Infection control and hospital epidemiology : the official journal of the Society of Hospital Epidemiologists of America
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Infect Control Hosp Epidemiol · Mar 2014
Activity of commonly used antimicrobial prophylaxis regimens against pathogens causing coronary artery bypass graft and arthroplasty surgical site infections in the United States, 2006-2009.
Coronary artery bypass graft (CABG) and primary arthroplasty surgical site infection (SSI) rates are declining slower than other healthcare-associated infection rates. We examined antimicrobial prophylaxis (AMP) regimens used for these operations and compared their spectrum of activity against reported SSI pathogens. ⋯ Standard AMP, used in three-quarters of CABG and primary arthroplasty procedures, has inadequate activity against more than half of SSI pathogens reported. Alternative strategies may be needed to prevent SSIs caused by pathogens resistant to standard AMP regimens.
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Infect Control Hosp Epidemiol · Mar 2014
Ventilator-associated pneumonia: overdiagnosis and treatment are common in medical and surgical intensive care units.
Diagnosing ventilator-associated pneumonia (VAP) is difficult, and misdiagnosis can lead to unnecessary and prolonged antibiotic treatment. We sought to quantify and characterize unjustified antimicrobial use for VAP and identify risk factors for continuation of antibiotics in patients without VAP after 3 days. ⋯ Overdiagnosis and treatment of VAP was common in this study and led to 1,183 excess days of antibiotics in patients with no indication for antibiotics. Clinical differences between non-VAP patients who had antibiotics continued or discontinued were minimal, suggesting that clinician preferences and behaviors contribute to unnecessary prescribing.
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Infect Control Hosp Epidemiol · Feb 2014
Pseudo-outbreak of Klebsiella oxytoca spontaneous bacterial peritonitis attributed to contamination of multidose vials of culture medium supplement.
To determine the source of a cluster of Klebsiella oxytoca isolates cultured from peritoneal fluid of 3 patients with cirrhosis on a single day. ⋯ A pseudo-outbreak of K. oxytoca peritonitis and high rates of contamination of peritoneal fluid were attributable to contamination of a multidose culture medium supplement. This article highlights the importance of discouraging the use of multidose vials in all clinical settings.
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Infect Control Hosp Epidemiol · Feb 2014
The descriptive epidemiology of central line-associated bloodstream infection among patients in non-intensive care unit settings.
To review and describe device utilization and central line-associated bloodstream (CLABSI) events among patients in a non-intensive care unit (ICU) setting and to examine the morbidity and mortality associated with these events. ⋯ CLABSI rates over a 1-year period were higher in patients outside the ICU at our hospital and were associated with significant mortality.
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Infect Control Hosp Epidemiol · Feb 2014
Readmissions after diagnosis of surgical site infection following knee and hip arthroplasty.
Surgical site infection (SSI) after total hip and knee arthroplasty is a common postoperative complication. We sought to determine readmission rates and costs for total hip and knee arthroplasty complicated by SSI. ⋯ Readmissions during the year after SSI diagnosis accounted for 1,072 hospital admissions and cost over $25.5 million. These readmissions are costly and might be a future target for decreased reimbursement.