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Majority of influenza-related deaths among hospitalized patients occur after discharge
SAN DIEGO – Over half of hospitalized, influenza-related deaths occurred within 30 days of discharge, according to a study presented at an annual scientific meeting on infectious diseases.
As physicians and pharmaceutical companies attempt to measure the burden of seasonal influenza, discharged patients are currently not considered as much as they should be, according to investigators.
Among 968 deceased patients studied, 444 (46%) died in hospital, while 524 (54%) died within 30 days of discharge.
Investigators conducted a retrospective study of 15,562 patients hospitalized for influenza-related cases between 2014 and 2015, as recorded in Influenza-Associated Hospitalizations Surveillance (FluSurv-NET), a database of the Centers for Disease Control and Prevention.
The majority of the studied patients were women (55%) and the majority were white.
Those who died were more likely to have been admitted to the hospital immediately after influenza onset, with 26% of those who died after discharge and 22% of those who died in hospital having been admitted the same day. In contrast, 13% of those who lived past 30 days were admitted immediately after onset.
A total of 46% of those who died after hospitalization had a length of stay longer than 1 week, compared to 15% of those who lived.
Among patients who died after discharge, 356 (68%) died within 2 weeks of discharge, with the highest number of deaths occurring within the first few days, according to presenter Craig McGowan of the Influenza Division of the CDC in Atlanta.
Age also seemed to be a possible mortality predictor, according to Mr. McGowan and his fellow investigators. “Those who died were more likely to be elderly, and those who died after discharge were even more likely to be 85 [years or older] than those who died during their influenza-related hospitalizations,” said Mr. McGowan, who added that patients aged 85 years and older made up more than half of those who died after discharge.
Patients who died in hospital were significantly more likely to have influenza listed as a cause of death. Overall, influenza-related and non–influenza-related respiratory issues were the two most common causes of death listed on death certificates of patients who died during hospitalization or within 14 days of discharge, while cardiovascular or other symptoms were listed for those who died between 15 and 30 days after discharge.
Admission and discharge locations among patients who did not die were almost 80% from a private residence to a private residence, while observations of those who died revealed a different pattern. “Those individuals who died after discharge were almost evenly split between admission from a nursing home or a private residence,” Mr. McGowan said. “Those who were admitted from the nursing home were almost exclusively discharged to either hospice care or back to a nursing home.”
Mr. McGowan noted rehospitalization to be a significant factor among those who died, with 34% of deaths occurring back in the hospital after initial discharge.
Influenza testing of studied patients was given at clinicians’ discretion, which may make the sample not generalizable to the overall influenza population, and the investigators included only bivariate associations, which means there were likely confounding effects that could not be accounted for.
Mr. McGowan and his fellow investigators plan to expand their research by determining underlying causes of death in these patients, to create more accurate estimates of influenza-associated mortality.
Mr. McGowan reported no relevant financial disclosures.
SOURCE: McGowan, C., et al., ID Week 2017, Abstract 951.
SAN DIEGO – Over half of hospitalized, influenza-related deaths occurred within 30 days of discharge, according to a study presented at an annual scientific meeting on infectious diseases.
As physicians and pharmaceutical companies attempt to measure the burden of seasonal influenza, discharged patients are currently not considered as much as they should be, according to investigators.
Among 968 deceased patients studied, 444 (46%) died in hospital, while 524 (54%) died within 30 days of discharge.
Investigators conducted a retrospective study of 15,562 patients hospitalized for influenza-related cases between 2014 and 2015, as recorded in Influenza-Associated Hospitalizations Surveillance (FluSurv-NET), a database of the Centers for Disease Control and Prevention.
The majority of the studied patients were women (55%) and the majority were white.
Those who died were more likely to have been admitted to the hospital immediately after influenza onset, with 26% of those who died after discharge and 22% of those who died in hospital having been admitted the same day. In contrast, 13% of those who lived past 30 days were admitted immediately after onset.
A total of 46% of those who died after hospitalization had a length of stay longer than 1 week, compared to 15% of those who lived.
Among patients who died after discharge, 356 (68%) died within 2 weeks of discharge, with the highest number of deaths occurring within the first few days, according to presenter Craig McGowan of the Influenza Division of the CDC in Atlanta.
Age also seemed to be a possible mortality predictor, according to Mr. McGowan and his fellow investigators. “Those who died were more likely to be elderly, and those who died after discharge were even more likely to be 85 [years or older] than those who died during their influenza-related hospitalizations,” said Mr. McGowan, who added that patients aged 85 years and older made up more than half of those who died after discharge.
Patients who died in hospital were significantly more likely to have influenza listed as a cause of death. Overall, influenza-related and non–influenza-related respiratory issues were the two most common causes of death listed on death certificates of patients who died during hospitalization or within 14 days of discharge, while cardiovascular or other symptoms were listed for those who died between 15 and 30 days after discharge.
Admission and discharge locations among patients who did not die were almost 80% from a private residence to a private residence, while observations of those who died revealed a different pattern. “Those individuals who died after discharge were almost evenly split between admission from a nursing home or a private residence,” Mr. McGowan said. “Those who were admitted from the nursing home were almost exclusively discharged to either hospice care or back to a nursing home.”
Mr. McGowan noted rehospitalization to be a significant factor among those who died, with 34% of deaths occurring back in the hospital after initial discharge.
Influenza testing of studied patients was given at clinicians’ discretion, which may make the sample not generalizable to the overall influenza population, and the investigators included only bivariate associations, which means there were likely confounding effects that could not be accounted for.
Mr. McGowan and his fellow investigators plan to expand their research by determining underlying causes of death in these patients, to create more accurate estimates of influenza-associated mortality.
Mr. McGowan reported no relevant financial disclosures.
SOURCE: McGowan, C., et al., ID Week 2017, Abstract 951.
SAN DIEGO – Over half of hospitalized, influenza-related deaths occurred within 30 days of discharge, according to a study presented at an annual scientific meeting on infectious diseases.
As physicians and pharmaceutical companies attempt to measure the burden of seasonal influenza, discharged patients are currently not considered as much as they should be, according to investigators.
Among 968 deceased patients studied, 444 (46%) died in hospital, while 524 (54%) died within 30 days of discharge.
Investigators conducted a retrospective study of 15,562 patients hospitalized for influenza-related cases between 2014 and 2015, as recorded in Influenza-Associated Hospitalizations Surveillance (FluSurv-NET), a database of the Centers for Disease Control and Prevention.
The majority of the studied patients were women (55%) and the majority were white.
Those who died were more likely to have been admitted to the hospital immediately after influenza onset, with 26% of those who died after discharge and 22% of those who died in hospital having been admitted the same day. In contrast, 13% of those who lived past 30 days were admitted immediately after onset.
A total of 46% of those who died after hospitalization had a length of stay longer than 1 week, compared to 15% of those who lived.
Among patients who died after discharge, 356 (68%) died within 2 weeks of discharge, with the highest number of deaths occurring within the first few days, according to presenter Craig McGowan of the Influenza Division of the CDC in Atlanta.
Age also seemed to be a possible mortality predictor, according to Mr. McGowan and his fellow investigators. “Those who died were more likely to be elderly, and those who died after discharge were even more likely to be 85 [years or older] than those who died during their influenza-related hospitalizations,” said Mr. McGowan, who added that patients aged 85 years and older made up more than half of those who died after discharge.
Patients who died in hospital were significantly more likely to have influenza listed as a cause of death. Overall, influenza-related and non–influenza-related respiratory issues were the two most common causes of death listed on death certificates of patients who died during hospitalization or within 14 days of discharge, while cardiovascular or other symptoms were listed for those who died between 15 and 30 days after discharge.
Admission and discharge locations among patients who did not die were almost 80% from a private residence to a private residence, while observations of those who died revealed a different pattern. “Those individuals who died after discharge were almost evenly split between admission from a nursing home or a private residence,” Mr. McGowan said. “Those who were admitted from the nursing home were almost exclusively discharged to either hospice care or back to a nursing home.”
Mr. McGowan noted rehospitalization to be a significant factor among those who died, with 34% of deaths occurring back in the hospital after initial discharge.
Influenza testing of studied patients was given at clinicians’ discretion, which may make the sample not generalizable to the overall influenza population, and the investigators included only bivariate associations, which means there were likely confounding effects that could not be accounted for.
Mr. McGowan and his fellow investigators plan to expand their research by determining underlying causes of death in these patients, to create more accurate estimates of influenza-associated mortality.
Mr. McGowan reported no relevant financial disclosures.
SOURCE: McGowan, C., et al., ID Week 2017, Abstract 951.
AT IDWEEK 2017
Key clinical point:
Major finding: Among patients who died with confirmed influenza, 46% died in hospital, while 54% died within 30 days of discharge.
Data source: Retrospective study of 15,562 influenza patients hospitalized or within 30 days of discharge between 2014 and 2015, recorded in Influenza-Associated Hospitalizations Surveillance (FluSurv-NET).
Disclosures: Mr. McGowen reported no relevant financial disclosures.
Inpatient antiviral treatment reduces ICU admissions among influenza patients
SAN DIEGO – Administering inpatient antiviral influenza treatment may reduce admissions to the ICU among adults hospitalized with flu, according to a study presented at ID Week 2017, an infectious diseases meeting.
While interventions did not directly affect flu-related deaths, lower ICU admission rates could reduce morbidity as well as ease the financial burden felt during the influenza season.
Investigators retrospectively studied 4,679 influenza patients admitted to Canadian Immunization Research Network Serious Outcomes Surveillance (SOS) Network hospitals during 2011-2014. Of the 54% of patients given inpatient antiviral treatment, the risk of being admitted to the ICU was reduced by 90% (odds ratio, 0.10;95% confidence interval, 0.08-0.13; P less than .001).
Antiviral treatment was not protective against death outcomes in patients with either influenza A or influenza B (OR, 0.9; 95% CI, 0.7-1.2; P =.454).
The median age of patients was 70 years, with a majority older than 75 years(41%); the majority presented with one or more comorbidities (89%), and had influenza A (72%).
Researchers found that, of the 4,679 patients studied, 798 (16%) were admitted to the ICU, 511 (11%) required mechanical ventilation, and the average length of hospital stay was 11 days.
Of those studied, 444 (9%) died within 30 days of discharge.
Researchers also found that only 38% of those studied had received the current seasonal vaccine upon admittance. However, these numbers may be skewed from the general population, because patients who have not taken the vaccine are more likely to be hospitalized.
Along with the results of antivirals on hospitalized patients, researchers wanted to uncover how the effectiveness of inpatient vaccine administration would vary based on treatment timing, said presenter Zach Shaffelburg of the Canadian Center for Vaccinology, Dalhousie University, Halifax, NS.
Even when administered 4.28 days after symptom onset, antiviral treatments in patients proved to be associated with significant reductions in ICU admissions and the need for mechanical ventilation.
The investigators concluded that antivirals show a strong association with positive effects on serious, influenza-related outcomes in hospitalized patients and, while therapy remained effective with later treatment start, patients would benefit the most from initiation as soon as possible.
Currently, the U.S. Centers for Disease Control and Prevention and the Canadian Immunization Research Network (CIRN) have guidelines instructing best practice for inpatient antiviral treatment, however the number of hospitalized patients given treatment has declined in Canada since 2009, according to Mr. Shaffelburg.
The reason more patients were not receiving inpatient antiviral treatment may be related to studies of different populations that failed to show significant impact, Mr. Shaffelburg suggested during a question and answer session following the presentation: “I think a lot of that comes from outpatient studies that involve patients who are younger and quite healthy [who received] antivirals, and it showed a very minimal impact,” Mr. Shaffelburg said. “So a lot of people saw that study and thought, ‘What’s that point of giving it if it’s not going to make an impact?’ ”
Mr. Shaffelburg and his colleagues are planning to continue their study of inpatient antiviral treatment, focusing more on the effectiveness of treatment in relation to time administered after onset.
Mr. Shaffelburg reported having no disclosures. The study was funded by the CIRN SOS network, Canadian Institutes for Health Research, and a partnership with GlaxoSmithKline Biologicals. Some of the investigators were GSK employees or received grant funding from the company.
SOURCE: Shaffelburg Z et al. IDWeek 2017 Abstract 890.
SAN DIEGO – Administering inpatient antiviral influenza treatment may reduce admissions to the ICU among adults hospitalized with flu, according to a study presented at ID Week 2017, an infectious diseases meeting.
While interventions did not directly affect flu-related deaths, lower ICU admission rates could reduce morbidity as well as ease the financial burden felt during the influenza season.
Investigators retrospectively studied 4,679 influenza patients admitted to Canadian Immunization Research Network Serious Outcomes Surveillance (SOS) Network hospitals during 2011-2014. Of the 54% of patients given inpatient antiviral treatment, the risk of being admitted to the ICU was reduced by 90% (odds ratio, 0.10;95% confidence interval, 0.08-0.13; P less than .001).
Antiviral treatment was not protective against death outcomes in patients with either influenza A or influenza B (OR, 0.9; 95% CI, 0.7-1.2; P =.454).
The median age of patients was 70 years, with a majority older than 75 years(41%); the majority presented with one or more comorbidities (89%), and had influenza A (72%).
Researchers found that, of the 4,679 patients studied, 798 (16%) were admitted to the ICU, 511 (11%) required mechanical ventilation, and the average length of hospital stay was 11 days.
Of those studied, 444 (9%) died within 30 days of discharge.
Researchers also found that only 38% of those studied had received the current seasonal vaccine upon admittance. However, these numbers may be skewed from the general population, because patients who have not taken the vaccine are more likely to be hospitalized.
Along with the results of antivirals on hospitalized patients, researchers wanted to uncover how the effectiveness of inpatient vaccine administration would vary based on treatment timing, said presenter Zach Shaffelburg of the Canadian Center for Vaccinology, Dalhousie University, Halifax, NS.
Even when administered 4.28 days after symptom onset, antiviral treatments in patients proved to be associated with significant reductions in ICU admissions and the need for mechanical ventilation.
The investigators concluded that antivirals show a strong association with positive effects on serious, influenza-related outcomes in hospitalized patients and, while therapy remained effective with later treatment start, patients would benefit the most from initiation as soon as possible.
Currently, the U.S. Centers for Disease Control and Prevention and the Canadian Immunization Research Network (CIRN) have guidelines instructing best practice for inpatient antiviral treatment, however the number of hospitalized patients given treatment has declined in Canada since 2009, according to Mr. Shaffelburg.
The reason more patients were not receiving inpatient antiviral treatment may be related to studies of different populations that failed to show significant impact, Mr. Shaffelburg suggested during a question and answer session following the presentation: “I think a lot of that comes from outpatient studies that involve patients who are younger and quite healthy [who received] antivirals, and it showed a very minimal impact,” Mr. Shaffelburg said. “So a lot of people saw that study and thought, ‘What’s that point of giving it if it’s not going to make an impact?’ ”
Mr. Shaffelburg and his colleagues are planning to continue their study of inpatient antiviral treatment, focusing more on the effectiveness of treatment in relation to time administered after onset.
Mr. Shaffelburg reported having no disclosures. The study was funded by the CIRN SOS network, Canadian Institutes for Health Research, and a partnership with GlaxoSmithKline Biologicals. Some of the investigators were GSK employees or received grant funding from the company.
SOURCE: Shaffelburg Z et al. IDWeek 2017 Abstract 890.
SAN DIEGO – Administering inpatient antiviral influenza treatment may reduce admissions to the ICU among adults hospitalized with flu, according to a study presented at ID Week 2017, an infectious diseases meeting.
While interventions did not directly affect flu-related deaths, lower ICU admission rates could reduce morbidity as well as ease the financial burden felt during the influenza season.
Investigators retrospectively studied 4,679 influenza patients admitted to Canadian Immunization Research Network Serious Outcomes Surveillance (SOS) Network hospitals during 2011-2014. Of the 54% of patients given inpatient antiviral treatment, the risk of being admitted to the ICU was reduced by 90% (odds ratio, 0.10;95% confidence interval, 0.08-0.13; P less than .001).
Antiviral treatment was not protective against death outcomes in patients with either influenza A or influenza B (OR, 0.9; 95% CI, 0.7-1.2; P =.454).
The median age of patients was 70 years, with a majority older than 75 years(41%); the majority presented with one or more comorbidities (89%), and had influenza A (72%).
Researchers found that, of the 4,679 patients studied, 798 (16%) were admitted to the ICU, 511 (11%) required mechanical ventilation, and the average length of hospital stay was 11 days.
Of those studied, 444 (9%) died within 30 days of discharge.
Researchers also found that only 38% of those studied had received the current seasonal vaccine upon admittance. However, these numbers may be skewed from the general population, because patients who have not taken the vaccine are more likely to be hospitalized.
Along with the results of antivirals on hospitalized patients, researchers wanted to uncover how the effectiveness of inpatient vaccine administration would vary based on treatment timing, said presenter Zach Shaffelburg of the Canadian Center for Vaccinology, Dalhousie University, Halifax, NS.
Even when administered 4.28 days after symptom onset, antiviral treatments in patients proved to be associated with significant reductions in ICU admissions and the need for mechanical ventilation.
The investigators concluded that antivirals show a strong association with positive effects on serious, influenza-related outcomes in hospitalized patients and, while therapy remained effective with later treatment start, patients would benefit the most from initiation as soon as possible.
Currently, the U.S. Centers for Disease Control and Prevention and the Canadian Immunization Research Network (CIRN) have guidelines instructing best practice for inpatient antiviral treatment, however the number of hospitalized patients given treatment has declined in Canada since 2009, according to Mr. Shaffelburg.
The reason more patients were not receiving inpatient antiviral treatment may be related to studies of different populations that failed to show significant impact, Mr. Shaffelburg suggested during a question and answer session following the presentation: “I think a lot of that comes from outpatient studies that involve patients who are younger and quite healthy [who received] antivirals, and it showed a very minimal impact,” Mr. Shaffelburg said. “So a lot of people saw that study and thought, ‘What’s that point of giving it if it’s not going to make an impact?’ ”
Mr. Shaffelburg and his colleagues are planning to continue their study of inpatient antiviral treatment, focusing more on the effectiveness of treatment in relation to time administered after onset.
Mr. Shaffelburg reported having no disclosures. The study was funded by the CIRN SOS network, Canadian Institutes for Health Research, and a partnership with GlaxoSmithKline Biologicals. Some of the investigators were GSK employees or received grant funding from the company.
SOURCE: Shaffelburg Z et al. IDWeek 2017 Abstract 890.
REPORTING FROM ID WEEK 2017
Key clinical point:
Major finding: Patients who received antiviral treatment were significantly less likely to go to the ICU or need mechanical ventilation (OR, 0.10; 95% CI, 0.08-0.13; P less than .001).
Study details: Study of 4,679 hospitalized influenza patients admitted to the Canadian Immunization Research Network Serious Outcomes Surveillance (CIRN SOS) network hospitals between 2011 to 2014.
Disclosures: Mr. Shaffelburg reported having no disclosures. The study was funded by the CIRN SOS network, Canadian Institutes for Health Research, and a partnership with GlaxoSmithKline Biologicals. Some of the investigators were GSK employees or received grant funding from the company.
Source: Shaffelburg Z et al. IDWeek 2017 Abstract 890.
Viral failure lower in dolutegravir treated HIV patients
SAN DIEGO – The proportion of viral failure was lower in people living with HIV who took dolutegravir (DTG), compared with patients on other integrase strand transfer inhibitor (INSTI) regimens, according to a study presented at ID Week 2017, an infectious diseases meeting.
Investigators studied records of 6,636 HIV patients who started regimens between August 2013 and August 2016, gathered from the Center for Aids Research (CFAR) Network of Integrated Clinical Systems. The information was collected from eight centers across the United States.
Patients were split among three ART regimen groups: dolutegravir based, other INSTI based, and darunavir (DRV) based. Among the 6,636 people living with HIV studied, those using a DTG-based regimen were less than half as likely to exhibit viral failure as were those in the DRV-based group (hazard ratio, 0.41; 95% confidence interval, 0.37-0.86), according to Heidi Crane, MD, MPH, associate director of CFAR Clinical Epidemiology and Health Services Research at the University of Washington, Seattle.
In a comparison of DTG-based therapy compared to other INSTI-based therapies, patients in the DTG groups showed significantly lower risk for viral failure in a crude hazard ratio (HR, 0.57; 95% CI, 0.46-0.70), although, when adjusted, the investigators found the odds did not hold the same level of significance, despite still being at a lower risk (adjusted HR, 0.82; 95% CI, 0.65-1.03).
In a sensitivity analysis of ART-naive patients, investigators found that patients taking DTG regimens were at nearly one-third the risk of viral failure, compared with those taking a darunavir-based regimen (adjusted HR, 0.32; 95% CI, 0.14-0.75). However, when comparing DTG with other INSTI therapies among the ART-naive population, there was no significant difference reported, Dr. Crane said in her presentation.
Investigators found this difference significant when comparing DTG with DRV and DTG with other INSTIs to be a trend across all testing models, according to Dr. Crane.
“In the various sensitivity models, the association for dolutegravir versus other integrase inhibitors ranged from 0.8 to 0.98 depending on censoring, sometimes significant and sometimes not,” said Dr. Crane. “In contrast, the hazard ratio for the dolutegravir versus the darunavir regimens ranged from 0.4 to 0.5, depending on censoring definitions, and we could not break that binding.”
The changing levels of significance are becuase of the different definitions of censoring for end of follow-up, according to Dr. Crane.
In addition to improved viral failure rates, patients taking DRV-based regimens had a higher proportion of patients lost to follow-up (20%), compared with those assigned DTG regimens (5%), which Dr. Crane hypothesized could be a result of the difference in time on the market between the two drugs.
This study was limited to studying only those patients receiving treatment after 2013,
Funding was provided by ViiV and the National Institutes of Health, which funds the CFAR Network of Integrated Clinical Systems.
[email protected]
SOURCE: Nance R et al. Abstract 1688.
SAN DIEGO – The proportion of viral failure was lower in people living with HIV who took dolutegravir (DTG), compared with patients on other integrase strand transfer inhibitor (INSTI) regimens, according to a study presented at ID Week 2017, an infectious diseases meeting.
Investigators studied records of 6,636 HIV patients who started regimens between August 2013 and August 2016, gathered from the Center for Aids Research (CFAR) Network of Integrated Clinical Systems. The information was collected from eight centers across the United States.
Patients were split among three ART regimen groups: dolutegravir based, other INSTI based, and darunavir (DRV) based. Among the 6,636 people living with HIV studied, those using a DTG-based regimen were less than half as likely to exhibit viral failure as were those in the DRV-based group (hazard ratio, 0.41; 95% confidence interval, 0.37-0.86), according to Heidi Crane, MD, MPH, associate director of CFAR Clinical Epidemiology and Health Services Research at the University of Washington, Seattle.
In a comparison of DTG-based therapy compared to other INSTI-based therapies, patients in the DTG groups showed significantly lower risk for viral failure in a crude hazard ratio (HR, 0.57; 95% CI, 0.46-0.70), although, when adjusted, the investigators found the odds did not hold the same level of significance, despite still being at a lower risk (adjusted HR, 0.82; 95% CI, 0.65-1.03).
In a sensitivity analysis of ART-naive patients, investigators found that patients taking DTG regimens were at nearly one-third the risk of viral failure, compared with those taking a darunavir-based regimen (adjusted HR, 0.32; 95% CI, 0.14-0.75). However, when comparing DTG with other INSTI therapies among the ART-naive population, there was no significant difference reported, Dr. Crane said in her presentation.
Investigators found this difference significant when comparing DTG with DRV and DTG with other INSTIs to be a trend across all testing models, according to Dr. Crane.
“In the various sensitivity models, the association for dolutegravir versus other integrase inhibitors ranged from 0.8 to 0.98 depending on censoring, sometimes significant and sometimes not,” said Dr. Crane. “In contrast, the hazard ratio for the dolutegravir versus the darunavir regimens ranged from 0.4 to 0.5, depending on censoring definitions, and we could not break that binding.”
The changing levels of significance are becuase of the different definitions of censoring for end of follow-up, according to Dr. Crane.
In addition to improved viral failure rates, patients taking DRV-based regimens had a higher proportion of patients lost to follow-up (20%), compared with those assigned DTG regimens (5%), which Dr. Crane hypothesized could be a result of the difference in time on the market between the two drugs.
This study was limited to studying only those patients receiving treatment after 2013,
Funding was provided by ViiV and the National Institutes of Health, which funds the CFAR Network of Integrated Clinical Systems.
[email protected]
SOURCE: Nance R et al. Abstract 1688.
SAN DIEGO – The proportion of viral failure was lower in people living with HIV who took dolutegravir (DTG), compared with patients on other integrase strand transfer inhibitor (INSTI) regimens, according to a study presented at ID Week 2017, an infectious diseases meeting.
Investigators studied records of 6,636 HIV patients who started regimens between August 2013 and August 2016, gathered from the Center for Aids Research (CFAR) Network of Integrated Clinical Systems. The information was collected from eight centers across the United States.
Patients were split among three ART regimen groups: dolutegravir based, other INSTI based, and darunavir (DRV) based. Among the 6,636 people living with HIV studied, those using a DTG-based regimen were less than half as likely to exhibit viral failure as were those in the DRV-based group (hazard ratio, 0.41; 95% confidence interval, 0.37-0.86), according to Heidi Crane, MD, MPH, associate director of CFAR Clinical Epidemiology and Health Services Research at the University of Washington, Seattle.
In a comparison of DTG-based therapy compared to other INSTI-based therapies, patients in the DTG groups showed significantly lower risk for viral failure in a crude hazard ratio (HR, 0.57; 95% CI, 0.46-0.70), although, when adjusted, the investigators found the odds did not hold the same level of significance, despite still being at a lower risk (adjusted HR, 0.82; 95% CI, 0.65-1.03).
In a sensitivity analysis of ART-naive patients, investigators found that patients taking DTG regimens were at nearly one-third the risk of viral failure, compared with those taking a darunavir-based regimen (adjusted HR, 0.32; 95% CI, 0.14-0.75). However, when comparing DTG with other INSTI therapies among the ART-naive population, there was no significant difference reported, Dr. Crane said in her presentation.
Investigators found this difference significant when comparing DTG with DRV and DTG with other INSTIs to be a trend across all testing models, according to Dr. Crane.
“In the various sensitivity models, the association for dolutegravir versus other integrase inhibitors ranged from 0.8 to 0.98 depending on censoring, sometimes significant and sometimes not,” said Dr. Crane. “In contrast, the hazard ratio for the dolutegravir versus the darunavir regimens ranged from 0.4 to 0.5, depending on censoring definitions, and we could not break that binding.”
The changing levels of significance are becuase of the different definitions of censoring for end of follow-up, according to Dr. Crane.
In addition to improved viral failure rates, patients taking DRV-based regimens had a higher proportion of patients lost to follow-up (20%), compared with those assigned DTG regimens (5%), which Dr. Crane hypothesized could be a result of the difference in time on the market between the two drugs.
This study was limited to studying only those patients receiving treatment after 2013,
Funding was provided by ViiV and the National Institutes of Health, which funds the CFAR Network of Integrated Clinical Systems.
[email protected]
SOURCE: Nance R et al. Abstract 1688.
REPORTING FROM ID WEEK 2017
Key clinical point:
Major finding: Patients on DTG-based regiments were half as likely to experience viral failure than those on darunavir-based treatment (HR, 0.41; 95% CI, 0.37-0.86).
Study details: Retrospective study of data of 6,636 HIV patients who started regimens during August 2013-August 2016, gathered from eight CFAR Network of Integrated Clinical Systems centers.
Disclosures: Study funded by ViiV Healthcare, CFAR Network of Integrated Clinical Systems is funded by NIAID/NHLBI R24 A1067039.
Source: Nance R et al. Abstract 1688.
Expanded hospital testing improves respiratory pathogen detection
SAN DIEGO – Systematic testing of acute respiratory illness patients can increase the likelihood of finding relevant pathogens, according to a study presented at an annual scientific meeting on infectious diseases.
Currently, hospitals conduct either nonroutine assessments or rely heavily on clinical laboratory testing among severe acute respiratory illness patients, which can lead to missing clinically key viruses.
Systematic testing expands on tests ordered and carried out at hospitals, expanding on them by testing for influenza, respiratory syncytial virus (RSV), human metapneumovirus, rhinovirus and enterovirus, adenovirus, coronavirus, and parainfluenza viruses 1-4. To test the efficacy of systematic testing, investigators studied 2,216 severe acute respiratory illness patients hospitalized in one of three hospitals in Minnesota during September 2015-August 2016. Patients were predominantly younger than 5 years old (57%) and had one or more chronic medical condition (63%).
Detection of at least one virus increased from 1,062 patients (48%) to 1,600 patients (72%) when comparing clinically ordered tests against expanded, systematic RT-PCR testing conducted through the Minnesota Health Department (MDH).
By patient age, viral detection increased by 27%, 24%, 18%, and 21% for patients aged younger than 5 years, 5-17 years, 18-64 years, and 65 years and older, respectively. Except for influenza viruses and RSV, the proportions of viruses identified, regardless of age, were all lower in hospital testing, compared with MDH testing.
“RSV targeting was almost systematic among children less than 5 years, but [accounted for] only 28% of RSV detection,” said Dr. Steffen in her presentation. “A smaller proportion of other respiratory viruses, including the human metapneumovirus, were detected at the hospital, and this was especially true for adults.”
Patients with rhinovirus and enterovirus saw a difference between hospital and expanded testing, increasing from a little over 300 patients detected, to nearly 800 patients.
“Patients admitted to the ICU were less likely to have a pathogen detection than those not admitted to the ICU, and those with one or more chronic medical condition had lower viral detection than those without,” Dr. Steffens said. “While testing at MDH did increase the percent of patients in each category, trends remained consistent and significant.”
Since testing information was only collected for patients with positive test results at the hospital, investigators were not able to compare testing practices between patients with and without viruses. This study may also have underrepresented pathogens detected through means other than the hospital laboratory, like rapid tests in emergency departments. The study was also limited by the short time frame of only 1 year.
The presenters reported no relevant financial disclosures.
SOURCE: Steffens A et al. Abstract 885.
SAN DIEGO – Systematic testing of acute respiratory illness patients can increase the likelihood of finding relevant pathogens, according to a study presented at an annual scientific meeting on infectious diseases.
Currently, hospitals conduct either nonroutine assessments or rely heavily on clinical laboratory testing among severe acute respiratory illness patients, which can lead to missing clinically key viruses.
Systematic testing expands on tests ordered and carried out at hospitals, expanding on them by testing for influenza, respiratory syncytial virus (RSV), human metapneumovirus, rhinovirus and enterovirus, adenovirus, coronavirus, and parainfluenza viruses 1-4. To test the efficacy of systematic testing, investigators studied 2,216 severe acute respiratory illness patients hospitalized in one of three hospitals in Minnesota during September 2015-August 2016. Patients were predominantly younger than 5 years old (57%) and had one or more chronic medical condition (63%).
Detection of at least one virus increased from 1,062 patients (48%) to 1,600 patients (72%) when comparing clinically ordered tests against expanded, systematic RT-PCR testing conducted through the Minnesota Health Department (MDH).
By patient age, viral detection increased by 27%, 24%, 18%, and 21% for patients aged younger than 5 years, 5-17 years, 18-64 years, and 65 years and older, respectively. Except for influenza viruses and RSV, the proportions of viruses identified, regardless of age, were all lower in hospital testing, compared with MDH testing.
“RSV targeting was almost systematic among children less than 5 years, but [accounted for] only 28% of RSV detection,” said Dr. Steffen in her presentation. “A smaller proportion of other respiratory viruses, including the human metapneumovirus, were detected at the hospital, and this was especially true for adults.”
Patients with rhinovirus and enterovirus saw a difference between hospital and expanded testing, increasing from a little over 300 patients detected, to nearly 800 patients.
“Patients admitted to the ICU were less likely to have a pathogen detection than those not admitted to the ICU, and those with one or more chronic medical condition had lower viral detection than those without,” Dr. Steffens said. “While testing at MDH did increase the percent of patients in each category, trends remained consistent and significant.”
Since testing information was only collected for patients with positive test results at the hospital, investigators were not able to compare testing practices between patients with and without viruses. This study may also have underrepresented pathogens detected through means other than the hospital laboratory, like rapid tests in emergency departments. The study was also limited by the short time frame of only 1 year.
The presenters reported no relevant financial disclosures.
SOURCE: Steffens A et al. Abstract 885.
SAN DIEGO – Systematic testing of acute respiratory illness patients can increase the likelihood of finding relevant pathogens, according to a study presented at an annual scientific meeting on infectious diseases.
Currently, hospitals conduct either nonroutine assessments or rely heavily on clinical laboratory testing among severe acute respiratory illness patients, which can lead to missing clinically key viruses.
Systematic testing expands on tests ordered and carried out at hospitals, expanding on them by testing for influenza, respiratory syncytial virus (RSV), human metapneumovirus, rhinovirus and enterovirus, adenovirus, coronavirus, and parainfluenza viruses 1-4. To test the efficacy of systematic testing, investigators studied 2,216 severe acute respiratory illness patients hospitalized in one of three hospitals in Minnesota during September 2015-August 2016. Patients were predominantly younger than 5 years old (57%) and had one or more chronic medical condition (63%).
Detection of at least one virus increased from 1,062 patients (48%) to 1,600 patients (72%) when comparing clinically ordered tests against expanded, systematic RT-PCR testing conducted through the Minnesota Health Department (MDH).
By patient age, viral detection increased by 27%, 24%, 18%, and 21% for patients aged younger than 5 years, 5-17 years, 18-64 years, and 65 years and older, respectively. Except for influenza viruses and RSV, the proportions of viruses identified, regardless of age, were all lower in hospital testing, compared with MDH testing.
“RSV targeting was almost systematic among children less than 5 years, but [accounted for] only 28% of RSV detection,” said Dr. Steffen in her presentation. “A smaller proportion of other respiratory viruses, including the human metapneumovirus, were detected at the hospital, and this was especially true for adults.”
Patients with rhinovirus and enterovirus saw a difference between hospital and expanded testing, increasing from a little over 300 patients detected, to nearly 800 patients.
“Patients admitted to the ICU were less likely to have a pathogen detection than those not admitted to the ICU, and those with one or more chronic medical condition had lower viral detection than those without,” Dr. Steffens said. “While testing at MDH did increase the percent of patients in each category, trends remained consistent and significant.”
Since testing information was only collected for patients with positive test results at the hospital, investigators were not able to compare testing practices between patients with and without viruses. This study may also have underrepresented pathogens detected through means other than the hospital laboratory, like rapid tests in emergency departments. The study was also limited by the short time frame of only 1 year.
The presenters reported no relevant financial disclosures.
SOURCE: Steffens A et al. Abstract 885.
REPORTING FROM ID WEEK 2017
Key clinical point:
Major finding: Among 2,216 patients studied, 1,600 (72%) were found to have at least one respiratory virus through expanded testing, compared with 1,062 (48%) patients tested through clincian-directed testing.
Study details: 2,351 severe acute respiratory illness patients hospitalized in one of three hospitals in Minnesota.
Disclosures: The presenter reported no relevant financial disclosures.
Source: Steffens A et al. Abstract 885.
Statin didn’t slow hepatic steatosis in HIV patients
SAN DIEGO – Statin therapy wasn’t effective against a rising rate of hepatic steatosis in HIV patients, and may increase nonalcoholic fatty liver disease (NAFLD) risk, according to a small study.
The findings are contrary to the limited data currently available, which suggest statins can have a beneficial effect on hepatic steatosis, according to the study’s investigators.
NAFLD is one of the leading causes of mortality and morbidity in people living with HIV, said Vanessa El Kamari, MD, of Case Western Reserve University, Cleveland, and rates are continuing to increase. With a lack of therapeutic interventions for NAFLD in patients with HIV, finding effective treatments is a major concern for providers.
Dr. El Kamari and her colleagues conducted a secondary analysis of the SATURN-HIV trial, a randomized, placebo-controlled trial of 147 patients with HIV who were on stable antiretroviral therapy (ART) with LDL cholesterol levels at or below 130 mg/dL. Patients were either treated with 10 mg rosuvastatin or placebo.
Patients in the treatment and placebo arms were an average age of 45 years, most patients were male (81% and 76%, respectively), and a majority was African American (69% and 67%, respectively). The two groups reported average CD4+ counts of 644 and 636, respectively.
Investigators used validated scores to determine hepatic steatosis in patients, although researchers acknowledged that liver biopsy is the gold standard for hepatic steatosis measurement.
“We understand liver fat score has its limitation,” said Dr. El Kamari in a question and answer session following the presentation at an annual scientific meeting on infectious diseases. “Further studies are needed in this area in order to detect, in noninvasive ways, hepatic steatosis.”
Liver fat scores (LFS) were measured on entry, at week 48, and week 96.
After 96 weeks, investigators saw significant increases in LFS in both the placebo and rosuvastatin groups (P = .01 and P less than .01, respectively). Progression from nonsteatosis at baseline to steatosis over 96 weeks was greater in patients given rosuvastatin than in those given placebo (odds ratio, 4.3; P = .03).
Studying predictors for LFS changes, a trend toward insignificance among the randomization group led investigators to the conclusion that statin may have negatively affected the liver fat score of patients over the 96-week time period.
The study researchers identified 92 patients who did not have hepatic steatosis at baseline to study how statins influenced the development of hepatic steatosis.
Of the 13 patients who developed steatosis during the trial period, 10 were part of the rosuvastatin group, while only 3 were from the placebo group.
Increases in LFS were associated with increases in insulin resistance, detected presence of HIV-1 RNA, and higher interferon-inducible proteins, according to Dr. El Kamari.
While increased homeostatic assessment of insulin resistance was associated with increased hepatic homeostasis, Dr. El Kamari was not able to determine if statins that are not associated with insulin resistance will have different outcomes.
The investigators cautioned that the findings may not be generalizable to the entire HIV population due to the overwhelming majority of African American patients with increased inflammation, as well as the study patients’ LDL cholesterol levels of less than or equal to 130 mg/dL.
The National Institutes of Health funded the study. Dr. El Kamari had no disclosures.
[email protected]
On Twitter @eaztweets
SAN DIEGO – Statin therapy wasn’t effective against a rising rate of hepatic steatosis in HIV patients, and may increase nonalcoholic fatty liver disease (NAFLD) risk, according to a small study.
The findings are contrary to the limited data currently available, which suggest statins can have a beneficial effect on hepatic steatosis, according to the study’s investigators.
NAFLD is one of the leading causes of mortality and morbidity in people living with HIV, said Vanessa El Kamari, MD, of Case Western Reserve University, Cleveland, and rates are continuing to increase. With a lack of therapeutic interventions for NAFLD in patients with HIV, finding effective treatments is a major concern for providers.
Dr. El Kamari and her colleagues conducted a secondary analysis of the SATURN-HIV trial, a randomized, placebo-controlled trial of 147 patients with HIV who were on stable antiretroviral therapy (ART) with LDL cholesterol levels at or below 130 mg/dL. Patients were either treated with 10 mg rosuvastatin or placebo.
Patients in the treatment and placebo arms were an average age of 45 years, most patients were male (81% and 76%, respectively), and a majority was African American (69% and 67%, respectively). The two groups reported average CD4+ counts of 644 and 636, respectively.
Investigators used validated scores to determine hepatic steatosis in patients, although researchers acknowledged that liver biopsy is the gold standard for hepatic steatosis measurement.
“We understand liver fat score has its limitation,” said Dr. El Kamari in a question and answer session following the presentation at an annual scientific meeting on infectious diseases. “Further studies are needed in this area in order to detect, in noninvasive ways, hepatic steatosis.”
Liver fat scores (LFS) were measured on entry, at week 48, and week 96.
After 96 weeks, investigators saw significant increases in LFS in both the placebo and rosuvastatin groups (P = .01 and P less than .01, respectively). Progression from nonsteatosis at baseline to steatosis over 96 weeks was greater in patients given rosuvastatin than in those given placebo (odds ratio, 4.3; P = .03).
Studying predictors for LFS changes, a trend toward insignificance among the randomization group led investigators to the conclusion that statin may have negatively affected the liver fat score of patients over the 96-week time period.
The study researchers identified 92 patients who did not have hepatic steatosis at baseline to study how statins influenced the development of hepatic steatosis.
Of the 13 patients who developed steatosis during the trial period, 10 were part of the rosuvastatin group, while only 3 were from the placebo group.
Increases in LFS were associated with increases in insulin resistance, detected presence of HIV-1 RNA, and higher interferon-inducible proteins, according to Dr. El Kamari.
While increased homeostatic assessment of insulin resistance was associated with increased hepatic homeostasis, Dr. El Kamari was not able to determine if statins that are not associated with insulin resistance will have different outcomes.
The investigators cautioned that the findings may not be generalizable to the entire HIV population due to the overwhelming majority of African American patients with increased inflammation, as well as the study patients’ LDL cholesterol levels of less than or equal to 130 mg/dL.
The National Institutes of Health funded the study. Dr. El Kamari had no disclosures.
[email protected]
On Twitter @eaztweets
SAN DIEGO – Statin therapy wasn’t effective against a rising rate of hepatic steatosis in HIV patients, and may increase nonalcoholic fatty liver disease (NAFLD) risk, according to a small study.
The findings are contrary to the limited data currently available, which suggest statins can have a beneficial effect on hepatic steatosis, according to the study’s investigators.
NAFLD is one of the leading causes of mortality and morbidity in people living with HIV, said Vanessa El Kamari, MD, of Case Western Reserve University, Cleveland, and rates are continuing to increase. With a lack of therapeutic interventions for NAFLD in patients with HIV, finding effective treatments is a major concern for providers.
Dr. El Kamari and her colleagues conducted a secondary analysis of the SATURN-HIV trial, a randomized, placebo-controlled trial of 147 patients with HIV who were on stable antiretroviral therapy (ART) with LDL cholesterol levels at or below 130 mg/dL. Patients were either treated with 10 mg rosuvastatin or placebo.
Patients in the treatment and placebo arms were an average age of 45 years, most patients were male (81% and 76%, respectively), and a majority was African American (69% and 67%, respectively). The two groups reported average CD4+ counts of 644 and 636, respectively.
Investigators used validated scores to determine hepatic steatosis in patients, although researchers acknowledged that liver biopsy is the gold standard for hepatic steatosis measurement.
“We understand liver fat score has its limitation,” said Dr. El Kamari in a question and answer session following the presentation at an annual scientific meeting on infectious diseases. “Further studies are needed in this area in order to detect, in noninvasive ways, hepatic steatosis.”
Liver fat scores (LFS) were measured on entry, at week 48, and week 96.
After 96 weeks, investigators saw significant increases in LFS in both the placebo and rosuvastatin groups (P = .01 and P less than .01, respectively). Progression from nonsteatosis at baseline to steatosis over 96 weeks was greater in patients given rosuvastatin than in those given placebo (odds ratio, 4.3; P = .03).
Studying predictors for LFS changes, a trend toward insignificance among the randomization group led investigators to the conclusion that statin may have negatively affected the liver fat score of patients over the 96-week time period.
The study researchers identified 92 patients who did not have hepatic steatosis at baseline to study how statins influenced the development of hepatic steatosis.
Of the 13 patients who developed steatosis during the trial period, 10 were part of the rosuvastatin group, while only 3 were from the placebo group.
Increases in LFS were associated with increases in insulin resistance, detected presence of HIV-1 RNA, and higher interferon-inducible proteins, according to Dr. El Kamari.
While increased homeostatic assessment of insulin resistance was associated with increased hepatic homeostasis, Dr. El Kamari was not able to determine if statins that are not associated with insulin resistance will have different outcomes.
The investigators cautioned that the findings may not be generalizable to the entire HIV population due to the overwhelming majority of African American patients with increased inflammation, as well as the study patients’ LDL cholesterol levels of less than or equal to 130 mg/dL.
The National Institutes of Health funded the study. Dr. El Kamari had no disclosures.
[email protected]
On Twitter @eaztweets
AT IDWEEK 2017
Key clinical point:
Major finding: Progression from nonsteatosis at baseline to steatosis over 96 weeks was greater in patients given rosuvastatin than in those given placebo (odds ratio, 4.3; P = .03).
Data source: A randomized, placebo-controlled study of 147 patients with HIV on stable ART.
Disclosures: The National Institutes of Health funded the study. Dr. El Kamari had no disclosures.
Young adult HIV patients may be at increased risk of hypertension
SAN DIEGO – Young adults with perinatally-acquired HIV are at an increased risk of developing hypertension, according to a study presented at IDWeek 2017, an infectious diseases conference.
With advances in HIV care and treatment increasing the lifespan of perinatally infected children, patients are seeing increased risks of HIV-associated, non-AIDS conditions like hypertension.
While the prevalence of hypertension in older HIV patients has been studied thoroughly, rates among younger, perinatal HIV populations is relatively unexplored, said Dr. Ryscavage.
Investigators examined 324 patients between the ages of 18-29 years, split between three arms for a cross sectional study: 108 patients with perinatally-acquired (PA) HIV, 108 patients with non-perinatally acquired (NPA) HIV, and 108 uninfected (UI) patients. The 3 study arms were a median age of 24 years, 95% black, and a slight majority female.
Dr. Ryscavage and fellow investigators defined systemic hypertension as two systolic blood pressure measurements greater than or equal to 140 mmHg, or diastolic measurements greater or equal to 90 mmHG within 3 months, or if a physician prescribed antihypertensive mediation.
The researchers discovered that, while UI patients had the highest prevalence of obesity, PA patients reported the highest rate of chronic kidney disease (19%) and dysplidemia (13%), compared to NPA (1% and 3% respectively) and UI (0% and 5% respectively) patients.
Hypertension prevalence was highest among PA patients, followed by NPA patients, and then UI at 23%, 10%, and 9% respectively.
Young adults with PA HIV were nearly 5 times as likely to have hypertension (aOR 4.7; CI 95% [1.9-11.5]) compared to the uninfected population, while NPA showed no significant difference compared to the uninfected (aOR 1.7; CI 95% [.7-4.6]).
Investigators checked to see if the increase in hypertension could be related to the high rate of chronic kidney disease, but were not successful.
“We found [chronic kidney disease] to be approximately one third increased odds of association with chronic kidney disease,” Dr. Ryscavage explained. “However excluding kidney disease, the prevalence odds ratios remained significant and in the context of the cross sectional study…it was difficult to establish a directional relationship between chronic kidney diseases and hypertension.”
This study was limited by using one center in West Baltimore. Also, due to a majority of patients having at least one deceased parent, investigators were not able to collect a complete family history.
Dr. Ryscavage and his colleagues are next looking for what specific factors in HIV groups are causing an increased prevalence. Meanwhile, the investigators implored other researchers to initiate studies in poorer nations where HIV is much more prevalent.
“These findings need to be explored in the developing world where we have the largest population of aging, perinatally infected patients,” said Dr. Ryscavage.
Presenters reported no relevant financial disclosures.
[email protected]
On Twitter @eaztweets
SAN DIEGO – Young adults with perinatally-acquired HIV are at an increased risk of developing hypertension, according to a study presented at IDWeek 2017, an infectious diseases conference.
With advances in HIV care and treatment increasing the lifespan of perinatally infected children, patients are seeing increased risks of HIV-associated, non-AIDS conditions like hypertension.
While the prevalence of hypertension in older HIV patients has been studied thoroughly, rates among younger, perinatal HIV populations is relatively unexplored, said Dr. Ryscavage.
Investigators examined 324 patients between the ages of 18-29 years, split between three arms for a cross sectional study: 108 patients with perinatally-acquired (PA) HIV, 108 patients with non-perinatally acquired (NPA) HIV, and 108 uninfected (UI) patients. The 3 study arms were a median age of 24 years, 95% black, and a slight majority female.
Dr. Ryscavage and fellow investigators defined systemic hypertension as two systolic blood pressure measurements greater than or equal to 140 mmHg, or diastolic measurements greater or equal to 90 mmHG within 3 months, or if a physician prescribed antihypertensive mediation.
The researchers discovered that, while UI patients had the highest prevalence of obesity, PA patients reported the highest rate of chronic kidney disease (19%) and dysplidemia (13%), compared to NPA (1% and 3% respectively) and UI (0% and 5% respectively) patients.
Hypertension prevalence was highest among PA patients, followed by NPA patients, and then UI at 23%, 10%, and 9% respectively.
Young adults with PA HIV were nearly 5 times as likely to have hypertension (aOR 4.7; CI 95% [1.9-11.5]) compared to the uninfected population, while NPA showed no significant difference compared to the uninfected (aOR 1.7; CI 95% [.7-4.6]).
Investigators checked to see if the increase in hypertension could be related to the high rate of chronic kidney disease, but were not successful.
“We found [chronic kidney disease] to be approximately one third increased odds of association with chronic kidney disease,” Dr. Ryscavage explained. “However excluding kidney disease, the prevalence odds ratios remained significant and in the context of the cross sectional study…it was difficult to establish a directional relationship between chronic kidney diseases and hypertension.”
This study was limited by using one center in West Baltimore. Also, due to a majority of patients having at least one deceased parent, investigators were not able to collect a complete family history.
Dr. Ryscavage and his colleagues are next looking for what specific factors in HIV groups are causing an increased prevalence. Meanwhile, the investigators implored other researchers to initiate studies in poorer nations where HIV is much more prevalent.
“These findings need to be explored in the developing world where we have the largest population of aging, perinatally infected patients,” said Dr. Ryscavage.
Presenters reported no relevant financial disclosures.
[email protected]
On Twitter @eaztweets
SAN DIEGO – Young adults with perinatally-acquired HIV are at an increased risk of developing hypertension, according to a study presented at IDWeek 2017, an infectious diseases conference.
With advances in HIV care and treatment increasing the lifespan of perinatally infected children, patients are seeing increased risks of HIV-associated, non-AIDS conditions like hypertension.
While the prevalence of hypertension in older HIV patients has been studied thoroughly, rates among younger, perinatal HIV populations is relatively unexplored, said Dr. Ryscavage.
Investigators examined 324 patients between the ages of 18-29 years, split between three arms for a cross sectional study: 108 patients with perinatally-acquired (PA) HIV, 108 patients with non-perinatally acquired (NPA) HIV, and 108 uninfected (UI) patients. The 3 study arms were a median age of 24 years, 95% black, and a slight majority female.
Dr. Ryscavage and fellow investigators defined systemic hypertension as two systolic blood pressure measurements greater than or equal to 140 mmHg, or diastolic measurements greater or equal to 90 mmHG within 3 months, or if a physician prescribed antihypertensive mediation.
The researchers discovered that, while UI patients had the highest prevalence of obesity, PA patients reported the highest rate of chronic kidney disease (19%) and dysplidemia (13%), compared to NPA (1% and 3% respectively) and UI (0% and 5% respectively) patients.
Hypertension prevalence was highest among PA patients, followed by NPA patients, and then UI at 23%, 10%, and 9% respectively.
Young adults with PA HIV were nearly 5 times as likely to have hypertension (aOR 4.7; CI 95% [1.9-11.5]) compared to the uninfected population, while NPA showed no significant difference compared to the uninfected (aOR 1.7; CI 95% [.7-4.6]).
Investigators checked to see if the increase in hypertension could be related to the high rate of chronic kidney disease, but were not successful.
“We found [chronic kidney disease] to be approximately one third increased odds of association with chronic kidney disease,” Dr. Ryscavage explained. “However excluding kidney disease, the prevalence odds ratios remained significant and in the context of the cross sectional study…it was difficult to establish a directional relationship between chronic kidney diseases and hypertension.”
This study was limited by using one center in West Baltimore. Also, due to a majority of patients having at least one deceased parent, investigators were not able to collect a complete family history.
Dr. Ryscavage and his colleagues are next looking for what specific factors in HIV groups are causing an increased prevalence. Meanwhile, the investigators implored other researchers to initiate studies in poorer nations where HIV is much more prevalent.
“These findings need to be explored in the developing world where we have the largest population of aging, perinatally infected patients,” said Dr. Ryscavage.
Presenters reported no relevant financial disclosures.
[email protected]
On Twitter @eaztweets
AT IDWEEK 2017
Key clinical point:
Major finding: The prevalence of hypertension was 23% among perinatally infected patients, compared with 10% among nonperinatally infected patients and 9% among uninfected patients.
Data source: A cross-sectional study of 324 young adults between 18-29 years as of Sept. 1, 2014, from West Baltimore.
Disclosures: The presenters reported no relevant financial disclosures.
Hep C screening falling short in neonatal abstinence syndrome infants
SAN DIEGO – A review of care for neonates born with neonatal abstinence syndrome (NAS) found that screening for hepatitis C virus (HCV) infection is low, based on Medicaid data from the state of Kentucky.
“These children are at high risk for HCV, and the screening rate should really be 100%. We think that it is important to get the message out there,” said Michael Smith, MD, of the department of pediatrics at the Duke University, Durham, N.C.
According to the Kentucky Medicaid data, the rates of NAS are not evenly distributed in the state. Stratifying the incidence rates by eight regions, Dr. Smith reported that 33% of the NAS births in 2016 were in region 8. Although region 8 is a rural Appalachian section on the eastern border of the state, the proportion in this region was more than 50% greater than any other region, including the more populated regions containing Louisville, the largest city, and Lexington, the capital.
Statewide, approximately one in three newborns with NAS were screened for HCV, but the rate was as low as 5% in some areas, and low rates were more common in those counties with the highest rates of opioid use and NAS, Dr. Smith said at an annual scientific meeting on infectious diseases. Although he acknowledged that rates of HCV screening in newborns with NAS appeared to be increasing when 2015 and 2012 data were compared, “there is still a long way to go.”
“Why is this important? There are a couple of reasons. One is that, if you get children into care early, you are more likely to have follow-up,” Dr. Smith said. Follow-up will be important if, as Dr. Smith predicted, HCV therapies become available for children. When providers know which children are infected, treatment can be initiated more efficiently, and this has implications for risk of transmission and, potentially, for outcomes.
At the University of Louisville, children with NAS are typically screened for HCV, HIV, and other transmissible infections that “travel together,” such as syphilis. The evaluation of the Medicaid data suggested that there were no differences in likelihood of HCV testing for sex and race, but Dr. Smith noted that children placed in foster care were significantly more likely to be tested, likely a reflection of processing regulations.
Overall, there are striking differences in the rates of opioid use, rates of NAS, and likelihood of HCV testing in NAS neonates in eastern Appalachian regions of Kentucky and those in regions in the center of the state closer to academic medical centers. The three regions near the University of Louisville, University of Kentucky in Lexington, and the Ohio River border with Cincinnati are known as “the Golden Triangle,” according to Dr. Smith; these regions are where HCV testing rates in neonates with NAS are higher, but testing still is not uniform.
Currently, HCV testing is mandated for adults in several states, but Dr. Smith emphasized that children with NAS are particularly “vulnerable.” He called for policy changes that would require testing in these children and urged HCV screening regardless of whether official policies are established.
SAN DIEGO – A review of care for neonates born with neonatal abstinence syndrome (NAS) found that screening for hepatitis C virus (HCV) infection is low, based on Medicaid data from the state of Kentucky.
“These children are at high risk for HCV, and the screening rate should really be 100%. We think that it is important to get the message out there,” said Michael Smith, MD, of the department of pediatrics at the Duke University, Durham, N.C.
According to the Kentucky Medicaid data, the rates of NAS are not evenly distributed in the state. Stratifying the incidence rates by eight regions, Dr. Smith reported that 33% of the NAS births in 2016 were in region 8. Although region 8 is a rural Appalachian section on the eastern border of the state, the proportion in this region was more than 50% greater than any other region, including the more populated regions containing Louisville, the largest city, and Lexington, the capital.
Statewide, approximately one in three newborns with NAS were screened for HCV, but the rate was as low as 5% in some areas, and low rates were more common in those counties with the highest rates of opioid use and NAS, Dr. Smith said at an annual scientific meeting on infectious diseases. Although he acknowledged that rates of HCV screening in newborns with NAS appeared to be increasing when 2015 and 2012 data were compared, “there is still a long way to go.”
“Why is this important? There are a couple of reasons. One is that, if you get children into care early, you are more likely to have follow-up,” Dr. Smith said. Follow-up will be important if, as Dr. Smith predicted, HCV therapies become available for children. When providers know which children are infected, treatment can be initiated more efficiently, and this has implications for risk of transmission and, potentially, for outcomes.
At the University of Louisville, children with NAS are typically screened for HCV, HIV, and other transmissible infections that “travel together,” such as syphilis. The evaluation of the Medicaid data suggested that there were no differences in likelihood of HCV testing for sex and race, but Dr. Smith noted that children placed in foster care were significantly more likely to be tested, likely a reflection of processing regulations.
Overall, there are striking differences in the rates of opioid use, rates of NAS, and likelihood of HCV testing in NAS neonates in eastern Appalachian regions of Kentucky and those in regions in the center of the state closer to academic medical centers. The three regions near the University of Louisville, University of Kentucky in Lexington, and the Ohio River border with Cincinnati are known as “the Golden Triangle,” according to Dr. Smith; these regions are where HCV testing rates in neonates with NAS are higher, but testing still is not uniform.
Currently, HCV testing is mandated for adults in several states, but Dr. Smith emphasized that children with NAS are particularly “vulnerable.” He called for policy changes that would require testing in these children and urged HCV screening regardless of whether official policies are established.
SAN DIEGO – A review of care for neonates born with neonatal abstinence syndrome (NAS) found that screening for hepatitis C virus (HCV) infection is low, based on Medicaid data from the state of Kentucky.
“These children are at high risk for HCV, and the screening rate should really be 100%. We think that it is important to get the message out there,” said Michael Smith, MD, of the department of pediatrics at the Duke University, Durham, N.C.
According to the Kentucky Medicaid data, the rates of NAS are not evenly distributed in the state. Stratifying the incidence rates by eight regions, Dr. Smith reported that 33% of the NAS births in 2016 were in region 8. Although region 8 is a rural Appalachian section on the eastern border of the state, the proportion in this region was more than 50% greater than any other region, including the more populated regions containing Louisville, the largest city, and Lexington, the capital.
Statewide, approximately one in three newborns with NAS were screened for HCV, but the rate was as low as 5% in some areas, and low rates were more common in those counties with the highest rates of opioid use and NAS, Dr. Smith said at an annual scientific meeting on infectious diseases. Although he acknowledged that rates of HCV screening in newborns with NAS appeared to be increasing when 2015 and 2012 data were compared, “there is still a long way to go.”
“Why is this important? There are a couple of reasons. One is that, if you get children into care early, you are more likely to have follow-up,” Dr. Smith said. Follow-up will be important if, as Dr. Smith predicted, HCV therapies become available for children. When providers know which children are infected, treatment can be initiated more efficiently, and this has implications for risk of transmission and, potentially, for outcomes.
At the University of Louisville, children with NAS are typically screened for HCV, HIV, and other transmissible infections that “travel together,” such as syphilis. The evaluation of the Medicaid data suggested that there were no differences in likelihood of HCV testing for sex and race, but Dr. Smith noted that children placed in foster care were significantly more likely to be tested, likely a reflection of processing regulations.
Overall, there are striking differences in the rates of opioid use, rates of NAS, and likelihood of HCV testing in NAS neonates in eastern Appalachian regions of Kentucky and those in regions in the center of the state closer to academic medical centers. The three regions near the University of Louisville, University of Kentucky in Lexington, and the Ohio River border with Cincinnati are known as “the Golden Triangle,” according to Dr. Smith; these regions are where HCV testing rates in neonates with NAS are higher, but testing still is not uniform.
Currently, HCV testing is mandated for adults in several states, but Dr. Smith emphasized that children with NAS are particularly “vulnerable.” He called for policy changes that would require testing in these children and urged HCV screening regardless of whether official policies are established.
AT ID WEEK 2017
Key clinical point: In Kentucky, which has one of the highest rates of neonates with NAS, screening rates for HCV remain low.
Major finding:
Data source: Retrospective data analysis of Kentucky Medicaid data.
Disclosures: Dr. Smith reported no financial relationships relevant to this study.
Staph bloodstream infection algorithm shortens treatment course
SAN DIEGO – By standardizing antibiotic treatment for simple and uncomplicated staphylococcal bloodstream infections (BSI), an algorithm effectively shortens therapy and simplifies decision making, according to results of a multinational randomized trial.
“The data from the study confirm that the algorithm achieves more with less and verify that shorter antibiotic courses are sufficient,” reported Thomas L. Holland, MD, an infectious disease specialist at Duke University Hospital in Durham, N.C.
In this study, the patients randomized to algorithm treatment received vancomycin (or daptomycin in allergic or intolerant patients), which was administered for periods of duration based on clinical features. In those randomized to SOC, the choice and duration of antibiotics were left to the discretion of the treating physician without restrictions.
In those with simple staphylococcal BSI, the algorithm called for no further antibiotics beyond what had already been administered empirically prior to randomization. Key features of simple coagulase-negative staphylococcal (CONS) BSIs include absence of fever or evidence of metastatic infection, as well as no more than one positive follow-up blood culture. The key features of simple Staphylococcus aureus BSI are similar. However, no positive blood cultures are required for S. aureus BSI to be classified as simple.
“In the algorithm arm, no antibiotics were given to those with simple staphylococcal BSI unless antibiotics had been given prior to randomization,” Dr. Holland explained, but he acknowledged that empiric antibiotics prior to randomization reflect “clinical reality.”
In those with uncomplicated rather than simple staphylococcal BSI, vancomycin was given for 5 days to those with CONS BSI and for 14 days to those with S. aureus BSI. In those who were randomized and then subsequently found to have a complicated infection, defined as multiple positive blood cultures or evidence of metastatic infection, patients received as few as 7 days or as many as 28 days of antibiotics, “reflecting the heterogeneity of these infections,” Dr. Holland reported at an annual scientific meeting on infectious diseases.
The coprimary endpoints were treatment success at test of cure and treatment safety, both of which were adjudicated by an external committee consisting of infectious disease specialists blinded to the therapy.
There were 509 patients from 16 sites in both the United States and Spain. CONS BSIs represented approximately 75% of patients in both arms. The complicated staphylococcal infections, which also were evenly distributed in the two arms, were included in the intention-to-treat analysis. Of complicated staphylococcal infections in this study, the pathogen was CONS in 34 instances and S. aureus in 37.
Treatment success was achieved in 82.0% and 81.5% of patients in the algorithm and SOC arms, respectively. Significant adverse events occurred in 32.9% and 28.3% of patients, respectively. Neither difference approached statistical significance.
“In other words, the algorithm was as effective and safe as standard of care,” Dr. Holland confirmed.
However, the median duration of treatment was reduced substantially for those randomized to the algorithm arm, compared with that seen in the standard of care arm. Among evaluable patients without complicated BSI, the mean duration of therapy was 4.4 days in the algorithm group vs. 6.2 days in the SOC group (P = .003). Most of this nearly 2-day reduction in treatment was achieved in uncomplicated CONS BSI patients. In this group, the mean days of treatment were 5.3 days and 8.4 days for the algorithm and SOC groups, respectively. In the uncomplicated S. aureus group, the reduction (from 15.9 to 15.3 days) was not significant.
“The study has several messages. For one, it suggests that patients who meet the criteria of simple staphylococcal BSI can be managed safely with monitoring alone. In addition, this study “provides the best evidence to date that 14 days of vancomycin from the first negative blood culture is sufficient in uncomplicated S. aureus bloodstream infections,” Dr. Holland stated.
“For many, these data will validate what they are already doing,” said Dr. Holland, who reported that the algorithm is now being applied routinely at his institution. “The value is that we now have a randomized trial to demonstrate that shorter therapy can be provided in uncomplicated staphylococcal blood stream infections without increasing risk of serious adverse events.”
SAN DIEGO – By standardizing antibiotic treatment for simple and uncomplicated staphylococcal bloodstream infections (BSI), an algorithm effectively shortens therapy and simplifies decision making, according to results of a multinational randomized trial.
“The data from the study confirm that the algorithm achieves more with less and verify that shorter antibiotic courses are sufficient,” reported Thomas L. Holland, MD, an infectious disease specialist at Duke University Hospital in Durham, N.C.
In this study, the patients randomized to algorithm treatment received vancomycin (or daptomycin in allergic or intolerant patients), which was administered for periods of duration based on clinical features. In those randomized to SOC, the choice and duration of antibiotics were left to the discretion of the treating physician without restrictions.
In those with simple staphylococcal BSI, the algorithm called for no further antibiotics beyond what had already been administered empirically prior to randomization. Key features of simple coagulase-negative staphylococcal (CONS) BSIs include absence of fever or evidence of metastatic infection, as well as no more than one positive follow-up blood culture. The key features of simple Staphylococcus aureus BSI are similar. However, no positive blood cultures are required for S. aureus BSI to be classified as simple.
“In the algorithm arm, no antibiotics were given to those with simple staphylococcal BSI unless antibiotics had been given prior to randomization,” Dr. Holland explained, but he acknowledged that empiric antibiotics prior to randomization reflect “clinical reality.”
In those with uncomplicated rather than simple staphylococcal BSI, vancomycin was given for 5 days to those with CONS BSI and for 14 days to those with S. aureus BSI. In those who were randomized and then subsequently found to have a complicated infection, defined as multiple positive blood cultures or evidence of metastatic infection, patients received as few as 7 days or as many as 28 days of antibiotics, “reflecting the heterogeneity of these infections,” Dr. Holland reported at an annual scientific meeting on infectious diseases.
The coprimary endpoints were treatment success at test of cure and treatment safety, both of which were adjudicated by an external committee consisting of infectious disease specialists blinded to the therapy.
There were 509 patients from 16 sites in both the United States and Spain. CONS BSIs represented approximately 75% of patients in both arms. The complicated staphylococcal infections, which also were evenly distributed in the two arms, were included in the intention-to-treat analysis. Of complicated staphylococcal infections in this study, the pathogen was CONS in 34 instances and S. aureus in 37.
Treatment success was achieved in 82.0% and 81.5% of patients in the algorithm and SOC arms, respectively. Significant adverse events occurred in 32.9% and 28.3% of patients, respectively. Neither difference approached statistical significance.
“In other words, the algorithm was as effective and safe as standard of care,” Dr. Holland confirmed.
However, the median duration of treatment was reduced substantially for those randomized to the algorithm arm, compared with that seen in the standard of care arm. Among evaluable patients without complicated BSI, the mean duration of therapy was 4.4 days in the algorithm group vs. 6.2 days in the SOC group (P = .003). Most of this nearly 2-day reduction in treatment was achieved in uncomplicated CONS BSI patients. In this group, the mean days of treatment were 5.3 days and 8.4 days for the algorithm and SOC groups, respectively. In the uncomplicated S. aureus group, the reduction (from 15.9 to 15.3 days) was not significant.
“The study has several messages. For one, it suggests that patients who meet the criteria of simple staphylococcal BSI can be managed safely with monitoring alone. In addition, this study “provides the best evidence to date that 14 days of vancomycin from the first negative blood culture is sufficient in uncomplicated S. aureus bloodstream infections,” Dr. Holland stated.
“For many, these data will validate what they are already doing,” said Dr. Holland, who reported that the algorithm is now being applied routinely at his institution. “The value is that we now have a randomized trial to demonstrate that shorter therapy can be provided in uncomplicated staphylococcal blood stream infections without increasing risk of serious adverse events.”
SAN DIEGO – By standardizing antibiotic treatment for simple and uncomplicated staphylococcal bloodstream infections (BSI), an algorithm effectively shortens therapy and simplifies decision making, according to results of a multinational randomized trial.
“The data from the study confirm that the algorithm achieves more with less and verify that shorter antibiotic courses are sufficient,” reported Thomas L. Holland, MD, an infectious disease specialist at Duke University Hospital in Durham, N.C.
In this study, the patients randomized to algorithm treatment received vancomycin (or daptomycin in allergic or intolerant patients), which was administered for periods of duration based on clinical features. In those randomized to SOC, the choice and duration of antibiotics were left to the discretion of the treating physician without restrictions.
In those with simple staphylococcal BSI, the algorithm called for no further antibiotics beyond what had already been administered empirically prior to randomization. Key features of simple coagulase-negative staphylococcal (CONS) BSIs include absence of fever or evidence of metastatic infection, as well as no more than one positive follow-up blood culture. The key features of simple Staphylococcus aureus BSI are similar. However, no positive blood cultures are required for S. aureus BSI to be classified as simple.
“In the algorithm arm, no antibiotics were given to those with simple staphylococcal BSI unless antibiotics had been given prior to randomization,” Dr. Holland explained, but he acknowledged that empiric antibiotics prior to randomization reflect “clinical reality.”
In those with uncomplicated rather than simple staphylococcal BSI, vancomycin was given for 5 days to those with CONS BSI and for 14 days to those with S. aureus BSI. In those who were randomized and then subsequently found to have a complicated infection, defined as multiple positive blood cultures or evidence of metastatic infection, patients received as few as 7 days or as many as 28 days of antibiotics, “reflecting the heterogeneity of these infections,” Dr. Holland reported at an annual scientific meeting on infectious diseases.
The coprimary endpoints were treatment success at test of cure and treatment safety, both of which were adjudicated by an external committee consisting of infectious disease specialists blinded to the therapy.
There were 509 patients from 16 sites in both the United States and Spain. CONS BSIs represented approximately 75% of patients in both arms. The complicated staphylococcal infections, which also were evenly distributed in the two arms, were included in the intention-to-treat analysis. Of complicated staphylococcal infections in this study, the pathogen was CONS in 34 instances and S. aureus in 37.
Treatment success was achieved in 82.0% and 81.5% of patients in the algorithm and SOC arms, respectively. Significant adverse events occurred in 32.9% and 28.3% of patients, respectively. Neither difference approached statistical significance.
“In other words, the algorithm was as effective and safe as standard of care,” Dr. Holland confirmed.
However, the median duration of treatment was reduced substantially for those randomized to the algorithm arm, compared with that seen in the standard of care arm. Among evaluable patients without complicated BSI, the mean duration of therapy was 4.4 days in the algorithm group vs. 6.2 days in the SOC group (P = .003). Most of this nearly 2-day reduction in treatment was achieved in uncomplicated CONS BSI patients. In this group, the mean days of treatment were 5.3 days and 8.4 days for the algorithm and SOC groups, respectively. In the uncomplicated S. aureus group, the reduction (from 15.9 to 15.3 days) was not significant.
“The study has several messages. For one, it suggests that patients who meet the criteria of simple staphylococcal BSI can be managed safely with monitoring alone. In addition, this study “provides the best evidence to date that 14 days of vancomycin from the first negative blood culture is sufficient in uncomplicated S. aureus bloodstream infections,” Dr. Holland stated.
“For many, these data will validate what they are already doing,” said Dr. Holland, who reported that the algorithm is now being applied routinely at his institution. “The value is that we now have a randomized trial to demonstrate that shorter therapy can be provided in uncomplicated staphylococcal blood stream infections without increasing risk of serious adverse events.”
AT ID WEEK 2017
Key clinical point:
Major finding: With no change in outcome or differences in adverse events, the algorithm reduced average antibiotic duration by 1.9 days (P = .003).
Data source: A randomized, prospective, multicenter trial of 509 patients randomized at 16 sites in the United States and Spain.
Disclosures: Dr. Holland reports no financial relationships relevant to this study.
CDC data show decline in some hospital-acquired infections
SAN DIEGO – There was an encouraging 22% reduction in hospital-acquired infections (HAIs) after adjustment for clinical variables when 2015 and 2011 data from national Centers for Disease Control and Prevention hospital surveys were compared.
“The data suggest that national efforts toward preventing HAIs are succeeding,” reported Shelley S. Magill, MD, PhD, a medical epidemiologist in the Division of Healthcare Quality Promotion at the CDC who summarized the data at an annual scientific meeting on infectious diseases .
The comparative data were drawn from point prevalence surveys conducted in 2011 and 2015 as part of the CDC’s Emerging Infections Program. In this type of survey, the data are collected over 1 day, providing a snapshot in time among selected hospitals. The analysis presented by Dr. Magill was restricted to the 148 hospitals that participated in both the 2011 and 2015 surveys, although the 2015 survey included a total of 199 hospitals, of which other data analyses are planned.
Due to the change in incidence, the rank order of HAIs was different in 2015 relative to 2011. While surgical site infections (SSIs) represented the most frequent HAI in 2011, they fell to the third most frequent HAI in 2015; pneumonia and gastrointestinal (GI) infections assumed the first and second spots, respectively. The GI HAI infection category includes Clostridium difficile infection.
The incidence of SSI HAI among all hospitalized patients in the survey fell by 41% between 2011 and 2015 (from 1.00% to 0.59%; P = .001). The other big contributor to the overall reduction in HAIs was the fall in the incidence of urinary tract infections, which fell 36% (from 0.55% to 0.35%; P = .04). The decrease in pneumonia (from 0.97% to 0.89%) was not significant, nor was the even more modest reduction in bloodstream HAI (from 0.45% to 0.43%). There was a modest increase in GI/Clostridium difficile infections (from 0.56% to 0.59%).
The surveys do not permit the reduction in HAI rates to be attributed to any specific prevention practices, but Dr. Magill pointed out that the overall reductions correlate with reduced use of urinary catheters and central lines; reductions of both have been advocated as a means for improved infection control. Of several factors that might contribute to a reduction in SSI HAI, Dr. Magill speculated that better adherence to guidelines and more rigorous steps at preoperative infection control strategies might be among them.
Detailed analyses of the data collected from all of the hospitals that participated in the 2015 survey are planned, including an evaluation of which antibiotics were used to treat the HAIs found in this survey. Although the findings so far encourage speculation that infection control practices, such as prudent use of urinary catheters, are having a positive effect, Dr. Magill said that the data also point out the challenges.
“Given that pneumonia continues to represent a large proportion of HAIs in hospitals, more work is needed to identify risk factors; understand the factors that are preventable, particularly in the nonventilated patients; and develop better preventive approaches,” Dr. Magill said.
Dr. Magill reported no financial relationships relevant to this study.
SAN DIEGO – There was an encouraging 22% reduction in hospital-acquired infections (HAIs) after adjustment for clinical variables when 2015 and 2011 data from national Centers for Disease Control and Prevention hospital surveys were compared.
“The data suggest that national efforts toward preventing HAIs are succeeding,” reported Shelley S. Magill, MD, PhD, a medical epidemiologist in the Division of Healthcare Quality Promotion at the CDC who summarized the data at an annual scientific meeting on infectious diseases .
The comparative data were drawn from point prevalence surveys conducted in 2011 and 2015 as part of the CDC’s Emerging Infections Program. In this type of survey, the data are collected over 1 day, providing a snapshot in time among selected hospitals. The analysis presented by Dr. Magill was restricted to the 148 hospitals that participated in both the 2011 and 2015 surveys, although the 2015 survey included a total of 199 hospitals, of which other data analyses are planned.
Due to the change in incidence, the rank order of HAIs was different in 2015 relative to 2011. While surgical site infections (SSIs) represented the most frequent HAI in 2011, they fell to the third most frequent HAI in 2015; pneumonia and gastrointestinal (GI) infections assumed the first and second spots, respectively. The GI HAI infection category includes Clostridium difficile infection.
The incidence of SSI HAI among all hospitalized patients in the survey fell by 41% between 2011 and 2015 (from 1.00% to 0.59%; P = .001). The other big contributor to the overall reduction in HAIs was the fall in the incidence of urinary tract infections, which fell 36% (from 0.55% to 0.35%; P = .04). The decrease in pneumonia (from 0.97% to 0.89%) was not significant, nor was the even more modest reduction in bloodstream HAI (from 0.45% to 0.43%). There was a modest increase in GI/Clostridium difficile infections (from 0.56% to 0.59%).
The surveys do not permit the reduction in HAI rates to be attributed to any specific prevention practices, but Dr. Magill pointed out that the overall reductions correlate with reduced use of urinary catheters and central lines; reductions of both have been advocated as a means for improved infection control. Of several factors that might contribute to a reduction in SSI HAI, Dr. Magill speculated that better adherence to guidelines and more rigorous steps at preoperative infection control strategies might be among them.
Detailed analyses of the data collected from all of the hospitals that participated in the 2015 survey are planned, including an evaluation of which antibiotics were used to treat the HAIs found in this survey. Although the findings so far encourage speculation that infection control practices, such as prudent use of urinary catheters, are having a positive effect, Dr. Magill said that the data also point out the challenges.
“Given that pneumonia continues to represent a large proportion of HAIs in hospitals, more work is needed to identify risk factors; understand the factors that are preventable, particularly in the nonventilated patients; and develop better preventive approaches,” Dr. Magill said.
Dr. Magill reported no financial relationships relevant to this study.
SAN DIEGO – There was an encouraging 22% reduction in hospital-acquired infections (HAIs) after adjustment for clinical variables when 2015 and 2011 data from national Centers for Disease Control and Prevention hospital surveys were compared.
“The data suggest that national efforts toward preventing HAIs are succeeding,” reported Shelley S. Magill, MD, PhD, a medical epidemiologist in the Division of Healthcare Quality Promotion at the CDC who summarized the data at an annual scientific meeting on infectious diseases .
The comparative data were drawn from point prevalence surveys conducted in 2011 and 2015 as part of the CDC’s Emerging Infections Program. In this type of survey, the data are collected over 1 day, providing a snapshot in time among selected hospitals. The analysis presented by Dr. Magill was restricted to the 148 hospitals that participated in both the 2011 and 2015 surveys, although the 2015 survey included a total of 199 hospitals, of which other data analyses are planned.
Due to the change in incidence, the rank order of HAIs was different in 2015 relative to 2011. While surgical site infections (SSIs) represented the most frequent HAI in 2011, they fell to the third most frequent HAI in 2015; pneumonia and gastrointestinal (GI) infections assumed the first and second spots, respectively. The GI HAI infection category includes Clostridium difficile infection.
The incidence of SSI HAI among all hospitalized patients in the survey fell by 41% between 2011 and 2015 (from 1.00% to 0.59%; P = .001). The other big contributor to the overall reduction in HAIs was the fall in the incidence of urinary tract infections, which fell 36% (from 0.55% to 0.35%; P = .04). The decrease in pneumonia (from 0.97% to 0.89%) was not significant, nor was the even more modest reduction in bloodstream HAI (from 0.45% to 0.43%). There was a modest increase in GI/Clostridium difficile infections (from 0.56% to 0.59%).
The surveys do not permit the reduction in HAI rates to be attributed to any specific prevention practices, but Dr. Magill pointed out that the overall reductions correlate with reduced use of urinary catheters and central lines; reductions of both have been advocated as a means for improved infection control. Of several factors that might contribute to a reduction in SSI HAI, Dr. Magill speculated that better adherence to guidelines and more rigorous steps at preoperative infection control strategies might be among them.
Detailed analyses of the data collected from all of the hospitals that participated in the 2015 survey are planned, including an evaluation of which antibiotics were used to treat the HAIs found in this survey. Although the findings so far encourage speculation that infection control practices, such as prudent use of urinary catheters, are having a positive effect, Dr. Magill said that the data also point out the challenges.
“Given that pneumonia continues to represent a large proportion of HAIs in hospitals, more work is needed to identify risk factors; understand the factors that are preventable, particularly in the nonventilated patients; and develop better preventive approaches,” Dr. Magill said.
Dr. Magill reported no financial relationships relevant to this study.
AT ID WEEK 2017
Key clinical point:
Major finding: In two point prevalence surveys conducted in the same hospitals, the rate of HAI was 22% lower in 2015 (P = .001), compared with 2011.
Data source: CDC national surveys of HAIs in 148 hospitals in two different years (2011 and 2015) were compared.
Disclosures: Dr. Magill reported no financial relationships relevant to this study.
Rio Olympics tally for U.S. athletes is 6% West Nile infections, no Zika
SAN DIEGO – When compared with pretravel blood screening, new arboviral infections were detected in 7% of U.S. athletes and support staff who attended the 2016 Olympic Games in Rio de Janeiro, according to study results revealed at an annual scientific meeting on infectious diseases.
Although the prospective screening program was largely set up and driven by concern about the risk of Zika virus infection, this was not among the arboviral infections identified, reported Krow Ampofo, MD, professor of pediatrics in the division of pediatric infectious diseases, University of Utah, Salt Lake City.
“The stories and images of children with microencephalopathy and other complications of the Zika syndrome were a major concern of athletes,” said Dr. Ampofo, who noted that many were threatening not to attend. The concern was reasonable, he said, given the scope of the epidemic and the fact that the majority of female athletes were of reproductive age.
At the time the screening program was being planned, the Zika virus epidemic in Brazil had, in fact, already peaked. Although it was not then known that the peak had been reached, the incidence rates began falling sharply beginning in about March 2016. New cases still were being reported, but the threat was greatly diminished by the time that the summer games were held.
In the screening program, blood samples were obtained prior to the games from 950 U.S. athletes and support staff. In most cases, these samples were obtained in Houston, where the Olympic team was processed just prior to departure. At that same time, the U.S. Centers for Disease Control and Prevention provided pretravel counseling about infection risk prevention.
For follow-up, the goal was to obtain blood samples within 2-12 weeks after return of all those who participated in the pretravel screening. Completion of a post-travel survey about activities in Rio de Janeiro, particularly their participation in risk prevention strategies, also was requested.
Blood samples were evaluated for four arboviral infections: Zika virus, dengue virus, chikungunya virus, and West Nile virus. The calculation of infection rates was based on the 457 (48%) of those screened prior to travel who provided blood samples after their return. Of these, 11% had antibody evidence of arboviral infections, but new infections were confirmed in only 7%.
The post-games survey was completed by 169 of those evaluated. A comparison of risk prevention behaviors in those who were and were not infected suggested that use of mosquito repellent did provide risk reduction, said Dr. Ampofo.
The substantial rate of new West Nile virus infections was “surprising,” Dr. Ampofo said. He recounted that there were no prior warnings from Brazilian authorities that West Nile virus was circulating. Infection with West Nile virus in Houston prior to departure was not considered an alternative explanation. According to Dr. Ampofo, Houston was not an endemic area for West Nile virus, and the stay in Houston for most athletes was 2 or 3 days.
SAN DIEGO – When compared with pretravel blood screening, new arboviral infections were detected in 7% of U.S. athletes and support staff who attended the 2016 Olympic Games in Rio de Janeiro, according to study results revealed at an annual scientific meeting on infectious diseases.
Although the prospective screening program was largely set up and driven by concern about the risk of Zika virus infection, this was not among the arboviral infections identified, reported Krow Ampofo, MD, professor of pediatrics in the division of pediatric infectious diseases, University of Utah, Salt Lake City.
“The stories and images of children with microencephalopathy and other complications of the Zika syndrome were a major concern of athletes,” said Dr. Ampofo, who noted that many were threatening not to attend. The concern was reasonable, he said, given the scope of the epidemic and the fact that the majority of female athletes were of reproductive age.
At the time the screening program was being planned, the Zika virus epidemic in Brazil had, in fact, already peaked. Although it was not then known that the peak had been reached, the incidence rates began falling sharply beginning in about March 2016. New cases still were being reported, but the threat was greatly diminished by the time that the summer games were held.
In the screening program, blood samples were obtained prior to the games from 950 U.S. athletes and support staff. In most cases, these samples were obtained in Houston, where the Olympic team was processed just prior to departure. At that same time, the U.S. Centers for Disease Control and Prevention provided pretravel counseling about infection risk prevention.
For follow-up, the goal was to obtain blood samples within 2-12 weeks after return of all those who participated in the pretravel screening. Completion of a post-travel survey about activities in Rio de Janeiro, particularly their participation in risk prevention strategies, also was requested.
Blood samples were evaluated for four arboviral infections: Zika virus, dengue virus, chikungunya virus, and West Nile virus. The calculation of infection rates was based on the 457 (48%) of those screened prior to travel who provided blood samples after their return. Of these, 11% had antibody evidence of arboviral infections, but new infections were confirmed in only 7%.
The post-games survey was completed by 169 of those evaluated. A comparison of risk prevention behaviors in those who were and were not infected suggested that use of mosquito repellent did provide risk reduction, said Dr. Ampofo.
The substantial rate of new West Nile virus infections was “surprising,” Dr. Ampofo said. He recounted that there were no prior warnings from Brazilian authorities that West Nile virus was circulating. Infection with West Nile virus in Houston prior to departure was not considered an alternative explanation. According to Dr. Ampofo, Houston was not an endemic area for West Nile virus, and the stay in Houston for most athletes was 2 or 3 days.
SAN DIEGO – When compared with pretravel blood screening, new arboviral infections were detected in 7% of U.S. athletes and support staff who attended the 2016 Olympic Games in Rio de Janeiro, according to study results revealed at an annual scientific meeting on infectious diseases.
Although the prospective screening program was largely set up and driven by concern about the risk of Zika virus infection, this was not among the arboviral infections identified, reported Krow Ampofo, MD, professor of pediatrics in the division of pediatric infectious diseases, University of Utah, Salt Lake City.
“The stories and images of children with microencephalopathy and other complications of the Zika syndrome were a major concern of athletes,” said Dr. Ampofo, who noted that many were threatening not to attend. The concern was reasonable, he said, given the scope of the epidemic and the fact that the majority of female athletes were of reproductive age.
At the time the screening program was being planned, the Zika virus epidemic in Brazil had, in fact, already peaked. Although it was not then known that the peak had been reached, the incidence rates began falling sharply beginning in about March 2016. New cases still were being reported, but the threat was greatly diminished by the time that the summer games were held.
In the screening program, blood samples were obtained prior to the games from 950 U.S. athletes and support staff. In most cases, these samples were obtained in Houston, where the Olympic team was processed just prior to departure. At that same time, the U.S. Centers for Disease Control and Prevention provided pretravel counseling about infection risk prevention.
For follow-up, the goal was to obtain blood samples within 2-12 weeks after return of all those who participated in the pretravel screening. Completion of a post-travel survey about activities in Rio de Janeiro, particularly their participation in risk prevention strategies, also was requested.
Blood samples were evaluated for four arboviral infections: Zika virus, dengue virus, chikungunya virus, and West Nile virus. The calculation of infection rates was based on the 457 (48%) of those screened prior to travel who provided blood samples after their return. Of these, 11% had antibody evidence of arboviral infections, but new infections were confirmed in only 7%.
The post-games survey was completed by 169 of those evaluated. A comparison of risk prevention behaviors in those who were and were not infected suggested that use of mosquito repellent did provide risk reduction, said Dr. Ampofo.
The substantial rate of new West Nile virus infections was “surprising,” Dr. Ampofo said. He recounted that there were no prior warnings from Brazilian authorities that West Nile virus was circulating. Infection with West Nile virus in Houston prior to departure was not considered an alternative explanation. According to Dr. Ampofo, Houston was not an endemic area for West Nile virus, and the stay in Houston for most athletes was 2 or 3 days.
AT ID WEEK 2017
Key clinical point: Prospective surveillance among U.S. athletes and staff attending the 2016 Olympics documented several arboviral infections, but not Zika.
Major finding: When pre- versus post-Olympics blood studies were evaluated, 6% had developed West Nile virus while no other arboviral infection incidence exceeded 1%.
Data source: Prospective and post-Olympics blood studies of 457 U.S. athletes and staff and survey results.
Disclosures: Dr. Ampofo reported no financial relationships relevant to this study.