Infection Control & Hospital Epidemiology最新文献

{"title":"Phantom Prescribing: Examining the Frequency of Antimicrobial Prescriptions Without a Patient Visit","authors":"B. Riedle, Linnea A. Polgreen, J. Cavanaugh, M. Schroeder, P. Polgreen","doi":"10.1017/ice.2016.269","DOIUrl":"https://doi.org/10.1017/ice.2016.269","url":null,"abstract":"OBJECTIVE To investigate the scale of antimicrobial prescribing without a corresponding visit, and to compare the attributes of patients who received antimicrobials with a corresponding visit with those who did not have a visit. DESIGN Retrospective cohort. METHODS We followed up 185,010 Medicare patients for 1 year after an acute myocardial infarction. For each antimicrobial prescribed, we determined whether the patient had an inpatient, outpatient, or provider claim in the 7 days prior to the antimicrobial prescription being filled. We compared the proportions of patient characteristics for those prescriptions associated with a visit and without a visit (ie, phantom prescriptions). We also compared the rates at which different antimicrobials were prescribed without a visit. RESULTS We found that of 356,545 antimicrobial prescriptions, 14.75% had no evidence of a visit in the week prior to the prescription being filled. A higher percentage of patients without a visit were identified as white (P<.001) and female (P<.001). Patients without a visit had a higher likelihood of survival and fewer additional cardiac events (acute myocardial infarction, cardiac arrest, stroke, all P<.001). Among the antimicrobials considered, amoxicillin, penicillin, and agents containing trimethoprim and methenamine were much more likely to be prescribed without a visit. In contrast, levofloxacin, metronidazole, moxifloxacin, vancomycin, and cefdinir were much less likely to be prescribed without a visit. CONCLUSIONS Among this cohort of patients with chronic conditions, phantom prescriptions of antimicrobials are relatively common and occurred more frequently among those patients who were relatively healthy. Infect Control Hosp Epidemiol 2017;38:273–280","PeriodicalId":13655,"journal":{"name":"Infection Control &#x0026; Hospital Epidemiology","volume":"121 1","pages":"273 - 280"},"PeriodicalIF":0.0,"publicationDate":"2016-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80777609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outbreak of Klebsiella pneumoniae Carbapenemase–Producing Citrobacter freundii at a Tertiary Acute Care Facility in Miami, Florida","authors":"A. Jimenez, José G. Castro, L. Munoz-Price, Dennise de Pascale, L. Shimose, M. Mustapha, Caressa N. Spychala, R. Mettus, V. Cooper, Y. Doi","doi":"10.1017/ice.2016.273","DOIUrl":"https://doi.org/10.1017/ice.2016.273","url":null,"abstract":"OBJECTIVE To describe the investigation and control of a rare cluster of Klebsiella pneumoniae carbapenemase–producing Citrobacter freundii in a hospital in southern Florida. METHODS An epidemiologic investigation, review of infection prevention procedures, and molecular studies including whole genome sequencing were conducted. RESULTS An outbreak of K. pneumoniae carbapenemase–3-producing C. freundii was identified at a tertiary hospital in Florida in 2014. Of the 6 cases identified, 3 occurred in the same intensive care unit and were caused by the same clone. For 2 of the 3 remaining cases, the isolates had low carbapenem minimum inhibitory concentrations and were unrelated by whole genome sequencing. As a response to the outbreak, supplementary environmental cleaning was implemented, including closure and terminal cleaning of the unit where the 3 cases clustered, in addition to the infection control bundle already in place at the time. No further cases were identified after these additional interventions. CONCLUSIONS Although C. freundii is not a species that commonly demonstrates carbapenem resistance, our findings suggest that carbapenemase-producing C. freundii may be underdetected even when active surveillance is in place and has a potential to cause hospital outbreak. Infect Control Hosp Epidemiol 2017;38:320–326","PeriodicalId":13655,"journal":{"name":"Infection Control &#x0026; Hospital Epidemiology","volume":"22 1","pages":"320 - 326"},"PeriodicalIF":0.0,"publicationDate":"2016-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73999213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergence of OXA-72-producing Acinetobacter baumannii Belonging to High-Risk Clones (CC15 and CC79) in Different Brazilian States","authors":"M. Pagano, L. Rocha, J. Sampaio, A. F. Martins, A. Barth","doi":"10.1017/ice.2016.287","DOIUrl":"https://doi.org/10.1017/ice.2016.287","url":null,"abstract":"hand hygiene compliance observations and consecutive training efforts is important, given that <10% of all hand disinfections were performed correctly in an observational study by Tschudin-Sutter et al, who observed the 6-step technique. Appropriate hand-surface coverage was reached in only 7.9% of hand hygiene procedures observed by Park et al, despite a high rate of compliance with the correct indications. Shah et al performed a video observation of hand washing. Of 1,081 recordings, 403 (37.3%) were excellent, 521 (48.2%) were acceptable, and 157 (14.5%) were unacceptable. A limitation of our study is the lack of bacterial counts, but the results of Riley et al, who showed no correlation between hand coverage and bacterial counts with a 6-step technique compared to a 3-step approach, had not been published at the time of our experiment. Another limitation is the small number of participants and the experimental setting of this proof-of-principle study. However, we believe that based on our results, the addition of dichotomous subjective quality assessment using the parameters time and skin coverage during live observation by experienced infection control staff is feasible and could be a valuable addition to conventional hand hygiene observation.","PeriodicalId":13655,"journal":{"name":"Infection Control &#x0026; Hospital Epidemiology","volume":"60 1","pages":"252 - 254"},"PeriodicalIF":0.0,"publicationDate":"2016-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80465827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Silent Epidemic of Colistin- and Carbapenem-Resistant Enterobacteriaceae at a Turkish University Hospital","authors":"G. Metan, A. İlbay, O. Eser, S. Unal, P. Zarakolu","doi":"10.1017/ice.2016.255","DOIUrl":"https://doi.org/10.1017/ice.2016.255","url":null,"abstract":"Financial support: This study was supported by the CAPES Foundation, Ministry of Education of Brazil, Brasília, Brazil, and by FIPE/HCPA (Research and Events Support Fund at Hospital de Clínicas de Porto Alegre). A.L.B is a research fellow and receives support from the CNPq, Ministry of Science and Technology, Brazil (grant no. 458489/2014-0). Potential conflict of interest:All authors report no conflicts of interest relevant to this article.","PeriodicalId":13655,"journal":{"name":"Infection Control &#x0026; Hospital Epidemiology","volume":"32 1","pages":"254 - 257"},"PeriodicalIF":0.0,"publicationDate":"2016-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81564531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Pediatric Approach to Ventilator-Associated Events Surveillance","authors":"N. Cocoros, G. Priebe, L. Logan, S. Coffin, G. Larsen, P. Toltzis, Thomas J. Sandora, M. Harper, J. Sammons, J. Gray, D. Goldmann, Kelly Horan, Michael Burton, P. Checchia, Matthew D. Lakoma, S. Sims, M. Klompas, Grace M. Lee","doi":"10.1017/ice.2016.277","DOIUrl":"https://doi.org/10.1017/ice.2016.277","url":null,"abstract":"OBJECTIVE Adult ventilator-associated event (VAE) definitions include ventilator-associated conditions (VAC) and subcategories for infection-related ventilator-associated complications (IVAC) and possible ventilator-associated pneumonia (PVAP). We explored these definitions for children. DESIGN Retrospective cohort SETTING Pediatric, cardiac, or neonatal intensive care units (ICUs) in 6 US hospitals PATIENTS Patients ≤18 years old ventilated for ≥1 day METHODS We identified patients with pediatric VAC based on previously proposed criteria. We applied adult temperature, white blood cell count, antibiotic, and culture criteria for IVAC and PVAP to these patients. We matched pediatric VAC patients with controls and evaluated associations with adverse outcomes using Cox proportional hazards models. RESULTS In total, 233 pediatric VACs (12,167 ventilation episodes) were identified. In the cardiac ICU (CICU), 62.5% of VACs met adult IVAC criteria; in the pediatric ICU (PICU), 54.2% of VACs met adult IVAC criteria; and in the neonatal ICU (NICU), 20.2% of VACs met adult IVAC criteria. Most patients had abnormal white blood cell counts and temperatures; we therefore recommend simplifying surveillance by focusing on “pediatric VAC with antimicrobial use” (pediatric AVAC). Pediatric AVAC with a positive respiratory diagnostic test (“pediatric PVAP”) occurred in 8.9% of VACs in the CICU, 13.3% of VACs in the PICU, and 4.3% of VACs in the NICU. Hospital mortality was increased, and hospital and ICU length of stay and duration of ventilation were prolonged among all pediatric VAE subsets compared with controls. CONCLUSIONS We propose pediatric AVAC for surveillance related to antimicrobial use, with pediatric PVAP as a subset of AVAC. Studies on generalizability and responsiveness of these metrics to quality improvement initiatives are needed, as are studies to determine whether lower pediatric VAE rates are associated with improvements in other outcomes. Infect Control Hosp Epidemiol 2017;38:327–333","PeriodicalId":13655,"journal":{"name":"Infection Control &#x0026; Hospital Epidemiology","volume":"47 1","pages":"327 - 333"},"PeriodicalIF":0.0,"publicationDate":"2016-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75096057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of an Ethanol-Based Spray Disinfectant for Decontamination of Cover Gowns Prior to Removal","authors":"Sreelatha Koganti, Heba Alhmidi, Myreen E. Tomas, J. Cadnum, Christopher Sass, A. Jencson, C. Donskey","doi":"10.1017/ice.2016.295","DOIUrl":"https://doi.org/10.1017/ice.2016.295","url":null,"abstract":"An ethanol-based spray disinfectant significantly reduced bacteriophage MS2 contamination on material from gowns meeting ASTM standard 1671 for resistance to blood and viral penetration and on a cover gown worn by personnel. Effectiveness of disinfection was affected by the type of gown material and the correctness of fit. Infect Control Hosp Epidemiol 2017;38:364–366","PeriodicalId":13655,"journal":{"name":"Infection Control &#x0026; Hospital Epidemiology","volume":"28 1","pages":"364 - 366"},"PeriodicalIF":0.0,"publicationDate":"2016-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75258141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantifying Antimicrobial Exposure: Hazards in Populations With End-Stage Renal Disease","authors":"G. Snyder, Christopher M. McCoy, E. D’Agata","doi":"10.1017/ice.2016.290","DOIUrl":"https://doi.org/10.1017/ice.2016.290","url":null,"abstract":"Using a rigorously collected data set of antimicrobial use among patients receiving chronic hemodialysis, antimicrobial use was calculated using 3 different methodologies: daily defined dose, days of therapy, and start–stop days. Estimates of antimicrobial use varied by as much as 10-fold, depending on the type of antimicrobial. Infect Control Hosp Epidemiol 2017;38:360–363","PeriodicalId":13655,"journal":{"name":"Infection Control &#x0026; Hospital Epidemiology","volume":"5 1","pages":"360 - 363"},"PeriodicalIF":0.0,"publicationDate":"2016-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78668738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uptake and Beliefs Regarding Seasonal Influenza Vaccination Among Childcare Center Staff, Administrators, and Parents","authors":"T. Rebmann, T. Loux, B. Daly","doi":"10.1017/ice.2016.263","DOIUrl":"https://doi.org/10.1017/ice.2016.263","url":null,"abstract":"Surveys were distributed to parents and childcare agency staff to determine seasonal influenza vaccine uptake. Multivariate logistic regressions identified vaccination determinants. Overall, 351 parents and staff participated (response rate, 32%). One-half (168 [48%]) received vaccine. Vaccination predictors included healthcare provider or employer recommendation, perceived seriousness, and no vaccine fear. Infect Control Hosp Epidemiol 2017;38:367–370","PeriodicalId":13655,"journal":{"name":"Infection Control &#x0026; Hospital Epidemiology","volume":"26 1","pages":"367 - 370"},"PeriodicalIF":0.0,"publicationDate":"2016-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73186507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Top 1% of Inpatients Administered Antimicrobial Agents Comprising 50% of Expenditures: A Descriptive Study and Opportunities for Stewardship Intervention","authors":"Jennifer Dela-Pena, L. Kerstenetzky, Lucas T. Schulz, R. Kendall, A. Lepak, B. Fox","doi":"10.1017/ice.2016.261","DOIUrl":"https://doi.org/10.1017/ice.2016.261","url":null,"abstract":"OBJECTIVE To characterize the top 1% of inpatients who contributed to the 6-month antimicrobial budget in a tertiary, academic medical center and identify cost-effective intervention opportunities targeting high-cost antimicrobial utilization. DESIGN Retrospective cohort study. PATIENTS Top 1% of the antimicrobial budget from July 1 through December 31, 2014. METHODS Patients were identified through a pharmacy billing database. Baseline characteristics were collected through a retrospective medical chart review. Patients were presented to the antimicrobial stewardship team to determine appropriate utilization of high-cost antimicrobials and potential intervention opportunities. Appropriate use was defined as antimicrobial therapy that was effective, safe, and most cost-effective compared with alternative agents. RESULTS A total of 10,460 patients received antimicrobials in 6 months; 106 patients accounted for $889,543 (47.2%) of the antimicrobial budget with an antimicrobial cost per day of $219±$192 and antimicrobial cost per admission of $4,733±$7,614. Most patients were immunocompromised (75%) and were followed by the infectious disease consult service (80%). The most commonly prescribed antimicrobials for treatment were daptomycin, micafungin, liposomal amphotericin B, and meropenem. Posaconazole and valganciclovir accounted for most of the prophylactic therapy. Cost-effective opportunities (n=71) were present in 57 (54%) of 106 patients, which included dose optimization, de-escalation, dosage form conversion, and improvement in transitions of care. CONCLUSION Antimicrobial stewardship oversight is important in implementing cost-effective strategies, especially in complex and immunocompromised patients who require the use of high-cost antimicrobials. Infect Control Hosp Epidemiol 2017;38:259–265","PeriodicalId":13655,"journal":{"name":"Infection Control &#x0026; Hospital Epidemiology","volume":"37 1","pages":"259 - 265"},"PeriodicalIF":0.0,"publicationDate":"2016-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73045074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effective Antibiotic Conservation by Emergency Antimicrobial Stewardship During a Drug Shortage","authors":"Kevin Hsueh, Maria M Reyes, Tamara Krekel, E. Casabar, D. Ritchie, Reza Jafarzadeh, Amanda J Hays, M. Lane, M. Durkin","doi":"10.1017/ice.2016.289","DOIUrl":"https://doi.org/10.1017/ice.2016.289","url":null,"abstract":"We present the first description of an antimicrobial stewardship program (ASP) used to successfully manage a multi-antimicrobial drug shortage. Without resorting to formulary restriction, meropenem utilization decreased by 69% and piperacillin-tazobactam by 73%. During the shortage period, hospital mortality decreased (P=.03), while hospital length of stay remained unchanged. Infect Control Hosp Epidemiol 2017;38:356–359","PeriodicalId":13655,"journal":{"name":"Infection Control &#x0026; Hospital Epidemiology","volume":"36 7 1","pages":"356 - 359"},"PeriodicalIF":0.0,"publicationDate":"2016-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80170408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}