The Effect of a Nationwide Infection Control Program Expansion on Hospital-Onset Gram-Negative Rod Bacteremia in 130 Veterans Health Administration Medical Centers: An Interrupted Time-Series Analysis

Goto, Michihiko; O'Shea, Amy; Livorsi, Daniel J; McDanel, Jennifer S.; Jones, Makoto; Richardson, Kelly; Beck, Brice; Alexander, Bruce; Evans, Martin E.; Roselle, Gary A.; Kralovic, Stephen M.; Perencevich, Eli N.

doi:10.1093/cid/ciw423

Cited by 40 publications

(44 citation statements)

References 36 publications

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“…17,18,27,28 This initiative may have also led to reductions in other noneS aureus infections as well, through expanded infection control programs and resources. 29 However, similar trends have been observed nationally outside the VA, which may suggest shifts in strain epidemiology and may also contribute to our findings. 30 Further work in this area will need to occur to identify why the trends we observed occurred.…”

Section: Discussionsupporting

confidence: 85%

Trends in Collection of Microbiological Cultures Across Veterans Affairs Community Living Centers in the United States Over 8 Years

Appaneal

Caffrey

Hughes

et al. 2020

Journal of the American Medical Directors Association

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Objectives: To describe and evaluate changes in the collection of microbiological cultures across Veterans Affairs (VA) Community Living Centers (CLCs) nationally. Design: Descriptive study. Setting: 146 VA CLCs. Participants: We identified both positive and negative microbiological cultures collected during VA CLC admissions from January 2010 through December 2017. Measures: We measured the average annual percentage change (AAPC) in the rate of cultures collected per 1000 bed days and per admission, overall and stratified by culture type (ie, urine, blood, skin and soft tissue, and respiratory tract). AAPCs were also calculated for the proportion and rate of positive cultures collected, overall and stratified by culture type and organism (ie, Escherichia coli, Proteus mirabilis, Staphylococcus aureus, Enterococcus spp, Pseudomonas aeruginosa, Klebsiella spp, Enterobacter spp, Morganella morganii, Citrobacter spp, Serratia marcescens, and Streptococcus pneumoniae). Joinpoint regression software was used to assess trends and estimate AAPCs and 95% confidence intervals (CIs). Results: Over 8 years, 355,329 cultures were collected. The rate of cultures collected per 1000 bed days of care decreased significantly by 6.0% per year (95% CI e8.7%, À3.2%). The proportion of positive cultures decreased by 0.9% (95% CI e1.4%, À0.4%). The most common culture types were urine (48.4%), followed by blood (27.7%). The rate of cultures collected per 1000 bed days of care decreased per year by 6.3% for urine, 5.0% for blood, 4.4% for skin and soft tissue, and 4.9% for respiratory tract. In 2010, S aureus was the most common organism identified, and in all subsequent years E coli was the most common. Conclusion and implications: We identified a significant reduction in the number of cultures collected over time among VA CLCs. Our findings may be explained by decreases in the collection of unnecessary

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Section: Discussionsupporting

confidence: 85%

Trends in Collection of Microbiological Cultures Across Veterans Affairs Community Living Centers in the United States Over 8 Years

Appaneal

Caffrey

Hughes

et al. 2020

Journal of the American Medical Directors Association

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“…Furthermore, in the USA, increases in hospital-onset Gram-negative bloodstream infections decreased after introduction of an MRSA prevention initiative, while community-acquired incidence remained unchanged. 37 MRSA and C difficile are predominantly hospitalassociated pathogens and differences in the epidemiology of E coli bloodstream infection suggest a need for different interventions, particularly in primary care. 7 For instance, recurrences in E coli bloodstream infection explain little of the ongoing increasing incidence, and the incidence of both co-amoxiclav-resistant and coamoxiclav-susceptible E coli bloodstream infections are increasing.…”

Section: Discussionmentioning

confidence: 99%

Trends over time in Escherichia coli bloodstream infections, urinary tract infections, and antibiotic susceptibilities in Oxfordshire, UK, 1998–2016: a study of electronic health records

Vihta

Stoesser

Llewelyn

et al. 2018

The Lancet Infectious Diseases

135

113

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“…Infection control measures are generally classified as vertical approaches and horizontal approaches [16]. While vertical approaches utilize activities that are directed at a single type of pathogen or resistance pattern, horizontal approaches, such as hand hygiene or prevention bundles for catheter-related bloodstream infection, aim to reduce the risk of infections due to a broad array of pathogens irrespective of resistance pattern [17]. Our results call for more attention towards horizontal infection control measures rather than vertical measures, which typically target only specific pathogens or resistant organisms.…”

Section: Discussionmentioning

confidence: 99%

Excess Length of Acute Inpatient Stay Attributable to Acquisition of Hospital-Onset Gram-Negative Bloodstream Infection with and without Antibiotic Resistance: A Multistate Model Analysis

et al. 2020

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Excess length of stay (LOS) is an important outcome when assessing the burden of nosocomial infection, but it can be subject to survival bias. We aimed to estimate the change in LOS attributable to hospital-onset (HO) Escherichia coli/Klebsiella spp. bacteremia using multistate models to circumvent survival bias. We analyzed a cohort of all patients with HO E. coli/Klebsiella spp. bacteremia and matched uninfected control patients within the U.S. Veterans Health Administration System in 2003–2013. A multistate model was used to estimate the change in LOS as an effect of the intermediate state (HO-bacteremia). We stratified analyses by susceptibilities to fluoroquinolones (fluoroquinolone susceptible (FQ-S)/fluoroquinolone resistant (FQ-R)) and extended-spectrum cephalosporins (ESC susceptible (ESC-S)/ESC resistant (ESC-R)). Among the 5964 patients with HO bacteremia analyzed, 957 (16.9%) and 1638 (28.9%) patients had organisms resistant to FQ and ESC, respectively. Any HO E.coli/Klebsiella bacteremia was associated with excess LOS, and both FQ-R and ESC-R were associated with a longer LOS than susceptible strains, but the additional burdens attributable to resistance were small compared to HO bacteremia itself (FQ-S: 12.13 days vs. FQ-R: 12.94 days, difference: 0.81 days (95% CI: 0.56–1.05), p < 0.001 and ESC-S: 11.57 days vs. ESC-R: 16.56 days, difference: 4.99 days (95% CI: 4.75–5.24), p < 0.001). Accurate measurements of excess attributable LOS associated with resistance can help support the business case for infection control interventions.

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The Effect of a Nationwide Infection Control Program Expansion on Hospital-Onset Gram-Negative Rod Bacteremia in 130 Veterans Health Administration Medical Centers: An Interrupted Time-Series Analysis

Cited by 40 publications

References 36 publications

Trends in Collection of Microbiological Cultures Across Veterans Affairs Community Living Centers in the United States Over 8 Years

Trends in Collection of Microbiological Cultures Across Veterans Affairs Community Living Centers in the United States Over 8 Years

Trends over time in Escherichia coli bloodstream infections, urinary tract infections, and antibiotic susceptibilities in Oxfordshire, UK, 1998–2016: a study of electronic health records

Excess Length of Acute Inpatient Stay Attributable to Acquisition of Hospital-Onset Gram-Negative Bloodstream Infection with and without Antibiotic Resistance: A Multistate Model Analysis

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