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Evan J Anderson,
Deanna B Shippee,
Melissa H Weinrobe,
Melissa D Davila,
Ben Z Katz,
Susheel Reddy,
Mary Gene Karen P Cuyugan,
Samuel Y Lee,
Yael M Simons,
Ram Yogev, Gary A Noskin
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ABSTRACT: Background. Pediatric vaccination has resulted in declines in disease in unvaccinated individuals through decreasing pathogen circulation in the community. About 2 years after implementation of pediatric rotavirus vaccination in the United States, dramatic declines in rotavirus disease were observed in both vaccinated and unvaccinated children. Whether this protection extends to adults is unknown.Methods. The prevalence of rotavirus, as determined by Rotaclone enzyme immunoassay, in adults who had stools submitted for bacterial stool culture (BSC) between February to May to Northwestern Memorial Hospital, Chicago, was compared between the prepediatric impact era (2006-2007) and the pediatric impact era (2008-2010). Isolates were genotyped and clinical characteristics of those with rotavirus were compared.Results. Of the 5788 BSC sent, 4725 met inclusion criteria and 3530 of these (74.7%) were saved for rotavirus testing. The prevalence of rotavirus among adults who had stool sent for BSC declined from 4.35% in 2006-2007 to 2.24% in 2008-2010 (a relative decline of 48.4%; P = .0007). The decline in the prevalence of rotavirus was of similar significant magnitude in both outpatients and inpatients. Marked year-to-year variability was observed in circulating rotavirus genotypes, with strain G2P[4] accounting for 24%; G1P[8], 22%; G3P[8], 11%; and G12P[6], 10% overall. About 30% of adults from whom rotavirus was isolated were immunocompromised and this remained constant.Conclusions. Pediatric rotavirus vaccination correlated with a relative decline of almost 50% in rotavirus identified from adult BSC during the peak rotavirus season, suggesting that pediatric rotavirus vaccination protects adults from rotavirus.
Clinical Infectious Diseases 01/2013; · 9.15 Impact Factor
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Kathryn M Weedon,
Angela H Rupp,
Annie C Heffron,
Sinead Forkan Kelly,
Xiaotian Zheng,
Stanford T Shulman,
Peggy Gutman,
Deli Wang,
Ying Zhou, Gary A Noskin,
Evan J Anderson
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ABSTRACT: Background: Respiratory syncytial virus (RSV) and influenza are important pediatric community-acquired (CA) and hospital-acquired (HA) pathogens. The occurrence of pandemic (H1N1) 2009 influenza resulted in additional efforts to intensify infection control (IC) strategies. We detail the impact of IC strategies between 2003 and 2010 on influenza and RSV. Methods: We assessed the rates of CA infections per 100 admissions and HA infections per 1000 patient-days for both RSV and influenza at Children's Memorial Hospital during the winter seasons (September through May) 2003-2010. The season of 2009, however, was extended through June due to ongoing admissions as a result of pandemic (H1N1) 2009 influenza. IC strategies implemented in response to pandemic (H1N1) 2009 influenza are described. The transmission ratio (HA cases/CA cases) was determined and correlated with IC efforts. Results: Substantial season- to-season variability exists for CA RSV and CA influenza rates. The rates of HA RSV and HA influenza and the transmission ratios for these viruses remained unchanged in 2009-10 in comparison to the prior year (at 0.02 and 0.01, respectively) despite implementation of multiple IC strategies. In contrast, since 2005 an inverse association was noted between hand hygiene compliance and the transmission ratio of both RSV and influenza, with Spearman correlation coefficients of -0.84 (p = 0.051) and -0.89 (p = 0.008), respectively. Conclusions: We observed that improvements in hand hygiene compliance correlated with less transmission of RSV and influenza in the hospital. The important role of hand hygiene in preventing transmission of RSV and influenza to hospitalized children should be emphasized.
Scandinavian Journal of Infectious Diseases 10/2012; · 1.72 Impact Factor
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Sara E Cosgrove,
Susan K Seo,
Maureen K Bolon,
Kent A Sepkowitz,
Michael W Climo,
Daniel J Diekema,
Kathleen Speck,
Vidhya Gunaseelan, Gary A Noskin,
Loreen A Herwaldt,
Edward Wong,
Trish M Perl
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ABSTRACT: To evaluate the impact of postprescription review of broad-spectrum antimicrobial (study-ABX) agents on rates of antimicrobial use.
Quasi-experimental before-after study.
Five academic medical centers.
Adults receiving at least 48 hours of study-ABX.
The baseline, intervention, and follow-up periods were 6 months each in 2 units at each of 5 sites. Adults receiving at least 48 hours of study-ABX entered the cohort as case-patients. During the intervention, infectious-diseases physicians reviewed the cases after 48 hours of study-ABX. The provider was contacted with alternative recommendations if antimicrobial use was considered to be unjustified on the basis of predetermined criteria. Acceptance rates were assessed 48 hours later. The primary outcome measure was days of study-ABX per 1,000 study-patient-days in the baseline and intervention periods.
There were 1,265 patients in the baseline period and 1,163 patients in the intervention period. Study-ABX use decreased significantly during the intervention period at 2 sites: from 574.4 to 533.8 study-ABX days/1,000 patient-days (incidence rate ratio [IRR], 0.93; 95% confidence interval [CI], 0.88-0.97; P = .002) at hospital B and from 615.6 to 514.4 study-ABX days/1,000 patient-days (IRR, 0.83; 95% CI, 0.79-0.88; P < .001) at hospital D. Both had established antimicrobial stewardship programs (ASP). Study-ABX use increased at 2 sites and stayed the same at 1 site. At all institutions combined, 390 of 1,429 (27.3%) study-ABX courses were assessed as unjustified; recommendations to modify or stop therapy were accepted for 260 (66.7%) of these courses.
Postprescription review of study-ABX decreased antimicrobial utilization in some of the study hospitals and may be more effective when performed as part of an established ASP.
Infection Control and Hospital Epidemiology 04/2012; 33(4):374-80. · 3.67 Impact Factor
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The Journal of Infectious Diseases 03/2012; 205(11):1762-4; author reply 1764-5. · 6.41 Impact Factor
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ABSTRACT: To determine the prevalence and epidemiological characteristics of rotavirus among adults admitted to the hospital with diarrhea that have bacterial stool cultures sent.
The prevalence of rotavirus was determined by Rotaclone EIA in samples submitted for bacterial stool culture from adults requiring hospitalization at Northwestern Memorial Hospital, Chicago from December 01, 2005-November 30, 2006.
Rotavirus was detected in 2.9% of eligible bacterial stool cultures. A bacterial pathogen (e.g., Salmonella, Shigella, Campylobacter) was identified in 3.3%. Bacterial stool pathogens were more common from June-October while rotavirus was 2.4 times more common than all bacterial pathogens from February-May. Adults in whom rotavirus was detected were older (p < 0.05) and more often immunosuppressed (p < 0.02), particularly with HIV (p < 0.04) compared to individuals from whom bacteria were isolated. The duration of hospitalization and the number of invasive procedures performed in those with rotavirus and bacterial diarrhea were comparable.
In the era immediately prior to widespread rotavirus vaccination of children, rotavirus was as commonly detected from adults admitted to the hospital with diarrhea as are the bacterial gastroenteritis pathogens. Rotavirus is particularly prevalent from February-May (as in children) and in immunosuppressed or older adults.
The Journal of infection 09/2011; 64(1):89-95. · 4.13 Impact Factor
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ABSTRACT: Immunochromatographic urine pneumococcal antigen testing (ICT) has become a common diagnostic tool for those presenting with possible invasive pneumococcal disease. The incidence and clinical impact of ICT false-positivity on hospitalized patients has not been assessed outside of specific patient subpopulations. ICT performance needs to be assessed in a real-world clinical setting. This study aims to describe the incidence and clinical impact of ICT false-positivity in a hospital setting over a 19-month period.
A retrospective cohort study was performed to assess the incidence of false-positive (FP) ICT among hospitalized patients from November 21, 2007 to June 30, 2009. The primary objective was to describe the incidence of FP ICT results. The secondary objective was to describe what clinical impact, if any, could be attributed to FP ICT results.
During the study period, 52 positive ICT results were obtained, of which 5 (9.6%) were deemed falsely positive. Interestingly, two of the 5 FP results were from patients who had received 23-valent pneumococcal vaccine (PPV) in the 2 days prior to ICT. The management of all 5 patients was impacted by the FP results through unnecessary antimicrobial treatment and/or deferral of further clinical evaluation.
Health care providers should be aware of the potential for ICT FP and should order and interpret these tests within an informed clinical framework.
Southern medical journal 08/2011; 104(8):593-7. · 0.92 Impact Factor
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ABSTRACT: Legionellae are Gram-negative bacteria which are capable of causing disease, most commonly in the form of pneumonia. We describe a case of native valve endocarditis caused by a Legionella strain which by genotypic (16S rRNA and mip gene sequencing) and phenotypic analyses is unlike previously described strains of Legionella.
Journal of clinical microbiology 07/2011; 49(9):3340-2. · 4.16 Impact Factor
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ABSTRACT: Data show that after the implementation of routine rotavirus vaccination for infants in the United States, community-acquired (CA) rotavirus cases declined substantially in the 2007-2008 season. The impact of community-based rotavirus vaccination on the substantial burden of hospital-acquired (HA) rotavirus has not been documented.
We assessed CA and HA rotavirus, respiratory syncytial virus, and influenza infections at Children's Memorial Hospital for 5 winter seasons (defined as occurring from September through May) from 2003 to 2008. We also report rotavirus data from the 2008-2009 season.
A similar dramatic decline (>60% compared with the median of previous seasons) occurred in the rates of cases of both CA (P < .0001) rotavirus hospitalizations and HA (P < .01) rotavirus infections in the 2007-2008 season compared with previous seasons, whereas the rates of CA and HA influenza and respiratory syncytial virus, respectively, remained stable. Improvements in hand-hygiene compliance did not correlate with a reduction in the transmission rate of rotavirus in the hospital. Both CA and HA rotavirus rates remained much lower in the 2008-2009 than in the 2003-2007 seasons.
Community-based rotavirus vaccination is associated with a substantial reduction in the number of children who are admitted with rotavirus. These data also indicate that routine community-based rotavirus infant vaccination protects hospitalized children from acquiring rotavirus. Vaccination efforts should be encouraged as a strategy to affect the substantial burden of HA rotavirus.
PEDIATRICS 02/2011; 127(2):e264-70. · 4.47 Impact Factor
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ABSTRACT: The recent rise in antimicrobial resistance among health-care associated pathogens is a growing public health concern. According to the National Nosocomial Infections Surveillance System, rates of methicillin-resistant Staphylococcus aureus (MRSA) in intensive care units have nearly doubled over the last decade. Of equal importance, gram-negative agents such as Pseudomonas aeruginosa, Acinetobacter baumannii, and extended-spectrum beta lactamase-producing Enterobacteriaceae demonstrate increasing resistance to third-generation cephalosporins, fluoroquinolones, and, in some cases, carbapenems. As a consequence, hospitalists may find themselves utilizing new antibiotics in the treatment of bacterial infections. This case-based review will highlight 8 antibiotics that have emerging clinical indications in treating these multidrug-resistant (MDR) pathogens.
Journal of Hospital Medicine 09/2009; 4(6):E8-15. · 1.40 Impact Factor
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ABSTRACT: To assess current infection control practices of interventional radiologists (IRs) in the context of recommendations by the Centers for Disease Control and Prevention and the Occupational Safety and Health Administration.
From November 2006 to January 2007, members of the Society of Interventional Radiology (SIR) were invited to participate in an anonymous, online infection control questionnaire.
A total of 3,019 SIR members in the United States were contacted via e-mail, and 1,061 (35%) completed the 57-item survey. Of the respondents, 283 (25%) experienced a needlestick injury within the previous year, most often as a result of operator error (76%). Less than 65% reported compliance with annual tuberculosis skin testing; notably, those who received a yearly reminder were much more likely to receive annual testing than those who did not (odds ratio, 19.0; 95% CI, 12.6-28.7; P < .05). During central venous catheter placement, only 56% wore gowns, 50% wore caps, and 54% used full barrier precautions. Only 19% reported routine hand washing between glove applications. More than 40% noted a change in infection control practices within the previous 5 years, citing new hospital guidelines and recommendations by a professional organization as the reasons for change. Only 44% had infection control training at the onset of their practice.
IRs demonstrate a wide variety of infection control practices that are not in accordance with current guidelines. IRs were most likely to change infection control practice if required to do so by their own hospitals or a professional organization. SIR can play an important role in the prevention of health care-associated infection by reinforcing current infection control guidelines as they pertain to interventional radiology.
Journal of vascular and interventional radiology: JVIR 08/2009; 20(8):1070-1074.e5. · 1.81 Impact Factor
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Maureen K Bolon,
David Hooper,
Kurt B Stevenson,
Maurice Greenbaum,
Margaret A Olsen,
Loreen Herwaldt, Gary A Noskin,
Victoria J Fraser,
Michael Climo,
Yosef Khan,
Johanna Vostok,
Deborah S Yokoe
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ABSTRACT: Screening methods that use automated data may streamline surgical site infection (SSI) surveillance and improve the accuracy and comparability of data on SSIs. We evaluated the use of automated inpatient diagnosis codes and pharmacy data to identify SSIs after arthroplasty.
This retrospective cohort study at 8 hospitals involved weighted, random samples of medical records from 2128 total hip arthroplasty (THA) procedures performed from 1 July 2002 through 30 June 2004, and 4194 total knee arthroplasty (TKA) procedures performed from 1 July 2003 through 30 June 2005. We compared routine surveillance with screening of inpatient pharmacy data and diagnoses codes followed by medical record review to confirm SSI status.
Records from 696 THA and 1009 TKA procedures were reviewed. The SSI rates were nearly double those determined by routine surveillance (1.32% [95% confidence interval, 0.83%-1.81%] vs. 0.75% for THA; 1.83% [95% confidence interval, 1.43%-2.23%] vs. 0.71% for TKA). An inpatient diagnosis code for infection within a year after the operation had substantially higher sensitivity (THA, 89%; TKA, 81%), compared with routine surveillance (THA, 56%; TKA, 39%). Adding antimicrobial exposure of 7 days after the procedure increased the sensitivity (THA, 93%; TKA, 86%). Record review confirmed SSIs after 51% of THAs and 55% of TKAs that met diagnosis code criteria and after 25% of THAs and 39% of TKAs that met antimicrobial exposure and/or diagnosis code criteria.
Focused surveillance among a subset of patients who met diagnosis code screening criteria with or without the addition of antimicrobial exposure-based screening was more sensitive than routine surveillance for detecting SSIs after arthroplasty and could be an efficient and readily standardized adjunct to traditional methods.
Clinical Infectious Diseases 06/2009; 48(9):1223-9. · 9.15 Impact Factor
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ABSTRACT: We sought to determine the cost-effectiveness of Antimicrobial Stewardship Teams (ASTs) on the reduction of morbidity and mortality associated with nosocomial bacteraemia.
A decision analytic model compared costs and outcomes of bacteraemic patients receiving standard treatment with or without an AST consult. Patients with a bacteraemic event during their hospital admission were included in the model. Effectiveness was estimated as quality-adjusted life years (QALYs) over the lifetime of patients. Model variables and costs, along with their distributions, were obtained from the literature and expert opinion. Incremental cost-effectiveness ratios (ICERs) were calculated to estimate the cost per QALY gained from the hospital perspective. Uncertainty in ICERs was evaluated with probabilistic sensitivity analyses. The cost-effectiveness of clinical decision support systems was evaluated as a secondary analysis.
Implementing an AST for bacteraemia review cost $39,737 (95% CI $27,272-53, 017) and standard treatment cost $39,563 (95% CI $27,164-52,797). The difference in effectiveness between the two strategies was 0.08 QALYs, and the base case ICER from the probabilistic analysis was $2367 per QALY gained [95% CI dominant (less costly, more effective) to $24,379]. Results from the probabilistic sensitivity analysis demonstrated there was more than a 90% likelihood that an AST would be cost-effective at a level of $10,000 per QALY.
Maintaining an AST to improve care for bacteraemia is cost-effective from the hospital perspective. The estimate of $2367 per QALY gained for the AST intervention compares favourably with many currently funded healthcare interventions and services.
Journal of Antimicrobial Chemotherapy 03/2009; 63(4):816-25. · 5.07 Impact Factor
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ABSTRACT: Hand hygiene (HH) compliance among health care workers (HCWs) has been historically low and hampered by poor surveillance methods. This study evaluated the use of an electronic device to measure and impact HH compliance.
The study is a prospective, interventional study in a 30-bed academic medical center hematology unit. Phase I of the study monitored baseline HH compliance, and phase II monitored HH compliance using automatic alerts. The primary outcome measure was HH compliance, and the secondary end point was nosocomial transmission of vancomycin-resistant Enterococcus (VRE).
Eight thousand two hundred thirty-five HH opportunities were measured during the study, with HH compliance improvement from 36.3% at baseline to 70.1% during phase II. The use of audible alerts improved HH compliance for both the day shift (odds ratio [OR], 3.6) and the night shift (OR, 5.9), as well as across rooms with higher HCW traffic (OR, 1.6) and lower HCW traffic (OR, 3.2).
Electronic devices can effectively monitor HH compliance among HCWs and facilitate improved adherence to guidelines. Electronic devices improve HH compliance regardless of time of day or room location. The development of innovative devices to improve HH is required to validate the long-term implications of this methodology.
American journal of infection control 05/2008; 36(3):199-205. · 3.01 Impact Factor
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ABSTRACT: An assessment of bacterial contamination on examination gloves indicated that contaminated gloves may be a mechanism of indirect bacterial transmission from the hands of healthcare workers to patients. This mechanism is indicated by the recovery of identical Acinetobacter baumannii isolates from gloves and from the clinical cultures of a patient with invasive infection.
Infection Control and Hospital Epidemiology 02/2008; 29(1):63-5. · 3.67 Impact Factor
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ABSTRACT: To evaluate the economic impact of performing rapid testing for Staphylococcus aureus colonization before admission for all inpatients who are scheduled to undergo elective surgery and providing subsequent decolonization therapy for those patients found to be colonized with S. aureus.
A budget impact model that used probabilistic sensitivity analysis to account for the uncertainties in the input variables was developed. Primary input variables included the marginal effect of S. aureus infection on patient outcomes among patients who underwent elective surgery, patient demographic characteristics, the prevalence of nasal carriage of S. aureus, the sensitivity and specificity of the rapid diagnostic test for S. aureus colonization, the efficacy of decolonization therapy for nasal carriage of S. aureus, and cost data. Data sources for the input variables included the 2003 Nationwide Inpatient Sample data and the published literature.
In 2003, there were an estimated 7,181,484 patients admitted to US hospitals for elective surgery. Our analysis indicated preadmission testing and subsequent decolonization therapy for patients colonized with S. aureus would have produced a mean annual cost savings to US hospitals of $231,538,400 (95% confidence interval [CI], -$300 million to $1.3 billion). The mean annual number of hospital-days that could have been eliminated was estimated at 364,919 days (95% CI, 67,893-926,983 days), and a mean of 935 in-hospital deaths (95% CI, 88-3,691) could have been avoided per year. Sensitivity analysis indicated a 64.5% probability that there would be cost savings to US hospitals as a result of preadmission testing and subsequent decolonization therapy.
The addition of preadmission testing and decolonization therapy to standard care would result in significant cost savings, even after accounting for variations in the model input values.
Infection Control and Hospital Epidemiology 02/2008; 29(1):16-24. · 3.67 Impact Factor
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Clinical Infectious Diseases 12/2007; 45(10):1351-2, 1397-9. · 9.15 Impact Factor
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ABSTRACT: We evaluated historical trends in the Staphylococcus aureus infection rate, economic burden, and mortality in US hospitals from 1998 through 2003.
The Nationwide Inpatient Sample was used to assess trends over time of S. aureus infection during 1998-2003. Historical trends were determined for 5 strata of hospital stays, including all inpatient stays, surgical procedure stays, invasive cardiovascular surgical stays, invasive orthopedic surgical stays, and invasive neurosurgical stays.
During the 6-year study period from 1998 through 2003, the rate of S. aureus infection increased significantly for all inpatient stays (from 0.74% to 1.0%; annual percentage change (APC), 7.1%; P=.004), surgical stays (from 0.90% to 1.3%; APC, 7.9%; P=.001), and invasive orthopedic surgical stays (from 1.2% to 1.8%; APC, 9.3%; P<.001). For invasive neurosurgical stays, the rate of S. aureus infection did not change from 1998 to 2000 but increased at an annual rate of 11.0% from 2000 to 2003 (from 1.4% to 1.8%; P=.034). The total economic burden of S. aureus infection for hospitals also increased significantly for all stay types, with the annual percentage increase ranging from 9.2% to 17.9% (P<.05 for all). In 2003, the total economic burden of S. aureus infection was estimated to be $14.5 billion for all inpatient stays and $12.3 billion for surgical patient stays. However, there were significant decreases in the risk of S. aureus-related in-hospital mortality from 1998 to 2003 for all inpatient stays (from 7.1% to 5.6%; APC, -4.6%; P=.001) and for surgical stays (from 7.1% to 5.5%; APC, -4.6%; P=.002).
The inpatient S. aureus infection rate and economic burden of S. aureus infections for US hospitals increased substantially from 1998 to 2003, whereas the in-hospital mortality rate decreased.
Clinical Infectious Diseases 11/2007; 45(9):1132-40. · 9.15 Impact Factor
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ABSTRACT: The emergence of methicillin-resistant Staphylococcus aureus (MRSA) within the community has altered health care practice because it is a major public health threat and has several important clinical implications. As the incidence of MRSA increases in the community, empirical treatment of community-acquired skin and soft tissue infections and necrotizing pneumonia without obtaining microbiological cultures from the infected site may not be appropriate and can lead to treatment failure if initial therapy includes a β-lactam antibiotic or other agents to which the bacteria is resistant. The Infectious Disease Society of America in their recently published guideline on community-acquired pneumonia recommends that although methicillin-resistant strains of S. aureus are still in the minority, the high mortality associated with inappropriate antibiotic therapy would suggest that empirical coverage should be considered when community-associated MRSA is a concern.
Infectious Disease in Clinical Practice 10/2007; 15(6):385-388.
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ABSTRACT: To report pharmacokinetic alterations and optimal dosing of piperacillin/tazobactam in an obese patient.
A 39-year-old morbidly obese (weight 167 kg, body mass index 50 kg/m2) man was treated with piperacillin/tazobactam 3.375 g every 4 hours for recurrent cellulitis. The wound culture grew Groups A and B Streptococcus and rare Pseudomonas aeruginosa. Blood samples were obtained at steady-state from a peripheral venous catheter at 0, 0.5, 1, 2, 3, and 4 hours after the start of the infusion. Population pharmacokinetics were generated from a previously published data set. The serum concentrations of piperacillin/tazobactam obtained in the patient were compared with the 95% confidence interval from the representative population. Pharmacokinetic parameters such as maximal serum concentration, minimal serum concentration, average steady-state concentration, half-life, elimination rate constant, volume of distribution (V(d)), clearance, area under the curve at steadystate, and percent of time greater than the minimum inhibitory concentration (%t>MIC) were calculated and qualitatively compared between the sample and the population.
Substantial differences were noted in both the absolute values at the times of sample collection and the overall concentration-versus-time profile of both compounds. The morbidly obese individual compared with the population demonstrated a reduced average serum steady-state concentration: 39.8 mg/L versus 123.6 mg/L, an increased V(d): 54.3 L versus 12.7 L, and an increased half-life: 1.4 hours versus 0.6 hours, respectively. The %t >MIC of piperacillin for the patient, assuming MICs of 2, 4, 8, 16, 32, 64, and 128 mg/L, was 100%, 100%, 90.9%, 55.4%, 19.9%, 0%, and 0%, respectively.
Pathogens with elevated MICs may require altered dosing schemes with piperacillin/tazobactam. Future studies are warranted to assess increased dosages, more frequent dosing intervals, or continuous infusion dosing schemes for obese individuals with serious infections.
Annals of Pharmacotherapy 10/2007; 41(10):1734-9. · 2.13 Impact Factor
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ABSTRACT: Persistent Staphylococcus aureus bacteremia (pSAB) is an emerging problem among hospitalized patients. We studied key clinical characteristics and outcomes associated with pSAB to better define the epidemiological features of this increasingly recognized clinical entity.
A retrospective case-control study of patients hospitalized with SAB between January 1, 2001, and September 30, 2004, was conducted to compare the clinical characteristics, management, and outcomes of patients with pSAB (> 7 days of bacteremia) with those of a cohort of patients with nonpersistent SAB (< 3 days of bacteremia). Patients with 4 to 6 days of bacteremia were excluded from the analysis. To detect a potential association between reduced susceptibility to vancomycin and persistent methicillin-resistant SAB, vancomycin susceptibilities were confirmed using standard dilution methods.
Eighty-four patients with pSAB and 152 patients with nonpersistent SAB were included in the analysis. Methicillin resistance (odds ratio [OR], 5.22; 95% confidence interval [CI], 2.63-10.38), intravascular catheter or other foreign body use (OR, 2.37; 95% CI, 1.11-3.96), chronic renal failure (OR, 2.08; 95% CI, 1.09-3.96), more than 2 sites of infection (OR, 3.31; 95% CI, 1.17-9.38), and infective endocarditis (OR, 10.30; 95% CI, 2.98-35.64) were independently associated with pSAB. The mean time to device removal was significantly longer in patients with pSAB than in patients with nonpersistent SAB (4.94 vs 1.64 days; P < .01). There was no evidence of reduced vancomycin susceptibility among persistent methicillin-resistant S aureus isolates. Clinical outcomes were significantly worse among patients with pSAB.
Many hospitalized patients may be at risk for pSAB. Aggressive attempts to minimize the risk of complications and poor outcomes associated with pSAB, such as early device removal, should be encouraged.
Archives of Internal Medicine 09/2007; 167(17):1861-7. · 11.46 Impact Factor
