C. difficile was responsible for almost half a million infections and was associated with approximately 29,000 deaths in 2011. (Funded by the Centers for Disease Control and Prevention.).

Corresponding author: Shelley S. Magill, MD, PhD, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, 1600 Clifton Rd., MS A-24, Atlanta, GA 30333, Phone: (404) 639-0291, smagill@cdc.gov. a Current affiliation: Mayo Clinic, Jacksonville, FL, USA b Current affiliation: Tanner Medical Center, Villa Rica, GA, USA The study described herein was presented in abstract form at the Fifth Decennial International Conference on Healthcare-Associated Infections, March 18-22, 2010, Atlanta, GA (Abstract #911). Objective-To determine healthcare-associated infection (HAI) prevalence in nine Jacksonville, FL hospitals, evaluate the performance of proxy indicators for HAIs, and refine methodology in preparation for a multi-state survey. HHS Public Access Design-Point prevalence survey.Patients-Acute care inpatients of any age.Methods-HAIs were defined using National Healthcare Safety Network criteria. In each facility a trained Primary Team (PT) of infection prevention (IP) staff performed the survey on 1 day, reviewing records and collecting data on a random sample of inpatients. PTs assessed patients with ≥1 proxy indicator (abnormal white blood cell count, abnormal temperature, or antimicrobial therapy) for the presence of HAIs. An external IP expert team collected data from a subset of patient records reviewed by PTs to assess proxy indicator performance and PT data collection.Results-Of 851 patients surveyed by PTs, 51 had ≥1 HAI (6.0%, 95% confidence interval 4.5-7.7%). Surgical site infections (n=18), urinary tract infections (n=9), pneumonia (n=9), and bloodstream infections (n=8) accounted for 75.8% of 58 HAIs detected by PTs. Staphylococcus aureus was the most common pathogen, causing 9 HAIs (15.5%). Antimicrobial therapy was the most sensitive proxy indicator, identifying 95.5% of patients with HAIs.

An ongoing question remains for family researchers: Why does a positive association between cohabitation and marital dissolution exist when one of the primary reasons to cohabit is to test relationship compatibility? Drawing on recently collected data from the 2006 – 2008 National Survey of Family Growth, the authors examined whether premarital cohabitation experiences were associated with marital instability among a recent contemporary (married since 1996) marriage cohort of men (N = 1,483) and women (N = 2,003). They found that a dichotomous indicator of premarital cohabitation was in fact not associated with marital instability among women and men. Furthermore, among cohabitors, marital commitment prior to cohabitation (engagement or definite plans for marriage) was tied to lower hazards of marital instability among women, but not men. This research contributes to our understanding of cohabitation, marital instability, and broader family change.

Objectives. To evaluate whether text-messaging programs can improve reproductive health among adolescent girls in low-and middle-income countries.Methods. We conducted a cluster-randomized controlled trial among 756 female students aged 14 to 24 years in Accra, Ghana, in 2014. We randomized 38 schools to unidirectional intervention (n=12), interactive intervention (n=12), and control (n=14).

OBJECTIVE: Little is known about the epidemiology of Clostridium difficile infection (CDI) among children, particularly children ≤3 years of age in whom colonization is common but pathogenicity uncertain. We sought to describe pediatric CDI incidence, clinical presentation, and outcomes across age groups. METHODS: Data from an active population- and laboratory-based CDI surveillance in 10 US geographic areas during 2010–2011 were used to identify cases (ie, residents with C difficile–positive stool without a positive test in the previous 8 weeks). Community-associated (CA) cases had stool collected as outpatients or ≤3 days after hospital admission and no overnight health care facility stay in the previous 12 weeks. A convenience sample of CA cases were interviewed. Demographic, exposure, and clinical data for cases aged 1 to 17 years were compared across 4 age groups: 1 year, 2 to 3 years, 4 to 9 years, and 10 to 17 years. RESULTS: Of 944 pediatric CDI cases identified, 71% were CA. CDI incidence per 100 000 children was highest among 1-year-old (66.3) and white (23.9) cases. The proportion of cases with documented diarrhea (72%) or severe disease (8%) was similar across age groups; no cases died. Among the 84 cases interviewed who reported diarrhea on the day of stool collection, 73% received antibiotics during the previous 12 weeks. CONCLUSIONS: Similar disease severity across age groups suggests an etiologic role for C difficile in the high rates of CDI observed in younger children. Prevention efforts to reduce unnecessary antimicrobial use among young children in outpatient settings should be prioritized.

Background Studies conflict regarding the importance of the fluoroquinolone-resistant North American pulsed-field gel electrophoresis type 1 (NAP1) strain in Clostridium difficile infection (CDI) outcome. We describe strain types causing CDI and evaluate their association with patient outcomes. Methods CDI cases were identified from population-based surveillance. Multivariate regression models were used to evaluate the associations of strain type with severe disease (ileus, toxic megacolon, or pseudomembranous colitis within 5 days; or white blood cell count ≥15,000/mm3 within one day of positive test), severe outcome (intensive care unit admission after positive test, colectomy for C. difficile infection, or death within 30 days of positive test), and death within 14 days of positive test. Results Strain typing results were available for 2,057 cases. Severe disease occurred in 363 (17.7%) cases, severe outcome in 100 (4.9%), and death within 14 days in 56 (2.7%). The most common strain types were NAP1 (28.4%), NAP4 (10.2%) and NAP11 (9.1%). In unadjusted analysis, NAP1 was associated with greater odds of severe disease than other strains. After controlling for patient risk factors, healthcare exposure, and antibiotic use, NAP1 was associated with severe disease (adjusted odds ratio [aOR] 1.74, 95% confidence interval [CI], 1.36–2.22), severe outcome (aOR 1.66, 95% CI, 1.09–2.54), and death within 14 days (aOR 2.12, 95% CI, 1.22–3.68). Conclusion NAP1 was the most prevalent strain and a predictor of severe disease, severe outcome, and death. Strategies to reduce NAP1 prevalence, such as antibiotic stewardship to reduce fluoroquinolone use, might reduce CDI morbidity.

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Objective: To assess the frequency and associated characteristics of COVID-19 vaccine hesitancy among pregnant and postpartum individuals.