Search

Despite the recent focus on prevention of health care-associated infections, rates of Candida bloodstream infections in adults have remained unchanged until recently. We report a decline of Candida bloodstream infections, not explained by changes in broad-spectrum antibiotic use, but coinciding with infection control policies aimed at central venous catheter maintenance., (Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.)

Background: Patients with a history of methicillin-resistant Staphylococcus aureus (MRSA) colonization or infection are often presumed to remain colonized when they are readmitted to the hospital. This assumption underlies the hospital practice that flags MRSA-positive patients so that these patients can be placed in contact isolation at hospital admission and, when necessary, be given the appropriate empirical therapy and/or antibiotic prophylaxis., Methods: To determine the duration of and factors associated with MRSA colonization among patients following discharge, we designed a cohort study of patients hospitalized between October 1, 2007, and July 31, 2009, at the Atlanta Veterans Affairs Medical Center, a 128-bed acute care facility. We defined 3 cohorts: cohort A; patients with both a MRSA infection during hospitalization and nasal colonization at discharge; cohort B; patients with a MRSA infection but no nasal colonization at discharge; and cohort C; patients only nasally colonized at discharge. We collected information on demographic characteristics, underlying conditions, infections, and antibiotic use. We cultured nasal swabs obtained from patients at home. We calculated hazard ratios (HR), comparing cohorts A, B, and C after controlling for other factors., Results: We obtained 231 swabs (23 in cohort A, 34 in cohort B, and 174 in cohort C). We documented MRSA colonization in 92 (39.9%) of the 231 patients who returned swabs. The median duration of colonization was 33.3 months. Factors significantly associated with persistent MRSA colonization were (1) total duration of hospital stay from previous admissions prior to study entry and (2) a member of cohort A who had a longer duration of colonization compared with cohorts B and C (P < .001)., Conclusion: Our data suggest that higher initial inocula of bacteria may be an important determinant of persistent colonization with MRSA., (Published by Mosby, Inc.)

Background: Staphylococcus aureus nasal colonization burden has been identified as a risk factor for infection. This study evaluates methicillin-resistant S aureus (MRSA) nasal burden, as defined by the cycle threshold (Ct) and risk of subsequent infection., Methods: In a retrospective cohort study, United States veterans were classified into 3 MRSA nasal colonization groups: noncarriers, low burden (Ct > 24 cycles), and high burden (Ct ≤ 24 cycles). MRSA infections were identified prospectively, and clinical information was obtained by chart review. Multivariate logistic regression assessed the association of MRSA nasal burden and risk of MRSA infection., Results: During 4-years of follow-up, 4.3% of noncarriers, 18.5% of low burden, and 17.2% of high burden developed a MRSA infection. In multivariate analysis, MRSA nasal colonization was a risk factor for MRSA infection (P = .008) with low burden (risk ratio [RR], 3.62; 95% confidence interval [CI]: 1.47-8.93) and high burden (RR, 2.71; 95% CI: 0.95-7.72) associated with subsequent MRSA infection when compared with noncarriers. When compared with low burden, high burden nasal carriers were not at increased risk of infection (RR, 0.75; 95% CI 0.36-1.55)., Conclusion: MRSA nasal colonization was a risk factor for MRSA infection. High nasal burden of MRSA did not increase the risk of infection., (Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.)

Background: Different approaches are used to classify methicillin-resistant Staphylococcus aureus (MRSA) infections as either community-acquired (CA-MRSA) or health care-associated MRSA (HA-MRSA)., Methods: We collected information on patients seen at the Atlanta Veterans Affairs Medical Center with MRSA infections from June 2007 through May 2008. We classified MRSA infections as either HA or CA using an epidemiologic definition and an antibiotic susceptibility phenotype rule. We used multivariate logistic regression to describe factors significantly associated with HA-MRSA infections compared with CA-MRSA infections., Results: Using the epidemiologic definition to classify infections, we found white race (odds ratio [OR], 3.2; 95% confidence interval [CI]: 2.0-5.2), oral antibiotics in the 3 months prior (OR, 4.0; 95% CI: 1.5-10.4), and endoscopy in the past year (OR, 3.8; 95% CI: 1.8-8.0) were significantly associated with health care-associated infections. When classifying by the resistance phenotype rule, we found hospitalization in the past year (OR: 1.8; 95% CI: 1.1-3.1) and an indwelling device in the past year (OR: 6.3; 95% CI: 2.5-15.8) were significantly associated with health care-associated infections., Conclusion: We found few differences between CA- and HA-MRSA infections, regardless of how health care-association was defined. We believe that the migration of CA-MRSA into health care settings and the recent increasing antibiotic resistance of CA-MRSA strains contribute to the lack of factors associated with HA (vs CA) MRSA., (Published by Mosby, Inc.)

The Association for Professionals in Infection Control and Epidemiology, Inc (APIC), is a multidisciplinary, voluntary, international organization of professionals who practice infection control and the application of epidemiology in all health settings. APIC is an international leader in prevention and control of infection transmission.

The Association for Professionals in Infection Control and Epidemiology, Inc. (APIC) is a multidisciplinary organization of more than 11,000 health care professionals who practice infection control and epidemiology within a variety of health care settings. As an authority in infection control, APIC endorses the Advisory Committee on Immunization Practices (ACIP) recommendations that are published by the Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report. APIC supports the immunization initiative of the Healthy People 2000: National Health Promotion and Disease Prevention Objectives, which contains a national strategy for significantly improving the health of the nation, including preventing infectious diseases through immunization.

The Association for Professionals in Infection Control and Epidemiology, Inc (APIC) is a multidisciplinary, voluntary, international organization of professionals who practice infection control and the application of epidemiology in all health settings. APIC is an international leader in prevention and control of infection transmission.