Antimicrobial stewardship & healthcare epidemiology : ASHE最新文献

{"title":"Mortality in hospitalized SARS-CoV-2 patients with contemporaneous bacterial and fungal infections.","authors":"John J Hanna, Zachary M Most, Lauren N Cooper, Abdi D Wakene, Alexander P Radunsky, Christoph U Lehmann, Trish M Perl, Richard J Medford","doi":"10.1017/ash.2024.424","DOIUrl":"https://doi.org/10.1017/ash.2024.424","url":null,"abstract":"<p><strong>Background: </strong>The interplay between SARS-CoV-2 and contemporaneous bacterial or fungal culture growth may have crucial implications for clinical outcomes of hospitalized patients. This study aimed to quantify the effect of microbiological culture positivity on mortality among hospitalized patients with SARS-CoV-2.</p><p><strong>Methods: </strong>In this retrospective cohort study, we included adult hospitalized patients from OPTUM COVID-19 specific data set, who tested positive for SARS-CoV-2 within 14 days of hospitalization between 01/20/2020 and 01/20/2022. We examined outcomes of individuals with organisms growing on cultures from the bloodstream infections (BSIs), urinary tract, and respiratory tract, and a composite of the three sites. We used propensity score matching on covariates included demographics, comorbidities, and hospitalization clinical parameters. In a sensitivity analysis, we included same covariates but excluded critical care variables such as length of stay, intensive care unit stays, mechanical ventilation, and extracorporeal membrane oxygenation.</p><p><strong>Results: </strong>The cohort included 104,560 SARS-CoV-2 positive adult hospitalized patients across the United States. The unadjusted mortality odds increased significantly with BSIs (98.7%) and with growth on respiratory cultures (RC) (176.6%), but not with growth on urinary cultures (UC). Adjusted analyses showed that BSIs and positive RC independently contribute to mortality, even after accounting for critical care variables.</p><p><strong>Conclusions: </strong>In SARS-CoV-2-positive hospitalized patients, positive bacterial and fungal microbiological cultures, especially BSIs and RC, are associated with an increased risk of mortality even after accounting for critical care variables associated with disease severity. These findings underscore the importance of stringent infection control and the effective management of secondary infections to improve patient outcomes.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11428019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contact precautions for MRSA and VRE: where are we now? A survey of the <i>Society for Healthcare Epidemiology of America</i> Research Network.","authors":"Elise Martin, Daniel J Morgan, Rachel Pryor, Gonzalo Bearman","doi":"10.1017/ash.2024.350","DOIUrl":"https://doi.org/10.1017/ash.2024.350","url":null,"abstract":"<p><strong>Objective: </strong>Contact precautions for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant <i>Enterococcus</i> (VRE) have limited data on efficacy and have been associated with patient harm. Still, a 2015 <i>Society for Healthcare Epidemiology of America</i> (SHEA) Research Network (SRN) survey showed only 7% of hospitals discontinued routine MRSA/VRE contact precautions. The study objectives were to identify the current proportion of hospitals that have discontinued routine MRSA/VRE contact precautions and motivations for change.</p><p><strong>Design: </strong>An online survey was conducted of the SRN on current use and views of contact precautions for MRSA/VRE in each facility. An initial survey followed by 2 reminders was sent between 5/18/2021 and 6/9/2021.</p><p><strong>Participants: </strong>SRN facilities.</p><p><strong>Results: </strong>The response rate was 43% (37/87) of facilities surveyed and 35% of respondents were not routinely using contact precautions for MRSA and VRE. The most frequently reported reason for discontinuing contact precautions was research on the safety of discontinuing contact precautions without an increase in healthcare-associated infections (reported for 92% of facilities for MRSA and 100% for VRE). Of those using contact precautions, the most frequently reported reason to continue was a lack of safety data for discontinuation (MRSA 58% and VRE 46%). Most of those continuing contact precautions were interested in using contact precautions differently in their facility (MRSA 63% and VRE 58%).</p><p><strong>Conclusions: </strong>Over one in three healthcare facilities surveyed do not use contact precautions for MRSA or VRE. Most facilities choosing to continue contact precautions are interested in a different implementation strategy.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11428003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immediate-use steam sterilization and the effect on surgical site infection risk in an acute care facility.","authors":"Victoria D Crall, Casey L Lewis, Avisha Risnear, Jason Miller, Joanne Sherer, Ashley M Ayres, Graham M Snyder","doi":"10.1017/ash.2024.408","DOIUrl":"https://doi.org/10.1017/ash.2024.408","url":null,"abstract":"<p><p>Immediate-use steam sterilization (IUSS) shortens the time of sterilization but may increase the risk of surgical site infection (SSI). Among 23,919 procedures with 416 (1.7%) procedures resulting in SSI, IUSS was associated with a 1.52 (95% CI, 1.10-2.11) times higher risk of SSI. IUSS should be minimized.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11427978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MRSA nasal screening predictive values assessment in patients with osteomyelitis.","authors":"Stefanie Stramel, Valerie Buckley, MaiCuc Tran, Todd Price","doi":"10.1017/ash.2024.368","DOIUrl":"https://doi.org/10.1017/ash.2024.368","url":null,"abstract":"<p><strong>Objective and design: </strong>The purpose of this study was to evaluate the diagnostic value of methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) nasal screening utilizing polymerase chain reaction (PCR) assays in patients with osteomyelitis.</p><p><strong>Setting: </strong>A multisite, retrospective adult chart review from March 2021 to June 2022 was conducted, with no interventions performed. Patients treated with anti-MRSA therapy for osteomyelitis, MRSA nares PCR collected within 48 hours of antibiotic initiation, and related cultures were evaluated.</p><p><strong>Patients: </strong>Adults with associated cultures were assessed for concordance with MRSA nares PCR screening results. The primary outcome was the diagnostic value of MRSA nares PCR assay screening for predicting MRSA osteomyelitis. An assessment of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) was performed. Key secondary outcomes included length of hospital stay and duration of anti-MRSA therapy.</p><p><strong>Results: </strong>One hundred seven patients with MRSA nares PCR sensitivities were included in this assessment. The PPV and NPV were determined to be 25% CI (10.08-49.79%) and 94.7% CI (91.29-96.87%), respectively. Median and interquartile range durations of anti-MRSA therapy were decreased in the MRSA PCR negative group at 5 (3-8) versus 6.5 (6-9.75) days (<i>p</i> = 0.03752).</p><p><strong>Conclusion: </strong>This research showed a high NPV (94.7%) and a low PPV (25%) that aligned with other studies evaluating MRSA nares PCR utilization in osteomyelitis. Additionally, despite no active intervention on the results, early de-escalation of inappropriate antibiotic therapy was observed.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11427970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Levees for a hundred-year flood: impact of a syndrome-based antimicrobial stewardship intervention for coronavirus disease 2019 on antimicrobial use and resistance.","authors":"Alfredo J Mena Lora, Rodrigo Burgos, Dylan Huber, Lawrence Sanchez, Mirza Ali, Candice Krill, Eden Takhsh, Susan C Bleasdale","doi":"10.1017/ash.2024.383","DOIUrl":"https://doi.org/10.1017/ash.2024.383","url":null,"abstract":"<p><p>Coronavirus disease 2019 can be indistinguishable from lower respiratory tract infections (LRTIs) caused by other viral and bacterial agents. This likely contributed to antimicrobial use (AU) and antimicrobial resistance (AMR) during the pandemic. Our antimicrobial stewardship program targeted the selection and duration of therapy for LRTIs and led to a reduction in AU and AMR.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11427971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>Staphylococcus aureus</i> infection disparities among Hispanics and non-Hispanics in Yuma, Arizona.","authors":"Talima Pearson, Sarah Kramer, David Panisello Yagüe, Emmanuel Nangkuu, Sarah Medina-Rodriguez, Colin Wood, Crystal Hepp, Ricky Camplain, Joseph Mihaljevic, Trudie Milner","doi":"10.1017/ash.2024.390","DOIUrl":"https://doi.org/10.1017/ash.2024.390","url":null,"abstract":"<p><p><i>Staphylococcus aureus</i> infection patterns in Yuma, Arizona show a 2.25x higher infection rate in non-Hispanics. Males had higher infection rates in most age classes. These disparities in infection are mostly consistent with previously observed patterns in colonization, suggesting that sex and ethnicity do not differentially impact colonization and infection.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11427975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic utility of nasal methicillin-resistant <i>Staphylococcus aureus</i> polymerase chain reaction testing in head and neck infection.","authors":"Jake Smith, Bailee Cummings, Ryan K Dare","doi":"10.1017/ash.2024.376","DOIUrl":"https://doi.org/10.1017/ash.2024.376","url":null,"abstract":"<p><p>In this retrospective study of adult inpatients who underwent an ear, nose, and throat (ENT) surgery with operative cultures and collection of nasal methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) polymerase chain reaction (PCR), we found that MRSA nasal PCR demonstrated 100% sensitivity and a negative predictive value (NPV) of 100% when compared to operative cultures.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11406558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inpatient clinicians' approach to diagnosis of urinary tract infections in older adults using the COM-B model: a qualitative assessment.","authors":"Sonali D Advani, Nathan Boucher, Alison G C Smith, Connor Deri, Jillian E Hayes, Rebekah Wrenn, Kenneth Schmader","doi":"10.1017/ash.2024.401","DOIUrl":"https://doi.org/10.1017/ash.2024.401","url":null,"abstract":"<p><p>Our interviews of inpatient clinicians (physicians, physician assistants) modeled after the Capability, Opportunity, and Motivation Model of Behavior model revealed opportunity and motivation as important drivers for overdiagnosis and overprescribing for asymptomatic bacteriuria in older adults. Understanding these barriers is an important step toward implementing age-friendly stewardship interventions.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11406559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends and outcomes in community-onset and hospital-onset <i>Staphylococcus bacteremia</i> among hospitals in the United States from 2015 to 2020.","authors":"Takaaki Kobayashi, ChinEn Ai, Molly Jung, Jorge L Salinas, Kalvin C Yu","doi":"10.1017/ash.2024.402","DOIUrl":"https://doi.org/10.1017/ash.2024.402","url":null,"abstract":"<p><strong>Background: </strong>We investigated trends in <i>Staphylococcus aureus</i> (staph) bacteremia incidence stratified by methicillin susceptibility (methicillin-susceptible <i>S. aureus</i> [MSSA] vs. methicillin-resistant <i>S. aureus</i> [MRSA]) and onset designation (community-onset [CO] vs. hospital-onset [HO]).</p><p><strong>Methods: </strong>We evaluated the microbiological data among adult patients who were admitted to 267 acute-care hospitals during October 1, 2015, to February 28, 2020. Using a subset of data from 41 acute-care hospitals, we conducted a retrospective cohort study to assess patient demographics, characteristics, mortality, length of stay, and costs. We also conducted a case-control study between those with and without staph bacteremia.</p><p><strong>Results: </strong>The incidence of MSSA bacteremia significantly increased from 2.43 per 1,000 admissions to 2.87 per 1,000 admissions (estimate=0.0047, <i>P</i>-value=.0006). The incidence of MRSA significantly increased from 2.11 per 1,000 admissions to 2.42 per 1,000 admissions (estimate=0.0126, <i>P</i>-value <.0001). While the incidence of CO MSSA and CO MRSA demonstrated a significant increase (p=0.0023, and p < 0.0001), the incidence of HO MSSA and HO MRSA did not significantly change (p=0.2795 and p < 0.4464). Compared to those without staph bacteremia, mortality, length of stay, and total cost were significantly higher in those with staph bacteremia, regardless of methicillin susceptibility or onset designation.</p><p><strong>Conclusion: </strong>The increasing incidence of CO MSSA and MRSA bacteremia might suggest the necessity for dedicated infection control measures and interventions for community members colonized with or at risk of acquiring <i>Staphylococcus aureus</i>.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11406565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigation of an outbreak of metallo-β-lactamase producing <i>Pseudomonas aeruginosa</i> linked to the water distribution system in a Hematopoietic Stem Cell Transplantation Unit.","authors":"Daniela Santonato, Ivana Martinelli, Alejandra Quevedo, Roxana Sadorin, Andrea Novau, Leonardo Fabbro, María de Los Ángeles Cuello Mena, Vanessa Araoz Sanchez, Wanda Cornistein","doi":"10.1017/ash.2024.378","DOIUrl":"https://doi.org/10.1017/ash.2024.378","url":null,"abstract":"<p><strong>Introduction: </strong><i>Pseudomonas aeruginosa</i> (PA) is an opportunistic pathogen. Metallo-β-lactamase producing PA (MBL-PA) poses a problematic issue given limited available treatments. In Argentina, it accounts for less than one percent of healthcare-associated infections.</p><p><strong>Objectives: </strong>To describe an outbreak of verona integron-encoded metallo-β-lactamase (VIM) <i>Pseudomonas aeruginosa</i> in a Hematopoietic Stem Cell Transplantation Unit (HSCTU), and the strategies implemented to control it.</p><p><strong>Materials and methods: </strong>Investigation of an outbreak by MBL-PA in an HSCTU in May 2023. Active case search, environmental sampling, identification and susceptibility pattern of strains, mitigation strategies. Case: patient admitted to the HSCTU with positive sample for MBL-PA after 48 hours of admission. Mitigation strategies: biweekly rectal swabbing, contact precautions, dedicated nursing staff, waterless patient care, and disinfection of bacterial reservoirs.</p><p><strong>Results: </strong>In May 2023 two cases were identified. A retrospective search determined an additional case. One (10%) of the environmental samples was positive for VIM type MBL-PA in the drain of the hand hygiene station in the nurse's office. Strains were susceptible to colistin and fosfomycin and intermediate to aztreonam. Incidence density (ID) of colonization and infection by MBL-PA in the HSCTU were .68/1,000 patient-days (pd) and 0, respectively, in the second semester of 2022. In the first semester of 2023, ID rose to 2.93/1,000 pd for colonization and .73/1,000 pd for infection.Mitigation strategies aimed at reducing exposure of immunocompromised hosts to water. No new cases have been identified since.</p><p><strong>Conclusions: </strong>We report an MBL-PA outbreak probably linked to the water distribution system in an HSCTU, and mitigation strategies put in place.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11406561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}