scholarly journals Are Patients Preferentially Receiving Oral Vancomycin for Clostridioides difficile Infection in 2018? A Population Perspective

2020 ◽  
Vol 41 (S1) ◽  
pp. s461-s462
Author(s):  
Dana Goodenough ◽  
Carolyn Mackey ◽  
Michael Woodworth ◽  
Max Adelman ◽  
Scott Fridkin
Keyword(s):  
Recurrent Infection ◽  
Population Based ◽  
Outpatient Setting ◽  
Definitive Treatment ◽  
Emerging Infections ◽  
Oral Vancomycin ◽  
Active Population ◽  
First Line Therapy ◽  
Clostridioides Difficile ◽  
Incident Cases

Background: Historically, metronidazole was first-line therapy for Clostridioides difficile infection (CDI). In February 2018, the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) updated clinical practice guidelines for CDI. The new guidelines recommend oral vancomycin or fidaxomicin for treatment of initial episode of CDI in adults. We examined the changes in treatment of CDI during 2018 across all types of healthcare settings in metropolitan Atlanta. Methods: Cases were identified through the Georgia Emerging Infections program (funded by the Centers for Disease Control and Prevention), which conducts active population-based surveillance in an 8-county area including Atlanta, Georgia (population, 4,126,399). An incident case was a resident of the catchment area with a positive C. difficile toxin test and no additional positive test in the previous 8 weeks. Recurrent CDI was defined as >1 incident CDI episode in 1 year. Clinical and treatment data were abstracted on a random 33% sample of adult (>17 years) cases. Definitive treatment categories were defined as the single antibiotic agent, metronidazole or vancomycin, used to complete a course. We examined the effect of time of infection, location of treatment, and number of CDI episodes on the use of metronidazole only. Results: We analyzed treatment information for 831 adult sampled cases. Overall, cases were treated at 29 hospitals (568 cases), 4 nursing homes (6 cases), and 101 outpatient providers (257 cases). The mean age was 60 (IQR, 34–86), and 111 (13.4%) had recurrent infection. Moreover, ∼28% of first-incident CDI episodes, 8% of second episodes, and 6% of third episodes were treated with metronidazole only. Compared to facility-based providers, outpatient providers were more likely to treat initial CDI episodes with metronidazole only (44% vs 21%; relative risk [RR], 2.1; 95% CI, 1.7–2.7). Treatment changed over time from 56% metronidazole only in January to 10% in December (Fig. 1). First-incident cases in the first quarter of 2018 were more likely to be treated with metronidazole only compared to those in the fourth quarter (RR, 2.76; 95% CI, 1.91–3.97). Conclusions: Preferential use of vancomycin for initial CDI episodes increased throughout 2018 but remained <100%. CDI episodes treated in the outpatient setting and nonrecurrent episodes were more likely to be treated with metronidazole only. Additional studies on persistent barriers to prescribing oral vancomycin, such as cost, are warranted.Funding: NoneDisclosures: Scott Fridkin reports that his spouse receives a consulting fee from the vaccine industry.

Epidemiology of Methicillin-ResistantStaphylococcus aureusBloodstream Coinfection Among Adults With Candidemia in Atlanta, GA, 2008–2012

2015 ◽  
Vol 36 (11) ◽  
pp. 1298-1304 ◽  
Author(s):  
Jessica Reno ◽  
Saumil Doshi ◽  
Amy K. Tunali ◽  
Betsy Stein ◽  
Monica M. Farley ◽  
...  
Keyword(s):  
Nursing Home ◽  
Medical Records ◽  
Odds Ratio ◽  
Nursing Home Residents ◽  
Population Based ◽  
Emerging Infections ◽  
Multivariate Logistic Regression ◽  
Factors Associated ◽  
Active Population ◽  
Invasive Infections

BACKGROUNDPatients with candidemia are at risk for other invasive infections, such as methicillin-resistantStaphylococcus aureus(MRSA) bloodstream infection (BSI).OBJECTIVETo identify the risk factors for, and outcomes of, BSI in adults withCandidaspp. and MRSA at the same time or nearly the same time.DESIGNPopulation-based cohort study.SETTINGMetropolitan Atlanta, March 1, 2008, through November 30, 2012.PATIENTSAll residents withCandidaspp. or MRSA isolated from blood.METHODSThe Georgia Emerging Infections Program conducts active, population-based surveillance for candidemia and invasive MRSA. Medical records for patients with incident candidemia were reviewed to identify cases of MRSA coinfection, defined as incident MRSA BSI 30 days before or after candidemia. Multivariate logistic regression was performed to identify factors associated with coinfection in patients with candidemia.RESULTSAmong 2,070 adult candidemia cases, 110 (5.3%) had coinfection within 30 days. Among these 110 coinfections, MRSA BSI usually preceded candidemia (60.9%; n=67) or occurred on the same day (20.0%; n=22). The incidence of coinfection per 100,000 population decreased from 1.12 to 0.53 between 2009 and 2012, paralleling the decreased incidence of all MRSA BSIs and candidemia. Thirty-day mortality was similarly high between coinfection cases and candidemia alone (45.2% vs 36.0%,P=.10). Only nursing home residence (odds ratio, 1.72 [95% CI, 1.03–2.86]) predicted coinfection.CONCLUSIONSA small but important proportion of patients with candidemia have MRSA coinfection, suggesting that heightened awareness is warranted after 1 major BSI pathogen is identified. Nursing home residents should be targeted in BSI prevention efforts.Infect. Control Hosp. Epidemiol.2015;36(11):1298–1304

scholarly journals Evaluation of Connecticut medical providers’ concordance with 2017 IDSA/SHEA Clostridioides difficile treatment guidelines in New Haven County, 2018–2019

2020 ◽  
pp. 1-8
Author(s):  
Casey Morgan Luc ◽  
Danyel Olson ◽  
David B. Banach ◽  
Paula Clogher ◽  
James Hadler
Keyword(s):  
Treatment Guidelines ◽  
Severe Disease ◽  
Recurrence Risk ◽  
Population Based ◽  
New Haven ◽  
Emerging Infections ◽  
Medical Providers ◽  
First Line ◽  
Clostridioides Difficile ◽  
Increased Risk

Abstract Objectives: To assess Connecticut medical providers’ concordance (2018–2019) with the 2017 Clostridioides difficile infection (CDI) treatment update by the Infectious Disease Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA). The effect of guideline concordance on CDI recurrence risk was also assessed. Design: Prospective, population-based study. Setting: New Haven County, Connecticut, from January 1, 2017, to December 31, 2019. Patients: CDI incident case (no positive tests in the prior 8 weeks), not limited by care setting. Methods: Using data from the Emerging Infections Program’s CDI surveillance, severity and concordance were defined. Presence of megacolon and/or ileus defined fulminant disease; absence defined nonsevere/severe disease. Using 2017 treatment as baseline, 2018–2019 concordance was defined as receiving the recommended first-line antibiotic (ie, vancomycin or fidaxomicin for adult patients, vancomycin or metronidazole for pediatric patients) for exactly 10 days. For all analyses, significance was P < .05. Results: Among 990 cases, concordance increased from 24.8% in 2018 to 37.0% in 2019. First-line antibiotic concordance increased from 61.2% in 2018 to 79.9% in 2019. Recurrence risk was significantly associated with patients aged ≥65 years and was highest for those aged 75–84 years, but this factor was not significantly associated with concordance. Conclusions: From 2018 through 2019, CDI treatment in New Haven County increasingly was concordant with the 2017 treatment update but remained low in 2019. Although concordance with treatment guidelines did not affect recurrence risk, close attention should be paid by medical providers to patients aged ≥65 years, specifically those aged 75–84 years because they are at an increased risk for recurrence.

scholarly journals 1761. Effect of Carbapenem-Resistant Enterobacteriaceae (CRE) Surveillance Case Definition Change on CRE Epidemiology—Selected US Sites, 2015–2016

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S61-S62
Author(s):  
Nadezhda Duffy ◽  
Sandra N Bulens ◽  
Hannah Reses ◽  
Maria S Karlsson ◽  
Uzma Ansari ◽  
...  
Keyword(s):  
Census Data ◽  
Clinical Laboratory ◽  
Population Based ◽  
Incidence Rates ◽  
Case Definition ◽  
Emerging Infections ◽  
Convenience Sample ◽  
Active Population ◽  
Carbapenem Resistant ◽  
Before And After

Abstract Background Carbapenem-resistant Enterobacteriacae (CRE) are an urgent US public health threat. CDC reported CRE incidence to be 2.93/100,000 population in 2012–2013 in selected sites but changed the CRE surveillance case definition in 2016 to improve sensitivity for detecting carbapenemase-producing (CP) CRE. We describe CRE epidemiology before and after the change. Methods Eight CDC Emerging Infections Program sites (CO, GA, MD, MN, NM, NY, OR, TN) conducted active, population-based CRE surveillance in selected counties. A case was defined as having an isolate of E. coli, Enterobacter, or Klebsiella meeting a susceptibility phenotype (figure) at a clinical laboratory from urine or a normally sterile body site in a surveillance area resident in a 30-day period. We collected data from medical records and defined cases as community-associated (CA) if no healthcare risk factors were documented. A convenience sample of isolates were tested for carbapenemase genes at CDC by real-time PCR. We calculated incidence rates (per 100,000 population) by using US Census data. Case epidemiology and the proportion of CP-CRE isolates in 2015 versus 2016 were compared. Results In total, 442 incident CRE cases were reported in 2015, and 1,149 cases were reported in 2016. Most isolates were cultured from urine: 87% in 2015 and 92% in 2016 (P &lt; .001). The crude overall pooled mean incidence in 2015 was 2.9 (range by site: 0.45–7.19) and in 2016 was 7.48 (range: 3.13–15.95). The most common CRE genus was Klebsiella (51%) in 2015, and in 2016 was Enterobacter (41%, P &lt; 0.001). Of the subset of CRE isolates tested at CDC, 109/227 (48%) were CP-CRE in 2015 and 109/551 (20%) were CP-CRE in 2016. In 2015, 52/442 (12%) of cases were CA CRE, and in 2016, 267/1,149 (23%) were CA CRE (P &lt; 0.001). In 2016, 3/111 (2.7%) of CA CRE isolates tested were CP-CRE. Conclusion A large increase in reported CRE incidence was observed after the change in the case definition. The new case definition includes a substantially larger number of Enterobacter cases. A decrease in CP-CRE prevalence appears to be driven by an increase in non-CP-CRE cases. Although CP-CRE in the community still appear to be rare, a substantial proportion of phenotypic CRE appear to be CA, and CDC is undertaking efforts to further investigate CA CRE, including CP-CRE. Disclosures G. Dumyati, Seres: Scientific Advisor, Consulting fee.

scholarly journals Genomic analysis of Clostridioides difficile in two regions reveals a diversity of strains and limited transmission

2020 ◽  
Vol 41 (S1) ◽  
pp. s237-s238
Author(s):  
Nicole Pecora ◽  
Stacy Holzbauer ◽  
Xiong Wang ◽  
Yu Gu ◽  
Trupti Hatwar ◽  
...  
Keyword(s):  
New York ◽  
Genomic Analysis ◽  
Illumina Miseq ◽  
The United States ◽  
Snp Analysis ◽  
Whole Genome ◽  
Emerging Infections ◽  
Clostridioides Difficile ◽  
Healthcare Associated ◽  
Incident Cases

Background: The epidemic NAP1/027 Clostridioides difficile strain (MLST1, ST1) that emerged in the mid-2000 is on the decline. The current distribution of C. difficile strain types and their transmission dynamics are poorly defined. We performed whole-genome sequencing (WGS) of C. difficile isolates in 2 regions to identify the predominant multilocus sequence types (MLSTs) in community- and healthcare-associated cases and potential transmission between cases using whole-genome single-nucleotide polymorphism (SNP) analysis. Methods: Isolates were collected through the CDC Emerging Infections Program population-based surveillance for C. difficile infections (CDI) for 3 months between 2016 and 2017 in 5 Minnesota counties and 1 New York county. Isolates were limited to incident cases (CDI in a county resident with no positive C. difficile test in the preceding 8 weeks). Cases were classified as healthcare associated (HA-CDI) or community associated (CA-CDI) based on healthcare exposures as previously described. WGS was performed on an Illumina Miseq. The CFSAN (FDA) pipeline was used to compute whole-genome SNPs, SPAdes was used for assembly, and MLST was assigned according to www.pubmlst.org. Results: Of 431 isolates, 269 originated from New York and 162 from Minnesota; 203 cases were classified as CA-CDI and 221 as HA-CDI. The proportion of CA-CDI cases was higher in Minnesota than in New York: 62% vs 38%. The predominant MLSTs across both sites were ST42 (9%), ST8 (8%), and ST2 (8%). MLSTs more frequently encountered in HA-CDI than CA-CDI included ST1 (note that this ST includes PCR Ribotype 027; 76% HA-CDI), ST53 (84% HA-CDI), and ST43 (80% HA-CDI). In contrast, ST110 (63% CA-CDI) and ST3 (67% CA-CDI) were more commonly isolated from CA-CDI cases. ST1 accounted for 7.6% of circulating strains and was more common in New York than Minnesota (10% vs 3%) and was concentrated among New York HA-CDI cases. Also, 412 isolates (1 per patient) were included in the final whole-genome SNP analysis. Of these, only 12 pairs were separated by 0–3 SNPs, indicating potential transmission, and most involved HA-CDI cases. ST1, ST17, and ST46 accounted for 8 of 12 pairs, with ST17 and ST46 potentially forming small clusters. Conclusions: This analysis provides a snapshot of the current genomic epidemiology of C. difficile across 2 geographically and epidemiologically distinct regions of the United States and supports other studies suggesting that the role of direct transmission in the spread of CDI may be limited.Funding: NoneDisclosures: None

scholarly journals 1162. Epidemiology of Carbapenem-Resistant Pseudomonas aeruginosa Identified Through the Emerging Infections Program (EIP), United States, 2016–2017

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S349-S350 ◽  
Author(s):  
Julian Grass ◽  
Sandra Bulens ◽  
Wendy Bamberg ◽  
Sarah J Janelle ◽  
Patrick Stendel ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Catchment Area ◽  
Clinical Laboratory ◽  
Population Based ◽  
Emerging Infections ◽  
Crude Incidence ◽  
Carbapenem Resistant ◽  
Incident Cases

Abstract Background Pseudomonas aeruginosa is intrinsically resistant to many commonly used antimicrobials and carbapenems are often required to treat infections. We describe the epidemiology and crude incidence of carbapenem-resistant P. aeruginosa(CRPA) in the EIP catchment area. Methods From August 1, 2016 through July 31, 2017, we conducted laboratory- and population-based surveillance for CRPA in selected metropolitan areas in Colorado, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, and Tennessee. We defined an incident case as the first isolate of P. aeruginosa-resistant to imipenem, meropenem, or doripenem from the lower respiratory tract, urine, wounds, or normally sterile sites identified from a resident of the EIP catchment area in a 30-day period. Patient charts were reviewed. A random sample of isolates was screened at CDC for carbapenemases using the modified carbapenem inactivation method (mCIM) and real-time PCR. Results During the 12-month period, we identified 3,042 incident cases among 2,154 patients. The crude incidence rate was 21.2 (95% CI, 20.4–21.9) per 100,000 persons and varied by site (range: 7.7 in Oregon to 31.1 in Maryland). The median age of patients was 64 years (range: &lt;1–101) and 41.2% were female. Nearly all (97.1%) had at least one underlying condition and 10.2% had cystic fibrosis (CF); 17.8% of cases were from CF patients. For most cases, isolates were from the lower respiratory tract (49.2%) or urine (35.3%) and occurred in patients with recent hospitalization (87.2%) or indwelling devices (70.3%); 8.7% died. At the clinical laboratory, 84.7% of isolates were susceptible to an aminoglycoside and 66.4% to ceftazidime or cefepime. Among the 391 isolates tested, nine (2.3%) were mCIM-positive; one had a carbapenemase detected by PCR (blaVIM-4). Conclusion The burden of CRPA varied by EIP site. Most cases occurred in persons with healthcare exposures and underlying conditions. The majority of isolates were susceptible to at least one first-line antimicrobial. Carbapenemase producers were rare; a more specific phenotypic definition would greatly facilitate surveillance for these isolates. Disclosures All authors: No reported disclosures.

Attributable costs and length of stay of hospital-acquired Clostridioides difficile: A population-based matched cohort study in Alberta, Canada

2019 ◽  
Vol 40 (10) ◽  
pp. 1135-1143 ◽  
Author(s):  
Jenine R. Leal ◽  
John Conly ◽  
Robert Weaver ◽  
James Wick ◽  
Elizabeth A. Henderson ◽  
...  
Keyword(s):  
Cohort Study ◽  
Length Of Stay ◽  
Propensity Score ◽  
Length Of Hospital Stay ◽  
Population Based ◽  
Matched Cohort ◽  
Matched Cohort Study ◽  
Clostridioides Difficile ◽  
Hospital Acquired ◽  
Incident Cases

AbstractObjective:To determine the attributable cost and length of stay of hospital-acquired Clostridioides difficile infection (HA-CDI) from the healthcare payer perspective using linked clinical, administrative, and microcosting data.Design:A retrospective, population-based, propensity-score–matched cohort study.Setting:Acute-care facilities in Alberta, Canada.Patients:Admitted adult (≥18 years) patients with incident HA-CDI and without CDI between April 1, 2012, and March 31, 2016.Methods:Incident cases of HA-CDI were identified using a clinical surveillance definition. Cases were matched to noncases of CDI (those without a positive C. difficile test or without clinical CDI) on propensity score and exposure time. The outcomes were attributable costs and length of stay of the hospitalization where the CDI was identified. Costs were expressed in 2018 Canadian dollars.Results:Of the 2,916 HA-CDI cases at facilities with microcosting data available, 98.4% were matched to 13,024 noncases of CDI. The total adjusted cost among HA-CDI cases was 27% greater than noncases of CDI (ratio, 1.27; 95% confidence interval [CI], 1.21–1.33). The mean attributable cost was $18,386 (CAD 2018; USD $14,190; 95% CI, $14,312–$22,460; USD $11,046-$17,334). The adjusted length of stay among HA-CDI cases was 13% greater than for noncases of CDI (ratio, 1.13; 95% CI, 1.07–1.19), which corresponds to an extra 5.6 days (95% CI, 3.10–8.06) in length of hospital stay per HA-CDI case.Conclusions:In this population-based, propensity score matched analysis using microcosting data, HA-CDI was associated with substantial attributable cost.

scholarly journals Evaluating Facility Characteristics and Connectivity Metrics as Predictors of Clostridioides difficile Rates in Nursing Homes, Atlanta, GA

2020 ◽  
Vol 41 (S1) ◽  
pp. s35-s36
Author(s):  
Samantha Sefton ◽  
Dana Goodenough ◽  
Sahebi Saiyed ◽  
Scott Fridkin
Keyword(s):  
Negative Binomial ◽  
Average Length ◽  
Incidence Rates ◽  
Inverse Association ◽  
Emerging Infections ◽  
Residual Variability ◽  
Healthcare Network ◽  
Clostridioides Difficile ◽  
Specimen Collection ◽  
Incident Cases

Background: Nursing home (NH) residents are at high risk for Clostridioides difficile infection (CDI) due to older age, frequent antibiotic exposure, and previous healthcare exposure. Incidence of CDI attributed to NHs is not well established, but it is hypothesized to be related to the magnitude of transfers. We evaluated the relationship between NH CDI incidence and facility characteristics to explain variability in rates in Atlanta, Georgia. Methods: Incident C. difficile cases from 2016 to 2018 were identified through the Georgia Emerging Infections Program (funded by the Centers for Disease Control and Prevention), which conducts active population-based surveillance in the 8-county metro Atlanta area. An incident case was defined as an NH resident with a toxin-positive stool specimen (without a positive test within 8 weeks). Sampled (1 to 3 on age and gender) incident cases were attributed to a NH if a patient was an NH resident within 4 days of specimen collection. Facility characteristics (beds, resident days, admissions, and average length of stay [ALOS]) were obtained from NH cost reports, and facility-specific connectivity metrics were calculated (indegree and betweenness) from 2016 Medicare claims data. Case counts were aggregated to estimate yearly incidence and correlated with facility characteristics and location within the healthcare network using the Spearman correlation. A negative binomial model was used to assess residual variability in NH CDI incidence. Results: In total, 386 incident CDI cases were attributed to 64 NHs (range, 0–27). Approximately half (54.7%) resided in the NH at the time of specimen collection; however, 33.7% were in inpatient units (≤4 days of admission), and 10.9% were in an emergency room (ER). The frequency of NH CDI cases correlated strongly with admissions (r = .70; P < .01), inversely with ALOS (r = −0.53; P < .01), and moderately with resident days (r = .38; P < .01). After accounting for admissions, incidence (per 1,000 admissions) still varied (Fig. 1) (median 14; range, 0–34). The inverse association with ALOS decreased and incidence no longer correlated with the remaining facility characteristics or location within the healthcare transfer network (P > .05, all comparisons). However, there was residual correlation with connectivity metrics (indegree r = 0.26; P = .04). Conclusions: Our data suggest that attributing CDI to NHs requires the inclusion of hospital and ER-based specimen collection. NH CDI incidence appears highest among facilities with a low ALOS and a high number of admissions; incidence rates calculated per 1,000 admissions may best account for infection risk inherent early in a resident’s stay. Residual variability attributed to connectivity to the healthcare network was of borderline significance and should be further explored in the NH setting.Funding: NoneDisclosures: Scott Fridkin, consulting fee, vaccine industry (spouse)

scholarly journals Reductions in Positive Clostridioides difficile Events Reportable to NHSN With Adoption of Reflex EIA Testing in 13 Atlanta Hospitals

2020 ◽  
Vol 41 (S1) ◽  
pp. s47-s48
Author(s):  
Dana Goodenough ◽  
Samantha Sefton ◽  
Elizabeth Smith ◽  
Colleen Kraft ◽  
Jay Varkey ◽  
...  
Keyword(s):  
Population Based ◽  
Performance Measure ◽  
Test Method ◽  
Nucleic Acid Amplification ◽  
Test Results ◽  
Emerging Infections ◽  
Percent Reduction ◽  
Clostridioides Difficile ◽  
Reflex Testing ◽  
The Impact

Background: US hospitals are required to report C. difficile infections (CDIs) to the NHSN as a performance measure tied to payment penalties for poor scores. Currently, only the charted CDI test results performed last in reflex testing scenarios are reported to the NHSN (CDI events). We describe the reduction in NHSN CDI events from the addition of a reflex toxin enzyme immunoassay (EIA) after a positive nucleic acid amplification test (NAAT) in teaching and nonteaching hospitals, and we estimate the impact on standardized infection ratios (SIR). Methods: Reporting of all CDI test results, by test method, occurred during April 2018–July 2019 to the Georgia Emerging Infections program (funded by the Centers for Disease Control and Prevention), which conducts active population-based surveillance in an 8-county Atlanta area (population, 4 million). Among facilities starting reflex EIA testing, results were aggregated by test method during months of reflex testing to calculate facility-specific reduction in NHSN CDI events (% reduction; 1-[no. EIA+/no. NAAT+]). Differences in percent reduction between facilities by characteristic were compared using the Kruskal-Wallis test. We simulated expected changes in the SIR for a range of reductions, assuming equal effect on both community-onset (CO) and hospital-onset (HO) tests. Each facility’s historical NHSN CDI events prior to reflex testing were used to estimate changes to facility-specific SIRs by reducing values by the corresponding facility’s percent reduction. Results: Overall, 13 acute-care hospitals (bed size, 52–633; ICU bed size, 6–105) started reflex testing during the study period (mean, 7 months, 15,800 admissions, 66,400 patient days), resulting in 550 +NAAT tests reflexing to 180 +EIA tests (pooled mean 58% reduction). Percent reduction varied (mean, 67%; range, 42%–81%) but did not differ between larger (≥217 beds) and smaller hospitals (61 vs 50% reduction; P > .05) or by outsourced versus inhouse testing (65% vs 54% reduction; P > .05). Simulations identified a threshold reduction at which point effect on HO counteract the effects on CO events enough to reduce the SIR; thresholds for nonteaching and teaching were 26% and 32% reduction, respectively (Fig. 1). The estimated reductions in facility-specific SIRs using measured percent reductions on historic NHSN CDI events closely paralleled the simulation, and the mean estimated change in SIR was −46% (range, −12% to −71%) (Fig. 1). Conclusions: Although the magnitude of the effect varied, all 13 facilities experienced dramatic reductions in CDI events reportable to NHSN due to reflex testing; applying these reductions to historical NHSN data illustrates anticipated reductions in their facility-specific SIRs due to this testing change.Funding: NoneDisclosures: Scott Fridkin, consulting fee, vaccine industry (various) (spouse)

Ethnic Differences in Self-Poisoning Across South London

Crisis ◽  
2014 ◽  
Vol 35 (4) ◽  
pp. 268-272
Author(s):  
Sean Cross ◽  
Dinesh Bhugra ◽  
Paul I. Dargan ◽  
David M. Wood ◽  
Shaun L. Greene ◽  
...  
Keyword(s):  
Black Women ◽  
Data Collection ◽  
White Women ◽  
Population Based ◽  
Care Services ◽  
Self Harm ◽  
Managing Risk ◽  
The Uk ◽  
Incident Cases ◽  
Minority Ethnic

Background: Self-poisoning (overdose) is the commonest form of self-harm cases presenting to acute secondary care services in the UK, where there has been limited investigation of self-harm in black and minority ethnic communities. London has the UK’s most ethnically diverse areas but presents challenges in resident-based data collection due to the large number of hospitals. Aims: To investigate the rates and characteristics of self-poisoning presentations in two central London boroughs. Method: All incident cases of self-poisoning presentations of residents of Lambeth and Southwark were identified over a 12-month period through comprehensive acute and mental health trust data collection systems at multiple hospitals. Analysis was done using STATA 12.1. Results: A rate of 121.4/100,000 was recorded across a population of more than half a million residents. Women exceeded men in all measured ethnic groups. Black women presented 1.5 times more than white women. Gender ratios within ethnicities were marked. Among those aged younger than 24 years, black women were almost 7 times more likely to present than black men were. Conclusion: Self-poisoning is the commonest form of self-harm presentation to UK hospitals but population-based rates are rare. These results have implications for formulating and managing risk in clinical services for both minority ethnic women and men.

Sign in / Sign up

Export Citation Format

Share Document