Infection Control and Hospital Epidemiology最新文献

{"title":"Comparison of Medicare claims-based <i>Clostridioides difficile</i> infection epidemiologic case classification algorithms to medical record review by the Emerging Infections Program using a linked cohort, 2016-2021.","authors":"Dustin W Currie, Chantal Lewis, Joseph D Lutgring, Sophia V Kazakova, James Baggs, Lauren Korhonen, Maria Correa, Dana Goodenough, Danyel M Olson, Jill Szydlowski, Ghinwa Dumyati, Scott K Fridkin, Christopher Wilson, Alice Y Guh, Sujan C Reddy, Kelly M Hatfield","doi":"10.1017/ice.2024.204","DOIUrl":"https://doi.org/10.1017/ice.2024.204","url":null,"abstract":"<p><strong>Background: </strong>Medicare claims are frequently used to study <i>Clostridioides difficile</i> infection (CDI) epidemiology. However, they lack specimen collection and diagnosis dates to assign location of onset. Algorithms to classify CDI onset location using claims data have been published, but the degree of misclassification is unknown.</p><p><strong>Methods: </strong>We linked patients with laboratory-confirmed CDI reported to four Emerging Infections Program (EIP) sites from 2016-2021 to Medicare beneficiaries with fee-for-service Part A/B coverage. We calculated sensitivity of ICD-10-CM codes in claims within ±28 days of EIP specimen collection. CDI was categorized as hospital, long-term care facility, or community-onset using three different Medicare claims-based algorithms based on claim type, ICD-10-CM code position, duration of hospitalization, and ICD-10-CM diagnosis code presence-on-admission indicators. We assessed concordance of EIP case classifications, based on chart review and specimen collection date, with claims case classifications using Cohen's kappa statistic.</p><p><strong>Results: </strong>Of 12,671 CDI cases eligible for linkage, 9,032 (71%) were linked to a single, unique Medicare beneficiary. Compared to EIP, sensitivity of CDI ICD-10-CM codes was 81%; codes were more likely to be present for hospitalized patients (93.0%) than those who were not (56.2%). Concordance between EIP and Medicare claims algorithms ranged from 68% to 75%, depending on the algorithm used (κ = 0.56-0.66).</p><p><strong>Conclusion: </strong>ICD-10-CM codes in Medicare claims data had high sensitivity compared to laboratory-confirmed CDI reported to EIP. Claims-based epidemiologic classification algorithms had moderate concordance with EIP classification of onset location. Misclassification of CDI onset location using Medicare algorithms may bias findings of claims-based CDI studies.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-9"},"PeriodicalIF":3.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709786","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":"Exploring social vulnerability in National Health Safety Network surgical site infections.","authors":"Michael Dewitt, Caroline Reinke, Michael Inman, Werner Bischoff, Shelley Kester, Anupama Neelakanta, Mindy Sampson, Catherine Passaretti","doi":"10.1017/ice.2025.52","DOIUrl":"https://doi.org/10.1017/ice.2025.52","url":null,"abstract":"<p><strong>Objective: </strong>To assess the association between social vulnerability index (SVI) and surgical site infections (SSIs) using National Healthcare Safety Network (NHSN) criteria.</p><p><strong>Design: </strong>Retrospective cohort study between August 1, 2022, and August 31, 2023.</p><p><strong>Setting: </strong>In total, 20 acute care hospitals in the Southeast United States.</p><p><strong>Patients: </strong>Totally, 23,768 total hip arthroplasty, total knee arthroplasty, abdominal hysterectomy, colon, and spinal fusion surgeries in 22,239 patients were included. Procedures with infection present at the time of surgery or incomplete geographic tracking data were excluded.</p><p><strong>Methods: </strong>Patient addresses as noted in the electronic health record were geocoded to determine census tract of residence and determine SVI. Demographic and clinical data were linked with SVI scores. SSIs were identified according to NHSN criteria. SVI was categorized into quartiles, and logistic regression was used to evaluate the association between SVI quartile (overall and for each SVI theme) and SSI risk. Subgroup analyses by procedure type and race were performed. Multivariable models of the association between overall SVI and SSI were adjusted for demographic and clinical factors.</p><p><strong>Results: </strong>Patients in the top SVI quartiles had significantly higher odds of developing SSIs after adjusting for other clinical and demographic factors. Increased risk was found for socioeconomic status and household characteristics themes, but not for the racial/ethnic minority theme. Association between SVI and SSI risk varied by type of surgery.</p><p><strong>Conclusions: </strong>Living in an area with a higher SVI is associated with increased SSI risk. Targeted interventions are needed to mitigate these disparities and improve outcomes.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-8"},"PeriodicalIF":3.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709794","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":"Weekend effect on blood culture contamination: an observational study at a university hospital in Japan.","authors":"Kazuhiko Nakaharai, Yoichi Shinozaki, Taku Tamura, Yasushi Nakazawa, Masaki Yoshida","doi":"10.1017/ice.2025.44","DOIUrl":"https://doi.org/10.1017/ice.2025.44","url":null,"abstract":"<p><strong>Background: </strong>An association between weekend/off-hour care and unfavorable clinical outcomes has been observed, commonly called the \"weekend effect.\" In the present study, we examined whether there was a weekend effect associated with blood culture (BC) contamination, which can lead to inappropriate medical resource consumption.</p><p><strong>Methods: </strong>We conducted a single-center retrospective observational study using data from BC tests performed on adult patients. The primary outcome was the incidence of BC contamination, which was compared between weekend and weekday sampling groups. In a multivariable logistic analysis, we evaluated the association between weekend sampling and the incidence of BC contamination.</p><p><strong>Results: </strong>The analysis included 7,597 weekend and 50,655 weekday BC sets from 1 January 2013 to 31 December 2019. The proportion of BC contamination during the study period was 1.15% (87/7,597) and 0.80% (405/50,655) in the weekend and weekday groups, respectively. In the logistic regression analysis adjusted for blood sampling settings, weekend sampling was significantly associated with increased BC contamination (odds ratio, 1.36; 95% confidence interval, 1.06-1.71).</p><p><strong>Conclusions: </strong>This study highlighted a significant association between weekend blood sampling for BC and an increased incidence of contamination. To provide better-quality care, further studies evaluating the differences in staffing and blood collection processes on weekends and weekdays are warranted.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-6"},"PeriodicalIF":3.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709795","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":"Development and validation of two novel antibiotic use metrics suitable for facilities and practitioners in post-acute and long-term care settings.","authors":"Sunah Song, Brigid Wilson, Taissa A Bej, Corinne Kowal, Federico Perez, David A Nace, Taylor Boyer, Katie J Suda, Charlesnika T Evans, Aoife Fleming, Robin L P Jump","doi":"10.1017/ice.2025.42","DOIUrl":"https://doi.org/10.1017/ice.2025.42","url":null,"abstract":"<p><strong>Objective: </strong>Many post-acute and long-term care settings (PALTCs) struggle to measure antibiotic use via the standard metric, days of therapy (DOT) per 1000 days of care (DOC). Our objective was to develop antibiotic use metrics more tailored to PALTCs.</p><p><strong>Design: </strong>Retrospective cohort study with a validation cohort.</p><p><strong>Setting: </strong>PALTC settings within the same network.</p><p><strong>Methods: </strong>We obtained census data and pharmacy dispensing data for 13 community PALTCs (January 2020-December 2023). We calculated antibiotic DOT/1000 DOC, DOT per unique residents, and antibiotic starts per unique residents, at monthly intervals for community PALTCs. The validation cohort was 135 Veterans Affairs Community Living Centers (VA CLCs). For community PALTCs only, we determined the DOT and antibiotics starts per unique residents cared for by individual prescribers.</p><p><strong>Results: </strong>For community PALTCs, the correlation between facility-level antibiotic DOT/1000 DOC and antibiotic DOT/unique residents and antibiotic courses/unique residents was 0.97 (<i>P</i> < 0.0001) and 0.84 (<i>P</i> < 0.0001), respectively. For VA CLCs, those values were 0.96 (<i>P</i> < 0.0001) and 0.85 (<i>P</i> < 0.0001), respectively. At community PALTCs, both novel metrics permitted assessment and comparison of antibiotic prescribing among practitioners.</p><p><strong>Conclusion: </strong>At the facility level, the novel metric antibiotic DOT/unique residents demonstrated strong correlation with the standard metric. In addition to supporting tracking and reporting of antibiotic use among PALTCs, antibiotic DOT/unique residents permits visualization of the antibiotic prescribing rates among individual practitioners, and thus peer comparison, which in turn can lead to actionable feedback that helps improve antibiotic use in the care of PALTC residents.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-7"},"PeriodicalIF":3.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709792","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-associated New Delhi metallo-beta-lactamase-producing carbapenem-resistant Enterobacterales: multiple states, from September 2021 through September 2022.","authors":"Sophie Jones, Richard Stanton, Marisa D'Angeli, Audrey Brezak, Jenna Sinkevitch, Megan Sredl, Shermalyn Greene, Kelley Garner, Trenton Gulley, Celina Santiago, Wei Wang, Samuel Cincotta, Maroya Spalding Walters","doi":"10.1017/ice.2025.28","DOIUrl":"https://doi.org/10.1017/ice.2025.28","url":null,"abstract":"<p><p>In the United States, New Delhi metallo-beta-lactamase (NDM)-producing carbapenem-resistant Enterobacterales (CRE) are frequently associated with healthcare encounters. From September 2021 to September 2022, 21 patients with NDM-CRE identified from urine and without healthcare exposure were reported to the Centers for Disease Control and Prevention. Isolates were genetically similar to healthcare-associated strains.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-4"},"PeriodicalIF":3.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691897","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":"Hospital <i>Enterococcus faecium</i> demonstrates distinct environmental and patient reservoirs: a genomic point prevalence survey.","authors":"Nenad Macesic, Hugh Cottingham, Jessica A Wisniewski, Luke V Blakeway, Ravali Theegala, Katherine Pragastis, Andrew Stewardson, Pauline Bass, Megan Gritt, Stephanie Spilsbury, Denise Del Rosario-Kelly, Amanda Dennison, Denis W Spelman, Adam W J Jenney, Anton Y Peleg","doi":"10.1017/ice.2025.27","DOIUrl":"https://doi.org/10.1017/ice.2025.27","url":null,"abstract":"<p><p>We assessed the hospital environment as a reservoir of vancomycin-resistant <i>E. faecium</i> (VRE) and compared environmental VRE isolates to bloodstream infection <i>E. faecium</i> isolates. We identified distinct environmental and patient reservoirs, with the environment dominated by <i>vanB</i> VRE. Environment-clinical reservoir spillover accounted for 292/895 (33%) of putative transmission links.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-4"},"PeriodicalIF":3.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669820","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":"WHO global research agenda for hand hygiene improvement in health care: a Delphi consensus study.","authors":"Benedetta Allegranzi, Ermira Tartari, Claire Kilpatrick, Julie Storr, Nita Bellare, João Bana, Ana Flávia Santos, Sarah Charnaud, Anna Laura Ross, Mitchell J Schwaber, Didier Pittet","doi":"10.1017/ice.2025.32","DOIUrl":"10.1017/ice.2025.32","url":null,"abstract":"<p><strong>Objective: </strong>To identify global research priorities for improving hand hygiene in healthcare settings and develop a 2023-2030 research agenda to guide funding, coordinate research, promote investment, and inform policy for enhanced healthcare quality and safety.</p><p><strong>Design: </strong>Expert consensus study using a modified Delphi process.</p><p><strong>Participants: </strong>A 105-member panel of international hand hygiene experts including the World Health Organization (WHO) Technical Advisory Group of Experts on Hand Hygiene in Healthcare representing all WHO regions and World Bank income levels.</p><p><strong>Methods: </strong>The research priorities were identified through a multiphase approach including a meta-review to establish knowledge gaps and inform initial priorities, followed by expert consultations using a modified Delphi process. 192 preliminary priorities were included in a two-round Delphi survey. Experts rated each priority in the first round, and then reviewed and adjusted responses based on the panel's aggregated, anonymous responses in the second round. Ratings were collected on a five-point Likert scale. Consensus was defined as a combined \"strongly agree\" and \"agree\" frequency of at least 70%.</p><p><strong>Results: </strong>Consensus was achieved for 178 of 192 priorities (92.7%), categorized into six domains: system change; training and education; evaluation and feedback; reminders and communications; institutional safety climate; and hand hygiene improvement impact on healthcare-associated infections and antimicrobial resistance. Of these, 121 priorities reached >80% consensus. The Delphi process, maintained a 92% response rate over two rounds.</p><p><strong>Conclusions: </strong>A structured consensus process yielded a research agenda to address gaps in hand hygiene improvement, supporting enhanced healthcare quality and safety globally.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-16"},"PeriodicalIF":3.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7617569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663344","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":"Response to Mr. Babar's Letter to the Editor regarding \"Healthcare worker attitudes on routine non-urological preoperative urine cultures: a qualitative assessment\".","authors":"Julia E Friberg Walhof, Marin L Schweizer, Kalpana Gupta, Madisen Brown, Daniel Suh, Judith Strymish, William J O'Brien, Jeffrey Chan, Kelly Miell, Vanessa Au, Barbara W Trautner, Kimberly C Dukes","doi":"10.1017/ice.2024.216","DOIUrl":"https://doi.org/10.1017/ice.2024.216","url":null,"abstract":"","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1"},"PeriodicalIF":3.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657193","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":"Reducing catheter-associated urinary tract infection rates in surgical critical care units via an informal catheter exchange protocol.","authors":"Aricia Shen, Ryan Raypon, Meghan Madhusudhan, Michael Nurok, Tejal Brahmbhatt, Jonathan D Grein, Galinos Barmparas, Michael A Ben-Aderet","doi":"10.1017/ice.2025.47","DOIUrl":"https://doi.org/10.1017/ice.2025.47","url":null,"abstract":"<p><p>Urinary catheter replacement prior to urinary tract infection assessment, introduced as a quality improvement recommendation in two surgical intensive care units, was associated with (88% and 84%) reduction in catheter-associated urinary tract infections and significant reductions in urine cultures performed.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-3"},"PeriodicalIF":3.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143648485","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":"Assessing the safety of increased outpatient cephalosporin use following the modification of penicillin allergy cross-reactivity alerts.","authors":"Bryan Schneider, Kelly M Percival, Anna M Rhinehart, Jared Frye, Deanna L McDanel, Kevin L Bebout, Lukasz D Weiner, Sarah A Auerbach, Amy M Dowden, Dilek Ince, Patrick Kinn","doi":"10.1017/ice.2025.9","DOIUrl":"https://doi.org/10.1017/ice.2025.9","url":null,"abstract":"<p><strong>Background: </strong>Concerns about penicillin-cephalosporin cross-reactivity have historically led to conservative prescribing and avoidance of cephalosporins in patients with penicillin allergy labels, potentially causing suboptimal outcomes. Recent evidence suggests a lower risk of cross-reactivity, prompting a reassessment of alert systems.</p><p><strong>Objective: </strong>To assess the impact of limited penicillin cross-reactivity alerts on outpatient cephalosporin use and the incidence of adverse reactions in a healthcare setting.</p><p><strong>Methods: </strong>This retrospective cohort study compared cephalosporin prescribing and adverse reactions in patients labeled as penicillin-allergic before and after limiting penicillin cross-reactivity alerts in the electronic medical record at a large academic medical center.</p><p><strong>Results: </strong>Among 17,174 patients (8,131 pre- and 9,043 post-implementation), there was a statistically significant increase in outpatient cephalosporin prescribing by 8% (<i>P</i> < .001). The use of alternative antibiotic classes decreased. There was no statistically significant increase in adverse events pre- and post-implementation (0.036%-0.058%, <i>P</i> = .547), and no severe events were attributable to cross-reactivity. The alert modification reduced alerts by 92% (<i>P</i> < .001).</p><p><strong>Conclusion: </strong>The reduction of penicillin-cephalosporin cross-reactivity alerts was associated with increased cephalosporin use, without a significant increase in adverse reactions. This demonstrates that the practice is safe and decreases alert burden.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-6"},"PeriodicalIF":3.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143614869","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}