Infection Control and Hospital Epidemiology最新文献

Objective: To report on the investigation of a pseudo-outbreak of Mycobacterium mucogenicum and examine its clinical and operational impact.

Design: Outbreak investigation, retrospective cohort study.

Setting: Academic medical center in Los Angeles, California.

Patients: Patients whose bronchoalveolar lavage (BAL) cultures grew M. mucogenicum from 2020-2024.

Methods: We performed an institutional outbreak investigation of M. mucogenicum, reviewed electronic medical records of a subset of affected patients (2023-2024), and assessed the operational impact.

Results: The incidence of M. mucogenicum in BAL cultures at Hospital A increased from 6.1% (29/473) in 2020 to 18.6% (29/156) in the first quarter of 2024. Epidemiologic investigation revealed non-sterile ice baths used to cool uncapped sterile syringes during bronchoscopy procedures as the contamination source. Next generation sequencing linked clinical isolates to M. mucogenicum recovered from a perioperative ice machine. Nearly all (157/160) clinical isolates grew from nocardia media rather than acid-fast bacilli media. Among 154 patients, including 51 (33.1%) who were highly immunocompromised, no true infections were identified. Thirty-nine (25.3%) patients were referred to infectious diseases for consultation, seven (4.5%) underwent additional workup, and only one received targeted treatment. The pseudo-outbreak incurred 458 hours of microbiology technologist and infection preventionist time and cost the laboratory $88,426.

Conclusions: A four-year pseudo-outbreak of M. mucogenicum traced to contaminated ice baths used during bronchoscopy resulted in unnecessary infectious disease referrals and substantial operational and financial burden to the institution. Avoidance of non-sterile ice use in procedures prevents costly and burdensome pseudo-outbreaks of environmental mycobacteria in healthcare settings.

Objective: While infection is a leading cause of mortality among patients on hemodialysis, there are limited data on patients' infection prevention knowledge and attitudes. We aimed to assess hemodialysis patients' knowledge of their elevated infection risk, their willingness to actively prevent infections, and the acceptability of a long-term intranasal decolonization intervention.

Design: We surveyed patients as part of a stepped wedge cluster randomized trial evaluating intranasal povidone-iodine (PVI) decolonization.

Setting: Sixteen outpatient hemodialysis centers affiliated with 5 academic medical centers.

Participants: Patients undergoing outpatient hemodialysis.

Methods: Patients were asked to complete a pre-intervention survey (9 questions) and two intervention surveys (13 questions; only patients interested in PVI) at 1 month and 6 months after starting PVI. We used the chi-squared test to compare responses over time.

Results: 469 (∼25%) participants completed at least one survey. Most (55%) participants underestimated their infection risk compared with an average person in the United States. The percentage of participants willing to expend "a lot of effort" to prevent an infection decreased from 79% (pre-intervention) to 63% (final survey) (p < 0.01). Among the 102 participants using PVI at 6 months, 87% said PVI felt neutral or pleasant and 75% used PVI for the past 3 dialysis sessions. Only 9.4% reported side effects.

Conclusions: Patients on hemodialysis underestimate their infection risk. Most patients found intranasal PVI to be acceptable. Future research should aim to improve patient education on their infection risk and remove barriers to adherence with infection prevention interventions.Clinical trial information: NCT04210505, https://clinicaltrials.gov/.

Healthcare personnel (HCP) are at risk for occupational exposure to tuberculosis. Current guidelines for managing exposed HCP are broad and resource intensive. Based on review of our internal data, we propose a risk-based stratification approach to streamline exposure follow-up testing and optimize resource utilization.

In this prospective cohort study, trimethoprim-sulfamethoxazole direct oral challenge (DOC) for hospitalized adults reporting a low-risk sulfa antibiotic allergy was safe with 75/76 (99%) inpatients delabeled. Within 90-days of DOC, immunocompromised patients were more likely to receive trimethoprim-sulfamethoxazole, compared with non-immunocompromised patients (adjusted OR 5.6 95% CI 1.3, 23.0).

Objective: Understand current Candidozyma auris prevention practices in the United States and identify opportunities to improve containment.

Design: Electronic survey.

Setting: Acute care hospitals.

Participants: Society for Healthcare Epidemiology (SHEA) Research Network (SRN) facilities located in the United States.

Methods: REDCap survey distributed via email exploring knowledge and perceptions related to C. auris screening methods, prevention practices, barriers to prevention, and tools needed to improve containment.

Results: Responses were received from 51/96 (53%) U.S.-based SRN facilities, with 80% identifying as teaching hospitals. Two-thirds of facilities (34/51) reported first-hand experience with C. auris, with 15/34 also experiencing at least one C. auris outbreak. Routine C. auris screening occurred in 47% (24/51) of facilities. C. auris prevention practices commonly included patient isolation, signage to notify staff of isolation status, and placement in a single patient room. When asked to identify barriers to control of C. auris at their facility, participants ranked lack of communication between healthcare facilities, lack of infection control at outside healthcare facilities, and lack of training as the top three barriers. C. auris prevention resources or tools perceived to be most helpful in their facility included effective decolonization regimens, standardized protocols for C. auris screening, and improved communication between healthcare facilities.

Conclusion: SRN facilities commonly used isolation practices to prevent the spread of C. auris. Development of additional tools to improve prevention practices should target effective decolonization strategies and standardized screening protocols to support C. auris containment.

Objective: Professional guidelines recommend an early switch from intravenous (IV)-to-oral antibiotics for community-acquired pneumonia (CAP) to facilitate early discharge and prevent hospital-related complications. However, it is unknown how often these IV-to-oral switches occur in clinical practice.

Design: We performed a retrospective cohort study across 124 acute-care Veterans Administration hospitals to measure the frequency of early switches.

Patients: Patient-admissions during 2018-2023 who had CAP and were started on IV antibiotics upon admission.

Methods: We measured the percentage of hospitalized patients with CAP who had an early switch from IV-to-oral antibiotics, i.e., within 72 hours of admission. In addition, we calculated an observed-to-expected ratio for early switches at each hospital and compared a composite outcome (mortality and/or hospital readmission within 30 days of discharge) at hospitals with switch rates that were higher and lower than expected.

Results: Of 31,183 patient-admissions for CAP, 17,282 (55.4%) were switched to oral antibiotics by day three of therapy. Overall, 5,629 (18.1%) died and/or were re-admitted within 30 days. The O:E ratio for early antibiotic switches ranged from 0.78 among hospitals in the lowest quartile to 1.23 in the highest quartile. There was no difference in the composite outcome across quartiles.

Conclusion: Early switches from IV-to-oral antibiotics for CAP occurred in half of eligible cases. The frequency of these switches varied widely across facilities. Outcomes among patients at hospitals with high switch rates were comparable to outcomes at hospitals with low rates, thereby supporting the safety of early switches. More concerted efforts to promote these switches are needed.

Background: This study aims to evaluate the effectiveness of an adapted methicillin-resistant Staphylococcus aureus (MRSA) decolonization program in an infirmary unit in Hong Kong that was inspired by successful interventions implemented in Orange County, California.

Methods: Nasal, skin, and rectal swabs were collected to assess MRSA colonization. Decolonization involved applying 10% povidone-iodine ointment to the anterior nares twice daily for five days every other week, along with twice weekly chlorhexidine gluconate (CHG) bathing for six months. Compliance with the application of povidone-iodine and CHG bathing techniques was monitored by measuring their respective levels in the anterior nares and on the skin. Air and environmental samples were collected and analyzed over time using linear regression.

Results: Among 60 patients in the infirmary unit (78% baseline MRSA carriers), overall MRSA colonization declined during the program, driven by significant reductions in skin colonization (65% to 29%, P < .001). Environmental contamination on high-touch patient-care equipment (bathing trolleys and slings) also significantly decreased over time (P < .001). These reductions coincided with the high-quality implementation of decolonization, evidenced by stable iodophor detection in nares during application weeks and sustained chlorhexidine levels on the skin, detectable 24 hours after bathing. In contrast, MRSA detection in air samples showed no significant change (P = .096), possibly due to dispersal by persistent carriers during care activities even as skin and environmental contamination declined.

Conclusions: The adapted MRSA decolonization program was effective, significantly reducing overall MRSA colonization, especially at skin sites, while achieving high compliance with the protocol.

Guidelines urge that infected fluid or tissue obtained during surgery be submitted for microbiologic study directly rather than via swab. A prospective study of operative specimens showed concordance in 64.7% of cases with better yield from abscess fluid, but swab cultures sometimes identified important pathogens missed by fluid culture.

Background: Surveillance activities are emerging as exemplar use cases for large language models (LLMs) in health care. The aim of this study was to evaluate the potential for LLMs to support the expansion of surveillance activities to include cardiovascular implantable electronic device (CIED) procedures.

Methods: A validated machine learning-based infection flagging tool was applied to a cohort of VA CIED procedures from 7/1/2021 to 9/30/2023; cases with ≥10% probability of CIED infection underwent manual review. Then, a weighted random sample of 50 infected and 50 uninfected cases was reviewed with generative artificial intelligence (GenAI) assistance. GenAI prompts were iteratively refined to extract and classify all components of infection-related variables from clinical notes. Data extracted by GenAI were compared with manual chart reviews to assess infection status and extraction consistency.

Results: Among 12,927 CIED procedures, 334 (2.58%) had ≥10% probability of CIED infection. Among 100 sampled cases, 50 of 50 uninfected cases were correctly categorized. Among 50 infection cases, GenAI identified all CIED infections, but the timing of events and the attribution to a preceding procedure were incorrect in 7 of 50 cases. The overall specificity of the GenAI-assisted process was 100% and the sensitivity for accurately classifying timing and attribution of CIED infection events was 82%. Errors in timing improved with iterative prompt updates. Manual chart reviews averaged 25 minutes per chart; the GenAI-assisted process averaged 5-7 minutes per chart.

Conclusions: LLMs can help streamline the review process for healthcare-associated infection surveillance, but manual adjudication of output is needed to ensure the correct timeline of events and attribution.