Infection Control and Hospital Epidemiology最新文献

{"title":"Sociodemographic differences in treatment of acute respiratory infections in pediatric urgent cares.","authors":"Rana E El Feghaly, Luis E Sainz, Brian R Lee, Matthew P Kronman, Adam L Hersh, Victoria Parente, Destani Bizune, Guillermo V Sanchez, Rana F Hamdy, Amanda Nedved","doi":"10.1017/ice.2024.196","DOIUrl":"https://doi.org/10.1017/ice.2024.196","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether differences exist in antibiotic prescribing for respiratory infections in pediatric urgent cares (PUCs) by patient race/ethnicity, insurance, and language.</p><p><strong>Design: </strong>Multi-center cohort study.</p><p><strong>Setting: </strong>Nine organizations (92 locations) from 22 states and Washington, DC.</p><p><strong>Participants: </strong>Patients ages 6 months-18 years evaluated April 2022-April 2023, with acute viral respiratory infections, otitis media with effusion (OME), acute otitis media (AOM), pharyngitis, community-acquired pneumonia (CAP), and sinusitis.</p><p><strong>Methods: </strong>We compared the use of first-line (FL) therapy as defined by published guidelines. We used race/ethnicity, insurance, and language as exposures. Multivariable logistic regression models estimated the odds of FL therapy by group.</p><p><strong>Results: </strong>We evaluated 396,340 ARI encounters. Among all encounters, 351,930 (88.8%) received FL therapy (98% for viral respiratory infections, 85.4% for AOM, 96.0% for streptococcal pharyngitis, 83.6% for sinusitis). OME and CAP had the lowest rates of FL therapy (49.9% and 60.7%, respectively). Adjusted odds of receiving FL therapy were higher in Black Non-Hispanic (NH) (adjusted odds ratio [aOR] 1.53 [1.47, 1.59]), Asian NH (aOR 1.46 [1.40, 1.53], and Hispanic children (aOR 1.37 [1.33, 1.41]), compared to White NH. Additionally, odds of receiving FL therapy were higher in children with Medicaid/Medicare (aOR 1.21 [1.18-1.24]) and self-pay (aOR 1.18 [1.1-1.27]) compared to those with commercial insurance.</p><p><strong>Conclusions: </strong>This multicenter collaborative showed lower rates of FL therapy for children of the White NH race and those with commercial insurance compared to other groups. Exploring these differences through a health equity lens is important for developing mitigating strategies.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-9"},"PeriodicalIF":3.0,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Say it ain't <i>Steno</i>: a microbiology nudge comment leads to less treatment of <i>Stenotrophomonas maltophilia</i> respiratory colonization.","authors":"Stormmy R Boettcher, Rachel M Kenney, Christen J Arena, Amy E Beaulac, Robert J Tibbetts, Anita B Shallal, Geehan Suleyman, Michael P Veve","doi":"10.1017/ice.2024.195","DOIUrl":"https://doi.org/10.1017/ice.2024.195","url":null,"abstract":"<p><strong>Objective: </strong>To describe the effect of a <i>Stenotrophomonas maltophilia</i> (SM) respiratory culture nudge on antibiotic use in colonized patients.</p><p><strong>Design: </strong>IRB-approved quasi-experiment.</p><p><strong>Setting: </strong>Five acute-care hospitals in Michigan.</p><p><strong>Patients: </strong>Adult patients with SM respiratory culture between 01/01/2022 and 01/27/2023 (pre-nudge) and 03/27/2023-12/31/2023 (post-nudge). Patients with active community/hospital/ventilator-acquired pneumonia or who received SM-targeted antibiotics at the time of culture were excluded.</p><p><strong>Methods: </strong>A nudge comment was implemented 02/2023 stating: \"<i>S. maltophilia</i> is a frequent colonizer of the respiratory tract. Clinical correlation for infection is required. Colonizers do not require antibiotic treatment.\" The primary outcome was no treatment with SM-therapy; secondary outcomes were treatment with SM-therapy ≥72 hrs, length of stay, and in-hospital, all-cause mortality. Safety outcomes included antibiotic-associated adverse drug events (ADEs).</p><p><strong>Results: </strong>94 patients were included: 53 (56.4%) pre- and 41 (43.6%) post-nudge. Most patients were men (53, 56.4%), had underlying lung disease (61, 64.8%), and required invasive ventilatory support (70, 74.5%). Eleven (11.7%) patients resided in a long-term care facility. No treatment with SM therapy was observed in 13 (23.1%) pre- versus 32 (78.0%) post-nudge patients (<i>P</i> <0.001). There were no differences in secondary outcomes. Antibiotic-associated ADEs were common (33/41, 76%) in patients who received ≥72hrs of SM-therapy: fluid overload (18, 44%), hyponatremia (17, 42%), elevated SCr (12, 29%), hyperkalemia (5, 12%). After adjustment for confounders, post-nudge was associated with 11-fold increased odds of no treatment with SM-therapy (adjOR, 11.72; 95%CI, 4.18-32.83).</p><p><strong>Conclusions: </strong>A targeted SM nudge was associated with a significant reduction in treatment of colonization, with similar patient outcomes. SM-treated patients frequently developed antibiotic-associated ADEs.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-5"},"PeriodicalIF":3.0,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term trends in the incidence of hospital-acquired carbapenem-resistant <i>Enterobacterales</i> and antimicrobial utilization in a network of community hospitals in the Southeastern United States from 2013 to 2023.","authors":"Tark Kim, Rebekah W Moehring, Nicholas A Turner, Elizabeth Dodds Ashley, Linda Crane, Polly Padgette, Valerie C Payne, Linda Roach, Brittain Wood, Deverick J Anderson","doi":"10.1017/ice.2024.173","DOIUrl":"10.1017/ice.2024.173","url":null,"abstract":"<p><strong>Background: </strong>Carbapenem-resistant <i>Enterobacterales</i> (CRE) are an urgent threat to healthcare, but the epidemiology of these antimicrobial-resistant organisms may be evolving in some settings since the COVID-19 pandemic. An updated analysis of hospital-acquired CRE (HA-CRE) incidence in community hospitals is needed.</p><p><strong>Methods: </strong>We retrospectively analyzed data on HA-CRE cases and antimicrobial utilization (AU) from two community hospital networks, the Duke Infection Control Outreach Network (DICON) and the Duke Antimicrobial Stewardship Outreach Network (DASON) from January 2013 to June 2023. The zero-inflated negative binomial regression model was used owing to excess zeros.</p><p><strong>Results: </strong>126 HA-CRE cases from 36 hospitals were included in the longitudinal analysis. The pooled incidence of HA CRE was 0.69 per 100,000 patient days (95% confidence interval [95% CI], 0.57-0.82 HA-CRE rate significantly decreased over time before COVID-19 (rate ratio [RR], 0.94 [95% CI, 0.89-0.99]; <i>p</i> = 0.02), but there was a significant slope change indicating a trend increase in HA-CRE after COVID-19 (RR, 1.32 [95% CI, 1.06-1.66]; <i>p</i> = 0.01). In 21 hospitals participating in both DICON and DASON from January 2018 to June 2023, there was a correlation between HA-CRE rates and AU for CRE treatment (Spearman's coefficient = 0.176; <i>p</i> < 0.01). Anti-CRE AU did not change over time, and there was no level or slope change after COVID.</p><p><strong>Conclusions: </strong>The incidence of HA-CRE decreased before COVID-19 in a network of community hospitals in the southeastern United States, but this trend was disrupted by the COVID-19 pandemic.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-7"},"PeriodicalIF":3.0,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11717479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using Centers for Medicare and Medicaid Services care compare data to create hospital-acquired infection count thresholds: a SAS program and analysis.","authors":"Benjamin D Pollock, Lorelle L Ziegelbauer","doi":"10.1017/ice.2024.191","DOIUrl":"https://doi.org/10.1017/ice.2024.191","url":null,"abstract":"<p><p>Using the Statistical Analysis System (SAS) program shared here, all US hospitals can calculate hospital-specific hospital-acquired infection threshold counts for achieving a pre-specified benchmarked Standardized Infection Ratio performance percentile.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-2"},"PeriodicalIF":3.0,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of post-admission SARS-CoV-2 serial testing in hospitalized patients with cancer.","authors":"Shauna Usiak, Anoshe Aslam, Judy Yan, Jerin Madhavappallil, Marissa Bokhari, Tiffany Romero, Tania N Bubb, Rich Kodama, Esther Babady, Mini Kamboj","doi":"10.1017/ice.2024.174","DOIUrl":"https://doi.org/10.1017/ice.2024.174","url":null,"abstract":"<p><strong>Background: </strong>SARS-CoV-2 asymptomatic surveillance testing (AST) is a common strategy to minimize the risk of nosocomial infection in patients and healthcare personnel. In contrast to admission screening, post-admission AST was less widely adopted.</p><p><strong>Objective: </strong>This study describes the diagnostic yield of post-admission serial SARS-COV-2 testing in hospitalized patients at a large cancer center with mostly double-occupancy rooms.</p><p><strong>Design: </strong>Retrospective cohort study design. Post-admission SARS-CoV-2 tests were examined over a 18 month study period. Positive results were reviewed to determine true hospital-onset infections using a combination criteria of screening all sample cycle threshold (Ct) values >30, results of non-concordant repeat testing, and clinical symptoms.</p><p><strong>Results: </strong>Post-admission serial testing of 15,048 hospitalized patients during an 18-month study period at a tertiary care cancer center detected hospital-onset infection in 1.6% (n = 245 patients). Among all hospital-onset positive SARS-CoV-2 RNA tests, 13% were clinically false positive. Most true infections were mild to moderate in severity.</p><p><strong>Conclusions: </strong>In summary, post-admission serial testing in a high-risk setting is a low-yield strategy with several unfavorable effects and should no longer be routinely applied.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-3"},"PeriodicalIF":3.0,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Positive impact of a diagnostic stewardship intervention on syndromic panel ordering practices and inappropriate <i>C. difficile</i> treatment.","authors":"Dan Ilges, Erin H Graf, Leah Grant, Ashley Long, Eric Siebeneck, Maria Teresa Seville, Thomas Grys, Lisa J Speiser","doi":"10.1017/ice.2024.180","DOIUrl":"10.1017/ice.2024.180","url":null,"abstract":"<p><strong>Objective: </strong>Multiplex polymerase chain reaction (PCR) panels for stool testing may be used to diagnose <i>Clostridioides difficile</i>, which can circumvent more appropriate targeted <i>C. difficile</i> testing, resulting in treatment of incidentally detected colonization. We sought to reduce <i>C. difficile</i> diagnosis via a gastrointestinal pathogen panel (GIPP).</p><p><strong>Design: </strong>Quasi-experimental, pre/post, retrospective cohort study from January 1, 2022, to January 31, 2024.</p><p><strong>Setting: </strong>Mayo Clinic Arizona-a single academic medical center and associated clinics.</p><p><strong>Patients: </strong>Adult patients receiving <i>C. difficile</i> testing and/or treatment.</p><p><strong>Methods: </strong>Preferred <i>C. difficile</i> testing consisted of glutamate dehydrogenase and toxin antigen immunoassay, followed by toxin gene testing for discrepant results. The GIPP contained 22 targets during the baseline period with <i>C. difficile</i> removed during the postintervention period. Surveys were provided to provider and nursing groups, separately, to identify <i>C. difficile</i> ordering practices and knowledge gaps.</p><p><strong>Results: </strong>At baseline, from January 1, 2022, to January 31, 2023, 2,772 GIPPs were completed for 2,307 unique patients (∼7 per day), primarily for outpatients (1,805 of 2,772, 65%). The most common positive target was <i>C. difficile</i> (517 of 1,018, 51%), which resulted in treatment for <i>C. difficile</i> infection in 94.9% (337 of 355) of cases. Following GIPP <i>C. difficile</i> target removal, GIPP orders decreased from 3.23 to 2.7 per 1,000 patient visits (<i>P</i> < .001). Prescribing of <i>C. difficile</i> treatments decreased in the postintervention period in inpatient and outpatient settings. There were no cases of delayed <i>C. difficile</i> diagnosis during the postintervention period.</p><p><strong>Conclusions: </strong>Removing <i>C. difficile</i> from the GIPP resulted in effective diagnostic and antimicrobial stewardship without resulting in delayed diagnoses.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-6"},"PeriodicalIF":3.0,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11717474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do blood contamination reduction devices work? A single institution comparison.","authors":"Maria E Navas, Salman Siddiq, Laurie Bauer, Jose A Rivera, Anita J White, Stella Ache, Mark Osborne, Nataliya Kachaluba, Brian Klonowski, Christine Robbins, Curtis Donskey","doi":"10.1017/ice.2024.169","DOIUrl":"https://doi.org/10.1017/ice.2024.169","url":null,"abstract":"<p><p>We compare two initial specimen diversion devices evaluated over 3 months to investigate their utility in lowering blood culture contamination rates at or below 1%. Overall contamination rates during trial periods were 2.46% and 2.60% but usage was low, whereas device-specific contamination rates were 0.68% and 0.8%, respectively.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-3"},"PeriodicalIF":3.0,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for healthcare-associated infection among patients hospitalized with COVID-19 infection.","authors":"Kenneth E Sands, E Jackie Blanchard, Adam Hasse, Kimberly Korwek, Michael Cuffe","doi":"10.1017/ice.2024.142","DOIUrl":"https://doi.org/10.1017/ice.2024.142","url":null,"abstract":"","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-2"},"PeriodicalIF":3.0,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns of inpatient antibiotic utilization by race and ethnicity at US children's hospitals.","authors":"Bethany A Wattles, Jeffrey I Campbell, Theresa Kluthe, Yana B Feygin, Kahir Jawad, Michelle D Stevenson, Deborah Winders Davis, Jennifer Porter, V Faye Jones, Matt Hall, Michael J Smith","doi":"10.1017/ice.2024.168","DOIUrl":"https://doi.org/10.1017/ice.2024.168","url":null,"abstract":"<p><strong>Background and objectives: </strong>Racial and ethnic variations in antibiotic utilization are well-reported in outpatient settings but little is known about inpatient settings. Our objective was to describe national inpatient antibiotic utilization among children by race and ethnicity.</p><p><strong>Methods: </strong>This study included hospital visit data from the Pediatric Health Information System between 01/01/2022 and 12/31/2022 for patients <20 years. Primary outcomes were the percentage of hospitalization encounters that received an antibiotic and antibiotic days of therapy (DOT) per 1000 patient days. Mixed-effect regression models were used to determine the association of race-ethnicity with outcomes, adjusting for covariates.</p><p><strong>Results: </strong>There were 846,530 hospitalizations. 45.2% of children were Non-Hispanic (NH) White, 27.1% were Hispanic, 19.2% were NH Black, 4.5% were NH Other, 3.5% were NH Asian, 0.3% were NH Native Hawaiian/Other Pacific Islander (NHPI) and 0.2% were NH American Indian. Adjusting for covariates, NH Black children had lower odds of receiving antibiotics compared to NH White children (aOR 0.96, 95%CI 0.94-0.97), while NH NHPI had higher odds of receiving antibiotics (aOR 1.16, 95%CI 1.05-1.29). Children who were Hispanic, NH Asian, NH American Indian, and children who were NH Other received antibiotic DOT compared to NH White children, while NH NHPI children received more antibiotic DOT.</p><p><strong>Conclusions: </strong>Antibiotic utilization in children's hospitals differs by race and ethnicity. Hospitals should assess policies and practices that may contribute to disparities in treatment; antibiotic stewardship programs may play an important role in promoting inpatient pharmacoequity. Additional research is needed to examine individual diagnoses, clinical outcomes, and drivers of variation.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-9"},"PeriodicalIF":3.0,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative quantification of varicella-zoster virus in air, pharyngeal swabs, and vesicle content in patients with varicella, disseminated zoster, and localized herpes zoster.","authors":"Kei Yamamoto, Maki Nagashima, Motoko Ishida, Masayuki Ota, Yuichi Katanami, Ryoko Adachi, Ayako Shigeno, Takeshi Tamaki, Norio Ohmagari","doi":"10.1017/ice.2024.188","DOIUrl":"10.1017/ice.2024.188","url":null,"abstract":"<p><p>We evaluated the viral load of varicella-zoster virus (VZV) in ambient air, vesicle, and pharyngeal swabs in VZV-infected patients. Of 46 cases, 6 had VZV detected in indoor air samples from patient rooms. Results suggest an association between viral load in the pharyngeal swab and indoor air.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-3"},"PeriodicalIF":3.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142619754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}