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Adherence to antibiotic guidelines for pneumonia in chronic-care facilities in Ontario.

https://arctichealth.org/en/permalink/ahliterature192097
Source
Clin Invest Med. 2001 Dec;24(6):304-10
Publication Type
Article
Date
Dec-2001
Author
M. Loeb
A E Simor
L. Landry
A. McGeer
Author Affiliation
Division of Medical Microbiology and Infectious Diseases, McMaster University and the Hamilton Regional Laboratory Program, Ont. loebm@mcmaster.ca
Source
Clin Invest Med. 2001 Dec;24(6):304-10
Date
Dec-2001
Language
English
Publication Type
Article
Keywords
Aged
Anti-Bacterial Agents - therapeutic use
Chronic Disease
Cohort Studies
Female
Humans
Long-Term Care
Male
Ontario - epidemiology
Pneumonia - drug therapy - mortality - radiography
Practice Guidelines as Topic
Prospective Studies
Treatment Outcome
Abstract
To evaluate adherence to antibiotic recommendations for the treatment of pneumonia in patients who receive long-term care and to assess outcomes associated with these recommendations.
A prospective cohort study.
Twenty-two facilities that provide long-term care in southern Ontario.
Older adults treated with antibiotics for a presumptive diagnosis of pneumonia and those with radiologically confirmed pneumonia
Over a 12-month period, older patients who were treated with antibiotics for presumptive pneumonia were prospectively identified. A random sample of these antibiotic courses (646 courses in 638 patients) was reviewed using a standardized data collection form, and demographic and clinical data were collected. Antibiotic courses were classified according to Canadian and American Thoracic Society antibiotic recommendations for pneumonia. In patients with radiologically confirmed pneumonia, the effect of adherence to these recommendations on mortality and persistence of symptoms was assessed.
Only 27.6% (178 of 646) of antibiotic prescriptions evaluated met antibiotic recommendations for nursing-home-acquired pneumonia, and the proportion meeting these varied greatly by facility, ranging from 0% to 53% (median 31%). For patients with radiologically confirmed pneumonia, age (adjusted odds ratio [OR] 1.6, 95% confidence interval [CI] 1.0-2.4, per increase in 10 yr, p = 0.02), sex (adjusted OR 3.0, 95% CI 1.1-8.0, p = 0.03), and adherence to recommended antibiotics (OR 3.0, 95% CI 1.3-7.2, p = 0.01) were associated with death. Adherence to the recommended antibiotics was also associated with adverse reactions, which occurred in 10% of prescriptions meeting the recommendations (OR 2.4, 95% CI 1.3-4.6, p = 0.01).
Adherence to recommended guidelines for antibiotic treatment was low and highly variable among study facilities. Use of recommended antibiotic regimens was associated with increased adverse events and worse outcomes in patients with radiologically confirmed pneumonia.
Notes
Comment In: Clin Invest Med. 2002 Jun;25(3):63-4; author reply 6412137250
PubMed ID
11767234 View in PubMed
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Antibiotic use in Ontario facilities that provide chronic care.

https://arctichealth.org/en/permalink/ahliterature194246
Source
J Gen Intern Med. 2001 Jun;16(6):376-83
Publication Type
Article
Date
Jun-2001
Author
M. Loeb
A E Simor
L. Landry
S. Walter
M. McArthur
J. Duffy
D. Kwan
A. McGeer
Author Affiliation
Division of Microbiology, Department of Pathology, McMaster University, Hamilton, Ontario, Canada. loebm@mcmaster.ca
Source
J Gen Intern Med. 2001 Jun;16(6):376-83
Date
Jun-2001
Language
English
Publication Type
Article
Keywords
Aged
Anti-Bacterial Agents - therapeutic use
Chronic Disease - drug therapy - epidemiology
Cohort Studies
Humans
Infection - drug therapy - epidemiology
Ontario - epidemiology
Prospective Studies
Abstract
To determine the incidence and variability of antibiotic use in facilities which provide chronic care and to determine how often clinical criteria for infection are met when antibiotics are prescribed in these facilities.
A prospective, 12-month, observational cohort study.
Twenty-two facilities which provide chronic care in southwestern Ontario.
Patients who were treated with systemic antibiotics over the study period.
Characteristics of antibiotic prescriptions (name, dose, duration, and indication) and clinical features of randomly selected patients who were treated with antibiotics.
A total of 9,373 courses of antibiotics were prescribed for 2,408 patients (66% of all patients in study facilities). The incidence of antibiotic prescriptions in the facilities ranged from 2.9 to 13.9 antibiotic courses per 1,000 patient-days. Thirty-six percent of antibiotics were prescribed for respiratory tract infections, 33% for urinary infections, and 13% for skin and soft tissue infections. Standardized surveillance definitions of infection were met in 49% of the 1,602 randomly selected patients who were prescribed antibiotics. Diagnostic criteria for respiratory, urinary, and skin infection were met in 58%, 28%, and 65% of prescriptions, respectively. One third of antibiotic prescriptions for a urinary indication were for asymptomatic bacteriuria. Adverse reactions were noted in 6% of prescriptions for respiratory and urinary infections and 4% of prescriptions for skin infection.
Antibiotic use is frequent and highly variable amongst patients who receive chronic care. Reducing antibiotic prescriptions for asymptomatic bacteriuria represents an important way to optimize antibiotic use in this population.
Notes
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PubMed ID
11422634 View in PubMed
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Broth microdilution testing of Haemophilus influenzae with haemophilus test medium versus lysed horse blood broth. Canadian Haemophilus Study Group.

https://arctichealth.org/en/permalink/ahliterature223213
Source
J Clin Microbiol. 1992 Sep;30(9):2284-9
Publication Type
Article
Date
Sep-1992
Author
S R Scriver
D E Low
A E Simor
B. Toye
A. McGeer
R. Jaeger
Author Affiliation
Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada.
Source
J Clin Microbiol. 1992 Sep;30(9):2284-9
Date
Sep-1992
Language
English
Publication Type
Article
Keywords
Amoxicillin - chemistry
Bacteriological Techniques
Blood
Canada - epidemiology
Clavulanic Acids - chemistry
Culture Media - metabolism - standards
Drug Stability
Evaluation Studies as Topic
Haemophilus Infections - diagnosis
Haemophilus influenzae - enzymology - growth & development - isolation & purification
Humans
Microbial Sensitivity Tests - methods
Observer Variation
Reproducibility of Results
beta-Lactamases - analysis
Abstract
Broth microdilution testing of 702 community-acquired isolates of Haemophilus influenzae from across Canada was performed with both Mueller-Hinton broth supplemented with 3% lysed horse blood broth (LHB) (BBL Microbiology Systems, Cockeysville, Md.) and haemophilus test medium (HTM). The prevalence of beta-lactamase production was found to be 26% with no regional variation. MICs determined with LHB tended to be higher than those with HTM, but interpretive errors due to these differences were observed only rarely with trimethoprim-sulfamethoxazole (n = 5), cefaclor (n = 8), and cefamandole (n = 3). The interobserver variability in MIC determinations was found to be greater when LHB was used than when HTM was used. There was no difference in intraobserver variability between the two medium formulations. beta-Lactamase-positive isolates developed false resistance to amoxicillin-clavulanate 2 weeks after microdilution panels of both types of medium were stored at -20 degrees C but not when panels were stored at -70 degrees C. In conclusion, this study supports the use of HTM rather than LHB for sensitivity testing of H. influenzae because of its lower rate of interobserver variability and its ability to support the growth of these organisms, which is comparable to that of LHB.
Notes
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PubMed ID
1400992 View in PubMed
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Calicivirus gastroenteritis in a geriatric long-term care facility--Ontario.

https://arctichealth.org/en/permalink/ahliterature227985
Source
Can Dis Wkly Rep. 1990 Nov 24;16(47):239-40, 243
Publication Type
Article
Date
Nov-24-1990

A cluster of surgical wound infections due to unrelated strains of group A streptococci.

https://arctichealth.org/en/permalink/ahliterature221095
Source
Infect Control Hosp Epidemiol. 1993 May;14(5):265-7
Publication Type
Article
Date
May-1993
Author
F B Jamieson
K. Green
D E Low
A E Simor
C. Goldman
J. Ng
A. McGeer
Author Affiliation
Department of Microbiology, Mount Sinai Hospital, University of Toronto, Ontario, Canada.
Source
Infect Control Hosp Epidemiol. 1993 May;14(5):265-7
Date
May-1993
Language
English
Publication Type
Article
Keywords
Cluster analysis
Cross Infection - epidemiology - microbiology
Diagnosis, Differential
Hospitals
Humans
Ontario - epidemiology
Restriction Mapping
Shock, Septic - diagnosis
Streptococcal Infections - epidemiology - microbiology
Streptococcus pyogenes - isolation & purification
Surgical Wound Infection - epidemiology - microbiology
Abstract
Group A streptococci account for less than 1% of all surgical wound infections but are an important cause of nosocomial outbreaks. We report here a cluster of four group A streptococcal infections that occurred within an 11-day period on a single surgical service. The index case presented with toxic shock-like syndrome. Epidemiologic investigation did not identify any relationship between infections. Restriction endonuclease analysis and M and T typing found the four isolates to be unrelated. Restriction endonuclease analysis is a useful tool for determining relatedness of nosocomial isolates of group A streptococci.
PubMed ID
8496580 View in PubMed
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A comparison of model-building strategies for lower respiratory tract infection in long-term care.

https://arctichealth.org/en/permalink/ahliterature200127
Source
J Clin Epidemiol. 1999 Dec;52(12):1239-48
Publication Type
Article
Date
Dec-1999
Author
M. Loeb
S D Walter
A. McGeer
A E Simor
M A McArthur
G. Norman
Author Affiliation
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. loebm@fhs.mcmaster.ca
Source
J Clin Epidemiol. 1999 Dec;52(12):1239-48
Date
Dec-1999
Language
English
Publication Type
Article
Keywords
Canada - epidemiology
Cohort Studies
Humans
Incidence
Logistic Models
Long-Term Care
Nursing Homes
Prognosis
Proportional Hazards Models
ROC Curve
Respiratory Tract Infections - diagnosis - epidemiology
Retrospective Studies
Risk factors
Abstract
Five strategies for creating predictive models of lower respiratory tract infection in residents of long-term care facilities were compared. A linear judgment model was derived by administering clinical vignettes to physicians who indicated the risk of infection based on the presence or absence of five predictor variables. A model based on physician consensus was created using the same variables. Three models based on empirical data (logistic regression, proportional hazards, and recursive partitioning) were created from a "derivation" sample of data from a cohort study of lower respiratory tract infections in nursing homes using the five predictor variables. All models were applied to a validation set and compared using receiver operating characteristic (ROC) curves. The data-derived and consensus models showed the highest discriminative ability while the linear judgment model showed inferior performance.
PubMed ID
10580788 View in PubMed
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The economic impact of methicillin-resistant Staphylococcus aureus in Canadian hospitals.

https://arctichealth.org/en/permalink/ahliterature195511
Source
Infect Control Hosp Epidemiol. 2001 Feb;22(2):99-104
Publication Type
Article
Date
Feb-2001
Author
T. Kim
P I Oh
A E Simor
Author Affiliation
Health Outcomes and PharmacoEconomics (HOPE) Research Centre, Toronto, Ontario, Canada.
Source
Infect Control Hosp Epidemiol. 2001 Feb;22(2):99-104
Date
Feb-2001
Language
English
Publication Type
Article
Keywords
Cost of Illness
Cross Infection - economics - epidemiology
Drug Costs
Hospital Bed Capacity, 500 and over
Hospital Costs - statistics & numerical data
Hospitals, Teaching - economics
Humans
Incidence
Length of Stay - economics
Methicillin Resistance
Ontario - epidemiology
Patient Isolation - economics
Staphylococcal Infections - economics - epidemiology - prevention & control
Staphylococcus aureus - drug effects
Abstract
To determine the costs associated with the management of hospitalized patients with methicillin-resistant Staphylococcus aureus (MRSA), and to estimate the economic burden associated with MRSA in Canadian hospitals.
Patient-specific costs were used to determine the attributable cost of MRSA associated with excess hospitalization and concurrent treatment. Excess hospitalization for infected patients was identified using the Appropriateness Evaluation Protocol, a criterion-based chart review process to determine the need for each day of hospitalization. Concurrent treatment costs were identified through chart review for days in isolation, antimicrobial therapy, and MRSA screening tests. The economic burden to Canadian hospitals was estimated based on 3,167,521 hospital discharges for 1996 and 1997 and an incidence of 4.12 MRSA cases per 1,000 admissions.
A tertiary-care, university-affiliated teaching hospital in Toronto, Ontario, Canada.
Inpatients with at least one culture yielding MRSA between April 1996 and March 1998.
A total of 20 patients with MRSA infections and 79 colonized patients (with 94 admissions) were identified. This represented a rate of 2.9 MRSA cases per 1,000 admissions. The mean number of additional hospital days attributable to MRSA infection was 14, with 11 admissions having at least 1 attributable day. The total attributable cost to treat MRSA infections was $287,200, or $14,360 per patient The cost for isolation and management of colonized patients was $128,095, or $1,363 per admission. Costs for MRSA screening in the hospital were $109,813. Assuming an infection rate of 10% to 20%, we determined the costs associated with MRSA in Canadian hospitals to be $42 million to $59 million annually.
These results indicate that there is a substantial economic burden associated with MRSA in Canadian hospitals. These costs will continue to rise if the incidence of MRSA increases further.
PubMed ID
11232886 View in PubMed
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The evolution of methicillin-resistant Staphylococcus aureus in Canadian hospitals: 5 years of national surveillance.

https://arctichealth.org/en/permalink/ahliterature193949
Source
CMAJ. 2001 Jul 10;165(1):21-6
Publication Type
Article
Date
Jul-10-2001
Author
A E Simor
M. Ofner-Agostini
E. Bryce
K. Green
A. McGeer
M. Mulvey
S. Paton
Author Affiliation
Department of Microbiology, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario. andrew.simor@swchsc.on.ca
Source
CMAJ. 2001 Jul 10;165(1):21-6
Date
Jul-10-2001
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Canada - epidemiology
Child
Child, Preschool
Cross Infection - epidemiology - microbiology
Female
Humans
Incidence
Infant
Male
Methicillin Resistance
Microbial Sensitivity Tests
Middle Aged
Population Surveillance
Staphylococcal Infections - epidemiology - microbiology
Staphylococcus aureus - drug effects
Abstract
To better understand the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) in Canadian hospitals, surveillance has been conducted in sentinel hospitals across the country since 1995. We report the results of the first 5 years of the program.
For each newly identified inpatient with MRSA, medical records were reviewed for demographic and clinical data. Isolates were subjected to susceptibility testing and molecular typing by pulsed-field gel electrophoresis.
A total of 4507 patients infected or colonized with MRSA were identified between January 1995 and December 1999. The rate of MRSA increased each year from a mean of 0.95 per 100 S. aureus isolates in 1995 to 5.97 per 100 isolates in 1999 (0.46 per 1000 admissions in 1995 to 4.12 per 1000 admissions in 1999) (p
Notes
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Comment In: CMAJ. 2001 Jul 10;165(1):31-211468951
PubMed ID
11468949 View in PubMed
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Factors associated with critical-care healthcare workers' adherence to recommended barrier precautions during the Toronto severe acute respiratory syndrome outbreak.

https://arctichealth.org/en/permalink/ahliterature160928
Source
Infect Control Hosp Epidemiol. 2007 Nov;28(11):1275-83
Publication Type
Article
Date
Nov-2007
Author
A. Shigayeva
K. Green
J M Raboud
B. Henry
A E Simor
M. Vearncombe
D. Zoutman
M. Loeb
A. McGeer
Author Affiliation
Department of Microbiology, Mount Sinai Hospital, Toronto, ON, M5G 1X5, Canada.
Source
Infect Control Hosp Epidemiol. 2007 Nov;28(11):1275-83
Date
Nov-2007
Language
English
Publication Type
Article
Keywords
Adult
Allied Health Personnel
Critical Care
Disease Outbreaks
Female
Guideline Adherence
Humans
Infection Control - methods
Male
Middle Aged
Ontario
Protective Clothing - utilization
Retrospective Studies
Severe Acute Respiratory Syndrome - prevention & control - therapy
Abstract
To assess factors associated with adherence to recommended barrier precautions among healthcare workers (HCWs) providing care to critically ill patients with severe acute respiratory syndrome (SARS).
Fifteen acute care hospitals in Ontario, Canada.
Retrospective cohort study.
All patients with SARS who required intubation during the Toronto SARS outbreak in 2003.
HCWs who provided care to or entered the room of a SARS patient during the period from 24 hours before intubation until 4 hours after intubation.
Standardized interviews were conducted with eligible HCWs to assess their interactions with the SARS patient, their use of barrier precautions, their practices for removing personal protective equipment, and the infection control training they received.
Of 879 eligible HCWs, 795 (90%) participated. In multivariate analysis, the following predictors of consistent adherence to recommended barrier precautions were identified: recognition of the patient as a SARS case (odds ratio [OR], 2.5 [95% confidence interval {CI}, 1.5-4.5); recent infection control training (OR for interactive training, 2.7 [95% CI, 1.7-4.4]; OR for passive training, 1.7 [95% CI, 1.0-3.0]), and working in a SARS unit (OR, 4.0 [95% CI, 1.8-8.9]) or intensive care unit (OR, 4.3 [95% CI, 2.0-9.0]). Two factors were associated with significantly lower rates of consistent adherence: the provision of care for patients with higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores (OR for score APACHE II of 20 or greater, 0.4 [95% CI, 0.28-0.68]) and work on shifts that required more frequent room entry (OR for 6 or more entries per shift, 0.5 [95% CI, 0.32-0.86]).
There were significant deficits in knowledge about self-protection that were partially corrected by education programs during the SARS outbreak. HCWs' adherence to self-protection guidelines was most closely associated with whether they provided care to patients who had received a definite diagnosis of SARS.
PubMed ID
17926279 View in PubMed
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Hospital-acquired invasive group a streptococcal infections in Ontario, Canada, 1992-2000.

https://arctichealth.org/en/permalink/ahliterature173925
Source
Clin Infect Dis. 2005 Aug 1;41(3):334-42
Publication Type
Article
Date
Aug-1-2005
Author
N. Daneman
A. McGeer
D E Low
G. Tyrrell
A E Simor
M. McArthur
B. Schwartz
P. Jessamine
R. Croxford
K A Green
Author Affiliation
University of Toronto, Toronto, Ontario, Canada.
Source
Clin Infect Dis. 2005 Aug 1;41(3):334-42
Date
Aug-1-2005
Language
English
Publication Type
Article
Keywords
Adult
Aged
Child
Cross Infection - epidemiology
Disease Outbreaks
Female
Humans
Male
Ontario - epidemiology
Population Surveillance
Puerperal Infection - epidemiology - microbiology
Risk factors
Streptococcal Infections - epidemiology - microbiology
Streptococcus pyogenes - isolation & purification
Surgical Wound Infection - epidemiology - microbiology
Abstract
A significant proportion of invasive group A streptococcal infections are hospital acquired. No large, prospective studies have characterized this subgroup of cases and evaluated the risk of transmission in hospitals.
We conducted prospective, population-based surveillance of invasive group A streptococcal infections in Ontario, Canada, from 1992 to 2000. Epidemiologic and microbiologic investigations were conducted to identify cross-transmission.
We identified 291 hospital-acquired cases (12.4%) among 2351 cases of invasive group A streptococcal disease. Hospital-acquired invasive group A streptococcal infections are heterogeneous, including surgical site (96 cases), postpartum (86 cases), and nonsurgical, nonobstetrical infections (109 cases). Surgical site infections affected 1 of 100,000 surgical procedures and involved all organ systems. Postpartum infections occurred at a rate of 0.7 cases per 10,000 live births and exhibited an excellent prognosis. Nonsurgical, nonobstetrical infections encompassed a broad range of infectious syndromes (case-fatality rate, 37%). Nine percent of cases were associated with in-hospital transmission. Transmission occurred from 3 of 142 patients with community-acquired cases of necrotizing fasciitis requiring intensive care unit (ICU) admission, compared with 1 of 367 patients with community-acquired cases without necrotizing fasciitis admitted to the ICU and 1 of 1551 patients with other cases (P
Notes
Comment In: Clin Infect Dis. 2005 Aug 1;41(3):343-416007531
PubMed ID
16007530 View in PubMed
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34 records – page 1 of 4.