Informing estimates of probability of Clostridioides difficile infection for testing and treatment: expert consensus from a modified-Delphi procedure.

BACKGROUND: Clostridioides difficile infection (CDI) may be misdiagnosed if testing is performed in the absence of signs or symptoms of disease. This study sought to support appropriate testing by estimating the impact of signs, symptoms, and healthcare exposures on pre-test likelihood of CDI. METHODS: A panel of fifteen experts in infectious diseases participated in a modified UCLA/RAND Delphi study to estimate likelihood of CDI. Consensus, defined as agreement by >70% of panelists, was assessed via a REDCap survey. Items without consensus were discussed in a virtual meeting followed by a second survey. RESULTS: All fifteen panelists completed both surveys (100% response rate). In the initial survey, consensus was present on 6 of 15 (40%) items related to risk of CDI. After panel discussion and clarification of questions, consensus (>70% agreement) was reached on all remaining items in the second survey. Antibiotics were identified as the primary risk factor for CDI and grouped into three categories: high-risk (likelihood ratio [LR] 7, 93% agreement among panelists in first survey), low-risk (LR 3, 87% agreement in first survey), and minimal-risk (LR 1, 71% agreement in first survey). Other major factors included new or unexplained severe diarrhea (e.g., ≥ 10 liquid bowel movements per day; LR 5, 100% agreement in second survey) and severe immunosuppression (LR 5, 87% agreement in second survey). CONCLUSION: Infectious disease experts concurred on the importance of signs, symptoms, and healthcare exposures for diagnosing CDI. The resulting risk estimates can be used by clinicians to optimize CDI testing and treatment

Persistent Staphylococcus aureus Colonization Is Not a Strongly Heritable Trait in Amish Families

About 20% of adults are persistently colonized with S. aureus in the anterior nares. Host genetic factors could contribute susceptibility to this phenotype. The objective of this study was to determine whether the phenotype of persistent S. aureus colonization aggregates in family members who live in different households. Healthy adults and their eligible same sex siblings who lived in different households were recruited from the Old Order Amish of Lancaster, Pennsylvania. All participants had two cultures of the anterior nares to determine if they were persistently colonized with S. aureus. Three hundred and ninety eight participants finished the study, of whom 166 were index cases and 232 were siblings of index cases. Eighteen per cent (71/398) of all participants and 17% (29/166) of index cases were persistently colonized with S. aureus. Twenty two per cent (8/36) of siblings of persistently colonized index cases were persistently colonized with S. aureus compared to 17% (34/196) of siblings of non-persistently colonized index cases, yielding a prevalence rate ratio of 1.28 (95% CI: 0.65–2.54, p = 0.64) and sibling relative risk of 1.25 (95% CI: 0.65–2.38, p = 0.51). The heritability of persistent colonization was 0.19±0.21 (p = 0.31). Persistent S. aureus colonization does not strongly aggregate in Amish family members in different households and heritability is low, suggesting that environmental factors or acquired host factors are more important than host genetic factors in determining persistent S. aureus colonization in this community

Abstract B103: HPV vaccine adherence in urban youth

Abstract This abstract is being presented as a short talk in Concurrent Session 15. A full abstract is printed in the Proferred Abstracts section (PR-11) of the Conference Proceedings. Citation Information: Cancer Prev Res 2010;3(12 Suppl):B103.</jats:p

Abstract PR-11: HPV vaccine adherence in urban youth

Abstract Background: Human papillomavirus (HPV) is the most common sexually transmitted disease among adolescent females in the United States, with 29.5% of sexually active 14-19 year olds infected at any given time. Persistent infection with cancer causing types of HPV is also a necessary step in the cervical cancer carcinogenesis process. HPV vaccines have been licensed in the United States since 2006; however, relatively modest proportions of the vaccine-eligible population have elected to receive the HPV vaccine. Further, among those who initiate HPV vaccination, a majority fail to complete the three-dose regimen needed for maximum protection. Methods: Data from the clinical data repository at the University of Maryland Medical Center was queried to identify women that initiated HPV vaccination between August 2006 (when UMMC began offering the HPV vaccine) and August 2010. Statistical analyses were conducted to assess vaccine adherence in the study population. The association of age and race with vaccination adherence was also assessed. Results: During the time period of interest, 9,658 women potentially eligible women between 9-26 years were seen at the UMMC outpatient practices. Of those, 2,641 women (27.3% of the target group) initiated HPV vaccination. African-American women comprised 2/3 of those who initiated vaccination. Among those women that initiated vaccination, 39.1% completed a single dose, 30.1% completed 2 doses, and 30.78 completed the recommended 3-dose regimen. Age was related to vaccine adherence, with women 18 and older being least likely to complete more than a single dose (p=0.001). African-American women were less likely than Caucasian women to complete the three-dose regimen (p&amp;lt;0.001). Conclusions: Despite strong efficacy data for the HPV vaccines, relatively small proportions of eligible women have elected to uptake the vaccine as primary prevention for cervical cancer. Further, of those who initiate vaccination, significant proportions fail to complete the recommended three-dose regimen. Young adult women are the least likely to complete the three-dose regimen as are women in minority groups. The public health consequence of this is that significant numbers of women remain unprotected or underprotected. Evidence-based interventions are needed to foster both vaccine uptake and adherence for optimal prevention cervical cancer. Interventions that address barriers for minority women and young adult women are needed. Technological innovations such as text messaging may offer an effective method to address these issues. This talk is also presented as Poster B103. Citation Information: Cancer Prev Res 2010;3(12 Suppl):PR-11.</jats:p

Short-stay admissions and lower staffing associated with larger COVID-19 outbreaks in Maryland nursing homes

AbstractObjectivesIdentify facility factors associated with a larger COVID-19 outbreak among residents in Maryland nursing homes (NHs).DesignObservationalSetting and ParticipantsAll Maryland NHs.MethodsResident COVID-19 cases were collected for each Maryland NH from January 1, 2020 through July 1, 2020. Cumulative COVID-19 incidence through July 1, 2020 was collected for each county and Baltimore City. Facility characteristics for each Maryland NH were collected from time periods prior to January 1, 2020. NH outbreaks were defined as larger when total resident COVID-19 cases exceeded 10% of licensed beds. Descriptive and multivariable analyses were conducted to assess the strongest predictors for the primary outcome of larger COVID-19 outbreak.ResultsNHs located in counties with high cumulative incidence of COVID-19 were more likely to have larger outbreaks (OR 4.5, 95% CI 2.3-8.7, p&lt;0.01). NHs with at least 100 beds were more likely to have larger outbreaks, especially among facilities with &gt;140 licensed beds (100-140 beds vs &lt;100 beds: OR 1.9, 95% CI 0.9-4.1, p=0.09; &gt;140 beds vs &lt;100 beds: OR 2.9, 95% CI 1.3-6.1, p&lt;0.01). NHs with more short-stay residents (OR 2.2, 95% CI 1.1-4.8, p=0.04) or fewer Certified Nursing Assistant hours daily (OR 2.6, 95% CI 1.3-5.3, p&lt;0.01) also were more likely to have larger outbreaks. Resident race and gender were not significant predictors of larger outbreaks after adjustment for other factors.ConclusionsLarge NHs with lower staffing levels and many short-stay residents in counties with high COVID-19 incidence were at increased risk for COVID-19 outbreaks. Understanding the characteristics of nursing homes associated with larger outbreaks can help us prepare for the next pandemic.Brief summaryMaryland nursing homes in counties with a high COVID-19 incidence, more licensed beds, a higher proportion of short-stay residents, or lower CNA staffing hours were more likely to have a larger outbreak early in the pandemic.</jats:sec

Short-Stay Admissions Associated With Large COVID-19 Outbreaks in Maryland Nursing Homes

At the beginning of the COVID-19 pandemic, some nursing homes (NHs) in Maryland suffered larger outbreaks than others. This study examined how facility characteristics influenced outbreak size. We conducted a retrospective analysis of secondary data from Maryland NHs to identify characteristics associated with large outbreaks, defined as when total resident cases exceeded 10% of licensed beds, from January 1, 2020, through July 1, 2020. Our dataset was unique in its inclusion of short-stay residents as a measure of resident type and family satisfaction as a measure of quality. Facility characteristics were collected prior to 2020. Like other studies, we found that large outbreaks were more likely to occur in counties with high cumulative incidence of COVID-19, and in NHs with more licensed beds or fewer daily certified nursing assistant (CNA) hours. We also found that NHs with a greater proportion of short-stay residents were more likely to have large outbreaks, even after adjustment for other facility characteristics. Lower family satisfaction was not significantly associated with large outbreaks after adjusting for CNA hours. Understanding the characteristics of NHs with large COVID-19 outbreaks can guide facility re-structuring to prevent the spread of respiratory infections in future pandemics. </jats:p