IDWeek 2012

SAN DIEGO – Conducting preoperative nasal screening and decolonization of Staphylococcus aureus in patients undergoing cardiothoracic surgery led to a significant reduction in the rate of all sternal surgical site infections, including those attributable to S. aureus, results from a large single-center study showed.

"Staphylococcus aureus sternal surgical site infections [SSIs] are associated with significant morbidity and mortality," lead researcher Jennifer Madigan said in an interview following IDWeek 2012, the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. "Multiple studies in the past have shown that screening and decolonization of S. aureus carriers are associated with a reduction in sternal SSIs."

One recent intervention that identified S. aureus nasal carriers concluded that S. aureus SSIs can be reduced by rapid screening and decolonization of nares on hospital admission (N. Engl. J. Med. 2010;362:9-17). "This study used [polymerase chain reaction testing] for identification of S. aureus nasal carriers, followed by treatment with mupirocin nasal ointment and chlorhexidine soap," said Ms. Madigan of the department of infection prevention and control at St. John Hospital and Medical Center, Detroit. "The results showed more than a 50% reduction in S. aureus infections."

Ms. Madigan and her associates compared the SSI rates 57 months before and 24 months after initiation of an S. aureus decolonization program for cardiothoracic surgery patients. For this program S. aureus nasal carriers were decolonized with mupirocin nasal ointment daily for 5 days and were asked to bathe with chlorhexidine gluconate rinse for 5 days immediately before surgery. The researchers reported results from 580 patients who were screened from April 2010 through March 2012. Of these patients, 118 (20%) tested positive for S. aureus colonization, including 34 (6%) who tested positive for methicillin-resistant S. aureus.

After the S. aureus decolonization program was initiated, the rate of postoperative sternal SSIs following coronary artery bypass grafting (CABG) decreased by 65% (from 76 infections per 1,416 cases before screening to 8 infections per 427 cases after screening; P = .0019), with a 75% drop in the number of mediastinitis cases (from 39 infections per 1,416 cases before screening to 3 infections per 427 cases after screening; P = .0106).

The researchers also found that sternal SSIs attributable to S. aureus dropped by 82% (from 39 infections per 1,416 cases before screening to 2 infections per 427 cases after screening; P = .0044), with S. aureus mediastinitis dropping by 87% (from 21 infections per 1,416 cases before screening to 1 infection per 427 cases after screening; P = .0337).

"We encourage hospitals that perform CABG surgeries to incorporate this [decolonization program] into their process," Ms. Madigan said. "The program is associated with significant reductions in infection, morbidity, and mortality. It provides a great tool to reduce the risk of patient harm. In addition, this may have a positive financial impact on hospitals as mediastinitis is no longer a reimbursable condition."

Ms. Madigan said that she had no relevant financial conflicts.

SAN DIEGO – Conducting preoperative nasal screening and decolonization of Staphylococcus aureus in patients undergoing cardiothoracic surgery led to a significant reduction in the rate of all sternal surgical site infections, including those attributable to S. aureus, results from a large single-center study showed.

"Staphylococcus aureus sternal surgical site infections [SSIs] are associated with significant morbidity and mortality," lead researcher Jennifer Madigan said in an interview following IDWeek 2012, the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. "Multiple studies in the past have shown that screening and decolonization of S. aureus carriers are associated with a reduction in sternal SSIs."

One recent intervention that identified S. aureus nasal carriers concluded that S. aureus SSIs can be reduced by rapid screening and decolonization of nares on hospital admission (N. Engl. J. Med. 2010;362:9-17). "This study used [polymerase chain reaction testing] for identification of S. aureus nasal carriers, followed by treatment with mupirocin nasal ointment and chlorhexidine soap," said Ms. Madigan of the department of infection prevention and control at St. John Hospital and Medical Center, Detroit. "The results showed more than a 50% reduction in S. aureus infections."

Ms. Madigan and her associates compared the SSI rates 57 months before and 24 months after initiation of an S. aureus decolonization program for cardiothoracic surgery patients. For this program S. aureus nasal carriers were decolonized with mupirocin nasal ointment daily for 5 days and were asked to bathe with chlorhexidine gluconate rinse for 5 days immediately before surgery. The researchers reported results from 580 patients who were screened from April 2010 through March 2012. Of these patients, 118 (20%) tested positive for S. aureus colonization, including 34 (6%) who tested positive for methicillin-resistant S. aureus.

After the S. aureus decolonization program was initiated, the rate of postoperative sternal SSIs following coronary artery bypass grafting (CABG) decreased by 65% (from 76 infections per 1,416 cases before screening to 8 infections per 427 cases after screening; P = .0019), with a 75% drop in the number of mediastinitis cases (from 39 infections per 1,416 cases before screening to 3 infections per 427 cases after screening; P = .0106).

The researchers also found that sternal SSIs attributable to S. aureus dropped by 82% (from 39 infections per 1,416 cases before screening to 2 infections per 427 cases after screening; P = .0044), with S. aureus mediastinitis dropping by 87% (from 21 infections per 1,416 cases before screening to 1 infection per 427 cases after screening; P = .0337).

"We encourage hospitals that perform CABG surgeries to incorporate this [decolonization program] into their process," Ms. Madigan said. "The program is associated with significant reductions in infection, morbidity, and mortality. It provides a great tool to reduce the risk of patient harm. In addition, this may have a positive financial impact on hospitals as mediastinitis is no longer a reimbursable condition."

Ms. Madigan said that she had no relevant financial conflicts.

SAN DIEGO – Conducting preoperative nasal screening and decolonization of Staphylococcus aureus in patients undergoing cardiothoracic surgery led to a significant reduction in the rate of all sternal surgical site infections, including those attributable to S. aureus, results from a large single-center study showed.

"Staphylococcus aureus sternal surgical site infections [SSIs] are associated with significant morbidity and mortality," lead researcher Jennifer Madigan said in an interview following IDWeek 2012, the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. "Multiple studies in the past have shown that screening and decolonization of S. aureus carriers are associated with a reduction in sternal SSIs."

One recent intervention that identified S. aureus nasal carriers concluded that S. aureus SSIs can be reduced by rapid screening and decolonization of nares on hospital admission (N. Engl. J. Med. 2010;362:9-17). "This study used [polymerase chain reaction testing] for identification of S. aureus nasal carriers, followed by treatment with mupirocin nasal ointment and chlorhexidine soap," said Ms. Madigan of the department of infection prevention and control at St. John Hospital and Medical Center, Detroit. "The results showed more than a 50% reduction in S. aureus infections."

Ms. Madigan and her associates compared the SSI rates 57 months before and 24 months after initiation of an S. aureus decolonization program for cardiothoracic surgery patients. For this program S. aureus nasal carriers were decolonized with mupirocin nasal ointment daily for 5 days and were asked to bathe with chlorhexidine gluconate rinse for 5 days immediately before surgery. The researchers reported results from 580 patients who were screened from April 2010 through March 2012. Of these patients, 118 (20%) tested positive for S. aureus colonization, including 34 (6%) who tested positive for methicillin-resistant S. aureus.

After the S. aureus decolonization program was initiated, the rate of postoperative sternal SSIs following coronary artery bypass grafting (CABG) decreased by 65% (from 76 infections per 1,416 cases before screening to 8 infections per 427 cases after screening; P = .0019), with a 75% drop in the number of mediastinitis cases (from 39 infections per 1,416 cases before screening to 3 infections per 427 cases after screening; P = .0106).

The researchers also found that sternal SSIs attributable to S. aureus dropped by 82% (from 39 infections per 1,416 cases before screening to 2 infections per 427 cases after screening; P = .0044), with S. aureus mediastinitis dropping by 87% (from 21 infections per 1,416 cases before screening to 1 infection per 427 cases after screening; P = .0337).

"We encourage hospitals that perform CABG surgeries to incorporate this [decolonization program] into their process," Ms. Madigan said. "The program is associated with significant reductions in infection, morbidity, and mortality. It provides a great tool to reduce the risk of patient harm. In addition, this may have a positive financial impact on hospitals as mediastinitis is no longer a reimbursable condition."

Ms. Madigan said that she had no relevant financial conflicts.

SAN DIEGO – Maternal acceptance of influenza vaccine during pregnancy and postpartum Tdap immunization both increase infant vaccination rates, results from a large single-center study showed.

"The postpartum period may be an optimal time for education of current threats related to vaccine-preventable infection for mothers and infants," lead study author Gina Calarco said in an interview after IDWeek 2012, the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. "Getting obstetricians and pediatricians actively discussing and educating their patients during this critical period appears to benefit both maternal and infant vaccination rates."

Ms. Calarco and her coinvestigators enrolled 900 postpartum women-infant dyads cared for at Shawnee Mission (Kan.) Medical Center in a prospective study intended to evaluate Tdap vaccine acceptance. This particular hospital was targeted as the research site because of its "location in a relatively affluent area with higher education and socioeconomic status and the highest birth rates in the bistate area," explained Ms. Calarco, who led the study during her tenure as infectious disease study coordinator at Children’s Mercy Hospitals and Clinics in Kansas City, Mo. "In past studies this type of demographic has been known to be vaccine hesitant and this is why we chose this facility. We compared maternal acceptance of Tdap to the infant’s 3-month vaccine record to determine if there are any early indicators of vaccine-hesitant parents. Our overall question was to determine if mom declined vaccination of herself, is she more likely to not fully vaccinate her infant, or conversely if a mom accepts Tdap, does that impact her infant’s vaccine status at 3 months of age."

The mean age of the study participants was 28 years, 83% were white, 66% were married, and 67% had private insurance. Ms. Calarco, who is now a clinical project manager with Quintiles in Overland Park, Kan., reported that 597 of the mothers (66%) received Tdap prior to discharge and 269 (30%) declined the vaccine, while 34 (4%) had received Tdap within 2 years and thus were not currently eligible to receive the vaccine prior to discharge.

A total of 757 maternal Tdap and infant vaccine records and 740 maternal influenza and infant vaccine records were available for analysis. The records revealed that mothers who accepted Tdap were 13.5 times more likely to fully immunize their infant than not to do so. In addition, mothers who received the influenza vaccine were 1.85 times more likely to fully immunize their children than were mothers who did not receive the influenza vaccine.

When the researchers adjusted for maternal age, they found that mothers older than 28 years had a 6% per year increase in having a fully vaccinated infant (OR, 1.06) However, the 34 mothers who had Tdap within the previous 2 years were less likely to have a fully vaccinated infant, compared with other mothers in the study (OR, 0.28). "This was surprising in that these women had accepted Tdap for themselves previously yet were not as likely to immunize their infant," Ms. Calarco commented. "We haven’t explored this finding further, but it may be that the education supplied when they received Tdap was too far removed from them vaccinating their infant, or maybe they received a required tetanus booster vaccine due to an accident and this wasn’t as much [of] a choice."

The study was supported by a grant from the Kenneth and Eva Smith Foundation. Ms. Calarco said she had no relevant financial disclosures.

SAN DIEGO – Maternal acceptance of influenza vaccine during pregnancy and postpartum Tdap immunization both increase infant vaccination rates, results from a large single-center study showed.

"The postpartum period may be an optimal time for education of current threats related to vaccine-preventable infection for mothers and infants," lead study author Gina Calarco said in an interview after IDWeek 2012, the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. "Getting obstetricians and pediatricians actively discussing and educating their patients during this critical period appears to benefit both maternal and infant vaccination rates."

Ms. Calarco and her coinvestigators enrolled 900 postpartum women-infant dyads cared for at Shawnee Mission (Kan.) Medical Center in a prospective study intended to evaluate Tdap vaccine acceptance. This particular hospital was targeted as the research site because of its "location in a relatively affluent area with higher education and socioeconomic status and the highest birth rates in the bistate area," explained Ms. Calarco, who led the study during her tenure as infectious disease study coordinator at Children’s Mercy Hospitals and Clinics in Kansas City, Mo. "In past studies this type of demographic has been known to be vaccine hesitant and this is why we chose this facility. We compared maternal acceptance of Tdap to the infant’s 3-month vaccine record to determine if there are any early indicators of vaccine-hesitant parents. Our overall question was to determine if mom declined vaccination of herself, is she more likely to not fully vaccinate her infant, or conversely if a mom accepts Tdap, does that impact her infant’s vaccine status at 3 months of age."

The mean age of the study participants was 28 years, 83% were white, 66% were married, and 67% had private insurance. Ms. Calarco, who is now a clinical project manager with Quintiles in Overland Park, Kan., reported that 597 of the mothers (66%) received Tdap prior to discharge and 269 (30%) declined the vaccine, while 34 (4%) had received Tdap within 2 years and thus were not currently eligible to receive the vaccine prior to discharge.

A total of 757 maternal Tdap and infant vaccine records and 740 maternal influenza and infant vaccine records were available for analysis. The records revealed that mothers who accepted Tdap were 13.5 times more likely to fully immunize their infant than not to do so. In addition, mothers who received the influenza vaccine were 1.85 times more likely to fully immunize their children than were mothers who did not receive the influenza vaccine.

When the researchers adjusted for maternal age, they found that mothers older than 28 years had a 6% per year increase in having a fully vaccinated infant (OR, 1.06) However, the 34 mothers who had Tdap within the previous 2 years were less likely to have a fully vaccinated infant, compared with other mothers in the study (OR, 0.28). "This was surprising in that these women had accepted Tdap for themselves previously yet were not as likely to immunize their infant," Ms. Calarco commented. "We haven’t explored this finding further, but it may be that the education supplied when they received Tdap was too far removed from them vaccinating their infant, or maybe they received a required tetanus booster vaccine due to an accident and this wasn’t as much [of] a choice."

The study was supported by a grant from the Kenneth and Eva Smith Foundation. Ms. Calarco said she had no relevant financial disclosures.

SAN DIEGO – Maternal acceptance of influenza vaccine during pregnancy and postpartum Tdap immunization both increase infant vaccination rates, results from a large single-center study showed.

"The postpartum period may be an optimal time for education of current threats related to vaccine-preventable infection for mothers and infants," lead study author Gina Calarco said in an interview after IDWeek 2012, the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. "Getting obstetricians and pediatricians actively discussing and educating their patients during this critical period appears to benefit both maternal and infant vaccination rates."

Ms. Calarco and her coinvestigators enrolled 900 postpartum women-infant dyads cared for at Shawnee Mission (Kan.) Medical Center in a prospective study intended to evaluate Tdap vaccine acceptance. This particular hospital was targeted as the research site because of its "location in a relatively affluent area with higher education and socioeconomic status and the highest birth rates in the bistate area," explained Ms. Calarco, who led the study during her tenure as infectious disease study coordinator at Children’s Mercy Hospitals and Clinics in Kansas City, Mo. "In past studies this type of demographic has been known to be vaccine hesitant and this is why we chose this facility. We compared maternal acceptance of Tdap to the infant’s 3-month vaccine record to determine if there are any early indicators of vaccine-hesitant parents. Our overall question was to determine if mom declined vaccination of herself, is she more likely to not fully vaccinate her infant, or conversely if a mom accepts Tdap, does that impact her infant’s vaccine status at 3 months of age."

The mean age of the study participants was 28 years, 83% were white, 66% were married, and 67% had private insurance. Ms. Calarco, who is now a clinical project manager with Quintiles in Overland Park, Kan., reported that 597 of the mothers (66%) received Tdap prior to discharge and 269 (30%) declined the vaccine, while 34 (4%) had received Tdap within 2 years and thus were not currently eligible to receive the vaccine prior to discharge.

A total of 757 maternal Tdap and infant vaccine records and 740 maternal influenza and infant vaccine records were available for analysis. The records revealed that mothers who accepted Tdap were 13.5 times more likely to fully immunize their infant than not to do so. In addition, mothers who received the influenza vaccine were 1.85 times more likely to fully immunize their children than were mothers who did not receive the influenza vaccine.

When the researchers adjusted for maternal age, they found that mothers older than 28 years had a 6% per year increase in having a fully vaccinated infant (OR, 1.06) However, the 34 mothers who had Tdap within the previous 2 years were less likely to have a fully vaccinated infant, compared with other mothers in the study (OR, 0.28). "This was surprising in that these women had accepted Tdap for themselves previously yet were not as likely to immunize their infant," Ms. Calarco commented. "We haven’t explored this finding further, but it may be that the education supplied when they received Tdap was too far removed from them vaccinating their infant, or maybe they received a required tetanus booster vaccine due to an accident and this wasn’t as much [of] a choice."

The study was supported by a grant from the Kenneth and Eva Smith Foundation. Ms. Calarco said she had no relevant financial disclosures.

SAN DIEGO  – The incidence rate of serious bacterial infections in infants age 1 week to 3 months is relatively low, at 4.6/1,000 full-term births, results from a long-term study showed.

In addition, Escherichia coli is the most common cause of bacteremia, urinary tract infections, and meningitis in this patient population.

Courtesy CDC/Janice Haney Carr

Despite decades of research, the incidence rate and current risk factors of serious bacterial infections have not been performed," investigators led by Dr. Tara L. Greenhow wrote in a poster presented during IDWeek, the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Dr. Greenhow, a pediatric infectious disease specialist with Kaiser Permanente Northern California, San Francisco, and her associates retrospectively reviewed all blood, urine, cerebral spine fluid, and stool cultures in 216,005 full-term healthy infants aged 1 week to 3 months between Jan. 1, 2005, and Sept. 1, 2011. Cultures were collected in the outpatient setting, emergency department, or first 24 hours of hospitalization. Nonpathogens were excluded from the analysis.

During the study period, 871 infants had a total of 1,004 serious bacterial infections, including 841 urinary tract infections, 125 cases of bacteremia, 22 cases of bacterial gastroenteritis, and 16 cases of bacterial meningitis. A higher proportion of males than females were affected by each infection, with the exception of meningitis, which affected females in 9 cases (56%). No cases of Listeria or meningococcal infection were observed.

The researchers reported that the overall incidence rate of serious bacterial infections was 4.6/1,000 full-term births, while the incidence rate of febrile serious bacterial infections was 3.5/1,000 full-term births. The incidence rate of bacteremia, UTI, meningitis, and gastroenteritis was 0.58, 3.89, 0.08, and 0.10 per 1,000 full-term births, respectively.

E. coli was the culprit in 64% of bacteremia cases, 91% of UTIs, and 44% of meningitis cases, while Salmonella sp. was the most common cause of gastroenteritis (86%).

Other authors on the study were Yun-Yi Hung, Ph.D., and Dr. Arnd Herz. The project was funded by a community benefit grant from Kaiser Permanente Northern California. The investigators had no relevant financial disclosures.

SAN DIEGO  – The incidence rate of serious bacterial infections in infants age 1 week to 3 months is relatively low, at 4.6/1,000 full-term births, results from a long-term study showed.

In addition, Escherichia coli is the most common cause of bacteremia, urinary tract infections, and meningitis in this patient population.

Courtesy CDC/Janice Haney Carr

Despite decades of research, the incidence rate and current risk factors of serious bacterial infections have not been performed," investigators led by Dr. Tara L. Greenhow wrote in a poster presented during IDWeek, the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Dr. Greenhow, a pediatric infectious disease specialist with Kaiser Permanente Northern California, San Francisco, and her associates retrospectively reviewed all blood, urine, cerebral spine fluid, and stool cultures in 216,005 full-term healthy infants aged 1 week to 3 months between Jan. 1, 2005, and Sept. 1, 2011. Cultures were collected in the outpatient setting, emergency department, or first 24 hours of hospitalization. Nonpathogens were excluded from the analysis.

During the study period, 871 infants had a total of 1,004 serious bacterial infections, including 841 urinary tract infections, 125 cases of bacteremia, 22 cases of bacterial gastroenteritis, and 16 cases of bacterial meningitis. A higher proportion of males than females were affected by each infection, with the exception of meningitis, which affected females in 9 cases (56%). No cases of Listeria or meningococcal infection were observed.

The researchers reported that the overall incidence rate of serious bacterial infections was 4.6/1,000 full-term births, while the incidence rate of febrile serious bacterial infections was 3.5/1,000 full-term births. The incidence rate of bacteremia, UTI, meningitis, and gastroenteritis was 0.58, 3.89, 0.08, and 0.10 per 1,000 full-term births, respectively.

E. coli was the culprit in 64% of bacteremia cases, 91% of UTIs, and 44% of meningitis cases, while Salmonella sp. was the most common cause of gastroenteritis (86%).

Other authors on the study were Yun-Yi Hung, Ph.D., and Dr. Arnd Herz. The project was funded by a community benefit grant from Kaiser Permanente Northern California. The investigators had no relevant financial disclosures.

SAN DIEGO  – The incidence rate of serious bacterial infections in infants age 1 week to 3 months is relatively low, at 4.6/1,000 full-term births, results from a long-term study showed.

In addition, Escherichia coli is the most common cause of bacteremia, urinary tract infections, and meningitis in this patient population.

Courtesy CDC/Janice Haney Carr

Despite decades of research, the incidence rate and current risk factors of serious bacterial infections have not been performed," investigators led by Dr. Tara L. Greenhow wrote in a poster presented during IDWeek, the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Dr. Greenhow, a pediatric infectious disease specialist with Kaiser Permanente Northern California, San Francisco, and her associates retrospectively reviewed all blood, urine, cerebral spine fluid, and stool cultures in 216,005 full-term healthy infants aged 1 week to 3 months between Jan. 1, 2005, and Sept. 1, 2011. Cultures were collected in the outpatient setting, emergency department, or first 24 hours of hospitalization. Nonpathogens were excluded from the analysis.

During the study period, 871 infants had a total of 1,004 serious bacterial infections, including 841 urinary tract infections, 125 cases of bacteremia, 22 cases of bacterial gastroenteritis, and 16 cases of bacterial meningitis. A higher proportion of males than females were affected by each infection, with the exception of meningitis, which affected females in 9 cases (56%). No cases of Listeria or meningococcal infection were observed.

The researchers reported that the overall incidence rate of serious bacterial infections was 4.6/1,000 full-term births, while the incidence rate of febrile serious bacterial infections was 3.5/1,000 full-term births. The incidence rate of bacteremia, UTI, meningitis, and gastroenteritis was 0.58, 3.89, 0.08, and 0.10 per 1,000 full-term births, respectively.

E. coli was the culprit in 64% of bacteremia cases, 91% of UTIs, and 44% of meningitis cases, while Salmonella sp. was the most common cause of gastroenteritis (86%).

Other authors on the study were Yun-Yi Hung, Ph.D., and Dr. Arnd Herz. The project was funded by a community benefit grant from Kaiser Permanente Northern California. The investigators had no relevant financial disclosures.

SAN DIEGO – Typhoid vaccines continue to be 84% effective and should be given to patients who are traveling to typhoid endemic areas, based on the results of a survey of case reports to the Centers for Disease Control and Prevention.

Patients also need to be reminded to follow safe food and water precautions, since the vaccine is not 100% effective, Anna Newton, M.P.H., said in an interview during a poster session during IDWeek.

Ms. Newton and her colleagues analyzed the National Typhoid and Paratyphoid Fever Surveillance database from 2008-2010. Managed by Ms. Newton, this database contains demographic information, travel history, and typhoid vaccination status in the 5 years before illness onset in cases of typhoid fever and paratyphoid fever reported to the CDC by state and local health officials. The researchers estimated vaccine effectiveness by comparing vaccination rates in travelers who became infected.

From 2008 to 2010, the CDC received data regarding 977 travelers with typhoid fever and 241 with paratyphoid fever. Vaccination status was available in 65% of travelers with typhoid fever and 50% of those with paratyphoid fever. From this data the researchers estimated the vaccine effectiveness to be 84%, "which is on par with what we expected to find," Ms. Newton said. "The vaccine is moderately effective."

Only 6% of patients with typhoid fever and 29% with paratyphoid fever reported having received a typhoid vaccine within the past 5 years. Asia was the most common region of travel for patients with typhoid fever (94%) and paratyphoid fever (99%), with India being the most commonly reported destination country (57% and 67%, respectively).

CDC/Armed Forces Institute of Pathology, Charles N. Farmer

Two typhoid vaccines are currently available in the United States: a live attenuated oral vaccine (Vivotif, Crucell/Berna) and an intramuscular polysaccharide vaccine (Typhim Vi, Sanofi Pasteur). Neither is licensed for use in children younger than 2 years of age. Prior to the current analysis little had been known about the effectiveness of either vaccine in U.S. travelers, said Ms. Newton, a surveillance epidemiologist with the Enteric Diseases Epidemiology Branch of the Centers for Disease Control and Prevention, Atlanta.

Ms. Newton acknowledged certain limitations of the study, including the fact that many patients were excluded due to unknown vaccination status. "Improvement in completeness of reporting vaccination status and type of vaccine received could enhance the reliability of these estimates and could facilitate estimation of vaccine effectiveness for each vaccine," the researchers concluded in their abstract.

IDWEEK was the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. Ms. Newton said that she had no relevant financial conflicts to disclose.

SAN DIEGO – Typhoid vaccines continue to be 84% effective and should be given to patients who are traveling to typhoid endemic areas, based on the results of a survey of case reports to the Centers for Disease Control and Prevention.

Patients also need to be reminded to follow safe food and water precautions, since the vaccine is not 100% effective, Anna Newton, M.P.H., said in an interview during a poster session during IDWeek.

Ms. Newton and her colleagues analyzed the National Typhoid and Paratyphoid Fever Surveillance database from 2008-2010. Managed by Ms. Newton, this database contains demographic information, travel history, and typhoid vaccination status in the 5 years before illness onset in cases of typhoid fever and paratyphoid fever reported to the CDC by state and local health officials. The researchers estimated vaccine effectiveness by comparing vaccination rates in travelers who became infected.

From 2008 to 2010, the CDC received data regarding 977 travelers with typhoid fever and 241 with paratyphoid fever. Vaccination status was available in 65% of travelers with typhoid fever and 50% of those with paratyphoid fever. From this data the researchers estimated the vaccine effectiveness to be 84%, "which is on par with what we expected to find," Ms. Newton said. "The vaccine is moderately effective."

Only 6% of patients with typhoid fever and 29% with paratyphoid fever reported having received a typhoid vaccine within the past 5 years. Asia was the most common region of travel for patients with typhoid fever (94%) and paratyphoid fever (99%), with India being the most commonly reported destination country (57% and 67%, respectively).

CDC/Armed Forces Institute of Pathology, Charles N. Farmer

Two typhoid vaccines are currently available in the United States: a live attenuated oral vaccine (Vivotif, Crucell/Berna) and an intramuscular polysaccharide vaccine (Typhim Vi, Sanofi Pasteur). Neither is licensed for use in children younger than 2 years of age. Prior to the current analysis little had been known about the effectiveness of either vaccine in U.S. travelers, said Ms. Newton, a surveillance epidemiologist with the Enteric Diseases Epidemiology Branch of the Centers for Disease Control and Prevention, Atlanta.

Ms. Newton acknowledged certain limitations of the study, including the fact that many patients were excluded due to unknown vaccination status. "Improvement in completeness of reporting vaccination status and type of vaccine received could enhance the reliability of these estimates and could facilitate estimation of vaccine effectiveness for each vaccine," the researchers concluded in their abstract.

IDWEEK was the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. Ms. Newton said that she had no relevant financial conflicts to disclose.

SAN DIEGO – Typhoid vaccines continue to be 84% effective and should be given to patients who are traveling to typhoid endemic areas, based on the results of a survey of case reports to the Centers for Disease Control and Prevention.

Patients also need to be reminded to follow safe food and water precautions, since the vaccine is not 100% effective, Anna Newton, M.P.H., said in an interview during a poster session during IDWeek.

Ms. Newton and her colleagues analyzed the National Typhoid and Paratyphoid Fever Surveillance database from 2008-2010. Managed by Ms. Newton, this database contains demographic information, travel history, and typhoid vaccination status in the 5 years before illness onset in cases of typhoid fever and paratyphoid fever reported to the CDC by state and local health officials. The researchers estimated vaccine effectiveness by comparing vaccination rates in travelers who became infected.

From 2008 to 2010, the CDC received data regarding 977 travelers with typhoid fever and 241 with paratyphoid fever. Vaccination status was available in 65% of travelers with typhoid fever and 50% of those with paratyphoid fever. From this data the researchers estimated the vaccine effectiveness to be 84%, "which is on par with what we expected to find," Ms. Newton said. "The vaccine is moderately effective."

Only 6% of patients with typhoid fever and 29% with paratyphoid fever reported having received a typhoid vaccine within the past 5 years. Asia was the most common region of travel for patients with typhoid fever (94%) and paratyphoid fever (99%), with India being the most commonly reported destination country (57% and 67%, respectively).

CDC/Armed Forces Institute of Pathology, Charles N. Farmer

Two typhoid vaccines are currently available in the United States: a live attenuated oral vaccine (Vivotif, Crucell/Berna) and an intramuscular polysaccharide vaccine (Typhim Vi, Sanofi Pasteur). Neither is licensed for use in children younger than 2 years of age. Prior to the current analysis little had been known about the effectiveness of either vaccine in U.S. travelers, said Ms. Newton, a surveillance epidemiologist with the Enteric Diseases Epidemiology Branch of the Centers for Disease Control and Prevention, Atlanta.

Ms. Newton acknowledged certain limitations of the study, including the fact that many patients were excluded due to unknown vaccination status. "Improvement in completeness of reporting vaccination status and type of vaccine received could enhance the reliability of these estimates and could facilitate estimation of vaccine effectiveness for each vaccine," the researchers concluded in their abstract.

IDWEEK was the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. Ms. Newton said that she had no relevant financial conflicts to disclose.

SAN DIEGO – The concomitant use of probiotics and antibiotics associated with a high risk of acquiring Clostridium difficile infections increased the risk of developing C. difficile by nearly threefold, a single-center retrospective study showed.

"We were very surprised by this finding," Justine E. Dickson, Pharm. D., said in an interview at IDWeek, the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Dr. Dickson and her colleagues at Yale–New Haven Hospital evaluated 389 adult inpatients who received high-risk antibiotics for 5 days or more between July 1 and Dec. 31, 2010. High-risk antibiotics investigated included ceftriaxone, ciprofloxacin, clindamycin, imipenem-cilastatin, levofloxacin, and meropenem. Formulary probiotics investigated were Lactobacillus GG and Saccharomyces boulardii.

Of the 389 patients, 246 (63%) received antibiotics alone while 143 (37%) received antibiotics and a probiotic. A total of 20 patients (5%) developed a C. difficile infection (CDI) within 90 days of antibiotic use. The average duration of high-risk antibiotic use was 7.3 days among those who received probiotics and 7.7 days among those in the antibiotics-only group.

Dr. Dickson, who is now a PGY-2 ambulatory care pharmacy resident at the University Hospital in Cincinnati, reported that the incidence of CDI was 8.4% among patients who received probiotics compared with 3.3% in the antibiotics-only group. Levofloxacin was the most common high-risk antibiotic used by patients who developed a CDI, representing 65% of cases.

The risk of developing CDI among patients who received probiotics was 2.7 times higher than in patients in the antibiotics-only group, a difference that reached statistical significance. After controlling for the use of levofloxacin (the researchers initially speculated that this antibiotic might be a key culprit), they found that the relative risk remained similar, at 2.6 times higher among patients who received probiotics.

When the researchers factored in the concomitant use of proton pump inhibitors, the incidence of CDI did not differ among patients in the antibiotics-only group, but the concomitant use of probiotics further increased the risk of CDI, "which may suggest a potential interaction between these two drug classes," the researchers wrote in their abstract, which was presented during a poster session.

The investigators stated that they had no relevant financial conflicts to disclose.

SAN DIEGO – The concomitant use of probiotics and antibiotics associated with a high risk of acquiring Clostridium difficile infections increased the risk of developing C. difficile by nearly threefold, a single-center retrospective study showed.

"We were very surprised by this finding," Justine E. Dickson, Pharm. D., said in an interview at IDWeek, the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Dr. Dickson and her colleagues at Yale–New Haven Hospital evaluated 389 adult inpatients who received high-risk antibiotics for 5 days or more between July 1 and Dec. 31, 2010. High-risk antibiotics investigated included ceftriaxone, ciprofloxacin, clindamycin, imipenem-cilastatin, levofloxacin, and meropenem. Formulary probiotics investigated were Lactobacillus GG and Saccharomyces boulardii.

Of the 389 patients, 246 (63%) received antibiotics alone while 143 (37%) received antibiotics and a probiotic. A total of 20 patients (5%) developed a C. difficile infection (CDI) within 90 days of antibiotic use. The average duration of high-risk antibiotic use was 7.3 days among those who received probiotics and 7.7 days among those in the antibiotics-only group.

Dr. Dickson, who is now a PGY-2 ambulatory care pharmacy resident at the University Hospital in Cincinnati, reported that the incidence of CDI was 8.4% among patients who received probiotics compared with 3.3% in the antibiotics-only group. Levofloxacin was the most common high-risk antibiotic used by patients who developed a CDI, representing 65% of cases.

The risk of developing CDI among patients who received probiotics was 2.7 times higher than in patients in the antibiotics-only group, a difference that reached statistical significance. After controlling for the use of levofloxacin (the researchers initially speculated that this antibiotic might be a key culprit), they found that the relative risk remained similar, at 2.6 times higher among patients who received probiotics.

When the researchers factored in the concomitant use of proton pump inhibitors, the incidence of CDI did not differ among patients in the antibiotics-only group, but the concomitant use of probiotics further increased the risk of CDI, "which may suggest a potential interaction between these two drug classes," the researchers wrote in their abstract, which was presented during a poster session.

The investigators stated that they had no relevant financial conflicts to disclose.

SAN DIEGO – The concomitant use of probiotics and antibiotics associated with a high risk of acquiring Clostridium difficile infections increased the risk of developing C. difficile by nearly threefold, a single-center retrospective study showed.

"We were very surprised by this finding," Justine E. Dickson, Pharm. D., said in an interview at IDWeek, the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Dr. Dickson and her colleagues at Yale–New Haven Hospital evaluated 389 adult inpatients who received high-risk antibiotics for 5 days or more between July 1 and Dec. 31, 2010. High-risk antibiotics investigated included ceftriaxone, ciprofloxacin, clindamycin, imipenem-cilastatin, levofloxacin, and meropenem. Formulary probiotics investigated were Lactobacillus GG and Saccharomyces boulardii.

Of the 389 patients, 246 (63%) received antibiotics alone while 143 (37%) received antibiotics and a probiotic. A total of 20 patients (5%) developed a C. difficile infection (CDI) within 90 days of antibiotic use. The average duration of high-risk antibiotic use was 7.3 days among those who received probiotics and 7.7 days among those in the antibiotics-only group.

Dr. Dickson, who is now a PGY-2 ambulatory care pharmacy resident at the University Hospital in Cincinnati, reported that the incidence of CDI was 8.4% among patients who received probiotics compared with 3.3% in the antibiotics-only group. Levofloxacin was the most common high-risk antibiotic used by patients who developed a CDI, representing 65% of cases.

The risk of developing CDI among patients who received probiotics was 2.7 times higher than in patients in the antibiotics-only group, a difference that reached statistical significance. After controlling for the use of levofloxacin (the researchers initially speculated that this antibiotic might be a key culprit), they found that the relative risk remained similar, at 2.6 times higher among patients who received probiotics.

When the researchers factored in the concomitant use of proton pump inhibitors, the incidence of CDI did not differ among patients in the antibiotics-only group, but the concomitant use of probiotics further increased the risk of CDI, "which may suggest a potential interaction between these two drug classes," the researchers wrote in their abstract, which was presented during a poster session.

The investigators stated that they had no relevant financial conflicts to disclose.

SAN DIEGO – An outpatient antimicrobial stewardship intervention dramatically reduced inappropriate use of antibiotics for acute respiratory tract infections in children, judging from the findings of a trial reported at IDWeek.

In the cluster-randomized trial, which involved 185,212 pediatric patients making more than 1.4 million outpatient visits, the rate of inappropriate prescribing for these infections – use of a broad-spectrum antibiotic when guidelines recommended a narrow-spectrum one – fell by nearly half in the intervention group over a year, compared with about one-fifth in the control group.

Susan London/IMNG Medical Media

Led by Dr. Jeffrey Gerber, the investigators enrolled 18 practices in a large pediatric primary care network that share an electronic health record, randomizing them evenly to intervention and control groups.

The intervention had two parts: an on-site clinician education session, including a refresher in current guidelines for treating sinusitis, group A streptococcal pharyngitis, and pneumonia, and then private quarterly audit and feedback reports to physicians of their antibiotic prescribing for these conditions.

The reports "showed how they were prescribing relative to national guidelines at baseline and over time throughout the intervention for 12 months, compared with those in the practice group and across the network," explained Dr. Gerber of Children’s Hospital of Philadelphia. "So the idea is to not only show providers how they prescribe relative to national recommendations, but also to have what we call achievable benchmarks available, to show how other folks in busy practices just like theirs are prescribing."

The rate of off-guideline antibiotic prescribing for acute respiratory tract infections was 28% overall, with a range of 15%-60% across practices, according to data reported at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

One year after the intervention, the rate had fallen by 48% in the intervention group and by 18% in the control group (P = .001).

In stratified analyses, the greatest reduction was seen for pneumonia: The rate of off-guideline prescribing fell by 75% in the intervention group, compared with 6% in the control group.

For acute respiratory tract infections overall, azithromycin was the greatest contributor to off-guideline antibiotic prescribing. For pneumonia specifically, amoxicillin plus clavulanic acid (Augmentin) was the greatest contributor.

"We are really encouraged by these results. We think that it is a relatively simple intervention that we hope will be scalable to other pediatric practices that have electronic health records," Dr. Gerber commented in a related press briefing. The Agency for Healthcare Research and Quality, which funded the study, has provided an extra year of funding so that the intervention can be packaged and disseminated for use by other practices.

He predicted that the findings would be largely generalizable, given the good mix of practices and patients in the trial. "We don’t think yet it’s broadly applicable to every practice, but at the same time, to practices that use electronic health records," he said, noting that the simple algorithms used in the study draw on data routinely captured in these records.

The findings could have a major impact nationally, given that broad-spectrum antibiotics account for roughly half of the 40 million antibiotic prescriptions written per year for children in the United States for acute respiratory tract infections in the outpatient setting, according to Dr. Gerber. Not only are they more expensive than narrow-spectrum ones, but they also more rapidly promote resistance.

The study’s findings are "very powerful," commented Dr. Liise-Anne Pirofski, moderator of the press briefing and IDWeek Chair. "This is a fairly unique study and probably pretty groundbreaking."

Susan London/IMNG Medical Media

She wondered whether factors such as better taste or greater ease of once-daily dosing of several broad-spectrum antibiotics contribute to off-guideline prescribing and need to be taken into account. "In children, multidosing is difficult because most schools don’t administer antibiotics to children in school," she pointed out. Also, parents sometimes request specific antibiotics.

"These are real issues," and likely driving forces behind at least some off-guideline prescribing, Dr. Gerber agreed. "However, the societies that recommend antibiotics really have to take into account the spectrum of activity to be careful because of the development of antibiotic resistance."

In addition, emerging research suggests that, in at least some cases, more frequent dosing of narrow-spectrum agents is not necessary. For example, the American Academy of Pediatrics now endorses once-daily amoxicillin for treating strep throat. "That used to be dosed more frequently, but studies have shown that once-daily dosing is actually as effective. So that’s helped combat this issue a bit," he said.

Dr. Pirofski noted that it’s nice to see evidence of the benefits of electronic health records, as putting them in place is typically a major undertaking. "It will be very interesting if good studies are done to determine how much that watchdog effect is driving people’s behavior. If it is, then I think the electronic component is absolutely essential because it’s the only way that you can really generate that data and data that people will believe."

That said, face-to-face interaction should not be underestimated in such interventions, she maintained. "The personal interaction, I believe, is really what drove the early success of some of these antibiotic stewardships, because medicine can be very lonely. If somebody comes in and chats you up a little bit, you feel like you are more in tune with what’s going on. ... My own feeling is that personal interaction always drives change better than these other things," said Dr. Pirofski, who is chief of the division of infectious diseases at Albert Einstein College of Medicine, New York.

Ascertaining the cost effectiveness of the intervention would be complicated because of copayment and reimbursement issues, according to Dr. Gerber, but "most of these broad-spectrum agents are between five and ten times more expensive than the narrow-spectrum agents." He predicted that, as insurers move toward a bundled-payment model, costs will get greater attention. "Maybe insurance companies won’t reimburse for broad-spectrum agents if we can show that recommendations should be followed, and there are no differences in outcomes," he said.

The investigators plan to assess the impact of the intervention on health outcomes and will monitor the durability of its efficacy, Dr. Gerber said. "We are going to follow up for at least another year, now that there are no more feedback reports coming in, to see if it continues or if people revert back to their initial prescribing patterns," he explained. In addition, they are interviewing participating clinicians to obtain their viewpoints on prescribing and auditing, along with suggestions for improving the intervention.

Neither Dr. Gerber nor Dr. Pirofski disclosed any relevant conflicts of interest.

SAN DIEGO – An outpatient antimicrobial stewardship intervention dramatically reduced inappropriate use of antibiotics for acute respiratory tract infections in children, judging from the findings of a trial reported at IDWeek.

In the cluster-randomized trial, which involved 185,212 pediatric patients making more than 1.4 million outpatient visits, the rate of inappropriate prescribing for these infections – use of a broad-spectrum antibiotic when guidelines recommended a narrow-spectrum one – fell by nearly half in the intervention group over a year, compared with about one-fifth in the control group.

Susan London/IMNG Medical Media

Led by Dr. Jeffrey Gerber, the investigators enrolled 18 practices in a large pediatric primary care network that share an electronic health record, randomizing them evenly to intervention and control groups.

The intervention had two parts: an on-site clinician education session, including a refresher in current guidelines for treating sinusitis, group A streptococcal pharyngitis, and pneumonia, and then private quarterly audit and feedback reports to physicians of their antibiotic prescribing for these conditions.

The reports "showed how they were prescribing relative to national guidelines at baseline and over time throughout the intervention for 12 months, compared with those in the practice group and across the network," explained Dr. Gerber of Children’s Hospital of Philadelphia. "So the idea is to not only show providers how they prescribe relative to national recommendations, but also to have what we call achievable benchmarks available, to show how other folks in busy practices just like theirs are prescribing."

The rate of off-guideline antibiotic prescribing for acute respiratory tract infections was 28% overall, with a range of 15%-60% across practices, according to data reported at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

One year after the intervention, the rate had fallen by 48% in the intervention group and by 18% in the control group (P = .001).

In stratified analyses, the greatest reduction was seen for pneumonia: The rate of off-guideline prescribing fell by 75% in the intervention group, compared with 6% in the control group.

For acute respiratory tract infections overall, azithromycin was the greatest contributor to off-guideline antibiotic prescribing. For pneumonia specifically, amoxicillin plus clavulanic acid (Augmentin) was the greatest contributor.

"We are really encouraged by these results. We think that it is a relatively simple intervention that we hope will be scalable to other pediatric practices that have electronic health records," Dr. Gerber commented in a related press briefing. The Agency for Healthcare Research and Quality, which funded the study, has provided an extra year of funding so that the intervention can be packaged and disseminated for use by other practices.

He predicted that the findings would be largely generalizable, given the good mix of practices and patients in the trial. "We don’t think yet it’s broadly applicable to every practice, but at the same time, to practices that use electronic health records," he said, noting that the simple algorithms used in the study draw on data routinely captured in these records.

The findings could have a major impact nationally, given that broad-spectrum antibiotics account for roughly half of the 40 million antibiotic prescriptions written per year for children in the United States for acute respiratory tract infections in the outpatient setting, according to Dr. Gerber. Not only are they more expensive than narrow-spectrum ones, but they also more rapidly promote resistance.

The study’s findings are "very powerful," commented Dr. Liise-Anne Pirofski, moderator of the press briefing and IDWeek Chair. "This is a fairly unique study and probably pretty groundbreaking."

Susan London/IMNG Medical Media

She wondered whether factors such as better taste or greater ease of once-daily dosing of several broad-spectrum antibiotics contribute to off-guideline prescribing and need to be taken into account. "In children, multidosing is difficult because most schools don’t administer antibiotics to children in school," she pointed out. Also, parents sometimes request specific antibiotics.

"These are real issues," and likely driving forces behind at least some off-guideline prescribing, Dr. Gerber agreed. "However, the societies that recommend antibiotics really have to take into account the spectrum of activity to be careful because of the development of antibiotic resistance."

In addition, emerging research suggests that, in at least some cases, more frequent dosing of narrow-spectrum agents is not necessary. For example, the American Academy of Pediatrics now endorses once-daily amoxicillin for treating strep throat. "That used to be dosed more frequently, but studies have shown that once-daily dosing is actually as effective. So that’s helped combat this issue a bit," he said.

Dr. Pirofski noted that it’s nice to see evidence of the benefits of electronic health records, as putting them in place is typically a major undertaking. "It will be very interesting if good studies are done to determine how much that watchdog effect is driving people’s behavior. If it is, then I think the electronic component is absolutely essential because it’s the only way that you can really generate that data and data that people will believe."

That said, face-to-face interaction should not be underestimated in such interventions, she maintained. "The personal interaction, I believe, is really what drove the early success of some of these antibiotic stewardships, because medicine can be very lonely. If somebody comes in and chats you up a little bit, you feel like you are more in tune with what’s going on. ... My own feeling is that personal interaction always drives change better than these other things," said Dr. Pirofski, who is chief of the division of infectious diseases at Albert Einstein College of Medicine, New York.

Ascertaining the cost effectiveness of the intervention would be complicated because of copayment and reimbursement issues, according to Dr. Gerber, but "most of these broad-spectrum agents are between five and ten times more expensive than the narrow-spectrum agents." He predicted that, as insurers move toward a bundled-payment model, costs will get greater attention. "Maybe insurance companies won’t reimburse for broad-spectrum agents if we can show that recommendations should be followed, and there are no differences in outcomes," he said.

The investigators plan to assess the impact of the intervention on health outcomes and will monitor the durability of its efficacy, Dr. Gerber said. "We are going to follow up for at least another year, now that there are no more feedback reports coming in, to see if it continues or if people revert back to their initial prescribing patterns," he explained. In addition, they are interviewing participating clinicians to obtain their viewpoints on prescribing and auditing, along with suggestions for improving the intervention.

Neither Dr. Gerber nor Dr. Pirofski disclosed any relevant conflicts of interest.

SAN DIEGO – An outpatient antimicrobial stewardship intervention dramatically reduced inappropriate use of antibiotics for acute respiratory tract infections in children, judging from the findings of a trial reported at IDWeek.

In the cluster-randomized trial, which involved 185,212 pediatric patients making more than 1.4 million outpatient visits, the rate of inappropriate prescribing for these infections – use of a broad-spectrum antibiotic when guidelines recommended a narrow-spectrum one – fell by nearly half in the intervention group over a year, compared with about one-fifth in the control group.

Susan London/IMNG Medical Media

Led by Dr. Jeffrey Gerber, the investigators enrolled 18 practices in a large pediatric primary care network that share an electronic health record, randomizing them evenly to intervention and control groups.

The intervention had two parts: an on-site clinician education session, including a refresher in current guidelines for treating sinusitis, group A streptococcal pharyngitis, and pneumonia, and then private quarterly audit and feedback reports to physicians of their antibiotic prescribing for these conditions.

The reports "showed how they were prescribing relative to national guidelines at baseline and over time throughout the intervention for 12 months, compared with those in the practice group and across the network," explained Dr. Gerber of Children’s Hospital of Philadelphia. "So the idea is to not only show providers how they prescribe relative to national recommendations, but also to have what we call achievable benchmarks available, to show how other folks in busy practices just like theirs are prescribing."

The rate of off-guideline antibiotic prescribing for acute respiratory tract infections was 28% overall, with a range of 15%-60% across practices, according to data reported at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

One year after the intervention, the rate had fallen by 48% in the intervention group and by 18% in the control group (P = .001).

In stratified analyses, the greatest reduction was seen for pneumonia: The rate of off-guideline prescribing fell by 75% in the intervention group, compared with 6% in the control group.

For acute respiratory tract infections overall, azithromycin was the greatest contributor to off-guideline antibiotic prescribing. For pneumonia specifically, amoxicillin plus clavulanic acid (Augmentin) was the greatest contributor.

"We are really encouraged by these results. We think that it is a relatively simple intervention that we hope will be scalable to other pediatric practices that have electronic health records," Dr. Gerber commented in a related press briefing. The Agency for Healthcare Research and Quality, which funded the study, has provided an extra year of funding so that the intervention can be packaged and disseminated for use by other practices.

He predicted that the findings would be largely generalizable, given the good mix of practices and patients in the trial. "We don’t think yet it’s broadly applicable to every practice, but at the same time, to practices that use electronic health records," he said, noting that the simple algorithms used in the study draw on data routinely captured in these records.

The findings could have a major impact nationally, given that broad-spectrum antibiotics account for roughly half of the 40 million antibiotic prescriptions written per year for children in the United States for acute respiratory tract infections in the outpatient setting, according to Dr. Gerber. Not only are they more expensive than narrow-spectrum ones, but they also more rapidly promote resistance.

The study’s findings are "very powerful," commented Dr. Liise-Anne Pirofski, moderator of the press briefing and IDWeek Chair. "This is a fairly unique study and probably pretty groundbreaking."

Susan London/IMNG Medical Media

She wondered whether factors such as better taste or greater ease of once-daily dosing of several broad-spectrum antibiotics contribute to off-guideline prescribing and need to be taken into account. "In children, multidosing is difficult because most schools don’t administer antibiotics to children in school," she pointed out. Also, parents sometimes request specific antibiotics.

"These are real issues," and likely driving forces behind at least some off-guideline prescribing, Dr. Gerber agreed. "However, the societies that recommend antibiotics really have to take into account the spectrum of activity to be careful because of the development of antibiotic resistance."

In addition, emerging research suggests that, in at least some cases, more frequent dosing of narrow-spectrum agents is not necessary. For example, the American Academy of Pediatrics now endorses once-daily amoxicillin for treating strep throat. "That used to be dosed more frequently, but studies have shown that once-daily dosing is actually as effective. So that’s helped combat this issue a bit," he said.

Dr. Pirofski noted that it’s nice to see evidence of the benefits of electronic health records, as putting them in place is typically a major undertaking. "It will be very interesting if good studies are done to determine how much that watchdog effect is driving people’s behavior. If it is, then I think the electronic component is absolutely essential because it’s the only way that you can really generate that data and data that people will believe."

That said, face-to-face interaction should not be underestimated in such interventions, she maintained. "The personal interaction, I believe, is really what drove the early success of some of these antibiotic stewardships, because medicine can be very lonely. If somebody comes in and chats you up a little bit, you feel like you are more in tune with what’s going on. ... My own feeling is that personal interaction always drives change better than these other things," said Dr. Pirofski, who is chief of the division of infectious diseases at Albert Einstein College of Medicine, New York.

Ascertaining the cost effectiveness of the intervention would be complicated because of copayment and reimbursement issues, according to Dr. Gerber, but "most of these broad-spectrum agents are between five and ten times more expensive than the narrow-spectrum agents." He predicted that, as insurers move toward a bundled-payment model, costs will get greater attention. "Maybe insurance companies won’t reimburse for broad-spectrum agents if we can show that recommendations should be followed, and there are no differences in outcomes," he said.

The investigators plan to assess the impact of the intervention on health outcomes and will monitor the durability of its efficacy, Dr. Gerber said. "We are going to follow up for at least another year, now that there are no more feedback reports coming in, to see if it continues or if people revert back to their initial prescribing patterns," he explained. In addition, they are interviewing participating clinicians to obtain their viewpoints on prescribing and auditing, along with suggestions for improving the intervention.

Neither Dr. Gerber nor Dr. Pirofski disclosed any relevant conflicts of interest.

SAN DIEGO – Influenza can be deadly even in children with no underlying high-risk conditions, results from a national 8-year study demonstrated.

"Because kids with and without high-risk medical conditions can die quickly from influenza, prevention is the best defense, and all children 6 months of age or older should receive influenza vaccination annually," lead study investigator Dr. Karen K. Wong said in an interview prior to IDWeek 2012, where the research was presented.

Dr. Wong, an epidemic intelligence service officer with the influenza division at the Centers for Disease Control and Prevention, and her associates evaluated data from 829 influenza-associated deaths among children under age 18 that occurred in the United States between Oct. 1, 2004, and Sept. 30, 2012. Their median age was 7 years, and 35% of children died in the emergency department or outside the hospital.

Of the 793 children with a known medical history, 341 (43%) had no high-risk medical conditions, 33% reported neurologic disorders, 26% reported pulmonary disorders including asthma, and 12% reported genetic or chromosomal disorders. These exceeded 100% because more than one medical condition could be reported for a child.

The median duration of illness from symptom onset to death was shorter among children with no underlying high-risk medical conditions than in children with at least one high-risk medical condition (4 vs. 7 days, respectively; P less than .01).

Of 386 children with a specimen collected for bacterial culture from a normally sterile site whose results were available, 153 (40%) had at least one bacterial coinfection. Of those 153 children, the most common bacterial coinfection was Staphylococcus aureus, which was identified in 76 cases (50%).

"Influenza-associated deaths in children are rare," Dr. Wong said. "By including all reported influenza-associated pediatric deaths over an 8-year period in the United States, this study builds on prior smaller studies to describe the children at risk."

She said that she and her associates were surprised to find that 43% of the children who died of influenza-related illness "did not have any medical conditions that placed them at higher risk for influenza complications. Compared with children with high-risk conditions, these otherwise healthy children tended to be younger, and they were more likely to progress to death rapidly before being admitted to the hospital."

Dr. Wong acknowledged certain limitations of the study, including the fact that it was not designed to evaluate the impact of any interventions, such as vaccination or antiviral treatment. "Also, the national influenza-associated pediatric mortality surveillance system likely underestimates the true burden of influenza-associated death in children," she said.

IDWeek 2012 is the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Dr. Wong said that she had no relevant financial disclosures.

SAN DIEGO – Influenza can be deadly even in children with no underlying high-risk conditions, results from a national 8-year study demonstrated.

"Because kids with and without high-risk medical conditions can die quickly from influenza, prevention is the best defense, and all children 6 months of age or older should receive influenza vaccination annually," lead study investigator Dr. Karen K. Wong said in an interview prior to IDWeek 2012, where the research was presented.

Dr. Wong, an epidemic intelligence service officer with the influenza division at the Centers for Disease Control and Prevention, and her associates evaluated data from 829 influenza-associated deaths among children under age 18 that occurred in the United States between Oct. 1, 2004, and Sept. 30, 2012. Their median age was 7 years, and 35% of children died in the emergency department or outside the hospital.

Of the 793 children with a known medical history, 341 (43%) had no high-risk medical conditions, 33% reported neurologic disorders, 26% reported pulmonary disorders including asthma, and 12% reported genetic or chromosomal disorders. These exceeded 100% because more than one medical condition could be reported for a child.

The median duration of illness from symptom onset to death was shorter among children with no underlying high-risk medical conditions than in children with at least one high-risk medical condition (4 vs. 7 days, respectively; P less than .01).

Of 386 children with a specimen collected for bacterial culture from a normally sterile site whose results were available, 153 (40%) had at least one bacterial coinfection. Of those 153 children, the most common bacterial coinfection was Staphylococcus aureus, which was identified in 76 cases (50%).

"Influenza-associated deaths in children are rare," Dr. Wong said. "By including all reported influenza-associated pediatric deaths over an 8-year period in the United States, this study builds on prior smaller studies to describe the children at risk."

She said that she and her associates were surprised to find that 43% of the children who died of influenza-related illness "did not have any medical conditions that placed them at higher risk for influenza complications. Compared with children with high-risk conditions, these otherwise healthy children tended to be younger, and they were more likely to progress to death rapidly before being admitted to the hospital."

Dr. Wong acknowledged certain limitations of the study, including the fact that it was not designed to evaluate the impact of any interventions, such as vaccination or antiviral treatment. "Also, the national influenza-associated pediatric mortality surveillance system likely underestimates the true burden of influenza-associated death in children," she said.

IDWeek 2012 is the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Dr. Wong said that she had no relevant financial disclosures.

SAN DIEGO – Influenza can be deadly even in children with no underlying high-risk conditions, results from a national 8-year study demonstrated.

"Because kids with and without high-risk medical conditions can die quickly from influenza, prevention is the best defense, and all children 6 months of age or older should receive influenza vaccination annually," lead study investigator Dr. Karen K. Wong said in an interview prior to IDWeek 2012, where the research was presented.

Dr. Wong, an epidemic intelligence service officer with the influenza division at the Centers for Disease Control and Prevention, and her associates evaluated data from 829 influenza-associated deaths among children under age 18 that occurred in the United States between Oct. 1, 2004, and Sept. 30, 2012. Their median age was 7 years, and 35% of children died in the emergency department or outside the hospital.

Of the 793 children with a known medical history, 341 (43%) had no high-risk medical conditions, 33% reported neurologic disorders, 26% reported pulmonary disorders including asthma, and 12% reported genetic or chromosomal disorders. These exceeded 100% because more than one medical condition could be reported for a child.

The median duration of illness from symptom onset to death was shorter among children with no underlying high-risk medical conditions than in children with at least one high-risk medical condition (4 vs. 7 days, respectively; P less than .01).

Of 386 children with a specimen collected for bacterial culture from a normally sterile site whose results were available, 153 (40%) had at least one bacterial coinfection. Of those 153 children, the most common bacterial coinfection was Staphylococcus aureus, which was identified in 76 cases (50%).

"Influenza-associated deaths in children are rare," Dr. Wong said. "By including all reported influenza-associated pediatric deaths over an 8-year period in the United States, this study builds on prior smaller studies to describe the children at risk."

She said that she and her associates were surprised to find that 43% of the children who died of influenza-related illness "did not have any medical conditions that placed them at higher risk for influenza complications. Compared with children with high-risk conditions, these otherwise healthy children tended to be younger, and they were more likely to progress to death rapidly before being admitted to the hospital."

Dr. Wong acknowledged certain limitations of the study, including the fact that it was not designed to evaluate the impact of any interventions, such as vaccination or antiviral treatment. "Also, the national influenza-associated pediatric mortality surveillance system likely underestimates the true burden of influenza-associated death in children," she said.

IDWeek 2012 is the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Dr. Wong said that she had no relevant financial disclosures.

SAN DIEGO – Children who received the influenza vaccine at school were three times less likely to become infected with the influenza virus and missed half the of number of school days during the flu season, compared with their counterparts who did not, results from a large study showed.

The finding "supports the implementation of school-located influenza immunization programs to bring down the rates of flu in this age group," lead researcher Dr. Pia S. Pannaraj said during a press telephone conference in advance of IDWeek.

During the 2010-2011 influenza season, Dr. Pannaraj and her associates conducted active influenza surveillance among 4,455 children enrolled at eight elementary schools in the Los Angeles area with similar sociodemographic characteristics. Four of the schools served as controls while the other half served as intervention sites, where school-located influenza vaccination was offered. The researchers conducted polymerase chain reaction (PCR) testing for respiratory viruses on nose and throat swabs collected from febrile children with influenzalike illness to the school nurse or during absenteeism.

"A fundamental difference between this study and previous studies is that [our] research actively documented the reasons for absences and confirmed cases of flu instead of relying on parent surveys," noted Dr. Pannaraj of the department of pediatrics at the University of Southern California, Los Angeles.

Between 27% and 47% of students attending an intervention school received at least one dose of influenza vaccine. Dr. Pannaraj reported findings from 1,021 PCR specimens obtained from 898 children during the 15-week surveillance period. Of these 898 specimens, 21% were positive for influenza, including 2009 H1N1 (31%), H3 (9%), and B (60%). An additional 126 children (12%) tested positive for other respiratory viruses.

Rates of influenza were significantly higher among control schools, compared with schools where vaccination was offered (5.8 vs. 4.0 per 100 children, respectively; P = .011). Unvaccinated children who attended any school were 3.1 times more likely to acquire influenza infection, compared with vaccinated children (5.5 vs. 1.8 per 100 children, respectively; P less than .001).

Rates of absenteeism were higher among control schools compared with schools where vaccination was offered (4.2 vs. 3.9 days per 100 school days, respectively; P = .02), and children with influenza missed more school days, compared with those who had developed other respiratory viruses (a median of 2 days vs. 1 day, respectively; P less than .001).

Protection for unvaccinated children was observed in one school that achieved a vaccination rate of 47% (odds ratio, 2.1; P = .039). In an interview, she speculated that efforts to achieve a 50% vaccination rate in elementary schools "might be a target number to use in planning for pandemics, or even in preparing for the regular flu season. More studies are needed to be sure," she said in advance of the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Dr. Pannaraj said that she had no relevant financial conflicts to disclose. One of the study investigators, Dr. Laurene Mascola, disclosed being a member of the speakers bureau and receiving speaker honorarium from Merck and MedImmune.

SAN DIEGO – Children who received the influenza vaccine at school were three times less likely to become infected with the influenza virus and missed half the of number of school days during the flu season, compared with their counterparts who did not, results from a large study showed.

The finding "supports the implementation of school-located influenza immunization programs to bring down the rates of flu in this age group," lead researcher Dr. Pia S. Pannaraj said during a press telephone conference in advance of IDWeek.

During the 2010-2011 influenza season, Dr. Pannaraj and her associates conducted active influenza surveillance among 4,455 children enrolled at eight elementary schools in the Los Angeles area with similar sociodemographic characteristics. Four of the schools served as controls while the other half served as intervention sites, where school-located influenza vaccination was offered. The researchers conducted polymerase chain reaction (PCR) testing for respiratory viruses on nose and throat swabs collected from febrile children with influenzalike illness to the school nurse or during absenteeism.

"A fundamental difference between this study and previous studies is that [our] research actively documented the reasons for absences and confirmed cases of flu instead of relying on parent surveys," noted Dr. Pannaraj of the department of pediatrics at the University of Southern California, Los Angeles.

Between 27% and 47% of students attending an intervention school received at least one dose of influenza vaccine. Dr. Pannaraj reported findings from 1,021 PCR specimens obtained from 898 children during the 15-week surveillance period. Of these 898 specimens, 21% were positive for influenza, including 2009 H1N1 (31%), H3 (9%), and B (60%). An additional 126 children (12%) tested positive for other respiratory viruses.

Rates of influenza were significantly higher among control schools, compared with schools where vaccination was offered (5.8 vs. 4.0 per 100 children, respectively; P = .011). Unvaccinated children who attended any school were 3.1 times more likely to acquire influenza infection, compared with vaccinated children (5.5 vs. 1.8 per 100 children, respectively; P less than .001).

Rates of absenteeism were higher among control schools compared with schools where vaccination was offered (4.2 vs. 3.9 days per 100 school days, respectively; P = .02), and children with influenza missed more school days, compared with those who had developed other respiratory viruses (a median of 2 days vs. 1 day, respectively; P less than .001).

Protection for unvaccinated children was observed in one school that achieved a vaccination rate of 47% (odds ratio, 2.1; P = .039). In an interview, she speculated that efforts to achieve a 50% vaccination rate in elementary schools "might be a target number to use in planning for pandemics, or even in preparing for the regular flu season. More studies are needed to be sure," she said in advance of the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Dr. Pannaraj said that she had no relevant financial conflicts to disclose. One of the study investigators, Dr. Laurene Mascola, disclosed being a member of the speakers bureau and receiving speaker honorarium from Merck and MedImmune.

SAN DIEGO – Children who received the influenza vaccine at school were three times less likely to become infected with the influenza virus and missed half the of number of school days during the flu season, compared with their counterparts who did not, results from a large study showed.

The finding "supports the implementation of school-located influenza immunization programs to bring down the rates of flu in this age group," lead researcher Dr. Pia S. Pannaraj said during a press telephone conference in advance of IDWeek.

During the 2010-2011 influenza season, Dr. Pannaraj and her associates conducted active influenza surveillance among 4,455 children enrolled at eight elementary schools in the Los Angeles area with similar sociodemographic characteristics. Four of the schools served as controls while the other half served as intervention sites, where school-located influenza vaccination was offered. The researchers conducted polymerase chain reaction (PCR) testing for respiratory viruses on nose and throat swabs collected from febrile children with influenzalike illness to the school nurse or during absenteeism.

"A fundamental difference between this study and previous studies is that [our] research actively documented the reasons for absences and confirmed cases of flu instead of relying on parent surveys," noted Dr. Pannaraj of the department of pediatrics at the University of Southern California, Los Angeles.

Between 27% and 47% of students attending an intervention school received at least one dose of influenza vaccine. Dr. Pannaraj reported findings from 1,021 PCR specimens obtained from 898 children during the 15-week surveillance period. Of these 898 specimens, 21% were positive for influenza, including 2009 H1N1 (31%), H3 (9%), and B (60%). An additional 126 children (12%) tested positive for other respiratory viruses.

Rates of influenza were significantly higher among control schools, compared with schools where vaccination was offered (5.8 vs. 4.0 per 100 children, respectively; P = .011). Unvaccinated children who attended any school were 3.1 times more likely to acquire influenza infection, compared with vaccinated children (5.5 vs. 1.8 per 100 children, respectively; P less than .001).

Rates of absenteeism were higher among control schools compared with schools where vaccination was offered (4.2 vs. 3.9 days per 100 school days, respectively; P = .02), and children with influenza missed more school days, compared with those who had developed other respiratory viruses (a median of 2 days vs. 1 day, respectively; P less than .001).

Protection for unvaccinated children was observed in one school that achieved a vaccination rate of 47% (odds ratio, 2.1; P = .039). In an interview, she speculated that efforts to achieve a 50% vaccination rate in elementary schools "might be a target number to use in planning for pandemics, or even in preparing for the regular flu season. More studies are needed to be sure," she said in advance of the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Dr. Pannaraj said that she had no relevant financial conflicts to disclose. One of the study investigators, Dr. Laurene Mascola, disclosed being a member of the speakers bureau and receiving speaker honorarium from Merck and MedImmune.

SAN DIEGO – A portable device that emits UV-C light destroyed vancomycin-resistant enterococci, Acinetobacter, and C. difficile from hospital rooms where patients infected with those bacteria had been housed, results from a small study demonstrated.

"There is growing evidence that the environment can be a source for acquisition of bad bugs," lead study investigator Dr. Deverick J. Anderson said in an interview prior to IDWeek 2012, where the research was presented during a poster session.

Courtesy Dr. Deverick Anderson

"Our study further strengthens the data that no-touch systems like UV-C light kill important bacteria and can potentially help with current cleaning strategies. While several groups have demonstrated that UV-C light work in experimental conditions we are demonstrating that it works in a real-world hospital environment."

Dr. Anderson of the department of medicine in the division of infectious diseases at Duke University, Durham, N.C., and his associates analyzed 39 rooms at two tertiary care hospitals that had just housed a patient with one of the different bad bugs: vancomycin-resistant enterococci (VRE), Acinetobacter, and C. difficile. After the patient was discharged but prior to the regular cleaning, the investigators obtained 15 or more cultures from several different locations in the hospital rooms, including bed rails, remote controls, and toilets. Then they wheeled in the TRU-D, an automated mobile disinfection system manufactured by Lumalier that is about 6 feet tall and is equipped with 8 sensors and 16 bulbs that emit UV-C light.*

"Each room was irradiated between 25 and 45 minutes in order to eradicate both bacteria and bacterial spores," Dr. Anderson explained during a premeeting telephone press conference. "We then went back into the rooms and cultured the environment from the same locations."

After comparing the number of colony-forming units (CFUs) before and after irradiation "we were able to demonstrate that we could achieve well over 90% reduction in each of those three bad bugs after using the UV light," said Dr. Anderson, who also chairs the antimicrobial stewardship and evaluation team at Duke University Medical Center. "This occurred in all locations sampled, in both direct and indirect light."

Specifically, the UV-C irradiation reduced CFUs of VRE by 98%, C. difficile by 93%, and Acinetobacter by 98%.

"Based on these results we came to the conclusion that UV-C light is indeed effective in killing VRE, C. difficile, and Acinetobacter from the real-world hospital environment," Dr. Anderson said during the telephone press conference. "The idea behind achieving bacterial irradiation in shadow is actually taking advantage of the reflective properties of UV light. It literally bounces around the room and ends up hitting areas in shadow. That’s how bacterial reduction occurs."

He acknowledged certain limitations of the study, including the fact that the researchers were only able to evaluate two hospital rooms with Acinetobacter "because of how infrequently this organism causes infections. Regardless, we reduced the amount of Acinetobacter in both of those rooms."

The study was sponsored by the Centers for Disease Control and Prevention. Lumalier donated the machines used in the study but had no role in the trial design or in review of the data. Dr. Anderson said that he had no relevant financial conflicts to disclose.

IDWeek 2012 is the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

CORRECTION 10/18/12: This sentence was amended to state the correct number of sensors and bulbs that emit UV-C light.

SAN DIEGO – A portable device that emits UV-C light destroyed vancomycin-resistant enterococci, Acinetobacter, and C. difficile from hospital rooms where patients infected with those bacteria had been housed, results from a small study demonstrated.

"There is growing evidence that the environment can be a source for acquisition of bad bugs," lead study investigator Dr. Deverick J. Anderson said in an interview prior to IDWeek 2012, where the research was presented during a poster session.

Courtesy Dr. Deverick Anderson

"Our study further strengthens the data that no-touch systems like UV-C light kill important bacteria and can potentially help with current cleaning strategies. While several groups have demonstrated that UV-C light work in experimental conditions we are demonstrating that it works in a real-world hospital environment."

Dr. Anderson of the department of medicine in the division of infectious diseases at Duke University, Durham, N.C., and his associates analyzed 39 rooms at two tertiary care hospitals that had just housed a patient with one of the different bad bugs: vancomycin-resistant enterococci (VRE), Acinetobacter, and C. difficile. After the patient was discharged but prior to the regular cleaning, the investigators obtained 15 or more cultures from several different locations in the hospital rooms, including bed rails, remote controls, and toilets. Then they wheeled in the TRU-D, an automated mobile disinfection system manufactured by Lumalier that is about 6 feet tall and is equipped with 8 sensors and 16 bulbs that emit UV-C light.*

"Each room was irradiated between 25 and 45 minutes in order to eradicate both bacteria and bacterial spores," Dr. Anderson explained during a premeeting telephone press conference. "We then went back into the rooms and cultured the environment from the same locations."

After comparing the number of colony-forming units (CFUs) before and after irradiation "we were able to demonstrate that we could achieve well over 90% reduction in each of those three bad bugs after using the UV light," said Dr. Anderson, who also chairs the antimicrobial stewardship and evaluation team at Duke University Medical Center. "This occurred in all locations sampled, in both direct and indirect light."

Specifically, the UV-C irradiation reduced CFUs of VRE by 98%, C. difficile by 93%, and Acinetobacter by 98%.

"Based on these results we came to the conclusion that UV-C light is indeed effective in killing VRE, C. difficile, and Acinetobacter from the real-world hospital environment," Dr. Anderson said during the telephone press conference. "The idea behind achieving bacterial irradiation in shadow is actually taking advantage of the reflective properties of UV light. It literally bounces around the room and ends up hitting areas in shadow. That’s how bacterial reduction occurs."

He acknowledged certain limitations of the study, including the fact that the researchers were only able to evaluate two hospital rooms with Acinetobacter "because of how infrequently this organism causes infections. Regardless, we reduced the amount of Acinetobacter in both of those rooms."

The study was sponsored by the Centers for Disease Control and Prevention. Lumalier donated the machines used in the study but had no role in the trial design or in review of the data. Dr. Anderson said that he had no relevant financial conflicts to disclose.

IDWeek 2012 is the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

CORRECTION 10/18/12: This sentence was amended to state the correct number of sensors and bulbs that emit UV-C light.

SAN DIEGO – A portable device that emits UV-C light destroyed vancomycin-resistant enterococci, Acinetobacter, and C. difficile from hospital rooms where patients infected with those bacteria had been housed, results from a small study demonstrated.

"There is growing evidence that the environment can be a source for acquisition of bad bugs," lead study investigator Dr. Deverick J. Anderson said in an interview prior to IDWeek 2012, where the research was presented during a poster session.

Courtesy Dr. Deverick Anderson

"Our study further strengthens the data that no-touch systems like UV-C light kill important bacteria and can potentially help with current cleaning strategies. While several groups have demonstrated that UV-C light work in experimental conditions we are demonstrating that it works in a real-world hospital environment."

Dr. Anderson of the department of medicine in the division of infectious diseases at Duke University, Durham, N.C., and his associates analyzed 39 rooms at two tertiary care hospitals that had just housed a patient with one of the different bad bugs: vancomycin-resistant enterococci (VRE), Acinetobacter, and C. difficile. After the patient was discharged but prior to the regular cleaning, the investigators obtained 15 or more cultures from several different locations in the hospital rooms, including bed rails, remote controls, and toilets. Then they wheeled in the TRU-D, an automated mobile disinfection system manufactured by Lumalier that is about 6 feet tall and is equipped with 8 sensors and 16 bulbs that emit UV-C light.*

"Each room was irradiated between 25 and 45 minutes in order to eradicate both bacteria and bacterial spores," Dr. Anderson explained during a premeeting telephone press conference. "We then went back into the rooms and cultured the environment from the same locations."

After comparing the number of colony-forming units (CFUs) before and after irradiation "we were able to demonstrate that we could achieve well over 90% reduction in each of those three bad bugs after using the UV light," said Dr. Anderson, who also chairs the antimicrobial stewardship and evaluation team at Duke University Medical Center. "This occurred in all locations sampled, in both direct and indirect light."

Specifically, the UV-C irradiation reduced CFUs of VRE by 98%, C. difficile by 93%, and Acinetobacter by 98%.

"Based on these results we came to the conclusion that UV-C light is indeed effective in killing VRE, C. difficile, and Acinetobacter from the real-world hospital environment," Dr. Anderson said during the telephone press conference. "The idea behind achieving bacterial irradiation in shadow is actually taking advantage of the reflective properties of UV light. It literally bounces around the room and ends up hitting areas in shadow. That’s how bacterial reduction occurs."

He acknowledged certain limitations of the study, including the fact that the researchers were only able to evaluate two hospital rooms with Acinetobacter "because of how infrequently this organism causes infections. Regardless, we reduced the amount of Acinetobacter in both of those rooms."

The study was sponsored by the Centers for Disease Control and Prevention. Lumalier donated the machines used in the study but had no role in the trial design or in review of the data. Dr. Anderson said that he had no relevant financial conflicts to disclose.

IDWeek 2012 is the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

CORRECTION 10/18/12: This sentence was amended to state the correct number of sensors and bulbs that emit UV-C light.