Archive for August 29, 2015

Pseudomonas aeruginosa Eradication: How Do We Measure Success?

Clinical Infectious Diseases SEP 1, 2015 V.61 N.5 P.716-718

Editorial Commentary

Edith T. Zemanick and Theresa A. Laguna

1Department of Pediatrics, University of Colorado School of Medicine, Aurora

2Department of Pediatrics, University of Minnesota School of Medicine, Minneapolis

Correspondence: Edith T. Zemanick, MD, MSCS, Department of Pediatrics, University of Colorado School of Medicine, 13123 E 16th Ave B-395, Aurora, CO 80045 (edith.zemanick@childrenscolorado.org).

Lung disease remains the major cause of morbidity and mortality for people living with cystic fibrosis (CF) [1].

Dysfunctional chloride conductance in the airways results in impaired mucus clearance, which drives a vicious cycle of infection, inflammation, and airway destruction.

Pseudomonas aeruginosa (Pa) is a bacterial pathogen largely feared by the CF community as its chronic presence is associated with lung damage, a more rapid decline in lung function, and earlier mortality [2–6]. Unfortunately, Pa in airway secretions will be cultured in 80% of people with CF by age 18 years.

PDF

http://cid.oxfordjournals.org/content/61/5/716.full.pdf

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August 29, 2015 at 7:36 pm

The Effect of Universal Glove and Gown Use on Adverse Events in Intensive Care Unit Patients

Clinical Infectious Diseases AUG 15, 2015 V.61 N.4 P.545-553

Editor’s Choice

Lindsay D. Croft, Anthony D. Harris, Lisa Pineles, Patricia Langenberg, Michelle Shardell, Jeffrey C. Fink, Linda Simoni-Wastila, and Daniel J. Morgan for the Benefits of Universal Glove and Gown (BUGG) Primary Investigators

1Department of Epidemiology and Public Health, University of Maryland School of Medicine

2VA Maryland Healthcare System

3Department of Medicine, Division of General Internal Medicine, University of Maryland School of Medicine

4Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore

Correspondence: Daniel J. Morgan, MD, MS, Department of Epidemiology and Public Health, University of Maryland School of Medicine, 685 W Baltimore St, MSTF 334, Baltimore, MD 21201 (dmorgan@epi.umaryland.edu).

Background

No randomized trials have examined the effect of contact precautions or universal glove and gown use on adverse events. We assessed if wearing gloves and gowns during all patient contact in the intensive care unit (ICU) changes adverse event rates.

Methods

From January 2012 to October 2012, intervention ICUs of the 20-site Benefits of Universal Gloving and Gowning cluster randomized trial required that healthcare workers use gloves and gowns for all patient contact. We randomly sampled 1800 medical records of adult patients not colonized with antibiotic-resistant bacteria and reviewed them for adverse events using the Institute for Healthcare Improvement Global Trigger Tool.

Results

Four hundred forty-seven patients (24.8%) had 1 or more ICU adverse events. Adverse events were not associated with universal glove and gown use (incidence rate ratio [IRR], 0.81; 95% confidence interval [CI], .48–1.36). This did not change with adjustment for ICU type, severity of illness, academic hospital status, and ICU size, (IRR, 0.91; 95% CI, .59–1.42; P = .68). Rates of infectious adverse events also did not differ after adjusting for the same factors (IRR, 0.75; 95% CI, .47–1.21; P = .24).

Conclusions

In ICUs where healthcare workers donned gloves and gowns for all patient contact, patients were no more likely to experience adverse events than in control ICUs. Concerns of adverse events resulting from universal glove and gown use were not supported. Similar considerations may be appropriate regarding use of contact precautions.

Clinical Trials Registration. NCT0131821.

PDF

http://cid.oxfordjournals.org/content/61/4/545.full.pdf

August 29, 2015 at 7:34 pm

Editorial Commentary: Getting Smart in How We Pay for HCV Drugs: KAOS vs CONTROL

Clinical Infectious Diseases JUL 15, 2015 V.61 N.2 P.169-170

Editor’s Choice

Center for AIDS Research, University of Alabama at Birmingham

Correspondence: Michael S. Saag, MD, Director, Center for AIDS Research, University of Alabama at Birmingham, 845 – 19th St South, Birmingham, AL 35294-2107 (msaag@uab.edu).

Over the last 2 years a therapeutic revolution has been occurring for the treatment of hepatitis C virus (HCV) infections. Direct acting antiviral (DAA) agents that allow all-oral regimens have been released.

These regimens replace the use of injectable peginterferon, which markedly reduce adverse effects, significantly reduce the duration of treatment (eg, from 48 weeks to 12 weeks), and increase cure rates from 60% to 70% to greater than 95% in most clinical scenarios [1].

Based on this set of facts alone, a clear message is that virtually every patient with chronic HCV should be treated [2]. Now.

As the new HCV agents were released, however, the price-tag of the drugs created sticker shock, especially among the payers who were not fully prepared to treat so many patients at one time with such expensive medications.

To keep expenditures under control, payers questioned the need to treat patients with less advanced disease (eg, those with F0- F2 fibrosis), owing to the uncertainty of who will progress (less than 50% of patients develop cirrhosis over 30 years) and the relatively slow progression of disease among those who do progress.

The payer’s reluctance to pay for drugs created barriers for patients and providers to gain access to therapy. All involved called out for data on the cost-effectiveness of the new all oral regimens, which heretofore did not exist.

In this issue of CID, Rein and colleagues provide, for the first time, the cost-effectiveness data for …

PDF

http://cid.oxfordjournals.org/content/61/2/169.full.pdf

 

August 29, 2015 at 7:32 pm

The Cost-effectiveness, Health Benefits, and Financial Costs of New Antiviral Treatments for Hepatitis C Virus

Clinical Infectious Diseases JUL 15, 2015 V.61 N.2 P.157-168

Editor’s Choice

David B. Rein, John S. Wittenborn, Bryce D. Smith, Danielle K. Liffmann, and John W. Ward

1Public Health Department, NORC at the University of Chicago, and

2Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia

Correspondence: David B. Rein, PhD, NORC at the University of Chicago, Public Health Department, 3520 Piedmont Rd NE, Ste 225, Atlanta, GA 30305 (rein-david@norc.org).

Background

New hepatitis C virus (HCV) treatments deliver higher cure rates with fewer contraindications, increasing demand for treatment and healthcare costs. The cost-effectiveness of new treatments is unknown.

Methods

We conducted a microsimulation of guideline testing followed by alternative treatment regimens for HCV among the US population aged 20 and older to estimate cases identified, treated, sustained viral response, deaths, medical costs, quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio (ICER) of different treatment options expressed as discounted lifetime costs and benefits from the healthcare perspective.

Results

Compared to treatment with pegylated interferon and ribavirin (PR), and a protease inhibitor for HCV genotype (G) 1 and PR alone for G2/3, treatment with PR and Sofosbuvir (PRS) for G1/4 and treatment with Sofosbuvir and ribavirin (SR) for G2/3 increased QALYs by 555 226, reduced deaths by 80 682, and increased costs by $26.2 billion at an ICER of $47 304 per QALY gained. As compared to PRS/SR, treating with an all oral regimen of Sofosbuvir and Simeprevir (SS) for G1/4 and SR for G2/3, increased QALYs by 1 110 451 and reduced deaths by an additional 164 540 at an incremental cost of $80.1 billion and an ICER of $72 169. In sensitivity analysis, where treatment with SS effectiveness was set to the list price of Viekira Pak and then Harvoni, treatment cost $24 921 and $25 405 per QALY gained as compared to PRS/SR.

Conclusions

New treatments are cost-effectiveness per person treated, but pent-up demand for treatment may create challenges for financing.

PDF

http://cid.oxfordjournals.org/content/61/2/157.full.pdf

August 29, 2015 at 7:30 pm

Enhancing Resident Safety by Preventing Healthcare-Associated Infection: A National Initiative to Reduce Catheter-Associated Urinary Tract Infections in Nursing Homes

Clinical Infectious Diseases JUL 1, 2015 V.61 N.1 P. 86-94

Lona Mody, Jennifer Meddings, Barbara S. Edson, Sara E. McNamara, Barbara W. Trautner, Nimalie D. Stone, Sarah L. Krein, and Sanjay Saint

1Geriatric Research Education and Clinical Center, Veteran Affairs Ann Arbor Healthcare System

2Division of Geriatric and Palliative Care Medicine

3Division of General Medicine

4Department of Internal Medicine, Department of Pediatrics and Communicable Diseases, Division of General Pediatrics, University of Michigan Medical School, Ann Arbor

5Health Research & Educational Trust, Chicago, Illinois

6The Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center

7Section of Infectious Diseases, Departments of Medicine and Surgery, Baylor College of Medicine, Houston, Texas

8Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia

9Center for Clinical Management Research

10Medicine Service, Veteran Affairs Ann Arbor Healthcare System, Michigan

Preventing healthcare-associated infection (HAI) is a key contributor to enhancing resident safety in nursing homes.

In 2013, the U.S. Department of Health and Human Services approved a plan to enhance resident safety by reducing HAIs in nursing homes, with particular emphasis on reducing indwelling catheter use and catheter-associated urinary tract infection (CAUTI).

Lessons learned from a recent multimodal Targeted Infection Prevention program in a group of nursing homes as well as a national initiative to prevent CAUTI in over 950 acute care hospitals called “On the CUSP: STOP CAUTI” will now be implemented in nearly 500 nursing homes in all 50 states through a project funded by the Agency for Healthcare Research and Quality (AHRQ).

This “AHRQ Safety Program in Long-Term Care: HAIs/CAUTI” will emphasize professional development in catheter utilization, catheter care and maintenance, and antimicrobial stewardship as well as promoting patient safety culture, team building, and leadership engagement.

We anticipate that an approach integrating technical and socio-adaptive principles will serve as a model for future initiatives to reduce other infections, multidrug resistant organisms, and noninfectious adverse events among nursing home residents.

PDF

http://cid.oxfordjournals.org/content/61/1/86.full.pdf

August 29, 2015 at 7:28 pm

Population Structure and Antimicrobial Resistance of Invasive Serotype IV Group B Streptococcus, Toronto, Ontario, Canada

Emerging Infectious Diseases MAY 2015 V.21 N.4

Research

Sarah Teatero, Allison McGeer, Aimin Li, Janice Gomes, Christine Seah, Walter Demczuk, Irene Martin, Jessica Wasserscheid, Ken Dewar, Roberto G. Melano, and Nahuel Fittipaldi

Public Health Ontario, Toronto, Ontario, Canada (S. Teatero, A. Li, J. Gomes, C. Seah, R.G. Melano, N. Fittipaldi); University of Toronto, Toronto (A. McGeer, R.G. Melano, N. Fittipaldi); Mount Sinai Hospital, Toronto (A. McGeer, R.G. Melano); Public Health Agency of Canada, Winnipeg, Manitoba, Canada (W. Demczuk, I. Martin); McGill University, Montreal, Quebec, Canada (J. Wasserscheid, K. Dewar); Genome Quebec Innovation Centre, Montreal (J. Wasserscheid, K. Dewar)

We recently showed that 37/600 (6.2%) invasive infections with group B Streptococcus (GBS) in Toronto, Ontario, Canada, were caused by serotype IV strains.

We report a relatively high level of genetic diversity in 37 invasive strains of this emerging GBS serotype. Multilocus sequence typing identified 6 sequence types (STs) that belonged to 3 clonal complexes.

Most isolates were ST-459 (19/37, 51%) and ST-452 (11/37, 30%), but we also identified ST-291, ST-3, ST-196, and a novel ST-682.

We detected further diversity by performing whole-genome single-nucleotide polymorphism analysis and found evidence of recombination events contributing to variation in some serotype IV GBS strains.

We also evaluated antimicrobial drug resistance and found that ST-459 strains were resistant to clindamycin and erythromycin, whereas strains of other STs were, for the most part, susceptible to these antimicrobial drugs.

PDF

http://wwwnc.cdc.gov/eid/article/21/4/pdfs/14-0759.pdf

August 29, 2015 at 11:05 am

Increased Risk for Group B Streptococcus Sepsis in Young Infants Exposed to HIV, Soweto, South Africa, 2004–2008

Emerging Infectious Diseases MAY 2015 V.21 N.4

Research

Clare L. Cutland, Stephanie J. Schrag, Michael C. Thigpen, Sithembiso C. Velaphi, Jeannette Wadula, Peter V. Adrian, Locadiah Kuwanda, Michelle J. Groome, Eckhart Buchmann, and Shabir A. Madhi

University of the Witwatersrand, Johannesburg, South Africa (C.L. Cutland, S.C. Velaphi, J. Wadula, P.V. Adrian, L. Kuwanda, M.J. Groome, E. Buchmann, S.A. Madhi); Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Johannesburg (C.L. Cutland, P.V. Adrian, L. Kuwanda, M.J. Groome, S.A. Madhi); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Schrag, M.C. Thigpen); Chris Hani Baragwanath Academic Hospital, Johannesburg (S.C. Velaphi, J. Wadula, E. Buchmann); National Institute for Communicable Diseases, Sandringham, South Africa (S.A. Madhi)

Although group B Streptococcus (GBS) is a leading cause of severe invasive disease in young infants worldwide, epidemiologic data and knowledge about risk factors for the disease are lacking from low- to middle-income countries.

To determine the epidemiology of invasive GBS disease among young infants in a setting with high maternal HIV infection, we conducted hospital-based surveillance during 2004–2008 in Soweto, South Africa.

Overall GBS incidence was 2.72 cases/1,000 live births (1.50 and 1.22, respectively, among infants with early-onset disease [EOD] and late-onset [LOD] disease). Risk for EOD and LOD was higher for HIV-exposed than HIV-unexposed infants.

GBS serotypes Ia and III accounted for 84.0% of cases, and 16.9% of infected infants died. We estimate that use of trivalent GBS vaccine (serotypes Ia, Ib, and III) could prevent 2,105 invasive GBS cases and 278 deaths annually among infants in South Africa; therefore, vaccination of all pregnant women in this country should be explored.

PDF

http://wwwnc.cdc.gov/eid/article/21/4/pdfs/14-1562.pdf

August 29, 2015 at 11:03 am

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