Pub Date : 2024-04-29eCollection Date: 2024-01-01DOI: 10.1017/ash.2024.40
Estefany Rios-Guzman, Alina G Stancovici, Lacy M Simons, Grace Barajas, Katia Glenn, Rachel T Weber, Egon A Ozer, Ramon Lorenzo-Redondo, Judd F Hultquist, Maureen K Bolon
Background: Inpatient behavioral health units (BHUs) had unique challenges in implementing interventions to mitigate coronavirus disease 2019 (COVID-19) transmission, in part due to socialization in BHU settings. The objective of this study was to identify the transmission routes and the efficacy of the mitigation strategies employed during a COVID-19 outbreak in an inpatient BHU during the Omicron surge from December 2021 to January 2022.
Methods: An outbreak investigation was performed after identifying 2 COVID-19-positive BHU inpatients on December 16 and 20, 2021. Mitigation measures involved weekly point prevalence testing for all inpatients, healthcare workers (HCWs), and staff, followed by infection prevention mitigation measures and molecular surveillance. Whole-genome sequencing on a subset of COVID-19-positive individuals was performed to identify the outbreak source. Finally, an outbreak control sustainability plan was formulated for future BHU outbreak resurgences.
Results: We identified 35 HCWs and 8 inpatients who tested positive in the BHU between December 16, 2021, and January 17, 2022. We generated severe acute respiratory coronavirus virus 2 (SARS-CoV-2) genomes from 15 HCWs and all inpatients. Phylogenetic analyses revealed 3 distinct but genetically related clusters: (1) an HCW and inpatient outbreak likely initiated by staff, (2) an HCW and inpatient outbreak likely initiated by an inpatient visitor, and (3) an HCW-only cluster initiated by staff.
Conclusions: Distinct transmission clusters are consistent with multiple, independent SARS-CoV-2 introductions with further inpatient transmission occurring in communal settings. The implemented outbreak control plan comprised of enhanced personal protective equipment requirements, limited socialization, and molecular surveillance likely minimized disruptions to patient care as a model for future pandemics.
{"title":"COVID-19 outbreak and genomic investigation in an inpatient behavioral health unit.","authors":"Estefany Rios-Guzman, Alina G Stancovici, Lacy M Simons, Grace Barajas, Katia Glenn, Rachel T Weber, Egon A Ozer, Ramon Lorenzo-Redondo, Judd F Hultquist, Maureen K Bolon","doi":"10.1017/ash.2024.40","DOIUrl":"https://doi.org/10.1017/ash.2024.40","url":null,"abstract":"<p><strong>Background: </strong>Inpatient behavioral health units (BHUs) had unique challenges in implementing interventions to mitigate coronavirus disease 2019 (COVID-19) transmission, in part due to socialization in BHU settings. The objective of this study was to identify the transmission routes and the efficacy of the mitigation strategies employed during a COVID-19 outbreak in an inpatient BHU during the Omicron surge from December 2021 to January 2022.</p><p><strong>Methods: </strong>An outbreak investigation was performed after identifying 2 COVID-19-positive BHU inpatients on December 16 and 20, 2021. Mitigation measures involved weekly point prevalence testing for all inpatients, healthcare workers (HCWs), and staff, followed by infection prevention mitigation measures and molecular surveillance. Whole-genome sequencing on a subset of COVID-19-positive individuals was performed to identify the outbreak source. Finally, an outbreak control sustainability plan was formulated for future BHU outbreak resurgences.</p><p><strong>Results: </strong>We identified 35 HCWs and 8 inpatients who tested positive in the BHU between December 16, 2021, and January 17, 2022. We generated severe acute respiratory coronavirus virus 2 (SARS-CoV-2) genomes from 15 HCWs and all inpatients. Phylogenetic analyses revealed 3 distinct but genetically related clusters: (1) an HCW and inpatient outbreak likely initiated by staff, (2) an HCW and inpatient outbreak likely initiated by an inpatient visitor, and (3) an HCW-only cluster initiated by staff.</p><p><strong>Conclusions: </strong>Distinct transmission clusters are consistent with multiple, independent SARS-CoV-2 introductions with further inpatient transmission occurring in communal settings. The implemented outbreak control plan comprised of enhanced personal protective equipment requirements, limited socialization, and molecular surveillance likely minimized disruptions to patient care as a model for future pandemics.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11062797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140854497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-29eCollection Date: 2024-01-01DOI: 10.1017/ash.2024.66
Mary Ellen Scales, Megan C Gallagher, Sarah Haessler, Kristy Lindsey, Michele Maryanski, Manju Mathew, Franklin Moore, Karen Hogan, Morgan Gilmore, Stacey Peters, Kristin Smith
Isolation of an unusual organism, Achromobacter xylosoxidans, from 2 cardiac surgical patients on the same day prompted an investigation to search for cases and cause. An extensive review demonstrated a pseudo-outbreak related to practices to conserve laboratory saline due to short supply resulting from supply chain shortage from the coronavirus disease 2019 pandemic.
{"title":"Achromobacter cluster related to COVID-19 supply chain issues.","authors":"Mary Ellen Scales, Megan C Gallagher, Sarah Haessler, Kristy Lindsey, Michele Maryanski, Manju Mathew, Franklin Moore, Karen Hogan, Morgan Gilmore, Stacey Peters, Kristin Smith","doi":"10.1017/ash.2024.66","DOIUrl":"https://doi.org/10.1017/ash.2024.66","url":null,"abstract":"<p><p>Isolation of an unusual organism, <i>Achromobacter xylosoxidans</i>, from 2 cardiac surgical patients on the same day prompted an investigation to search for cases and cause. An extensive review demonstrated a pseudo-outbreak related to practices to conserve laboratory saline due to short supply resulting from supply chain shortage from the coronavirus disease 2019 pandemic.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11062781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140867742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-29eCollection Date: 2024-01-01DOI: 10.1017/ash.2024.33
Rachel Marusinec, Munira Shemsu, Tyler Lloyd, Brendan M Kober, Dustin T Heaton, Jade A Herrera, Misha Gregory, Vici Varghese, Joelle Nadle, Kavita K Trivedi
Objective: Carbapenem-resistant organisms (CROs) are an urgent health threat. Since 2017, Alameda County Health Public Health Department (ACPHD) mandates reporting of carbapenem-resistant Enterobacterales (CRE) and encourages voluntary reporting of non-CRE CROs including carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant Pseudomonas aeruginosa (CRPA). Surveillance data from ACPHD were analyzed to describe the epidemiology of CROs and target public health interventions.
Methods: Healthcare facilities in Alameda County reported CRO cases and submitted isolates to ACPHD to characterize carbapenemase genes; deaths were identified via the California Electronic Death Registration System. CRO cases with isolates resistant to one or more carbapenems were analyzed from surveillance data from July 2019 to June 2021.
Results: Four hundred and forty-two cases of CROs were reported to Alameda County from 408 patients. The county case rate for CROs was 29 cases per 100,000 population, and cases significantly increased over the 2-year period. CRPA was most commonly reported (157 cases, 36%), and cases of CRAB increased 1.83-fold. One-hundred eighty-six (42%) cases were identified among residents of long-term care facilities; 152 (37%) patients had died by January 2022. One hundred and seven (24%) cases produced carbapenemases.
Conclusions: The high burden of CROs in Alameda County highlights the need for continued partnership on reporting, testing, and infection prevention to limit the spread of resistant organisms. A large proportion of cases were identified in vulnerable long-term care residents, and CRAB was an emerging CRO among this population. Screening for CROs and surveillance at the local level are important to understand epidemiology and implement public health interventions.
{"title":"Epidemiology of carbapenem-resistant organisms in Alameda County, California, 2019-2021.","authors":"Rachel Marusinec, Munira Shemsu, Tyler Lloyd, Brendan M Kober, Dustin T Heaton, Jade A Herrera, Misha Gregory, Vici Varghese, Joelle Nadle, Kavita K Trivedi","doi":"10.1017/ash.2024.33","DOIUrl":"https://doi.org/10.1017/ash.2024.33","url":null,"abstract":"<p><strong>Objective: </strong>Carbapenem-resistant organisms (CROs) are an urgent health threat. Since 2017, Alameda County Health Public Health Department (ACPHD) mandates reporting of carbapenem-resistant Enterobacterales (CRE) and encourages voluntary reporting of non-CRE CROs including carbapenem-resistant <i>Acinetobacter baumannii</i> (CRAB) and carbapenem-resistant <i>Pseudomonas aeruginosa</i> (CRPA). Surveillance data from ACPHD were analyzed to describe the epidemiology of CROs and target public health interventions.</p><p><strong>Methods: </strong>Healthcare facilities in Alameda County reported CRO cases and submitted isolates to ACPHD to characterize carbapenemase genes; deaths were identified via the California Electronic Death Registration System. CRO cases with isolates resistant to one or more carbapenems were analyzed from surveillance data from July 2019 to June 2021.</p><p><strong>Results: </strong>Four hundred and forty-two cases of CROs were reported to Alameda County from 408 patients. The county case rate for CROs was 29 cases per 100,000 population, and cases significantly increased over the 2-year period. CRPA was most commonly reported (157 cases, 36%), and cases of CRAB increased 1.83-fold. One-hundred eighty-six (42%) cases were identified among residents of long-term care facilities; 152 (37%) patients had died by January 2022. One hundred and seven (24%) cases produced carbapenemases.</p><p><strong>Conclusions: </strong>The high burden of CROs in Alameda County highlights the need for continued partnership on reporting, testing, and infection prevention to limit the spread of resistant organisms. A large proportion of cases were identified in vulnerable long-term care residents, and CRAB was an emerging CRO among this population. Screening for CROs and surveillance at the local level are important to understand epidemiology and implement public health interventions.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11062789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140872445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-29eCollection Date: 2024-01-01DOI: 10.1017/ash.2024.50
Daryl Lindsay Williams, Benjamin Kave, Charles Bodas, Megan Roberts, Irene Ng
Objective: Many available facepiece filtering respirators contain ferromagnetic components, which may cause significant problems in the magnetic resonance imaging (MRI) environment. We conducted a randomized crossover trial to assess the effectiveness, usability, and comfort of 3 types of respirators, judged to be "conditionally MRI safe" with an aluminum nosepiece (Halyard 46727 duckbill-type respirators and Care Essentials MSK-002 bifold cup-type respirators) or "MRI safe" completely metal free (Eagle AG2200 semirigid cup-type respirators).
Design and setting: We recruited 120 participants to undergo a quantitative fit test (QNFT) on each of the 3 respirators in a randomized order. Participants then completed a usability and comfort assessment of each respirator.
Results: There were significant differences in the QNFT pass rates (51% for Halyard 46727, 73% for Care Essentials MSK-002, and 86% for Eagle AG2200, P < .001). The first-time fit test pass rate and overall fit factor were significantly higher for Eagle AG2200 compared with the other 2 respirators. Eagle AG2200 scored the lowest ratings in the ease of use and overall comfort. There were no significant differences in other modalities, including the seal rating, breathability, firmness, and overall assessment.
Conclusions: Our study supports the utility of the Eagle AG2200 and Care Essentials MSK-002 respirators for healthcare professionals working in an MRI environment, based on their high QNFT pass rates and reasonably good overall usability and comfort scores. Eagle AG2200 is unique because of its metal-free construction. However, its comparatively lower usability and comfort ratings raise questions about practicality, which may be improved by greater user training.
{"title":"Magnetic resonance imaging respirators: a randomized crossover trial to assess respiratory protection, usability, and comfort.","authors":"Daryl Lindsay Williams, Benjamin Kave, Charles Bodas, Megan Roberts, Irene Ng","doi":"10.1017/ash.2024.50","DOIUrl":"https://doi.org/10.1017/ash.2024.50","url":null,"abstract":"<p><strong>Objective: </strong>Many available facepiece filtering respirators contain ferromagnetic components, which may cause significant problems in the magnetic resonance imaging (MRI) environment. We conducted a randomized crossover trial to assess the effectiveness, usability, and comfort of 3 types of respirators, judged to be \"conditionally MRI safe\" with an aluminum nosepiece (Halyard 46727 duckbill-type respirators and Care Essentials MSK-002 bifold cup-type respirators) or \"MRI safe\" completely metal free (Eagle AG2200 semirigid cup-type respirators).</p><p><strong>Design and setting: </strong>We recruited 120 participants to undergo a quantitative fit test (QNFT) on each of the 3 respirators in a randomized order. Participants then completed a usability and comfort assessment of each respirator.</p><p><strong>Results: </strong>There were significant differences in the QNFT pass rates (51% for Halyard 46727, 73% for Care Essentials MSK-002, and 86% for Eagle AG2200, <i>P</i> < .001). The first-time fit test pass rate and overall fit factor were significantly higher for Eagle AG2200 compared with the other 2 respirators. Eagle AG2200 scored the lowest ratings in the ease of use and overall comfort. There were no significant differences in other modalities, including the seal rating, breathability, firmness, and overall assessment.</p><p><strong>Conclusions: </strong>Our study supports the utility of the Eagle AG2200 and Care Essentials MSK-002 respirators for healthcare professionals working in an MRI environment, based on their high QNFT pass rates and reasonably good overall usability and comfort scores. Eagle AG2200 is unique because of its metal-free construction. However, its comparatively lower usability and comfort ratings raise questions about practicality, which may be improved by greater user training.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11062788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140866883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-29eCollection Date: 2024-01-01DOI: 10.1017/ash.2024.57
Julie Gray, Russell J Benefield, Chanah K Gallagher, Heather Cummins, Laura K Certain
Objective: To compare outcomes between patients discharged on intravenous (IV) versus oral (PO) antibiotics for the treatment of orthopedic infections, after creation of an IV-to-PO guideline, at a single academic medical center in the United States.
Methods: This was a retrospective, propensity score matched, cohort study of adult patients hospitalized for orthopedic infections from September 30, 2020, to April 30, 2022. Patients discharged on PO antibiotics were matched to patients discharged on IV antibiotics. The primary outcome was one-year treatment failure following discharge. Secondary outcomes were incidence of 60-day treatment failure, adverse drug events (ADE), readmissions, infectious disease clinic "no-show" rates, and emergency department (ED) encounters.
Results: Ninety PO-treated patients were matched to 90 IV-treated patients. Baseline characteristics were similar in the two groups after matching. There was no significant difference in the proportions of patients on PO versus IV antibiotics experiencing treatment failure at one year (26% vs 31%, P = .47). There were no significant differences for any secondary outcomes: treatment failure within 60 days (13% vs 14%, P = 1.00), ADE (13% vs 11%, P = .82), unplanned readmission (17% vs 21%, P = .57), or ED encounters (9% vs 18%, P = .54). Survival analyses identified no significant differences in time-to-event between PO and IV treatment for any of the outcomes assessed.
Conclusions: There were no appreciable differences in outcomes between patients discharged on PO compared to IV regimens. Antimicrobial stewardship interventions to increase prescribing of PO antibiotics for the treatment of orthopedic infections should be encouraged.
目的:比较一家学术医疗中心在制定静脉注射转口服抗生素指南后,采用静脉注射与口服抗生素治疗骨科感染的患者的疗效:比较美国一家学术医疗中心在制定静脉注射转口服抗生素指南后,使用静脉注射抗生素和口服抗生素治疗骨科感染的患者出院后的治疗效果:这是一项倾向得分匹配的回顾性队列研究,研究对象是 2020 年 9 月 30 日至 2022 年 4 月 30 日期间因骨科感染住院的成年患者。使用 PO 抗生素出院的患者与使用 IV 抗生素出院的患者相匹配。主要结果是出院后一年的治疗失败率。次要结果为 60 天治疗失败发生率、药物不良事件 (ADE)、再入院率、传染病诊所 "未就诊 "率和急诊科就诊率:90名接受过口服药物治疗的患者与90名接受过静脉注射治疗的患者进行了配对。配对后,两组患者的基线特征相似。使用 PO 抗生素和 IV 抗生素的患者在一年后治疗失败的比例没有明显差异(26% vs 31%,P = .47)。在以下次要结果中也无明显差异:60 天内治疗失败(13% vs 14%,P = 1.00)、ADE(13% vs 11%,P = .82)、非计划再入院(17% vs 21%,P = .57)或急诊就诊(9% vs 18%,P = .54)。生存分析表明,在任何一项评估结果中,口服和静脉注射治疗的事件发生时间均无显著差异:结论:与静脉注射疗法相比,采用口服药物出院的患者在治疗效果上没有明显差异。应鼓励采取抗菌药物管理干预措施,增加处方口服抗生素治疗骨科感染。
{"title":"\"Once more, with feeling\": no difference in outcomes between patients discharged on oral versus intravenous antibiotics for orthopedic infections in a propensity score matched cohort at a US medical center.","authors":"Julie Gray, Russell J Benefield, Chanah K Gallagher, Heather Cummins, Laura K Certain","doi":"10.1017/ash.2024.57","DOIUrl":"https://doi.org/10.1017/ash.2024.57","url":null,"abstract":"<p><strong>Objective: </strong>To compare outcomes between patients discharged on intravenous (IV) versus oral (PO) antibiotics for the treatment of orthopedic infections, after creation of an IV-to-PO guideline, at a single academic medical center in the United States.</p><p><strong>Methods: </strong>This was a retrospective, propensity score matched, cohort study of adult patients hospitalized for orthopedic infections from September 30, 2020, to April 30, 2022. Patients discharged on PO antibiotics were matched to patients discharged on IV antibiotics. The primary outcome was one-year treatment failure following discharge. Secondary outcomes were incidence of 60-day treatment failure, adverse drug events (ADE), readmissions, infectious disease clinic \"no-show\" rates, and emergency department (ED) encounters.</p><p><strong>Results: </strong>Ninety PO-treated patients were matched to 90 IV-treated patients. Baseline characteristics were similar in the two groups after matching. There was no significant difference in the proportions of patients on PO versus IV antibiotics experiencing treatment failure at one year (26% vs 31%, <i>P</i> = .47). There were no significant differences for any secondary outcomes: treatment failure within 60 days (13% vs 14%, <i>P</i> = 1.00), ADE (13% vs 11%, <i>P</i> = .82), unplanned readmission (17% vs 21%, <i>P</i> = .57), or ED encounters (9% vs 18%, <i>P</i> = .54). Survival analyses identified no significant differences in time-to-event between PO and IV treatment for any of the outcomes assessed.</p><p><strong>Conclusions: </strong>There were no appreciable differences in outcomes between patients discharged on PO compared to IV regimens. Antimicrobial stewardship interventions to increase prescribing of PO antibiotics for the treatment of orthopedic infections should be encouraged.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11062794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140872243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-29eCollection Date: 2024-01-01DOI: 10.1017/ash.2024.58
Sarah Davies, Jimmy Zhang, Yongjun Yi, Eric R Burge, Marc Desjardins, Peter C Austin, Carl van Walraven
Background: Many factors have been associated with the risk of toxigenic C. difficile diarrhea (TCdD). This study derived and internally validated a multivariate model for estimating the risk of TCdD in patients with diarrhea using readily available clinical factors.
Methods: A random sample of 3,050 symptomatic emergency department or hospitalized patients undergoing testing for toxigenic C. difficile at a single teaching hospital between 2014 and 2018 was created. Unformed stool samples positive for both glutamate dehydrogenase antigen by enzyme immunoassay and tcdB gene by polymerase chain reaction were classified as TCdD positive. The TCdD Model was created using logistic regression and was modified to the TCdD Risk Score to facilitate its use.
Results: 8.1% of patients were TCdD positive. TCdD risk increased with abdominal pain (adjusted odds ratio 1.3; 95% CI, 1.0-1.8), previous C. difficile diarrhea (2.5, 1.1-6.1), and prior antibiotic exposure, especially when sampled in the emergency department (4.2, 2.5-7.0) versus the hospital (1.7, 1.3-2.3). TCdD risk also increased when testing occurred earlier during the hospitalization encounter, when age and white cell count increased concurrently, and with decreased eosinophil count. In internal validation, the TCdD Model had moderate discrimination (optimism-corrected C-statistic 0.65, 0.62-0.68) and good calibration (optimism-corrected Integrated Calibration Index [ICI] 0.017, 0.001-0.022). Performance decreased slightly for the TCdD Risk Score (C-statistic 0.63, 0.62-0.63; ICI 0.038, 0.004-0.038).
Conclusions: TCdD risk can be predicted using readily available clinical risk factors with modest accuracy.
{"title":"Derivation and internal validation of the multivariate toxigenic <i>C. difficile</i> diarrhea model and risk score for emergency room and hospitalized patients with diarrhea.","authors":"Sarah Davies, Jimmy Zhang, Yongjun Yi, Eric R Burge, Marc Desjardins, Peter C Austin, Carl van Walraven","doi":"10.1017/ash.2024.58","DOIUrl":"https://doi.org/10.1017/ash.2024.58","url":null,"abstract":"<p><strong>Background: </strong>Many factors have been associated with the risk of toxigenic <i>C. difficile</i> diarrhea (TCdD). This study derived and internally validated a multivariate model for estimating the risk of TCdD in patients with diarrhea using readily available clinical factors.</p><p><strong>Methods: </strong>A random sample of 3,050 symptomatic emergency department or hospitalized patients undergoing testing for toxigenic <i>C. difficile</i> at a single teaching hospital between 2014 and 2018 was created. Unformed stool samples positive for both glutamate dehydrogenase antigen by enzyme immunoassay and <i>tcdB</i> gene by polymerase chain reaction were classified as TCdD positive. The TCdD Model was created using logistic regression and was modified to the TCdD Risk Score to facilitate its use.</p><p><strong>Results: </strong>8.1% of patients were TCdD positive. TCdD risk increased with abdominal pain (adjusted odds ratio 1.3; 95% CI, 1.0-1.8), previous <i>C. difficile</i> diarrhea (2.5, 1.1-6.1), and prior antibiotic exposure, especially when sampled in the emergency department (4.2, 2.5-7.0) versus the hospital (1.7, 1.3-2.3). TCdD risk also increased when testing occurred earlier during the hospitalization encounter, when age and white cell count increased concurrently, and with decreased eosinophil count. In internal validation, the TCdD Model had moderate discrimination (optimism-corrected C-statistic 0.65, 0.62-0.68) and good calibration (optimism-corrected Integrated Calibration Index [ICI] 0.017, 0.001-0.022). Performance decreased slightly for the TCdD Risk Score (C-statistic 0.63, 0.62-0.63; ICI 0.038, 0.004-0.038).</p><p><strong>Conclusions: </strong>TCdD risk can be predicted using readily available clinical risk factors with modest accuracy.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11062795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140869332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-29eCollection Date: 2024-01-01DOI: 10.1017/ash.2024.56
Jamilah L Shubeilat, Dan Ilges, Angie N Ton, Maria Teresa A Seville
Objective: Prescribing of antibiotics for viral upper respiratory infections (URIs) remains a pressing public health problem. We sought to reduce inappropriate prescribing of antibiotics for URIs in Mayo Clinic Arizona.
Design: Single-center, quasi-experimental, and retrospective cohort study.
Setting: Emergency medicine and all primary care departments.
Methods: The interventions included sharing baseline prescribing data, education, resources, and quarterly peer comparison reports. Encounters with diagnostic codes for respiratory infections commonly caused by viruses were categorized as Tier 3 (ie, never appropriate to prescribe antibiotics). Our goal was to reduce inappropriate prescribing for Tier 3 encounters by 22% in 2022.
Results: Department education was completed by June 2022. The annual antibiotic prescribing rate for Tier 3 encounters was reduced by 29%, from a baseline rate of 23.6% in 2021 to 16.4% in 2022 (P < .001). The posteducation prescribing rate was 13.1%. Repeat respiratory-related healthcare contact within 14 days of Tier 3 encounters did not differ between patients prescribed and not prescribed an antibiotic in all of 2022 (4.7% antibiotic vs 4.2% no antibiotic, P = .595) or during the posteducation period (3.7% vs 4.6%, P = .604).
Conclusion: A multi-faceted intervention, which included baseline education, syndrome-specific order panels, resources for symptomatic management, and peer comparison reports, resulted in significant reduction of inappropriate antibiotic prescribing for URIs.
{"title":"It takes a village: decreasing inappropriate antibiotic prescribing for upper respiratory tract infections.","authors":"Jamilah L Shubeilat, Dan Ilges, Angie N Ton, Maria Teresa A Seville","doi":"10.1017/ash.2024.56","DOIUrl":"https://doi.org/10.1017/ash.2024.56","url":null,"abstract":"<p><strong>Objective: </strong>Prescribing of antibiotics for viral upper respiratory infections (URIs) remains a pressing public health problem. We sought to reduce inappropriate prescribing of antibiotics for URIs in Mayo Clinic Arizona.</p><p><strong>Design: </strong>Single-center, quasi-experimental, and retrospective cohort study.</p><p><strong>Setting: </strong>Emergency medicine and all primary care departments.</p><p><strong>Methods: </strong>The interventions included sharing baseline prescribing data, education, resources, and quarterly peer comparison reports. Encounters with diagnostic codes for respiratory infections commonly caused by viruses were categorized as Tier 3 (ie, never appropriate to prescribe antibiotics). Our goal was to reduce inappropriate prescribing for Tier 3 encounters by 22% in 2022.</p><p><strong>Results: </strong>Department education was completed by June 2022. The annual antibiotic prescribing rate for Tier 3 encounters was reduced by 29%, from a baseline rate of 23.6% in 2021 to 16.4% in 2022 (<i>P</i> < .001). The posteducation prescribing rate was 13.1%. Repeat respiratory-related healthcare contact within 14 days of Tier 3 encounters did not differ between patients prescribed and not prescribed an antibiotic in all of 2022 (4.7% antibiotic vs 4.2% no antibiotic, <i>P</i> = .595) or during the posteducation period (3.7% vs 4.6%, <i>P</i> = .604).</p><p><strong>Conclusion: </strong>A multi-faceted intervention, which included baseline education, syndrome-specific order panels, resources for symptomatic management, and peer comparison reports, resulted in significant reduction of inappropriate antibiotic prescribing for URIs.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11062784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140873529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-29eCollection Date: 2024-01-01DOI: 10.1017/ash.2024.53
Alessio Strazzulla, Vladimir Adrien, Segla Robert Houngnandan, Sandra Devatine, Ouerdia Bahmed, Sarra Abroug, Sarra Hamrouni, Mehran Monchi, Sylvain Diamantis
Objectives: To investigate the factors associated with Pseudomonas aeruginosa isolates in intensive care unit (ICU) before and after an antimicrobial stewardship program.
Materials: Monocentric retrospective cohort study. Patients admitted to the ICU in 2007-2014 were included. Characteristics of P. aeruginosa patients were compared to overall ICU population. Clinical and microbiological characteristics of P. aeruginosa patients before (2007-2010) and after (2011-2014) the beginning of the AMP were compared.
Results: Overall, 5,263 patients were admitted to the ICU, 274/5,263 (5%) had a P. aeruginosa isolate during their staying. In 2011-2014, the percentage P. aeruginosa isolates reduced (7% vs 4%, P ≤ .0001). Patients with P. aeruginosa had higher rates of in-hospital death (43% vs 20%, P < .0001) than overall ICU population. In 2011-2014, rates of multidrug-resistant (11% vs 2%, P = .0020), fluoroquinolone-resistant (35% vs 12%, P < .0001), and ceftazidime-resistant (23% vs 8%, P = .0009) P. aeruginosa reduced. Treatments by fluoroquinolones (36% vs 4%, P ≤ .0001), carbapenems (27% vs 9%, P = .0002), and third-generation cephalosporins (49% vs 12%, P ≤ .0001) before P. aeruginosa isolation reduced while piperacillin (0% vs 13%, P < .0001) and trimethoprim-sulfamethoxazole (8% vs 26%, P = .0023) increased. Endotracheal intubation reduced in 2011-2014 (61% vs 35%, P < .0001). Fluoroquinolone-resistance was higher in patients who received endotracheal intubation (29% vs 17%, P = .0197). Previous treatment by fluoroquinolones (OR = 2.94, P = .0020) and study period (2007-2010) (OR = 2.07, P = .0462) were the factors associated with fluoroquinolone-resistance at the multivariate analysis.
Conclusions: Antibiotic susceptibility in P. aeruginosa isolates was restored after the reduction of endotracheal intubation, fluoroquinolones, carbapenems, and third-generation cephalosporins and the increased use of molecules with a low ecological footprint, as piperacillin and trimethoprim-sulfamethoxazole.
目的:研究重症监护病房铜绿假单胞菌分离的相关因素:研究重症监护病房(ICU)在实施抗菌药物管理计划前后铜绿假单胞菌分离的相关因素:单中心回顾性队列研究。材料:单中心回顾性队列研究。将铜绿假单胞菌患者的特征与重症监护病房的总体情况进行比较。比较了 AMP 启用前(2007-2010 年)和启用后(2011-2014 年)铜绿假单胞菌患者的临床和微生物学特征:结果:共有5263名患者入住重症监护室,其中274人/5263人(5%)在住院期间分离到铜绿假单胞菌。2011-2014年,铜绿假单胞菌分离率有所下降(7% vs 4%,P ≤ .0001)。铜绿假单胞菌患者的院内死亡率(43% vs 20%,P < .0001)高于重症监护病房的总体死亡率。2011-2014年,耐多药(11% vs 2%,P = .0020)、耐氟喹诺酮(35% vs 12%,P < .0001)和耐头孢唑肟(23% vs 8%,P = .0009)铜绿假单胞菌的发病率有所下降。铜绿假单胞菌分离前使用氟喹诺酮类(36% vs 4%,P ≤ .0001)、碳青霉烯类(27% vs 9%,P = .0002)和第三代头孢菌素类(49% vs 12%,P ≤ .0001)治疗的情况减少,而使用哌拉西林(0% vs 13%,P < .0001)和三甲双胍-磺胺甲噁唑(8% vs 26%,P = .0023)治疗的情况增加。2011-2014年,气管插管率有所下降(61% vs 35%,P < .0001)。接受气管插管治疗的患者对氟喹诺酮类药物的耐药性更高(29% vs 17%,P = .0197)。曾接受氟喹诺酮类药物治疗(OR = 2.94,P = .0020)和研究时间(2007-2010年)(OR = 2.07,P = .0462)是多变量分析中与氟喹诺酮耐药相关的因素:结论:在减少气管插管、氟喹诺酮类、碳青霉烯类和第三代头孢菌素以及增加使用哌拉西林和三甲双氨-磺胺甲噁唑等生态足迹小的分子后,铜绿假单胞菌分离株的抗生素敏感性得到恢复。
{"title":"Characteristics of <i>Pseudomonas aeruginosa</i> infection in intensive care unit before (2007-2010) and after (2011-2014) the beginning of an antimicrobial stewardship program.","authors":"Alessio Strazzulla, Vladimir Adrien, Segla Robert Houngnandan, Sandra Devatine, Ouerdia Bahmed, Sarra Abroug, Sarra Hamrouni, Mehran Monchi, Sylvain Diamantis","doi":"10.1017/ash.2024.53","DOIUrl":"https://doi.org/10.1017/ash.2024.53","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the factors associated with <i>Pseudomonas aeruginosa</i> isolates in intensive care unit (ICU) before and after an antimicrobial stewardship program.</p><p><strong>Materials: </strong>Monocentric retrospective cohort study. Patients admitted to the ICU in 2007-2014 were included. Characteristics of <i>P. aeruginosa</i> patients were compared to overall ICU population. Clinical and microbiological characteristics of <i>P. aeruginosa</i> patients before (2007-2010) and after (2011-2014) the beginning of the AMP were compared.</p><p><strong>Results: </strong>Overall, 5,263 patients were admitted to the ICU, 274/5,263 (5%) had a <i>P. aeruginosa</i> isolate during their staying. In 2011-2014, the percentage <i>P. aeruginosa</i> isolates reduced (7% vs 4%, <i>P</i> ≤ .0001). Patients with <i>P. aeruginosa</i> had higher rates of in-hospital death (43% <i>vs</i> 20%, <i>P</i> < .0001) than overall ICU population. In 2011-2014, rates of multidrug-resistant (11% <i>vs</i> 2%, <i>P</i> = .0020), fluoroquinolone-resistant (35% vs 12%, <i>P</i> < .0001), and ceftazidime-resistant (23% vs 8%, <i>P</i> = .0009) <i>P. aeruginosa</i> reduced. Treatments by fluoroquinolones (36% vs 4%, <i>P</i> ≤ .0001), carbapenems (27% vs 9%, <i>P</i> = .0002), and third-generation cephalosporins (49% vs 12<i>%</i>, <i>P</i> ≤ .0001) before <i>P. aeruginosa</i> isolation reduced while piperacillin (0% vs 13%, <i>P</i> < .0001) and trimethoprim-sulfamethoxazole (8% vs 26%, <i>P</i> = .0023) increased. Endotracheal intubation reduced in 2011-2014 (61% vs 35%, <i>P</i> < .0001). Fluoroquinolone-resistance was higher in patients who received endotracheal intubation (29% vs 17%, <i>P</i> = .0197). Previous treatment by fluoroquinolones (OR = 2.94, <i>P</i> = .0020) and study period (2007-2010) (OR = 2.07, <i>P</i> = .0462) were the factors associated with fluoroquinolone-resistance at the multivariate analysis.</p><p><strong>Conclusions: </strong>Antibiotic susceptibility in <i>P. aeruginosa</i> isolates was restored after the reduction of endotracheal intubation, fluoroquinolones, carbapenems, and third-generation cephalosporins and the increased use of molecules with a low ecological footprint, as piperacillin and trimethoprim-sulfamethoxazole.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11062793/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140872977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-24eCollection Date: 2024-01-01DOI: 10.1017/ash.2024.17
Nathaly Valdivia, Lisa R Hirschhorn, Thanh-Huyen Vu, Cerina Dubois, Judith T Moskowitz, John T Wilkins, Charlesnika T Evans
Objective: To describe utilization of at-home coronavirus disease 2019 (COVID-19) testing among healthcare workers (HCW).
Design: Serial cross-sectional study.
Setting and participants: HCWs in the Chicago area.
Methods: Serial surveys were conducted from the Northwestern Medicine (NM HCW SARS-CoV-2) Serology Cohort Study. In April 2022, participants reflected on the past 30 days to complete an online survey regarding COVID-19 home testing. Surveys were repeated in June and November 2022. The percentage of completed home tests and ever-positive tests were reported. Multivariable Poisson regression was used to calculate prevalence rate ratios (PRR) and univariate analysis was used for association between participant characteristics with home testing and positivity.
Results: Overall, 2,226 (62.4%) of 3,569 responded to the survey in April. Home testing was reported by 26.6% of respondents and 5.9% reported having at least one positive home test. Testing was highest among those 30-39 years old (35.9%) and nurses (28.3%). A positive test was associated (P < .001) with exposure to people, other than patients with known or suspected COVID-19. Home testing increased in June to 36.4% (positivity 19.9%) and decreased to 25% (positivity 13.5%) by November.
Conclusion: Our cohort findings show the overall increase in both home testing and ever positivity from April to November - a period where changes in variants of concern of SARS-CoV-2 were reported nationwide. Having an exposure to people, other than patients with known or suspected COVID-19 was significantly associated with both, higher home testing frequency and ever-test positivity.
{"title":"Utilization of at-home tests for coronavirus disease 2019 (COVID-19) among healthcare workers in Chicago.","authors":"Nathaly Valdivia, Lisa R Hirschhorn, Thanh-Huyen Vu, Cerina Dubois, Judith T Moskowitz, John T Wilkins, Charlesnika T Evans","doi":"10.1017/ash.2024.17","DOIUrl":"10.1017/ash.2024.17","url":null,"abstract":"<p><strong>Objective: </strong>To describe utilization of at-home coronavirus disease 2019 (COVID-19) testing among healthcare workers (HCW).</p><p><strong>Design: </strong>Serial cross-sectional study.</p><p><strong>Setting and participants: </strong>HCWs in the Chicago area.</p><p><strong>Methods: </strong>Serial surveys were conducted from the Northwestern Medicine (NM HCW SARS-CoV-2) Serology Cohort Study. In April 2022, participants reflected on the past 30 days to complete an online survey regarding COVID-19 home testing. Surveys were repeated in June and November 2022. The percentage of completed home tests and ever-positive tests were reported. Multivariable Poisson regression was used to calculate prevalence rate ratios (PRR) and univariate analysis was used for association between participant characteristics with home testing and positivity.</p><p><strong>Results: </strong>Overall, 2,226 (62.4%) of 3,569 responded to the survey in April. Home testing was reported by 26.6% of respondents and 5.9% reported having at least one positive home test. Testing was highest among those 30-39 years old (35.9%) and nurses (28.3%). A positive test was associated (<i>P</i> < .001) with exposure to people, other than patients with known or suspected COVID-19. Home testing increased in June to 36.4% (positivity 19.9%) and decreased to 25% (positivity 13.5%) by November.</p><p><strong>Conclusion: </strong>Our cohort findings show the overall increase in both home testing and ever positivity from April to November - a period where changes in variants of concern of SARS-CoV-2 were reported nationwide. Having an exposure to people, other than patients with known or suspected COVID-19 was significantly associated with both, higher home testing frequency and ever-test positivity.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11062791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140867743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-24eCollection Date: 2024-01-01DOI: 10.1017/ash.2024.46
Rhett Vandervelde, Mark E Mlynarek, Mayur Ramesh, Nimish Patel, Michael P Veve, Benjamin A August
Objective: Data evaluating timeliness of antibiotic therapy in Clostridioides difficile infections (CDI) are not well established. The study's purpose was to evaluate the impact of time-to-CDI treatment on disease progression.
Methods: A case-control study was performed among hospitalized patients with CDI from 1/2018 to 2/2022. Inclusion criteria were age ≥65 years, first occurrence, non-severe CDI at symptom onset, and CDI treatment for ≥72 hours. Cases included patients who progressed to severe or fulminant CDI; controls were patients without CDI progression. Time to CDI treatment was evaluated in three ways: a classification and regression tree (CART)-defined threshold, time as a continuous variable, and time as a categorical variable.
Results: 272 patients were included; 136 with CDI progression, 136 patients without. The median (IQR) age was 74 (69-81) years, 167 (61%) were women, and 108 (40%) were immunosuppressed. CDI progression patients more commonly were toxin positive (66 [49%] vs 52 [38%], P = .087) with hospital-acquired disease (57 [42%] vs 29 [21%], P < 0.001). A CART-derived breakpoint for optimal time-to-CDI treatment of 64 hours established early (184, 68%) and delayed treatment (88, 32%). When accounting for confounding variables, delayed CDI treatment was associated with disease progression (adjOR, 4.6; 95%CI, 2.6-8.2); this was observed regardless of how time-to-CDI-active therapy was evaluated (continuous adjOR, 1.02; categorical adjOR, 2.11).
Conclusion: Delayed CDI treatment was associated with disease progression and could represent an important antimicrobial stewardship measure with future evaluation.
{"title":"Impact of time to treatment in first occurrence, non-severe <i>Clostridioides difficile</i> infection for elderly patients: are we waiting too long to treat?","authors":"Rhett Vandervelde, Mark E Mlynarek, Mayur Ramesh, Nimish Patel, Michael P Veve, Benjamin A August","doi":"10.1017/ash.2024.46","DOIUrl":"https://doi.org/10.1017/ash.2024.46","url":null,"abstract":"<p><strong>Objective: </strong>Data evaluating timeliness of antibiotic therapy in <i>Clostridioides difficile</i> infections (CDI) are not well established. The study's purpose was to evaluate the impact of time-to-CDI treatment on disease progression.</p><p><strong>Methods: </strong>A case-control study was performed among hospitalized patients with CDI from 1/2018 to 2/2022. Inclusion criteria were age ≥65 years, first occurrence, non-severe CDI at symptom onset, and CDI treatment for ≥72 hours. Cases included patients who progressed to severe or fulminant CDI; controls were patients without CDI progression. Time to CDI treatment was evaluated in three ways: a classification and regression tree (CART)-defined threshold, time as a continuous variable, and time as a categorical variable.</p><p><strong>Results: </strong>272 patients were included; 136 with CDI progression, 136 patients without. The median (IQR) age was 74 (69-81) years, 167 (61%) were women, and 108 (40%) were immunosuppressed. CDI progression patients more commonly were toxin positive (66 [49%] vs 52 [38%], <i>P</i> = .087) with hospital-acquired disease (57 [42%] vs 29 [21%], <i>P</i> < 0.001). A CART-derived breakpoint for optimal time-to-CDI treatment of 64 hours established early (184, 68%) and delayed treatment (88, 32%). When accounting for confounding variables, delayed CDI treatment was associated with disease progression (adjOR, 4.6; 95%CI, 2.6-8.2); this was observed regardless of how time-to-CDI-active therapy was evaluated (continuous adjOR, 1.02; categorical adjOR, 2.11).</p><p><strong>Conclusion: </strong>Delayed CDI treatment was associated with disease progression and could represent an important antimicrobial stewardship measure with future evaluation.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11062792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140854498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}