scholarly journals Uptake of Antibiotic Stewardship Programs in US Acute Care Hospitals: Findings From the 2015 National Healthcare Safety Network Annual Hospital Survey

2017 ◽  
Vol 65 (10) ◽  
pp. 1748-1750 ◽  
Author(s):  
Erin N O’Leary ◽  
Katharina L van Santen ◽  
Amy K Webb ◽  
Daniel A Pollock ◽  
Jonathan R Edwards ◽  
...  
Keyword(s):  
Acute Care ◽  
Antibiotic Stewardship ◽  
Acute Care Hospitals ◽  
National Healthcare ◽  
National Healthcare Safety Network

scholarly journals Antibiotic Stewardship Programs in U.S. Acute Care Hospitals: Findings From the 2014 National Healthcare Safety Network Annual Hospital Survey

2016 ◽  
Vol 63 (4) ◽  
pp. 443-449 ◽  
Author(s):  
Lori A. Pollack ◽  
Katharina L. van Santen ◽  
Lindsey M. Weiner ◽  
Margaret A. Dudeck ◽  
Jonathan R. Edwards ◽  
...  
Keyword(s):  
Acute Care ◽  
Antibiotic Stewardship ◽  
Acute Care Hospitals ◽  
National Healthcare ◽  
National Healthcare Safety Network

scholarly journals Antibiotic Multidrug Resistance of Escherichia coli Causing Device- and Procedure-related Infections in the United States Reported to the National Healthcare Safety Network, 2013–2017

2020 ◽  
Author(s):  
Athena P Kourtis ◽  
Edward A Sheriff ◽  
Lindsey M Weiner-Lastinger ◽  
Kim Elmore ◽  
Leigh Ellyn Preston ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Multidrug Resistance ◽  
Acute Care ◽  
Acute Care Hospitals ◽  
The United States ◽  
E Coli ◽  
National Healthcare ◽  
National Healthcare Safety Network ◽  
Hospital Referral

Abstract Background Escherichia coli is one of the most common causes of healthcare-associated infections (HAIs); multidrug resistance reduces available options for antibiotic treatment. We examined factors associated with the spread of multidrug-resistant E. coli phenotypes responsible for device- and procedure-related HAIs from acute care hospitals, long-term acute care hospitals, and inpatient rehabilitation facilities, using isolate and antimicrobial susceptibility data reported to the National Healthcare Safety Network during 2013–2017. Methods We used multivariable logistic regression to examine associations between co-resistant phenotypes, patient and healthcare facility characteristics, and time. We also examined the geographic distribution of co-resistant phenotypes each year by state and by hospital referral region to identify hot spots. Results A total of 96 672 E. coli isolates were included. Patient median age was 62 years, and 60% were female; more than half (54%) were reported from catheter-associated urinary tract infections. From 2013 to 2017, 35% of the isolates were nonsusceptible to fluoroquinolones (FQs), 17% to extended-spectrum cephalosporins (ESCs), and 13% to both ESCs and FQs. The proportion of isolates co-resistant to ESCs and FQs was higher in 2017 (14%) than in 2013 (11%) (P < .0001); overall prevalence and increases were heterogeneously distributed across healthcare referral regions. Co-resistance to FQs and ESCs was independently associated with male sex, central line–associated bloodstream infections, long-term acute care hospitals, and the 2016–2017 (vs 2013–2014) reporting period. Conclusions Multidrug resistance among E. coli causing device- and procedure-related HAIs has increased in the United States. FQ and ESC co-resistant strains appear to be spreading heterogeneously across hospital referral regions.

scholarly journals 1153. National Trend of Urinary Catheter Device Utilization by Hospital Type, National Healthcare Safety Network (2015–2019)

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S411-S412
Author(s):  
Minn M Soe
Keyword(s):  
Acute Care ◽  
Negative Binomial ◽  
Urinary Catheter ◽  
Inpatient Rehabilitation ◽  
Acute Care Hospitals ◽  
Equation Modeling ◽  
Quality Reporting ◽  
Factors Associated ◽  
National Healthcare ◽  
National Healthcare Safety Network

Abstract Background Reducing unnecessary urinary catheter use and optimizing insertion techniques and catheter maintenance and care practices are the most important urinary tract infection (CAUTI) prevention strategies. To monitor device use (DU) as quality improvement activity, the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN) developed the risk adjusted, standardized urinary catheter device utilization ratio in 2015. This study aims to assess national trends of DU from the baseline year 2015 through 2019. Methods For our trend analysis, we analyzed DU data (catheter days per 100 inpatient-days) that acute care hospitals (ACHs), long-term acute care hospitals (LTACHs), inpatient rehabilitation facilities (IRFs), and critical access hospitals (CAHs) reported to NHSN from 2015Q1 through 2019Q1. The ward and intensive care unit patient care locations included in our analysis are those that ACHs, LTACHs, IRFs and CAHs are required to report to CMS to comply with CMS Inpatient Quality Reporting program requirements. We regressed DU by quarterly period using generalized estimating equation modeling with the negative-binomial distribution, after adjusting for factors associated with corresponding SUR models of 2015 baseline and accounting for autocorrelation of error terms within a location. For graphic display, we also computed quarterly DU using marginal predictive models. Results The DU decreased over time (P ≤ 0.05, average percent change per quarter (%change): −0.54 [95% CI: −0.54, −0.53]) among ACHs (Table 1, Figure 1), and −0.54 [95% CI: −0.58, −0.49] among LTACHs (Table 1, Figure 2). Among IRFs, quarterly DU in 2015Q2–2016Q3 were similar relative to 2015Q1, but decreased from 2016Q4 onward (P ≤ 0.05, % change: −0.51 [95% CI: −0.61, −0.40]) (Table 1, Figure 3). Among CAHs, quarterly DU in 2015Q2–2016Q4 were similar relative to 2015Q1, but decreased from 2017Q1 onward (P ≤ 0.05, % change: −0.22 [95% CI: −0.39, −0.04]) (Table 1, Figure 4). Conclusion There was a statistically significant decrease in National DU of urinary catheter during 2015–2019 across NHSN, although the magnitude of change per quarter was not large. Further research is needed to explore causal factors associated with such reduction. Disclosures All authors: No reported disclosures.

scholarly journals Antimicrobial-resistant pathogens associated with adult healthcare-associated infections: Summary of data reported to the National Healthcare Safety Network, 2015–2017

2019 ◽  
Vol 41 (1) ◽  
pp. 1-18 ◽  
Author(s):  
Lindsey M. Weiner-Lastinger ◽  
Sheila Abner ◽  
Jonathan R. Edwards ◽  
Alexander J. Kallen ◽  
Maria Karlsson ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Acute Care ◽  
Acute Care Hospitals ◽  
Healthcare Associated Infections ◽  
National Healthcare ◽  
National Healthcare Safety Network ◽  
Tract Infections ◽  
Healthcare Associated ◽  
Location Type

AbstractObjective:Describe common pathogens and antimicrobial resistance patterns for healthcare-associated infections (HAIs) that occurred during 2015–2017 and were reported to the Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN).Methods:Data from central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), ventilator-associated events (VAEs), and surgical site infections (SSIs) were reported from acute-care hospitals, long-term acute-care hospitals, and inpatient rehabilitation facilities. This analysis included device-associated HAIs reported from adult location types, and SSIs among patients ≥18 years old. Percentages of pathogens with nonsusceptibility (%NS) to selected antimicrobials were calculated for each HAI type, location type, surgical category, and surgical wound closure technique.Results:Overall, 5,626 facilities performed adult HAI surveillance during this period, most of which were general acute-care hospitals with <200 beds. Escherichia coli (18%), Staphylococcus aureus (12%), and Klebsiella spp (9%) were the 3 most frequently reported pathogens. Pathogens varied by HAI and location type, with oncology units having a distinct pathogen distribution compared to other settings. The %NS for most pathogens was significantly higher among device-associated HAIs than SSIs. In addition, pathogens from long-term acute-care hospitals had a significantly higher %NS than those from general hospital wards.Conclusions:This report provides an updated national summary of pathogen distributions and antimicrobial resistance among select HAIs and pathogens, stratified by several factors. These data underscore the importance of tracking antimicrobial resistance, particularly in vulnerable populations such as long-term acute-care hospitals and intensive care units.

Mucosal Barrier Injury Laboratory-Confirmed Bloodstream Infection: Results from a Field Test of a New National Healthcare Safety Network Definition

2013 ◽  
Vol 34 (8) ◽  
pp. 769-776 ◽  
Author(s):  
Isaac See ◽  
Martha Iwamoto ◽  
Kathy Allen-Bridson ◽  
Teresa Horan ◽  
Shelley S. Magill ◽  
...  
Keyword(s):  
Bloodstream Infection ◽  
Acute Care ◽  
Field Test ◽  
Acute Care Hospitals ◽  
Field Testing ◽  
Hospital Staff ◽  
Mucosal Barrier ◽  
National Healthcare ◽  
National Healthcare Safety Network ◽  
Mucosal Barrier Injury

Objective.To assess challenges to implementation of a new National Healthcare Safety Network (NHSN) surveillance definition, mucosal barrier injury laboratory-confirmed bloodstream infection (MBI-LCBI).Design.Multicenter field test.Setting.Selected locations of acute care hospitals participating in NHSN central line-associated bloodstream infection (CLABSI) surveillance.Methods.Hospital staff augmented their CLABSI surveillance for 2 months to incorporate MBI-LCBI: a primary bloodstream infection due to a selected group of organisms in patients with either neutropenia or an allogeneic hematopoietic stem cell transplant with gastrointestinal graft-versus-host disease or diarrhea. Centers for Disease Control and Prevention (CDC) staff reviewed submitted data to verify whether CLABSIs met MBI-LCBI criteria and summarized the descriptive epidemiology of cases reported.Results.Eight cancer, 2 pediatric, and 28 general acute care hospitals including 193 inpatient units (49% oncology/bone marrow transplant [BMT], 21% adult ward, 20% adult critical care, 6% pediatric, 4% step-down) conducted field testing. Among 906 positive blood cultures reviewed, 282 CLABSIs were identified. Of the 103 CLABSIs that also met MBI-LCBI criteria, 100 (97%) were reported from oncology/BMT locations. Agreement between hospital staff and CDC classification of reported CLABSIs as meeting the MBI-LCBI definition was high (90%; k= 0.82). Most MBI-LCBIs (91%) occurred in patients meeting neutropenia criteria. Some hospitals indicated that their laboratories' methods of reporting cell counts prevented application of neutropenia criteria; revised neutropenia criteria were created using data from field testing.Conclusions.Hospital staff applied the MBI-LCBI definition accurately. Field testing informed modifications for the January 2013 implementation of MBI-LCBI in the NHSN.

scholarly journals Antimicrobial-Resistant Pathogens Associated With Healthcare-Associated Infections: Summary of Data Reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2011–2014

2016 ◽  
Vol 37 (11) ◽  
pp. 1288-1301 ◽  
Author(s):  
Lindsey M. Weiner ◽  
Amy K. Webb ◽  
Brandi Limbago ◽  
Margaret A. Dudeck ◽  
Jean Patel ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Disease Control ◽  
Acute Care ◽  
Surgical Site Infections ◽  
Acute Care Hospitals ◽  
Healthcare Associated Infections ◽  
National Healthcare ◽  
National Healthcare Safety Network ◽  
Resistance Patterns ◽  
Healthcare Associated

OBJECTIVETo describe antimicrobial resistance patterns for healthcare-associated infections (HAIs) that occurred in 2011–2014 and were reported to the Centers for Disease Control and Prevention’s National Healthcare Safety Network.METHODSData from central line–associated bloodstream infections, catheter-associated urinary tract infections, ventilator-associated pneumonias, and surgical site infections were analyzed. These HAIs were reported from acute care hospitals, long-term acute care hospitals, and inpatient rehabilitation facilities. Pooled mean proportions of pathogens that tested resistant (or nonsusceptible) to selected antimicrobials were calculated by year and HAI type.RESULTSOverall, 4,515 hospitals reported that at least 1 HAI occurred in 2011–2014. There were 408,151 pathogens from 365,490 HAIs reported to the National Healthcare Safety Network, most of which were reported from acute care hospitals with greater than 200 beds. Fifteen pathogen groups accounted for 87% of reported pathogens; the most common included Escherichia coli (15%), Staphylococcus aureus (12%), Klebsiella species (8%), and coagulase-negative staphylococci (8%). In general, the proportion of isolates with common resistance phenotypes was higher among device-associated HAIs compared with surgical site infections. Although the percent resistance for most phenotypes was similar to earlier reports, an increase in the magnitude of the resistance percentages among E. coli pathogens was noted, especially related to fluoroquinolone resistance.CONCLUSIONThis report represents a national summary of antimicrobial resistance among select HAIs and phenotypes. The distribution of frequent pathogens and some resistance patterns appear to have changed from 2009–2010, highlighting the need for continual, careful monitoring of these data across the spectrum of HAI types.Infect Control Hosp Epidemiol 2016;1–14

scholarly journals Antifungal Susceptibility Testing Practices at Acute Care Hospitals Enrolled in the National Healthcare Safety Network, United States, 2011–2015

2017 ◽  
Vol 4 (4) ◽  
Author(s):  
Snigdha Vallabhaneni ◽  
Mathew Sapiano ◽  
Lindsey M Weiner ◽  
Shawn R Lockhart ◽  
Shelley Magill
Keyword(s):  
United States ◽  
Acute Care ◽  
Susceptibility Testing ◽  
Medical Center ◽  
Antifungal Susceptibility ◽  
Acute Care Hospitals ◽  
Antifungal Susceptibility Testing ◽  
National Healthcare ◽  
National Healthcare Safety Network ◽  
Testing Practices

Abstract We assessed availability of antifungal susceptibility testing (AFST) at nearly 4000 acute care hospitals enrolled in the National Healthcare Safety Network. In 2015, 95% offered any AFST, 28% offered AFST at their own laboratory or at an affiliated medical center, and 33% offered reflexive AFST. Availability of AFST improved from 2011 to 2015, but substantial gaps exist in the availability of AFST.

scholarly journals A Statewide Assessment of Antifungal Stewardship Activities in Acute-Care Hospitals in Connecticut

2020 ◽  
Vol 41 (S1) ◽  
pp. s105-s105
Author(s):  
Romina Bromberg ◽  
Vivian Leung ◽  
Meghan Maloney ◽  
Anu Paranandi ◽  
David Banach
Keyword(s):  
Infectious Diseases ◽  
Acute Care ◽  
Antifungal Therapy ◽  
Antibiotic Stewardship ◽  
Susceptibility Testing ◽  
Antifungal Susceptibility ◽  
Acute Care Hospitals ◽  
Antifungal Susceptibility Testing ◽  
Antifungal Stewardship ◽  
Infectious Diseases Consultation

Background: Morbidity and mortality associated with invasive fungal infections and concerns of emerging antifungal resistance have highlighted the importance of optimizing antifungal therapy among hospitalized patients. Little is known about antifungal stewardship (AFS) practices among acute-care hospitals. We sought to assess AFS activities within Connecticut and to identify opportunities for improvement. Methods: An electronic survey assessing AFS practices was distributed to infectious disease physicians or pharmacy antibiotic stewardship program leaders in Connecticut hospitals. Survey questions evaluated AFS activities based on antibiotic stewardship principles, including several CDC Core Elements. Questions assessed antifungal restriction, prospective audit and feedback practices, antifungal utilization measurements, and the perceived utility of a local or statewide antifungal antibiogram. Results: Responses were received from 15 respondents, which represented 20 of 31 hospitals (65%); these hospitals made up the majority of the acute-care hospitals in Connecticut. Furthermore, 18 of these hospitals (58%) include antifungals in their stewardship programs. Also, 16 hospitals (52%) conduct routine review of antifungal ordering and provide feedback to providers for some antifungals, most commonly for amphotericin B, voriconazole, micafungin, isavuconazole, and flucytosine. All hospitals include guidance on intravenous (IV) to oral (PO) conversions, when appropriate. Only 14 of hospitals (45%) require practitioners to document indication(s) for systemic antifungal use. Most hospitals (17, 55%) provide recommendations for de-escalation of therapy in candidemia, though only 4 (13%) have institutional guidelines for candidemia treatment, and only 11 hospital mandates an infectious diseases consultation for candidemia. Assessing outcomes pertaining to antifungal utilization is uncommon; only 8 hospitals (26%) monitor days of therapy and 5 (16%) monitor antifungal expenditures. Antifungal susceptibility testing on Candida bloodstream isolates is performed routinely at 6 of the hospitals (19%). Most respondents (19, 95%) support developing an antibiogram for Candida bloodstream isolates at the statewide level. Conclusions: Although AFS interventions occur in Connecticut hospitals, there are opportunities for enhancement, such as providing institutional guidelines for candidemia treatment and mandating infectious diseases consultation for candidemia. The Connecticut Department of Public Health implemented statewide Candida bloodstream isolate surveillance in 2019, which includes antifungal susceptibility testing. The creation of a statewide antibiogram for Candida bloodstream infections is underway to support empiric antifungal therapy.Funding: NoneDisclosures: None

scholarly journals Mucosal Barrier Injury Laboratory-Confirmed Bloodstream Infections (MBI-LCBI): Descriptive Analysis of Data Reported to National Healthcare Safety Network (NHSN), 2013

2015 ◽  
Vol 37 (1) ◽  
pp. 2-7 ◽  
Author(s):  
Lauren Epstein ◽  
Isaac See ◽  
Jonathan R. Edwards ◽  
Shelley S. Magill ◽  
Nicola D. Thompson
Keyword(s):  
Acute Care ◽  
Descriptive Analysis ◽  
Bloodstream Infections ◽  
Central Line ◽  
Mucosal Barrier ◽  
National Healthcare ◽  
National Healthcare Safety Network ◽  
Mucosal Barrier Injury ◽  
The Impact ◽  
Clabsi Rate

OBJECTIVESTo determine the impact of mucosal barrier injury laboratory-confirmed bloodstream infections (MBI-LCBIs) on central-line–associated bloodstream infection (CLABSI) rates during the first year of MBI-LCBI reporting to the National Healthcare Safety Network (NHSN)DESIGNDescriptive analysis of 2013 NHSN dataSETTINGSelected inpatient locations in acute care hospitalsMETHODSA descriptive analysis of MBI-LCBI cases was performed. CLABSI rates per 1,000 central-line days were calculated with and without the inclusion of MBI-LCBIs in the subset of locations reporting ≥1 MBI-LCBI, and in all locations (regardless of MBI-LCBI reporting) to determine rate differences overall and by location type.RESULTSFrom 418 locations in 252 acute care hospitals reporting ≥1 MBI-LCBIs, 3,162 CLABSIs were reported; 1,415 (44.7%) met the MBI-LCBI definition. Among these locations, removing MBI-LCBI from the CLABSI rate determination produced the greatest CLABSI rate decreases in oncology (49%) and ward locations (45%). Among all locations reporting CLABSI data, including those reporting no MBI-LCBIs, removing MBI-LCBI reduced rates by 8%. Here, the greatest decrease was in oncology locations (38% decrease); decreases in other locations ranged from 1.2% to 4.2%.CONCLUSIONSAn understanding of the potential impact of removing MBI-LCBIs from CLABSI data is needed to accurately interpret CLABSI trends over time and to inform changes to state and federal reporting programs. Whereas the MBI-LCBI definition may have a large impact on CLABSI rates in locations where patients with certain clinical conditions are cared for, the impact of MBI-LCBIs on overall CLABSI rates across inpatient locations appears to be more modest.Infect. Control Hosp. Epidemiol. 2015;37(1):2–7

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