Infection Control and Hospital Epidemiology最新文献

National Healthcare Safety Network developed a hospital-onset bacteremia (HOB) reporting module which may be used for Centers for Medicare and Medicaid Services (CMS)-reimbursement in the future. This retrospective study compared CMS-reported, HOB, and Overlap events. There were twice as many HOB as CMS events, but >40% of HOB were due to infections that lack defined infection prevention practices.

Objective: To assess preparedness for Candida auris in Canadian hospitals.

Design: Cross-sectional survey.

Setting: Canadian Nosocomial Infection Surveillance Program (CNISP) hospitals.

Methods: In June 2024, surveys were e-mailed to the infection prevention and control departments of 109 CNISP hospitals and their 33 microbiology laboratories. The surveys assessed policies for patient screening/management and laboratory processes supporting C. auris transmission prevention. Results were compared to a similar 2018 survey.

Results: All 109 hospitals and 32/33 laboratories responded. Most hospitals had policies for admission screening (80%, 87/109) and policies/defined plans for post-exposure screening (95%, 104/109). Policy presence increased from 18% to 73% in 56 hospitals completing both 2018 and 2024 surveys (P < 0.001). Among hospitals with admission screening policies, 69% (60/87) screened for recent out-of-country hospitalization. All but one hospital implemented transmission-based precautions for cases; 70% (76/109) continued precautions indefinitely. Overall, 94% (99/105; excluding hospitals with exclusively private rooms) and 55% (60/109) of hospitals screened roommates and wardmates, respectively. Frequency and timing of screening and policies regarding precautions for exposed patients varied. All hospitals used axilla and groin swabs, at minimum, for screening. Most (81%, 26/32) laboratories identified all clinically significant Candida isolates to species level, increasing from 48% to 85% (P < 0.001) in the 27 laboratories completing both 2018 and 2024 surveys. Twenty-four laboratories (75%) had standard operating procedures for processing screening specimens; 96% (23/24) used direct plating onto chromogenic agar.

Conclusions: Despite progress in C. auris preparedness, areas for improvement remain. Variability in practice may be related to evidence gaps and resource constraints.

After implementation of a molecular syndromic panel for infectious diarrhea, a significantly greater proportion of C. difficile results were classified as colonization rather than infection compared to the pre-implementation period. Routine C. difficile reporting from multiplex panels should be re-evaluated to minimize diagnostic uncertainty in some patients.

We describe an outbreak of hospital-acquired Legionella pneumonia in a hematology ward; a cold drinking water dispenser was identified as the source. Regular surveillance and provision of appropriate water quality to high-risk patients are critical, and hospitals should be aware of the risks associated with the use of these devices.

Background: Algorithms using electronic health record data to identify children with community-acquired pneumonia (CAP) and to evaluate the appropriateness of antibiotic use may facilitate antibiotic stewardship efforts, but validated measures of antibiotic choice and duration are unavailable.

Methods: We performed a cross-sectional study within a single hospital system, including hospitalized children ages 6 months to 17 years who were admitted between 1/1/2019 and 10/31/2022. CAP was defined electronically as an ICD-10 code for pneumonia, a chest x-ray or chest CT within 48 hours of admission, and at least two days of antibiotics starting within 48 hours of admission. Hospital transfers and those who died within 48 hours or had chronic conditions, intensive care unit stays ≥48 hours, or concurrent infections were excluded. We validated electronic measures of appropriate antibiotic choice and duration using a reference standard of manual chart review. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each metric.

Results: The electronic algorithm identified 1058 CAP encounters, and 100 were randomly selected for validation. Inappropriate antibiotic choice and duration occurred in one and 75 encounters of the 100 encounters, respectively, based on manual chart review. The electronic algorithm had a sensitivity of 100%, specificity of 93%, PPV of 14%, and NPV of 100% for inappropriate antibiotic choice and a sensitivity of 97%, specificity of 88%, PPV of 96%, and NPV of 92% for inappropriate antibiotic duration.

Conclusion: Metrics of inappropriate antibiotic choice and duration had acceptable performance characteristics and may facilitate syndrome-based stewardship efforts.

This multisociety guidance was endorsed by SHEA, APIC, IDSA, PALTmed, and AGS. It provides recommendations for infection prevention and control (IPC) in the context of the increasing complexity of nursing home care in the United States: increased medical acuity of residents, the spread of multidrug-resistant organisms, and the threat of emerging pathogens. Recommendations and implementation suggestions address IPC leadership, staffing, and resources, healthcare personnel and residents' adherence to precautions and effective hand hygiene, outbreak preparedness, training, occupational health, cleaning and disinfection in the care environment, and the involvement of IPC in the facility. The guidance also addresses the challenges of maintaining a home-like care space while sustaining necessary IPC measures. The guidance covers the role of regulatory bodies like the Centers for Medicare and Medicaid Services (CMS) and recommendations from the Centers for Disease Control and Prevention (CDC). It should serve as a resource for IPC program leaders in nursing homes who are aiming to enhance infection prevention efforts.

Molecular tests without well-defined test performance characteristics are increasingly available for diagnosis of infectious diseases. These tests present a diagnostic stewardship challenge for institutions. We share the results of a local modified Delphi consensus undertaken to define appropriate scenarios for use of plasma metagenomic next-generation sequencing.

Objective: Inappropriate urine cultures (UCs) are common and lead to inappropriate antimicrobial use. Urinalyses (UAs) have been increasingly incorporated into diagnostic stewardship interventions, but the impact of these interventions nationally has not been assessed. We describe UA and UC utilization practices using a nationwide dataset of patients admitted to acute care hospitals.

Methods: Design, Setting and Participants: We performed a retrospective cohort study of index UCs and their associated UAs performed for adult patients (age ≥ 18 years) admitted in U.S. acute care hospitals, participating in the PINC AI™ Healthcare Database (PHD) from January 1, 2017, through December 31, 2020. A positive UA was defined as >10 leukocytes per high power field, positive leukocyte esterase, or positive nitrite.

Results: The overall rate of UCs in this study was 124.7 per 1000 discharges and annual UC rates decreased from 2017 (129.2) to 2020 (120.0). The proportion of UCs that had a positive UA increased from 60.5% in 2017 to 68.1% in 2020; UCs without a UA decreased from 19.3% to 10.5%, and UCs with a negative UA did not significantly change (20.2% to 21.5%). A multivariate multinomial logistic regression model identified male sex, age <65, and a diagnosis of cancer to be predictors of having a UC with a negative UA or no UA.

Conclusions: UC utilization decreased over the study period. The proportion of UCs with a positive UA increased. This may suggest a positive impact of diagnostic stewardship practices at the national level although further progress is needed.