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Modeling Spread of KPC-Producing Bacteria in Long-Term Acute Care Hospitals in the Chicago Region, USA
- Manon R. Haverkate, Martin C. J. Bootsma, Shayna Weiner, Donald Blom, Michael Y. Lin, Karen Lolans, Nicholas M. Moore, Rosie D. Lyles, Robert A. Weinstein, Marc J. M. Bonten, Mary K. Hayden
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 36 / Issue 10 / October 2015
- Published online by Cambridge University Press:
- 24 July 2015, pp. 1148-1154
- Print publication:
- October 2015
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- Article
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OBJECTIVE
Prevalence of blaKPC-encoding Enterobacteriaceae (KPC) in Chicago long-term acute care hospitals (LTACHs) rose rapidly after the first recognition in 2007. We studied the epidemiology and transmission capacity of KPC in LTACHs and the effect of patient cohorting.
METHODSData were available from 4 Chicago LTACHs from June 2012 to June 2013 during a period of bundled interventions. These consisted of screening for KPC rectal carriage, daily chlorhexidine bathing, medical staff education, and 3 cohort strategies: a pure cohort (all KPC-positive patients on 1 floor), single rooms for KPC-positive patients, and a mixed cohort (all KPC-positive patients on 1 floor, supplemented with KPC-negative patients). A data-augmented Markov chain Monte Carlo (MCMC) method was used to model the transmission process.
RESULTSAverage prevalence of KPC colonization was 29.3%. On admission, 18% of patients were colonized; the sensitivity of the screening process was 81%. The per admission reproduction number was 0.40. The number of acquisitions per 1,000 patient days was lowest in LTACHs with a pure cohort ward or single rooms for colonized patients compared with mixed-cohort wards, but 95% credible intervals overlapped.
CONCLUSIONSPrevalence of KPC in LTACHs is high, primarily due to high admission prevalence and the resultant impact of high colonization pressure on cross transmission. In this setting, with an intervention in place, patient-to-patient transmission is insufficient to maintain endemicity. Inclusion of a pure cohort or single rooms for KPC-positive patients in an intervention bundle seemed to limit transmission compared to use of a mixed cohort.
Infect Control Hosp Epidemiol 2015;36(10):1148–1154
Contributors
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- By Douglas L. Arnold, Laura J. Balcer, Amit Bar-Or, Sergio E. Baranzini, Frederik Barkhof, Robert A. Bermel, Francois A. Bethoux, Dennis N. Bourdette, Richard K. Burt, Peter A. Calabresi, Zografos Caramanos, Tanuja Chitnis, Stacey S. Cofield, Jeffrey A. Cohen, Nadine Cohen, Alasdair J. Coles, Devon Conway, Stuart D. Cook, Gary R. Cutter, Peter J. Darlington, Ann Dodds-Frerichs, Ranjan Dutta, Gilles Edan, Michelle Fabian, Franz Fazekas, Massimo Filippi, Elizabeth Fisher, Paulo Fontoura, Corey C. Ford, Robert J. Fox, Natasha Frost, Alex Z. Fu, Siegrid Fuchs, Kazuo Fujihara, Kristin M. Galetta, Jeroen J.G. Geurts, Gavin Giovannoni, Nada Gligorov, Ralf Gold, Andrew D. Goodman, Myla D. Goldman, Jenny Guerre, Stephen L. Hauser, Peter B. Imrey, Douglas R. Jeffery, Stephen E. Jones, Adam I. Kaplin, Michael W. Kattan, B. Mark Keegan, Kyle C. Kern, Zhaleh Khaleeli, Samia J. Khoury, Joep Killestein, Soo Hyun Kim, R. Philip Kinkel, Stephen C. Krieger, Lauren B. Krupp, Emmanuelle Le Page, David Leppert, Scott Litwiller, Fred D. Lublin, Henry F. McFarland, Joseph C. McGowan, Don Mahad, Jahangir Maleki, Ruth Ann Marrie, Paul M. Matthews, Francesca Milanetti, Aaron E. Miller, Deborah M. Miller, Xavier Montalban, Charity J. Morgan, Ichiro Nakashima, Sridar Narayanan, Avindra Nath, Paul W. O’Connor, Jorge R. Oksenberg, A. John Petkau, Michael D. Phillips, J. Theodore Phillips, Tammy Phinney, Sean J. Pittock, Sarah M. Planchon, Chris H. Polman, Alexander Rae-Grant, Stephen M. Rao, Stephen C. Reingold, Maria A. Rocca, Richard A. Rudick, Amber R. Salter, Paula Sandler, Jaume Sastre-Garriga, John R. Scagnelli, Dana J. Serafin, Lynne Shinto, Nancy L. Sicotte, Jack H. Simon, Per Soelberg Sørensen, Ryan E. Stagg, James M. Stankiewicz, Lael A. Stone, Amy Sullivan, Matthew Sutliff, Jessica Szpak, Alan J. Thompson, Bruce D. Trapp, Helen Tremlett, Maria Trojano, Orla Tuohy, Rhonda R. Voskuhl, Marc K. Walton, Mike P. Wattjes, Emmanuelle Waubant, Martin S. Weber, Howard L Weiner, Brian G. Weinshenker, Bianca Weinstock-Guttman, Jeffrey L. Winters, Jerry S. Wolinsky, Vijayshree Yadav, E. Ann Yeh, Scott S. Zamvil
- Edited by Jeffrey A. Cohen, Richard A. Rudick
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- Book:
- Multiple Sclerosis Therapeutics
- Published online:
- 05 December 2011
- Print publication:
- 20 October 2011, pp viii-xii
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Response to Walter Sokel
- Edited by Stephen D. Dowden, Brandeis University, Massachusetts, Meike G. Werner, Vanderbilt University, Tennessee
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- Book:
- German Literature, Jewish Critics
- Published by:
- Boydell & Brewer
- Published online:
- 03 May 2023
- Print publication:
- 15 November 2002, pp 207-212
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Summary
As always, Professor Sokel has provided us with a text that is both rich and thought-provoking, a text in which he elegantly and forthrightly employs the insights of cultural psychoanalysis — with which we all associate his groundbreaking work on Kafka and Expressionism — in a candid discussion of the trajectory of his own life and career. As someone who is two intellectual generations removed from Professor Sokel, I feel indebted to him and honored to have been asked to discuss some of the issues and questions that his reflections have engendered. In what follows, I wish to make some observations that I feel might serve to illuminate: (1) the degree to which Professor Sokel’s experience is representative of his generation; (2) some of the methodological issues and assumptions underlying his reflections on his career; and, above all (3) the ideological implications, whether intended or unacknowledged, of his approach to the material he has chosen to discuss.
The first observation I wish to make is perhaps the most obvious and concerns the belief, harbored in Professor Sokel’s youth, that the Germany represented in its literature and other arts may act as a model of a cultural, and perhaps communal, essence that is superior to the realm of politics, and indeed even a counter to it. Of course, such a belief has a longstanding tradition in the bourgeoisie of which Professor Sokel writes and is perhaps most emphatically and encyclopedically articulated in Stefan Zweig’s classic Die Welt von Gestern (1944), in which time and again the author, like most of the writers Zweig cites of his generation, valorizes aesthetic production as the vessel in which the cultural essence of a nation might be preserved from the barbarous and more base political reality surrounding it. From this notion it is but a small step to the émigrés’ investment in their identity as the “true” representatives of German-speaking culture, as “das andere, bessere Deutschland.”