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An Outbreak of Pseudomonas aeruginosa Infection in Coronary Artery Bypass Graft Patients Related to Endoscopic Vein Harvesting Equipment.

Abstract Background Pseudomonas aeruginosa outbreaks have been associated with hospital water systems and endoscopic equipment. Twelve post-Coronary Artery Bypass Graft (CABG) patients were infected with a clonal strain of Pseudomonas aeruginosa, from October 2016 to February 2017. We describe the outbreak, and our investigation into the outbreak. Methods Multiple series of environmental sampling, solution and water system sampling were conducted during the outbreak. Samples were also taken from all equipment used in the CABG procedures. Samples were cultured by routine methods. Any growth of Pseudomonas aeruginosa isolated from these samples were compared with cultures from the patients for clonal relationship by using Pulse-field gel electrophoresis (PFGE). Results Pseudomonas aeruginosa was isolated from four environment and equipment samples. Two were from the waste-traps of two separate sinks in the Cardiac Intensive Care Unit, one from a suction bottle in the operating theatre, and one from the conical tips used for Endoscopic Vein Harvesting (EVH). A clonal relationship of 100% similarity was found by PFGE between 12 patients and the conical tips used for EVH. Conclusion Pseudomonas aeruginosa outbreaks can occur due to contaminated endoscopic vein harvesting equipment used in CABG due to poor sterilization methods and non-compliance to manufacturers recommendations. Disclosures All authors: No reported disclosures.

Background. Duodenoscopy, done 700,000 times annually, is potentially life saving in biliary and pancreatic disease. ERCP is prone to device associated infections due to a complex elevator mechanism and slim margin of safety in scope reprocessing with a high microbial burden. Nosocomial infections are difficult to detect without a marker organism or antibiotic phenotype. A cluster of ESBL infections was detected by electronic surveillance in 2014 in a large 865 bed facility.
Methods. Utilizing electronic surveillance, a line listing of ESBLs from the prior year was made, and antibiotic phenotypes examined. After chart review, one phenotype Pattern A clustered with ERCP. Scopes were quarantined and cultured; isolates were sent out for pulsed-field gel electropheresis, and gene sequencing;patients and providers were notified; patients were offered rectal screening; additional scopes and new AERs purchased; double scope AER reprocessing with peracetic acid was centralized for five hospitals in the healthcare system; centralized weekly scope microbial sampling and monitoring after reprocessing was implemented 10/2015 using CDC guidance of March 2015; and prospective electronic surveillance of ERCP procedures was begun.
Results. Twenty-two phenotypes of ESBLs were found. Scope, environmental, and AER cultures were negative. Pattern A organisms were clonal. 235 patients of 274 exposed underwent screening with no additional pattern A isolated. Prevalence of ESBL colonization in this exposed cohort in New England was 11%. Scope post-reprocessing sampling and cultures were positive in 2015 for low concern organisms 5% of cultures, and one positive culture for an organism of high concern. Currently culture positivity is 1.3%, with 0% organisms of high concern for 18 months. Contamination of the culture media did occur rarely initially, and was detected by controls. Prospective electronic surveillance has identified no additional clusters.
Conclusion. Electronic infection control surveillance will detect device associated infections, aid the investigation, and monitor procedures prospectively. The CDC guidance for weekly sampling and culturing after ERCP is easily implemented after an initial investment of training, additional scopes, and lab support; expected positivity will be < 2 %.
Disclosures. All authors: No reported disclosures.

Rapid Detection of Invasive Mycobacterium chimaera Infection by Using a Novel Plasma-Based Next-Generation Sequencing Assay
Jim Nomura, MD 1 ; Gunter Rieg, MD 2 ; Gary Bluestone, DO 3 ; Townson Tsai, nonspecific and growth by acid-fast bacilli (AFB) culture typically requires weeks, delaying confirmed diagnosis and possibly contributing to a high case fatality rate (CFR). We compared a novel plasma-based next-generation sequencing (NGS) assay with AFB culture for detection of Mc infection.
Methods. Mc cases were identified from February-April 2017 among patients with history of cardiac surgery performed at a Southern California hospital with known Mc exposure risk. A confirmed case was Mc infection identified by AFB culture; a probable case was MAC identified by AFB culture. AFB cultures from blood and biopsy samples were performed at the hospital laboratory. NGS assays on plasma were performed at an outside reference laboratory using an assay developed to detect cell-free pathogen DNA. Human DNA sequences were removed and pathogen reads were aligned against a reference-sequence database with a reportable range of >1,250 bacteria, fungi, protozoa, and viruses. Organisms present at a significance level above a