Guideline for prevention of surgical wound infections, 1985 /

Shipping list no. 86-0332-P."Supersedes Guideline for prevention of surgical wound infections, published in 1982."Includes bibliographical references.Mode of access: Internet

Guideline for prevention of surgical wound infections, 1985 /

"99-2381."Shipping list no.: 86-347-P."Supersedes Guideline for prevention of surgical wound infections published in 1982."Includes bibliographies.Mode of access: Internet

Assessment of the Appropriateness of Antimicrobial Use in US Hospitals

Authors: Shelley S. Magill, Erin O’Leary, Susan M. Ray, Marion A. Kainer, Christopher Evans, Wendy M. Bamberg, Helen Johnston, Sarah J. Janelle, Tolulope Oyewumi, Ruth Lynfield, Jean Rainbow, Linn Warnke, Joelle Nadle, Deborah L. Thompson, Shamima Sharmin, Rebecca Pierce, Alexia Y. Zhang, Valerie Ocampo, Meghan Maloney, Samantha Greissman, Lucy E. Wilson, Ghinwa Dumyati, Jonathan R. Edwards, Nora Chea, Melinda M. Neuhauser; Emerging Infections Program Hospital Prevalence Survey Team:Karen Click, Linda Frank, Deborah Godine, Brittany Martin, Erin Parker, Lauren Pasutti, Sarabeth Friedman, Annika Jones, Tabetha Kosmicki, James Fisher, Amber Maslar, James Meek, Richard Melchreit, Farzana Badrun, Lauren Epstein, Ryan Fagan, Anthony Fiore, Nicole R. Gualandi, Arjun Srinivasan, Scott K. Fridkin, Susan L. Morabit, Lewis A. Perry, Rebecca Perlmutter, Elisabeth Vaeth, Annastasia Gross, Jane Harper, Brittany Pattee, Nabeelah Rahmathullah, Joan Baumbach, Marla Sievers, Cathleen Concannon, Christina Felsen, Anita Gellert, Monika Samper, Raphaelle H. Beard, Patricia Lawson, Daniel Muleta, Vicky P. ReedImportance Hospital antimicrobial consumption data are widely available; however, large-scale assessments of the quality of antimicrobial use in US hospitals are limited. Objective To evaluate the appropriateness of antimicrobial use for hospitalized patients treated for community-acquired pneumonia (CAP) or urinary tract infection (UTI) present at admission or for patients who had received fluoroquinolone or intravenous vancomycin treatment. Design, Setting, and Participants This cross-sectional study included data from a prevalence survey of hospitalized patients in 10 Emerging Infections Program sites. Random samples of inpatients on hospital survey dates from May 1 to September 30, 2015, were identified. Medical record data were collected for eligible patients with 1 or more of 4 treatment events (CAP, UTI, fluoroquinolone treatment, or vancomycin treatment), which were selected on the basis of common infection types reported and antimicrobials given to patients in the prevalence survey. Data were analyzed from August 1, 2017, to May 31, 2020. Exposure Antimicrobial treatment for CAP or UTI or with fluoroquinolones or vancomycin. Main Outcomes and Measures The percentage of antimicrobial use that was supported by medical record data (including infection signs and symptoms, microbiology test results, and antimicrobial treatment duration) or for which some aspect of use was unsupported. Unsupported antimicrobial use was defined as (1) use of antimicrobials to which the pathogen was not susceptible, use in the absence of documented infection signs or symptoms, or use without supporting microbiologic data; (2) use of antimicrobials that deviated from recommended guidelines; or (3) use that exceeded the recommended duration. Results Of 12 299 patients, 1566 patients (12.7%) in 192 hospitals were included; the median age was 67 years (interquartile range, 53-79 years), and 864 (55.2%) were female. A total of 219 patients (14.0%) were included in the CAP analysis, 452 (28.9%) in the UTI analysis, 550 (35.1%) in the fluoroquinolone analysis, and 403 (25.7%) in the vancomycin analysis; 58 patients (3.7%) were included in both fluoroquinolone and vancomycin analyses. Overall, treatment was unsupported for 876 of 1566 patients (55.9%; 95% CI, 53.5%-58.4%): 110 of 403 (27.3%) who received vancomycin, 256 of 550 (46.6%) who received fluoroquinolones, 347 of 452 (76.8%) with a diagnosis of UTI, and 174 of 219 (79.5%) with a diagnosis of CAP. Among patients with unsupported treatment, common reasons included excessive duration (103 of 174 patients with CAP [59.2%]) and lack of documented infection signs or symptoms (174 of 347 patients with UTI [50.1%]). Conclusions and Relevance The findings suggest that standardized assessments of hospital antimicrobial prescribing quality can be used to estimate the appropriateness of antimicrobial use in large groups of hospitals. These assessments, performed over time, may inform evaluations of the effects of antimicrobial stewardship initiatives nationally.Obtained funding: Magill, Bamberg, Maloney, Dumyati. The Emerging Infections Program Hospital Prevalence Survey of Healthcare-associated Infections and Antimicrobial Use was supported by the CDC through the Emerging Infections Program Cooperativehttps://jamanetwork.com/journals/jamanetworkopen/article-abstract/277763

Antimicrobial Use in US Hospitals: Comparison of Results From Emerging Infections Program Prevalence Surveys, 2015 and 2011

Authors: Shelley S Magill, Erin O’Leary, Susan M Ray, Marion A Kainer, Christopher Evans, Wendy M Bamberg, Helen Johnston, Sarah J Janelle, Tolulope Oyewumi, Ruth Lynfield, Jean Rainbow, Linn Warnke, Joelle Nadle, Deborah L Thompson, Shamima Sharmin, Rebecca Pierce, Alexia Y Zhang, Valerie Ocampo, Meghan Maloney, Samantha Greissman, Lucy E Wilson, Ghinwa Dumyati, Jonathan R Edwards; Emerging Infections Program Hospital Prevalence Survey Team: Karen Click, Linda Frank, Deborah Godine, Brittany Martin, Erin Parker, Lauren Pasutti, Sarabeth Friedman, Annika Jones, Tabetha Kosmicki, James Fisher, Amber Maslar, James Meek, Richard Melchreit, Farzana Badrun, Anthony Fiore, Scott K. Fridkin, Susan L. Morabit, Lewis A. Perry, Rebecca Perlmutter, Elisabeth Vaeth, Annastasia Gross, Jane Harper, Brittany Pattee, Nabeelah Rahmathullah, Joan Baumbach, Marla Sievers, Cathleen Concannon, Christina Felsen, Anita Gellert, Monika Samper, Raphaelle H. Beard, Patricia Lawson, Daniel Muleta, Vicky P. ReedBackground In the 2011 US hospital prevalence survey of healthcare-associated infections and antimicrobial use 50% of patients received antimicrobial medications on the survey date or day before. More hospitals have since established antimicrobial stewardship programs. We repeated the survey in 2015 to determine antimicrobial use prevalence and describe changes since 2011. Methods The Centers for Disease Control and Prevention’s Emerging Infections Program sites in 10 states each recruited ≤25 general and women’s and children’s hospitals. Hospitals selected a survey date from May–September 2015. Medical records for a random patient sample on the survey date were reviewed to collect data on antimicrobial medications administered on the survey date or day before. Percentages of patients on antimicrobial medications were compared; multivariable log-binomial regression modeling was used to evaluate factors associated with antimicrobial use. Results Of 12 299 patients in 199 hospitals, 6084 (49.5%; 95% CI, 48.6–50.4%) received antimicrobials. Among 148 hospitals in both surveys, overall antimicrobial use prevalence was similar in 2011 and 2015, although the percentage of neonatal critical care patients on antimicrobials was lower in 2015 (22.8% vs 32.0% [2011]; P = .006). Fluoroquinolone use was lower in 2015 (10.1% of patients vs 11.9% [2011]; P < .001). Third- or fourth-generation cephalosporin use was higher (12.2% vs 10.7% [2011]; P = .002), as was carbapenem use (3.7% vs 2.7% [2011]; P < .001). Conclusions Overall hospital antimicrobial use prevalence was not different in 2011 and 2015; however, differences observed in selected patient or antimicrobial groups may provide evidence of stewardship impact.The authors thank the following members of the Emerging Infections Program (EIP) Hospital Survey Team and nonauthor contributors: California Emerging Infections Program, Oakland, CA: Karen Click; Linda Frank, RN, BSN, PHN; Deborah Godine, RN; Brittany Martin, MPH; Erin Parker, MPH; Lauren Pasutti, MPH; Colorado Department of Public Health and Environment, Denver, CO: Sarabeth Friedman, CNM, MSN; Annika Jones, MPH; Tabetha Kosmicki, MPH, CIC; Connecticut Emerging Infections Program, New Haven and Hartford, CT: James Fisher, MPH; Amber Maslar, MPA; James Meek, MPH; Richard Melchreit, MD; Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA: Farzana Badrun, MD, MS (Eagle Medical Services); Anthony Fiore, MD, MPH; Georgia Emerging Infections Program, Decatur, GA: Scott K. Fridkin, MD; Susan L. Morabit, MSN, RN, PHCNS-BC, CIC; Lewis A. Perry, DrPH, MPH, RN; Maryland Department of Health, Baltimore, MD: Rebecca Perlmutter, MPH, CIC; Elisabeth Vaeth, MPH; Minnesota Department of Health, St Paul, MN: Annastasia Gross, MPH, MT(ASCP); Jane Harper, MS, BSN, CIC; Brittany Pattee, MPH; Nabeelah Rahmathullah, MBBS, MPH; New Mexico Department of Health, Santa Fe, NM: Joan Baumbach, MD, MS, MPH; Marla Sievers, MPH; New York Emerging Infections Program and University of Rochester Medical Center, Rochester, NY: Cathleen Concannon, MPH; Christina Felsen, MPH; Anita Gellert, RN; Oregon Health Authority, Portland, OR: Monika Samper, RN; Tennessee Department of Health, Nashville, TN: Raphaelle H. Beard, MPH; Patricia Lawson, RN, MS, MPH; Daniel Muleta, MD, MPH; Vicky P. Reed, RN. The authors also thank the hospitals and staff in the 10 EIP sites for their participation and significant contributions to this multiphase prevalence survey effort. This work was supported by the Centers for Disease Control and Prevention through the Emerging Infections Program Cooperative Agreement CK17–1701.https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa373/585545