321Screening Strategy to Detect Vancomycin-Resistant Enterococci Conversion in Exposed Roommates
Bibliographic record
Abstract
Background. The Ontario Provincial Infectious Diseases Advisory Committee recommends screening VRE roommate contacts on different days, with one taken at minimum of 7 days post exposure (PE). This study aimed to better delineate the risk of conversion, by duration of exposure, and the optimal screening strategy after inadvertent exposure to VRE-positive roommates at a 430 bed community teaching hospital in Toronto, Canada. Methods. All exposed roommates from December 2004 to March 2014 were screened for VRE at 3 time periods PE, as per protocol: T1 (0-1 day PE), T2 (2-4 days PE), and T3 (5-10 days PE) by rectal swab culture. Screens undertaken ≥11 days PE were grouped as T4. The sensitivity at various time periods for detecting newly colonized roommates were determined and defined as the number of patients who were culture positive at the specific time period(s) divided by the total number of VRE converted patients (from any follow-up period) who were swabbed at the specific time period(s). Results. Among 377 exposure episodes (367 patients), 253 (67%) had complete follow-up. VRE conversion was detected in 17 of the 253 episodes (7%). The sensitivity at each time period was: T1 = 58%, T2 = 63%, T3 = 75%, and T4 = 78%. Thirteen of the 17 VRE conversions (76%) were detected by 10 days (T3). Testing more than once, with at least one done at T3, achieved a higher sensitivity than testing at T1 alone (T1/T3 combined = 100%, p = 0.11 or T2/T3 combined = 100%, p = 0.24). Of those with first conversions at T4, none were screened more than once prior to T4 and the median time to positive test was 22 days. Contacts exposed to VRE patients for ≥3 days were significantly more likely to acquire VRE (11%) than those with <72 hours exposure (2.4%, p = 0.01). Nonetheless, the conversion rate was significantly higher for those exposed <72 hours compared with the overall prevalence found on admission (2.4% vs 0.17%, p < 0.001). All patients were colonized; no infections developed in this cohort. Conclusion. Roommates exposed to VRE patients are at substantial risk of becoming colonized, with the degree of risk increasing in those exposed for ≥3 days. Our data supports the provincial guidelines of screening exposed roommates at multiple times with at least one taken at 7 days PE. Disclosures. All authors: No reported disclosures.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".