Tyler Prentiss

Risk Factors for 30-Day Mortality in Patients with Methicillin-Resistant Staphylococcus aureus Bloodstream Infections

OBJECTIVES Methicillin-resistant Staphylococcus aureus (MRSA) blood stream infections (BSI) are a major health care problem accounting for a large percentage of nosocomial infections. The aim of this study was to identify risk factors associated with 30-day mortality in patients with MRSA BSI. METHODS This was a retrospective study performed in Southeast Michigan. Over a 9- year period, a total of 1,168 patients were identified with MRSA BSI. Patient demographics and clinical data were retrieved and evaluated using electronic medical health records. RESULTS 30-day mortality during the 9-year study period was 16%. Significant risk factors for 30-day mortality were age, cancer, heart disease, neurologic disease, nursing home residence and Charlson score >3 with Odds Ratio (OR) of 1.03 (CI 1.02-1.04), 2.29 (CI 1.40-3.75), 1.78 (CI 1.20-2.63), 1.65 (CI 1.08-2.25), 1.66 (CI 1.02 - 2.70) and 1.86 (CI 1.18 - 2.95) correspondingly. Diabetes mellitus, peripheral vascular disease (PVD), and readmission were protective factors for 30-day mortality with OR of 0.53 (CI 0.36-0.78), 0.46 (CI 0.26-0.84) and 0.13 (CI0.05 - 0.32) respectively. CONCLUSIONS Our study identified significant risk factors for 30-day mortality in patients with MRSA BSI. Interestingly, diabetes mellitus, PVD and readmission were protective effects on 30-day mortality. There was no statistically significant variability in 30-day mortality over the 9-year study period.

Community Health Workers (CHWs) as Innovators: Insights from a Tele-Education Pilot for CHWs in Detroit, Michigan

Communityhealthworkers(CHWs)havealongstandingroleinimprovingthehealthandwell-being ofunderservedpopulationsinresource-limitedsettings.CHWsaretrustedinthecommunitiesthey serveandareoftenabletoseethroughsolutionsoncommunitychallengesthatoutsidepersonscannot. Notwithstanding,suchsolutionsoftenmustbelow-cost,easilyimplementable,andpermitknowledge gapsamongCHWstobefilledviaappropriatetraining.Inthissense,useofcost-effectiveinformation technology(IT)solutionscanbekeytoincreasingaccesstoknowledgeforthesecommunityagents. Thispaperhighlights insightsgleanedfromapilot studyperformed inDetroit,Michiganwitha groupofCHWsinbasicgrant-writingtrainingviaane-platform,theCommunityHealthInnovator Program(CHIP).Theresultsarediscussedwithinthecontextoflearningtheory.Itisconcludedthat e-platformsarenecessaryforCHWstoleverageknowledgefrommultiplesourcesinanadaptive environmenttowardsaddressingever-evolvingglobalhealthchallenges. KEyWoRDS Community Health Innovator Program (CHIP), Community Health Workers (CHWs), E-Platform, Global Health, Information Technology (IT), Learning Theory

Building Capacity in Infection Prevention and Antimicrobial Stewardship in Low- and Middle-Income Countries: the Role of Partnerships Inter-countries

Opinion statementAntimicrobial resistance is increasing globally at a rapid pace, and patients in low- and middle-income countries are at high risk. The need for inter-country partnerships with the ultimate goal of building capacity in the fields of infection prevention and antimicrobial stewardship in these settings is of utmost importance. Reciprocal, long-term, supported relationships between collaborators from low- and middle-income countries and high-income countries will have high benefit to all partners. This paper looks at recent literature in antimicrobial stewardship and infection prevention and offers recommendations for building sustainable partnerships benefitting all collaborators working to reduce antimicrobial resistance.

Community Health Workers as Innovators: Methods and Results from a Tele-Education Pilot for Community Health Workers in Detroit, Michigan

Community health workers (CHWs) have played an important role in improving the health of underserved populations in resource-limited settings. CHWs are trusted in communities that they serve, and are often able to see solutions to community problems that outside persons cannot. Solutions need to be low cost and easily accessible, and address the knowledge gaps among CHWs through appropriate training. Utilizing information technology solutions can be key to increasing access to knowledge for these community agents. This paper outlines the methods and results from a pilot study of the Community Health Innovator Program performed in Detroit, Michigan with a group of community health workers in basic grant-writing training, utilizing an information technology platform. The results will be discussed as a larger response to growing issues in global health and how such platforms can be used and adapted in response to ever-evolving global health challenges.

Multidrug-resistant microorganisms colonizing lower extremity wounds in patients in a tertiary care hospital, Lima, Peru

Multidrug-resistant organism (MDRO) infections cause high morbidity and mortality, and high costs to patients and hospitals. The study aims were to determine the frequency of MDRO colonization and associated factors in patients with lower-extremity wounds with colonization. A cross-sectional study was designed during November 2015 to July 2016 in a tertiary care hospital in Lima, Peru. A wound swab was obtained for culture and susceptibility testing. MDRO colonization was defined if the culture grew with methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and/or extended spectrum beta-lactamase (ESBL) microorganisms. The frequency of MDRO wound colonization was 26.8% among the 97 patients enrolled. The most frequent MDRO obtained was ESBL-producing Escherichia coli, which was significantly more frequent in chronic wounds versus acute wounds (17.2% versus 0%, P < 0.05). Infection control measures should be implemented when patients with chronic lower-extremity wounds are admitted.

High vancomycin serum trough is not associated with reduction of mortality in methicillin-resistant Staphylococcus aureus bloodstream infections

The current Infectious Diseases Society of America (IDSA) and the American Society of Health-System Pharmacists (ASHP) guidelines recommend a vancomycin serum trough concentration of 15 to 20 mg/L in patients with methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI). The objective of this study was to evaluate the mortality difference in MRSA BSI pre and post hospital-wide implementation of higher serum trough concentration per IDSA/ ASHP guidelines. This was a retrospective cohort study performed in an integrated hospital health system (2238 beds) in Southeast Michigan. We evaluated 1173 consecutive individual patients with MRSA BSI over a 9-year period. The vancomycin minimum inhibitory concentrations (MICs) were determined by Etest method for all isolates. Attainment of vancomycin serum trough concentration per IDSA/ASHP guidelines was implemented in January 2010 by clinical pharmacist as part of the antimicrobial stewardship program. During the study period, the mean vancomycin MIC was 1.57 ± 0.26 mg/L, the percentage of MRSA isolates with vancomycin MIC ≥ 2 mg/L was 17.5%, and the 30-day all-cause mortality was 16.5%. There was no difference in mortality during the 9-year period (p=0.193). There was no change in all-cause mortality for MRSA BSI after the hospital-wide implementation of higher vancomycin dose and serum trough concentration per IDSA/ ASHP guidelines. Prospective multicenter, controlled studies evaluating optimal dosing strategies for vancomycin are warranted. Correspondence to: Marcus J. Zervos, Division Head, Infectious Diseases, Henry Ford Health System, Professor of Medicine, Wayne State University School of Medicine, Detroit, MI 48202, USA, Tel: +1-313-916-2573; Fax: +1-313-9162993; E-mail: mzervos1@hfhs.org

733Vancomycin-Resistant Enterococcus (VRE) faecium Bloodstream Infections and Mortality

– A retrospective review of medical records was performed from 2010-2013 of all VRE faecium bloodstream infections from individual patients at a single 900 bed teaching hospital in Detroit – 166 VRE faecium isolates, collected from 2010-2013, were evaluated – Identification and susceptibility of isolates was performed in the microbiology laboratory using Vitek 2 (bioMerieux, Durham, NC) – Baseline demographics and characteristics, risk factors, and therapeutic antibiotic regimens used were evaluated to assess 90-day all-cause mortality