Infection Control and Hospital Epidemiology最新文献

{"title":"Examining the impact of the COVID-19 pandemic on hospital-associated <i>Clostridioides difficile</i> infection.","authors":"Michael J Ray, Jon P Furuno, Luke C Strnad, Eric T Lofgren, Jessina C McGregor","doi":"10.1017/ice.2024.128","DOIUrl":"https://doi.org/10.1017/ice.2024.128","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the impact of changes in the size and characteristics of the hospitalized patient population during the COVID-19 pandemic on the incidence of hospital-associated <i>Clostridioides difficile</i> infection (HA-CDI).</p><p><strong>Design: </strong>Interrupted time-series analysis.</p><p><strong>Setting: </strong>A 576-bed academic medical center in Portland, Oregon.</p><p><strong>Methods: </strong>We established March 23, 2020 as our pandemic onset and included 24 pre-pandemic and 24 pandemic-era 30-day intervals. We built an autoregressive segmented regression model to evaluate immediate and gradual changes in HA-CDI rate during the pandemic while controlling for changes in known CDI risk factors.</p><p><strong>Results: </strong>We observed 4.5 HA-CDI cases per 10,000 patient-days in the two years prior to the pandemic and 4.7 cases per 10,000 patient-days in the first two years of the pandemic. According to our adjusted segmented regression model, there were neither significant changes in HA-CDI rate at the onset of the pandemic (level-change coefficient = 0.70, <i>P</i>-value = 0.57) nor overtime during the pandemic (slope-change coefficient = 0.003, <i>P</i>-value = 0.97). We observed significant increases in frequency and intensity of antibiotic use, time at risk, comorbidities, and patient age before and after the pandemic onset. Frequency of <i>C. difficile</i> testing did not significantly change during the pandemic (<i>P</i>= 0.72).</p><p><strong>Conclusions: </strong>Despite large increases in several CDI risk factors, we did not observe the expected corresponding changes in HA-CDI rate during the first two years of the COVID-19 pandemic. We hypothesize that infection prevention measures responding to COVID-19 played a role in CDI prevention.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-7"},"PeriodicalIF":3.0,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464403","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":"Multicenter study on <i>Clostridioides difficile</i> infections in Mexico: exploring the landscape.","authors":"Daniel De-la-Rosa-Martinez, Diana Vilar-Compte, Nancy Martínez-Rivera, Eric Ochoa-Hein, Rayo Morfin-Otero, María Esther Rangel-Ramírez, Pamela Garciadiego-Fossas, Juan Luis Mosqueda-Gómez, Ana Patricia Rodríguez Zulueta, Isaí Medina-Piñón, Rafael Franco-Cendejas, Christian Gerardo Alfaro-Rivera, Norma Eréndira Rivera-Martínez, Jonathan Mendoza-Barragán, Alicia Estela López-Romo, Marisol Manríquez-Reyes, David Humberto Martínez-Oliva, Samantha Flores-Treviño, Jhoan M Azamar-Marquez, Lirio Nathali Valverde-Ramos, José Raúl Nieto-Saucedo, Sara Alejandra Aguirre-Díaz, Adrián Camacho-Ortiz","doi":"10.1017/ice.2024.153","DOIUrl":"https://doi.org/10.1017/ice.2024.153","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to outline <i>Clostridioides difficile</i> infection (CDI) trends and outcomes in Mexican healthcare facilities during the COVID-19 pandemic.</p><p><strong>Design: </strong>Observational study of case series.</p><p><strong>Setting: </strong>Sixteen public hospitals and private academic healthcare institutions across eight states in Mexico from January 2016 to December 2022.</p><p><strong>Patients: </strong>CDI patients.</p><p><strong>Methods: </strong>Demographic, clinical, and laboratory data of CDI patients were obtained from clinical records. Cases were classified as community or healthcare-associated infections, with incidence rates calculated as cases per 10,000 patient days. Risk factors for 30-day all-cause mortality were analyzed by multivariate logistic regression.</p><p><strong>Results: </strong>We identified 2,356 CDI cases: 2,118 (90%) were healthcare-associated, and 232 (10%) were community-associated. Common comorbidities included hypertension, diabetes, and cancer. Previous high use of proton-pump inhibitors, steroids, and antibiotics was observed. Recurrent infection occurred in 112 (5%) patients, and 30-day mortality in 371 (16%). Risk factors associated with death were a high Charlson score, prior use of steroids, concomitant use of antibiotics, leukopenia, leukocytosis, elevated serum creatine, hypoalbuminemia, septic shock or abdominal sepsis, and SARS-CoV-2 coinfection. The healthcare-associated CDI incidence remained stable at 4.78 cases per 10,000 patient days during the pre-and pandemic periods. However, the incidence was higher in public hospitals.</p><p><strong>Conclusions: </strong>Our study underscores the need for routine epidemiology surveillance and standardized CDI classification protocols in Mexican institutions. Though CDI rates in our country align with those in some European countries, disparities between public and private healthcare sectors emphasize the importance of targeted interventions.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-8"},"PeriodicalIF":3.0,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464407","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":"Validation of electronic health record data to identify hospital-associated <i>Clostridioides difficile</i> infections for retrospective research.","authors":"Michael J Ray, Kathleen L Lacanilao, Maela Robyne Lazaro, Luke C Strnad, Jon P Furuno, Kelly Royster, Jessina C McGregor","doi":"10.1017/ice.2024.140","DOIUrl":"10.1017/ice.2024.140","url":null,"abstract":"<p><p><i>Clostridioides difficile</i> infection (CDI) research relies upon accurate identification of cases when using electronic health record (EHR) data. We developed and validated a multi-component algorithm to identify hospital-associated CDI using EHR data and determined that the tandem of CDI-specific treatment and laboratory testing has 97% accuracy in identifying HA-CDI cases.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-3"},"PeriodicalIF":3.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464355","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":"Recurrent colonization with methicillin-susceptible <i>Staphylococcus aureus</i> after successful decolonization in a neonatal intensive care unit.","authors":"Archana Balamohan, Medini K Annavajhala, Vitaliya Boyar, Alexander Chong, Anne-Catrin Uhlemann, Lorry G Rubin","doi":"10.1017/ice.2024.110","DOIUrl":"https://doi.org/10.1017/ice.2024.110","url":null,"abstract":"<p><p>Recurrent methicillin-susceptible <i>Staphylococcus aureus</i> colonization following successful decolonization in a neonatal intensive care unit (NICU) has been observed. Of 17 recolonization events, 53% were due to concordant strains; 19 different <i>spa</i> types were identified. Results of this study support sources of re-acquisition both intrinsic and extrinsic to the NICU.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-3"},"PeriodicalIF":3.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464350","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":"Is the BLADDER score the \"boost\" we need?","authors":"Lindsay N Taylor, Christopher J Crnich, Robin L P Jump","doi":"10.1017/ice.2024.149","DOIUrl":"https://doi.org/10.1017/ice.2024.149","url":null,"abstract":"","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-2"},"PeriodicalIF":3.0,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464406","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":"To see, or not to see… pathogens in virtual reality hand hygiene training.","authors":"Aline Wolfensberger, Juliette C Désiron, Beatrice Domenech-Jakob, Dominik Petko, Walter Zingg","doi":"10.1017/ice.2024.135","DOIUrl":"https://doi.org/10.1017/ice.2024.135","url":null,"abstract":"<p><strong>Background: </strong>ViRTUE, a virtual reality (VR) hand hygiene trainer, offers users the option of visualizing pathogen transfers during virtual patient care either in \"real-time\" or at the end of a level as a \"summary\" visualization. In this study, we aimed to evaluate the effect of different timings of pathogen visualization (\"real-time\" vs \"summary\") on in-trainer performance and user's immersion.</p><p><strong>Methods: </strong>The study included first-year medical students undergoing hand hygiene training with ViRTUE, randomized to one of three visualization set-ups: set-up 1 (\"on-off-off\", with \"real-time\" visualization at the first level only, and \"summary\" visualization at level 2 and 3), set-up 2 (\"off-on-off\"), and set-up 3 (\"off-off-off\"). In-trainer performance was defined by number of pathogen transmission events (=contaminations) in level 3. The virtual experience of user's (among others: immersion) was assessed with a questionnaire.</p><p><strong>Results: </strong>173 medical students participated in the study, with 58, 54, and 61 assigned to set-up 1, set-up 2, and set-up 3, respectively. Users assigned to set-up 3 with \"summary\" visualization at all levels, performed best with 1.02 (standard deviation (SD) +/- 1.86) contaminations, compared to 2.34 (SD +/- 3.09) and 2.07 (SD +/- 2.52) contaminations of users assigned to the other set-ups. \"Summary\" visualization at all levels also resulted in higher immersion of users.</p><p><strong>Conclusions: </strong>\"Real-time\" visualization of pathogen transmission during VR hand hygiene training with ViRTUE may negatively affect in-trainer performance and user immersion. This emphasizes the importance of pilot testing the effect of VR-based trainings in order to understand their impact on users.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-6"},"PeriodicalIF":3.0,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464354","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":"Impacts of indoor masks wearing on air contamination during 10-minute speaking in patients with SARS-CoV-2 omicron variant infection.","authors":"Se Yoon Park, Min-Chul Kim, Ji Yeun Kim, Joung Ha Park, Seongman Bae, Jin-Won Chung, Saerom Yun, Minki Sung, Sung-Han Kim","doi":"10.1017/ice.2024.139","DOIUrl":"https://doi.org/10.1017/ice.2024.139","url":null,"abstract":"<p><p>In 10-minute speaking, N95 respirators significantly decreased SARS-CoV-2 emissions compared with no-mask wearing. However, SARS-CoV-2 was detected in the air even when wearing N95 and surgical masks in patients with high viral loads. Therefore, universal masking of infected and uninfected persons is important for preventing COVID-19 transmission via the air.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-3"},"PeriodicalIF":3.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464405","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":"Postoperative wound care protocol prevents surgical site infection after craniotomy.","authors":"Mariya Kovryga Kornick, Eunjung Lee, Lisa Wilhelm, Janice White, Oh-Hyun Cho, Michelle Paff, Frank P K Hsu, Jefferson Chen, Linda Dickey, Susan S Huang","doi":"10.1017/ice.2024.134","DOIUrl":"https://doi.org/10.1017/ice.2024.134","url":null,"abstract":"<p><strong>Background: </strong>Postoperative wound care after craniotomy is not standardized.</p><p><strong>Objective: </strong>Evaluate the impact of a standardized post-craniotomy wound care protocol on surgical site infection (SSI).</p><p><strong>Design and setting: </strong>Prospective quasi-experimental single-center intervention cohort study involving adult patients undergoing craniotomy at a 461-bed academic medical center in Orange County, California from January 2019-March 2023 (intervention) compared to January 2017-December 2018 (baseline).</p><p><strong>Methods: </strong>A postoperative neurosurgical wound care protocol was developed involving chlorhexidine cloths to remove incisional clots and to clean the surgical incision and adjacent hair after craniotomy surgery. Protocol adherence was monitored by routine inpatient surveillance of wounds and photo-documentation for real-time feedback to surgeons and nursing staff. Impact of the intervention was assessed using multivariable regression models.</p><p><strong>Results: </strong>There were 3560 craniotomy surgeries and 62 (1.7%) SSIs; 1251 surgeries and 30 (2.4%) SSIs during baseline, and 2309 surgeries and 32 (1.4%) SSIs during intervention. Process evaluation after implementation found significant decreases in incisional clots, erythema, drainage, and unclean hair. In multivariable analysis, the intervention was associated with fewer SSI (odds ratio (OR): 0.5 (0.3, 0.9), <i>P</i> = 0.02).</p><p><strong>Conclusions: </strong>A standardized post-craniotomy wound care protocol involving cleaning of the incision and adjacent hair, including removal of incisional clots with chlorhexidine cloths was effective in reducing the risk of SSI.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-6"},"PeriodicalIF":3.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464349","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 of invasive MDRO infection in MDRO-colonized patients.","authors":"Ali M Alshubaily, Aeshah S Alosaimi, Bushra I Alhothli, Sahar I Althawadi, Salem M Alghamdi","doi":"10.1017/ice.2024.156","DOIUrl":"https://doi.org/10.1017/ice.2024.156","url":null,"abstract":"<p><strong>Objective: </strong>In this study, we aim to estimate the risk of developing clinical multidrug-resistant organism (MDRO) infection with carbapenem-resistant <i>Enterobacterales</i> (CRE), methicillin-resistant <i>Staphylococcus aureus</i> (MRSA), or vancomycin-resistant enterococci (VRE) in colonized patients compared with non-colonized admitted to high-risk areas with a main focus on CRE colonization/infection.</p><p><strong>Design and setting: </strong>Retrospective cohort study conducted at a tertiary care facility.</p><p><strong>Methods: </strong>This study included patients enrolled in active surveillance testing (AST) for CRE, MRSA, or VRE during the year 2021. Development of relevant invasive infection within 365 days of the AST result was collected as the primary outcome. The association between MDRO colonization and infection was calculated using the risk ratio. The prevalence of CRE organisms and carbapenemase genes is presented.</p><p><strong>Results: </strong>A total of 19,134 ASTs were included in the analysis (4,919 CRE AST, 8,303 MRSA AST, and 5,912 VRE AST). Patient demographics were similar between colonized and non-colonized groups. Colonization was associated with an increased risk of infection in the 3 cohorts (CRE, MRSA, and VRE), with risk ratios reported as 4.6, 8.2, and 22, respectively. Most patients (88%) develop CRE infection with the same colonizing carbapenemase gene. Oxa-48/NDM <i>Klebsiella pneumoniae</i> was the most common organism detected in CRE infection.</p><p><strong>Conclusions: </strong>The study demonstrated that colonization with CRE, MRSA, or VRE is a risk factor for developing infections caused by the respective bacteria. The high percentage of match between carbapenemase genes detected in colonization and infection indicates that screening results might be used to inform infection management and treatment.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-5"},"PeriodicalIF":3.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464352","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":"Comparing rates of recurrent infection for first occurrence of <i>Clostridioides difficile</i> between tapered oral vancomycin and standard vancomycin: a retrospective, propensity matched cohort study.","authors":"Sarah E Moore, Matthew Song, Elena A Swingler, Stephen Furmanek, Thomas Chandler, Dakota Smith, Martin T Brenneman, Ashley M Wilde","doi":"10.1017/ice.2024.117","DOIUrl":"https://doi.org/10.1017/ice.2024.117","url":null,"abstract":"<p><strong>Objective: </strong>To compare rates of <i>Clostridioides difficile</i> infection (CDI) recurrence following initial occurrence treated with tapered enteral vancomycin compared to standard vancomycin.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Community health system.</p><p><strong>Patients: </strong>Adults ≥18 years of age hospitalized with positive <i>C. difficile</i> polymerase chain reaction or toxin enzyme immunoassay who were prescribed either standard 10-14 days of enteral vancomycin four times daily or a 12-week tapered vancomycin regimen.</p><p><strong>Methods: </strong>Retrospective propensity score pair matched cohort study. Groups were matched based on age < or ≥ 65 years and receipt of non-<i>C. difficile</i> antibiotics during hospitalization or within 6 months post-discharge. Recurrence rates were analyzed via logistic regression conditioned on matched pairs and reported as conditional odds ratios. The primary outcome was recurrence rates compared between standard vancomycin versus tapered vancomycin for treatment of initial CDI.</p><p><strong>Results: </strong>The CDI recurrence rate at 6 months was 5.3% (4/75) in the taper cohort versus 28% (21/75) in the standard vancomycin cohort. The median time to CDI recurrence was 115 days versus 20 days in the taper and standard vancomycin cohorts, respectively. When adjusted for matching, patients in the taper arm were less likely to experience CDI recurrence at 6 months when compared to standard vancomycin (cOR = 0.19, 95% CI 0.07-0.56, <i>p</i> < 0.002).</p><p><strong>Conclusions: </strong>Larger prospective trials are needed to elucidate the clinical utility of tapered oral vancomycin as a treatment option to achieve sustained clinical cure in first occurrences of CDI.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-7"},"PeriodicalIF":3.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464400","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}