We sought to determine the burden of nosocomial Clostridium difficile infection in comparison to other healthcare-associated infections (HAIs) in community hospitals participating in an infection ...control network. Our data suggest that C. difficile has replaced MRSA as the most common etiology of HAI in community hospitals in the southeastern United States.
Evolving resistance to arte misi ni n-based compounds threatens to derail attempts to control malaria. Resistance has been confirmed in western Cambodia and has recently emerged in western Thailand, ...but is absent from neighboring Laos. Artemisinin resistance results in reduced parasite clearance rates (CRs) after treatment. We used a two-phase strategy to identify genome region(s) underlying this ongoing selective event. Geographical differentiation and haplotype structure at 6969 polymorphic single-nucleotide polymorphisms (SNPs) in 91 parasites from Cambodia, Thailand, and Laos identified 33 genome regions under strong selection. We screened SNPs and microsatellites within these regions in 715 parasites from Thailand, identifying a selective sweep on chromosome 13 that shows strong association (P = 10⁻⁶ to 10⁻¹²) with slow CRs, illustrating the efficacy of targeted association for identifying the genetic basis of adaptive traits.
We describe 3 cases of daptomycin-induced pulmonary toxic effects that are consistent with drug-induced acute eosinophilic pneumonia. Patients presented similarly with dyspnea, cough, hypoxia, and ...diffuse ground-glass opacities at chest computed tomography. Clinical suspicion for this adverse drug event and cessation of daptomycin until definitive diagnosis can be made is crucial.
BACKGROUND
Failure to reconcile medications across transitions in care is an important source of harm to patients. Little is known about medication discrepancies upon admission to skilled nursing ...facilities (SNFs).
OBJECTIVE
To describe the prevalence of, type of medications involved in, and sources of medication discrepancies upon admission to the SNF setting.
DESIGN
Cross-sectional study.
PARTICIPANTS
Patients admitted to SNF for subacute care.
MEASUREMENTS
Number of medication discrepancies, defined as unexplained differences among documented medication regimens, including the hospital discharge summary, patient care referral form and SNF admission orders.
RESULTS
Of 2,319 medications reviewed on admission, 495 (21.3%) had a medication discrepancy. At least one medication discrepancy was identified in 142 of 199 (71.4%) SNF admissions. The discharge summary and the patient care referral form did not match in 104 of 199 (52.3%) SNF admissions. Disagreement between the discharge summary and the patient care referral form accounted for 62.0% (n = 307) of all medication discrepancies. Cardiovascular agents, opioid analgesics, neuropsychiatric agents, hypoglycemics, antibiotics, and anticoagulants accounted for over 50% of all discrepant medications.
CONCLUSIONS
Medication discrepancies occurred in almost three out of four SNF admissions and accounted for one in five medications prescribed on admission. The discharge summary and the patient care referral forms from the discharging institution are often in disagreement. Our study findings underscore the importance of current efforts to improve the quality of inter-institutional communication.
Invasions by non-native plant species after fire can negatively affect important ecosystem services and lead to invasion-fire cycles that further degrade ecosystems. The relationship between fire and ...plant invasion is complex, and the risk of invasion varies greatly between functional types and across geographic scales. Here, we examined patterns and predictors of non-native plant invasion following fire across the western United States. We specifically analyzed how the abundance of non-native plants after fire was related to fire characteristics and environmental conditions, such as climate, soil, and topography, in 26,729 vegetation plots from government networks and individual studies. Non-native plant cover was higher in plots measured after wildfires compared to prescribed burns or unburned plots. The post-fire cover of non-native species varied by plant functional type, and only the cover of short-lived (i.e., annual and biennial) forbs and short-lived C3 grasses was significantly higher in burned plots compared to unburned plots. Cool-season short-lived grasses composed most of the non-native post-fire vegetation, with cheatgrass (
Bromus tectorum
) being the most recorded species in the dataset. Climate variables were the most influential predictors of the cover of non-native short-lived grasses and forbs after fires, with invasion being more common in areas with drier summers and a higher proportion of yearly precipitation falling in October through March. Models using future projected climate for mid (2041–2070) and end (2071–2100) of century showed a potential for increasing post-fire invasion risk at higher elevations and latitudes. These findings highlight priorities for mitigation, monitoring, and restoration efforts to reduce post-fire plant invasion risk across the western United States.
Abstract Background The epidemiology of community-associated Clostridium difficile infection is not well known. We performed a multicenter, case-control study to further describe community-associated ...C. difficile infection and assess novel risk factors. Methods We conducted this study at 5 sites from October 2006 through November 2007. Community-associated C. difficile infection included individuals with diarrhea, a positive C. difficile toxin, and no recent (12 weeks) discharge from a health care facility. We selected controls from the same clinics attended by cases. We collected clinical and exposure data at the time of illness and cultured residual stool samples and performed ribotyping. Results Of 1041 adult C. difficile infections, 162 (15.5%) met criteria for community-associated: 66 case and 114 control patients were enrolled. Case patients were relatively young (median 64 years), female (56%), and frequently required hospitalization (38%). Antimicrobials, malignancy, exposure to high-risk persons, and remote health care exposure were independently associated with community-associated C. difficile infection. In 40% of cases, we could not confirm recent antibiotic exposure. Stomach-acid suppressants were not associated with community-associated infection, and 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors appeared protective. Prevalence of the hypervirulent NAP-1/027 strain was infrequent (17%). Conclusions Community-associated C. difficile infection resulted in a substantial health care burden. Antimicrobials are a significant risk factor for community-associated infection. However, other unique factors also may contribute, including person-to-person transmission, remote health care exposures, and 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors. A role for stomach-acid suppressants in community-associated C. difficile infection is not supported.
The U.S. Forest Service is reconsidering policies that limit the size of trees that can be removed in the course of restoration treatments in dry forests of eastern Oregon. To evaluate the effects of ...diameter limits on the ability of managers to meet restoration objectives, we used an existing network of long‐term research plots to summarize historical and contemporary structure and composition of mixed‐conifer forests within a one million‐ha study area in eastern Oregon. Then, we used a novel thinning simulation procedure to quantify the degree to which thinning using different diameter limits restored stands to historical conditions. Contemporary mixed‐conifer forests within the study area are significantly denser, have more basal area, and have a greater proportion of shade‐tolerant species than historical conditions. Our simulations of thinning under current policy that prohibits cutting of trees ≥53 cm show that a quarter of mixed‐conifer stands cannot be restored to within the historical range of basal area or density. Those stands that could be restored to within historical basal area ranges still had a substantially higher component of shade‐tolerant trees than historical stands. Permitting larger shade‐tolerant trees to be removed allowed restoration of all or most of stands to within historical structural and compositional ranges. Forest conditions in the late 1800s may not necessarily provide the best template for management because climate and disturbance projections suggest that eastern Oregon forests will be less well suited to shade‐tolerant species in the future. Adapting stands to future conditions will require robust monitoring of forest structural and compositional response to restoration treatments.
Nontuberculous mycobacteria are increasingly associated with cutaneous infections after cosmetic procedures. Fractionated CO
2
resurfacing, a widely used technique for photorejuvenation, has been ...associated with a more favorable side effect profile than alternative procedures. We describe 2 cases of nontuberculous mycobacterial infection after treatment with a fractionated CO
2
laser at a private clinic. Densely distributed erythematous papules and pustules developed within the treated area within 2 weeks of the laser procedure. Diagnosis was confirmed by histologic analysis and culture. Both infections responded to a 4-month course of a multidrug regimen. An environmental investigation of the clinic was performed, but no source of infection was found. The case isolates differed from each other and from isolates obtained from the clinic, suggesting that the infection was acquired by postprocedure exposure. Papules and pustules after fractionated CO
2
resurfacing should raise the suspicion of nontuberculous mycobacterial infection.
We implemented a direct-observer hand hygiene audit program that used trained observers, wireless data entry devices, and an intranet portal. We improved the reliability and utility of the data by ...standardizing audit processes, regularly retraining auditors, developing an audit guidance tool, and reporting weighted composite hand hygiene compliance scores.
To describe the rates of several key outcomes and healthcare-associated infections (HAIs) among hospitals that participated in the Duke Infection Control Outreach Network (DICON).
Prospective, ...observational cohort study of patients admitted to 24 community hospitals from 2003 through 2009.
The following data were collected and analyzed: incidence of central line-associated bloodstream infections (CLABSIs), ventilator-associated pneumonia (VAP), catheter-associated urinary tract infections (CAUTIs), and HAIs caused by methicillin-resistant Staphylococcus aureus (MRSA); employee exposures to bloodborne pathogens (EBBPs); physician EBBPs; patient-days; central line-days; ventilator-days; and urinary catheter-days. Poisson regression was used to determine whether incidence rates of these HAIs and exposures changed during the first 5 and 7 years of participation in DICON; nonrandom clustering of each outcome was controlled for. Cost saved and lives saved were calculated on the basis of published estimates.
In total, we analyzed 6.5 million patient-days, 4,783 EBPPs, 2,948 HAIs due to MRSA, and 2,076 device-related infections. Rates of employee EBBPs, HAIs due to MRSA, and device-related infections decreased significantly during the first 5 years of participation in DICON (P< .05 for all models; average decrease was approximately 50%); in contrast, physician EBBPs remained unchanged. In aggregate, 210 CLABSIs, 312 cases of VAP, 332 CAUTIs, 1,042 HAIs due to MRSA, and 1,016 employee EBBPs were prevented. Each hospital saved approximately $100,000 per year of participation, and collectively the hospitals may have prevented 52-105 deaths from CLABSI or VAP. The 7-year analysis demonstrated that these trends continued with further participation.
Hospitals with long-term participation in an infection control network decreased rates of significant HAIs by approximately 50%, decreased costs, and saved lives.
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