Last data update: May 13, 2024. (Total: 46773 publications since 2009)
Records 1-9 (of 9 Records) |
Query Trace: Rimland D[original query] |
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Trends in incidence of norovirus-associated acute gastroenteritis in four Veterans Affairs Medical Center populations in the United States, 2011-2015
Grytdal S , Browne H , Collins N , Vargas B , Rodriguez-Barradas MC , Rimland D , Beenhouwer DO , Brown ST , Bidwell Goetz M , Lucero-Obusan C , Holodniy M , Kambhampati A , Parashar U , Vinje J , Lopman B , Hall AJ , Cardemil CV . Clin Infect Dis 2019 70 (1) 40-48 BACKGROUND: Norovirus is an important cause of epidemic acute gastroenteritis (AGE), yet the burden of endemic disease in adults has not been well documented. We estimated the prevalence and incidence of outpatient and community-acquired inpatient norovirus AGE at 4 Veterans Affairs Medical Centers (VAMC) (Atlanta, Bronx, Houston, and Los Angeles) and examined trends over 4 surveillance years. METHODS: From November 2011 to September 2015, stool specimens collected within 7 days of AGE symptom onset for clinician-requested diagnostic testing were tested for norovirus and positive samples were genotyped. Incidence was calculated by multiplying norovirus prevalence among tested specimens by AGE-coded outpatient encounters and inpatient discharges, and dividing by the number of unique patients served. RESULTS: Of 1,603 stool specimens, 6% tested were positive for norovirus; GII.4 viruses (GII.4 New Orleans [17%] and GII.4 Sydney [47%]) were the most common genotypes. Overall prevalence and outpatient and inpatient community-acquired incidence followed a seasonal pattern, with higher median rates during November-April (9.2%, 376/100,000, and 45/100,000 respectively) compared to May-October (3.0%, 131/100,000 and 13/100,000, respectively). An alternate-year pattern was also detected, with highest peak prevalence, outpatient, and inpatient community-acquired norovirus incidence rates in the first and third years of surveillance (14-25%, 349-613/100,000, and 43-46/100,000). CONCLUSION: This multiyear analysis of laboratory-confirmed AGE surveillance from 4 VAMCs demonstrates dynamic intra- and inter-annual variability in prevalence and incidence of outpatient and inpatient community-acquired norovirus in US Veterans, highlighting the burden of norovirus disease in this adult population. |
Incidence of medically-attended norovirus-associated acute gastroenteritis in four Veteran's Affairs Medical Center populations in the United States, 2011-2012
Grytdal SP , Rimland D , Shirley SH , Rodriguez-Barradas MC , Goetz MB , Brown ST , Lucero-Obusan C , Holodniy M , Graber C , Parashar U , Vinje J , Lopman B . PLoS One 2015 10 (5) e0126733 An estimated 179 million acute gastroenteritis (AGE) illnesses occur annually in the United States. The role of noroviruses in hospital-related AGE has not been well-documented in the U. S. We estimated the population incidence of community- acquired outpatient and inpatient norovirus AGE encounters, as well as hospital-acquired inpatient norovirus AGE among inpatients at four Veterans Affairs (VA) Medical Centers (VAMCs). Fifty (4%) of 1,160 stool specimens collected ≤7 days from symptom onset tested positive for norovirus. During a one year period, the estimated incidence of outpatient, community- and hospital-acquired inpatient norovirus AGE was 188 cases, 11 cases, and 54 cases/ 100,000 patients, respectively. This study demonstrates the incidence of outpatient and community- and hospital-acquired inpatient norovirus AGE among the VA population seeking care at these four VAMCs. |
Duration of colonization with methicillin-resistant Staphylococcus aureus in an acute care facility: a study to assess epidemiologic features
Rogers C , Sharma A , Rimland D , Stafford C , Jernigan J , Satola S , Crispell E , Gaynes R . Am J Infect Control 2014 42 (3) 249-53 BACKGROUND: Patients with a history of methicillin-resistant Staphylococcus aureus (MRSA) colonization or infection are often presumed to remain colonized when they are readmitted to the hospital. This assumption underlies the hospital practice that flags MRSA-positive patients so that these patients can be placed in contact isolation at hospital admission and, when necessary, be given the appropriate empirical therapy and/or antibiotic prophylaxis. METHODS: To determine the duration of and factors associated with MRSA colonization among patients following discharge, we designed a cohort study of patients hospitalized between October 1, 2007, and July 31, 2009, at the Atlanta Veterans Affairs Medical Center, a 128-bed acute care facility. We defined 3 cohorts: cohort A; patients with both a MRSA infection during hospitalization and nasal colonization at discharge; cohort B; patients with a MRSA infection but no nasal colonization at discharge; and cohort C; patients only nasally colonized at discharge. We collected information on demographic characteristics, underlying conditions, infections, and antibiotic use. We cultured nasal swabs obtained from patients at home. We calculated hazard ratios (HR), comparing cohorts A, B, and C after controlling for other factors. RESULTS: We obtained 231 swabs (23 in cohort A, 34 in cohort B, and 174 in cohort C). We documented MRSA colonization in 92 (39.9%) of the 231 patients who returned swabs. The median duration of colonization was 33.3 months. Factors significantly associated with persistent MRSA colonization were (1) total duration of hospital stay from previous admissions prior to study entry and (2) a member of cohort A who had a longer duration of colonization compared with cohorts B and C (P < .001). CONCLUSION: Our data suggest that higher initial inocula of bacteria may be an important determinant of persistent colonization with MRSA. |
Updates of lifetime costs of care and quality of life estimates for HIV-infected persons in the United States: late versus early diagnosis and entry into care
Farnham PG , Gopalappa C , Sansom SL , Hutchinson AB , Brooks JT , Weidle PJ , Marconi VC , Rimland D . J Acquir Immune Defic Syndr 2013 64 (2) 183-9 BACKGROUND: Lifetime costs of care and quality of life estimates for human immunodeficiency virus (HIV)-infected persons depend upon the disease stage at which these persons are diagnosed, enter care, and start antiretroviral therapy (ART). Using updated estimates, we analyzed the effect of late versus early diagnosis/entry on U.S. lifetime care costs, quality of life estimates, and HIV transmissions. METHODS: We used the Progression and Transmission of HIV/AIDS (PATH) model to estimate discounted (3%) lifetime treatment costs ($US 2011) and quality of life variables from time of infection for cohorts of 10,000 HIV-infected index patients in four categories of CD4 count (cells/microL) at diagnosis: (I) ≤ 200; (II) 201 - 350; (III) 351 - 500 and (IV) 501 - 900. We assumed index patient diagnoses were uniformly distributed across the CD4 count range in each category and that patients entered care at the time of diagnosis, remained in care, and were eligible to initiate ART at a CD4 count of 500 cells/microL. We also estimated lifetime transmissions of the index patients. RESULTS: Discounted average lifetime costs varied from $253,000 for category (I) index patients to $402,000 for category (IV) patients. Discounted quality-adjusted life years lost decreased from 7.95 to 4.45 across these categories, additional years of life expectancy increased from 30.8 to 38.1, and lifetime transmissions decreased from 1.40 to 0.72. CONCLUSIONS: Early diagnosis and treatment of HIV infection increases lifetime costs but improves length and quality of life and reduces by nearly 50% the number of new infections transmitted. |
Methicillin-resistant Staphylococcus aureus colonization of the groin and risk for clinical infection among HIV-infected adults
Peters PJ , Brooks JT , McAllister SK , Limbago B , Lowery HK , Fosheim G , Guest JL , Gorwitz RJ , Bethea M , Hageman J , Mindley R , McDougal LK , Rimland D . Emerg Infect Dis 2013 19 (4) 623-629 Data on the interaction between methicillin-resistant Staphylococcus aureus (MRSA) colonization and clinical infection are limited. During 2007-2008, we enrolled HIV-infected adults in Atlanta, Georgia, USA, in a prospective cohort study. Nares and groin swab specimens were cultured for S. aureus at enrollment and after 6 and 12 months. MRSA colonization was detected in 13%-15% of HIV-infected participants (n = 600, 98% male) at baseline, 6 months, and 12 months. MRSA colonization was detected in the nares only (41%), groin only (21%), and at both sites (38%). Over a median of 2.1 years of follow-up, 29 MRSA clinical infections occurred in 25 participants. In multivariate analysis, MRSA clinical infection was significantly associated with MRSA colonization of the groin (adjusted risk ratio 4.8) and a history of MRSA infection (adjusted risk ratio 3.1). MRSA prevention strategies that can effectively prevent or eliminate groin colonization are likely necessary to reduce clinical infections in this population. |
Evaluation of the impact of direct plating, broth enrichment, and specimen source on recovery and diversity of methicillin-resistant Staphylococcus aureus among HIV-infected outpatients
McAllister SK , Albrecht VS , Fosheim GE , Lowery HK , Peters PJ , Gorwitz R , Guest JL , Hageman J , Mindley R , McDougal LK , Rimland D , Limbago B . J Clin Microbiol 2011 49 (12) 4126-30 We compared recovery of Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) from nasal and groin swabs of 600 HIV-infected outpatients by selective and non-selective direct plating and broth enrichment. Swabs were collected at baseline, 6-month and 12-month visits, cultured by direct plating to Mannitol Salt Agar (MSA), CHROMagar MRSA (CM), and overnight broth enrichment with sub-culture to MSA (Broth). MRSA isolates were characterized by pulsed-field gel electrophoresis (PFGE), SCCmec typing and PCR for the Panton-Valentine leukocidin. At each visit 13-15% of patients were colonized with MRSA and 30-33% with methicillin-susceptible S. aureus (MSSA). Broth, CM and MSA detected 95%, 82% and 76% of MRSA-positive specimens, respectively. MRSA recovery was significantly higher from Broth compared to CM (p ≤ 0.001) or MSA (p ≤ 0.001); there was no significant difference in recovery between MSA and CM. MSSA recovery also increased significantly using Broth compared to MSA (p ≤ 0.001). Among specimens collected from the groin, Broth, CM, and MSA detected 88%, 54%, and 49% of the MRSA-positive isolates, respectively. Broth enrichment had a greater impact on recovery of MRSA from the groin than from the nose compared to both CM (p ≤ 0.001) and MSA (p ≤ 0.001). Overall, 19% of MRSA-colonized patients would have been missed with nasal culture only. USA500/Iberian and USA300 were the most common MRSA strains recovered, and USA300 was more likely than other strain types to be recovered from the groin than from the nose (p=0.05). |
Cost-effectiveness of HIV screening in STD clinics, emergency departments, and inpatient units: a model-based analysis
Prabhu VS , Farnham PG , Hutchinson AB , Soorapanth S , Heffelfinger JD , Golden MR , Brooks JT , Rimland D , Sansom SL . PLoS One 2011 6 (5) e19936 BACKGROUND: Identifying and treating persons with human immunodeficiency virus (HIV) infection early in their disease stage is considered an effective means of reducing the impact of the disease. We compared the cost-effectiveness of HIV screening in three settings, sexually transmitted disease (STD) clinics serving men who have sex with men, hospital emergency departments (EDs), settings where patients are likely to be diagnosed early, and inpatient diagnosis based on clinical manifestations. METHODS AND FINDINGS: We developed the Progression and Transmission of HIV/AIDS model, a health state transition model that tracks index patients and their infected partners from HIV infection to death. We used program characteristics for each setting to compare the incremental cost per quality-adjusted life year gained from early versus late diagnosis and treatment. We ran the model for 10,000 index patients for each setting, examining alternative scenarios, excluding and including transmission to partners, and assuming HAART was initiated at a CD4 count of either 350 or 500 cells/microL. Screening in STD clinics and EDs was cost-effective compared with diagnosing inpatients, even when including only the benefits to the index patients. Screening patients in STD clinics, who have less-advanced disease, was cost-effective compared with ED screening when treatment with HAART was initiated at a CD4 count of 500 cells/microL. When the benefits of reduced transmission to partners from early diagnosis were included, screening in settings with less-advanced disease stages was cost-saving compared with screening later in the course of infection. The study was limited by a small number of observations on CD4 count at diagnosis and by including transmission only to first generation partners of the index patients. CONCLUSIONS: HIV prevention efforts can be advanced by screening in settings where patients present with less-advanced stages of HIV infection and by initiating treatment with HAART earlier in the course of infection. |
Methicillin-resistant Staphylococcus aureus colonization in HIV-infected outpatients is common and detection is enhanced by groin culture
Peters PJ , Brooks JT , Limbago B , Lowery HK , McAllister SK , Mindley R , Fosheim G , Gorwitz RJ , Guest JL , Hageman J , Fridge J , Rimland D . Epidemiol Infect 2010 139 (7) 1-11 Although high rates of clinical infection with methicillin-resistant Staphylococcus aureus (MRSA) have been reported in HIV-infected adults, data on MRSA colonization are limited. We enrolled HIV-infected adults receiving care at the Atlanta VA Medical Center. Swabs from each participant's nares and groin were cultured with broth enrichment for S. aureus. Of 600 HIV-infected adults, 79 (13%) were colonized with MRSA and 180 (30%) with methicillin-susceptible S. aureus. MRSA pulsed-field gel electrophoresis types USA300 (n=44, 54%) and USA500/Iberian (n=29, 35%) predominated. Inclusion of groin swabs increased MRSA detection by 24% and USA300 detection by 38%. In multivariate analysis, MRSA colonization compared to no MRSA colonization was associated with a history of MRSA clinical infection, rarely or never using condoms, and contact with prisons and jails. In summary, the prevalence of MRSA colonization was high in this study of HIV-infected adults and detection of USA300 was enhanced by groin culture. |
Hospitalization earlier than 1 year prior to admission as an additional risk factor for methicillin-resistant Staphylococcus aureus colonization
McAllister L , Gaynes RP , Rimland D , McGowan Jr JE . Infect Control Hosp Epidemiol 2010 31 (5) 538-40 Our case-control study sought to identify risk factors for colonization with methicillin-resistant Staphylococcus aureus (MRSA) at hospital admission among patients with no known healthcare-related risk factors. We found that patients whose most recent hospitalization occurred greater than 1 year before their current hospital admission were more likely to have MRSA colonization. In addition, both the time that elapsed since the most recent hospitalization and the duration of that hospitalization affected risk. |
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