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Metuchen, NJ, United States

De Kraker M.E.A.,National Institute for Public Health and the Environment RIVM | De Kraker M.E.A.,University of Groningen | Wolkewitz M.,Albert Ludwigs University of Freiburg | Davey P.G.,Community Informatics | And 2 more authors.
Antimicrobial Agents and Chemotherapy

Antimicrobial resistance is threatening the successful management of nosocomial infections worldwide. Despite the therapeutic limitations imposed by methicillin-resistant Staphylococcus aureus (MRSA), its clinical impact is still debated. The objective of this study was to estimate the excess mortality and length of hospital stay (LOS) associated with MRSA bloodstream infections (BSI) in European hospitals. Between July 2007 and June 2008, a multicenter, prospective, parallel matched-cohort study was carried out in 13 tertiary care hospitals in as many European countries. Cohort I consisted of patients with MRSA BSI and cohort II of patients with methicillin-susceptible S. aureus (MSSA) BSI. The patients in both cohorts were matched for LOS prior to the onset of BSI with patients free of the respective BSI. Cohort I consisted of 248 MRSA patients and 453 controls and cohort II of 618 MSSA patients and 1,170 controls. Compared to the controls, MRSA patients had higher 30-day mortality (adjusted odds ratio [aOR] = 4.4) and higher hospital mortality (adjusted hazard ratio [aHR] = 3.5). Their excess LOS was 9.2 days. MSSA patients also had higher 30-day (aOR = 2.4) and hospital (aHR = 3.1) mortality and an excess LOS of 8.6 days. When the outcomes from the two cohorts were compared, an effect attributable to methicillin resistance was found for 30-day mortality (OR = 1.8; P = 0.04), but not for hospital mortality (HR = 1.1; P = 0.63) or LOS (difference = 0.6 days; P = 0.96). Irrespective of methicillin susceptibility, S. aureus BSI has a significant impact on morbidity and mortality. In addition, MRSA BSI leads to a fatal outcome more frequently than MSSA BSI. Infection control efforts in hospitals should aim to contain infections caused by both resistant and susceptible S. aureus. Copyright © 2011, American Society for Microbiology. All Rights Reserved. Source

de Kraker M.E.A.,National Institute for Public Health and the Environment RIVM | de Kraker M.E.A.,Academic Medical Center Groningen | Wolkewitz M.,Albert Ludwigs University of Freiburg | Davey P.G.,Community Informatics | And 26 more authors.
Journal of Antimicrobial Chemotherapy

Objectives: This study determined excess mortality and length of hospital stay (LOS) attributable to bloodstream infection (BSI) caused by third-generation-cephalosporin-resistant Escherichia coli in Europe. Methods: A prospective parallel matched cohort design was used. Cohort I consisted of patients with thirdgeneration-cephalosporin-resistant E. coli BSI (REC) and cohort II consisted of patients with third-generationcephalosporin-susceptible E. coli BSI (SEC). Patients in both cohorts were matched for LOS before infection with patients free of the respective BSI. Thirteen European tertiary care centres participated between July 2007 and June 2008. Results: Cohort I consisted of 111 REC patients and 204 controls and cohort II consisted of 1110 SEC patients and 2084 controls. REC patients had a higher mortality at 30 days (adjusted odds ratio=4.6) and a higher hospital mortality (adjusted hazard ratio=5.7) than their controls. LOS was increased by 8 days. For SEC patients, these figures were adjusted odds ratio=1.9, adjusted hazard ratio=2.0 and excess LOS=3 days. A 2.5 times [95% confidence interval (95% CI) 0.9-6.8] increase in all-cause mortality at 30 days and a 2.9 times (95% CI 1.2-6.9) increase in mortality during entire hospital stay as well as an excess LOS of 5 days (95% CI 0.4-10.2) could be attributed to resistance to third-generation cephalosporins in E. coli BSI. Conclusions: Morbidity and mortality attributable to third-generation-cephalosporin-resistant E. coli BSI is significant. If prevailing resistance trends continue, high societal and economic costs can be expected. Better management of infections caused by resistant E. coli is becoming essential. © The Author 2010. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. Source

Talbot T.R.,Vanderbilt University | Carr D.,Vanderbilt University | Lee Parmley C.,Vanderbilt University | Martin B.J.,Vanderbilt University | And 4 more authors.
Infection Control and Hospital Epidemiology

background. The effectiveness of practice bundles on reducing ventilator-associated pneumonia (VAP) has been questioned. objective. To implement a comprehensive program that included a real-time bundle compliance dashboard to improve compliance and reduce ventilator-associated complications. design. Before-and-after quasi-experimental study with interrupted time-series analysis. setting. Academic medical center. methods. In 2007 a comprehensive institutional ventilator bundle program was developed. To assess bundle compliance and stimulate instant course correction of noncompliant parameters, a real-time computerized dashboard was developed. Program impact in 6 adult intensive care units (ICUs) was assessed. Bundle compliance was noted as an overall cumulative bundle adherence assessment, reflecting the percentage of time all elements were concurrently in compliance for all patients. results. The VAP rate in all ICUs combined decreased from 19.5 to 9.2 VAPs per 1,000 ventilator-days following program implementation (P<.001). Bundle compliance significantly increased (Z100 score of 23% in August 2007 to 83% in June 2011 [P<.001]). The implementation resulted in a significant monthly decrease in the overall ICU VAP rate of 3.28/1,000 ventilator-days (95% CI, 2.64–3.92/1,000 ventilator-days). Following the intervention, the VAP rate decreased significantly at a rate of 0.20/1,000 ventilator-days per month (95% CI, 0.14–0.30/1,000 ventilator-days per month). Among all adult ICUs combined, improved bundle compliance was moderately correlated with monthly VAP rate reductions (Pearson correlation coefficient, −0.32). conclusion. A prevention program using a real-time bundle adherence dashboard was associated with significant sustained decreases in VAP rates and an increase in bundle compliance among adult ICU patients. © 2015 by The Society for Healthcare Epidemiology of America. All rights reserved. Source

Stillman L.,Community Informatics
ACM International Conference Proceeding Series

This Note discusses current and prospective research into understandings of Participatory Action Research (PAR) and its relationship to the development of inclusive and pluralistic forms of Information and Knowledge Management (IKM) in ICT4D/ICTD contexts through the Oxfam Australia-Monash University Partnership. It is intended that an innovative demonstration project to trial new ways of implementing PAR & pluralistic IKM will be then be undertaken with international development NGOs with an aim to more widespread adoption of these techniques. Source

Al-Mutlaq H.M.,Qassim University | Bawazir A.A.,University of Aden | Bawazir A.A.,Community Informatics | Jradi H.,Community Informatics | And 2 more authors.
Asian Pacific Journal of Cancer Prevention

Background: Although childhood cancer is a rare disease, 100,000 children younger than 15 years of age die from cancer each year, the majority of them in developing countries. More data need to be gathered and published particularly in developing countries to better understand the scale of the problem. Aims: This study aimed to describe the patterns of childhood cancers in Saudi Arabia over a period of ten years (1999-2008). Materials and Methods: This descriptive retrospective study was based on secondary data from the Saudi Cancer Registry from 1999 to 2008. All Saudi cases (both genders), under the age of 15 years, who were diagnosed with cancer during the study period, were included in this study. Results: Childhood cancer in Saudi Arabia, in the period between 1999 and 2008, accounted for about 8% of total cancer cases. The most common encountered cancers were leukemia (34.1%), followed by lymphoma (15.2%), brain (12.4%), and kidney cancers (5.3%). The overall incidence of childhood cancers increased from 8.8 per 100,000 in 1999 to 9.8 per 100,000 in 2008. The incidence rates of cancers per 100,000 in the years 1999 and 2008 were generally higher among males, (9.4 and 11.5 in males vs. 8.3 and 8.1 in females). The highest incidence rate in the surveyed years was apparent in the birth to age 4 years group. Conclusions: Cancer is an important public health problem in Saudi Arabia and a major ascending contributor to mortality and morbidity in children. More studies are required to describe the patterns of childhood cancers and related risk factors in Saudi Arabia. Source

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