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Mena Lora AJ, Fermin RR, Guzman A, Borgetti S, Bleasdale SC. 1199. Epidemiology of Carbapenem-Resistant Klebsiella pneumoniae: A Comparative Study Between Facilities in the United States and the Dominican Republic. Open Forum Infect Dis 2018. [PMCID: PMC6252768 DOI: 10.1093/ofid/ofy210.1032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background The prevalence of multi-drug-resistant organisms (MDRO) is on the rise globally. MDRO infections carry high morbidity and mortality. There is a paucity of data on Carbapenem-resistant Klebsiella pneumoniae (CRKp) in the Dominican Republic (DR). Evaluating CRKp in various settings will provide data on contrasting epidemiologic risk factors. We evaluated the epidemiology of CKRp in three contrasting settings, a 495-bed urban academic center (AC), a 151-bed urban community hospital (CH) and a 200 bed teaching hospital in the DR (DRH). Methods We performed a retrospective cohort study of patients with CRKp cultures from 2014 to 2016 from AC, CH and DRH. A comparative evaluation of the epidemiology of CRKp between the cohorts was performed. Demographics, co-morbid conditions, antibiotic sensitivity, and outcomes were compared between hospital cohorts. Results Cohort AC had 64 patients, compared with eight from CH and eight from DRH. AC (59%) and CH (62%) cohorts included more men than the DRH cohort (25%). Average age was 62, 66, and 51, respectively. History of MDRO, antibiotic use in the past 6 months and hospitalization within the past year were common risk factors (Figure 1). Diabetes and end-stage renal disease were common comorbidities at all facilities (Figure 2). Charleston Comorbidity Index (CCI) score was highest at AC (6.6) and DRH (6.4) compared with CH (4). Mortality was highest in DRH (63%, 6/8) and AC (11%, 7/64) while CH had no deaths. Urine was the most common source at AC (67%) and CH (75%) while blood was most common at DRH (62.5%). CRKp isolates were susceptible to colistin at varying rates (AC=85%, CH = 63%, DRH = 80%). Conclusion Prior antibiotic use and hospitalization were common risk factors in all settings. Mortality and CCI scores for CRKp was highest at AC and DRH, which are tertiary referral centers. CH had less overall mortality and higher rates of colistin resistance. Further studies are needed to understand these risk factors. Strengthening antimicrobial stewardship and infection control practices in the United States and abroad may help curb the spread of resistance in different clinical settings. Disclosures All authors: No reported disclosures.
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Bleasdale SC, Hermoso C, Aguada MG, Casto EJ, O’Connell L. 2093. Chlorhexidine Gluconate Bathing to Prevent Central Line Associated Infections: What to Do When the Patient Can Bathe Themselves. Open Forum Infect Dis 2018. [PMCID: PMC6253499 DOI: 10.1093/ofid/ofy210.1749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Bathing with pre-medicated 2% chlorhexidine gluconate (CHG) impregnated cloths is for prevention of central line associated blood stream infections (CLABSI). The use of CHG on patients outside of intensive care units has not been well studied. In our bone marrow and stem cell transplant unit (BMTU) we found compliance with CHG bathing to be lacking. Methods This was a quality improvement quasi-experimental pre-post intervention project to improve the use of CHG bathing for prevention of CLABSI in BMTU patients with central venous catheters (CVC). Review of CLABSI data identified high rates in BMTU compared with other units and significant numbers of Gram-positive organisms, suggesting needed increase in interventions directed at CVC maintenance. Review of cases, identified barriers to CHG bathing compliance. Audits of compliance with CHG bathing was performed pre-intervention. Interviews of staff and patients identified key barriers to compliance, which included, education on the benefit of CHG bathing in prevention of CLABSI, education of the potential for “sticky” feeling after bathing, education of staff on benefits and risk, and patient self-bathing education. Our implementation began in July 2016, and included, patient and staff education, a patient contract for use of CHG, daily patient signatures after bathing, signage in patient rooms with bathing instructions, and improved compliance parameters. Results Compliance with CHG bathing pre-intervention was 81%, and post was 93%. Definitions for compliance changed as part of implementation, to include patient signature, and reasons for noncompliance. CLABSI rate for the BMTU pre-intervention was 2.2/1,000 device days in 2015, post intervention 1.0/1000 device days in 2017 for a 55% reduction in CLABSI. Figure 1 illustrates the decline in CLABSI rate over time after the intervention. No concomitant interventions were implement during this period. Conclusion Patients outside of the ICU are typically nonventilated, awake and capable of self-bathing. Many interventions have been implemented to decrease CLABSI; however, the need for patient engagement and education in the implementation is a critical step that needs to be addressed to ensure fidelity and success of the intervention. ![]()
Disclosures All authors: No reported disclosures.
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Mena Lora AJ, Gonzalez P, Lluberes M, Grau G, Bleasdale SC. 1215. Geographic Distribution of Staphylococcus aureus With Reduced Sensitivity and Resistance to Vancomycin in the Dominican Republic. Open Forum Infect Dis 2018. [PMCID: PMC6253155 DOI: 10.1093/ofid/ofy210.1048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Resistant Staphylococcus aureus (SA) poses a major challenge to clinicians. The prevalence of methicillin-resistant SA (MRSA) has increased over the past decades, while vancomycin resistance remains rare. Only 14 cases of vancomycin-resistant SA (VRSA) have been described in the United States since 2002. VRSA and SA with reduced susceptibility to vancomycin (VISA) cause high morbidity and mortality. There is a paucity of data on VRSA in developing nations. We seek to define the prevalence and resistance profile of SA in the Dominican Republic (DR). Methods This is a retrospective review of resistance patterns of SA isolates from a clinical laboratory in the DR (Amadita Laboratories). Amadita provides services nationwide. Data collected from 2016 to 2017 included SA phenotypic sensitivity patterns and geographic location and income level. VISA and VRSA were defined as having minimum inhibitory (MIC) concentrations between 4 and 8 and MIC >16. Results Of 5,372 SA samples, 2,735 (51%) were MRSA, 21 were VISA and 39 were VRSA. VRSA samples were more commonly from Santo Domingo (SD) (Figure 1). Communities in SD with mixed and low incomes had greater burden of VRSA (Figure 2). Antimicrobial susceptibilities are shown in Table 1. Conclusion In this nationwide sample, we found an alarming number of VISA and VRSA. Most cases were in metropolitan SD, with lower income communities carrying a higher case burden. Linezolid and TMP-SMX retain activity against VISA and VRSA in the DR. The rise of vancomycin resistance in developing countries and the disproportionate burden on communities of low income is concerning and requires further study. Infection control measures and antimicrobial stewardship interventions may help prevent further spread of resistant strains. Disclosures All authors: No reported disclosures.
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Weber RT, Phan LT, Edomwande O, Fritzen-Pedicini CM, Bleasdale SC, Jones R. Environmental and Personal Protective Equipment Contamination During Simulated Healthcare Activities. Am J Infect Control 2018. [DOI: 10.1016/j.ajic.2018.04.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gross AE, Johannes RS, Gupta V, Tabak YP, Srinivasan A, Bleasdale SC. The Effect of a Piperacillin/Tazobactam Shortage on Antimicrobial Prescribing and Clostridium difficile Risk in 88 US Medical Centers. Clin Infect Dis 2018; 65:613-618. [PMID: 28444166 DOI: 10.1093/cid/cix379] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 04/20/2017] [Indexed: 12/14/2022] Open
Abstract
Background Anti-infective shortages are a pervasive problem in the United States. The objective of this study was to identify any associations between changes in prescribing of antibiotics that have a high risk for CDI during a piperacillin/tazobactam (PIP/TAZO) shortage and hospital-onset Clostridium difficile infection (HO-CDI) risk in 88 US medical centers. Methods We analyzed electronically captured microbiology and antibiotic use data from a network of US hospitals from July 2014 through June 2016. The primary outcome was HO-CDI rate and the secondary outcome was changes in antibiotic usage. We fit a Poisson model to estimate the risk of HO-CDI associated with PIP/TAZO shortage that were associated with increased high-risk antibiotic use while controlling for hospital characteristics. Results A total of 88 hospitals experienced PIP/TAZO shortage and 72 of them experienced a shift toward increased use of high-risk antibiotics during the shortage period. The adjusted relative risk (RR) of HO-CDI for hospitals experiencing a PIP/TAZO shortage was 1.03 (95% confidence interval [CI], .85-1.26; P = .73). The adjusted RR of HO-CDI for hospitals that both experienced a shortage and also showed a shift toward increased use of high-risk antibiotics was 1.30 (95% CI, 1.03-1.64; P < .05). Conclusions Hospitals that experienced a PIP/TAZO shortage and responded to that shortage by shifting antibiotic usage toward antibiotics traditionally known to place patients at greater risk for CDI experienced greater HO-CDI rates; this highlights an important adverse effect of the PIP/TAZO shortage and the importance of antibiotic stewardship when mitigating drug shortages.
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Kaye KS, Bhowmick T, Metallidis S, Bleasdale SC, Sagan OS, Stus V, Vazquez J, Zaitsev V, Bidair M, Chorvat E, Dragoescu PO, Fedosiuk E, Horcajada JP, Murta C, Sarychev Y, Stoev V, Morgan E, Fusaro K, Griffith D, Lomovskaya O, Alexander EL, Loutit J, Dudley MN, Giamarellos-Bourboulis EJ. Effect of Meropenem-Vaborbactam vs Piperacillin-Tazobactam on Clinical Cure or Improvement and Microbial Eradication in Complicated Urinary Tract Infection: The TANGO I Randomized Clinical Trial. JAMA 2018; 319:788-799. [PMID: 29486041 PMCID: PMC5838656 DOI: 10.1001/jama.2018.0438] [Citation(s) in RCA: 219] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Meropenem-vaborbactam is a combination carbapenem/beta-lactamase inhibitor and a potential treatment for severe drug-resistant gram-negative infections. OBJECTIVE To evaluate efficacy and adverse events of meropenem-vaborbactam in complicated urinary tract infection (UTI), including acute pyelonephritis. DESIGN, SETTING, AND PARTICIPANTS Phase 3, multicenter, multinational, randomized clinical trial (TANGO I) conducted November 2014 to April 2016 and enrolling patients (≥18 years) with complicated UTI, stratified by infection type and geographic region. INTERVENTIONS Eligible patients were randomized 1:1 to receive meropenem-vaborbactam (2g/2g over 3 hours; n = 274) or piperacillin-tazobactam (4g/0.5g over 30 minutes; n = 276) every 8 hours. After 15 or more doses, patients could be switched to oral levofloxacin if they met prespecified criteria for improvement, to complete 10 days of total treatment. MAIN OUTCOMES AND MEASURES Primary end point for FDA criteria was overall success (clinical cure or improvement and microbial eradication composite) at end of intravenous treatment in the microbiologic modified intent-to-treat (ITT) population. Primary end point for European Medicines Agency (EMA) criteria was microbial eradication at test-of-cure visit in the microbiologic modified ITT and microbiologic evaluable populations. Prespecified noninferiority margin was -15%. Because the protocol prespecified superiority testing in the event of noninferiority, 2-sided 95% CIs were calculated. RESULTS Among 550 patients randomized, 545 received study drug (mean age, 52.8 years; 361 [66.2%] women; 374 [68.6%] in the microbiologic modified ITT population; 347 [63.7%] in the microbiologic evaluable population; 508 [93.2%] completed the trial). For the FDA primary end point, overall success occurred in 189 of 192 (98.4%) with meropenem-vaborbactam vs 171 of 182 (94.0%) with piperacillin-tazobactam (difference, 4.5% [95% CI, 0.7% to 9.1%]; P < .001 for noninferiority). For the EMA primary end point, microbial eradication in the microbiologic modified ITT population occurred in 128 of 192 (66.7%) with meropenem-vaborbactam vs 105 of 182 (57.7%) with piperacillin-tazobactam (difference, 9.0% [95% CI, -0.9% to 18.7%]; P < .001 for noninferiority); microbial eradication in the microbiologic evaluable population occurred in 118 of 178 (66.3%) vs 102 of 169 (60.4%) (difference, 5.9% [95% CI, -4.2% to 16.0%]; P < .001 for noninferiority). Adverse events were reported in 106 of 272 (39.0%) with meropenem-vaborbactam vs 97 of 273 (35.5%) with piperacillin-tazobactam. CONCLUSIONS AND RELEVANCE Among patients with complicated UTI, including acute pyelonephritis and growth of a baseline pathogen, meropenem-vaborbactam vs piperacillin-tazobactam resulted in a composite outcome of complete resolution or improvement of symptoms along with microbial eradication that met the noninferiority criterion. Further research is needed to understand the spectrum of patients in whom meropenem-vaborbactam offers a clinical advantage. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02166476.
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Su YM, Phan L, Edomwande O, Weber R, Bleasdale SC, Brosseau LM, Fritzen-Pedicini C, Sikka M, Jones RM. Contact patterns during cleaning of vomitus: A simulation study. Am J Infect Control 2017; 45:1312-1317. [PMID: 28844383 DOI: 10.1016/j.ajic.2017.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 07/05/2017] [Accepted: 07/06/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Environmental service workers cleaning bodily fluids may transfer pathogens through the environment and to themselves through contacts. METHODS Participants with experience in cleaning of hospital environments were asked to clean simulated vomitus using normal practices in a simulated patient room while being videorecorded. Contacts with environmental surfaces and self were later observed. RESULTS In 21 experimental trials with 7 participants, environmental surfaces were contacted 26.8 times per trial, at a frequency of 266 contacts per hour, on average. Self-contact occurred in 9 of 21 trials, and involved 1-18 contacts, mostly to the upper body. The recommended protocol of cleaning bodily fluids was followed by a minority of participants (2 of 7), and was associated with fewer surface contacts, improved cleaning quality, and different tool use. Participants used different cleaning practices, but each employed similar practices each time they performed an experimental trial. CONCLUSIONS Training in the use of the recommended protocol may standardize cleaning practices and reduce the number of surface contacts.
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Lodise TP, Rosenkranz SL, Finnemeyer M, Huvane J, Pereira A, Sims M, Zervos MJ, Creech CB, Patel PC, Keefer M, Riska P, Silveira FP, Scheetz M, Wunderink RG, Rodriguez M, Schrank J, Bleasdale SC, Schultz S, Barron M, Stapleton A, Chambers H, Fowler V, Holland TL. The Emperor’s New Clothes: Prospective Observational Evaluation of the Association between the Day 2 Vancomycin Exposure and Failure Rates among Adult Hospitalized Patients with MRSA Bloodstream Infections (PROVIDE). Open Forum Infect Dis 2017. [PMCID: PMC5632097 DOI: 10.1093/ofid/ofx162.074] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Current guidelines recommend vancomycin (VAN) dosing to achieve AUC/MIC ratio ≥400 for patients (pts) with serious MRSA bloodstream infections (BSI), but supporting data were largely derived in single center retrospective studies. A recent study using a Bayesian approach to estimate the VAN AUC found that patients with MRSA BSI who had an AUCDAY2/MICBMD ≥ 650 or an AUCDAY2/MICETEST ≥ 320 had lower incidences of failure (Clin Infect Dis 59:666, 2014). This study prospectively evaluated if these VAN AUCDAY2/MIC targets were associated with lower incidences of failure (PROVIDE, Award number UM1AI104681, Antibacterial Resistance Leadership Group). Methods Prospective, multi-center (n = 14), observational study (2014–2106) of hospitalized adults with confirmed MRSA BSI treated with VAN ≥ 72h. Exclusion: (1) neutropenia; (2) cystic fibrosis; (3) renal replacement therapy; (4) APACHE-II score > 25; (5) previous MRSA BSI within 60 days. VAN exposures were estimated using maximum a posteriori probability procedure in ADAPT 5. MICBMD and MICETEST were performed at a central laboratory. Outcomes: failure (30-day mortality or MRSA BSI ≥ 7 days); acute kidney injury (AKI), ≥1.5 × increase in serum creatinine (Scr) among patients with a baseline SCR < 2.0mg/dl. The study was powered at 80% to detect a 17.5% difference in failure between AUCDAY2/MIC groups. Results Among the 265 evaluable patients, mean (SD) age was 61 (17) and APACHE-II was 12 (6). Endocarditis was definite/possible in 29%. The MIC50/90 by BMD and ETEST were 1/1 and 1.5/1.5mg/l, respectively. Failure occurred in 18%; 26% had AKI. Mean (SD) VAN duration was 18 (14) days. Mean (SD) AUCDAY2 was 586.9 (235.5) and 44% and 73% of patients achieved an AUCDAY2/MICBMD ≥ 650 and AUCDAY2/MICETEST ≥ 320. In the multivariate analyses (Figure 1), failure was not significantly different between AUCDAY2/MIC groups. In contrast, AKI was significantly more common in patients with an AUCDAY2/ MICETEST > = 320. Conclusion Achievement of higher VAN AUCDAY2/MIC exposures for patients with MRSA BSIs were not associated with better outcomes and were found to result in increased AKI. Clinicians should assess the benefits vs. risks of using VAN regimens that confer high AUCDAY2/MIC exposures for patients with MRSA BSIs. Disclosures T. P. Lodise Jr., allergan: Consultant, Grant Investigator, Scientific Advisor and Speaker’s Bureau, Consulting fee and Speaker honorarium; medicines company: Consultant, Grant Investigator, Scientific Advisor and Speaker’s Bureau, Consulting fee, Research support and Speaker honorarium; melinta: Consultant, Consulting fee; motif: Consultant and Scientific Advisor, Consulting fee; paratek: Consultant and Scientific Advisor, Consulting fee; nabriva: Consultant, Consulting fee; M. J. Zervos, Merck, Inc.: Investigator, Research grant; M. Scheetz, Bayer: Scientific Advisor, Consulting fee; V. Fowler Jr., Pfizer, Novartis, Galderma, Novadigm, Durata, Debiopharm, Genentech, Achaogen, Affinium, Medicines Co., Cerexa, Tetraphase, Trius, MedImmune, Bayer, Theravance, Cubist, Basilea, Affinergy, Janssen, xBiotech, Contrafect: Consultant, Consulting fee; NIH, Basilea, MedImmune, Cerexa/Forest/Actavis/Allergan, Pfizer, Advanced Liquid Logics, Theravance, Novartis, Cubist/Merck; Medical Biosurfaces; Locus; Affinergy; Contrafect; Karius: Grant Investigator, Research grant; Green Cross, Cubist, Cerexa, Durata, Theravance; Debiopharm: Consultant, Consulting fee; UpToDate: author on several chapters, Royalties
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Molino ST, Stranges PM, Bleasdale SC, Shapiro NL, Suda KJ, Gross AE. Evaluation of Antibiotic Prescribing for Acute Respiratory Tract Infections in the Ambulatory Care Setting. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.1510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sikka MK, Moritz D, Bleasdale SC, Fritzen-Pedicini C, Brosseau L, Jones R. Experiences of Hospitals in the Chicago Area with PPE Acquisition and Use During the 2014 Ebola Virus Disease Outbreak. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bleasdale SC, Wenzler E, Sikka MK, Bunnell K, Finnemeyer M, Rosenkranz SL, Danziger LH, Rodvold KA. Phase I Study To Evaluate The Safety And Tolerability Of Two Dosing Regimens Of Oral Fosfomycin Tromethamine In Healthy Adult Participants. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.1410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Wenzler E, Bleasdale SC, Sikka MK, Bunnell K, Finnemeyer M, Rosenkranz SL, Danziger LH, Rodvold KA. Phase I Study to Evaluate the Pharmacokinetics of Two Dosing Regimens of Oral Fosfomycin Tromethamine in Healthy Adult Participants. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.1377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gross AE, Gupta V, Bleasdale SC, Tabak YP, Johannes RS. The Effect of a Piperacillin/Tazobactam Shortage on Antimicrobial Prescribing and Hospital-Onset Clostridium difficile Infection Rates in 88 United States Medical Centers. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Santarossa M, Bleasdale SC, Harrington A, Benken ST, Merrick MC, Murrell DS, Stolar E, Williams A, Gross AE. Clinical Outcomes of a MALDI-TOF-Tied Antimicrobial Stewardship Intervention Compared to MALDI-TOF Reporting Without Intervention: A Quasi-Experimental study. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Moritz D, Merrick M, Bleasdale SC, Sikka MK. Pseudo-Outbreak of Mycobacterium farcinogenes senegalense Group in Sputum Cultures in the Intensive Care Unit at a Veterans Administration Hospital. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hughart R, Merrick M, Adelaja OT, Bleasdale SC, Harrington A, Tsoukas M. Cutaneous phaeohyphomycosis caused by Biatriospora mackinnonii in a renal transplant recipient. JAAD Case Rep 2016; 2:230-2. [PMID: 27299152 PMCID: PMC4890109 DOI: 10.1016/j.jdcr.2016.03.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Barry S, Bleasdale SC. Epidemiology of Carbapenem-Resistant Enterobacteriaceae Infection and Colonization at the University of Illinois Hospital in Chicago, Illinois. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.1331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hota B, Harting B, Weinstein RA, Lyles RD, Bleasdale SC, Trick W. Electronic Algorithmic Prediction of Central Vascular Catheter Use. Infect Control Hosp Epidemiol 2015; 31:4-11. [DOI: 10.1086/649015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objective.To develop prediction algorithms for the presence of a central vascular catheter in hospitalized patients with use of data present in an electronic health record. Such algorithms could be used for measurement of device utilization rates and for clinical decision support rules.Design.Criterion standard.Setting.John H. Stroger, Jr, Hospital of Cook County, a 464-bed public hospital in Chicago, Illinois.Participants.Patients admitted to the medical intensive care unit from May 31, 2005 through June 26, 2006 (derivation data set, May 31, 2005-September 28, 2005; validation data set, September 29, 2005-June 28, 2006).Methods.Covariates were collected from the electronic medical record for each patient; the outcome variable was presence of a central vascular device. Multivariate models were developed using the derivation set and the generalized estimating equation. Three models, each with increasing database requirements, were validated using the validation set. Device utilization ratios and performance characteristics were calculated.Results.Although Charlson score and duration of intensive care unit stay were significant predictors in all models, factors that indicated use or presence of a central line were also important. Device utilization rates derived from the algorithmic models were as accurate as those obtained using manual sampling.Conclusions.Automated calculation of central vascular catheter use is both feasible and accurate, providing estimates statistically similar to those obtained using manual surveillance. Prediction modeling of central vascular catheter use may enable automated surveillance of bloodstream infections and enhance important prevention interventions, such as timely removal of unnecessary central lines.
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Means L, Gross AE, Sikka MK, Bleasdale SC. 1298Predictors of Hospital Readmission in Patients Receiving Outpatient Parenteral Antimicrobial Therapy (OPAT). Open Forum Infect Dis 2014. [PMCID: PMC5782339 DOI: 10.1093/ofid/ofu051.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Bleasdale SC, Trick WE, Gonzalez IM, Lyles RD, Hayden MK, Weinstein RA. Effectiveness of chlorhexidine bathing to reduce catheter-associated bloodstream infections in medical intensive care unit patients. ACTA ACUST UNITED AC 2007; 167:2073-9. [PMID: 17954801 DOI: 10.1001/archinte.167.19.2073] [Citation(s) in RCA: 249] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine whether patients bathed daily with chlorhexidine gluconate (CHG) have a lower incidence of primary bloodstream infections (BSIs) compared with patients bathed with soap and water. METHODS The study design was a 52-week, 2-arm, crossover (ie, concurrent control group) clinical trial with intention-to-treat analysis. The study setting was the 22-bed medical intensive care unit (MICU), which comprises 2 geographically separate, similar 11-bed units, of the John H. Stroger Jr (Cook County) Hospital, a 464-bed public teaching hospital in Chicago, Illinois. The study population comprised 836 MICU patients. During the first of 2 study periods (28 weeks), 1 hospital unit was randomly selected to serve as the intervention unit in which patients were bathed daily with 2% CHG-impregnated washcloths (Sage 2% CHG cloths; Sage Products Inc, Cary, Illinois); patients in the concurrent control unit were bathed daily with soap and water. After a 2-week wash-out period at the end of the first period, cleansing methods were crossed over for 24 more weeks. Main outcome measures included incidences of primary BSIs and clinical (culture-negative) sepsis (primary outcomes) and incidences of other infections (secondary outcomes). RESULTS Patients in the CHG intervention arm were significantly less likely to acquire a primary BSI (4.1 vs 10.4 infections per 1000 patient days; incidence difference, 6.3 [95% confidence interval, 1.2-11.0). The incidences of other infections, including clinical sepsis, were similar between the units. Protection against primary BSI by CHG cleansing was apparent after 5 or more days in the MICU. CONCLUSION Daily cleansing of MICU patients with CHG-impregnated cloths is a simple, effective strategy to decrease the rate of primary BSIs.
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Olsen SJ, Bleasdale SC, Magnano AR, Landrigan C, Holland BH, Tauxe RV, Mintz ED, Luby S. Outbreaks of typhoid fever in the United States, 1960-99. Epidemiol Infect 2003; 130:13-21. [PMID: 12613741 PMCID: PMC2869934 DOI: 10.1017/s0950268802007598] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Although the incidence of typhoid fever in the United States has been low since the 1940s, Salmonella Typhi continues to cause outbreaks. We reviewed reported outbreaks of typhoid fever from 1960 to 1999. There were 60 outbreaks; in 54, exposure occurred within the United States. These 54 outbreaks accounted for 957 total cases (median 10) and 4 deaths. In 36 (67%) outbreaks the route of transmission was identified, and in 16 (62%) of the 26 foodborne outbreaks an asymptomatic carrier was identified by culture or serology. The median incubation period was 2 weeks. Isolates from 10 (40%) of 25 outbreaks were phage type E1. The average frequency of outbreaks decreased from 1.85/year during 1960-79 to 0.85/year during 1980-99 (P=0.0001). S. Typhi outbreaks in the United States are generally small in size but can cause significant morbidity, and are often foodborne, warranting thorough investigation.
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