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Van Belkum A, Gros MF, Ferry T, Lustig S, Laurent F, Durand G, Jay C, Rochas O, Ginocchio CC. Novel strategies to diagnose prosthetic or native bone and joint infections. Expert Rev Anti Infect Ther 2021; 20:391-405. [PMID: 34384319 DOI: 10.1080/14787210.2021.1967745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Bone and Joint Infections (BJI) are medically important, costly and occur in native and prosthetic joints. Arthroplasties will increase significantly in absolute numbers over time as well as the incidence of Prosthetic Joint Infections (PJI). Diagnosis of BJI and PJI is sub-optimal. The available diagnostic tests have variable effectiveness, are often below standard in sensitivity and/or specificity, and carry significant contamination risks during the collection of clinical samples. Improvement of diagnostics is urgently needed. AREAS COVERED We provide a narrative review on current and future diagnostic microbiology technologies. Pathogen identification, antibiotic resistance detection, and assessment of the epidemiology of infections via bacterial typing are considered useful for improved patient management. We confirm the continuing importance of culture methods and successful introduction of molecular, mass spectrometry-mediated and next-generation genome sequencing technologies. The diagnostic algorithms for BJI must be better defined, especially in the context of diversity of both disease phenotypes and clinical specimens rendered available. EXPERT OPINION Whether interventions in BJI or PJI are surgical or chemo-therapeutic (antibiotics and bacteriophages included), prior sensitive and specific pathogen detection remains a therapy-substantiating necessity. Innovative tests for earlier and more sensitive and specific detection of bacterial pathogens in BJI are urgently needed.
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Affiliation(s)
- Alex Van Belkum
- bioMérieux, Open Innovation and Partnerships, 3 Route De Port Michaud, La Balme Les Grottes, France
| | | | - Tristan Ferry
- Service Des Maladies Infectieuses Et Tropicales, Hospices Civils De Lyon, Hôpital De La Croix-Rousse, Lyon, France.,Maladies Infectieuses, Université Claude Bernard Lyon 1, Villeurbanne, France.,Centre Interrégional De Référence Pour La Prise En Charge Des Infections Ostéo-articulaires Complexes (Crioac Lyon), Hôpital De La Croix-Rousse, Lyon, France.,Ciri - Centre International De Recherche En Infectiologie, Inserm, U1111, Université́ Claude Bernard Lyon 1CNRS, UMR5308, Ecole Normale Supérieure De Lyon, Univ Lyon, Lyon, France
| | - Sebastien Lustig
- Maladies Infectieuses, Université Claude Bernard Lyon 1, Villeurbanne, France.,Service De Chirurgie Orthopédique, Hôpital De La Croix-Rousse, Lyon, France
| | - Frédéric Laurent
- Service Des Maladies Infectieuses Et Tropicales, Hospices Civils De Lyon, Hôpital De La Croix-Rousse, Lyon, France.,Ciri - Centre International De Recherche En Infectiologie, Inserm, U1111, Université́ Claude Bernard Lyon 1CNRS, UMR5308, Ecole Normale Supérieure De Lyon, Univ Lyon, Lyon, France
| | | | - Corinne Jay
- bioMérieux, BioFire Development Emea, Grenoble, France
| | - Olivier Rochas
- Corporate Business Development, bioMérieux, Marcy-l'Étoile, France
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Schweizer ML, Richardson K, Vaughan Sarrazin MS, Goto M, Livorsi DJ, Nair R, Alexander B, Beck BF, Jones MP, Puig-Asensio M, Suh D, Ohl M, Perencevich EN. Comparative Effectiveness of Switching to Daptomycin Versus Remaining on Vancomycin Among Patients With Methicillin-resistant Staphylococcus aureus (MRSA) Bloodstream Infections. Clin Infect Dis 2021; 72:S68-S73. [PMID: 33512521 DOI: 10.1093/cid/ciaa1572] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/13/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Patients with methicillin-resistant Staphylococcus aureus bloodstream infections (MRSA BSI) usually receive initial treatment with vancomycin but may be switched to daptomycin for definitive therapy, especially if treatment failure is suspected. Our objective was to evaluate the effectiveness of switching from vancomycin to daptomycin compared with remaining on vancomycin among patients with MRSA BSI. METHODS Patients admitted to 124 Veterans Affairs Hospitals who experienced MRSA BSI and were treated with vancomycin during 2007-2014 were included. The association between switching to daptomycin and 30-day mortality was assessed using Cox regression models. Separate models were created for switching to daptomycin any time during the first hospitalization and for switching within 3 days of receiving vancomycin. RESULTS In total, 7411 patients received vancomycin for MRSA BSI. Also, 606 (8.2%) patients switched from vancomycin to daptomycin during the first hospitalization, and 108 (1.5%) switched from vancomycin to daptomycin within 3 days of starting vancomycin. In the multivariable analysis, switching to daptomycin within 3 days was significantly associated with lower 30-day mortality (hazards ratio [HR] = 0.48; 95% confidence interval [CI]: .25, .92). However, switching to daptomycin at any time during the first hospitalization was not significantly associated with 30-day mortality (HR: 0.87; 95% CI: .69, 1.09). CONCLUSIONS Switching to daptomycin within 3 days of initial receipt of vancomycin is associated with lower 30-day mortality among patients with MRSA BSI. This benefit was not seen when the switch occurred later. Future studies should prospectively assess the benefit of early switching from vancomycin to other anti-MRSA antibiotics.
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Affiliation(s)
- Marin L Schweizer
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa USA.,Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa USA
| | - Kelly Richardson
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa USA
| | - Mary S Vaughan Sarrazin
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa USA.,Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa USA
| | - Michihiko Goto
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa USA.,Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa USA
| | - Daniel J Livorsi
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa USA.,Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa USA
| | - Rajeshwari Nair
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa USA.,Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa USA
| | - Bruce Alexander
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa USA
| | - Brice F Beck
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa USA
| | - Michael P Jones
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa USA.,Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa USA
| | - Mireia Puig-Asensio
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa USA
| | - Daniel Suh
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa USA
| | - Madeline Ohl
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa USA
| | - Eli N Perencevich
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa USA.,Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa USA
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Chiu S, Davis J, Giaconi J, Lee A, Orshansky G, Kleinman L, Tsui I. Variable validity of computer extracted problem lists for complications of diabetes mellitus within the VA Greater Los Angeles Health System. Diabetes Metab Syndr 2017; 11 Suppl 2:S611-S615. [PMID: 28647302 DOI: 10.1016/j.dsx.2017.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 04/10/2017] [Indexed: 11/22/2022]
Abstract
PURPOSE Electronic health data in the form of International Classification of Disease, Ninth Revision (ICD-9) codes is routinely used for clinical research, yet the accuracy of specific diagnoses is largely unknown. The purpose of this study is to assess the validity of computer extracted problem lists for diabetic retinopathy (DR) and other complications of diabetes mellitus (DM) within the VA Greater Los Angeles Health Administration (VHAGLA). METHODS The study population consisted of patients at the VHAGLA with an ICD-9 diagnosis of DM between Jan 1st 1999 and March 22nd 2016 with visits to the eye clinic. Fifty patients either with or without an ICD-9 diagnosis of DR were randomly selected. The accuracy of ICD-9 codes for DR, as well as related co-morbidities such as hypertension, hyperlipidemia, coronary artery disease (CAD), and cerebrovascular accident (CVA), were assessed through chart review. RESULTS A total of 3193 patients met our inclusion criteria. Of the 50 patients with an ICD-9 diagnosis of DR, the positive predictive value (PPV) was 0.7. For 50 patients without a ICD-9 diagnosis of DR, the negative predictive value (NPV) was 0.9. Of the other co-morbid medical conditions, NPV ranged from a low of 63% for obesity to a high of 98% for CVA and CAD. CONCLUSION Validity of ICD-9 diagnoses of diabetic complications in this VA population varied considerably, with DR demonstrating moderate agreement, obesity being more under-documented, and CVA and CAD being more consistently documented. These discrepancies should be considered when using billing codes for research purposes.
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Affiliation(s)
- Stephan Chiu
- Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, 100 Stein Plaza, Los Angeles, CA, United States
| | - John Davis
- Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, 100 Stein Plaza, Los Angeles, CA, United States
| | - JoAnn Giaconi
- Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, 100 Stein Plaza, Los Angeles, CA, United States; VA Greater Los Angeles Health Administration, 11301 Wilshire Blvd, Los Angeles, CA, United States
| | - Aaron Lee
- Department of Ophthalmology, University of Washington, 325 Ninth Avenue, Seattle, WA, United States
| | - Greg Orshansky
- VA Greater Los Angeles Health Administration, 11301 Wilshire Blvd, Los Angeles, CA, United States
| | - Leonard Kleinman
- VA Greater Los Angeles Health Administration, 11301 Wilshire Blvd, Los Angeles, CA, United States
| | - Irena Tsui
- Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, 100 Stein Plaza, Los Angeles, CA, United States; VA Greater Los Angeles Health Administration, 11301 Wilshire Blvd, Los Angeles, CA, United States.
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McDanel JS, Roghmann MC, Perencevich EN, Ohl ME, Goto M, Livorsi DJ, Jones M, Albertson JP, Nair R, O’Shea AMJ, Schweizer ML. Comparative Effectiveness of Cefazolin Versus Nafcillin or Oxacillin for Treatment of Methicillin-Susceptible Staphylococcus aureus Infections Complicated by Bacteremia: A Nationwide Cohort Study. Clin Infect Dis 2017; 65:100-106. [DOI: 10.1093/cid/cix287] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 03/28/2017] [Indexed: 01/05/2023] Open
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Gundlapalli AV, Carter ME, Divita G, Shen S, Palmer M, South B, Durgahee BSB, Redd A, Samore M. Extracting Concepts Related to Homelessness from the Free Text of VA Electronic Medical Records. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2014; 2014:589-598. [PMID: 25954364 PMCID: PMC4419940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Mining the free text of electronic medical records (EMR) using natural language processing (NLP) is an effective method of extracting information not always captured in administrative data. We sought to determine if concepts related to homelessness, a non-medical condition, were amenable to extraction from the EMR of Veterans Affairs (VA) medical records. As there were no off-the-shelf products, a lexicon of terms related to homelessness was created. A corpus of free text documents from outpatient encounters was reviewed to create the reference standard for NLP training and testing. V3NLP Framework was used to detect instances of lexical terms and was compared to the reference standard. With a positive predictive value of 77% for extracting relevant concepts, this study demonstrates the feasibility of extracting positively asserted concepts related to homelessness from the free text of medical records.
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Affiliation(s)
- Adi V Gundlapalli
- VA Salt Lake City Health Care System, Salt Lake City, UT ; University of Utah School of Medicine, Salt Lake City, UT
| | - Marjorie E Carter
- VA Salt Lake City Health Care System, Salt Lake City, UT ; University of Utah School of Medicine, Salt Lake City, UT
| | - Guy Divita
- VA Salt Lake City Health Care System, Salt Lake City, UT ; University of Utah School of Medicine, Salt Lake City, UT
| | - Shuying Shen
- VA Salt Lake City Health Care System, Salt Lake City, UT ; University of Utah School of Medicine, Salt Lake City, UT
| | - Miland Palmer
- University of Utah School of Medicine, Salt Lake City, UT
| | - Brett South
- VA Salt Lake City Health Care System, Salt Lake City, UT ; University of Utah School of Medicine, Salt Lake City, UT
| | - B S Begum Durgahee
- VA Salt Lake City Health Care System, Salt Lake City, UT ; University of Utah School of Medicine, Salt Lake City, UT
| | - Andrew Redd
- VA Salt Lake City Health Care System, Salt Lake City, UT ; University of Utah School of Medicine, Salt Lake City, UT
| | - Matthew Samore
- VA Salt Lake City Health Care System, Salt Lake City, UT ; University of Utah School of Medicine, Salt Lake City, UT
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Clinical and molecular epidemiology of community-onset invasive Staphylococcus aureus infection in New Zealand children. Epidemiol Infect 2014; 142:1713-21. [DOI: 10.1017/s0950268814000053] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
SUMMARYOur aim was to describe the epidemiology and incidence of community-onset invasive S. aureus disease in children presenting to our hospital, and to compare the clonal complexes and virulence genes of S. aureus strains causing invasive and non-invasive disease. The virulence gene repertoire of invasive disease isolates was characterized using DNA microarray and compared with the virulence gene repertoire of non-invasive S. aureus isolates. Over the study period, 163 children had an invasive S. aureus infection. There was no difference in the distribution of clonal complexes or in the prevalence of genes encoding virulence factors between invasive and non-invasive isolates. Future research should include a strong focus on identifying the host and environmental factors that, along with organism virulence factors, are contributing to the patterns of invasive S. aureus disease observed in New Zealand.
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Williamson DA, Lim A, Thomas MG, Baker MG, Roberts SA, Fraser JD, Ritchie SR. Incidence, trends and demographics of Staphylococcus aureus infections in Auckland, New Zealand, 2001-2011. BMC Infect Dis 2013; 13:569. [PMID: 24299298 PMCID: PMC4219404 DOI: 10.1186/1471-2334-13-569] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 11/18/2013] [Indexed: 11/10/2022] Open
Abstract
Background New Zealand has a higher incidence of Staphylococcus aureus disease than other developed countries, with significant sociodemographic variation in incidence rates. In contrast to North America, the majority of disease is due to methicillin-susceptible S. aureus (MSSA), although relatively little is known about the comparative demographics of MSSA and methicillin-resistant S. aureus (MRSA) infections in New Zealand. Methods Our objectives were to describe the trends, incidence and patient demographics of all S. aureus infections in patients presenting to our institution between 2001 and 2011, and compare the epidemiology of MSSA and MRSA infections. We identified all patients with S. aureus infections over the study period. A unique S. aureus infection was defined as the first positive S. aureus culture taken from the same patient within a thirty-day period. Standard definitions were used to classify episodes into community- or healthcare-associated S. aureus infection. Results There were 16,249 S. aureus infections over the study period. The incidence increased significantly over the study period from 360 to 412 per 100,000 population (P < 0.001), largely driven by an increase in community-associated non-invasive MSSA infections. When compared with MSSA infections, patients with non-multiresistant MRSA infections were more likely to be older, have hospital-onset infections and be Māori or Pacific Peoples. Conclusions Our work provides valuable baseline data on the epidemiology and trends of S. aureus infections in New Zealand. The significant increase in community-associated S. aureus infections is of public health importance. Future studies should investigate the reasons underlying this concerning trend.
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Affiliation(s)
- Deborah A Williamson
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
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Gundlapalli AV, Carter ME, Palmer M, Ginter T, Redd A, Pickard S, Shen S, South B, Divita G, Duvall S, Nguyen TM, D'Avolio LW, Samore M. Using natural language processing on the free text of clinical documents to screen for evidence of homelessness among US veterans. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2013; 2013:537-546. [PMID: 24551356 PMCID: PMC3900197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Information retrieval algorithms based on natural language processing (NLP) of the free text of medical records have been used to find documents of interest from databases. Homelessness is a high priority non-medical diagnosis that is noted in electronic medical records of Veterans in Veterans Affairs (VA) facilities. Using a human-reviewed reference standard corpus of clinical documents of Veterans with evidence of homelessness and those without, an open-source NLP tool (Automated Retrieval Console v2.0, ARC) was trained to classify documents. The best performing model based on document level work-flow performed well on a test set (Precision 94%, Recall 97%, F-Measure 96). Processing of a naïve set of 10,000 randomly selected documents from the VA using this best performing model yielded 463 documents flagged as positive, indicating a 4.7% prevalence of homelessness. Human review noted a precision of 70% for these flags resulting in an adjusted prevalence of homelessness of 3.3% which matches current VA estimates. Further refinements are underway to improve the performance. We demonstrate an effective and rapid lifecycle of using an off-the-shelf NLP tool for screening targets of interest from medical records.
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Affiliation(s)
- Adi V Gundlapalli
- VA Salt Lake City Health Care System, Salt Lake City, UT ; University of Utah School of Medicine, Salt Lake City, UT
| | - Marjorie E Carter
- VA Salt Lake City Health Care System, Salt Lake City, UT ; University of Utah School of Medicine, Salt Lake City, UT
| | - Miland Palmer
- VA Salt Lake City Health Care System, Salt Lake City, UT ; University of Utah School of Medicine, Salt Lake City, UT
| | - Thomas Ginter
- VA Salt Lake City Health Care System, Salt Lake City, UT ; University of Utah School of Medicine, Salt Lake City, UT
| | - Andrew Redd
- VA Salt Lake City Health Care System, Salt Lake City, UT ; University of Utah School of Medicine, Salt Lake City, UT
| | - Steven Pickard
- VA Salt Lake City Health Care System, Salt Lake City, UT ; University of Utah School of Medicine, Salt Lake City, UT
| | - Shuying Shen
- VA Salt Lake City Health Care System, Salt Lake City, UT ; University of Utah School of Medicine, Salt Lake City, UT
| | - Brett South
- VA Salt Lake City Health Care System, Salt Lake City, UT ; University of Utah School of Medicine, Salt Lake City, UT
| | - Guy Divita
- VA Salt Lake City Health Care System, Salt Lake City, UT ; University of Utah School of Medicine, Salt Lake City, UT
| | - Scott Duvall
- VA Salt Lake City Health Care System, Salt Lake City, UT ; University of Utah School of Medicine, Salt Lake City, UT
| | | | | | - Matthew Samore
- VA Salt Lake City Health Care System, Salt Lake City, UT ; University of Utah School of Medicine, Salt Lake City, UT
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Levine PJ, Elman MR, Kullar R, Townes JM, Bearden DT, Vilches-Tran R, McClellan I, McGregor JC. Use of electronic health record data to identify skin and soft tissue infections in primary care settings: a validation study. BMC Infect Dis 2013; 13:171. [PMID: 23574801 PMCID: PMC3637223 DOI: 10.1186/1471-2334-13-171] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 04/04/2013] [Indexed: 11/14/2022] Open
Abstract
Background Epidemiologic studies of skin and soft tissue infections (SSTIs) depend upon accurate case identification. Our objective was to evaluate the positive predictive value (PPV) of electronic medical record data for identification of SSTIs in a primary care setting. Methods A validation study was conducted among primary care outpatients in an academic healthcare system. Encounters during four non-consecutive months in 2010 were included if any of the following were present in the electronic health record: International Classification of Diseases, Ninth Revision (ICD-9) code for an SSTI, Current Procedural Terminology (CPT) code for incision and drainage, or a positive wound culture. Detailed chart review was performed to establish presence and type of SSTI. PPVs and 95% confidence intervals (CI) were calculated among all encounters, initial encounters, and cellulitis/abscess cases. Results Of the 731 encounters included, 514 (70.3%) were initial encounters and 448 (61.3%) were cellulitis/abscess cases. When the presence of an ICD-9 code, CPT code, or positive culture was used to identify SSTIs, 617 encounters were true positives, yielding a PPV of 84.4% [95% CI: 81.8–87.0%]. The PPV for using ICD-9 codes alone to identify SSTIs was 90.7% [95 % CI: 88.5–92.9%]. For encounters with cellulitis/abscess codes, the PPV was 91.5% [95% CI: 88.9–94.1%]. Conclusions ICD-9 codes may be used to retrospectively identify SSTIs with a high PPV. Broadening SSTI case identification with microbiology data and CPT codes attenuates the PPV. Further work is needed to estimate the sensitivity of this method.
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Affiliation(s)
- Pamela J Levine
- Department of Pharmacy Practice, College of Pharmacy, Oregon State University/Oregon Health & Science University, 3303 SW Bond Avenue CH12C, Portland, OR 97239, USA
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Stenehjem E, Stafford C, Rimland D. Reduction of methicillin-resistant Staphylococcus aureus infection among veterans in Atlanta. Infect Control Hosp Epidemiol 2012; 34:62-8. [PMID: 23221194 DOI: 10.1086/668776] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Describe local changes in the incidence of community-onset and hospital-onset methicillin-resistant Staphylococcus aureus (MRSA) infection and evaluate the impact of MRSA active surveillance on hospital-onset infection. DESIGN Observational study using prospectively collected data. SETTING Atlanta Veterans Affairs Medical Center (AVAMC). PATIENTS All patients seen at the AVAMC over an 8-year period with clinically and microbiologically proven MRSA infection. METHODS All clinical cultures positive for MRSA were prospectively identified, and corresponding clinical data were reviewed. MRSA infections were classified into standard clinical and epidemiologic categories. The Veterans Health Administration implemented the MRSA directive in October 2007, which required active surveillance cultures in acute care settings. RESULTS The incidence of community-onset MRSA infection peaked in 2007 at 5.45 MRSA infections per 1,000 veterans and decreased to 3.14 infections per 1,000 veterans in 2011 ([Formula: see text] for trend). Clinical and epidemiologic categories of MRSA infections did not change throughout the study period. The prevalence of nasal MRSA colonization among veterans admitted to AVAMC decreased from 15.8% in 2007 to 11.2% in 2011 ([Formula: see text] for trend). The rate of intensive care unit (ICU)-related hospital-onset MRSA infection decreased from October 2005 through March 2007, before the MRSA directive. Rates of ICU-related hospital-onset MRSA infection remained stable after the implementation of active surveillance cultures. No change was observed in rates of non-ICU-related hospital-onset MRSA infection. CONCLUSIONS Our study of the AVAMC population over an 8-year period shows a consistent trend of reduction in the incidence of MRSA infection in both the community and healthcare settings. The etiology of this reduction is most likely multifactorial.
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Top KA, Buet A, Whittier S, Ratner AJ, Saiman L. Predictors of Staphylococcus aureus Rectovaginal Colonization in Pregnant Women and Risk for Maternal and Neonatal Infections. J Pediatric Infect Dis Soc 2012; 1:7-15. [PMID: 23687569 PMCID: PMC3656550 DOI: 10.1093/jpids/pis001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Accepted: 12/20/2011] [Indexed: 11/13/2022]
Abstract
BACKGROUND Staphylococcus aureus infections are increasing among pregnant and postpartum women and neonates, but risk factors for S. aureus colonization in pregnancy and the association between maternal colonization and infant infections are not well defined. We sought to identify risk factors for maternal S. aureus rectovaginal colonization and assess colonization as a risk factor for infections among mothers and infants. METHODS We conducted a retrospective cohort study of pregnant women and their infants. Demographic and clinical data, including S. aureus infections that occurred in mothers from 3 months before to 3 months after delivery and in infants during the first 3 months of life, were extracted from electronic medical records. Predictors for maternal S. aureus rectovaginal colonization were assessed through multivariable logistic regression analysis. RESULTS The cohort included 2702 women and 2789 infants. The prevalence of maternal rectovaginal colonization with methicillin-susceptible S. aureus and methicillin-resistant S. aureus (MRSA) was 13% and 0.7%. Independent predictors of colonization included multigravidity, human immunodeficiency virus seropositivity, and group B Streptococcus colonization. S. aureus colonization was associated with an increased risk of infection in mothers (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.4-8.8) but not in their infants (OR, 1.9; 95% CI, .6-5.6). The frequency of S. aureus infections was 0.8% in mothers and 0.7% in infants. CONCLUSIONS S. aureus rectovaginal colonization was associated with an increased risk of infections in women but not in their infants. The frequency of MRSA infections was low. These data suggest that routine MRSA screening of pregnant women may not be indicated.
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Affiliation(s)
- Karina A. Top
- Departments of Pediatrics, and,Present affiliation: Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | | | - Lisa Saiman
- Departments of Pediatrics, and Department of Infection Control & Prevention, NewYork-Presbyterian Hospital, New York
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Tracy LA, Furuno JP, Harris AD, Singer M, Langenberg P, Roghmann MC. Staphylococcus aureus infections in US veterans, Maryland, USA, 1999-2008. Emerg Infect Dis 2011; 17:441-8. [PMID: 21392435 PMCID: PMC3165993 DOI: 10.3201/eid1703.100502] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Trends in Staphylococcus aureus infections are not well described. To calculate incidence in overall S. aureus infection and invasive and noninvasive infections according to methicillin susceptibility and location, we conducted a 10-year population-based retrospective cohort study (1999-2008) using patient-level data in the Veterans Affairs Maryland Health Care System. We found 3,674 S. aureus infections: 2,816 (77%) were noninvasive; 2,256 (61%) were methicillin-resistant S. aureus (MRSA); 2,517 (69%) were community onset, and 1,157 (31%) were hospital onset. Sixty-one percent of noninvasive infections were skin and soft tissue infections; 1,112 (65%) of these were MRSA. Ten-year averaged incidence per 100,000 veterans was 749 (± 132 SD, range 549-954) overall, 178 (± 41 SD, range 114-259) invasive, and 571 (± 152 SD, range 364-801) noninvasive S. aureus infections. Incidence of all S. aureus infections significantly increased (p<0.001), driven by noninvasive, MRSA, and community-onset infections (p<0.001); incidence of invasive S. aureus infection significantly decreased (p<0.001).
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Affiliation(s)
- LaRee A Tracy
- University of Maryland, Department of Epidemiology and Public Health, 685 W Baltimore St, MSTF 336, Baltimore, MD 21201, USA.
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Tracy LA, Furuno JP, Harris AD, Singer M, Langenberg P, Roghmann MC. Staphylococcus aureusInfections in US Veterans, Maryland, USA, 1999–20081. Emerg Infect Dis 2011; 17:1296-8. [DOI: 10.3201/eid1707.100502] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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