ORAL ABSTRACT 118 TOMPKINS L, MADISON A, SCHAFFNER T, TRAN J, ANG P, TIEN V. ELIMINATING BLOOD CULTURE CONTAMINATION WITH AN INITIAL-SPECIMEN DIVERSION DEVICE
The study investigators evaluated whether the use of an initial-specimen diversion device (ISDD) would reduce blood culture contamination by skin flora. Blood cultures were obtained by phlebotomists using either the ISDD (n = 4462) or traditional method (n = 922) as well as by nursing staff using a standard approach (n = 1413) over a 4-month period at Sanford Health Care. National Healthcare Safety Net criteria were used to define contaminants. No contaminants were identified in the cultures obtained using an ISDD, whereas 29 and 28 sets were contaminated when standard methods were used to draw cultures by phlebotomists and nursing staff respectively. The authors' conclusions supported the use of an ISDD as standard practice for collecting blood cultures at their institution.
Comments by Dr. Mangat: Blood culture contamination with skin flora poses a major problem in the health care field. Not only does it lead to diagnostic challenges for clinicians to distinguish between contamination and true infection, it often leads to unnecessary use of antibiotics, increased diagnostic testing, and increased hospital length of stay. The financial burden of blood culture contamination is also significant with increased pharmacy charges reported to be between $210 and $12,611 and increased laboratory charges between $2,397 and $11,152 (1). Multiple interventions have been used in the past to reduce blood culture contamination rates, including education and sterile kits, yet contamination continues to be an ongoing complication. The ISDD, a more novel intervention, diverts and sequesters the first 1.5 to 2 mL of blood before the collection of blood in culture bottles to reduce contamination. A brief literature search revealed that this device has reduced contamination rates at other institutions as well. It will be interesting to evaluate the ongoing improvements in patient morbidity as well as health care expenditure if this device becomes standard practice nationwide.
1. Dempsey C, Skoglund E, Muldrew KL, Garey KW. Economic health care costs of blood culture contamination: A systematic review. Am J Infect Control. 2019 Aug;47(8):963–967. doi: 10.1016/j.ajic.2018.12.020. Epub 2019 Feb 20. PMID: 30795840.
ORAL ABSTRACT 135. SCHWARTZ I, WOC-COLBURN L, MCCARTY T, CUTRELL J, CORTES-PENFIELD N. IMPACT OF #IDJCLUB, A SYNCHRONOUS TWITTER JOURNAL CLUB, AS A NOVEL INFECTIOUS DISEASE EDUCATION PLATFORM
The authors started an Infectious Diseases (ID) journal club on Twitter allowing followers from around the world to participate in a 1-hour discussion of a relevant article led by an ID physician. Attendees are guided through a discussion by pre-scripted tweets. One hundred thirty-four participants completed a survey, with the majority indicating that the journal club provided useful clinical knowledge, and helped with their confidence in analyzing articles. Additionally, greater than 70% of respondents felt that they learned more than they would have during an in-person journal club. Gathering more than 5000 followers by June 2020, the authors were able to demonstrate that this novel method of enhancing medical education provided an open-access environment to discuss and critically appraise relevant literature.
Comments by Dr. Mangat: We are all aware of the advances in patient care associated with the improvement of technology. However, little had changed in the form of medical education in the digital era before the pandemic. The COVID-19 pandemic resulted in a large push toward virtual medicine, including more online platforms for medical education. With the use of video conferencing applications and even virtual reality, the modernization of medical education is finally upon us. This group in particular started using Twitter before the pandemic which quickly grew to become an online platform to host journal clubs with participants from around the world, allowing global networking to share data related to COVID-19 as well as other ID-related topics.
CLOSING PLENARY SESSION, SUNDAY OCTOBER 25, 2020. 40 YEARS SINCE DECLARATION OF THE ERADICATION OF SMALLPOX: WHAT HAVE WE LEARNED
Moderator: Damon I. Speakers: Orenstein W, Lane M, Henderson L.
In October 22, 1977, Ali Maow became the last individual diagnosed with smallpox in the world, after which smallpox was declared eradicated. This was truly a triumph for public health, made possible through the coordinated work of many nations united for one single goal.
According to Dr. J. Kaplan from Emory University, this was possible because of a combined strategy that included the following: (1) the containment strategy, including isolation of cases, and contact tracing, which facilitated the stop of spreading; (2) massive vaccination campaigns.
In the second part of this exposition, Dr. Henderson, emphasized the importance of surveillance as an essential epidemiological tool. Before this measure was implemented, cases were frequently underreported (especially in some regions of sub-Saharan Africa), and it took multiple efforts between the government and some public entities promoting diverse programs, to better monitor the activity of smallpox. However, it took more than political will to achieve the end result. It also required multiple other conditions related to the interaction between virus and host. In the words of Professor Worenstein, many other factors played a role, including absence of a nonhuman reservoir, level of contagiousness, the role of asymptomatic carriers in the spread of disease, and acquisition of prolonged and protective immunity after vaccination.
Comments by Dr. Carvajal: This talk is now more necessary than ever, because it reminds us about the importance of scientists joining forces to conquer a common enemy. Also, we also need to remember that science should be colorblind when it comes to helping human beings threatened by infectious disease.
LIVE SESSION OCTOBER 23, 2020. “BOARDERS CROSSING BORDERS.” MODERATOR BRYANT K, SPEAKERS SHINGADIA D, BARNETT E, BAAUW A
In 2016, there were 84,995 refugees coming to the United States, but by 2018 that number had declined to slightly more than 20,000, of which 10,804 were younger than 20 years. The refugees had many medical needs covered by the immigration program: vaccines, communicable disease management, settlement in urban centers or refugee camps, as well as health interventions with improvement of living conditions. Currently, the protocol in the United States mandates predeparture immunization, screening and treatment for tuberculosis, sexually transmitted diseases, hepatitis B, malaria, and soil-transmitted helminths.
In the Netherlands, there is only screening for tuberculosis. There is lack of screening for congenital diseases in refugees. There is also a lack of follow up after they are relocated. This is not unusual: only 8 countries have clear protocols for health recommendations in refugees. Displaced children are placed in overcrowded camps, which exacerbates the transmission of infectious diseases.
Lebanon has welcomed more than 1.2 million Syrian refugees, which are now a third of the current population, representing the highest per capita concentration of refugees in the world. The number of cases of hepatitis B, measles, mumps and polio rose dramatically since 2012.
Comment by Dr. Carvajal: There is an urgent need for uniform criteria and guidelines for screening, treatment, and prevention of infectious diseases. Nations of the world must begin to frame the refugee crisis from an infectious disease perspective, and it will be necessary for a multinational effort to treat this as a public health issue that goes beyond national borders.
ORAL ABSTRACT 125. GENEVA, I, LUPONE C, WEGMAN AD, PAOLINO K. EFFECT OF BODY TEMPERATURE BEFORE HOSPITAL DISCHARGE ON THE READMISSION RATE
This study evaluated in retrospective analysis the minimal and maximal body temperatures collected during the 24 hours preceding discharge (n = 19,038 patients) over a 1-year period from a tertiary care center in Syracuse, NY. The majority of these patients (~42%) were discharged from a general medicine service, with smaller numbers in other services, such as pediatrics (~18%), general surgery (~10.5%), orthopedics (~10%), and neurology (~5%). Both axillary and oral temperatures were measured (80.4% oral vs 18.9% axillary); the study noted a statistically significant difference in the average temperatures these produced, but the clinical discrepancy between the variance was so small as to not be clinically relevant. Of the patients who were included, approximately 10.2% achieved 30-day readmission to hospital (the study also cites that this is not too far off from, but better than, the national average of 14% based on national data from 2010 to 2016). Analysis of variance analysis of febrile, normothermic, or hypothermic patients did not reveal any statistically significant differences between the groups; χ2 analysis noted some statistically significant difference in rates of readmission for temperatures at discharge measuring 1 significant deviation above the distribution of temperatures (in this instance, 99.5°F), but noted no similar differences in 2 significant deviations above, and similarly no statistically significant connection to hypothermic temperatures and readmission rates. Ultimately, the authors concluded that abnormal body temperature before discharge is not, generally, a useful tool to predict readmission, and that delaying discharge based on body temperature alone may be a wasteful practice.
Comment by Dr Gray:
Although the study does admit the caveat that they did not assess patients for readmissions to other hospitals, as well as the limitation that there is an inherent selection bias against discharging patients who do not have a “safe” body temperature, this provides an excellent insight into the appreciation of more complete clinical context rather than just taking an isolated value as a determinant of safe discharge. Although the typically favorite vital sign of the ID clinician, this serves as a thoughtful reminder that such physiologic indices are to be always taken as an aspect of the patient presentation, not as a whole.
POSTER 1535. SRINIVAS M, YANG E, TANG W, TUCKER J. IMPACT OF DEFUNDING FAMILY PLANNING HEALTH CENTERS ON GONORRHEA AND CHLAMYDIA CASES IN IOWA: A SPATIOTEMPORAL ANALYSIS
The authors here used a state-based evaluation of Iowa's gonorrhea and chlamydia cases in the context of increasingly restrictive legislation for family planning health centers (FPHCs) that were implemented in 2017 for particular counties in Iowa (n = 4), comparing sexually transmitted infection (STI) rates before defunding to rates found postdefunding legislation rates in 2018. These rates of infection were also contrasted to counties in which there were no closures (n = 95). The results were compared via t testing to compare rates between these 2 settings, with linear regression modeling to evaluate the correlation between clinic closure and STI rate. In this analysis, statewide transmission of gonorrhea showed a significant increase between predefunding rates of gonorrhea (83 cases/100,000) to an almost doubled postdefunding (153.8 cases/100,000), although without a significant change in chlamydia cases (414.7 cases/100,000 to 466.7 cases/100,000). Comparing counties that had FPHC closures with those that did not experience closures, an increase in gonorrhea was also significant (217 cases/100,000 in counties with closures, compared with 121 cases/100,000 in counties that did not; P = 0.0015). The trend for chlamydia was less significant (P = 0.057).
Comment by Dr Gray and Dr. Alpizar: Given that FPHCs constitute a significant majority of women's primary access to health care, especially in poor and underserved communities, ideologically driven efforts to close centers like these are becoming a more frequently voiced topic of contention in an increasingly polarized political climate. In the context of the increasing incidence of highly resistant gonococcal disease, the deprivation of some of the most basic elements of Women's Health and of STI treatment is very much at odds with the public interest.
We are in urgent need of policies that envision and understand that investing in health care is not only humane but also economic. Although the incentive to defund FPHCs may be to save money, in the long run, it leads to a higher monetary burden. This study exemplifies that defunding health care centers, increases the incidence of diseases, which translates to a higher cost for the health care system. This was demonstrated independently when observed in a place that loses resources over time and when comparing 2 different counties with different resources at a time.
POSTER 264. CAFFREY A, LAPLANTE K, LOPES V, NIZET V, O'NEIL E, SAKOULAS G, ULLOA E. ANTI-PLATELET THERAPY SIGNIFICANTLY REDUCES INPATIENT MORTALITY IN PATIENTS WITH STAPHYLOCOCCUS AUREUS BACTEREMIA
The authors performed a retrospective cohort study in patients with Staphylococcus aureus bacteremia (SAB). They observed patients that were on P2Y12 inhibitors for at least 30 days before diagnosis of SAB and continued treatment for at least 5 days after admission. They compared this population to patients that presented with SAB and had not been on P2Y12 inhibitor treatment for the past year. They found that inpatient mortality was significantly lower in patients that were treated with P2Y12 inhibitors, but there was no difference in readmission or reinfection.
Comment by Dr. Alpizar: In a time that SAB continues to increase in incidence, this poster presents quite an interesting observation. Their results suggest an important benefit from treating patients that present with SAB with P2Y12 inhibitors. It sets the stage for a prospective study to treat patients with MRSA bacteremia with P2Y12 inhibitors as adjunctive therapy to antibiotics with a potential to change practice. Of note, the population in this cohort was relatively older so it would be worth investigating for reproducibility in a younger population. Another consideration would be to assess for differences in outcomes between use of P2Y12 inhibitors in MSSA versus MRSA infections.
POSTER 309. AXELROD P, D'ORAZIO J, MUELLER D, SPIVACK S. THE IMPACT OF ADDICTION MEDICINE CONSULTATION ON DISCHARGES AGAINST MEDICAL ADVICE IN PATIENTS WITH OPIOID USE DISORDER AND SAB
The authors performed a retrospective cohort study in patients with active opioid use disorder admitted with SAB, to evaluate the impact of addiction medicine consultation in preventing discharges against medical advice (AMA) in this population. They found that the involvement of addiction medicine in the care of this population had less AMA discharges with a statistically significant difference. They also found that patients that were engaged by addiction medicine consultants had fewer readmissions, although not statistically significant, most likely because of the small number of consultations. They also found high rates of human immunodeficiency virus (HIV) and hepatitis C virus coinfection.
Comment by Dr. Alpizar:
Patients with intravenous drug use are a vulnerable population requiring a multidisciplinary approach to treatment, close follow-up and support. They frequently have coinfections with HIV and hepatitis C virus that require long term treatment. Unfortunately, this population is also more likely to leave AMA and be lost to follow up if not engaged by a trained specialist. As this study suggests, upfront addiction medicine consultation results in better outcomes and less readmissions. Similar to reflex ID consultations for SAB or HIV, patients admitted for complications of intravenous drug use should have an electronic health record-based opt-out prompted addiction medicine consult.