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BackgroundColonized patients represent a reservoir for transmission to other non-colonized patients for health institutions, so surveillance measures and contact precautions have been taken in the worldwide to mitigate transmission. However, despite the different interventions implemented, factors associated with persistence have not been evaluated in our context. This study aimed to describe the persistence of colonization in patients with multidrug-resistant organisms (MDROs) re-admitted to a health institution.MethodsA retrospective observational study was conducted. Patients re-admitted with a previous positive rapid test for MDROs, who had received chlorhexidine bathing and contact precautions during hospitalization were included. Samples were obtained from two rectal and one nasal swap. Colonization was defined as MDRO detection in at least one anatomical site, in the absence of symptoms or signs of infection. Persistence was defined as two positive screening for the same MDRO. Laboratory tests were chromID®, CHROMID® CARBA and MacConkey agar. VITEK MS® MALDI-TOF conducted MDROs genus identification, and carbapenem-resistant was evaluated through Sensi-Disc™. Logistic regression was performed to examine any association between persistence and clinical data.ResultsA total of 4,362 screening for MDROs was analyzed form July 2015 to December 2016, and 142 patients were included in the study; the median age was 39 years (IQR=12–62) and 56% were male. The most frequent MDRO was carbapenem-resistant Enterobacteriaceae. There was a statistically significant difference in length of hospitalization (P = 0.003) and ICU (P = 0.035) between non-colonized and persistence of colonization. Factor associated with persistence of colonization included liver disease [OR=3.1; 95% CI: 1.068–9.019; P = 0.037], history of infection in the last year [OR=3.78; 95% CI: 1.036–13.839; P = 0.044], use of permanent urinary catheter [OR=6.48; 95% CI: 1.314–31.975; P = 0.022], history of gastrostomy before hospitalization [OR=5.37; 95% CI: 1.547–18.638; P = 0.008], and use of nasogastric tube [OR=5.14; 95% CI: 1.108–23.861; P = 0.036].ConclusionIt is necessary to consider the previous history of infection in the last year, and other patient’s comorbidities and conditions as risk factors of persistence to colonization by MDROs.Disclosures All authors: No reported disclosures.

BackgroundCRE colonized patients that undergo HSCT have a higher incidence of CRE bacteremia, especially during the initial neutropenic period, with a high mortality rate. This situation is critical in countries highly endemic for CRE such as Colombia. It is necessary to find measures that decrease the occurrence of this infection, permitting a safer transplant. Daily CHX bathing could be effective reducing this risk.MethodsSince March 2014 in our hospital in Cali, Colombia, all adult patients admitted to the HSCT unit were peri-rectal screened for CRE colonization, and then CHX daily bathing (CHX 4% soap or CHX 2% pads) was used regardless of the screening results. Prospectively all type of microorganism bacteremia were recorded from 2014 to 2017. We compare bacteremia, and CRE bacteremia rates between CRE colonized vs. non-colonized patients. We compared the annual proportion of CRE bacteremia in this two groups. Nonparametrical statistic χ2 for trend was used to compare the difference.ResultsWe analyzed data collected from 155 patients from July 2014 to June 2017. There were 39.5% females, and the average age was 42 years, 60% were autologous, and 40% were allogeneic. The total of CRE colonized patients was 25/155 (16%), and the overall of bacteremia was 54/155 (34%). All type of microorganism bacteremia and CRE bacteremia were more frequent in CRE Colonized patients. (52% vs. 31% and 24% vs. 3,8%, RR: 6.24, 95% CI 2.06–18.8, P = 0.002). With the increase in compliance with CHX bathing, there was a decreasing trend in CRE bacteremia in the colonized patient, dropping from 50% during 2014, to 14% in 2017 (OR 0.167; P = 0.21).ConclusionDaily CHX bathing in the CRE colonized patient reduce the incidence of CRE bacteremia in HSCT patients. We propose this intervention as a significant protective measure in CRE colonized hospitalized patients.Disclosures All authors: No reported disclosures.

BackgroundColombia is an endemic country for CRE infections, with an increased rate of hospital-acquired infection due to this microorganism. Therefore, we have a high empirical use of carbapenem, colistin, and polymyxin B in nosocomial suspected septic patients. Infection control strategies could reduce CRE infection rates and lower antibiotic consumption.MethodsSince 2014, a Comprehensive Infection control strategy was implemented in our hospital. This strategy included: (1) Hospital daily CHX bathing (4% soap or 2% pads) was applied to all patients in our institution (intensive care units and medical/surgical wards). Additionally, recommendations for patient care were provided to patients and family. (2) Active surveillance of perirectal CRE screening was implemented toward high suspected patients. (3) Isolation of all CRE colonized or-infected patient, and gloves use, and alcohol for hand sanitation was reinforced. To evaluate the effectiveness of this strategy, annually nosocomial infection rates due to CRE were compared. Defined daily dose (DDD) of polymyxin B use was obtained annually.ResultsAfter introducing this protocol, we found a progressive decrease in CRE bacteremia from 2.24 infections per 10,000 patients-day in 2014, to 1, 26 during 2015, 0.92 in 2016 and 0.78 infections per 10,000 patients day during 2017. This was also correlated to a decrease in the use of polymyxin in the adult population, DDD drop from 2.36 to 1.06.ConclusionUniversal hospital daily CHX bathing, CRE screening, and Isolation as a comprehensive strategy was effective decreasing CRE nosocomial infections and polymyxin use.Disclosures All authors: No reported disclosures.