Knowledge-sharing networks of hospital-based infection preventionists in Kentucky.

Background: Infection preventionists (IPs) have a multitude of tasks aimed at the prevention and control of infections in the healthcare setting. These tasks require a great deal of knowledge that has been more challenging to gain over the past decade due to the rapidly changing healthcare environment, the IPs\u27 increasing numbers of duties, limited staffing, and a number of other issues. Because of these challenges, other mechanisms of rapid and efficient knowledge acquisition are needed for optimal job performance. One possible mechanism is knowledge sharing through social or professional networks. Objective: To examine the knowledge-sharing network structure of hospital-based IPs in Kentucky. Methods: An electronic survey instrument was e-mailed to all hospital-based IPs in Kentucky. Roster lists were used to elicit alters for knowledge sharing. Basic demographics and employment data were collected. Directed sociograms were utilized to visually examine the network. Density and component analyses were used to evaluate network cohesion. In and out-degree, betweenness, and eigenvector statistics were calculated to examine node centrality. Key player reach and fragmentation algorithms were used to identify key players. Geospatial network analysis was also used to analyze the network structure. Results: A total of 75 IPs completed the survey for a 58% response rate. Seven IPs were excluded due to their limited focus on infection prevention activities. The network density was ,1.8%. Three network components were identified. The median (range) centrality measures were as follows: in-degree, 2 (0-11); out-degree, 0.5 (0-5); betweenness, 0 (0-567); and eigenvector 0.02 (0-0.45). One IP had the highest centrality measures. Three key players were identified in the reach and fragmentation analyses, of which most were in the age range that would soon qualify them for retirement. Geospatial analysis of the network revealed that it spanned the entire state of Kentucky and did not fit into any particular sectioning of the state (Medical Trade Area, APIC chapter, physical barriers, etc.). Conclusions: Very low network density and centrality statistics indicate that the knowledge-sharing network of hospital-based IPs in Kentucky is not adequate for optimal knowledge sharing. In a state such as Kentucky with predominantly small, rural facilities that may have limited access to knowledge as compared to large, university settings, an optimal knowledge-sharing network among these facilities may allow for diffusion of new information to IPs at these facilities. Future research is needed to identify interventions to increase network connections in this field

Severity of disease and mortality for hospitalized patients with community-acquired viral pneumonia compared to patients with community-acquired bacterial pneumonia

Background: There exists a large body of literature to help identify, diagnose, treat, and manage community-acquired pneumonia (CAP). Despite this, there is little data that directly compares the clinical syndromes and complications of pure bacterial pneumonia to pure viral pneumonia. Our study compares the clinical presentation, morbidity and mortality of viral vs. bacterial etiologies of CAP. Methods: This was a secondary data analysis of the Community-Acquired Pneumonia Organization (CAPO) international study database. Data was collected concerning patient demographics, physical examination findings, laboratory findings, radiological findings, severity of illness, and clinical outcomes and stratified according to the two study groups, CAVP and CABP. A microbiological diagnosis of CABP was based on the isolation of a bacterium from a respiratory sample, blood culture and/or identification of a urinary antigen for Streptococcus or Legionella; microbiological diagnosis of CAVP was based on polymerase chain reaction or antigen detection from respiratory samples. Results: Our study included 1,913 patients. Of these, 286 (15.0%) had viral infection, while 1,627 (85.0%) had CAVP. We found that bacterial CAP patients are older, more frequently male, and suffer from a higher proportion of comorbidities when compared to viral CAP patients. Comparison of physical exam findings and laboratory values failed to find a clinically significant difference between bacterial and viral CAP patients. When comparing severity of illness, bacterial CAP patients had greater frequency of PSI ≥ class IV; however, viral CAP patients more frequently needed ICU admission, ventilator support, vasopressor support, and had higher rate of in hospital mortality. Conclusions: Our study confirms the extreme difficulty differentiating CABP from CAVP using demographics, physical exam, or x-ray findings. We found no major clinical or laboratory findings distinguishing CABP from CAVP. The increased severity of illness of CAVP compared to bacterial etiologies shows that PSI scores may not be an accurate indicator of severity of disease. More studies are needed to identify the best process of care for patients with CAP, including the potential benefits of routine respiratory viral panel testing and empiric antiviral therapy

Analysis of the Local and Systemic Cytokine Response Profiles in Patients with Community-Acquired Pneumonia. Relationship with Disease Severity and Outcomes.

The goals of this study were to investigate the relationship of systemic and local cytokine responses with time to clinical stability (TCS) in patients with community-acquired pneumonia (CAP) and to develop a model to integrate multiple cytokine data into “cytokine response profiles” based on local vs. systemic and pro- vs. anti-inflammatory cytokine patterns in order to better understand their relationships with measures of CAP severity and outcomes. Forty hospitalized patients enrolled through the Community Acquired Pneumonia Inflammatory Study Group (CAPISG) were analyzed. Based on the ranked distribution of the levels of eight different pro-inflammatory cytokines and chemokines (IL-1b, IL-6, IL-8, IL-12p40, IL-17A, IFNg, TNFa and CXCL10) in plasma and sputum on hospital admission, a “pro-inflammatory cytokine score (PICS)” was defined. PICS in plasma and sputum were plotted against each other and quadrants used to define profiles based on the four possible high/low combinations. A similar approach was used to contrast sputum PICS vs. anti-inflammatory cytokines (IL-1ra and IL-10). Some of the “profiles” thus defined were found to group patients with common etiologic characteristics and/or associate with similar measures of disease severity and/or clinical outcomes, suggesting the predictive value of the use of cytokine data in CAP patients

Impact of Obesity on Mortality in Hospitalized Patients with Pneumonia Due to 2009 H1N1 Influenza A Virus Versus Other Etiologies

Background: Reports from the 2009 H1N1 influenza A virus (2009 H1N1) pandemic indicate increased mortality in obese patients hospitalized with pneumonia. However, articles published prior to the pandemic have suggested that obesity may be a protective factor for mortality in these patients. The objective of this study was to compare the impact of obesity on mortality in hospitalized patients with pneumonia due to the 2009 H1N1 versus pneumonia due to other etiologies. Methods: This was a secondary analysis of the CAPO international cohort study. Study groups were defined as follows: Group One, pneumonia due to 2009 H1N1: Patients hospitalized with pneumonia after March 2009 with a positive RT-PCR for 2009 H1N1 and Group Two, pneumonia due to other etiologies: Patients hospitalized with pneumonia before March 2009. Body Mass Index (BMI) was used to predict the influence of obesity on mortality. The effect of BMI on mortality was analyzed using a propensity-adjusted logistic regression model. Results: From the total of 897 patients, 215 (24%) had pneumonia due to 2009 H1N1. After adjustment, increased BMI was associated with increased mortality in patients with pneumonia due to 2009 H1N1 and with decreased mortality in patients with pneumonia due to other etiologies. Conclusions: Obesity is associated with poor outcomes in patients with pneumonia due to 2009 H1N1 but is protective in patients with pneumonia due to other etiologies. Defining the molecular mechanisms by which obesity influences outcomes in patients with pneumonia may help to develop novel therapeutic strategies. Funding: US Department of Homeland Security

Sepsis in Patients with Ventilator Associated Pneumonia due to Methicillin- Resistant Staphylococcus aureus: Incidence and Impact on Clinical outcomes

Background: Sepsis is a clinical syndrome associated with organ dysfunction due to a dysregulated host response to infection. Methicillin-resistant Staphylococcus aureus (MRSA) Ventilator-associated pneumonia (VAP) is a serious infection frequently associated with sepsis. The objectives of this study were to define the incidence of sepsis and clinical failure in patients with MRSA VAP. Methods: This was a secondary analysis of the Improving Medicine through Pathway Assessment of Critical Therapy in Hospital-Acquired Pneumonia (IMPACT-HAP) study database. VAP was defined according to CDC criteria. MRSA VAP was considered when MRSA was isolated from a tracheal aspirate or bronchoalveolar lavage. We used the 3rd International Consensus Definitions for sepsis. The presence of clinical failure was evaluated at the 14-day follow-up and defined as: 1) progression of baseline signs and symptoms of pneumonia, or 2) death. The Chi- Square Trend Test was utilized to determine the association between the level of organ dysfunction and clinical failure. Results: MRSA VAP was diagnosed in 205 patients with 138 (67%) presenting with sepsis. Clinical failure occurred in 14% (8/57) of patients without sepsis. Clinical failure occurred in 18% (13/73) of patients with sepsis and 1 organ dysfunction, in 28% (12/43) of patients with sepsis and 2 organ dysfunction, in 28% (5/18) of patients with sepsis and 3 organ dysfunction, and in 100% (4/4) of patients with sepsis and 4 organ dysfunction (p= 0.01). Conclusions: Sepsis is a frequent complication of MRSA VAP and the number of organ dysfunction correlates with clinical failure in these patients. Effective prevention and treatment of sepsis and associated organ dysfunction is essential to avoid cumulative burden of disease in MRSA VAP

Estimated global public health and economic impact of COVID-19 vaccines in the pre-omicron era using real-world empirical data

Background Limited data are available describing the global impact of COVID-19 vaccines. This study estimated the global public health and economic impact of COVID-19 vaccines before the emergence of the Omicron variant. Methods A static model covering 215 countries/territories compared the direct effects of COVID-19 vaccination to no vaccination during 13 December 2020–30 September 2021. After adjusting for underreporting of cases and deaths, base case analyses estimated total cases and deaths averted, and direct outpatient and productivity costs saved through averted health outcomes. Sensitivity analyses applied alternative model assumptions. Results COVID-19 vaccines prevented an estimated median (IQR) of 151.7 (133.7–226.1) million cases and 620.5 (411.1–698.1) thousand deaths globally through September 2021. In sensitivity analysis applying an alternative underreporting assumption, median deaths averted were 2.1 million. Estimated direct outpatient cost savings were $21.2 ($18.9–30.9) billion and indirect savings of avoided productivity loss were $135.1 ($121.1–206.4) billion, yielding a total cost savings of $155 billion globally through averted infections. Conclusions Using a conservative modeling approach that considered direct effects only, we estimated that COVID-19 vaccines have averted millions of infections and deaths, generating billions of cost savings worldwide, which underscore the continued importance of vaccination in public health response to COVID-19