Background Drug-resistant gram-negative (GN) pathogens are a common cause of neonatal sepsis in low- and middle-income countries. Identifying GN transmission patterns is vital to inform preventive efforts. Methods We conducted a prospective cohort study, 12 October 2018 to 31 October 2019 to describe the association of maternal and environmental GN colonization with bloodstream infection (BSI) among neonates admitted to a neonatal intensive care unit (NICU) in Western India. We assessed rectal and vaginal colonization in pregnant women presenting for delivery and colonization in neonates and the environment using culture-based methods. We also collected data on BSI for all NICU patients, including neonates born to unenrolled mothers. Organism identification, antibiotic susceptibility testing, and next-generation sequencing (NGS) were performed to compare BSI and related colonization isolates. Results Among 952 enrolled women who delivered, 257 neonates required NICU admission, and 24 (9.3%) developed BSI. Among mothers of neonates with GN BSI (n = 21), 10 (47.7%) had rectal, 5 (23.8%) had vaginal, and 10 (47.7%) had no colonization with resistant GN organisms. No maternal isolates matched the species and resistance pattern of associated neonatal BSI isolates. Thirty GN BSI were observed among neonates born to unenrolled mothers. Among 37 of 51 BSI with available NGS data, 21 (57%) showed a single nucleotide polymorphism distance of ≤5 to another BSI isolate. Conclusions Prospective assessment of maternal GN colonization did not demonstrate linkage to neonatal BSI. Organism-relatedness among neonates with BSI suggests nosocomial spread, highlighting the importance of NICU infection prevention and control practices to reduce GN BSI.

Background Neonatal infections with resistant Gram-negative (GN) organisms are associated with high rates of mortality, with limited antibiotic treatment options. The role of maternal colonization and environmental GN organisms as reservoirs for transmission to neonates has not been well described. Methods We performed a prospective cohort study from October 12, 2018, until October 31, 2019, to describe the role of maternal and environmental GN colonization in BSI among neonates admitted to the neonatal intensive care unit (NICU) at a tertiary care center in Pune, India. Women admitted to Labor & Delivery with risk factors for neonatal sepsis who provided consent were enrolled and their neonates were followed until hospital discharge. For neonates who developed bloodstream infection (BSI), colonization with resistant GN organisms was assessed in their mothers from frozen vaginal and rectal swabs collected at enrollment and at delivery and in the neonates from frozen skin swabs and peri-rectal swabs collected at day of life (DOL) 0, 3, 7, and weekly until discharge. Environmental colonization was assessed with weekly sampling of unit sinks and the immediate neonatal care environment. Colonization samples were processed to identify organisms that matched neonatal blood culture isolates. Results 953 women were enrolled, of whom 741 (78%) received antepartum antibiotics. Among 987 live born neonates, 12 (1%) died in the delivery room and 257 (26%) required NICU admission. Among neonates admitted to the NICU, 143 (56%) had at least one blood culture, of which 28 (20%) were positive; 21 (75%) had a GN BSI. The most common cause of neonatal BSI was Klebsiella pneumoniae, and 8 (38%) GN BSI were due to a carbapenem-resistant organism. No organism isolated from maternal samples matched organism and resistance pattern from neonatal blood culture. Matching strains were found in unit sinks and neonatal rectal and skin samples (Figure 1). Organism recovery from swabs and match to bloodstream isolate by sample source and time of collection from birth Conclusion Among neonates born to mothers with risk factors for neonatal sepsis, GN organisms were the most common cause of neonatal BSI. Environmental and neonatal colonization may represent important reservoirs of transmission for these pathogens among neonates hospitalized in a tertiary care NICU in Pune, India. Disclosures All Authors: No reported disclosures

Introduction: Blood is a valuable resource & Ideally  in  a  good  set  up,  wastage  of  blood  and  blood products should never occur. But to maintain balance between demand and supply of blood and blood products blood banks have to keep adequate and satisfactory stock of blood all the time, still a very small amount of blood wasting in blood bank can occur. Aims & objectives: Present study was undertaken to analyse the causes of discarded whole blood units, discard rate and the measures to reduce number of discard in blood bank attached to tertiary care institute. Material and Methods: In present study yearly data of whole blood discarded units & yearly collection of 10 years from 2010-2019 was collected from the discard registers & yearly reports of blood bank, govt. medical college, akola and analysed. Results & Conclusion: It has been found that out of total 77514 whole blood units which were collected, 2276 (2.93%) whole blood units were discarded. Of the total discarded whole blood units, 966 (42.44%) were discarded due to seropositivity for TTI, 801 (35.19%) due to insufficient quantity, 378 (16.61%) due to expiry, 112 (4.92%) due to other causes & 19 whole blood units were hemolysed. Blood stock and quality management system, Trained, dedicated & adequate staff, properly functioning blood transfusion committee to monitor activities of blood transfusion service and timely implementation of guidelines are the pre-requisites to provide safe and effective blood and to minimize discard of blood. Keywords: Blood, valuable resource, discard, TTI, quality management system