Infection control and hospital epidemiology : the official journal of the Society of Hospital Epidemiologists of America
-
Infect Control Hosp Epidemiol · Apr 2009
Influx of multidrug-resistant, gram-negative bacteria in the hospital setting and the role of elderly patients with bacterial bloodstream infection.
Multidrug-resistant (MDR) gram-negative bacteria are reported increasingly frequently among isolates recovered from elderly patients. The clinical epidemiology of bloodstream infection (BSI) due to MDR gram-negative bacteria among elderly patients is unknown. ⋯ The 16-fold increase in BSI due to MDR gram-negative bacteria at hospital admission among elderly patients, especially among those who resided in long-term care facilities prior to admission, contributes further to the expanding body of evidence that these patients are the main reservoirs of MDR gram-negative bacteria. Given their contribution to the influx of antimicrobial-resistant bacteria in the hospital setting, infection control interventions that target this high-risk group need to be considered.
-
Infect Control Hosp Epidemiol · Apr 2009
Hospital-associated Clostridium difficile infection: is it necessary to track community-onset disease?
To compare Clostridium difficile infection (CDI) rates determined with use of a traditional definition (ie, with healthcare-onset CDI defined as diagnosis of CDI more than 48 hours after hospital admission) with rates determined with use of expanded definitions, including both healthcare-onset CDI and community-onset CDI, diagnosed within 48 hours after hospital admission in patients who were hospitalized in the previous 30 or 60 days, and to determine whether differences exist between patients with CDI onset in the community and those with CDI onset in a healthcare setting. ⋯ Compared with the traditional definition, expanded definitions identify more patients with CDI. There is good correlation between traditional and expanded CDI definitions; therefore, it is unclear whether expanded surveillance is necessary to identify an abnormal change in CDI rates. Cases that met the expanded definitions were less likely to have occurred in patients with fourth-generation cephalosporin and vancomycin exposure.
-
Infect Control Hosp Epidemiol · Apr 2009
Epidemiology of ventilator-associated pneumonia in a long-term acute care hospital.
To characterize the epidemiology and microbiology of ventilator-associated pneumonia (VAP) in a long-term acute care hospital (LTACH). ⋯ The VAP rate in the LTACH is lower than the VAP rate reported in acute care hospitals. Cases of VAP in the LTACH were frequently polymicrobial and were associated with multidrug-resistant pathogens and increased length of stay. The guidelines from the Centers for Disease Control and Prevention that are aimed at reducing cases of VAP appear to be effective if applied in the LTACH setting.
-
Infect Control Hosp Epidemiol · Mar 2009
Challenges of implementing national guidelines for the control and prevention of methicillin-resistant Staphylococcus aureus colonization or infection in acute care hospitals in the Republic of Ireland.
Of the 49 acute care hospitals in Ireland that responded to the survey questionnaire drafted by the Infection Control Subcommittee of the Health Protection Surveillance Centre's Strategy for the Control of Antimicrobial Resistance in Ireland, 43 reported barriers to the full implementation of national guidelines for the control and prevention of methicillin-resistant Staphylococcus aureus infection; these barriers included poor infrastructure (42 hospitals), inadequate laboratory resources (40 hospitals), inadequate staffing (39 hospitals), and inadequate numbers of isolation rooms and beds (40 hospitals). Four of the hospitals did not have an educational program on hand hygiene, and only 17 had an antibiotic stewardship program.
-
Infect Control Hosp Epidemiol · Mar 2009
Epidemiology of healthcare-associated bloodstream infection caused by USA300 strains of methicillin-resistant Staphylococcus aureus in 3 affiliated hospitals.
To describe the epidemiology of bloodstream infection caused by USA300 strains of methicillin-resistant Staphylococcus aureus (MRSA), which are traditionally associated with cases of community-acquired infection, in the healthcare setting. ⋯ The prevalence of USA300 strains among cases of healthcare-associated MRSA bloodstream infection varied dramatically among geographically clustered hospitals. USA300 strains are replacing traditional healthcare-related strains of MRSA in some healthcare settings. Our data suggest that the prevalence of USA300 strains in the community is the dominant factor affecting the prevalence of this strain type in the healthcare setting.