Last data update: Nov 11, 2024. (Total: 48109 publications since 2009)
Records 1-11 (of 11 Records) |
Query Trace: Sievert DM[original query] |
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Comparative antimicrobial use in coronavirus disease 2019 (COVID-19) and non-COVID-19 inpatients from 2019 to 2020: A multicenter ecological study
Santos CAQ , Tseng M , Martinez AI , Shankaran S , Hodgson HA , Ahmad FS , Zhang H , Sievert DM , Trick WE . Infect Control Hosp Epidemiol 2023 1-8 OBJECTIVE: We sought to determine whether increased antimicrobial use (AU) at the onset of the coronavirus disease 2019 (COVID-19) pandemic was driven by greater AU in COVID-19 patients only, or whether AU also increased in non-COVID-19 patients. DESIGN: In this retrospective observational ecological study from 2019 to 2020, we stratified inpatients by COVID-19 status and determined relative percentage differences in median monthly AU in COVID-19 patients versus non-COVID-19 patients during the COVID-19 period (March-December 2020) and the pre-COVID-19 period (March-December 2019). We also determined relative percentage differences in median monthly AU in non-COVID-19 patients during the COVID-19 period versus the pre-COVID-19 period. Statistical significance was assessed using Wilcoxon signed-rank tests. SETTING: The study was conducted in 3 acute-care hospitals in Chicago, Illinois. PATIENTS: Hospitalized patients. RESULTS: Facility-wide AU for broad-spectrum antibacterial agents predominantly used for hospital-onset infections was significantly greater in COVID-19 patients versus non-COVID-19 patients during the COVID-19 period (with relative increases of 73%, 66%, and 91% for hospitals A, B, and C, respectively), and during the pre-COVID-19 period (with relative increases of 52%, 64%, and 66% for hospitals A, B, and C, respectively). In contrast, facility-wide AU for all antibacterial agents was significantly lower in non-COVID-19 patients during the COVID-19 period versus the pre-COVID-19 period (with relative decreases of 8%, 7%, and 8% in hospitals A, B, and C, respectively). CONCLUSIONS: AU for broad-spectrum antimicrobials was greater in COVID-19 patients compared to non-COVID-19 patients at the onset of the pandemic. AU for all antibacterial agents in non-COVID-19 patients decreased in the COVID-19 period compared to the pre-COVID-19 period. |
Antibiotic resistance: A global problem and the need to do more
Lessa FC , Sievert DM . Clin Infect Dis 2023 77 S1-s3 The discovery of penicillin in 1928 and its initial use in the 1940s to treat serious infections marked a turning point in modern medicine saving millions of lives [1]. However, antibiotic resistance (AR) has long threatened the advances of modern medicine. Widespread use of penicillin in clinical therapy started in 1943, and a decade later penicillin resistance had already become a major clinical problem [2]. This same phenomenon has been seen with each new antibiotic that has been approved for clinical use. A landmark study recently published showed that in 2019 AR killed more people than any other infectious diseases including human immunodeficiency virus (HIV) and malaria [3]. One in 8 deaths globally are linked to bacterial infections, the second leading cause of death after ischemic heart disease |
Antimicrobial-resistant pathogens associated with healthcare-associated infections: Summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2011-2014
Weiner LM , Webb AK , Limbago B , Dudeck MA , Patel J , Kallen AJ , Edwards JR , Sievert DM . Infect Control Hosp Epidemiol 2016 37 (11) 1-14 OBJECTIVE To describe antimicrobial resistance patterns for healthcare-associated infections (HAIs) that occurred in 2011-2014 and were reported to the Centers for Disease Control and Prevention's National Healthcare Safety Network. METHODS Data from central line-associated bloodstream infections, catheter-associated urinary tract infections, ventilator-associated pneumonias, and surgical site infections were analyzed. These HAIs were reported from acute care hospitals, long-term acute care hospitals, and inpatient rehabilitation facilities. Pooled mean proportions of pathogens that tested resistant (or nonsusceptible) to selected antimicrobials were calculated by year and HAI type. RESULTS Overall, 4,515 hospitals reported that at least 1 HAI occurred in 2011-2014. There were 408,151 pathogens from 365,490 HAIs reported to the National Healthcare Safety Network, most of which were reported from acute care hospitals with greater than 200 beds. Fifteen pathogen groups accounted for 87% of reported pathogens; the most common included Escherichia coli (15%), Staphylococcus aureus (12%), Klebsiella species (8%), and coagulase-negative staphylococci (8%). In general, the proportion of isolates with common resistance phenotypes was higher among device-associated HAIs compared with surgical site infections. Although the percent resistance for most phenotypes was similar to earlier reports, an increase in the magnitude of the resistance percentages among E. coli pathogens was noted, especially related to fluoroquinolone resistance. CONCLUSION This report represents a national summary of antimicrobial resistance among select HAIs and phenotypes. The distribution of frequent pathogens and some resistance patterns appear to have changed from 2009-2010, highlighting the need for continual, careful monitoring of these data across the spectrum of HAI types. Infect Control Hosp Epidemiol 2016;1-14. |
Evaluating state-specific antibiotic resistance measures derived from central line-associated bloodstream infections, National Healthcare Safety Network, 2011
Soe MM , Edwards JR , Sievert DM , Ricks PM , Magill SS , Fridkin SK . Infect Control Hosp Epidemiol 2015 36 (1) 54-64 DISCLOSURE: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or the Agency for Toxic Substances and Diseases Registry. OBJECTIVE: Describe the impact of standardizing state-specific summary measures of antibiotic resistance that inform regional interventions to reduce transmission of resistant pathogens in healthcare settings. DESIGN: Analysis of public health surveillance data. METHODS: Central line-associated bloodstream infection (CLABSI) data from intensive care units (ICUs) of facilities reporting to the National Healthcare Safety Network in 2011 were analyzed. For CLABSI due to methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum cephalosporin (ESC)-nonsusceptible Klebsiella species, and carbapenem-nonsusceptible Klebsiella species, we computed 3 state-level summary measures of nonsusceptibility: crude percent nonsusceptible, model-based adjusted percent nonsusceptible, and crude infection incidence rate. RESULTS: Overall, 1,791 facilities reported CLABSIs from ICU patients. Of 1,618 S. aureus CLABSIs with methicillin-susceptibility test results, 791 (48.9%) were due to MRSA. Of 756 Klebsiella CLABSIs with ESC-susceptibility test results, 209 (27.7%) were due to ESC-nonsusceptible Klebsiella, and among 661 Klebsiella CLABSI with carbapenem susceptibility test results, 70 (10.6%) were due to carbapenem-nonsusceptible Klebsiella. All 3 state-specific measures demonstrated variability in magnitude by state. Adjusted measures, with few exceptions, were not appreciably different from crude values for any phenotypes. When linking values of crude and adjusted percent nonsusceptible by state, a state's absolute rank shifted slightly for MRSA in 5 instances and only once each for ESC-nonsusceptible and carbapenem-nonsusceptible Klebsiella species. Infection incidence measures correlated strongly with both percent nonsusceptibility measures. CONCLUSIONS: Crude state-level summary measures, based on existing NHSN CLABSI data, may suffice to assess geographic variability in antibiotic resistance. As additional variables related to antibiotic resistance become available, risk-adjusted summary measures are preferable. |
National Healthcare Safety Network report, data summary for 2013, device-associated Module
Dudeck MA , Edwards JR , Allen-Bridson K , Gross C , Malpiedi PJ , Peterson KD , Pollock DA , Weiner LM , Sievert DM . Am J Infect Control 2015 43 (3) 206-21 This report is a summary of Device-associated (DA) Module data collected by hospitals participating in the National Healthcare Safety Network (NHSN) for events occurring from January through December 2013 and reported to the Centers for Disease Control and Prevention (CDC) by June 1, 2014. This report updates previously published DA Module data from NHSN and provides contemporary comparative rates.1 Figure 1 provides a brief summary of highlights from this report. This report complements other NHSN reports, including national and state-specific progress reports for select healthcare-associated infections (HAIs).2 |
National Healthcare Safety Network (NHSN) report, data summary for 2012, Device-associated module
Dudeck MA , Weiner LM , Allen-Bridson K , Malpiedi PJ , Peterson KD , Pollock DA , Sievert DM , Edwards JR . Am J Infect Control 2013 41 (12) 1148-66 This report is a summary of Device-associated (DA) Module data collected by hospitals participating in the National Healthcare Safety Network (NHSN) for events occurring from January through December 2012 and reported to the Centers for Disease Control and Prevention (CDC) by July 1, 2013. This report updates previously published DA Module data from NHSN and provides contemporary comparative rates.1 Figure 1 provides a brief summary of key findings from this report. This report complements other NHSN reports, including national and state-specific reports of standardized infection ratios (SIRs) for select healthcare-associated infections (HAIs).2, 3 |
Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009-2010
Sievert DM , Ricks P , Edwards JR , Schneider A , Patel J , Srinivasan A , Kallen A , Limbago B , Fridkin S . Infect Control Hosp Epidemiol 2013 34 (1) 1-14 OBJECTIVE: To describe antimicrobial resistance patterns for healthcare-associated infections (HAIs) reported to the National Healthcare Safety Network (NHSN) during 2009-2010. METHODS: Central line-associated bloodstream infections, catheter-associated urinary tract infections, ventilator-associated pneumonia, and surgical site infections were included. Pooled mean proportions of isolates interpreted as resistant (or, in some cases, nonsusceptible) to selected antimicrobial agents were calculated by type of HAI and compared to historical data. RESULTS: Overall, 2,039 hospitals reported 1 or more HAIs; 1,749 (86%) were general acute care hospitals, and 1,143 (56%) had fewer than 200 beds. There were 69,475 HAIs and 81,139 pathogens reported. Eight pathogen groups accounted for about 80% of reported pathogens: Staphylococcus aureus (16%), Enterococcus spp. (14%), Escherichia coli (12%), coagulase-negative staphylococci (11%), Candida spp. (9%), Klebsiella pneumoniae (and Klebsiella oxytoca; 8%), Pseudomonas aeruginosa (8%), and Enterobacter spp. (5%). The percentage of resistance was similar to that reported in the previous 2-year period, with a slight decrease in the percentage of S. aureus resistant to oxacillins (MRSA). Nearly 20% of pathogens reported from all HAIs were the following multidrug-resistant phenotypes: MRSA (8.5%); vancomycin-resistant Enterococcus (3%); extended-spectrum cephalosporin-resistant K. pneumoniae and K. oxytoca (2%), E. coli (2%), and Enterobacter spp. (2%); and carbapenem-resistant P. aeruginosa (2%), K. pneumoniae/oxytoca (<1%), E. coli (<1%), and Enterobacter spp. (<1%). Among facilities reporting HAIs with 1 of the above gram-negative bacteria, 20%-40% reported at least 1 with the resistant phenotype. CONCLUSION: While the proportion of resistant isolates did not substantially change from that in the previous 2 years, multidrug-resistant gram-negative phenotypes were reported from a moderate proportion of facilities. |
Device-associated infection rates, device utilization, and antimicrobial resistance in long-term acute care hospitals reporting to the National Healthcare Safety Network, 2010
Chitnis AS , Edwards JR , Ricks PM , Sievert DM , Fridkin SK , Gould CV . Infect Control Hosp Epidemiol 2012 33 (10) 993-1000 OBJECTIVE: To evaluate national data on healthcare-associated infections (HAIs), device utilization, and antimicrobial resistance in long-term acute care hospitals (LTACHs). DESIGN AND SETTING: Comparison of data from LTACHs and from medical and medical-surgical intensive care units (ICUs) in short-stay acute care hospitals reporting to the National Healthcare Safety Network (NHSN) during 2010. METHODS: Rates of central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), and ventilator-associated pneumonia (VAP) as well as device utilization ratios were calculated. For each HAI, pathogen profiles and antimicrobial resistance prevalence were evaluated. Comparisons were made using Poisson regression and the Mood median and chi(2) tests. RESULTS: In 2010, 104 LTACHs reported CLABSIs and 57 reported CAUTIs and VAP to the NHSN. Median CLABSI rates in LTACHs (1.25 events per 1,000 device-days reported; range, 0.0-5.96) were comparable to rates in major teaching ICUs and were higher than those in other ICUs. CAUTI rates in LTACHs (median, 2.61; range, 0.0-9.92) were higher and VAP rates (median, 0.0; range, 0.0-3.29) were generally lower than those in ICUs. Central line utilization in LTACHs was higher than that in ICUs, whereas urinary catheter and ventilator utilization was lower. Methicillin resistance among Staphylococcus aureus CLABSIs (83%) and vancomycin resistance among Enterococcus faecalis CAUTIs (44%) were higher in LTACHs than in ICUs. Multidrug resistance among Pseudomonas aeruginosa CAUTIs (25%) was higher in LTACHs than in most ICUs. CONCLUSIONS: CLABSIs and CAUTIs associated with multidrug-resistant organisms present a challenge in LTACHs. Continued HAI surveillance with pathogen-level data can guide prevention efforts in LTACHs. |
A multivariable model to classify methicillin-resistant staphylococcus aureus infections as health care or community associated
Sievert DM , Boulton ML , Wilson ML , Wilkins MJ , Gillespie BW . Infect Dis Clin Pract (Baltim Md) 2012 20 (1) 42-48 BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) infections are often defined as health care (HA) or community-associated (CA) using common classification schemes involving health care risk factor, infection type, susceptibility pattern, or molecular typing. This investigation compared pulsed-field gel electrophoresis (PFGE) molecular typing results (dichotomized as HA or CA) with our new MRSA infection classification method. The goal was to develop an improved predictive model for PFGE-type based primarily on the other 3 classification variables. METHODS: Methicillin-resistant S. aureus infections reported to the Michigan Department of Community Health from October 2004 to December 2005 were analyzed. Patients' demographics, risk factors, infection information, and susceptibility results were collected for 2151 cases. A subset of 244 MRSA infections with available PFGE results was analyzed. Results of logistic regression are presented using a receiver operating characteristic curve analysis. RESULTS: The multivariable models predicted the PFGE classification as HA or CA (Max-rescaled R = 61%) better than health care risk factor, infection type, or susceptibility pattern alone (max-rescaled R = 21%, 34%, and 46%, respectively). The best model included infection type, susceptibility pattern, age, and hospitalized during infection. CONCLUSIONS: This model provides a simpler, more accurate prediction of HA or CA status, thus enhancing efforts to control MRSA infections. (Copyright 2011 Lippincott Williams &Wilkins.) |
Using electronic health information to risk-stratify rates of Clostridium difficile infection in US hospitals
Zilberberg MD , Tabak YP , Sievert DM , Derby KG , Johannes RS , Sun X , McDonald LC . Infect Control Hosp Epidemiol 2011 32 (7) 649-55 BACKGROUND: Expanding hospitalized patients' risk stratification for Clostridium difficile infection (CDI) is important for improving patient safety. We applied definitions for hospital-onset (HO) and community-onset (CO) CDI to electronic data from 85 hospitals between January 2007 and June 2008 to identify factors associated with higher HO CDI rates. METHODS: Nonrecurrent CDI cases were identified among adult (≥18-year-old) inpatients by a positive C. difficile toxin assay result more than 8 weeks after any previous positive result. Case categories included HO, CO-hospital associated (CO-HA), CO-indeterminate hospital association (CO-IN), and CO-non-hospital associated (CO-NHA). C. difficile testing intensity (CDTI) was defined as the total number of C. difficile tests performed, normalized to the number of patients with at least 1 C. difficile toxin test recorded. We calculated both the incidence density and the prevalence of CDI where appropriate. We fitted a multivariable Poisson model to identify factors associated with higher HO CDI rates. RESULTS: Among 1,351,156 unique patients with 2,022,213 admissions, 9,803 cases of CDI were identified; of these, 50.6% were HO, 17.4% were CO-HA, 9.0% were CO-IN, and 23.0% were CO-NHA. The incidence density of HO was 6.3 per 10,000 patient-days. The prevalence of CO CDI on admission was, per 10,000 admissions, 8.4 for CO-HA, 4.4 for CO-IN, and 11.1 for CO-NHA. Factors associated ([Formula: see text]) with higher HO CDI rates included older age, higher CO-NHA prevalence on admission, and increased CDTI. CONCLUSION: Electronic health information can be leveraged to risk-stratify HO CDI rates by patient age and CO-NHA prevalence on admission. Hospitals should optimize diagnostic testing to improve patient care and measured CDI rates. |
Public health surveillance for methicillin-resistant Staphylococcus aureus: comparison of methods for classifying health care- and community-associated infections
Sievert DM , Wilson ML , Wilkins MJ , Gillespie BW , Boulton ML . Am J Public Health 2010 100 (9) 1777-83 OBJECTIVES: We compared 3 methods for classifying methicillin-resistant Staphylococcus aureus (MRSA) infections as health care associated or community associated for use in public health surveillance. METHODS: We analyzed data on MRSA infections reported to the Michigan Department of Community Health from October 1, 2004, to December 31, 2005. Patient demographics, risk factors, infection information, and susceptibility were collected for 2151 cases. We classified each case by the health care risk factor, infection-type, and susceptibility pattern methods and compared the results of the 3 methods. RESULTS: Demographic, clinical, and microbiological variables yielded similar health care-associated and community-associated distributions when classified by risk factor and infection type. When 2 methods yielded the same classifications, the overall distribution was similar to classification by 3 methods. No specific combination of 2 methods was superior. CONCLUSIONS: MRSA categorization by 2 methods is more accurate than it is by a single method. The health care risk factor and infection-type methods yield comparable classification results. Accuracy is increased by using more variables; however, further research is needed to identify the optimal combination. |
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