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We conducted a laboratory simulation to evaluate the contamination of environmental surfaces when using wipe vs spray methods of personal protective equipment (PPE) decontamination. We did not observe any environmental contamination with the bacteriophage MS-2 when bleach solution spray or wipes were used for PPE disinfection.

We examined the effect of glove decontamination prior to removal on bacterial contamination of healthcare personnel hands in a laboratory simulation study. Glove decontamination reduced bacterial contamination of hands following removal. However, hand contamination still occurred with all decontamination methods, reinforcing the need for hand hygiene following glove removal.

Background Rapid diagnostic testing for the management of bloodstream infections has become paramount to improving patient outcomes. The primary objective of this study was to assess the differences between 2 FDA approved instruments. Methods Retrospective study from August 2018 to April 2019 at the University of Maryland Medical Center. One positive blood culture from each patient was tested using the Verigene® blood culture Gram-positive (BC-GP) or Gram-negative (BC-GN) panels based on the Gram stain and then analyzed using the ePlex® Blood Culture Identification (BCID) Gram-positive (BCID-GP) or Gram-negative (BCID-GN) research-use-only panels and compared with culture results. Results The study consisted of 140 positive blood culture bottles. 14 bottles were excluded for a total of 55 GN and 71 GP bottles. Of the 55 GN bottles, 3 had 2 GN rods for a total of 58 GNRs. BCID-GN missed 1 P. aeruginosa, 2 S. maltophilia, and 1 E. coli for a 93% (53/57) positive agreement. The BCID-GN does not detect A. junii and therefore it was excluded. BC-GN did not identify 1 K. pneumoniae with a 98% (47/48) positive agreement. BC-GN does not include the detection of S. maltophilia (4), Serratia (4), Morganella (1), and B. fragilis (1)and these were excluded in the BC-GN analysis. CTX-M was the only resistant marker detected and both panels identified it correctly. 5 samples using the BCID-GN also detected Pan Gram-Positive; 3 grew GP organisms, the other 2 only grew E. coli. Of the 71 GP bottles, 3 had two GP bacteria totaling 74 GPs. BCID-GP missed 1 S. aureus, 1 invalid, and called an E. faecalis that was not identified by the reference method for a 99% (72/73) positive agreement. BC-GP does not detect Micrococcus (6) or E. gallinarum (1) and missed 1 S. mitis/oralis for a 99% (66/67) positive agreement. 18 samples were positive for mecA detected by both panels. 4 samples were vanA/B positive; 1 by BCID-GP was sensitive to vancomycin and not detected by BC-GP. BCID-GP detected 1 sample as Pan Gram-negative although a GNR was not detected. Conclusion BothVerigene® and ePlex® GP and GN panels have a high percent positive agreement. Laboratories should take into consideration the epidemiology of their bloodstream infections when deciding on panels for the rapid detection of bloodstream infections. Disclosures All authors: No reported disclosures.

Background Rapid diagnostic tests (RDTs) for bloodstream infection (BSIs) are increasingly common. Decisions regarding which RDT to implement remains a clinical challenge given the diversity of organisms and resistance mechanisms detected by different platforms. The desirability of Outcome Ranking Management of Antimicrobial Therapy (DOOR-MAT) has been proposed as a framework to compare RDT platforms but reports of clinical application are lacking. This study compared potential antibiotic decisions based on results of two different RDTs for BSI using DOOR-MAT. Methods Retrospective study at University of Maryland Medical Center from August 2018 to April 2019 comparing Verigene® BC (VBC) to GenMark Dx ePlex® BCID for clinical blood cultures. VBC was part of standard of care, ePlex was run on discarded fresh or frozen blood samples. In this theoretical analysis, RDT result and local susceptibility data were applied by two Infectious Diseases pharmacists to make decisions regarding antibiotic selection in a blinded manner. Cohen’s Kappa statistic summarized overall agreement. DOOR-MAT, a partial credit scoring system, was applied to decisions based on final organism/susceptibility results (Figure 1). Scores were averaged between reviewers and mean scores compared between RDT systems using the t-test. Additionally, a sensitivity analysis with varied point assignment among Gram-negatives (AmpC-producers) was conducted. Results 110 clinical isolates were included; 41 Gram-negative, 69 Gram-positive organisms. Overall agreement was 82% for VBC and 83% for ePlex. The average score for VBC was 86.1 (SD 31.3) compared with ePlex 92.9 (SD 22.9), P = 0.004. Among Gram-negatives, the average score for VBC was 79.9 (SD 32.1) compared with ePlex 88.1 (SD 28.8), P = 0.032. Among GPs the average score for VBC was 89.9 (SD 30.4) compared with ePlex 95.8 (SD 18.3), P = 0.048. Sensitivity analysis demonstrated an average score for of 89.9 (SD 30.4) for VBC compared with 95.8 (SD 18.3) for ePlex, P = 0.27. Conclusion The use of a partial credit scoring system such as the DOOR-MAT allows for comparisons between RDT systems beyond sensitivity and specificity allowing for enhanced clinical interpretation. In this theoretical comparison, the Genmark ePlex BCID scored higher among both GP and GN organisms. Disclosures All authors: No reported disclosures.

Background Rapid diagnostic testing (RDT) technology in bloodstream infections (BSI) has outpaced provider understanding of how to effectively use it. To optimize the use of RDT platforms and antibiotic therapy, decision makers must determine which RDTs to implement at their institutions. A thorough understanding of which platform to choose extends beyond simple analytic measures of sensitivities and specificities and should include a robust analysis of how these RDTs could impact clinical decisions. Methods Retrospective study of adult patients with Gram-negative (GN) BSI from at University of Maryland Medical Center. The clinical microbiology laboratory used Verigene® BC-GN in clinical practice. Discarded blood samples were run on BioFire® FilmArray BCID. Final organism identification/susceptibility, antibiotic exposures, and clinical outcomes were reviewed. DOOR was applied to theoretical therapy decisions based on both actual prescribing adherence to institutional algorithm recommendations; 1 being most and 6 being least desirable (Table 1). A partial credit scoring system was applied to DOOR from most (100) to least desirable (0) outcome. Comparisons were made in a paired manner. Results 77 patients met inclusion. The median age was 58 (IQR 47, 68), 44.2% were in the ICU, and 75.3% had ID consult within 24 hours of BSI. Organism identification included: E. coli (35.1%), K. pneumoniae (23.4%), P. mirabilis (10.4%), S. marcescens (10.4%), Enterobacter spp. (9.4%), P. aeruginosa (3.9%). The only resistance determinant was CTX-M (11.6%). An antibiotic change occurred in 26.2% of cases, divided between antibiotic escalation and de-escalation. Based on the actual utilization of RDT results, median DOOR was not different between BC-GN and BCID (3 [IQR 3.4] vs. 4 [IQR 3.4], P = 0.44). Using a partial credit scoring system, the mean score was not different between platforms (49.8 [SD 26.8] vs. 47.7 [SD 20.3], P = 0.44). Through pairwise comparisons, BC-GN would have resulted in an optimal outcome of 15.3% (95% CI 4.7% to 19.3%) more often than BCID. Conclusion Based on the actual use of RDTs for GN BSI there was no difference in potential clinical outcomes between platforms in this relatively small sample. DOOR is a novel mechanism to quantitate clinical utility and compare RDTs. Disclosures All authors: No reported disclosures.