Infection Control and Hospital Epidemiology最新文献

Objective: To identify host and clinical risk factors contributing to the development of Clostridioides difficile infection (CDI) among colonized patients.

Design: Retrospective, matched case-control study.

Setting: Duke University Health System, including 3 hospitals and affiliated outpatient clinics.

Participants: Adult patients who underwent ≥2 two-step C. difficile tests (nucleic acid amplification test (NAAT) followed by toxin enzyme immunoassay) between 03/15/2020-12/31/2023. Cases were patients with C. difficile colonization (NAAT+/toxin-) who converted to CDI (NAAT+/toxin+) within 90 days; controls were colonized patients who remained toxin-negative. Cases were matched to controls by date of index testing (±1 year).

Methods: Data collection encompassed a 90-day "pre-exposure" period preceding index testing and a ≤ 90-day "exposure" period between index and repeat testing. Antibiotic use was stratified by risk for each period. Multivariate conditional logistic regression with forward selection was used to identify predictors of progression.

Results: Among 2,212 colonized patients, 71 cases and 133 matched controls were identified. Several host and clinical characteristics were independently associated with progression to CDI in our multivariate model. Notably, high-risk antibiotic use across the pre-exposure and exposure periods was associated with greater odds of progression to CDI compared to other patterns of antibiotic use (adjusted odds ratio 2.70; P = .03).

Conclusions: Sustained exposure to high-risk antibiotics was a strong predictor of the progression from C. difficile colonization to infection, underscoring the need for further research on longitudinal stewardship strategies for CDI prevention, particularly among patients previously identified as colonized.

Objective: The purpose of the study is to analyze bloodstream infection (BSI) data reported by outpatient hemodialysis facilities to understand temporal trends, the potential impact of infection prevention practices and the COVID-19 pandemic on BSI rates.

Methods: Outpatient hemodialysis facilities report BSI data to the National Healthcare Safety Network. We used interrupted time series with mixed effects negative binomial modeling to estimate the annual change of BSI rates from 2012 to 2021, using March 2020 as the COVID-19 inflection point. The model controlled for seasonal factors, vascular access types, and facility characteristics.

Results: The number of facilities used for analysis increased from 5,581 in 2012 to 7,313 in 2021. Most facilities were freestanding (range: 90%-93%) and belonged to for-profit organizations (range: 85%-88%). The annual adjusted BSI rates decreased by an average of 8.90% (95% CI: -9.10 %, -8.71%) January 2012-February 2020. The annual decrease in BSI rate was not significant during March 2020-December 2021 (P = 0.15). There was a level drop of 32.03% (95%CI: -33.84%, -30.17%) in BSI rates in the period of March 2020-December 2021 compared with the period of January 2012-February 2020.

Conclusions: BSI rates decreased steadily from January 2012 to February 2020 likely due to the identification and adoption of evidence-based prevention practices. BSI rates plateaued at lower levels during March 2020-December 2021. This suggests that infection prevention measures implemented by facilities prior to the emergence of COVID-19 contributed to substantial decreases in BSI rates and may have helped to stabilize BSI rates after March 2020.

In this post hoc analysis of a quasi-experimental pilot/feasibility trial, a bundled diagnostic stewardship intervention safely reduced respiratory culturing rates without increasing ventilator-associated events (VAEs). Using difference-in-differences methodology, we observed a significant reduction in possible ventilator-associated pneumonia (PVAP) events, suggesting the intervention may reduce pneumonia overdiagnosis without compromising patient safety.

Objectives: This study investigates the potential aerosol transmission of respiratory syncytial virus (RSV), a major cause of viral pneumonia and bronchiolitis in young children.

Methods: Two hundred samples were collected in a long-term environmental surveillance program from January 2022 until January 2023. Samples were collected in a pediatric emergency corridor. The analyses were performed using reverse transcription-quantitative polymerase chain reaction (RT-qPCR) targeting the RSV matrix gene. Information on the daily number of emergencies related with pediatric RSV infections was provided by the hospital.

Results: Aerosol samples collected from a pediatric hospital corridor revealed detectable RSV RNA, particularly during peak infection seasons. RSV RNA was detected in 35 of 200 aerosol samples with a median concentration (interquartile range) of 1.8 (4.1) gc/m³. During the month of the peak season of RSV infections (November), RSV RNA was detected in 95% of the aerosol samples. Correlation analysis suggests a link between pediatric RSV cases and airborne RSV RNA concentration.

Conclusions: RSV RNA has been detected in aerosols in a healthcare setting, particularly during peak infection periods. This does not constitute evidence of transmission of the RSV via aerosols. However, the observed correlation with pediatric RSV cases suggests that further research on viral viability and infectivity from RSV detected in aerosols should be conducted. It also shows the potential of characterizing RSV RNA in aerosols for environmental surveillance purposes.

Timely blood cultures (BCx) are required by SEP-1. The recent BCx bottle shortage necessitated enhanced BCx stewardship. At two hospitals during the shortage, SEP-1 metric compliance declined related to BCx utilization. Review of cases where BCx were not obtained demonstrated most BCx were safely avoided without demonstrable patient harm.

Objective: We evaluated whether patient perceptions of cleanliness are associated with objective measures of Clostridioides difficile infection (CDI), as an early indicator of facility-level CDI rates and prevention.

Design: Cross-sectional analysis of Medicare-certified hospitals across the United States.

Methods: Data from the CMS Hospital Compare website and U.S. Census Bureau from 2023 were analyzed using multivariate logistic regression models. The primary outcome was C. difficile standardized infection ratios (SIRs) compared to the national average. The primary exposure was patient-rated cleanliness star ratings from the Hospital Consumer Assessment of Healthcare Providers and Systems survey.

Results: The population studied was 3,616 medicare-certified hospitals with an estimated 17,994,034 unique patient admissions. There was no association between better patient-rated cleanliness and improved CDI performance. Facilities with a 5-star cleanliness rating were not more likely to have an SIR less than or equal to the national average compared to those with a lower star rating. For every 1% increase in patients who reported their room and bathroom as always clean, the odds of CDI observed cases being higher than predicted increases by 4.2% (ie, increasing patient-related cleanliness was weakly associated with worse CDI performance).

Conclusions: Patient-rated cleanliness was not associated with improved CDI performance in U.S. national hospital data. Findings were consistent across multiple operationalizations of cleanliness and CDI suggesting patient perceptions of cleanliness are not a strong indicator of CDI control measure performance.

Objective: Community-acquired pneumonia (CAP) is a leading cause of hospitalization and mortality in the US. Studies report racial disparities in various infectious syndromes. Our objective was to assess the relationship between patient race and antibiotic prescribing in inpatient CAP management.

Design: Retrospective cohort study.

Setting: 11 Cleveland Clinic community hospitals.

Patients: Patients aged ≥18 years hospitalized with CAP between November 1, 2022, and January 31, 2025.

Methods: Parametric and non-parametric methods were used to describe demographic and clinical differences by race. The association between race and extended spectrum antibiotic (ESA) guideline concordance was assessed using multivariable logistic regression models adjusting for age, gender, admission source, area deprivation index (ADI), hospital, diabetes, cardiovascular disease, chronic respiratory disease, renal failure, liver disease, immunocompromising condition, alcohol and substance use disorder, dialysis, and clinical instability and severity on day 1.

Results: In bivariate analyses, Non-Hispanic Black (NHB) patients were less likely than NHW patients to receive ESA guideline-concordant CAP therapy (63.2% vs 64.4%; OR = 0.91, P = .2). After adjusting for patient characteristics, there were no differences between NHB and NHW patients in receipt of ESA therapy (adjusted OR = 0.93; 95% CI = 0.83, 1.00). After adjusting for hospital, NHB patients were more likely to receive ESA guideline-concordant CAP therapy (adjusted OR = 1.17; 95% CI = 1.06, 1.30).

Conclusion: NHB patients were more likely to receive ESA-guideline concordant therapy, but this was influenced by where they sought care. Further studies are needed to understand why prescribing varies across hospitals.