Antimicrobial Stewardship & Healthcare Epidemiology最新文献

Using whole genome sequencing to characterize Clostridioides difficile isolates at a tertiary center in Melbourne, Australia 利用全基因组测序确定澳大利亚墨尔本一家三级中心艰难梭菌分离物的特征

Antimicrobial Stewardship & Healthcare Epidemiology Pub Date : 2024-01-12 DOI: 10.1017/ash.2023.529

Alice Liu, Eddie Chan, Victoria Madigan, Vivian Leung, Lucille Dosvaldo, N. Sherry, Benjamin Howden, Katherine Bond, Caroline Marshall

{"title":"Using whole genome sequencing to characterize Clostridioides difficile isolates at a tertiary center in Melbourne, Australia","authors":"Alice Liu, Eddie Chan, Victoria Madigan, Vivian Leung, Lucille Dosvaldo, N. Sherry, Benjamin Howden, Katherine Bond, Caroline Marshall","doi":"10.1017/ash.2023.529","DOIUrl":"https://doi.org/10.1017/ash.2023.529","url":null,"abstract":"Abstract Objective: Clostridioides difficile infection (CDI) is the commonest cause of healthcare-associated diarrhea and undergoes standardized surveillance and mandatory reporting in most Australian states and territories. Historically attributed to nosocomial spread, local and international whole genome sequencing (WGS) data suggest varied sources of acquisition. This study describes C. difficile genotypes isolated at a tertiary center in Melbourne, Australia, their likely source of acquisition, and common risk factors. Design: Retrospective observational study. Setting: The Royal Melbourne Hospital (RMH), a 570-bed tertiary center in Victoria, Australia. Methods: Short-read whole genome sequencing was performed on 75 out of 137 C. difficile isolates obtained from 1/5/2021 to 28/2/2022 and compared to previous data from 8/11/2015 to 1/11/2016. Existing data from infection control surveillance and electronic medical records were used for epidemiological and risk factor analysis. Results: Eighty-five (62.1%) of the 137 cases were defined as healthcare-associated from epidemiological data. On genome sequencing, 33 different multi-locus sequence type (MLST) subtypes were identified, with changes in population structure compared to the 2015–16 period. Risk factors for CDI were present in 130 (94.9%) cases, including 108 (78.8%) on antibiotics, 86 (62.8%) on acid suppression therapy, and 25 (18.2) on chemotherapy. Conclusion: In both study periods, most C. difficile isolates were not closely related, suggesting varied sources of acquisition and that spread of C. difficile within the hospital was unlikely. Current infection control precautions may therefore warrant review. Underlying risk factors for CDI were common and may contribute to the proportion of healthcare-associated infections in the absence of proven hospital transmission.","PeriodicalId":7953,"journal":{"name":"Antimicrobial Stewardship & Healthcare Epidemiology","volume":"3 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139437831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Bring it on again: antimicrobial stewardship in transplant infectious diseases: updates and new challenges 再接再厉：移植传染病中的抗菌药物管理：最新进展与新挑战

Antimicrobial Stewardship & Healthcare Epidemiology Pub Date : 2024-01-11 DOI: 10.1017/ash.2023.517

H. Tsai, Rachel Bartash, Daniel Burack, Neeraja Swaminathan, M. So

{"title":"Bring it on again: antimicrobial stewardship in transplant infectious diseases: updates and new challenges","authors":"H. Tsai, Rachel Bartash, Daniel Burack, Neeraja Swaminathan, M. So","doi":"10.1017/ash.2023.517","DOIUrl":"https://doi.org/10.1017/ash.2023.517","url":null,"abstract":"Abstract Advancement in solid organ transplantation and hematopoietic stem cell transplant continues to improve the health outcomes of patients and widens the number of eligible patients who can benefit from the medical progress. Preserving the effectiveness of antimicrobials remains crucial, as otherwise transplant surgeries would be unsafe due to surgical site infections, and the risk of sepsis with neutropenia would preclude stem cell transplant. In this review, we provide updates on three previously discussed stewardship challenges: febrile neutropenia, Clostridioides difficile infection, and asymptomatic bacteriuria. We also offer insight into four new stewardship challenges: the applicability of the “shorter is better” paradigm shift to antimicrobial duration; antibiotic allergy delabeling and desensitization; colonization with multidrug-resistant gram-negative organisms; and management of cytomegalovirus infections. Specifically, data are accumulating for “shorter is better” and antibiotic allergy delabeling in transplant patients, following successes in the general population. Unique to transplant patients are the impact of multidrug-resistant organism colonization on clinical decision-making of antibiotic prophylaxis in transplant procedure and the need for antiviral stewardship in cytomegalovirus. We highlighted the expansion of antimicrobial stewardship interventions as potential solutions for these challenges, as well as gaps in knowledge and opportunities for further research.","PeriodicalId":7953,"journal":{"name":"Antimicrobial Stewardship & Healthcare Epidemiology","volume":"3 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139438540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Professor Mahmood Bhutta on disrupting unhealthy supply chains and promoting environmental sustainability in health care 马哈茂德-布塔（Mahmood Bhutta）教授谈打破不健康的供应链和促进医疗保健的环境可持续性

Antimicrobial Stewardship & Healthcare Epidemiology Pub Date : 2024-01-11 DOI: 10.1017/ash.2023.533

Mahmood F. Bhutta

引用次数: 0

Influenza outbreak management tabletop exercise for congregate living settings 针对集体生活场所的流感爆发管理桌面演练

Antimicrobial Stewardship & Healthcare Epidemiology Pub Date : 2024-01-11 DOI: 10.1017/ash.2023.528

Christina K. Chan, Jerome A. Leis, Heather Candon, Neethu R. Thomas, Jaclyn O’Brien, James Callahan, Brigitte Pascual, Marianna Ofner, Fatima Fazalullasha, Adrienne K. Chan, Jeff E. Powis, Charlie Tan

引用次数: 0

Intermittent hemodialysis: a review of the top antimicrobial stewardship practices to be employed 间歇性血液透析：应采用的顶级抗菌管理方法回顾

Antimicrobial Stewardship & Healthcare Epidemiology Pub Date : 2024-01-11 DOI: 10.1017/ash.2023.525

Nour Shamas, F. Khamis, K. Eljaaly, Zaher Al Salmi, M. Al Bahrani

引用次数: 0

Oral amoxicillin challenges for low-risk penicillin-allergic patients at a large Veterans Affairs facility: a retrospective feasibility analysis 一家大型退伍军人事务机构的低风险青霉素过敏患者口服阿莫西林的挑战：回顾性可行性分析

Antimicrobial Stewardship & Healthcare Epidemiology Pub Date : 2024-01-11 DOI: 10.1017/ash.2023.532

Jessica M. Guastadisegni, Misozi K. Kolala, Jazmyn M. Criss, M. Kouma, D. Storey, R. Arasaratnam

引用次数: 0

Efficacy of noncarbapenem therapy for the treatment of ceftriaxone-resistant Enterobacterales outside the urinary tract 治疗尿路外耐药头孢曲松肠杆菌的非碳青霉烯类疗法的疗效

Antimicrobial Stewardship & Healthcare Epidemiology Pub Date : 2024-01-09 DOI: 10.1017/ash.2023.137

Ethan Rausch, K. Alby, William Wilson

{"title":"Efficacy of noncarbapenem therapy for the treatment of ceftriaxone-resistant Enterobacterales outside the urinary tract","authors":"Ethan Rausch, K. Alby, William Wilson","doi":"10.1017/ash.2023.137","DOIUrl":"https://doi.org/10.1017/ash.2023.137","url":null,"abstract":"Abstract Objective: To determine the safety of noncarbapenem versus carbapenem antibiotics for treatment of adults with documented infection caused by ceftriaxone-resistant infections outside the urinary tract. Design: Retrospective cohort of adult patients with a documented infection caused by an extended-spectrum β-lactamase (ESBL)–producing organism isolated between January 2018 and October 2021. Setting: An academic tertiary-care center. Patients: Adult patients with a documented infection caused by an ESBL-producing organism outside the urinary tract. Methods: The primary outcome was a composite of treatment failure defined as 30-day mortality, 30-day readmission, microbiological recurrence, and/or clinical worsening requiring antibiotic change. Secondary outcomes included differentiation of primary composite components and postantibiotic Clostridioides difficile infection (CDI). Results: This study included 130 patients. The primary source of infections were bloodstream (67.7%) and caused by Escherichia coli (81.5%). Overall, 101 patients received carbapenem therapy and 29 received noncarbapenem therapy (NCT). NCT was comprised of mainly fluoroquinolones (18 of 29) followed by cefepime (7 of 29). Patients receiving NCT had shorter hospital stays (median, 7 days vs 9 days) and were more often discharged on antibiotics (79.3% vs 50.5%). We did not detect a significant difference in the primary composite outcome of treatment failure for carbapenem (23.8%) versus noncarbapenem treatment (24.2%; P = .967). Secondary outcomes included a numerically higher 30-day mortality rate in the noncarbapenem group compared to the carbapenem group: 4 (13.8%) of 29 versus 4 (3.9%) of 101. We did not detect a difference in rates of CDI. Conclusion: Noncarbapenem therapy may play a role for certain patients with infections caused by ESBL-producing organisms.","PeriodicalId":7953,"journal":{"name":"Antimicrobial Stewardship & Healthcare Epidemiology","volume":"81 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139444769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The use of UV-C radiation for terminal disinfection of pathogenic Gram-negative rods: a pilot study 利用紫外线-C 辐射对致病性革兰氏阴性杆菌进行终端消毒：一项试点研究

Antimicrobial Stewardship & Healthcare Epidemiology Pub Date : 2023-12-21 DOI: 10.1017/ash.2023.514

J. Tholany, Hiroyuki Suzuki, Amy R. Frank, Steven H. Bryant, Cassie Cunningham Goedken, Daniel Suh, Michael S. Stevens, Stacey M. Hockett Sherlock, Eli N. Perencevich

引用次数: 0

A novel approach to correcting attribution of Clostridioides difficile in a healthcare setting 纠正医疗机构中艰难梭菌归属的新方法

Antimicrobial Stewardship & Healthcare Epidemiology Pub Date : 2023-12-20 DOI: 10.1017/ash.2023.516

Hunter Doyle, Abby L. Valek, Theresa Murillo, Ashley M. Ayres, Julie Slaughter, Madeline L. Berg, Graham M. Snyder

{"title":"A novel approach to correcting attribution of Clostridioides difficile in a healthcare setting","authors":"Hunter Doyle, Abby L. Valek, Theresa Murillo, Ashley M. Ayres, Julie Slaughter, Madeline L. Berg, Graham M. Snyder","doi":"10.1017/ash.2023.516","DOIUrl":"https://doi.org/10.1017/ash.2023.516","url":null,"abstract":"Abstract Objective: To describe a novel attribution metric estimating the causal source location of healthcare-associated Clostridioides difficile and compare it with the current US National Healthcare Safety Network (NHSN) surveillance reporting standard. Design: Quality improvement study. Setting: Two acute care facilities. Methods: A novel attribution metric assigned days of attribution to locations where patients were located for 14 days before and the day of their C. difficile diagnosis. We correlated the NHSN-assigned unit attribution with the novel attribution measure and compared the proportion of attribution assigned to inpatient units. Results: During a 30-month period, there were 727 NHSN C. difficile healthcare-associated infections (HAIs) and 409 non-HAIs; the novel metric attributed 17,034 days. The correlation coefficients for NHSN and novel attributions among non-ICU units were 0.79 (95% CI, 0.76–0.82) and 0.74 (95% CI, 0.70–0.78) and among ICU units were 0.70 (95% CI, 0.63–0.76) and 0.69 (95% CI, 0.60–0.77) at facilities A and B, respectively. The distribution of difference in percent attribution showed higher inpatient unit attribution using NHSN measure than the novel attribution metric: 38% of ICU units and 15% of non-ICU units in facility A, and 20% of ICU units and 25% of non-ICU units in facility B had a median difference >0; no inpatient units showed a greater attribution using the novel attribution metric. Conclusion: The novel attribution metric shifts attribution from inpatient units to other settings and correlates modestly with NHSN methodology of attribution. If validated, the attribution metric may more accurately target C. difficile reduction efforts.","PeriodicalId":7953,"journal":{"name":"Antimicrobial Stewardship & Healthcare Epidemiology","volume":"70 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138956767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A cluster investigation of Candida auris among hospitalized incarcerated patients 住院监禁患者中念珠菌的群集调查

Antimicrobial Stewardship & Healthcare Epidemiology Pub Date : 2023-12-19 DOI: 10.1017/ash.2023.520

April N. McDougal, Mary Ann DeMaet, Bobbiejean Garcia, Teresa York, Thomas Iverson, Olugbenga Ojo, Janak Patel

{"title":"A cluster investigation of Candida auris among hospitalized incarcerated patients","authors":"April N. McDougal, Mary Ann DeMaet, Bobbiejean Garcia, Teresa York, Thomas Iverson, Olugbenga Ojo, Janak Patel","doi":"10.1017/ash.2023.520","DOIUrl":"https://doi.org/10.1017/ash.2023.520","url":null,"abstract":"Abstract Objective: Investigate and mitigate a cluster of Candida auris cases among incarcerated patients in a maximum-security prison hospital utilizing contact tracing, screening, whole genome sequencing, and environmental sampling and decontamination. Design: Outbreak investigation. Setting: Inpatient prison hospital affiliated with an academic tertiary referral center. Patients: Inmates of the Texas Department of Criminal Justice. Methods: Epidemiologic and environmental investigations were conducted including contact tracing, point prevalence surveys, and environmental sampling. Whole genome sequencing was performed on positive patient isolates. Results: Following a clinical case of C. auris fungemia, 344 patients underwent C. auris surveillance screening. Eight (2.3%) patients were identified with C. auris colonization. All patients were male. Our index patient was the only clinical case and death. Whole genome sequencing was performed on the nine patient isolates. All isolates were clade III (Africa) and clustered together with the largest SNP difference being 21. Environmental cultures from 7 of 61 rooms (11.5%) were positive following terminal disinfection with bleach. Sites nearest to the patient were most often positive including the hospital bed rails and bedside table. The transmission cluster was successfully mitigated within 60 days of identification. Conclusions: Implementation of an aggressive surveillance and decontamination program resulted in mitigation of a C. auris transmission cluster among our incarcerated patients. This investigation provides valuable insight into C. auris transmission in the incarcerated population, which is not considered a classic high-risk population as well as the challenges faced to stop transmission in a facility that requires the use of shared patient environments.","PeriodicalId":7953,"journal":{"name":"Antimicrobial Stewardship & Healthcare Epidemiology","volume":" 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138961020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0