Predischarge postpartum methicillin resistant Staphylococcus aureus infection and group B streptococcus carriage at the individual and hospital levels.

BACKGROUND: We sought to characterize the relationship between individual group B streptococcus (GBS) colonization and pre-discharge postpartum methicillin resistant Staphylococcus aureus (MRSA) infection in United States women delivering at term. We also sought to examine the association between hospital GBS colonization prevalence and MRSA infection. MATERIALS AND METHODS: Data was from the Nationwide Inpatient Sample, a representative sample of United States community hospitals. Hierarchical regression models were used to estimate odds ratios adjusted for patient age, race, expected payer, and prepregnancy diabetes and hospital teaching status, urbanicity, ownership, size, and geographic region. We used multiple imputation for missing covariate data. RESULTS: There were 3,136,595 deliveries and 462 cases of MRSA infection included in this study. The odds ratio for individual GBS colonization was 1.2 (95% confidence interval: 0.9 to 1.5). For a five-percent increase in the hospital prevalence of GBS colonization, the odds ratio was 0.9 (95% CI: 0.1 to 5.6). CONCLUSIONS: The odds ratio estimate for the association of hospital GBS prevalence with MRSA infection is too imprecise to make conclusions about its magnitude and direction. Barring major bias in our estimates, individual GBS carriage does not appear to be strongly associated with predischarge postpartum MRSA infection.

Association of the coronavirus disease 2019 (COVID-19) pandemic with the incidence of healthcare-associated infections in California hospitals.

OBJECTIVE: To assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on the incidence of central-line-associated bloodstream infections (CLABSIs), Clostridioides difficile infections (CDIs), and methicillin-resistant Staphyloccocus aureus (MRSA) bloodstream infections (BSIs) in California acute-care hospitals. DESIGN: Retrospective cohort and before-and-after study. METHODS: We compared standardized infection ratios (SIRs) for CLABSI, CDI, and MRSA BSI from the second half of 2020 to the second half of 2019. We performed interrupted time-series (ITS) analyses for these infections to assess departures from long-term trends. We also examined the association between the proportion of facility beds that were occupied by COVID-19 patients in May and June of 2020 and the incidence of infections using negative binomial models. In addition, we compared standardized antimicrobial administration ratios (SAARs) for the second halves of 2019 and 2020. RESULTS: We detected substantial and significant increases in the SIRs for CLABSI and MRSA BSI from 2019 to 2020. For the ITS analysis, CLABSI and had significant positive values for the pandemic onset level-change parameters, and CLABSI and MRSA BSI had significant positive values for the postinterruption slope-change parameters. We also detected a positive association between facility COVID-19 patient occupancy and CLABSI and MRSA BSI incidence. We did not detect associations with the onset of the pandemic or COVID-19 patient occupancy and CDI. The SAAR for all antibacterial drugs decreased slightly, but the SAAR for drugs with a high risk for CDI increased slightly. CONCLUSIONS: This study adds to a body of literature documenting increases in CLABSI and MRSA BSI incidence during the pandemic.

Healthcare-associated infection reporting completeness and quality during the coronavirus disease 2019 (COVID-19) pandemic in California hospitals.

We examined markers of completeness in healthcare-associated infection (HAI) data reported by California hospitals to the National Healthcare Safety Network for each half of 2020 compared with 2019. There were indications of decreased data completeness for both halves of 2020. California 2020 HAI data should be interpreted with caution.

Incidence and predictors of onset of injection drug use in a San Francisco cohort of homeless youth.

Few studies document incidence of injection drug use among homeless youth. We followed a cohort of 70 street-recruited homeless youth in San Francisco, California who had never injected drugs for six months in 2004-5. We examined initiation of injection drug use and its predictors, informed by prior ethnographic findings. Data were analyzed using exact logistic regression. 11.4% of youth initiated injection drug use. Having no high school education, being over 21 years old, and being in disequilibrium predicted initiation. Limitations, implications and suggestions for future research are noted. Funding was provided by the National Institute for Child Health and Development.

Patient volumes and pre- and postdischarge postpartum infection: A retrospective cohort study.

BACKGROUND: To examine the association between hospital and clinician obstetric volume and postpartum infection risk in the pre- and postdischarge periods. METHODS: We used data from the 2011 New York State Inpatient and Emergency Department Databases to fit generalized estimating equation models to examine the effect of hospital and clinician obstetric volume on infection before discharge and in the 30 days after discharge after delivery. RESULTS: Higher clinician volume was associated with lower predischarge infection risk (odds ratio [OR] for first vs third quartile was 0.84; 95% confidence interval [CI], 0.77-0.98). There was an uncertain trend toward higher predischarge infection risk in higher volume hospitals (OR for first vs third quartile was 1.36; 95% CI, 0.79-2.34). We found no associations between patient volumes and postdischarge infections; however, power was insufficient to rule out small associations. The joint association of hospital and clinician volumes with postdischarge infection appeared submultiplicative (product term OR = 0.95; 95% CI, 0.92-0.98). CONCLUSION: This study adds to the evidence that hospital obstetric volume is positively associated with predischarge postpartum infections, whereas clinician volume may be negatively associated with those predischarge infections. The associations between hospital obstetric volume and postdischarge infection appear to differ. These results underscore the importance of including postdischarge follow-up in hospital-based studies of postpartum infection.

Hospital and provider patient volumes, cesarean section rates, and early postpartum invasive methicillin-resistant Staphylococcus aureus infection.

OBJECTIVE: We sought to examine whether hospital and provider volumes and cesarean section rates influenced early postpartum invasive methicillin-resistant Staphylococcus aureus (MRSA) infection. METHODS: We used data from the Nationwide Inpatient Sample, a representative sample of US community hospitals. Multivariate hierarchical regression models were used to estimate odds ratios adjusted for hospital total discharges, nurse:patient ratio, urbanicity, teaching status, bed size, ownership, and geographic region and patient age, race, expected payer, and comorbidities. RESULTS: The total sample size for the hospital analysis was 3,487,350 deliveries, which included 555 cases of MRSA infection. The total sample size for the provider analysis was 1,186,703 deliveries, with 221 cases of MRSA infection. Hospital and provider patient (deliveries) volumes and cesarean section rates were not associated with early postpartum invasive MRSA infection. CONCLUSIONS: Barring major bias in our estimates, our results suggest that transmission from providers may not be a predominant route of postpartum MRSA infection in US hospitals.

Diabetes and early postpartum methicillin-resistant Staphylococcus aureus infection in US hospitals.

BACKGROUND: The epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) infection in postpartum women is not well characterized. Because diabetes is a risk factor for some infections, we sought to characterize the relationship between diabetes and invasive MRSA infections in women admitted to US hospitals for delivery of an infant. METHODS: We used data from the Nationwide Inpatient Sample, a representative sample of US community hospitals. Multivariate hierarchical logistic regression was used to estimate odds ratios (OR), adjusting for age, race, selected comorbidities, and expected payer, and hospital teaching status, urbanicity, bed size, geographic region, and ownership. RESULTS: The odds ratio for prepregnancy diabetes was 3.4 (95% confidence interval: 1.9-6.0). The relationship remained strong after external adjustment for obesity (OR, 2.5; 95% CI: 1.3-4.8). The OR comparing women with complicated versus uncomplicated diabetes was 1.5 (95% CI: 0.3-6.0). We did not find an association with gestational diabetes (OR, 1.1; 95% CI: 0.7-1.7). CONCLUSION: Prepregnancy diabetes, but not gestational diabetes, appears to be a risk factor for invasive MRSA infection in the early postpartum period. Women with diabetic complications may be at additional risk, but estimates were imprecise.