IDWeek 2015

SAN DIEGO – Antibiotic prescribing patterns for pediatric community-acquired pneumonia vary substantially across both children’s hospitals and facilities that are not children’s hospitals, a large analysis found.

Specifically, children’s hospitals are far more likely to prescribe in accordance with national guidelines than are other hospitals.

“Moving forward, I think there’s a need for further study to understand these differences, so we can begin to narrow this gap between children’s and non–children’s hospitals,” lead study author Dr. Alison Tribble said at an annual scientific meeting on infectious diseases. “Across the board, we need to continue efforts to improve guideline adherence for all children hospitalized with community-acquired pneumonia.”

In 2012, community-acquired pneumonia (CAP) accounted for 120,000 known pneumonia admissions among children in the United States and about 7% of all pediatric hospitalizations, said Dr. Tribble, a pediatric infectious disease specialist at C.S. Mott Children’s Hospital and the University of Michigan Medical Center, both in Ann Arbor. “We also know that pneumonia accounts for more days of antibiotic therapy than any other indication for admission to U.S. children’s hospitals,” she said.

In 2011, the Infectious Diseases Society of America and Pediatric Infectious Diseases Society released guidelines for pediatric CAP, which recommend a first-line therapy with penicillin, ampicillin, or amoxicillin for most children who are immunized and healthy. “Only in situations where there’s a significant concern for an atypical organism should we be adding coverage for that – even in older children,” Dr. Tribble said. Following the release of the guidelines, she continued, multiple studies have shown that the use of first-line therapy is increasing in children’s hospitals. “However, a substantial proportion of children with pneumonia are admitted to non–children’s hospitals,” she said. “Prior to release of the guidelines, one study showed that use of first-line therapy for pediatric CAP was low in non–children’s hospitals (J Pediatr. 2014 165[3]:585-91), but postguideline CAP therapy in non–children’s hospitals has not yet been evaluated.”

For the current study, Dr. Tribble and her associates set out to evaluate antibiotic prescribing patterns for pediatric CAP in non–children’s hospitals and to compare prescribing patterns between children’s and non–children’s hospitals. They conducted a retrospective cross-sectional study of children aged 1-17 years admitted for CAP in 2013 to 323 hospitals, captured via the Pediatric Health Information System (PHIS) and Premier Perspective databases. PHIS is an administrative database that includes billing data, diagnosis codes, and procedure codes for about 44 freestanding children’s hospitals nationwide, while Premier Perspective encompasses data from 522 hospitals nationwide. The researchers used a validated ICD-9 code-based algorithm to identify patients with CAP and excluded those with complicated pneumonia or complex chronic conditions, those who received intensive care, and those with methicillin-resistant Staphylococcus aureus infection or colonization.

Children’s hospitals were defined as those with pediatric admissions accounting for more than 75% of all admissions. “This was after excluding newborns and admission for childbirth, because many community hospitals will have a birthing center or a NICU, but otherwise would not be considered a children’s hospital,” Dr. Tribble explained. Any other hospital was considered a non–children’s hospital.

Three different outcomes for antibiotic use were examined: those who ever received penicillin, amoxicillin, or ampicillin (guideline therapy); those who ever received a macrolide, fluoroquinolone, or tetracycline (atypical therapy); and those who received anything other than penicillin, amoxicillin, or ampicillin (nonguideline therapy). The standardized probability of exposure to select antibiotics was compared between children’s and non–children’s hospitals, adjusted for age, sex, and insurance provider.

In all, 323 hospitals contributed 15,495 CAP cases. Of the 323 hospitals, 49 were identified as children’s hospitals (44 from the PHIS database and 5 from the Premier database). Dr. Tribble reported results from 9,224 subjects admitted to children’s hospitals and 6,271 subjects admitted to non–children’s hospitals. The demographics between the two groups were similar: The patients’ mean age was 3 years, and 66% were younger than age 5 years.

After adjustment of data, patients admitted to children’s hospitals were found to be more likely to receive guideline therapy, compared with those admitted to non–children’s hospitals (46% vs. 15%, respectively), were less likely to received atypical therapy (36% vs. 51%), and were less likely to receive nonguideline therapy (78% vs. 94%; P less than .001 for all comparisons).

Dr. Tribble acknowledged certain limitations of the study, including the potential for misclassification of children’s hospitals in the Premier database, “although most likely I think we would have failed to identify a children’s hospital, and this would have biased us toward the null and made our difference less significant,” she said. “We are developing an absolute volume classification so we can look at this in another way.” Another limitation is that the study design did not account for the potential of combination therapy, “and you can’t account for change in therapy during hospitalization. Lastly, we compared data across different databases and across different hospital types.”

IDWeek marks the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. The study was supported by a training grant from the National Institute of Child Health and Human Development. The researchers reported having no relevant financial disclosures.

SAN DIEGO – Antibiotic prescribing patterns for pediatric community-acquired pneumonia vary substantially across both children’s hospitals and facilities that are not children’s hospitals, a large analysis found.

Specifically, children’s hospitals are far more likely to prescribe in accordance with national guidelines than are other hospitals.

“Moving forward, I think there’s a need for further study to understand these differences, so we can begin to narrow this gap between children’s and non–children’s hospitals,” lead study author Dr. Alison Tribble said at an annual scientific meeting on infectious diseases. “Across the board, we need to continue efforts to improve guideline adherence for all children hospitalized with community-acquired pneumonia.”

In 2012, community-acquired pneumonia (CAP) accounted for 120,000 known pneumonia admissions among children in the United States and about 7% of all pediatric hospitalizations, said Dr. Tribble, a pediatric infectious disease specialist at C.S. Mott Children’s Hospital and the University of Michigan Medical Center, both in Ann Arbor. “We also know that pneumonia accounts for more days of antibiotic therapy than any other indication for admission to U.S. children’s hospitals,” she said.

In 2011, the Infectious Diseases Society of America and Pediatric Infectious Diseases Society released guidelines for pediatric CAP, which recommend a first-line therapy with penicillin, ampicillin, or amoxicillin for most children who are immunized and healthy. “Only in situations where there’s a significant concern for an atypical organism should we be adding coverage for that – even in older children,” Dr. Tribble said. Following the release of the guidelines, she continued, multiple studies have shown that the use of first-line therapy is increasing in children’s hospitals. “However, a substantial proportion of children with pneumonia are admitted to non–children’s hospitals,” she said. “Prior to release of the guidelines, one study showed that use of first-line therapy for pediatric CAP was low in non–children’s hospitals (J Pediatr. 2014 165[3]:585-91), but postguideline CAP therapy in non–children’s hospitals has not yet been evaluated.”

For the current study, Dr. Tribble and her associates set out to evaluate antibiotic prescribing patterns for pediatric CAP in non–children’s hospitals and to compare prescribing patterns between children’s and non–children’s hospitals. They conducted a retrospective cross-sectional study of children aged 1-17 years admitted for CAP in 2013 to 323 hospitals, captured via the Pediatric Health Information System (PHIS) and Premier Perspective databases. PHIS is an administrative database that includes billing data, diagnosis codes, and procedure codes for about 44 freestanding children’s hospitals nationwide, while Premier Perspective encompasses data from 522 hospitals nationwide. The researchers used a validated ICD-9 code-based algorithm to identify patients with CAP and excluded those with complicated pneumonia or complex chronic conditions, those who received intensive care, and those with methicillin-resistant Staphylococcus aureus infection or colonization.

Children’s hospitals were defined as those with pediatric admissions accounting for more than 75% of all admissions. “This was after excluding newborns and admission for childbirth, because many community hospitals will have a birthing center or a NICU, but otherwise would not be considered a children’s hospital,” Dr. Tribble explained. Any other hospital was considered a non–children’s hospital.

Three different outcomes for antibiotic use were examined: those who ever received penicillin, amoxicillin, or ampicillin (guideline therapy); those who ever received a macrolide, fluoroquinolone, or tetracycline (atypical therapy); and those who received anything other than penicillin, amoxicillin, or ampicillin (nonguideline therapy). The standardized probability of exposure to select antibiotics was compared between children’s and non–children’s hospitals, adjusted for age, sex, and insurance provider.

In all, 323 hospitals contributed 15,495 CAP cases. Of the 323 hospitals, 49 were identified as children’s hospitals (44 from the PHIS database and 5 from the Premier database). Dr. Tribble reported results from 9,224 subjects admitted to children’s hospitals and 6,271 subjects admitted to non–children’s hospitals. The demographics between the two groups were similar: The patients’ mean age was 3 years, and 66% were younger than age 5 years.

After adjustment of data, patients admitted to children’s hospitals were found to be more likely to receive guideline therapy, compared with those admitted to non–children’s hospitals (46% vs. 15%, respectively), were less likely to received atypical therapy (36% vs. 51%), and were less likely to receive nonguideline therapy (78% vs. 94%; P less than .001 for all comparisons).

Dr. Tribble acknowledged certain limitations of the study, including the potential for misclassification of children’s hospitals in the Premier database, “although most likely I think we would have failed to identify a children’s hospital, and this would have biased us toward the null and made our difference less significant,” she said. “We are developing an absolute volume classification so we can look at this in another way.” Another limitation is that the study design did not account for the potential of combination therapy, “and you can’t account for change in therapy during hospitalization. Lastly, we compared data across different databases and across different hospital types.”

IDWeek marks the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. The study was supported by a training grant from the National Institute of Child Health and Human Development. The researchers reported having no relevant financial disclosures.

SAN DIEGO – Antibiotic prescribing patterns for pediatric community-acquired pneumonia vary substantially across both children’s hospitals and facilities that are not children’s hospitals, a large analysis found.

Specifically, children’s hospitals are far more likely to prescribe in accordance with national guidelines than are other hospitals.

“Moving forward, I think there’s a need for further study to understand these differences, so we can begin to narrow this gap between children’s and non–children’s hospitals,” lead study author Dr. Alison Tribble said at an annual scientific meeting on infectious diseases. “Across the board, we need to continue efforts to improve guideline adherence for all children hospitalized with community-acquired pneumonia.”

In 2012, community-acquired pneumonia (CAP) accounted for 120,000 known pneumonia admissions among children in the United States and about 7% of all pediatric hospitalizations, said Dr. Tribble, a pediatric infectious disease specialist at C.S. Mott Children’s Hospital and the University of Michigan Medical Center, both in Ann Arbor. “We also know that pneumonia accounts for more days of antibiotic therapy than any other indication for admission to U.S. children’s hospitals,” she said.

In 2011, the Infectious Diseases Society of America and Pediatric Infectious Diseases Society released guidelines for pediatric CAP, which recommend a first-line therapy with penicillin, ampicillin, or amoxicillin for most children who are immunized and healthy. “Only in situations where there’s a significant concern for an atypical organism should we be adding coverage for that – even in older children,” Dr. Tribble said. Following the release of the guidelines, she continued, multiple studies have shown that the use of first-line therapy is increasing in children’s hospitals. “However, a substantial proportion of children with pneumonia are admitted to non–children’s hospitals,” she said. “Prior to release of the guidelines, one study showed that use of first-line therapy for pediatric CAP was low in non–children’s hospitals (J Pediatr. 2014 165[3]:585-91), but postguideline CAP therapy in non–children’s hospitals has not yet been evaluated.”

For the current study, Dr. Tribble and her associates set out to evaluate antibiotic prescribing patterns for pediatric CAP in non–children’s hospitals and to compare prescribing patterns between children’s and non–children’s hospitals. They conducted a retrospective cross-sectional study of children aged 1-17 years admitted for CAP in 2013 to 323 hospitals, captured via the Pediatric Health Information System (PHIS) and Premier Perspective databases. PHIS is an administrative database that includes billing data, diagnosis codes, and procedure codes for about 44 freestanding children’s hospitals nationwide, while Premier Perspective encompasses data from 522 hospitals nationwide. The researchers used a validated ICD-9 code-based algorithm to identify patients with CAP and excluded those with complicated pneumonia or complex chronic conditions, those who received intensive care, and those with methicillin-resistant Staphylococcus aureus infection or colonization.

Children’s hospitals were defined as those with pediatric admissions accounting for more than 75% of all admissions. “This was after excluding newborns and admission for childbirth, because many community hospitals will have a birthing center or a NICU, but otherwise would not be considered a children’s hospital,” Dr. Tribble explained. Any other hospital was considered a non–children’s hospital.

Three different outcomes for antibiotic use were examined: those who ever received penicillin, amoxicillin, or ampicillin (guideline therapy); those who ever received a macrolide, fluoroquinolone, or tetracycline (atypical therapy); and those who received anything other than penicillin, amoxicillin, or ampicillin (nonguideline therapy). The standardized probability of exposure to select antibiotics was compared between children’s and non–children’s hospitals, adjusted for age, sex, and insurance provider.

In all, 323 hospitals contributed 15,495 CAP cases. Of the 323 hospitals, 49 were identified as children’s hospitals (44 from the PHIS database and 5 from the Premier database). Dr. Tribble reported results from 9,224 subjects admitted to children’s hospitals and 6,271 subjects admitted to non–children’s hospitals. The demographics between the two groups were similar: The patients’ mean age was 3 years, and 66% were younger than age 5 years.

After adjustment of data, patients admitted to children’s hospitals were found to be more likely to receive guideline therapy, compared with those admitted to non–children’s hospitals (46% vs. 15%, respectively), were less likely to received atypical therapy (36% vs. 51%), and were less likely to receive nonguideline therapy (78% vs. 94%; P less than .001 for all comparisons).

Dr. Tribble acknowledged certain limitations of the study, including the potential for misclassification of children’s hospitals in the Premier database, “although most likely I think we would have failed to identify a children’s hospital, and this would have biased us toward the null and made our difference less significant,” she said. “We are developing an absolute volume classification so we can look at this in another way.” Another limitation is that the study design did not account for the potential of combination therapy, “and you can’t account for change in therapy during hospitalization. Lastly, we compared data across different databases and across different hospital types.”

IDWeek marks the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. The study was supported by a training grant from the National Institute of Child Health and Human Development. The researchers reported having no relevant financial disclosures.

SAN DIEGO – Antibiotic prescribing patterns for pediatric community-acquired pneumonia vary substantially across both children’s hospitals and facilities that are not children’s hospitals, a large analysis found.

Specifically, children’s hospitals are far more likely to prescribe in accordance with national guidelines than are other hospitals.

“Moving forward, I think there’s a need for further study to understand these differences, so we can begin to narrow this gap between children’s and non–children’s hospitals,” lead study author Dr. Alison Tribble said at an annual scientific meeting on infectious diseases. “Across the board, we need to continue efforts to improve guideline adherence for all children hospitalized with community-acquired pneumonia.”

In 2012, community-acquired pneumonia (CAP) accounted for 120,000 known pneumonia admissions among children in the United States and about 7% of all pediatric hospitalizations, said Dr. Tribble, a pediatric infectious disease specialist at C.S. Mott Children’s Hospital and the University of Michigan Medical Center, both in Ann Arbor. “We also know that pneumonia accounts for more days of antibiotic therapy than any other indication for admission to U.S. children’s hospitals,” she said.

In 2011, the Infectious Diseases Society of America and Pediatric Infectious Diseases Society released guidelines for pediatric CAP, which recommend a first-line therapy with penicillin, ampicillin, or amoxicillin for most children who are immunized and healthy. “Only in situations where there’s a significant concern for an atypical organism should we be adding coverage for that – even in older children,” Dr. Tribble said. Following the release of the guidelines, she continued, multiple studies have shown that the use of first-line therapy is increasing in children’s hospitals. “However, a substantial proportion of children with pneumonia are admitted to non–children’s hospitals,” she said. “Prior to release of the guidelines, one study showed that use of first-line therapy for pediatric CAP was low in non–children’s hospitals (J Pediatr. 2014 165[3]:585-91), but postguideline CAP therapy in non–children’s hospitals has not yet been evaluated.”

For the current study, Dr. Tribble and her associates set out to evaluate antibiotic prescribing patterns for pediatric CAP in non–children’s hospitals and to compare prescribing patterns between children’s and non–children’s hospitals. They conducted a retrospective cross-sectional study of children aged 1-17 years admitted for CAP in 2013 to 323 hospitals, captured via the Pediatric Health Information System (PHIS) and Premier Perspective databases. PHIS is an administrative database that includes billing data, diagnosis codes, and procedure codes for about 44 freestanding children’s hospitals nationwide, while Premier Perspective encompasses data from 522 hospitals nationwide. The researchers used a validated ICD-9 code-based algorithm to identify patients with CAP and excluded those with complicated pneumonia or complex chronic conditions, those who received intensive care, and those with methicillin-resistant Staphylococcus aureus infection or colonization.

Children’s hospitals were defined as those with pediatric admissions accounting for more than 75% of all admissions. “This was after excluding newborns and admission for childbirth, because many community hospitals will have a birthing center or a NICU, but otherwise would not be considered a children’s hospital,” Dr. Tribble explained. Any other hospital was considered a non–children’s hospital.

Three different outcomes for antibiotic use were examined: those who ever received penicillin, amoxicillin, or ampicillin (guideline therapy); those who ever received a macrolide, fluoroquinolone, or tetracycline (atypical therapy); and those who received anything other than penicillin, amoxicillin, or ampicillin (nonguideline therapy). The standardized probability of exposure to select antibiotics was compared between children’s and non–children’s hospitals, adjusted for age, sex, and insurance provider.

In all, 323 hospitals contributed 15,495 CAP cases. Of the 323 hospitals, 49 were identified as children’s hospitals (44 from the PHIS database and 5 from the Premier database). Dr. Tribble reported results from 9,224 subjects admitted to children’s hospitals and 6,271 subjects admitted to non–children’s hospitals. The demographics between the two groups were similar: The patients’ mean age was 3 years, and 66% were younger than age 5 years.

After adjustment of data, patients admitted to children’s hospitals were found to be more likely to receive guideline therapy, compared with those admitted to non–children’s hospitals (46% vs. 15%, respectively), were less likely to received atypical therapy (36% vs. 51%), and were less likely to receive nonguideline therapy (78% vs. 94%; P less than .001 for all comparisons).

Dr. Tribble acknowledged certain limitations of the study, including the potential for misclassification of children’s hospitals in the Premier database, “although most likely I think we would have failed to identify a children’s hospital, and this would have biased us toward the null and made our difference less significant,” she said. “We are developing an absolute volume classification so we can look at this in another way.” Another limitation is that the study design did not account for the potential of combination therapy, “and you can’t account for change in therapy during hospitalization. Lastly, we compared data across different databases and across different hospital types.”

IDWeek marks the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. The study was supported by a training grant from the National Institute of Child Health and Human Development. The researchers reported having no relevant financial disclosures.

[email protected]

SAN DIEGO – Antibiotic prescribing patterns for pediatric community-acquired pneumonia vary substantially across both children’s hospitals and facilities that are not children’s hospitals, a large analysis found.

Specifically, children’s hospitals are far more likely to prescribe in accordance with national guidelines than are other hospitals.

“Moving forward, I think there’s a need for further study to understand these differences, so we can begin to narrow this gap between children’s and non–children’s hospitals,” lead study author Dr. Alison Tribble said at an annual scientific meeting on infectious diseases. “Across the board, we need to continue efforts to improve guideline adherence for all children hospitalized with community-acquired pneumonia.”

In 2012, community-acquired pneumonia (CAP) accounted for 120,000 known pneumonia admissions among children in the United States and about 7% of all pediatric hospitalizations, said Dr. Tribble, a pediatric infectious disease specialist at C.S. Mott Children’s Hospital and the University of Michigan Medical Center, both in Ann Arbor. “We also know that pneumonia accounts for more days of antibiotic therapy than any other indication for admission to U.S. children’s hospitals,” she said.

In 2011, the Infectious Diseases Society of America and Pediatric Infectious Diseases Society released guidelines for pediatric CAP, which recommend a first-line therapy with penicillin, ampicillin, or amoxicillin for most children who are immunized and healthy. “Only in situations where there’s a significant concern for an atypical organism should we be adding coverage for that – even in older children,” Dr. Tribble said. Following the release of the guidelines, she continued, multiple studies have shown that the use of first-line therapy is increasing in children’s hospitals. “However, a substantial proportion of children with pneumonia are admitted to non–children’s hospitals,” she said. “Prior to release of the guidelines, one study showed that use of first-line therapy for pediatric CAP was low in non–children’s hospitals (J Pediatr. 2014 165[3]:585-91), but postguideline CAP therapy in non–children’s hospitals has not yet been evaluated.”

For the current study, Dr. Tribble and her associates set out to evaluate antibiotic prescribing patterns for pediatric CAP in non–children’s hospitals and to compare prescribing patterns between children’s and non–children’s hospitals. They conducted a retrospective cross-sectional study of children aged 1-17 years admitted for CAP in 2013 to 323 hospitals, captured via the Pediatric Health Information System (PHIS) and Premier Perspective databases. PHIS is an administrative database that includes billing data, diagnosis codes, and procedure codes for about 44 freestanding children’s hospitals nationwide, while Premier Perspective encompasses data from 522 hospitals nationwide. The researchers used a validated ICD-9 code-based algorithm to identify patients with CAP and excluded those with complicated pneumonia or complex chronic conditions, those who received intensive care, and those with methicillin-resistant Staphylococcus aureus infection or colonization.

Children’s hospitals were defined as those with pediatric admissions accounting for more than 75% of all admissions. “This was after excluding newborns and admission for childbirth, because many community hospitals will have a birthing center or a NICU, but otherwise would not be considered a children’s hospital,” Dr. Tribble explained. Any other hospital was considered a non–children’s hospital.

Three different outcomes for antibiotic use were examined: those who ever received penicillin, amoxicillin, or ampicillin (guideline therapy); those who ever received a macrolide, fluoroquinolone, or tetracycline (atypical therapy); and those who received anything other than penicillin, amoxicillin, or ampicillin (nonguideline therapy). The standardized probability of exposure to select antibiotics was compared between children’s and non–children’s hospitals, adjusted for age, sex, and insurance provider.

In all, 323 hospitals contributed 15,495 CAP cases. Of the 323 hospitals, 49 were identified as children’s hospitals (44 from the PHIS database and 5 from the Premier database). Dr. Tribble reported results from 9,224 subjects admitted to children’s hospitals and 6,271 subjects admitted to non–children’s hospitals. The demographics between the two groups were similar: The patients’ mean age was 3 years, and 66% were younger than age 5 years.

After adjustment of data, patients admitted to children’s hospitals were found to be more likely to receive guideline therapy, compared with those admitted to non–children’s hospitals (46% vs. 15%, respectively), were less likely to received atypical therapy (36% vs. 51%), and were less likely to receive nonguideline therapy (78% vs. 94%; P less than .001 for all comparisons).

Dr. Tribble acknowledged certain limitations of the study, including the potential for misclassification of children’s hospitals in the Premier database, “although most likely I think we would have failed to identify a children’s hospital, and this would have biased us toward the null and made our difference less significant,” she said. “We are developing an absolute volume classification so we can look at this in another way.” Another limitation is that the study design did not account for the potential of combination therapy, “and you can’t account for change in therapy during hospitalization. Lastly, we compared data across different databases and across different hospital types.”

IDWeek marks the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. The study was supported by a training grant from the National Institute of Child Health and Human Development. The researchers reported having no relevant financial disclosures.

[email protected]

SAN DIEGO – Antibiotic prescribing patterns for pediatric community-acquired pneumonia vary substantially across both children’s hospitals and facilities that are not children’s hospitals, a large analysis found.

Specifically, children’s hospitals are far more likely to prescribe in accordance with national guidelines than are other hospitals.

“Moving forward, I think there’s a need for further study to understand these differences, so we can begin to narrow this gap between children’s and non–children’s hospitals,” lead study author Dr. Alison Tribble said at an annual scientific meeting on infectious diseases. “Across the board, we need to continue efforts to improve guideline adherence for all children hospitalized with community-acquired pneumonia.”

In 2012, community-acquired pneumonia (CAP) accounted for 120,000 known pneumonia admissions among children in the United States and about 7% of all pediatric hospitalizations, said Dr. Tribble, a pediatric infectious disease specialist at C.S. Mott Children’s Hospital and the University of Michigan Medical Center, both in Ann Arbor. “We also know that pneumonia accounts for more days of antibiotic therapy than any other indication for admission to U.S. children’s hospitals,” she said.

In 2011, the Infectious Diseases Society of America and Pediatric Infectious Diseases Society released guidelines for pediatric CAP, which recommend a first-line therapy with penicillin, ampicillin, or amoxicillin for most children who are immunized and healthy. “Only in situations where there’s a significant concern for an atypical organism should we be adding coverage for that – even in older children,” Dr. Tribble said. Following the release of the guidelines, she continued, multiple studies have shown that the use of first-line therapy is increasing in children’s hospitals. “However, a substantial proportion of children with pneumonia are admitted to non–children’s hospitals,” she said. “Prior to release of the guidelines, one study showed that use of first-line therapy for pediatric CAP was low in non–children’s hospitals (J Pediatr. 2014 165[3]:585-91), but postguideline CAP therapy in non–children’s hospitals has not yet been evaluated.”

For the current study, Dr. Tribble and her associates set out to evaluate antibiotic prescribing patterns for pediatric CAP in non–children’s hospitals and to compare prescribing patterns between children’s and non–children’s hospitals. They conducted a retrospective cross-sectional study of children aged 1-17 years admitted for CAP in 2013 to 323 hospitals, captured via the Pediatric Health Information System (PHIS) and Premier Perspective databases. PHIS is an administrative database that includes billing data, diagnosis codes, and procedure codes for about 44 freestanding children’s hospitals nationwide, while Premier Perspective encompasses data from 522 hospitals nationwide. The researchers used a validated ICD-9 code-based algorithm to identify patients with CAP and excluded those with complicated pneumonia or complex chronic conditions, those who received intensive care, and those with methicillin-resistant Staphylococcus aureus infection or colonization.

Children’s hospitals were defined as those with pediatric admissions accounting for more than 75% of all admissions. “This was after excluding newborns and admission for childbirth, because many community hospitals will have a birthing center or a NICU, but otherwise would not be considered a children’s hospital,” Dr. Tribble explained. Any other hospital was considered a non–children’s hospital.

Three different outcomes for antibiotic use were examined: those who ever received penicillin, amoxicillin, or ampicillin (guideline therapy); those who ever received a macrolide, fluoroquinolone, or tetracycline (atypical therapy); and those who received anything other than penicillin, amoxicillin, or ampicillin (nonguideline therapy). The standardized probability of exposure to select antibiotics was compared between children’s and non–children’s hospitals, adjusted for age, sex, and insurance provider.

In all, 323 hospitals contributed 15,495 CAP cases. Of the 323 hospitals, 49 were identified as children’s hospitals (44 from the PHIS database and 5 from the Premier database). Dr. Tribble reported results from 9,224 subjects admitted to children’s hospitals and 6,271 subjects admitted to non–children’s hospitals. The demographics between the two groups were similar: The patients’ mean age was 3 years, and 66% were younger than age 5 years.

After adjustment of data, patients admitted to children’s hospitals were found to be more likely to receive guideline therapy, compared with those admitted to non–children’s hospitals (46% vs. 15%, respectively), were less likely to received atypical therapy (36% vs. 51%), and were less likely to receive nonguideline therapy (78% vs. 94%; P less than .001 for all comparisons).

Dr. Tribble acknowledged certain limitations of the study, including the potential for misclassification of children’s hospitals in the Premier database, “although most likely I think we would have failed to identify a children’s hospital, and this would have biased us toward the null and made our difference less significant,” she said. “We are developing an absolute volume classification so we can look at this in another way.” Another limitation is that the study design did not account for the potential of combination therapy, “and you can’t account for change in therapy during hospitalization. Lastly, we compared data across different databases and across different hospital types.”

IDWeek marks the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. The study was supported by a training grant from the National Institute of Child Health and Human Development. The researchers reported having no relevant financial disclosures.

[email protected]

SAN DIEGO – Medicaid patients were nearly twice as likely to develop surgical site infections after cesarean delivery than privately insured women, according to investigators from the Centers for Disease Control and Prevention.

The association remained even after researchers accounted for several demographic and clinical variables, Dr. Sarah Yi said in an interview at an annual scientific meeting on infectious diseases.

“If we can identify a population that is at higher risk for health care–associated infections, then maybe we can intervene at some level,” said Dr. Yi of the division of healthcare quality promotion at the CDC. “If we can elucidate the mechanism better, it will give us other clues about where we can prevent infections.”

More than 1.2 million cesareans were performed in the United States in 2012, and low transverse C-sections ranked fifth among all procedures performed during hospital stays, Dr. Yi noted. Post-cesarean surgical site infections (SSIs) remain a major cause of expense and morbidity, but not many studies have evaluated the relationship between insurance type and the risk of SSIs or other health care–associated infections, she added.

To explore the issue, Dr. Yi and her associates analyzed national health care safety data for 2,769 women who had a cesarean delivery in New York in 2010 or 2011 and had either Medicaid or private insurance at the time of their delivery. The Medicaid group included 1,763 women, while the privately insured group included 1,006 women. Medicaid patients were younger, more likely to be Hispanic, black, or homeless, and were more often treated at government and teaching facilities than privately insured patients were.

©monkeybusinessimages/Thinkstock.com

After researchers accounted for age, race, ethnicity, body mass index, facility type, American Society of Anesthesiologists score, emergency and labor status, use of anesthesia, duration of surgery, and wound classification, Medicaid patients still had nearly double the risk of an SSI after cesarean as did their counterparts with private insurance (risk ratio, 1.8; 95% confidence interval, 1.2-2.8; P = .02).

While homelessness could potentially increase the risk of SSI by limiting opportunities for self-care, social support, and clinical follow-up, Medicaid remained a significant predictor of SSI even after excluding homeless women from the analysis, Dr. Yi said.

But Medicaid might represent one, or several, factors that the model did not account for, such as socioeconomic status or prenatal care, said Dr. Yi.

Prenatal care, in particular, might have been lower among Medicaid patients for women who did not obtain coverage until after arriving at the hospital for delivery, she said. Inadequate prenatal care has been linked to complications after delivery, and the proportion of eligible women who are enrolled in Medicaid has been found to vary at different times during pregnancy, she added (MMWR Surveill Summ. 2015 Jun 19;64[4]:1-19).

The CDC investigators plan to continue the research by trying to validate the association in other populations, in other years, and in other states, Dr. Yi said.

IDWeek marks the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

The researchers reported having no financial disclosures.

SAN DIEGO – Medicaid patients were nearly twice as likely to develop surgical site infections after cesarean delivery than privately insured women, according to investigators from the Centers for Disease Control and Prevention.

The association remained even after researchers accounted for several demographic and clinical variables, Dr. Sarah Yi said in an interview at an annual scientific meeting on infectious diseases.

“If we can identify a population that is at higher risk for health care–associated infections, then maybe we can intervene at some level,” said Dr. Yi of the division of healthcare quality promotion at the CDC. “If we can elucidate the mechanism better, it will give us other clues about where we can prevent infections.”

More than 1.2 million cesareans were performed in the United States in 2012, and low transverse C-sections ranked fifth among all procedures performed during hospital stays, Dr. Yi noted. Post-cesarean surgical site infections (SSIs) remain a major cause of expense and morbidity, but not many studies have evaluated the relationship between insurance type and the risk of SSIs or other health care–associated infections, she added.

To explore the issue, Dr. Yi and her associates analyzed national health care safety data for 2,769 women who had a cesarean delivery in New York in 2010 or 2011 and had either Medicaid or private insurance at the time of their delivery. The Medicaid group included 1,763 women, while the privately insured group included 1,006 women. Medicaid patients were younger, more likely to be Hispanic, black, or homeless, and were more often treated at government and teaching facilities than privately insured patients were.

©monkeybusinessimages/Thinkstock.com

After researchers accounted for age, race, ethnicity, body mass index, facility type, American Society of Anesthesiologists score, emergency and labor status, use of anesthesia, duration of surgery, and wound classification, Medicaid patients still had nearly double the risk of an SSI after cesarean as did their counterparts with private insurance (risk ratio, 1.8; 95% confidence interval, 1.2-2.8; P = .02).

While homelessness could potentially increase the risk of SSI by limiting opportunities for self-care, social support, and clinical follow-up, Medicaid remained a significant predictor of SSI even after excluding homeless women from the analysis, Dr. Yi said.

But Medicaid might represent one, or several, factors that the model did not account for, such as socioeconomic status or prenatal care, said Dr. Yi.

Prenatal care, in particular, might have been lower among Medicaid patients for women who did not obtain coverage until after arriving at the hospital for delivery, she said. Inadequate prenatal care has been linked to complications after delivery, and the proportion of eligible women who are enrolled in Medicaid has been found to vary at different times during pregnancy, she added (MMWR Surveill Summ. 2015 Jun 19;64[4]:1-19).

The CDC investigators plan to continue the research by trying to validate the association in other populations, in other years, and in other states, Dr. Yi said.

IDWeek marks the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

The researchers reported having no financial disclosures.

SAN DIEGO – Medicaid patients were nearly twice as likely to develop surgical site infections after cesarean delivery than privately insured women, according to investigators from the Centers for Disease Control and Prevention.

The association remained even after researchers accounted for several demographic and clinical variables, Dr. Sarah Yi said in an interview at an annual scientific meeting on infectious diseases.

“If we can identify a population that is at higher risk for health care–associated infections, then maybe we can intervene at some level,” said Dr. Yi of the division of healthcare quality promotion at the CDC. “If we can elucidate the mechanism better, it will give us other clues about where we can prevent infections.”

More than 1.2 million cesareans were performed in the United States in 2012, and low transverse C-sections ranked fifth among all procedures performed during hospital stays, Dr. Yi noted. Post-cesarean surgical site infections (SSIs) remain a major cause of expense and morbidity, but not many studies have evaluated the relationship between insurance type and the risk of SSIs or other health care–associated infections, she added.

To explore the issue, Dr. Yi and her associates analyzed national health care safety data for 2,769 women who had a cesarean delivery in New York in 2010 or 2011 and had either Medicaid or private insurance at the time of their delivery. The Medicaid group included 1,763 women, while the privately insured group included 1,006 women. Medicaid patients were younger, more likely to be Hispanic, black, or homeless, and were more often treated at government and teaching facilities than privately insured patients were.

©monkeybusinessimages/Thinkstock.com

After researchers accounted for age, race, ethnicity, body mass index, facility type, American Society of Anesthesiologists score, emergency and labor status, use of anesthesia, duration of surgery, and wound classification, Medicaid patients still had nearly double the risk of an SSI after cesarean as did their counterparts with private insurance (risk ratio, 1.8; 95% confidence interval, 1.2-2.8; P = .02).

While homelessness could potentially increase the risk of SSI by limiting opportunities for self-care, social support, and clinical follow-up, Medicaid remained a significant predictor of SSI even after excluding homeless women from the analysis, Dr. Yi said.

But Medicaid might represent one, or several, factors that the model did not account for, such as socioeconomic status or prenatal care, said Dr. Yi.

Prenatal care, in particular, might have been lower among Medicaid patients for women who did not obtain coverage until after arriving at the hospital for delivery, she said. Inadequate prenatal care has been linked to complications after delivery, and the proportion of eligible women who are enrolled in Medicaid has been found to vary at different times during pregnancy, she added (MMWR Surveill Summ. 2015 Jun 19;64[4]:1-19).

The CDC investigators plan to continue the research by trying to validate the association in other populations, in other years, and in other states, Dr. Yi said.

IDWeek marks the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

The researchers reported having no financial disclosures.

SAN DIEGO – Rhode Island’s universal vaccine policy led to widespread vaccination against rotavirus, steep drops in pediatric hospitalizations for gastroenteritis, and major shifts in circulating rotavirus genotypes, investigators reported at an annual scientific meeting on infectious diseases.

“Vaccination with both RV5 (RotaTeq) and RV1 (Rotarix) decreased rotavirus disease in Rhode Island,” said Dr. Sabina Holland, who led the single-center, prospective study at Hasbro Children’s Hospital, Brown University, Providence, R.I. “Variations in genotype distribution and the emergence of uncommon strains occurred only after introduction of RV1,” she and her associates reported.

Rotavirus, the leading cause of severe diarrhea worldwide, was implicated in 453,000 deaths in 2008 alone, Dr. Holland noted. The Rhode Island health department gives pediatric vaccines to health care providers free of charge, and as a result, rotavirus vaccine coverage in the state is about 89%, she said.

To understand the effects of this high vaccination rate, Dr. Holland and her associates conducted active surveillance for hospitalizations of children younger than 10 years old with gastroenteritis between 2002 and 2012. Between 2012 and 2015, they performed passive laboratory surveillance by testing stool samples for rotavirus with a commercially available enzyme immunoassay. They also used reverse transcription polymerase chain reaction (RT-PCR) to genotype rotavirus RNA. Finally, they examined vaccination records of cases from the state immunization registry for the years 2009-2015, Dr. Holland said at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

The hospital admitted between 79 and 159 children every year with rotavirus disease between 2002 and 2006, and there was no overall upward or downward trend during this period, said Dr. Holland. Hospitalizations for rotavirus then dropped by about 50% 1 year after RV5 was introduced, she said. Hospitalizations kept dropping every subsequent year until 2014, when the hospital admitted only one child with rotavirus disease.

But, in 2015, the hospital admitted six children for rotavirus disease, including three who had not received RV1 or RV5, Dr. Holland said. “We need to continue surveillance to see if the increase in hospitalizations in 2015 will continue, and if it is related to genotype variation secondary to vaccine-induced immune pressure, or due to natural variation,” she added.

Genotype 1 rotavirus, which is most common globally, predominated until after Rhode Island implemented RV5, the study found. Genotype 2 prevailed in 2010, when the state switched to RV1. Since then, nontypeable strains have predominated, and the research team is continuing to sequence them.

The National Science Foundation partially supported the research with a grant to the University of Rhode Island Genomics and Sequencing Center in Kingston. The Center for International Health Research also helped with analyses. Dr. Holland reported no relevant financial disclosures. Senior author Dr. Penelope Dennehy reported receiving relevant research funding from Merck, the maker of RotaTeq.

SAN DIEGO – Rhode Island’s universal vaccine policy led to widespread vaccination against rotavirus, steep drops in pediatric hospitalizations for gastroenteritis, and major shifts in circulating rotavirus genotypes, investigators reported at an annual scientific meeting on infectious diseases.

“Vaccination with both RV5 (RotaTeq) and RV1 (Rotarix) decreased rotavirus disease in Rhode Island,” said Dr. Sabina Holland, who led the single-center, prospective study at Hasbro Children’s Hospital, Brown University, Providence, R.I. “Variations in genotype distribution and the emergence of uncommon strains occurred only after introduction of RV1,” she and her associates reported.

Rotavirus, the leading cause of severe diarrhea worldwide, was implicated in 453,000 deaths in 2008 alone, Dr. Holland noted. The Rhode Island health department gives pediatric vaccines to health care providers free of charge, and as a result, rotavirus vaccine coverage in the state is about 89%, she said.

To understand the effects of this high vaccination rate, Dr. Holland and her associates conducted active surveillance for hospitalizations of children younger than 10 years old with gastroenteritis between 2002 and 2012. Between 2012 and 2015, they performed passive laboratory surveillance by testing stool samples for rotavirus with a commercially available enzyme immunoassay. They also used reverse transcription polymerase chain reaction (RT-PCR) to genotype rotavirus RNA. Finally, they examined vaccination records of cases from the state immunization registry for the years 2009-2015, Dr. Holland said at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

The hospital admitted between 79 and 159 children every year with rotavirus disease between 2002 and 2006, and there was no overall upward or downward trend during this period, said Dr. Holland. Hospitalizations for rotavirus then dropped by about 50% 1 year after RV5 was introduced, she said. Hospitalizations kept dropping every subsequent year until 2014, when the hospital admitted only one child with rotavirus disease.

But, in 2015, the hospital admitted six children for rotavirus disease, including three who had not received RV1 or RV5, Dr. Holland said. “We need to continue surveillance to see if the increase in hospitalizations in 2015 will continue, and if it is related to genotype variation secondary to vaccine-induced immune pressure, or due to natural variation,” she added.

Genotype 1 rotavirus, which is most common globally, predominated until after Rhode Island implemented RV5, the study found. Genotype 2 prevailed in 2010, when the state switched to RV1. Since then, nontypeable strains have predominated, and the research team is continuing to sequence them.

The National Science Foundation partially supported the research with a grant to the University of Rhode Island Genomics and Sequencing Center in Kingston. The Center for International Health Research also helped with analyses. Dr. Holland reported no relevant financial disclosures. Senior author Dr. Penelope Dennehy reported receiving relevant research funding from Merck, the maker of RotaTeq.

SAN DIEGO – Rhode Island’s universal vaccine policy led to widespread vaccination against rotavirus, steep drops in pediatric hospitalizations for gastroenteritis, and major shifts in circulating rotavirus genotypes, investigators reported at an annual scientific meeting on infectious diseases.

“Vaccination with both RV5 (RotaTeq) and RV1 (Rotarix) decreased rotavirus disease in Rhode Island,” said Dr. Sabina Holland, who led the single-center, prospective study at Hasbro Children’s Hospital, Brown University, Providence, R.I. “Variations in genotype distribution and the emergence of uncommon strains occurred only after introduction of RV1,” she and her associates reported.

Rotavirus, the leading cause of severe diarrhea worldwide, was implicated in 453,000 deaths in 2008 alone, Dr. Holland noted. The Rhode Island health department gives pediatric vaccines to health care providers free of charge, and as a result, rotavirus vaccine coverage in the state is about 89%, she said.

To understand the effects of this high vaccination rate, Dr. Holland and her associates conducted active surveillance for hospitalizations of children younger than 10 years old with gastroenteritis between 2002 and 2012. Between 2012 and 2015, they performed passive laboratory surveillance by testing stool samples for rotavirus with a commercially available enzyme immunoassay. They also used reverse transcription polymerase chain reaction (RT-PCR) to genotype rotavirus RNA. Finally, they examined vaccination records of cases from the state immunization registry for the years 2009-2015, Dr. Holland said at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

The hospital admitted between 79 and 159 children every year with rotavirus disease between 2002 and 2006, and there was no overall upward or downward trend during this period, said Dr. Holland. Hospitalizations for rotavirus then dropped by about 50% 1 year after RV5 was introduced, she said. Hospitalizations kept dropping every subsequent year until 2014, when the hospital admitted only one child with rotavirus disease.

But, in 2015, the hospital admitted six children for rotavirus disease, including three who had not received RV1 or RV5, Dr. Holland said. “We need to continue surveillance to see if the increase in hospitalizations in 2015 will continue, and if it is related to genotype variation secondary to vaccine-induced immune pressure, or due to natural variation,” she added.

Genotype 1 rotavirus, which is most common globally, predominated until after Rhode Island implemented RV5, the study found. Genotype 2 prevailed in 2010, when the state switched to RV1. Since then, nontypeable strains have predominated, and the research team is continuing to sequence them.

The National Science Foundation partially supported the research with a grant to the University of Rhode Island Genomics and Sequencing Center in Kingston. The Center for International Health Research also helped with analyses. Dr. Holland reported no relevant financial disclosures. Senior author Dr. Penelope Dennehy reported receiving relevant research funding from Merck, the maker of RotaTeq.

SAN DIEGO – Onchocerca lupi, a zoonotic parasite previously described as causing eye disease in cats and dogs, as well as in humans from Europe, Asia, and the Middle East, is emerging in the Southwestern United States.

“The life cycle of this organism is not yet clearly defined, but likely includes a canine and/or feline animal reservoir, as well as an insect vector,” Dr. Christiana Smith said in an interview at an annual scientific meeting on infectious diseases. “No specific risk factors for developing this disease have been identified, other than residing in or traveling through the Southwestern U.S.”

Sally Koch Kubetin/Frontline Medical News

To date, six cases of humans infected by Onchocerca lupi have come to the attention of health officials, including those at the Centers for Disease Control and Prevention, due to symptoms from a nodule containing the parasite, according to Dr. Smith, a pediatrician with the University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora. The affected patients range in age from 22 months to 50 years of age; three of the six reside in Arizona, two in New Mexico, and one in Texas.

In three of the six cases, the nodule was located in the cervical spinal canal. In the remaining three cases, nodules were located on the scalp, the forearm, and the superior rectus muscle of the orbit. Two of the patients reported insect bites at the nodule site years prior to presentation, while another patient owned a dog with eye lesions.

“No previous Onchocerca parasites are known to have tropism for the central nervous system,” Dr. Smith said. “In addition, five of the six cases presented in children. It is not clear whether children are disproportionately affected by this disease, or whether they are diagnosed more frequently.”

Treatment included surgical excision and antiparasitic treatment for most cases. To date, all patients have remained asymptomatic following treatment. Dr. Smith said that more information about Onchocerca lupi will become available as additional cases are described. “Continued epidemiologic investigation will help define the life cycle of this organism, describe the spectrum of human disease, develop approaches to diagnosis and management, and design prevention strategies,” she said.

IDWeek marks the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. The researchers reported having no financial disclosures.

[email protected]

SAN DIEGO – Onchocerca lupi, a zoonotic parasite previously described as causing eye disease in cats and dogs, as well as in humans from Europe, Asia, and the Middle East, is emerging in the Southwestern United States.

“The life cycle of this organism is not yet clearly defined, but likely includes a canine and/or feline animal reservoir, as well as an insect vector,” Dr. Christiana Smith said in an interview at an annual scientific meeting on infectious diseases. “No specific risk factors for developing this disease have been identified, other than residing in or traveling through the Southwestern U.S.”

Sally Koch Kubetin/Frontline Medical News

To date, six cases of humans infected by Onchocerca lupi have come to the attention of health officials, including those at the Centers for Disease Control and Prevention, due to symptoms from a nodule containing the parasite, according to Dr. Smith, a pediatrician with the University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora. The affected patients range in age from 22 months to 50 years of age; three of the six reside in Arizona, two in New Mexico, and one in Texas.

In three of the six cases, the nodule was located in the cervical spinal canal. In the remaining three cases, nodules were located on the scalp, the forearm, and the superior rectus muscle of the orbit. Two of the patients reported insect bites at the nodule site years prior to presentation, while another patient owned a dog with eye lesions.

“No previous Onchocerca parasites are known to have tropism for the central nervous system,” Dr. Smith said. “In addition, five of the six cases presented in children. It is not clear whether children are disproportionately affected by this disease, or whether they are diagnosed more frequently.”

Treatment included surgical excision and antiparasitic treatment for most cases. To date, all patients have remained asymptomatic following treatment. Dr. Smith said that more information about Onchocerca lupi will become available as additional cases are described. “Continued epidemiologic investigation will help define the life cycle of this organism, describe the spectrum of human disease, develop approaches to diagnosis and management, and design prevention strategies,” she said.

IDWeek marks the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. The researchers reported having no financial disclosures.

[email protected]

SAN DIEGO – Onchocerca lupi, a zoonotic parasite previously described as causing eye disease in cats and dogs, as well as in humans from Europe, Asia, and the Middle East, is emerging in the Southwestern United States.

“The life cycle of this organism is not yet clearly defined, but likely includes a canine and/or feline animal reservoir, as well as an insect vector,” Dr. Christiana Smith said in an interview at an annual scientific meeting on infectious diseases. “No specific risk factors for developing this disease have been identified, other than residing in or traveling through the Southwestern U.S.”

Sally Koch Kubetin/Frontline Medical News

To date, six cases of humans infected by Onchocerca lupi have come to the attention of health officials, including those at the Centers for Disease Control and Prevention, due to symptoms from a nodule containing the parasite, according to Dr. Smith, a pediatrician with the University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora. The affected patients range in age from 22 months to 50 years of age; three of the six reside in Arizona, two in New Mexico, and one in Texas.

In three of the six cases, the nodule was located in the cervical spinal canal. In the remaining three cases, nodules were located on the scalp, the forearm, and the superior rectus muscle of the orbit. Two of the patients reported insect bites at the nodule site years prior to presentation, while another patient owned a dog with eye lesions.

“No previous Onchocerca parasites are known to have tropism for the central nervous system,” Dr. Smith said. “In addition, five of the six cases presented in children. It is not clear whether children are disproportionately affected by this disease, or whether they are diagnosed more frequently.”

Treatment included surgical excision and antiparasitic treatment for most cases. To date, all patients have remained asymptomatic following treatment. Dr. Smith said that more information about Onchocerca lupi will become available as additional cases are described. “Continued epidemiologic investigation will help define the life cycle of this organism, describe the spectrum of human disease, develop approaches to diagnosis and management, and design prevention strategies,” she said.

IDWeek marks the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. The researchers reported having no financial disclosures.

[email protected]

SAN DIEGO – Among HIV-infected males, positivity rates for gonorrhea and chlamydia infections varied significantly by anatomical site and presence of symptoms, judging from the results from a large, 3-year analysis.

The findings “suggest a need to consider testing multiple sites regardless of reported symptom, possibly depending on reported sexual practice,” Dr. Sarah Rowan said at an annual scientific meeting on infectious diseases.

Guidelines from the Infectious Diseases Society of America and the Centers for Disease Control and Prevention recommend annual urine testing for gonorrhea and chlamydia (GC/CT) for HIV-infected individuals, with the addition of rectal and pharyngeal screening based on report of sexual practice. The investigators explored GC/CT positivity rates by body site and reason for testing in an urban HIV clinic population. They evaluated all GC/CT tests for HIV-infected males at Denver Health from May 2012 through April 2015. On chart review, tests with documented symptoms suggesting GC/CT infection were considered diagnostic tests, while tests without documented symptoms were considered screening tests. The researchers excluded tests with inaccessible medical records and used chi square analysis to examine associations between test results, presence or absence of symptoms, and anatomical test sites.

Results were available from 5,755 tests conducted in 1,232 men with a median age of 44 years. The men had an average of 4.67 tests, most of which were screening tests (81%; the remaining 19% were diagnostic). Among all tests, 5% were positive for GC or CT and a significantly higher proportion of diagnostic tests were positive, compared with screening tests (10% vs. 3%, respectively; P less than .001), reported Dr. Rowan, an internist and pediatrician with the Denver Health and Hospital Authority.

By anatomic site, the majority of all tests were urine tests (65%), followed by those obtained from pharyngeal sites (26%), and rectal sites (9%), while rectal tests were positive more often than pharyngeal or urine tests (10% vs. 5% and 3%, respectively; P less than .001). Combined GC/CT positivity rates were highest for diagnostic rectal (16%) and urine tests (10%) and screening rectal tests (9%).

The researchers also observed that in the absence of symptoms, the most prevalent infection was rectal CT (12%), followed by pharyngeal GC (6%) and rectal GC (6%). Genitourinary symptoms were more often associated with infection in any site, compared with pharyngeal or rectal symptoms (12% vs. 5% and 10%, respectively; P = .115), while rectal tests were positive more often than other anatomic sites regardless of symptom reported.

“Although only 3% of all screening tests were positive, 12% of rectal chlamydia screening tests and 6% of pharyngeal and rectal gonorrhea screening tests were positive, suggesting that screening extragenital sites may identify more infections than screening urine,” Dr. Rowan said.

IDWeek marks the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. The researchers reported having no financial disclosures.

[email protected]

SAN DIEGO – Among HIV-infected males, positivity rates for gonorrhea and chlamydia infections varied significantly by anatomical site and presence of symptoms, judging from the results from a large, 3-year analysis.

The findings “suggest a need to consider testing multiple sites regardless of reported symptom, possibly depending on reported sexual practice,” Dr. Sarah Rowan said at an annual scientific meeting on infectious diseases.

Guidelines from the Infectious Diseases Society of America and the Centers for Disease Control and Prevention recommend annual urine testing for gonorrhea and chlamydia (GC/CT) for HIV-infected individuals, with the addition of rectal and pharyngeal screening based on report of sexual practice. The investigators explored GC/CT positivity rates by body site and reason for testing in an urban HIV clinic population. They evaluated all GC/CT tests for HIV-infected males at Denver Health from May 2012 through April 2015. On chart review, tests with documented symptoms suggesting GC/CT infection were considered diagnostic tests, while tests without documented symptoms were considered screening tests. The researchers excluded tests with inaccessible medical records and used chi square analysis to examine associations between test results, presence or absence of symptoms, and anatomical test sites.

Results were available from 5,755 tests conducted in 1,232 men with a median age of 44 years. The men had an average of 4.67 tests, most of which were screening tests (81%; the remaining 19% were diagnostic). Among all tests, 5% were positive for GC or CT and a significantly higher proportion of diagnostic tests were positive, compared with screening tests (10% vs. 3%, respectively; P less than .001), reported Dr. Rowan, an internist and pediatrician with the Denver Health and Hospital Authority.

By anatomic site, the majority of all tests were urine tests (65%), followed by those obtained from pharyngeal sites (26%), and rectal sites (9%), while rectal tests were positive more often than pharyngeal or urine tests (10% vs. 5% and 3%, respectively; P less than .001). Combined GC/CT positivity rates were highest for diagnostic rectal (16%) and urine tests (10%) and screening rectal tests (9%).

The researchers also observed that in the absence of symptoms, the most prevalent infection was rectal CT (12%), followed by pharyngeal GC (6%) and rectal GC (6%). Genitourinary symptoms were more often associated with infection in any site, compared with pharyngeal or rectal symptoms (12% vs. 5% and 10%, respectively; P = .115), while rectal tests were positive more often than other anatomic sites regardless of symptom reported.

“Although only 3% of all screening tests were positive, 12% of rectal chlamydia screening tests and 6% of pharyngeal and rectal gonorrhea screening tests were positive, suggesting that screening extragenital sites may identify more infections than screening urine,” Dr. Rowan said.

IDWeek marks the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. The researchers reported having no financial disclosures.

[email protected]

SAN DIEGO – Among HIV-infected males, positivity rates for gonorrhea and chlamydia infections varied significantly by anatomical site and presence of symptoms, judging from the results from a large, 3-year analysis.

The findings “suggest a need to consider testing multiple sites regardless of reported symptom, possibly depending on reported sexual practice,” Dr. Sarah Rowan said at an annual scientific meeting on infectious diseases.

Guidelines from the Infectious Diseases Society of America and the Centers for Disease Control and Prevention recommend annual urine testing for gonorrhea and chlamydia (GC/CT) for HIV-infected individuals, with the addition of rectal and pharyngeal screening based on report of sexual practice. The investigators explored GC/CT positivity rates by body site and reason for testing in an urban HIV clinic population. They evaluated all GC/CT tests for HIV-infected males at Denver Health from May 2012 through April 2015. On chart review, tests with documented symptoms suggesting GC/CT infection were considered diagnostic tests, while tests without documented symptoms were considered screening tests. The researchers excluded tests with inaccessible medical records and used chi square analysis to examine associations between test results, presence or absence of symptoms, and anatomical test sites.

Results were available from 5,755 tests conducted in 1,232 men with a median age of 44 years. The men had an average of 4.67 tests, most of which were screening tests (81%; the remaining 19% were diagnostic). Among all tests, 5% were positive for GC or CT and a significantly higher proportion of diagnostic tests were positive, compared with screening tests (10% vs. 3%, respectively; P less than .001), reported Dr. Rowan, an internist and pediatrician with the Denver Health and Hospital Authority.

By anatomic site, the majority of all tests were urine tests (65%), followed by those obtained from pharyngeal sites (26%), and rectal sites (9%), while rectal tests were positive more often than pharyngeal or urine tests (10% vs. 5% and 3%, respectively; P less than .001). Combined GC/CT positivity rates were highest for diagnostic rectal (16%) and urine tests (10%) and screening rectal tests (9%).

The researchers also observed that in the absence of symptoms, the most prevalent infection was rectal CT (12%), followed by pharyngeal GC (6%) and rectal GC (6%). Genitourinary symptoms were more often associated with infection in any site, compared with pharyngeal or rectal symptoms (12% vs. 5% and 10%, respectively; P = .115), while rectal tests were positive more often than other anatomic sites regardless of symptom reported.

“Although only 3% of all screening tests were positive, 12% of rectal chlamydia screening tests and 6% of pharyngeal and rectal gonorrhea screening tests were positive, suggesting that screening extragenital sites may identify more infections than screening urine,” Dr. Rowan said.

IDWeek marks the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. The researchers reported having no financial disclosures.

[email protected]

SAN DIEGO – Less than a third of hospitals reprocessed duodenoscopes adequately to prevent potential transmission of carbapenem-resistant Enterobacteriaceae (CRE) and other pathogens, investigators reported at an annual scientific meeting on infectious diseases.

Moreover, only a third of facilities had conducted active surveillance for multidrug-resistant infections related to use of their duodenoscopes in the past year, reported Susan Beekmann of the Emerging Infections Network of the Infectious Diseases Society of America. “These findings suggest that endemic bacterial transmission associated with duodenoscopy may occur and may go unrecognized,” said Ms. Beekmann, program coordinator for EIN at the University of Iowa Carver College of Medicine in Iowa City.

©CDC/James Archer

Duodenoscopes, which are used in endoscopic retrograde cholangiopancreatography (ERCP), became a hot topic earlier this year after causing outbreaks of fatal CRE infections in Los Angeles County. The Food and Drug Administration has acknowledged that the “complex design of the devices makes it difficult to remove contaminants compared to other types of endoscopes,” and both the CDC and the FDA have recommended specific reprocessing and surveillance steps to reduce the chances that the scopes transmit serious infections.

To understand how hospitals were actually reprocessing and culturing the scopes at the time CDC released its guidance, Ms. Beekmann and her colleagues electronically surveyed 740 hospital epidemiologists through IDSA-EIN. They received responses from 378 physicians (52%), of which half said their facilities used duodenoscopes, Ms. Beekmann reported at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Only 55 (29%) of these respondents said their facilities reprocessed duodenoscopes to an extent that the IDSA researchers defined as adequate – that is, manual reprocessing with high-level disinfection, either alone or in combination with other options, Ms. Beekmann said. Furthermore, only a third of facilities had cultured their duodenoscopes or done any other surveillance for bacterial transmission after duodenoscopy in the past year, even though most said they reviewed their reprocessing policies and procedures more often than once a year.

Respondents also described widely varying methodologies for sampling and culturing, Ms. Beekmann said. “Although we did not ask about them, ten respondents mentioned ATP bioluminescence assays,” she added. Based on the findings, better reprocessing technologies and consistent, real-time strategies to monitor the effectiveness of scope reprocessing are “urgent patient safety needs,” she and her colleagues concluded.

Ms. Beekmann and her associates reported no relevant financial disclosures.

SAN DIEGO – Less than a third of hospitals reprocessed duodenoscopes adequately to prevent potential transmission of carbapenem-resistant Enterobacteriaceae (CRE) and other pathogens, investigators reported at an annual scientific meeting on infectious diseases.

Moreover, only a third of facilities had conducted active surveillance for multidrug-resistant infections related to use of their duodenoscopes in the past year, reported Susan Beekmann of the Emerging Infections Network of the Infectious Diseases Society of America. “These findings suggest that endemic bacterial transmission associated with duodenoscopy may occur and may go unrecognized,” said Ms. Beekmann, program coordinator for EIN at the University of Iowa Carver College of Medicine in Iowa City.

©CDC/James Archer

Duodenoscopes, which are used in endoscopic retrograde cholangiopancreatography (ERCP), became a hot topic earlier this year after causing outbreaks of fatal CRE infections in Los Angeles County. The Food and Drug Administration has acknowledged that the “complex design of the devices makes it difficult to remove contaminants compared to other types of endoscopes,” and both the CDC and the FDA have recommended specific reprocessing and surveillance steps to reduce the chances that the scopes transmit serious infections.

To understand how hospitals were actually reprocessing and culturing the scopes at the time CDC released its guidance, Ms. Beekmann and her colleagues electronically surveyed 740 hospital epidemiologists through IDSA-EIN. They received responses from 378 physicians (52%), of which half said their facilities used duodenoscopes, Ms. Beekmann reported at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Only 55 (29%) of these respondents said their facilities reprocessed duodenoscopes to an extent that the IDSA researchers defined as adequate – that is, manual reprocessing with high-level disinfection, either alone or in combination with other options, Ms. Beekmann said. Furthermore, only a third of facilities had cultured their duodenoscopes or done any other surveillance for bacterial transmission after duodenoscopy in the past year, even though most said they reviewed their reprocessing policies and procedures more often than once a year.

Respondents also described widely varying methodologies for sampling and culturing, Ms. Beekmann said. “Although we did not ask about them, ten respondents mentioned ATP bioluminescence assays,” she added. Based on the findings, better reprocessing technologies and consistent, real-time strategies to monitor the effectiveness of scope reprocessing are “urgent patient safety needs,” she and her colleagues concluded.

Ms. Beekmann and her associates reported no relevant financial disclosures.

SAN DIEGO – Less than a third of hospitals reprocessed duodenoscopes adequately to prevent potential transmission of carbapenem-resistant Enterobacteriaceae (CRE) and other pathogens, investigators reported at an annual scientific meeting on infectious diseases.

Moreover, only a third of facilities had conducted active surveillance for multidrug-resistant infections related to use of their duodenoscopes in the past year, reported Susan Beekmann of the Emerging Infections Network of the Infectious Diseases Society of America. “These findings suggest that endemic bacterial transmission associated with duodenoscopy may occur and may go unrecognized,” said Ms. Beekmann, program coordinator for EIN at the University of Iowa Carver College of Medicine in Iowa City.

©CDC/James Archer

Duodenoscopes, which are used in endoscopic retrograde cholangiopancreatography (ERCP), became a hot topic earlier this year after causing outbreaks of fatal CRE infections in Los Angeles County. The Food and Drug Administration has acknowledged that the “complex design of the devices makes it difficult to remove contaminants compared to other types of endoscopes,” and both the CDC and the FDA have recommended specific reprocessing and surveillance steps to reduce the chances that the scopes transmit serious infections.

To understand how hospitals were actually reprocessing and culturing the scopes at the time CDC released its guidance, Ms. Beekmann and her colleagues electronically surveyed 740 hospital epidemiologists through IDSA-EIN. They received responses from 378 physicians (52%), of which half said their facilities used duodenoscopes, Ms. Beekmann reported at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Only 55 (29%) of these respondents said their facilities reprocessed duodenoscopes to an extent that the IDSA researchers defined as adequate – that is, manual reprocessing with high-level disinfection, either alone or in combination with other options, Ms. Beekmann said. Furthermore, only a third of facilities had cultured their duodenoscopes or done any other surveillance for bacterial transmission after duodenoscopy in the past year, even though most said they reviewed their reprocessing policies and procedures more often than once a year.

Respondents also described widely varying methodologies for sampling and culturing, Ms. Beekmann said. “Although we did not ask about them, ten respondents mentioned ATP bioluminescence assays,” she added. Based on the findings, better reprocessing technologies and consistent, real-time strategies to monitor the effectiveness of scope reprocessing are “urgent patient safety needs,” she and her colleagues concluded.

Ms. Beekmann and her associates reported no relevant financial disclosures.

SAN DIEGO – Third-generation cephalosporin-resistant Escherichia coli infection carriage was present in 4.2% of healthy children who underwent stool testing, especially in young children and in those with a household member who traveled internationally within the last year.

Those are key findings from a multicenter study which set out to examine the epidemiology of antibiotic-resistant E. coli colonization in healthy children.

“Overall, the results suggest that there is circulation and spread of third-generation cephalosporin-resistant Escherichia coli infection at the community and global level,” Dr. Shamim M. Islam said at an annual scientific meeting on infectious diseases.

Doug Brunk/Frontline Medical News

Dr. Islam of the department of pediatrics at the State University of New York at Buffalo characterized the management of extended-spectrum beta-lactamase infections as “particularly complicated in children given limited antibiotic options. ESBL [Extended spectrum beta-lactamase]–producing Enterobacteriaceae infections are steadily rising, including in the community setting.”

As part of the Centers for Disease Control and Prevention’s New Vaccine Surveillance Network acute gastroenteritis project, the researchers enrolled 520 healthy children ranging in age from 14 days to 11 years during well-child visits in Oakland, Calif.; Kansas City, Mo.; and Nashville, Tenn., between December of 2013 and March of 2015. Dr. Islam and his associates administered a four-question survey to parents of the children, including questions about recent antibiotic use in the child and travel and hospitalization history of all members of their household. They collected stool samples from the children and used chromogenic commercial media technology to screen for ESBL-producing bacteria, and also performed confirmatory testing.

Dr. Islam reported that third-generation cephalosporin-resistant E. coli was present in 4.2% of overall stools, with a range from 3.4% to 5.1% among the three study sites. It was found to be more prevalent in children younger than age 5, compared with those aged 5 and older (4.9% vs. 1.7%, respectively; P = .21).

At the Oakland site, 50% of children carrying third-generation cephalosporin-resistant E. coli isolates had a household member who traveled internationally in the past year, compared with 11% of noncarriers (P = .05), while international travel at the other two sites was low. Combined results from those two sites indicated that 18.2% of children carrying third-generation cephalosporin-resistant E. coli isolates had a household member who traveled internationally in the past year, compared with 6.1% of noncarriers (P = .07).

Going forward, the researchers are planning to conduct further genetic and molecular characterization of the isolates they found with mutliplex pCR and whole-genome sequencing. “We’re going to continue surveillance of bacterial carriage at our current three sites for another year to try and expand our risk factor analysis to include more dietary risk factors and more antibiotic exposure,” Dr. Islam said.

IDWeek marks the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. The researchers reported having no financial disclosures.

[email protected]

SAN DIEGO – Third-generation cephalosporin-resistant Escherichia coli infection carriage was present in 4.2% of healthy children who underwent stool testing, especially in young children and in those with a household member who traveled internationally within the last year.

Those are key findings from a multicenter study which set out to examine the epidemiology of antibiotic-resistant E. coli colonization in healthy children.

“Overall, the results suggest that there is circulation and spread of third-generation cephalosporin-resistant Escherichia coli infection at the community and global level,” Dr. Shamim M. Islam said at an annual scientific meeting on infectious diseases.

Doug Brunk/Frontline Medical News

Dr. Islam of the department of pediatrics at the State University of New York at Buffalo characterized the management of extended-spectrum beta-lactamase infections as “particularly complicated in children given limited antibiotic options. ESBL [Extended spectrum beta-lactamase]–producing Enterobacteriaceae infections are steadily rising, including in the community setting.”

As part of the Centers for Disease Control and Prevention’s New Vaccine Surveillance Network acute gastroenteritis project, the researchers enrolled 520 healthy children ranging in age from 14 days to 11 years during well-child visits in Oakland, Calif.; Kansas City, Mo.; and Nashville, Tenn., between December of 2013 and March of 2015. Dr. Islam and his associates administered a four-question survey to parents of the children, including questions about recent antibiotic use in the child and travel and hospitalization history of all members of their household. They collected stool samples from the children and used chromogenic commercial media technology to screen for ESBL-producing bacteria, and also performed confirmatory testing.

Dr. Islam reported that third-generation cephalosporin-resistant E. coli was present in 4.2% of overall stools, with a range from 3.4% to 5.1% among the three study sites. It was found to be more prevalent in children younger than age 5, compared with those aged 5 and older (4.9% vs. 1.7%, respectively; P = .21).

At the Oakland site, 50% of children carrying third-generation cephalosporin-resistant E. coli isolates had a household member who traveled internationally in the past year, compared with 11% of noncarriers (P = .05), while international travel at the other two sites was low. Combined results from those two sites indicated that 18.2% of children carrying third-generation cephalosporin-resistant E. coli isolates had a household member who traveled internationally in the past year, compared with 6.1% of noncarriers (P = .07).

Going forward, the researchers are planning to conduct further genetic and molecular characterization of the isolates they found with mutliplex pCR and whole-genome sequencing. “We’re going to continue surveillance of bacterial carriage at our current three sites for another year to try and expand our risk factor analysis to include more dietary risk factors and more antibiotic exposure,” Dr. Islam said.

IDWeek marks the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. The researchers reported having no financial disclosures.

[email protected]

SAN DIEGO – Third-generation cephalosporin-resistant Escherichia coli infection carriage was present in 4.2% of healthy children who underwent stool testing, especially in young children and in those with a household member who traveled internationally within the last year.

Those are key findings from a multicenter study which set out to examine the epidemiology of antibiotic-resistant E. coli colonization in healthy children.

“Overall, the results suggest that there is circulation and spread of third-generation cephalosporin-resistant Escherichia coli infection at the community and global level,” Dr. Shamim M. Islam said at an annual scientific meeting on infectious diseases.

Doug Brunk/Frontline Medical News

Dr. Islam of the department of pediatrics at the State University of New York at Buffalo characterized the management of extended-spectrum beta-lactamase infections as “particularly complicated in children given limited antibiotic options. ESBL [Extended spectrum beta-lactamase]–producing Enterobacteriaceae infections are steadily rising, including in the community setting.”

As part of the Centers for Disease Control and Prevention’s New Vaccine Surveillance Network acute gastroenteritis project, the researchers enrolled 520 healthy children ranging in age from 14 days to 11 years during well-child visits in Oakland, Calif.; Kansas City, Mo.; and Nashville, Tenn., between December of 2013 and March of 2015. Dr. Islam and his associates administered a four-question survey to parents of the children, including questions about recent antibiotic use in the child and travel and hospitalization history of all members of their household. They collected stool samples from the children and used chromogenic commercial media technology to screen for ESBL-producing bacteria, and also performed confirmatory testing.

Dr. Islam reported that third-generation cephalosporin-resistant E. coli was present in 4.2% of overall stools, with a range from 3.4% to 5.1% among the three study sites. It was found to be more prevalent in children younger than age 5, compared with those aged 5 and older (4.9% vs. 1.7%, respectively; P = .21).

At the Oakland site, 50% of children carrying third-generation cephalosporin-resistant E. coli isolates had a household member who traveled internationally in the past year, compared with 11% of noncarriers (P = .05), while international travel at the other two sites was low. Combined results from those two sites indicated that 18.2% of children carrying third-generation cephalosporin-resistant E. coli isolates had a household member who traveled internationally in the past year, compared with 6.1% of noncarriers (P = .07).

Going forward, the researchers are planning to conduct further genetic and molecular characterization of the isolates they found with mutliplex pCR and whole-genome sequencing. “We’re going to continue surveillance of bacterial carriage at our current three sites for another year to try and expand our risk factor analysis to include more dietary risk factors and more antibiotic exposure,” Dr. Islam said.

IDWeek marks the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. The researchers reported having no financial disclosures.

[email protected]

YES – Eliminating HAIs is feasible and may help better focus prevention efforts.

For many years, research suggested that reducing hospital-acquired infections (HAIs) by one-third was the best we could do. But recent landmark efforts, such as the Pittsburgh Regional Healthcare Initiative (Morb. Mortal. Wkly. Rep. 2005;54:1013-16) and the Michigan Keystone Project (N. Engl. J. Med. 2006;355:2725-32), have shattered our notions of how many HAIs might be preventable, achieving reductions of nearly 70% in central line–associated bloodstream infections (CLABSIs). Similarly, a national campaign in England has achieved a 68% reduction in Clostridium difficile infections (Health Prot. Rep. 2012;6:38).

These new data suggest that possibly all HAIs are preventable, and there are now many published reports in which institutions have reached zero. For example, the Hawaii experience has shown that a prevention initiative achieved a median rate of zero catheter-related bloodstream infections (Am. J. Med. Qual. 2012;27:124-9).

The advances in HAI prevention are coming in the context of an ever increasingly sick patient population, with patients who are more complicated than ever before. In fact, many of the greatest gains in CLABSI prevention have been among the very sickest patients in our hospitals – in the intensive care unit – as at the Johns Hopkins Hospital in Baltimore (Crit. Care Med. 2004;32:2014-20). So the rationale that we cannot get to zero because our patients are too sick simply is not relevant anymore.

We won’t know how many HAIs are preventable until we hit the bottom. But if our goal is not zero, we will likely end up accepting some infections that might be preventable. Therefore, we must set the goal at zero infections.

What if we don’t get there? That would suggest that some of these infections might not be related to health care delivery but rather to patient risk factors. And these are the infections that we can target. New research could end up preventing some of them. Modifications in definitions might be necessary to account for some of these infections.

One might then argue that we are just defining our way to zero. I would counter that plenty of places have, in fact, hit zero CLABSIs without any changes in our current definitions. But I will also argue that rational changes in our definitions will be needed to help us differentiate truly preventable HAIs and allow us to better focus our prevention efforts.

An excellent example is the new definition of the mucosal barrier injury–related bloodstream infections, which was discussed during the recent IDWeek. Making such an evidence-based change to a definition to focus prevention efforts is neither gaming nor cheating—it’s called good science and good policy.

The zero goal will also improve medical care through the wider adoption of best practices. Published reports of HAI prevention efforts show the successes have been obtained through the implementation of best practices, not through gaming, not through cheating. Zero HAIs as a goal is already driving real improvements in patient safety and quality.

Pushing for zero HAIs will also further research. How much can we argue for pushing the prevention research envelope if we decide that some of these infections are simply okay? How are we going to argue for funding for more prevention research if we tell them the infections aren’t really preventable? We will be much more successful if it’s clear that we need it to get to zero HAIs.

Getting to zero has been put forth as a goal that we should aim for, not as a standard that people should be punished for in the event it is not attained. In fact, value-based purchasing rules are based on relative infection rates – not on zero infection rates.

Moreover, it’s a long-range goal. This is not something that anyone is advocating for overnight. Evidence of that can be seen in the National Action Plan to Prevent HAIs, which calls for 30%-50% reductions, not zero, as the target for the first 5 years.

It must be acknowledged that sometimes an HAI is someone’s fault. Many U.S. institutions have yet to implement best practices for preventing CLABSIs, for example. How long can we hold these hospitals blameless for failing to do this?

In sum, getting to zero HAIs is not the right medicine, but the only medicine. It is our successes, published in our own medical literature, that have prompted the push to get to zero. We shouldn’t run away from the success that we have had; we should embrace it and build on it. Patients will no longer accept a goal of preventing some HAIs, and neither should we.

Dr. Srinivasan is associate director for health care–associated infection prevention programs, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention. He disclosed no relevant conflicts of interest.

NO – Eliminating HAIs is unrealistic and has unintended negative consequences.

There are a variety of reasons why getting to zero HAIs is not the right medicine. First and probably most important is that it is dishonest. Patients today are sicker and more immunosuppressed, and the devices we use are ever more invasive. When we have patients in our hospitals who, for example, have total artificial hearts in place for more than a year, can we realistically imagine that there would not be any HAIs? I don’t think so.

Extensive medical literature documenting infection prevention initiatives attests to this. For example, a recent analysis suggests that even if all U.S. hospitals implemented all of the measures known to prevent HAIs, at best 55%-70% of common HAIs would reasonably be preventable (Infect. Control Hosp. Epidemiol. 2011;32:101-14). None were found to be 100% preventable.

If one looks closely at the Hawaii experience showing a median rate of zero HAIs, you actually see a 61% reduction in the rate of CLABSIs over 1.5 years, but it never reaches zero (Am. J. Med. Qual. 2012;27:124-9). That translates to up to 10 infections per quarter. So we can use words in loose ways and talk about zero median infections, but there were not zero infections in that study. If the final rate of 0.6/1,000 catheter-days were applied to my hospital, it would translate to 11 CLABSIs annually – hardly a number that would allow me to say I had eliminated these infections.

Efforts to achieve zero HAIs may be a manifestation of postmodernism, a philosophical paradigm in which there is no absolute truth, and one that puts evidence-based medicine on par with practices such as homeopathy and the notion that the measles, mumps, and rubella vaccine causes autism.

Aiming for zero HAIs drives a punitive culture. If we accept the concept of getting to zero, it then means that zero is actually attainable, and if that is true, then all HAIs are preventable. And if that is true, logic tells us then that the occurrence of an HAI must be someone’s fault.

The zero goal places enormous pressure on infection preventionists and their programs, and it creates adversarial relationships between infection prevention services and clinicians as they argue about whether an event is an infection. Hospital administrators ask why programs are not reaching zero. And the infection prevention people are caught in the middle of all this. They are in a terrible position: In some cases, they are deciding – in a way – whether people will get a pay raise or will be fired from their jobs.

Trying to eliminate HAIs fosters problems with surveillance, such as outright cheating, making subtle changes to case definitions that reduce infection rates, and underfunding infection prevention programs to reduce their sensitivity for case ascertainment.

It also leads to inappropriate medical practices. For example, many hospitals now check urine cultures on admission in patients with urinary catheters, or obtain blood cultures on asymptomatic patients simply because they have a central line. We know what those kinds of practices lead to nonindicated treatment and overuse of antibiotics.

Aiming for zero separates infection prevention from quality and safety because now, the "be all, end all" becomes an infection-free hospital stay, when maybe that is not the main goal from a patient perspective.

The zero goal also fosters expedient solutions over the hard work of behavior change. A report predicts that, in 2016, the market for infection-control devices and products will be $18 billion – triple that of the market for antibiotics to treat those infections. So there’s a lot of industry out there waiting to get into the market. That in turn contributes to a conflict of interest. Some leading infectious disease associations now have strong sponsorship from these industries that is likely not serving us well.

Aiming for zero also punishes hospitals that care for poor and sicker patients. As an example, in public reporting of hospitals’ infection rates, academic medical centers may appear to have comparatively worse performance.

Finally, if we already know how to get to zero, why would we ever invest any more in research to reduce infections? It really weakens the rationale for funding in the whole field of HAI prevention.

In sum, getting to zero HAIs is not a realistic or beneficial goal and may actually produce many unintended negative consequences. Clinicians and patients alike would be better served by a focus on achieving realistic reductions.

Dr. Edmond is the Richard P. Wenzel Professor of Internal Medicine and chair of the infectious diseases division, Virginia Commonwealth University Hospital, and an epidemiologist at the VCU Health System, both in Richmond. He disclosed no relevant conflicts of interest.

YES – Eliminating HAIs is feasible and may help better focus prevention efforts.

For many years, research suggested that reducing hospital-acquired infections (HAIs) by one-third was the best we could do. But recent landmark efforts, such as the Pittsburgh Regional Healthcare Initiative (Morb. Mortal. Wkly. Rep. 2005;54:1013-16) and the Michigan Keystone Project (N. Engl. J. Med. 2006;355:2725-32), have shattered our notions of how many HAIs might be preventable, achieving reductions of nearly 70% in central line–associated bloodstream infections (CLABSIs). Similarly, a national campaign in England has achieved a 68% reduction in Clostridium difficile infections (Health Prot. Rep. 2012;6:38).

These new data suggest that possibly all HAIs are preventable, and there are now many published reports in which institutions have reached zero. For example, the Hawaii experience has shown that a prevention initiative achieved a median rate of zero catheter-related bloodstream infections (Am. J. Med. Qual. 2012;27:124-9).

The advances in HAI prevention are coming in the context of an ever increasingly sick patient population, with patients who are more complicated than ever before. In fact, many of the greatest gains in CLABSI prevention have been among the very sickest patients in our hospitals – in the intensive care unit – as at the Johns Hopkins Hospital in Baltimore (Crit. Care Med. 2004;32:2014-20). So the rationale that we cannot get to zero because our patients are too sick simply is not relevant anymore.

We won’t know how many HAIs are preventable until we hit the bottom. But if our goal is not zero, we will likely end up accepting some infections that might be preventable. Therefore, we must set the goal at zero infections.

What if we don’t get there? That would suggest that some of these infections might not be related to health care delivery but rather to patient risk factors. And these are the infections that we can target. New research could end up preventing some of them. Modifications in definitions might be necessary to account for some of these infections.

One might then argue that we are just defining our way to zero. I would counter that plenty of places have, in fact, hit zero CLABSIs without any changes in our current definitions. But I will also argue that rational changes in our definitions will be needed to help us differentiate truly preventable HAIs and allow us to better focus our prevention efforts.

An excellent example is the new definition of the mucosal barrier injury–related bloodstream infections, which was discussed during the recent IDWeek. Making such an evidence-based change to a definition to focus prevention efforts is neither gaming nor cheating—it’s called good science and good policy.

The zero goal will also improve medical care through the wider adoption of best practices. Published reports of HAI prevention efforts show the successes have been obtained through the implementation of best practices, not through gaming, not through cheating. Zero HAIs as a goal is already driving real improvements in patient safety and quality.

Pushing for zero HAIs will also further research. How much can we argue for pushing the prevention research envelope if we decide that some of these infections are simply okay? How are we going to argue for funding for more prevention research if we tell them the infections aren’t really preventable? We will be much more successful if it’s clear that we need it to get to zero HAIs.

Getting to zero has been put forth as a goal that we should aim for, not as a standard that people should be punished for in the event it is not attained. In fact, value-based purchasing rules are based on relative infection rates – not on zero infection rates.

Moreover, it’s a long-range goal. This is not something that anyone is advocating for overnight. Evidence of that can be seen in the National Action Plan to Prevent HAIs, which calls for 30%-50% reductions, not zero, as the target for the first 5 years.

It must be acknowledged that sometimes an HAI is someone’s fault. Many U.S. institutions have yet to implement best practices for preventing CLABSIs, for example. How long can we hold these hospitals blameless for failing to do this?

In sum, getting to zero HAIs is not the right medicine, but the only medicine. It is our successes, published in our own medical literature, that have prompted the push to get to zero. We shouldn’t run away from the success that we have had; we should embrace it and build on it. Patients will no longer accept a goal of preventing some HAIs, and neither should we.

Dr. Srinivasan is associate director for health care–associated infection prevention programs, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention. He disclosed no relevant conflicts of interest.

NO – Eliminating HAIs is unrealistic and has unintended negative consequences.

There are a variety of reasons why getting to zero HAIs is not the right medicine. First and probably most important is that it is dishonest. Patients today are sicker and more immunosuppressed, and the devices we use are ever more invasive. When we have patients in our hospitals who, for example, have total artificial hearts in place for more than a year, can we realistically imagine that there would not be any HAIs? I don’t think so.

Extensive medical literature documenting infection prevention initiatives attests to this. For example, a recent analysis suggests that even if all U.S. hospitals implemented all of the measures known to prevent HAIs, at best 55%-70% of common HAIs would reasonably be preventable (Infect. Control Hosp. Epidemiol. 2011;32:101-14). None were found to be 100% preventable.

If one looks closely at the Hawaii experience showing a median rate of zero HAIs, you actually see a 61% reduction in the rate of CLABSIs over 1.5 years, but it never reaches zero (Am. J. Med. Qual. 2012;27:124-9). That translates to up to 10 infections per quarter. So we can use words in loose ways and talk about zero median infections, but there were not zero infections in that study. If the final rate of 0.6/1,000 catheter-days were applied to my hospital, it would translate to 11 CLABSIs annually – hardly a number that would allow me to say I had eliminated these infections.

Efforts to achieve zero HAIs may be a manifestation of postmodernism, a philosophical paradigm in which there is no absolute truth, and one that puts evidence-based medicine on par with practices such as homeopathy and the notion that the measles, mumps, and rubella vaccine causes autism.

Aiming for zero HAIs drives a punitive culture. If we accept the concept of getting to zero, it then means that zero is actually attainable, and if that is true, then all HAIs are preventable. And if that is true, logic tells us then that the occurrence of an HAI must be someone’s fault.

The zero goal places enormous pressure on infection preventionists and their programs, and it creates adversarial relationships between infection prevention services and clinicians as they argue about whether an event is an infection. Hospital administrators ask why programs are not reaching zero. And the infection prevention people are caught in the middle of all this. They are in a terrible position: In some cases, they are deciding – in a way – whether people will get a pay raise or will be fired from their jobs.

Trying to eliminate HAIs fosters problems with surveillance, such as outright cheating, making subtle changes to case definitions that reduce infection rates, and underfunding infection prevention programs to reduce their sensitivity for case ascertainment.

It also leads to inappropriate medical practices. For example, many hospitals now check urine cultures on admission in patients with urinary catheters, or obtain blood cultures on asymptomatic patients simply because they have a central line. We know what those kinds of practices lead to nonindicated treatment and overuse of antibiotics.

Aiming for zero separates infection prevention from quality and safety because now, the "be all, end all" becomes an infection-free hospital stay, when maybe that is not the main goal from a patient perspective.

The zero goal also fosters expedient solutions over the hard work of behavior change. A report predicts that, in 2016, the market for infection-control devices and products will be $18 billion – triple that of the market for antibiotics to treat those infections. So there’s a lot of industry out there waiting to get into the market. That in turn contributes to a conflict of interest. Some leading infectious disease associations now have strong sponsorship from these industries that is likely not serving us well.

Aiming for zero also punishes hospitals that care for poor and sicker patients. As an example, in public reporting of hospitals’ infection rates, academic medical centers may appear to have comparatively worse performance.

Finally, if we already know how to get to zero, why would we ever invest any more in research to reduce infections? It really weakens the rationale for funding in the whole field of HAI prevention.

In sum, getting to zero HAIs is not a realistic or beneficial goal and may actually produce many unintended negative consequences. Clinicians and patients alike would be better served by a focus on achieving realistic reductions.

Dr. Edmond is the Richard P. Wenzel Professor of Internal Medicine and chair of the infectious diseases division, Virginia Commonwealth University Hospital, and an epidemiologist at the VCU Health System, both in Richmond. He disclosed no relevant conflicts of interest.

YES – Eliminating HAIs is feasible and may help better focus prevention efforts.

For many years, research suggested that reducing hospital-acquired infections (HAIs) by one-third was the best we could do. But recent landmark efforts, such as the Pittsburgh Regional Healthcare Initiative (Morb. Mortal. Wkly. Rep. 2005;54:1013-16) and the Michigan Keystone Project (N. Engl. J. Med. 2006;355:2725-32), have shattered our notions of how many HAIs might be preventable, achieving reductions of nearly 70% in central line–associated bloodstream infections (CLABSIs). Similarly, a national campaign in England has achieved a 68% reduction in Clostridium difficile infections (Health Prot. Rep. 2012;6:38).

These new data suggest that possibly all HAIs are preventable, and there are now many published reports in which institutions have reached zero. For example, the Hawaii experience has shown that a prevention initiative achieved a median rate of zero catheter-related bloodstream infections (Am. J. Med. Qual. 2012;27:124-9).

The advances in HAI prevention are coming in the context of an ever increasingly sick patient population, with patients who are more complicated than ever before. In fact, many of the greatest gains in CLABSI prevention have been among the very sickest patients in our hospitals – in the intensive care unit – as at the Johns Hopkins Hospital in Baltimore (Crit. Care Med. 2004;32:2014-20). So the rationale that we cannot get to zero because our patients are too sick simply is not relevant anymore.

We won’t know how many HAIs are preventable until we hit the bottom. But if our goal is not zero, we will likely end up accepting some infections that might be preventable. Therefore, we must set the goal at zero infections.

What if we don’t get there? That would suggest that some of these infections might not be related to health care delivery but rather to patient risk factors. And these are the infections that we can target. New research could end up preventing some of them. Modifications in definitions might be necessary to account for some of these infections.

One might then argue that we are just defining our way to zero. I would counter that plenty of places have, in fact, hit zero CLABSIs without any changes in our current definitions. But I will also argue that rational changes in our definitions will be needed to help us differentiate truly preventable HAIs and allow us to better focus our prevention efforts.

An excellent example is the new definition of the mucosal barrier injury–related bloodstream infections, which was discussed during the recent IDWeek. Making such an evidence-based change to a definition to focus prevention efforts is neither gaming nor cheating—it’s called good science and good policy.

The zero goal will also improve medical care through the wider adoption of best practices. Published reports of HAI prevention efforts show the successes have been obtained through the implementation of best practices, not through gaming, not through cheating. Zero HAIs as a goal is already driving real improvements in patient safety and quality.

Pushing for zero HAIs will also further research. How much can we argue for pushing the prevention research envelope if we decide that some of these infections are simply okay? How are we going to argue for funding for more prevention research if we tell them the infections aren’t really preventable? We will be much more successful if it’s clear that we need it to get to zero HAIs.

Getting to zero has been put forth as a goal that we should aim for, not as a standard that people should be punished for in the event it is not attained. In fact, value-based purchasing rules are based on relative infection rates – not on zero infection rates.

Moreover, it’s a long-range goal. This is not something that anyone is advocating for overnight. Evidence of that can be seen in the National Action Plan to Prevent HAIs, which calls for 30%-50% reductions, not zero, as the target for the first 5 years.

It must be acknowledged that sometimes an HAI is someone’s fault. Many U.S. institutions have yet to implement best practices for preventing CLABSIs, for example. How long can we hold these hospitals blameless for failing to do this?

In sum, getting to zero HAIs is not the right medicine, but the only medicine. It is our successes, published in our own medical literature, that have prompted the push to get to zero. We shouldn’t run away from the success that we have had; we should embrace it and build on it. Patients will no longer accept a goal of preventing some HAIs, and neither should we.

Dr. Srinivasan is associate director for health care–associated infection prevention programs, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention. He disclosed no relevant conflicts of interest.

NO – Eliminating HAIs is unrealistic and has unintended negative consequences.

There are a variety of reasons why getting to zero HAIs is not the right medicine. First and probably most important is that it is dishonest. Patients today are sicker and more immunosuppressed, and the devices we use are ever more invasive. When we have patients in our hospitals who, for example, have total artificial hearts in place for more than a year, can we realistically imagine that there would not be any HAIs? I don’t think so.

Extensive medical literature documenting infection prevention initiatives attests to this. For example, a recent analysis suggests that even if all U.S. hospitals implemented all of the measures known to prevent HAIs, at best 55%-70% of common HAIs would reasonably be preventable (Infect. Control Hosp. Epidemiol. 2011;32:101-14). None were found to be 100% preventable.

If one looks closely at the Hawaii experience showing a median rate of zero HAIs, you actually see a 61% reduction in the rate of CLABSIs over 1.5 years, but it never reaches zero (Am. J. Med. Qual. 2012;27:124-9). That translates to up to 10 infections per quarter. So we can use words in loose ways and talk about zero median infections, but there were not zero infections in that study. If the final rate of 0.6/1,000 catheter-days were applied to my hospital, it would translate to 11 CLABSIs annually – hardly a number that would allow me to say I had eliminated these infections.

Efforts to achieve zero HAIs may be a manifestation of postmodernism, a philosophical paradigm in which there is no absolute truth, and one that puts evidence-based medicine on par with practices such as homeopathy and the notion that the measles, mumps, and rubella vaccine causes autism.

Aiming for zero HAIs drives a punitive culture. If we accept the concept of getting to zero, it then means that zero is actually attainable, and if that is true, then all HAIs are preventable. And if that is true, logic tells us then that the occurrence of an HAI must be someone’s fault.

The zero goal places enormous pressure on infection preventionists and their programs, and it creates adversarial relationships between infection prevention services and clinicians as they argue about whether an event is an infection. Hospital administrators ask why programs are not reaching zero. And the infection prevention people are caught in the middle of all this. They are in a terrible position: In some cases, they are deciding – in a way – whether people will get a pay raise or will be fired from their jobs.

Trying to eliminate HAIs fosters problems with surveillance, such as outright cheating, making subtle changes to case definitions that reduce infection rates, and underfunding infection prevention programs to reduce their sensitivity for case ascertainment.

It also leads to inappropriate medical practices. For example, many hospitals now check urine cultures on admission in patients with urinary catheters, or obtain blood cultures on asymptomatic patients simply because they have a central line. We know what those kinds of practices lead to nonindicated treatment and overuse of antibiotics.

Aiming for zero separates infection prevention from quality and safety because now, the "be all, end all" becomes an infection-free hospital stay, when maybe that is not the main goal from a patient perspective.

The zero goal also fosters expedient solutions over the hard work of behavior change. A report predicts that, in 2016, the market for infection-control devices and products will be $18 billion – triple that of the market for antibiotics to treat those infections. So there’s a lot of industry out there waiting to get into the market. That in turn contributes to a conflict of interest. Some leading infectious disease associations now have strong sponsorship from these industries that is likely not serving us well.

Aiming for zero also punishes hospitals that care for poor and sicker patients. As an example, in public reporting of hospitals’ infection rates, academic medical centers may appear to have comparatively worse performance.

Finally, if we already know how to get to zero, why would we ever invest any more in research to reduce infections? It really weakens the rationale for funding in the whole field of HAI prevention.

In sum, getting to zero HAIs is not a realistic or beneficial goal and may actually produce many unintended negative consequences. Clinicians and patients alike would be better served by a focus on achieving realistic reductions.

Dr. Edmond is the Richard P. Wenzel Professor of Internal Medicine and chair of the infectious diseases division, Virginia Commonwealth University Hospital, and an epidemiologist at the VCU Health System, both in Richmond. He disclosed no relevant conflicts of interest.