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  • 1
    Online Resource
    Online Resource
    State of the Union: Timeliness to Antibiotics in Open Fractures
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Journal of Orthopaedic Trauma Vol. 37, No. 5 ( 2023-05), p. e213-e218
    Details
    In: Journal of Orthopaedic Trauma, Ovid Technologies (Wolters Kluwer Health), Vol. 37, No. 5 ( 2023-05), p. e213-e218
    Abstract: In open fractures, early administration of systemic antibiotics has recently been recognized as a universal recommendation, with the current American College of Surgeons Trauma Center Verification recommendation for administration within 1 hour of facility arrival. We sought to quantify the baseline rate of timely antibiotic administration and the various factors associated with delay. Methods: Data from the National Trauma Data Bank were obtained for all patients treated for open fractures in 2019. 65,552 patients were included. Univariate and multivariate analyses were performed, first for patient, prehospital, and hospital factors compared with rate of antibiotic administration within 1 hour of hospital arrival, then with a multivariate analysis of factors affecting these times. Results: The overall rate of antibiotic administration within 1 hour of arrival was 47.6%. Patient factors associated with lower rates of timely antibiotics include increased age, Medicare status, and a higher number of comorbidities. Associated prehospital factors included non–work-related injuries, fixed-wing air or police transport, and walk-in arrival method. Patients with lower extremity open fractures were more likely to receive antibiotics within 1 hour of arrival than those with upper extremity open fractures. Traumatic amputations had a higher rate of timely administration (67.3%). ACS trauma Level II (52.5%) centers performed better than Level III (48.3%), Level I (45.5%), and Level IV (34.5%) centers. Multivariate analysis confirmed the findings of the univariate analysis. Conclusions: Despite current clinical standards, rates of adherence to rapid antibiotic administration are low. Certain patient, facility, and environmental factors are associated with delays in antibiotic administration and can be a focus for quality improvement processes. We plan to use these data to evaluate how focus on antibiotic administration as this quality standard changes practice over time. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
    Type of Medium: Online Resource
    ISSN: 0890-5339
    URL: Article
    DOI: 10.1097/BOT.0000000000002546
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 2041334-8
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  • 2
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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)
    Abstract: 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.
    Type of Medium: Online Resource
    ISSN: 2732-494X
    URL: Article
    DOI: 10.1017/ash.2022.361
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2023
    detail.hit.zdb_id: 3074908-6
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  • 3
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    A Population-Based Assessment of Depression and Anxiety in Patients With Brachial Plexus Injuries
    Elsevier BV ; 2018
    In:  The Journal of Hand Surgery Vol. 43, No. 12 ( 2018-12), p. 1136.e1-1136.e9
    Details
    In: The Journal of Hand Surgery, Elsevier BV, Vol. 43, No. 12 ( 2018-12), p. 1136.e1-1136.e9
    Type of Medium: Online Resource
    ISSN: 0363-5023
    URL: Article
    DOI: 10.1016/j.jhsa.2018.03.056
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2018
    detail.hit.zdb_id: 2023397-8
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  • 4
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    Microbiology Clinical Culture Diagnostic Yields and Antimicrobial Resistance Proportions before and during the COVID-19 Pandemic in an Indian Community Hospital and Two US Community Hospitals
    MDPI AG ; 2023
    In:  Antibiotics Vol. 12, No. 3 ( 2023-03-08), p. 537-
    Details
    In: Antibiotics, MDPI AG, Vol. 12, No. 3 ( 2023-03-08), p. 537-
    Abstract: Studies comparing the impact of the COVID-19 pandemic on diagnostic microbiology culture yields and antimicrobial resistance proportions in low-to-middle-income and high-income countries are lacking. A retrospective study using blood, respiratory, and urine microbiology data from a community hospital in India and two community hospitals (Hospitals A and B) in St. Louis, MO, USA was performed. We compared the proportion of cultures positive for selected multi-drug-resistant organisms (MDROs) listed on the WHO’s priority pathogen list both before the COVID-19 pandemic (January 2017–December 2019) and early in the COVID-19 pandemic (April 2020–October 2020). The proportion of blood cultures contaminated with coagulase-negative Staphylococcus (CONS) was significantly higher during the pandemic in all three hospitals. In the Indian hospital, the proportion of carbapenem-resistant (CR) Klebsiella pneumoniae in respiratory cultures was significantly higher during the pandemic period, as was the proportion of CR Escherichia coli in urine cultures. In the US hospitals, the proportion of methicillin-resistant Staphylococcus aureus in blood cultures was significantly higher during the pandemic period in Hospital A, while no significant increase in the proportion of Gram-negative MDROs was observed. Continuity of antimicrobial stewardship activities and better infection prevention measures are critical to optimize outcomes and minimize the burden of antimicrobial resistance among COVID-19 patients.
    Type of Medium: Online Resource
    ISSN: 2079-6382
    URL: Article
    DOI: 10.3390/antibiotics12030537
    Language: English
    Publisher: MDPI AG
    Publication Date: 2023
    detail.hit.zdb_id: 2681345-2
    SSG: 15,3
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  • 5
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    Infectious Diseases Consultation Reduces 30-Day and 1-Year All-Cause Mortality for Multidrug-Resistant Organism Infections
    Oxford University Press (OUP) ; 2018
    In:  Open Forum Infectious Diseases Vol. 5, No. 3 ( 2018-03-01)
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 5, No. 3 ( 2018-03-01)
    Abstract: Multidrug-resistant organism (MDRO) infections are associated with high mortality and readmission rates. Infectious diseases (ID) consultation improves clinical outcomes for drug-resistant Staphylococcus aureus bloodstream infections. Our goal was to determine the association between ID consultation and mortality following various MDRO infections. Methods This study was conducted with a retrospective cohort (January 1, 2006–October 1, 2015) at an academic tertiary referral center. We identified patients with MDROs in a sterile site or bronchoalveolar lavage/bronchial wash culture. Mortality and readmissions within 1 year of index culture were identified, and the association of ID consultation with these outcomes was determined using Cox proportional hazards models with inverse weighting by the propensity score for ID consultation. Results A total of 4214 patients with MDRO infections were identified. ID consultation was significantly associated with reductions in 30-day and 1-year mortality for resistant S. aureus (hazard ratio [HR] , 0.48; 95% confidence interval [CI], 0.36–0.63; and HR, 0.73, 95% CI, 0.61–0.86) and Enterobacteriaceae (HR, 0.41; 95% CI, 0.27–0.64; and HR, 0.74; 95% CI, 0.59–0.94), and 30-day mortality for polymicrobial infections (HR, 0.51; 95% CI, 0.31–0.86) but not Acinetobacter or Pseudomonas. For resistant Enterococcus, ID consultation was marginally associated with decreased 30-day mortality (HR, 0.81; 95% CI, 0.62–1.06). ID consultation was associated with reduced 30-day readmission for resistant Enterobacteriaceae. Conclusions ID consultation was associated with significant reductions in 30-day and 1-year mortality for resistant S. aureus and Enterobacteriaceae, and 30-day mortality for polymicrobial infections. There was no association between ID consultation and mortality for patients with resistant Pseudomonas, Acinetobacter, or Enterococcus, possibly due to small sample sizes. Our results suggest that ID consultation may be beneficial for patients with some MDRO infections.
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofy026
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2018
    detail.hit.zdb_id: 2757767-3
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  • 6
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    Increased Incidence and Risk of Septicemia and Urinary Tract Infection After Clostridioides difficile Infection
    Oxford University Press (OUP) ; 2023
    In:  Open Forum Infectious Diseases Vol. 10, No. 8 ( 2023-08-01)
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 10, No. 8 ( 2023-08-01)
    Abstract: Although increased occurrence of septicemia in persons with Clostridioides difficile infection (CDI) has been reported, incidence rates and risk of septicemia and urinary tract infection (UTI) after CDI are unclear. Methods The first episode of CDI was identified using 2011–2017 MarketScan and CMS Medicare data and CDI cases categorized by standard surveillance definitions. Uninfected persons were frequency matched 4:1 to cases by the CDI case surveillance definition. Multivariable Cox proportional hazards models were used to identify risk factors for septicemia and UTI within 90 days of CDI onset, accounting for the competing risk of death in the Medicare population. Results The incidence of septicemia was highest after hospital-onset CDI in the Medicare, younger commercial, and younger Medicaid populations (25.5%, 15.7%, and 19.5%, respectively) and lowest in those with community-associated CDI (3.8%, 4.3%, and 8.3%, respectively). In contrast, the incidence of UTI was highest in those with other healthcare facility onset CDI in all 3 populations (32.1%, 24.2%, and 18.1%, respectively). Hospital-onset CDI was associated with highest risk of septicemia compared with uninfected controls in all 3 populations. In the younger populations, risk of septicemia was more uniform across the CDI surveillance definitions. The risk of UTI was significantly higher in all CDI surveillance categories compared to uninfected controls, and among CDI cases it was lowest in those with community-associated CDI. Conclusions The incidence of septicemia is high after CDI, particularly after hospital-onset infection. Additional preventive measures are needed to reduce infectious complications of CDI.
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofad313
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
    detail.hit.zdb_id: 2757767-3
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  • 7
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    2037. Epidemiology and Preventability of Hospital Onset Bacteremia and Fungemia in two Hospitals in India
    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: The National Healthcare Safety Network (NHSN) central line-associated bloodstream infection (CLABSI) is a widely accepted quality measure. However, studies from the United States indicate that NHSN reportable CLABSIs account for less than 20% of all hospital-onset bacteremia and fungemia (HOB, i.e., any positive blood culture obtained at least 3 calendar days after hospital admission) events and about 66% of all HOB events are potentially preventable. The incidence and overall preventability of HOB is unknown in low and middle-income countries (LMICs). This study evaluated the epidemiology and preventability of HOB in two hospitals in India. Methods Six months data on all consecutive blood cultures processed in two hospitals (Hospital A- 8.16.2020 to 2.15.2021; Hospital B- 1.1.2021 to 6.30.2021) were collected prospectively to calculate HOB and CLABSI incidence. Correlation between HOB and CLABSI rates was assessed using Spearman’s rank correlation. Medical records of 300 consecutive HOB events were retrospectively reviewed to determine the source and preventability of HOB utilizing a structured guide developed for the study. Results Among 3,558 hospitalized patients from whom blood cultures were obtained, 10.4% developed HOB with 409 unique HOB events (HOB incidence: 2.87 per 1000 patient-days). Only 15% (59 of 409) of HOB events were reported as CLABSI as per hospital CLABSI surveillance programs. The CLABSI rate was 4.4 per 1000 central line-days. There was a moderation correlation (r=0.51; p=0.07) between HOB and CLABSI rates. Among the 300 HOB events for which medical records were reviewed, the most common organism isolated was Klebsiella pneumoniae and 75% of K. pneumoniae were carbapenem resistant (Figure 1). The most common source of HOB was CLABSI (26.3%) (Figure 2). Fifty-two percent of all HOB events and 45% of HOB events not attributable to contaminants were potentially preventable (Figure 3). CLABSIs accounted for 69% of non-contaminant HOB preventable events. Conclusion We found that 69% of the non-contaminant related HOB preventable events were due to CLABSI. Prevention efforts in these hospitals could focus on CLABSI to reduce HOB rates while additional studies are performed to better understand the epidemiology of HOB in LMICs. Microorganisms identified from 300 Hospital Onset Bacteremia and Fungemia Events in Two Hospitals in India. Source of Hospital Onset Bacteremia and Fungemia Events in Two Hospitals in India (n=300). Preventability Rating Source of Hospital Onset Bacteremia and Fungemia events in Two Hospitals in India (n=300). Disclosures All Authors: No reported disclosures.
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofac492.1659
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 2757767-3
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  • 8
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    Creation and Internal Validation of a Clinical Predictive Model for Fluconazole Resistance in Patients With Candida Bloodstream Infection
    Oxford University Press (OUP) ; 2022
    In:  Open Forum Infectious Diseases Vol. 9, No. 9 ( 2022-09-02)
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 9, No. 9 ( 2022-09-02)
    Abstract: Fluconazole is recommended as first-line therapy for candidemia when risk of fluconazole resistance (fluc-R) is low. Lack of methods to estimate resistance risk results in extended use of echinocandins and prolonged hospitalization. This study aimed to develop a clinical predictive model to identify patients at low risk for fluc-R where initial or early step-down fluconazole would be appropriate. Methods Retrospective analysis of hospitalized adult patients with positive blood culture for Candida spp from 2013 to 2019. Multivariable logistic regression model was performed to identify factors associated with fluc-R. Stepwise regression was performed on bootstrapped samples to test individual variable stability and estimate confidence intervals (CIs). We used receiver operating characteristic curves to assess performance across the probability spectrum. Results We identified 539 adults with candidemia and 72 Candida isolates (13.4%) were fluc-R. Increased risk of fluc-R was associated with older age, prior bacterial bloodstream infection (odds ratio [OR] , 2.02 [95% CI, 1.13–3.63]), myelodysplastic syndrome (OR, 3.09 [95% CI, 1.13–8.44] ), receipt of azole therapy (OR, 5.42 [95% CI, 2.90–10.1]) within 1 year of index blood culture, and history of bone marrow or stem cell transplant (OR, 2.81 [95% CI, 1.41–5.63] ). The model had good discrimination (optimism-corrected c-statistic 0.771), and all of the selected variables were stable. The prediction model had a negative predictive value of 95.7% for the selected sensitivity cutoff of 90.3%. Conclusions This model is a potential tool for identifying patients at low risk for fluc-R candidemia to receive first-line or early step-down fluconazole.
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofac447
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 2757767-3
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  • 9
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    The burden of clostridium difficile infection: estimates of the incidence of CDI from U.S. Administrative databases
    Springer Science and Business Media LLC ; 2016
    In:  BMC Infectious Diseases Vol. 16, No. 1 ( 2016-12)
    Details
    In: BMC Infectious Diseases, Springer Science and Business Media LLC, Vol. 16, No. 1 ( 2016-12)
    Type of Medium: Online Resource
    ISSN: 1471-2334
    URL: Article
    DOI: 10.1186/s12879-016-1501-7
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2016
    detail.hit.zdb_id: 2041550-3
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  • 10
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    The Incidence and Risk Factors Associated With the Need for Fasciotomy in Tibia and Forearm Fractures: An Analysis of the National Trauma Data Bank
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Journal of Orthopaedic Trauma Vol. 34, No. 5 ( 2020-05), p. e154-e158
    Details
    In: Journal of Orthopaedic Trauma, Ovid Technologies (Wolters Kluwer Health), Vol. 34, No. 5 ( 2020-05), p. e154-e158
    Abstract: The aims of this study were to analyze a large national trauma database to determine the incidence of, risk factors for, and outcomes after a fasciotomy of the lower leg or forearm after fracture. Methods: Data from the National Trauma Data Bank for the years 2004–2016 were analyzed, and we identified 301,351 patients with forearm fractures and 369,237 patients with tibial fractures. Risk factors, length of stay (LOS), and mortality were assessed to determine associations with an injury that required a fasciotomy. Results: A total of 1.22% of the forearm fractures and 3.79% of the tibial fractures had a fasciotomy. Patients with a fasciotomy were more likely to have invasive procedures ( P 〈 0.0001); have injuries resulting from machinery, motor vehicle collisions, and firearms ( P 〈 0.0001); and smoke, use drugs, and/or alcohol ( P 〈 0.05) compared with patients who did not undergo fasciotomies. Fasciotomy procedures were associated with longer LOS and higher mortality rate ( P 〈 0.05). Conclusions: The incidence of a fasciotomy is less than 5% in tibia or forearm fractures. Patients who underwent fasciotomy have higher energy injuries, increased alcohol or drug use, higher rates of surgical interventions, and increased LOS. Furthermore, having a fasciotomy is associated with increased mortality rate. When counseling patients and evaluating surgeon/hospital performance, fasciotomies can serve as an indicator and modifier for a more complex trauma pathology. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
    Type of Medium: Online Resource
    ISSN: 0890-5339
    URL: Article
    DOI: 10.1097/BOT.0000000000001702
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2041334-8
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