Epidemiology and Outcomes of Vancomycin-Resistant Enterococcus Infections in the U.S. Military Health System

ABSTRACT Introduction Vancomycin-resistant enterococci (VRE) are classified by the Centers for Diseases Control and Prevention as a serious antibiotic resistance threat. Our study aims to characterize the epidemiology, associated conditions, and outcomes of VRE infections among hospitalized patients in the U.S. military health system (MHS). Materials and Methods We performed a retrospective cohort study of patients with VRE infection using the MHS database. Cases included all patients admitted to a military treatment facility for ≥2 days from October 2008 to September 2015 with a clinical culture growing Enterococcus faecalis, Enterococcus faecium, or Enterococcus species (unspecified), reported as resistant to vancomycin. Co-morbid conditions and procedures associated with VRE infection were identified by multivariable conditional logistic regression. Patient case-mix adjusted outcomes including in-hospital mortality, length of stay, and hospitalization cost were evaluated by high-dimensional propensity score adjustment. Results During the seven-year study period and among 1,161,335 hospitalized patients within the MHS, we identified 577 (0.05%) patients with VRE infection. A majority of VRE infections were urinary tract infections (57.7%), followed by bloodstream (24.7%), other site/device-related (12.9%), respiratory (2.9%), and wound infections (1.8%). Risk factors for VRE infection included invasive gastrointestinal, pulmonary, and urologic procedures, indwelling devices, and exposure to 4th generation cephalosporins, but not to glycopeptides. Patients hospitalized with VRE infection had significantly higher hospitalization costs (attributable difference [AD] $135,534, P<0.001), prolonged hospital stays (AD 20.44 days, P<0.001, and higher in-hospital mortality (case-mix adjusted odds ratio 5.77; 95% confidence interval 4.59-7.25). Conclusions VRE infections carry a considerable burden for hospitalized patients given their impact on length of stay, hospitalization costs, and in-hospital mortality. Active surveillance and infection control efforts should target those identified as high-risk for VRE infection. Antimicrobial stewardship programs should focus on limiting exposure to 4th generation cephalosporins.

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Epidemiology and Outcomes of Clostridium difficile Infection in Hospitalized Patients within the US Military Health Care System

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.970 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S390-S390

Author(s):

Matthew Eberly ◽

Apryl Susi ◽

Michael Rajnik ◽

Daniel Adams ◽

Cade Nylund

Keyword(s):

Clostridium Difficile ◽

Length Of Stay ◽

Hospital Mortality ◽

Odds Ratio ◽

Hospitalized Patients ◽

Case Mix ◽

Military Health ◽

Medical Centers ◽

Us Military ◽

The Us

Abstract Background Clostridium difficile infection (CDI) has become an emerging epidemic in the healthcare community. Our study aims to characterize the epidemiology and measure the attributable cost, length of stay, and in-hospital mortality of CDI among hospitalized patients in the US military health system (MHS). Methods We performed a retrospective cohort study of patients with CDI using MHS database billing records. Cases included all active duty patients, their dependents, or retirees admitted to a US military treatment facility for ≥2 days from October 2008 to September 2015 with a stool sample positive for Clostridium difficile via enzyme immunoassay, tissue cytotoxin assay, toxigenic culture, or polymerase chain reaction (PCR). Patient case-mix adjusted outcomes including in-hospital mortality, length of stay, and hospitalization cost were evaluated by high-dimensional propensity score adjusted logistic regression. Results Among 1,156,672 admissions within the MHS from 2008–2015, we identified 1,640 (0.14%) patients with CDI and found a significant increase in the trend of CDI over the 7-year study period (P < 0.001). Median age (IQR) was 63 (41–76) in the CDI hospitalized group and 26 (6–46) in the non-CDI hospitalized group. Male gender was a risk factor for CDI (unadjusted odds ratio, 1.94; 95% confidence interval 1.76–2.14) and the majority of patients (84.5%) were associated with large-size medical centers. Patients hospitalized with CDI had significantly higher hospitalization cost (attributable difference [AD] $51,959, P < 0.001), prolonged hospital stay (AD 11.8 days, P < 0.001), and in-hospital mortality (case-mix adjusted odds ratio 3.28; 95% confidence interval 2.69–4.00). Conclusion CDI in hospitalized patients within the MHS is associated with advanced age, large medical centers, and an increased length of stay, hospital cost, and in-hospital mortality. We identified a significantly increased burden of hospitalization among patients admitted with CDI, highlighting the importance of infection control and antimicrobial stewardship initiatives aimed at decreasing the spread of this pathogen. Disclosures All authors: No reported disclosures.

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Survival among Lung Cancer Patients in the U.S. Military Health System: A Comparison with the SEER Population

Cancer Epidemiology Biomarkers & Prevention ◽

10.1158/1055-9965.epi-17-0822 ◽

2018 ◽

Vol 27 (6) ◽

pp. 673-679 ◽

Cited By ~ 4

Author(s):

Jie Lin ◽

Christine Kamamia ◽

Derek Brown ◽

Stephanie Shao ◽

Katherine A. McGlynn ◽

...

Keyword(s):

Lung Cancer ◽

Health System ◽

Cancer Patients ◽

Military Health System ◽

Military Health ◽

Lung Cancer Patients ◽

System A ◽

The U.S

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Opioid prescribing in the U.S Military Health System, 2014-2018

Pain ◽

10.1097/j.pain.0000000000002313 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

LCDR Ashton H. Goldman ◽

LT Daniel D. Johnson ◽

LCDR Clare E. Griffis ◽

ENS Vaughn Land ◽

CDR George C. Balazs

Keyword(s):

Health System ◽

Military Health System ◽

Military Health ◽

Opioid Prescribing ◽

The U.S

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Palliative Care in the U.S. Military Health System

Military Medicine ◽

10.7205/milmed-d-15-00047 ◽

2015 ◽

Vol 180 (10) ◽

pp. 1024-1026

Author(s):

Scott Snyder

Keyword(s):

Palliative Care ◽

Health System ◽

Military Health System ◽

Military Health ◽

The U.S

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Diplopia and Strabismus After Corneal Refractive Surgery

Military Medicine ◽

10.1093/milmed/usz395 ◽

2019 ◽

Vol 185 (5-6) ◽

pp. e755-e758 ◽

Cited By ~ 1

Author(s):

Aditya Mehta ◽

Donovan Reed ◽

Kyle E Miller

Keyword(s):

Health System ◽

Retrospective Review ◽

Refractive Surgery ◽

Medical Center ◽

Minimal Risk ◽

Military Health System ◽

Military Health ◽

Operational Readiness ◽

Corneal Refractive Surgery ◽

The U.S

Abstract Introduction Diplopia and strabismus are known complications after corneal refractive surgery (CRS). Within the U.S. Armed Forces, refractive surgery is used to improve the operational readiness of the service member, and these complications could cause significant degradation to their capability. This study was performed in order to identify the incidence of strabismus and diplopia following CRS within the U.S. Military Health System. Methods A retrospective review of all patients who underwent photorefractive keratectomy (PRK) or laser-assisted in situ keratomileusis (LASIK) in the Department of Defense from January 2006 through September 2013 was designed and approved by the Naval Medical Center Portsmouth Institutional Review Board. The military health system data mart was queried for all patients who underwent one of these procedures and subsequently had an International Classification of Disease-9 code for any strabismus or diplopia through 2014 allowing at least 1 year of follow-up. We then calculated the incidence of both diplopia and strabismus for these procedures as the primary measure and the overall prevalence as a secondary measure. Results A total of 108,157 patients underwent PRK or LASIK during our study period with 41 of these patients subsequently having a diagnosis of diplopia or strabismus. After chart review, 16 of these patients were excluded resulting in 25 patients for inclusion in either the strabismus (23 patients, 0.02%) or diplopia (3 patients, 0.003%) cohorts with one patient having both. Of the 23 patients with postoperative strabismus, 4 were new cases giving an incidence of 0.004% and 2 new cases of diplopia for an incidence of 0.002%. Conclusion Diplopia and strabismus are rare complications after CRS in the U.S. military population. These procedures continue to increase the operational readiness of our service members with minimal risk of these potentially debilitating complications. Overall, this study provides support for the continued use of PRK and LASIK despite study limitations related to the use of large databases for retrospective review. Future prospective studies using delineated preoperative and postoperative examinations with sensorimotor testing included may be able to resolve the limitations of this study.

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