To identify risk factors for surgical site infections (SSIs) following C-sections in an underserved, urban population.

Retrospective case-control study and multivariable regression analyses.

Multicenter urban hospital system.

All women undergoing C-sections during 2023.

To identify risk factors for SSIs, patients suffering SSIs were compared to a propensity-matched control group (controlled for the following variables: age, body mass index, diabetes mellitus, American Society of Anesthesia (ASA) score, wound class, and duration of surgery). In addition, multivariable logistic regression analysis was performed to identify independent risks for SSIs.

Of 4,642 C-sections performed, 73 SSIs were identified; 90% were detected after hospital discharge. Compared to a propensity-matched group, more patients in the SSI cohort received gentamicin with clindamycin (vs a cefazolin-based regimen); gentamicin dosing was consistently below recommended levels. Also, significantly more patients in the SSI group were recent immigrants to the United States compared to the control group (20.5% vs 4.1%, P = .004). Multivariate regression analysis revealed 3 independent risk factors for SSIs: ASA score, surgery at a hospital without an Obstetrics-Gynecology residency program, and residence in the borough of the Bronx, NY.

For women living in areas of low socioeconomic status, most SSIs after C-sections are detected following hospital discharge. Women who are recent immigrants and living in areas of high poverty are particularly at higher risk. Addressing the broader social determinants of health, particularly in underserved areas, will be crucial in reducing SSIs and improving overall maternal health outcomes.

Despite the existent studies investigating the risk factors for postoperative pneumonia (POP) following coronary artery bypass grafting (CABG), the comprehensive understanding of POP is constrained by the scarcity of epidemiological data.

To investigate the epidemiology and contributing factors of POP in patients undergoing isolated CABG, and establish a prediction model.

A single center, retrospective case-control study.

Seven cardiovascular surgery wards across three campuses of a large general hospital in Henan Province, Mid-China.

Patients aged ≥ 18 years who underwent isolated CABG between January 1, 2020 and November 30, 2023.

Univariate and multivariate analyses with restricted cubic splines (RCS) were performed to identify factors that independently contributed to POP and explore the potential nonlinear relationships. The prediction model was evaluated via receiver operating characteristic curve analysis.

POP occurred in 11.34% of patients (518/4569). A total of 416 pathogenic strains were isolated from 381 patients, predominantly Gram-negative bacteria (86.5%). Pathogen distribution varied annually and quarterly. Multivariate analyses indicated that age, diabetes mellitus, smoking, operative duration, red blood cell transfusion, and duration of mechanical ventilation were significantly associated with higher POP risk, whereas higher hemoglobin and total cholesterol levels indicated a reduced likelihood. RCS analysis revealed a nonlinear relationship between operative duration and POP. The prediction model demonstrated a high predictive value (C-statistic: 0.774, 95% CI: 0.735-0.813).

This study identified eight independent factors that significantly influence the risk of POP following CABG, thereby clarifying the direction for optimizing perioperative prevention strategies for POP.

To assess the association between social vulnerability index (SVI) and surgical site infections (SSIs) using National Healthcare Safety Network (NHSN) criteria.

Retrospective cohort study between August 1, 2022, and August 31, 2023.

In total, 20 acute care hospitals in the Southeast United States.

Totally, 23,768 total hip arthroplasty, total knee arthroplasty, abdominal hysterectomy, colon, and spinal fusion surgeries in 22,239 patients were included. Procedures with infection present at the time of surgery or incomplete geographic tracking data were excluded.

Patient addresses as noted in the electronic health record were geocoded to determine census tract of residence and determine SVI. Demographic and clinical data were linked with SVI scores. SSIs were identified according to NHSN criteria. SVI was categorized into quartiles, and logistic regression was used to evaluate the association between SVI quartile (overall and for each SVI theme) and SSI risk. Subgroup analyses by procedure type and race were performed. Multivariable models of the association between overall SVI and SSI were adjusted for demographic and clinical factors.

Patients in the top SVI quartiles had significantly higher odds of developing SSIs after adjusting for other clinical and demographic factors. Increased risk was found for socioeconomic status and household characteristics themes, but not for the racial/ethnic minority theme. Association between SVI and SSI risk varied by type of surgery.

Living in an area with a higher SVI is associated with increased SSI risk. Targeted interventions are needed to mitigate these disparities and improve outcomes.

Nursing home (NH) residents have an elevated risk of coronavirus disease 2019 (COVID-19) infection and severe outcomes. However, literature regarding outbreak outcomes at the facility level is limited.

NH outbreaks beginning between March 1, 2020, and February 22, 2022, at facilities under Los Angeles County jurisdiction were assigned to 1 of 6 time periods defined by dominant variants, surges in community transmission, and vaccination levels. Outbreaks were defined as 1 or more NH resident cases with lab-confirmed COVID-19 infection and no periods of 14 or more days between successive COVID-19 resident cases. Outbreak size and duration were the number of NH resident cases and the number of days between the index case(s) and 14 days after the last resident case(s). Rates of severe outcomes were measured per 100 licensed beds among all outbreaks per time period.

44,279 cases were analyzed from 1,587 outbreaks. Median outbreak duration peaked during the first winter surge (39 days; time period 3); median outbreak size per 100 licensed beds peaked in time period 6 (17), after widespread vaccination - during the second winter surge. Hospitalizations and deaths per 100 resident cases fell from 31 and 24 prior to widespread vaccination to 11 and 7, respectively, after.

NH COVID-19 outbreaks may have been affected by vaccine uptake and community transmission levels. Because outbreak size and duration peaked during peak community transmission but severe outcome rates did not, the latter may be preferable to outbreak size and duration as outbreak metrics.

Hospital-onset bacteremia and fungemia (HOB) has been suggested as a suitable and automatable surveillance target to include in surveillance programs, however differences in definitions across studies limit interpretation and large-scale implementation. We aimed to apply an automated surveillance system for HOB in multiple hospitals using a consensus definition, and describe HOB rates.

Retrospective cohort study in four Dutch hospitals: 1 tertiary hospital and 3 secondary hospitals.

All patients admitted for at least one overnight stay between 2017 and 2021 were included, except patients in psychiatry wards.

Data from the electronic health records and laboratory information system were used to identify HOBs based on the PRAISE consensus definition. HOB rates were calculated at ward and micro-organism-level.

Hospital-wide HOB rates varied from 1.0 to 1.9, and ICU rates varied from of 8.2 to 12.5 episodes per 1000 patient days. The median time between admission and HOB was 8–13 days. HOBs were predominantly caused by Enterobacterales, Enterococci, S. aureus and coagulase-negative staphylococci. Longitudinal HOB surveillance detected differences over time at ward and micro-organism level; for example increased HOB rates were observed during the COVID-19 pandemic. Sensitivity analyses demonstrated the impact of assumptions regarding the collection of confirmatory blood cultures for common commensals.

Applying a fully automated definition for HOB surveillance was feasible in multiple centers with different data infrastructures, and enabled detection of differences over time at ward and micro-organism-level. HOB surveillance may lead to prevention initiatives in the future.

To determine the regional impact of transmission of multidrug-resistant organisms (MRDOs) and Clostridioides difficile (C. difficile) among a tertiary care hospital and surrounding facilities including long-term care facilities (LTCFs).

Retrospective cohort study.

Patients admitted to a tertiary care hospital from July 2019 to July 2021 were recruited if their clinically collected cultures grew the following pathogens: Methicillin-resistant Staphylococcus aureus (MRSA), Extended-Spectrum Beta-Lactamase (ESBL) producing Enterobacterales, Pseudomonas aeruginosa with difficult-to-treat resistance, Carbapenem-resistant Enterobaterales, Vancomycin-resistant Enterococci, and C. difficile. Patient characteristics including admission and discharge pathway were collected. For the isolates of MRSA, ESBL-producing Escherichia coli (E. coli), and C. difficile, a molecular epidemiological analysis was conducted, utilizing the PCR-based Open-Reading Frame Typing (POT) method.

Three hundred-five patients were identified with a total of 332 culture specimens of the target pathogens. The top three were 132 MRSA isolates (43.3%, out of 305), 97 ESBL E. coli (31.8%), and 32 ESBL Enterobacterales (non-E. coli) (10.5%). The target pathogens were more detectable within 3 days among patients admitted from LTCFs or other hospitals than those admitted from home (Odds Ratio 4.6, 95% confidence interval 2.8-7.6, p-value < 0.001). The molecular epidemiological analysis suggested the transmissions of MRSA, ESBL E. coli and C. difficile occurred 52 out of 111 patients within the in-hospital environment, and 7 out of 128 within the prehospital environment, respectively.

MDROs/C. difficile transmission is prevalent within a tertiary care hospital and further complicated by its inter-facility transmission across surrounding LTCFs and hospitals in Japan.

To compare the risk and exposure-adjusted central line-associated bloodstream infection (CLABSI) rates between racial and ethnic groups.

Retrospective cohort study.

15 network hospitals in Illinois and Michigan (Part of OSF HealthCare).

Patients of all age groups who had a central line inserted and removed during the same hospitalization between 01/2018 and 06/2023.

CLABSI rates/1000 Central line days of the four major racial and ethnic categories (Hispanic, non-Hispanic White [NHW], non-Hispanic Black [NHB], and non-Hispanic others) were analyzed by generalized Poisson regression. Confounding variables included in the regression model based on a directed acyclic graph and included age group, insurance class, language, ICU admission, diagnostic cohorts (obesity, diabetes, dialysis, cancer, neutropenia), and line usage (blood products, chemotherapy, total parenteral nutrition).

27,674 central lines (244,889 catheter days) on 23,133 unique patients (median age 64 years, 8% pediatric patients) were included in the analysis. Overall, the CLABSI rate was 1.070/1000 Central line days. 76% of the study population was NHW, 17% NHB, and 4% Hispanic. After adjusting for confounding variables, Hispanic patients had higher CLABSI rates than NHW (IRR 1.89, 95% CI 1.15–3.10, P = .013). No significant difference was observed in the CLABSI rates between NHW and NHB patients.

Disparities in hospital-associated conditions persist even after controlling for patient-level risk factors and exposures, with Hispanic patients at the highest risk.

To evaluate the impact of a mobile-app-based central line-associated bloodstream infection (CLABSI) prevention program in nursing home residents with peripherally inserted central catheters (PICCs).

Pre-post prospective cohort study with baseline (September 2015–December 2016), phase-in (January 2017–April 2017), and intervention (May 2017–December 2018). Generalized linear mixed models compared intervention with baseline frequency of localized inflammation/infection, dressing peeling, and infection-related hospitalizations. Cox proportional hazards models compared days-to-removal of lines with localized inflammation/infection.

Six nursing homes in Orange County, California.

Adult nursing home residents with PICCs.

CLABSI prevention program consisting of an actionable scoring system for identifying insertion site infection/inflammation coupled with a mobile-app enabling photo-assessments and automated physician alerting for remote response.

We completed 8,131 assessments of 817 PICCs in 719 residents (baseline: 4,865 assessments, 422 PICCs, 385 residents; intervention: 4,264 assessments, 395 PICCs, 334 residents). The intervention was associated with 57% lower odds of peeling dressings (OR 0.43, 95% CI 0.28–0.64, P < .001), 73% lower local inflammation/infection (OR = 0.27, 95% CI: 0.13–0.56, P < .001), and 41% lower risk of infection-related hospitalizations (OR = 0.59, 95% CI: 0.42–0.83, P = .002). Physician mobile-app alerting and response enabled 62% lower risk of lines remaining in place after inflammation/infection was identified (HR 0.38, CI: 0.24–0.62, P < .001) and 95% faster removal of infected lines from mean (SD) 19 (20) to 1 (2) days.

A mobile-app-based CLABSI prevention program decreased the frequency of inflamed/infected central line insertion sites, improved dressing integrity, increased speed of removal when inflammation/infection were found, and reduced infection-related hospitalization risk.

Asymptomatic patients colonized with toxigenic Clostridioides difficile are at risk of progressing to C. difficile infection (CDI), but risk factors associated with progression are poorly understood. The objectives of this study were to estimate the incidence and identify risk factors to progression of hospital-onset CDI (HO-CDI) among colonized patients.

This was a nested case-control study at an academic medical center including adult patients colonized with toxigenic C. difficile, detected via polymerase chain reaction (PCR) on a rectal swab collected on admission from 2017 to 2020. Patients with prior CDI or symptoms on admission, neutropenia, prior rectal surgery, or hospitalization less than 24 hours were excluded. Colonized patients that developed HO-CDI were matched 1:3 to colonized patients who did not based on PCR test date. Bivariate and multivariable-adjusted Cox regression analyses were used to identify risk factors.

Of 2,150 colonized patients, 109 developed HO-CDI, with an incidence of 5.1%. After exclusions, 321 patients (69 with HO-CDI) were included, with an estimated incidence of 4.2%. Risk factors included cirrhosis (aHR 1.94), ICU admission (aHR 1.76), malignancy (aHR 1.88), and hospitalization within six months (aHR 1.6). Prior antibiotic exposure in the past three months (aHR 2.14) and receipt of at-risk antibiotics were also identified as potential risk factors (aHR 2.17).

Progression to HO-CDI among colonized patients was not uncommon. This study highlights key risk factors associated with progression, underscoring the importance of enhanced monitoring and prevention efforts tailored to high-risk populations to mitigate HO-CDI.

Carbapenem-resistant Enterobacterales (CRE) are an urgent threat to healthcare, but the epidemiology of these antimicrobial-resistant organisms may be evolving in some settings since the COVID-19 pandemic. An updated analysis of hospital-acquired CRE (HA-CRE) incidence in community hospitals is needed.

We retrospectively analyzed data on HA-CRE cases and antimicrobial utilization (AU) from two community hospital networks, the Duke Infection Control Outreach Network (DICON) and the Duke Antimicrobial Stewardship Outreach Network (DASON) from January 2013 to June 2023. The zero-inflated negative binomial regression model was used owing to excess zeros.

126 HA-CRE cases from 36 hospitals were included in the longitudinal analysis. The pooled incidence of HA CRE was 0.69 per 100,000 patient days (95% confidence interval [95% CI], 0.57–0.82 HA-CRE rate significantly decreased over time before COVID-19 (rate ratio [RR], 0.94 [95% CI, 0.89–0.99]; p = 0.02), but there was a significant slope change indicating a trend increase in HA-CRE after COVID-19 (RR, 1.32 [95% CI, 1.06–1.66]; p = 0.01). In 21 hospitals participating in both DICON and DASON from January 2018 to June 2023, there was a correlation between HA-CRE rates and AU for CRE treatment (Spearman’s coefficient = 0.176; p < 0.01). Anti-CRE AU did not change over time, and there was no level or slope change after COVID.

The incidence of HA-CRE decreased before COVID-19 in a network of community hospitals in the southeastern United States, but this trend was disrupted by the COVID-19 pandemic.

Bathing intensive care unit (ICU) patients with chlorhexidine gluconate (CHG) decreases healthcare-associated infections (HAIs). The optimal method of CHG bathing remains undefined.

Prospective crossover study comparing CHG daily bathing with 2% CHG-impregnated cloths versus 4% CHG solution. In phase 1, from January 2020 through March 2020, 1 ICU utilized 2% cloths, while the other ICU utilized 4% solution. After an interruption caused by the coronavirus disease 2019 pandemic, in phase 2, from July 2020 through September 2020, the unit CHG bathing assignments were reversed. Swabs were performed 3 times weekly from patients’ arms and legs to measure skin microbial colonization and CHG concentration. Other outcomes included HAIs, adverse reactions, and skin tolerability.

411 assessments occurred after baths with 2% cloth, and 425 assessments occurred after baths with 4% solution. Average microbial colonization was 691 (interquartile range 0, 30) colony-forming units per square centimeter (CFU/cm2) for patients bathed with 2% cloths, 1,627 (0, 265) CFUs/cm2 for 4% solution, and 8,519 (10, 1130) CFUs/cm2 for patients who did not have a CHG bath (P < .001). Average CHG skin concentration (parts per million) was 1300.4 (100, 2000) for 2% cloths, 307.2 (30, 200) for 4% solution, and 32.8 (0, 20) for patients without a recorded CHG bath. Both CHG bathing methods were well tolerated. Although underpowered, no difference in HAI was noted between groups.

Either CHG bathing method resulted in a significant decrease in microbial skin colonization with a greater CHG concentration and fewer organisms associated with 2% CHG cloths.

Therapeutic guidelines for Clostridioides difficile infections (CDI) were revised a few years ago, promoting the usage of oral vancomycin even for primary mild infections. Vancomycin-resistant enterococci (VRE) is one of the worldwide most significant pathogens. Our study aim was to explore the independent association between oral vancomycin treatment for CDI, and subsequent VRE acquisitions.

Retrospective cohort study.

Academic 904-bed general hospital (Shamir Medical Center, Israel).

Adult (>18 yr) inpatients with primary CDI and no prior VRE.

Study was conducted for calendar years 2016-2020. Logistic regression was used to model-independent predictors for VRE acquisitions. A propensity score (PS)-matched analysis (logistic regression) of the risk of receiving oral vancomycin was conducted to further eliminate potential confounders.

Overall, 606 patients were included (54% females), with a median age of 75 (IQR = 65–85) years. Independent predictors for VRE acquisition were oral vancomycin as a main therapy (aOR = 4.3, P < 0.001), exposure to systemic vancomycin in the previous 3 months (aOR = 3.2, P < 0.001), dependent functional status (aOR = 2.3, P = 0.006), and diabetes (aOR = 1.8, P = 0.04). After controlling for the PS, the independent association between oral vancomycin and later VRE acquisition remained significant in the regression model (aOR = 3.6, P < 0.01) and per PS matched-pairs analysis (aOR = 4.4, P < 0.01).

Oral vancomycin administered for CDI had a strong independent association with later VRE acquisitions. This finding could promote stewardship interventions in an effort to reduce the usage of oral vancomycin for certain CDI indications, leading to improved CDI management, while curbing the continued emergence of VRE at hospitals.

Asymptomatic bacteriuria (ASB) treatment is a common form of antibiotic overuse and diagnostic error. Antibiotic stewardship using the inappropriate diagnosis of urinary tract infection (ID-UTI) measure has reduced ASB treatment in diverse hospitals. However, critical access hospitals (CAHs) have differing resources that could impede stewardship. We aimed to determine if stewardship including the ID-UTI measure could reduce ASB treatment in CAHs.

From October 2022 to July 2023, ten CAHs participated in an Intensive Quality Improvement Cohort (IQIC) program including 3 interventions to reduce ASB treatment: 1) learning labs (ie, didactics with shared learning), 2) mentoring, and 3) data-driven performance reports including hospital peer comparison based on the ID-UTI measure. To assess effectiveness of the IQIC program, change in the ID-UTI measure (ie, percentage of patients treated for a UTI who had ASB) was compared to two non-equivalent control outcomes (antibiotic duration and unjustified fluoroquinolone use).

Ten CAHs abstracted a total of 608 positive urine culture cases. Over the cohort period, the percentage of patients treated for a UTI who had ASB declined (aOR per month = 0.935, 95% CI: 0.873, 1.001, P = 0.055) from 28.4% (range across hospitals, 0%-63%) in the first to 18.6% (range, 0%-33%) in the final month. In contrast, antibiotic duration and unjustified fluoroquinolone use were unchanged (P = 0.768 and 0.567, respectively).

The IQIC intervention, including learning labs, mentoring, and performance reports using the ID-UTI measure, was associated with a non-significant decrease in treatment of ASB, while control outcomes (duration and unjustified fluoroquinolone use) did not change.

To identify Surgical Site Infection (SSI) risk factors for abdominal hysterectomy patients and report the results of a performance improvement initiative.

Retrospective case-control.

Parkland Hospital, an 882-bed academic, safety-net, tertiary referral center and a level 1 trauma center serving a diverse population of primarily uninsured patients in North Texas.

Patients over 18 who underwent abdominal hysterectomy and were diagnosed with SSIs within 30 days of surgery between 2019 and 2021.

Cases were matched to controls from the same or closest calendar month in a 1:2 ratio. Chart review of electronic medical records (EMR) was performed comparing variables using Pearson’s χ2 test for categorical variables and Student’s t-test for continuous variables followed by logistic regression for multivariate analysis. Upon identifying vaginal preparation technique as an area of improvement while investigating SSI bundle compliance, we implemented an OR staff training intervention.

Diabetes was identified as a significant risk factor while Hispanic or Latino ethnicity was associated with significantly lower rates of infection. Most organisms identified were enteric pathogens. Following the intervention, Parkland’s deep and organ-space Standardized Infection Ratio (SIR) decreased from 1.46 in 2021 to 0.519 for the rolling 12 months as of June 2024.

Our multidisciplinary intervention improving the quality and consistency of pre-operative vaginal preparation was associated with a reduction in abdominal hysterectomy SSI.

Cases of hospital-onset bacteremia and fungemia (HOBF) are on the rise in Japanese hospitals, but little is known about their incidence in hospitals and how it relates to the availability of services provided by infectious diseases departments.

We herein investigated the monthly incidence density of HOBF per 1,000 patient days from 2013 through 2023 at a tertiary care hospital in Japan. The incidence of overall HOBF and pathogen-specific HOBF, including those caused by Enterobacterales, Staphylococcus aureus, coagulase-negative staphylococci (CNS), and Candida species, was tracked. Changes in the HOBF trend before and after the establishment of an infectious diseases department at the hospital were evaluated.

In total, 4,315 HOBF-related events were identified. The overall incidence density of HOBF increased by 2.4-fold from 0.58 per 1,000 PD in 2013 to 1.42 per 1,000 PD in 2023. Both the level and trend changes in the incidence density of overall HOBF (+0.3142 for change in level [P < .001]; +0.0085 for change in trend [P < .001]), HOBF caused by S. aureus (+0.0983 for change in level [P < .001]; +0.0016 for change in trend [P = 0.016]), and Candida spp. (+0.0466 for change in level [P = 0.030]; +0.0019 for change in trend [P = 0.002]) significantly increased after the establishment of the infectious diseases department.

The incidence density of overall HOBF and clinically important pathogen-specific HOBF increased over the last decade. The availability of services through the infectious diseases department was significantly associated with an increase in the HOBF incidence, likely suggesting improvement in the diagnosis of HOBF.

Inappropriate diagnosis and treatment of urinary tract infections (UTIs) contribute to antibiotic overuse. The Inappropriate Diagnosis of UTI (ID-UTI) measure uses a standard definition of asymptomatic bacteriuria (ASB) and was validated in large hospitals. Critical access hospitals (CAHs) have different resources which may make ASB stewardship challenging. To address this inequity, we adapted the ID-UTI metric for use in CAHs and assessed the adapted measure’s feasibility, validity, and reliability.

Retrospective observational study

10 CAHs

From October 2022 to July 2023, CAHs submitted clinical information for adults admitted or discharged from the emergency department who received antibiotics for a positive urine culture. Feasibility of case submission was assessed as the number of CAHs achieving the goal of 59 cases. Validity (sensitivity/specificity) and reliability of the ID-UTI definition were assessed by dual-physician review of a random sample of submitted cases.

Among 10 CAHs able to participate throughout the study period, only 40% (4/10) submitted >59 cases (goal); an additional 3 submitted >35 cases (secondary goal). Per the ID-UTI metric, 28% (16/58) of cases were ASB. Compared to physician review, the ID-UTI metric had 100% specificity (ie all cases called ASB were ASB on clinical review) but poor sensitivity (48.5%; ie did not identify all ASB cases). Measure reliability was high (93% [54/58] agreement).

Similar to measure performance in non-CAHs, the ID-UTI measure had high reliability and specificity—all cases identified as ASB were considered ASB—but poor sensitivity. Though feasible for a subset of CAHs, barriers remain.

To quantify the impact of patient- and unit-level risk adjustment on infant hospital-onset bacteremia (HOB) standardized infection ratio (SIR) ranking.

A retrospective, multicenter cohort study.

Infants admitted to 284 neonatal intensive care units (NICUs) in the United States between 2016 and 2021.

Expected HOB rates and SIRs were calculated using four adjustment strategies: birthweight (model 1), birthweight and postnatal age (model 2), birthweight and NICU complexity (model 3), and birthweight, postnatal age, and NICU complexity (model 4). Sites were ranked according to the unadjusted HOB rate, and these rankings were compared to rankings based on the four adjusted SIR models.

Compared to unadjusted HOB rate ranking (smallest to largest), the number and proportion of NICUs that left the fourth quartile (worst-performing) following adjustments were as follows: adjusted for birthweight (16, 22.5%), birthweight and postnatal age (19, 26.8%), birthweight and NICU complexity (22, 31.0%), birthweight, postnatal age and NICU complexity (23, 32.4%). Comparing NICUs that moved into the better-performing quartiles after birthweight adjustment to those that remained in the better-performing quartiles regardless of adjustment, the median percentage of low birthweight infants was 17.1% (Interquartile Range (IQR): 15.8, 19.2) vs 8.7% (IQR: 4.8, 12.6); and the median percentage of infants who died was 2.2% (IQR: 1.8, 3.1) vs 0.5% (IQR: 0.01, 12.0), respectively.

Adjusting for patient and unit-level complexity moved one-third of NICUs in the worst-performing quartile into a better-performing quartile. Risk adjustment may allow for a more accurate comparison across units with varying levels of patient acuity and complexity.

Patients with Opioid Use Disorder (OUD) are prone to Multidrug-Resistant Organism (MDRO) colonization and infections, thus at risk for worse outcomes during critical illness. Understanding the prevalence and predictors of MDRO infections is essential to optimize interventions and treatments.

Retrospective cohort study.

The study evaluated the prevalence of MDRO isolation among adults with OUD admitted to an intensive care unit (ICU) between January 1, 2018, and July 31, 2023. It included adults admitted to an ICU with bacterial infections and positive cultures obtained within 48 hours of admission. Demographics, clinical traits, and MDRO isolation rates were analyzed using descriptive statistics, univariate methods, and Least Absolute Shrinkage and Selection Operator (LASSO) regression.

MDRO isolation occurred in 178 of 790 patients (22.5%), with methicillin-resistant Staphylococcus aureus as the most frequently isolated organism. LASSO regression identified housing insecurity (OR: 1.79, 95% CI 1.09–2.93, P = .022), no receipt of medications for OUD treatment (OR: 1.56, 95% CI 1.06–2.29, P = .023), positive hepatitis C virus (HCV) status (OR: 2.19, 95% CI 1.19–4.03, P = .012), and intravenous antibiotic use in the prior 90 days (OR: 1.04 per 24 h, 95% CI 1.01–1.07, P = .007) as significant predictors of MDRO isolation.

The study highlights a high prevalence of MDRO isolation in critically ill OUD patients admitted for infection-related issues with positive cultures obtained within 48 hours of admission, influenced by factors like housing insecurity, no receipt of medications for OUD treatment, HCV status, and prior antibiotic use.

Medicare claims are frequently used to study Clostridioides difficile infection (CDI) epidemiology. However, they lack specimen collection and diagnosis dates to assign location of onset. Algorithms to classify CDI onset location using claims data have been published, but the degree of misclassification is unknown.

We linked patients with laboratory-confirmed CDI reported to four Emerging Infections Program (EIP) sites from 2016–2021 to Medicare beneficiaries with fee-for-service Part A/B coverage. We calculated sensitivity of ICD-10-CM codes in claims within ±28 days of EIP specimen collection. CDI was categorized as hospital, long-term care facility, or community-onset using three different Medicare claims-based algorithms based on claim type, ICD-10-CM code position, duration of hospitalization, and ICD-10-CM diagnosis code presence-on-admission indicators. We assessed concordance of EIP case classifications, based on chart review and specimen collection date, with claims case classifications using Cohen’s kappa statistic.

Of 12,671 CDI cases eligible for linkage, 9,032 (71%) were linked to a single, unique Medicare beneficiary. Compared to EIP, sensitivity of CDI ICD-10-CM codes was 81%; codes were more likely to be present for hospitalized patients (93.0%) than those who were not (56.2%). Concordance between EIP and Medicare claims algorithms ranged from 68% to 75%, depending on the algorithm used (κ = 0.56–0.66).

ICD-10-CM codes in Medicare claims data had high sensitivity compared to laboratory-confirmed CDI reported to EIP. Claims-based epidemiologic classification algorithms had moderate concordance with EIP classification of onset location. Misclassification of CDI onset location using Medicare algorithms may bias findings of claims-based CDI studies.

Environmental features of a patient’s room depend on the patient’s level of acuity and their clinical manifestations upon admission and during their hospital stay. In this study, we wish to apply statistical methodology to explore the association between room features and hospital onset infections caused by Clostridioides difficile (HO-CDI) while accounting for room assignment.

We conducted a nested case–control study using retrospective electronic health record (EHR) data of patients hospitalized at the Ohio State University Wexner Medical Center (OSUWMC) between January 2019 and April 2021. We collected clinical information and combined that with room-based information, collected as surveys. Data were analyzed to assess the association between room factors and HO-CDI.

2427 patients and 968 unique rooms were included in the study. Results indicated protective effects for rooms with cubical curtains near the patient (OR = 0.705, 95% CI = 0.549–0.906), rooms with separate shower units (OR = 0.674, 95% CI = 0.528–0.860), rooms with wall-mounted toilets (OR = 0.749, 95% CI = 0.592–0.950), rooms with sliding bathroom doors (OR = 0.593, 95% CI = 0.432–0.816), and sliding door knobs (OR = 0.593, 95% CI = 0.431-0.815). Rooms with manual paper towel dispensers had increased odds of HO-CDI (OR = 1.334, 95% CI = 1.053–1.691) compared to those with automatic towel dispensers.

Results suggest possible association between specific room features and HO-CDI, which could be further investigated with techniques like environmental sampling. Moreover, findings from the study offer valuable insights for targeted intervention measures.