Translating Evidence into Practice Using a Systems Engineering Framework for Infection Prevention

2014 ◽  
Vol 35 (9) ◽  
pp. 1176-1182 ◽  
Author(s):  
Eric Yanke ◽  
Pascale Carayon ◽  
Nasia Safdar
Keyword(s):  
Systems Engineering ◽  
Infection Prevention ◽  
The United States ◽  
Multidrug Resistant ◽  
Recent Analysis ◽  
Emerging Pathogens ◽  
The Us ◽  
Significant Burden ◽  
Current Infection ◽  
Healthcare Associated

The current infection prevention era is defined by the rise of healthcare-associated infections (HAIs) and multidrug-resistant organisms (MDROs). Efforts to combat these and other emerging pathogens have resulted in rapid and ongoing evolution of the contemporary infection prevention environment. Currently, HAIs impose a significant burden on the US healthcare system. Recent analysis of National Healthcare Safety Network data from the early 2000s suggests that at least 1.7 million HAIs occur yearly in US hospitals, associated with at least 99,000 deaths. These numbers have likely increased over the past decade and suggest that HAIs are among the leading causes of death in the United States.

scholarly journals Carbapenem-Resistant Acinetobacter baumannii in US hospitals: diversification of circulating lineages and antimicrobial resistance

2021 ◽  
Author(s):  
Alina Vladimirovna Iovleva ◽  
Mustapha M Mustapha ◽  
Marissa P Griffith ◽  
Lauren Komarow ◽  
Courtney Luterbach ◽  
...  
Keyword(s):  
Molecular Epidemiology ◽  
Acinetobacter Baumannii ◽  
The United States ◽  
Drug Susceptibility ◽  
Multidrug Resistant ◽  
Carbapenem Resistant ◽  
Vulnerable Patients ◽  
The Us ◽  
Hospital Systems ◽  
Healthcare Associated

Carbapenem-resistant Acinetobacter baumannii (CRAb) are a major cause of healthcare-associated infections. CRAb are typically multidrug-resistant and infection is difficult to treat. Despite the urgent threat that CRAb pose, few systematic studies of CRAb clinical and molecular epidemiology have been conducted. The Study Network of Acinetobacter as a Carbapenem-Resistant Pathogen (SNAP) is designed to investigate the clinical characteristics and contemporary population structure of CRAb circulating in US hospital systems using whole genome sequencing (WGS). Analysis of the initial 120 SNAP patients from four US centers revealed that CRAb remain a significant threat to hospitalized patients, affecting the most vulnerable patients and resulting in 24% all-cause 30-day mortality. The majority of currently circulating isolates belonged to ST2Pas, a part of Clonal Complex 2 (CC2), which is the dominant drug-resistant lineage in the United States and Europe. We identified three distinct sub-lineages within CC2, which differed in their antibiotic resistance phenotypes and geographic distribution. Most concerning, colistin resistance (38%) and cefiderocol (10%) resistance were common within CC2 sub-lineage C (CC2C), where the majority of isolates belonged to ST2Pas/ST281Ox. Additionally, we identified a newly emergent lineage, ST499Pas that was the most common non-CC2 lineage in our study and had a more favorable drug susceptibility profile compared to CC2. Our findings suggest a shift within the CRAb population in the US during the past 10 years, and emphasize the importance of real-time surveillance and molecular epidemiology in studying CRAb dissemination and clinical impact.

scholarly journals 130. increase in Multidrug Resistance (2011–2018) and the Emergence of Extensive Drug Resistance (2020) in shigella Sonnei in the United States

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S195-S195
Author(s):  
Naeemah Z Logan ◽  
Beth E Karp ◽  
Kaitlin A Tagg ◽  
Claire Burns-Lynch ◽  
Jessica Chen ◽  
...  
Keyword(s):  
United States ◽  
Multidrug Resistance ◽  
Disease Surveillance ◽  
Sequence Data ◽  
The United States ◽  
Multidrug Resistant ◽  
Shigella Sonnei ◽  
Short Read ◽  
Men 2 ◽  
The Us

Abstract Background Multidrug-resistant (MDR) Shigella sonnei infections are a serious public health threat, and outbreaks are common among men who have sex with men (MSM). In February 2020, Australia’s Department of Health notified CDC of extensively drug-resistant (XDR) S. sonnei in 2 Australian residents linked to a cruise that departed from Florida. We describe an international outbreak of XDR S. sonnei and report on trends in MDR among S. sonnei in the United States. Methods Health departments (HDs) submit every 20th Shigella isolate to CDC’s National Antimicrobial Resistance Monitoring System (NARMS) laboratory for susceptibility testing. We defined MDR as decreased susceptibility to azithromycin (MIC ≥32 µg/mL) with resistance to ampicillin, ciprofloxacin, and cotrimoxazole, and XDR as MDR with additional resistance to ceftriaxone. We used PulseNet, the national subtyping network for enteric disease surveillance, to identify US isolates related to the Australian XDR isolates by short-read whole genome sequencing. We screened these isolates for resistance determinants (ResFinder v3.0) and plasmid replicons (PlasmidFinder) and obtained patient histories from HDs. We used long-read sequencing to generate closed plasmid sequences for 2 XDR isolates. Results NARMS tested 2,781 S. sonnei surveillance isolates during 2011–2018; 80 (2.9%) were MDR, including 1 (0.04%) that was XDR. MDR isolates were from men (87%), women (9%), and children (4%). MDR increased from 0% in 2011 to 15.3% in 2018 (Figure). In 2020, we identified XDR isolates from 3 US residents on the same cruise as the Australians. The US residents were 41–42 year-old men; 2 with available information were MSM. The US and Australian isolates were highly related (0–1 alleles). Short-read sequence data from all 3 US isolates mapped to the blaCTX-M-27 harboring IncFII plasmids from the 2 Australian isolates with >99% nucleotide identity. blaCTX-M-27 genes confer ceftriaxone resistance. Increase in Percentage of Shigella sonnei Isolates with Multidrug Resistance* in the United States, 2011–2018† Conclusion MDR S. sonnei is increasing and is most often identified among men. XDR S. sonnei infections are emerging and are resistant to all recommended antibiotics, making them difficult to treat without IV antibiotics. This outbreak illustrates the alarming capacity for XDR S. sonnei to disseminate globally among at-risk populations, such as MSM. Disclosures All Authors: No reported disclosures

scholarly journals National Scientific Funding for Interdisciplinary Research: A Comparison Study of Infectious Diseases in the US and EU

2019 ◽  
Vol 11 (15) ◽  
pp. 4120 ◽  
Author(s):  
Heo ◽  
Kang ◽  
Kim
Keyword(s):  
Infectious Diseases ◽  
Interdisciplinary Approach ◽  
The United States ◽  
Research Trends ◽  
Scientometric Analysis ◽  
The European Union ◽  
Emerging Pathogens ◽  
Network Analyses ◽  
The Us ◽  
Project Data

Infectious diseases have been continuously and increasingly threatening human health and welfare due to a variety of factors such as globalisation, environmental, demographic changes, and emerging pathogens. In order to establish an interdisciplinary approach for coordinating R&D via funding, it is imperative to discover research trends in the field. In this paper, we apply machine learning methodologies and network analyses to understand how the European Union (EU) and the United States (US) have invested their funding in infectious diseases research utilising an interdisciplinary approach. The purpose of this paper is to use public R&D project data as data and to grasp the research trends of epidemic diseases in the US and EU through scientometric analysis.

Panton-Valentine Leukocidin-Positive Methicillin-Resistant Staphylococcus Aureus with Reduced Vancomycin Susceptibility: An Emerging Trend?

2020 ◽  
Vol 3 (4) ◽  
pp. 165-181
Author(s):  
Tatsuo Yamamoto ◽  
Olga E. Khokhlova ◽  
Tsai-Wen Wan ◽  
Darya N. Akhusheva ◽  
Ivan V Reva ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
The United States ◽  
Multidrug Resistant ◽  
Virus Infections ◽  
Methicillin Resistant ◽  
Invasive Infections ◽  
Spread Factor ◽  
Healthcare Associated ◽  
Panton Valentine Leukocidin ◽  
Valentine Leukocidin

AbstractMethicillin-resistant Staphylococcus aureus (MRSA) is a major multidrug-resistant nosocomial pathogen. This class of MRSA, first reported in the early 1960s and now termed healthcare-associated MRSA (HA-MRSA), was followed by a newer class of MRSA, community-associated MRSA (CA-MRSA). The unique feature of the initial CAMRSA included Panton-Valentine leukocidin (PVL), an abscess-associated toxin and also S. aureus spread factor. CA-MRSA usually causes skin and soft-tissue infections, but occasionally causes invasive infections, including (necrotizing) pneumonia, sometimes preceded by respiratory virus infections. The most successful CA-MRSA USA300 (ST8/SCCmecIVa) caused an epidemic in the United States. In Russia, we first detected PVL-positive CAMRSA (ST30/SCCmecIVc) in Vladivostok in 2006, but with no more PVL-positive MRSA isolation. However, we recently isolated four lineages of PVL-positive MRSA in Krasnoyarsk. Regarding chemotherapy against invasive MRSA infections, vancomycin still remains a gold standard, in addition to some other anti-MRSA agents such as teicoplanin, linezolid, and daptomycin. For resistance, vancomycin-resistant MRSA (VRSA) with MICs of ≥16 μg/mL appeared in patients, but cases are still limited. However, clinically, infections from strains with MICs of ≥1.5 μg/mL, even albeit with susceptible MICs (≤2 μg/mL), respond poorly to vancomycin. Some of those bacteria have been bacteriologically characterized as vancomycin-intermediate S. aureus (VISA) and heterogeneous VISA (hVISA), generally with HA-MRSA genetic backgrounds. The features of the above PVL-positive Krasnoyarsk MRSA include reduced susceptibility to vancomycin, which meets the criteria of hVISA. In this review, we discuss a possible new trend of PVL-positive hVISA, which may spread and threaten human health in community settings.

Infections due to Clostridium Difficile

2021 ◽  
Author(s):  
Marcia B Goldberg ◽  
Molly Paras ◽  
K.C Coffey
Keyword(s):  
Clostridium Difficile ◽  
Disease Process ◽  
The United States ◽  
Healthcare Associated Infection ◽  
Therapeutic Guidelines ◽  
Common Causes ◽  
Control And Prevention ◽  
Current Infection ◽  
Healthcare Associated ◽  
Healthcare Epidemiology

Clostridium difficile is one of the most common causes of healthcare associated infection in the United States. Despite significant attention and resources, national rates increased dramatically between 2000-2011 and have only started to decline in the last five years.. The Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) updated their clinical practice guidelines on the diagnosis and management of C. difficile disease in 2017. The recommended changes in therapeutic guidelines, recommendations for pediatric patient populations, and overview of available diagnostics are described herein. Additionally, this review discusses the changing epidemiology, examines the pathophysiology of the disease process, and outlines current infection control and prevention strategies.  This review has 6 figures and 9 tables. Key Words: Clostridium difficile, diarrhea, colitis, antibiotics, spores, nosocomial, hospital

scholarly journals A Multicenter Longitudinal Study of Hospital-Onset Bacteremia: Time for a New Quality Outcome Measure?

2015 ◽  
Vol 37 (2) ◽  
pp. 143-148 ◽  
Author(s):  
Clare Rock ◽  
Kerri A. Thom ◽  
Anthony D. Harris ◽  
Shanahan Li ◽  
Daniel Morgan ◽  
...  
Keyword(s):  
Infection Prevention ◽  
Outcome Measure ◽  
The United States ◽  
Central Line ◽  
Healthcare Associated Infection ◽  
Interrater Variability ◽  
Important Quality ◽  
Healthcare Associated ◽  
Quality Assessments ◽  
Clabsi Rate

BACKGROUNDCentral-line–associated bloodstream infection (CLABSI) rate is an important quality measure, but it suffers from subjectivity and interrater variability, and decreasing national CLABSI rates may compromise its power to discriminate between hospitals. This study evaluates hospital-onset bacteremia (HOB, ie, any positive blood culture obtained 48 hours post admission) as a healthcare-associated infection–related outcome measure by assessing the association between HOB and CLABSI rates and comparing the power of each to discriminate quality among intensive care units (ICUs).METHODSIn this multicenter study, ICUs provided monthly CLABSI and HOB rates for 2012 and 2013. A Poisson regression model was used to assess the association between these 2 rates. We compared the power of each measure to discriminate between ICUs using standardized infection ratios (SIRs) with 95% confidence intervals (CIs). A measure was defined as having greater power to discriminate if more of the SIRs (with surrounding CIs) were different from 1.RESULTSIn 80 ICUs from 16 hospitals in the United States and Canada, a total of 663 CLABSIs, 475,420 central line days, 11,280 HOBs, and 966,757 patient days were reported. An absolute change in HOB of 1 per 1,000 patient days was associated with a 2.5% change in CLABSI rate (P<.001). Among the 80 ICUs, 20 (25%) had a CLABSI SIR and 60 (75%) had an HOB SIR that was different from 1 (P<.001).CONCLUSIONChange in HOB rate is strongly associated with change in CLABSI rate and has greater power to discriminate between ICU performances. Consideration should be given to using HOB to replace CLABSI as an outcome measure in infection prevention quality assessments.Infect. Control Hosp. Epidemiol. 2016;37(2):143–148

Costs and Mortality Associated With Multidrug-Resistant Healthcare-Associated Acinetobacter Infections

2016 ◽  
Vol 37 (10) ◽  
pp. 1212-1218 ◽  
Author(s):  
Richard E. Nelson ◽  
Marin L. Schweizer ◽  
Eli N. Perencevich ◽  
Scott D. Nelson ◽  
Karim Khader ◽  
...  
Keyword(s):  
United States ◽  
Incidence Rate ◽  
Cumulative Incidence ◽  
The United States ◽  
Multidrug Resistant ◽  
Risk Of Mortality ◽  
Payer Perspective ◽  
Using Data ◽  
Healthcare Associated ◽  
The Cost

BACKGROUNDOur objective was to estimate the per-infection and cumulative mortality and cost burden of multidrug-resistant (MDR) Acinetobacter healthcare-associated infections (HAIs) in the United States using data from published studies.METHODSWe identified studies that estimated the excess cost, length of stay (LOS), or mortality attributable to MDR Acinetobacter HAIs. We generated estimates of the cost per HAI using 3 methods: (1) overall cost estimates, (2) multiplying LOS estimates by a cost per inpatient-day ($4,350) from the payer perspective, and (3) multiplying LOS estimates by a cost per inpatient-day from the hospital ($2,030) perspective. We deflated our estimates for time-dependent bias using an adjustment factor derived from studies that estimated attributable LOS using both time-fixed methods and either multistate models (70.4% decrease) or matching patients with and without HAIs using the timing of infection (47.4% decrease). Finally, we used the incidence rate of MDR Acinetobacter HAIs to generate cumulative incidence, cost, and mortality associated with these infections.RESULTSOur estimates of the cost per infection were $129,917 (method 1), $72,025 (method 2), and $33,510 (method 3). The pooled relative risk of mortality was 4.51 (95% CI, 1.10–32.65), which yielded a mortality rate of 10.6% (95% CI, 2.5%–29.4%). With an incidence rate of 0.141 (95% CI, 0.136–0.161) per 1,000 patient-days at risk, we estimated an annual cumulative incidence of 12,524 (95% CI, 11,509–13,625) in the United States.CONCLUSIONThe estimates presented here are relevant to understanding the expenditures and lives that could be saved by preventing MDR Acinetobacter HAIs.Infect Control Hosp Epidemiol 2016;1–7

scholarly journals Status Update on Infection Prevention and Control at Deployed Medical Treatment Facilities

2019 ◽  
Vol 185 (3-4) ◽  
pp. 451-460
Author(s):  
Alice E Barsoumian ◽  
Steffanie L Solberg ◽  
Ashley S Hanhurst ◽  
Amanda L Roth ◽  
Tamara S Funari ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Prevention And Control ◽  
Infection Prevention ◽  
Multidrug Resistant ◽  
Infection Prevention And Control ◽  
Targeted Interventions ◽  
Multidrug Resistant Organisms ◽  
Treatment Facilities ◽  
Healthcare Associated ◽  
And Control

Abstract Introduction Infections with multidrug resistant organisms that spread through nosocomial transmission complicate the care of combat casualties. Missions conducted to review infection prevention and control (IPC) practices at deployed medical treatment facilities (MTFs) previously showed gaps in best practices and saw success with targeted interventions. An IPC review has not been conducted since 2012. Recently, an IPC review was requested in response to an outbreak of multidrug resistant organisms at a deployed facility. Materials and Methods A Joint Service team conducted onsite IPC reviews of MTFs in the U.S. Central Command area of operations. Self-assessments were completed by MTF personnel in anticipation of the onsite assessment, and feedback was given individually and at monthly IPC working group teleconferences. Goals of the onsite review were to assist MTF teams in conducting assessments, review practices for challenges and successes, provide on the spot education or risk mitigation, and identify common trends requiring system-wide action. Results Nine deployed MTFs participated in the onsite assessments, including four Role 3, three Role 2 capable of surgical support, and two Role 1 facilities. Seventy-eight percent of sites had assigned IPC officers although only 43% underwent required predeployment training. Hand hygiene and healthcare associated infection prevention bundles were monitored at 67% and 29% of MTFs, respectively. Several challenges including variability in practices with turnover of deployed teams were noted. Successes highlighted included individual team improvements in healthcare associated infections and mentorship of untrained personnel. Conclusions Despite successes, ongoing challenges with optimal deployed IPC were noted. Recommendations for improvement include strengthening IPC culture, accountability, predeployment training, and stateside support for deployed IPC assets. Variability in IPC practices may occur from rotation to rotation, and regular reassessment is required to ensure that successes are sustained through times of turnover.

scholarly journals 1670. Access to Antibiotics Without Prescription for Travelers and Colombian Citizens at Community Pharmacies in Bogotá, Colombia: A Cross-Sectional Study

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S611-S611
Author(s):  
Marie Kasbaum ◽  
Catalina V Lizarraga ◽  
Alejandro De la Hoz ◽  
Jinnethe Reyes ◽  
Cesar A Arias
Keyword(s):  
The United States ◽  
Multidrug Resistant ◽  
Cross Sectional Study ◽  
Community Pharmacies ◽  
Prescription Data ◽  
Sectional Study ◽  
Cross Sectional ◽  
The Us ◽  
Rapid Dissemination ◽  
International Visitors

Abstract Background Antimicrobial-resistant pathogens often emerge in communities where antibiotics are frequently sold without prescriptions. In Colombia, nonprescription sale of antibiotics still occurs despite national regulations. Use of antimicrobials in international travelers has been linked to the rapid dissemination of multidrug-resistant pathogens around the globe. Despite the exponential increase of international visitors to Colombia recently, there is a notable lack of studies investigating the accessibility of antibiotics to foreign travelers without prescriptions in Colombian pharmacies. Methods This cross-sectional study compares the access to antibiotics without prescription in community pharmacies between travelers from the United States and local Colombian citizens in Bogotá. Both groups visited 91 pharmacies and conducted trials as covert simulated clients (SCs). The SCs followed a standardized script when interacting with pharmacy personnel, acting as though they were seeking antibiotics for moderate Traveler’s Diarrhea (TD), without a prescription. Data were gathered on the employees’ responses, including the level of “prompting” needed for an employee to offer antibiotics, reasons given to the SCs for refusing to sell antibiotics if no sale was offered, and generic brand of compounds offered. Results Antibiotics were offered to the US travelers in 62 (68.13%) pharmacies, and to the Colombian group in 57 (62.64%) pharmacies. The traveler group was significantly more likely than the comparator group to be offered antibiotics without any prompting (P = 0.003). When pharmacy employees refused to sell antibiotics during trials, the traveler group was significantly more likely to be given a clinical reason not to receive antibiotics. Refusal to Colombian citizens was more frequently due legal reasons (P < 0.001). Conclusion Antibiotics were accessible without prescriptions at similarly high frequencies, regardless of the customers’ nationality. The US travelers were more likely than the Colombian group to be offered antibiotics without needing to prompt the pharmacist. Additionally, pharmacists were much more likely to deny antibiotics to the Colombian group due to legal reasons, as opposed to clinical reasons for US travelers. Disclosures All authors: No reported disclosures.

scholarly journals Epidemiology of community-acquired and recurrent Clostridioides difficile infection

2021 ◽  
Vol 14 ◽  
pp. 175628482110162
Author(s):  
Yichun Fu ◽  
Yuying Luo ◽  
Ari M Grinspan
Keyword(s):  
Large Scale ◽  
Infection Prevention ◽  
The United States ◽  
Future Research ◽  
Clostridioides Difficile ◽  
Epidemiologic Surveillance ◽  
Scale Population ◽  
Clostridioides Difficile Infection ◽  
Healthcare Associated ◽  
Hospital Acquired

Clostridioides difficile infection is a leading cause of healthcare-associated infections with significant morbidity and mortality. For the past decade, the bulk of infection prevention and epidemiologic surveillance efforts have been directed toward mitigating hospital-acquired C. difficile. However, the incidence of community-associated infection is on the rise. Patients with community-associated C. difficile tend to be younger and have lower mortality rate. Rates of recurrent C. difficile infection overall have decreased in the United States, but future research and public health endeavors are needed to standardize and improve disease detection, stratify risk factors in large-scale population studies, and to identify regional and local variations in strain types, reservoirs and transmission routes to help characterize and combat the changing epidemiology of C. difficile.

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