Prevalence and risk factors for antibiotic-resistant community-associated bloodstream infections

Antibiotic resistance is increasing in many community settings. The purpose of this study was to determine the proportion of antibiotic resistant community-associated bloodstream infections [CA-BSIs] present on hospital admissions to identify risk factors for acquiring resistant versus susceptible CA-BSIs and to describe the incidence of concurrent infections with CA-BSIs. We conducted a retrospective cohort study of patients discharged from one community, one pediatric, and two tertiary/quaternary care hospitals within an academically affiliated network in the borough of Manhattan in New York, NY, from 2006 to 2008. The CA-BSIs present at hospital admission were defined as BSIs occurring within the first 48 h of hospitalization. Infections and patient characteristics were identified using data available from patients' electronic medical records and discharge records. In total, 1677 CA-BSIs were identified. Staphylococcus aureus had the largest proportion of resistance [41.2%], followed by enterococcal species [24.3%], Pseudomonas aeruginosa [20.2%], Streptococcus pneumoniae [16.6%], Acinetobacter baumannii [10.0%], and Klebsiella pneumoniae [9.9%]. Significant predictors of resistance were prior residence in a skilled nursing facility [OR, 2.55; 95% Cl, 1.39-4.70], advanced age [1.01; 1.002-1.02], presence of malignancy [0.58; 0.37-0.91], prior hospitalization [1.62; 1.17-2.23], a weighted Charlson score [1.09; 1.02-1.17] for S. aureus, presence of malignancy [1.82; 1.004-3.30], prior hospitalizations [2.03; 1.12-3.38] for enterococcal species, and younger age for S. pneumoniae [p = 0.02]. Urinary tract infections were the most common concurrent infection [n = 45/87, 51.7%]. Over 27% of the CA-BSIs present on admission were antibiotic resistant. Understanding the prevalence and risk factors for CA-BSIs may help improve empiric antibiotic therapy and outcomes for patients with community-onset infections

Prevalence and correlates of hepatitis C virus infection among inmates at two New York State correctional facilities

Previous studies have reported decreasing hepatitis C virus [HCV] infection rates in the general population. However, differential susceptibility in institutionalized populations suggest that HCV infection is even more prevalent in prison populations than previously reported yet, routine screening for HCV infection among prisoners is not generally available. We estimated the HCV prevalence and identified associated exposures at two maximum-security prisons using data obtained from 2788 inmates from the Risk Factors for Spread of Staphylococcus aureus in Prisons Study in New York, which recruited participants from January 2009 and January 2013. HCV prevalence was 10.1% [n = 295]; injection drug use, injection drug use sex partners, and HIV diagnosis exhibited the strongest associations with HCV infection in multivariable models, adjusting for covariates. Taken together, the findings of the present study provide an updated estimate of HCV prevalence and suggest that incarcerated populations represent a declining yet significant portion of the hepatitis epidemic