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  • 1
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 10, No. 7 ( 2023-07-01)
    Abstract: Respiratory syncytial virus (RSV) disease in older adults is undercharacterized. To help inform future immunization policies, this study aimed to describe the disease burden in Canadian adults aged ≥50 years hospitalized with RSV. Methods Using administrative data and nasopharyngeal swabs collected from active surveillance among adults aged ≥50 years hospitalized with an acute respiratory illness (ARI) during the 2012–2013, 2013–2014, and 2014–2015 influenza seasons, RSV was identified using a respiratory virus multiplex polymerase chain reaction test to describe the associated disease burden, incidence, and healthcare costs. Results Of 7797 patients tested, 371 (4.8%) were RSV positive (2.2% RSV-A and 2.6% RSV-B). RSV prevalence varied by season from 4.2% to 6.2%. Respiratory virus coinfection was observed in 11.6% (43/371) of RSV cases, with influenza A being the most common. RSV hospitalization rates varied between seasons and increased with age, from 8–12 per 100 000 population in adults aged 50–59 years to 174–487 per 100 000 in adults aged ≥80 years. The median age of RSV cases was 74.9 years, 63.7% were female, and 98.1% of cases had ≥1 comorbidity. Among RSV cases, the mean length of hospital stay was 10.6 days, 13.7% were admitted to the intensive care unit, 6.4% required mechanical ventilation, and 6.1% died. The mean cost per RSV case was $13 602 (Canadian dollars) but varied by age and Canadian province. Conclusions This study adds to the growing literature on adult RSV burden by showing considerable morbidity, mortality, and healthcare costs in hospitalized adults aged ≥50 years with ARIs such as influenza.
    Type of Medium: Online Resource
    ISSN: 2328-8957
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
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  • 2
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 9, No. Supplement_2 ( 2022-12-15)
    Abstract: The spread of carbapenemase-producing Enterobacterales (CPE) is global threat. Numerous outbreaks of CPE have been reported during the COVID-19 pandemic. We describe the impact of of the SARS-CoV-2 pandemic on the emergence of CPE in south-central Ontario, Canada. Incidence of clinical isolates of CPE and isolates with different CPE genes in Toronto/Peel region, 2017–2021. The upper panel shows the incidence of patients with clinical isolates of CPE by year and quarter from q4 2007 to q1 2022. The lower panel shows the incidence of patients with clinical isolates with different carbapenemase genes by fiscal year during the same period. Methods TIBDN has performed population-based surveillance for CPE in Toronto/Peel region (pop 4.5M) from first identified isolate in 2007. All laboratories test/refer all carbapenem non-susceptible Enterobacterial isolates for identification of CPE. Hospital charts are reviewed and patients/physicians interviewed. Population data are obtained from Statistics Canada. Results From 10/2007 to 3/31/2022, 1367 persons colonized or infected with CPE were identified. Their median age was 68.7yrs (IQR 54–78yrs); 761 (56%) were male. 772 (56%) were colonized when first identified; 115 (8.4%) were bacteremic at identification or subsequently developed bacteremia. The most common organisms were E. coli (651, 48%), K. pneumoniae (436, 32%), Enterobacter spp. (146, 11%), Citrobacter spp (62, 5%); the most common genes were NDM±OXA-48 (722, 53%), OXA-48-like (341, 25%), KPC (225, 16%), VIM (44, 3%). The incidence of CPE infections increased steadily until 3/2020 then declined by 61% and remained stable until 3/2022 (Figure, upper panel). The decline was greater for E. coli (56% decrease), K. pneumoniae (62%) than for Enterobacter spp. (30%) and other species (19%). It occurred in all genes in 2020; however, KPC containing organisms increased again in 2021 (Figure, lower panel). Conclusion The advent of the COVID-19 pandemic was associated with an immediate, substantial decline in the incidence of patients with CPE in our population area. This decline occurred in both isolates with genes usually occurring in cases imported from other countries, and in those usually occurring in cases associated with transmission within Canadian hospitals. Decreased travel and enhanced infection prevention and control in hospitals may both have contributed to reductions in CPE during the pandemic. Disclosures All Authors: No reported disclosures.
    Type of Medium: Online Resource
    ISSN: 2328-8957
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
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  • 3
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 7, No. Supplement_1 ( 2020-12-31), p. S459-S460
    Abstract: The hospital water environment is a CPE reservoir, and transmission of CPE from drains to patients is a risk. Methods We cultured sink and shower drains in patient rooms and communal shower rooms that were exposed to inpatients with CPE colonization/infection from October 2007 to December 2017 at 10 hospitals. We compared patient room drain CPE to prior room occupant CPE using Illumina and MinION whole-genome sequencing. Results Three-hundred and ten inpatients exposed 1,209 drains, of which 53 (4%) yielded 62 CPE isolates at 7 (70%) hospitals. Compared to room occupant CPE isolates, drain CPE isolates were more likely Enterobacter spp. (6, 10% vs. 25, 51%, p & lt; 0.0001) or KPC-producers (9, 15% vs. 23, 47%, p=0.0002). Of the 49 CPE isolates in patient room drains, 4 (8%) were linked to a prior room occupant (Table), 24 (49%) had the same carbapenemase as a prior room occupant but isolates/carbapenemase gene-containing plasmids that were unrelated, and 21 (43%) did not share a carbapenemase with a prior room occupant. The 4 drains linked to prior room occupants were likely contaminated by these room occupants, who were CPE-colonized prior to drain exposure. Despite few links between drain and room occupant CPE, there were 10 isolates harbouring related blaNDM-1-containing IncHI2A/HI2-type plasmids in 8 rooms on two units at one hospital. Nine of these were Enterobacter hormaechei ST66 isolates that were 0 to 6 SNVs apart and one was a Klebsiella oxytoca STnovel isolate. Table. Four patient room drain CPE isolates (D1b, D4, D5, D12) and isolates from prior room occupants that they were related to by whole-genome sequencing. Conclusion It was uncommon for drain CPE to be linked to prior patient exposure. This suggests contamination of most drains by undetected colonized patients and a need for more aggressive patient screening in our hospitals. This may also suggest retrograde (drain-to-drain) transmission, especially considering the 10 isolate drain cluster at one hospital. Reasons for the preponderance of Enterobacter spp. in drains requires further study. Disclosures Allison McGeer, MD, FRCPC, GlaxoSmithKline (Advisor or Review Panel member, Research Grant or Support)Merck (Advisor or Review Panel member, Research Grant or Support)Pfizer (Research Grant or Support)
    Type of Medium: Online Resource
    ISSN: 2328-8957
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
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  • 4
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 6, No. Supplement_2 ( 2019-10-23), p. S441-S441
    Abstract: Hospital drains may be a source of CPE in patients. We determined prevalence of and risk factors for CPE contamination of hospital drains exposed to patients with CPE colonization/infection. Methods We cultured hand hygiene and patient use sink as well as tub/shower drains exposed to 310 inpatients colonized/infected with CPE in 10 Ontario hospitals. A multi-level logistic regression model was fitted to determine whether type of drain/room/unit was associated with CPE drain contamination. Drain and room occupant CPE isolates underwent Illumina whole-genome and MinION sequencing. Single nucleotide variant (SNV) phlogenomic analyses and plasmid characterization were performed. Results 53/ Of the 1,209 drains, 53 (4%) at 7 (70%) hospitals yielded CPE. Patient room shower drains were significantly more likely to yield CPE than hand hygiene sink (OR 3.35, 95% CI 1.61–6.97) and patient use sink (OR 10.89, 95% CI 3.62–32.80) drains. Hand hygiene sink drains were significantly more likely to yield CPE than patient use sink drains (OR 3.26, 95% CI 1.05–10.13). 8 (15%) drain isolates matched the room occupant CPE gene/species; 24 (44%) matched the gene but not species, and 23 (42%) matched neither gene nor species. Among 13 drain/11 room occupant pairs with molecular comparisons to date, only 1/13 (8%) drain isolates matched the respective room occupant carbapenemase allele and replicon harboring the carbapenemase gene (IncN replicon harboring blaKPC-3). In addition, one drain isolate had a plasmid highly related to plasmids of 2 isolates from a patient occupying a room in an adjacent unit (IncN3 replicons harboring blaKPC-2). At another hospital, all 6 drain isolates were located on one unit and had an IncHI2A/HI2/TrfA replicon harboring blaNDM-1; 5 of these were E. cloacae ST66, with 0–3 SNV differences observed between isolates. Conclusion Different drain types have different risks of CPE contamination. In our setting, most drain contamination was not caused by recognized room occupants. Further investigation is needed to understand the sources of hospital drain CPE contamination. Disclosures All authors: No reported disclosures.
    Type of Medium: Online Resource
    ISSN: 2328-8957
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
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  • 5
    In: Antimicrobial Stewardship & Healthcare Epidemiology, Cambridge University Press (CUP), Vol. 3, No. S2 ( 2023-06), p. s112-s113
    Abstract: Background: Data regarding the effects of the SARS-COV-2 (COVID-19) pandemic on healthcare-associated infections (HAIs) in Canadian acute-care hospitals are limited. We examined the impact of the COVID-19 pandemic on HAIs and antimicrobial resistant organisms in hospitals participating in the Canadian Nosocomial Infection Surveillance Program. Methods: We analyzed 13,406 HAIs including adult mixed intensive care unit (ICU) central-line–associated bloodstream infections (CLABSIs), and healthcare-associated (HA) Clostridioides difficile infection (CDI), methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSI), vancomycin-resistant Enterococcus (VRE) BSI, and carbapenemase-producing Enterobacterales (CPE) infections collected using standardized case definitions and questionnaires from 29–64 hospitals participating in the Canadian Nosocomial Infection Surveillance Program (CNISP) from January 2018 to December 2021. We used a generalized linear mixed model with quasi-Poisson distribution to assess step and slope changes in monthly HAI rates between the pre–COVID-19 pandemic period (January 1, 2018–February 29, 2020; 26 time points) and the COVID-19 pandemic period (March 1, 2020–December 31, 2021; 22 time points). Results were reported as incidence rate ratios (IRRs) with 95% confidence intervals (CIs) and adjusted for seasonality, hospital clustering, and hospital characteristics of interest. Results: In the CNISP network, 7,352 (55%) HAIs were reported in the prepandemic period and 6,054 (45%) in the pandemic period. Median age was significantly younger during the pandemic period compared to the prepandemic period among patients with HA-CDI, HA-MRSA BSI, and adult mixed ICU CLABSIs, and more than half of cases among all reported HAIs were male (range, 52%–65%). The 30-day all-cause in-hospital mortality rate did not significantly change between the prepandemic and pandemic periods for all reported HAIs and was highest among HA-VRE BSIs (34%). Modeling results indicated that the COVID-19 pandemic was associated with an immediate increase in HA-CDI and adult mixed ICU CLABSI rates whereas HA-MRSA BSI, HA-CPE and HA-VRE BSI rates immediately decreased. However, pandemic status did not have a statistically significant lasting impact on monthly rate trends for all reported HAIs after adjusting for seasonality, clustering, and hospital covariates (Fig. 1 and 2). Adjusted IRRs for all HAIs ranged from 1.00 to 1.01 (95% CI, 0.94–0.99 to 1.01–1.05). Conclusions: Although the COVID-19 pandemic placed a significant burden on the Canadian healthcare system, the immediate impact on monthly rates of HAIs in Canadian acute-care hospitals was not sustained over time. Understanding the epidemiological effects of the COVID-19 pandemic in the context of changing patient populations, and clinical and infection control practices, are essential to inform the continued management and prevention of HAIs in Canadian acute-care settings. Disclosures: None
    Type of Medium: Online Resource
    ISSN: 2732-494X
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2023
    detail.hit.zdb_id: 3074908-6
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  • 6
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 4, No. suppl_1 ( 2017), p. S573-S574
    Type of Medium: Online Resource
    ISSN: 2328-8957
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2017
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  • 7
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 5, No. suppl_1 ( 2018-11-26), p. S293-S294
    Abstract: To inform public health decision making around influenza prevention and treatment, ongoing surveillance of the influenza burden of disease and assessment of influenza vaccine effectiveness (VE) is critical. The Canadian Immunization Research Network (CIRN) Serious Outcomes Surveillance (SOS) Network conducts active surveillance each influenza season to characterize the burden of influenza disease and to provide estimates of influenza VE to prevent influenza-related hospitalization in Canadian adults (≥16 years of age). Methods Active surveillance for influenza was conducted at 13 hospitals in four provinces beginning on November 15, 2016 and ending April 30, 2017. Patients admitted with any respiratory diagnosis or symptom were eligible for enrolment. Eligible patients had a nasopharyngeal swab collected and tested for influenza using polymerase chain reaction (PCR). Patients who tested positive for influenza were considered cases; patients who tested negative for influenza were eligible to become matched controls. Detailed demographic and medical information were obtained from the medical record. Influenza VE was estimated as 1 − odds ratio (OR) of influenza in vaccinated vs. unvaccinated patients × 100% using conditional logistic regression, with corresponding 95% confidence intervals (CIs). Results A total of 1,431 influenza cases were enrolled; the majority were influenza A (n = 1,299) and 100% of patients with known influenza A subtype were A/H3N2. Among all influenza cases, 144 (10.1%) patients were admitted to the intensive care unit (ICU) and 91 (6.4%) patients died within 30 days of discharge. Overall adjusted influenza VE for prevention of influenza-related hospitalization in all ages was 23.3% (95% CI: 2.9–39.4%), with slightly lower VE observed in patients ≥65 years (VE: 19.4%; 95% CI: −7.8–39.8%) and higher VE observed in patients & lt;65 years (VE: 47.9%; 95% CI: 9.9–69.9%). Conclusion Overall, influenza VE was low but effective (VE: 23%) for preventing influenza-related hospitalization during the 2016–2017 season in Canada. Given the low influenza VE observed, continued assessment of influenza VE is crucial to inform immunization policy in Canada and to emphasize the importance of the development and utilization of improved influenza vaccines. Disclosures M. K. Andrew, GSK: Grant Investigator, Research grant. Pfizer: Grant Investigator, Research grant. sanofi pasteur: Grant Investigator, Research grant. T. F. Hatchette, GSK: Grant Investigator, Research grant. Pfizer: Grant Investigator, Research grant. Abbvie: Consultant, Speaker honorarium. J. McElhaney, GSK: Scientific Advisor, Speaker honorarium. sanofi pasteur: Scientific Advisor, Speaker honorarium. A. McGeer, GSK: Grant Investigator, Research grant. Hoffman La Roche: Grant Investigator, Research grant. sanofi pasteur: Grant Investigator, Research grant. A. Poirier, sanofi pasteur: Investigator, Research grant. Actelion: Grant Investigator, Research grant. J. Powis, GSK: Grant Investigator, Research grant. Merck: Grant Investigator, Research grant. Roche: Grant Investigator, Research grant. Synthetic Biologics: Investigator, Grant recipient. M. Semret, GSK: Grant Investigator, Research grant. Pfizer: Grant Investigator, Research grant. S. Trottier, CIHR: Grant Investigator, Research grant. S. A. McNeil, GSK: Grant Investigator, Research grant. Pfizer: Grant Investigator, Research grant. Merck: Collaborator and Consultant, Contract clinical trials and Speaker honorarium. Novartis: Collaborator, Contract clinical trials. sanofi pasteur: Collaborator, Contract clinical trials.
    Type of Medium: Online Resource
    ISSN: 2328-8957
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2018
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  • 8
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 3, No. suppl_1 ( 2016-12-01)
    Type of Medium: Online Resource
    ISSN: 2328-8957
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2016
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  • 9
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 3, No. suppl_1 ( 2016-12-01)
    Type of Medium: Online Resource
    ISSN: 2328-8957
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2016
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  • 10
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 6, No. Supplement_2 ( 2019-10-23), p. S955-S956
    Abstract: In Ontario, Canada, PCV13 is covered for immunocompromised (IC) adults over 50y. PCV13 programs are thought not to be cost-effective in other adults because it is assumed that herd immunity from pediatric vaccination programs (PCV7 since 2005; PCV13 since 2010) will reduce PCV13 disease burden dramatically in adults. We analyzed data from the Toronto Invasive Bacterial Diseases Network (TIBDN) to ask whether PCV13-type invasive pneumococcal disease (IPD) in adults persists in our population. Methods TIBDN performs population-based surveillance for IPD in Toronto+Peel Region, Ontario (pop4.1M). All microbiology laboratories receiving specimens from residents report cases of IPD and submit isolates to a central study lab for serotyping; annual audits are conducted. Demographic, medical and vaccination information are obtained from patients, families and physicians. Population data are from Statistics Canada. Results Since 1995, 10,365 episodes of IPD have been identified; detailed medical information was available for 9,801 (95%) and serotyping for 9411 (91%). Among 8658 adult cases, 4,273 (49%) were in those aged 15–64 years, and 4,285 (51%) in those aged 〉 645 years. The most common diagnoses were pneumonia (5,978/8,025, 74%) and bacteremia without focus (1,030, 13%); 470 (4.6%) cases had meningitis; the case fatality rate (CFR) was 21%. The incidence of disease due to STs in PCV13 in adults declined from 7.0/100,000/year 2001 to 2.9/100,000/year in 2015–2018 and was stable from 2015–2018 (Figure 1). The incidence was 〉 5/100,000/year in non-IC patients over 65 years, and younger patients with cancer and kidney disease (Figure 2). In IPD from 2015 to 2018, adult patients with PCV13 ST disease were younger (median age 64 years vs. 67 years, P = .03) than other patients; there was no significant difference in the proportion with at least one underlying chronic condition (253, 69% PCV13ST, vs. 541,74% other ST, P = 0.08), or in CFR (59, 16% PCV13 vs. 145, 20% other, P = 0.13). The ST distribution of cases due to PCV13 STs is shown in Figure 3. Conclusion A significant burden of IPD due to PCV13 serotypes persists in adults in our population despite 8 years of routine pediatric PCV13 vaccination. This burden needs to be considered in assessing the value and cost-effectiveness of PCV programs for adults. Disclosures All authors: No reported disclosures.
    Type of Medium: Online Resource
    ISSN: 2328-8957
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
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