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114. Prospective Trial of Passive Diversion Device to Reduce Blood Culture Contamination

114. Prospective Trial of Passive Diversion Device to Reduce Blood Culture Contamination Session: O-24. New Developments in Infectious Diseases Diagnostics at the Memorial ED of 1.1% and 1.4% (P=0.57), and at the University ED of 2.3% and 3.5% (P=0.024) for the diversion device and standard equipment periods, respectively. Background. Among children with acute otitis media (AOM) S.pneumoniae, Conclusion. e b Th lood diversion device was able to significantly lower blood cul - H.inu fl enzae , and M.catarrhalis are the predominant bacterial otopathogens. There is a ture contamination rates overall by 1% at the institution’s two EDs (34% relative reduc- high correlation between nasopharyngeal (NP) and middle ear fluid (MEF) organisms tion), with a stronger effect noted at the campus with both a level 1 trauma center and during AOM. u Th s, NP samples could serve as a surrogate for detection of otopatho - transplant programs.  gens and are more easily collected in a typical practice environment than MEF. Though Disclosures. All Authors: No reported disclosures culture is considered the gold standard for detection, it is time-consuming, which can limit its diagnostic utility to guide clinical care. We aimed to determine the sensitivity, specificity, positive (PPV) and negative predictive value (NPV) for NP qualitative PCR 115. The Utility of (1→3)-β-D-glucan Assay in the Diagnosis of Severe for bacterial otopathogens compared to NP culture.  Coccidioidomycosis Infections among Immunocompromised Hosts  1 1 2 Methods. Patients age 6-35  months with uncomplicated AOM who were pro- Parham Ayazi, n/a ; Tirdad Zangeneh, DO ; Aishan Shi, MD ; 3 1 1 spectively enrolled in an AOM study in Denver, CO from Jan 2019-Dec 2020 were Matthew A. Campanella, N/A, n/a ; Mohanad Al Obaidi, MD ; University of included. All patients had an NP flocked swab (Eswab , Copan Diagnostics) at enroll- Arizona, Chandler, Arizona; Banner University of Arizona Tucson, Tucson, Arizona; ment. Otopathogen culture was completed using standard techniques. Nucleic acids University of Arizona College of Medicine Phoenix, Phoenix, Arizona were extracted using the NucliSENS® easyMAG® system (Quidel, San Diego, CA) per Session: O-24. New Developments in Infectious Diseases Diagnostics manufacturer’s instructions.  Multiplex RT-PCR for S.pneumoniae, H.inu fl enzae, and ® ® M.catarrhalis was completed using Lyra (Quidel, San Diego, CA) and AnDiaTec assay Background. Coccidioidomycosis is associated with increased morbidity and kits (Quidel Germany GmbH, Kornwestheim, Germany). Nucleic acid amplification mortality in immunocompromised (IC) patients. e di Th agnosis of invasive fungal and detection was completed on the Applied Biosystems (ABI) 7500 Fast Dx Real- infections can be challenging in IC hosts. Culture results may take time to iden- Time PCR Instrument.   tify  Coccidioides  species, and serologic based tests are less sensitive in IC patients. Results. Of the 80 children included, 18 (22.5%) had no organism detected on (1-3)-β-d-glucan (BDG) has been reported to be detected in patients with coccidioido- culture, 31 (38.8%) had one and 31 (38.8%) had multiple organisms detected. The most mycosis. We hypothesized that BDG in combination with serology may assist in the commonly identified organisms on culture were M.catarrhalis (42, 52.5%), followed early detection of coccidioidomycosis in IC patients. by S.pneumoniae (30, 37.5%), and H.inu fl enzae (17, 21.3%). Of H.inu fl enzae isolates Methods. Aer t ft he institutional review board approved the study, we conducted a 8 (47.1%) produced beta-lactamase. The sensitivity of PCR was high ( >94%) for all retrospective chart review from 10/1/2017 through 09/15/2020, including ≥18 years old organisms whereas the specificity was lower (50.0-77.8%) and varied by organism IC patients with a confirmed diagnosis of coccidioidomycosis by culture. Information (Table). NPV were high ( >96%) for all otopathogens, whereas, PPV ranged from 53.3 regarding demographics, comorbidities, immunosuppression, medications, BDG, ser- to 68.9%. PCR detected 1.6 times more organisms than culture (149 vs. 96). ology, and clinical presentation was collected. Patients with infusions that can result in Sensitivity, specificity, positive and negative predictive value of PCR compared to possible false-positive BDG were excluded. Patients with other fungal infections were culture for otopathogens. also excluded. Chi-square test was used to compare categorical variables, Wilcoxon rank-sum and Kruskal-Wallis tests were used to compare non-parametric variables, accordingly. Results. Over the study period, 269 encounters with positive  Coccidioides spp. cultures were identified, 78/269 of patients were IC patients, 55/78 were excluded, and 23 cases were included in the final analysis. Among the 23 IC patients, the median age was 64, 43% were female, 74% were White. There were 8 post solid organ trans - plantation, 7 with a hematological malignancy, and 8 with other types of IC condi- tions. 19/23 had a pulmonary infection. 4/23 patients died within one month of their Conclusion. NP PCR has a high predictive value for excluding otopathogens encounter. There was no statistical significance difference between positive BDG and and warrants further exploration as a diagnostic tool to evaluate for otopathogens in serology tests, with 12/23 had positive BDG, and another 12/23 had positive serology. children.  Combined serology and BDG detected 18/23 of the Coccidioidomycosis cases. 17% of Disclosures. Andreas Bress, PhD, Quidel Laboratories- Germany (Employee) the cohort died within the one-month follow-up. Richard Egan, PhD, Quidel Laboratories (Employee) Samuel R.  Dominguez, Conclusion. e co Th mbined use of BDG assay and  Coccidioides serology increases MD, PhD, BioFire Diagnostics (Consultant, Research Grant or Support)DiaSorin the sensitivity of coccidioidomycosis diagnosis to 78% in IC  patients. Future pro- Molecular (Consultant)Pfizer (Grant/Research Support) Samuel R. Dominguez, MD, spective studies are needed to further evaluate the utility of serum BDG in diagnosing PhD, BioFire (Individual(s) Involved: Self): Consultant, Research Grant or Support; coccidioidomycosis in IC patients. DiaSorin Molecular (Individual(s) Involved: Self): Consultant; Pfizer (Individual(s) Disclosures. Mohanad Al Obaidi, MD, Shionogi Inc. (Advisor or Review Panel Involved: Self ): Grant/Research Support member) 114. Prospective Trial of Passive Diversion Device to Reduce Blood Culture 116. Characterization of small colony variants from a patient with bloodstream Contamination infection of Candida glabrata 1 2 1 1 1 1 Sami Arnaout, MD ; Richard T. Ellison, III, MD ; Thomas C. Greenough, MD ; Shaoji Cheng, MD, PhD ; Badrane Hassan, n/a ; Guojun Liu, n/a ; 1 1 1 1 1 Azalea Wedig, BS, CIC ; Michael J. Mitchell, MD ; Lauren St. John, Bachelor’s Degree Cornelius J. Clancy, MD ; Minh-Hong Nguyen, MD ; University of Pittsburgh, 3 4 1 in Mathematics, Statistics ; Shannon Stock, Ph.D. ; UMass Memorial Medical Center, Pittsburgh, PA Westborough, MA; University of Massachusetts Medical School, Worcester, MA; 3 4 Session: O-24. New Developments in Infectious Diseases Diagnostics College Of The Holy Cross, Worcester, Massachusetts; College of The Holy Cross, Worcester, Massachusetts Background. Bacterial small colony variants (SCVs) that are tolerant to com- monly used antibiotics are well recognized. Clinical SCV Candida have been rarely Session: O-24. New Developments in Infectious Diseases Diagnostics reported.  We describe SCV C.  glabrata (CG) strains recovered from within a popu- Background. Blood culture contaminants can lead to inappropriate antibiotic lation causing bloodstream infection (BSI) in a patient (pt), which were not recog- use, prolonged length of stay, and additional hospital costs. Several devices have been nized by the micro lab. Pt J developed CG BSI shortly aer ft liver transplant (OLTX), developed to reduce the risk of blood culture contamination by diverting a portion of which was treated with voriconazole (VOR).  VOR was also used for post-OLTX mold the initial blood sample from the blood culture bottle. We have assessed the effective - prophylaxis. 67 d aer BS ft I, he developed intra-abdominal infection due to VOR- ness of one blood diversion device in a prospective trial performed at the two separate resistant CG. We hypothesized that BSI might be caused by an unrecognized mixed emergency departments (EDs) of a three-campus Academic Medical Center. population of azole-susceptible and –resistant strains.   Methods. A multi-phase prospective crossover trial was performed with the Methods. Ten colonies from small (SCV) and large colonies (LC) from blood cul- blood diversion device initially in use at one ED (Memorial) and standard equipment ture (BC) agar plates underwent Illumina NextSeq WGS and phenotype testing.  at the other ED (University) for 10 weeks. Aer a wa ft shout phase, a second 10-week Results. BCs from pt J harbored a diverse population of genetically distinct CG study phase used the blood diversion device in the other ED (University) and standard strains, differing by unique SNPs and indels [Fig.  1]. Gene variants identified were equipment at the first ED (Memorial). Contaminants were identified by the clinical enriched for biological processes involved in mitochondrial processes (2.5e-9), cell microbiology lab using standard criteria, and further defined by independent retro - adhesion (3.3e-5), and respiration (3.5e-4). Unlike LC, SCVs were fluconazole (FLU) spective review by 3 infectious disease physicians prior to statistical analysis. An resistant (MIC: 128  µg/mL), and exhibited enhanced CDR1 and PDR1 expression intention-to-treat analysis was performed, and Chi-square tests were used to compare (257  ±  11, 15  ±  4, respectively). Compared to LCs, SCVs grew slowly in YPD, did contaminant rates among samples obtained using the blood diversion device versus not grow on media containing glycerol as sole carbon source, and were less adherent standard equipment. to agar. SCVs stained poorly with rhodamine 123 by fluorescence flow cytometry Results. 5,675 blood samples were obtained with 5,661 samples analyzed aer ft and had fewer mitochrondria by transmission electron microscopy, consistent with 14 were deemed inconclusive by the ID physician review. There were 1,719 samples WGS findings and respiratory deficiency. SCVs were less susceptible to macrophage obtained at Memorial ED and 3,942 at University ED, with 2,836 samples collected (J774) phagocytosis, and they were significantly outgrown by other strains in competi - during diversion device periods and 2,825 during standard equipment periods. Based tive infections in vitro and during disseminated candidiasis in mice.  LCs incubated on the ID physician review,  the contaminant rates were 1.9% in diversion device peri- with FLU in vitro yielded SCVs in concentration-dependent manner.  Likewise, LCVs ods versus 2.9% in standard equipment periods (P = 0.018). There was a marked differ - passed through spleens of mice following IV inoculation yielded SCVs in both pres- ence in blood culture contamination rates between the two EDs with contaminant rates ence and absence of FLU. S70 • OFID 2021:8 (Suppl 1) • Abstracts http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Open Forum Infectious Diseases Oxford University Press

114. Prospective Trial of Passive Diversion Device to Reduce Blood Culture Contamination

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Oxford University Press
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© The Author(s) 2021. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
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2328-8957
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10.1093/ofid/ofab466.114
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Abstract

Session: O-24. New Developments in Infectious Diseases Diagnostics at the Memorial ED of 1.1% and 1.4% (P=0.57), and at the University ED of 2.3% and 3.5% (P=0.024) for the diversion device and standard equipment periods, respectively. Background. Among children with acute otitis media (AOM) S.pneumoniae, Conclusion. e b Th lood diversion device was able to significantly lower blood cul - H.inu fl enzae , and M.catarrhalis are the predominant bacterial otopathogens. There is a ture contamination rates overall by 1% at the institution’s two EDs (34% relative reduc- high correlation between nasopharyngeal (NP) and middle ear fluid (MEF) organisms tion), with a stronger effect noted at the campus with both a level 1 trauma center and during AOM. u Th s, NP samples could serve as a surrogate for detection of otopatho - transplant programs.  gens and are more easily collected in a typical practice environment than MEF. Though Disclosures. All Authors: No reported disclosures culture is considered the gold standard for detection, it is time-consuming, which can limit its diagnostic utility to guide clinical care. We aimed to determine the sensitivity, specificity, positive (PPV) and negative predictive value (NPV) for NP qualitative PCR 115. The Utility of (1→3)-β-D-glucan Assay in the Diagnosis of Severe for bacterial otopathogens compared to NP culture.  Coccidioidomycosis Infections among Immunocompromised Hosts  1 1 2 Methods. Patients age 6-35  months with uncomplicated AOM who were pro- Parham Ayazi, n/a ; Tirdad Zangeneh, DO ; Aishan Shi, MD ; 3 1 1 spectively enrolled in an AOM study in Denver, CO from Jan 2019-Dec 2020 were Matthew A. Campanella, N/A, n/a ; Mohanad Al Obaidi, MD ; University of included. All patients had an NP flocked swab (Eswab , Copan Diagnostics) at enroll- Arizona, Chandler, Arizona; Banner University of Arizona Tucson, Tucson, Arizona; ment. Otopathogen culture was completed using standard techniques. Nucleic acids University of Arizona College of Medicine Phoenix, Phoenix, Arizona were extracted using the NucliSENS® easyMAG® system (Quidel, San Diego, CA) per Session: O-24. New Developments in Infectious Diseases Diagnostics manufacturer’s instructions.  Multiplex RT-PCR for S.pneumoniae, H.inu fl enzae, and ® ® M.catarrhalis was completed using Lyra (Quidel, San Diego, CA) and AnDiaTec assay Background. Coccidioidomycosis is associated with increased morbidity and kits (Quidel Germany GmbH, Kornwestheim, Germany). Nucleic acid amplification mortality in immunocompromised (IC) patients. e di Th agnosis of invasive fungal and detection was completed on the Applied Biosystems (ABI) 7500 Fast Dx Real- infections can be challenging in IC hosts. Culture results may take time to iden- Time PCR Instrument.   tify  Coccidioides  species, and serologic based tests are less sensitive in IC patients. Results. Of the 80 children included, 18 (22.5%) had no organism detected on (1-3)-β-d-glucan (BDG) has been reported to be detected in patients with coccidioido- culture, 31 (38.8%) had one and 31 (38.8%) had multiple organisms detected. The most mycosis. We hypothesized that BDG in combination with serology may assist in the commonly identified organisms on culture were M.catarrhalis (42, 52.5%), followed early detection of coccidioidomycosis in IC patients. by S.pneumoniae (30, 37.5%), and H.inu fl enzae (17, 21.3%). Of H.inu fl enzae isolates Methods. Aer t ft he institutional review board approved the study, we conducted a 8 (47.1%) produced beta-lactamase. The sensitivity of PCR was high ( >94%) for all retrospective chart review from 10/1/2017 through 09/15/2020, including ≥18 years old organisms whereas the specificity was lower (50.0-77.8%) and varied by organism IC patients with a confirmed diagnosis of coccidioidomycosis by culture. Information (Table). NPV were high ( >96%) for all otopathogens, whereas, PPV ranged from 53.3 regarding demographics, comorbidities, immunosuppression, medications, BDG, ser- to 68.9%. PCR detected 1.6 times more organisms than culture (149 vs. 96). ology, and clinical presentation was collected. Patients with infusions that can result in Sensitivity, specificity, positive and negative predictive value of PCR compared to possible false-positive BDG were excluded. Patients with other fungal infections were culture for otopathogens. also excluded. Chi-square test was used to compare categorical variables, Wilcoxon rank-sum and Kruskal-Wallis tests were used to compare non-parametric variables, accordingly. Results. Over the study period, 269 encounters with positive  Coccidioides spp. cultures were identified, 78/269 of patients were IC patients, 55/78 were excluded, and 23 cases were included in the final analysis. Among the 23 IC patients, the median age was 64, 43% were female, 74% were White. There were 8 post solid organ trans - plantation, 7 with a hematological malignancy, and 8 with other types of IC condi- tions. 19/23 had a pulmonary infection. 4/23 patients died within one month of their Conclusion. NP PCR has a high predictive value for excluding otopathogens encounter. There was no statistical significance difference between positive BDG and and warrants further exploration as a diagnostic tool to evaluate for otopathogens in serology tests, with 12/23 had positive BDG, and another 12/23 had positive serology. children.  Combined serology and BDG detected 18/23 of the Coccidioidomycosis cases. 17% of Disclosures. Andreas Bress, PhD, Quidel Laboratories- Germany (Employee) the cohort died within the one-month follow-up. Richard Egan, PhD, Quidel Laboratories (Employee) Samuel R.  Dominguez, Conclusion. e co Th mbined use of BDG assay and  Coccidioides serology increases MD, PhD, BioFire Diagnostics (Consultant, Research Grant or Support)DiaSorin the sensitivity of coccidioidomycosis diagnosis to 78% in IC  patients. Future pro- Molecular (Consultant)Pfizer (Grant/Research Support) Samuel R. Dominguez, MD, spective studies are needed to further evaluate the utility of serum BDG in diagnosing PhD, BioFire (Individual(s) Involved: Self): Consultant, Research Grant or Support; coccidioidomycosis in IC patients. DiaSorin Molecular (Individual(s) Involved: Self): Consultant; Pfizer (Individual(s) Disclosures. Mohanad Al Obaidi, MD, Shionogi Inc. (Advisor or Review Panel Involved: Self ): Grant/Research Support member) 114. Prospective Trial of Passive Diversion Device to Reduce Blood Culture 116. Characterization of small colony variants from a patient with bloodstream Contamination infection of Candida glabrata 1 2 1 1 1 1 Sami Arnaout, MD ; Richard T. Ellison, III, MD ; Thomas C. Greenough, MD ; Shaoji Cheng, MD, PhD ; Badrane Hassan, n/a ; Guojun Liu, n/a ; 1 1 1 1 1 Azalea Wedig, BS, CIC ; Michael J. Mitchell, MD ; Lauren St. John, Bachelor’s Degree Cornelius J. Clancy, MD ; Minh-Hong Nguyen, MD ; University of Pittsburgh, 3 4 1 in Mathematics, Statistics ; Shannon Stock, Ph.D. ; UMass Memorial Medical Center, Pittsburgh, PA Westborough, MA; University of Massachusetts Medical School, Worcester, MA; 3 4 Session: O-24. New Developments in Infectious Diseases Diagnostics College Of The Holy Cross, Worcester, Massachusetts; College of The Holy Cross, Worcester, Massachusetts Background. Bacterial small colony variants (SCVs) that are tolerant to com- monly used antibiotics are well recognized. Clinical SCV Candida have been rarely Session: O-24. New Developments in Infectious Diseases Diagnostics reported.  We describe SCV C.  glabrata (CG) strains recovered from within a popu- Background. Blood culture contaminants can lead to inappropriate antibiotic lation causing bloodstream infection (BSI) in a patient (pt), which were not recog- use, prolonged length of stay, and additional hospital costs. Several devices have been nized by the micro lab. Pt J developed CG BSI shortly aer ft liver transplant (OLTX), developed to reduce the risk of blood culture contamination by diverting a portion of which was treated with voriconazole (VOR).  VOR was also used for post-OLTX mold the initial blood sample from the blood culture bottle. We have assessed the effective - prophylaxis. 67 d aer BS ft I, he developed intra-abdominal infection due to VOR- ness of one blood diversion device in a prospective trial performed at the two separate resistant CG. We hypothesized that BSI might be caused by an unrecognized mixed emergency departments (EDs) of a three-campus Academic Medical Center. population of azole-susceptible and –resistant strains.   Methods. A multi-phase prospective crossover trial was performed with the Methods. Ten colonies from small (SCV) and large colonies (LC) from blood cul- blood diversion device initially in use at one ED (Memorial) and standard equipment ture (BC) agar plates underwent Illumina NextSeq WGS and phenotype testing.  at the other ED (University) for 10 weeks. Aer a wa ft shout phase, a second 10-week Results. BCs from pt J harbored a diverse population of genetically distinct CG study phase used the blood diversion device in the other ED (University) and standard strains, differing by unique SNPs and indels [Fig.  1]. Gene variants identified were equipment at the first ED (Memorial). Contaminants were identified by the clinical enriched for biological processes involved in mitochondrial processes (2.5e-9), cell microbiology lab using standard criteria, and further defined by independent retro - adhesion (3.3e-5), and respiration (3.5e-4). Unlike LC, SCVs were fluconazole (FLU) spective review by 3 infectious disease physicians prior to statistical analysis. An resistant (MIC: 128  µg/mL), and exhibited enhanced CDR1 and PDR1 expression intention-to-treat analysis was performed, and Chi-square tests were used to compare (257  ±  11, 15  ±  4, respectively). Compared to LCs, SCVs grew slowly in YPD, did contaminant rates among samples obtained using the blood diversion device versus not grow on media containing glycerol as sole carbon source, and were less adherent standard equipment. to agar. SCVs stained poorly with rhodamine 123 by fluorescence flow cytometry Results. 5,675 blood samples were obtained with 5,661 samples analyzed aer ft and had fewer mitochrondria by transmission electron microscopy, consistent with 14 were deemed inconclusive by the ID physician review. There were 1,719 samples WGS findings and respiratory deficiency. SCVs were less susceptible to macrophage obtained at Memorial ED and 3,942 at University ED, with 2,836 samples collected (J774) phagocytosis, and they were significantly outgrown by other strains in competi - during diversion device periods and 2,825 during standard equipment periods. Based tive infections in vitro and during disseminated candidiasis in mice.  LCs incubated on the ID physician review,  the contaminant rates were 1.9% in diversion device peri- with FLU in vitro yielded SCVs in concentration-dependent manner.  Likewise, LCVs ods versus 2.9% in standard equipment periods (P = 0.018). There was a marked differ - passed through spleens of mice following IV inoculation yielded SCVs in both pres- ence in blood culture contamination rates between the two EDs with contaminant rates ence and absence of FLU. S70 • OFID 2021:8 (Suppl 1) • Abstracts

Journal

Open Forum Infectious Diseases – Oxford University Press

Published: Dec 4, 2021

Keywords: blood culture; diversion procedure; disclosure; emergency service, hospital; hospital costs; length of stay; trauma centers; microbiology; transplantation; infectious disease medicine; antibiotics; blood tests; academic medical centers; intention to treat analysis

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