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  • Cambridge University Press (CUP)  (7)
  • 1
    Online-Ressource
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    Healthcare-associated infections (HAIs) during the coronavirus disease 2019 (COVID-19) pandemic: A time-series analysis
    Cambridge University Press (CUP) ; 2023
    In:  Antimicrobial Stewardship & Healthcare Epidemiology Vol. 3, No. 1 ( 2023)
    Details
    In: Antimicrobial Stewardship & Healthcare Epidemiology, Cambridge University Press (CUP), Vol. 3, No. 1 ( 2023)
    Kurzfassung: To use interrupted time-series analyses to investigate the impact of the coronavirus disease 2019 (COVID-19) pandemic on healthcare-associated infections (HAIs). We hypothesized that the pandemic would be associated with higher rates of HAIs after adjustment for confounders. Design: We conducted a cross-sectional study of HAIs in 3 hospitals in Missouri from January 1, 2017, through August 31, 2020, using interrupted time-series analysis with 2 counterfactual scenarios. Setting: The study was conducted at 1 large quaternary-care referral hospital and 2 community hospitals. Participants: All adults ≥18 years of age hospitalized at a study hospital for ≥48 hours were included in the study. Results: In total, 254,792 admissions for ≥48 hours occurred during the study period. The average age of these patients was 57.6 (±19.0) years, and 141,107 (55.6%) were female. At hospital 1, 78 CLABSIs, 33 CAUTIs, and 88 VAEs were documented during the pandemic period. Hospital 2 had 13 CLABSIs, 6 CAUTIs, and 17 VAEs. Hospital 3 recorded 11 CLABSIs, 8 CAUTIs, and 11 VAEs. Point estimates for hypothetical excess HAIs suggested an increase in all infection types across facilities, except for CLABSIs and CAUTIs at hospital 1 under the “no pandemic” scenario. Conclusions: The COVID-19 era was associated with increases in CLABSIs, CAUTIs, and VAEs at 3 hospitals in Missouri, with variations in significance by hospital and infection type. Continued vigilance in maintaining optimal infection prevention practices to minimize HAIs is warranted.
    Materialart: Online-Ressource
    ISSN: 2732-494X
    URL: Article
    DOI: 10.1017/ash.2022.361
    Sprache: Englisch
    Verlag: Cambridge University Press (CUP)
    Publikationsdatum: 2023
    ZDB Id: 3074908-6
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  • 2
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    Trends in the incidence of Clostridioides difficile infection in adults and the elderly insured by Medicaid compared to commercial insurance or Medicare only
    Cambridge University Press (CUP) ; 2023
    In:  Infection Control & Hospital Epidemiology Vol. 44, No. 7 ( 2023-07), p. 1076-1084
    Details
    In: Infection Control & Hospital Epidemiology, Cambridge University Press (CUP), Vol. 44, No. 7 ( 2023-07), p. 1076-1084
    Kurzfassung: Few data are available to quantify the Clostridioides difficile infection (CDI) burden in US adults depending on Medicaid insurance status; thus, we sought to contribute to this body of information. Methods: Retrospective cohort study to identify adults with codes for CDI from 2011 to 2017 in MarketScan commercial and Medicaid databases (for those aged 25–64 years) and the CMS Medicare database (for those aged ≥65 years). CDI was categorized as healthcare-facility–associated (HCA-CDI) and community-associated CDI (CA-CDI). CDI incidence rates were compared by year, insurer, and age group. Results: The overall CDI incidence in the elderly was 3.1-fold higher in persons insured by Medicare plus Medicaid than in those insured by Medicare only (1,935 vs 618 per 100,000 person years (PY)), and the CDI incidence was 2.7-fold higher in younger adults with Medicaid compared to commercial insurance (195 vs 73 per 100,000 PY). From 2011 to 2017, HCA-CDI rates declined in the younger Medicaid population (124.0 to 95.2 per 100,000 PY; P 〈 .001) but were stable in those commercially insured (25.9 to 24.8 per 100,000 PY; P = .33). In the elderly HCA-CDI rates declined from 2011 to 2017 in the Medicare-only population (403 to 318 per 100,000 PY; P 〈 .001) and the Medicare plus Medicaid population (1,770 to 1,163 per 100,000 PY; P 〈 .002). Persons with chronic medical conditions and those with immunocompromising conditions insured by Medicaid had 2.8- and 2.7-fold higher CDI incidence compared to the commercially insured population, respectively. The incidence of CDI was lowest in Medicaid and commercially insured younger adults without chronic medical or immunosuppressive conditions (67.5 and 45.6 per 100,000 PY, respectively). Conclusions: Although HCA-CDI incidence decreased from 2011 to 2017 in elderly and younger adults insured by Medicaid, the burden of CDI remains much higher in low-income adults insured by Medicaid.
    Materialart: Online-Ressource
    ISSN: 0899-823X , 1559-6834
    URL: Article
    DOI: 10.1017/ice.2022.208
    Sprache: Englisch
    Verlag: Cambridge University Press (CUP)
    Publikationsdatum: 2023
    ZDB Id: 2106319-9
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  • 3
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    Clostridium difficile infection increases acute and chronic morbidity and mortality
    Cambridge University Press (CUP) ; 2019
    In:  Infection Control & Hospital Epidemiology Vol. 40, No. 1 ( 2019-01), p. 65-71
    Details
    In: Infection Control & Hospital Epidemiology, Cambridge University Press (CUP), Vol. 40, No. 1 ( 2019-01), p. 65-71
    Kurzfassung: In this study, we aimed to quantify short- and long-term outcomes of Clostridium difficile infection (CDI) in the elderly, including all-cause mortality, transfer to a facility, and hospitalizations. Design Retrospective study using 2011 Medicare claims data, including all elderly persons coded for CDI and a sample of uninfected persons. Analysis of propensity score-matched pairs and the entire population stratified by the propensity score was used to determine the risk of all-cause mortality, new transfer to a long-term care facility (LTCF), and short-term skilled nursing facility (SNF), and subsequent hospitalizations within 30, 90, and 365 days. Results The claims records of 174,903 patients coded for CDI were compared with those of 1,318,538 control patients. CDI was associated with increased risk of death (odds ratio [OR], 1.77; 95% confidence interval [CI] , 1.74–1.81; attributable mortality, 10.9%), new LTCF transfer (OR, 1.74; 95% CI, 1.67–1.82), and new SNF transfer (OR, 2.52; 95% CI, 2.46–2.58) within 30 days in matched-pairs analyses. In a stratified analysis, CDI was associated with greatest risk of 30-day all-cause mortality in persons with lowest baseline probability of CDI (hazard ratio [HR], 3.04; 95% CI, 2.83–3.26); the risk progressively decreased as the baseline probability of CDI increased. CDI was also associated with increased risk of subsequent 30-day, 90-day, and 1-year hospitalization. Conclusions CDI was associated with increased risk of short- and long-term adverse outcomes, including transfer to short- and long-term care facilities, hospitalization, and all-cause mortality. The magnitude of mortality risk varied depending on baseline probability of CDI, suggesting that even lower-risk patients may benefit from interventions to prevent CDI.
    Materialart: Online-Ressource
    ISSN: 0899-823X , 1559-6834
    URL: Article
    DOI: 10.1017/ice.2018.280
    Sprache: Englisch
    Verlag: Cambridge University Press (CUP)
    Publikationsdatum: 2019
    ZDB Id: 2106319-9
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  • 4
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    Epidemiology and preventability of hospital-onset bacteremia and fungemia in 2 hospitals in India
    Cambridge University Press (CUP) ; 2023
    In:  Infection Control & Hospital Epidemiology
    Details
    In: Infection Control & Hospital Epidemiology, Cambridge University Press (CUP)
    Kurzfassung: Studies evaluating the incidence, source, and preventability of hospital-onset bacteremia and fungemia (HOB), defined as any positive blood culture obtained after 3 calendar days of hospital admission, are lacking in low- and middle-income countries (LMICs). Design, setting, and participants: All consecutive blood cultures performed for 6 months during 2020–2021 in 2 hospitals in India were reviewed to assess HOB and National Healthcare Safety Network (NHSN) reportable central-line–associated bloodstream infection (CLABSI) events. Medical records of a convenience sample of 300 consecutive HOB events were retrospectively reviewed to determine source and preventability. Univariate and multivariable logistic regression analyses were performed to identify factors associated with HOB preventability. Results: Among 6,733 blood cultures obtained from 3,558 hospitalized patients, there were 409 and 59 unique HOB and NHSN-reportable CLABSI events, respectively. CLABSIs accounted for 59 (14%) of 409 HOB events. There was a moderate but non-significant correlation (r = 0.51; P = .070) between HOB and CLABSI rates. Among 300 reviewed HOB cases, CLABSIs were identified as source in only 38 (13%). Although 157 (52%) of all 300 HOB cases were potentially preventable, CLABSIs accounted for only 22 (14%) of these 157 preventable HOB events. In multivariable analysis, neutropenia, and sepsis as an indication for blood culture were associated with decreased odds of HOB preventability, whereas hospital stay ≥7 days and presence of a urinary catheter were associated with increased likelihood of preventability. Conclusions: HOB may have utility as a healthcare-associated infection metric in LMIC settings because it captures preventable bloodstream infections beyond NHSN-reportable CLABSIs.
    Materialart: Online-Ressource
    ISSN: 0899-823X , 1559-6834
    URL: Article
    DOI: 10.1017/ice.2023.170
    Sprache: Englisch
    Verlag: Cambridge University Press (CUP)
    Publikationsdatum: 2023
    ZDB Id: 2106319-9
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  • 5
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    Epidemiology of Positive Blood Cultures due to Multidrug-Resistant Organisms From an Academic Center and Community Hospitals
    Cambridge University Press (CUP) ; 2020
    In:  Infection Control & Hospital Epidemiology Vol. 41, No. S1 ( 2020-10), p. s473-s473
    Details
    In: Infection Control & Hospital Epidemiology, Cambridge University Press (CUP), Vol. 41, No. S1 ( 2020-10), p. s473-s473
    Kurzfassung: Background: Multidrug-resistant organisms (MDROs) are a threat to public health. The objective of this study was to define risk factors and outcomes of patients with positive blood cultures due to MDROs in 2 rural community hospitals as compared to a tertiary-care academic center. Methods: Retrospective cohort study with IRB approval from 1 tertiary-care academic center and 2 rural community hospitals (Barnes-Jewish [BJH], Parkland Health Center, and Missouri Baptist Sullivan Hospital) from July 1, 2013, to August 1, 2018. Demographics, comorbidities, procedures, outcomes, and blood and urine culture data were collected from the BJH informatics database for hospitalized patients with positive blood cultures due to MDROs. MDROs were defined according to European and US CDC standards. Results: Of the patients with positive blood cultures growing organisms with the potential to be MDR, 1,065 (55%) blood cultures grew MDROs from the academic center and 157 (33%) grew MDROs from the 2 community hospitals ( P 〈 .0001). Among these, methicillin-resistant Staphylococcus aureus (35% at BJH and 37% at community hospitals) and MDR Enterobacteriaceae (29% at BJH and 36% at community hospitals) were the most common organisms grown from blood cultures at all hospitals. Among patients with positive MDRO blood cultures, 60% were males and 69% were white, with a mean age of 58 years at BJH. At the community hospitals, 47% were male and 99% were white, with a mean age of 66 years. The most common comorbidity in patients with MDRO bacteremia at BJH was cancer, compared to diabetes at the community hospitals. At all hospitals, 〉 33% of patients with MDRO bacteremia required an ICU stay. Also, 17% of patients with MDRO bacteremia at BJH died during hospitalization compared to 4% at the community hospitals. Among individuals with positive MDRO blood cultures, 9% had a matching isolate from a urine culture at BJH and 46% had a matching urine isolate at the community hospitals. Conclusions: At an academic medical center, the most common organisms identified in MRDO-positive blood cultures included MRSA, MDR Enterobacteriaceae , and VRE. However, at the community hospitals, MRSA, MDR Enterobacteriaceae , and ESBL Enterobacteriaceae were most common. Patients with a positive MDRO blood culture were more likely to have a matching isolate from urine culture at a community hospital compared to the academic center. Further research is needed regarding risk factors and interventions to prevent, detect, and treat MDRO infections. Funding: None Disclosures: Margaret A. Olsen reports consulting fees for contract research from Pfizer, Merck, and Sanofi Pasteur.
    Materialart: Online-Ressource
    ISSN: 0899-823X , 1559-6834
    URL: Article
    DOI: 10.1017/ice.2020.1149
    Sprache: Englisch
    Verlag: Cambridge University Press (CUP)
    Publikationsdatum: 2020
    ZDB Id: 2106319-9
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  • 6
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    Early coronavirus disease 2019 (COVID-19) pandemic effects on individual-level risk for healthcare-associated infections in hospitalized patients
    Cambridge University Press (CUP) ; 2023
    In:  Infection Control & Hospital Epidemiology
    Details
    In: Infection Control & Hospital Epidemiology, Cambridge University Press (CUP)
    Kurzfassung: We compared the individual-level risk of hospital-onset infections with multidrug-resistant organisms (MDROs) in hospitalized patients prior to and during the coronavirus disease 2019 (COVID-19) pandemic. We also quantified the effects of COVID-19 diagnoses and intrahospital COVID-19 burden on subsequent MDRO infection risk. Design: Multicenter, retrospective, cohort study. Setting: Patient admission and clinical data were collected from 4 hospitals in the St. Louis area. Patients: Data were collected for patients admitted between January 2017 and August 2020, discharged no later than September 2020, and hospitalized ≥48 hours. Methods: Mixed-effects logistic regression models were fit to the data to estimate patients’ individual-level risk of infection with MDRO pathogens of interest during hospitalization. Adjusted odds ratios were derived from regression models to quantify the effects of the COVID-19 period, COVID-19 diagnosis, and hospital-level COVID-19 burden on individual-level hospital-onset MDRO infection probabilities. Results: We calculated adjusted odds ratios for COVID-19–era hospital-onset Acinetobacter spp., P. aeruginosa and Enterobacteriaceae spp infections. Probabilities increased 2.64 (95% confidence interval [CI], 1.22–5.73) times, 1.44 (95% CI, 1.03–2.02) times, and 1.25 (95% CI, 1.00–1.58) times relative to the prepandemic period, respectively. COVID-19 patients were 4.18 (95% CI, 1.98–8.81) times more likely to acquire hospital-onset MDRO S. aureus infections. Conclusions: Our results support the growing body of evidence indicating that the COVID-19 pandemic has increased hospital-onset MDRO infections.
    Materialart: Online-Ressource
    ISSN: 0899-823X , 1559-6834
    URL: Article
    DOI: 10.1017/ice.2023.83
    Sprache: Englisch
    Verlag: Cambridge University Press (CUP)
    Publikationsdatum: 2023
    ZDB Id: 2106319-9
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  • 7
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    Impact of the Severe acute respiratory syndrome coronavirus 2 pandemic on mortality associated with healthcare-associated infections
    Cambridge University Press (CUP) ; 2023
    In:  Antimicrobial Stewardship & Healthcare Epidemiology Vol. 3, No. 1 ( 2023)
    Details
    In: Antimicrobial Stewardship & Healthcare Epidemiology, Cambridge University Press (CUP), Vol. 3, No. 1 ( 2023)
    Kurzfassung: To determine the relationship between severe acute respiratory syndrome coronavirus 2 infection, hospital-acquired infections (HAIs), and mortality. Design: Retrospective cohort. Setting: Three St. Louis, MO hospitals. Patients: Adults admitted ≥48 hours from January 1, 2017 to August 31, 2020. Methods: Hospital-acquired infections were defined as those occurring ≥48 hours after admission and were based on positive urine, respiratory, and blood cultures. Poisson interrupted time series compared mortality trajectory before (beginning January 1, 2017) and during the first 6 months of the pandemic. Multivariable logistic regression models were fitted to identify risk factors for mortality in patients with an HAI before and during the pandemic. A time-to-event analysis considered time to death and discharge by fitting Cox proportional hazards models. Results: Among 6,447 admissions with subsequent HAIs, patients were predominantly White (67.9%), with more females (50.9% vs 46.1%, P  = .02), having slightly lower body mass index (28 vs 29, P  = .001), and more having private insurance (50.6% vs 45.7%, P  = .01) in the pre-pandemic period. In the pre-pandemic era, there were 1,000 (17.6%) patient deaths, whereas there were 160 deaths (21.3%, P  = .01) during the pandemic. A total of 53 (42.1%) coronavirus disease 2019 (COVID-19) patients died having an HAI. Age and comorbidities increased the risk of death in patients with COVID-19 and an HAI. During the pandemic, Black patients with an HAI and COVID-19 were more likely to die than White patients with an HAI and COVID-19. Conclusions: In three Midwestern hospitals, patients with concurrent HAIs and COVID-19 were more likely to die if they were Black, elderly, and had certain chronic comorbidities.
    Materialart: Online-Ressource
    ISSN: 2732-494X
    URL: Article
    DOI: 10.1017/ash.2023.409
    Sprache: Englisch
    Verlag: Cambridge University Press (CUP)
    Publikationsdatum: 2023
    ZDB Id: 3074908-6
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