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For 94 patients with culture-positive pulmonary tuberculosis, time-to-detection (TTD), acid-fast bacilli (AFB) smear, and nucleic acid amplification test (NAAT) results were reviewed. All 12 patients whose first specimen was negative by AFB smear and NAAT had prolonged TTD, indicating low transmissibility and supporting discontinuing isolation for low-risk patients. Infect Control Hosp Epidemiol 2018;39:619–621

C. difficile PCR testing identifies both colonized and infected patients, making it critical to only test patients that meet clinical criteria for C. difficile infection (CDI). We implemented an automated order-entry protocol that reduced inappropriate testing by 64% and hospital-onset (HO) CDI Standardized Infection Ratio (SIR) from 1.62 to 0.82.

Abstract Background The Food and Drug Administration released a safety alert in May 2016 against the use of fluoroquinolones (FQ) in uncomplicated infections including uncomplicated cystitis due to concern for increased risk of disabling and potentially permanent adverse drug effects (ADEs). The aim of the study is to compare the rates of FQ prescriptions for uncomplicated cystitis before and after prescriber education to assess if prescriber education decreases the use of FQs. Methods This is a single-center, two-phase retrospective chart review comparing a five year pre-intervention and a four month post-intervention periods that evaluated patients seen at UC Irvine’s emergency department (ED) or outpatient clinics for uncomplicated cystitis. Adult female, non-pregnant patients 18 years of age or older with the diagnosis of uncomplicated cystitis were included. The treatment guideline for uncomplicated cystitis was developed by the antibiotic stewardship subcommittee with the recommendation to use nitrofurantoin as the first line agent. The infectious diseases pharmacy resident provided educational sessions from December 2016 to January 2017. The primary objective is to evaluate the impact of prescriber education on FQ prescribing rates for uncomplicated cystitis in the ED and outpatient clinics. Secondary objectives include the resistance rates of FQ and trimethoprim/sulfamethoxazole (TMP/SMX) against uropathogens to determine the local resistance rates and ADEs due to FQs. Results A total of 1056 patients were included in the analysis: 974 in the pre-intervention and 82 in the post-intervention groups. The rate of FQ prescriptions decreased from 32.3% in the pre-intervention group to 13.1% in the post-intervention group (P = 0.0002). The overall resistance rates of uropathogens were 19.3% to FQ and to 34.3% to TMP/SMX. There were 5 (0.5%) ADEs in the pre-intervention and 2 (2.5%) in the post-intervention groups. Conclusion Prescriber education regarding the appropriate treatment of uncomplicated cystitis and proper use of FQs was effective in reducing the rate of FQ prescriptions in management of uncomplicated cystitis. After prescriber education, the rate of FQ prescriptions decreased by 59%. Disclosures All authors: No reported disclosures.

Abstract Background Early diagnosis of BSI and appropriate antimicrobials are crucial; additionally avoidance of overly broad antibiotics is important to curb the development of resistance. Rapid molecular approaches are costly and have spectrum limitations. In our prior pilot study simple phenotypic RDDDT provided accurate susceptibility data for GNB over 24 hours earlier than conventional methods. This follow up pilot study evaluated RDDDT plus prompt stewardship intervention to decrease the time to optimal antimicrobial therapy. Methods GNB positive blood cultures (BACTEC) were inoculated by expressed swab to MH agar plates. 12 antibiotic discs were applied. After at least 8 hr incubation, results in conjunction with MALDI-TOF speciation, were reported to EMR at 9am or 3pm. After review the ID Fellow contacted the primary MD to escalate, deescalate, or continue current antibiotics. Results of the RDDDT were compared with routine VITEK and assessed as complete agreement (CA) or as very major (VM), major (M), minor (MI) discrepancies. Times to susceptibility, RDDDT based antibiotic optimization, and VITEK reports were assessed. Time to VITEK based optimization was obtained from the prior baseline pilot study. Results 164 patients with GNB were evaluated. 1688 individual RDDDT readings, including 297 ESBL and 66 CRE were compared with VITEK. RDDDT had 85% CA and 0.4% VM, 2.3% M, 13% MI discrepancies. The median time from BC positivity to RDDDT report was 17.5 hours vs. 46 hours for VITEK. Of 164 patients, 162 were assessed clinically. Of those, 72 (44%) required antibiotic change with median time to optimization 21 hours based on RDDDT vs. 71 hours based on prior baseline VITEK. Conclusion RDDDT coupled with prompt stewardship intervention provided a safe and reliable strategy to improve time to antibiotic optimization with savings of ~2 days compared with standard VITEK reporting. Furthermore, RDDDT is simple and applicable worldwide, especially in resource limited areas. Accuracy: RDDDT vs. VITEK Results Total N (%) Excluding Cefazolin N (%) Discrepancies VM 6 (0.4) 6 (0.4) M 39 (2.3) 31 (2) MI 217 (13) 152 (10) CA 1426 (85) 1349 (88) Total 1688 1538 Intervention Based on RDDDT vs. VITEK RDDDT (%) VITEK (%) Escalation 25 (35) 16 (25) De-escalation 47 (65) 47 (75) Total 72 (100) 63 (100) Disclosures All authors: No reported disclosures.

This guideline summarizes recommendations for (1) developing cogent procedures for diagnosis and antimicrobial susceptibility testing; (2) developing quality-control parameters for the microbiological components of clinical trials; (3) continually updating U.S. Food and Drug Administration (FDA) guidelines; (4) reviewing microbiological recommendations from other groups, such as Microbiology Subcommittees of the National Committee for Clinical Laboratory Standards; and (5) improving the microbiological aspects of FDA package inserts for antimicrobial drugs. Sensitive and specific methods for isolation and identification of pathogens are essential to the proper conduct of clinical trials. Susceptibility tests should be performed in an accurate and reproducible fashion. Verification of results in a reference laboratory is encouraged to monitor quality control.

We evaluated the antibacterial activities of various fruit and vegetable extracts on common potential pathogens including antibiotic-resistant strains. Standardized bacterial inocula were added to serial dilutions of sterile vegetable and fruit extracts in broth, with final bacterial concentrations of 10 4–5 cells/mL. After overnight incubation at 35°C, antibacterial activity was measured by minimum inhibitory and minimum bactericidal dilutions (for raw juices) or concentrations (for tea). Among the vegetable and fruit extracts tested, all green vegetables showed no antibacterial activity on Staphylococcus epidermidis and Klebsiella pneumoniae. All purple and red vegetable and fruit juices had antibacterial activities in dilutions ranging from 1:2 to 1:16. Garlic juice had significant activity, with bactericidal action in dilutions ranging up to 1:128 of the original juice. Tea also had significant activity, with bactericidal action in concentrations ranging up to 1.6 mg/mL, against a spectrum of pathogens including resistant strains such as methicillin- and ciprofloxacin-resistant staphylococci, vancomycin-resistant enterococci, and ciprofloxacin-resistant Pseudomonas aeruginosa. Tea and garlic have the potential for exploration of broader applications as antibacterial agents.