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780. How Much Does Prior Hospitalization Contribute to Readmission with Community-onset Clostridioides difficile Infection?

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Open Forum Infectious Diseases 2020年第SUPPLEMENT_1期7卷 S434–S435页

作者： Alice Guh Lauren C Korhonen Lisa Gail Winston Brittany Martin Helen Johnston Geoffrey Brousseau Elizabeth Basiliere Danyel M Olson Scott Fridkin Lucy E Wilson Rebecca Perlmutter Stacy Holzbauer Maria Bye Erin C Phipps Kristina Flores Ghinwa Dumyati Deborah Nelson Trupti Hatwar Valerie Ocampo Marion Kainer Clifford McDonald Centers for Disease Control and Prevention Atlanta GA University of California San Francisco San Francisco California California Emerging Infections Program Oakland California Colorado Department of Public Health and Environment Denver Colorado Yale University New Haven CT Emory University Atlanta GA University of Maryland Baltimore County Baltimore MD Maryland Department of Health Baltimore Maryland Minnesota Department of Health St. Paul Minnesota University of New Mexico Albuquerque New Mexico New York Rochester Emerging Infections Program at the University of Rochester Medical Center Rochester NY New York Emerging Infections Program and University of Rochester Medical Center Rochester New York Oregon Health Authority Portland OR Tennessee Department of Health Nashville Tennessee

BackgroundInterventions to reduce community-onset (CO)Clostridioides difficileInfection (CDI) are not usually hospital-based due to the perception that they are often acquired outside the hospital. We determined the p...

Background Interventions to reduce community-onset (CO) Clostridioides difficile Infection (CDI) are not usually hospital-based due to the perception that they are often acquired outside the hospital. We determined the proportion of admitted CO CDI that might be associated with previous hospitalization.

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Practice-, Provider-, and Patient-level interventions to improve preventive care: Development of the P3 Model

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Preventive Medicine Reports 2018年 11卷 131-138页

作者： Bednarczyk, Robert A. Chamberlain, Allison Mathewson, Kara Salmon, Daniel A. Omer, Saad B. Hubert Department of Global Health Rollins School of Public Health Emory University Atlanta GA United States Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA United States Cancer Prevention and Control Program Winship Cancer Institute Emory University Atlanta GA United States Emory Vaccine Center Emory University Atlanta GA United States Institute for Vaccine Safety Bloomberg School of Public Health Johns Hopkins University Baltimore MD United States Department of Pediatrics School of Medicine Emory University Atlanta GA United States

For adequate provision of preventive services, there is an interplay between activities at the healthcare practice, healthcare provider, and patient levels of the clinical encounter. Commonly used health promotion and behavior theoretical models address some of these three levels, but none fully account for all three. Building off of key components of many existing theoretical models, including the Health Belief Model, Theory of Planned Behavior/Theory of Reasoned Action, Social Cognitive Theory, Social Ecological Model, and the Systems Model of Clinical Preventive Care, we describe the development of the P3 (Practice-, Provider-, and Patient-level) Model for preventive care interventions. The P3 Model accounts for all three levels of the clinical encounter, and the factors that impact these levels, concurrently. This yields a model for preventive care that is applicable and adaptable to different settings, and that provides a framework for the development, implementation, and evaluation of preventive care promotion interventions. The applicability of the P3 Model is shown through two exemplar preventive care programs – immunization and colorectal cancer screening. The P3 Model allows interventions to be developed and evaluated in a modular approach, to allow more practical refinement and optimization of the intervention. © 2018 The Authors

关键词： Behavior change Behavior change theory Cancer prevention and control Health promotion Immunization

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Implementing a vector surveillanceresponse system for chagas disease control:a 4-year field trial in Nicaragua

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Infectious Diseases of Poverty 2017年第1期6卷 154-165页

作者： Kota Yoshioka Doribel Tercero Byron Perez Jiro Nakamura Lenin Perez Doctor of Public Health Program Harvard T.H.Chan School of Public HealthBostonUSA School of Tropical Medicine and Global Health Nagasaki UniversityNagasakiJapan Former Chagas Disease Control Project Japan International Cooperation AgencyManaguaNicaragua Department of Disease Prevention Ministry of Health in NicaraguaManaguaNicaragua

Background:Chagas disease is one of the neglected tropical diseases(NTDs).International goals for its control involve elimination of vector-borne *** American countries face challenges in establishing sustainable vector control programmes,since the main vector,Triatoma dimidiata,cannot be *** 2012,the Ministry of Health in Nicaragua started a field test of a vector surveillance-response system to control domestic vector *** paper reports the main findings from this pilot ***:This study was carried out from 2012 to 2015 in the Municipality of *** Japan International Cooperation Agency provided technical cooperation in designing and monitoring the surveillance-response system until *** system involved 1)vector reports by householders to health facilities,2)data analysis and planning of responses at the municipal health centre and 3)house visits or insecticide spraying by health personnel as a *** registered all vector reports and responses in a digital *** collected data were used to describe and analyse the system performance in terms of amount of vector reports as well as rates and timeliness of ***:During the study period,*** was reported 396 *** analysis identified some high-risk *** houses reported to be infested were visited by health personnel in 2013 and this response rate dropped to 39%in *** of insecticide spraying rose above 80%in 2013 but no spraying was carried out in the following 2 *** timeliness of house visits improved significantly after the responsibility was transferred from a vector control technician to primary health care ***:We argue that the proposed vector surveillance-response system is workable within the resourceconstrained health system in *** to the primary health care services was a key to improve the system *** efforts are necessary to keep adap

关键词： Chagas disease Triatoma dimidiata Vector control Surveillance-response system programme integration Nicaragua

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2525. Understanding PrEP in Female Adolescents: A Parent/Adolescent Dyad Perspective

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Open Forum Infectious Diseases 2019年第SUPPLEMENT_2期6卷 S878–S878页

作者： Shah, Meera Murray, Ashley Gillespie, Scott Camacho-Gonzalez, Andres Emory University School of Medicine Atlanta Georgia Centers for Disease Control and Prevention Atlanta Georgia School of Medicine Department of Pediatrics Emory University Atlanta Georgia Ponce Family and Youth Clinic Grady Infectious Diseases Program Grady Health Systems Atlanta Georgia

Background Adolescents aged 13–24 years account for 23% of HIV diagnoses in the Atlanta Metropolitan Area, indicating the need for new prevention strategies. Pre-Exposure Prophylaxis (PrEP), recently approved for adolescent use, is effective in HIV prevention and is often marketed to young men who have sex with men (MSM); however, problems with access, scalability and waning adherence have limited its use in this population and more broadly. A 2016 CDC HIV surveillance report showed 19.2% of new HIV diagnoses were attributed to heterosexual transmission in women aged 13–24, relative to 0% in their heterosexual male counterparts, and 5.4% in same-aged MSM. This study assesses parent and female adolescent knowledge on HIV risk and PrEP perception to inform potential implementation strategies. Methods PrEP acceptability and barrier surveys were administered to 102 adolescent-parent dyads attending an adolescent clinic and emergency room in Atlanta, Georgia. Eight female adolescent-parent pairs were randomly selected to participate in in-depth phone interviews. Responses were analyzed using computer-assisted thematic analyses. Results Of the 8 female adolescent participants (mean age = 18.9 years), all were African American, and 1 was sexually active. Of the 8 parent participants (mean age = 44.1 years), all were female and African American. None of the participants had ever used PrEP. Analysis indicated that both parents and adolescent females had poor HIV risk assessment and knowledge, as well as barriers to PrEP usage including concerns about side effects, cost, and desire for alternative PrEP delivery methods and/or schedules. Finally, adolescent females expressed reliance on self-efficacy to be able to discuss HIV protection methods with their partner. Conclusion Female adolescents use unreliable methods to ensure HIV prevention, and with poor HIV knowledge, are at risk of transmission. Thus, PrEP may be a viable option for adolescent females at high risk for infec

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Bites from the same dog,different outcomes for two patients:a case report

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Infectious Diseases of Poverty 2017年第1期6卷 963-966页

作者： Xue-Yong Huang Xing-Le Li Shu-Yu Wu Yu-Lei Gu Xin-Jun Lv John David Klena Bian-Li Xu Henan Center for Disease Control and Prevention ZhengzhouChina Henan Key Laboratory of Pathogenic Microorganisms ZhengzhouChina Henan Collaborative Innovation Center of Molecular Diagnosis and Laboratory Medicine XinxiangChina International Emerging Infections Program United States Centers for Disease Control and PreventionBeijingChina Global Disease Detection Branch Division of Global Health ProtectionCenter for Global HealthUnited States Centers for Disease Control and PreventionAtlantaGAUSA The First Affiliated Hospital of Zhengzhou University ZhengzhouChina Chinese Center for Disease Control and Prevention BeijingChina

Background:Rabies is a serious reemerging zoonosis in *** present human rabies cases are primarily diagnosed based on clinical *** presentation:In August 2012,a woman and her son were attacked by a stray dog in Henan,*** son received rabies postexposure prophylaxis(wound treatment followed by vaccine,no immunoglobulin),however,the mother did *** infection was subsequently laboratory confirmed in the mother and she died in December;her son is alive and healthy after 2 years of ***:This report documents that the timely utilization of postexposure prophylaxis is a required measure in preventing rabies after exposure to an animal bite.

关键词： China Encephalitis Neglected diseases Rabies Rabies atypical manifestations Rabies laboratory diagnosis Rabies postexposure prophylaxis Zoonosis

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Relationships between the inflammatory potential of the diet, aging and anthropometric measurements in a cross-sectional study in Pakistan

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Nutrition and Healthy Aging 2018年第4期4卷 335-343页

作者： Alam, Iftikhar Shivappa, Nitin Hebert, James R. Pawelec, Graham Larbi, Anis Department of Community Health Sciences Clinical Nutrition Program College of Applied Medical Sciences King Saud University King Abdullah Street Saudi Arabia Department of Human Nutrition and Dietetics Bacha Khan University Charsadda KPK Pakistan Cancer Prevention and Control Program University of South Carolina Columbia SC United States Department of Epidemiology and Biostatistics Arnold School of Public Health University of South Carolina Columbia SC United States Tübingen Ageing and Tumour Immunology Group Zentrum für Medizinische Forschung University of Tübingen Waldhörnlestraße 22 Tübingen Germany Health Sciences North Research Institute Sudbury ON Canada Singapore Immunology Network (SIgN) Biopolis Agency for Science Technology and Research (A STAR) Singapore Singapore Department of Biology Faculty of Sciences El-Manar University Tunis Tunisia

BACKGROUND: Little is known about associations between dietary inflammation, age and anthropometric measurements. OBJECTIVE: In this regard, we examine how DII is related to age, anthropometrics [weight, Body mass index (BMI), waist to hip ratio (WHR)] and other parameters of nutrition (energy, protein, fats and cholesterol intake, Net Endogenous Acid Production (NEAP) and Phytochemical Index (PI)) in a cross-sectional study in Pakistan. DESIGN: Only men (n = 651, age 54-95 years) participated in the study. Anthropometric data were collected using standard methods. DII was calculated from nutrients derived from 24-hr Dietary Recall questionnaires. NEAP and PI were calculated by established algorithms using information on nutrient intake. RESULTS: The results show that with increasing age, there was a significant increase in the DII score (p < 0.05). Similarly significant positive correlations were found between DII score and weight, BMI, WHR and % BF (p, for all trends < 0.05). DII score significantly positively correlated with the dietary factors studied i.e. energy, protein, and fats (p, for all trends < 0.0001) but non-significantly with cholesterol (p > 0.05). Similarly, a significant positive correlation with NEAP (p < 0.0001) was found, but negative with PI (p < 0.0001). CONCLUSION: In conclusion, the present study shows direct positive correlations between the DII, age and indices of obesity, and thus supports the hypothesis that diet may have a role in the development of obesity through inflammatory modulation mechanisms in elderly. © 2018 - IOS Press and the authors. All rights reserved.

关键词： Aging anthropometrics diet dietary inflammatory index (DII) inflammation

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Deciphering colorectal cancer genetics through multi-omic analysis of 100,204 cases and 154,587 controls of European and east Asian ancestries (vol 55, pg 89, 2023)

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NATURE GENETICS 2023年第3期55卷 519-520页

作者： Fernandez-Rozadilla, Ceres Timofeeva, Maria Chen, Zhishan Law, Philip Thomas, Minta Schmit, Stephanie Diez-Obrero, Virginia Hsu, Li Fernandez-Tajes, Juan Palles, Claire Sherwood, Kitty Briggs, Sarah Svinti, Victoria Donnelly, Kevin Farrington, Susan Blackmur, James Vaughan-Shaw, Peter Shu, Xiao-ou Long, Jirong Cai, Qiuyin Guo, Xingyi Lu, Yingchang Broderick, Peter Studd, James Huyghe, Jeroen Harrison, Tabitha Conti, David Dampier, Christopher Devall, Mathew Schumacher, Fredrick Melas, Marilena Rennert, Gad Obon-Santacana, Mireia Martin-Sanchez, Vicente Moratalla-Navarro, Ferran Oh, Jae Hwan Kim, Jeongseon Jee, Sun Ha Jung, Keum Ji Kweon, Sun-Seog Shin, Min-Ho Shin, Aesun Ahn, Yoon-Ok Kim, Dong-Hyun Oze, Isao Wen, Wanqing Matsuo, Keitaro Matsuda, Koichi Tanikawa, Chizu Ren, Zefang Gao, Yu-Tang Jia, Wei-Hua Hopper, John Jenkins, Mark Win, Aung Ko Pai, Rish Figueiredo, Jane Haile, Robert Gallinger, Steven Woods, Michael Newcomb, Polly Duggan, David Cheadle, Jeremy Kaplan, Richard Maughan, Timothy Kerr, Rachel Kerr, David Kirac, Iva Bohm, Jan Mecklin, Lukka-Pekka Jousilahti, Pekka Knekt, Paul Aaltonen, Lauri Rissanen, Harri Pukkala, Eero Eriksson, Johan Cajuso, Tatiana Hanninen, Ulrika Kondelin, Johanna Palin, Kimmo Tanskanen, Tomas Renkonen-Sinisalo, Laura Zanke, Brent Mannisto, Satu Albanes, Demetrius Weinstein, Stephanie Ruiz-Narvaez, Edward Palmer, Julie Buchanan, Daniel Platz, Elizabeth Visvanathan, Kala Ulrich, Cornelia Siegel, Erin Brezina, Stefanie Gsur, Andrea Campbell, Peter Chang-Claude, Jenny Hoffmeister, Michael Brenner, Hermann Slattery, Martha Potter, John Tsilidis, Konstantinos Schulze, Matthias Gunter, Marc Murphy, Neil Castells, Antoni Castellvi-Bel, Sergi Moreira, Leticia Arndt, Volker Shcherbina, Anna Stern, Mariana Pardamean, Bens Bishop, Timothy Giles, Graham Southey, Melissa Idos, Gregory McDonnell, Kevin Abu-Ful, Zomoroda Greenson, Joel Shulman, Katerina Lejbkowicz, Flavio Offit, Kenneth Su, Yu-Ru Steinfelder, Robert Keku, Temitope van Guelpen, Bethany Hudson, Thomas Hampel, Heather Pearlman, Edinburgh Cancer Research Centre Institute of Genomics and Cancer University of Edinburgh Edinburgh UK Genomic Medicine Group Instituto de Investigacion Sanitaria de Santiago Santiago de Compostela Spain Colon Cancer Genetics Group Medical Research Council Human Genetics Unit Institute of Genetics and Cancer University of Edinburgh Edinburgh UK Danish Institute for Advanced Study Department of Public Health University of Southern Denmark Odense Denmark Division of Epidemiology Department of Medicine Vanderbilt-Ingram Cancer Center Vanderbilt Epidemiology Center Vanderbilt University Medical Center Nashville TN USA Division of Genetics and Epidemiology Institute of Cancer Research London UK Public Health Sciences Division Fred Hutchinson Cancer Research Center Seattle WA USA Genomic Medicine Institute Cleveland Clinic Cleveland OH USA Population and Cancer Prevention Program Case Comprehensive Cancer Center Cleveland OH USA Colorectal Cancer Group ONCOBELL Program Bellvitge Biomedical Research Institute Barcelona Spain Oncology Data Analytics Program Catalan Institute of Oncology Barcelona Spain Consortium for Biomedical Research in Epidemiology and Public Health Madrid Madrid Spain Department of Clinical Sciences Faculty of Medicine University of Barcelona Barcelona Spain Department of Biostatistics School of Public Health University of Washington Seattle WA USA Institute of Cancer and Genomic Sciences College of Medical and Dental Sciences University of Birmingham Birmingham UK Department of Public Health Richard Doll Building University of Oxford Oxford UK Department of Biomedical Informatics Vanderbilt University School of Medicine Nashville TN USA Department of Preventive Medicine USC Norris Comprehensive Cancer Center Keck School of Medicine University of Southern California Los Angeles CA USA Center for Public Health Genomics Department of Public Health Sciences University of Virginia Charlottesville VA USA Department of Populat

Colorectal cancer (CRC) is a leading cause of mortality worldwide. We conducted a genome-wide association study meta-analysis of 100,204 CRC cases and 154,587 controls of European and east Asian ancestry, identifying 205 independent risk associations, of which 50 were unreported. We performed integrative genomic, transcriptomic and methylomic analyses across large bowel mucosa and other tissues. Transcriptome- and methylome-wide association studies revealed an additional 53 risk associations. We identified 155 high-confidence effector genes functionally linked to CRC risk, many of which had no previously established role in CRC. These have multiple different functions and specifically indicate that variation in normal colorectal homeostasis, proliferation, cell adhesion, migration, immunity and microbial interactions determines CRC risk. Crosstissue analyses indicated that over a third of effector genes most probably act outside the colonic mucosa. Our findings provide insights into colorectal oncogenesis and highlight potential targets across tissues for new CRC treatment and chemoprevention strategies.

关键词： Colorectal cancer Epigenomics Genome-wide association studies Transcriptomics

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Changes in sedentary time are associated with changes in mental wellbeing over 1 year in young adults

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Preventive Medicine Reports 2018年 11卷 274-281页

作者： Ellingson, Laura D. Meyer, Jacob D. Shook, Robin P. Dixon, Philip M. Hand, Gregory A. Wirth, Michael D. Paluch, Amanda E. Burgess, Stephanie Hebert, James R. Blair, Steven N. Department of Kinesiology Iowa State University Ames IA United States Department of Pediatrics Children's Mercy Hospital Kansas City MO United States Department of Statistics Iowa State University Ames IA United States Department of Epidemiology West Virginia University Morgantown WV United States Department of Epidemiology and the Cancer Prevention and Control Program University of South Carolina Columbia SC United States School of Medicine Northwestern University Evanston IL United States University of South Carolina College of Nursing Columbia SC United States Department of Exercise Science University of South Carolina Columbia SC United States

Excessive sedentary time is related to poor mental health. However, much of the current literature uses cross-sectional data and/or self-reported sedentary time, and does not assess factors such as sedentary bout length. To address these limitations, the influence of objectively measured sedentary time including sedentary bout length (i.e. <30 min, ≥30 min) on mood, stress, and sleep, was assessed in 271 healthy adults (49% women;age 27.8 ± 3.7) across a 1-year period between 2011 and 2013 in Columbia, SC. Participants completed the Profile of Mood States and the Perceived Stress Scale, and wore a Sensewear Armband to assess sedentary time, physical activity, and sleep for ten days at baseline and one year. A series of fixed-effects regressions was used to determine the influence of both baseline levels and changes in daily sedentary time (total and in bouts) and physical activity on changes in mood, stress, and sleep over one year. Results showed that across the year, decreases in total sedentary time, and time in both short and long bouts, were associated with improvements in mood, stress and sleep (p < 0.05). Increases in physical activity were only significantly predictive of increases in sleep duration (p < 0.05). Thus, reductions in sedentary time, regardless of bout length, positively influenced mental wellbeing. Specifically, these results suggest that decreasing daily sedentary time by 60 min may significantly attenuate the negative effects of high levels of pre-existing sedentary time on mental wellbeing. Interventions manipulating sedentary behavior are needed to determine a causal link with wellbeing and further inform recommendations. © 2018 The Authors

关键词： Cohort Longitudinal Mental health Mood Sleep Stress

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Ovatodiolide and antrocin synergistically inhibit the stemness and metastatic potential of hepatocellular carcinoma via impairing ribosome biogenesis and modulating ERK/Akt-mTOR signaling axis

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Phytomedicine : international journal of phytotherapy and phytopharmacology 2023年 108卷 154478页

作者： Ming-Yao Chen Chia-Hung Hsu Syahru Agung Setiawan David T W Tzeng Hon-Ping Ma Jiann Ruey Ong Yi Cheng Chu Ming-Shou Hsieh Alexander T H Wu Yew-Min Tzeng Chi-Tai Yeh Division of Gastroenterology and Hepatology Department of Internal Medicine School of Medicine College of Medicine Taipei Medical University Taipei City 110 Taiwan Division of Gastroenterology and Hepatology Department of Internal Medicine Taipei Medical University-Shuang Ho Hospital New Taipei City 235 Taiwan. Department of Emergency Medicine Taipei Medical University-Shuang Ho Hospital New Taipei City 235 Taiwan Graduate Institute of Injury Prevention and Control College of Public Health Taipei Medical University Taipei City 110 Taiwan Department of Emergency Medicine School of Medicine Taipei Medical University Taipei City 110 Taiwan. International Ph.D. Program in Medicine College of Medicine Taipei Medical University Taipei City 110 Taiwan Department of Medical Research & Education Taipei Medical University - Shuang-Ho Hospital New Taipei City 235 Taiwan. School of Life Sciences The Chinese University of Hong Kong Hong Kong SAR 999077 China Lifebit Mindspace Shoreditch London England EC2A 2AP UK. Department of Medicine St. George's University School of Medicine St. George Grenada. Department of Applied Science National Taitung University Taitung 95092 Taiwan. Electronic address: ymtzeng@nttu.edu.tw. Department of Medical Research & Education Taipei Medical University - Shuang-Ho Hospital New Taipei City 235 Taiwan Continuing Education Program of Food Biotechnology Applications College of Science and Engineering National Taitung University Taitung 95092 Taiwan. Electronic address: ctyeh@s.tmu.edu.tw.

Activation of mitogen-activated protein kinase (MAPK) and PI3K signaling confers resistance against sorafenib, a mainstay treatment for advanced hepatocellular carcinoma (HCC). Antrocin and ovatodiolide constitute as the most potent secondary metabolites isolated from Antrodia camphorata and Anisomeles indica, respectively. Both natural compounds have recently gained a lot of attention due to their putative inhibition of MAPK and PI3K signaling in various solid cancers. However, whether their combination is effective in HCC remains unknown. Here, we investigated their effect, alone or in various combinations, on MAPK and PI3K signaling pathways in HCC cells. An array of in vitro study were used to investigate anticancer and stemness effects to treat HCC, such as cytotoxicity, drug combination index, migration, invasion, colony formation, and tumor sphere formation. Drug effect in vivo was evaluated using mouse xenograft models. In this study, antrocin and ovatodiolide synergistically inhibited the SNU387, Hep3B, Mahlavu, and Huh7 cell lines. Sequential combination treatment of Huh7 and Mahlavu with ovatodiolide followed by antrocin resulted stronger cytotoxic effect than did treatment with antrocin followed by ovatodiolide, their simultaneous administration, antrocin alone, or ovatodiolide alone. In the Huh7 and Mahlavu cell lines, ovatodiolide→antrocin significantly suppressed colony formation and proliferation as well as markedly downregulated ERK1/2, Akt, and mTOR expression. Inhibition of ERK1/2 and Akt/mTOR signaling by ovatodiolide→antrocin suppressed ribosomal biogenesis, autophagy, and cancer stem cell-like phenotypes and promoted apoptosis in Huh7 and Mahlavu cells. The sorafenib-resistant clone of Huh7 was effectively inhibited by synergistic combination of both compound in vitro. Eventually, the ovatodiolide→antrocin combination synergistically suppressed the growth of HCC xenografts. Taken together, our findings suggested that ovatodiolide→antrocin combi

关键词： Advanced HCC Antrocin (ANC) MAPK Ovatodiolide (OVA) PI3K

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1009. Measuring the quality of fluoroquinolone prescribing in hospitals: results from the Emerging Infections program Hospital Prevalence Survey Antimicrobial Quality Assessment

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Open Forum Infectious Diseases 2019年第SUPPLEMENT_2期6卷 S355–S355页

作者： Magill, Shelley S O’Leary, Erin Nadle, Joelle Johnston, Helen Janelle, Sarah J Maloney, Meghan Ray, Susan Wilson, Lucy E Lynfield, Ruth Rainbow, Jean Sievers, Marla M Dumyati, Ghinwa Ocampo, Valerie Samper, Monika Zhang, Alexia Y Evans, Christopher D Kainer, Marion A Edwards, Jonathan R Chea, Nora Neuhauser, Melinda M Centers for Disease Control and Prevention Atlanta Georgia California Emerging Infections Program Oakland California Colorado Department of Public Health and Environment Denver Colorado Connecticut Department of Health Hartford Connecticut Emory University School of Medicine Atlanta Georgia University of Maryland Baltimore County Baltimore Maryland Minnesota Department of Health Saint Paul Minnesota New Mexico Department of Health Santa Fe New Mexico New York Rochester Emerging Infections Program at the University of Rochester Medical Center Rochester New York Oregon Health Authority Portland Oregon Oregon Public Health Division-Acute and Communicable Disease Prevention Portland Oregon Tennessee Department of Health Nashville Tennessee Center for Disease Control and Prevention Atlanta Georgia

Background Improving antimicrobial use is a key component of controlling antimicrobial resistance. Multiple factors influence inpatient provider antimicrobial prescribing decisions, making it challenging to develop standard methods to evaluate prescribing quality in hospitals. In 2015, CDC’s Emerging Infections program (EIP) conducted a hospital antimicrobial use prevalence survey and collected data to assess prescribing quality in selected scenarios, including fluoroquinolone (FQ) treatment. Methods EIP sites (CA, CO, CT, GA, MD, MN, NM, NY, OR, TN) each recruited up to 25 hospitals for the survey. Each hospital selected a survey date during May–September 2015. Among randomly selected inpatients on the survey date, EIP staff identified those ≥18 years old who received FQ treatment on the survey date or the day prior and reviewed medical records to gather data on underlying conditions, infections, and diagnostic tests. We used these data to update a previously developed prescribing quality assessment pathway that categorized FQ treatment as supported or unsupported based on medical record documentation. Results Among 12,299 patients in 199 hospitals, 1084 (8.7%) received FQ treatment; 756 (70%) were treated for a single infection type during their hospitalization and were ≥18 years old. The pathway categorized FQ treatment as supported for 646 (85.4%) and unsupported for 110 patients (14.6%) (figure). Almost half of unsupported treatment was due to a lack of compatible signs or symptoms of infection in a patient from whom an organism susceptible or likely susceptible to an FQ was identified from a nonsterile site (49/110 patients, 44.5%), suggesting colonization. Conclusion Utilization of a pathway that incorporates detailed clinical data enabled us to apply a standard approach to assess FQ prescribing quality in hospitals. A high percentage of FQ treatment was supported, possibly reflecting efforts in recent years to reduce inappropriate use. Our assessment approac

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