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Background. Recent evidence suggests that among patients receiving vancomycin, receipt of concomitant piperacillin–tazobactam increases the risk of nephrotoxicity. Well-controlled, adequately powered studies comparing rates of acute kidney injury (AKI) among patients receiving vancomycin + piperacillin–tazobactam (VPT) compared to similar patients receiving vancomycin + cefepime (VC) are lacking. In this study we compared the incidence of AKI among patients receiving combination therapy with VPT to a matched group receiving VC. Methods. A retrospective, matched, cohort study was performed. Patients were eligible if they received combination therapy for ≥48 hours. Patients were excluded if their baseline serum creatinine was >1.2mg/dL or they were receiving renal replacement therapy. Patients receiving VC were matched to patients receiving VPT based on severity of illness, intensive care unit status, duration of combination therapy, vancomycin dose, and number of concomitant nephrotoxins. The primary outcome was the incidence of AKI. Multivariate modeling was performed using Cox proportional hazards. Results. A total of 558 patients were included. AKI rates were significantly higher in the VPT group than the VC group (81/279 [29%] vs 31/279 [11%]). In multivariate analysis, therapy with VPT was an independent predictor for AKI (hazard ratio = 4.27; 95% confidence interval, 2.73–6.68). Among patients who developed AKI, the median onset was more rapid in the VPT group compared to the VC group (3 vs 5 days P =< .0001). Conclusion. The VPT combination was associated with both an increased AKI risk and a more rapid onset of AKI compared to the VC combination.

Background. Polymyxins including colistin are an important \"last-line\" treatment for infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKp). Increasing use of colistin has led to resistance to this cationic antimicrobial peptide. Methods. A cohort nested within the Consortium on Resistance against Carbapenems in Klebsiella pneumoniae (CRACKLE) was constructed of patients with infection, or colonization with CRKp isolates tested for colistin susceptibility during the study period of December, 2011 to October, 2014. Reference colistin resistance determination as performed by broth macrodilution was compared to results from clinical microbiology laboratories (Etest) and to polymyxin resistance testing. Each patient was included once, at the time of their first colistin-tested CRKp positive culture. Time to 30-day in-hospital all-cause mortality was evaluated by Kaplan-Meier curves and Cox proportional hazard modeling. Results. In 246 patients with CRKp, 13% possessed ColR CRKp. ColR was underestimated by Etest (very major error rate = 35%, major error rate = 0.4%). A variety of rep-PCR strain types were encountered in both the ColS and the ColR groups. Carbapenem resistance was mediated primarily by blaKPC-2 (46%) and blaKPC-3 (50%). ColR was associated with increased hazard for in-hospital mortality (aHR 3.48; 95% confidence interval, 1.73–6.57; P < .001). The plasmid-associated ColR genes, mcr-1 and mcr-2 were not detected in any of the ColR CRKp. Conclusions. In this cohort, 13% of patients with CRKp presented with ColR CRKp. The apparent polyclonal nature of the isolates suggests de novo emergence of ColR in this cohort as the primary factor driving ColR. Importantly, mortality was increased in patients with ColR isolates.

INTRODUCTION:No prior prospective study has assessed the efficacy of a more intensive bowel preparation (prep) for outpatients who have already failed a 4 liter (4L) PEG-3350 (GoLYTELY®) split-prep. This study assesses efficacy and safety of a 4L-2L PEG-3350 split-prep.METHODS:Inclusion Criteria- (a) colonoscopy for average-risk screening, FIT+, family history-CRC, or colon polyp surveillance; (b) history of inadequate prep with 4L GoLYTELY® or >2 risk factors for inadequate prep (daily laxative, BMI > 35, diabetes, daily tricyclic antidepressant, daily opioid). Intervention: 4L-2L PEG-3350 (GoLYTELY®) split-prep consisting of clear liquid diet (all day) and drink 4L GoLYTELY® starting at 6pm on day before procedure PLUS drink 2L of GoLYTELY® starting 5 hours before colonoscopy. Patients completed a questionnaire about demographics, adherence to prep protocol, ease of drinking prep, and adverse events. Primary Outcome: Adequate bowel prep, defined by 2-2-2 or better on Boston Bowel Preparation Scale (BBPS), among patients who failed 4L GoLYTELY® split-prep. Secondary Outcome: (a) Adequate bowel prep among patients who failed 4l GoLYTELY® pm-only prep or any lower volume prep; and, (b) patients with > 2 risk factors for inadequate prep; Tertiary Outcome: Frequency of guideline-adherent recommendations for surveillance colonoscopy among patients with adequate prep and patients with inadequate prep (i.e., repeat colonoscopy in ≤ 1 year). Data Analysis: The intention-to-treat population included all patients who underwent colonoscopy and the per-protocol population only included patients who drank ≥ 75% of prep.RESULTS:204 consecutive patients met inclusion criteria and presented for colonoscopy. Demographic data: mean age = 65 (40-79 years); M: F = 189:15. Frequency of adequate prep in each group is presented in Table 1. Frequency of guideline-adherent recommendations was 89.6% in patients with adequate prep and was 96.6% among patients with inadequate prep. Three serious adverse events occurred: vomiting with ED visit, asymptomatic bradycardia (HR = 30-40) and spontaneous paroxysmal atrial fibrillation. Based on questionnaires, 28% stopped to pass stool during trip to endoscopy center and 80% would be willing to repeat the prep in the future.CONCLUSION:The 6L GoLYTELY® split-prep achieves adequate prep in > 85% of patients who have already failed a 4l GoLYTELY® split-prep.Table 1.Frequency of adequate prep in each group

The impact of the 2013 NHSN CAUTI definition on CAUTI rates was analyzed. A total of 107 CAUTI episodes were identified; 60 according to NHSN 2013 definitions only and 47 according to the 2012 and 2013 definitions. Physician-diagnosed “other infections” were more common among patients who had CAUTI only according to NHSN 2013 definitions ( P <.001). Infect Control Hosp Epidemiol 2014;00(0): 1–4

IntroductionExtended-spectrum beta-lactamase (ESBL)-producing Escherichia coli infections have become endemic worldwide. We aimed to describe the molecular and clinical epidemiology of ESBL-producing E. coli infections during a period of rising global prevalence.MethodsThree hundred sixty-nine consecutive ESBL-producing E. coli infections in Detroit from 2010–2011 were analyzed. Sequence typing (ST) and CH typing were performed. Clinical characteristics and outcomes were compared between patients infected with ST131 and non-ST131 isolates.ResultsNinety-six percent of isolates were ST 131, and 78.6% of ST 131 isolates produced blaCTX-M-15. Median time to effective therapy was 48 h vs. 35 h (P = 0.38) in the ST131 vs. non-ST131 groups. Ninety-day mortality rates (8% vs. 8%, P = 1.0) were similar between the two groups.ConclusionblaCTX-M-15 ST131 E. coli predominated in Detroit during an early period of global ST131 dissemination. Patients with ST131 E. coli infections had similar clinical outcomes to those with non-ST131 E. coli infections.

The Birmingham Hip Resurfacing procedure (BHR) is metal-on-metal resurfacing procedure for hip arthritis. BHR was associated with low risk of surgical site infection (SSI; 0.6%). In addition to antimicrobials, superficial SSIs were treated with incision and drainage, whereas deep incisional or organ-space SSIs required removal of prosthesis. Infect Control Hosp Epidemiol 2016;1–4