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We performed a retrospective analysis of the changes in accuracy of International Classification of Diseases, Clinical Modification (ICD-CM) diagnosis codes for colectomy and hysterectomy surgical site infection surveillance. After the transition from ICD-CM ninth edition to tenth edition codes, there was no significant change in the accuracy of these codes for SSI surveillance.

Abstract Background Community-acquired extended-spectrum beta-lactamase–producing Enterobacteriaceae (ESBL) infections are an evolving public health problem. Identifying predictive risk factors may improve patient management. Methods We identified 251 adult inpatients admitted to a 22-hospital system with an ESBL urinary tract infection (UTI) between 2001 and 2016. Cases were matched 1:1 with controls who had a UTI at admission with non-ESBL Enterobacteriaceae. Cases with a history of ESBL infections or hospitalization within 3 months of index admission were excluded. Univariate and multiple logistic regression were used to identify risk factors associated with ESBL UTIs. Results In univariate analysis, history of repeated UTIs, neurogenic bladder, urinary catheter presence at admission, and exposure to outpatient third-generation cephalosporins or fluoroquinolones within 3 months were associated with higher risk of ESBL UTIs. When controlling for severity of illness and comorbid conditions, history of repeated UTIs (adjusted odds ratio [aOR], 6.40; 95% confidence interval [CI], 3.42–12.66; P < .001), presence of urinary catheter at admission (aOR, 2.36; 95% CI, 1.15–4.98; P < .05), and prior antibiotic exposure (aOR, 7.98; 95% CI, 2.92–28.19; P < .001) remained associated with risk of ESBL infection. Conclusions Patients in the community with indwelling urinary catheters, history of recurrent UTIs, or recent antimicrobial use are at higher risk for de novo ESBL Enterobacteriaceae UTIs.

OBJECTIVE To determine the frequency, risk factors, and outcomes for vancomycin-resistant Enterococcus (VRE) colonization and infection in patients with newly diagnosed acute leukemia. DESIGN Retrospective clinical study with VRE molecular strain typing. SETTING A regional referral center for acute leukemia. PATIENTS Two hundred fourteen consecutive patients with newly diagnosed acute leukemia between 2006 and 2012. METHODS All patients had a culture of first stool and weekly surveillance for VRE. Clinical data were abstracted from the Intermountain Healthcare electronic data warehouse. VRE molecular typing was performed utilizing the semi-automated DiversiLab System. RESULTS The rate of VRE colonization was directly proportional to length of stay and was higher in patients with acute lymphoblastic leukemia. Risk factors associated with colonization include administration of corticosteroids (P=0.004) and carbapenems (P=0.009). Neither a colonized prior room occupant nor an increased unit colonization pressure affected colonization risk. Colonized patients with acute myelogenous leukemia had an increased risk of VRE bloodstream infection (BSI, P=0.002). Other risk factors for VRE BSI include severe neutropenia (P=0.04) and diarrhea (P=0.008). Fifty-eight percent of BSI isolates were identical or related by molecular typing. Eighty-nine percent of bloodstream isolates were identical or related to stool isolates identified by surveillance cultures. VRE BSI was associated with increased costs (P=0.0003) and possibly mortality. CONCLUSIONS VRE colonization has important consequences for patients with acute myelogenous leukemia undergoing induction therapy. For febrile neutropenic patients with acute myelogenous leukemia, use of empirical antibiotic regimens that avoid carbapenems and include VRE coverage may be helpful in decreasing the risks associated with VRE BSI.

Pneumococcal conjugate vaccines (PCV) have indirect effects due to decreased Streptococcus pneumoniae colonization in vaccine recipients. We sought to determine whether the introduction of PCV13 in children led to changes in the epidemiology and clinical manifestations of invasive pneumococcal disease (IPD) in adults. We described demographics, comorbidities, clinical manifestations, and serotypes of IPD in Utah adults before (November 2009−February 2010) and after (March 2010−March 2012) the introduction of PCV13 in children. We also compare serotypes causing IPD in Utah adults and children. After the introduction of PCV13 in the childhood vaccine program, the proportion of IPD due to PCV13 exclusive serotypes decreased significantly in Utah adults (64−40%, p=0.009), primarily due to a decline in serotype 7F (36−15%, p=0.008). There were non-significant increases in IPD due to Pneumococcal polysaccharide 23 (PPV23) unique serotypes and non-vaccine serotypes, most notably serotype 22F. Changes in the proportions of vaccine and non-vaccine serotypes were similar in adults and children. Meningitis was more commonly due to non-vaccine serotypes relative to non-meningitis cases (47% vs. 18%, p=0.007). When stratified by sex, decreases in PCV13 serotype IPD were only noted in men (76−33%, p=0.001). Serotype epidemiology of IPD in adults closely follows that of children in the PCV13 era. Continued surveillance is needed to confirm whether replacement serotypes will lead to increases in pneumococcal meningitis and whether there are sex differences in the indirect effects of PCV vaccination in children.

A study with a test-negative design analyzed 41,552 admissions to 187 hospitals and 21,522 visits to 221 EDs or urgent care clinics. The mRNA-based vaccines (≥14 days after the second dose) were highly effective against SARS-CoV-2 infection leading to hospitalization (89%), ICU admission (90%), or an urgent care visit (91%).

► We investigated the serotype distribution of IPD in Utah adults. ► PCV7 does not seem to have increased necrotizing pneumonia and empyema in adults. ► PCV7 serotypes have nearly disappeared among Utah adults and children. ► The majority of IPD serotypes in Utah adults and children are included in PCV13. ► PCV in children may impact serotypes in adults more than PPV in adults. While heptavalent pneumococcal conjugate vaccine (PCV) has decreased vaccine type invasive pneumococcal disease (IPD) nationwide, rapid serotype replacement and increasing parapneumonic empyema, has been reported in Utah children. The effect of pediatric vaccination on adults in this population is unknown. We identified 117 adults with IPD from the Intermountain Healthcare Central Laboratory between November 2009 and October 2010. We serotyped 61 (52%) stored isolates. We compared the serotype distribution of adult IPD isolates with that of pediatric isolates collected in 2009–2010. PCV7 serotypes were rare in adults (3%) and children (3%). Emerging 13-valent PCV serotypes 3, 7F, and 19A caused the majority of IPD in adults (63%) and children (56%). Fifty-one (84%) adult isolates were serotypes included in 23-valent polysaccharide vaccine and 66% in PCV13. Adult and pediatric IPD serotypes are closely associated in Utah. PCV13 vaccination in Utah children is likely to significantly impact IPD in Utah adults.

AbstractObjectiveTo estimate the effectiveness of mRNA vaccines against moderate and severe covid-19 in adults by time since second, third, or fourth doses, and by age and immunocompromised status.DesignTest negative case-control study.SettingHospitals, emergency departments, and urgent care clinics in 10 US states, 17 January 2021 to 12 July 2022.Participants893 461 adults (≥18 years) admitted to one of 261 hospitals or to one of 272 emergency department or 119 urgent care centers for covid-like illness tested for SARS-CoV-2.Main outcome measuresThe main outcome was waning of vaccine effectiveness with BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna) vaccine during the omicron and delta periods, and the period before delta was dominant using logistic regression conditioned on calendar week and geographic area while adjusting for age, race, ethnicity, local virus circulation, immunocompromised status, and likelihood of being vaccinated.Results45 903 people admitted to hospital with covid-19 (cases) were compared with 213 103 people with covid-like illness who tested negative for SARS-CoV-2 (controls), and 103 287 people admitted to emergency department or urgent care with covid-19 (cases) were compared with 531 168 people with covid-like illness who tested negative for SARS-CoV-2. In the omicron period, vaccine effectiveness against covid-19 requiring admission to hospital was 89% (95% confidence interval 88% to 90%) within two months after dose 3 but waned to 66% (63% to 68%) by four to five months. Vaccine effectiveness of three doses against emergency department or urgent care visits was 83% (82% to 84%) initially but waned to 46% (44% to 49%) by four to five months. Waning was evident in all subgroups, including young adults and individuals who were not immunocompromised; although waning was morein people who were immunocompromised. Vaccine effectiveness increased among most groups after a fourth dose in whom this booster was recommended.ConclusionsEffectiveness of mRNA vaccines against moderate and severe covid-19 waned with time after vaccination. The findings support recommendations for a booster dose after a primary series and consideration of additional booster doses.

Respiratory syncytial virus vaccines first recommended for use during 2023 were efficacious against lower respiratory tract disease in clinical trials. Limited real-world data regarding respiratory syncytial virus vaccine effectiveness are available. To inform vaccine policy and address gaps in evidence from the clinical trials, we aimed to assess the effectiveness against respiratory syncytial virus-associated hospitalisations and emergency department encounters among adults aged at least 60 years. We conducted a test-negative design analysis in an electronic health records-based network in eight states in the USA, including hospitalisations and emergency department encounters with respiratory syncytial virus-like illness among adults aged at least 60 years who underwent respiratory syncytial virus testing from Oct 1, 2023, to March 31, 2024. Respiratory syncytial virus vaccination status at the time of the encounter was derived from electronic health record documentation, state and city immunisation registries, and, for some sites, medical claims. Vaccine effectiveness was estimated by immunocompromise status, comparing the odds of vaccination among respiratory syncytial virus-positive case patients and respiratory syncytial virus-negative control patients, and adjusting for age, race and ethnicity, sex, calendar day, social vulnerability index, number of underlying non-respiratory medical conditions, presence of respiratory underlying medical conditions, and geographical region. Among 28 271 hospitalisations for respiratory syncytial virus-like illness among adults aged at least 60 years without immunocompromising conditions, vaccine effectiveness was 80% (95% CI 71–85) against respiratory syncytial virus-associated hospitalisations, and vaccine effectiveness was 81% (52–92) against respiratory syncytial virus-associated critical illness (ICU admission or death, or both). Among 8435 hospitalisations for respiratory syncytial virus-like illness among adults with immunocompromising conditions, vaccine effectiveness was 73% (48–85) against associated hospitalisation. Among 36 521 emergency department encounters for respiratory syncytial virus-like illness among adults aged at least 60 years without an immunocompromising condition, vaccine effectiveness was 77% (70–83) against respiratory syncytial virus-associated emergency department encounters. Vaccine effectiveness estimates were similar by age group and product type. Respiratory syncytial virus vaccination was effective in preventing respiratory syncytial virus-associated hospitalisations and emergency department encounters among adults aged at least 60 years in the USA during the 2023–24 respiratory syncytial virus season, which was the first season after respiratory syncytial virus vaccine was approved. The Centers for Disease Control and Prevention.

On November 7, 2018, the Utah Department of Health (UDOH) reported the first confirmed human rabies death in the state since 1944 (1). The case occurred in a person who had been treated over a period of 19 days at four health care facilities and an emergency medical transport service across three counties and two states. Human rabies is preventable through preexposure or postexposure vaccination but is invariably fatal upon symptom onset. Timely identification of persons who might have been exposed to rabies virus is therefore crucial to administer postexposure prophylaxis (PEP). Because of the large number of health care workers who had been involved in the patient's care, a standardized online risk assessment survey was developed by UDOH based on Advisory Committee on Immunization Practices recommendations (2). This online tool was evaluated for accuracy, acceptability, and administrative obligation by reviewing the results from the tool and conducting focus group discussions and a follow-up survey. Among 90 health care workers initially identified by the online risk assessment as being potentially exposed to infectious material, 74 were classified as exposed. All 74 health care workers received PEP following consultation with occupational health staff members, indicating a positive predictive value of the assessment tool of 82%. In a follow-up survey, 42 (76%) of the 55 respondents reported that they were satisfied with the assessment process. In focus group discussions, participants suggested that the survey could be improved by providing additional information about rabies exposures because many of them were unfamiliar with human-to-human rabies transmission. This evaluation highlighted the importance of adopting clear communication strategies, demonstrated the benefits of using an online risk assessment during a mass rabies exposure, and provided specific feedback for CDC to improve resources available for states and health care facilities after mass rabies exposures.On November 7, 2018, the Utah Department of Health (UDOH) reported the first confirmed human rabies death in the state since 1944 (1). The case occurred in a person who had been treated over a period of 19 days at four health care facilities and an emergency medical transport service across three counties and two states. Human rabies is preventable through preexposure or postexposure vaccination but is invariably fatal upon symptom onset. Timely identification of persons who might have been exposed to rabies virus is therefore crucial to administer postexposure prophylaxis (PEP). Because of the large number of health care workers who had been involved in the patient's care, a standardized online risk assessment survey was developed by UDOH based on Advisory Committee on Immunization Practices recommendations (2). This online tool was evaluated for accuracy, acceptability, and administrative obligation by reviewing the results from the tool and conducting focus group discussions and a follow-up survey. Among 90 health care workers initially identified by the online risk assessment as being potentially exposed to infectious material, 74 were classified as exposed. All 74 health care workers received PEP following consultation with occupational health staff members, indicating a positive predictive value of the assessment tool of 82%. In a follow-up survey, 42 (76%) of the 55 respondents reported that they were satisfied with the assessment process. In focus group discussions, participants suggested that the survey could be improved by providing additional information about rabies exposures because many of them were unfamiliar with human-to-human rabies transmission. This evaluation highlighted the importance of adopting clear communication strategies, demonstrated the benefits of using an online risk assessment during a mass rabies exposure, and provided specific feedback for CDC to improve resources available for states and health care facilities after mass rabies exposures.

Background: In October 2018 a patient presented to hospital A’s emergency department (ED) for a work injury, arm spasms, and inability to drink liquids. He developed rapid neurologic decline and was transferred to hospital B for neurocritical care. He developed a fever, was intubated, and had an unrevealing infectious diseases (ID) consultation. He became comatose, had refractory seizures, and was transferred to hospital C. A second ID consultation revealed that he had many bats in his home, and his symptoms were consistent with rabies encephalitis. Antemortem specimens of serum, CSF, skin biopsy, and saliva were all positive for rabies virus PCR, and/or rabies serologies. Objective: We describe the response of a multihospital system to the exposure of employees across 3 facilities to rabies-infected body fluids. Methods: Three hospitals in 1 system (222 caregivers) cared for the index patient (hospital A, n = 8; hospital B, n = 107; hospital C, n = 107; 19 students and residents), as did 2 additional facilities outside the system. These included physicians (n = 21), registered nurses (n = 57), respiratory therapists (n = 29), imaging technicians (n = 24), phlebotomists (n = 12), laboratorians (n = 8) and others (n = 71). Infection prevention, employee health, and pharmacy leadership created a centralized team to ensure that all exposed caregivers were screened, and if exposed, were vaccinated. An electronic screening tool developed and administered by the Utah Department of Health via Research Electronic Data Capture (Redcap), rapidly assessed caregiver body fluid exposure risks (saliva, tears, neurologic tissue), and use of personal protective equipment in patient care. After completion, caregivers received notification that he or she (1) had no exposure (no further action), (2) had exposure and should report to employee health for vaccination, or (3) had unclear exposure and should contact the employee health department. Results: Caregivers feared that the tool underestimated exposure risk. Many caregivers (n = 48), repeated the assessment more than once, changing answers. The most common reasons cited were incomplete forms (n = 21), caregiver did not recall using personal protective equipment with contact with saliva (n = 8) or did not understand rabies transmission (n = 3). All vaccinations were initiated by 11 of 26 care givers, 18 days after initial deployment of the tool. All exposed caregivers completed the course. No caregivers developed symptoms of rabies encephalitis. Conclusions: An online tool can safely assess large healthcare exposure such as rabies. A team comprising infection preventionists, employee health representatives, pharmacists, and public health department representatives made the assessment of many geographically dispersed caregivers rapid and effective. Caregivers should employ the basic tenets of standard precautions in the daily care of patients to avoid unknown exposures to common bodily fluids. Funding: None Disclosures: None