter species and Klebsiella species from normally sterile site or urine, and resistant to ≥1 carbapenem. A CRAB case is defined as the isolation of A.baumannii complex from a normally sterile site or urine (2016-2020). In 2021, cultures from a lower respiratory tract or wound were added. Incident case is defined as a report of the first case in 30 days. Data analysis was performed using SAS Version 9.4.
Results
One hundred nine CRAB and 467 CRE cases were reported from 2016–2021. The proportion of males was higher for CRAB (62.39% vs 37.61%, p< 0.0001), while the proportion of females were higher for CRE cases (68.74% vs 31.26%, p< 0.0001). The mean age was 65 and 60 years for CRE and CRAB case respectively. The incidence rate of CRAB was significantly higher in non-white populations (15.90 per 100,000) compared to white populations (4.86 per 100,000) (p< 0.0001). Smoking was more prevalent among CRAB patients (27.52%) than CRE patients (16.49%) (p=0.0076). The prevalence of neurological health conditions was higher in CRAB than CRE (59.63% vs 38.33%; p< 0.0001), as were renal conditions (38.53% vs 26.12%; p=0.0097) and diabetes (48.62% vs 37.69%; p=0.0357). The prevalence of urinary tract infections was higher in CRE than CRAB cases (52.29% vs 77.09%; p< 0.0001). CRAB (95%) and CRE (65%) cases were healthcare-associated infections.
Conclusion
Patients with CRAB had significantly higher prevalence of neurological, renal, diabetes and smoking history, while UTI was more common in patients with CRE. CRAB incidence was significantly higher in non-whites than whites. More research is needed to explain the disparities and reduce infection burden in vulnerable populations.
Disclosures
All Authors: No reported disclosures
Abstract
Background
Currently, data on the incidence of Enterobacterales bacteria that produce extended-spectrum beta-lactamases (ESBL) within community settings is lacking. We set out to describe ...patient characteristics for healthcare-associated (HA) and community-associated (CA) ESBL-producing Enterobacterales in Tennessee.
Methods
ESBL cases were defined as isolation of Escherichia coli, Klebsiella pneumoniae, or Klebsiella oxytoca, resistant to cefotaxime, ceftriaxone, or ceftazidime, non-resistant to all tested carbapenems, from a normally sterile body site, or urine, within Maury, Lewis, Marshall, or Wayne Counties, with a specimen collection date from July 1st, 2019, to the end of 2020. Patient data was collected by reviewing patients’ medical records. HA cases were defined as those with previous healthcare exposures, of any kind, in the year preceding specimen collection. All analysis was performed using SAS 9.4.
Results
566 cases were included in this study. Demographically, 459 (81.1%) cases identified as white with an equal number (81.1%) of patients being female. The average age was 66.2 years. 560 (98.94%) specimens were collected from urine, 468 (85.1%) patients had a urinary tract infection (UTI), and 174 (37.2%) of those patients had a record of recurrent UTIs. 243 (49.6%) cases were identified as CA. 138 (24.4%) cases were identified as being hospitalized within 29 days of their specimen collection and 247 (50.4%) cases were determined to be HA. 142 (25.1%) patients were treated with antibiotic in the month before specimen collection. Cephalosporins (31.7%), fluroquinolones (29.6%), doxycycline (7.7%), and sulfonamides (7.7%) were the most common antibiotics used to treat the patients. Among patients prescribed these antibiotics (N=109), 19 (17.4%) patients had specimens resistant. Figure 1:Characteristics of patients with extended-spectrum beta-lactamases (ESBL) producing Enterobacterales isolated from 2019-2020Figure 2:Characteristics of patients with extended-spectrum beta-lactamases (ESBL) producing Enterobacterales isolated from 2019-2020, continued
Conclusion
Most cases were described in white women with UTIs, often recurrent, coming from private residences. With approximately 50% of cases described as CA, targeted intervention outside of healthcare facilities is necessary to reduce spread of ESBL infections. As 17.4% of cases were treated with antibiotics that the organism was resistant, there is an opportunity to improve judicial use of antibiotics based on susceptibility data.
Disclosures
All Authors: No reported disclosures.
Abstract
Background
The spread of Carbapenem-resistant Enterobacterales (CRE) continue to be a public health threat. Tennessee has participated in the Multidrug-Resistant Gram-Negative Bacilli ...Surveillance Initiative (MuGSI) since 2014. We investigated our data to describe the trends of CRE and CP-CRE and their changes during the COVID-19 outbreak.
Methods
Population-based surveillance targeting selected CRE organisms was conducted in Davidson County and seven surrounding counties in Tennessee. A CRE case was defined as isolation of Escherichia coli, Klebsiella spp., or Enterobacter spp. resistant to ≥1 carbapenem from a normally sterile body site or urine, in a surveillance area resident. A case was identified as incident if it was reported for the first time in the surveillance year or was a subsequent report of a case ≥30 days after the last report. The Tennessee state public health laboratory tests for carbapenemase production on CRE isolates received from clinical laboratories. The data analysis was conducted using SAS software version 9.4.
Results
474 incident CRE cases were reported from 2016 to 2021. Females made up 68.63% and the average age was 65 years for both sexes.
The incidence rate of CRE cases increased throughout study period and the rate in 2021 was 1.8-fold of 2016 (lowest rate for the study period) (P-value< 0.001). The incidence rate of CP-CRE increased in 2017 and 2018 compared to 2016 (p-value=0.01). The incidence rate for CP-CRE declined to the lowest level in 2020 (0.3 per 100,000 population). In 2021, the CP-CRE rate significantly increased compared to 2020 (p-value=0.02). The carbapenemase production (CP) positivity rate was also significantly higher in 2017(28.8%), 2018 (26.6%), and 2021 (25.8%) compared to the year 2020 where the positivity rate was the lowest (10.0%) (P-value< 0.05).
Conclusion
The transmission of CP-CRE cases decreased during the years prior to the COVID-19 outbreak despite the steady increase in CRE cases. The transmission of CP-CRE gained momentum during the COVID outbreak as evidenced by an increased infection rate and CP positivity rate in 2021. Renewed focus on implementing coordinated infection prevention strategies is likely to contribute to reducing the spread of antimicrobial-resistant pathogens.
Disclosures
All Authors: No reported disclosures.
Abstract
Background
Injection drug use using nonsterile equipment can lead to transmission of viral, bacterial, and fungal infections. Frontline healthcare workers (HCW) are at high risk for ...substance use disorder due to unprecedented job stress and access to injectable controlled substances. The Tennessee Department of Health (TDH) developed a collaborative investigative process to determine the risk of bloodborne pathogen (BBP) transmission from licensed HCWs engaging in drug diversion. This program recommends public health action and provides consultation to improve drug diversion programs.
Methods
In 2019 TDH formed a drug diversion investigation team (DDIT) consisting of pharmacists, epidemiologists and medical directors from the HAI and HIV/STI/Viral Hepatitis programs. The DDIT responds to notification by the Health-Related Boards (HRB) of a licensed HCW under investigation for diversion of injectable products. The DDIT interviews the investigator and meets the facility drug diversion program to review drug diversion policies and processes. Based on the suspected method(s) and, if known, the individual’s Hepatitis B/C and HIV status, recommendations are made regarding the need for patient notification and testing.
Results
From 2020–2022 the DDIT received notification of 49 licensed HCWs under investigation for diversion of injectable products. Patient notification and testing was recommended in seven facilities for CDC Category A infection control breaches; in two cases, later HCW testing negated the need for further action. Among the 34 facilities queried, only five (14.7%) had existing policies for for-cause BBP testing. Other recommendations to improve diversion programs include infection prevention participation and releasing “not eligible for rehire” status to other facilities.
Conclusion
The TDH DDIT facilitates communication with HRB on reported cases of injectable drug diversion. Joint investigations with facilities raise awareness of the risk of BBP transmission and improve facility diversion programs. Tennessee facilities are adding for-cause BBP testing to their investigation procedures. The TDH DDIT model receives mostly positive responses from facility and health system drug diversion teams and may be considered by other public health jurisdictions.
Disclosures
All Authors: No reported disclosures
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