3 results
Characteristics Associated with Death in Patients with Carbapenem-Resistant Acinetobacter baumannii, United States, 2012–2017
- Hannah E. Reses, Kelly Hatfield, Jesse Jacob, Chris Bower, Elisabeth Vaeth, Jacquelyn Mounsey, Daniel Muleta, Medora Witwer, Ghinwa Dumyati, Emily Hancock, James Baggs, Maroya Walters, Sandra Bulens
-
- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s59-s60
- Print publication:
- October 2020
-
- Article
-
- You have access Access
- Export citation
-
Background: Carbapenem-resistant Acinetobacter baumannii (CRAB) is an important cause of healthcare-associated infections with limited treatment options and high mortality. To describe risk factors for mortality, we evaluated characteristics associated with 30-day mortality in patients with CRAB identified through the Emerging Infections Program (EIP). Methods: From January 2012 through December 2017, 8 EIP sites (CO, GA, MD, MN, NM, NY, OR, TN) participated in active, laboratory-, and population-based surveillance for CRAB. An incident case was defined as patient’s first isolation in a 30-day period of A. baumannii complex from sterile sites or urine with resistance to ≥1 carbapenem (excluding ertapenem). Medical records were abstracted. Patients were matched to state vital records to assess mortality within 30 days of incident culture collection. We developed 2 multivariable logistic regression models (1 for sterile site cases and 1 for urine cases) to evaluate characteristics associated with 30-day mortality. Results: We identified 744 patients contributing 863 cases, of which 185 of 863 cases (21.4%) died within 30 days of culture, including 113 of 257 cases (44.0%) isolated from a sterile site and 72 of 606 cases (11.9%) isolated from urine. Among 628 hospitalized cases, death occurred in 159 cases (25.3%). Among hospitalized fatal cases, death occurred after hospital discharge in 27 of 57 urine cases (47.4%) and 21 of 102 cases from sterile sites (20.6%). Among sterile site cases, female sex, intensive care unit (ICU) stay after culture, location in a healthcare facility, including a long-term care facility (LTCF), 3 days before culture, and diagnosis of septic shock were associated with increased odds of death in the model (Fig. 1). In urine cases, age 40–54 or ≥75 years, ICU stay after culture, presence of an indwelling device other than a urinary catheter or central line (eg, endotracheal tube), location in a LTCF 3 days before culture, diagnosis of septic shock, and Charlson comorbidity score ≥3 were associated with increased odds of mortality (Fig. 2). Conclusion: Overall 30-day mortality was high among patients with CRAB, including patients with CRAB isolated from urine. A substantial fraction of mortality occurred after discharge, especially among patients with urine cases. Although there were some differences in characteristics associated with mortality in patients with CRAB isolated from sterile sites versus urine, LTCF exposure and severe illness were associated with mortality in both patient groups. CRAB was associated with major mortality in these patients with evidence of healthcare experience and complex illness. More work is needed to determine whether prevention of CRAB infections would improve outcomes.
Funding: None
Disclosures: None
Carbapenem-Resistant Acinetobacter baumannii Incidence Trends Identified Through the Emerging Infections Program, 2012–2018
- Sandra Bulens, Sophia Kazakova, Hannah E. Reses, Sarah Yi, James Baggs, Jesse Jacob, Chris Bower, Elisabeth Vaeth, Marion Kainer, Jacquelyn Mounsey, Daniel Muleta, Wendy Bamberg, Helen Johnston, Medora Witwer, Meghan Maloney, Ghinwa Dumyati, Nicole Stabach, Rebecca Pierce, Emily Hancock, Maroya Walters
-
- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s462-s463
- Print publication:
- October 2020
-
- Article
-
- You have access Access
- Export citation
-
Background: Carbapenem-resistant Acinetobacter baumannii (CRAB) is a serious threat to patient safety due to limited treatment options and propensity to spread in healthcare settings. Using Emerging Infections Program (EIP) data, we describe changes in CRAB incidence and epidemiology. Methods: During January 2012 to December 2018, 9 sites (Colorado, Connecticut, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, and Tennessee) participated in active laboratory- and population-based surveillance. An incident case was defined as the first isolation of A. baumannii complex, in a 30-day period, resistant to ≥1 carbapenem (excluding ertapenem) from a normally sterile site or urine of a surveillance area resident. Cases were considered hospital-onset (HO) if the culture was collected >3 days after hospital admission; all others were community-onset (CO). Cases were classified as device-associated (DA) if the patient had 1 or more medical devices (ie, urinary catheter, central venous catheter (CVC), endotracheal/nasotracheal tube, tracheostomy, or another indwelling device) present in the 2 days prior to culture collection. Temporal trends were estimated using generalized linear models adjusted for age, race, sex, and EIP site. Results: Overall, 984 incident CRAB cases were identified, representing 849 patients. Among these patients, 291 (34%) were women, 510 (61%) were nonwhite, and the median age was 62 years (mean, 59; range, 0–102). Among the cases, 226 (23%) were HO; 758 (77%) were CO; and 793 (81%) were DA. Overall incidence rates in 2012 and 2018 were 1.58 (95% CI, 1.29–1.90) and 0.60 (95% CI, 0.40–0.67) per 100,000 population, respectively. There was a 15% annual decrease in incidence (adjusted rate ratio [aRR] 0.85; 95% CI: 0.82-0.88, P < .0001). Decreases were observed among sterile site (aRR 0.88; 95% CI, 0.84–0.93) and urine cases (aRR 0.83; 95% CI, 0.80–0.87). Annual decreases occurred for HO cases (aRR, 0.78; 95% CI, 0.73–0.85) and CO cases (aRR, 0.86; 95% CI, 0.83–0.9). The DA cases decreased 16% annually overall (aRR, 0.84; 95% CI, 0.81–0.88). Decreases among cases in patients with CVC (aRR, 0.85; 95% CI, 0.80–0.90) and urinary catheters (aRR, 0.84; 95% CI, 0.80–0.88) were smaller than what was seen in patients with other indwelling devices (aRR, 0.81; 95% CI, 0.77–0.86). Discussion: Overall, from 2012 to 2018, the incidence of CRAB decreased >60%. Decreases were observed in all case groups, regardless of source, infection onset location, or types of devices. Smaller annual decreases in rates of CO-CRAB than HO-CRAB suggest that there may be opportunities to accelerate prevention outside the hospital to further reduce the incidence of these difficult-to-treat infections.
Funding: None
Disclosures: None
13 - Radical reading? Working-class libraries in the nineteenth and early twentieth centuries
- from Part Two - The Voluntary Ethic: Libraries of our Own
-
- By Chris Baggs
- Edited by Alistair Black, Peter Hoare
-
- Book:
- The Cambridge History of Libraries in Britain and Ireland
- Published online:
- 28 March 2008
- Print publication:
- 26 October 2006, pp 169-179
-
- Chapter
- Export citation
-
Summary
Introduction
Had you conducted a library audit in many towns in the industrial North of England between 1860 and 1880, or the mining communities of South Wales between 1895 and 1914, you would have encountered numerous libraries, which were not part of the public library system, but instead belonged to the local Co-operative Society or Miners' Institute respectively. Why should that have been? Why, when the legislation allowing for local authority provision had been passed in 1850, should these alternative libraries not just be flourishing, but have been established in the first place?
This chapter investigates the phenomenon of independent working-class libraries in Great Britain in the nineteenth and early twentieth centuries, looking for broad explanations as to their origins. Were they a conscious attempt by this newly emerging and, then, increasingly self-confident class to break clear of middle-class hegemony? Could their existence in part be understood by the phenomenon of ‘radical reading’, i.e. that the reading practices of the working class involved materials that were politically, economically, socially and culturally radical in their outlook? Were there more mundane reasons for their existence?
The discussion concentrates on those libraries associated with working-class organisations and groups; libraries that arose from a collective response to reading needs based on either a common group identity or a shared ideological position. It does not attempt to deal with those countless libraries assembled by individual working people, acting on their own. These organisations and groups were many and varied, but to come within this chapter's parameters the libraries must essentially be self-administered and self-financed by the working class, and not provided for them via some external agency.