Evaluating Epidemiology and Improving Surveillance of Infections Associated with Health Care, United States

Magill, Shelley S.; Dumyati, Ghinwa; Ray, Susan M.; Fridkin, Scott K.

doi:10.3201/eid2109.150508

Cited by 24 publications

(23 citation statements)

References 22 publications

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“…No signs or symptoms of disease were reported, indicating probable asymptomatic bacteriuria. The isolate was submitted to the CDC as part of the Emerging Infections Program Multi-site Gramnegative Surveillance Initiative (MuGSI), (13), which has conducted active populationand laboratory-based surveillance for carbapenem-resistant pathogens since 2012.…”

mentioning

confidence: 99%

Identification of a Carbapenemase-Producing Hypervirulent Klebsiella pneumoniae Isolate in the United States

Karlsson

Stanton

Ansari

et al. 2019

Antimicrob Agents Chemother

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We report on a carbapenemase-producing hypervirulent Klebsiella pneumoniae (CP-hvKP) isolate collected from a U.S. patient at an outpatient clinic. The isolate was identified as K. pneumoniae serotype K1 sequence type 23 and included both a hypervirulence (with rmpA, rmpA2 iroBCDN, peg-344, and iucABCD-iutA genes) and a carbapenemase-encoding (bla KPC-2 ) plasmid. The emergence of CP-hvKP underscores the importance of clinical awareness of this pathotype and the need for continued monitoring of CP-hvKP in the United States.

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mentioning

confidence: 99%

Identification of a Carbapenemase-Producing Hypervirulent Klebsiella pneumoniae Isolate in the United States

Karlsson

Stanton

Ansari

et al. 2019

Antimicrob Agents Chemother

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“…In 2011, the Centers for Disease Control and Prevention identified via a prevalence survey that 4 percent of hospitalized patients had an HAI. 2,3 The same survey repeated in 2015 found that 3.2 percent of patients had an HAI. 2 Patients in the 2015 survey also had a 16 percent lower risk of acquiring an HAI than patients surveyed in 2011.…”

Section: Prevalence Datamentioning

confidence: 95%

Ongoing efforts to reduce health care–associated infection rates

Croke¹

2019

AORN Journal

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H ealth care-associated infections (HAIs), which are associated with significant morbidity and mortality, are one of the most common complications in hospitalized patients. 1 In addition, government agencies and consumers use such infections as one factor to evaluate the quality of care provided by hospitals. 2 There have been nationwide efforts to prevent HAIs, with recent prevalence data indicating decreasing rates. 2 Prevalence dataIn 2011, the Centers for Disease Control and Prevention identified via a prevalence survey that 4 percent of hospitalized patients had an HAI. 2,3 The same survey repeated in 2015 found that 3.2 percent of patients had an HAI. 2 Patients in the 2015 survey also had a 16 percent lower risk of acquiring an HAI than patients surveyed in 2011. The study authors attributed this reduced HAI rate to a decreased prevalence of surgical site infections and urinary tract infections, specifically. That being said, surgical site infections remained the third most common HAI. Pneumonia was the most common, with nonventilator-associated pneumonia having a higher prevalence than ventilator-associated pneumonia. Gastrointestinal infections, which were mainly attributed to Clostridium difficile, were the second most common. Neither of the top two infections decreased significantly from 2011 to 2015. 2 Ongoing effortsThese results suggest that, although efforts to prevent HAIs have been relatively effective, continued focus is needed to keep making strides, particularly for pneumonia and C difficile infection. 2 Unfortunately, there is little evidence in the literature of effective ways to prevent non-ventilator-associated pneumonia; therefore, greater attention to this type of pneumonia would be beneficial. 2 For C difficile infection, prevention strategies can concentrate on improving practices related to antibiotic use, stopping patient-topatient transmission, and environmental cleaning. 2 Health care personnel can help with prevention efforts by ensuring their day-to-day practice incorporates evidence-based prevention strategies. The Centers for Disease Control and Prevention provides a variety of helpful resources aimed at HAI prevention, 4 and AORN's Guidelines for Perioperative Practice 5 outline such important tactics as hand hygiene performance, patient skin antisepsis, hypothermia prevention, and environmental cleaning. ConclusionAlthough reported overall rates of HAIs have been decreasing, health care facilities should continue efforts to maintain this trend. Based on recent data, greater focus on pneumonia and C difficile infection may be worthwhile to address the lack of progress in these areas. This month's lead feature article discusses best practices for performing surgical hand antisepsis, which is just one of the many strategies to prevent infections in the perioperative setting. References 1. Health care-associated infections. Agency for Healthcare Research and Quality. https://psnet. ahrq.gov/primers/primer/7/health-careassociated-infections.

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“…Infection with C. difficile, a major focus for hospitalized patients in the general population (24)(25)(26), was also specifically examined in the Peer report (12). Admissions for C. difficile infections among dialysis patients within the first 12 months of initiation increased nearly 44% between 2004 and 2012, from approximately 1.6 (95% CI, 1.5 to 1.7) to 2.3 (95% CI, 2.1 to 2.4) admissions per 100 patient-years.…”

Section: Novel Disease Findingsmentioning

confidence: 99%

Improving Outcomes in Patients Receiving Dialysis: The Peer Kidney Care Initiative

Wetmore

Gilbertson

Liu

et al. 2016

CJASN

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The past decade has witnessed a marked reduction in mortality rates among patients receiving maintenance dialysis. However, the reasons for this welcome development are uncertain, and greater understanding is needed to translate advances in care into additional survival gains. To fill important knowledge gaps and to enable dialysis provider organizations to learn from one another, with the aim of advancing patient care, the Peer Kidney Care Initiative (Peer) was created in 2014 by the chief medical officers of 14 United States dialysis provider organizations and the Chronic Disease Research Group. Areas of particular clinical importance were targeted to help shape the public health agenda in CKD and ESRD. Peer focuses on the effect of geographic variation on outcomes, the implications of seasonality for morbidity and mortality, the clinical significance of understudied disorders affecting dialysis patients, and the debate about how best to monitor and evaluate progress in care. In the realm of geovariation, Peer has provided key observations on regional variation in the rates of ESRD incidence, hospitalization, and pre-ESRD care. Regarding seasonality, Peer has reported on variation in both infectionrelated and non-infection-related hospitalizations, suggesting that ambient environmental conditions may affect a range of health outcomes in dialysis patients. Specific medical conditions that Peer highlights include Clostridium difficile infection, which has become strikingly more common in patients in the year after dialysis initiation, and chronic obstructive pulmonary disease, the treatments for which have the potential to contribute to sudden cardiac death. Finally, Peer challenges the nephrology community to consider alternatives to standardized mortality ratios in assessing progress in care, positing that close scrutiny of trends over time may be the most effective way to drive improvements in patient care.

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Evaluating Epidemiology and Improving Surveillance of Infections Associated with Health Care, United States

Abstract: This national resource provides much-needed data on pathogens, infections, and antimicrobial drug use.

Cited by 24 publications

References 22 publications

Identification of a Carbapenemase-Producing Hypervirulent Klebsiella pneumoniae Isolate in the United States

Identification of a Carbapenemase-Producing Hypervirulent Klebsiella pneumoniae Isolate in the United States

Ongoing efforts to reduce health care–associated infection rates

Improving Outcomes in Patients Receiving Dialysis: The Peer Kidney Care Initiative

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