ASP Scan (Weekly) for Sep 21, 2018

News brief

CARB-X report highlights growing portfolio, new partnerships

A new report from CARB-X highlights the progress the public-private partnership made in its second year of operation.

In its 2017-2018 "Progress Against Superbugs" annual report, released yesterday, CARB-X (the Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator) says its portfolio of innovative antibiotics, rapid diagnostics, and alternative therapies to address the threat of drug-resistant bacteria nearly doubled during the fiscal year. As of Jul 31, CARB-X has awarded more than $91 million to 33 research projects in seven countries, including 10 new classes of antibiotics, five rapid-diagnostics projects, and 11 non-traditional therapeutics.

CARB-X also added two new funding partners in 2017-2018, with the UK government's Global Antimicrobial Resistance Innovation Fund committing £20 million (US $26 million) and the Bill and Melinda Gates Foundation committing $25 million. They join current partners the Wellcome Trust, the Biomedical Advanced Research and Development Authority, and the National Institute of Allergy and Infectious Diseases. CARB-X now has more than $500 million to invest in antibacterial development.

"Looking to the year ahead, we will continue to fund the most innovative early development projects from around the world, focus our resources on the most urgent medical needs, and expand our global network of accelerators to support our growing portfolio," CARB-X executive director Kevin Outterson, JD, said in the report.
Sep 20 CARB-X annual report 2017-2018

 

Study finds high rate of carbapenem resistance in respiratory samples, ICUs

A review of gram-negative bacterial isolates from a large US hospital database has found that more than 3% were carbapenem non-susceptible, with high rates of non-susceptibility found in respiratory samples and intensive care units (ICUs). The findings were published today in Open Forum Infectious Diseases.

The retrospective cross-sectional study analyzed all non-duplicate Enterobacteriaceae, Pseudomonas aeruginosa, and Acinetobacter spp. isolates collected from patients at 358 US hospitals in 2017. Isolates were classified as carbapenem non-susceptible (Carb-NS) based on hospital reports of intermediate susceptibility or resistance to at least one of the following agents: ertapenem, imipenem, meropenem, or doripenem. The primary outcome was the rate of Carb-NS isolates as determined by local laboratory breakpoints and practices per routine clinical standard of care.

Of the 312,075 isolates tested, 10,698 Carb-NS pathogens (3.4%) were found. Respiratory samples were the most frequent source of Carb-NS isolates (35.3%), followed by urine (30.9%), skin/wound (23.6%), and blood (5.5%). P aeruginosa accounted for over half (58.8%) of all Carb-NS pathogens, followed by Enterobacteriaceae (30.2%). The pathogens with the highest rate of Carb-NS were Acinetobacter spp. (35.6%) and P aeruginosa (14.6%). The majority of Carb-NS pathogens were multidrug-resistant.

Analysis of care settings found that the rate of Carb-NS was significantly higher in ICU settings (5.4%) than in non-ICU settings (2.7%), although non-ICU settings had greater overall numbers. The difference remained significant in multivariable analysis after adjusting for infection and hospital characteristics (odds ratio, 1.35).

The authors of the study say that while overall Carb-NS rates are fairly low in US hospitals, the high rates found in certain sources (respiratory), pathogens (Pseudomonas and Acinetobacter), and settings (ICU) indicate that Carb-NS gram-negative bacteria continue to be an important problem in hospitals.

"We hope our data encourage hospitals to conduct evaluations at a facility level that can be used to guide local antimicrobial therapy," they write. "In addition to these efforts, continued research into therapeutic options to treat carbapenem-resistant infections is urgently needed, particularly for respiratory infections."            
Sep 21 Open Forum Infect Dis abstract

 

Pew launches platform to help scientists working on antibiotic discovery

The Pew Charitable Trusts today launched a cloud-based, interactive data-sharing tool to help scientists advance research on new antibiotics.

Built by a team of antibiotic discovery experts from around the world, SPARK (Shared Platform for Antibiotic Research and Knowledge) aims to support the development of new antibiotics for gram-negative bacteria by integrating chemical and biological data from published studies as well as previously unpublished data, and making that data publicly available to scientists. The hope is that the platform will provide scientists in industry, academia, government, and the non-profit sector an opportunity to share data, learn from past research, and collaborate.

The idea for SPARK emerged from a 2016 Pew report on antibiotic discovery, which noted that scientists often cannot build on past work because much of the research is scattered across academic journals and industry archives, or not published at all. Pew announced its intention to build the platform in August 2017.

Interested researchers can request access to SPARK on the Pew website.
Sep 21 Pew press release
Aug 21, 2017 CIDRAP News story "New data-sharing platform aims to boost antibiotic discovery"

 

New York study finds need for stewardship programs in outpatient clinics

Originally published by CIDRAP News Sep 18

Few outpatient clinics in New York City—one of the nation's most densely populated cities—have antibiotic stewardship programs, according to a study that focused on prescriptions written for acute respiratory infections. A team from several facilities in the city published its findings today in Infection Control & Hospital Epidemiology.

The goal of the study was to determine baseline data for clinic-based antibiotic stewardship programs, an initial step in improving outpatient prescribing practices as part of the United Hospital Fund's efforts to improve the city's healthcare system.

The team surveyed 31 hospital-owned clinics from nine hospitals and health systems about their current stewardship practices and performed chart reviews of 30 randomly selected adult acute respiratory illness (ARI) patients, collecting their data from June to August 2016.

Few sites had outpatient stewardship activities. Though 68% of practices had stewardship programs in their health systems, only 25% of the clinics had institutional guidelines for antibiotic use and selection and only 11% had ambulatory-specific guidance.

A review of 1,004 patient charts found that 37.3% overall had received antibiotics for ARIs, but sites varied from 17.4% to 71%. Antibiotic prescriptions for bronchitis and sinusitis was also high—doctors prescribed the drugs for nearly 67% of patients who had acute bronchitis and more than 80% with acute sinusitis.

Macrolides were the most commonly prescribed antibiotics. Most of the 302 respondents acknowledged the need for tools to help guide prescribing. "It remains unclear whether the pervasive reliance on macrolides results from gaps in knowledge of [the] antibiotic spectrum and the common causes of ARIs or the convenience of macrolides," the authors wrote.

The authors said the second stage of the United Hospital Fund's initiative will use the baseline findings to help form site-specific plans to improve outpatient prescribing practices.
Sep 18 Infect Control Hosp Epidemiol abstract

 

Study finds outpatient antibiotic prescribing in US seniors remains steady

Originally published by CIDRAP News Sep 18

A new study by researchers from the US Centers for Disease Control and Prevention (CDC) has found that outpatient antibiotic prescribing among older adults did not change much from 2011 to 2014, though significant regional variations were noted. The findings appeared yesterday in the Journal of the American Geriatrics Society.

Using a database that collects information on outpatient prescribing from US pharmacies, the researchers conducted a chi-square trend analysis to assess annual changes in antibiotic prescribing among US adults aged 65 and older. They also calculated prescribing rates by antibiotic, age-group, sex, state, census region, and provider specialty.

The results showed that prescribing rates remained stable overall (P = 0.89) during the study period, with adults aged 65 and over receiving 46 million outpatient antibiotic prescriptions in 2011 (1,113 prescriptions per 1,000 persons) and 51.6 million in 2014 (1,115 prescriptions/1,000 persons). In 2014, the prescribing rate was higher in women than in men (1,225 vs. 974 prescriptions/1,000 persons) and in patients older than 75 compared with those aged 65 to 74 (1,157 vs. 1,084 prescriptions/1,000 persons). The highest prescribing rate was in the South census region (1,228 prescriptions/1,000 persons), which was 44% higher than the rate in the West (854 prescriptions/1,000 persons).

Quinolones were the most widely prescribed antibiotic class, followed by penicillins and macrolides, and azithromycin was the most commonly prescribed antibiotic drug, followed by amoxicillin and ciprofloxacin. Internists and family physicians prescribed 43% of antibiotic courses.

The researchers conclude that future efforts to optimize outpatient prescribing in US seniors should focus on reducing quinolone and azithromycin use and targeting primary care providers in the South. 
Sep 17 J Am Geriatr Soc abstract

 

High levels of resistant gut bacteria tied to bloodstream infection risk

Originally published by CIDRAP News Sep 18

New research from Rush University and the University of Michigan shows that patients with higher levels of K pneumonia–carbapenemase-producing K pneumoniae (KPC-Kp) within the gut microbiota had a higher risk of bloodstream infection in the long-term acute care hospital (LTACH) setting. The research is published in Clinical Infectious Diseases.

The study is based on weekly rectal swabs collected from 506 patients of an LTACH in Chicago from May of 2015 through May of 2016. The swab samples were cultured and tested for KPC-Kp.

Almost half the patients (255, or 45.4%) provided samples that were colonized with KPC-Kp, and 11 (4.3%) had KPC-Kp bacteremia. In an analysis, the researchers concluded that a relative abundance cutoff of 22% predicted KPC-Kp bacteremia with sensitivity of 73%, specificity of 72%, and relative risk of 4.2 (95% confidence interval [CI], 1.3-14.0, P = 0.01).

"Among antibiotics analyzed, only preceding carbapenem use was associated with a relative abundance of KPC-Kp ≥22% (HR [hazard ratio], 2.19; 95% CI, 1.06-4.55; P = 0.036)," the authors said.  
Sep 18 Clin Infect Dis study

 

Study links seasonal macrolides use, resistance in N gonorrhoeae

Originally published by CIDRAP News Sep 17

Using a mathematical model that links seasonal patterns of antibiotic use with resistance, researchers from Harvard and the CDC have found that seasonal changes in population-wide macrolide use is associated with a small rise in azithromycin non-susceptibility in Neisseria gonorrhoeae isolates.

The ecological study, published in the Journal of Infectious Diseases, used the mathematical model to link seasonal variations in the use of macrolides (azithromycin, clarithromycin, and erythromycin) with seasonal minimum inhibitory concentrations (MICs) for azithromycin. Their hypothesis was that periods of above-average use would create more selection pressure and result in higher azithromycin MICs 3 months later.

The researchers measured the seasonality of macrolide use from 2011 through 2015 using a nationwide pharmacy prescription claims database and investigated N gonorrhoeae azithromycin MIC seasonality using 62,500 isolates collected as part of the CDC's Gonococcal Isolate Surveillance Project.

The results showed that year-round macrolide use was 12.8 monthly outpatient pharmacy fills per 1,000 insurance members, with seasonal amplitude of 4.8 monthly fills per 1,000 members and a peak in use in December/January. Azithromycin resistance among N gonorrhoeae isolates was seasonal, with an amplitude of 0.076 dilutions. As predicted by the model, seasonal resistance peaked in March/April, 3 months after peak macrolide use. A back-of-the-envelope calculation showed that a 10% increase in macrolide use is associated with an additive increase in mean MIC of 0.0015 micrograms per milliliter.

The authors speculate that seasonal patterns in azithromycin MICs arise because N gonorrhoeaehosts are more likely to use macrolides for respiratory conditions in the winter than in the summer. This subjects N gonorrhoeae to a seasonal "bystander effect," in which the bacteria are exposed to additional antibiotic pressure in the winter for reasons unrelated to gonorrhea. The findings could partly explain rising azithromycin MICs in N gonorrhoeae, which are threatening the efficacy of the currently recommended treatment regimen (azithromycin and ceftriaxone) for gonorrhea infections.

The researchers conclude, "The anticipated bystander effect of antibiotics used for conditions other than gonorrhea should be considered as treatment guidelines for gonococcal infections are updated."
Sep 15 J Infect Dis abstract

 

UK study finds reduced prescribing, persistent geographic variation

Originally published by CIDRAP News Sep 17

Researchers from the University of Oxford report in the Journal of Antimicrobial Chemotherapythat while overall antibiotic prescribing has decreased in primary care settings in England since 2013, considerable geographic variation persists.

Using two sources of data routinely collected by England's National Health Service (NHS)—monthly practice-level prescribing data and annual prescription cost analysis data—the researchers set out to determine antibiotic prescribing trends in primary care in England from 1998 through 2017, geographic variation in antibiotic prescribing in 2017, trends in variation between practices from 2010 through 2017, and seasonal variation. They also looked at factors associated with higher prescribing.

The results showed that the overall rate of antibiotic prescribing fell by 18% from 2010 through 2017, with the steepest after 2013. In addition, from 2006 through 2017 the percentage of broad-spectrum antibiotic prescribing was reduced from 18% to 8.4%.

While variation across general practices has declined, there was a twofold variation for total prescribing and a sevenfold variation for cephalosporin prescribing between the highest prescribing and lowest prescribing Clinical Commission Groups (CCGs)—the NHS bodies responsible for planning and commissioning of healthcare services in a local area. The CCG to which a practice belongs accounted for 12.6% of current variation in prescribing.

Higher antibiotic prescribing was associated with greater practice size, proportion of patients older than 65 and younger than 18, poorer prescribing on other measures of rural location, and deprivation. Seasonal increases declined for most antibiotics.

The researchers conclude that while the reduction in antibiotic prescribing in primary care is encouraging, better access to and use of audit data could further improve clinical care and antibiotic use. 
Sep 15 J Antimicrob Chemother study

 

Point-of-care viral respiratory test could aid stewardship, early results show

Originally published by CIDRAP News Sep 17

Initial results on a point-of-care test (POCT) for respiratory viruses indicate the potential to reduce unnecessary antibiotic use and hospital admissions, according to research presented yesterday at the European Respiratory Society International Congress.

In a study conducted at West Hertfordshire Hospitals NHS Trust in England from Jan 15 to May 1, the results of the test were combined with other important clinical factors, including chest x-ray results and lack of evidence of bacterial infection, to identify 121 patients (out of 387) who were potentially suitable for avoiding hospital admission and antibiotics. Hospital admission was avoided in 25% of these patients, and unnecessary use of antibiotics was avoided in 50%.

"None of the 30 patients who avoided hospital admission and who were not prescribed antibiotics experienced adverse clinical outcomes, which is reassuring," Kay Roy, MBChB, a consultant physician in respiratory and general internal medicine, said in a press release from the European Lung Foundation. Roy also estimated that the test could save hospitals £2,000 ($2,632) per patient not admitted to hospital.

The test involves inserting a swab into a patient's nostril, collecting secretions from the back of the nose, and analyzing the sample with a compact device called the FilmArray (made by Biofire, Biomerieux). The entire process takes 50 minutes.

"The frequent underestimation of the role of viruses in respiratory admissions, both in previously well patients and those with chronic underlying disease such as COPD [chronic obstructive pulmonary disease], has hindered good antimicrobial stewardship," said Roy. "This has sometimes led to other health problems for patients, from inappropriate antibiotic use and hospital admission. We hope that quality of patient care can be improved with POCT for respiratory viruses, as well as helping to reduce the development of antibiotic resistance."

The research is not peer-reviewed. 
Sep 16 European Lung Foundation press release

 

Study finds male gender, catheter use tied to MDR urinary tract infections

Originally published by CIDRAP News Sep 17

A study of 948 patients in Europe, Turkey, and Israel has found an "alarming" rate of multidrug-resistant (MDR) gram-negative bacteria in complicated urinary tract infections (cUTIs), with predictors including male gender, acquisition of cUTI in a medical facility, and having an indwelling urinary catheter.

Writing in Antimicrobial Resistance & Infection Control, researchers said they analyzed 1,074 isolates from consecutive cUTI patients from January 2013 through December 2014. Of the isolated pathogens, 559 (52.0%) were Escherichia coli, and 97 (9.0%) were P aeruginosa—the two most common causal organisms. Fully 54.2% of the E coli isolates were MDR, compared with 38.1% of the P aeruginosa isolates.

The investigators also found the being male increased the odds of having MDR gram-negative infections by 66% (odds ratio [OR], 1.66). Other risk factors were acquisition of cUTI in a medical facility (OR, 2.59), presence of an indwelling catheter (OR, 1.44), having had a UTI within the year (OR, 1.89), and antibiotic treatment within the previous 30 days (OR, 1.68).

The authors conclude, "The current high rate of multidrug-resistant gram-negative bacteria infections among hospitalised patients with cUTIs in the studied area is alarming. Our predictive model could be useful to avoid inappropriate antibiotic treatment and implement antibiotic stewardship policies that enhance the use of carbapenem-sparing regimens in patients at low risk of multidrug-resistance."
Sep 14 Antimicrob Resist Infect Control study

Stewardship / Resistance Scan for Sep 21, 2018

News brief

CARB-X report highlights growing portfolio, new partnerships

A new report from CARB-X highlights the progress the public-private partnership made in its second year of operation.

In its 2017-2018 "Progress Against Superbugs" annual report, released yesterday, CARB-X (the Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator) says its portfolio of innovative antibiotics, rapid diagnostics, and alternative therapies to address the threat of drug-resistant bacteria nearly doubled during the fiscal year. As of Jul 31, CARB-X has awarded more than $91 million to 33 research projects in seven countries, including 10 new classes of antibiotics, five rapid-diagnostics projects, and 11 non-traditional therapeutics.

CARB-X also added two new funding partners in 2017-2018, with the UK government's Global Antimicrobial Resistance Innovation Fund committing £20 million (US $26 million) and the Bill and Melinda Gates Foundation committing $25 million. They join current partners the Wellcome Trust, the Biomedical Advanced Research and Development Authority, and the National Institute of Allergy and Infectious Diseases. CARB-X now has more than $500 million to invest in antibacterial development.

"Looking to the year ahead, we will continue to fund the most innovative early development projects from around the world, focus our resources on the most urgent medical needs, and expand our global network of accelerators to support our growing portfolio," CARB-X executive director Kevin Outterson, JD, said in the report.
Sep 20 CARB-X annual report 2017-2018

 

Study finds high rate of carbapenem resistance in respiratory samples, ICUs

A review of gram-negative bacterial isolates from a large US hospital database has found that more than 3% were carbapenem non-susceptible, with high rates of non-susceptibility found in respiratory samples and intensive care units (ICUs). The findings were published today in Open Forum Infectious Diseases.

The retrospective cross-sectional study analyzed all non-duplicate Enterobacteriaceae, Pseudomonas aeruginosa, and Acinetobacter spp. isolates collected from patients at 358 US hospitals in 2017. Isolates were classified as carbapenem non-susceptible (Carb-NS) based on hospital reports of intermediate susceptibility or resistance to at least one of the following agents: ertapenem, imipenem, meropenem, or doripenem. The primary outcome was the rate of Carb-NS isolates as determined by local laboratory breakpoints and practices per routine clinical standard of care.

Of the 312,075 isolates tested, 10,698 Carb-NS pathogens (3.4%) were found. Respiratory samples were the most frequent source of Carb-NS isolates (35.3%), followed by urine (30.9%), skin/wound (23.6%), and blood (5.5%). P aeruginosa accounted for over half (58.8%) of all Carb-NS pathogens, followed by Enterobacteriaceae (30.2%). The pathogens with the highest rate of Carb-NS were Acinetobacter spp. (35.6%) and P aeruginosa (14.6%). The majority of Carb-NS pathogens were multidrug-resistant.

Analysis of care settings found that the rate of Carb-NS was significantly higher in ICU settings (5.4%) than in non-ICU settings (2.7%), although non-ICU settings had greater overall numbers. The difference remained significant in multivariable analysis after adjusting for infection and hospital characteristics (odds ratio, 1.35).

The authors of the study say that while overall Carb-NS rates are fairly low in US hospitals, the high rates found in certain sources (respiratory), pathogens (Pseudomonas and Acinetobacter), and settings (ICU) indicate that Carb-NS gram-negative bacteria continue to be an important problem in hospitals.

"We hope our data encourage hospitals to conduct evaluations at a facility level that can be used to guide local antimicrobial therapy," they write. "In addition to these efforts, continued research into therapeutic options to treat carbapenem-resistant infections is urgently needed, particularly for respiratory infections."           
Sep 21 Open Forum Infect Dis abstract

 

Pew launches platform to help scientists working on antibiotic discovery

The Pew Charitable Trusts today launched a cloud-based, interactive data-sharing tool to help scientists advance research on new antibiotics.

Built by a team of antibiotic discovery experts from around the world, SPARK (Shared Platform for Antibiotic Research and Knowledge) aims to support the development of new antibiotics for gram-negative bacteria by integrating chemical and biological data from published studies as well as previously unpublished data, and making that data publicly available to scientists. The hope is that the platform will provide scientists in industry, academia, government, and the non-profit sector an opportunity to share data, learn from past research, and collaborate.

The idea for SPARK emerged from a 2016 Pew report on antibiotic discovery, which noted that scientists often cannot build on past work because much of the research is scattered across academic journals and industry archives, or not published at all. Pew announced its intention to build the platform in August 2017.

Interested researchers can request access to SPARK on the Pew website.
Sep 21 Pew press release
Aug 21, 2017 CIDRAP News story "New data-sharing platform aims to boost antibiotic discovery"

News Scan for Sep 21, 2018

News brief

Ground beef recalled after 18-case deadly E coli outbreak

Cargill Meat Solutions of Fort Morgan, Colo., has recalled more than 130,000 pounds of ground beef products after they were tied to an 18-case, four-state outbreak of Escherichia coli infections that has left one person dead, federal officials said yesterday.

The Centers for Disease Control and Prevention (CDC) said that E coli O26 has hospitalized 6 people in the outbreak. The person who died was from Florida, which has recorded 15 of the cases. Colorado, Massachusetts, and Tennessee have each confirmed 1 outbreak case.

Illness-onset dates range from Jul 5 to Jul 25, and patient ages vary from 1 to 75 years old, with a median age of 16. Twelve of the patients are male. All 14 patients interviewed reported eating ground beef in the week before they fell ill. Whole-genome sequencing did not identify any antibiotic resistance in the outbreak isolates, the CDC said.

"Initial information collected from ill people in Florida indicated that the ground beef was purchased from various Publix grocery stores," the CDC said. "On August 30, 2018, Publix Super Markets, Inc. recalled ground chuck products sold in several Florida counties." That meat was later traced to the Cargill operation in Colorado, according to a Sep 19 US Department of Agriculture's Food Safety and Inspection Service (FSIS) news release. The recall totals 132,606 pounds of ground beef made from the chuck portion of the cattle.

"E. coli O26, like the more common E. coli O157:H7, is a serovar of Shiga toxin-producing E. coli (STEC)," the FSIS said. "People can become ill from STECs 2–8 days (average of 3–4 days) after exposure to the organism."
Sep 20 CDC statement
Sep 18 FSIS news release

 

Polio cases confirmed in Afghanistan, DR Congo

The Global Polio Eradication Initiative (GPEI) today reported one new case of wild poliovirus type 1 (WPV1) in Afghanistan and two new cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) in the Democratic Republic of the Congo (DRC).

The WPV1 case in Afghanistan is in Kandahar province in the Kandahar district. The patient had onset of paralysis on Aug 11, and the case raises the 2018 total to 14, the same number the country had in all of 2017. At this point last year, Afghanistan had confirmed only 6 WPV1 cases.

Both of the DRC's cVDPV2 cases are in Mongola province, one in Yamaluka district and one in Bumba district. The Yamaluka patient experienced paralysis onset on Jul 30, and the other on Aug 5. Officials also detected the presence of cVDPV2 in a healthy community contact in the province. DCR is addressing three separate cVDPV2 outbreaks in separate provinces. The DRC has now confirmed 15 cVDPV cases this year, compared with 9 at this point last year and 22 for all of 2017.

Global totals of WPV1 now stand at 18 so far this year (Pakistan has had 4 cases), compared with 10 at this time last year. cVDPV cases number 36, compared with 49 at this point in 2017. Syria, however, accounted for 40 of the cVDPV cases year-to-date in 2017, and it has confirmed none so far this year.
Sep 21 GPEI update

 

Interventions found to cut healthcare-associated infections 35% to 55%

Healthcare-associated infections can be reduced 35% to 55% by systematically implementing evidence-based infection prevention and control strategies, according to a systematic review of 144 studies published yesterday in Infection Control & Hospital Epidemiology.

Swiss investigators assessed multifaceted interventions to reduce catheter-associated urinary tract infections (CAUTIs), central-line–associated bloodstream infections (CLABSIs), surgical-site infections (SSIs), ventilator-associated pneumonia (VAP), and hospital-acquired pneumonia not associated with mechanical ventilation (HAP) in acute-care or long-term care settings. Fifty-six of the studies were conducted in the United States.

They found that interventions reduced infections from around 35% to 55%. Pooled incidence rate ratios associated with multifaceted interventions were 0.54 for CAUTI, 0.46 for CLABSI, and 0.55 for VAP. The pooled rate ratio was 0.46 for interventions aiming at SSI reduction. For VAP-reduction initiatives, the pooled rate ratios were 0.61 for before-and-after studies and 0.51 for randomized controlled trials. The researchers determined that reductions in infection rates were independent of the economic status of the study country.

"Our analysis shows that even in high income countries and in institutions that supposedly have implemented the standard-of-care infection prevention and control measures, improvements may still be possible," said Peter W. Schreiber, MD, the study's lead author, in a news release from the Society for Healthcare Epidemiology of America (SHEA), which publishes the journal.
Sep 20 Infect Control Hosp Epidemiol study
Sep 20 SHEA news release

This week's top reads

Our underwriters