Background. The role of antibiotics in preventing urinary tract infection (UTI) in older adults is unknown. We sought to quantify the benefits and risks of antibiotic prophylaxis among older adults. Methods. We conducted a matched cohort study comparing older adults (>= 66 years) receiving antibiotic prophylaxis, defined as antibiotic treatment for >= 30 days starting within 30 days of a positive culture, with patients with positive urine cultures who received antibiotic treatment but did not receive prophylaxis. We matched each prophylaxis recipient to 10 nonrecipients based on organism, number of positive cultures, and propensity score. Outcomes included (1) emergency department (ED) visit or hospitalization for UTI, sepsis, or bloodstream infection within 1 year; (2) acquisition of antibiotic resistance in urinary tract pathogens; and (3) antibiotic-related complications. Results. Overall, 4.7% (151/3190) of UTI prophylaxis patients and 3.6% (n = 1092/30 542) of controls required an ED visit or hospitalization for UTI, sepsis, or bloodstream infection (hazard ratio [HR], 1.33; 95% confidence interval [CI], 1.12-1.57). Acquisition of antibiotic resistance to any urinary antibiotic (HR, 1.31; 95% CI, 1.18-1.44) and to the specific prophylaxis agent (HR, 2.01; 95% CI, 1.80-2.24) was higher in patients receiving prophylaxis. While the overall risk of antibiotic-related complications was similar between groups (HR, 1.08; 95% CI,.94-1.22), the risk of Clostridioides difficile and general medication adverse events was higher in prophylaxis recipients (HR [95% CI], 1.56 [1.05-2.23] and 1.62 [1.11-2.29], respectively). Conclusions. Among older adults with UTI, the harms of long-term antibiotic prophylaxis may outweigh their benefits.

Objective: Selective reporting of antibiotic susceptibility test results may help guide appropriate antibiotic prescribing, particularly for urinary tract infections. Our objective was to describe laboratory urine culture susceptibility reporting practices and to estimate their impact on antibiotic prescribing in outpatients. Methods: We examined all positive urine cultures with Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis associated with an antibiotic prescription among outpatients over 65 years of age in Ontario, Canada from 2014 through 2017. We evaluated antibiotic prescribing in the empirical window (1-3 days before culture result) and in the directed window (0-5 days after culture result). Unadjusted and adjusted odds ratios were reported to estimate the association between reporting and prescribing. Results: In total 113 780 eligible urine cultures from 48 laboratories were included in the study cohort. Susceptibility reporting practices were highly variable between laboratories, with a range across antibiotics from norfloxacin (n = 5/48, 10.4% reporting) to nitrofurantoin (n = 40/48, 83.3% reporting). Reporting antibiotic susceptibility was associated with increased odds of prescribing that antibiotic in the directed window (aOR 2.98, 95%CI 2.07-4.28). At the laboratory level, the proportion of urine cultures reporting specific antibiotic susceptibility results was also associated with an increase in prescribing of that antibiotic in the empirical window (adjusted OR 1.23, 95%CI 1.13-1.33, per 25% increase in reporting). Conclusions: Laboratory reporting of antibiotic susceptibility results for urine cultures is associated with empirical and directed prescribing of the reported antibiotics. Laboratories can play an important role in guiding appropriate antibiotic selection for urinary indications. Bradley J. Langford, Clin Microbiol Infect 2021;27:568 Crown Copyright ? 2020 Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases. All rights reserved.

In Ontario, Canada, since 2012, some hospitals discontinued contact precautions for vancomycin-resistant Enterococcus (VRE). Between 2009 and 2018, there was an associated rise in VRE bloodstream infections in hospitals where contact precautions were discontinued but not in hospitals that maintained contact precautions. These data suggest contact precautions are important for hospital VRE control programs.

Abstract Background Health care worker (HCW) hand hygiene is effective in reducing healthcare associated infections, yet hand hygiene rates are suboptimal. Psychological theories of behavior change can be used to improve and sustain hand hygiene adherence. While past research has examined HCW explicit attitudes towards hand hygiene (ie., self-reported attitudes), it is unclear if these explicit attitudes are consistent with implicit attitudes (ie., attitudes outside of one’s awareness). Understanding HCW explicit and implicit attitudes is important when designing effective interventions to improve hand hygiene rates. This study examined explicit attitudes towards HCW hand hygiene and compared these to implicit attitudes. Methods HCWs (N = 420) from 70 long-term care facilities in Ontario, Canada completed: (1) a survey tool based on psychological theories of behavior change to examine explicit attitudes towards hand hygiene, and (2) a computer administered implicit association test (IAT) and affect misattribution procedure (AMP) to evaluate implicit attitudes towards hand hygiene. Sociodemographics and self-reported hand hygiene adherence were measured. Factor analysis was performed to identify themes. Correlations were conducted between explicit and implicit measures. Results Factor analysis identified key explicit attitudes themes: (1) beliefs about consequences to self and others, (2) environmental resources, (3) time pressure and workload, and (4) social/professional role and identity. AMP and IAT results indicated that these procedures can be successfully applied to hand hygiene. While results suggested implicit positive attitudes towards hand hygiene, implicit test scores were neither correlated with explicit attitudes nor with self-reported hand hygiene adherence. Conclusion Explicit attitudes did not predict implicit attitudes. So, what we say is not always what we really think or do. Interventions have successfully targeted implicit attitudes to foster behavior change when targeting explicit attitudes alone did not work. This is yet to be explored in the hand hygiene arena, and is a key area for future research in order to guide the development of successful interventions to sustainably improve hand hygiene rates. Disclosures All authors: No reported disclosures.