المؤلفون: Talbot, Thomas R, Beekmann, Susan E, Babcock, Hilary M, Polgreen, Philip M

المصدر: Infection Control and Hospital Epidemiology. 43(12)

مصطلحات موضوعية: Biomedical and Clinical Sciences, Clinical Sciences, Health Sciences, Immunization, Prevention, Vaccine Related, Clinical Research, Infectious Diseases, Infection, Good Health and Well Being, Humans, COVID-19 Vaccines, Cross-Sectional Studies, COVID-19, Vaccination, Vaccines, Delivery of Health Care, Health Services and Systems, Health Services, Biodefense, Emerging Infectious Diseases, Patient Safety, Lung, SARS-CoV-2, Respiratory Aerosols and Droplets, Health Facilities, Infection Control, Medical and Health Sciences, Epidemiology, Biomedical and clinical sciences, Health sciences

الوصف: ObjectiveAlthough a growing number of healthcare facilities are implementing healthcare personnel (HCP) coronavirus disease 2019 (COVID-19) vaccination requirements, vaccine exemption request management as a part of such programs is not well described.DesignCross-sectional survey.ParticipantsInfectious disease (ID) physician members of the Emerging Infections Network with infection prevention or hospital epidemiology responsibilities.MethodsEligible persons were sent a web-based survey focused on hospital plans and practices around exemption allowances from HCP COVID-19 vaccine requirements.ResultsOf the 695 ID physicians surveyed, 263 (38%) responded. Overall, 160 respondent institutions (92%) allowed medical exemptions, whereas 132 (76%) allowed religious exemptions. In contrast, only 14% (n = 24) allowed deeply held personal belief exemptions. The types of medical exemptions allowed varied considerably across facilities, with allergic reactions to the vaccine or its components accepted by 145 facilities (84%). For selected scenarios commonly used as the basis for religious and deeply held personal belief exemption requests, 144 institutions (83%) would not approve exemptions focused on concerns regarding right of consent or violations of freedom of personal choice, and 140 institutions (81%) would not approve exemptions focused on introducing foreign substances into one's body or the sanctity of the body. Most respondents noted plans for additional infection prevention interventions for HCP who received an exemption for COVID-19 vaccination.ConclusionsAlthough many respondent institutions allowed exemptions from HCP COVID-19 vaccination requirements, the types of exemptions allowed and how the exemption programs were structured varied widely.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/0bc0t0h6Test

المؤلفون: Bahr, Nathan C, Beekmann, Susan E, Polgreen, Philip M, Walker, Jeremey B, Spec, Andrej, Boulware, David R, Baddley, John W

المصدر: Open Forum Infectious Diseases ; ISSN 2328-8957

مصطلحات موضوعية: Infectious Diseases, Oncology

الوصف: Background Several recent randomized trials have been conducted in resource-limited settings for cryptococcal meningitis which have rapidly innovated international guidelines. The 2010 IDSA cryptococcal meningitis guideline has not been updated with recent trials. The 2022 AMBITION-cm trial found that single 10mg/kg dose of liposomal amphotericin B plus daily flucytosine and fluconazole for two weeks was non-inferior to one-week of amphotericin B deoxycholate with flucytosine. It is unknown whether physicians in high-resource settings are using this regimen or more traditional regimens. Methods We developed an electronic survey in June 2023 to better understand whether or not physician members of the IDSA Emerging Infections Network (EIN) and Mycoses Study Group Education and Research Consortium (MSG-ERC) had used the AMBITION-cm induction regimen, would use the regimen in hypothetical clinical scenarios, and what perceived barriers to use existed. Results 242 of 561 (43%) physicians responded to the survey of which 205 provided care for persons with cryptococcal meningitis in the last year. Overall, 29 (14%) had used the AMBITION-cm regimen, and 176 (86%) had not. In various hypothetical clinical scenarios, only ∼10% of 209 respondents selected the AMBITION-cm regimen as preferred. Perceived barriers to uptake included: the applicability of trials performed in low-resource settings to high-resource settings, that the regimen is not recommended in 2010 IDSA guidelines, and the applicability to persons without HIV. Conclusions Most respondents had not used single-dose liposomal amphotericin B regimen, but the regimen is being used. Further study of this regimen in other patient populations and settings is necessary.

الإتاحة: https://doi.org/10.1093/ofid/ofae120Test

المؤلفون: Howard-Anderson, Jessica R., Gottlieb, Lindsey B., Beekmann, Susan E., Polgreen, Philip M., Jacob, Jesse T., Uslan, Daniel Z.

المصدر: Infection Control & Hospital Epidemiology ; page 1-6 ; ISSN 0899-823X 1559-6834

مصطلحات موضوعية: Infectious Diseases, Microbiology (medical), Epidemiology

الوصف: Objective: To understand how healthcare facilities employ contact precautions for patients with multidrug-resistant organisms (MDROs) in the post–coronavirus disease 2019 (COVID-19) era and explore changes since 2014. Design: Cross-sectional survey. Participants: Emerging Infections Network (EIN) physicians involved in infection prevention or hospital epidemiology. Methods: In September 2022, we sent via email an 8-question survey on contact precautions and adjunctive measures to reduce MDRO transmission in inpatient facilities. We also asked about changes since the COVID-19 pandemic. We used descriptive statistics to summarize data and compared results to a similar survey administered in 2014. Results: Of 708 EIN members, 283 (40%) responded to the survey and 201 reported working in infection prevention. A majority of facilities (66% and 69%) routinely use contact precautions for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) respectively, compared to 93% and 92% in 2014. Nearly all (>90%) use contact precautions for Candida auris , carbapenem-resistant Enterobacterales (CRE), and carbapenem-resistant Acinetobacter baumannii . More variability was reported for carbapenem-resistant Pseudomonas aeruginosa and extended-spectrum β-lactamase–producing gram-negative organisms. Compared to 2014, fewer hospitals perform active surveillance for MRSA and VRE. Overall, 90% of facilities used chlorhexidine gluconate bathing in all or select inpatients, and 53% used ultraviolet light or hydrogen peroxide vapor disinfection at discharge. Many respondents (44%) reported changes to contact precautions since COVID-19 that remain in place. Conclusions: Heterogeneity exists in the use of transmission-based precautions and adjunctive infection prevention measures aimed at reducing MDRO transmission. This variation reflects a need for updated and specific guidance, as well as further research on the use of contact precautions in healthcare facilities.

الإتاحة: https://doi.org/10.1017/ice.2024.11Test
https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S0899823X24000114Test

المؤلفون: Karris, Maile Young, Moore, Alison A, Hicks, Charles B, Benson, Constance A, Moore, David J, Templeman, James R, Polgreen, Philip M, Beekmann, Susan E

الوصف: Background: People living with HIV (PLWH) experience age-associated health conditions earlier thantheir HIV-uninfected peers and have higher rates of co-occurring conditions that impact aging. Thus, HIVproviders frequently confront issues related to HIV and aging.Objective: The objective of this project was to understand provider opinions about the care of older PLWHbetter.Design: This was accomplished using a quantitative survey.Participants: This study involved 681 physicians treating PLWH in North America.MAIN MEASURES: We collaborated with the Emerging Infections Network (EIN) to administer a ninequestion survey covering practice characteristics, attitudes, and perceived barriers in caring for older PLWH.Key Results: Two hundred and ninety-four (43.2%) responses were collected. Providers estimate that 35%(IQR: 25-50) of their HIV-infected patients were >50 years. The majority (72%) agreed it is difficult to carefor older PLWH but had confidence in their ability to do so (85%). Most list a lack of time (55.4%) andinsufficient multidisciplinary support (58.5%) as limitations to the effective management of older PLWH.Multi-morbidity was overwhelmingly perceived as the most important barrier to healthy aging (62.2%)followed by tobacco/alcohol use (10%), low income/savings (8.2%), polypharmacy (4.8%) and mentalillness (4.4%). Loneliness, frailty, and cognitive difficulties were judged to be less important. In conclusion,HIV providers recognized the complexity of caring for older PLWH, and yet were confident they could carefor this population.Conclusion: Multi-morbidity was identified as a major barrier to healthy aging, while syndromes such asfrailty and cognitive difficulties were deemed less important despite a growing body of evidence that thesegeriatric syndromes are common in older PLWH.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/9wf2q59hTest

المؤلفون: Liu, Catherine, Strnad, Luke, Beekmann, Susan E, Polgreen, Philip M, Chambers, Henry F

المصدر: Clinical Infectious Diseases. 69(3)

مصطلحات موضوعية: Infectious Diseases, Vaccine Related, Prevention, Emerging Infectious Diseases, Hematology, Biodefense, Sepsis, Infection, Good Health and Well Being, Adult, Anti-Bacterial Agents, Bacteremia, Disease Management, Humans, Infectious Disease Medicine, Practice Patterns, Physicians', Staphylococcal Infections, Staphylococcus aureus, Surveys and Questionnaires, Treatment Outcome, bacteremia, infectious disease physicians, Biological Sciences, Medical and Health Sciences, Microbiology

الوصف: Infectious disease management of Staphylococcus aureus bacteremia (SAB) was surveyed through the Emerging Infections Network. Although there were areas of consensus, we found substantial practice variation in diagnostic evaluation and management of adult patients with SAB. These findings highlight opportunities for further research and guidance to define best practices.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/9ww2208bTest

المؤلفون: Nolan, Nathanial S, Fracasso Francis, Sarah M, Marks, Laura R, Beekmann, Susan E, Polgreen, Philip M, Liang, Stephen Y, Durkin, Michael J

المصدر: Open Forum Infectious Diseases ; volume 10, issue 8 ; ISSN 2328-8957

مصطلحات موضوعية: Infectious Diseases, Oncology

الوصف: Background The rise in injection drug use (IDU) has led to an increase in drug-related infections. Harm reduction is an important strategy for preventing infections among people who inject drugs (PWID). We attempted to evaluate the harm reduction counseling that infectious diseases physicians provide to PWID presenting with infections. Methods An electronic survey was distributed to physician members of the Emerging Infections Network to inquire about practices used when caring for patients with IDU-related infections. Results In total, 534 ID physicians responded to the survey. Of those, 375 (70%) reported routinely caring for PWID. Most respondents report screening for human immunodeficiency virus (HIV) and viral hepatitis (98%) and discussing the risk of these infections (87%); 63% prescribe immunization against viral hepatitis, and 45% discuss HIV preexposure prophylaxis (PrEP). However, 55% of respondents (n = 205) reported not counseling patients on safer injection strategies. Common reasons for not counseling included limited time and a desire to emphasize antibiotic therapy/medical issues (62%), lack of training (55%), and believing that it would be better addressed by other services (47%). Among respondents who reported counseling PWID, most recommended abstinence from IDU (72%), handwashing and skin cleansing before injection (62%), and safe disposal of needles/drug equipment used before admission (54%). Conclusions Almost all ID physicians report screening PWID for HIV and viral hepatitis and discussing the risks of these infections. Despite frequently encountering PWID, fewer than half of ID physicians provide safer injection advice. Opportunities exist to standardize harm reduction education, emphasizing safer injection practices in conjunction with other strategies to prevent infections (eg, HIV PrEP or hepatitis A virus/hepatitis B virus vaccination).

الإتاحة: https://doi.org/10.1093/ofid/ofad402Test
https://academic.oup.com/ofid/article-pdf/10/8/ofad402/51115656/ofad402.pdfTest

المؤلفون: Cortes-Penfield, Nicolas W, Beekmann, Susan E, Polgreen, Philip M, Ryan, Keenan L, Sekar, Poorani

المصدر: Open Forum Infectious Diseases ; volume 10, issue Supplement_2 ; ISSN 2328-8957

مصطلحات موضوعية: Infectious Diseases, Oncology

الوصف: Background Osteoarticular infections (OAI) have been commonly treated with prolonged intravenous (IV) antimicrobials. The Oral versus Intravenous Antibiotics for Bone and Joint Infection (OVIVA) trial demonstrated that oral (PO) antibiotic therapy was noninferior to IV antibiotics in the treatment of OAIs. We surveyed Infectious disease (ID) physicians to see how often they used PO antibiotics in the treatment of OAIs and the barriers to using PO antibiotics. Methods An EIN survey was sent to 1475 ID physicians. The survey had 9 questions pertaining to antibiotic prescribing patterns in the treatment of OAIs. The questions were mostly multiple choice, Yes/No questions with an area provided for free text. Definitive oral antibiotic therapy was defined as switching to PO antibiotics within 2 weeks of starting antibiotics. Results There were 413 respondents who treated OAIs and responded to the survey. A plurality of respondents 150/413 (36%) switched from IV to PO antibiotics after 4 weeks of IV therapy. 129/413 (31%) switched to oral antibiotics as definitive treatment (Fig 1). PO antibiotics were used as definitive therapy most often for diabetic foot osteomyelitis and native joint septic arthritis (Fig 2). Trimethoprim-sulfamethoxazole was most often used as definitive therapy for Staphylococcus aureus infections followed by doxycycline/minocycline. Amoxicillin/ cefadroxil/ cephalexin was used for treatment of streptococcal infections and fluoroquinolones were used as definitive treatment for infections caused by Gram-negative organisms. The most common reasons for not transitioning to PO antibiotics included non-susceptible pathogen, comorbidities preventing therapeutic drug levels and concern about adherence For the following infections, how often do you use oral antibiotics as definitive therapy? Conclusion A sizeable portion of ID physicians utilize PO antibiotics for the management of OAIs, although significant practice variation exists regarding the timing of IV to PO switch. Disclosures Philip ...

الإتاحة: https://doi.org/10.1093/ofid/ofad500.1144Test
https://academic.oup.com/ofid/article-pdf/10/Supplement_2/ofad500.1144/53762730/ofad500.1144.pdfTest

المؤلفون: Santibanez, Scott S, Gundlapalli, Adi, Beekmann, Susan E, Uyeki, Timothy M, Satheshkumar, Panayampalli, Plumb, Ian D, David-Ferdon, Corinne, Polgreen, Philip M, McDonald, L Clifford, Jones, Jefferson M

المصدر: Open Forum Infectious Diseases ; volume 10, issue Supplement_2 ; ISSN 2328-8957

مصطلحات موضوعية: Infectious Diseases, Oncology

الوصف: Background Although clinical applications of SARS-CoV-2 antibody tests during the COVID-19 pandemic were limited to identifying recent/prior infection, how these tests were used for clinical management of COVID-19 patients is unknown. We consider US infectious disease (ID) physicians’ perceptions about SARS-CoV-2 antibody tests to inform preparedness for future events. Methods In March 2022, we surveyed members of the Emerging Infections Network (EIN), a national network of ID physicians on use of SARS-CoV-2 antibody assays, interpretation of results, and clinical scenarios for which such tests were considered. We analyzed comments provided in a free text field for key themes. Results Overall, 96 respondents provided non-mutually exclusive free-text comments. Fourteen used serology to assess patients with suspected MIS-C. Another 8 used serology in individuals with immunocompromising conditions, including organ transplant recipients and those with human immunodeficiency virus (HIV) infection, for example, when making decisions to utilize anti-SARS-CoV-2 mAbs (available at the time of the survey but no longer authorized for PReP or treatment.) Twenty-one respondents shared that the most important need for SARS-CoV-2 antibody assays was to discern a correlate of immune protection. Twenty-six considered that serology was not useful for clinical decision-making, and 23 recognized the limitations of the antibody tests, called for more studies, and indicated that additional guidance would be beneficial, noting for example, “Many clinicians order antibody tests but have no idea how to interpret or misinterpret, so guidelines on usage and when not to use would be extremely helpful.” Conclusion This analysis provides historical insights into challenges practicing ID physicians faced in the midst of a pandemic. During March 2022, some respondents reported use of SARS-CoV-2 antibody assays including when making treatment decisions. As diagnostic and treatment modalities continue to evolve, federal agencies, ...

الإتاحة: https://doi.org/10.1093/ofid/ofad500.1625Test
https://academic.oup.com/ofid/article-pdf/10/Supplement_2/ofad500.1625/53756435/ofad500.1625.pdfTest

المؤلفون: Howard-Anderson, Jessica, Gottlieb, Lindsey, Beekmann, Susan E., Polgreen, Philip, Jacob, Jesse T., Uslan, Daniel Z.

المصدر: Antimicrobial Stewardship & Healthcare Epidemiology ; volume 3, issue S2, page s102-s103 ; ISSN 2732-494X

مصطلحات موضوعية: Infectious Diseases, Microbiology (medical), Epidemiology

الوصف: Background: The CDC recommends routine use of contact precautions for patients infected or colonized with multidrug-resistant organisms (MDROs). There is variability in implementation of and adherence to this recommendation, which we hypothesized may have been exacerbated by the COVID-19 pandemic. Methods: In September 2022, we emailed an 8-question survey to Emerging Infections Network (EIN) physician members with infection prevention and hospital epidemiology responsibilities. The survey asked about the respondent’s primary hospital’s recommendations on transmission-based precautions, adjunctive measures to reduce MDRO transmission, and changes that occurred during the COVID-19 pandemic. We sent 2 reminder emails over a 1-month period. We used descriptive statistics to summarize the data and to compare results to a similar EIN survey (n = 336) administered in 2014 (Russell D, et al. doi:10.1017/ice.2015.246). Results: Of 708 EIN members, 283 (40%) responded to the survey, and 201 were involved in infection prevention. Most respondents were adult infectious diseases physicians (n = 228, 80%) with at least 15 years of experience (n = 174, 63%). Respondents were well distributed among community, academic, and nonuniversity teaching facilities (Table 1). Most respondents reported that their facility routinely used CP for methicillin-resistant Staphylococcus aureus (MRSA, 66%) and vancomycin-resistant Enterococcus (VRE, 69%), compared to 93% and 92% respectively, in the 2014 survey. Nearly all (>90%) reported using contact precautions for Candida auris , carbapenem-resistant Enterobacterales (CRE), and carbapenem-resistant Acinetobacter spp, but there was variability in the use of contact precautions for carbapenem-resistant Pseudomonas aeruginosa and extended-spectrum β-lactamase–producing gram-negative organisms. In 2014, 81% reported that their hospital performed active surveillance testing for MRSA, and in 2022 this rate fell to 54% (Table 2). The duration of contact precautions varied by MDRO (Table 3). ...

الإتاحة: https://doi.org/10.1017/ash.2023.374Test
https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S2732494X23003741Test

المؤلفون: Hennessee, Ian, Forsberg, Kaitlin, Beekmann, Susan E., Polgreen, Philip, Gold, Jeremy, Lyman, Meghan

المصدر: Antimicrobial Stewardship & Healthcare Epidemiology ; volume 3, issue S2, page s99-s99 ; ISSN 2732-494X

مصطلحات موضوعية: Infectious Diseases, Microbiology (medical), Epidemiology

الوصف: Background: Candida auris , an emerging fungal pathogen, is frequently drug resistant and spreads rapidly in healthcare facilities. Screening to identify patients colonized with C. auris can prevent further spread by prompting aggressive infection prevention and control measures. The CDC recommends C. auris screening based on local epidemiological conditions, patient characteristics, and facility-level risk factors; such screening might help facilities in higher burden areas to mitigate transmission and those in lower-burden areas to detect new introductions before spread begins. To describe US screening practices and challenges, we surveyed a network of infection disease practitioners, comparing responses by local C. auris case burdens. Methods: In August 2022, we emailed a survey about C. auris screening practices to ~3,000 members of the IDSA Emerging Infection Network. We describe survey results, stratifying findings by whether the healthcare facility was in a region where C. auris is frequently identified (tier 3 facility) or not frequently identified (tier 2 facility), based on CDC assessment using existing multidrug-resistant organism containment guidance (https://www.cdc.gov/hai/containment/guidelines.htmlTest). Results: We received 253 responses (tier 3 facilities: 119, tier 2 facilities: 134); overall, 37% performed screening. Tier 3 facilities more frequently performed screening than tier 2 facilities (59% vs 17%). Among facilities that performed screening, tier 3 facilities, compared with tier 2 facilities, more frequently screened patients on admission (84% vs 55%) and used an in-house laboratory for testing (68% vs 29%), most often with culture-based methods. Tier 2 facilities more frequently screened patients already admitted in the facility (eg, in response to cases or as part of point-prevalence surveys) compared with tier 3 facilities (59% vs 49%). Among facilities performing screening, 72% had identified ≥1 case in the previous year (tier 3 facilities, 85%; tier 2 facilities, 33%). Barriers to ...

الإتاحة: https://doi.org/10.1017/ash.2023.371Test
https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S2732494X23003716Test