Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-6 (of 6 Records) |
Query Trace: Belflower R[original query] |
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Evaluation of manual and automated bloodstream infection surveillance in outpatient dialysis centers
Thompson ND , Wise M , Belflower R , Kanago M , Kainer MA , Lovell C , Patel PR . Infect Control Hosp Epidemiol 2016 37 (4) 1-3 Outpatient hemodialysis bloodstream infection rates, now used for performance measurement and were significantly higher for manual compared with automated surveillance (P<.001), largely owing to the absence of blood culture data in the dialysis electronic health record. Improvement in data sharing between hospitals and outpatient dialysis centers is necessary. |
Risk factors for invasive methicillin-resistant Staphylococcus aureus infection after recent discharge from an acute care hospitalization, 2011-2013
Epstein L , Mu Y , Belflower R , Scott J , Ray S , Dumyati G , Felsen C , Petit S , Yousey-Hindes K , Nadle J , Pasutti L , Lynfield R , Warnke L , Schaffner W , Leib K , Kallen AJ , Fridkin SK , Lessa FC . Clin Infect Dis 2015 62 (1) 45-52 BACKGROUND: Significant progress has been made in reducing methicillin-resistant Staphylococcus aureus (MRSA) infections among hospitalized patients. However, the decreases in invasive MRSA infections among recently discharged patients have been less substantial. We assessed risk factors for developing invasive MRSA infections following acute care hospitalizations to inform prevention strategies. METHODS: We conducted a prospective, matched case-control study. A case was defined as MRSA cultured from a normally sterile body site in a patient discharged from a hospital within the prior 12 weeks. Eligible cases were identified from 15 hospitals across 6 U.S. states. For each case, two controls were matched on hospital, month of discharge, and age group. Medical record reviews and telephone interviews were performed. Conditional logistic regression was used to identify independent risk factors for post-discharge invasive MRSA. RESULTS: From February 1, 2011 through March 31, 2013, 194 cases and 388 matched controls were enrolled. The median time between hospital discharge and positive culture was 23 days (range: 1-83 days). Factors independently associated with post-discharge MRSA infection included MRSA colonization (mOR 7.71, 95%CI 3.60-16.51), discharge to a nursing home (mOR 2.65, 95%CI 1.41-4.99), presence of a chronic wound during the post-discharge period (mOR 4.41, 95%CI 2.14-9.09), and discharge with a central venous catheter (CVC) (mOR 2.16, 95%CI 1.13-4.99) or a non-CVC invasive device (mOR 3.03, 95%CI 1.24-7.39) in place. CONCLUSION: Prevention efforts should target patients with MRSA colonization or those with invasive devices or chronic wounds at hospital discharge. In addition, MRSA prevention efforts in nursing homes are warranted. |
Invasive methicillin-resistant staphylococcus aureus infections among chronic dialysis patients in the United States, 2005-2011
Nguyen DB , Lessa FC , Belflower R , Mu Y , Wise M , Nadle J , Bamberg WM , Petit S , Ray SM , Harrison LH , Lynfield R , Dumyati G , Thompson J , Schaffner W , Patel PR . Clin Infect Dis 2013 57 (10) 1393-400 BACKGROUND: Approximately 15,700 invasive methicillin-resistant Staphylococcus aureus (MRSA) infections occurred in U.S. dialysis patients in 2010. Frequent hospital visits and prolonged bloodstream access, especially via central venous catheters (CVCs), are risk factors among hemodialysis patients. We describe the epidemiology of and recent trends in invasive MRSA infections among dialysis patients. METHODS: We analyzed population-based data from nine U.S. metropolitan areas from 2005-2011. Cases were defined as MRSA isolated from a normally sterile body site in a surveillance area resident who received dialysis, and were classified as hospital-onset (HO) (culture collected >3 days after hospital admission) or healthcare-associated community-onset (HACO) (all others). Incidence was calculated using denominators from the U.S. Renal Data System. Temporal trends in incidence and national estimates were calculated controlling for age, gender, and race. RESULTS: From 2005-2011, 7,489 cases were identified; 85.7% were HACO; 93.2% were bloodstream infections. Incidence of invasive MRSA infections decreased from 6.5 to 4.2 per 100 dialysis patients (annual decrease: 7.3%) with annual decreases of 6.7% for HACO and 10.5% for HO cases. Of cases identified during 2009-2011, 70% were hospitalized in the year prior to infection. Among hemodialysis cases, 60.4% were dialyzed through a CVC. The 2011 national estimated number of MRSA infections was 15,169. CONCLUSIONS: There has been a substantial decrease in invasive MRSA infection incidence among dialysis patients. Most cases had previous hospitalizations, suggesting that efforts to control MRSA in hospitals might have contributed to the declines. Infection prevention measures should include improved vascular access and CVC care. |
Epidemiology of community-associated clostridium difficile infection, 2009 Through 2011
Chitnis AS , Holzbauer SM , Belflower RM , Winston LG , Bamberg WM , Lyons C , Farley MM , Dumyati GK , Wilson LE , Beldavs ZG , Dunn JR , Gould LH , Maccannell DR , Gerding DN , McDonald LC , Lessa FC . JAMA Intern Med 2013 173 (14) 1359-67 IMPORTANCE Clostridium difficile infection (CDI) has been increasingly reported among healthy individuals in the community. Recent data suggest that community-associated CDI represents one-third of all C difficile cases. The epidemiology and potential sources of C difficile in the community are not fully understood. OBJECTIVES To determine epidemiological and clinical characteristics of community-associated CDI and to explore potential sources of C difficile acquisition in the community. DESIGN AND SETTING Active population-based and laboratory-based CDI surveillance in 8 US states. PARTICIPANTS Medical records were reviewed and interviews performed to assess outpatient, household, and food exposures among patients with community-associated CDI (ie, toxin or molecular assay positive for C difficile and no overnight stay in a health care facility within 12 weeks). Molecular characterization of C difficile isolates was performed. Outpatient health care exposure in the prior 12 weeks among patients with community-associated CDI was a priori categorized into the following 3 levels: no exposure, low-level exposure (ie, outpatient visit with physician or dentist), or high-level exposure (ie, surgery, dialysis, emergency or urgent care visit, inpatient care with no overnight stay, or health care personnel with direct patient care). MAIN OUTCOMES AND MEASURES Prevalence of outpatient health care exposure among patients with community-associated CDI and identification of potential sources of C difficile by level of outpatient health care exposure. RESULTS Of 984 patients with community-associated CDI, 353 (35.9%) did not receive antibiotics, 177 (18.0%) had no outpatient health care exposure, and 400 (40.7%) had low-level outpatient health care exposure. Thirty-one percent of patients without antibiotic exposure received proton pump inhibitors. Patients having CDI with no or low-level outpatient health care exposure were more likely to be exposed to infants younger than 1 year (P = .04) and to household members with active CDI (P = .05) compared with those having high-level outpatient health care exposure. No association between food exposure or animal exposure and level of outpatient health care exposure was observed. North American pulsed-field gel electrophoresis (NAP) 1 was the most common (21.7%) strain isolated; NAP7 and NAP8 were uncommon (6.7%). CONCLUSIONS AND RELEVANCE Most patients with community-associated CDI had recent outpatient health care exposure, and up to 36% would not be prevented by reduction of antibiotic use only. Our data support evaluation of additional strategies, including further examination of C difficile transmission in outpatient and household settings and reduction of proton pump inhibitor use. |
Follow-up assessment of health consequences after a chlorine release from a train derailment - Graniteville, SC, 2005
Duncan MA , Drociuk D , Belflower-Thomas A , Van Sickle D , Gibson JJ , Youngblood C , Daley WR . J Med Toxicol 2011 7 (1) 85-91 INTRODUCTION: After a train derailment released chlorine gas in Graniteville, South Carolina, in 2005, a multiagency team performed an epidemiologic assessment of chlorine exposure and resulting health effects. Five months later, participants were resurveyed to determine their health status and needs and to assist in planning additional interventions in the community. METHODS: Questionnaires were mailed to 279 patients interviewed in the initial assessment; follow-up telephone calls were made to nonresponders. The questionnaire included questions regarding duration of symptoms experienced after exposure and a posttraumatic stress disorder (PTSD) assessment tool. RESULTS: Ninety-four questionnaires were returned. Seventy-six persons reported chronic symptoms related to the chlorine exposure, 47 were still under a doctor's care, and 49 were still taking medication for chlorine-related problems. Agreement was poor between the first and second questionnaires regarding symptoms experienced after exposure to the chlorine (kappa = 0.30). Forty-four respondents screened positive for PTSD. PTSD was associated with post-exposure hospitalization for three or more nights [relative risk (RR) = 1.7; 95% confidence interval (CI) = 1.1-2.6] and chronic symptoms (RR = 9.1; 95% CI = 1.3-61.2), but not with a moderate-to-extreme level of chlorine exposure (RR = 1.2; 95% CI = 0.8-1.8). CONCLUSIONS: Some victims of this chlorine exposure event continued to experience physical symptoms and continued to require medical care 5 months later. Chronic mental health symptoms were prevalent, especially among persons experiencing the most severe or persistent physical health effects. Patients should be interviewed as soon as possible after an incident because recall of acute symptoms experienced can diminish within months. |
Influenza testing and antiviral prescribing practices among emergency department clinicians in 9 states during the 2006 to 2007 influenza season
Mueller MR , Smith PJ , Baumbach JP , Palumbo JP , Meek JI , Gershman K , Vandermeer M , Thomas AR , Long CE , Belflower R , Spina NL , Martin KG , Lynfield R , Openo KP , Kirley PD , Pasutti LE , Barnes BG , Schaffner W , Kamimoto L . Ann Emerg Med 2010 55 (1) 32-9 STUDY OBJECTIVE: Influenza causes significant widespread illness each year. Emergency department (ED) clinicians are often first-line providers to evaluate and make treatment decisions for patients presenting with influenza. We sought to better understand ED clinician testing and treatment practices in the Emerging Infections Program Network, a federal, state, and academic collaboration that conducts active surveillance for influenza-associated hospitalizations. METHODS: During 2007, a survey was administered to ED clinicians who worked in Emerging Infections Program catchment area hospitals' EDs. The survey encompassed the role of the clinician, years since completing clinical training, hospital type, influenza testing practices, and use of antiviral medications during the 2006 to 2007 influenza season. We examined factors associated with influenza testing and antiviral use. RESULTS: A total of 1,055 ED clinicians from 123 hospitals responded to the survey. A majority of respondents (85.3%; n=887) reported they had tested their patients for influenza during the 2006 to 2007 influenza season (Emerging Infections Program site range: 59.3 to 100%; P<.0001). When asked about antiviral medications, 55.7% (n=576) of respondents stated they had prescribed antiviral medications to some of their patients in 2006 to 2007 (Emerging Infections Program site range 32.9% to 80.3%; P<.0001). A positive association between influenza testing and prescribing antiviral medications was observed. Additionally, the type of hospital, location in which an ED clinician worked, and the number of years since medical training were associated with prescribing antiviral influenza medications. CONCLUSION: There is much heterogeneity in clinician-initiated influenza testing and treatment practices. Additional exploration of the role of hospital testing and treatment policies, clinicians' perception of influenza disease, and methods for educating clinicians about new recommendations is needed to better understand ED clinician testing and treatment decisions, especially in an environment of rapidly changing influenza clinical guidelines. Until influenza testing and treatment guidelines are better promulgated, clinicians may continue to test and treat influenza with inconsistency. |
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