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Background: Approximately 40% of all antibiotics related to an acute-care hospital stay are prescribed at the time of hospital discharge. However, there is no metric to compare hospitals on their antibiotic-prescribing at this transition of care. In this study, we sought to build a risk-adjusted metric for comparing hospitals on their overall post-discharge antibiotic use. Methods: This was a retrospective study across all acute-care admissions within the Veterans Health Administration during 2018-2021. For patients discharged to home or self-care, data on antibiotics administered while inpatient and those prescribed at discharge were collected. To predict post-discharge antibiotic use (days of therapy, DOT), we built a zero-inflated negative binomial model with a random intercept for each VA medical center. Data were split into training and testing sets to measure model performance and absolute error. Covariates included patient demographics, medical specialty at discharge, comorbidities, discharge diagnoses of infection, and the length of inpatient antibiotic therapy. Outliers, defined as DOT ≥ 30, were excluded, and the predicted random intercept was used to determine hospital performance. To compare hospitals with a positive versus negative random intercept in our model (i.e. higher vs. lower than expected overall post-discharge use, respectively), we calculated mean total antibiotic duration (inpatient + post-discharge) for two uncomplicated infection types: community-acquired pneumonia (CAP) and skin and soft tissue infections (SSTI). Results: 1,804,400 patients were discharged to home or self-care across 130 hospitals. The mean age was 67.8 (SD 12.9), and 93.7% were male. Antibiotics were prescribed to 41.5% while hospitalized and 19.5% at discharge. The median number of post-discharge DOT among those prescribed post-discharge antibiotics was 7 (IQR 4-12). The predictive model detected post-discharge antibiotic use with fidelity, including accurate identification of any post-discharge antibiotic exposure (area under the precision-recall curve=0.97 ) and reliable prediction of the number of post-discharge DOT in those who were exposed (mean absolute error = 1.65; Figure 1). At negative versus positive random intercept hospitals (Figure 2), antibiotic duration for CAP and SSTIs was 7.3 versus 8.1 days (p < 0 .001) and 9.4 vs. 10.2 days (p < 0 .001), respectively. Conclusion: A model using electronically available data was able to accurately predict antibiotic use prescribed at hospital discharge. Hospitals with lower than expected overall post-discharge antibiotic use also prescribed shorter courses of antibiotic therapy for uncomplicated cases of CAP and SSTI, which may reflect more robust processes at these sites to reduce antibiotic overuse at discharge.

Background: Many urologists continue antibiotics after common urologic procedure beyond the timeframes recommended by professional guidelines. In this study, we sought to evaluate the association between postprocedural antibiotic use and patient outcomes. Methods: We identified all patients who underwent 1 of 3 urologic procedures (transurethral resection of bladder tumor [TURBT], transurethral resection of prostate [TURP], and ureteroscopy) within the Veterans’ Health Administration (VHA) between January 1, 2017, and June 30, 2021. A postprocedural antibiotic was any antibiotic potentially used for a urinary tract–related indication that was prescribed for administration after the day of the procedure. Outcomes were captured within 30 days of the procedure and included (1) return visits, defined as any emergency department or urgent care encounter or hospital readmission, and (2) Clostridium difficile infection (CDI), defined as a positive test for C. difficile and the prescription of an anti-CDI antibiotic. We used log-binomial models with risk adjustment to determine the association between postprocedural antibiotic use and outcomes. We constructed hospital-level observed-to-expected ratios for postprocedural antibiotic use, and we used these models to calculate the probability of each patient receiving postprocedural antibiotics. Results: Overall, we identified 74,629 patients; 98% were male; the mean age was 70 years (SD, 10). Among them, 50% underwent TURBT, 28% underwent TURP, and 23% underwent ureteroscopy. A postprocedural antibiotic was prescribed to 25,738 (35%) cases for a median duration of 3 days (IQR, 3–6). Return visits occurred in 13,489 patients (18%), and CDI occurred in 104 patients (0.1%). Patients exposed to postprocedural antibiotics had 16% more return visits (RR, 1.16; 95% CI, 1.13–1.20) and more than twice as much CDI (RR, 2.22; 95% CI, 1.51–3.26) than patients not exposed to postprocedural antibiotics. In log-binomial risk-adjusted analysis, the risk of return visits did not differ between the 2 groups (RR, 1.00; 95% CI, 0.97–1.04) but the risk of CDI was higher in patients who received post-procedural antibiotics (RR, 1.87; 95% CI, 1.00–3.51). Hospitals (n = 105) varied widely in their observed-to-expected ratios for prescribing postprocedural antibiotics, and the frequency of return visits was similar regardless of the frequency at which postprocedural antibiotics were prescribed (Table 1). Conclusions: Postprocedural antibiotics were prescribed beyond recommended intervals after more than one-third of common urologic procedures, with a large degree of variability across hospitals. The use of postprocedural antibiotics was not associated with fewer return visits but was associated with a nonsignificant increase in CDI risk. Efforts to reduce postprocedural antibiotics are needed.

Bacteremia caused by gram-negative bacteria is associated with serious illness and death, and emergence of antimicrobial drug resistance in these bacteria is a major concern. Using national microbiology and patient data for 2003–2013 from the US Veterans Health Administration, we characterized nonsusceptibility trends of community-acquired, community-onset; healthcare-associated, community-onset; and hospital-onset bacteremia for selected gram-negative bacteria (Escherichia coli, Klebsiella spp., Pseudomonas aeruginosa, and Acinetobacter spp.). For 47,746 episodes of bacteremia, the incidence rate was 6.37 episodes/10,000 person-years for community-onset bacteremia and 4.53 episodes/10,000 patient-days for hospital-onset bacteremia. For Klebsiella spp., P. aeruginosa, and Acinetobacter spp., we observed a decreasing proportion of nonsusceptibility across nearly all antimicrobial drug classes for patients with healthcare exposure; trends for community-acquired, community-onset isolates were stable or increasing. The role of infection control and antimicrobial stewardship efforts in inpatient settings in the decrease in drug resistance rates for hospital-onset isolates needs to be determined.

Abstract Objectives We sought to define regional variations in fluoroquinolone non-susceptibility (FQ-NS) among bloodstream isolates of Escherichia coli across the Veterans Health Administration (VHA) in the United States. Methods We analyzed a retrospective cohort of patients managed at 136 VHA hospitals who had a blood culture positive for E.coli between 2003 and 2013. Hospitals were classified based on US Census Divisions, and regional variations in FQ-NS were analyzed. Results Twenty-four thousand five hundred twenty-three unique E.coli bloodstream infections (BSIs) were identified between 2003 and 2013. 53.9 % of these were community-acquired, 30.7 % were healthcare-associated, and 15.4 % were hospital-onset BSIs. The proportion of E.coli BSIs with FQ-NS significantly varied across US Census Divisions (p

Evidence-based psychotherapies (EBP) for Posttraumatic Stress Disorder are not utilized to their full extent within the Department of Veterans Affairs (VA). VA provides care to many persons with PTSD and has been in the forefront of clinical practice guidelines and EBP training and dissemination. Yet VA continues to find EBP implementation difficult. Veterans with PTSD often initially present to prescribing clinicians, who then help make care decisions. It is therefore critical that these clinicians correctly screen and triage appropriate mental health care. The purpose of this study was to assess VA prescribing clinicians’ knowledge, perceptions, and referral behaviors related to EBPs for PTSD and to identify facilitators and barriers to implementing EBPs within VA. We conducted qualitative interviews with 26 VA prescribing clinicians. Limited access to EBPs was the most commonly noted barrier. The clinicians we interviewed also held specific beliefs and behaviors that may delay or deter EBPs. Strategies to improve utilization also emerged. Findings suggest the need for increased access to EBPs, training to optimize the role of prescribing clinicians in helping Veterans with PTSD make appropriate care decisions, and specific organizational changes to facilitate access and effective referral systems for EBPs.

Introducción. La leishmaniasis cutánea americana es endémica en Colombia, donde cada año son notificados aproximadamente 6000 casos nuevos. En la actualidad las medidas de prevención y control están limitadas al diagnóstico y tratamiento de los casos. Objetivo. Evaluar la eficacia de una intervención múltiple para prevenir la transmisión de Leishmania en el foco endémico de Tumaco, costa Pacífica de Colombia. Materiales y métodos. Se realizó un ensayo de grupos aleatorizados. Veinte veredas fueron pareadas según prevalencia deLeishmania, habitantes y participación comunitaria y luego asignadas aleatoriamente a intervención o control. La intervención incluyó toldillos impregnados con deltametrina, repelente (N, N-dietil-m-toluamida 20% y Permetrina 0,5%), modificación de lugares de reposo para los vectores y educación. Al cabo de un año se comparó la incidencia de infección y enfermedad producida porLeishmania en los dos grupos, se monitorearon la adherencia a la intervención y la aparición de efectos adversos. Los resultados finales fueron ajustados por el efecto de correlación intra-grupo. Resultados. Se presentaron 10 casos de leishmaniasis cutánea americana en el grupo que recibió la intervención y 23 en el grupo control, OR=0,42, IC95% 0,14-1,26. La intervención tuvo un mayor efecto en los niños menores de 10 años, en aquellos que residían en la periferia de la vereda y en veredas con una prevalencia de infección en niños pequeños mayor del 1%. Se reportaron eventos adversos leves asociados con el uso de los toldillos impregnados y el repelente en 2% de los participantes. Conclusión. Los casos nuevos de Leishmaniasis cutánea americana se redujeron en un 58% en el grupo que recibió la intervención. Sin embargo, el número pequeño de casos hace que la estimación de la medida de efecto sea imprecisa y no nos permite afirmar que la intervención tiene un efecto protector. Poblaciones específicas podrían ser el blanco de futuras intervenciones más simples y costo-efectivas.

Zoonotic visceral leishmaniasis (ZVL) is a serious public health problem in several Brazilian cities. Although the proximity of chicken houses is often cited as a risk factor in studies of urban ZVL, the role chickens play in the epidemiology of the disease has not been defined. Chickens attract both male and female sand flies (Lutzomyia longipalpis), but are unable to sustain Leishmania infections, and their presence may exert a zooprophylactic effect. We discuss environmental, physiologic, socioeconomic, and cultural factors related to chicken raising that could influence Le. infantum transmission in Brazilian cities and evaluate whether this practice significantly affects the risk of acquiring ZVL.

Transmission of Leishmania was studied in 27 coffee plantations in the Brazilian State of Minas Gerais. Eighteen females and six males (11.6% of the people tested), aged between 7-65 gave a positive response to the Montenegro skin test. Awareness of sand flies based on the ability of respondents to identify the insects using up to seven predetermined characteristics was significantly greater among inhabitants of houses occupied by at least one Mn+ve individual. Five species of phlebotomine sand fly, including three suspected Leishmania vectors, were collected within plantations under three different cultivation systems. Four of these species i.e., Lu. fischeri (Pinto 1926), Lu. migonei (França 1920), Lu. misionensis (Castro 1959) and Lutzomyia whitmani (Antunes & Coutinho 1939) were collected in an organic plantation and the last of these was also present in the other two plantation types. The remaining species, Lu. intermedia (Lutz & Neiva 1912), was collected in plantations under both the "adensado" and "convencional" systems. The results of this study indicate that transmission of Leishmania to man in coffee-growing areas of Minas Gerais may involve phlebotomine sand flies that inhabit plantations.

The daily man-biting activity of Anopheles (Nyssorhynchus) albimanus and An. (Kerteszia) neivai was determined in four ecologically distinct settlements of the Naya River, Department of Valle, Colombia. Differences were found among the settlements with respect to the mosquito species present, intradomiciliary and extradomiciliary biting activity and population densities.

Lutzomyia umbratilis, a known vector of Leishmania guyanensis in the north of Amazon basin, has been exclusively found in the Amazonian region. Here we report for the first time the occurrence of this species in northeastern Brazil. The epidemiological importance of the occurrence of this species in the Atlantic Forest is commented.

The phlebotomine sand fly fauna of two coffee plantations in a Leishmania-endemic area of Norte de Santander, Colombia was studied. Regular insect collections using a variety of methods were made for three and a half years. Information was obtained on diurnal resting sites, host range and seasonal abundance for 17 species, of wich five (Lutzomyia spinicrassa, Lu. serrana,Lu. shannoni, Lu. ovallesi and Lu. gomezi) were far more numerous than the others, anthropophilic and present throughout the year. The behaviour of these and the remaining 12 species is discussed in relation to their potential role in transmission of Leishmania (Viannia) brasiliensis in the area.

Dispersal of five species of phlebotomine sand flies was studied in a coffee plantation near Arboledas, Colombia by mark-release-recapture studies using fluorescent powders. The estimated recapture rate for males of Lutzomyia shannoni marked and released during the day was 28.1% significantly higher than that for all other species (p < 0.05). Recapture rate of female Lu. shannoni was 9.5% and no females of the other four species were recovered. This suggests either that Lu. shannoni is a more sedentary species than the others, or that the large trees on wich these insects were captured and recaptured function as foci of lekking behaviour in males. The high recapture rates of females of this species may indicate that oviposition occurs in close proximity to the bases of these trees. Although most marked sand flies were recaptured within 200 m of their release point, a single female Lu. gomezi was recovered 960 m away 36 h after release. This suggests that the dispersal capacity of Lutzomyia species may be greater than has been though, an important consideration in future control programs directed against these insects in Leishmania-endemic areas.

A three-stage genome-wide association study recently identified single nucleotide polymorphisms (SNPs) in five loci (fibroblast growth receptor 2 (FGFR2), trinucleotide repeat containing 9 (TNRC9), mitogen-activated protein kinase 3 K1 (MAP3K1), 8q24, and lymphocyte-specific protein 1 (LSP1)) associated with breast cancer risk. We investigated whether the associations between these SNPs and breast cancer risk varied by clinically important tumor characteristics in up to 23,039 invasive breast cancer cases and 26,273 controls from 20 studies. We also evaluated their influence on overall survival in 13,527 cases from 13 studies. All participants were of European or Asian origin. rs2981582 in FGFR2 was more strongly related to ER-positive (per-allele OR (95%CI) = 1.31 (1.27-1.36)) than ER-negative (1.08 (1.03-1.14)) disease (P for heterogeneity = 10(-13)). This SNP was also more strongly related to PR-positive, low grade and node positive tumors (P = 10(-5), 10(-8), 0.013, respectively). The association for rs13281615 in 8q24 was stronger for ER-positive, PR-positive, and low grade tumors (P = 0.001, 0.011 and 10(-4), respectively). The differences in the associations between SNPs in FGFR2 and 8q24 and risk by ER and grade remained significant after permutation adjustment for multiple comparisons and after adjustment for other tumor characteristics. Three SNPs (rs2981582, rs3803662, and rs889312) showed weak but significant associations with ER-negative disease, the strongest association being for rs3803662 in TNRC9 (1.14 (1.09-1.21)). rs13281615 in 8q24 was associated with an improvement in survival after diagnosis (per-allele HR = 0.90 (0.83-0.97). The association was attenuated and non-significant after adjusting for known prognostic factors. Our findings show that common genetic variants influence the pathological subtype of breast cancer and provide further support for the hypothesis that ER-positive and ER-negative disease are biologically distinct. Understanding the etiologic heterogeneity of breast cancer may ultimately result in improvements in prevention, early detection, and treatment.

Lutzomyia sipani n.sp. is described from males collected in Loreto Department, Peru. The new species belongs to the subgenus Evandromyia mangabeira and confirms the presence of this group in Peru.

Flight behavior is an important component to understand in the context of pest management. However, because of their small size, little is known about the flight capacity of most stored-product insects, and when a flight has been assessed, it usually consists of a propensity for initiating flight. Despite a priori expectations of the importance of flight for moths, there are no data about the flight capacity and little on the flight behavior of the Mediterranean flour moth, Ephestia kuehniella Zeller (Lepidoptera: Pyralidae). As a result, the objective of the current study was to (i) characterize the baseline flight capacity of E. kuehniella and (ii) determine how flight capacity is affected by the presence of kairomonal, pheromonal, or no stimuli. We found adult E. kuehniella flew a mean of 24–34 km in a 24-h period, and the distance flown per bout increased from 91 to 207 m in the presence of pheromones but decreased to 41 m when food was nearby compared to a negative control. The total number of flight bouts was 1.6-fold higher in the presence of pheromone compared to the negative control, but E. kuehniella flew significantly slower with pheromone and food cues present, suggesting they may be exhibiting an optimal foraging strategy. Our data on flight capacity results in qualitatively and quantitatively different conclusions about flight than those conclusions formed if only flight initiation is considered. Overall, this novel information is useful for understanding the spread within facilities and in the landscape (between facilities), as well as parameterizing ecological modeling. [ABSTRACT FROM AUTHOR]

Understanding the ability of internal‐ and external‐infesting stored product insects to vector microbes is important for estimating the relative risk that insects pose to postharvest commodities as they move between habitat patches and in the landscape. Thus, the aim of the current study was to evaluate and compare the microbial growth in novel food patches at different dispersal periods by different populations of Sitophilus oryzae (e.g., internal‐infesting) and Lasioderma serricorne (e.g., external‐infesting). Adults of both species collected from laboratory colonies or field‐captured populations were either placed immediately in a novel food patch, or given a dispersal period of 24 or 72 h in a sterilized environment before entering a surrogate food patch. Vectored microbes in new food patches were imaged after 3 or 5 days of foraging, and microbial growth was processed using ImageJ while fungal species were identified through sequencing the ITS4/5 ribosomal subunit. We found that increasing dispersal time resulted in multiple‐fold reductions in microbial growth surrogate food patches by L. serricorne but not S. oryzae. This was likely attributable to higher mobility by S. oryzae than L. serricorne. A total of 20 morphospecies were identified from 13 genera among the 59 sequences, with a total of 23% and 16% classified as Aspergillus and Penicillium spp. Our data suggest that there is a persistent risk of microbial contamination by both species, which has important food safety implications at food facilities. The study investigated how Sitophilus oryzae and Lasioderma serricorne, two types of stored product insects (internal‐ and external‐infesting), affect microbial growth in new food patches over varying dispersal periods. We found that longer dispersal times led to a significant reduction in microbial growth in food patches for L. serricorne but not for S. oryzae, likely due to differences in mobility between the two species. This suggests an ongoing risk of microbial contamination from both insect types, with implications for food safety in storage facilities. [ABSTRACT FROM AUTHOR]