Low level of resistance to major diseases such as ascochyta blight (AB), botrytis grey mould (BGM) and dry root rot (DRR) in the cultivated chickpea genepool necessitates harnessing wild Cicer species. Sixty-eight accessions belonging to eight annual wild Cicer species and seven chickpea cultivars were screened for AB, BGM and DRR under controlled environmental conditions over the years. Intra-accession variability was observed among wild Cicer accessions for each disease. Hence, progenies of single resistant plants were selected for further evaluations and the trait-specific genetic stocks (TGS) were developed for each disease after re-screening following the single seed descent method. For AB, a high level of resistance was identified in four accessions belonging to tertiary genepool species, ICC 17334 (Cicer judaicum), ICC 17302, ICC 17308 and ICC 20177 (C. bijugum). Nine accessions, ICC 17160, ICC 17264, ICC 17270, ICC 20170, ICC 20186, ICC 20225, ICC 20247, ICC 20251 and IG 72941 of primary (C. reticulatum) and one accession, ICC 20190 of secondary (C. echinospermum) genepool species were resistant to BGM whereas, four accessions, ICC 20187 (C. reticulatum) and ICC 20218, ICC 20244 and ICC 20257 (C. echinospermum) were resistant to DRR. Development and utilization of these TGS in chickpea pre-breeding will assist in developing disease-resistant chickpea cultivars with broad genetic base.

In India, the restriction of genetically modified (GM) crops and derived products not approved in the country necessitates surveillance for transgene(s) in plant material/products imported into the country. CDC Triffid expressing acetolactate synthase (ALS) conferring tolerance to sulphonylurea herbicide is the only GM flax event that has got approval in Canada in 1990s and subsequently deregistered in 2001. In spite of deregistration, the unexpected and unauthorized detection of traces of GM flax in the consignments imported from Canada to Europe has further necessitated the stringent monitoring of flax shipments from Canada for suspected GM incidents. This study reports on the detection of transgenic elements being present in GM flax employing polymerase chain reaction assays, in a set of 123 flaxseed accessions imported from Canada for research purpose. Based on the tests conducted, none of the transgenic elements, namely, nos promoter (P-nos), nos terminator (T-nos), nptII marker gene, ALS transgene, as present in the GM flax CDC Triffid were detected in any of the tested accessions. The well-known herbicide tolerance gene cp4-epsps, being employed in Roundup® Ready events of other crops, was also not detected in these samples. This case study has demonstrated the importance of monitoring the presence of transgene(s) in flaxseed imports, and such studies need to be carried out for the imported seeds from the country where GM events of respective crop are being approved whereas they have not been approved in the country of import as a part of precautionary approach.

Background: As the COVID-19 pandemic continues, special attention is focused on high-risk patients. In this study, we assessed the risk factors for COVID-19 mortality in nursing home patients. Methods: In this retrospective cohort study, we reviewed the electronic medical records of SARS-COV-2 PCR–positive nursing-home patients between March 8 and June 14, 2020. The primary outcome was in-hospital mortality. Risk factors were compared between those who were discharged or died using the Student t test, the Mann-Whitney U test, χ2 analysis, and logistic regression. Results: Among 169 hospitalized nursing-home patients, the case fatality rate was 43.2%. The mean age was 72.3 ± 13.8 years; 92 patients (54.4%) were male; and 112 patients (66.3%) were black. Within the first day of hospitalization, 83 (49%) patients developed fever. On admission, 24 (14.2%) patients were hypotensive. Leukopenia, lymphopenia, and thrombocytopenia were present in 20 (12%), 91 (53%), and 40 (23.7%) patients, respectively. Among the inflammatory markers, elevations in CRP and ferritin levels occurred in 79% and 24%, respectively. Intensive care admission was needed for 40 patients (23.7%). Septic shock occurred in 25 patients (14.8%). Patients over the age of 70 were more likely to die than younger patients (OR, 2.2; 95% CI, 1.2– 4.1; P = .20). Patients with a fever on admission were more likely to die than those who were afebrile (OR, 2.03; 95% CI, 1.08–3.8; P = .03). Also, 66.7% hypotensive patients died compared to 39.3% normotensive patients (OR, 3.1; 95% CI, 1.2–7.7 P = .01). Intubated patients died more often than those not intubated, 78.4% versus 33.3%, respectively (OR=7.3, p < 0.001, CI 3.1, 17.2) Factors significantly associated with death included higher mean qSofa (p < 0.001), higher median Charlson scores (0.02), thrombocytopenia (p = 0.04) and lymphocytopenia (0.04). From multivariable logistic regression, independent factors associated with death were Charlson score (OR=1.2, p=0.05), qSofa (OR=2.0, p=0.004), thrombocytopenia (OR = 3.0, p = 0.01) and BMI less than 25 (OR = 3.5, p=0.002). Conclusions: Our multivariable analysis revealed that patients with a greater burden of comorbidities, lower BMI, higher qSOFA sepsis score, and thrombocytopenia had a higher risk of death, perhaps because of severe infection despite a robust immune response.

Funding: No

Disclosures: None

Background: Central-line–associated bloodstream infections (CLABSIs) are a significant contributor to morbidity and mortality for neonates; they also increased healthcare costs and duration of hospitalization. This population is susceptible to infections because of their undeveloped immune systems, and they require intravenous access until they can tolerate enteral feedings, which for extremely premature infants can take several weeks (if not months) to achieve. Our hospital is a regional-referral teaching hospital with 772 licensed beds. The neonatal intensive care unit (NICU) is a level 3, 35-bed unit where the most critically ill neonates receive care. After a sustained 3-year period of zero CLABSIs, we identified 10 infections between September 2016 through April 2018. Methods: A multidisciplinary team known as the neonatal infection prevention team (NIPT) was reinstated. This team included members from nursing and infection prevention (IP) and from NICU Shared Governance, as well as a neonatal nurse practitioner (NNP) and a neonatologist to review these CLABSIs. Evidence-based practices, policies, and procedures were implemented to help reduce CLABSIs. Nurse educators provided education and training. The infection prevention team reinstated and modified the central-line maintenance and insertion tools to document compliance and to identify any gaps in care. Nurses were expected to document line maintenance once per shift (a.m. and p.m.). All CLABSIs were entered into the CDC NHSN and the hospital’s safety event reporting system, which required follow-up by a clinical manager. The infection prevention team monitored NHSN standardized infection ratios (SIRs) monthly. The SIR is the number of observed events divided by the number predicted (calculated based on national aggregate data). Results: The highest reported quarterly SIR was 1.423, which occurred in the third quarter of 2018 (Fig. 1). Overall compliance with line maintenance protocols was 86% on the morning shift and 89% on the afternoon shift. With implementation of an evidence-based bundle, the NICU had a rolling 12-month SIR of 0.00 as of October 2019. Conclusions: Multidisciplinary team development, implementation of evidence-based bundle elements, and education on catheter care contributed to the long-term success in decreasing CLABSI rates in our NICU. Although this implementation achieved a zero CLABSI rate, we experienced some barriers, including compliance issues with staff not completing the audit tools, staff turnover, and high patient census.

Funding: None

Disclosures: None

Background: Healthcare-associated infections (HAIs) are a major global threat to patient safety. Systematic surveillance is crucial for understanding HAI rates and antimicrobial resistance trends and to guide infection prevention and control (IPC) activities based on local epidemiology. In India, no standardized national HAI surveillance system was in place before 2017. Methods: Public and private hospitals from across 21 states in India were recruited to participate in an HAI surveillance network. Baseline assessments followed by trainings ensured that basic microbiology and IPC implementation capacity existed at all sites. Standardized surveillance protocols for central-line–associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) were modified from the NHSN for the Indian context. IPC nurses were trained to implement surveillance protocols. Data were reported through a locally developed web portal. Standardized external data quality checks were performed to assure data quality. Results: Between May 2017 and April 2019, 109 ICUs from 37 hospitals (29 public and 8 private) enrolled in the network, of which 33 were teaching hospitals with >500 beds. The network recorded 679,109 patient days, 212,081 central-line days, and 387,092 urinary catheter days. Overall, 4,301 bloodstream infection (BSI) events and 1,402 urinary tract infection (UTI) events were reported. The network CLABSI rate was 9.4 per 1,000 central-line days and the CAUTI rate was 3.4 per 1,000 catheter days. The central-line utilization ratio was 0.31 and the urinary catheter utilization ratio was 0.57. Moreover, 3,542 (73%) of 4,742 pathogens reported from BSIs and 868 (53%) of 1,644 pathogens reported from UTIs were gram negative. Also, 1,680 (26.3%) of all 6,386 pathogens reported were Enterobacteriaceae. Of 1,486 Enterobacteriaceae with complete antibiotic susceptibility testing data reported, 832 (57%) were carbapenem resistant. Of 951 Enterobacteriaceae subjected to colistin broth microdilution testing, 62 (7%) were colistin resistant. The surveillance platform identified 2 separate hospital-level HAI outbreaks; one caused by colistin-resistant K. pneumoniae and another due to Burkholderia cepacia. Phased expansion of surveillance to additional hospitals continues. Conclusions: HAI surveillance was successfully implemented across a national network of diverse hospitals using modified NHSN protocols. Surveillance data are being used to understand HAI burden and trends at the facility and national levels, to inform public policy, and to direct efforts to implement effective hospital IPC activities. This network approach to HAI surveillance may provide lessons to other countries or contexts with limited surveillance capacity.

Funding: None

Disclosures: None

Background: Interventions to reduce unnecessary device use may select a higher-risk population, leading to a paradoxical increase in SIR for some high-performing facilities. The standardized utilization ratio (SUR) adjusts for device use for different units and facilities. We evaluated the performance of a population SIR (pSIR) metric compared to device SIR (dSIR) in the situations of increased, decreased, and no change in SUR for a large system. Methods: We evaluated hospitals that had a reduction, increase, and no substantial change (±5% relative change) in their SUR in FY2019 (July 2018–June 2019) compared to baseline FY2017 (July 2016–June 2017). The dSIR (defined as Σ observed events divided by Σ predicted events based on actual device days) and pSIR (defined as Σ observed events divided by Σ predicted events based on predicted device days). We calculated the cumulative attributable difference (CAD) for catheter-associated urinary tract infections (CAUTIs) for the same facilities based on dSIR and pSIR. Results: Overall, the system SUR dropped from 0.92 in 2017 to 0.85 in 2019 (7.3% decrease). Of the 48 hospitals included, 25 (52%) exhibited a drop, 13 (27%) exhibited an increase, and 10 (21%) had no change in SUR during 2019. For hospitals in which SUR decreased, the dSIR decreased by 15.9% from 0.88 to 0.74, and the pSIR decreased by 32.3% from 0.85 to 0.58 (Table 1). In 2019, the CAD for CAUTI to a target SIR of 1 was 133 for the dSIR compared to 181 for the pSIR, and 36% more events were avoided. Conclusions: The traditional SIR (dSIR) underestimated improvements in infection rates compared to the pSIR because it failed to account for reduced device utilization associated with infection prevention interventions. The pSIR accounts for overall risk of infection associated with device exposure in a population and better reflects the efficacy of prevention efforts compared to dSIR. The pSIR should be considered in situations in which interventions have led to substantial reductions in device use.

Funding: None

Disclosures: None

Background: Acute-care hospitals in the United States are required to submit 6 healthcare-associated infection (HAI) metrics to the CMS for reporting and performance purposes prior to payment. We examined the association between HAI rate trends and hospital-onset bloodstream infection (HO-BSI) rate trends across a large, multihospital health system. Methods: HO-BSI events were identified across 52 hospitals attributable to Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, or Candida spp using the NHSN Lab ID event definition of ≥day 4 of admission. We compared the performance from January 2016 to March 2019 for HO-BSI and the 6 NHSN-defined HAIs: central-line–associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), Clostridioides difficile, methicillin-resistant Staphylococcus aureus (MRSA) bacteremia, abdominal hysterectomy surgical site infections (SSIs), and colon SSI. We calculated 2 “infection composite scores” to account for the 6 HAIs based on all observed or predicted events (score 1) and an average of the 6 HAI standardized infection ratios (SIRs; score 2). We normalized both measures to 1 for a 12-months rolling baseline. We evaluated the HO-BSI rate change over time and compared it to the change in the infection score over the same period. We compared the change in the 12-month rolling rates of the 2 HAI scores and the HO-BSI rate. Results: During the 39-month period, 3,288 HO-BSI events occurred over 9,775,118 patient days. The source of HO-BSI events included S. aureus (33.5%), P. aeruginosa (10.2%), E. coli (19.7%), K. pneumoniae (13.8%), and Candida spp (22.8%). HO-BSI event rates decreased by 17.3% from 12-month rolling baseline to last 12 months (3.70 vs 3.06 per 10,000 patient days). Similarly, 7,648 HAI events were observed, with the source of events being Clostridioides difficile (57.0%), CAUTI (15.1%), CLABSI (12.8%), MRSA (7.0%), colon SSI (6.4%), and abdominal hysterectomy SSI (1.7%). The 2 HAI scores and the HO-BSI rate all showed a notable decrease from the 2016 baseline period (Fig. 1). The reductions in the HAI scores were both strongly correlated with the reduction in the HO-BSI rate, with the HAI score 1 having a stronger correlation (r = 0.949; P < .001) than was observed for HAI score 2 (r = 0.867; P < .001). Conclusions: Utilization of a HO-BSI measure may prove useful as a correlated but distinct marker of infection prevention improvement or trends. HO-BSI could be useful as an objective electronically obtainable measure to assist in the evaluation of performance within and across facilities.

Funding: None

Disclosures: None

Laboratory-identified bloodstream infections (LAB-ID BSIs) in recently discharged patients are likely to be classified as healthcare-associated community-onset (HCA-CO) infections, even though they may represent hospital-onset (HO) infections. A review of LAB-ID BSIs among patients discharged within 14 days revealed that 109 of 756 cases (14.4%) were HO infections. The BSI risk being misclassified as HCA CO may underestimate the hospital infection risk.

Genetic diversity of a red clover global collection was assessed using 36 simple sequence repeat (SSR) primers representing all seven linkage groups (LGs). The number of fragments amplified ranged from 1 to 6 for all the primers. Primer RCS0060 detected highest number of fragments, whereas four SSRs viz., RCS0899, RCS1594, TPSSR40 and RCS6927 amplified single fragment. Size range of amplicons generated by all the primers varied from 100 to 400 bp. Polymorphism information content values ranged from 0.301 to 0.719 with an average value of 0.605. LG wise diversity analysis showed that LG 3 was most diverse (I = 0.65, Ht = 0.44), whereas LG-1 showed minimum diversity (I = 0.48, Ht = 0.26) for the microsatellites used. Bayesian model-based clustering inferred three genetically distinct populations in the red clover germplasm holding and showed considerable admixture in individuals within clusters. Neighbour-joining analysis showed intermixing of accessions within groups. Principal component analysis plot complemented the clustering shown by Structure and distinguished three populations to greater extent. Analysis of molecular variance showed that 91% of the genetic variation was residing within populations, while 9% variation was among populations. Overall, the results showed that a high level of genetic diversity is prevailing in this worldwide collection of red clover, which can be exploited for its genetic improvement through breeding approaches.