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Padgett CH, King GS, Hughes RE, Hull MN, Colon EA. Evaluation of Empiric Coverage of Previously Cultured Multidrug Resistant Organisms in Critically Ill Patients Admitted for Sepsis. J Pharm Pract 2024:8971900241262359. [PMID: 38875258 DOI: 10.1177/08971900241262359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2024]
Abstract
Purpose: Multidrug-resistant organisms (MDROs) are associated with an increased length of stay and a higher risk of mortality in hospitalized patients. A lack of literature exists that evaluates the need to empirically cover patients for historic MDROs upon readmission. Methods: A retrospective, single-center, cohort study was conducted to evaluate the impact of empiric MDRO antibiotic coverage in patients with a history of MDROs. Differences in length of stay were assessed between two groups of patients: those empirically treated for their historic MDRO and those not. Secondary outcomes included in-hospital mortality, ICU length of stay, need for antibiotic escalation, need for antibiotic de-escalation, and antibiotic duration. Results: Seventy-two patients with historic MDRO(s) were readmitted to the hospital and met inclusion criteria for this study. Hospital length of stay was similar between those empirically covered and those not (11 days vs 15.1 days; P = 0.149). When analyzed in a population only including Gram-negative MDROs, hospital length of stay was shorter in those who received empiric coverage (10.7 days vs 17.2 days; P = 0.032). Conclusion: In the total study population, empiric coverage of historic MDROs failed to significantly reduce hospital length of stay. When analyzed in a population of only Gram-negative MDROs, empiric coverage of historic organisms reduced hospital length of stay by 6.5 days. This suggests that in patients readmitted to the ICU for sepsis, empiric coverage of historic Gram-negative MDROs may be beneficial.
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Affiliation(s)
| | - G Shawn King
- Department of Pharmacy, Saint Joseph Hospital, Lexington, KY, USA
| | - R Ethan Hughes
- Department of Pharmacy, Saint Joseph Hospital, Lexington, KY, USA
| | - Megan N Hull
- Department of Pharmacy, Saint Joseph Hospital, Lexington, KY, USA
| | - Eliseo A Colon
- Department of Critical Care/Pulmonology, Saint Joseph Hospital, Lexington, KY, USA
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Viseskul N, Kasatpibal N, Kaewsakol C, Kunkhet A, Viriyachetkun S, Turale S. Nurses' satisfaction with an educational web application to prevent transmission of multidrug-resistant organisms. Nurs Health Sci 2024; 26:e13126. [PMID: 38754867 DOI: 10.1111/nhs.13126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 04/07/2024] [Accepted: 04/21/2024] [Indexed: 05/18/2024]
Abstract
Multidrug-resistant organism infections are a serious health problem globally, and can result in patient mortality and morbidity. In this descriptive study, we produced the first web application for transmission prevention specific to the situation based on nursing experience, knowledge, and practice guidelines and to evaluate web application satisfaction among Thai nurses. The sample comprised 282 Thai registered nurses experienced in caring for patients with multidrug-resistant organisms in a tertiary hospital. A demographic form and knowledge test were completed anonymously online. Data were analyzed using descriptive statistics. The application emphasized crucial topics for which participants had low preliminary knowledge and included tutorial sessions, pictures, video clips, drills, and a post-test. The application was piloted with a random sample of 30 nurses, and an instrument tested their satisfaction with this. Results revealed that preliminary knowledge scores for preventing transmission were moderate, and participants were highly satisfied with the application. Findings suggest the application is suitable for Thai nurses and could be applied to nursing practice elsewhere. However, further testing is recommended before implementing it into nursing practice.
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Affiliation(s)
- Nongkran Viseskul
- Division of Nursing Science, Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
| | - Nongyao Kasatpibal
- Division of Nursing Science, Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
| | | | - Arus Kunkhet
- College of Arts, Media and Technology, Chiang Mai University, Chiang Mai, Thailand
| | | | - Sue Turale
- Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
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Chang PW, Bui A, Zhou S, Sahakian AB, Buxbaum JL, Phan J. Increasing Antibiotic-Resistant Infections With Inpatient Endoscopic Retrograde Cholangioscopies (ERCP) Is Associated With Higher Mortality in the United States: A Cross-sectional Cohort Study. J Clin Gastroenterol 2024; 58:487-493. [PMID: 37339277 DOI: 10.1097/mcg.0000000000001874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/11/2023] [Indexed: 06/22/2023]
Abstract
GOALS This study aims to investigate associated mortality with inpatient endoscopic retrograde cholangiopancreatography (ERCP) with and without resistant infections. The co-primary objective compares frequencies of inpatient ERCP with resistant infections to overall hospitalizations with resistant infections. BACKGROUND The risks of inpatient antibiotic-resistant organisms are known, but the associated mortality for inpatient ERCP is unknown. We aim to use a national database of hospitalizations and procedures to understand trends and mortality for patients with antibiotic-resistant infections during inpatient ERCP. STUDY The largest publicly available all-payer inpatient database in the United States (National Inpatient Sample) was used to identify hospitalizations associated with ERCPs and antibiotic-resistant infections for MRSA, VRE, ESBL, and MDRO. National estimates were generated, frequencies were compared across years, and multivariate regression for mortality was performed. RESULTS From 2017 to 2020, national weighted estimates of 835,540 inpatient ERCPs were generated, and 11,440 ERCPs had coincident resistant infections. Overall resistant infection, MRSA, VRE, and MDRO identified at the same hospitalization of inpatient ERCPs were associated with higher mortality (OR CI(95%): Overall: 2.2(1.77-2.88), MRSA: 1.90 (1.34-2.69), VRE: 3.53 (2.16-5.76), and MDRO: 2.52 (1.39-4.55)). While overall hospitalizations with resistant infections have been decreasing annually, there has been a yearly increase in admissions requiring ERCPs with simultaneous resistant infections ( P =0.001-0.013), as well as infections with VRE, ESBL, and MDRO ( P =0.001-0.016). Required Research Practices for Studies Using the NIS scoring was 0, or the most optimal. CONCLUSIONS Inpatient ERCPs have increasing coincident resistant infections and are associated with higher mortality. These rising infections during ERCP highlight the importance of endoscopy suite protocols and endoscopic infection control devices.
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Affiliation(s)
- Patrick W Chang
- Department of Internal Medicine, Division of Gastroenterology, University of Southern CA
| | - Aileen Bui
- Department of Internal Medicine, Division of Gastroenterology, University of Southern CA
| | - Selena Zhou
- Keck School of Medicine and Vatche and Tamar Manoukian Division of Digestive Diseases, University of California, Los Angeles, CA
| | - Ara B Sahakian
- Department of Internal Medicine, Division of Gastroenterology, University of Southern CA
| | - James L Buxbaum
- Department of Internal Medicine, Division of Gastroenterology, University of Southern CA
| | - Jennifer Phan
- Department of Internal Medicine, Division of Gastroenterology, University of Southern CA
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Chen S, Qian Y, Wan D, Li Y, Zhou C. Synthesis and Synergistic Antimicrobial Efficacy of Covalent Conjugates Composed of Epsilon-Poly-l-lysine and Beta-Lactam Antibiotics. ACS APPLIED BIO MATERIALS 2024; 7:1990-1999. [PMID: 38363728 DOI: 10.1021/acsabm.4c00093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
The increasing severity of problems posed by drug-resistant pathogens has compelled researchers to explore innovative approaches for infection prevention. Among these strategies, conjugation methods stand out for their convenience and high efficacy. In this study, multiple covalent conjugates were synthesized, incorporating the natural antimicrobial peptide epsilon-poly-l-lysine (EPL) and two commonly used β-lactam antibiotics: penicillin G or ampicillin. Enhanced antimicrobial efficacy against typical Gram-negative pathogens, along with faster kill kinetics compared to combination approaches, was demonstrated by the EPL-Ampicillin covalent conjugates. Their antimicrobial mechanism was also substantiated through SEM and fluorescence tests in this work, confirming the inheritance of membrane-disrupting properties from EPL. Furthermore, the excellent biocompatibility of the raw materials was reserved in the covalent conjugates. This simplified conjugation method holds promise for the development of infection therapeutic drugs and potentially restores the sensitivity of conventional antibiotics to drug-resistant pathogens by introducing membrane-disrupting mechanisms.
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Affiliation(s)
- Sijin Chen
- School of Material Science and Engineering, Tongji University, 4800 Caoan Road, Shanghai 201804, China
| | - Yusheng Qian
- School of Material Science and Engineering, Tongji University, 4800 Caoan Road, Shanghai 201804, China
| | - Decheng Wan
- School of Material Science and Engineering, Tongji University, 4800 Caoan Road, Shanghai 201804, China
| | - Yan Li
- School of Material Science and Engineering, Tongji University, 4800 Caoan Road, Shanghai 201804, China
| | - Chuncai Zhou
- School of Material Science and Engineering, Tongji University, 4800 Caoan Road, Shanghai 201804, China
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Gordon J, Gheorghe M, Harrison C, Miller R, Dennis J, Steuten L, Goldenberg S, Gandra S, Al-Taie A. Estimating the Treatment and Prophylactic Economic Value of New Antimicrobials in Managing Antibiotic Resistance and Serious Infections for Common Pathogens in the USA: A Population Modelling Study. PHARMACOECONOMICS 2024; 42:329-341. [PMID: 38001394 PMCID: PMC10861689 DOI: 10.1007/s40273-023-01337-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/05/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Antimicrobial resistance is a growing public health concern. There is a global need to estimate the population-level value of developing new antimicrobials and to ensure the effective use of existing antimicrobials as strategies to counteract antimicrobial resistance. To this aim, population-level value criteria need to be considered alongside conventional value measures. OBJECTIVE The objective of this study was to develop a novel modelling approach to estimate the value of new antimicrobials, considering the transmission, diversity and enablement elements of STEDI value. METHODS We developed a population-based mathematical model for the assessment of antimicrobial value considering both prophylactic use of antimicrobials and the treatment of selected serious hospital-acquired infections in hospitals in the USA at a population level. Large-scale clinical and population healthcare data were used to inform a modelling-based analysis assessing the impact of introducing a new antimicrobial compared with continuing with no new antimicrobial, accounting for the transmission, diversity and enablement value of antimicrobial agents. RESULTS Over a 10-year period, the addition of a new antimicrobial as part of an antimicrobial stewardship strategy in the USA was estimated to result in a proportional reduction of 9.03% in projected antimicrobial resistance levels. This yielded an estimated reduction of $64.3 million in hospitalization costs and a gain of over 153,000 quality-adjusted life-years at an economic value of over $15.4 billion over 10 years. Considering input uncertainty, the estimate of monetary benefit ranged from $11.1 to $21.4 billion. CONCLUSIONS The use of a new antimicrobial for treatment and prophylactic indications yields considerable clinical and economic benefits including transmission diversity and enablement value. These findings may provide decision makers with important evidence to support investment in new antimicrobials and antimicrobial stewardship policy that address the patient, population and system burden associated with antimicrobial resistance.
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Affiliation(s)
- Jason Gordon
- Health Economics and Outcomes Research Ltd, Cardiff, UK
| | | | - Cale Harrison
- Health Economics and Outcomes Research Ltd, Cardiff, UK
| | - Ryan Miller
- Health Economics and Outcomes Research Ltd, Cardiff, UK
| | - James Dennis
- Health Economics and Outcomes Research Ltd, Cardiff, UK
| | | | - Simon Goldenberg
- Centre for Clinical Infection & Diagnostics Research, King's College London and Guy's & St. Thomas' NHS, London, UK
| | - Sumanth Gandra
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - Amer Al-Taie
- Pfizer R&D UK Ltd, Dorking Road, Tadworth, KT20 7NT, UK.
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Vaziri C, Darkoh C. Environmental contamination contributing to the spread of vancomycin-resistant enterococci in nursing homes. THE LANCET. HEALTHY LONGEVITY 2023; 4:e587-e588. [PMID: 37924838 DOI: 10.1016/s2666-7568(23)00197-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 11/06/2023] Open
Affiliation(s)
- Catherine Vaziri
- School of Public Health, University of Texas Health Science Center, Houston, TX, USA
| | - Charles Darkoh
- School of Public Health, University of Texas Health Science Center, Houston, TX, USA; MD Anderson Cancer Center UT Health Graduate School of Biomedical Sciences, Microbiology, and Infectious Diseases Program, Houston, TX, USA.
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Arenas S, Patel S, Seely SO, Pagan PP, Warde PR, Tamrakar LJ, Parekh DJ, Ferreira T, Zhou Y, Gershengorn HB, Shukla BS. Operational impact of decreased turnaround times for Candida auris screening tests in a tertiary academic medical center. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e176. [PMID: 38028904 PMCID: PMC10644160 DOI: 10.1017/ash.2023.445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/08/2023] [Accepted: 09/09/2023] [Indexed: 12/01/2023]
Abstract
Objective Assess turnaround time (TAT) and cost-benefit of on-site C. auris screening and its impact on length of stay (LOS) and costs compared to reference laboratories. Design Before-and-after retrospective cohort study. Setting Large-tertiary medical center. Methods We validated an on-site polymerase chain reaction-based testing platform for C. auris and retrospectively reviewed hospitalized adults who screened negative before and after platform implementation. We constructed multivariable models to assess the association of screening negative with hospital LOS/cost in the pre and postimplementation periods. We adjusted for confounders such as demographics and indwelling device use, and compared TATs for all samples tested. Results The sensitivity and specificity of the testing platform were 100% and 98.11%, respectively, compared to send-out testing. The clinical cohort included 287 adults in the pre and 1,266 postimplementation period. The TAT was reduced by more than 2 days (3 (interquartile range (IQR): 2.0, 7.0) vs 0.42 (IQR: 0.24, 0.81), p < 0.001). Median LOS was significantly lower in the postimplementation period; however, this was no longer evident after adjustment. In relation to total cost, the time period had an effect of $6,965 (95% CI: -$481, $14,412); p = 0.067) on reducing the cost. The median adjusted total cost per patient was $7,045 (IQR: $3,805, $13,924) less in the post vs the preimplementation period. Conclusions Our assessment did not find a statistically significant change in LOS, nevertheless, on-site testing was not cost-prohibitive for the institution. The value of on-site testing may be supported if an institutional C. auris reduction strategy emphasizes faster TATs.
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Affiliation(s)
| | - Samira Patel
- University of Miami Health System, Miami, FL, USA
| | - Spencer O. Seely
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | - Labu J. Tamrakar
- Division of Infectious Diseases, Department of Internal Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dipen J. Parekh
- University of Miami Health System, Miami, FL, USA
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tanira Ferreira
- University of Miami Health System, Miami, FL, USA
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Yi Zhou
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hayley B. Gershengorn
- University of Miami Health System, Miami, FL, USA
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Medicine, Division of Critical Care, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Bhavarth S. Shukla
- University of Miami Health System, Miami, FL, USA
- Division of Infectious Diseases, Department of Internal Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
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Wang Y, Zhang J, Chen X, Sun M, Li Y, Wang Y, Gu Y, Cai Y. Development and Validation of a Nomogram Prediction Model for Multidrug-Resistant Organisms Infection in a Neurosurgical Intensive Care Unit. Infect Drug Resist 2023; 16:6603-6615. [PMID: 37840828 PMCID: PMC10573443 DOI: 10.2147/idr.s411976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/21/2023] [Indexed: 10/17/2023] Open
Abstract
Objective To develop a predictive model for assessing the risk of multidrug-resistant organisms (MDROs) infection and validate its effectiveness. We conducted a study on a total of 2516 patients admitted to the neurosurgery intensive care unit (NICU) of a Grade-III hospital in Nantong City, Jiangsu Province, China, between January 2014 and February 2022. Patients meeting the inclusion criteria were selected using convenience sampling. The patients were randomly divided into modeling and validation groups in a 7:3 ratio. To address the category imbalance, we employed the Synthetic Minority Over-sampling Technique (SMOTE) to adjust the MDROs infection ratio from 203:1558 to 812:609 in the training set. Univariate analysis and logistic regression analysis were performed to identify risk factors associated with MDROs infection in the NICU. A risk prediction model was developed, and a nomogram was created. Receiver operating characteristic (ROC) analysis was used to assess the predictive performance of the model. Patients and Methods Results Logistic regression analysis revealed that sex, hospitalization time, febrile time, invasive operations, postoperative prophylactic use of antibiotics, mechanical ventilator time, central venous catheter indwelling time, urethral catheter indwelling time, ALB, PLT, WBC, and L% were independent predictors of MDROs infection in the NICU. The area under the ROC curve for the training set and validation set were 0.880 (95% CI: 0.857-0.904) and 0.831 (95% CI: 0.786-0.876), respectively. The model's prediction curve closely matched the ideal curve, indicating excellent predictive performance. Conclusion The prediction model developed in this study demonstrates good accuracy in assessing the risk of MDROs infection. It serves as a valuable tool for neurosurgical intensive care practitioners, providing an objective means to effectively evaluate and target the risk of MDROs infection.
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Affiliation(s)
- Ya Wang
- Neurosurgical Intensive Care Unit, Department of Neurosurgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People’s Republic of China
| | - Jiajia Zhang
- Neurosurgery Section Two, Department of Neurosurgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People’s Republic of China
| | - Xiaoyan Chen
- Neurosurgical Intensive Care Unit, Department of Neurosurgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People’s Republic of China
| | - Min Sun
- Department of Geriatrics Section Three, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People’s Republic of China
| | - Yanqing Li
- Department of Neurosurgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People’s Republic of China
| | - Yanan Wang
- Respiratory and Critical Care Medicine Intensive Care Unit, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People’s Republic of China
| | - Yan Gu
- Infection Management Office, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People’s Republic of China
| | - Yinyin Cai
- Neurosurgical Intensive Care Unit, Department of Neurosurgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People’s Republic of China
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Sun Y, Wu Q, Liu J, Wang Q. Effectiveness of ultraviolet-C disinfection systems for reduction of multi-drug resistant organism infections in healthcare settings: A systematic review and meta-analysis. Epidemiol Infect 2023; 151:e149. [PMID: 37644902 PMCID: PMC10540170 DOI: 10.1017/s0950268823001371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/17/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023] Open
Abstract
This study aimed to summarise the findings of the studies assessing the effectiveness of ultraviolet C (UV-C) room disinfection in reducing the incidence rate of healthcare-associated multi-drug-resistant organism (MDRO) infections. A systematic screening was conducted using PubMed, EMBASE, and Scopus for randomised controlled trials (RCTs), quasi-experimental studies, and before-after studies, which assessed the efficacy of the UV-C disinfectant system in reducing the incidence of MDRO infections. A random-effects model was used for the analysis. Effect sizes were described as incidence rate ratio (IRR) with 95% confidence intervals (CI). Nine studies were included, all of which were conducted in the USA. No statistically significant reduction in Clostridioides difficile (CD) (IRR: 0.90, 95% CI; 0.62-1.32) and vancomycin-resistant enterococcal (VRE) infection rates (IRR 0.72, 95% CI; 0.38-1.37) was observed with the use of UV-C, but the risk of Gram-negative rod infection was reduced (IRR 0.82, 95% CI; 0.68-0.99).
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Affiliation(s)
- YanLin Sun
- Day Surgery Center, The Affiliated Qingdao Central Hospital of Qingdao University, Qingdao, China
| | - Qi Wu
- Department of Infection Management, The Affiliated Qingdao Central Hospital of Qingdao University, Qingdao, China
| | - Jinzhi Liu
- Department of Gastroenterology, The Affiliated Qingdao Central Hospital of Qingdao University, Qingdao, China
| | - Qian Wang
- Department of Infection Management, The Affiliated Qingdao Central Hospital of Qingdao University, Qingdao, China
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Li S, Lin J, Tao S, Guo L, Huang W, Li J, Du C, Wang Z, Liu L, Chen Y, Qiao F. Multi-Model Strategies for Prevention of Infection Caused by Certain Multi-Drug Resistant Organisms in A Rehabilitation Unit: A Semi-Experimental Study. Antibiotics (Basel) 2023; 12:1199. [PMID: 37508295 PMCID: PMC10376457 DOI: 10.3390/antibiotics12071199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/12/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
Objective: To assess the effectiveness of multi-model strategies on healthcare-associated infections (HAIs) caused by multi-drug resistant organisms (MDROs) in rehabilitation units. Methods: A semi-experimental study was conducted in a rehabilitation unit with 181 beds from January 2021 to December 2022 in a teaching hospital with 4300 beds in China. In 2021, many basic prevention and control measures were conducted routinely. Based on the basic measures, strengthening multi-model strategies for the prevention and control of MDROs was pursued year-round since 1 January 2022. Results: A total of 6206 patients were enrolled during the study period. The incidence density of HAIs caused by MDROs decreased from 1.22 (95% CI, 0.96~1.54) cases/1000 patient-days in the pre-intervention period to 0.70 (95% CI, 0.50~0.95) cases/1000 patient-days (p = 0.004). Similarly, the incidence of HAIs in the intervention period was 50.85% lower than that in the pre-intervention period (2.02 (95% CI, 1.50~2.72) vs. 4.11 (95% CI, 3.45-4.85) cases/100 patients, p < 0.001). The rate of MDROs isolated from the environment decreased by 30.00%, although the difference was not statistically significant (p = 0.259). Conclusion: Multi-model strategies can reduce the incidence of HAIs and HAIs caused by certain MDROs in the rehabilitation unit.
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Affiliation(s)
- Shiyu Li
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
- Department of Infection Control, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Ji Lin
- Department of Infection Control, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Siyuan Tao
- Department of Infection Control, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Linwen Guo
- Department of Infection Control, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Wenzhi Huang
- Department of Infection Control, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jingwen Li
- Department of Infection Control, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Chunping Du
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Zhiting Wang
- Department of Operation Management, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Liwen Liu
- Department of Equipment and Materials, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yi Chen
- Department of Infection Control, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Fu Qiao
- Department of Infection Control, West China Hospital, Sichuan University, Chengdu 610041, China
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11
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Kwok CS, Bains NK, Ford DE, Gomez CR, Hanley DF, Hassan AE, Nguyen TN, Siddiq F, Spiotta AM, Zaidi SF, Qureshi AI. Intra-arterial thrombolysis as adjunct to mechanical thrombectomy in acute ischemic stroke patients in the United States: A case control analysis. J Stroke Cerebrovasc Dis 2023; 32:107093. [PMID: 37149924 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/20/2023] [Accepted: 03/22/2023] [Indexed: 05/09/2023] Open
Abstract
BACKGROUND Although observational studies have reported favorable clinical outcomes associated with intra-arterial thrombolysis as adjunct to mechanical thrombectomy, the cost and length of hospitalization associated with this intervention has not been studied. METHODS We analyzed the nationally representative data of the United States data from Nationwide Inpatient Sample (NIS) to compare hospitalization cost and duration in addition to other outcomes in patients receiving (n = 1990) with those not receiving intra-arterial thrombolysis (n = 1990) in acute ischemic stroke patients undergoing mechanical thrombectomy using a case control design matched for age, gender, and presence of aphasia, hemiplegia, neglect, coma/stupor, hemianopsia and dysphagia. RESULTS There was no difference in the median hospitalization cost in patients treated with intra-arterial thrombolysis compared with those not treated with intra-arterial thrombolysis: $36,992 [28,361 to 54,336] versus $35,440 [24,383 to 50,438], (regression coefficient 2,485 [-1,947 to 6,917], p = 0.27). There was no difference in the median length of hospitalization in patients treated with intra-arterial thrombolysis compared with those not treated with intra-arterial thrombolysis: 6 days [3 to 10] versus 6 days [4 to 10], (regression coefficient -0.34 [-1.47 to 0.80], p = 0.56). There was no difference in odds of home-discharge (OR 1.02 95%CI 0.72-1.43, p = 0.93) or post-procedural intracranial hemorrhage (OR 1.16 95%CI 0.83-1.64, p = 0.39) between the two groups. CONCLUSIONS We did not observe an increase in the cost or length of hospitalization associated with the use of intra-arterial thrombolysis as adjunct to mechanical thrombectomy in acute ischemic stroke patients. If the ongoing randomized clinical trials demonstrate therapeutic efficacy in reducing death or disability, this intervention has a high likelihood of being beneficial overall.
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Affiliation(s)
- Chun Shing Kwok
- Department of Post Qualifying Healthcare Practice, Birmingham City University, Birmingham, United Kingdom; Department of Cardiology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom.
| | - Navpreet K Bains
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO, USA
| | - Daniel E Ford
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Camilo R Gomez
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO, USA
| | - Daniel F Hanley
- Departments of Neurology and Neurosurgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Ameer E Hassan
- Department of Neurology, UTRGV - Valley Baptist Neuroscience Institute, Harlingen, TX, USA
| | - Thanh N Nguyen
- Division of Interventional Neurology/Neuroradiology, Boston Medical Center, Boston, MA, USA
| | - Farhan Siddiq
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO, USA
| | - Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
| | - Syed F Zaidi
- Department of Neurology, The University of Toledo, Toledo, OH, USA
| | - Adnan I Qureshi
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO, USA
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12
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Johnson C, Nordby A, Brage Hudson D, Struwe L, Ruppert R. Quality improvement: Antimicrobial stewardship in pediatric primary care. J Pediatr Nurs 2023; 70:54-60. [PMID: 36801625 DOI: 10.1016/j.pedn.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 02/20/2023]
Abstract
BACKGROUND Antimicrobial resistance is the resistance of microorganisms to antibacterial, antiviral, antiparasitic, and antifungal medication resulting in increased healthcare costs with extended hospital stays in the United States. The goals of this quality improvement project were to increase the understanding and importance of antimicrobial stewardship by nurses and health care staff and increase pediatric parents'/guardians' knowledge of the proper use of antibiotics and differences between viruses and bacterial infections. METHODS A retrospective pre-post study was conducted in a midwestern clinic to determine if an antimicrobial stewardship teaching leaflet increased parent/guardian antimicrobial stewardship knowledge. The two interventions for patient education were a modified United States Center for Disease Control antimicrobial stewardship teaching leaflet and a poster regarding antimicrobial stewardship. RESULTS Seventy-six parents/guardians participated in the pre-intervention survey, with 56 being included in the post-intervention survey. There was a significant increase in knowledge between the pre-intervention survey and the post-intervention survey with a large effect size, p < .001, d = 0.86. This effect was also seen when comparing parents/guardians with no college education, who had a mean knowledge increased change score of 0.62, to those parents/guardians with a college education, whose mean knowledge increase was 0.23, p < .001 with a large effect size of 0.81. Health care staff thought the antimicrobial stewardship teaching leaflets and posters were beneficial. PRACTICE IMPLICATIONS The use of an antimicrobial stewardship teaching leaflet and a patient education poster may be effective interventions for improving healthcare staff's and pediatric parents'/guardians' knowledge of antimicrobial stewardship.
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Affiliation(s)
- Christine Johnson
- College of Nursing, University of Nebraska Medical Center, United States of America
| | - Alyssa Nordby
- College of Nursing, University of Nebraska Medical Center, United States of America
| | - Diane Brage Hudson
- College of Nursing, University of Nebraska Medical Center, United States of America.
| | - Leeza Struwe
- College of Nursing, University of Nebraska Medical Center, United States of America
| | - Ronelle Ruppert
- College of Nursing, University of Nebraska Medical Center, United States of America
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Morowvat MH, Kazemi K, Jaberi MA, Amini A, Gholami A. Biosynthesis and Antimicrobial Evaluation of Zinc Oxide Nanoparticles Using Chlorella vulgaris Biomass against Multidrug-Resistant Pathogens. MATERIALS (BASEL, SWITZERLAND) 2023; 16:842. [PMID: 36676578 PMCID: PMC9863921 DOI: 10.3390/ma16020842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 06/17/2023]
Abstract
The rampant increase in antibiotic resistance has created a global barrier to the treatment of multidrug-resistant infections. Biogenic synthesis of nanomaterials is a novel approach to producing nanostructures with biological resources. Algae are known to be clean, nontoxic, cost-beneficial, and environmentally acceptable. Chlorella vulgaris is a popular microalga for its broad applications in food, supplements, pharmaceuticals, and cosmetics. In this study, we used Chlorella vulgaris biomass lyophilized powder as our green resource for the biosynthesis ZnONPs. Chlorella vulgaris culture was harvested at the end of the logarithmic phase, and the biomass was lyophilized. ZnONPs were synthesized using lyophilized biomass and 20 mM zinc acetate dihydrate at a temperature of 70 °C and continuous stirring in a water bath overnight. At the end of the reaction, UV-Vis absorption of colloidal suspension proved the synthesis of ZnONPs. The physicochemical characteristics of nanoparticles were analyzed using FTIR, DLS, TEM, and XRD. Based on FTIR spectra. The antibacterial activity of green synthesized nanostructures was evaluated against methicillin-resistant staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). The synthesized ZnONPs have oxygen-containing groups on the surface that show the synthesized nanoparticles' stabilization. The Zeta potential was -27.4 mV, and the mean particle size was measured as 33.4 nanometers. Biogenic ZnONPs produced in this method have a notable size distribution and excellent surface energy, which can have vast applications like antimicrobial potential in pharmaceuticals as topical forms. Additionally, in order to evaluate the antimicrobial activity of ZnO nanoparticles, we used MRSA and VRE strains and the results showed the anti-MRSA activity at 400 and 625 μg mL-1, respectively. Thus, these biogenic ZnO nanoparticles revealed a substantial antibacterial effect against multidrug-resistant pathogens, associated with several serious systemic infections, and have the potential as an antimicrobial agent for further study.
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Affiliation(s)
- Mohammad Hossein Morowvat
- Biotechnology Research Center, Shiraz University of Medical Sciences, Shiraz P.O. Box 71468-64685, Iran
| | - Kimia Kazemi
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz P.O. Box 71468-64685, Iran
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz P.O. Box 71468-64685, Iran
| | - Maral Ansari Jaberi
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz P.O. Box 71468-64685, Iran
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz P.O. Box 71468-64685, Iran
| | - Abbas Amini
- Department of Mechanical Engineering, Australian University (AU)-Kuwait, Mishref, Safat 13015, Kuwait
- Center for Infrastructure Engineering, Western Sydney University, Penrith, NSW 2751, Australia
| | - Ahmad Gholami
- Biotechnology Research Center, Shiraz University of Medical Sciences, Shiraz P.O. Box 71468-64685, Iran
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz P.O. Box 71468-64685, Iran
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14
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Prevalence of healthcare-associated infections in public hospitals in New Zealand, 2021. J Hosp Infect 2023; 131:164-172. [PMID: 36270518 DOI: 10.1016/j.jhin.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND There are no contemporary data on healthcare-associated infections (HAIs) in New Zealand. AIMS To determine the epidemiology of HAIs, prevalence of medical devices, and microbiology of HAIs in adults in public hospitals in New Zealand. METHODS Point prevalence survey. Surveyors reviewed patients aged ≥18 years using the HAI definitions of the European Centres for Disease Prevention and Control. Device use and microbiology of HAIs were recorded. FINDINGS In total, 5468 patients were surveyed; 361 patients (6.6%) had 423 HAIs (7.7 HAIs per 100 patients). The most common HAIs were: surgical site infections (N=104, 25%), urinary tract infections (N=80, 19%), pneumonia (N=75, 18%) and bloodstream infections (N=55, 13%). Overall, 3585 patients (66%) had at least one device, with 2922 (53%) patients having a peripheral intravenous catheter. Sixty-nine (16%) HAIs were device-associated. On multi-variable analysis, independent risk factors for HAIs included the presence of a peripheral [odds ratio (OR) 2.0] or central (OR 5.7) intravenous catheter and clinical service. HAI rates were higher in surgical patients (OR 1.8), intensive care unit patients (OR 2.6) and rehabilitation/older persons' health patients (OR 2.4) compared with general medicine patients (P≤0.01 for all groups). In total, 301 organisms were identified. Clostridioides difficile infection was uncommon, accounting for 1.7% of all HAIs. Forty-two isolates (14%) were drug-resistant, and most (N=33, 79%) were Enterobacterales. CONCLUSION This study established the most common HAIs and their risk factors in New Zealand. The high prevalence of device use underscores the need to ensure that proven multi-modal prevention interventions are in place. However, as less than half of HAIs are device- or surgery-associated, other intervention strategies will be required to reduce their burden.
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15
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Pinheiro FR, Rozza-de-Menezes RE, Blum MC, Pereira RFA, Rocha JA, Guedes Pinto MCF, Penna BA, Riley LW, Aguiar-Alves F. Evaluation of changes in antimicrobial susceptibility in bacteria infecting children and their mothers in pediatric, neonatal-intensive care unit, and gynecology/obstetrics wards of a quaternary referral hospital during the COVID-19 pandemic. Front Microbiol 2023; 14:1096223. [PMID: 36891399 PMCID: PMC9986255 DOI: 10.3389/fmicb.2023.1096223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/24/2023] [Indexed: 02/22/2023] Open
Abstract
The World Health Organization released a statement warning of increased risk for the incidence of multidrug resistant microorganisms and the absence of new drugs to control such infections soon. Since the beginning of the COVID-19 pandemic, the prescription of antimicrobial agents has increased and may have accelerated the emergence of multidrug resistant (MDR) bacteria. This study aimed to evaluate maternal and pediatric infections within a hospital from January 2019 to December 2021. An observational retrospective cohort study was performed at a quaternary referral hospital in a metropolitan area of Niteroi city, Rio de Janeiro state, Brazil. A total of 196 patients' medical records were analyzed. The data from 90 (45.9%) patients were collected before the SARS-CoV-2 pandemic, 29 (14.8%) from the 2020 pandemic period, and 77 (39.3%) from the 2021 pandemic period. A total of 256 microorganisms were identified during this period. Out of those, 101 (39.5%) were isolated in 2019, 51 (19.9%) in 2020, and 104 (40.6%) in 2021. Antimicrobial susceptibility tests were performed on 196 (76.6%) clinical isolates. The exact binomial test showed that the distribution of Gram-negative bacteria was predominant. The most common microorganism was Escherichia coli (23%; n = 45), followed by Staphylococcus aureus (17.9%, n = 35), Klebsiella pneumoniae (12.8%, n = 25), Enterococcus faecalis (7.7%, n = 15), Staphylococcus epidermidis (6.6%, n = 13) and Pseudomonas aeruginosa (5.6%, n = 11). Staphylococcus aureus was the predominant species among resistant bacteria. Among the antimicrobial agents tested, the following were resistant, presented on a descending scale: penicillin (72.7%, p = 0.001, Binomial test), oxacillin (68.3%, p = 0.006, Binomial test), ampicillin (64.3%, p = 0.003, Binomial test), and ampicillin/sulbactam (54.9%, p = 0.57, Binomial test). Infections with S. aureus were 3.1 times greater in pediatrics and maternal units than in other hospital wards. Despite the global reduction in the incidence of MRSA, we observed an increase in MDR S. aureus in this study. No changes were observed in the frequency of resistance profiles of the clinical isolates after the establishment of the global SARS-CoV-2 pandemic. More comprehensive studies are needed to understand the impact of the global SARS-CoV-2 pandemic on the resistance levels of bacteria associated with neonate and pediatric patients.
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Affiliation(s)
- Felipe Ramos Pinheiro
- Molecular Epidemiology and Biotechnology Laboratory, School of Pharmacy, Fluminense Federal University, Niteroi, Brazil.,Pathology Post Graduate Program, School of Medicine, Fluminense Federal University, Niteroi, Brazil
| | | | - Marina Camille Blum
- Division of Health and Social Behavior, School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | - Renata Freire Alves Pereira
- Molecular Epidemiology and Biotechnology Laboratory, School of Pharmacy, Fluminense Federal University, Niteroi, Brazil.,Applied Microbiology and Parasitology Post Graduate Programs, Fluminense Federal University, Niteroi, Brazil
| | - Jaqueline Abel Rocha
- Epidemiological Surveillance Unit, Antonio Pedro University Hospital, Fluminense Federal University, Niteroi, Brazil
| | - Maria Cristina F Guedes Pinto
- Epidemiological Surveillance Unit, Antonio Pedro University Hospital, Fluminense Federal University, Niteroi, Brazil
| | - Bruno A Penna
- Gram-Positive Cocci Laboratory, Biomedical Institute Fluminense Federal University, Niteroi, Brazil
| | - Lee W Riley
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | - Fabio Aguiar-Alves
- Pathology Post Graduate Program, School of Medicine, Fluminense Federal University, Niteroi, Brazil.,Applied Microbiology and Parasitology Post Graduate Programs, Fluminense Federal University, Niteroi, Brazil.,Department of Pharmaceutical Sciences, Lloyd L. Gregory School of Pharmacy, Palm Beach Atlantic University, West Palm Beach, FL, United States
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16
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Delaplain PT, Kaafarani HMA, Benedict LAO, Guidry CA, Kim D, Loor MM, Machado-Aranda D, Mele TS, Mendoza AE, Morris-Stiff G, Rattan R, Upperman JS, Barie PS, Schubl SD. Different Surgeon, Different Duration: Lack of Consensus on the Appropriate Duration of Antimicrobial Prophylaxis and Therapy in Surgical Practice. Surg Infect (Larchmt) 2022; 23:232-247. [PMID: 35196154 DOI: 10.1089/sur.2021.323] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
Background: The principles of antimicrobial stewardship promote the appropriate prescribing of agents with respect to efficacy, safety, duration, and cost. Antibiotic resistance often results from inappropriate use (e.g., indication, selection, duration). We evaluated practice variability in duration of antimicrobials in surgical infection treatment (Rx) or prophylaxis (Px). Hypothesis: There is lack of consensus regarding the duration of antibiotic Px and Rx for many common indications. Methods: A survey was distributed to the Surgical Infection Society (SIS) regarding the use of antimicrobial agents for a variety of scenarios. Standard descriptive statistics were used to compare survey responses. Heterogeneity among question responses were compared using the Shannon Index, expressed as natural units (nats). Results: Sixty-three SIS members responded, most of whom (67%) have held a leadership position within the SIS or contributed as an annual meeting moderator or discussant; 76% have been in practice for more than five years. Regarding peri-operative Px, more than 80% agreed that a single dose is adequate for most indications, with the exceptions of gangrenous cholecystitis (40% single dose, 38% pre-operative +24 hours) and inguinal hernia repair requiring a bowel resection (70% single dose). There was more variability regarding the use of antibiotic Px for various bedside procedures with respondents split between none needed (range, 27%-66%) versus a single dose (range, 31%-67%). Opinions regarding the duration of antimicrobial Rx for hospitalized patients who have undergone a source control operation or procedure varied widely based on indication. Only two of 20 indications achieved more than 60% consensus despite available class 1 evidence: seven days for ventilator-associated pneumonia (77%), and four plus one days for perforated appendicitis (62%). Conclusions: Except for peri-operative antibiotic Px, there is little consensus regarding antibiotic duration among surgical infection experts, despite class 1 evidence and several available guidelines. This highlights the need for further high-level research and better dissemination of guidelines.
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Affiliation(s)
- Patrick T Delaplain
- Department of Surgery, University of California-Irvine, Orange, California, USA
| | - Haytham M A Kaafarani
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - L Andrew O Benedict
- Critical Care and Acute Care Surgery, St. Luke's Hospital, Kansas City, Missouri, USA
| | - Christopher A Guidry
- Trauma/Critical & Acute Care Surgery Division, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Dennis Kim
- Division of Trauma/Acute Care Surgery/Surgical Critical Care, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Michele M Loor
- Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - David Machado-Aranda
- Department of Surgery, Michigan Medicine and Veteran's Affairs Healthcare System, Ann Arbor, Michigan, USA
| | - Tina S Mele
- Divisions of General Surgery and Critical Care, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - April E Mendoza
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gareth Morris-Stiff
- Department of Surgery, Case Western Reserve University, Cleveland, Ohio. USA
| | - Rishi Rattan
- Department of Surgery, University of California-Irvine, Orange, California, USA
| | - Jeffrey S Upperman
- Department of Pediatric Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Philip S Barie
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Sebastian D Schubl
- Department of Surgery, University of California-Irvine, Orange, California, USA
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17
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Managing antibiotics wisely in a neonatal intensive care unit in a low resource setting. J Perinatol 2022; 42:965-970. [PMID: 35459905 PMCID: PMC9023725 DOI: 10.1038/s41372-022-01388-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 03/17/2022] [Accepted: 03/31/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVES Unnecessary early antibiotic exposure is deleterious, it may induce the selection of multi-drug-resistant organisms. The objective of this project was to decrease antibiotic exposure of newborns admitted to the neonatal intensive care unit at Hospital Cayetano Heredia, a level 3 unit in Lima, Peru. METHODS Quality improvement project in which we implemented an antibiotic stewardship program for early onset sepsis in the neonatal intensive care unit. Primary outcome measure was antibiotic usage rate, total number of days infants were exposed to antibacterial agents divided by 1000 patient-days. RESULTS Antibiotic usage rate declined from 291/1000 patient-days to 82/1000 patient-days during the last months of 2020, representing a total decrease of 65.1%. CONCLUSIONS Antibiotic stewardship for early-onset sepsis implemented in a perinatal center like ours is effective, appears to be safe and results in a sustained and significant decrease in the use of antibiotics for early-onset sepsis.
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18
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Puzniak L, Gupta V, Yu KC, Ye G, Outterson K. The impact of infections on reimbursement in 92 US hospitals, 2015-2018. Am J Infect Control 2021; 49:1275-1280. [PMID: 33891989 DOI: 10.1016/j.ajic.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The diagnosis-related group (DRG) is a payment system introduced to standardize healthcare costs. However, reimbursement for treatment of infections does not always cover costs. METHODS We used 2015-2018 data from 92 US hospitals in the Becton Dickinson Insights Research Database to compare the financial burden of hospital admissions within non-infection DRGs for patients with a bacterial infection (INF+) versus those without an infection (INF-). Included patients were adults with a hospital length of stay (LOS) ≥3 days and evidence of infection. Multi-variable adjusted analyses via generalized linear mixed models were used to evaluate the impact of an infection on outcomes. RESULTS We analyzed data from 133,423 INF+ admissions and 170,531 INF- admissions. Infections were associated with an approximately two-fold increase in model-estimated LOS (9.2 vs 4.8 d; P < .001) and intensive care unit LOS (5.1 vs 2.8 d; P < .001). The average additional hospital cost for INF+ versus INF- admissions was $10,326 per admission (P < .001) and the average loss after reimbursement was $1,067 (P = .006). Only private insurance payers had a positive margin. CONCLUSIONS Current reimbursement options for infections result in significant hospital financial burden. Reimbursement models should be reconsidered to enable adoption of costlier diagnostics and antimicrobials.
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19
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Rates of nosocomial infection associated with interhospital transfer of patients receiving extracorporeal membrane oxygenation. Infect Control Hosp Epidemiol 2021; 43:864-869. [PMID: 34176533 DOI: 10.1017/ice.2021.251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Critically ill patients requiring extracorporeal membrane oxygenation (ECMO) frequently require interhospital transfer to a center that has ECMO capabilities. Patients receiving ECMO were evaluated to determine whether interhospital transfer was a risk factor for subsequent development of a nosocomial infection. DESIGN Retrospective cohort study. SETTING A 425-bed academic tertiary-care hospital. PATIENTS All adult patients who received ECMO for >48 hours between May 2012 and May 2020. METHODS The rate of nosocomial infections for patients receiving ECMO was compared between patients who were cannulated at the ECMO center and patients who were cannulated at a hospital without ECMO capabilities and transported to the ECMO center for further care. Additionally, time to infection, organisms responsible for infection, and site of infection were compared. RESULTS In total, 123 patients were included in analysis. For the primary outcome of nosocomial infection, there was no difference in number of infections per 1,000 ECMO days (25.4 vs 29.4; P = .03) by univariate analysis. By Cox proportional hazard analysis, transport was not significantly associated with increased infections (hazard ratio, 1.7; 95% confidence interval, 0.8-4.2; P = .20). CONCLUSION In this study, we did not identify an increased risk of nosocomial infection during subsequent hospitalization. Further studies are needed to identify sources of nosocomial infection in this high-risk population.
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McGuire RJ, Yu SC, Payne PRO, Lai AM, Vazquez-Guillamet MC, Kollef MH, Michelson AP. A Pragmatic Machine Learning Model To Predict Carbapenem Resistance. Antimicrob Agents Chemother 2021; 65:e0006321. [PMID: 33972243 PMCID: PMC8218615 DOI: 10.1128/aac.00063-21] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/30/2021] [Indexed: 12/23/2022] Open
Abstract
Infection caused by carbapenem-resistant (CR) organisms is a rising problem in the United States. While the risk factors for antibiotic resistance are well known, there remains a large need for the early identification of antibiotic-resistant infections. Using machine learning (ML), we sought to develop a prediction model for carbapenem resistance. All patients >18 years of age admitted to a tertiary-care academic medical center between 1 January 2012 and 10 October 2017 with ≥1 bacterial culture were eligible for inclusion. All demographic, medication, vital sign, procedure, laboratory, and culture/sensitivity data were extracted from the electronic health record. Organisms were considered CR if a single isolate was reported as intermediate or resistant. Patients with CR and non-CR organisms were temporally matched to maintain the positive/negative case ratio. Extreme gradient boosting was used for model development. In total, 68,472 patients met inclusion criteria, with 1,088 patients identified as having CR organisms. Sixty-seven features were used for predictive modeling. The most important features were number of prior antibiotic days, recent central venous catheter placement, and inpatient surgery. After model training, the area under the receiver operating characteristic curve was 0.846. The sensitivity of the model was 30%, with a positive predictive value (PPV) of 30% and a negative predictive value of 99%. Using readily available clinical data, we were able to create a ML model capable of predicting CR infections at the time of culture collection with a high PPV.
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Affiliation(s)
- Ryan J. McGuire
- Department of Internal Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Sean C. Yu
- Institute for Informatics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Philip R. O. Payne
- Institute for Informatics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Albert M. Lai
- Institute for Informatics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - M. Cristina Vazquez-Guillamet
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
- Division of Infectious Disease, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Marin H. Kollef
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Andrew P. Michelson
- Institute for Informatics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
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21
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Aliyu S, McGowan K, Hussain D, Kanawati L, Ruiz M, Yohannes S. Prevalence and Outcomes of Multi-Drug Resistant Blood Stream Infections Among Nursing Home Residents Admitted to an Acute Care Hospital. J Intensive Care Med 2021; 37:565-571. [PMID: 33938320 DOI: 10.1177/08850666211014450] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The prevalence of multi-drug resistant organism (MDRO) colonization in nursing home residents has been well documented, but little is known about the impact of MDRO bloodstream infections (BSIs). The aim of this study was to assess the prevalence, cost, and outcomes of MDRO-BSI vs. non-MDRO-BSI among nursing home residents. DESIGN Retrospective cohort study. SETTING 960 bed tertiary academic medical center. PATIENTS Persons ≥18 years old admitted to an acute care tertiary hospital from Skilled Nursing Facilities with a diagnosis of sepsis between 2015 and 2018. INTERVENTIONS Retrospective analysis of prevalence and outcomes. MEASUREMENTS AND MAIN RESULTS Among patients admitted to the study hospital with a diagnosis of sepsis during the study period, 7% were from nursing homes. The prevalence of MDRO-BSI was 47%. We identified 54 (50%) gram positive BSIs, 48 (45%) gram negative BSI and 5 (5%) fungal BSI. Thirty-one (57%) of the gram-positive infections and 14 (30%) of the gram-negative infections were with MDROs. The prevalence of BSI organisms were Staphylococcus aureus in 24%, Escherichia coli in 14%, Proteus mirabilis in 13%, Staphylococcus epidermidis in 8%, Enterococcus faecalis in 7%, and Klebsiella pneumoniae in 6%. We found that intensive care unit length of stay (7 days vs 5 days, P = .009), direct cost ($13,639 vs $9,922, P = .027), and total cost ($23,752 vs $17,900 P = .032) were significantly higher in patients with MDRO-BSI vs. non-MDRO-BSI. Patients with MDRO-BSI were twice as likely to receive inappropriate empiric antiinfective therapy (31% vs 16%, P = .006) and were more likely to die (49.1% vs 29.6%, P = .049). CONCLUSION Nursing home residents have a high prevalence of MDRO-BSI, which is associated with higher risk of receiving inappropriate initial anti-infective therapy, higher cost, higher ICU LOS, and higher mortality. Our research adds new information about the prevalence of fungemia in this population.
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Affiliation(s)
- Sainfer Aliyu
- 8405MedStar Washington Hospital Center, Washington, DC, USA
| | - Kevin McGowan
- Georgetown University School of Medicine, Washington, DC, USA
| | - Dilbi Hussain
- 8405MedStar Washington Hospital Center, Washington, DC, USA
| | - Lama Kanawati
- 8405MedStar Washington Hospital Center, Washington, DC, USA
| | - Maria Ruiz
- 8405MedStar Washington Hospital Center, Washington, DC, USA
| | - Seife Yohannes
- 8405MedStar Washington Hospital Center, Washington, DC, USA
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22
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Romandini A, Pani A, Schenardi PA, Pattarino GAC, De Giacomo C, Scaglione F. Antibiotic Resistance in Pediatric Infections: Global Emerging Threats, Predicting the Near Future. Antibiotics (Basel) 2021; 10:antibiotics10040393. [PMID: 33917430 PMCID: PMC8067449 DOI: 10.3390/antibiotics10040393] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/30/2021] [Accepted: 04/03/2021] [Indexed: 12/28/2022] Open
Abstract
Antibiotic resistance is a public health threat of the utmost importance, especially when it comes to children: according to WHO data, infections caused by multidrug resistant bacteria produce 700,000 deaths across all ages, of which around 200,000 are newborns. This surging issue has multipronged roots that are specific to the pediatric age. For instance, the problematic overuse and misuse of antibiotics (for wrong diagnoses and indications, or at wrong dosage) is also fueled by the lack of pediatric-specific data and trials. The ever-evolving nature of this age group also poses another issue: the partly age-dependent changes of a developing system of cytochromes determine a rather diverse population in terms of biochemical characteristics and pharmacokinetics profiles, hard to easily codify in an age- or weight-dependent dosage. The pediatric population is also penalized by the contraindications of tetracyclines and fluoroquinolones, and by congenital malformations which often require repeated hospitalizations and pharmacological and surgical treatments from a very young age. Emerging threats for the pediatric age are MRSA, VRSA, ESBL-producing Enterobacteriaceae, carbapenem-resistant Enterobacteriaceae and the alarming colistin resistance. Urgent actions need to be taken in order to step back from a now likely post-antibiotic era, where simple infections might cause infant death once again.
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Affiliation(s)
- Alessandra Romandini
- Department of Oncology and Hemato-Oncology, Postgraduate School of Clinical Pharmacology and Toxicology, Università degli Studi di Milano, 20122 Milan, Italy; (A.R.); (P.A.S.)
| | - Arianna Pani
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, 20122 Milan, Italy; (A.P.); (F.S.)
| | - Paolo Andrea Schenardi
- Department of Oncology and Hemato-Oncology, Postgraduate School of Clinical Pharmacology and Toxicology, Università degli Studi di Milano, 20122 Milan, Italy; (A.R.); (P.A.S.)
| | | | - Costantino De Giacomo
- Maternal and Infantile Department of Pediatrics, ASST Grande Ospedale Metropolitano Niguarda, 20122 Milan, Italy;
- Correspondence: ; Tel.: +39-02-6444-2432
| | - Francesco Scaglione
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, 20122 Milan, Italy; (A.P.); (F.S.)
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Prusakov P, Goff DA, Wozniak PS, Cassim A, Scipion CE, Urzúa S, Ronchi A, Zeng L, Ladipo-Ajayi O, Aviles-Otero N, Udeigwe-Okeke CR, Melamed R, Silveira RC, Auriti C, Beltrán-Arroyave C, Zamora-Flores E, Sanchez-Codez M, Donkor ES, Kekomäki S, Mainini N, Trochez RV, Casey J, Graus JM, Muller M, Singh S, Loeffen Y, Pérez MET, Ferreyra GI, Lima-Rogel V, Perrone B, Izquierdo G, Cernada M, Stoffella S, Ekenze SO, de Alba-Romero C, Tzialla C, Pham JT, Hosoi K, Consuegra MCC, Betta P, Hoyos OA, Roilides E, Naranjo-Zuñiga G, Oshiro M, Garay V, Mondì V, Mazzeo D, Stahl JA, Cantey JB, Monsalve JGM, Normann E, Landgrave LC, Mazouri A, Avila CA, Piersigilli F, Trujillo M, Kolman S, Delgado V, Guzman V, Abdellatif M, Monterrosa L, Tina LG, Yunis K, Rodriguez MAB, Saux NL, Leonardi V, Porta A, Latorre G, Nakanishi H, Meir M, Manzoni P, Norero X, Hoyos A, Arias D, Sánchez RG, Medoro AK, Sánchez PJ. A global point prevalence survey of antimicrobial use in neonatal intensive care units: The no-more-antibiotics and resistance (NO-MAS-R) study. EClinicalMedicine 2021; 32:100727. [PMID: 33554094 PMCID: PMC7848759 DOI: 10.1016/j.eclinm.2021.100727] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/04/2021] [Accepted: 01/08/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Global assessment of antimicrobial agents prescribed to infants in the neonatal intensive care unit (NICU) may inform antimicrobial stewardship efforts. METHODS We conducted a one-day global point prevalence study of all antimicrobials provided to NICU infants. Demographic, clinical, and microbiologic data were obtained including NICU level, census, birth weight, gestational/chronologic age, diagnoses, antimicrobial therapy (reason for use; length of therapy), antimicrobial stewardship program (ASP), and 30-day in-hospital mortality. FINDINGS On July 1, 2019, 26% of infants (580/2,265; range, 0-100%; median gestational age, 33 weeks; median birth weight, 1800 g) in 84 NICUs (51, high-income; 33, low-to-middle income) from 29 countries (14, high-income; 15, low-to-middle income) in five continents received ≥1 antimicrobial agent (92%, antibacterial; 19%, antifungal; 4%, antiviral). The most common reasons for antibiotic therapy were "rule-out" sepsis (32%) and "culture-negative" sepsis (16%) with ampicillin (40%), gentamicin (35%), amikacin (19%), vancomycin (15%), and meropenem (9%) used most frequently. For definitive treatment of presumed/confirmed infection, vancomycin (26%), amikacin (20%), and meropenem (16%) were the most prescribed agents. Length of therapy for culture-positive and "culture-negative" infections was 12 days (median; IQR, 8-14) and 7 days (median; IQR, 5-10), respectively. Mortality was 6% (42%, infection-related). An NICU ASP was associated with lower rate of antibiotic utilization (p = 0·02). INTERPRETATION Global NICU antibiotic use was frequent and prolonged regardless of culture results. NICU-specific ASPs were associated with lower antibiotic utilization rates, suggesting the need for their implementation worldwide. FUNDING Merck & Co.; The Ohio State University College of Medicine Barnes Medical Student Research Scholarship.
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Affiliation(s)
- Pavel Prusakov
- Department of Pharmacy, Nationwide Children's Hospital, Columbus, OH, USA
| | - Debra A. Goff
- Department of Pharmacy, The Ohio State University Wexner Medical Center, The Ohio State University College of Pharmacy, Columbus, OH, USA
| | | | - Azraa Cassim
- Chris Hani Baragwanath Hospital, Johannesburg, South Africa
| | | | - Soledad Urzúa
- Department of Neonatology, Pontificia Universidad Catolica, Santiago, Chile
| | - Andrea Ronchi
- Division of Neonatology and NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lingkong Zeng
- Department of Neonatology, Wuhan Children's Hospital Wuhan Maternal and Child Healthcare Hospital Tongji Medical College Huazhong University of Science & Technology, Wuhan, China
| | | | | | | | - Rimma Melamed
- Pediatric Infectious Diseases Unit and Faculty of Health Sciences, Ben Gurion University of the Negev, Soroka University Medical Center, Beer Sheva, Israel
| | - Rita C. Silveira
- Department of Pediatrics, Newborn Section, Universidade Federal do Rio Grande do Sul. Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Cinzia Auriti
- Department of Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Elena Zamora-Flores
- Division of Neonatology, Hospital Materno Infantil Gregorio Marañon University Hospital, Madrid, Spain
| | - Maria Sanchez-Codez
- Division of Pediatric Infectious Diseases, Puerta del Mar University Hospital, Cadiz, Spain
| | - Eric S. Donkor
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
| | - Satu Kekomäki
- Division of Pediatric Infectious Diseases, Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| | | | | | - Jamalyn Casey
- Department of Pharmacy, St. Vincent Women's Hospital, Indianapolis, IN, United States
| | - Juan M. Graus
- Department of Neonatology, Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Mallory Muller
- Department of Pharmacy, Arnold Palmer Hospital for Children, Orlando, FL, USA
| | - Sara Singh
- University of Guyana, School of Medicine, Georgetown, Guyana
| | - Yvette Loeffen
- Division of Pediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, Utrecht, Netherlands
| | - María Eulalia Tamayo Pérez
- Coordinator of Neonatology Fellow Program, Head of Neonatal Intensive Care, University of Antioquia, Hospital San Vicente Fundacion, Medellin, Colombia
| | - Gloria Isabel Ferreyra
- Department of Neonatology, Instituto de Maternidad Ntra. Sra. de las Mercedes, San Miguel de Tucumán, Argentina
| | - Victoria Lima-Rogel
- Division of Neonatology, Hospital General Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico
| | - Barbara Perrone
- Division of Neonatology and NICU, G. Salesi Children's Hospital, Ancona, Italy
| | - Giannina Izquierdo
- Division of Neonatology and Pediatric Infectious Diseases, Hospital Barros Luco Trudeau, Santiago, Chile
| | - María Cernada
- Division of Neonatology and Neonatal Research Group, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Sylvia Stoffella
- Department of Pharmacy, UCSF Benioff Children's Hospital, San Francisco, CA, USA
| | | | | | | | - Jennifer T. Pham
- Department of Pharmacy, University of Illinois Hospital & Health Sciences System, Chicago, IL, USA
| | - Kenichiro Hosoi
- Department of Pediatrics, Kyorin University School of Medicine, Tokyo, Japan
| | | | - Pasqua Betta
- Division of Neonatology and NICU, AOU Policlinico G Rodolico, Catania, Italy
| | - O. Alvaro Hoyos
- Clínica Universitaria Bolivariana/Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Emmanuel Roilides
- Infectious Diseases Unit, 3rd Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
| | | | - Makoto Oshiro
- Department of Pediatrics, Nagoya Red Cross Daiichi Hospital, Nagoya, Japan
| | - Victor Garay
- Division of Neonatology, Alberto Sabogal Hospital, Lima, Peru
| | | | - Danila Mazzeo
- Division of Patology and Intensive Neonatal Care, A.O.U. Policlinico di Messina, Messina, Italy
| | - James A. Stahl
- Department of Pharmacy, Norton Children's Hospital, Louisville, KY, USA
| | - Joseph B. Cantey
- Department of Pediatrics, Division of Neonatology, University Hospital UT Health San Antonio, San Antonio, TX
| | | | - Erik Normann
- Department of Women's and Children's Health, Uppsala University, Uppsala University Children's Hospital, Uppsala, Sweden
| | | | - Ali Mazouri
- Iran University of Medical Sciences, Tehran, Iran
| | - Claudia Alarcón Avila
- Department of Perinatology and Neonatology, Central Military Hospital, Nueva Granada Military University, Bogotá, Colombia
| | | | - Monica Trujillo
- Program Coordinator Pediatric Infectious Diseases Clinica Universiraria Bolivariana, Hospital Pablo Tobon Uribe, Medellin, Colombia
| | - Sonya Kolman
- Department of Pharmacy, Nelson Mandela Children Hospital, Johannesburg, South Africa
| | - Verónica Delgado
- Head of Neonatal Intensive Care, Hospital de los Valles, Quito, Ecuador
| | - Veronica Guzman
- Pontificia Universidad Catolica del Ecuador, Hospital Metropolitano Quito, Quito, Ecuador
| | - Mohamed Abdellatif
- Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman
| | - Luis Monterrosa
- Department of Pediatrics, Division of Neonatology, Saint John Regional Hospital, Saint John, Canada
| | | | - Khalid Yunis
- Division of Neonatology, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Nicole Le Saux
- Division of Infectious Disease, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Valentina Leonardi
- Division of Neonatology and NICU, Careggi Univerisity Hospital, Florence, Italy
| | | | | | - Hidehiko Nakanishi
- Research and Development Center for New Medical Frontiers, Department of Advanced Medicine, Division of Neonatal Intensive Care Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Michal Meir
- Division of Pediatric Infectious Diseases, The Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Paolo Manzoni
- Division of Pediatrics and Neonatology, Degli Infermi Hospital, Biella, Italy
| | | | - Angela Hoyos
- Division of Neonatology, Clínica del Country / Clínica La Colina, Bogotá, Colombia
| | | | | | - Alexandra K. Medoro
- The Ohio State University College of Medicine, Columbus, OH, USA
- Department of Pediatrics, Divisions of Neonatology and Pediatric Infectious Diseases, Nationwide Children's Hospital, Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Pablo J. Sánchez
- The Ohio State University College of Medicine, Columbus, OH, USA
- Department of Pediatrics, Divisions of Neonatology and Pediatric Infectious Diseases, Nationwide Children's Hospital, Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Corresponding author at: Divisions of Neonatology and Pediatric Infectious Diseases, Nationwide Children's Hospital - The Ohio State University College of Medicine, Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, RB3, WB5245, Columbus, Ohio 43205-2664, United States.
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Gupta A, Tennakoon L, Spain DA, Forrester JD. Outcomes after Surgery among Patients Diagnosed with One or More Multi-Drug-Resistant Organisms. Surg Infect (Larchmt) 2021; 22:722-729. [PMID: 33471591 DOI: 10.1089/sur.2020.400] [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: 01/18/2023] Open
Abstract
Background: Infections with multi-drug-resistant organisms (MDROs) may be difficult to treat and prolong patient hospitalization and recovery. Multiple MDRO coinfections may increase the complexity of clinical management. However, association between multiple MDROs and outcomes of patients who undergo surgery is unknown. Patients and Methods: We performed a retrospective, cross-sectional analysis of the 2016 National Inpatient Sample for identified by International Classification of Disease, 10th Revision Clinical Modification (ICD-10-CM) diagnosis codes associated with multi-drug-resistant organisms: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), multi-drug-resistant gram-negative bacilli, and Clostridioides difficile infection (CDI). Admitted patients with diagnosis codes for MDROs were cross-matched with codes for common general surgery procedures. Outcomes of interest included length of stay and mortality. Weighted univariable and multivariable analyses accounting for the survey methodology were performed. Results: Of 1,550,224 patients undergoing surgery in 2016, 39,065 (3%) admissions were diagnosed with an MDRO and 1,176 (0.1%) were associated with dual MDROs diagnoses. Patients diagnosed with one MDRO were hospitalized three times longer (17.3 days; 95% confidence interval [CI], 16.8-17.7) and patients diagnosed with two MDROs five times longer (31.6 days; 95% CI, 27.0-36.2; p < 0.0001) than undiagnosed patients (6.1 days; 95% CI, 6.1-6.1; all p < 0.0001). On multivariable analysis, the strongest predictor of mortality was a diagnosis of two MDRO infections (odds ratio [OR], 4.8; 95% CI, 3.16-7.21; p < 0.0001). The second strongest predictor was diagnosis of single MDRO infection (OR, 2.9; 95% CI, 2.64-3.20; p < 0.0001). Conclusion: Presence of an MDRO was associated with increased odds of mortality and length of stay in admitted surgical patients. Interventions to reduce MDRO infection among surgical patients may reduce hospital length of stay and mortality.
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Affiliation(s)
- Anshal Gupta
- Division of General Surgery, Department of Surgery, Stanford University, Stanford, California, USA
| | - Lakshika Tennakoon
- Division of General Surgery, Department of Surgery, Stanford University, Stanford, California, USA
| | - David A Spain
- Division of General Surgery, Department of Surgery, Stanford University, Stanford, California, USA
| | - Joseph D Forrester
- Division of General Surgery, Department of Surgery, Stanford University, Stanford, California, USA
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25
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Squire MM, Sessel GK, Lin G, Squire EN, Igusa T. Optimal Design of Paired Built Environment Interventions for Control of MDROs in Acute Care and Community Hospitals. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2020; 14:109-129. [PMID: 33375862 DOI: 10.1177/1937586720976585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Our goal was to optimize infection control of paired environmental control interventions within hospitals to reduce methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Enterobacteriaceae (CRE), and vancomycin-resistant Enterococci (VRE). BACKGROUND The most widely used infection control interventions are deployment of handwashing (HW) stations, control of relative humidity (RH), and negative pressure (NP) treatment rooms. Direct costs of multidrug-resistant organism (MDRO) infections are typically not included in the design of such interventions. METHODS We examined the effectiveness of pairing HW with RH and HW with NP. We used the following three data sets: A meta-analysis of progression rates from uncolonized to colonized to infected, 6 years of MDRO treatment costs from 400 hospitals, and 8 years of MDRO incidence rates at nine army hospitals. We used these data as inputs into an Infection De-Escalation Model with varying budgets to obtain optimal intervention designs. We then computed the infection and prevention rates and cost savings resulting from these designs. RESULTS The average direct cost of an MDRO infection was $3,289, $1,535, and $1,067 for MRSA, CRE, and VRE. The mean annual incidence rates per facility were 0.39%, 0.034%, and 0.011% for MRSA, CRE, and VRE. After applying the cost-minimizing intervention pair to each scenario, the percentage reductions in infections (and annual direct cost savings) in large, community, and small acute care hospitals were 69% ($1.5 million), 73% ($631K), 60% ($118K) for MRSA, 52% ($460.5K), 58% ($203K), 50% ($37K) for CRE, and 0%, 0%, and 50% ($12.8K) for VRE. CONCLUSION The application of this Infection De-Escalation Model can guide cost-effective decision making in hospital built environment design to improve control of MDRO infections.
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Affiliation(s)
- Marietta M Squire
- Department of Civil and Systems Engineering, 1466Johns Hopkins University, Baltimore, MD, USA
| | - Gareth K Sessel
- Outreach Engineering NPC (Nonprofit Company), Johannesburg, South Africa
| | - Gary Lin
- Department of Emergency Medicine, 1466Johns Hopkins University, Baltimore, MD, USA
| | | | - Takeru Igusa
- Department of Civil and Systems Engineering, 1466Johns Hopkins University, Baltimore, MD, USA
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Eldridge GR, Hughey H, Rosenberger L, Martin SM, Shapiro AM, D'Antonio E, Krejci KG, Shore N, Peterson J, Lukes AS, Starks CM. Safety and immunogenicity of an adjuvanted Escherichia coli adhesin vaccine in healthy women with and without histories of recurrent urinary tract infections: results from a first-in-human phase 1 study. Hum Vaccin Immunother 2020; 17:1262-1270. [PMID: 33325785 PMCID: PMC8078672 DOI: 10.1080/21645515.2020.1834807] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Antibiotic resistance among gram-negative bacteria continues to rise globally at an alarming rate. New vaccines that prevent bacterial infections and reduce antibiotic use could provide a potential solution to these problems. This study focused on development of an investigational vaccine to prevent recurrent urinary traction infections (UTI) caused by gram-negative bacteria that use type 1 pili to adhere to, invade, and colonize human bladders. The vaccine antigen is FimH, an adhesin protein on the tip of type 1 pili with a lectin binding domain that enables attachment to glycoproteins on mammalian bladders. This was a phase 1, open-label, dose escalation study evaluating the vaccine in 67 healthy women with and without histories of recurrent UTI. The objectives of the study were to evaluate the safety, tolerability, and immunogenicity of different dosages of the antigen and adjuvant of the vaccine. All dosages were well-tolerated and a low incidence of systemic reactions occurred. No serious adverse events related to the vaccine were reported. The vaccine induced both binding and functional antibodies. The women with histories of recurrent UTI demonstrated greater than 150-fold increases in antibodies against the N-terminal region of FimH. Based on the results of this phase 1 study, this vaccine is proceeding to a double-blind, randomized, placebo-controlled phase 2 study. If this vaccine is successful in future studies, it could potentially prevent millions of recurrent UTI globally and reduce the development of antibiotic resistance.
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Affiliation(s)
| | | | - Lois Rosenberger
- LBR Regulatory and Clinical Consulting Services, Inc, Florence, KY, USA
| | | | | | | | | | - Neal Shore
- Atlantic Urology Clinics, Myrtle Beach, SC, USA
| | | | - Andrea S Lukes
- Women's Wellness Clinic, Carolina Women's Research and Wellness Center (CWRWC), Durham, NC, USA
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Rewley J, Koehly L, Marcum CS, Reed-Tsochas F. A passive monitoring tool using hospital administrative data enables earlier specific detection of healthcare-acquired infections. J Hosp Infect 2020; 106:562-569. [PMID: 32745591 PMCID: PMC7395302 DOI: 10.1016/j.jhin.2020.07.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/27/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Healthcare-associated infections impose a significant burden on the healthcare system. Current methods for detecting these infections are constrained by combinations of high cost, long processing times and imperfect accuracy, reducing their effectiveness. METHODS This study examined whether the amount of time a patient spends on a ward with other patients clinically suspected of infection, termed 'co-presence', can be used as a tool to predict subsequent healthcare-associated infection. Compared with contact tracing, this leverages passively collected electronic data rather than manually collected data, allowing for improved monitoring. All 133,304 inpatient records between 2011 and 2015 were abstracted from a healthcare system in the UK. The area under the receiver-operator curve (AUROC) for each of five pathogens was calculated based on co-presence time, sensitivity and specificity of the test, and how much earlier co-presence would have predicted infection for the true-positive cases. FINDINGS For the five pathogens, AUROC ranged from 0.92 to 0.99, and was 0.52 for the negative control. Optimal cut-points of co-presence ranged from 25 to 59 h, and would have led to detection of true-positive cases up to an average of 1 day earlier. INTERPRETATION These findings show that co-presence time would help to predict healthcare-acquired infection, and would do so earlier than the current standard of care. Using this measure prospectively in hospitals based on real-time data could limit the consequences of infection, both by being able to treat individual infected patients earlier, and by preventing potential secondary infections stemming from the original infected patient.
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Affiliation(s)
- J Rewley
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA; CABDyN Complexity Centre, Saïd Business School, University of Oxford, Oxford, UK.
| | - L Koehly
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - C S Marcum
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - F Reed-Tsochas
- CABDyN Complexity Centre, Saïd Business School, University of Oxford, Oxford, UK
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Fukuda H, Sato D, Iwamoto T, Yamada K, Matsushita K. Healthcare resources attributable to methicillin-resistant Staphylococcus aureus orthopedic surgical site infections. Sci Rep 2020; 10:17059. [PMID: 33051484 PMCID: PMC7555535 DOI: 10.1038/s41598-020-74070-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/21/2020] [Indexed: 01/16/2023] Open
Abstract
The number of orthopedic surgeries is increasing as populations steadily age, but surgical site infection (SSI) rates remain relatively consistent. This study aimed to quantify the healthcare resources attributable to methicillin-resistant Staphylococcus aureus (MRSA) SSIs in orthopedic surgical patients. The analysis was conducted using a national claims database comprising data from almost all Japanese residents. We examined patients who underwent any of the following surgeries between April 2012 and March 2018: amputation (AMP), spinal fusion (FUSN), open reduction of fracture (FX), hip prosthesis (HPRO), knee prosthesis (KPRO), and laminectomy (LAM). Propensity score matching was performed to identify non-SSI control patients, and generalized estimating equations were used to estimate the differences in outcomes between the case and control groups. The numbers of MRSA SSI cases (infection rates) ranged from 64 (0.03%) to 1,152 (2.33%). MRSA SSI-attributable increases in healthcare expenditure ranged from $11,630 ($21,151 vs. $9,521) for LAM to $35,693 ($50,122 vs. $14,429) for FX, and increases in hospital stay ranged from 40.6 days (59.2 vs. 18.6) for LAM to 89.5 days (122.0 vs. 32.5) for FX. In conclusion, MRSA SSIs contribute to substantial increases in healthcare resource utilization, emphasizing the need to implement effective infection prevention measures for orthopedic surgeries.
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Affiliation(s)
- Haruhisa Fukuda
- Department of Health Care Administration and Management, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Daisuke Sato
- Center for Next Generation of Community Health, Chiba University Hospital, Chiba, Japan
| | | | - Koji Yamada
- Department of Orthopaedic Surgery, Kanto Rosai Hospital, Kanagawa, Japan
| | - Kazuhiko Matsushita
- Department of Orthopaedic Surgery, Kawasaki Municipal Tama Hospital, Kanagawa, Japan
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Kwak S, Choi J, Hink T, Reske KA, Blount K, Jones C, Bost MH, Sun X, Burnham CAD, Dubberke ER, Dantas G. Impact of investigational microbiota therapeutic RBX2660 on the gut microbiome and resistome revealed by a placebo-controlled clinical trial. MICROBIOME 2020; 8:125. [PMID: 32862830 PMCID: PMC7457799 DOI: 10.1186/s40168-020-00907-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/11/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Intestinal microbiota restoration can be achieved by complementing a subject's perturbed microbiota with that of a healthy donor. Recurrent Clostridioides difficile infection (rCDI) is one key application of such treatment. Another emerging application of interest is reducing antibiotic-resistant genes (ARGs) and organisms (AROs). In this study, we investigated fecal specimens from a multicenter, randomized, double-blind, placebo-controlled phase 2b study of microbiota-based investigational drug RBX2660. Patients were administered either placebo, 1 dose of RBX2660 and 1 placebo, or 2 doses of RBX2660 via enema and longitudinally tracked for changes in their microbiome and antibiotic resistome. RESULTS All patients exhibited significant recovery of gut microbiome diversity and a decrease of ARG relative abundance during the first 7 days post-treatment. However, the microbiome and resistome shifts toward average configurations from unperturbed individuals were more significant and longer-lasting in RBX2660 recipients compared to placebo. We quantified microbiome and resistome modification by RBX2660 using a novel "transplantation index" metric. We identified taxonomic and metabolic features distinguishing the baseline microbiome of non-transplanted patients and taxa specifically enriched during the process of transplantation. We elucidated the correlation between resistome and taxonomic transplantations and post-treatment dynamics of patient-specific and RBX2660-specific ARGs. Whole genome sequencing of AROs cultured from RBX2660 product and patient samples indicate ARO eradication in patients via RBX2660 administration, but also, to a lesser extent, introduction of RBX2660-derived AROs. CONCLUSIONS Through shotgun metagenomic sequencing, we elucidated the effects of RBX2660 in the microbiome and resistome. Antibiotic discontinuation alone resulted in significant recovery of gut microbial diversity and reduced ARG relative abundance, but RBX2660 administration more rapidly and completely changed the composition of patients' microbiome, resistome, and ARO colonization by transplanting RBX2660 microbiota into the recipients. Although ARGs and AROs were transmitted through RBX2660, the resistome post-RBX2660 more closely resembled that of the administered product-a proxy for the donor-than an antibiotic perturbed state. TRIAL REGISTRATION ClinicalTrials.gov, NCT02299570 . Registered 19 November 2014 Video Abstract.
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Affiliation(s)
- Suryang Kwak
- The Edison Family Center for Genome Sciences & Systems Biology, Washington University School of Medicine in St. Louis, St. Louis, MO 63110 USA
- Department of Pathology and Immunology, Division of Laboratory and Genomic Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO 63110 USA
| | - JooHee Choi
- The Edison Family Center for Genome Sciences & Systems Biology, Washington University School of Medicine in St. Louis, St. Louis, MO 63110 USA
| | - Tiffany Hink
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine in St. Louis, St. Louis, MO 63110 USA
| | - Kimberly A. Reske
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine in St. Louis, St. Louis, MO 63110 USA
| | - Kenneth Blount
- Rebiotix Inc. a Ferring Company, Minneapolis, MN 55113 USA
| | - Courtney Jones
- Rebiotix Inc. a Ferring Company, Minneapolis, MN 55113 USA
| | - Margaret H. Bost
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine in St. Louis, St. Louis, MO 63110 USA
| | - Xiaoqing Sun
- The Edison Family Center for Genome Sciences & Systems Biology, Washington University School of Medicine in St. Louis, St. Louis, MO 63110 USA
- Department of Pathology and Immunology, Division of Laboratory and Genomic Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO 63110 USA
| | - Carey-Ann D. Burnham
- Department of Pathology and Immunology, Division of Laboratory and Genomic Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO 63110 USA
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine in St. Louis, St. Louis, MO 63110 USA
- Department of Molecular Microbiology, Washington University School of Medicine in St. Louis, St. Louis, MO 63110 USA
| | - Erik R. Dubberke
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine in St. Louis, St. Louis, MO 63110 USA
| | - Gautam Dantas
- The Edison Family Center for Genome Sciences & Systems Biology, Washington University School of Medicine in St. Louis, St. Louis, MO 63110 USA
- Department of Pathology and Immunology, Division of Laboratory and Genomic Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO 63110 USA
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63110 USA
- Department of Molecular Microbiology, Washington University School of Medicine in St. Louis, St. Louis, MO 63110 USA
| | - for the CDC Prevention Epicenter Program
- The Edison Family Center for Genome Sciences & Systems Biology, Washington University School of Medicine in St. Louis, St. Louis, MO 63110 USA
- Department of Pathology and Immunology, Division of Laboratory and Genomic Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO 63110 USA
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine in St. Louis, St. Louis, MO 63110 USA
- Rebiotix Inc. a Ferring Company, Minneapolis, MN 55113 USA
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63110 USA
- Department of Molecular Microbiology, Washington University School of Medicine in St. Louis, St. Louis, MO 63110 USA
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30
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Garcia Reeves AB, Trogdon JG, Stearns SC, Lewis JW, Weber DJ, Weinberger M. Are Rates of Methicillin-Resistant Staphylococcus aureus and Clostridioides difficile Associated With Quality and Clinical Outcomes in US Acute Care Hospitals? Am J Med Qual 2020; 36:90-98. [PMID: 32686484 DOI: 10.1177/1062860620942310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to examine the association between rates of methicillin-resistant Staphylococcus aureus (MRSA)/Clostridioides difficile and quality and clinical outcomes in US acute care hospitals. The population was all Medicare-certified US acute care hospitals with MRSA/C difficile standardized infection ratio (SIR) data available from 2013 to 2017. Hospital-level data from the Centers for Medicare & Medicaid Services were used to estimate hospital and time fixed effects models for 30-day hospital readmissions, length of stay, 30-day mortality, and days in the intensive care unit. The key explanatory variables were SIR for MRSA and C difficile. No association was found between MRSA or C difficile rates and any of the 4 outcomes. The null results add to the mixed evidence in the field, but there are likely residual confounding factors. Future research should use larger samples of patient-level data and appropriate methods to provide evidence to guide efforts to tackle antimicrobial resistance.
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Affiliation(s)
- Alessandra B Garcia Reeves
- University of North Carolina, Chapel Hill, NC North Carolina Department of Health and Human Services, Raleigh, NC
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Jit M, Ng DHL, Luangasanatip N, Sandmann F, Atkins KE, Robotham JV, Pouwels KB. Quantifying the economic cost of antibiotic resistance and the impact of related interventions: rapid methodological review, conceptual framework and recommendations for future studies. BMC Med 2020; 18:38. [PMID: 32138748 PMCID: PMC7059710 DOI: 10.1186/s12916-020-1507-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/31/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Antibiotic resistance (ABR) poses a major threat to health and economic wellbeing worldwide. Reducing ABR will require government interventions to incentivise antibiotic development, prudent antibiotic use, infection control and deployment of partial substitutes such as rapid diagnostics and vaccines. The scale of such interventions needs to be calibrated to accurate and comprehensive estimates of the economic cost of ABR. METHODS A conceptual framework for estimating costs attributable to ABR was developed based on previous literature highlighting methodological shortcomings in the field and additional deductive epidemiological and economic reasoning. The framework was supplemented by a rapid methodological review. RESULTS The review identified 110 articles quantifying ABR costs. Most were based in high-income countries only (91/110), set in hospitals (95/110), used a healthcare provider or payer perspective (97/110), and used matched cohort approaches to compare costs of patients with antibiotic-resistant infections and antibiotic-susceptible infections (or no infection) (87/110). Better use of methods to correct biases and confounding when making this comparison is needed. Findings also need to be extended beyond their limitations in (1) time (projecting present costs into the future), (2) perspective (from the healthcare sector to entire societies and economies), (3) scope (from individuals to communities and ecosystems), and (4) space (from single sites to countries and the world). Analyses of the impact of interventions need to be extended to examine the impact of the intervention on ABR, rather than considering ABR as an exogeneous factor. CONCLUSIONS Quantifying the economic cost of resistance will require greater rigour and innovation in the use of existing methods to design studies that accurately collect relevant outcomes and further research into new techniques for capturing broader economic outcomes.
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Affiliation(s)
- Mark Jit
- The National Institute for Health Research (NIHR) Health Protection Research Unit in Immunisation, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
- Modelling and Economics Unit, National Infections Service, Public Health England, London, UK.
- School of Public Health, University of Hong Kong, Hong Kong, SAR, China.
| | - Dorothy Hui Lin Ng
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | - Nantasit Luangasanatip
- The National Institute for Health Research (NIHR) Health Protection Research Unit in Immunisation, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Frank Sandmann
- The National Institute for Health Research (NIHR) Health Protection Research Unit in Immunisation, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Modelling and Economics Unit, National Infections Service, Public Health England, London, UK
| | - Katherine E Atkins
- The National Institute for Health Research (NIHR) Health Protection Research Unit in Immunisation, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Centre for Global Health Research, The Usher Institute for Population Health Science and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Julie V Robotham
- Modelling and Economics Unit, National Infections Service, Public Health England, London, UK
- The National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK
- The National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
| | - Koen B Pouwels
- Modelling and Economics Unit, National Infections Service, Public Health England, London, UK
- The National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Tampi MP, Pilcher L, Urquhart O, Kennedy E, O'Brien KK, Lockhart PB, Abt E, Aminoshariae A, Durkin MJ, Fouad AF, Gopal P, Hatten BW, Lang MS, Patton LL, Paumier T, Suda KJ, Cho H, Carrasco-Labra A. Antibiotics for the urgent management of symptomatic irreversible pulpitis, symptomatic apical periodontitis, and localized acute apical abscess: Systematic review and meta-analysis-a report of the American Dental Association. J Am Dent Assoc 2019; 150:e179-e216. [PMID: 31761029 DOI: 10.1016/j.adaj.2019.09.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/17/2019] [Accepted: 09/19/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Patients with pulpal and periapical conditions often seek treatment for pain, intraoral swelling, or both. Even when definitive, conservative dental treatment (DCDT) is an option, antibiotics are often prescribed. The purpose of this review was to summarize available evidence regarding the effect of antibiotics, either alone or as adjuncts to DCDT, to treat immunocompetent adults with pulpal and periapical conditions, as well as additional population-level harms associated with antibiotic use. TYPE OF STUDIES REVIEWED The authors updated 2 preexisting systematic reviews to identify newly published randomized controlled trials. They also searched for systematic reviews to inform additional harm outcomes. They conducted searches in MEDLINE, Embase, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature. Pairs of reviewers independently conducted study selection, data extraction, and assessment of risk of bias and certainty in the evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. RESULTS The authors found no new trials via the update of the preexisting reviews. Ultimately, 3 trials and 8 additional reports proved eligible for this review. Trial estimates for all outcomes suggested both a benefit and harm over 7 days (very low to low certainty evidence). The magnitude of additional harms related to antibiotic use for any condition were potentially large (very low to moderate certainty evidence). CONCLUSIONS AND PRACTICAL IMPLICATIONS Evidence for antibiotics, either alone or as adjuncts to DCDT, showed both a benefit and a harm for outcomes of pain and intraoral swelling and a large potential magnitude of effect in regard to additional harm outcomes. The impact of dental antibiotic prescribing requires further research.
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Lockhart PB, Tampi MP, Abt E, Aminoshariae A, Durkin MJ, Fouad AF, Gopal P, Hatten BW, Kennedy E, Lang MS, Patton LL, Paumier T, Suda KJ, Pilcher L, Urquhart O, O'Brien KK, Carrasco-Labra A. Evidence-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling: A report from the American Dental Association. J Am Dent Assoc 2019; 150:906-921.e12. [PMID: 31668170 PMCID: PMC8270006 DOI: 10.1016/j.adaj.2019.08.020] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 08/21/2019] [Accepted: 08/22/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND An expert panel convened by the American Dental Association Council on Scientific Affairs and the Center for Evidence-Based Dentistry conducted a systematic review and formulated clinical recommendations for the urgent management of symptomatic irreversible pulpitis with or without symptomatic apical periodontitis, pulp necrosis and symptomatic apical periodontitis, or pulp necrosis and localized acute apical abscess using antibiotics, either alone or as adjuncts to definitive, conservative dental treatment (DCDT) in immunocompetent adults. TYPES OF STUDIES REVIEWED The authors conducted a search of the literature in MEDLINE, Embase, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature to retrieve evidence on benefits and harms associated with antibiotic use. The authors used the Grading of Recommendations Assessment, Development and Evaluation approach to assess the certainty in the evidence and the Evidence-to-Decision framework. RESULTS The panel formulated 5 clinical recommendations and 2 good practice statements, each specific to the target conditions, for settings in which DCDT is and is not immediately available. With likely negligible benefits and potentially large harms, the panel recommended against using antibiotics in most clinical scenarios, irrespective of DCDT availability. They recommended antibiotics in patients with systemic involvement (for example, malaise or fever) due to the dental conditions or when the risk of experiencing progression to systemic involvement is high. CONCLUSION AND PRACTICAL IMPLICATIONS Evidence suggests that antibiotics for the target conditions may provide negligible benefits and probably contribute to large harms. The expert panel suggests that antibiotics for target conditions be used only when systemic involvement is present and that immediate DCDT should be prioritized in all cases.
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Gupta V, Ye G, Olesky M, Lawrence K, Murray J, Yu K. National prevalence estimates for resistant Enterobacteriaceae and Acinetobacter species in hospitalized patients in the United States. Int J Infect Dis 2019; 85:203-211. [PMID: 31229615 DOI: 10.1016/j.ijid.2019.06.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/13/2019] [Accepted: 06/15/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To determine antimicrobial nonsusceptibility rates for Enterobacteriaceae and Acinetobacter spp. in US hospitals. METHODS We analyzed antimicrobial susceptibilities of non-duplicate Enterobacteriaceae and Acinetobacter spp. isolates reported in 2017 from 375 US hospitals in the BD Insights Research Database. Logistic and Poisson regression modeling methods were used to estimate proportions of resistant isolates and rates per 1000 hospital admissions. National projections were generated based on raking (weighting) methods. RESULTS The nationwide proportions of resistant isolates in inpatients were an estimated 12.6%, 6.6%, and 1.2% for Enterobacteriaceae with extended-spectrum beta-lactamase (ESBL), multidrug resistant (MDR), and carbapenem-nonsusceptible (Carb-NS) phenotypes, respectively, and 42.4% and 34.5% for Acinetobacter spp. with MDR and Carb-NS phenotypes. Resistance varied by geographic region and hospital size/type. Estimated nationwide rates per 1000 hospital admissions ranged from a high of 7.1 for ESBL Enterobacteriaceae to a low of 0.3 for Carb-NS Acinetobacter spp. The estimated number of isolates occurring in US inpatients each year was 290,220 ESBL, 173,984 MDR, and 30,194 Carb-NS for Enterobacteriaceae and 12,274 MDR and 9,991 Carb-NS for Acinetobacter spp. CONCLUSIONS National prevalence estimates suggest high levels of antimicrobial resistance and a substantial number of patients with resistant Enterobacteriaceae and Acinetobacter spp. in US hospitals.
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Affiliation(s)
- Vikas Gupta
- Becton, Dickinson and Company, Franklin Lakes, NJ, United States.
| | - Gang Ye
- Becton, Dickinson and Company, Franklin Lakes, NJ, United States
| | - Melanie Olesky
- Tetraphase Pharmaceuticals, Watertown, MA, United States
| | | | - John Murray
- Becton, Dickinson and Company, Franklin Lakes, NJ, United States
| | - Kalvin Yu
- Becton, Dickinson and Company, Franklin Lakes, NJ, United States
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Johnston KJ, Thorpe KE, Jacob JT, Murphy DJ. The incremental cost of infections associated with multidrug-resistant organisms in the inpatient hospital setting-A national estimate. Health Serv Res 2019; 54:782-792. [PMID: 30864179 DOI: 10.1111/1475-6773.13135] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To estimate the cost of infections associated with multidrug-resistant organisms (MDROs) during inpatient hospitalization in the United States. DATA SOURCES/STUDY SETTING 2014 National Inpatient Sample. STUDY DESIGN Multivariable regression models assessed the incremental effect of MDROs on the cost of hospitalization and hospital length of stay among patients with bacterial infections. DATA COLLECTION/EXTRACTION METHODS We retrospectively identified 6 385 258 inpatient stays for patients with bacterial infection. PRINCIPAL FINDINGS The national incidence rate of inpatient stays with bacterial infection is 20.1 percent. At least 10.8 percent of such stays-and as many as 16.9 percent if we account for undercoded infections-show evidence of one or more MDROs. MRSA, C. difficile, infection with another MDRO, and the presence of more than one MDRO are associated with $1718 (95% CI, $1609-$1826), $4617 (95% CI, $4407-$4827), $2302 (95% CI, $2044-$2560), and $3570 (95% CI, $3019-$4122) in additional costs per stay, respectively. The national cost of infections associated with MDROs is at least $2.39 billion (95% CI, $2.25-$2.52 billion) and as high as $3.38 billion (95% CI, $3.13-$3.62 billion) if we account for undercoded infections. CONCLUSIONS Infections associated with MDROs result in a substantial cost burden to the US health care system.
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Affiliation(s)
- Kenton J Johnston
- Department of Health Management and Policy, Center for Outcomes Research, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri
| | - Kenneth E Thorpe
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jesse T Jacob
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine and Emory Antibiotic Resistance Center, Atlanta, Georgia
| | - David J Murphy
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.,Office of Quality and Risk, Emory Healthcare, Atlanta, Georgia
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