Prevalence of and Risk Factors for Colonization With Methicillin-ResistantStaphylococcus aureusat the Time of Hospital Admission

AbstractObjectives:To determine the prevalence of methicillin-resistantStaphylococcus aureus(MRSA) colonization among patients presenting for hospital admission and to identify risk factors for MRSA colonization.Design:Surveillance cultures were performed at the time of hospital admission to identify patients colonized with S.aureus.A case-control study was performed to identify risk factors for MRSA colonization.Setting:A tertiary-care academic medical center.Patients:Adults presenting for hospital admission (N = 974).Results:S.aureuswas isolated from 205 (21%) of the patients for whom cultures were performed. Methicillin-sensitive S.aureuswas isolated from 179 (18.4%) of the patients, and MRSA was isolated from 26 (2.7%) of the patients. All 26 MRSA-colonized patients had been admitted to a healthcare facility in the preceding year, had at least one chronic illness, or both. In multivariate analyses comparing MRSA-colonized patients with control-patients, admission to a nursing home (odds ratio [OR], 16.5; 95% confidence interval [CI95], 1.4 to 192.1;P= .025) or a hospitalization of 5 days or longer during the preceding year (OR, 3.91; CI95, 1.1 to 13.9;P= .035) were independent predictors of MRSA colonization.Conclusions:Patients colonized with MRSA admitted to this hospital likely acquired the organism during previous encounters with healthcare facilities. There was no evidence that MRSA colonization occurs commonly among low-risk individuals in this community. These data suggest that evaluation of recent healthcare exposures is essential if true community acquisition of MRSA is to be confirmed.

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Extended-Spectrum β-Lactamase–ProducingEscherichia coliandKlebsiellaSpecies: Risk Factors for Colonization and Impact of Antimicrobial Formulary Interventions on Colonization Prevalence

Infection Control and Hospital Epidemiology ◽

10.1086/502045 ◽

2002 ◽

Vol 23 (5) ◽

pp. 254-260 ◽

Cited By ~ 51

Author(s):

Gregory Bisson ◽

Neil O. Fishman ◽

Jean Baldus Patel ◽

Paul H. Edelstein ◽

Ebbing Lautenbach

Keyword(s):

Risk Factors ◽

Medical Center ◽

Tertiary Care ◽

Healthcare Facility ◽

System A ◽

Extended Spectrum ◽

Tertiary Care Medical Center ◽

Duration Of Hospitalization ◽

Third Generation Cephalosporins ◽

Control Study

Objective:The incidence of extended-spectrum β-lactamase (ESβL)–mediated resistance has increased markedly during the past decade. Risk factors for colonization with ESβL-producingEscherichia coliand Klebsiella species(ESβL-EK) remain unclear, as do methods to control their further emergence.Design:Case–control study.Setting:Two hospitals within a large academic health system: a 725-bed academic tertiary-care medical center and a 344-bed urban community hospital.Patients:Thirteen patients with ESβL-EK fecal colonization were compared with 46 randomly selected noncolonized controls.Results:Duration of hospitalization was the only independent risk factor for ESβL-EK colonization (odds ratio, 1.11; 95% confidence interval, 1.02 to 1.21). Of note, 8 (62%) of the patients had been admitted from another healthcare facility. In addition, there was evidence for dissemination of a singleK. oxytocaclone. Finally, the prevalence of ESβL-EK colonization decreased from 7.9% to 5.7% following restriction of third-generation cephalosporins (P= .51).Conclusions:ESβL-EK colonization was associated only with duration of hospitalization and there was no significant reduction following antimicrobial formulary interventions. The evidence for nosocomial spread and the high percentage of patients with ESβL-EK admitted from other sites suggest that greater emphasis must be placed on controlling the spread of such organisms within and between institutions.

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Clostridium difficile infection in an academic medical center in Saudi Arabia: prevalence and risk factors

Annals of Saudi Medicine ◽

10.5144/0256-4947.2020.305 ◽

2020 ◽

Vol 40 (4) ◽

pp. 305-309

Author(s):

Mai Alalawi ◽

Seba Aljahdali ◽

Bashaer Alharbi ◽

Lana Fagih ◽

Raghad Fatani ◽

...

Keyword(s):

Risk Factors ◽

Clostridium Difficile ◽

Broad Spectrum ◽

Medical Center ◽

Academic Medical Center ◽

Infection Prevalence ◽

Healthcare Facilities ◽

Broad Spectrum Antibiotics ◽

Academic Medical ◽

Significant Difference

ABSTRACT BACKGROUND: Clostridium difficile infection is one of the most common causes of diarrhea in healthcare facilities. More studies are needed to identify patients at high risk of C difficile infection in our community. OBJECTIVES: Estimate the prevalence of C difficile infection among adult patients and evaluate the risk factors associated with infection. DESIGN: Retrospective record review. SETTING: Tertiary academic medical center in Jeddah. PATIENTS AND METHODS: Eligible patients were adults (≥18 years old) with confirmed C difficile diagnosis between January 2013 and May 2018. MAIN OUTCOME MEASURES: Prevalence rate and types of risk factors. SAMPLE SIZE: Of 1886 records, 129 patients had positive lab results and met the inclusion criteria. RESULTS: The prevalence of C difficile infection in our center over five years was 6.8%. The mean (SD) age was 56 (18) years, and infection was more prevalent in men (53.5%) than in women (46.5%). The most common risk factors were use of proton-pump inhibitors (PPI) and broad-spectrum antibiotics. The overlapping exposure of both PPIs and broad-spectrum antibiotics was 56.6%. There was no statistically significant difference between the type of PPI ( P =.254) or antibiotic ( P =.789) and the onset of C difficile infection. CONCLUSION: The overall C difficile infection prevalence in our population was low compared to Western countries. The majority of the patients who developed C difficile infection were using PPIs and/or antibiotics. No differences were observed in the type of antibiotic or PPI and the onset of C difficile infection development. Appropriate prescribing protocols for PPIs and antibiotics in acute settings are needed. LIMITATIONS: Single center and retrospective design. CONFLICT OF INTEREST: None.

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Mo1095 Racial/Ethnic Differences in Inflammatory Bowel Disease Risk Factors Medication Compliance and Outcomes At a Tertiary Care Academic Medical Center

Gastroenterology ◽

10.1016/s0016-5085(13)62129-0 ◽

2013 ◽

Vol 144 (5) ◽

pp. S-576

Author(s):

Christie Mannino ◽

Jessica Malin ◽

Andrew R. Conn ◽

Thomas A. Judge ◽

Yize R. Wang

Keyword(s):

Risk Factors ◽

Ethnic Differences ◽

Disease Risk ◽

Medication Compliance ◽

Medical Center ◽

Academic Medical Center ◽

Tertiary Care ◽

Academic Medical ◽

Inflammatory Bowel ◽

Racial Ethnic

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Clinical Team Distribution and Antibiotic Use Patterns at a Tertiary-Care Academic Medical Center

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.695 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s168-s169

Author(s):

Rebecca Choudhury ◽

Ronald Beaulieu ◽

Thomas Talbot ◽

George Nelson

Keyword(s):

Medical Center ◽

Academic Medical Center ◽

Tertiary Care ◽

Antibiotic Use ◽

Care Hospital ◽

Hospital Units ◽

Antibiotic Utilization ◽

Academic Medical ◽

Level Data ◽

Utilization Data

Background: As more US hospitals report antibiotic utilization to the CDC, standardized antimicrobial administration ratios (SAARs) derived from patient care unit-based antibiotic utilization data will increasingly be used to guide local antibiotic stewardship interventions. Location-based antibiotic utilization surveillance data are often utilized given the relative ease of ascertainment. However, aggregating antibiotic use data on a unit basis may have variable effects depending on the number of clinical teams providing care. In this study, we examined antibiotic utilization from units at a tertiary-care hospital to illustrate the potential challenges of using unit-based antibiotic utilization to change individual prescribing. Methods: We used inpatient pharmacy antibiotic use administration records at an adult tertiary-care academic medical center over a 6-month period from January 2019 through June 2019 to describe the geographic footprints and AU of medical, surgical, and critical care teams. All teams accounting for at least 1 patient day present on each unit during the study period were included in the analysis, as were all teams prescribing at least 1 antibiotic day of therapy (DOT). Results: The study population consisted of 24 units: 6 ICUs (25%) and 18 non-ICUs (75%). Over the study period, the average numbers of teams caring for patients in ICU and non-ICU wards were 10.2 (range, 3.2–16.9) and 13.7 (range, 10.4–18.9), respectively. Units were divided into 3 categories by the number of teams, accounting for ≥70% of total patient days present (Fig. 1): “homogenous” (≤3), “pauciteam” (4–7 teams), and “heterogeneous” (>7 teams). In total, 12 (50%) units were “pauciteam”; 7 (29%) were “homogeneous”; and 5 (21%) were “heterogeneous.” Units could also be classified as “homogenous,” “pauciteam,” or “heterogeneous” based on team-level antibiotic utilization or DOT for specific antibiotics. Different patterns emerged based on antibiotic restriction status. Classifying units based on vancomycin DOT (unrestricted) exhibited fewer “heterogeneous” units, whereas using meropenem DOT (restricted) revealed no “heterogeneous” units. Furthermore, the average number of units where individual clinical teams prescribed an antibiotic varied widely (range, 1.4–12.3 units per team). Conclusions: Unit-based antibiotic utilization data may encounter limitations in affecting prescriber behavior, particularly on units where a large number of clinical teams contribute to antibiotic utilization. Additionally, some services prescribing antibiotics across many hospital units may be minimally influenced by unit-level data. Team-based antibiotic utilization may allow for a more targeted metric to drive individual team prescribing.Funding: NoneDisclosures: None

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Financial Impact of Tertiary Care in an Academic Medical Center

Annals of Surgery ◽

10.1097/00000658-200006000-00010 ◽

2000 ◽

Vol 231 (6) ◽

pp. 860-868 ◽

Cited By ~ 16

Author(s):

Thomas S. Huber ◽

Lori M. Carlton ◽

Donna G. O’Hern ◽

Nancy S. Hardt ◽

C. Keith Ozaki ◽

...

Keyword(s):

Medical Center ◽

Academic Medical Center ◽

Tertiary Care ◽

Financial Impact ◽

Academic Medical

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421. Effect of SARs-Cov-2 mRNA Vaccination in Healthcare Workers with Household COVID Exposure

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.621 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S311-S311

Author(s):

Laura Selby ◽

Richard Starlin

Keyword(s):

Healthcare Workers ◽

Screening Program ◽

Medical Center ◽

Severe Disease ◽

Academic Medical Center ◽

Tertiary Care ◽

Limited Data ◽

Viral Shedding ◽

Academic Medical ◽

Significant Burden

Abstract Background Healthcare workers have experienced a significant burden of COVID-19 disease. COVID mRNA vaccines have shown great efficacy in prevention of severe disease and hospitalization due to COVID infection, but limited data is available about acquisition of infection and asymptomatic viral shedding. Methods Fully vaccinated healthcare workers at a tertiary-care academic medical center in Omaha Nebraska who reported a household exposure to COVID-19 infection are eligible for a screening program in which they are serially screened with PCR but allowed to work if negative on initial test and asymptomatic. Serial screening by NP swab was completed every 5-7 days, and workers became excluded from work if testing was positive or became symptomatic. Results Of the 94 employees who were fully vaccinated at the time of the household exposure to COVID-19 infection, 78 completed serial testing and were negative. Sixteen were positive on initial or subsequent screening. Vaccine failure rate of 17.0% (16/94). Healthcare workers exposed to household COVID positive contact Conclusion High risk household exposures to COVID-19 infection remains a significant potential source of infections in healthcare workers even after workers are fully vaccinated with COVID mRNA vaccines especially those with contact to positive domestic partners. Disclosures All Authors: No reported disclosures

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Emergency General Surgery—A Misnomer?

The American Surgeon ◽

10.1177/000313481808400741 ◽

2018 ◽

Vol 84 (7) ◽

pp. 1214-1216

Author(s):

Kirby Quinn ◽

Mary E. Davis ◽

Lewin Carter ◽

Cynthia K. Shortell ◽

Courtney Sommer

Keyword(s):

Hospital Admission ◽

General Surgery ◽

Nonoperative Management ◽

Medical Center ◽

Academic Medical Center ◽

Emergency General Surgery ◽

Surgical Subspecialty ◽

Surgical Emergencies ◽

Academic Medical ◽

Assessment And Treatment

Emergency general surgery (EGS) is defined as the urgent assessment and treatment of non-trauma, general surgical emergencies involving adults. Acute surgical emergencies often represent the most common reason for hospital admission with diagnoses, including bowel obstruction and appendicitis. EGS is a growing surgical subspecialty that includes both operative and nonoperative management of acutely ill patients. We sought to assess the burden of nonoperative care in EGS patients at our academic medical center. This study was conducted by retrospective analysis of prospectively collected data from patients entered into the Duke EGS Registry between July 1, 2016 and September 10, 2017. Fifty-six per cent (n = 771) of patients in the Duke EGS Registry (n = 1377) were managed nonoperatively as compared with 44 per cent (n = 606) who were managed operatively. Nonoperative management of disease represents a large subset of EGS and, therefore, needs further investigation to improve processes, outcomes, and standardization of care.

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