GLORIA

GEOMAR Library Ocean Research Information Access

X

Your email was sent successfully. Check your inbox.

An error occurred while sending the email. Please try again.

Proceed reservation?

Export
  • 1
    Online Resource
    Online Resource
    Epidemiologic and Microbiologic Characteristics of Hospitalized Patients Co-colonized With Multiple Species of Carbapenem-Resistant Enterobacteriaceae in the United States
    Oxford University Press (OUP) ; 2020
    In:  Open Forum Infectious Diseases Vol. 7, No. 10 ( 2020-10-01)
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 7, No. 10 ( 2020-10-01)
    Abstract: We describe the epidemiologic and microbiologic characteristics of patients co-colonized with different species of carbapenem-resistant Enterobacteriaceae (CRE) from 5 hospitals in 4 states. Twenty-eight of 313 patients (8.9%) were co-colonized with at least 2 different CRE species. Different species within the same patient showed identical mechanism resistance in 18/28 (64%) cases.
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofaa386
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
    detail.hit.zdb_id: 2757767-3
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
  • 2
    Online Resource
    Online Resource
    563. Association Between Chlorhexidine Gluconate Concentrations and Resistant Bacterial Bioburden on Skin
    Oxford University Press (OUP) ; 2019
    In:  Open Forum Infectious Diseases Vol. 6, No. Supplement_2 ( 2019-10-23), p. S267-S267
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 6, No. Supplement_2 ( 2019-10-23), p. S267-S267
    Abstract: Little research exists to guide optimal Chlorhexidine gluconate (CHG) bathing practices. We examined the association between CHG concentrations and methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Enterobacteriaceae (CRE), and vancomycin-resistant Enterococcus (VRE) on the skin. Also, we studied whether bioburden is affected by bathing method (2% CHG cloth vs. 4% liquid CHG soap) and time since last CHG bath. Methods Patients with MRSA, CRE and VRE at 4 US hospitals were enrolled. Skin swabs (arm, chest) were collected to quantify bioburden and CHG concentrations. Information on bathing method and time since last CHG bath was collected. χ 2 test, Spearman’s correlation, and linear regression were performed. Results 253 patients were enrolled. On arm skin, MRSA was detected in 17 (19%), CRE on 16 (12%), and VRE on 12 (21%) patients. Detectable CHG levels were observed in 82 (93%) MRSA, 81 (79%) CRE, and 44 (79%) VRE patients. A negative correlation was observed between bioburden and CHG concentration for MRSA (rs = −0.11, P = 0.28) and CRE (rs = −0.02, P = 0.82) while a positive correlation was observed for VRE (rs = 0.15, P = 0.28). On chest skin, MRSA was detected in 25 (28%), CRE on 18 (12%), and VRE on 7 (13%) patients. Detectable CHG levels were observed in 83 (95.4%) MRSA, 78 (72%) CRE, and 43 (77%) VRE patients. MRSA bioburden was negatively correlated with CHG concentration (rs = −0.16, P = 0.12), while a positive correlation was noted for CRE (rs = 0.18, P = 0.06) and VRE (rs =0.24, P = 0.06). There was no significant difference in bacterial bioburden between CHG concentrations ( 〉 20 ppm vs. ≤20 ppm) at both skin sites (Table 1). The bioburden did not differ by method of CHG bath. The mean estimates of bacterial bioburden on both skin sites did not show a significant decrease with increase in CHG concentrations and were not affected by time since last bath (Table 2). Conclusion Detection of MRSA, CRE and VRE was infrequent irrespective of CHG bathing method and time since last bath. We found inconsistent associations between increasing CHG concentrations and bacterial bioburden. CHG bathing frequency may be optimized for individual patient populations to augment the reduction of bacteria. Additional research to understand the association of CHG skin concentrations and resistant bacterial burden is required. Disclosures All authors: No reported disclosures.
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofz360.632
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
    detail.hit.zdb_id: 2757767-3
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
  • 3
    Online Resource
    Online Resource
    1837. Considerations for a Targeted Approach to Contact Precautions for Patients with MRSA in Hospitals: A Multicenter Cohort Study to Identify High-Risk Patient Characteristics and Healthcare Personnel Interactions
    Oxford University Press (OUP) ; 2019
    In:  Open Forum Infectious Diseases Vol. 6, No. Supplement_2 ( 2019-10-23), p. S45-S45
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 6, No. Supplement_2 ( 2019-10-23), p. S45-S45
    Abstract: Healthcare personnel’s (HCP) gloves and gowns are frequently contaminated with antibiotic-resistant bacteria in the intensive care unit (ICU). Guidelines recommend contact precautions for patients with methicillin-resistant Staphylococcus aureus (MRSA); however, this approach remains controversial. This study aimed to identify which patients are more likely to transfer MRSA to HCP gloves or gowns and to identify HCP interactions more likely to lead to glove or gown contamination. Methods In a multicenter cohort study of MRSA colonized patients, we observed HCP–patient interactions and cultured HCP’s gloves and gowns before doffing. We also assessed the association between bacterial burden and contamination by sampling patients’ anterior nares, perianal area, chest, and arm. Results We enrolled 402 MRSA-colonized patients and observed 3,982 HCP interactions. MRSA contamination of HCP gloves and gown occurred in 14.3% and 5.9% of interactions, respectively. Contamination of either gloves or gown occurred in 16.2% of interactions. Occupational/physical therapists had the highest rates of contamination (OR: 6.96 [95% CI: 3.51–13.79]), followed by respiratory therapists (OR: 5.34 [95% CI: 3.04–9.39] ) when compared with the “Other” category. Touching the patient was associated with higher contamination (OR: 2.59 [95% CI: 1.04–6.51]) when compared with touching nothing in the room. Touching only the environment was not associated with glove or gown contamination (OR: 1.13 [95% CI: 0.43, 3.00] ) when compared with touching nothing. Touching the endotracheal tube (OR: 1.75 [95% CI: 1.38–2.19]), bedding (OR: 1.43 [95% CI: 1.20–1.70] ) and bathing a patient (OR: 1.32 [95% CI: 1.01–1.75]) increased odds of contamination when compared with not having such contacts (Figures 1 and 2). We found an association between increasing bacterial burden in the patient’s nares, perianal area, and chest skin and glove or gown contamination. Conclusion Contamination of HCP gloves and gowns with MRSA occurs frequently when caring for ICU patients. We identified interactions that are high-risk for transmission. Hospitals may consider optimizing contact precautions by using less precautions for low-risk interactions and more precautions for high-risk interactions. Disclosures All Authors: No reported Disclosures.
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofz359.099
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
    detail.hit.zdb_id: 2757767-3
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
  • 4
    Online Resource
    Online Resource
    Acquisition of Antibiotic-Resistant Gram-negative Bacteria in the Benefits of Universal Glove and Gown (BUGG) Cluster Randomized Trial
    Oxford University Press (OUP) ; 2021
    In:  Clinical Infectious Diseases Vol. 72, No. 3 ( 2021-02-01), p. 431-437
    Details
    In: Clinical Infectious Diseases, Oxford University Press (OUP), Vol. 72, No. 3 ( 2021-02-01), p. 431-437
    Abstract: The Benefits of Universal Glove and Gown (BUGG) cluster randomized trial found varying effects on methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus and no increase in adverse events. The aim of this study was to assess whether the intervention decreases the acquisition of antibiotic-resistant gram-negative bacteria. Methods This was a secondary analysis of a randomized trial in 20 hospital intensive care units. The intervention consisted of healthcare workers wearing gloves and gowns when entering any patient room compared to standard care. The primary composite outcome was acquisition of any antibiotic-resistant gram-negative bacteria based on surveillance cultures. Results A total of 40 492 admission and discharge perianal swabs from 20 246 individual patient admissions were included in the primary outcome. For the primary outcome of acquisition of any antibiotic-resistant gram-negative bacteria, the intervention had a rate ratio (RR) of 0.90 (95% confidence interval [CI], .71–1.12; P = .34). Effects on the secondary outcomes of individual bacteria acquisition were as follows: carbapenem-resistant Enterobacteriaceae (RR, 0.86 [95% CI, .60–1.24; P = .43), carbapenem-resistant Acinetobacter (RR, 0.81 [95% CI, .52–1.27; P = .36), carbapenem-resistant Pseudomonas (RR, 0.88 [95% CI, .55–1.42] ; P = .62), and extended-spectrum β-lactamase–producing bacteria (RR, 0.94 [95% CI, .71–1.24]; P = .67). Conclusions Universal glove and gown use in the intensive care unit was associated with a non–statistically significant decrease in acquisition of antibiotic-resistant gram-negative bacteria. Individual hospitals should consider the intervention based on the importance of these organisms at their hospital, effect sizes, CIs, and cost of instituting the intervention. Clinical Trials Registration NCT01318213.
    Type of Medium: Online Resource
    ISSN: 1058-4838 , 1537-6591
    URL: Article
    DOI: 10.1093/cid/ciaa071
    RVK:
    XA 10000
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
    detail.hit.zdb_id: 2002229-3
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
  • 5
    Online Resource
    Online Resource
    515. Acquisition of Antibiotic-Resistant Gram-Negative Bacteria in the Benefits of Universal Glove and Gown (BUGG) Cluster Randomized Trial
    Oxford University Press (OUP) ; 2019
    In:  Open Forum Infectious Diseases Vol. 6, No. Supplement_2 ( 2019-10-23), p. S248-S249
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 6, No. Supplement_2 ( 2019-10-23), p. S248-S249
    Abstract: The Benefits of Universal Gloves and Gowns (BUGG) randomized trial found a decrease in MRSA acquisition, no effect on VRE acquisition and no increase in adverse events with the intervention of wearing gloves and gowns for all patient contact in the intensive care unit (ICU). The objective of the study was to assess whether wearing gloves and gowns for all patient contact in the ICU decreases the acquisition of antibiotic-resistant Gram-negative bacteria. Methods Design: Secondary study of the BUGG cluster-randomized trial. Participants: 20 medical and surgical ICUs in 20 US hospitals. Intervention: Healthcare workers were required to wear gloves and gowns when entering any patient room compared with standard care. Main outcomes and measures: The primary composite outcome was acquisition of any antibiotic-resistant Gram-negative bacteria based on surveillance cultures collected on admission and discharge. Secondary outcomes were acquisition of carbapenem-resistant Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacteriaceae, or ESBL-producing Enterobacteriaceae. Results For the primary outcome, the intervention had a RR of 0.90 (95% CI 0.71 to 1.12, P = 0.34). Effects on the secondary outcomes were: carbapenem-resistant Enterobacteriaceae [RR 0.86 (95% CI, 0.60 to 1.24), P = 0.43], carbapenem-resistant Acinetobacter [RR 0.81 (95% CI, 0.52 to 1.27) P = 0.36] , carbapenem-resistant Pseudomonas [RR 0.88 (95% CI, 0.55 to 1.42) P = 0.62], ESBL producing bacteria [RR 0.94, (95% CI, 0.71 to 1.24) P = 0.67] . Conclusion The association of universal glove and gown use in the ICU with acquisition of antibiotic-resistant Gram-negative bacteria was inconclusive. The observed rate ratios for all five outcomes suggest that the intervention was protective, however, none were statistically significant. The study was likely underpowered to detect statistical significance for the effect sizes found. Individual hospitals should consider implementing the intervention based on the importance of these organisms at their hospital, effect sizes, confidence intervals, and cost. Disclosures All authors: No reported disclosures.
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofz360.584
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
    detail.hit.zdb_id: 2757767-3
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
  • 6
    Online Resource
    Online Resource
    Optimizing Contact Precautions to Curb the Spread of Antibiotic-resistant Bacteria in Hospitals: A Multicenter Cohort Study to Identify Patient Characteristics and Healthcare Personnel Interactions Associated With Transmission of Methicillin-resistant Staphylococcus aureus
    Oxford University Press (OUP) ; 2019
    In:  Clinical Infectious Diseases Vol. 69, No. Supplement_3 ( 2019-09-13), p. S171-S177
    Details
    In: Clinical Infectious Diseases, Oxford University Press (OUP), Vol. 69, No. Supplement_3 ( 2019-09-13), p. S171-S177
    Abstract: Healthcare personnel (HCP) acquire antibiotic-resistant bacteria on their gloves and gowns when caring for intensive care unit (ICU) patients. Yet, contact precautions for patients with methicillin-resistant Staphylococcus aureus (MRSA) remains controversial despite existing guidelines. We sought to understand which patients are more likely to transfer MRSA to HCP and to identify which HCP interactions are more likely to lead to glove or gown contamination. Methods This was a prospective, multicenter cohort study of cultured HCP gloves and gowns for MRSA. Samples were obtained from patients’ anterior nares, perianal area, and skin of the chest and arm to assess bacterial burden. Results Among 402 MRSA-colonized patients with 3982 interactions, we found that HCP gloves and gowns were contaminated with MRSA 14.3% and 5.9% of the time, respectively. Contamination of either gloves or gowns occurred in 16.2% of interactions. Contamination was highest among occupational/physical therapists (odds ratio [OR], 6.96; 95% confidence interval [CI] , 3.51, 13.79), respiratory therapists (OR, 5.34; 95% CI, 3.04, 9.39), and when any HCP touched the patient (OR, 2.59; 95% CI, 1.04, 6.51). Touching the endotracheal tube (OR, 1.75; 95% CI, 1.38, 2.19), bedding (OR, 1.43; 95% CI, 1.20, 1.70), and bathing (OR, 1.32; 95% CI, 1.01, 1.75) increased the odds of contamination. We found an association between increasing bacterial burden on the patient and HCP glove or gown contamination. Conclusions Gloves and gowns are frequently contaminated with MRSA in the ICU. Hospitals may consider using fewer precautions for low-risk interactions and more for high-risk interactions and personnel.
    Type of Medium: Online Resource
    ISSN: 1058-4838 , 1537-6591
    URL: Article
    DOI: 10.1093/cid/ciz621
    RVK:
    XA 10000
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
    detail.hit.zdb_id: 2002229-3
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
  • 7
    Online Resource
    Online Resource
    1053. Comorbidities Associated with All-Cause Readmission to the Same Hospital after Index COVID-19 Hospitalization: A Retrospective Cohort Study of 232155 Patients in the United States
    Oxford University Press (OUP) ; 2022
    In:  Open Forum Infectious Diseases Vol. 9, No. Supplement_2 ( 2022-12-15)
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 9, No. Supplement_2 ( 2022-12-15)
    Abstract: Understanding comorbidities that drive all-cause readmission in patients hospitalized with Coronavirus disease 2019 (COVID-19) can inform healthcare system capacity planning and improve post-discharge care. Methods This was a retrospective cohort study of patients hospitalized for COVID-19 between April 2020-December 2020 (index cohort) across 760 hospitals in the Premier Healthcare Database. Patients who died or left against medical advice were excluded from the index cohort. Surviving patients in the index cohort were followed until May 2021. First readmission to the same hospital as the COVID-19 index admission was considered all-cause readmission. The all-cause 14-month risk (95% confidence interval) of readmission was calculated using the Kaplan-Meier approach. A multivariable Cox proportional hazards model adjusted for demographic variables, hospital characteristics, co-existing comorbidities, and COVID-19 severity was built to study the association between Elixhauser comorbidities and readmission. Results Among 232155 unique patients in the index cohort, 36680 were readmitted to the same hospital at least once, followed through May 2021. The 14-month risk of readmission was 16.2% (95% CI:16.1% - 16.4%). The most frequent primary diagnosis on readmission was infectious disease (14240, 38.8%), of which 8754 (24%) were for COVID-19. With each additional comorbidity, the readmission hazard increased by 19% (HR, 1.19; 95% CI:1.18 - 1.19). In the multivariable Cox proportional hazards model, many comorbidity categories were associated with an increased risk of readmission. Metastatic cancer (HR, 1.74; 95% CI:1.60 –1.89), lymphoma (HR, 1.61; 95% CI:1.47 – 1.77), drug abuse (HR, 1.51; 95% CI:1.41 – 1.62), congestive heart failure (HR, 1.47; 95% CI:1.44– 1.51), and alcohol abuse (HR, 1.46; 95% CI:1.36– 1.56) were associated with the highest hazard for readmission. Conclusion COVID-19 patients have a high risk of all-cause readmission and are frequently readmitted for COVID-19. With the continued emergence of COVID-19 variants, this study provides valuable insights into developing more informed discharge plans and improving post-discharge care for COVID-19 patients with existing comorbidities to prevent readmission. Disclosures Lyndsay M. O'Hara, PhD, MPH, PDI: Grant/Research Support.
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofac492.894
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 2757767-3
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
  • 8
    Online Resource
    Online Resource
    Prospective observational cohort study on grading the severity of postoperative complications in global surgery research
    Oxford University Press (OUP) ; 2019
    In:  British Journal of Surgery Vol. 106, No. 2 ( 2019-01-08), p. e73-e80
    Details
    In: British Journal of Surgery, Oxford University Press (OUP), Vol. 106, No. 2 ( 2019-01-08), p. e73-e80
    Abstract: The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally.
    Type of Medium: Online Resource
    ISSN: 0007-1323 , 1365-2168
    URL: Article
    DOI: 10.1002/bjs.11025
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
    detail.hit.zdb_id: 2006309-X
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
  • 9
    Online Resource
    Online Resource
    2147. Sample Size Estimates for Cluster Randomized Trials in Infection Control and Antimicrobial Stewardship
    Oxford University Press (OUP) ; 2018
    In:  Open Forum Infectious Diseases Vol. 5, No. suppl_1 ( 2018-11-26), p. S632-S632
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 5, No. suppl_1 ( 2018-11-26), p. S632-S632
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofy210.1803
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2018
    detail.hit.zdb_id: 2757767-3
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
Close ⊗
This website uses cookies and the analysis tool Matomo. More information can be found here...