124 results on '"Shelley S Magill"'
Search Results
2. Development of a Broth Microdilution Method To Characterize Chlorhexidine MICs among Bacteria Collected from 2005 to 2019 at Three U.S. Sites
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Joseph D. Lutgring, Julian E. Grass, David Lonsway, Brian B. Yoo, Erin Epson, Megan Crumpler, Karen Galliher, Kathleen O’Donnell, Matthew Zahn, Eric Evans, Jesse T. Jacob, Alexander Page, Sarah W. Satola, Gillian Smith, Marion Kainer, Daniel Muleta, Christopher D. Wilson, Mary K. Hayden, Sujan Reddy, Christopher A. Elkins, J. Kamile Rasheed, Maria Karlsson, Shelley S. Magill, and Alice Y. Guh
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broth microdilution ,chlorhexidine ,susceptibility testing ,Microbiology ,QR1-502 - Abstract
ABSTRACT Chlorhexidine bathing to prevent transmission of multidrug-resistant organisms has been adopted by many U.S. hospitals, but increasing chlorhexidine use has raised concerns about possible emergence of resistance. We sought to establish a broth microdilution method for determining chlorhexidine MICs and then used the method to evaluate chlorhexidine MICs for bacteria that can cause health care-associated infections. We adapted a broth microdilution method for determining chlorhexidine MICs, poured panels, established quality control ranges, and tested Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae complex isolates collected at three U.S. sites. Chlorhexidine MICs were determined for 535 isolates including 129 S. aureus, 156 E. coli, 142 K. pneumoniae, and 108 E. cloacae complex isolates. The respective MIC distributions for each species ranged from 1 to 8 mg/L (MIC50 = 2 mg/L and MIC90 = 4 mg/L), 1 to 64 mg/L (MIC50 = 2 mg/L and MIC90 = 4 mg/L), 4 to 64 mg/L (MIC50 = 16 mg/L and MIC90 = 32 mg/L), and 1 to >64 mg/L (MIC50 = 16 mg/L and MIC90 = 64 mg/L). We successfully adapted a broth microdilution procedure that several laboratories were able to use to determine the chlorhexidine MICs of bacterial isolates. This method could be used to investigate whether chlorhexidine MICs are increasing. IMPORTANCE Chlorhexidine bathing to prevent transmission of multidrug-resistant organisms and reduce health care-associated infections has been adopted by many hospitals. There is concern about the possible unintended consequences of using this agent widely. One possible unintended consequence is decreased susceptibility to chlorhexidine, but there are not readily available methods to perform this evaluation. We developed a method for chlorhexidine MIC testing that can be used to evaluate for possible unintended consequences.
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- 2023
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3. Risk Factors for SARS-CoV-2 Infection Among US Healthcare Personnel, May–December 2020
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Nora Chea, Cedric J. Brown, Taniece Eure, Rebecca Alkis Ramirez, Gregory Blazek, Austin R. Penna, Ruoran Li, Christopher A. Czaja, Helen Johnston, Devra Barter, Betsy Feighner Miller, Kathleen Angell, Kristen E. Marshall, Ashley Fell, Sara Lovett, Sarah Lim, Ruth Lynfield, Sarah Shrum Davis, Erin C. Phipps, Marla Sievers, Ghinwa Dumyati, Cathleen Concannon, Kathryn McCullough, Amy Woods, Sandhya Seshadri, Christopher Myers, Rebecca Pierce, Valerie L.S. Ocampo, Judith A. Guzman-Cottrill, Gabriela Escutia, Monika Samper, Nicola D. Thompson, Shelley S. Magill, and Cheri T. Grigg
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COVID-19 ,2019 novel coronavirus disease ,coronavirus disease ,severe acute respiratory syndrome coronavirus 2 ,SARS-CoV-2 ,viruses ,Medicine ,Infectious and parasitic diseases ,RC109-216 - Abstract
To determine risk factors for coronavirus disease (COVID-19) among US healthcare personnel (HCP), we conducted a case–control analysis. We collected data about activities outside the workplace and COVID-19 patient care activities from HCP with positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test results (cases) and from HCP with negative test results (controls) in healthcare facilities in 5 US states. We used conditional logistic regression to calculate adjusted matched odds ratios and 95% CIs for exposures. Among 345 cases and 622 controls, factors associated with risk were having close contact with persons with COVID-19 outside the workplace, having close contact with COVID-19 patients in the workplace, and assisting COVID-19 patients with activities of daily living. Protecting HCP from COVID-19 may require interventions that reduce their exposures outside the workplace and improve their ability to more safely assist COVID-19 patients with activities of daily living.
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- 2022
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4. Vital Signs: Health Disparities in Hemodialysis-Associated Staphylococcus aureus Bloodstream Infections — United States, 2017–2020
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Brian Rha, Isaac See, Lindsay Dunham, Preeta K. Kutty, Lauren Moccia, Ibironke W. Apata, Jennifer Ahern, Shelley Jung, Rongxia Li, Joelle Nadle, Susan Petit, Susan M. Ray, Lee H. Harrison, Carmen Bernu, Ruth Lynfield, Ghinwa Dumyati, Marissa Tracy, William Schaffner, D. Cal Ham, Shelley S. Magill, Erin N. O’Leary, Jeneita Bell, Arjun Srinivasan, L. Clifford McDonald, Jonathan R. Edwards, and Shannon Novosad
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Transplantation ,Health (social science) ,Health Information Management ,Epidemiology ,Health, Toxicology and Mutagenesis ,Immunology and Allergy ,Pharmacology (medical) ,General Medicine - Published
- 2023
5. Epidemiology of Pulmonary and Extrapulmonary Nontuberculous Mycobacteria Infections at 4 US Emerging Infections Program Sites: A 6-Month Pilot
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Cheri Grigg, Kelly A Jackson, Devra Barter, Christopher A Czaja, Helen Johnston, Ruth Lynfield, Paula Snippes Vagnone, Laura Tourdot, Nancy Spina, Ghinwa Dumyati, P Maureen Cassidy, Rebecca Pierce, Emily Henkle, D Rebecca Prevots, Max Salfinger, Kevin L Winthrop, Nadege Charles Toney, and Shelley S Magill
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Microbiology (medical) ,Infectious Diseases - Abstract
Background Nontuberculous mycobacteria (NTM) cause pulmonary (PNTM) and extrapulmonary (ENTM) disease. Infections are difficult to diagnose and treat, and exposures occur in healthcare and community settings. In the United States, NTM epidemiology has been described largely through analyses of microbiology data from health departments, electronic health records, and administrative data. We describe findings from a multisite pilot of active, laboratory- and population-based NTM surveillance. Methods The Centers for Disease Control and Prevention’s Emerging Infections Program conducted NTM surveillance at 4 sites (Colorado, 5 counties; Minnesota, 2 counties; New York, 2 counties; and Oregon, 3 counties [PNTM] and statewide [ENTM]) from 1 October 2019 through 31 March 2020. PNTM cases were defined using published microbiologic criteria. ENTM cases required NTM isolation from a nonpulmonary specimen, excluding stool and rectal swabs. Patient data were collected via medical record review. Results Overall, 299 NTM cases were reported (PNTM: 231, 77%); Mycobacterium avium complex was the most common species group. Annualized prevalence was 7.5/100 000 population (PNTM: 6.1/100 000; ENTM: 1.4/100 000). Most patients had signs or symptoms in the 14 days before positive specimen collection (ENTM: 62, 91.2%; PNTM: 201, 87.0%). Of PNTM cases, 145 (62.8%) were female and 168 (72.7%) had underlying chronic lung disease. Among ENTM cases, 29 (42.6%) were female, 21 (30.9%) did not have documented underlying conditions, and 26 (38.2%) had infection at the site of a medical device or procedure. Conclusions Active, population-based NTM surveillance will provide data for monitoring the burden of disease and characterize affected populations to inform interventions.
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- 2023
6. Epidemiology of Sepsis in US Children and Young Adults
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Shelley S Magill, Mathew R P Sapiano, Runa Gokhale, Joelle Nadle, Helen Johnston, Geoff Brousseau, Meghan Maloney, Susan M Ray, Lucy E Wilson, Rebecca Perlmutter, Ruth Lynfield, Malini DeSilva, Marla Sievers, Lourdes Irizarry, Ghinwa Dumyati, Rebecca Pierce, Alexia Zhang, Marion Kainer, Anthony E Fiore, Raymund Dantes, and Lauren Epstein
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Infectious Diseases ,Oncology - Abstract
Background Most multicenter studies of US pediatric sepsis epidemiology use administrative data or focus on pediatric intensive care units. We conducted a detailed medical record review to describe sepsis epidemiology in children and young adults. Methods In a convenience sample of hospitals in 10 states, patients aged 30 days–21 years, discharged during 1 October 2014–30 September 2015, with explicit diagnosis codes for severe sepsis or septic shock, were included. Medical records were reviewed for patients with documentation of sepsis, septic shock, or similar terms. We analyzed overall and age group–specific patient characteristics. Results Of 736 patients in 26 hospitals, 442 (60.1%) had underlying conditions. Most patients (613 [83.3%]) had community-onset sepsis, although most community-onset sepsis was healthcare associated (344 [56.1%]). Two hundred forty-one patients (32.7%) had outpatient visits 1–7 days before sepsis hospitalization, of whom 125 (51.9%) received antimicrobials ≤30 days before sepsis hospitalization. Age group–related differences included common underlying conditions ( Conclusions Our data suggest potential opportunities to raise sepsis awareness among outpatient providers to facilitate prevention, early recognition, and intervention in some patients. Consideration of age-specific differences may be important as approaches are developed to improve sepsis prevention, risk prediction, recognition, and management.
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- 2023
7. Occupational risk factors for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection among healthcare personnel: A 6-month prospective analysis of the COVID-19 Prevention in Emory Healthcare Personnel (COPE) Study
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Jessica R. Howard-Anderson, Carly Adams, William C. Dube, Teresa C. Smith, Amy C. Sherman, Neena Edupuganti, Minerva Mendez, Nora Chea, Shelley S. Magill, Daniel O. Espinoza, Yerun Zhu, Varun K. Phadke, Srilatha Edupuganti, James P. Steinberg, Benjamin A. Lopman, Jesse T. Jacob, Scott K. Fridkin, and Matthew H. Collins
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Microbiology (medical) ,Infectious Diseases ,SARS-CoV-2 ,Risk Factors ,Epidemiology ,Health Personnel ,Immunoglobulin G ,Humans ,COVID-19 ,Delivery of Health Care - Abstract
Objectives:To determine the incidence of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection among healthcare personnel (HCP) and to assess occupational risks for SARS-CoV-2 infection.Design:Prospective cohort of healthcare personnel (HCP) followed for 6 months from May through December 2020.Setting:Large academic healthcare system including 4 hospitals and affiliated clinics in Atlanta, Georgia.Participants:HCP, including those with and without direct patient-care activities, working during the coronavirus disease 2019 (COVID-19) pandemic.Methods:Incident SARS-CoV-2 infections were determined through serologic testing for SARS-CoV-2 IgG at enrollment, at 3 months, and at 6 months. HCP completed monthly surveys regarding occupational activities. Multivariable logistic regression was used to identify occupational factors that increased the risk of SARS-CoV-2 infection.Results:Of the 304 evaluable HCP that were seronegative at enrollment, 26 (9%) seroconverted for SARS-CoV-2 IgG by 6 months. Overall, 219 participants (73%) self-identified as White race, 119 (40%) were nurses, and 121 (40%) worked on inpatient medical-surgical floors. In a multivariable analysis, HCP who identified as Black race were more likely to seroconvert than HCP who identified as White (odds ratio, 4.5; 95% confidence interval, 1.3–14.2). Increased risk for SARS-CoV-2 infection was not identified for any occupational activity, including spending >50% of a typical shift at a patient’s bedside, working in a COVID-19 unit, or performing or being present for aerosol-generating procedures (AGPs).Conclusions:In our study cohort of HCP working in an academic healthcare system
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- 2022
8. Risk Factors for SARS-CoV-2 Infection Among US Healthcare Personnel, May–December 2020
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Kristen E Marshall, Sarah Shrum Davis, Judith A Guzman-Cottrill, Amy Woods, Devra Barter, Rebecca Pierce, Nicola D. Thompson, Christopher A. Czaja, Kathryn McCullough, Taniece Eure, Kathleen Angell, Marla Sievers, Christopher A. Myers, Helen Johnston, Ashley Fell, Sarah Lim, Gregory Blazek, Cedric Brown, Cathleen Concannon, Sandhya Seshadri, Rebecca Alkis Ramirez, Gabriela Escutia, Sara Lovett, Austin R Penna, Valerie Ocampo, Cheri Grigg, Monika Samper, Betsy Feighner Miller, Ghinwa Dumyati, Erin C Phipps, Shelley S. Magill, Nora Chea, Ruth Lynfield, and Ruoran Li
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Microbiology (medical) ,medicine.medical_specialty ,Activities of daily living ,Coronavirus disease 2019 (COVID-19) ,Epidemiology ,Health Personnel ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Psychological intervention ,Disease ,Infectious and parasitic diseases ,RC109-216 ,medicine.disease_cause ,2019 novel coronavirus disease ,respiratory infections ,Risk Factors ,Occupational Exposure ,Activities of Daily Living ,Health care ,Humans ,Medicine ,viruses ,Coronavirus ,business.industry ,SARS-CoV-2 ,Research ,COVID-19 ,Odds ratio ,United States ,zoonoses ,Infectious Diseases ,coronavirus disease ,Emergency medicine ,business ,Delivery of Health Care ,Risk Factors for SARS-CoV-2 Infection Among US Healthcare Personnel, May–December 2020 ,healthcare personnel ,severe acute respiratory syndrome coronavirus 2 - Abstract
To determine risk factors for coronavirus disease (COVID-19) among US healthcare personnel (HCP), we conducted a case–control analysis. We collected data about activities outside the workplace and COVID-19 patient care activities from HCP with positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test results (cases) and from HCP with negative test results (controls) in healthcare facilities in 5 US states. We used conditional logistic regression to calculate adjusted matched odds ratios and 95% CIs for exposures. Among 345 cases and 622 controls, factors associated with risk were having close contact with persons with COVID-19 outside the workplace, having close contact with COVID-19 patients in the workplace, and assisting COVID-19 patients with activities of daily living. Protecting HCP from COVID-19 may require interventions that reduce their exposures outside the workplace and improve their ability to more safely assist COVID-19 patients with activities of daily living.
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- 2022
9. Evaluating Epidemiology and Improving Surveillance of Infections Associated with Health Care, United States
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Shelley S. Magill, Ghinwa Dumyati, Susan M. Ray, and Scott K. Fridkin
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epidemiology ,nosocomial infections ,antimicrobial resistance ,health care ,surveillance ,United States ,Medicine ,Infectious and parasitic diseases ,RC109-216 - Abstract
The Healthcare-Associated Infections Community Interface (HAIC), launched in 2009, is the newest major activity of the Emerging Infections Program. The HAIC activity addresses population- and laboratory-based surveillance for Clostridium difficile infections, candidemia, and multidrug-resistant gram-negative bacilli. Other activities include special projects: the multistate Healthcare-Associated Infections and Antimicrobial Use Prevalence Survey and projects that evaluate new approaches for improving surveillance. The HAIC activity has provided information about the epidemiology and adverse health outcomes of health care–associated infections and antimicrobial drug use in the United States and informs efforts to improve patient safety through prevention of these infections.
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- 2015
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10. Practices and activities among healthcare personnel with severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection working in different healthcare settings—ten Emerging Infections Program sites, April–November 2020
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Sarah Shrum Davis, Matthew R. Groenewold, Christopher A. Czaja, Nora Chea, Kaytlynn Marceaux-Galli, Sarah Lim, Cedric Brown, Devra Barter, Lucy E. Wilson, Cathleen Concannon, Katie Angell, Betsy Feighner Miller, Helen Johnston, Kathryn McCullough, Gabriela Escutia, Christopher Myers, Stepy Thomas, James Meek, Sandra A Pena, Erin C Phipps, Ghinwa Dumyati, Joelle Nadle, Stacy Carswell, Ruth Lynfield, Rebecca Perlmutter, Amy Woods, Ashley Fell, Sandhya Seshadri, Monica Brackney, Marla Sievers, Kristen E Marshall, Linda Frank, Deborah Godine, Austin R Penna, Judith A Guzman-Cottrill, Taniece Eure, Cullen Adre, Valerie Ocampo, Nicola D. Thompson, Monika Samper, Shelley S. Magill, and Rebecca Pierce
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Microbiology (medical) ,2019-20 coronavirus outbreak ,medicine.medical_specialty ,Infection risk ,Epidemiology ,viruses ,Health Personnel ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,030501 epidemiology ,medicine.disease_cause ,Virus ,03 medical and health sciences ,Emerging infections ,Health care ,medicine ,Humans ,Skilled Nursing Facilities ,Coronavirus ,SARS-CoV-2 ,business.industry ,Concise Communication ,COVID-19 ,Personnel, Hospital ,Infectious Diseases ,Healthcare settings ,Emergency medicine ,0305 other medical science ,business ,Delivery of Health Care - Abstract
Healthcare personnel with severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection were interviewed to describe activities and practices in and outside the workplace. Among 2,625 healthcare personnel, workplace-related factors that may increase infection risk were more common among nursing-home personnel than hospital personnel, whereas selected factors outside the workplace were more common among hospital personnel.
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- 2021
11. Outcomes at least 90 days since onset of myocarditis after mRNA COVID-19 vaccination in adolescents and young adults in the USA: a follow-up surveillance study
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Ian Kracalik, Matthew E Oster, Karen R Broder, Margaret M Cortese, Maleeka Glover, Karen Shields, C Buddy Creech, Brittney Romanson, Shannon Novosad, Jonathan Soslow, Emmanuel B Walter, Paige Marquez, Jeffrey M Dendy, Jared Woo, Amy L Valderrama, Alejandra Ramirez-Cardenas, Agape Assefa, M Jay Campbell, John R Su, Shelley S Magill, David K Shay, Tom T Shimabukuro, Sridhar V Basavaraju, Paula Campbell, Chidera Anugwom, Colenda Arvelo Jefferson, Kimberly Badger, Nastocia Bafford, Chandra Barnes, Stephanie Boles, Emory Collins, Mitesh Desai, Theresa Dulski, Barbara Dyleski, Kathryn Edwards, Melanie Feyereisen, Stephanie Gonsahn, Tchernavia Gregory, Jyothi Gunta, Kara Jacobs Slifka, Charlotte Kabore, Bryan K. Kapella, Susan Karol, Kalah Kennebrew, Nancy Kluisza, Sean Lang, Labretta Lanier Gholston, Marcella Law, Jennifer Lehman, Jacek M. Mazurek, Henraya McGruder, Kiara McNamara, Maria-Luisa Moore, Pedro Moro, John F. Moroney, Oidda Museru, Cassandra Nale, Andi Neiman, Kim Newsome, Erika Odom, Brooke Pantazides, Suchita Patel, Agam Rao, Laura Reynolds, Sonya Robinson, Frederick L. Ruberg, Tammy Schaeffer, Dipesh Solanky, Laurence Sperling, Toscha Stanley, Regina Sullivan, Allan Taylor, Kimberly Thomas, Shayle Thompson, Jigsa Tola, Cuc H. Tran, Steven Wiersma, and Kimberly Works
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Male ,COVID-19 Vaccines ,Adolescent ,Vaccination ,COVID-19 ,Contrast Media ,Gadolinium ,Troponin ,United States ,Myocarditis ,Young Adult ,Pediatrics, Perinatology and Child Health ,Developmental and Educational Psychology ,Quality of Life ,Humans ,Female ,RNA, Messenger ,Pandemics ,Follow-Up Studies - Abstract
Data on medium-term outcomes in indivduals with myocarditis after mRNA COVID-19 vaccination are scarce. We aimed to assess clinical outcomes and quality of life at least 90 days since onset of myocarditis after mRNA COVID-19 vaccination in adolescents and young adults.In this follow-up surveillance study, we conducted surveys in US individuals aged 12-29 years with myocarditis after mRNA COVID-19 vaccination, for whom a report had been filed to the Vaccine Adverse Event Reporting System between Jan 12 and Nov 5, 2021. A two-component survey was administered, one component to patients (or parents or guardians) and one component to health-care providers, to assess patient outcomes at least 90 days since myocarditis onset. Data collected were recovery status, cardiac testing, and functional status, and EuroQol health-related quality-of-life measures (dichotomised as no problems or any problems), and a weighted quality-of-life measure, ranging from 0 to 1 (full health). The EuroQol results were compared with published results in US populations (aged 18-24 years) from before and early on in the COVID-19 pandemic.Between Aug 24, 2021, and Jan 12, 2022, we collected data for 519 (62%) of 836 eligible patients who were at least 90 days post-myocarditis onset: 126 patients via patient survey only, 162 patients via health-care provider survey only, and 231 patients via both surveys. Median patient age was 17 years (IQR 15-22); 457 (88%) patients were male and 61 (12%) were female. 320 (81%) of 393 patients with a health-care provider assessment were considered recovered from myocarditis by their health-care provider, although at the last health-care provider follow-up, 104 (26%) of 393 patients were prescribed daily medication related to myocarditis. Of 249 individuals who completed the quality-of-life portion of the patient survey, four (2%) reported problems with self-care, 13 (5%) with mobility, 49 (20%) with performing usual activities, 74 (30%) with pain, and 114 (46%) with depression. Mean weighted quality-of-life measure (0·91 [SD 0·13]) was similar to a pre-pandemic US population value (0·92 [0·13]) and significantly higher than an early pandemic US population value (0·75 [0·28]; p0·0001). Most patients had improvements in cardiac diagnostic marker and testing data at follow-up, including normal or back-to-baseline troponin concentrations (181 [91%] of 200 patients with available data), echocardiograms (262 [94%] of 279 patients), electrocardiograms (240 [77%] of 311 patients), exercise stress testing (94 [90%] of 104 patients), and ambulatory rhythm monitoring (86 [90%] of 96 patients). An abnormality was noted among 81 (54%) of 151 patients with follow-up cardiac MRI; however, evidence of myocarditis suggested by the presence of both late gadolinium enhancement and oedema on cardiac MRI was uncommon (20 [13%] of 151 patients). At follow-up, most patients were cleared for all physical activity (268 [68%] of 393 patients).After at least 90 days since onset of myocarditis after mRNA COVID-19 vaccination, most individuals in our cohort were considered recovered by health-care providers, and quality of life measures were comparable to those in pre-pandemic and early pandemic populations of a similar age. These findings might not be generalisable given the small sample size and further follow-up is needed for the subset of patients with atypical test results or not considered recovered.US Centers for Disease Control and Prevention.
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- 2022
12. Epidemiology of extended-spectrum β-lactamase–producing Enterobacterales in five US sites participating in the Emerging Infections Program, 2017
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Nadezhda Duffy, Maria Karlsson, Hannah E. Reses, Davina Campbell, Jonathan Daniels, Richard A. Stanton, Sarah J. Janelle, Kyle Schutz, Wendy Bamberg, Paulina A. Rebolledo, Chris Bower, Rebekah Blakney, Jesse T. Jacob, Erin C. Phipps, Kristina G. Flores, Ghinwa Dumyati, Hannah Kopin, Rebecca Tsay, Marion A. Kainer, Daniel Muleta, Benji Byrd-Warner, Julian E. Grass, Joseph D. Lutgring, J. Kamile Rasheed, Christopher A. Elkins, Shelley S. Magill, and Isaac See
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Microbiology (medical) ,Klebsiella pneumoniae ,Infectious Diseases ,Epidemiology ,Escherichia coli ,Humans ,Microbial Sensitivity Tests ,Article ,beta-Lactamases ,Escherichia coli Infections ,Anti-Bacterial Agents ,Klebsiella Infections - Abstract
ObjectiveThe incidence of infections from extended-spectrum β-lactamase (ESBL)–producing Enterobacterales (ESBL-E) is increasing in the United States. We describe the epidemiology of ESBL-E at 5 Emerging Infections Program (EIP) sites.MethodsDuring October–December 2017, we piloted active laboratory- and population-based (New York, New Mexico, Tennessee) or sentinel (Colorado, Georgia) ESBL-E surveillance. An incident case was the first isolation from normally sterile body sites or urine of Escherichia coli or Klebsiella pneumoniae/oxytoca resistant to ≥1 extended-spectrum cephalosporin and nonresistant to all carbapenems tested at a clinical laboratory from a surveillance area resident in a 30-day period. Demographic and clinical data were obtained from medical records. The Centers for Disease Control and Prevention (CDC) performed reference antimicrobial susceptibility testing and whole-genome sequencing on a convenience sample of case isolates.ResultsWe identified 884 incident cases. The estimated annual incidence in sites conducting population-based surveillance was 199.7 per 100,000 population. Overall, 800 isolates (96%) were from urine, and 790 (89%) were E. coli. Also, 393 cases (47%) were community-associated. Among 136 isolates (15%) tested at the CDC, 122 (90%) met the surveillance definition phenotype; 114 (93%) of 122 were shown to be ESBL producers by clavulanate testing. In total, 111 (97%) of confirmed ESBL producers harbored a blaCTX-M gene. Among ESBL-producing E. coli isolates, 52 (54%) were ST131; 44% of these cases were community associated.ConclusionsThe burden of ESBL-E was high across surveillance sites, with nearly half of cases acquired in the community. EIP has implemented ongoing ESBL-E surveillance to inform prevention efforts, particularly in the community and to watch for the emergence of new ESBL-E strains.
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- 2022
13. Antimicrobial Use in US Hospitals: Comparison of Results From Emerging Infections Program Prevalence Surveys, 2015 and 2011
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Shelley S, Magill, Erin, O'Leary, Susan M, Ray, Marion A, Kainer, Christopher, Evans, Wendy M, Bamberg, Helen, Johnston, Sarah J, Janelle, Tolulope, Oyewumi, Ruth, Lynfield, Jean, Rainbow, Linn, Warnke, Joelle, Nadle, Deborah L, Thompson, Shamima, Sharmin, Rebecca, Pierce, Alexia Y, Zhang, Valerie, Ocampo, Meghan, Maloney, Samantha, Greissman, Lucy E, Wilson, Ghinwa, Dumyati, Jonathan R, Edwards, and Vicky P, Reed
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Microbiology (medical) ,medicine.medical_specialty ,Health authority ,030501 epidemiology ,Article ,Antimicrobial Stewardship ,03 medical and health sciences ,0302 clinical medicine ,Anti-Infective Agents ,Emerging infections ,Surveys and Questionnaires ,Prevalence ,Humans ,Medicine ,030212 general & internal medicine ,Child ,Cross Infection ,business.industry ,Public health ,Infant, Newborn ,Prevalence survey ,Disease control ,Anti-Bacterial Agents ,Medical services ,Infectious Diseases ,Antimicrobial use ,Family medicine ,Female ,0305 other medical science ,business - Abstract
Background In the 2011 US hospital prevalence survey of healthcare-associated infections and antimicrobial use 50% of patients received antimicrobial medications on the survey date or day before. More hospitals have since established antimicrobial stewardship programs. We repeated the survey in 2015 to determine antimicrobial use prevalence and describe changes since 2011. Methods The Centers for Disease Control and Prevention’s Emerging Infections Program sites in 10 states each recruited ≤25 general and women’s and children’s hospitals. Hospitals selected a survey date from May–September 2015. Medical records for a random patient sample on the survey date were reviewed to collect data on antimicrobial medications administered on the survey date or day before. Percentages of patients on antimicrobial medications were compared; multivariable log-binomial regression modeling was used to evaluate factors associated with antimicrobial use. Results Of 12 299 patients in 199 hospitals, 6084 (49.5%; 95% CI, 48.6–50.4%) received antimicrobials. Among 148 hospitals in both surveys, overall antimicrobial use prevalence was similar in 2011 and 2015, although the percentage of neonatal critical care patients on antimicrobials was lower in 2015 (22.8% vs 32.0% [2011]; P = .006). Fluoroquinolone use was lower in 2015 (10.1% of patients vs 11.9% [2011]; P < .001). Third- or fourth-generation cephalosporin use was higher (12.2% vs 10.7% [2011]; P = .002), as was carbapenem use (3.7% vs 2.7% [2011]; P < .001). Conclusions Overall hospital antimicrobial use prevalence was not different in 2011 and 2015; however, differences observed in selected patient or antimicrobial groups may provide evidence of stewardship impact.
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- 2020
14. Transmission of COVID-19 to Health Care Personnel During Exposures to a Hospitalized Patient — Solano County, California, February 2020
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Kerui Xu, Amy Heinzerling, Heather Resseger, Jennifer R. Verani, Shelley S. Magill, Kiran M. Perkins, Erin Epson, Meileen Acosta, P Matthew J. Stuckey, Seema Jain, and Tara Scheuer
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Adult ,Male ,medicine.medical_specialty ,Infectious Disease Transmission, Patient-to-Professional ,Health (social science) ,Isolation (health care) ,Epidemiology ,Health, Toxicology and Mutagenesis ,Pneumonia, Viral ,MEDLINE ,Risk Assessment ,01 natural sciences ,California ,Betacoronavirus ,03 medical and health sciences ,0302 clinical medicine ,Health Information Management ,Bronchoscopy ,Occupational Exposure ,Health care ,Positive airway pressure ,Humans ,Medicine ,Full Report ,030212 general & internal medicine ,0101 mathematics ,Pandemics ,Personal Protective Equipment ,Personal protective equipment ,medicine.diagnostic_test ,SARS-CoV-2 ,business.industry ,010102 general mathematics ,COVID-19 ,General Medicine ,Middle Aged ,medicine.disease ,Hospitalization ,Personnel, Hospital ,Pneumonia ,Emergency medicine ,Female ,Coronavirus Infections ,business ,Risk assessment - Abstract
On February 26, 2020, the first U.S. case of community-acquired coronavirus disease 2019 (COVID-19) was confirmed in a patient hospitalized in Solano County, California (1). The patient was initially evaluated at hospital A on February 15; at that time, COVID-19 was not suspected, as the patient denied travel or contact with symptomatic persons. During a 4-day hospitalization, the patient was managed with standard precautions and underwent multiple aerosol-generating procedures (AGPs), including nebulizer treatments, bilevel positive airway pressure (BiPAP) ventilation, endotracheal intubation, and bronchoscopy. Several days after the patient's transfer to hospital B, a real-time reverse transcription-polymerase chain reaction (real-time RT-PCR) test for SARS-CoV-2 returned positive. Among 121 hospital A health care personnel (HCP) who were exposed to the patient, 43 (35.5%) developed symptoms during the 14 days after exposure and were tested for SARS-CoV-2; three had positive test results and were among the first known cases of probable occupational transmission of SARS-CoV-2 to HCP in the United States. Little is known about specific risk factors for SARS-CoV-2 transmission in health care settings. To better characterize and compare exposures among HCP who did and did not develop COVID-19, standardized interviews were conducted with 37 hospital A HCP who were tested for SARS-CoV-2, including the three who had positive test results. Performing physical examinations and exposure to the patient during nebulizer treatments were more common among HCP with laboratory-confirmed COVID-19 than among those without COVID-19; HCP with COVID-19 also had exposures of longer duration to the patient. Because transmission-based precautions were not in use, no HCP wore personal protective equipment (PPE) recommended for COVID-19 patient care during contact with the index patient. Health care facilities should emphasize early recognition and isolation of patients with possible COVID-19 and use of recommended PPE to minimize unprotected, high-risk HCP exposures and protect the health care workforce.
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- 2020
15. Antimicrobial-resistant pathogens associated with pediatric healthcare-associated infections: Summary of data reported to the National Healthcare Safety Network, 2015–2017
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Lindsey M. Weiner-Lastinger, Sheila Abner, Andrea L. Benin, Jonathan R. Edwards, Alexander J. Kallen, Maria Karlsson, Shelley S. Magill, Daniel Pollock, Isaac See, Minn M. Soe, Maroya S. Walters, and Margaret A. Dudeck
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0301 basic medicine ,Microbiology (medical) ,Adolescent ,Epidemiology ,Staphylococcus ,030106 microbiology ,Article ,03 medical and health sciences ,Catheters, Indwelling ,0302 clinical medicine ,Drug Resistance, Bacterial ,Enterococcus faecalis ,Escherichia coli ,Humans ,Surgical Wound Infection ,030212 general & internal medicine ,Child ,Cross Infection ,Infant, Newborn ,virus diseases ,Infant ,Pneumonia, Ventilator-Associated ,Bacterial Infections ,Hospitals ,United States ,Anti-Bacterial Agents ,Klebsiella pneumoniae ,Infectious Diseases ,Carbapenems ,Catheter-Related Infections ,Child, Preschool ,Equipment Contamination ,Centers for Disease Control and Prevention, U.S - Abstract
Objective:To describe common pathogens and antimicrobial resistance patterns for healthcare-associated infections (HAIs) among pediatric patients that occurred in 2015–2017 and were reported to the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN).Methods:Antimicrobial resistance data were analyzed for pathogens implicated in central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), ventilator-associated pneumonias (VAPs), and surgical site infections (SSIs). This analysis was restricted to device-associated HAIs reported from pediatric patient care locations and SSIs among patients Results:Overall, 2,545 facilities performed surveillance of pediatric HAIs in the NHSN during this period. Staphylococcus aureus (15%), Escherichia coli (12%), and coagulase-negative staphylococci (12%) were the 3 most commonly reported pathogens associated with pediatric HAIs. Pathogens and the %NS varied by HAI type, location type, and/or surgical category. Among CLABSIs, the %NS was generally lowest in neonatal intensive care units and highest in pediatric oncology units. Staphylococcus spp were particularly common among orthopedic, neurosurgical, and cardiac SSIs; however, E. coli was more common in abdominal SSIs. Overall, antimicrobial nonsusceptibility was less prevalent in pediatric HAIs than in adult HAIs.Conclusion:This report provides an updated national summary of pathogen distributions and antimicrobial resistance patterns among pediatric HAIs. These data highlight the need for continued antimicrobial resistance tracking among pediatric patients and should encourage the pediatric healthcare community to use such data when establishing policies for infection prevention and antimicrobial stewardship.
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- 2019
16. Spread of Cryptococcus gattii into Pacific Northwest Region of the United States
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Kausik Datta, Karen H. Bartlett, Rebecca Baer, Edmond Byrnes, Eleni Galanis, Joseph Heitman, Linda Hoang, Mira J. Leslie, Laura MacDougall, Shelley S. Magill, Muhammad G. Morshed, and Kieren A. Marr
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Cryptococcus gattii ,cryptococcosis ,fungi ,Vancouver Island ,Pacific northwest ,Canada ,Medicine ,Infectious and parasitic diseases ,RC109-216 - Abstract
Cryptococcus gattii has emerged as a human and animal pathogen in the Pacific Northwest. First recognized on Vancouver Island, British Columbia, Canada, it now involves mainland British Columbia, and Washington and Oregon in the United States. In Canada, the incidence of disease has been one of the highest worldwide. In the United States, lack of cryptococcal species identification and case surveillance limit our knowledge of C. gattii epidemiology. Infections in the Pacific Northwest are caused by multiple genotypes, but the major strain is genetically novel and may have emerged recently in association with unique mating or environmental changes. C. gattii disease affects immunocompromised and immunocompetent persons, causing substantial illness and death. Successful management requires an aggressive medical and surgical approach and consideration of potentially variable antifungal drug susceptibilities. We summarize the study results of a group of investigators and review current knowledge with the goal of increasing awareness and highlighting areas where further knowledge is required.
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- 2009
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17. Effectiveness of mRNA Covid-19 Vaccine among U.S. Health Care Personnel
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Tamara, Pilishvili, Ryan, Gierke, Katherine E, Fleming-Dutra, Jennifer L, Farrar, Nicholas M, Mohr, David A, Talan, Anusha, Krishnadasan, Karisa K, Harland, Howard A, Smithline, Peter C, Hou, Lilly C, Lee, Stephen C, Lim, Gregory J, Moran, Elizabeth, Krebs, Mark T, Steele, David G, Beiser, Brett, Faine, John P, Haran, Utsav, Nandi, Walter A, Schrading, Brian, Chinnock, Daniel J, Henning, Frank, Lovecchio, Jane, Lee, Devra, Barter, Monica, Brackney, Scott K, Fridkin, Kaytlynn, Marceaux-Galli, Sarah, Lim, Erin C, Phipps, Ghinwa, Dumyati, Rebecca, Pierce, Tiffanie M, Markus, Deverick J, Anderson, Amanda K, Debes, Michael Y, Lin, Jeanmarie, Mayer, Jennie H, Kwon, Nasia, Safdar, Marc, Fischer, Rosalyn, Singleton, Nora, Chea, Shelley S, Magill, Jennifer R, Verani, Stephanie J, Schrag, and Jennifer, Dobson
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Prioritization ,Adult ,Male ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,Adolescent ,viruses ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Health Personnel ,MEDLINE ,Immunization, Secondary ,Vaccine Efficacy ,Polymerase Chain Reaction ,COVID-19 Serological Testing ,Health care ,Medicine ,Humans ,BNT162 Vaccine ,Aged ,Messenger RNA ,business.industry ,virus diseases ,COVID-19 ,General Medicine ,biochemical phenomena, metabolism, and nutrition ,Middle Aged ,Virology ,United States ,Case-Control Studies ,Female ,Original Article ,business ,2019-nCoV Vaccine mRNA-1273 - Abstract
Background The prioritization of U.S. health care personnel for early receipt of messenger RNA (mRNA) vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (Covid-19), allowed for the evaluation of the effectiveness of these new vaccines in a real-world setting. Methods We conducted a test-negative case–control study involving health care personnel across 25 U.S. states. Cases were defined on the basis of a positive polymerase-chain-reaction (PCR) or antigen-based test for SARS-CoV-2 and at least one Covid-19–like symptom. Controls were defined on the basis of a negative PCR test for SARS-CoV-2, regardless of symptoms, and were matched to cases according to the week of the test date and site. Using conditional logistic regression with adjustment for age, race and ethnic group, underlying conditions, and exposures to persons with Covid-19, we estimated vaccine effectiveness for partial vaccination (assessed 14 days after receipt of the first dose through 6 days after receipt of the second dose) and complete vaccination (assessed ≥7 days after receipt of the second dose). Results The study included 1482 case participants and 3449 control participants. Vaccine effectiveness for partial vaccination was 77.6% (95% confidence interval [CI], 70.9 to 82.7) with the BNT162b2 vaccine (Pfizer–BioNTech) and 88.9% (95% CI, 78.7 to 94.2) with the mRNA-1273 vaccine (Moderna); for complete vaccination, vaccine effectiveness was 88.8% (95% CI, 84.6 to 91.8) and 96.3% (95% CI, 91.3 to 98.4), respectively. Vaccine effectiveness was similar in subgroups defined according to age (
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- 2021
18. Interim Estimates of Vaccine Effectiveness of Pfizer-BioNTech and Moderna COVID-19 Vaccines Among Health Care Personnel - 33 U.S. Sites, January-March 2021
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Kaytlynn Marceaux-Galli, Ryan Gierke, Katherine E. Fleming-Dutra, Nicholas M. Mohr, Rebecca Pierce, Joelle Nadle, Gregory J. Moran, Jeanmarie Mayer, Brian Chinnock, Elizabeth Krebs, Daniel J. Henning, Monica Brackney, Walter A. Schrading, Erin C Phipps, Karisa K. Harland, Jennifer L. Farrar, David G. Beiser, Tiffanie M. Markus, Shelley S. Magill, Anusha Krishnadasan, John P. Haran, Marc Fischer, Rosalyn J. Singleton, Michael Lin, Nasia Safdar, Frank LoVecchio, Stephanie J. Schrag, Devra Barter, Mark P. Steele, Stephen C. Lim, Deverick J. Anderson, Jennifer R. Verani, Amber Britton, Brett A. Faine, Lilly C. Lee, Peter C. Hou, Tamara Pilishvili, Amanda K. Debes, David A. Talan, Hilary M. Babcock, Utsav Nandi, Sarah Lim, Howard A. Smithline, Ghinwa Dumyati, and Nora Chea
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Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Health (social science) ,COVID-19 Vaccines ,Epidemiology ,Health, Toxicology and Mutagenesis ,Health Personnel ,Population ,01 natural sciences ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,COVID-19 Testing ,Health Information Management ,Interim ,Health care ,Pandemic ,medicine ,Humans ,030212 general & internal medicine ,Full Report ,0101 mathematics ,education ,Immunization Schedule ,Aged ,education.field_of_study ,business.industry ,010102 general mathematics ,Case-control study ,COVID-19 ,General Medicine ,Middle Aged ,Confidence interval ,United States ,Vaccination ,Clinical trial ,Occupational Diseases ,Case-Control Studies ,Female ,business - Abstract
Throughout the COVID-19 pandemic, health care personnel (HCP) have been at high risk for exposure to SARS-CoV-2, the virus that causes COVID-19, through patient interactions and community exposure (1). The Advisory Committee on Immunization Practices recommended prioritization of HCP for COVID-19 vaccination to maintain provision of critical services and reduce spread of infection in health care settings (2). Early distribution of two mRNA COVID-19 vaccines (Pfizer-BioNTech and Moderna) to HCP allowed assessment of the effectiveness of these vaccines in a real-world setting. A test-negative case-control study is underway to evaluate mRNA COVID-19 vaccine effectiveness (VE) against symptomatic illness among HCP at 33 U.S. sites across 25 U.S. states. Interim analyses indicated that the VE of a single dose (measured 14 days after the first dose through 6 days after the second dose) was 82% (95% confidence interval [CI] = 74%-87%), adjusted for age, race/ethnicity, and underlying medical conditions. The adjusted VE of 2 doses (measured ≥7 days after the second dose) was 94% (95% CI = 87%-97%). VE of partial (1-dose) and complete (2-dose) vaccination in this population is comparable to that reported from clinical trials and recent observational studies, supporting the effectiveness of mRNA COVID-19 vaccines against symptomatic disease in adults, with strong 2-dose protection.
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- 2021
19. Antibiotic Susceptibility of Common Organisms Isolated from Urine Cultures of Nursing Home Residents
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Linda Li, Lourdes Irizarry, Susan M. Ray, Devra Barter, Austin R Penna, Alexia Y Zhang, Krithika Srinivasan, Lucy E. Wilson, J P Mahoehney, Marion A. Kainer, Marla Sievers, Nimalie D. Stone, Helen Johnston, Deborah Godine, Joelle Nadle, Christina B Felsen, Ruth Lynfield, Linda Frank, Taniece Eure, Ghinwa Dumyati, Grant Barney, Nicola D. Thompson, Shelley S. Magill, Paula Clogher, Erin Epson, and Sarah Shrum Davis
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Microbiology (medical) ,medicine.medical_specialty ,Infectious Diseases ,Epidemiology ,business.industry ,medicine.drug_class ,Internal medicine ,Antibiotics ,medicine ,Urine ,Nursing homes ,business - Abstract
Background: With the emergence of antibiotic resistant threats and the need for appropriate antibiotic use, laboratory microbiology information is important to guide clinical decision making in nursing homes, where access to such data can be limited. Susceptibility data are necessary to inform antibiotic selection and to monitor changes in resistance patterns over time. To contribute to existing data that describe antibiotic resistance among nursing home residents, we summarized antibiotic susceptibility data from organisms commonly isolated from urine cultures collected as part of the CDC multistate, Emerging Infections Program (EIP) nursing home prevalence survey. Methods: In 2017, urine culture and antibiotic susceptibility data for selected organisms were retrospectively collected from nursing home residents’ medical records by trained EIP staff. Urine culture results reported as negative (no growth) or contaminated were excluded. Susceptibility results were recorded as susceptible, non-susceptible (resistant or intermediate), or not tested. The pooled mean percentage tested and percentage non-susceptible were calculated for selected antibiotic agents and classes using available data. Susceptibility data were analyzed for organisms with ≥20 isolates. The definition for multidrug-resistance (MDR) was based on the CDC and European Centre for Disease Prevention and Control’s interim standard definitions. Data were analyzed using SAS v 9.4 software. Results: Among 161 participating nursing homes and 15,276 residents, 300 residents (2.0%) had documentation of a urine culture at the time of the survey, and 229 (76.3%) were positive. Escherichia coli, Proteus mirabilis, Klebsiella spp, and Enterococcus spp represented 73.0% of all urine isolates (N = 278). There were 215 (77.3%) isolates with reported susceptibility data (Fig. 1). Of these, data were analyzed for 187 (87.0%) (Fig. 2). All isolates tested for carbapenems were susceptible. Fluoroquinolone non-susceptibility was most prevalent among E. coli (42.9%) and P. mirabilis (55.9%). Among Klebsiella spp, the highest percentages of non-susceptibility were observed for extended-spectrum cephalosporins and folate pathway inhibitors (25.0% each). Glycopeptide non-susceptibility was 10.0% for Enterococcus spp. The percentage of isolates classified as MDR ranged from 10.1% for E. coli to 14.7% for P. mirabilis. Conclusions: Substantial levels of non-susceptibility were observed for nursing home residents’ urine isolates, with 10% to 56% reported as non-susceptible to the antibiotics assessed. Non-susceptibility was highest for fluoroquinolones, an antibiotic class commonly used in nursing homes, and ≥ 10% of selected isolates were MDR. Our findings reinforce the importance of nursing homes using susceptibility data from laboratory service providers to guide antibiotic prescribing and to monitor levels of resistance.Disclosures: NoneFunding: None
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- 2020
20. Evaluation of Discrepancies in Carbapenem Minimum Inhibitory Concentrations Obtained at Clinical Laboratories Compared to a Public Health Laboratory
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Julian E. Grass, Shelley S. Magill, Isaac See, Uzma Ansari, Lucy E. Wilson, Elisabeth Vaeth, Paula Snippes Vagnone, Brittany Pattee, Jesse T. Jacob, Georgia Emerging Infections Program, Chris Bower, Atlanta Veterans Affairs Medical Center, Foundation for Atlanta Veterans Education and Research, Sarah W. Satola, Sarah J. Janelle, Kyle Schutz, Rebecca Tsay, Marion A. Kainer, Daniel Muleta, P. Maureen Cassidy, Vivian H. Leung, Meghan Maloney, Erin C. Phipps, New Mexico Emerging Infections Program, Kristina G. Flores, Erin Epson, Joelle Nadle, Maria Karlsson, and Joseph D. Lutgring
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Microbiology (medical) ,Imipenem ,education.field_of_study ,Carbapenem ,biology ,Epidemiology ,Klebsiella pneumoniae ,business.industry ,Broth microdilution ,Population ,Enterobacter ,biology.organism_classification ,Meropenem ,Microbiology ,chemistry.chemical_compound ,Infectious Diseases ,chemistry ,medicine ,education ,business ,Ertapenem ,medicine.drug - Abstract
Background: Automated testing instruments (ATIs) are commonly used by clinical microbiology laboratories to perform antimicrobial susceptibility testing (AST), whereas public health laboratories may use established reference methods such as broth microdilution (BMD). We investigated discrepancies in carbapenem minimum inhibitory concentrations (MICs) among Enterobacteriaceae tested by clinical laboratory ATIs and by reference BMD at the CDC. Methods: During 2016–2018, we conducted laboratory- and population-based surveillance for carbapenem-resistant Enterobacteriaceae (CRE) through the CDC Emerging Infections Program (EIP) sites (10 sites by 2018). We defined an incident case as the first isolation of Enterobacter spp (E. cloacae complex or E. aerogenes), Escherichia coli, Klebsiella pneumoniae, K. oxytoca, or K. variicola resistant to doripenem, ertapenem, imipenem, or meropenem from normally sterile sites or urine identified from a resident of the EIP catchment area in a 30-day period. Cases had isolates that were determined to be carbapenem-resistant by clinical laboratory ATI MICs (MicroScan, BD Phoenix, or VITEK 2) or by other methods, using current Clinical and Laboratory Standards Institute (CLSI) criteria. A convenience sample of these isolates was tested by reference BMD at the CDC according to CLSI guidelines. Results: Overall, 1,787 isolates from 112 clinical laboratories were tested by BMD at the CDC. Of these, clinical laboratory ATI MIC results were available for 1,638 (91.7%); 855 (52.2%) from 71 clinical laboratories did not confirm as CRE at the CDC. Nonconfirming isolates were tested on either a MicroScan (235 of 462; 50.9%), BD Phoenix (249 of 411; 60.6%), or VITEK 2 (371 of 765; 48.5%). Lack of confirmation was most common among E. coli (62.2% of E. coli isolates tested) and Enterobacter spp (61.4% of Enterobacter isolates tested) (Fig. 1A), and among isolates testing resistant to ertapenem by the clinical laboratory ATI (52.1%, Fig. 1B). Of the 1,388 isolates resistant to ertapenem in the clinical laboratory, 1,006 (72.5%) were resistant only to ertapenem. Of the 855 nonconfirming isolates, 638 (74.6%) were resistant only to ertapenem based on clinical laboratory ATI MICs. Conclusions: Nonconfirming isolates were widespread across laboratories and ATIs. Lack of confirmation was most common among E. coli and Enterobacter spp. Among nonconfirming isolates, most were resistant only to ertapenem. These findings may suggest that ATIs overcall resistance to ertapenem or that isolate transport and storage conditions affect ertapenem resistance. Further investigation into this lack of confirmation is needed, and CRE case identification in public health surveillance may need to account for this phenomenon.Funding: NoneDisclosures: None
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- 2020
21. Antimicrobial Use in a Cohort of US Nursing Homes, 2017
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Lourdes Irizarry, Lucy E Wilson, Sarah Shrum Davis, Devra Barter, J P Mahoehney, Joelle Nadle, Ghinwa Dumyati, Ruth Lynfield, Christina B Felsen, Meghan Maloney, Grant Barney, Cedric Brown, Linda Frank, Austin R Penna, Deborah Godine, Marla Sievers, Alexia Y Zhang, Valerie Ocampo, Taniece Eure, Wendy Bamberg, Nicola D. Thompson, Shelley S. Magill, Rebecca Pierce, Krithika Srinivasan, Marion A. Kainer, Susan M. Ray, Paula Clogher, Nimalie D. Stone, Malini B. DeSilva, and Linda Li
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Male ,medicine.medical_specialty ,Cross-sectional study ,MEDLINE ,01 natural sciences ,03 medical and health sciences ,Antimicrobial Stewardship ,0302 clinical medicine ,Antibiotic resistance ,Anti-Infective Agents ,Health care ,medicine ,Antimicrobial stewardship ,Humans ,030212 general & internal medicine ,0101 mathematics ,Prescription Drug Overuse ,Aged ,Aged, 80 and over ,business.industry ,Public health ,010102 general mathematics ,General Medicine ,Middle Aged ,Antimicrobial ,Drug Utilization ,United States ,Anti-Bacterial Agents ,Nursing Homes ,Cross-Sectional Studies ,Logistic Models ,Family medicine ,Cohort ,Urinary Tract Infections ,Female ,business ,Fluoroquinolones - Abstract
Importance Controlling antimicrobial resistance in health care is a public health priority, although data describing antimicrobial use in US nursing homes are limited. Objective To measure the prevalence of antimicrobial use and describe antimicrobial classes and common indications among nursing home residents. Design, Setting, and Participants Cross-sectional, 1-day point-prevalence surveys of antimicrobial use performed between April 2017 and October 2017, last survey date October 31, 2017, and including 15 276 residents present on the survey date in 161 randomly selected nursing homes from selected counties of 10 Emerging Infections Program (EIP) states. EIP staff reviewed nursing home records to collect data on characteristics of residents and antimicrobials administered at the time of the survey. Nursing home characteristics were obtained from nursing home staff and the Nursing Home Compare website. Exposures Residence in one of the participating nursing homes at the time of the survey. Main Outcomes and Measures Prevalence of antimicrobial use per 100 residents, defined as the number of residents receiving antimicrobial drugs at the time of the survey divided by the total number of surveyed residents. Multivariable logistic regression modeling of antimicrobial use and percentages of drugs within various classifications. Results Among 15 276 nursing home residents included in the study (mean [SD] age, 77.6 [13.7] years; 9475 [62%] women), complete prevalence data were available for 96.8%. The overall antimicrobial use prevalence was 8.2 per 100 residents (95% CI, 7.8-8.8). Antimicrobial use was more prevalent in residents admitted to the nursing home within 30 days before the survey date (18.8 per 100 residents; 95% CI, 17.4-20.3), with central venous catheters (62.8 per 100 residents; 95% CI, 56.9-68.3) or with indwelling urinary catheters (19.1 per 100 residents; 95% CI, 16.4-22.0). Antimicrobials were most often used to treat active infections (77% [95% CI, 74.8%-79.2%]) and primarily for urinary tract infections (28.1% [95% CI, 15.5%-30.7%]). While 18.2% (95% CI, 16.1%-20.1%) were for medical prophylaxis, most often use was for the urinary tract (40.8% [95% CI, 34.8%-47.1%]). Fluoroquinolones were the most common antimicrobial class (12.9% [95% CI, 11.3%-14.8%]), and 33.1% (95% CI, 30.7%-35.6%) of antimicrobials used were broad-spectrum antibiotics. Conclusions and Relevance In this cross-sectional survey of a cohort of US nursing homes in 2017, prevalence of antimicrobial use was 8.2 per 100 residents. This study provides information on the patterns of antimicrobial use among these nursing home residents.
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- 2021
22. Occupational risk factors for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection among healthcare personnel: A cross-sectional analysis of subjects enrolled in the COVID-19 Prevention in Emory Healthcare Personnel (COPE) study
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Matthew H. Collins, Nora Chea, William C. Dube, Teresa C Smith, Varun K Phadke, Carly Adams, Daniel Espinoza, James P. Steinberg, Jesse T. Jacob, Yerun Zhu, Jessica Howard-Anderson, Neena Edupuganti, Scott K. Fridkin, Amy C Sherman, Shelley S. Magill, Benjamin A. Lopman, and Srilatha Edupuganti
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Microbiology (medical) ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Cross-sectional study ,Occupational risk ,Epidemiology ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,viruses ,Health Personnel ,medicine.disease_cause ,Virus ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Health care ,Medicine ,Humans ,030212 general & internal medicine ,Respiratory system ,030304 developmental biology ,Coronavirus ,0303 health sciences ,business.industry ,SARS-CoV-2 ,Concise Communication ,COVID-19 ,Infectious Diseases ,Cross-Sectional Studies ,Emergency medicine ,business ,Delivery of Health Care - Abstract
Among 353 healthcare personnel in a longitudinal cohort in 4 hospitals in Atlanta, Georgia (May–June 2020), 23 (6.5%) had severe acute respiratory coronavirus virus 2 (SARS-CoV-2) antibodies. Spending >50% of a typical shift at the bedside (OR, 3.4; 95% CI, 1.2–10.5) and black race (OR, 8.4; 95% CI, 2.7–27.4) were associated with SARS-CoV-2 seropositivity.
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- 2021
23. Rates and causative pathogens of surgical site infections attributed to liver transplant procedures and other hepatic, biliary, or pancreatic procedures, 2015-2018
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Liang Zhou, Jonathan R. Edwards, Victoria Russo, Stephanie M Pouch, Jennifer Watkins, Lauren Epstein, Katherine Allen-Bridson, Shelley S. Magill, Alice Guh, Nora Chea, and Mathew R. P. Sapiano
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microbial ,medicine.medical_specialty ,Klebsiella pneumoniae ,medicine.medical_treatment ,Staphylococcus ,Drug resistance ,030230 surgery ,Liver transplantation ,Gastroenterology ,Enterococcus faecalis ,03 medical and health sciences ,0302 clinical medicine ,Antibiotic resistance ,Internal medicine ,Medicine ,Humans ,Surgical Wound Infection ,Transplantation ,drug resistance ,biology ,liver transplantation ,business.industry ,Original Articles ,biology.organism_classification ,Anti-Bacterial Agents ,Infectious Diseases ,Enterococcus ,Viridans streptococci ,030211 gastroenterology & hepatology ,Original Article ,business ,Enterococcus faecium - Abstract
Liver transplant recipients are at high risk for surgical site infections (SSIs). Limited data are available on SSI epidemiology following liver transplant procedures (LTPs). We analyzed data on SSIs from 2015 to 2018 reported to CDC's National Healthcare Safety Network to determine rates, pathogen distribution, and antimicrobial resistance after LTPs and other hepatic, biliary, or pancreatic procedures (BILIs). LTP and BILI SSI rates were 5.7% and 5.9%, respectively. The odds of SSI after LTP were lower than after BILI (adjusted odds ratio = 0.70, 95% confidence interval 0.57‐0.85). Among LTP SSIs, 43.1% were caused by Enterococcus spp., 17.2% by Candida spp., and 15.0% by coagulase‐negative Staphylococcus spp. (CNS). Percentages of SSIs caused by Enterococcus faecium or CNS were higher after LTPs than BILIs, whereas percentages of SSIs caused by Enterobacteriaceae, Enterococcus faecalis, or viridans streptococci were higher after BILIs. Antimicrobial resistance was common in LTP SSI pathogens, including E. faecium (69.4% vancomycin resistant); Escherichia coli (68.8% fluoroquinolone non‐susceptible and 44.7% extended spectrum cephalosporin [ESC] non‐susceptible); and Klebsiella pneumoniae and K. oxytoca (39.4% fluoroquinolone non‐susceptible and 54.5% ESC non‐susceptible). National LTP SSI pathogen and resistance data can help prioritize studies to determine effective interventions to prevent SSIs and reduce antimicrobial resistance in liver transplant recipients.
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- 2021
24. Documentation of acute change in mental status in nursing homes highlights opportunity to augment infection surveillance criteria
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Christina B Felsen, Stacy Carswell, Ruth Lynfield, Austin R Penna, Wendy Bamberg, Alexia Y Zhang, Lucy E. Wilson, Helen Johnston, Christina L Sancken, Taniece Eure, Nicola D. Thompson, Marla Sievers, Grant Barney, Ghinwa Dumyati, Deborah Godine, Susan M. Ray, Linda Li, Devra Barter, Linda Frank, J P Mahoehney, Joelle Nadle, Marion A. Kainer, Shelley S. Magill, Rebecca Pierce, Paula Clogher, Sarah Shrum Davis, and Nimalie D. Stone
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Microbiology (medical) ,Epidemiology ,MEDLINE ,Documentation ,Infections ,Article ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,030212 general & internal medicine ,Infection surveillance ,Confusion ,Retrospective Studies ,030504 nursing ,business.industry ,Medical record ,Mental Disorders ,medicine.disease ,Nursing Homes ,Infectious Diseases ,Assessment methods ,Nursing Care ,Medical emergency ,medicine.symptom ,Augment ,0305 other medical science ,Nursing homes ,business - Abstract
Acute change in mental status (ACMS), defined by the Confusion Assessment Method, is used to identify infections in nursing home residents. A medical record review revealed that none of 15,276 residents had an ACMS documented. Using the revised McGeer criteria with a possible ACMS definition, we identified 296 residents and 21 additional infections. The use of a possible ACMS definition should be considered for retrospective nursing home infection surveillance.
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- 2020
25. Burden of Candidemia in the United States, 2017
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Rajal K. Mody, Sherry Hillis, Sharon Tsay, Brittany Pattee, William Schaffner, Brendan R Jackson, Stepy Thomas, Wendy Bamberg, Erin Epson, Sarah Shrum Davis, Alexia Y Zhang, Brenda L Tesini, Sabrina R Williams, Snigdha Vallabhaneni, Helen Johnston, Kaytlynn Marceaux, Rosemary Hollick, Erin C Phipps, Anita Gellert, Joelle Nadle, Tom Chiller, Caroline R Graber, Lindsay Bonner, Lee H. Harrison, Monica M. Farley, Shelley S. Magill, Sasha Harb, Devra Barter, Yi Mu, and Danielle Ndi
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Adult ,Male ,Microbiology (medical) ,Population ,Psychological intervention ,High morbidity ,Emerging infections ,Bloodstream infection ,Humans ,Medicine ,Blood culture ,education ,Aged ,Candida ,Cross Infection ,education.field_of_study ,medicine.diagnostic_test ,business.industry ,Incidence ,Incidence (epidemiology) ,Candidemia ,United States ,Confidence interval ,Infectious Diseases ,Population Surveillance ,business ,Demography - Abstract
BackgroundCandidemia is a common healthcare-associated bloodstream infection with high morbidity and mortality. There are no current estimates of candidemia burden in the United States (US).MethodsIn 2017, the Centers for Disease Control and Prevention conducted active population-based surveillance for candidemia through the Emerging Infections Program in 45 counties in 9 states encompassing approximately 17 million persons (5% of the national population). Laboratories serving the catchment area population reported all blood cultures with Candida, and a standard case definition was applied to identify cases that occurred in surveillance area residents. Burden of cases and mortality were estimated by extrapolating surveillance area cases to national numbers using 2017 national census data.ResultsWe identified 1226 candidemia cases across 9 surveillance sites in 2017. Based on this, we estimated that 22 660 (95% confidence interval [CI], 20 210–25 110) cases of candidemia occurred in the US in 2017. Overall estimated incidence was 7.0 cases per 100 000 persons, with highest rates in adults aged ≥ 65 years (20.1/100 000), males (7.9/100 000), and those of black race (12.3/100 000). An estimated 3380 (95% CI, 1318–5442) deaths occurred within 7 days of a positive Candida blood culture, and 5628 (95% CI, 2465–8791) deaths occurred during the hospitalization with candidemia.ConclusionsOur analysis highlights the substantial burden of candidemia in the US. Because candidemia is only one form of invasive candidiasis, the true burden of invasive infections due to Candida is higher. Ongoing surveillance can support future burden estimates and help assess the impact of prevention interventions.
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- 2020
26. Antimicrobial-resistant pathogens associated with adult healthcare-associated infections: Summary of data reported to the National Healthcare Safety Network, 2015-2017
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Maroya Spalding Walters, Isaac See, Jonathan R. Edwards, Sheila Abner, Alexander J. Kallen, Lindsey M Weiner-Lastinger, Maria Karlsson, Minn M. Soe, Margaret A. Dudeck, Shelley S. Magill, and Daniel A. Pollock
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Microbiology (medical) ,Adult ,medicine.medical_specialty ,Gram-Negative Facultatively Anaerobic Rods ,Epidemiology ,Drug resistance ,medicine.disease_cause ,Gram-Positive Bacteria ,Article ,03 medical and health sciences ,0302 clinical medicine ,Antibiotic resistance ,Internal medicine ,Intensive care ,Drug Resistance, Multiple, Bacterial ,medicine ,Antimicrobial stewardship ,Infection control ,Central Venous Catheters ,Humans ,Surgical Wound Infection ,030212 general & internal medicine ,0303 health sciences ,Cross Infection ,030306 microbiology ,business.industry ,Pneumonia, Ventilator-Associated ,Bacterial Infections ,Antimicrobial ,medicine.disease ,Hospitals ,United States ,Anti-Bacterial Agents ,Pneumonia ,Infectious Diseases ,Gram-Negative Aerobic Rods and Cocci ,Staphylococcus aureus ,Catheter-Related Infections ,Urinary Tract Infections ,Centers for Disease Control and Prevention, U.S ,business - Abstract
Objective: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 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.
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- 2019
27. Pathogen Distribution and Antimicrobial Resistance Among Pediatric Healthcare-Associated Infections Reported to the National Healthcare Safety Network, 2011–2014
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Jason G Lake, Lindsey M. Weiner, Aaron M. Milstone, Isaac See, Shelley S. Magill, and Lisa Saiman
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0301 basic medicine ,Microbiology (medical) ,medicine.medical_specialty ,Epidemiology ,Klebsiella pneumoniae ,Staphylococcus ,030106 microbiology ,Drug resistance ,medicine.disease_cause ,Pediatrics ,Article ,Enterococcus faecalis ,03 medical and health sciences ,Catheters, Indwelling ,0302 clinical medicine ,Antibiotic resistance ,Internal medicine ,Intensive care ,Drug Resistance, Bacterial ,Escherichia coli ,medicine ,Humans ,Surgical Wound Infection ,Antimicrobial stewardship ,Infection control ,030212 general & internal medicine ,Child ,Cross Infection ,biology ,business.industry ,Pseudomonas aeruginosa ,Infant, Newborn ,Infant ,Pneumonia, Ventilator-Associated ,Bacterial Infections ,biology.organism_classification ,Hospitals ,United States ,Anti-Bacterial Agents ,Infectious Diseases ,Carbapenems ,Catheter-Related Infections ,Child, Preschool ,Equipment Contamination ,Centers for Disease Control and Prevention, U.S ,business - Abstract
OBJECTIVETo describe pathogen distribution and antimicrobial resistance patterns for healthcare-associated infections (HAIs) reported to the National Healthcare Safety Network (NHSN) from pediatric locations during 2011–2014.METHODSDevice-associated infection data were analyzed for central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infections (CAUTI), ventilator-associated pneumonia (VAP), and surgical site infection (SSI). Pooled mean percentage resistance was calculated for a variety of pathogen-antimicrobial resistance pattern combinations and was stratified by location for device-associated infections (neonatal intensive care units [NICUs], pediatric intensive care units [PICUs], pediatric oncology and pediatric wards) and by surgery type for SSIs.RESULTSFrom 2011 to 2014, 1,003 hospitals reported 20,390 pediatric HAIs and 22,323 associated pathogens to the NHSN. Among all HAIs, the following pathogens accounted for more than 60% of those reported:Staphylococcus aureus(17%), coagulase-negative staphylococci (17%),Escherichia coli(11%),Klebsiella pneumoniaeand/oroxytoca(9%), andEnterococcus faecalis(8%). Among device-associated infections, resistance was generally lower in NICUs than in other locations. For several pathogens, resistance was greater in pediatric wards than in PICUs. The proportion of organisms resistant to carbapenems was low overall but reached approximately 20% forPseudomonas aeruginosafrom CLABSIs and CAUTIs in some locations. Among SSIs, antimicrobial resistance patterns were similar across surgical procedure types for most pathogens.CONCLUSIONThis report is the first pediatric-specific description of antimicrobial resistance data reported to the NHSN. Reporting of pediatric-specific HAIs and antimicrobial resistance data will help identify priority targets for infection control and antimicrobial stewardship activities in facilities that provide care for children.Infect Control Hosp Epidemiol2018;39:1–11
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- 2017
28. Use of Antimicrobials in a Cohort of US Nursing Homes—Reply
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Shelley S. Magill, Nimalie D. Stone, and Nicola D. Thompson
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medicine.medical_specialty ,business.industry ,Family medicine ,Cohort ,medicine ,MEDLINE ,General Medicine ,Nursing homes ,business ,Antimicrobial ,Cohort study - Published
- 2021
29. Prevalence and Epidemiology of Healthcare-Associated Infections (HAI) in US Nursing Homes (NH), 2017
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Linda Li, Srinivasan Krithika, Austin R Penna, Helen Johnston, Valerie Ocampo, Marla Sievers, Shelley S. Magill, Devra Barter, Grant Barney, Sarah Shrum, Taniece Eure, Susan M. Ray, Monika Samper, Ruth Lynfield, Lourdes Irizarry, Nimalie D. Stone, Marion A. Kainer, Lucy E. Wilson, Deborah Godine, J P Mahoehney, Alexia Zhang, Paula Clogher, Joelle Nadle, Christina B Felsen, Linda Frank, Ghinwa Dumyati, Nicola D. Thompson, Erin Epson, and Cedric Brown
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Microbiology (medical) ,Healthcare associated infections ,medicine.medical_specialty ,Population ageing ,animal structures ,Epidemiology ,business.industry ,Medical record ,virus diseases ,Pharyngitis ,Infectious Diseases ,Interquartile range ,Emerging infections ,Emergency medicine ,medicine ,medicine.symptom ,Nursing homes ,business - Abstract
Background: With an aging population, increasingly complex care, and frequent re-admissions, prevention of healthcare-associated infections (HAIs) in nursing homes (NHs) is a federal priority. However, few contemporary sources of HAI data exist to inform surveillance, prevention, and policy. Prevalence surveys (PSs) are an efficient approach to generating data to measure the burden and describe the types of HAI. In 2017, the Centers for Disease Control and Prevention (CDC) performed its first large-scale HAI PS through the Emerging Infections Program (EIP) to measure the prevalence and describe the epidemiology of HAI in NH residents. Methods: NHs from several states (CA, CO, CT, GA, MD, MN, NM, NY, OR, & TN) were randomly selected and asked to participate in a 1-day HAI PS between April and October 2017; participation was voluntary. EIP staff reviewed available medical records for NH residents present on the survey date to collect demographic and basic clinical information and infection signs and symptoms. HAIs with onset on or after NH day 3 were identified using revised McGeer infection definitions applied to data collected by EIP staff and were reported to the CDC through a web-based system. Data were reviewed by CDC staff for potential errors and to validate HAI classifications prior to analysis. HAI prevalence, number of residents with >1 HAI per number of surveyed residents ×100, and 95% CIs were calculated overall (pooled mean) and for selected resident characteristics. Data were analyzed using SAS v9.4 software. Results: Among 15,296 residents in 161 NHs, 358 residents with 375 HAIs were identified. The most common HAI sites were skin (32%), respiratory tract (29%), and urinary tract (20%). Cellulitis, soft-tissue or wound infection, symptomatic UTI, and cold or pharyngitis were the most common individual HAIs (Fig. 1). Overall HAI prevalence was 2.3 per 100 residents (95% CI, 2.1–2.6); at the NH level, the median HAI prevalence was 1.8 and ranged from 0 to 14.3 (interquartile range, 0–3.1). At the resident level (Fig. 2), HAI prevalence was significantly higher in persons admitted for postacute care with diabetes, with a pressure ulcer, receiving wound care, or with a device. Conclusions: In this large-scale survey, 1 in 43 NH residents had an HAI on a given day. Three HAI types comprised >80% of infections. In addition to identifying characteristics that place residents at higher risk for HAIs, these findings provide important data on HAI epidemiology in NHs that can be used to expand HAI surveillance and inform prevention policies and practices.Funding: NoneDisclosures: None
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- 2020
30. Appropriateness of Initiating Antibiotics for Urinary Tract Infection Among Nursing Home Residents
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Christina B Felsen, Ghinwa Dumyati, Helen Johnston, Lucy E. Wilson, Deborah Godine, Alexia Y Zhang, Monika Samper, Erin Epson, Taniece Eure, Krithika Srinivasan, Devra Barter, Austin R Penna, J P Mahoehney, Joelle Nadle, Shelley S. Magill, Valerie Ocampo, Grant Barney, Susan M. Ray, Linda Frank, Lourdes Irizarry, Nicola D. Thompson, Marla Sievers, Wendy Bamberg, Linda Li, Paula Clogher, Ruth Lynfield, Marion A. Kainer, Sarah Shrum Davis, Nimalie D. Stone, and Malini B. DeSilva
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Microbiology (medical) ,medicine.medical_specialty ,Epidemiology ,business.industry ,medicine.drug_class ,Urinary system ,Medical record ,Antibiotics ,Gold standard ,Antibiotic prescribing ,Infectious Diseases ,Emerging infections ,Emergency medicine ,Medicine ,Antibiotic use ,business ,Nursing homes - Abstract
Background: Antibiotics are among the most commonly prescribed drugs in nursing homes; urinary tract infections (UTIs) are a frequent indication. Although there is no gold standard for the diagnosis of UTIs, various criteria have been developed to inform and standardize nursing home prescribing decisions, with the goal of reducing unnecessary antibiotic prescribing. Using different published criteria designed to guide decisions on initiating treatment of UTIs (ie, symptomatic, catheter-associated, and uncomplicated cystitis), our objective was to assess the appropriateness of antibiotic prescribing among NH residents. Methods: In 2017, the CDC Emerging Infections Program (EIP) performed a prevalence survey of healthcare-associated infections and antibiotic use in 161 nursing homes from 10 states: California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, and Tennessee. EIP staff reviewed resident medical records to collect demographic and clinical information, infection signs, symptoms, and diagnostic testing documented on the day an antibiotic was initiated and 6 days prior. We applied 4 criteria to determine whether initiation of treatment for UTI was supported: (1) the Loeb minimum clinical criteria (Loeb); (2) the Suspected UTI Situation, Background, Assessment, and Recommendation tool (UTI SBAR tool); (3) adaptation of Infectious Diseases Society of America UTI treatment guidelines for nursing home residents (Crnich & Drinka); and (4) diagnostic criteria for uncomplicated cystitis (cystitis consensus) (Fig. 1). We calculated the percentage of residents for whom initiating UTI treatment was appropriate by these criteria. Results: Of 248 residents for whom UTI treatment was initiated in the nursing home, the median age was 79 years [IQR, 19], 63% were female, and 35% were admitted for postacute care. There was substantial variability in the percentage of residents with antibiotic initiation classified as appropriate by each of the criteria, ranging from 8% for the cystitis consensus, to 27% for Loeb, to 33% for the UTI SBAR tool, to 51% for Crnich and Drinka (Fig. 2). Conclusions: Appropriate initiation of UTI treatment among nursing home residents remained low regardless of criteria used. At best only half of antibiotic treatment met published prescribing criteria. Although insufficient documentation of infection signs, symptoms and testing may have contributed to the low percentages observed, adequate documentation in the medical record to support prescribing should be standard practice, as outlined in the CDC Core Elements of Antibiotic Stewardship for nursing homes. Standardized UTI prescribing criteria should be incorporated into nursing home stewardship activities to improve the assessment and documentation of symptomatic UTI and to reduce inappropriate antibiotic use.Funding: NoneDisclosures: None
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- 2020
31. Incidence of Mucosal Barrier Injury Bloodstream Infections Reported to the National Healthcare Safety Network
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Dominque Godfrey-Johnson, Shelley S. Magill, Nicola D. Thompson, Nora Chea, Prachi R Patel, and Margaret A. Dudeck
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Microbiology (medical) ,medicine.medical_specialty ,Infectious Diseases ,Epidemiology ,business.industry ,Incidence (epidemiology) ,Emergency medicine ,Health care ,Medicine ,business - Abstract
Background: The NHSN collects data on mucosal barrier injury, laboratory-confirmed, bloodstream infections (MBI-LCBIs) as part of bloodstream infection (BSI) surveillance. Specialty care areas (SCAs), which include oncology patient care locations, tend to report the most MBI-LCBI events compared to other location types. During the update of the NSHN aggregate data and risk models in 2015, MBI-LCBI events were excluded from central-line–associated BSI (CLABSI) model calculations; separate models were generated for MBI-LCBIs, resulting in MBI-specific standardized infection ratios (SIRs). This is the first analysis to describe risk-adjusted incidence of MBI-LCBIs at the national level. Methods: Data were analyzed for MBI-LCBIs attributed to oncology locations conducting BSI surveillance from January 2015 through December 2018. We generated annual national MBI-LCBI SIRs using risk models developed from 2015 data and compared the annual SIRs to the baseline (2015) using a mid-P exact test. To account for the impact of an expansion in the MBI-LCBI organism list in 2017 from 489 organisms (32 genera) to 1,003 organisms (89 genera), we removed the MBI-LCBI events that met the newly added MBI organisms and generated additional MBI SIRs for 2017 and 2018. Results: The annual SIRs remained above 1 since 2015, indicating a greater number of MBI-LCBIs identified than were predicted based on the 2015 national data (Fig. 1). Each year’s SIR was significantly different than the national baseline, and the highest SIR was observed in 2017 (SIR, 1.377). In 2017, 12% of MBI events were attributed to an organism that was added to the MBI organism list, and in 2018 it was 10%. After removal of MBIs attributed to the expanded organisms, the 2017 and 2018 SIRs remained higher than those of previous years (1.241 and 1.232, respectively). Conclusions: The distinction of MBI-LCBIs from all other CLABSIs provides an opportunity to assess the burden of this infection type within specific patient populations. Since 2015, the increase of these events in the oncology population highlights the need for greater attention on prevention strategies pertinent to MBI-LCBI in this vulnerable population.Funding: NoneDisclosures: None
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- 2020
32. 909. Reassessing Pathogens Eligible for the Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN) 'Mucosal Barrier Injury-Laboratory Confirmed Bloodstream Infection' Criteria
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Nora Chea, Andrea L. Benin, Nicola D Thomson, Prachi R Patel, Shelley S. Magill, Katherine Allen-Bridson, and Margaret A Dudeck
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medicine.medical_specialty ,business.industry ,Disease control ,Viridans streptococcus ,Pathogenic organism ,AcademicSubjects/MED00290 ,Infectious Diseases ,Oncology ,Bloodstream infection ,Poster Abstracts ,Emergency medicine ,Health care ,Medicine ,Health care safety ,Antibiotic prophylaxis ,business - Abstract
Background NHSN Mucosal Barrier Injury-Laboratory Confirmed Bloodstream Infection (MBI-LCBI) includes pathogens likely to cause bloodstream infections (BSI) in some oncology patients. MBI-LCBIs are excluded from central line-associated BSI (CLABSI) reporting to the Centers for Medicare & Medicaid Services. NHSN users have requested other pathogens be added to MBI-LCBI. To make decision, we compared CLABSI pathogen distributions in three NHSN patient location groups. Methods We analyzed CLABSI data from hospitals conducting surveillance for ≥ 1 month from January 2014–December 2018 in ≥ 1 MBI high-risk location (leukemia, lymphoma, and adult and pediatric hematopoietic stem cell transplant wards). We compared CLABSI pathogen distributions and rates in MBI high-risk locations to medium-risk (solid tumor, adult and pediatric general hematology-oncology wards) and low-risk locations (adult and pediatric medical, surgical, and medical-surgical wards), and used χ2 tests to compare percentages with statistical significance at P ≤ 0.05. Results Overall, 122 hospitals reported 23,578 CLABSIs and 12,961,921 central line (CL)-days (1.81 CLABSIs per 1,000 CL-days) (Table). Percentages of CLABSIs due to three MBI-LCBI pathogens (E. coli, E. faecium, Viridans streptococci) were significantly higher in high- versus low-risk locations, while for other MBI-LCBI pathogens (K. pneumoniae/oxytoca, E. faecalis, Candida spp., Enterobacter spp.) percentages were significantly lower in high-risk locations (Figure). For pathogens not currently in MBI-LCBI, coagulase-negative staphylococci caused similar percentages of CLABSIs across locations, S. aureus caused a significantly higher percentage of CLABSIs in low-risk locations, while PA caused a significantly higher percentage of CLABSIs in high-risk locations. Table CLABSIs attributed to MBI high-risk, medium-risk, and low-risk locations, NHSN, 2014–2018 Figure Percentages of top 10 pathogen-specific CLABSIs in MBI high-risk, medium-risk, and low-risk locations, NHSN, 2014–2018 Conclusion Differences in percentages of CLABSIs due to selected pathogens between MBI high-risk and low-risk locations are evident in NHSN data. Lower percentages of Klebsiella and Candida spp. in high-risk locations might be partially due to antimicrobial prophylaxis in oncology patients. Although PA caused a significantly higher percentage of CLABSIs in high-risk locations, the absolute difference was modest. Additional analyses are needed. Disclosures All Authors: No reported disclosures
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- 2020
33. Incidence and Characteristics of Ventilator-Associated Events Reported to the National Healthcare Safety Network in 2014*
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Margaret A. Dudeck, Jonathan R. Edwards, Shelley S. Magill, Qunna Li, Cindy Gross, and Katherine Allen-Bridson
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Male ,Critical Care ,MEDLINE ,Pneumonia ventilator associated ,Critical Care and Intensive Care Medicine ,03 medical and health sciences ,Patient safety ,0302 clinical medicine ,Public health surveillance ,Risk Factors ,Health care ,Humans ,Medicine ,030212 general & internal medicine ,Aged ,business.industry ,Incidence ,Incidence (epidemiology) ,Pneumonia, Ventilator-Associated ,Middle Aged ,medicine.disease ,Respiration, Artificial ,United States ,Pneumonia ,030228 respiratory system ,Population Surveillance ,Female ,Patient Safety ,Medical emergency ,business - Abstract
Ventilator-associated event surveillance was introduced in the National Healthcare Safety Network in 2013, replacing surveillance for ventilator-associated pneumonia in adult inpatient locations. We determined incidence rates and characteristics of ventilator-associated events reported to the National Healthcare Safety Network.We analyzed data reported from U.S. healthcare facilities for ventilator-associated events that occurred in 2014, the first year during which ventilator-associated event surveillance definitions were stable. We used negative binomial regression modeling to identify healthcare facility and inpatient location characteristics associated with ventilator-associated events. We calculated ventilator-associated event incidence rates, rate distributions, and ventilator utilization ratios in critical care and noncritical care locations and described event characteristics.A total of 1,824 healthcare facilities reported 32,772 location months of ventilator-associated event surveillance data to the National Healthcare Safety Network in 2014. Critical care unit pooled mean ventilator-associated event incidence rates ranged from 2.00 to 11.79 per 1,000 ventilator days, whereas noncritical care unit rates ranged from 0 to 14.86 per 1,000 ventilator days. The pooled mean proportion of ventilator-associated events defined as infection-related varied from 15.38% to 47.62% in critical care units. Pooled mean ventilator utilization ratios in critical care units ranged from 0.24 to 0.47.We found substantial variability in ventilator-associated event incidence, proportions of ventilator-associated events characterized as infection-related, and ventilator utilization within and among location types. More work is needed to understand the preventable fraction of ventilator-associated events and identify patient care strategies that reduce ventilator-associated events.
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- 2016
34. Epidemiology of Antibiotic Use for Urinary Tract Infection in Nursing Home Residents
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Nimalie D. Stone, Marion A. Kainer, Lourdes Irizarry, Erin Epson, Malini B. DeSilva, Paula Clogher, Nicola D. Thompson, Devra Barter, Marla Sievers, Taniece Eure, Wendy Bamberg, Austin R Penna, Lucy E. Wilson, Valerie Ocampo, J P Mahoehney, Joelle Nadle, Deborah Godine, Grant Barney, Lewis Perry, Linda Li, Shelley S. Magill, Sarah Shrum Davis, Susan M. Ray, Linda Frank, Ruth Lynfield, Ghinwa Dumyati, and Alexia Y Zhang
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medicine.medical_specialty ,medicine.drug_class ,Urinary system ,Antibiotics ,Prevalence ,03 medical and health sciences ,Antimicrobial Stewardship ,0302 clinical medicine ,Epidemiology ,medicine ,Homes for the Aged ,Humans ,030212 general & internal medicine ,Adverse effect ,General Nursing ,Aged ,Aged, 80 and over ,business.industry ,Health Policy ,Medical record ,General Medicine ,Planned Duration ,Anti-Bacterial Agents ,Nursing Homes ,Emergency medicine ,Urinary Tract Infections ,Geriatrics and Gerontology ,Nursing homes ,business ,030217 neurology & neurosurgery - Abstract
Objectives Describe antibiotic use for urinary tract infection (UTI) among a large cohort of US nursing home residents. Design Analysis of data from a multistate, 1-day point prevalence survey of antimicrobial use performed between April and October 2017. Setting and participants Residents of 161 nursing homes in 10 US states of the Emerging Infections Program (EIP). Methods EIP staff reviewed nursing home medical records to collect data on systemic antimicrobial drugs received by residents, including therapeutic site, rationale for use, and planned duration. For drugs with the therapeutic site documented as urinary tract, pooled mean and nursing home–specific prevalence rates were calculated per 100 nursing home residents, and proportion of drugs by selected characteristics were reported. Data were analyzed in SAS, version 9.4. Results Among 15,276 residents, 407 received 424 antibiotics for UTI. The pooled mean prevalence rate of antibiotic use for UTI was 2.66 per 100 residents; nursing home–specific rates ranged from 0 to 13.6. One-quarter of antibiotics were prescribed for UTI prophylaxis, with a median planned duration of 111 days compared with 7 days when prescribed for UTI treatment (P Conclusions and Implications One in 38 residents was receiving an antibiotic for UTI on a given day, and nursing home–specific prevalence rates varied by more than 10-fold. UTI prophylaxis was common with a long planned duration, despite limited evidence to support this practice among older persons in nursing homes. The planned duration was ≥7 days for half of antibiotics prescribed for treatment of a UTI. Fluoroquinolones were the most commonly used antibiotics, despite their association with significant adverse events, particularly in a frail and older adult population. These findings help to identify priority practices for nursing home antibiotic stewardship.
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- 2019
35. Bacterial and Fungal Infections in Persons Who Inject Drugs - Western New York, 2017
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Runa H Gokhale, Anthony E. Fiore, Ana C Bardossy, Chris A. Van Beneden, Michael Mendoza, Ghinwa Dumyati, Michele K. Bohm, Elizabeth Dufort, Isaac See, Kelly A. Jackson, Robert McDonald, Olivia L McGovern, John T. Brooks, Christina B Felsen, Alice Asher, Shelley S. Magill, Ian Kracalik, Debra Blog, Todd Lucas, and Kathleen P. Hartnett
- Subjects
Adult ,Male ,medicine.medical_specialty ,Health (social science) ,Adolescent ,Epidemiology ,Health, Toxicology and Mutagenesis ,media_common.quotation_subject ,New York ,medicine.disease_cause ,01 natural sciences ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Health Information Management ,Hygiene ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Full Report ,0101 mathematics ,Substance Abuse, Intravenous ,media_common ,Aged ,business.industry ,Public health ,010102 general mathematics ,Opioid use disorder ,General Medicine ,Emergency department ,Bacterial Infections ,Middle Aged ,medicine.disease ,Substance abuse ,Mycoses ,Staphylococcus aureus ,Population Surveillance ,Female ,business ,Methadone ,medicine.drug ,Buprenorphine - Abstract
During 2014-2017, CDC Emerging Infections Program surveillance data reported that the occurrence of invasive methicillin-resistant Staphylococcus aureus (MRSA) infections associated with injection drug use doubled among persons aged 18-49 years residing in Monroe County in western New York.* Unpublished surveillance data also indicate that an increasing proportion of all Candida spp. bloodstream infections in Monroe County and invasive group A Streptococcus (GAS) infections in 15 New York counties are also occurring among persons who inject drugs. In addition, across six surveillance sites nationwide, the proportion of invasive MRSA infections that occurred in persons who inject drugs increased from 4.1% of invasive MRSA cases in 2011 to 9.2% in 2016 (1). To better understand the types and frequency of these infections and identify prevention opportunities, CDC and public health partners conducted a rapid assessment of bacterial and fungal infections among persons who inject drugs in western New York. The goals were to assess which bacterial and fungal pathogens most often cause infections in persons who inject drugs, what proportion of persons who inject use opioids, and of these, how many were offered medication-assisted treatment for opioid use disorder. Medication-assisted treatment, which includes use of medications such as buprenorphine, methadone, and naltrexone, reduces cravings and has been reported to lower the risk for overdose death and all-cause mortality in persons who use opioids (2,3). In this assessment, nearly all persons with infections who injected drugs used opioids (97%), but half of inpatients (22 of 44) and 12 of 13 patients seen only in the emergency department (ED) were not offered medication-assisted treatment. The most commonly identified pathogen was S. aureus (80%), which is frequently found on skin. Health care visits for bacterial and fungal infections associated with injection opioid use are an opportunity to treat the underlying opioid use disorder with medication-assisted treatment. Routine care for patients who continue to inject should include advice on hand hygiene and not injecting into skin that has not been cleaned or to use any equipment contaminated by reuse, saliva, soil, or water (4,5).
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- 2019
36. Public Health Importance of Invasive Methicillin-sensitive Staphylococcus aureus Infections: Surveillance in 8 US Counties, 2016
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David C. Ham, Joelle Nadle, Kelly A. Jackson, Shelley S. Magill, Ruth Lynfield, Susan M. Ray, Ghinwa Dumyati, William Schaffner, Runa H Gokhale, and Isaac See
- Subjects
Methicillin-Resistant Staphylococcus aureus ,0301 basic medicine ,Microbiology (medical) ,Staphylococcus aureus ,medicine.medical_specialty ,030106 microbiology ,Population ,Staphylococcal infections ,medicine.disease_cause ,Article ,Methicillin ,03 medical and health sciences ,0302 clinical medicine ,Renal Dialysis ,Internal medicine ,medicine ,Humans ,Infection control ,030212 general & internal medicine ,education ,education.field_of_study ,business.industry ,Public health ,Incidence (epidemiology) ,Odds ratio ,biochemical phenomena, metabolism, and nutrition ,Staphylococcal Infections ,bacterial infections and mycoses ,medicine.disease ,Methicillin-resistant Staphylococcus aureus ,United States ,Infectious Diseases ,Public Health ,Methicillin Susceptible Staphylococcus Aureus ,business - Abstract
Background Public health and infection control prevention and surveillance efforts in the United States have primarily focused on methicillin-resistant Staphylococcus aureus (MRSA). We describe the public health importance of methicillin-susceptible S. aureus (MSSA) in selected communities. Methods We analyzed Emerging Infections Program surveillance data for invasive S. aureus (SA) infections (isolated from a normally sterile body site) in 8 counties in 5 states during 2016. Cases were considered healthcare-associated if culture was obtained >3 days after hospital admission; if associated with dialysis, hospitalization, surgery, or long-term care facility (LTCF) residence within 1 year prior; or if a central venous catheter was present ≤2 days prior. Incidence per 100 000 census population was calculated, and a multivariate logistic regression model with random intercepts was used to compare MSSA risk factors with those of MRSA. Results Invasive MSSA incidence (31.3/100 000) was 1.8 times higher than MRSA (17.5/100 000). Persons with MSSA were more likely than those with MRSA to have no underlying medical conditions (adjusted odds ratio [aOR], 2.06; 95% confidence interval [CI], 1.26–3.39) and less likely to have prior hospitalization (aOR, 0.70; 95% CI, 0.60–0.82) or LTCF residence (aOR, 0.37; 95% CI, 0.29–0.47). MSSA accounted for 59.7% of healthcare-associated cases and 60.1% of deaths. Conclusions Although MRSA tended to be more closely associated with healthcare exposures, invasive MSSA is a substantial public health problem in the areas studied. Public health and infection control prevention efforts should consider MSSA prevention in addition to MRSA.
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- 2019
37. Changes in Prevalence of Health Care-Associated Infections. Reply
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Emerging Infections Program Healthcare-Associated Infections, Erin O’Leary, Jonathan R. Edwards, and Shelley S. Magill
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medicine.medical_specialty ,Cross Infection ,business.industry ,Family medicine ,medicine ,MEDLINE ,Prevalence ,Humans ,General Medicine ,business ,Health care associated ,Article ,Hospitals - Published
- 2019
38. Changes in Prevalence of Health Care–Associated Infections in U.S. Hospitals
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Ruth Lynfield, Linn Warnke, Jean Rainbow, Badrun F, Emily B. Hancock, Cathy Concannon, Shelley S. Magill, O'Leary E, Lucy E. Wilson, John T. Brooks, Joelle Nadle, Monika Samper, Phelps R, Shamima Akhtar Sharmin, Leaptrot D, Zintar G. Beldavs, Samantha Greissman, Marla Sievers, Edwards, Buhr N, Wendy Bamberg, Katherine Richards, Marion A. Kainer, Deborah L. Thompson, Ray Sm, Sarah J Janelle, Meghan Maloney, Gross C, Ghinwa Dumyati, Ocampo, Scalise E, and Tolulope Oyewumi
- Subjects
0301 basic medicine ,Cross infection ,medicine.medical_specialty ,Multivariate analysis ,Hospitalized patients ,business.industry ,030106 microbiology ,MEDLINE ,Clostridium Infections ,General Medicine ,medicine.disease ,Infant newborn ,Health care associated ,Article ,03 medical and health sciences ,Pneumonia ,0302 clinical medicine ,Emergency medicine ,medicine ,030212 general & internal medicine ,business - Abstract
BACKGROUND: A point-prevalence survey that was conducted in the United States in 2011 showed that 4% of hospitalized patients had a health care–associated infection. We repeated the survey in 2015 to assess changes in the prevalence of health care–associated infections during a period of national attention to the prevention of such infections. METHODS: At Emerging Infections Program sites in 10 states, we recruited up to 25 hospitals in each site area, prioritizing hospitals that had participated in the 2011 survey. Each hospital selected 1 day on which a random sample of patients was identified for assessment. Trained staff reviewed medical records using the 2011 definitions of health care–associated infections. We compared the percentages of patients with health care–associated infections and performed multivariable log-binomial regression modeling to evaluate the association of survey year with the risk of health care–associated infections. RESULTS: In 2015, a total of 12,299 patients in 199 hospitals were surveyed, as compared with 11,282 patients in 183 hospitals in 2011. Fewer patients had health care–associated infections in 2015 (394 patients [3.2%; 95% confidence interval {CI}, 2.9 to 3.5]) than in 2011 (452 [4.0%; 95% CI, 3.7 to 4.4]) (P
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- 2018
39. Assessment of the Appropriateness of Antimicrobial Use in US Hospitals
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Ruth Lynfield, Nora Chea, Jean Rainbow, Shelley S. Magill, Erin O’Leary, Tolulope Oyewumi, Alexia Y Zhang, Joelle Nadle, Valerie Ocampo, Helen Johnston, Christopher H. Evans, Wendy Bamberg, Shamima Sharmin, Meghan Maloney, Rebecca Pierce, Ghinwa Dumyati, Melinda M. Neuhauser, Deborah L Thompson, Marion A. Kainer, Sarah J Janelle, Susan M. Ray, Samantha Greissman, Lucy E Wilson, Jonathan R. Edwards, and Linn Warnke
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Male ,medicine.medical_specialty ,Cross-sectional study ,Risk Assessment ,Antimicrobial Stewardship ,Community-acquired pneumonia ,Interquartile range ,Internal medicine ,Prevalence ,medicine ,Humans ,Antimicrobial stewardship ,Practice Patterns, Physicians' ,Aged ,Retrospective Studies ,Inpatients ,business.industry ,Medical record ,Retrospective cohort study ,General Medicine ,Middle Aged ,medicine.disease ,Antimicrobial ,Drug Utilization ,Hospitals ,United States ,Anti-Bacterial Agents ,Community-Acquired Infections ,Cross-Sectional Studies ,Vancomycin ,Female ,business ,medicine.drug - Abstract
Importance Hospital antimicrobial consumption data are widely available; however, large-scale assessments of the quality of antimicrobial use in US hospitals are limited. Objective To evaluate the appropriateness of antimicrobial use for hospitalized patients treated for community-acquired pneumonia (CAP) or urinary tract infection (UTI) present at admission or for patients who had received fluoroquinolone or intravenous vancomycin treatment. Design, Setting, and Participants This cross-sectional study included data from a prevalence survey of hospitalized patients in 10 Emerging Infections Program sites. Random samples of inpatients on hospital survey dates from May 1 to September 30, 2015, were identified. Medical record data were collected for eligible patients with 1 or more of 4 treatment events (CAP, UTI, fluoroquinolone treatment, or vancomycin treatment), which were selected on the basis of common infection types reported and antimicrobials given to patients in the prevalence survey. Data were analyzed from August 1, 2017, to May 31, 2020. Exposure Antimicrobial treatment for CAP or UTI or with fluoroquinolones or vancomycin. Main Outcomes and Measures The percentage of antimicrobial use that was supported by medical record data (including infection signs and symptoms, microbiology test results, and antimicrobial treatment duration) or for which some aspect of use was unsupported. Unsupported antimicrobial use was defined as (1) use of antimicrobials to which the pathogen was not susceptible, use in the absence of documented infection signs or symptoms, or use without supporting microbiologic data; (2) use of antimicrobials that deviated from recommended guidelines; or (3) use that exceeded the recommended duration. Results Of 12 299 patients, 1566 patients (12.7%) in 192 hospitals were included; the median age was 67 years (interquartile range, 53-79 years), and 864 (55.2%) were female. A total of 219 patients (14.0%) were included in the CAP analysis, 452 (28.9%) in the UTI analysis, 550 (35.1%) in the fluoroquinolone analysis, and 403 (25.7%) in the vancomycin analysis; 58 patients (3.7%) were included in both fluoroquinolone and vancomycin analyses. Overall, treatment was unsupported for 876 of 1566 patients (55.9%; 95% CI, 53.5%-58.4%): 110 of 403 (27.3%) who received vancomycin, 256 of 550 (46.5%) who received fluoroquinolones, 347 of 452 (76.8%) with a diagnosis of UTI, and 174 of 219 (79.5%) with a diagnosis of CAP. Among patients with unsupported treatment, common reasons included excessive duration (103 of 174 patients with CAP [59.2%]) and lack of documented infection signs or symptoms (174 of 347 patients with UTI [50.1%]). Conclusions and Relevance The findings suggest that standardized assessments of hospital antimicrobial prescribing quality can be used to estimate the appropriateness of antimicrobial use in large groups of hospitals. These assessments, performed over time, may inform evaluations of the effects of antimicrobial stewardship initiatives nationally.
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- 2021
40. Vital Signs: Epidemiology of Sepsis: Prevalence of Health Care Factors and Opportunities for Prevention
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Lacey Avery, Raymund Dantes, Shannon A. Novosad, John A. Jernigan, Elizabeth Dufort, Shelley S. Magill, Jason G Lake, Debra Blog, Cheri Grigg, Mathew R. P. Sapiano, Shelley M. Zansky, Misha Robyn, Kathryn Wiedeman, Anthony E. Fiore, Lauren Epstein, Ghinwa Dumyati, and Christina B Felsen
- Subjects
Adult ,Male ,0301 basic medicine ,medicine.medical_specialty ,Chronic condition ,Health (social science) ,Adolescent ,Epidemiology ,Health, Toxicology and Mutagenesis ,New York ,Vital signs ,Medical Records ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,Health Information Management ,Risk Factors ,medicine ,Humans ,Infection control ,030212 general & internal medicine ,Child ,Intensive care medicine ,Aged ,Retrospective Studies ,Aged, 80 and over ,Septic shock ,business.industry ,Medical record ,Infant, Newborn ,Infant ,General Medicine ,Middle Aged ,medicine.disease ,Hospitals ,Pneumonia ,030104 developmental biology ,Child, Preschool ,Female ,business - Abstract
BACKGROUND Sepsis is a serious and often fatal clinical syndrome, resulting from infection. Information on patient demographics, risk factors, and infections leading to sepsis is needed to integrate comprehensive sepsis prevention, early recognition, and treatment strategies. METHODS To describe characteristics of patients with sepsis, CDC and partners conducted a retrospective chart review in four New York hospitals. Random samples of medical records from adult and pediatric patients with administrative codes for severe sepsis or septic shock were reviewed. RESULTS Medical records of 246 adults and 79 children (aged birth to 17 years) were reviewed. Overall, 72% of patients had a health care factor during the 30 days before sepsis admission or a selected chronic condition likely to require frequent medical care. Pneumonia was the most common infection leading to sepsis. The most common pathogens isolated from blood cultures were Escherichia coli in adults aged ≥18 years, Klebsiella spp. in children aged ≥1 year, and Enterococcus spp. in infants aged
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- 2016
41. Clinical Correlates of Surveillance Events Detected by National Healthcare Safety Network Pneumonia and Lower Respiratory Infection Definitions—Pennsylvania, 2011–2012
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Sydney Hubbard, Genevieve L. Buser, Debra Hess, Judith O'donnell, Isaac See, Julia Chang, Jane M. Gould, Pamela Rohrbach, Patricia Hennessey, David A. Pegues, Shelley S. Magill, Andrea Kiernan, Mary Jo Bellush, Debra A Smeltz, Jeffrey R. Miller, Nicole Gualandi, and Susan E. Coffin
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Adult ,Microbiology (medical) ,medicine.medical_specialty ,Epidemiology ,medicine.medical_treatment ,030501 epidemiology ,Article ,03 medical and health sciences ,0302 clinical medicine ,Health care ,Pneumonia, Bacterial ,medicine ,Humans ,030212 general & internal medicine ,Medical diagnosis ,Child ,Lower respiratory infection ,Intensive care medicine ,Respiratory Tract Infections ,Aged ,Retrospective Studies ,Aged, 80 and over ,Mechanical ventilation ,Cross Infection ,Respiratory tract infections ,business.industry ,Medical record ,Infant, Newborn ,Infant ,Pneumonia, Ventilator-Associated ,Retrospective cohort study ,Pneumonia ,Middle Aged ,Pennsylvania ,medicine.disease ,Community-Acquired Infections ,Infectious Diseases ,Child, Preschool ,Population Surveillance ,Emergency medicine ,0305 other medical science ,business - Abstract
OBJECTIVETo determine the clinical diagnoses associated with the National Healthcare Safety Network (NHSN) pneumonia (PNEU) or lower respiratory infection (LRI) surveillance eventsDESIGNRetrospective chart reviewSETTINGA convenience sample of 8 acute-care hospitals in PennsylvaniaPATIENTSAll patients hospitalized during 2011–2012METHODSMedical records were reviewed from a random sample of patients reported to the NHSN to have PNEU or LRI, excluding adults with ventilator-associated PNEU. Documented clinical diagnoses corresponding temporally to the PNEU and LRI events were recorded.RESULTSWe reviewed 250 (30%) of 838 eligible PNEU and LRI events reported to the NHSN; 29 reported events (12%) fulfilled neither PNEU nor LRI case criteria. Differences interpreting radiology reports accounted for most misclassifications. Of 81 PNEU events in adults not on mechanical ventilation, 84% had clinician-diagnosed pneumonia; of these, 25% were attributed to aspiration. Of 43 adult LRI, 88% were in mechanically ventilated patients and 35% had no corresponding clinical diagnosis (infectious or noninfectious) documented at the time of LRI. Of 36 pediatric PNEU events, 72% were ventilator associated, and 70% corresponded to a clinical pneumonia diagnosis. Of 61 pediatric LRI patients, 84% were mechanically ventilated and 21% had no corresponding clinical diagnosis documented.CONCLUSIONSIn adults not on mechanical ventilation and in children, most NHSN-defined PNEU events corresponded with compatible clinical conditions documented in the medical record. In contrast, NHSN LRI events often did not. As a result, substantial modifications to the LRI definitions were implemented in 2015.Infect Control Hosp Epidemiol 2016;37:818–824
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- 2016
42. Causative Organisms and Associated Antimicrobial Resistance in Healthcare-Associated, Central Line–Associated Bloodstream Infections From Oncology Settings, 2009–2012
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Isaac See, Alison G. Freifeld, and Shelley S. Magill
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Adult ,0301 basic medicine ,Microbiology (medical) ,Oncology ,medicine.medical_specialty ,030106 microbiology ,Bacteremia ,Rate ratio ,medicine.disease_cause ,Article ,Immunocompromised Host ,03 medical and health sciences ,symbols.namesake ,0302 clinical medicine ,Antibiotic resistance ,Neoplasms ,Internal medicine ,Drug Resistance, Bacterial ,medicine ,Humans ,030212 general & internal medicine ,Poisson regression ,Cross Infection ,Central line ,Bacteria ,biology ,business.industry ,Pseudomonas aeruginosa ,biology.organism_classification ,Antimicrobial ,Confidence interval ,Infectious Diseases ,Catheter-Related Infections ,symbols ,business ,Enterococcus faecium - Abstract
BACKGROUND Recent antimicrobial resistance data are lacking from inpatient oncology settings to guide infection prophylaxis and treatment recommendations. We describe central line-associated bloodstream infection (CLABSI) pathogens and antimicrobial resistance patterns reported from oncology locations to the Centers for Disease Control and Prevention's National Healthcare Safety Network (NHSN). METHODS CLABSI data reported to NHSN from 2009 to 2012 from adult inpatient oncology locations were compared to data from nononcology adult locations within the same hospitals. Pathogen profile, antimicrobial resistance rates, and CLABSI incidence rates per 1000 central line-days were calculated. CLABSI incidence rates were compared using Poisson regression. RESULTS During 2009-2012, 4654 CLABSIs were reported to NHSN from 299 adult oncology units. The most common organisms causing CLABSI in oncology locations were coagulase-negative staphylococci (16.9%), Escherichia coli (11.8%), and Enterococcus faecium (11.4%). Fluoroquinolone resistance was more common among E. coli CLABSI in oncology than nononcology locations (56.5% vs 41.5% of isolates tested; P < .0001) and increased significantly from 2009-2010 to 2011-2012 (49.5% vs 60.4%; P = .01). Furthermore, rates of CLABSI were significantly higher in oncology compared to nononcology locations for fluoroquinolone-resistant E. coli (rate ratio, 7.37; 95% confidence interval [CI], 6.20-8.76) and vancomycin-resistant E. faecium (rate ratio, 2.27, 95% CI, 2.03-2.53). However, resistance rates for some organisms, such as Klebsiella species and Pseudomonas aeruginosa, were lower in oncology than in nononcology locations. CONCLUSIONS Antimicrobial-resistant E. coli and E. faecium have become significant pathogens in oncology. Practices for antimicrobial prophylaxis and empiric antimicrobial therapy should be regularly assessed in conjunction with contemporary antimicrobial resistance data.
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- 2016
43. Epidemiology and factors associated with candidaemia following Clostridium difficile infection in adults within metropolitan Atlanta, 2009–2013
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Olivia Almendares, Fernanda C. Lessa, Snigdha Vallabhaneni, Shelley S. Magill, Rachel M. Smith, Jessica Reno, Angela A. Cleveland, Zirka Smith, Betsy Stein, and Monica M. Farley
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Adult ,Male ,0301 basic medicine ,medicine.medical_specialty ,Georgia ,Adolescent ,genetic structures ,Epidemiology ,030106 microbiology ,Population ,Short Report ,Young Adult ,03 medical and health sciences ,Risk Factors ,Vancomycin ,Metronidazole ,Internal medicine ,Prevalence ,medicine ,Humans ,Longitudinal Studies ,Young adult ,education ,Intensive care medicine ,Aged ,Candida ,education.field_of_study ,Clostridioides difficile ,business.industry ,Case-control study ,Candidemia ,Clostridium Infections ,Middle Aged ,Clostridium difficile ,Anti-Bacterial Agents ,Infectious Diseases ,Case-Control Studies ,Female ,business ,medicine.drug - Abstract
SUMMARYWe assessed prevalence of and risk factors for candidaemia following Clostridium difficile infection (CDI) using longitudinal population-based surveillance. Of 13 615 adults with CDI, 113 (0·8%) developed candidaemia in the 120 days following CDI. In a matched case-control analysis, severe CDI and CDI treatment with vancomycin + metronidazole were associated with development of candidaemia following CDI.
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- 2015
44. Impact of removing mucosal barrier injury laboratory-confirmed bloodstream infections from central line–associated bloodstream infection rates in the National Healthcare Safety Network, 2014
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Lauren Epstein, Nicola D. Thompson, Jonathan R. Edwards, Shelley S. Magill, Minn M. Soe, and Isaac See
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Catheterization, Central Venous ,medicine.medical_specialty ,Epidemiology ,030501 epidemiology ,Article ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,Public reporting ,Bloodstream infection ,Health care ,Prevalence ,Humans ,Medicine ,030212 general & internal medicine ,Intensive care medicine ,Central line ,Mucous Membrane ,business.industry ,Health Policy ,Public Health, Environmental and Occupational Health ,medicine.disease ,Catheter-Related Infections ,Infectious Diseases ,Event data ,0305 other medical science ,business - Abstract
Central line-associated bloodstream infection (CLABSI) event data reported to the National Healthcare Safety Network from 2014, the first year of required use of the mucosal barrier injury laboratory-confirmed bloodstream infection (MBI-LCBI) definition, were analyzed to assess the impact of removing MBI-LCBI events from CLABSI rates. CLABSI rates decreased significantly in some location types after removing MBI-LCBI events, and MBI-LCBI events will be removed from publicly reported CLABSI rates.
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- 2017
45. Characteristics of Pediatric Ventilator-Associated Events Reported to the National Healthcare Safety Network, 2019
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Cindy Gross, Cheri Grigg, Shelley S. Magill, and Allan Nkwata
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Microbiology (medical) ,medicine.medical_specialty ,Infectious Diseases ,Epidemiology ,business.industry ,Emergency medicine ,Health care ,medicine ,Pneumonia ventilator associated ,business - Abstract
Background: Mechanical ventilation is a life-saving measure for patients with respiratory failure; however, these patients are at high risk for complications and poor outcomes. Surveillance for ventilator-associated events (VAEs) via the CDC NHSN began in 2013 in adult patient care locations in hospitals. Pediatric ventilator-associated event (PedVAE) surveillance began in January 2019. The PedVAE definition is based on increases in mean airway pressure (MAP) or fraction of inspired oxygen (FiO2). We summarized the first 9 months of PedVAE data reported to the NHSN. Methods: Neonatal and pediatric locations of US acute-care hospitals, long-term acute-care hospitals, and inpatient rehabilitation facilities were eligible to participate in PedVAE surveillance as of January 1, 2019. When submitting PedVAEs to the NHSN, facilities may also optionally report information about antimicrobials, pathogens, and clinical events associated with PedVAEs. We analyzed PedVAE data from January through September 2019 submitted by facilities participating in surveillance according to the NHSN protocol. We calculated pooled mean incidence rates (no. events per 1,000 ventilator days) for neonatal and pediatric intensive care units (NICUs and PICUs), and we describe characteristics of PedVAEs. Results: Overall, 205 PedVAEs were reported: 111 events from 147 NICUs in 140 facilities and 94 events from 117 PICUs in 85 facilities. The pooled mean incidence was 1.61 events per 1,000 ventilator days in level 2 and 3 NICUs, 1.09 events per 1,000 ventilator days in level III NICUs, and 1.25 events per 1,000 ventilator days in PICUs. Of 205 PedVAEs, 133 (65%) met only the MAP criterion, 65 (32%) met only the FiO2 criterion, and 7 (3%) met both. Optional data on antimicrobials, pathogens, and clinical events were reported for 74 of 205 PedVAEs (36%). Among these 74 events, antimicrobial administration was common (50 of 74, 68%). By contrast, a minority had a pathogen reported (21 of 74, 28%). Of 74 PedVAEs, 60 were associated with a clinical event (80%), although only 15 (20%) were reported to be associated with a clinical infection. Of 74 PedVAEs, 4 (5%) were associated with mechanical ventilation weaning. Conclusions: PedVAE incidence rates are low in NICUs and PICUs. Most PedVAEs appear to be associated with clinical events. Although a minority of PedVAEs were associated with infections or pathogens, antimicrobial administration was reported for >60%. Further evaluation of the clinical correlates of PedVAEs can inform development of effective prevention and antimicrobial stewardship in mechanically ventilated children.Funding: NoneDisclosures: Cheri Grigg, Centers for Disease Control and Prevention
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- 2020
46. Chlorhexidine MICs Remain Stable Among Antibiotic-Resistant Bacterial Isolates Collected from 2005 to 2019 at Three US Sites
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Shelley S. Magill, Mary K. Hayden, Christopher A. Elkins, Megan Crumpler, David Lonsway, Matthew Zahn, Alice Guh, Jesse T. Jacob, Karen Galliher, Alexander M. Page, Eric Evans, Gillian Smith, Julian E. Grass, Brian Yoo, Sujan C Reddy, Erin Epson, Joseph D. Lutgring, Marion A. Kainer, and Sarah W. Satola
- Subjects
Microbiology (medical) ,biology ,Epidemiology ,Enterobacter cloacae complex ,business.industry ,Klebsiella pneumoniae ,Broth microdilution ,Chlorhexidine ,030501 epidemiology ,medicine.disease_cause ,biology.organism_classification ,Microbiology ,03 medical and health sciences ,Infectious Diseases ,Antibiotic resistance ,Emerging infections ,Staphylococcus aureus ,medicine ,0305 other medical science ,business ,Escherichia coli ,medicine.drug - Abstract
Background: Chlorhexidine bathing reduces bacterial skin colonization and prevents infections in specific patient populations. As chlorhexidine use becomes more widespread, concerns about bacterial tolerance to chlorhexidine have increased; however, testing for chlorhexidine minimum inhibitory concentrations (MICs) is challenging. We adapted a broth microdilution (BMD) method to determine whether chlorhexidine MICs changed over time among 4 important healthcare-associated pathogens. Methods: Antibiotic-resistant bacterial isolates (Staphylococcus aureus from 2005 to 2019 and Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae complex from 2011 to 2019) were collected through Emerging Infections Program surveillance in 2 sites (Georgia and Tennessee) or through public health reporting in 1 site (Orange County, California). A convenience sample of isolates were collected from facilities with varying amounts of chlorhexidine use. We performed BMD testing using laboratory-developed panels with chlorhexidine digluconate concentrations ranging from 0.125 to 64 μg/mL. After successfully establishing reproducibility with quality control organisms, 3 laboratories performed MIC testing. For each organism, epidemiological cutoff values (ECVs) were established using ECOFFinder. Results: Among 538 isolates tested (129 S. aureus, 158 E. coli, 142 K. pneumoniae, and 109 E. cloacae complex), S. aureus, E. coli, K. pneumoniae, and E. cloacae complex ECVs were 8, 4, 64, and 64 µg/mL, respectively (Table 1). Moreover, 14 isolates had an MIC above the ECV (12 E. coli and 2 E. cloacae complex). The MIC50 of each species is reported over time (Table 2). Conclusions: Using an adapted BMD method, we found that chlorhexidine MICs did not increase over time among a limited sample of S. aureus, E. coli, K. pneumoniae, and E. cloacae complex isolates. Although these results are reassuring, continued surveillance for elevated chlorhexidine MICs in isolates from patients with well-characterized chlorhexidine exposure is needed as chlorhexidine use increases.Funding: NoneDisclosures: None
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- 2020
47. Assessment of Health Care Exposures and Outcomes in Adult Patients With Sepsis and Septic Shock
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Anthony E. Fiore, Geoff Brousseau, Deborah Nelson, Lauren Epstein, Mathew R. P. Sapiano, Nicola D. Thompson, Runa H Gokhale, Katherine Fay, Rebecca Perlmutter, Marla Sievers, Raymund Dantes, Rebecca Pierce, Meghan Maloney, Shelley S. Magill, Wendy Bamberg, Helen Johnston, Lourdes Irizarry, Alexia Zhang, Monika Samper, Joelle Nadle, Malini B. DeSilva, Valerie Ocampo, David E. Katz, Lucy E. Wilson, Ruth Lynfield, Deborah Godine, Susan M. Ray, Ghinwa Dumyati, Marion A. Kainer, and Linda Frank
- Subjects
Male ,medicine.medical_specialty ,Population ,Cohort Studies ,Sepsis ,Risk Factors ,Epidemiology ,medicine ,Humans ,Hospital Mortality ,education ,Original Investigation ,Cross Infection ,education.field_of_study ,Septic shock ,business.industry ,Incidence ,Research ,Medical record ,Retrospective cohort study ,Environmental Exposure ,General Medicine ,Odds ratio ,Middle Aged ,medicine.disease ,Shock, Septic ,United States ,Causality ,Hospitalization ,Online Only ,Outcome and Process Assessment, Health Care ,Emergency medicine ,Female ,Public Health ,business ,Cohort study - Abstract
Key Points Question What types of health care exposures occur during the 30 days before hospitalization of a patient with sepsis or septic shock, and how common are these exposures? Findings In this cohort study of 1078 US adults with sepsis and septic shock across 10 states, most patients experienced sepsis onset outside of the hospital, had recent encounters with the health care system, and had a sepsis-associated pathogen documented; 42% of patients received antimicrobial drugs, chemotherapy, wound care, dialysis, or surgery in the 30 days before sepsis occurred. After controlling for other factors, an association was found between underlying comorbidities, such as cirrhosis, immunosuppression, and vascular disease, and 30-day mortality. Meaning The findings suggest that future efforts to improve outcomes among patients with sepsis and septic shock would benefit from examination of health maintenance practices and recent health care exposures as potential opportunities among high-risk patients., Importance Current information on the characteristics of patients who develop sepsis may help in identifying opportunities to improve outcomes. Most recent studies of sepsis epidemiology have focused on changes in incidence or have used administrative data sets that provided limited patient-level data. Objective To describe sepsis epidemiology in adults. Design, Setting, and Participants This retrospective cohort study reviewed the medical records, death certificates, and hospital discharge data of adult patients with sepsis or septic shock who were discharged from the hospital between October 1, 2014, and September 30, 2015. The convenience sample was obtained from hospitals in the Centers for Disease Control and Prevention Emerging Infections Program in 10 states (California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, and Tennessee). Patients 18 years and older with discharge diagnosis codes for severe sepsis or septic shock were randomly selected. Data were analyzed between May 1, 2018, and January 31, 2019. Main Outcomes and Measures The population’s demographic characteristics, health care exposures, and sepsis-associated infections and pathogens were described, and risk factors for death within 30 days after sepsis diagnosis were assessed. Results Among 1078 adult patients with sepsis (569 men [52.8%]; median age, 64 years [interquartile range, 53-75 years]), 973 patients (90.3%) were classified as having community-onset sepsis (ie, sepsis diagnosed within 3 days of hospital admission). In total, 654 patients (60.7%) had health care exposures before their hospital admission for sepsis; 260 patients (24.1%) had outpatient encounters in the 7 days before admission, and 447 patients (41.5%) received medical treatment, including antimicrobial drugs, chemotherapy, wound care, dialysis, or surgery, in the 30 days before admission. A pathogen associated with sepsis was found in 613 patients (56.9%); the most common pathogens identified were Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, and Clostridioides difficile. After controlling for other factors, an association was found between underlying comorbidities, such as cirrhosis (odds ratio, 3.59; 95% CI, 2.03-6.32), immunosuppression (odds ratio, 2.52; 95% CI, 1.81-3.52), vascular disease (odds ratio, 1.54; 95% CI, 1.10-2.15), and 30-day mortality. Conclusions and Relevance Most adults experienced sepsis onset outside of the hospital and had recent encounters with the health care system. A sepsis-associated pathogen was identified in more than half of patients. Future efforts to improve sepsis outcomes may benefit from examination of health maintenance practices and recent health care exposures as potential opportunities among high-risk patients., This cohort study uses medical records, death certificates, and hospital discharge data to describe health care exposures and outcomes among adult patients with sepsis and septic shock.
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- 2020
48. 1179. Rates and Causative Pathogens of Device-Associated Bloodstream and Urinary Tract Infections Attributed to Solid-Organ Transplant Units, 2015–2017
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Liang Zhou, Alice Guh, Jonathan R. Edwards, Nora Chea, Lauren Epstein, Matthew R P Sapiano, and Shelley S. Magill
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biology ,business.industry ,Klebsiella pneumoniae ,Urinary system ,Antimicrobial ,biology.organism_classification ,Intensive care unit ,Microbiology ,law.invention ,Transplantation ,Abstracts ,Infectious Diseases ,Oncology ,Immunity ,law ,Poster Abstracts ,Medicine ,Health care safety ,business ,Solid organ transplantation - Abstract
Background Due to complex invasive medical procedures and compromised immunity, solid-organ transplant (SOT) patients are at high risk for infections. However, whether SOT patients are at higher risk than other hospitalized patients for selected healthcare-associated infections (HAI), such as central line-associated bloodstream infections (CLABSI) or catheter-associated urinary tract infections (CAUTI), or for infections with antimicrobial-resistant (AR) pathogens, is not well described. We analyzed data reported to the Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN) from inpatient SOT units and compared CLABSI and CAUTI rates and AR in hospitals with both SOT and non-SOT units. Methods We analyzed 2015–2017 CLABSI and CAUTI data reported to NHSN from hospitals with adult or pediatric inpatient SOT units. We calculated CLABSI and CAUTI incidence rates per 1,000 central-line days (CLD) and urinary catheter days (UCD), respectively, and compared rates, pathogen distributions, and AR among events attributed to three unit types: (1) SOT units; (2) adult, pediatric, and neonatal critical care units; and (3) adult and pediatric medical, surgical, and combined medical-surgical wards. We compared proportions using χ 2 tests and determined statistical significance at P ≤ 0.05. Results CLABSI and CAUTI rates in SOT units were lower than rates in critical care units, but higher than rates in wards (table). Although the most common CLABSI and CAUTI pathogens were similar in all three unit types, the prevalence of individual pathogens differed (figure). Among CLABSI pathogens, Enterococcus faecium, Escherichia coli, and Klebsiella pneumoniae or oxytoca were significantly more prevalent in SOT compared with critical care units. Vancomycin resistance among CLABSI E. faecium was significantly lower (71.4% vs. 87.5%) and fluoroquinolone resistance among CAUTI E. coli was significantly higher (49.3% vs. 32.5%) in SOT compared with critical care units. Conclusion SOT units have lower CLABSI and CAUTI rates compared with critical care units. Differences in pathogens and AR among device-associated HAIs in SOT units should be considered when implementing infection prevention and treatment policies. Disclosures All authors: No reported disclosures.
- Published
- 2019
49. 363. National Burden of Candidemia, United States, 2017
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Monica M. Farley, Helen Johnston, William Schaffner, Sarah Shrum, Ghinwa Dumyati, Sabrina R Williams, Lee H. Harrison, Yi Mu, Sharon Tsay, Snigdha Vallabhaneni, Shelley S. Magill, Alexia Zhang, Erin Epson, and Brittany VonBank
- Subjects
0301 basic medicine ,medicine.medical_specialty ,business.industry ,Medical record ,030106 microbiology ,bacterial infections and mycoses ,03 medical and health sciences ,High morbidity ,Abstracts ,Infectious Diseases ,Oncology ,B. Poster Abstracts ,Bloodstream infection ,medicine ,Intensive care medicine ,business - Abstract
Background Candidemia is a common healthcare-associated bloodstream infection associated with high morbidity and mortality. No current estimates exist for understanding its burden in the United States. Methods In 2017, CDC’s Emerging Infections Program (EIP) performed laboratory- and active population-based candidemia surveillance in 45 counties in nine states (California, Colorado, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, Tennessee), encompassing ~17 million persons. A case was defined as Candida species isolated from blood in a surveillance area resident. EIP site staff reviewed medical records to collect demographic and clinical data. Using 2016 US census data, we created weighted estimates of national and regional incidence rates and mortality in persons with candidemia (defined as death from any cause within 7 days of incident candidemia). Results A total of 1,226 candidemia cases were identified in 2017. We estimated 23,000 candidemia cases (95% CI 20,000–25,000) occurred in the United States in 2017. Overall estimated incidence was 7.0/100,000 persons, with elevated rates in adults ≥65 years (20.3/100,000), males (8.0/100,000), and people of Black race (12.6/100,000) (table). Incidence was highest in the South Atlantic region (8.0/100,000) and lowest in the Pacific (6.0/100,000). Estimated number of deaths was 3,000 (1,000–5,000). Conclusion Our analysis highlights the substantial burden of candidemia in the US Because candidemia is only one form of invasive candidiasis, the true burden of invasive infections due to Candida species is likely higher. Ongoing surveillance can support future burden estimates and help assess the impact of prevention interventions. Disclosures All authors: No reported disclosures.
- Published
- 2018
50. 1836. Characteristics of Nursing Homes Associated With Self-reported Implementation of Centers for Disease Control and Prevention (CDC) Core Elements of Antibiotic Stewardship
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Shelley S. Magill, J P Mahoehney, Nicola D. Thompson, Joelle Nadle, Lucy E. Wilson, Taniece Eure, Nimalie D. Stone, Rebecca Pierce, Marla Sievers, Erin Epson, Lourdes Irizarry, Linda Frank, Paula Clogher, Cedric Brown, Ruth Lynfield, Ghinwa Dumyati, Grant Barney, Deborah Godine, Helen Johnston, Devra Barter, Susan M. Ray, Nicolai Buhr, Sarah Shrum, Meghan Maloney, Austin R Penna, Marion A. Kainer, and Susan Morabit
- Subjects
medicine.medical_specialty ,business.industry ,030501 epidemiology ,Nurse Administrator ,Disease control ,Abstracts ,03 medical and health sciences ,0302 clinical medicine ,Infectious Diseases ,B. Poster Abstracts ,Oncology ,Family medicine ,medicine ,Antibiotic Stewardship ,Antimicrobial stewardship ,030212 general & internal medicine ,Formulary ,0305 other medical science ,business ,Nursing homes ,Self report ,health care economics and organizations ,Infection Control Practitioners - Abstract
Background CDC released the Core Elements of Antibiotic Stewardship (Core Elements) for Nursing Homes (NHs) in 2015. In 2017, CDCs Emerging Infections Program (EIP) evaluated uptake of the Core Elements in a cohort of NHs. Methods NHs from California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, and Tennessee were randomly selected to participate in a CDC EIP antimicrobial use prevalence survey; participation was voluntary. A NH leader (typically Director of Nursing or Infection Preventionist) completed a CDC questionnaire to self-report facility implementation of 15 individual activities within the 7 domains of the Core Elements. The number and percentage of facilities reporting “Yes” to each activity and a facility stewardship score (range 0–15, 1 point per activity) were calculated. Associations between the stewardship score and facility-level factors, obtained from the questionnaire and publically available Centers for Medicare and Medicaid Services (CMS) NH quality data, were identified using Analysis of Variance (Proc GLM) in SAS 9.4; a P < 0.05 was considered significant. Results In 161 NHs (mean certified beds 118, 92% dual certified, 68% for-profit), the % of NHs reporting implementation of the 15 activities (figure) ranged from 25% (has a formulary of antibiotic agents, providers required to perform an antibiotic “time-out”) to 88% (providers required to document dose, duration and indication). The median facility stewardship score was 9 (interquartile range 7–12). A higher stewardship score was significantly associated with having: an infection preventionist who completed a certified training course (Yes vs. No, P = 0.029), higher number of attending physicians per 100 NH beds (upper quartile vs. lower three quartiles, P = 0.029), and higher CMS quality measure score (scale of 1 to 5 points, P = 0.025). Conclusion These data, collected approximately 2 years after release of the Core Elements, show NHs have begun to implement many policies or practices consistent with CDC antibiotic stewardship guidance. However, improved understanding of the uptake and barriers associated with implementation of the Core Elements can inform development of stewardship initiatives, identify NHs in need of stewardship interventions, and accelerate adoption. Disclosures All authors: No reported disclosures.
- Published
- 2018
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