Infection Control and Hospital Epidemiology最新文献

{"title":"Length of antibiotic therapy among adults hospitalized with uncomplicated community-acquired pneumonia, 2013-2020.","authors":"Natalie L McCarthy, James Baggs, Hannah Wolford, Sophia V Kazakova, Sarah Kabbani, Brandon K Attell, Melinda M Neuhauser, Lindsey Walker, Sarah H Yi, Kelly M Hatfield, Sujan Reddy, Lauri A Hicks","doi":"10.1017/ice.2024.14","DOIUrl":"10.1017/ice.2024.14","url":null,"abstract":"<p><strong>Objective: </strong>The 2014 US National Strategy for Combating Antibiotic-Resistant Bacteria (CARB) aimed to reduce inappropriate inpatient antibiotic use by 20% for monitored conditions, such as community-acquired pneumonia (CAP), by 2020. We evaluated annual trends in length of therapy (LOT) in adults hospitalized with uncomplicated CAP from 2013 through 2020.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study among adults with a primary diagnosis of bacterial or unspecified pneumonia using <i>International Classification of Diseases Ninth and Tenth Revision</i> codes in MarketScan and the Centers for Medicare & Medicaid Services databases. We included patients with length of stay (LOS) of 2-10 days, discharged home with self-care, and not rehospitalized in the 3 days following discharge. We estimated inpatient LOT based on LOS from the PINC AI Healthcare Database. The total LOT was calculated by summing estimated inpatient LOT and actual postdischarge LOT. We examined trends from 2013 to 2020 in patients with total LOT >7 days, which was considered an indicator of likely excessive LOT.</p><p><strong>Results: </strong>There were 44,976 and 400,928 uncomplicated CAP hospitalizations among patients aged 18-64 years and ≥65 years, respectively. From 2013 to 2020, the proportion of patients with total LOT >7 days decreased by 25% (68% to 51%) among patients aged 18-64 years and by 27% (68%-50%) among patients aged ≥65 years.</p><p><strong>Conclusions: </strong>Although likely excessive LOT for uncomplicated CAP patients decreased since 2013, the proportion of patients treated with LOT >7 days still exceeded 50% in 2020. Antibiotic stewardship programs should continue to pursue interventions to reduce likely excessive LOT for common infections.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11323296/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139729611","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":"High touch surface bioburden associated with the use of disinfectants with and without continuously active disinfection in ambulatory care settings.","authors":"Heidi M Torres, Jamie Marino, Matthew S Simon, Harjot K Singh, Lars F Westblade, David P Calfee","doi":"10.1017/ice.2024.27","DOIUrl":"10.1017/ice.2024.27","url":null,"abstract":"<p><p>A quaternary ammonium and alcohol-based disinfectant with reported continuous activity demonstrated reduced microbial buildup on surfaces over time compared to routine disinfectants without continuous activity in <i>in vitro</i> and hospital studies. We compared these disinfectants in ambulatory settings and found no difference in bioburden on high-touch surfaces over time.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11102821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139905588","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":"Impact of oral vancomycin treatment duration on rate of <i>Clostridioides difficile</i> recurrence in patients requiring concurrent systemic antibiotics.","authors":"Diana Kwiatkowski, Kassandra Marsh, Alyson Katz, John Papadopoulos, Jonathan So, Vincent J Major, Philip M Sommer, Sarah Hochman, Yanina Dubrovskaya, Serena Arnouk","doi":"10.1017/ice.2024.4","DOIUrl":"10.1017/ice.2024.4","url":null,"abstract":"<p><strong>Background: </strong>There is a paucity of data guiding treatment duration of oral vancomycin for <i>Clostridiodes difficile</i> infection (CDI) in patients requiring concomitant systemic antibiotics.</p><p><strong>Objectives: </strong>To evaluate prescribing practices of vancomycin for CDI in patients that required concurrent systemic antibiotics and to determine whether a prolonged duration of vancomycin (>14 days), compared to a standard duration (10-14 days), decreased CDI recurrence.</p><p><strong>Methods: </strong>In this retrospective cohort study, we evaluated adult hospitalized patients with an initial episode of CDI who were treated with vancomycin and who received overlapping systemic antibiotics for >72 hours. Outcomes of interest included CDI recurrence and isolation of vancomycin-resistant <i>Enterococcus</i> (VRE).</p><p><strong>Results: </strong>Among the 218 patients included, 36% received a standard duration and 64% received a prolonged duration of treatment for a median of 13 days (11-14) and 20 days (16-26), respectively. Patients who received a prolonged duration had a longer median duration of systemic antibiotic overlap with vancomycin (11 vs 8 days; <i>P</i> < .001) and significantly more carbapenem use and infectious disease consultation. Recurrence at 8 weeks (12% standard duration vs 8% prolonged duration; <i>P</i> = .367), recurrence at 6 months (15% standard duration vs 10% prolonged duration; <i>P</i> = .240), and VRE isolation (3% standard duration vs 9% prolonged duration; <i>P</i> = .083) were not significantly different between groups. Discontinuation of vancomycin prior to completion of antibiotics was an independent predictor of 8-week recurrence on multivariable logistic regression (OR, 4.8; 95% CI, 1.3-18.1).</p><p><strong>Conclusions: </strong>Oral vancomycin prescribing relative to the systemic antibiotic end date may affect CDI recurrence to a greater extent than total vancomycin duration alone. Further studies are needed to confirm these findings.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139574560","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":"Antibiotic consumption in French nursing homes between 2018 and 2022: A multicenter survey.","authors":"Ségolène Bouges, Amélie Jouzeau, Florence Lieutier-Colas, Muriel Péfau, Lory Dugravot, Anne-Marie Rogues, Loic Simon, Catherine Dumartin","doi":"10.1017/ice.2024.19","DOIUrl":"10.1017/ice.2024.19","url":null,"abstract":"<p><strong>Objectives: </strong>Monitoring antibiotic consumption is a key component to steer antimicrobial stewardship programs, including in nursing homes. We analyzed changes in antibiotic consumption in French nursing homes during 5 years, including the COVID-19 pandemic, to identify potential priorities for improvement.</p><p><strong>Design: </strong>A multicenter survey was conducted between 2018 and 2022.</p><p><strong>Setting: </strong>The study was conducted across 220 French nursing homes with on-site pharmacies.</p><p><strong>Method: </strong>Antibiotic consumption data were collected from pharmacy records and are expressed as defined daily doses per 1,000 resident days. Antibiotic indicators promoted by health authorities were calculated from quantitative data to evaluate the quality of prescribing.</p><p><strong>Results: </strong>Antibiotic consumption significantly decreased between 2018 and 2022, particularly during the coronavirus disease 2019 (COVID-19) pandemic, despite a slight increase in 2022. During the study period, the most used antibiotic classes were penicillins (61.9% in 2022) followed by cephalosporins (10.5%), macrolides-lincosamides-streptogramins (7.3%) then fluoroquinolones (7.0%). Amoxicillin-clavulanic acid was the most consumed antibiotic; amoxicillin and ceftriaxone ranked second and third. Azithromycin consumption increased from 2020, as did the indicator regarding broad-spectrum antibiotics.</p><p><strong>Conclusions: </strong>The decreasing trend in antibiotic use and control of fluoroquinolone use over the study period suggest compliance with antibiotic use guidelines. However, changes in the use of broad-spectrum antibiotics and the substantial use of amoxicillin-clavulanic acid, although it is rarely a first-line antibiotic, highlight the need for antimicrobial stewardship activities and the usefulness of antibiotic consumption surveillance to identify priorities.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11102820/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139899763","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":"Genomic investigation of multispecies and multivariant <i>bla</i>_NDM outbreak reveals key role of horizontal plasmid transmission.","authors":"Nenad Macesic, Adelaide Dennis, Jane Hawkey, Ben Vezina, Jessica A Wisniewski, Hugh Cottingham, Luke V Blakeway, Taylor Harshegyi, Katherine Pragastis, Gnei Zweena Badoordeen, Pauline Bass, Andrew J Stewardson, Amanda Dennison, Denis W Spelman, Adam W J Jenney, Anton Y Peleg","doi":"10.1017/ice.2024.8","DOIUrl":"10.1017/ice.2024.8","url":null,"abstract":"<p><strong>Objectives: </strong>New Delhi metallo-β-lactamases (NDMs) are major contributors to the spread of carbapenem resistance globally. In Australia, NDMs were previously associated with international travel, but from 2019 we noted increasing incidence of NDM-positive clinical isolates. We investigated the clinical and genomic epidemiology of NDM carriage at a tertiary-care Australian hospital from 2016 to 2021.</p><p><strong>Methods: </strong>We identified 49 patients with 84 NDM-carrying isolates in an institutional database, and we collected clinical data from electronic medical record. Short- and long-read whole genome sequencing was performed on all isolates. Completed genome assemblies were used to assess the genetic setting of <i>bla</i>_NDM genes and to compare NDM plasmids.</p><p><strong>Results: </strong>Of 49 patients, 38 (78%) were identified in 2019-2021 and only 11 (29%) of 38 reported prior travel, compared with 9 (82%) of 11 in 2016-2018 (<i>P =</i> .037). In patients with NDM infection, the crude 7-day mortality rate was 0% and the 30-day mortality rate was 14% (2 of 14 patients). NDMs were noted in 41 bacterial strains (ie, species and sequence type combinations). Across 13 plasmid groups, 4 NDM variants were detected: <i>bla</i>_NDM-1, <i>bla</i>_NDM-4, <i>bla</i>_NDM-5, and <i>bla</i>_NDM-7. We noted a change from a diverse NDM plasmid repertoire in 2016-2018 to the emergence of conserved <i>bla</i>_NDM-1 IncN and <i>bla</i>_NDM-7 IncX3 epidemic plasmids, with interstrain spread in 2019-2021. These plasmids were noted in 19 (50%) of 38 patients and 35 (51%) of 68 genomes in 2019-2021.</p><p><strong>Conclusions: </strong>Increased NDM case numbers were due to local circulation of 2 epidemic plasmids with extensive interstrain transfer. Our findings underscore the challenges of outbreak detection when horizontal transmission of plasmids is the primary mode of spread.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11102827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139722315","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":"Antibiotic prescribing for acute respiratory infections during the coronavirus disease 2019 (COVID-19) pandemic: Patterns in a nationwide telehealth service provider.","authors":"Jeffrey A Linder, Stephen D Persell, Marcella A Kelley, Mark Friedberg, Noah J Goldstein, Tara K Knight, Katrina M Kaiser, Jason N Doctor, Wendy J Mack, Jason Tibbels, Bridget McCabe, Steve Haenchen, Daniella Meeker","doi":"10.1017/ice.2023.292","DOIUrl":"10.1017/ice.2023.292","url":null,"abstract":"<p><p>We examined 3,046,538 acute respiratory infection (ARI) encounters with 6,103 national telehealth physicians from January 2019 to October 2021. The antibiotic prescribing rates were 44% for all ARIs; 46% were antibiotic appropriate; 65% were potentially appropriate; 19% resulted from inappropriate diagnoses; and 10% were related to coronavirus disease 2019 (COVID-19) diagnosis.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11102822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139702441","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":"Why is there a discrepancy between laboratory test results and real-world efficacy of continuously active quaternary ammonium disinfectants?","authors":"Jennifer L Cadnum, Samir Memic, Annette L Jencson, Curtis J Donskey","doi":"10.1017/ice.2024.15","DOIUrl":"10.1017/ice.2024.15","url":null,"abstract":"","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139722318","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":"Community respiratory viral metrics to inform masking in healthcare settings: A regional consensus approach.","authors":"Eric J Chow, Lawrence Lee, Jennifer Lenahan, Sargis Pogosjans, Christopher Baliga, Mary Fairchok, John B Lynch, John Pauk, Francis X Riedo, Paul Thottingal, Danielle M Zerr, Nigel Turner, James Lewis, Vicki Sakata, Jeffrey S Duchin","doi":"10.1017/ice.2024.10","DOIUrl":"10.1017/ice.2024.10","url":null,"abstract":"","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11102823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139722414","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":"The devil's in the defaults: An interrupted time-series analysis of the impact of default duration elimination on exposure to fluoroquinolone therapy.","authors":"Rebekah H Wrenn, Cara N Slaton, Tony Diez, Nicholas A Turner, Michael E Yarrington, Deverick J Anderson, Rebekah W Moehring","doi":"10.1017/ice.2024.16","DOIUrl":"10.1017/ice.2024.16","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether removal of default duration, embedded in electronic prescription (e-script), influenced antibiotic days of therapy.</p><p><strong>Design: </strong>Interrupted time-series analysis.</p><p><strong>Setting: </strong>The study was conducted across 2 community hospitals, 1 academic hospital, 3 emergency departments, and 86 ambulatory clinics.</p><p><strong>Patients: </strong>Adults prescribed a fluoroquinolone with a duration <31 days.</p><p><strong>Interventions: </strong>Removal of standard 10-day fluoroquinolone default duration and addition of literature-based duration guidance in the order entry on December 19, 2017. The study period included data for 12 months before and after the intervention.</p><p><strong>Results: </strong>The study included 35,609 fluoroquinolone e-scripts from the preintervention period and 31,303 fluoroquinolone e-scripts from the postintervention period, accounting for 520,388 cumulative fluoroquinolone DOT. Mean durations before and after the intervention were 7.8 (SD, 4.3) and 7.7 (SD, 4.5), a nonsignificant change. E-scripts with a 10-day duration decreased prior to and after the default removal. The inpatient setting showed a significant 8% drop in 10-day e-scripts after default removal and a reduced median duration by 1 day; 10-day scripts declined nonsignificantly in ED and ambulatory settings. In the ambulatory settings, both 7- and 14-day e-script durations increased after default removal.</p><p><strong>Conclusion: </strong>Removal of default 10-day antibiotic durations did not affect overall mean duration but did shift patterns in prescribing, depending on practice setting. Stewardship interventions must be studied in the context of practice setting. Ambulatory stewardship efforts separate from inpatient programs are needed because interventions cannot be assumed to have similar effects.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139722317","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":"The cardinal rules: Principles of personal protective equipment for high-consequence infectious disease events.","authors":"Sara K Donovan, Jocelyn J Herstein, Aurora B Le, Shawn G Gibbs, Elizabeth L Beam, Christopher K Brown, Abigail E Lowe, John J Lowe, James V Lawler","doi":"10.1017/ice.2023.264","DOIUrl":"10.1017/ice.2023.264","url":null,"abstract":"<p><p>In recognition of an increasing number of high-consequence infectious disease events, a group of subject-matter experts identified core safety principles that can be applied across all donning and doffing protocols for personal protective equipment.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11102819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139702442","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}