Assessment of race and sex as risk factors for colonization with multidrug-resistant organisms in six nursing homes

Gontjes, Kyle J.; Gibson, Kristen E.; Lansing, Bonnie; Mody, Lona; Cassone, Marco

doi:10.1017/ice.2020.215

Cited by 7 publications

(5 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although not within the study's scope, we observed a higher MDR rate in Coagulase-Negative Staphylococci (Co-N), which colonize the skin, mucous membranes, and environmental surfaces in the community and the hospital. This may contribute to the transmission of antibiotic resistance to Staphylococcus aureus species [15].…”

Section: Discussionmentioning

confidence: 99%

Multidrug-Resistant ESKAPE Pathogens in a Romanian Secondary-Care Hospital during the COVID-19 Pandemic

Vlase,

Iancu,

Stefan

et al. 2023

Preprint

View full text Add to dashboard Cite

The ESKAPE pathogens are public health concerns worldwide, defining the present major antibiotic resistance issues: E. faecium vancomycin-R, S. aureus methicillin-R, Ps. Aeruginosa and A. baumannii carbapenem-R, resistance to 3rd generation cephalosporins of Kl. pneumoniae and Enterobacter spp. Covid-19 pandemic disturbed the health care usual procedures, contributing to the spread of antibiotic-resistant bacteria. The present study retrospectively assessed the prevalence and antimicrobial resistance (AMR) profile of ESKAPE microorganisms during 2020-2022 in a multidisciplinary emergency hospital from Romania, based on microbiological reports. The AMR issues mainly interest the urology department. ESKAPE group accounts for 33.5% of the total bacterial isolated. The specific AMR of ESKAPE pathogens cumulates 30.9%, while antimicrobial multidrug resistance characterizes 21% from all ESKAPE strains. Kl. Pneumoniae, followed by S. aureus, and Ps. aeruginosa are the main hospital problems concerning the ESKAPE surveillance. The directions of the near future antibiotic stewardship program focus to revise the clinical protocols for diagnostic and treatment in each department, to intensify the bacteriological samples collection, to improve the microbiological diagnostic techniques for AMR identification, to continue the epidemiological current actions of surveillance, control, and education.

show abstract

Section: Discussionmentioning

confidence: 99%

Multidrug-Resistant ESKAPE Pathogens in a Romanian Secondary-Care Hospital during the COVID-19 Pandemic

Vlase,

Iancu,

Stefan

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…Adjusted analyses accounted for age, sex, race and ethnicity, Medicaid insurance, antibiotic or nursing home exposure in the last year, mean Elixhauser comorbidity count, and history of MDRO. Race and ethnicity were included given prior evidence of association with risk for pneumonia, MDRO, and predisposing chronic pulmonary conditions . All analyses were performed using SAS version 9.4 (SAS Institute) or R version 4.0.0 (R Foundation).…”

Section: Methodsmentioning

confidence: 99%

“…Pairing was done by calculating the Mahalanobis distance between facilities across baseline values of weighted variables and choosing pairings with the minimum mean within-pair distance. 18,19 Randomization was performed within these pairs.…”

Section: Randomizationmentioning

confidence: 99%

Stewardship Prompts to Improve Antibiotic Selection for Pneumonia

Gohil,

Septimus,

Kleinman

et al. 2024

JAMA

View full text Add to dashboard Cite

ImportancePneumonia is the most common infection requiring hospitalization and is a major reason for overuse of extended-spectrum antibiotics. Despite low risk of multidrug-resistant organism (MDRO) infection, clinical uncertainty often drives initial antibiotic selection. Strategies to limit empiric antibiotic overuse for patients with pneumonia are needed.ObjectiveTo evaluate whether computerized provider order entry (CPOE) prompts providing patient- and pathogen-specific MDRO infection risk estimates could reduce empiric extended-spectrum antibiotics for non–critically ill patients admitted with pneumonia.Design, Setting, and ParticipantsCluster-randomized trial in 59 US community hospitals comparing the effect of a CPOE stewardship bundle (education, feedback, and real-time MDRO risk-based CPOE prompts; n = 29 hospitals) vs routine stewardship (n = 30 hospitals) on antibiotic selection during the first 3 hospital days (empiric period) in non–critically ill adults (≥18 years) hospitalized with pneumonia. There was an 18-month baseline period from April 1, 2017, to September 30, 2018, and a 15-month intervention period from April 1, 2019, to June 30, 2020.InterventionCPOE prompts recommending standard-spectrum antibiotics in patients ordered to receive extended-spectrum antibiotics during the empiric period who have low estimated absolute risk (&lt;10%) of MDRO pneumonia, coupled with feedback and education.Main Outcomes and MeasuresThe primary outcome was empiric (first 3 days of hospitalization) extended-spectrum antibiotic days of therapy. Secondary outcomes included empiric vancomycin and antipseudomonal days of therapy and safety outcomes included days to intensive care unit (ICU) transfer and hospital length of stay. Outcomes compared differences between baseline and intervention periods across strategies.ResultsAmong 59 hospitals with 96 451 (51 671 in the baseline period and 44 780 in the intervention period) adult patients admitted with pneumonia, the mean (SD) age of patients was 68.1 (17.0) years, 48.1% were men, and the median (IQR) Elixhauser comorbidity count was 4 (2-6). Compared with routine stewardship, the group using CPOE prompts had a 28.4% reduction in empiric extended-spectrum days of therapy (rate ratio, 0.72 [95% CI, 0.66-0.78]; P &lt; .001). Safety outcomes of mean days to ICU transfer (6.5 vs 7.1 days) and hospital length of stay (6.8 vs 7.1 days) did not differ significantly between the routine and CPOE intervention groups.Conclusions and RelevanceEmpiric extended-spectrum antibiotic use was significantly lower among adults admitted with pneumonia to non-ICU settings in hospitals using education, feedback, and CPOE prompts recommending standard-spectrum antibiotics for patients at low risk of MDRO infection, compared with routine stewardship practices. Hospital length of stay and days to ICU transfer were unchanged.Trial RegistrationClinicalTrials.gov Identifier: NCT03697070

show abstract

“…Adjusted analyses accounted for age, sex, race and ethnicity, Medicaid insurance, prior antibiotic or nursing home exposure within the last year, mean Elixhauser Comorbidity Index count, and history of MDRO. Race and ethnicity information was included given prior evidence of association with risk for MDRO UTIs and predisposing urologic conditions . All analyses were performed using SAS (version 9.4; SAS Institute) or R (version 4.0.0; R Project for Statistical Computing).…”

Section: Methodsmentioning

confidence: 99%

Stewardship Prompts to Improve Antibiotic Selection for Urinary Tract Infection

Gohil,

Septimus,

Kleinman

et al. 2024

JAMA

View full text Add to dashboard Cite

ImportanceUrinary tract infection (UTI) is the second most common infection leading to hospitalization and is often associated with gram-negative multidrug-resistant organisms (MDROs). Clinicians overuse extended-spectrum antibiotics although most patients are at low risk for MDRO infection. Safe strategies to limit overuse of empiric antibiotics are needed.ObjectiveTo evaluate whether computerized provider order entry (CPOE) prompts providing patient- and pathogen-specific MDRO risk estimates could reduce use of empiric extended-spectrum antibiotics for treatment of UTI.Design, Setting, and ParticipantsCluster-randomized trial in 59 US community hospitals comparing the effect of a CPOE stewardship bundle (education, feedback, and real-time and risk-based CPOE prompts; 29 hospitals) vs routine stewardship (n = 30 hospitals) on antibiotic selection during the first 3 hospital days (empiric period) in noncritically ill adults (≥18 years) hospitalized with UTI with an 18-month baseline (April 1, 2017–September 30, 2018) and 15-month intervention period (April 1, 2019–June 30, 2020).InterventionsCPOE prompts recommending empiric standard-spectrum antibiotics in patients ordered to receive extended-spectrum antibiotics who have low estimated absolute risk (&lt;10%) of MDRO UTI, coupled with feedback and education.Main Outcomes and MeasuresThe primary outcome was empiric (first 3 days of hospitalization) extended-spectrum antibiotic days of therapy. Secondary outcomes included empiric vancomycin and antipseudomonal days of therapy. Safety outcomes included days to intensive care unit (ICU) transfer and hospital length of stay. Outcomes were assessed using generalized linear mixed-effect models to assess differences between the baseline and intervention periods.ResultsAmong 127 403 adult patients (71 991 baseline and 55 412 intervention period) admitted with UTI in 59 hospitals, the mean (SD) age was 69.4 (17.9) years, 30.5% were male, and the median Elixhauser Comorbidity Index count was 4 (IQR, 2-5). Compared with routine stewardship, the group using CPOE prompts had a 17.4% (95% CI, 11.2%-23.2%) reduction in empiric extended-spectrum days of therapy (rate ratio, 0.83 [95% CI, 0.77-0.89]; P &lt; .001). The safety outcomes of mean days to ICU transfer (6.6 vs 7.0 days) and hospital length of stay (6.3 vs 6.5 days) did not differ significantly between the routine and intervention groups, respectively.Conclusions and RelevanceCompared with routine stewardship, CPOE prompts providing real-time recommendations for standard-spectrum antibiotics for patients with low MDRO risk coupled with feedback and education significantly reduced empiric extended-spectrum antibiotic use among noncritically ill adults admitted with UTI without changing hospital length of stay or days to ICU transfers.Trial RegistrationClinicalTrials.gov Identifier: NCT03697096

show abstract

Assessment of race and sex as risk factors for colonization with multidrug-resistant organisms in six nursing homes

Cited by 7 publications

References 10 publications

Multidrug-Resistant ESKAPE Pathogens in a Romanian Secondary-Care Hospital during the COVID-19 Pandemic

Multidrug-Resistant ESKAPE Pathogens in a Romanian Secondary-Care Hospital during the COVID-19 Pandemic

Stewardship Prompts to Improve Antibiotic Selection for Pneumonia

Stewardship Prompts to Improve Antibiotic Selection for Urinary Tract Infection

Contact Info

Product

Resources

About