Charting the course for the future of science in healthcare epidemiology: results of a survey of the membership of the Society of Healthcare Epidemiology of America.
ABSTRACT To describe the results of a survey of members of the Society for Healthcare Epidemiology of America (SHEA) that (1) measured members' perceptions of gaps in the healthcare epidemiology knowledge base and members' priorities for SHEA research goals, (2) assessed whether members would be willing to participate in consortia to address identified gaps in knowledge, and (3) evaluated the need for training for the next generation of investigators in the field of healthcare epidemiology.
Electronic and paper survey of members of SHEA, a professional society formed to advance the science of healthcare epidemiology through research and education.
All society members were invited to participate.
Of 1,289 SHEA members, 593 (46.0%) responded. Respondents identified the following issues as important for the Research Committee of SHEA: setting the scientific agenda for healthcare epidemiology, developing collaborative infrastructure to conduct research, and developing funding mechanisms for research. Respondents ranked multidrug-resistant gram-negative organisms, antimicrobial stewardship, methicillin-resistant Staphylococcus aureus, adherence to effective hand hygiene guidelines, and Clostridium difficile infections as the most important scientific issues facing the field. Respondents ranked inadequate project funding, lack of protected time for research, and inability to obtain a grant, contract, and/or outside funding as the most significant barriers to conducting research. More than 92% of respondents support creating a SHEA research consortium; more than 40% would participate even if no additional funding were available; nearly 90% identified developing research training as a key function for SHEA.
These data provide a road map for the SHEA Research Committee for the next decade.
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ABSTRACT: To measure trends in aminoglycoside antibiotic use and gentamicin-resistant clinical isolates across a network of hospitals and compare network-level relationships with those of individual hospitals. Longitudinal observational investigation. US academic medical centers. Adult inpatients. Adult aminoglycoside use was measured from 2002 or 2003 through 2009 in 29 hospitals. Hospital-wide antibiograms assessed gentamicin resistance by proportions and incidence rates for Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae, and Escherichia coli. Mixed-effects analysis of variance was used to assess the significance of changes in aminoglycoside use and changes in resistance rates and proportions. Generalized estimating equations were used to assess the relationship between aminoglycoside use and resistance. Mean aminoglycoside use declined by 41%, reflecting reduced gentamicin (P < .0001) and tobramycin (P < .005) use; amikacin use did not change. The rate and proportion of gentamicin-resistant P. aeruginosa decreased by 48% (P < .0001) and 31% (P < .0001), respectively. The rate and proportion of gentamicin-resistant E. coli increased by 166% and 124%, respectively (P < .0001), and they were related to increasing quinolone resistance in E. coli. Resistance among K. pneumoniae and A. baumannii did not change. Relationships between aminoglycoside use and resistance at the network level were highly variable at the individual hospital level. Mean aminoglycoside use declined in this network of US hospitals and was associated with significant and opposite changes in rates of resistance for some organisms and no change for others. At the individual hospital level, antibiograms appear to be an unreliable reflection of antibiotic use, at least for aminoglycosides.Infection Control and Hospital Epidemiology 06/2012; 33(6):594-601. DOI:10.1086/665724 · 3.94 Impact Factor
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ABSTRACT: The incidence of extended-spectrum β-lactamase-producing Enterobacteriacae (ESBLPE) is increasing, due to the emergence of CTX-M ESBL Escherichia coli, together with the resurgence of classical ESBLPE. Carbapenemase-producing Enterobacteriaceae (CPE) rapidly disseminate in many countries, but still are emergent in France, with small outbreaks originating from repatriated patients. These multiply- or highly-resistant Gram-negative bacteria (HRGNB) pose a serious threat for the upcoming years, in the community (ESBLPE) and in the healthcare setting (ESBLPE and CPE). Contrary to MRSA, controlling the spread of ESBLPE must include strict infection control measures together with sharp decreasing of antimicrobial use. For ESBLPE, standard and contact precautions should stem their dissemination. For HRGNB, a strict control policy, similar to that applied for vancomycin-resistant enterococci (VRE), can prevent the establishment of these strains in France. Awareness is urgently needed from healthcare authorities, healthcare professionals, public and medias.06/2011; 13(2). DOI:10.1016/j.antinf.2011.03.006
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ABSTRACT: To describe and analyse factors associated with Clostridium difficile infection (CDI) severity in hospitalised medical intensive care unit patients. We performed a retrospective cohort study of 40 patients with CDI in a medical intensive care unit (MICU) at a French university hospital. We include patients hospitalised between January 1, 2007 and December 31, 2011. Data on demographics characteristics, past medical history, CDI description was collected. Exposure to risk factors associated with CDI within 8 wk before CDI was recorded, including previous hospitalisation, nursing home residency, antibiotics, antisecretory drugs, and surgical procedures. All included cases had their first episode of CDI. The mean incidence rate was 12.94 cases/1000 admitted patients, and 14.93, 8.52, 13.24, 19.70, and 8.31 respectively per 1000 admitted patients annually from 2007 to 2011. Median age was 62.9 [interquartile range (IQR) 55.4-72.40] years, and 13 (32.5%) were women. Median length of MICU stay was 14.0 d (IQR 5.0-22.8). In addition to diarrhoea, the clinical symptoms of CDI were fever (> 38 °C) in 23 patients, abdominal pain in 15 patients, and ileus in 1 patient. The duration of diarrhoea was 13.0 (8.0-19.5) d. In addition to diarrhoea, the clinical symptoms of CDI were fever (> 38 °C) in 23 patients, abdominal pain in 15 patients, and ileus in 1 patient. Prior to CDI, 38 patients (95.0%) were exposed to antibiotics, and 12 (30%) received at least 4 antibiotics. Fluoroquinolones, 3(rd) generation cephalosporins, coamoxiclav and tazocillin were prescribed most frequently (65%, 55%, 40% and 37.5%, respectively). The majority of cases were hospital-acquired (n = 36, 90%), with 5 cases (13.9%) being MICU-acquired. Fifteen patients had severe CDI. The crude mortality rate within 30 d after diagnosis was 40% (n = 16), with 9 deaths (9 over 16; 56.3%) related to CDI. Of our 40 patients, 15 (37.5%) had severe CDI. Multivariate logistic regression showed that male gender [odds ratio (OR): 8.45; 95%CI: 1.06-67.16, P = 0.044], rising serum C-reactive protein levels (OR = 1.11; 95%CI: 1.02-1.21, P = 0.021), and previous exposure to fluoroquinolones (OR = 9.29; 95%CI: 1.16-74.284, P = 0.036) were independently associated with severe CDI. We report predictors of severe CDI not dependent on time of assessment. Such factors could help in the development of a quantitative score in ICU's patients.World Journal of Gastroenterology 11/2013; 19(44):8034-41. DOI:10.3748/wjg.v19.i44.8034 · 2.43 Impact Factor