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Journal of the Association of Medical Microbiology and Infectious Disease Canada logoLink to Journal of the Association of Medical Microbiology and Infectious Disease Canada
. 2019 Jul 11;4(Suppl):118–123. doi: 10.3138/jammi_4.s1.abst-04

Incubator Poster Presentations

PMCID: PMC9603423
Off J Assoc Med Microbiol Infect Dis Can. 2019 Jul 11;4(Suppl):118.

IP01. Appropriate antibiotic prescribing module: How to choose which drug to use

D Doyle 1, N Bridger 1

Objective

Antibiotics are a class of medication which can be challenging for medical students to learn, as microbiology and pharmacology must be learned in addition to the diagnostic component of infectious disease content. A learning need was identified by pre-clerkship medical students for supplemental learning material on antibiotics to complement didactic lectures in the pre-clerkship curriculum.

Methods

A module covering common antibiotic classes was created to assist pre-clerkship medical student learning. Objectives were developed to guide student learning. They include recalling spectrum of activity, mechanism of action, and adverse reactions of antibiotic classes covered, as well as selecting treatment on a case-by-case basis, based on patient-specific factors. The module was designed to optimize recall of information through the use of mnemonics, questions, cases and a historical description of antibiotic design as it pertains to spectrum of activity for β-lactam antibiotics. A post-module evaluation was conducted to determine the opinion of twenty-five pre-clerkship medical students. Eight questions used a 1–5 Likert scale and two questions assessed student opinion on module strengths and areas for improvement.

Results

Responses to quantitative questions ranged from 4.3 to 4.6, with “amount of detail” scoring lowest and “recommending module to others” scoring highest. Areas for improvement included adding more cases to provide a broader range of difficulty and including more information on certain classes. Strengths included mnemonics, simplified spectrum of activity, and review questions and cases.

Conclusion

The module received positive feedback and evaluation results were used to make changes to improve the module for future students. Additions include more clinical cases, more information on certain antibiotics, and appendices to summarize module topics. The module is available to undergraduate medical students online to be used as a supplemental learning tool.

Off J Assoc Med Microbiol Infect Dis Can. 2019 Jul 11;4(Suppl):118–119.

IP02. A point-of-care diagnostic tool to replace chest x-ray for the diagnosis of childhood pneumonia

Q Mian 1, A Conroy 2, R Opoka 3, S Namasopo 4, M Hawkes 1,5,6

Background

Pneumonia is the leading cause of mortality in children under 5 years globally and a major cause of hospitalization of Canadian children. Accurate diagnosis is critical for the appropriate and judicious use of antibiotics, and is challenging in contexts without easy access to a chest x-ray (CXR). In low-income settings, identifying children with pneumonia at high risk of mortality is important when allocating scarce resources. Novel solutions for pneumonia diagnosis are required in these settings.

Objectives

Our team identified novel biomarkers for childhood pneumonia, including chitinase-3-like-1 (CHI3L1), lipocalin-2 (LCN2), tissue inhibitor of metalloproteinase 1 (TIMP1) and surfactant protein-D (SP-D) in several African cohorts. These are newly described putative biomarkers for diagnosis and prognosis for pneumonia and could be incorporated into a point-of-care diagnostic test.

Methods

114 children with WHO-defined pneumonia presenting to two hospitals in Jinja and Kambuga, Uganda were enrolled. Plasma samples were obtained and analyzed via ELISA to measure serum host-response biomarkers: CHI3L1, LCN2, TIMP-1, SP-D and C-reactive protein (CRP).

Results

We identified a novel marker, CHI3L1, with strong predictive value (93% sensitive and 81% specific) for the detection of primary endpoint pneumonia. In combination, these biomarkers are strongly predictive for chest x-ray consolidation, with 80% probability with all five biomarkers above threshold, and less than 10% probability with no biomarkers above threshold. In a separate cohort of children from Uganda with hypoxemic pneumonia, we found that CHI3L1 and LCN2 distinguish between children with lobar consolidation versus no consolidation.

Conclusions

These newly identified biomarkers are strongly predictive of chest x-ray consolidation in children. Applied to a point-of-care diagnostic mechanism, these biomarkers could transform pneumonia diagnosis in low-resource settings across the globe.

Figure IP02-1:

Figure IP02-1:

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Used in combination, five novel biomarkers discriminate between radiographic pneumonia and normal chest x-ray in Ugandan children with clinical signs of lower respiratory tract infection

Note. When all five biomarkers are elevated, the probability of lobar consolidation is ~80%; when none are elevated, the probability is less than 10%, demonstrating the clinical utility of these biomarkers

Off J Assoc Med Microbiol Infect Dis Can. 2019 Jul 11;4(Suppl):119–120.

IP03. Rapid and sustained adoption of a novel antimicrobial stewardship mobile app throughout Saskatchewan

S Peermohamed 1,2, J Kosar 2

Background

Smartphones are ubiquitous amongst clinicians and smartphone apps are increasingly being used to support clinical decision making. Spectrum is a novel, mobile antimicrobial stewardship app that can be customized to deliver local guidelines, pathogen information, antimicrobial information and local antibiogram data. Spectrum was launched in the Saskatoon Area of the Saskatchewan Health Authority on April 12, 2018.

Objectives

To study the user engagement and most commonly accessed content of Spectrum over a seven-month period in the Saskatoon Area of the Saskatchewan Health Authority.

Methods

The number of active users and sessions, use by health care profession and location, daily user engagement time, and accessed content sections categorized by guidelines, pathogens and antimicrobials was analyzed.

Results

Seven months following the launch of Spectrum, there were 744 active users (Figure IP03-1) with an average daily user engagement time of two minutes and forty-two seconds. Active users were composed of the following health care professions: physician (28.1%), pharmacist (23.8%), resident/fellow (20.0%), nurse practitioner/registered nurse (11.8%), medical student (9.8%) and other (6.5%). In November 2018, there was a total of 2418 Spectrum sessions and an average daily Spectrum usage rate of 1.4 sessions per user (Figure IP03-1). The most commonly accessed guidelines were urinary tract infection (20.1%), community-acquired pneumonia (14.7%) and non-purulent cellulitis (8.3%). The most commonly accessed pathogens were Enterococcus faecalis (10.0%), Escherichia coli (8.1%) and Klebsiella pneumoniae (5.1%). The most commonly accessed antimicrobials were ceftriaxone (9.2%), ciprofloxacin (7.7%) and piperacillin-tazobactam (7.2%).

Figure IP03-1:

Figure IP03-1:

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Number of active users and number of sessions per user of Spectrum over a seven-month period

Notes. Sold line = active users; dotted line = sessions per user

Conclusions

Spectrum has been widely used amongst health care professionals throughout Saskatchewan and its sustained usage supports this innovative app being an effective, localized antimicrobial stewardship tool in providing clinical decision support.

Off J Assoc Med Microbiol Infect Dis Can. 2019 Jul 11;4(Suppl):120.

IP04. Leveraging an electronic medical record system to reduce high blood culture contamination rates in the emergency department of a large community hospital

L Jacob 1, D Merrithew 1, HL Candon 1, D Chen 1, I Ying 1

Objective

International standards recommend blood culture contamination (BCC) rates be continuously monitored and not exceed 2%–3%. False-positive results lead to unnecessary emergency department (ED) call-backs, hospital admissions, increased length-of-stay, inappropriate antimicrobials use and increased costs blood cultures (BC) are frequently drawn in our ED by nursing staff, where there is no dedicated phlebotomist; the ED contamination rate was calculated to be 4.6%. To address the high rate of BCC, a quality improvement (QI) project was initiated to implement strategies to reduce BCC to the acceptable benchmark.

Methods

A multidisciplinary QI team was assembled. A retrospective chart review established the baseline BCC rate from April 1–June 31, 2018, using the standard definition provided by Institute for Quality Management in Healthcare. The hospital implemented a new electronic medical record system (EPIC), which provided the specific individual who drew every BC. Those individuals with BCC rates >3% were directly observed and provided education. Education focused on collection technique, identifying opportunities for contamination when deviating from best practice, and discussing negative resulting outcomes. For the next 3-months (July 1 to September 31, 2018) individuals received feedback when their rate was >3% and the BCC rates was shared corporately.

Results

The frequency of BCC in the ED in the 3 months prior to the QI initiative was 4.6% (range 3.6–5.3). Following individual feedback and education, the rate was reduced to 3.1% (range 2.8–3.5) over the subsequent 3-months representing a statistically significant decrease of 31% (p<0.05, χ2 analysis). Direct observation identified a large variation in practice. By calculating individual rates, we identified one clinician whose collection technique was responsible for 40% of BCCs.

Conclusion

BCC rates were successfully reduced by leveraging an EMR system to track individual contamination rates. This allowed direct observation and education in the prevention of BCC.

Off J Assoc Med Microbiol Infect Dis Can. 2019 Jul 11;4(Suppl):120–121.

IP05. Creation of an evidence-based background for developing a comprehensive scoring system for targeted admission screening for colonization with carbapenemase-producing organisms (CPO)

E Lytvyak 1, K Trepanier 2, A Doroshenko 1, A Chandran 1,3

Introduction

Identification of CPO carriers at admission is critical for hospital transmission risk mitigation; however, no standardized cohesive approach exists for admission screening practices.

Objectives

Our objectives were to (1) review available literature; (2) collect and appraise criteria recommended by various studies/organizations to identify the greatest at-risk population; (3) create an evidence-based background for developing a comprehensive scoring system for targeted admission screening.

Methods

PubMed, EMBASE, Web of Science, and Cochrane Library (January 2000 to August 2018) were searched. Retrospective and prospective cohort and case-control, cross-sectional studies, reviews, local, regional and international guidelines were included. The criteria identified were categorized into three main clusters: health care interaction (international, domestic hospitalizations, procedures, transfers, etc.), epidemiological (high-risk unit admission, contact with CPO, etc.) and individual (history of CPO, general health status, immunosuppression, etc.) factors. Frequencies of various criteria appearing in the literature were calculated.

Results

Twenty studies from 10 different countries with various CPO endemicity levels were analyzed. Three studies (15%) utilized criteria from all three clusters. Health care interaction factors only were used by 5 studies (25%), epidemiological factors only by 3 (15%), and individual factors only by 4 (20%). Two studies (10%) concluded that CPO admission screening is not needed at all. The most common criteria used were international hospitalization within the last 12 months (n = 9, 45%), previously receiving care in/transferred from CPO-prevalent areas/facilities (n = 6, 30%), and current admission to a high-risk unit (n = 5, 25%). A risk scoring system was proposed based on these factors.

Conclusions

Criteria for CPO admission screening vary considerably across jurisdictions with different CPO endemicity levels. Assigning criteria with different weights and ranks, correlation with local epidemiological patterns and individual test results, and further development and subsequent validation of a comprehensive scoring system will help to most accurately identify the greatest at-risk population for targeted CPO admission screening.

Off J Assoc Med Microbiol Infect Dis Can. 2019 Jul 11;4(Suppl):121.

IP06. The Real-World: Opportunities and challenges of pragmatic implementation studies for tackling infectious diseases for vulnerable populations

B Goodall 1, S Oldford 2, N Bartlett 1, L Barrett 1,2,3

Background

Novel approaches will be required to tackle infectious diseases for vulnerable populations and best practices remain unclear. Pragmatic embedded study design, in real-world settings, will likely be imperative to understanding these complex health system changes. Most academic organizations have rigorous processes for evaluating clinical trials, however there remains a knowledge gap with pragmatic study designs that may substantially impair the ability to conduct research in a timely and meaningful manner. Our objective is to describe the challenges and solutions of pragmatic study design approval in the context of an HCV elimination strategy.

Methods

A prospective evaluation and health outcomes research plan has been integrated into Nova Scotia’s HCV elimination strategy. Two previously described tools will be implemented and evaluated in Phase 1 of the strategy: training providers in motivational interviewing and point of care testing. During the 24-month development of Phase 1, barriers and solutions to ethics approval, as well as the estimated temporal impact on research progression, were determined.

Results

Three main challenges were identified during the ethics submission for the implementation and design of the pragmatic embedded study: 1) Potential for informed consent in vulnerable individuals; 2) Scientific validity of synonymous interventions; and 3) Lack of pragmatic embedded study design knowledge. Ethics board education on pragmatic trials and extensive re-consultation before resubmission were key to addressing concerns. This iterative process of ethics submission took approximately 18 months compared with an average time of less than 2 months for non-pragmatic trials within our group.

Conclusions

To successfully tackle infectious diseases for vulnerable populations evaluation of methods in complex, real-world settings involving pragmatic study designs are required. It is important to include pragmatic study training resources to investigators and institutional ethics boards when developing coordinated elimination strategies to reduce delays associated with adoption of newer research tools for elimination.

Off J Assoc Med Microbiol Infect Dis Can. 2019 Jul 11;4(Suppl):121–122.

IP07. Using toys’ humanoid robots to get better hand hygiene compliance

BR Couto 1,2,3, BS Mendes 1, IF Oliveira 1, MS Nogueira 2, CC Viana 2, MB Peixoto 2, MV Peredo 2, AL Alvim 3, CE Starling 3

Background

Even nowadays compliance with hand hygiene practices is still unacceptably low. In this study we want to answer three questions: a) How to adapt a toy robot as an instrument of continuous education of health care workers? b) What is the effectiveness of the use of a humanoid robot to improve hand hygiene performance?

Methods

MeccaNoid G15KS, a humanoid robot 122 cm tall, it was released as a toy in the beginning of 2015. It can be purchased for less than US$ 200. It is a programmable robot mainly designed to interact with children. It became “he” when MeccaNoid was baptized Ozires, in honor of the Brazilian engineer Ozires Silva, from Embraer. The robot was adapted with mini projector, an automatic alcohol hand sanitizer dispenser, and an audio amplifier. The mini projector allows video lessons even in small rooms. Ozires, accompanied by infection control practitioners, performs short video-lecture presentations and own reports of the institution’s data regarding infections and the hand hygiene rate, working from 10 to 15 minutes in each target sector. Ozires was engaged as a hand hygiene improvement strategy in two hospitals from Belo Horizonte, Brazil: Hospital-A (Jan–Nov/2016) and Hospital-B (Jul/2017–Dec/2018).

Results

After the insertion of Ozires in three ICUs of Hospital-A, hand hygiene rate increased from about 36%, between January–July, to 65% in August–November/2016. In all months of 2017, consumption of alcohol preparation remained above 20 mL/patient-day, the minimum expected consumption recommended by the World Health Organization. Hospital-B: Ozires started his lectures in May/2018. Hand hygiene adherence increased from about 23%, between July and December/2017, to 60% in June–December/2018.

Conclusion

We succeeded in adapting a toy robot as instrument of continuous education of health care workers, creating a new education tool, a robot tutor. Hand hygiene compliance raised significantly after the intervention in both hospitals.

Off J Assoc Med Microbiol Infect Dis Can. 2019 Jul 11;4(Suppl):122.

IP08. Diagnostics for the Discrimination of Viral and Bacterial Infections in a Cohort of Children Hospitalized for Respiratory Infection

K Inch 1, A Van Meer 1, K Luinstra 2, R Carciumaru 1, M Smieja 2, JM Pernica 3

Background

Lower respiratory tract infections (LRTI) prompting hospitalization are common in pediatrics. Children with a bacterial cause for their illness should be given antibiotics, however establishing microbiological diagnoses is challenging. Molecular testing can reliably identify viral pathogens in nasopharyngeal swabs (NPS) but viral-bacterial coinfections are common and no criteria reliably identify bacterial pneumonia. Consequently, diagnostic tools that distinguish between bacterial and viral infections would be useful. Our aim was to investigate salivary C-reactive protein (CRP) and quantitative pneumococcal NPS carriage.

Methods

In this prospective study, we enrolled a convenience sample of previously healthy children hospitalized with LRTI between October 2015 and December 2018. Only those with respiratory signs/symptoms and fever (unless diagnosed with bronchiolitis) were eligible. Participants were categorized as: bronchiolitis, asthma exacerbation, uncomplicated pneumonia, pneumonia complicated by effusion, or indeterminate. S. pneumoniae NPS density was quantified via PCR. CRP levels were assayed in serum and salivary swabs.

Results

There were 118 eligible participants. The median age was 1.8 years (25–75 percentile 0.6–4.4 y). Forty-nine (42%) participants had bronchiolitis or asthma, 47 (40%) had pneumonia or an “indeterminate” diagnosis, and 22 (19%) had complicated pneumonia. Overall, 24% of participants had no respiratory virus detected, including 8% of the bronchiolitis/asthma group, 26% of the pneumonia/indeterminate group, and 55% of the complicated pneumonia group. There was no difference in pneumococcal NPS density seen between groups, though 26% of participants received antibiotics for >24 hours before collection. Serum CRP correlated with salivary CRP and varied significantly between groups, with highest values in complicated pneumonia and lowest in bronchiolitis/asthma.

Conclusions

In children with LRTI, pneumococcal carriage was not associated with bacterial pneumonia. Serum and salivary CRP were correlated and were lowest in children with viral disease. Salivary CRP merits further study as a non-invasive test to identify those at low risk for serious bacterial infection.

Off J Assoc Med Microbiol Infect Dis Can. 2019 Jul 11;4(Suppl):122–123.

IP09. Results of introducing a lab developed molecular assay for bacterial enteric pathogens that includes detection of STEC and Escherichia coli O157 on the BD MAX

C Rutherford 1,2, M Smieja 3, A Cabrera 4

Objective

To replace enteric culture with a Lab Developed Test (LDT) for Salmonella, Shigella, Campylobacter, Yersinia enterocolitica, Escherichia coli O157 and the stx1 and stx2 genes of STEC (Shiga toxin producing E. coli).

Methods

Validation compared culture to the LDT and used the BD Max IVD Enteric Panel for discordant resolution. Starting June 4th 2018, we tested exclusively with the molecular assay. The LDT is a Taqman multiplex in a two tube format. The base is Luna Universal Probe qPCR Kit (New England Biolabs). TNA2 strips are loaded on the BD Max with both master mixes and neutralization buffer. Sample buffer tubes are inoculated with 5ul stool in Cary Blair transport medium (Para-Pak™ Enteric Plus, Meridian Bioscience). BD Max extracts the nucleic acid, sets up the PCR and analyzes the results.

Results

There was an increase in detection by PCR for Salmonella, Shigella, Campylobacter and Yersinia versus culture. The ratio of non-O157 STEC to O157 STEC was 23:6 from 3,491 specimens (as of January 7, 2019). A method of isolating these strains was introduced. Culture of STEC was performed on Colorex STEC (CHROMagar, Paris France produced by Dalynn Biologicals, Canada). If the Colorex was no growth, the specimen was cultured to Urine Orientation agar (BBL). E. coli colonies were isolated to blood agar for identification and stx typing by singleplex PCR. A serogrouping PCR based on O antigens was done from the isolation. Various serogroups were detected including O26, O103, O118 and O113.

Conclusion

Molecular methods are more sensitive than culture for enteric pathogens. Molecular methods that detect STEC allow a greater appreciation of disease burden caused by these organisms versus O157:H7. The use of Chromogenic media to isolate STEC is recommended. The development of a typing PCR may permit rapid detection of local outbreaks.

Articles from Journal of the Association of Medical Microbiology and Infectious Disease Canada are provided here courtesy of University of Toronto Press

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