Infectious Disease Commons^™

The Power Of Proximity: Driving Hand Hygiene Compliance Through Sanitizer Placement, Jennifer E. Jones, Eric Van Middendorp, Leanne Wendt

Posters

Hand hygiene is the cornerstone of infection prevention in healthcare settings and is particularly critical in the Neonatal Intensive Care Unit (NICU) where patients are highly vulnerable due to immature immune systems and frequent exposure to invasive procedures. Healthcare associated infections (HAIs) remain a significant cause of morbidity and mortality among neonates. Evidence consistently identifies proper hand hygiene as the single most effective intervention to reduce HAIs in NICUs. Despite its simplicity, compliance among healthcare workers is often suboptimal, influenced by factors such as workload and accessibility of hand hygiene resources.

Quality In Action: A Systematic Approach To Central Line Associated Bloodstream Infection Prevention, Jennifer E. Jones, Maggie Simons, Sherri Hoard, Gabriel Laney, Adam Nicholson, Victoria Springvloed, Tracy James, Erica Tuffs

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Central line associated bloodstream infections (CLABSIs) are a major source of morbidity, mortality, and increased healthcare costs in hospitalized patients. Reducing CLABSI rates requires more than isolated interventions; it demands a coordinated, multi-disciplinary strategy that addresses clinical practice, workflow and organizational culture.

Proactive Strategies For Catheter-Associated Urinary Tract Infection (Cauti) Reduction: Leveraging Audit Tools And Interdisciplinary Collaboration, Mica Blauw

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Catheter-associated urinary tract infections (CAUTIs) are a known cause of harm to patients. Policies enforcing infection prevention measures may help minimize the risk of harm to patients, but written policies do not always translate to bedside practice. We implemented a proactive daily audit to increase awareness of, and compliance with, CAUTI prevention tactics.

Code Wet: Navigating Water Leak Mitigation And Remediation Behind The Red Line, Mica Blauw

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Water leaks in the hospital setting are concerning because of the possibility of mold growthon porous materials such asdrywallthatmaylead toinfections. Water leaksbehind the line of demarcation in the surgical services suiterequire extra care during the remediation processdue to the high-risk nature of surgical patients. We navigated water leakmitigation and remediation in a surgical suite while keeping surgical operations funning safely.

Health Disparities For Pneumonia And Sinusitis Antibiotic Treatment In The Emergency Department, Joshua Saucedo, Leslie Hueschen, Amanda Nedved, Rana El Feghaly Md

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Optimal antibiotic selection and duration are pillars of antimicrobial stewardship efforts. In our emergency department (ED), >80% of community acquired pneumonia (CAP) and acute bacterial rhinosinusitis (ABRS) are treated with first-line (FL) guideline-concordant antibiotics. Differences in care based on socioeconomic factors (race, ethnicity, language, and insurance status) have not been characterized. We sought to compare differences in antibiotic choice and duration for different socioeconomic factors, and analyze changes after quality improvement (QI) efforts. Multidisciplinary QI team used multiple Plan- Do-Study-Act cycles and was successful in improving antibiotic duration for CAP and ABRS from a baseline of 13% to 61% (January …

Monitoring The Laboratory Frequency For Musculoskeletal Infections At A Tertiary Care Children's Hospital: A Diagnostic Stewardship Qi Project, Kedar Tilak, Douglas Swanson, Christine Symes, Alaina N. Burns, Ann L. Wirtz, Rana El Feghaly

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Patients with musculoskeletal infections (MSKI) undergo several laboratory tests. To promote laboratory stewardship, our Infectious diseases (ID) division recommended the following frequencies for labs: 1) C-reactive protein (CRP) every 2-3 days until >50% reduction while >3mg/dL, otherwise weekly until normal, 2) Sedimentation rate (ESR) at the start of therapy and end if > 20mm/hr initially, 3) Complete blood cell count (CBC) at the start of therapy and when transitioning to oral therapy if WBC is initially elevated. Baseline data showed that of 42 children evaluated between July 2023-May 2024, only 15 (35.7%) had a CBC and 13 (30.95%) had a CRP …

Circulation Of Respiratory Viruses From Air And Human Specimens In A Pre-Kindergarten-12th Grade School District In Kansas City, Mo, Nicole Neeley, Brian Lee, Brittney Fritschmann, Luke Gard, Nibha Sagar, Dithi Banerjee, Anjana Sasidharan, Rangaraj Selvarangan, Olivia Almendares, Hannah L. Kirking, Jennifer Goldman, Jennifer E. Schuster

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Background: Air sampling with respiratory virus testing in community settings may be a potential non-invasive, scalable method to monitor respiratory viruses. We performed an ecological analysis to describe the correlation between respiratory virus detections in air and human samples across all schools to evaluate the potential for air sampling as a tool for community-level surveillance. Methods: Knowledge of Infectious Diseases in Schools (School KIDS) is a voluntary respiratory virus surveillance program in a pre-kindergarten-12th grade public school district in Kansas City, MO. In 10 schools, students and staff collected anterior nasal swabs while at school, with optional on-demand swabbing when …

Neonatal Early-Onset Sepsis: It’S Not Always What You Think, Gabriela M. Henriquez, Kedar Tilak, Douglas Swanson, Susana Chavez-Bueno

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No abstract provided.

Epidemiology And Microbiology Of Admission Surveillance Nasal Swabs In A Level Iv Neonatal Intensive Care Unit (Nicu) And Their Association With Subsequent Infections ​, Kedar Tilak, Neena Kanwar, Rangaraj Selvarangan, Venkatesh Sampath

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Background Newborns, especially preterm infants, are highly susceptible to sepsis, a major cause of neonatal morbidity and mortality. Known risk factors include prematurity, low birth weight, prolonged NICU stay, and use of central venous catheters. The link between early nasal colonization (within the first week of life) and later infections is unclear. Although many NICUs screen for Staphylococcus aureus using nasal swabs, the predictive value of early colonization by other Gram-positive and Gram-negative bacteria is not well understood. In our NICU, admission nasal swabs were sent for aerobic cultures to detect these organisms, highlighting the need for further research into …

A Rare Case Of Adolescent Epiglottitis Secondary To Streptococcus Dysgalactiae, Kedar Tilak, Mohamed Aashiq Abdul Ghayum, Douglas Swanson, Rana El Feghaly

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Streptococcus dysgalactiae causes pharyngitis, cellulitis, necrotizing soft tissue infections, sepsis, and streptococcal toxic shock syndrome • It can lead to both toxin-mediated and immune-mediated diseases • Mostly seen in adults, rare in pediatric patients • Here we present a 15-year-old with S. dysgalactiae- associated septicemia, and epiglottitis with extensive neck infection

Treatment Rates In A Two-Step Clostridioides Difficile Diagnostic Testing Algorithm, Renee Ringler, Matthew Sims

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Clostridioides difficile is a Gram-positive obligate anaerobe long associated with healthcare-acquired infections in the United States. 1 Clostridioides difficile infection (CDI) has thus become a key metric for assessing facility cleanliness and iatrogenic infection. C. difficile carriage is common, present in approximately 8% of hospitalized patients.2 Therefore, appropriate patient selection for testing and careful testing procedures is crucial to appropriately identify CDI while avoiding the detection of chronic colonization.

Considerable variability exists among institutions regarding standardized CDI laboratory diagnostic methods. Historically, the gold standard for CDI testing was the clinically inefficient toxigenic culture (TC). 3 This was followed by cytotoxic …

Index Cost Comparison Of Laparoscopic Vs Robotic Surgery In Colon And Rectal Cancer Resection: A Retrospective Financial Investigation Of Surgical Methodology Innovation At A Single Institution, Ekene Ezeokoli, Roula Hilli, Harry J. Wasvary

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Robotic assisted colorectal cancer resection (R-CR) has become increasingly commonplace in contrast to traditional laparoscopic cancer resection (L-CR). The aim of this study was to compare the total direct costs of R-CR to that of L-CR and to compare the groups with respect to costs related to LOS.

When The Farm Turns Fatal: A Rare Infection Causing Heart Block, Shaun Abid Md, Anton Stolear, Sumedh Iyengar, Yussif Issaka Md, Vanessa Agberien Md, Stuart Zarich

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Brucellosis, a zoonotic bacterial infection caused by Brucella species, is typically acquired through contact with infected livestock or consumption of unpasteurized dairy products. It can manifest with various systemic symptoms but is rarely associated with cardiac complications, particularly conduction disturbances such as heart block. When brucellosis does affect the heart, it may result in endocarditis, myocarditis, or, more infrequently, conduction abnormalities. This report describes an unusual case of brucellosis-induced complete heart block in an elderly woman who recently returned from a farm in Colombia, a region where brucellosis is endemic.

Predictors Of Incidence Of Candida Endocarditis In Patients With Candidemia: Insights From The National Inpatient Sample (2016-2020, Didien Meyahnwi Md, Tawanda Zinyandu, Ashraf Ahmed, Isaac Opoku Md

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This study identifies critical predictors of CE incidence in patients with candidemia, including IV drug use, male gender, and the presence of prosthetic devices. These findings highlight the importance of targeted surveillance and management strategies in vulnerable populations.

A Rising Threat: Epidemiologic Trends In Incidence, Mortality, And Cost Of Candida Endocarditis In The United States, Didien Meyahnwi Md, Ashraf Ahmed, Tawanda Zinyandu, Isaac Opoku Md

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Candida Endocarditis (CE) is a rare yet critical form of infective endocarditis (IE), accounting for approximately 1% of all IE cases. In light of the evolving epidemiology of candidemia, this study aims to elucidate any associated shifts in the epidemiology of CE within the United States.

Viral Detection In Anterior Nasal Swabs Versus Nasopharyngeal Swabs In Children, Nicole Neeley, Abby Kietzman, Rangaraj Selvarangan, Dithi Banerjee, Jennifer Goldman, Jennifer Schuster

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Background: Respiratory viruses are a significant cause of pediatric illness and healthcare utilization. Diagnostic testing for respiratory viruses is generally performed using nasopharyngeal (NP) specimens obtained by trained medical staff, limiting testing to medical settings. Evaluating additional sampling methods in children, such as anterior nasal swab (NS) specimens may expand access to diagnostic testing and aid public health surveillance. Methods: Eligible children hospitalized at Children’s Mercy Hospital in Kansas City who had a standard of care NP specimen collected for nucleic acid amplification testing for respiratory viruses were enrolled. Research NS specimens were obtained through self, caregiver, or staff collection. …

An Interesting Case Of Candida Tropicalis Endocarditis, Abbas Mallick Md, Farrah R. Khan Md, Sohrab Singh Md, Salman Ayaz Md, Prandeep Kumar Devarakonda Md, Iyad Al-Bustami Md

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Infective Endocarditis (IE) is a disease characterized by microbe and fibrin rich complex adhesion to the cardiac valvular apparatus. Common culprit microorganisms include gram positive bacteria however valvular infections with fungal organisms are rare. We present an uncommon case of Candida Tropicalis endocarditis.

Increased Red Cell Distribution Width (Rdw) Is Associated With Culture Positive Sepsis And With Increased Need Of Escalation In Respiratory Support In Very Low Birth Weight Infants More Than Seven Days Of Life Undergoing Sepsis Workup Secondary To Vitals Instability In The Form Of Multiple Episodes Of True Apneas Or Bradycardia And Desaturations Associated With Apnea, Kedar Tilak, Aashka Patel, Anna Zylak

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Background Apnea of prematurity is nearly universal among very low birth weight infants (VLBW). In VLBW infants, changes in clinical status usually occur due to sepsis or non-infectious causes and it is challenging to differentiate between the two. We as clinicians use irregularities in vital signs as an early warning sign of sepsis to facilitate early treatment and improve patient outcomes. Adults have used RDW as a marker of worsening respiratory status and mortality from acute respiratory distress syndrome (ARDS). In this study, we seek to investigate elevations in Red Cell Distribution Width (RDW) as markers for culture positive sepsis …

Methenamine Prophylaxis Reduces Recurrent Urinary Tract Infections, Salwan Al Hani, Matthew Sims

Posters

• Recurrent urinary tract infections (UTIs) are the most common outpatient infection in the US and are often managed with antibiotics in clinical practice.
• A recurrent UTI is defined as 2 or UTIs each 6 months or 3 or more UTIs each year.
• Methenamine is an antiseptic compound approved by the FDA to prevent rUTIs but is seldom used in clinical practice.
• Under acidic conditions, methenamine is converted to 6 molecules of formaldehyde, a compound which prevents bacterial growth.
• This study seeks to determine the effectiveness of methenamine for prevention of recurrent UTIs.

The Hiv Care Continuum - A Quality Improvement Project To Reconnect With Hiv-Positive Patients Lost To Follow-Up Care, Kate Romero, Janet Lombardi, Carmen Demarco, Paul C. Johnson

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• Human Immunodeficiency Virus (HIV): incurable illness transmitted through sex, blood, and trans placentally • Consistent management of HIV prevents progression to AIDS.
• 2013 study à HIV-positive patients who failed to attend their follow-up visit within 4-6 months of the prior visit were more likely to have virologic failure.
• Not much published on barriers to care, but one prior study found barriers shown in Figure 2 below – What are barriers to care faced by HIV-positive patients in Southeast Michigan?

Hiv Diagnosis And Linkage To Care In The Emergency Department, Gabrielle Rowlison, Christopher F. Carpenter

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• It is estimated that 1.2 million people are living with human immunodeficiency virus (HIV) in the United States, and that 14% of this population are unaware of their status.
• Approximately 40% of community transmissions happen between people who do not know they have HIV.
• Current CDC recommendations are that anyone seeking treatment for a sexually transmitted infection (STI) be routinely screened for HIV.
• The Emergency Department (ED) is an ideal place to test for HIV, especially in areas with underinsured populations and high rates of ED visits.
• The HIV testing rate in Corewell Health (CH) East’s ED was previously found …

Factors Associated With Respiratory Pathogen Panel Utilization In Children Hospitalized With Acute Respiratory Illness — New Vaccine Surveillance Network, Kansas City, 2017–2021, Edward Lyon, Brian R. Lee, Benjamin Clopper, Heidi L. Moline, Rangaraj Selvarangan, Jennifer Schuster

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Background: Respiratory pathogen panels (RPP) are multiplex PCR platforms that detect several respiratory viruses from one specimen. For most children hospitalized with acute respiratory illness (ARI), management is supportive, and detection of a specific virus from RPP does not impact clinical care. Therefore, clinical RPP use is not standardized, and ordering is at the discretion of the clinician. We sought to understand factors associated with RPP utilization among pediatric patients hospitalized with ARI. Methods: From October 2017 to September 2021, participants < 18 years hospitalized with ARI were enrolled at a single site in the New Vaccine Surveillance Network (NVSN). Eligible patients were residents of Jackson County, MO, had one or more ARI symptoms (e.g., cough, fever, nasal congestion) lasting < 14 days, and were enrolled within 48 hours of admission. Parent interviews and medical chart reviews were conducted. All participants had a research RPP, but results were not available to the clinical providers. Clinical providers were able to order a clinical RPP (cRPP), for which they received test results. Characteristics of NVSN enrollees hospitalized with ARI with and without a cRPP are described. Lastly, medical complexity was assessed via the pediatric complex chronic conditions classification system (CCC) then analyzed via chi- square test between groups. Findings: During the study period, 1,038 participants were enrolled, and 555 (53.4%) received a cRPP. Most, 299 (53%), cRPPs were ordered in the emergency department or urgent care before admission. Age was a significant factor associated with cRPP use (Table 1). cRPP participants were more likely to have complex chronic conditions, and/or technology dependence. No difference in cRPP use was observed by race/ethnicity, payer status, or sex. More participants were enrolled in 2020-2021, but the overall usage of cRPP is similar between years (Table 2). Conclusions: In this large cohort of children hospitalized with ARI, medical complexity, technological dependence, and age < 2 months were associated with increased utilization of cRPPs. Understanding the impact of cRPP on clinical care requires further investigation to better understand the utility of these tests.

Increasing Vaccination Rates Of 23-Valent Pneumococcal Polysaccharide Vaccine Among Patients At High-Risk For Invasive Pneumococcal Disease., Edward Lyon, Tracey Wetzel, Ann L. Wirtz, Douglas Swanson, Rachel Moran, Jessica Peters, Christine Symes, Liset Olarte, Rana El Feghaly

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Introduction: Pneumococcal disease causes significant morbidity and mortality in children. Routine childhood immunizations protect for 13 or 15 pneumococcal serotypes via two pneumococcal conjugated vaccines. Patients with immunocompromising and chronic medical conditions are at high risk of invasive pneumococcal disease. A 23-valent pneumococcal polysaccharide vaccine (PPSV23) is recommended in these patients to protect against more pneumococcal serotypes, but many patients have not received it. Our AIM is to increase PPSV23 vaccination rates among eligible patients in both the inpatient and outpatient infectious diseases (ID) settings from a baseline of 44% to 55% by October 2024. Methods: In collaboration with Children’s …

Combining Drip Score And Rapid Diagnostics For Improved Antibiotic Stewardship, Richard Ramirez, Matthew Sims

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Treatment analysis patterns for broad-spectrum antibiotic use in pneumonia revealed that 60% of patients were overtreated, highlighting the need for effective antibiotic stewardship practices. Systems such as the Drug Resistance in Pneumonia (DRIP) score select patients more likely to require broad spectrum antibiotics but still leads to overtreatment as it does not target specific pathogens. Rapid diagnostics such as the Unyvero Lower Respiratory Tract Panel (LRTP) combined with the DRIP score can identify specific pathogens to further narrow antibiotic use.

Review Of Salvage Therapy For Mrsa Bacteremia At Beaumont Health System, Hazem Alakhras, Matthew D. Sims, Tracey A.H. Taylor

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Treating methicillin-resistant Staphylococcus aureus (MRSA) effectively is imperative to reduce mortality rates, as it contributes to a large amount of healthcare-associated bacteremia in the U.S. However, due to the insufficient and sometimes contradicting studies to guide salvage therapy, there is a lack of clear consensus on treatment of MRSA bacteremia after vancomycin failure. The goal of this study is to showcase the salvage therapies of choice for patients with MRSA bacteremia at Beaumont Health System.

Designing A Surgical Scorecard To Inform And Evaluate Appropriate Perioperative Antibiotic Prophylaxis, Rehan Tariq, Paul Chittick

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Perioperative antibiotic prophylaxis (PAP) implementation is a widespread strategy used to ensure the minimization of surgical site infections (SSIs) during various surgical procedures including hip and knee replacements and organ transplants. Despite the widespread implementation of PAP, there exists a gap in understanding what is considered appropriate PAP. This may be due in part to the absence of a feedback mechanism that educates physicians on which antibiotics are truly appropriate for preventing the SSIs arising from certain surgical procedures. The goal of this project is to design an informative surgical prophylaxis scorecard that physicians can use to determine which antibiotic …

Stewardship Opportunities For Cervical Lymphadenitis And Deep Neck Space Infections, Aaron Shaw, Brian R. Lee, Lauren Kazmaier, Emily Baker, Tina Dao, Sandra Arnold, Angela Myers

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Background: Cervical lymphadenitis (LAD) and deep neck space abscesses (DNSA) are common pediatric infections caused by similar bacteria. We sought to determine differences in presentation, diagnosis, and treatment between LAD and DNSA to identify antimicrobial and diagnostic stewardship opportunities. Methods: Charts were obtained using ICD9/10 codes for retropharyngeal and parapharyngeal abscessed (DNSA), and LAD between 1/1/10-12/31/20 from two pediatric centers. 1981 charts were identified. Charts were excluded if the diagnosis was not a bacterial infection (e.g. Kawasaki disease), if the LAD was not in the neck, or if caused by less common bacteria (e.g. tuberculosis). Data on presenting signs, symptoms, …

Repeat Tracheal Aspirates In Pediatric Intensive Care Patients: Frequency, Resistance And Antimicrobial Use, Edward Lyon, Jennifer Goldman, Brian Lee, Margaret Campbell, Rangaraj Selvarangan, Elizabeth Monsees

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Background: Tracheal aspirates (TA) are frequently obtained in the pediatric intensive care unit (PICU); however, no data exists on the frequency or clinical management of multiple TA cultures on the same PICU patient. In this study, we describe the frequency of repeat TAs in PICU patients, the emergence of multidrug resistant organisms (MDRO), frequently cultured pathogens of TAs, and associated antibiotic prescribing patterns. Methods: We identified 70 PICU patients between 2018-2019 who met our criteria for retrospective chart review with ≥2 TAs obtained during their hospitalization. The following information was collected: patient demographics, number of TAs per patient, microbiology with …

Detection Of Enterotoxin Gene Cluster In Staphylococcus Epidermidis Recovered From Neonatal Liver Abscess, Bishara J. Freij, Barbara E. Robinson-Dunn, Patrick M. Schlievert

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• Neonatal pyogenic liver abscesses are rare • Potential routes of hepatic infection include: portal vein, biliary ducts, hepatic artery during sepsis, or direct spread from infected contiguous structures • Risk factors may include bloodstream infection, abdominal surgery, umbilical vein catheterization, total parenteral nutrition, necrotizing enterocolitis, and/or immune deficiencies • More common in premature infants at present • Variety of etiologic agents for neonatal liver abscess: Staphylococcus aureus (methicillin-susceptible and resistant), coagulase-negative staphylococci (CONS), streptococci, Escherichia coli, Klebsiella, Pseudomonas, Enterobacter, Serratia, and Candida • Umbilical stump and catheter exit site hub often colonized with CONS • CONS colonize nearly all …

Vampirism For The Microbiologist, Joudeh B. Freij, Bishara J. Freij

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Vampirism has been a means to explain the cause of communicable diseases throughout the centuries.