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ABSTRACT: Healthcare providers need a better empiric antibiotic prescribing aid than the traditional antibiogram, which supplies no information on the relative frequency of organisms recovered in a given infection and which is uninformative in situations where multiple antimicrobials are used or multiple organisms are anticipated. We aimed to develop and demonstrate a novel empiric prescribing decision aid.
This is a demonstration involving more than 9,000 unique encounters for abdominal-biliary infection (ABI) and urinary tract infection (UTI) to a large healthcare system with a fully integrated electronic health record (EHR).
We developed a novel method of displaying microbiology data called the weighted-incidence syndromic combination antibiogram (WISCA) for 2 clinical syndromes, ABI and UTI. The WISCA combines simple diagnosis and microbiology data from the EHR to (1) classify patients by syndrome and (2) determine, for each patient with a given syndrome, whether a given regimen (1 or more agents) would have covered all the organisms recovered for their infection. This allows data to be presented such that clinicians can see the probability that a particular regimen will cover a particular infection rather than the probability that a single drug will cover a single organism.
There were 997 encounters for ABI and 8,232 for UTI. A WISCA was created for each syndrome and compared with a traditional antibiogram for the same period.
Novel approaches to data compilation and display can overcome limitations to the utility of the traditional antibiogram in helping providers choose empiric antibiotics.
Infection Control and Hospital Epidemiology 04/2012; 33(4):381-8. · 3.67 Impact Factor
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Kristen E Metzger,
Stephanie R Black,
Roderick C Jones,
Shaun R Nelson,
Ari Robicsek,
Gordon M Trenholme,
Mary Alice Lavin, Stephen G Weber,
Sylvia Garcia-Houchins,
Emily Landon,
Jorge P Parada,
Susan I Gerber
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ABSTRACT: To describe the identification, management, and clinical characteristics of hospitalized patients with influenza-like illness (ILI) during the peak period of activity of the 2009 pandemic strain of influenza A virus subtype H1N1 (2009 H1N1).
Retrospective review of electronic medical records.
Hospitalized patients who presented to the emergency department during the period October 18 through November 14, 2009, at 4 hospitals in Cook County, Illinois, with the capacity to perform real-time reverse-transcriptase polymerase chain reaction testing for influenza.
Vital signs and notes recorded within 1 calendar day after emergency department arrival were reviewed for signs and symptoms consistent with ILI. Cases of ILI were classified as recognized by healthcare providers if an influenza test was performed or if influenza was mentioned as a possible diagnosis in the physician notes. Logistic regression was used to determine the patient attributes and symptoms that were associated with ILI recognition and with influenza infection.
We identified 460 ILI case patients, of whom 412 (90%) had ILI recognized by healthcare providers, 389 (85%) were placed under airborne or droplet isolation precautions, and 243 (53%) were treated with antiviral medication. Of 401 ILI case patients tested for influenza, 91 (23%) had a positive result. Fourteen (3%) ILI case patients and none of the case patients who tested positive for influenza had sore throat in the absence of cough.
Healthcare providers identified a high proportion of hospitalized ILI case patients. Further improvements in disease detection can be made through the use of advanced electronic health records and efficient diagnostic tests. Future studies should evaluate the inclusion of sore throat in the ILI case definition.
Infection Control and Hospital Epidemiology 10/2011; 32(10):998-1002. · 3.67 Impact Factor
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Stephanie R Black,
Kingsley N Weaver,
Roderick C Jones,
Kathleen A Ritger,
Laurica A Petrella,
Susan P Sambol,
Michael Vernon,
Stephanie Burton,
Sylvia Garcia-Houchins, Stephen G Weber,
Mary Alice Lavin,
Dale Gerding,
Stuart Johnson,
Susan I Gerber
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ABSTRACT: Describe the clinical and molecular epidemiology of incident Clostridium difficile infection (CDI) cases in Chicago area acute healthcare facilities (HCFs).
Laboratory, clinical, and epidemiologic information was collected for patients with incident CDI who were admitted to acute HCFs in February 2009. Stool cultures and restriction endonuclease analysis typing of the recovered C. difficile isolates was performed.
Two hundred sixty-three patients from 25 acute HCFs.
Acute HCF rates ranged from 2 to 7 patients with CDI per 10,000 patient-days. The crude mortality rate was 8%, with 20 deaths occurring in patients with CDI. Forty-two (16%) patients had complications from CDI, including 4 patients who required partial, subtotal, or total colectomy, 3 of whom died. C. difficile was isolated and typed from 129 of 178 available stool specimens. The BI strain was identified in 79 (61%) isolates. Of patients discharged to long-term care who had their isolate typed, 36 (67%) had BI-associated CDI.
Severe disease was common and crude mortality was substantial among patients with CDI in Chicago area acute HCFs in February 2009. The outbreak-associated BI strain was the predominant endemic strain identified, accounting for nearly two-thirds of cases. Focal HCF outbreaks were not reported, despite the presence of the BI strain. Transfer of patients between acute and long-term HCFs may have contributed to the high incidence of BI cases in this investigation.
Infection Control and Hospital Epidemiology 09/2011; 32(9):897-902. · 3.67 Impact Factor
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ABSTRACT: In August 2007, Illinois passed legislation mandating methicillin-resistant Staphylococcus aureus (MRSA) admission screening for intensive care unit patients. We assessed hospital staff perceptions of the implementation of this law.
Mixed-methods evaluation using structured focus groups and questionnaires.
Eight Chicago-area hospitals.
Three strata of staff (leadership, midlevel, and frontline) at each hospital.
All participants completed a questionnaire and participated in a focus group. Focus group transcripts were thematically coded and analyzed. The proportion of staff agreeing with statements about MRSA and the legislation was compared across staff types.
Overall, 126 hospital staff participated in 23 focus groups. Fifty-six percent of participants agreed that the legislation had a positive effect at their facility; frontline staff were more likely to agree than midlevel and leadership staff (P < .01). Perceived benefits of the legislation included increased awareness of MRSA among staff and better knowledge of the epidemiology of MRSA colonization. Perceived negative consequences included the psychosocial effect of screening and contact precautions on patients and increased use of resources. Most participants (59%) would choose to continue the activities associated with the legislation but advised facilities in states considering similar legislation to educate staff and patients about MRSA screening and to draft clear implementation plans.
Staff from Chicago-area hospitals perceived that mandatory MRSA screening legislation resulted in some benefits but highlighted implementation challenges. States considering similar initiatives might minimize these challenges by optimizing messaging to patients and healthcare staff, drafting implementation plans, and developing program evaluation strategies.
Infection Control and Hospital Epidemiology 06/2011; 32(6):573-8. · 3.67 Impact Factor
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ABSTRACT: Curbing antibiotic resistance is a challenge in health care today. Infections caused by multidrug-resistant organisms are estimated to cause 12,000 deaths and cost 3.5 billion dollars in excess health care costs in the United States annually. This article focuses on relevant infection control measures for vancomycin-resistant enterococci, multidrug-resistant gram-negative infections, and Clostridium difficile. Common control strategies targeting these pathogens are reviewed and opportunities for research and more effective deployment of existing tools are highlighted. When there is less extensive evidence available from the published literature, the experience with methicillin-resistant Staphylococcus aureus is discussed as it might apply to other pathogens.
Infectious disease clinics of North America 03/2011; 25(1):181-200. · 2.29 Impact Factor
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ABSTRACT: The use of contact precautions is an essential component of an effective multidrug-resistant organism (MDRO) control plan. Despite reliance on a passive automated reminder system to alert clinicians of the need for contact precautions, poor adherence was recognized at the study medical center. DEVELOPING THE INTERVENTION: A performance improvement project incorporating brief weekly surveillance rounds on each inpatient unit was developed to maximize compliance with implementation of contact precautions and to evaluate risk factors for failure to institute precautions. In the weekly rounds, infection preventionists determined the point prevalence of the appropriate implementation of contact precautions for MDRO (that is, whether or not patients with electronic flags had been appropriately placed on contact precautions). This project was evaluated during a 22-week rollout period followed by a four-year follow-up period. The experience and data derived from the rollout period were intended to shape the long-term plan to sustain high levels of compliance with contact-precaution initiation.
During the first week of surveillance, only 70% of eligible patients were isolated, but by week 16 90% were isolated appropriately. Because surveillance rounding was successful in improving institution of contact precautions during the rollout period, this practice was continued. During the following four years (follow-up period), > or = 90% success at implementing isolation precautions was demonstrated during 74% of the weeks.
This experience with surveillance demonstrated an effective, practical, and sustainable method of improving implementation of contact precautions for patients with MDRO.
Joint Commission journal on quality and patient safety / Joint Commission Resources 09/2010; 36(9):418-23.
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ABSTRACT: Candida species are a common cause of bloodstream infection among hospitalized patients. Increasingly these infections are caused by strains resistant to commonly used antifungal agents. The aim of this study was to assess the association between exposure to specific antimicrobial agents and subsequent bloodstream infection with fluconazole-non-susceptible and fluconazole-susceptible Candida strains. A retrospective case-case-control study was performed. From 2002 to 2006, 50 consecutive patients with hospital-acquired bloodstream infection caused by Candida strains not fully susceptible to fluconazole were identified (case group 1). For comparison, 54 patients with fluconazole-susceptible candidaemia (case group 2) and a control group of 104 patients without candidaemia were studied. Models were adjusted for demographic and clinical risk factors. The risk for candidaemia associated with exposure to specific antimicrobial agents was assessed. Piperacillin/tazobactam (odds ratio (OR) 6.8, 95% confidence interval (CI) 1.4-32.2) and ciprofloxacin (OR 8.0, 95% CI 1.5-42.5), but not fluconazole, were significant risk factors for bloodstream infection with fluconazole-non-susceptible Candida. Only ciprofloxacin (OR 7.8, 95% CI 1.2-50.7) was associated with bloodstream infection with fluconazole-susceptible Candida. Despite adjustment for prior exposure to fluconazole, exposure to specific antibacterial agents was associated with hospital-acquired bloodstream infection with fluconazole-non-susceptible Candida.
Scandinavian Journal of Infectious Diseases 04/2010; 42(6-7):506-9. · 1.72 Impact Factor
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ABSTRACT: To determine whether the use of dual antimicrobial therapy based on the results of a combination antibiotic susceptibility report (antibiogram) increases the likelihood of selecting adequate empirical coverage in critically ill patients with infection due to potentially resistant gram-negative pathogens.
Retrospective data analysis.
Urban academic medical center.
An analysis of culture results and susceptibility data from intensive care unit patients determined by the clinical microbiology laboratory was performed. The proportion of 5 common gram-negative pathogens susceptible to monotherapy with 1 of 3 antipseudomonal antibiotics (piperacillin-tazobactam, ceftazidime, or imipenem) was compared with the proportion susceptible to each of these 3 "backbone" agents plus 1 of 4 additional antimicrobial agents used in combination.
More than 5,000 clinical isolates were examined. When all isolates recovered during the entire study period were included, the addition of any of the second antibiotics studied to each of the 3 backbone agents significantly increased the likelihood of covering the causative pathogen (P < .01 for each). The benefit of combination therapy was variable when results for each of the 5 organisms were examined individually. When temporal trends in susceptibility were examined, the decrease in the proportion of organisms susceptible to monotherapy was statistically significant for both imipenem and ceftazidime (P < .01).
Reporting antibiotic susceptibility data in the form of a combination antibiogram may be useful to clinicians who are considering empirical antimicrobial therapy in the intensive care unit.
Infection Control and Hospital Epidemiology 03/2010; 31(3):256-61. · 3.67 Impact Factor
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ABSTRACT: To compare the proportion of antimicrobial-resistant strains among bacterial isolates from younger and older hospital patients and to quantify changes in the proportion of antimicrobial-resistant strains in both groups over time.
A retrospective analysis of microbiology data from two centres in Maryland and Chicago was performed. Adult hospital inpatients with positive clinical cultures for specific antimicrobial-resistant bacterial pathogens between 1999 and 2005 (55 427 isolates) were included. The proportions of isolates not susceptible to specific antimicrobial agents were compared between patients > or =65 and <65 years. Additional analyses examined temporal trends in the frequency of resistance and the frequency of resistance among the oldest patients (> or =80 years), in bacteria isolated from blood cultures and in bacteria obtained from intensive care unit patients.
Heterogeneity was observed in the frequency of resistance among different bacteria between older and younger patients, between the two centres and over the study period. Staphylococcus aureus isolates were more likely to be resistant to methicillin when obtained from older patients at Chicago (50.9% versus 40.9%; P < 0.001). In contrast, younger patients yielded a greater proportion of enterococci resistant to vancomycin at Maryland (19.4% versus 16.5%; P = 0.009). Results were variable when resistance to fluoroquinolones, cephalosporins and imipenem were compared for Pseudomonas aeruginosa, Escherichia coli and Klebsiella spp.
Overall, advanced patient age was not uniformly associated with a greater likelihood of antimicrobial resistance among all bacterial pathogens. Moreover, the frequency of resistance in older and younger patients varied considerably at the two sites over the study period. Variability in the frequency of resistance precludes simplistic conclusions regarding the relationship between age and resistance.
Journal of Antimicrobial Chemotherapy 09/2009; 64(6):1291-8. · 5.07 Impact Factor
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Edith Lederman,
Roque Miramontes,
John Openshaw,
Victoria A Olson,
Kevin L Karem,
John Marcinak,
Rodrigo Panares,
Wayne Staggs,
Donna Allen, Stephen G Weber,
Surabhi Vora,
Susan I Gerber,
Christine M Hughes,
Russell Regnery,
Limone Collins,
Pamela S Diaz,
Mary G Reynolds,
Inger Damon
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ABSTRACT: On March 3, 2007, a 2-year-old boy was hospitalized with eczema vaccinatum. His two siblings, one with eczema, were subsequently removed from the home. Swabs of household items obtained on March 13th were analyzed for orthopoxvirus DNA signatures with real-time PCR. Virus culture was attempted on positive specimens. Eight of 25 household samples were positive by PCR for orthopoxvirus; of these, three yielded viable vaccinia virus in culture. Both siblings were found to have serologic evidence of orthopoxvirus exposure. These findings have implications for smallpox preparedness, especially in situations where some household members are not candidates for vaccination.
Vaccine 12/2008; 27(3):375-7. · 3.77 Impact Factor
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ABSTRACT: Necrotizing fasciitis has conventionally been associated with the streptococci, and when it is caused by other organisms, it is most often the result of a polymicrobial infection. We report on two cases of fatal monomicrobial necrotizing fasciitis due to Acinetobacter baumannii, an unusual finding that may be an indication of enhanced virulence of the organism.
Journal of clinical microbiology 11/2008; 47(1):258-63. · 4.16 Impact Factor
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ABSTRACT: To use the findings of an active surveillance program to delineate the unique epidemiology of vancomycin-resistant enterococci (VRE) in a mixed population of transplant and nontransplant patients hospitalized on a single patient care unit.
Surveillance survey and case-control analysis.
A 19-bed adult bone marrow and stem cell transplant unit at a referral and primary-care center.
The study included patients undergoing transplantation, patients who had previously received bone marrow or stem cell transplants, and patients with other malignancies and hematological disorders who were admitted to the study unit.
Patients not previously identified as colonized with VRE had perirectal swab specimens collected at admission and once weekly while hospitalized on the unit. The prevalence of VRE colonization at admission and the incidence throughout the hospital stay, genotypes of VRE specimens as determined by pulsed field gel electrophoresis, and risk factors related to colonization were analyzed.
There was no significant difference in the prevalence or incidence of new colonization between nontransplant patients and prior or current transplant recipients, although overall prevalence at admission was significantly higher in the prior transplant group. Preliminary genotypic analysis of VRE isolates from transplant patients suggests that a proportion of cases of newly detected VRE carriage may represent prior colonization not detected at admission, with different risk factors suggestive of a potential epidemiological distinction.
Examination of epidemiological and microbiological data collected by an active surveillance program provides useful information about the epidemiology of VRE that can be applied to inform rational infection control strategies.
Infection Control and Hospital Epidemiology 10/2008; 29(11):1019-25. · 3.67 Impact Factor
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ABSTRACT: This pilot, observational study involving 286 patients who underwent cardiac surgery found that patients who had endotracheal colonization with gram-negative bacteria at 1 week after surgery were more likely to develop subsequent infection compared to those without colonization (8 of 23 vs. 4 of 40; relative risk 2.3 [95% confidence interval, 1.3-4.1; P value <.05]).
Infection Control and Hospital Epidemiology 07/2008; 29(6):546-8. · 3.67 Impact Factor
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Surabhi Vora,
Inger Damon,
Vincent Fulginiti, Stephen G Weber,
Madelyn Kahana,
Sarah L Stein,
Susan I Gerber,
Sylvia Garcia-Houchins,
Edith Lederman,
Dennis Hruby, [......],
Scott Smith,
Zach Braden,
Kevin Karem,
Victoria Olson,
Whitni Davidson,
Giliane Trindade,
Tove Bolken,
Robert Jordan,
Debbie Tien,
John Marcinak
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ABSTRACT: We report the first confirmed case of eczema vaccinatum in the United States related to smallpox vaccination since routine vaccination was discontinued in 1972. A 28-month-old child with refractory atopic dermatitis developed eczema vaccinatum after exposure to his father, a member of the US military who had recently received smallpox vaccine. The father had a history of inactive eczema but reportedly reacted normally to the vaccine. The child's mother also developed contact vaccinia infection.
Treatment of the child included vaccinia immune globulin administered intravenously, used for the first time in a pediatric patient; cidofovir, never previously used for human vaccinia infection; and ST-246, an investigational agent being studied for the treatment of orthopoxvirus infection. Serological response to vaccinia virus and viral DNA levels, correlated with clinical events, were utilized to monitor the course of disease and to guide therapy. Burn patient-type management was required, including skin grafts.
The child was discharged from the hospital after 48 days and has recovered with no apparent systemic sequelae or significant scarring.
This case illustrates the need for careful screening prior to administration of smallpox vaccine and awareness by clinicians of the ongoing vaccination program and the potential risk for severe adverse events related to vaccinia virus.
Clinical Infectious Diseases 06/2008; 46(10):1555-61. · 9.15 Impact Factor
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ABSTRACT: To examine the relative proportions of central line-associated bloodstream infection (BSI) due to gram-negative bacteria and due to gram-positive bacteria among patients who had undergone surgery and patients who had not. The study also evaluated clinical predictive factors and unadjusted outcomes associated with central line-associated BSI caused by gram-negative bacteria in the postoperative period.
Observational, case-control study based on a retrospective review of medical records.
University of Chicago Medical Center, a 500-bed tertiary care center located on Chicago's south side.
Adult intensive care unit (ICU) patients who developed central line-associated BSI.
There were a total of 142 adult patients who met the Centers for Disease Control and Prevention National Nosocomial Infection Surveillance System definition for central line-associated BSI. Of those, 66 patients (46.5%) had infections due to gram-positive bacteria, 49 patients (34.5%) had infections due to gram-negative bacteria, 23 patients (16.2%) had infections due to yeast, and 4 patients (2.8%) had mixed infections. Patients who underwent surgery were more likely to develop central line-associated BSI due to gram-negative bacteria within 28 days of the surgery, compared with patients who had not had surgery recently (57.6% vs 27.3%; P= .002). On multivariable logistic regression analysis, diabetes mellitus (adjusted odds ratio [OR], 4.6 [95% CI, 1.2-18.1]; P= .03) and the presence of hypotension at the time of the first blood culture positive for a pathogen (adjusted OR, 9.8 [95% CI, 2.5-39.1]; P= .001) were found to be independently predictive of central line-associated BSI caused by gram-negative bacteria. Unadjusted outcomes were not different in the group with BSI due to gram-negative pathogens, compared to the group with BSI due to gram-positive pathogens.
Clinicians caring for critically ill patients after surgery should be especially concerned about the possibility of central line-associated BSI caused by gram-negative pathogens. The presence of diabetes and hypotension appear to be significant associated factors.
Infection Control and Hospital Epidemiology 02/2008; 29(1):51-6. · 3.67 Impact Factor
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Stephen G Weber,
Susan S Huang,
Shannon Oriola,
W Charles Huskins,
Gary A Noskin,
Kathleen Harriman,
Russell N Olmsted,
Marc Bonten,
Tammy Lundstrom,
Michael W Climo,
Mary-Claire Roghmann,
Cathryn L Murphy,
Tobi B Karchmer
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ABSTRACT: Legislation aimed at controlling antimicrobial-resistant pathogens through the use of active surveillance cultures to screen hospitalized patients has been introduced in at least 2 US states. In response to the proposed legislation, the Society for Healthcare Epidemiology of America (SHEA) and the Association for Professionals in Infection Control and Epidemiology, Inc., (APIC) have developed this joint position statement. Both organizations are dedicated to combating health care-associated infections with a wide array of methods, including the use of active surveillance cultures in appropriate circumstances. This position statement reviews the proposed legislation and the rationale for use of active surveillance cultures, examines the scientific evidence supporting the use of this strategy, and discusses a number of unresolved issues surrounding legislation mandating use of active surveillance cultures. The following 5 consensus points are offered. (1) Although reducing the burden of antimicrobial-resistant pathogens, including methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), is of preeminent importance, the APIC and the SHEA do not support legislation to mandate use of active surveillance cultures to screen for MRSA, VRE, or other antimicrobial-resistant pathogens. (2) The SHEA and the APIC support the continued development, validation, and application of efficacious and cost-effective strategies for the prevention of infections caused by MRSA, VRE, and other antimicrobial-resistant and antimicrobial-susceptible pathogens. (3) The APIC and the SHEA welcome efforts by health care consumers, together with private, local, state, and federal policy makers, to focus attention on and formulate solutions for the growing problem of antimicrobial resistance and health care-associated infections. (4) The SHEA and the APIC support ongoing additional research to determine and optimize the appropriateness, utility, feasibility, and cost-effectiveness of using active surveillance cultures to screen both lower-risk and high-risk populations. (5) The APIC and the SHEA support stronger collaboration between state and local public health authorities and institutional infection prevention and control experts.
American Journal of Infection Control 04/2007; 35(2):73-85. · 2.40 Impact Factor
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ABSTRACT: Due to the greater in vitro activity of ciprofloxacin than that of levofloxacin against Pseudomonas aeruginosa, the likelihood of isolating a clinical strain of quinolone-resistant (QR) P. aeruginosa might be greater after exposure to levofloxacin than ciprofloxacin. We examined the risk of isolating QR P. aeruginosa in association with prior levofloxacin or ciprofloxacin exposure. A case-case-control study was conducted. Two groups of cases, one with nosocomial QR P. aeruginosa infections and one with nosocomial quinolone-susceptible (QS) P. aeruginosa infections, were compared to a control group of hospitalized patients without P. aeruginosa infections. Bivariable and multivariable analyses were used to determine risk factors for isolation of QR P. aeruginosa and QS P. aeruginosa. One hundred seventeen QR P. aeruginosa and 255 QS P. aeruginosa cases were identified, and 739 controls were selected. Exposures to ciprofloxacin were similar among all three groups (8% for controls, 9.4% for QR P. aeruginosa cases, and 7.5% for QS P. aeruginosa cases; P >/= 0.6). Levofloxacin use was more frequent in the QR P. aeruginosa cases than in the controls (35.9% and 22.1%, respectively; odds ratio [OR] = 2.0; 95% confidence interval [CI] = 1.3 to 3.0) and less frequent in QS P. aeruginosa cases (14.1% of QS P. aeruginosa cases; OR = 0.6; 95% CI = 0.4 to 0.9). In multivariable analysis, levofloxacin, but not ciprofloxacin, was a significant risk factor for isolation of QR P. aeruginosa (OR for levofloxacin = 1.7 [95% CI = 1.0 to 2.9]; OR for ciprofloxacin = 1.2 [95% CI = 0.6 to 2.5]). Levofloxacin was associated with a reduced risk of isolation of QS P. aeruginosa (OR = 0.6; 95% CI = 0.4 to 0.9), whereas ciprofloxacin had no significant effect (OR = 1.0; 95% CI = 0.6 to 1.8). In conclusion, the use of levofloxacin, but not ciprofloxacin, was associated with isolation of QR P. aeruginosa.
Antimicrobial Agents and Chemotherapy 06/2006; 50(6):2192-6. · 4.84 Impact Factor
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Susan I Gerber,
Roderick C Jones,
Mary V Scott,
Joel S Price,
Mark S Dworkin,
Mala B Filippell,
Terri Rearick,
Stacy L Pur,
James B McAuley,
Mary Alice Lavin, [......],
Patrick J Gavin,
Adrienne G Fisher,
Richard B Thomson,
Thomas Vescio,
Teresa Chou,
Daniel C Johnson,
Mary Beth Fry,
Anne H Molloy,
Laura Bardowski,
Gary A Noskin
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ABSTRACT: In 2002, the Chicago Department of Public Health (CDPH; Chicago, Illinois) convened the Chicago-Area Neonatal MRSA Working Group (CANMWG) to discuss and compare approaches aimed at control of methicillin-resistant Staphylococcus aureus (MRSA) in neonatal intensive care units (NICUs). To better understand these issues on a regional level, the CDPH and the Evanston Department of Health and Human Services (EDHHS; Evanston, Illinois) began an investigation.
Survey to collect demographic, clinical, microbiologic, and epidemiologic data on individual cases and clusters of MRSA infection; an additional survey collected data on infection control practices.
Level III NICUs at Chicago-area hospitals.
Neonates and healthcare workers associated with the level III NICUs.
From June 2001 through September 2002, the participating hospitals reported all clusters of MRSA infection in their respective level III NICUs to the CDPH and the EDHHS.
Thirteen clusters of MRSA infection were detected in level III NICUs, and 149 MRSA-positive infants were reported. Infection control surveys showed that hospitals took different approaches for controlling MRSA colonization and infection in NICUs.
The CANMWG developed recommendations for the prevention and control of MRSA colonization and infection in the NICU and agreed that recommendations should expand to include future data generated by further studies. Continuing partnerships between hospital infection control personnel and public health professionals will be crucial in honing appropriate guidelines for effective approaches to the management and control of MRSA colonization and infection in NICUs.
Infection Control and Hospital Epidemiology 03/2006; 27(2):139-45. · 3.67 Impact Factor
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ABSTRACT: The incidence of infections caused by Candida glabrata and Candida krusei, which are generally more resistant to fluconazole than Candida albicans, is increasing in hospitalized patients. However, the extent to which prior exposure to specific antimicrobial agents increases the risk of subsequent C. glabrata or C. krusei candidemia has not been closely studied. A retrospective case-case-control study was performed at a university hospital. From 1998 to 2003, 60 patients were identified with hospital-acquired non-C. albicans candidemia (C. glabrata or C. krusei; case group 1). For comparison, 68 patients with C. albicans candidemia (case group 2) and a common control group of 121 patients without candidemia were studied. Models were adjusted for demographic and clinical risk factors, and the risk for candidemia associated with exposure to specific antimicrobial agents was assessed. After adjusting for both nonantimicrobial risk factors and receipt of other antimicrobial agents, piperacillin-tazobactam (odds ratio [OR], 4.15; 95% confidence interval [CI], 1.04 to 16.50) and vancomycin (OR, 6.48; CI, 2.20 to 19.13) were significant risk factors for C. glabrata or C. krusei candidemia. For C. albicans candidemia, no specific antibiotics remained a significant risk after adjusted analysis. Prior fluconazole use was not significantly associated with either C. albicans or non-C. albicans (C. glabrata or C. krusei) candidemia. In this single-center study, exposure to antibacterial agents, specifically vancomycin or piperacillin-tazobactam, but not fluconazole, was associated with subsequent hospital-acquired C. glabrata or C. krusei candidemia. Further studies are needed to prospectively analyze specific antimicrobial risks for nosocomial candidemia across multiple hospital centers.
Antimicrobial Agents and Chemotherapy 12/2005; 49(11):4555-60. · 4.84 Impact Factor
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ABSTRACT: To determine a potential source of MRSA colonization and infection among preterm infants in a neonatal intensive care unit (NICU) using molecular analysis of breast milk samples.
Case report, outbreak investigation.
Preterm triplets were delivered at 26 weeks' gestation via cesarean section when routine active surveillance for MRSA was performed for all infants in a NICU. Surveillance consisted of swabbing the throat, nose, and umbilicus (TNU) weekly. Although infants A and B initially had negative TNU swabs, repeat cultures were positive for MRSA on day of life (DOL) 10 and DOL 18, respectively. Surveillance and clinical cultures for infant C were negative. Infant A developed sepsis, and multiple blood cultures were positive for MRSA beginning on DOL 14. Infant B developed conjunctivitis and a conjunctival exudate culture was positive for MRSA on DOL 70. Both infants were fed breast milk via nasogastric tube. Cultures of breast milk samples for infants A and B dated prior to either infant's first positive surveillance culture were positive for MRSA. All MRSA isolates had identical results on antibiotic susceptibility testing. PFGE demonstrated identical banding patterns for the MRSA isolates from the blood culture of infant A, breast milk for infants A and B, and a surveillance swab from infant B. At no time did the mother develop evidence of mastitis or other local breast infection.
MRSA can be passed from mother to preterm infant through contaminated breast milk, even in the absence of maternal infection. Colonization and clinical disease can result.
Infection Control and Hospital Epidemiology 10/2004; 25(9):778-80. · 3.67 Impact Factor
