Syed, Sadia

Abstract Background We aim to investigate the incidence, clinical presentation, management, and outcome of infections due to Actinotignum species observed at Mayo Clinic Rochester over the last 5 years. Methods We searched the clinical microbiology laboratory database to identify isolates of Actinotignum spp. from all body sites between January 1, 2014 and December 31, 2018. Results Fifty-four patients with positive culture with Actinotignum were identified. Mean age was 67 years and 27 (50%) had an underlying urogenital condition. Actinotignum was isolated in 26 urine cultures, 6 blood cultures, 12 abscess fluid cultures, and 10 bone/joint tissue cultures (Table 1). Fifteen (28%) specimens were monomicrobial while 39 (72%) were polymicrobial. Recovery from urine cultures was interpreted as colonization in 11 (20%) cases. Of the 54 patients with positive cultures, 43 patients had Actinotignum-associated clinical infection; 15 (35%) with urinary tract infections (11 with cystitis and 4 with pyelonephritis), 12 (28%) with abscesses (skin, intraabdominal, and surgical site infections), 10 (23%) with bone/joint infection, and 6 (14%) with bacteremia (Table 2). Most frequently isolated species was A. schaalii (n = 40); followed by 2 cases of A. sanguinis. Susceptibility testing (n = 40) showed that all stains were susceptible to penicillin (MIC< = 0.5), 36% were susceptible to clindamycin (MIC < = 2) and 10% susceptible to metronidazole (MIC < = 8). There was no recurrence of Actinotignum-related infections in any of the treated cases. Two patients with bone/joint infection underwent repeat surgical intervention due to worsening infection while on antibiotic treatment prior to resolution of infection. There was 1 death in a patient with bacteremia (polymicrobial) who had presented with a massive stroke (Table 3). Conclusion A. schaalii was most commonly associated with urinary tract infections followed by abscesses and bone/joint infections in elderly population. Majority of the infections were polymicrobial. All tested isolated were susceptible to penicillin; however, resistance was frequent for clindamycin and metronidazole. All appropriately treated patients had resolution of infection without recurrence from Actinotignum, except for one patient with bacteremia who died from massive stroke Disclosures All authors: No reported disclosures.

Context.— Blood culture contamination is a common problem faced by medical centers and leads to significant cost. A possible method to reduce contamination is to discard the initial aliquot of blood, which contains skin and bacteria. Objective.— To determine whether the rate of contaminant blood cultures could be reduced by changing the order of draw to divert the first 7 mL to a gold- or green-top tube. Design.— A preintervention and postintervention study was conducted. During the 18-month intervention phase (September 2015–February 2017), all nurses in the emergency department and inpatient floor phlebotomists collected blood cultures by drawing the first 7 mL of blood into a gold- or green-top tube followed by drawing blood for blood culture bottles. The 18 months immediately preceding the study period (February 2014–July 2015) were used for comparison. Results.— There was an overall statistically significant decrease in contamination rate from 2.46% in the prediversion protocol group to 1.70% in the postdiversion protocol group (P < .001). Emergency department drawn cultures and inpatient cultures showed significant decrease in contamination rates between the preprotocol and postprotocol groups, 2.92% versus 1.95% (P < .001) for emergency department, and 1.82% versus 1.31% (P = .03) for inpatient. We noted less month-to-month variation during the study period compared with the preintervention period. Conclusions.— By using this simple diversion method, we were able to improve blood culture contamination rates for our emergency department and inpatients while incurring no added cost to the procedure.