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490. Comparison of Clostridium difficile Infection Outcomes by Diagnostic Testing Method

Open Forum Infect Dis 2018年第SUPPL 1期5卷 S181-S181页

作者： Alice Guh Kelly Hatfield Lisa G Winston Brittany Martin Helen Johnston Geoff Brousseau Monica M Farley Lucy E Wilson Rebecca Perlmutter Erin C Phipps Ghinwa Dumyati Deborah Nelson Trupti Hatwar Marion A Kainer L Clifford McDonald Centers for Disease Control and Prevention Atlanta Georgia Medicine University of California San Francisco and Zuckerberg San Francisco General Hospital and Trauma Center San Francisco California California Emerging Infections Program Oakland California Colorado Department of Public Health and Environment Denver Colorado Department of Medicine Emory University School of Medicine and Atlanta VA Medical Center Atlanta Georgia Georgia Emerging Infections Program Atlanta Georgia Maryland Department of Health Baltimore Maryland New Mexico Emerging Infections Program University of New Mexico Albuquerque New Mexico NY Emerging Infections Program Center for Community Health and Prevention University of Rochester Medical Center Rochester New York Communicable and Environmental Diseases and Emergency Preparedness Tennessee Department of Public Health Nashville Tennessee

Background US laboratories are increasingly using nucleic acid amplification tests (NAAT) to diagnose Clostridium difficile infection (CDI) due to their increased sensitivity over toxin enzyme immunoassays (EIA), but NAATs may be more likely than toxin EIAs to detect colonization rather than true disease. Limited data indicate patients positive by toxin EIA (toxin+) have worse outcomes than those positive by NAAT (NAAT+) only, suggesting toxin EIA detects true infection more often than NAAT. We used multisite CDI surveillance data from the Centers for Disease control and prevention’s Emerging Infections program to compare clinical course and outcomes between toxin+ and NAAT+ only patients. Methods A case was defined as a positive C. difficile test in a person ≥1 year old with no positive tests in the prior 8 weeks. Cases detected during 2014–2015 by a testing algorithm using toxin EIA and NAAT were classified as toxin+ or NAAT+ only. Medical charts were reviewed. Death data were obtained from state death registries. Multivariable logistic regression models were used to compare CDI recurrence and 90-day mortality between the two groups, adjusting for age, sex, race, Charlson comorbidity index, and receipt of oral vancomycin. For the outcome of recurrence, we also adjusted for history of CDI in the prior 6 months. Results Of 4,878 cases, 2160 (44%) were toxin+ and 2,718 (56%) were NAAT+ only. Toxin+ cases were more likely than NAAT+ only cases to be ≥65 years old (48% vs. 38%; P < 0.0001), have white blood cells ≥15,000/µL (483/1,539 [31%] vs. 423/1,978 [21%]; P < 0.0001), and have received oral vancomycin ≤3 days of diagnosis (32% vs. 29%; P = 0.03). Comparing toxin+ to NAAT+ only cases, 21% vs. 11% had a recurrence ( P < 0.0001), of which 71% vs. 33% had a toxin+ recurrence ( P < 0.0001), and 10% vs. 9% died ≤90 days of diagnosis ( P = 0.12). In multivariable analysis, a toxin+ result was associated with recurrence (adjusted odds ratio [aOR]: 1.89, 95% CI: 1.61–2.22

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1162. Epidemiology of Carbapenem-ResistantPseudomonas aeruginosaIdentified Through the Emerging Infections program (EIP), United States, 2016–2017

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Open Forum Infectious Diseases 2018年第SUPPL_1期5卷 S349–S350页

作者： Grass, Julian Bulens, Sandra Bamberg, Wendy Janelle, Sarah J Stendel, Patrick Jacob, Jesse T Bower, Chris Sukumaran, Stephen Wilson, Lucy E Vaeth, Elisabeth Li, Linda Lynfield, Ruth Vagnone, Paula Snippes Dobbins, Ginette Phipps, Erin C Hancock, Emily B Dumyati, Ghinwa Tsay, Rebecca Pierce, Rebecca Cassidy, P Maureen West, Nicole Kainer, Marion A Muleta, Daniel Mounsey, Jacquelyn Campbell, Davina Stanton, Richard Karlsson, Maria S Walters, Maroya Spalding Division of Healthcare Quality Promotion Centers for Disease Control and Prevention Atlanta Georgia Colorado Department of Public Health and Environment Denver Colorado Division of Infectious Diseases Emory University School of Medicine Atlanta Georgia Georgia Emerging Infections Program Decatur Georgia Atlanta Veterans Affairs Medical Center Decatur Georgia Atlanta Research and Education Foundation Decatur Georgia Maryland Department of Health Baltimore Maryland Infectious Disease Epidemiology and Outbreak Response Bureau Maryland Department of Health Baltimore Maryland Minnesota Department of Health St. Paul Minnesota New Mexico Emerging Infections Program University of New Mexico Albuquerque New Mexico New York Emerging Infections Program Center for Community Health and Prevention University of Rochester Medical Center Rochester New York Acute and Communicable Disease Prevention Oregon Health Authority Portland Oregon Oregon Health Authority Portland Oregon Tennessee Department of Health Nashville Tennessee Division of Healthcare Quality Promotion National Center for Emerging and Zoonotic Infectious Diseases Centers for Disease Control and Prevention Atlanta Georgia

Background Pseudomonas aeruginosa is intrinsically resistant to many commonly used antimicrobials and carbapenems are often required to treat infections. We describe the epidemiology and crude incidence of carbapenem-resistant P. aeruginosa (CRPA) in the EIP catchment area. Methods From August 1, 2016 through July 31, 2017, we conducted laboratory- and population-based surveillance for CRPA in selected metropolitan areas in Colorado, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, and Tennessee. We defined an incident case as the first isolate of P. aeruginosa -resistant to imipenem, meropenem, or doripenem from the lower respiratory tract, urine, wounds, or normally sterile sites identified from a resident of the EIP catchment area in a 30-day period. Patient charts were reviewed. A random sample of isolates was screened at CDC for carbapenemases using the modified carbapenem inactivation method (mCIM) and real-time PCR. Results During the 12-month period, we identified 3,042 incident cases among 2,154 patients. The crude incidence rate was 21.2 (95% CI, 20.4–21.9) per 100,000 persons and varied by site (range: 7.7 in Oregon to 31.1 in Maryland). The median age of patients was 64 years (range: <1–101) and 41.2% were female. Nearly all (97.1%) had at least one underlying condition and 10.2% had cystic fibrosis (CF); 17.8% of cases were from CF patients. For most cases, isolates were from the lower respiratory tract (49.2%) or urine (35.3%) and occurred in patients with recent hospitalization (87.2%) or indwelling devices (70.3%); 8.7% died. At the clinical laboratory, 84.7% of isolates were susceptible to an aminoglycoside and 66.4% to ceftazidime or cefepime. Among the 391 isolates tested, nine (2.3%) were mCIM-positive; one had a carbapenemase detected by PCR ( bla VIM-4 ). Conclusion The burden of CRPA varied by EIP site. Most cases occurred in persons with healthcare exposures and underlying conditions. The majority of isolates were susceptible to at

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Establishing Core Competencies for Antimicrobial Stewardship Teams: A Consensus Development Using the Modified Delphi Technique;an ESGAP position paper

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Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases 2025年

作者： Joana Alves Jeroen Schouten Karin Thursky Ran Nir Paz Jordi Rello David Chien Lye Tomislav Kostyanev Jacob Strahilevitz Katja de With Aleksandra Barac Ezgi Gülten Diane Ashiru-Oredope Giorgia Caruana Nathan Peiffer-Smadja Rita Murri Lucy Catteau Bojana Beović Department of Infectious Diseases Hospital de Braga Portugal Local Unit of the Program for Prevention and Control of Infection and Antimicrobial Resistance Hospital de Braga Portugal. Department of Intensive Care Medicine Radboud University Medical Center Nijmegen The Netherlands Scientific Center for Quality of Healthcare (IQ Healthcare) Radboud Institute for Health Sciences Radboud University Medical Center Nijmegen The Netherlands. Victorian Infectious Diseases Service and National Health and Medical Research Council Centre of Clinical Research Excellence in Infectious Diseases Royal Melbourne Hospital Melbourne Australia. Department of Clinical Microbiology and Infectious Diseases Hadassah Hebrew University Medical Center Jerusalem Israel. CRIPS Research Group Vall d'Hebron Institute of Research Barcelona Spain Formation Recherche Evaluation (FOREVA) CHU Nîmes Nîmes France Centro de investigación biomédica en Red de Enfermedades respiratorias (ciberes) Instituto de Salud Carlos III Madrid Spain. National Centre for Infectious Diseases Tan Tock Seng Hospital Yong Loo Lin School of Medicine National University of Singapore Lee Kong Chian School of Medicine Nanyang Technological University Singapore. Department of Clinical Microbiology University Hospital of Southern Denmark - South-West Jutland Esbjerg Denmark. Institute of Infectious Diseases University Hospital Carl Gustav Carus Technical University Dresden Germany. Faculty of Medicine University of Belgrade 11000 Belgrade Serbia Clinic for Infectious and Tropical Diseases University Clinical Center of Serbia Belgrade Serbia. Ankara University School of Medicine Department of Infectious Diseases and Clinical Microbiology Ankara Türkiye. ESCMID Study Group for Antimicrobial Stewardship (ESGAP) Executive Committee ESCMID Aeschenvorstadt 55 Basel Switzerland UK Health Security Agency London United Kingdom School of Pharmacy University College London London UK. Cantonal Hospital of Sion and Institut Central d

OBJECTIVES:This study aimed to identify and develop a standard set of competencies needed for members of an AMS team. METHODS:A panel of experts in AMS utilized a survey based on a modified Delphi technique to establish consensus on AMS competencies. RESULTS:The authors identified 88 competencies covering 15 domains with strong agreement by 58 international experts. The identified domains were: the objectives of AMS; management of infection; microbiology diagnostics; pharmacology of antimicrobial agents; general principles of antibiotic use; the structure and the position of AMS; antimicrobial stewardship interventions; AMS in special settings; surveillance and monitoring; behavior change and communication; infection prevention and control; quality management and patient safety; IT support; communication with patients and general public and governance/policy framework. The consensus-based list of competencies was ratified by ESGAP Executive Committee. CONCLUSIONS:The identified competencies can be used as a tool in planning of AMS training and to develop and optimize AMS programmes worldwide.

关键词： Delphi process antimicrobial prescription antimicrobial stewardship competencies health-care professionals

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Author Correction: Deciphering colorectal cancer genetics through multi-omic analysis of 100,204 cases and 154,587 controls of European and east Asian ancestries

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Nature genetics 2023年第3期55卷 519-520页

作者： Ceres Fernandez-Rozadilla Maria Timofeeva Zhishan Chen Philip Law Minta Thomas Stephanie Schmit Virginia Díez-Obrero Li Hsu Juan Fernandez-Tajes Claire Palles Kitty Sherwood Sarah Briggs Victoria Svinti Kevin Donnelly Susan Farrington James Blackmur Peter Vaughan-Shaw Xiao-Ou Shu Jirong Long Qiuyin Cai Xingyi Guo Yingchang Lu Peter Broderick James Studd Jeroen Huyghe Tabitha Harrison David Conti Christopher Dampier Mathew Devall Fredrick Schumacher Marilena Melas Gad Rennert Mireia Obón-Santacana Vicente Martín-Sánchez Ferran Moratalla-Navarro Jae Hwan Oh Jeongseon Kim Sun Ha Jee Keum Ji Jung Sun-Seog Kweon Min-Ho Shin Aesun Shin Yoon-Ok Ahn Dong-Hyun Kim Isao Oze Wanqing Wen Keitaro Matsuo Koichi Matsuda Chizu Tanikawa Zefang Ren Yu-Tang Gao Wei-Hua Jia John Hopper Mark Jenkins Aung Ko Win Rish Pai Jane Figueiredo Robert Haile Steven Gallinger Michael Woods Polly Newcomb David Duggan Jeremy Cheadle Richard Kaplan Timothy Maughan Rachel Kerr David Kerr Iva Kirac Jan Böhm Lukka-Pekka Mecklin Pekka Jousilahti Paul Knekt Lauri Aaltonen Harri Rissanen Eero Pukkala Johan Eriksson Tatiana Cajuso Ulrika Hänninen Johanna Kondelin Kimmo Palin Tomas Tanskanen Laura Renkonen-Sinisalo Brent Zanke Satu Männistö Demetrius Albanes Stephanie Weinstein Edward Ruiz-Narvaez Julie Palmer Daniel Buchanan Elizabeth Platz Kala Visvanathan Cornelia Ulrich Erin Siegel Stefanie Brezina Andrea Gsur Peter Campbell Jenny Chang-Claude Michael Hoffmeister Hermann Brenner Martha Slattery John Potter Konstantinos Tsilidis Matthias Schulze Marc Gunter Neil Murphy Antoni Castells Sergi Castellví-Bel Leticia Moreira Volker Arndt Anna Shcherbina Mariana Stern Bens Pardamean Timothy Bishop Graham Giles Melissa Southey Gregory Idos Kevin McDonnell Zomoroda Abu-Ful Joel Greenson Katerina Shulman Flavio Lejbkowicz Kenneth Offit Yu-Ru Su Robert Steinfelder Temitope Keku Bethany van Guelpen Thomas Hudson Heather Hampel Rachel Pearlman Sonja Berndt Richard Hayes Marie Elena Martinez Sushma Thomas Douglas Corley Paul Pharoah Susanna Larsson Yun Yen Heinz-Jo 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. De

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Evidence of increased multiple-insecticide resistance in urban Aedes albopictus population

Evidence of increased multiple-insecticide resistance in urb...

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中国动物学会寄生虫学专业委员会第十六次全国学术会议暨第七次国际寄生虫学学术研讨会

作者： Yiji Li Jiabao Xu Daibin Zhong Hong Zhang Wenqiang Yang Guofa Zhou Xinghua Su Yang Wu Kun Wu Songwu Cai Guiyun Yan Xiao-Guang Chen Department of Pathogen Biology Guangdong Provincial Key laboratory of Tropical Disease ResearchSchool of Public HealthSouthern Medical University Key Laboratory of Translation Medicine Tropical Diseases of Ministry of Education Hainan Medical UniversityHaikouHainanChina Department of Pathogen BiologyHainan Medical University Program in Public Health School of MedicineUniversity of CaliforniaIrvineUSA Department of Vector Control Centers for Disease Control and Prevention of Guangdong Province

Introduction:Aedes albopictus(Skuse) is an invasive mosquito that has become an important vector of chikungunya,dengue and Zika *** the absence of specific antiviral therapy and vaccine,vector management is the sole method available for reducing Aedes-induced disease *** the resistance status of *** to insecticides and to explorethe resistance mechanisms is essential for future vector control ***: *** larvae and pupae were sampled from six sites(two sites each from urban,suburban and rural) in *** resistance bioassays were conducted against Bacillus thuringiensis ***(Bti),deltamethrin,propoxur and malathion for larvae,and deltamethrin,DDT,propoxur and malathion for adults.P450 monooxygenase(P450 s),glutathione S-transferase(GSTs) and carboxylesterase(COEs) activities of adult mosquitoes were *** at the knockdown resistance(kdr) gene were analyzed,and association between kdr mutations and phenotypic resistance was ***: Adult bioassays revealed varied resistance levels against DDT and deltamethrin in the six *** populations with corrected mortalities ranging between 74 to 97% and 88 to 99%,*** mosquito populations showed higher resistance levels against DDT and deltamethrin than populations from suburban and rural *** populations tested were fully susceptible to propoxur and malathion except urban strain(UYS) and rural strain(RCD).Larval bioassays results indicated that all populations of *** were sensitive to the larvicide Bti and *** the populations showed resistance to deltamethrin and the average RR50 in urban,suburban and rural areas compared to the control is 27,14 and 18 fold,*** presence of F1534 S and F1534 L mutations was significantly associated with deltamethrinand DDT-resistant *** assays indicated that GSTs may play a role in DDT resistance in adult ***

关键词： Aedes albopictus Insecticide resistance Biochemical assay Kdr Urbanization Guangzhou

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Geographic distribution of blood collections in Haiti before and after the 2010 earthquake

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ISBT science series 2017年第2期12卷 291-296页

作者： A Bjork A E Jean Baptiste E Noel N P D Jean Charles E Polo J P Pitman Division of Global HIV/AIDS and TB (DGHT) Center for Global Health (CGH) Centers for Disease Control and Prevention (CDC) Atlanta GA USA. DGHT CGH CDC Port-au-Prince Haiti. National Blood Safety Program Ministry of Public Health and Population Port-au-Prince Haiti. Division of Global Health Protection (DGHP) CGH CDC Port-au-Prince Haiti.

BACKGROUND:The January 2010 Haiti earthquake destroyed the National Blood Transfusion Center and reduced monthly national blood collections by > 46%. Efforts to rapidly scale-up blood collections outside of the earthquake-affected region were investigated. STUDY DESIGN AND METHODS:Blood collection data for 2004-2014 from Haiti's 10 administrative departments were grouped into four regions: Northern, Central, Port-au-Prince and Southern. Analyses compared regional collection totals during the study period. RESULTS:Collections in Port-au-Prince accounted for 52% of Haiti's blood supply in 2009, but fell 96% in February 2010. Haiti subsequently increased blood collections in the North, Central and Southern regions to compensate. By May 2010, national blood collections were only 10·9% lower than in May 2009, with 70% of collections coming from outside of Port-au-Prince. By 2013 national collections (27 478 units) had surpassed 2009 levels by 30%, and Port-au-Prince collections had recovered (from 11 074 units in 2009 to 11 670 units in 2013). CONCLUSION:Haiti's National Blood Safety program managed a rapid expansion of collections outside of Port-au-Prince following the earthquake. Annual collections exceeded pre-earthquake levels by 2012 and continued rising annually. Increased regional collections provided a greater share of the national blood supply, reducing dependence on Port-au-Prince for collections.

关键词： Haiti National Blood Safety program Port-au-Prince blood collection centre blood collections earthquake

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720. Respiratory and Nonrespiratory Complications Among Patients Hospitalized with Influenza, FluSurv-NET, 2016–2017

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Open Forum Infectious Diseases 2018年第SUPPL_1期5卷 S258–S259页

作者： Garg, Shikha Cummings, Charisse Nitura O’Halloran, Alissa Kirley, Pam Daily Herlihy, Rachel Yousey-Hindes, Kimberly Monroe, Maya Eckel, Seth McMahon, Melissa Angeles, Kathy Muse, Alison Bennett, Nancy M Billing, Laurie Thomas, Ann Talbot, H Keipp George, Andrea Anderson, Evan J Reed, Carrie Centers for Disease Control and Prevention Atlanta Georgia Influenza Division Centers for Disease Control and Prevention Atlanta Georgia California Emerging Infections Program Oakland California Colorado Department of Public Health and Environment Denver Colorado Connecticut Emerging Infections Program Yale School of Public Health New Haven Connecticut Maryland Department of Health and Mental Hygiene Baltimore Maryland Communicable Disease Division Michigan Department of Health and Human Services Lansing Michigan Minnesota Department of Health St. Paul Minnesota New Mexico Emerging Infections Program University of New Mexico Albuquerque New Mexico New York State Department of Health Albany New York Emerging Infections Program New York New York Ohio Department of Health Columbus Ohio Oregon Public Health Division Portland Oregon Infectious Diseases Vanderbilt University Medical Center Nashville Tennessee Salt Lake County Health Department Salt Lake City Utah Emerging Infections Program Atlanta Veterans Affairs Medical Center Atlanta Georgia

Background Influenza is most commonly associated with respiratory complications; however, nonrespiratory complications occur frequently among patients hospitalized with influenza. We used data from the Influenza Hospitalization Surveillance Network (FluSurv-NET) to describe complications recorded on discharge summaries of patients hospitalized with influenza. Methods We included children (0–17 years) and adults (≥18 years), who resided within a FluSurv-NET catchment area and were hospitalized with laboratory-confirmed influenza during 2016–2017. We abstracted data on underlying conditions and discharge diagnoses from medical charts. We calculated the frequency of respiratory and nonrespiratory complications in all age groups and used univariate and multivariable logistic regression to examine factors associated with select complications among adults. Results Among 17,489 patients, the most common respiratory complications were pneumonia (26%) and acute respiratory failure (23%) and the most common nonrespiratory complications were sepsis (16%) and acute renal failure (ARF) (12%). Complications varied by age group (figure). Pneumonia was the most common respiratory complication in all age groups except 0–4 years; among children aged 0–4 years bronchiolitis was most common (104/712; 15%). Among 97 children aged 0–4 years with bronchiolitis who underwent testing for respiratory syncytial virus (RSV), 37% had RSV. The most common nonrespiratory complication was seizures in children aged 0–17 years (17% had a history of prior seizures) and sepsis in adults. Among adults ( n = 16,057), factors most strongly associated with ARF included chronic renal disease (adjusted odds ratio (AOR) 2.5; 95% confidence interval (95% CI) 2.2–2.8), male sex (AOR 1.5 95% CI 1.4–1.7) and age ≥65 years (AOR 1.4 95% CI 1.2–1.7); the factor most strongly associated with sepsis was chronic neuromuscular disease (AOR 1.5 95% CI 1.3–1.8). Conclusion Influenza hospitalizations are associated with a

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275. Evaluation of Vancomycin Prescribing Quality in Hospitalized Pediatric Patients

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Open Forum Infectious Diseases 2018年第SUPPL_1期5卷 S114–S114页

作者： Abanyie-Bimbo, Francisca O’Leary, Erin Nadle, Joelle Thompson, Deborah L Muleta, Daniel Kainer, Marion A Epstein, Lauren Magill, Shelley S CDC Atlanta Georgia Division of Healthcare Quality Promotion Centers for Disease Control and Prevention Atlanta Georgia California Emerging Infections Program Oakland California New Mexico Department of Health Santa Fe New Mexico Tennessee Department of Health Nashville Tennessee Communicable and Environmental Diseases and Emergency Preparedness Tennessee Department of Public Health Nashville Tennessee

Background Vancomycin is the most common antimicrobial drug administered to hospitalized patients, including children >90 days old, although the prevalence of β-lactam antibiotic resistance among Gram-positive pathogens is relatively low in children. Reducing inappropriate vancomycin use in children can reduce harm from antibiotic-associated adverse events and antimicrobial resistance (AR). We developed an approach to evaluating pediatric intravenous (IV) vancomycin prescribing quality using medical record data. Methods Hospitals in three Emerging Infections program (EIP) sites (CA, NM, and TN) were recruited to participate. Patients <18 years who received IV vancomycin in 2013 were identified through pharmacy records, excluding those on IV vancomycin solely for surgical prophylaxis. Trained EIP staff collected medical record data. We created a prescribing quality evaluation pathway using data on infection type, signs, symptoms, penicillin allergy, and AR risk factors. Clinically supported prescribing events were those with a positive culture for a Gram-positive organism with β-lactam resistance or unknown susceptibility; severe penicillin allergy; bone, joint, skin/soft tissue or central nervous system infection; pneumonia with AR risk factors; or events where vancomycin was stopped within 1 day of culture results for an oxacillin or penicillin/ampicillin-susceptible organism. Results Sixty-five patients in 12 hospitals were evaluated. The median age was 7 years (interquartile range [IQR] 4–14), and median hospital stay was 7 days (IQR 3–16). The median vancomycin treatment length was 3 days (IQR 2–6); 41 patients (63%) received ≥3 days. Vancomycin use was clinically supported in 47 patients (72%) and unsupported in 18 (28%) (figure). Most unsupported use was for infections lacking microbiology data and for which vancomycin would not usually be indicated, such as pneumonia without AR risk factors (9/18, 50%). Conclusion The use of IV vancomycin was not supported fo

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151. Evaluation of Pneumococcal Vaccine Effectiveness Against Invasive Pneumococcal Disease Among US Medicare Beneficiaries ≥65 Years Old

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Open Forum Infect Dis 2018年第SUPPL 1期5卷 S10-S10页

作者： Tamara Pilishvili Olivia M Almendares Srinivas Nanduri Rob Warnock Xiyuan Wu Stephen McKean Jeffrey Kelman Monica M Farley William Schaffner Ann Thomas Arthur Reingold Lee H Harrison Corinne Holtzman Jemma V Rowlands Susan Petit Meghan Barnes Salina Torres Bernard Beall Cynthia Whitney National Center for Immunizations and Respiratory Diseases Centers for Disease Control and Prevention Atlanta Georgia Centers for Disease Control and Prevention Atlanta Georgia Respiratory Diseases Branch Centers for Disease Control and Prevention Atlanta Georgia Acumen LLC Burlingame California Centers for Medicare and Medicaid Services Baltimore Maryland Department of Medicine Emory University School of Medicine and Atlanta VA Medical Center Atlanta Georgia Vanderbilt University School of Medicine Nashville Tennessee Oregon Public Health Division Portland Oregon California Emerging Infections Program Oakland California University of Pittsburgh Pittsburgh Pennsylvania Minnesota Department of Health St. Paul Minnesota New York State Department of Health Albany New York Connecticut Department of Public Health New Haven Connecticut Colorado Department of Public Health and Environment Denver Colorado New Mexico Deparment of Health Santa Fe New Mexico

Background Pneumococcal conjugate vaccine (PCV13) was recommended in series with PPSV23 for all US adults ≥65 years in late 2014. We evaluated effectiveness of PCV13 against invasive pneumococcal disease (IPD) among Medicare beneficiaries ≥65 years old to assess this new policy. Methods We linked records for IPD cases (pneumococcus isolated from sterile sites) in persons ≥65 years old identified through Active Bacterial Core surveillance with those of Medicare beneficiaries. Isolates were serotyped and classified as PCV13 (with or without cross-reacting type 6C), and nonvaccine types. We selected Medicare beneficiaries with no record of IPD or pneumonia as controls, and matched to cases on age, residence census tract, and length of Medicare enrollment; we included all eligible controls. Vaccination and medical histories were obtained through Medicare. We estimated vaccine effectiveness (VE) as 1 minus the IPD odds ratio for vaccinated (PCV13) vs. unvaccinated (no PCV13 or PPSV23) persons using conditional logistic regression, adjusted for sex and underlying conditions. Results From 2,246 IPD cases identified in 2015–2016, 1,017 (45%) were matched to Medicare beneficiaries. After excluding cases in persons residing in long-term care facilities or with <1 year of Medicare enrollment, we included 699 eligible cases and 10,152 controls in our analysis. PCV13-types (+6C) accounted for 164 (23%) cases, and serotype 3 was the most common PCV13-type. Case patients were more likely than controls to have one or more chronic (88% vs. 58%) or immunocompromising (54% vs. 32%) conditions present. Fourteen percent, 22%, and 8% of case patients, and 18%, 21%, and 8% of controls received PCV13 only, PPSV23 only, or both vaccines, respectively. PCV13-only VE against PCV13-types was 36% (95% CI −18, 65%). When we included type 6C with PCV13-types, VE was 67% (95% CI 11, 88%). PCV13 showed similar effectiveness against PCV13 type (+6C) IPD among adults >75 years of age (VE 61%, 95% CI

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Clinical characteristics of invasive disease caused by a rare Group AStreptococcussubtype (emm26.3) — Alaska, 2016–2017

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Open Forum Infectious Diseases 2017年第SUPPL_1期4卷 S553–S553页

作者： Mosites, Emily Frick, Anna Gounder, Prabhu Castrodale, Louisa Rudolph, Karen Lecy, K Danielle Zulz, Tammy Mclaughlin, Joseph Hennessy, Thomas Bruce, Michael Arctic Investigations Program Centers for Disease Control and Prevention Anchorage Alaska Section of Epidemiology Alaska Division of Public Health Anchorage Alaska

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