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OBJECTIVETo determine the impact of total household decolonization with intranasal mupirocin and chlorhexidine gluconate body wash on recurrent methicillin-resistant Staphylococcus aureus (MRSA) infection among subjects with MRSA skin and soft-tissue infection.DESIGNThree-arm nonmasked randomized controlled trial.SETTINGFive academic medical centers in Southeastern Pennsylvania.PARTICIPANTSAdults and children presenting to ambulatory care settings with community-onset MRSA skin and soft-tissue infection (ie, index cases) and their household members.INTERVENTIONEnrolled households were randomized to 1 of 3 intervention groups: (1) education on routine hygiene measures, (2) education plus decolonization without reminders (intranasal mupirocin ointment twice daily for 7 days and chlorhexidine gluconate on the first and last day), or (3) education plus decolonization with reminders, where subjects received daily telephone call or text message reminders.MAIN OUTCOME MEASURESOwing to small numbers of recurrent infections, this analysis focused on time to clearance of colonization in the index case.RESULTSOf 223 households, 73 were randomized to education-only, 76 to decolonization without reminders, 74 to decolonization with reminders. There was no significant difference in time to clearance of colonization between the education-only and decolonization groups (log-rank P=.768). In secondary analyses, compliance with decolonization was associated with decreased time to clearance (P=.018).CONCLUSIONSTotal household decolonization did not result in decreased time to clearance of MRSA colonization among adults and children with MRSA skin and soft-tissue infection. However, subjects who were compliant with the protocol had more rapid clearanceTrial registration. ClinicalTrials.gov identifier: NCT00966446Infect Control Hosp Epidemiol 2016;1–8

Compared to chart review, a definition based on the International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code for healthcare-associated influenza-like illness (HA-ILI) among young children in a large pediatric network demonstrated high positive and negative predictive values. This finding suggests that electronic health record–based definitions for surveillance can accurately identify medically attended outpatient HA-ILI cases for research and surveillance.Infect Control Hosp Epidemiol 2016;1–4

SUMMARYThis study investigates neighbourhood variation in rates of pneumococcal bacteraemia and community-level factors associated with neighbourhood heterogeneity in disease risk. We analysed data from 1416 adult and paediatric cases of pneumococcal bacteraemia collected during 2005–2008 from a population-based hospital surveillance network in metropolitan Philadelphia. Cases were geocoded using residential address to measure disease incidence by neighbourhood and identify potential neighbourhood-level risk factors. Overall incidence of pneumococcal bacteraemia was 36·8 cases/100 000 population and varied significantly (0–67·8 cases/100 000 population) in 281 neighbourhoods. Increased disease incidence was associated with higher population density [incidence rate ratio (IRR) 1·10/10 000 people per mile2, 95% confidence interval (CI) 1·0–1·19], higher percent black population (per 10% increase) (IRR 1·07, 95% CI 1·04–1·09), population aged ⩽5 years (IRR 3·49, CI 1·8–5·18) and population aged ⩾65 years (IRR 1·19, CI 1·00–1·38). After adjusting for these characteristics, there was no significant difference in neighbourhood disease rates. This study demonstrates substantial small-area variation in pneumococcal bacteraemia risk that appears to be explained by neighbourhood sociodemographic characteristics. Identifying neighbourhoods with increased disease risk may provide valuable information to optimize implementation of prevention strategies.

Background.A number of recent studies of antimicrobial resistance have focused on the role of antimicrobial-resistant pathogens that colonize the gastrointestinal tract. However, participation rates have been low in studies that involve fecal sampling. Attitudes toward such studies among potential study participants have not been assessed.Methods.We conducted a cross-sectional survey, enrolling 3 groups of inpatients from a large academic center. Group 1 consisted of patients who had previously participated in a cohort study of fluoroquinolone-resistant Escherichia coli, which involved the collection of perirectal swab samples. Group 2 consisted of patients who had previously refused to participate in the study of fluoroquinolone-resistant E. coli. Group 3 consisted of patients who had never been asked to participate in the study of the fluoroquinolone-resistant E. coli. The survey assessed patients' attitudes and beliefs regarding medical research and their willingness to consent to collection of a perirectal swab sample. Response options were recorded on a 5-point Likert scale. The Fisher exact test was used to compare dichotomized responses across study groups.Results.A total of 90 patients were surveyed: there were 29 in group 1 and in group 2 and 32 in group 3. Of 90 patients, 31 (35%) believed researchers might run additional tests on collected samples without informing the patient, whereas 25 (27%) believed persons other than the research team might gain access to study results. The belief that a person could get sicker as a result of a having a perirectal swab sample collected was significantly more common among patients who had previously refused to participate in the fluoroquinolone-resistant E. coli study.Conclusion.This study highlights important beliefs and attitudes that are associated with the likelihood of participating in studies of antimicrobial resistance. Explicitly addressing these concerns with eligible patients is critical to optimize participation in future studies.

Background.Antimicrobial stewardship programs (ASPs) decrease unnecessary antimicrobial use, decrease antimicrobial resistance, and improve patient outcomes. The effectiveness of a prior approval system—that is, the requirement that approval be obtained from ASP practitioners before certain antimicrobials can be used—depends on the accuracy of the patient data communicated from the primary service.Objectives.To determine the incidence of inaccurate communication of patient data during ASP interactions, describe examples of inaccurate communications, and identify risk factors for inaccurate communication.Design.We used a retrospective cohort design. We evaluated the communicated patient data for clinically important inaccuracies, using the patients' medical records as the gold standard.Setting.A tertiary care medical center that has a prior approval system for restricted antimicrobials.Patients.Inpatients discussed in telephone ASP interactions.Intervention.Observational study.Results.Of telephone calls requesting prior approval from ASP practitioners, 39% (95% confidence interval [CI], 31%-48%) contained an inaccuracy in at least 1 type of patient data (eg, current antimicrobial therapy); the incidence varied widely between data types. Examples of inaccuracies are given to demonstrate their clinical relevance. In multivariable analysis, inaccurate communications were more common for telephone calls from surgical services (versus calls from nonsurgical services: odds ratio, 2.1 [95% CI, 1.1-3.9]) and for calls received by Infectious Diseases fellows (versus pharmacists: odds ratio, 2.0 [95% CI, 1.1-3.8]).Conclusions.A high proportion of ASP calls requesting prior approval included patient data inaccuracies, which have the potential to affect the prescribing of antimicrobials. Although risk factors were identified, these communication errors were common across the different types of ASP interactions. Inaccurate communications may compromise the utility of ASPs that use a prior approval system for optimizing antimicrobial use.

The Centers for Disease Control and Prevention (CDC) recently narrowed its definition of catheter-associated urinary tract infection (CAUTI) to exclude asymptomatic bacteriuria. Although CAUTI rates decreased after the definition was changed, rates of related measures remained relatively stagnant, which indicates that longitudinal measurements of CAUTI may be misleading and that the change in definition did not itself impact care.