659. Correlate Clinically and More-Use of Interpretative Comments in Clinical Microbiology Reporting

Abstract Background Microbial identification & antibiotic susceptibility testing is an important investigation in clinical microbiology laboratory. In many centres in India the report has only the isolate and antibiotics tested. The additional comments if added give guidance to the clinicians to utilize the results. Pre-analytical issues of adequate & relevant clinical history, appropriate sampling techniques, timely transport & storage, history of antibiotic usage along with post analytical issues of recommended line of antibiotic therapy and infection control practices are better addressed with this practice. Methods This was a prospective qualitative study from the period of January 2017-March 2021 where in the standard operating protocol of Clinical Microbiology was reviewed and appropriate comments were included in the Laboratory Information System once the isolate was identified using VITEK 2, automated ID/AST instrument and interfaced. The Clinical Microbiologist would then review the comments upon discussion with the clinicians and then authorize reports. The reports included sample & isolate specific details , recommended antibiotic therapy and infection control related comments. This was based on standard international and national guidelines (CLSI, EUCAST, IDSA, IAP, and National Treatment Guidelines of India). Results There was a gradual improvement in completion of request forms with clinical history, sample site and antibiotic history being mentioned. This was assessed through periodic audits conducted every quarter from 36% in March 2017 to 95% in March 2021. Clinical communication with the microbiology laboratory also showed improvement with documentation. Feedback from clinicians was also taken on the utility of these comments, (87/120)72.5% of the clinicians found them useful(Grade 5). (32/120) 26 %(Grade 3) of the clinicians had concerns about the turnaround time and requested for provisional reports. Conclusion Interpretative comments in reports act as a bridge between clinical microbiology, infectious diseases and infection control. They help us to choose the correct antibiotics or sometimes no antibiotics when the situation demands it. With all the recent advancements, the clinico-microbiological utility of culture reports is the need of the hour. Disclosures All Authors: No reported disclosures


Conclusion.
These diagnostic testing patterns suggest a subset of patients with suspected rCDI have toxin concentrations below the EIA threshold for detection or may have an alternative cause of diarrhea, such as post-infectious IBS. Thus, the limitations of EIA toxin testing need to be considered in clinical practice when evaluating patients with compatible symptoms of rCDI and a high prior probability of infection. In contrast, in trials of investigational agents, toxin testing assures enrollment of patients with active disease and accurate estimates of efficacy.
Disclosures Background. Microbial identification & antibiotic susceptibility testing is an important investigation in clinical microbiology laboratory. In many centres in India the report has only the isolate and antibiotics tested. The additional comments if added give guidance to the clinicians to utilize the results. Pre-analytical issues of adequate & relevant clinical history, appropriate sampling techniques, timely transport & storage, history of antibiotic usage along with post analytical issues of recommended line of antibiotic therapy and infection control practices are better addressed with this practice.

Methods.
This was a prospective qualitative study from the period of January 2017-March 2021 where in the standard operating protocol of Clinical Microbiology was reviewed and appropriate comments were included in the Laboratory Information System once the isolate was identified using VITEK 2, automated ID/AST instrument and interfaced. The Clinical Microbiologist would then review the comments upon discussion with the clinicians and then authorize reports. The reports included sample & isolate specific details , recommended antibiotic therapy and infection control related comments. This was based on standard international and national guidelines (CLSI, EUCAST, IDSA, IAP, and National Treatment Guidelines of India).

Results.
There was a gradual improvement in completion of request forms with clinical history, sample site and antibiotic history being mentioned. This was assessed through periodic audits conducted every quarter from 36% in March 2017 to 95% in March 2021. Clinical communication with the microbiology laboratory also showed improvement with documentation. Feedback from clinicians was also taken on the utility of these comments, (87/120)72.5% of the clinicians found them useful(Grade 5). (32/120) 26 %(Grade 3) of the clinicians had concerns about the turnaround time and requested for provisional reports.

Conclusion.
Interpretative comments in reports act as a bridge between clinical microbiology, infectious diseases and infection control. They help us to choose the correct antibiotics or sometimes no antibiotics when the situation demands it. With all the recent advancements, the clinico-microbiological utility of culture reports is the need of the hour. Background. Blood cultures are the gold standard for diagnosing bloodstream infections and a vital part of the work-up in systemic infections. However, contamination of blood cultures represents a significant burden on patients and the healthcare system with increased hospital length of stay, unnecessary antibiotics, and financial cost. The data discussed here offer insight into blood culture contamination rates before and through the COVID-19 pandemic at a community hospital and the processes that were affected by the pandemic.

Effect of the COVID-19 Pandemic on Blood Culture Contamination Rates and Quality Improvement Processes
Methods. Blood culture contaminations were determined by using the number of sets of blood cultures with growth and the presence of an organism from the National Healthcare Safety Network's (NHSN) commensal organism. Contamination rates were evaluated by status as a standard unit or a COVID-19 isolation unit in either the emergency department (ED) or inpatient floor units. The identified four groups had different processes for drawing blood cultures, particularly in terms of training of staff in use of diversion devices. The electronic medical record was used to track contaminations and the use of diversion devices in the different units.
Results. The inpatient COVID units were consistently elevated above the other units and the institutional contaminant goal of 2.25%, ranging from 9.6% to 13.3% from 4/2020-9/2020. Those units were the primary driver of the increase in overall contamination rates. COVID ED nursing staff (that had previously undergone training in the use of diversion devices) used diversion devices to draw 51 of 133 (38.3%) cultures compared to only 15 of 84 (17.9%) on the COVID inpatient units.    Conclusion. Evaluation revealed that nursing staff with less training in blood culture collection, particularly the use of diversion devices, were the primary staff collecting blood cultures in the inpatient COVID units. The difference in training is felt to be the primary driver of the increase in contaminants in the inpatient COVID units. The marked increase in contaminations highlights the difficulties of maintaining quality control processes during an evolving pandemic and the importance of ongoing efforts to improve the quality of care. These findings demonstrate the importance of training and routine use of procedures to reduce contaminations even during.
Disclosures. Background. Metagenomic next-generation sequencing (mNGS) of microbial cell-free DNA (mcfDNA) allows for non-invasive broad-range pathogen detection from plasma. The Karius® test that emerged in 2016 made mNGS widely available. However, there is little data describing the optimal role for this assay in clinical decision making.
Methods. We performed a single-center retrospective cohort study of adult patients for whom a Karius test was sent between May 2019 and February 2021 to assess clinical utility. We predefined criteria for clinical impact categories (Table 1) and stratified data by patient comorbidities, infectious syndromes, duration of antimicrobial therapy prior to Karius testing, reasons for sending the test, and final clinical diagnoses. Clinical impact was arbitrated by all authors after review and discussion of each case.