Electronic Detection of MRSA Infections in a National VA Population Augments Current Manual Process

Abstract Background: Automated measurement of hospital-acquired infections (HAIs) can improve the efficiency and reliability of surveillance. Within the VA, inpatient MRSA HAIs are manually reviewed and reported to the Inpatient Evaluation Center (IPEC). These MRSA HAI metrics are used as part of facility rankings to compare quality. However, IPEC uses CDC surveillance definitions which may vary in interpretation across facilities and not reflect all clinically relevant MRSA events. Thus, we sought to compare this manual process to a previously-developed electronic algorithm for detecting clinical MRSA infections to evaluate whether the algorithm could be used to expand MRSA surveillance activities. Methods: Electronic data were extracted from the national VA healthcare system during the period from January 1, 2014–December 31, 2014. The electronic detection algorithm defined MRSA infections as a culture positive for MRSA from a sterile site or from a non-sterile site with receipt of an antimicrobial with MRSA activity ± 5 days from the date of culture collection. Cultures obtained ≥48 hours after admission were classified as HAI. IPEC data for five facilities was extracted and IPEC rates were compared with rates estimated by the electronic algorithm. Flagged infections at one facility were manually reviewed to evaluate any discordances. Results: N = 14,260 MRSA clinical cultures were identified in 9,209 unique patients. Of these, 1,703 met definition for MRSA HAI infection. Electronic algorithm detected MRSA HAI rates varied widely across 137 facilities (Figure 1), ranked by rate per 1,000 patient-days. IPEC rates were universally lower than estimates derived using the MRSA electronic detection tool. Discordance in the estimates was attributable to infections present on admission, differences in capture of surgical site infections, and differences between clinical and surveillance definitions of infection. Conclusion: Applying the MRSA algorithm provided additional information about the burden of MRSA infections across the VA. This algorithm could be used as a tool to complement IPEC reporting and further inform infection prevention activities. Disclosures All authors: No reported disclosures

ADEQUACY OF THE CURRENT RECOMMENDED DOSAGE OF CIPROFLOXACIN IN PRETERM AND TERM NEONATES WITH SEPSIS

Objectives: To determine the percentage of neonates with sepsis, on treatment with standard recommended dose of intravenous  ciprofloxacin, who had the serum ciprofloxacin Peak concentration: Minimum inhibitory concentration (Cmax:MIC), within the acceptable range. Design: Observational study design Intervention : In the Neonatology ICU, ciprofloxacin was initiated at a dose of 10mg/kg, twice daily in 95 neonates diagnosed with sepsis. On day 3 of ciprofloxacin, blood specimens were collected to measure the trough and peak concentrations  of ciprofloxacin and was measured by high performance liquid chromatography. The MIC was measured if the blood culture was positive. When the blood culture was negative,the reference values for the MIC from ‘The Clinical and Laboratory Standard Institute Guidelines’ were adopted. Main outcomes: Minimum inhibitory concentration and serum concentrations of ciprofloxacin Results: Blood culture was positive in 14 babies. The mean (±SD) trough concentration of ciprofloxacin in term, preterm and very preterm neonates was 3.21(±1.99), 2.54 (±1.26)  and  4.01(±1.80) μg/mL respectively. The mean (±SD) peak concentration of serum ciprofloxacinin term, preterm and very preterm neonates was, 12.55 (±4.945) 8.68(±3.61) and 12.07(±3.63) μg/mL, respectively.  The percentage of neonates who achieved the acceptable Cmax /MIC ratio was predicted to be 74.07% if the strain was sensitive, 7.41% if intermediate and zero for resistant strains. Conclusion: The current recommended dose of intravenous ciprofloxacin in neonates in India may be adequate for treating sepsis due to susceptible organisms. For the treatment of sepsis caused by organisms with intermediate susceptibility, higher dosing regimens may be needed

Comparison of intralesional verapamil with intralesional triamcinolone in the treatment of hypertrophic scars and keloids

<b>Background</b> : The calcium channel blocker, verapamil stimulates procollagenase synthesis in keloids and hypertrophic scars. <b> Aim</b> : To study the effect of verapamil in the treatment of hypertrophic scars and keloids and to evaluate the effect of verapamil on the rate of reduction of hypertrophic scars and keloids in comparison with triamcinolone. <b> Methods</b> : The study was a randomized, single blind, parallel group study in which 54 patients were allocated to to receive either verapamil or triamcinolone. Drugs were administered intralesionally in both groups. Improvement of the scar was measured using modified Vancouver scale and by using a centimeter scale serially till the scar flattened. <b> Results</b> : There was a reduction in vascularity, pliability, height and width of the scar with both the drugs after 3 weeks of treatment. These changes were present at one year of follow-up after stopping treatment. Scar pigmentation was not changed desirably by either drug. Length of the scars was also not altered significantly by either drug. The rate of reduction in vascularity, pliability, height and width of the scar with triamcinolone was faster than with verapamil. Adverse drug reactions were more with triamcinolone than with verapamil. <b> Conclusion</b> : Intralesional verapamil may be a suitable alternative to triamcinolone in the treatment of hypertrophic scars and keloids

Effect of potassium channel modulators on toxicity of <i>Cleistanthus collinus</i>

81-85The study was conducted to determine the effects of boiled extract of Cleistanthus collinus on rats by observing ECG changes and electrolyte levels in serum and urine. Influence of minoxidil and glibenclamide on Cleistanthus collinus induced toxicity was determined. ED50 for arrhythmia, changes in contractility and heart rate were recorded using the isolated frog heart. Cleistanthus at low doses caused transient tachycardia and increase in contractility and at high dose caused arrhythmia and cardiac arrest in rat. LD50 was found to be 1690 mg/kg. Minoxidil potentiated cardiac toxicity, whereas glibenclamide did not produce any significant change. High concentration of potassium in Cleistanthus extract hindered comparison of its levels. There was excretion of sodium even in the presence of hyponatraemia. Cleistanthus at low dose caused transient tachycardia and increase in contractility and at high dose caused arrhythmia and cardiac arrest in isolated frog heart. ED50 for arrhythmia was found to be 1406 mg/kg. Acute toxicity was mainly due to depressive cardiac activity of Cleistanthus. It also caused renal failure. Potassium channel modulators did not have important role in acute cardiac toxicity treatment. Probably in chronic toxicity, electrolyte level changes are involved and potassium channel modulators might have a role