The development and validation of screening tools for semi-automated surveillance of surgical site infection following various surgeries.

Background: Surveillance of surgical site infections (SSIs) is essential for better prevention. We developed a screening method for SSIs in adults. Methods: The training dataset included data from patients who underwent orthopedic surgeries (N = 1,090), colorectal surgeries (N = 817), and abdominal hysterectomies (N = 523) during 2015-2018. The gold standard for the validation of the screening tool was the presence of SSI as determined by a trained infection control practitioner, via manual full medical record review, using the US Center for Disease Control and Prevention criteria. Using multivariable regression models, we identified the correlates of SSI. Patients who had at least one of these correlates were classified as likely to having SSI and those who did not have any of the correlates were classified as unlikely to have SSI. We calculated the sensitivity and specificity of this tool compared to the gold standard and applied the tool to a validation dataset (N = 1,310, years 2019-2020). Results: SSI was diagnosed by an infection control specialist in 8.2, 5.2, and 31.2% of the patients in the training dataset who underwent hysterectomies, orthopedic surgeries and colorectal surgeries, respectively, vs. 6.2, 6.6, and 25.5%, respectively, in the validation dataset. The correlates of SSI after abdominal hysterectomy were prolonged hospitalization, ordering wound or blood culture, emergency room visit and reoperation; in orthopedic surgery, emergency room visit, wound culture, reoperation, and documentation of SSI, and in colorectal surgeries prolonged hospitalization, readmission, and ordering wound or blood cultures. Area under the curve was >90%. The sensitivity and specificity (95% CI) of the screening tool were 98% (88-100) and 58% (53-62), for abdominal hysterectomy, 91% (81-96) and 82% (80-84) in orthopedic surgeries and 96% (90-98) and 62% (58-66) in colorectal surgeries. The corresponding values for the validation dataset were 89% (67-97) and 75% (69-80) in abdominal hysterectomy; 85% (72-93) and 83% (80-86) in orthopedic surgeries and 98% (93-99) and 59% (53-64) in colorectal surgeries. The number of files needed to be fully reviewed declined by 61-66. Conclusion: The presented semi-automated simple screening tool for SSI surveillance had good sensitivity and specificity and it has great potential of reducing workload and improving SSI surveillance.

Validation of a semiautomated system for surveillance of surgical site infection after cesarean section.

Surveillance of surgical site infection after cesarean section is challenging due to the high volume of these surgeries. A manual chart review of women undergoing cesarean section between January and June 2017 (675 charts, 40 infections) was compared to charts identified via an algorithm (141 charts, 39 infections). The algorithm achieved 97.5% sensitivity and 83.9% specificity and reduced the workload of infection control personnel.

Hospital-wide methicillin-resistant Staphylococcus aureus control program: A 5-year follow-up.

We investigated the influence of different interventions (active surveillance, contact isolation, monitoring, and rapid diagnostic testing) on the number of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia cases. An interrupted time-series analysis was used. MRSA bacteremia cases were reduced by 70% when all interventions were in place. We proved monitoring to be an essential component.

Reporting of adverse events in randomized controlled trials of highly active antiretroviral therapy: systematic review.

OBJECTIVES: Our objectives were to systematically assess the quality of reporting of adverse events (AEs) in publications of randomized trials of highly active antiretroviral therapy (HAART), and to examine whether reporting quality affects the effect estimates reported for AEs. METHODS: We searched the PubMed, Cochrane library and EMBASE electronic databases up to December 2008. We included all published randomized controlled trials assessing HAART for treatment-naive adult HIV-infected individuals, with 48 weeks' follow-up. The quality of AE reporting was extracted according to CONSORT guidelines. We pooled the relative risks for AEs and compared results by sponsorship and different reporting methods. RESULTS: Forty-nine trials, including 19 882 patients, published between 2000 and 2008, met the inclusion criteria. Only one of the trials reported on AE collection methods. Twenty-six trials reported only AEs attributed to drugs, 17 of which did not refer to the attribution methods. AE reporting was nearly always selective and selection criteria were highly variable, based on severity grading or occurrence threshold. Presentation of AEs above an occurrence threshold was more common in studies sponsored by industry (30/31) than in studies sponsored by non-profit organizations (3/18). Moreover, we showed that differences in the methods of reporting AEs may affect the results reported for AEs. No significant improvement in AE reporting was seen over this period. CONCLUSIONS: We found substantial variability in AE reporting. Variability was influenced by sponsor identity and affected outcomes. These facts obstruct our ability to choose HAART based on currently published data.

Long-term Death Rates, West Nile virus epidemic, Israel, 2000.

We studied the 2-year death rate of 246 adults discharged from hospital after experiencing acute West Nile Virus infection in Israel during 2000. The age- and sex-adjusted death rates were significantly higher than in the general population. This excess was greater for men. Significant adverse prognostic factors were age, male sex, diabetes mellitus, and dementia.

Measurement of HIV RNA in patients infected by subtype C by assays optimized for subtype B results in an underestimation of the viral load.

Quantitation assays of HIV-1 RNA used currently were designed and optimized for subtype B viruses. However, infection with non-B HIV viruses has become more common worldwide. Unfortunately, little information is available regarding the suitability of these assays for measurement of viral load in specific non-B subtypes. The performance of two commercial HIV-1 RNA quantitation assays was evaluated in 82 HIV subtype C-infected patients and in 43 HIV-1 subtype B-infected patients. Blood samples were tested by the Amplicor HIV-1 Monitor Assay, Version 1.5, and by the nucleic acid sequence-based amplification HIV-1 assay (NucliSens). The results were compared by using a paired, two-tailed Student's t-test; the difference between the assays was found to be significant only for subtype C. Discordant results (>0.5 log difference) between the two assays were detected in 39% of subtype C samples, compared to 23.2% of subtype B samples. In all cases in which a discordant result was detected, the lower results were obtained by the NucliSens assay. Discordant results between CD4 and viral load (CD4 < 200 cells/ml with a viral load <5,000 copies/ml) were observed in eight of the subtype C-infected patients when a viral load was measured by NucliSens (9.7%), compared to three patients (3.6%) when measured by the Amplicor assay. In conclusion, in patients with HIV subtype C infection, measurement of HIV RNA by the NucliSens assay resulted in a significant underestimation of the viral load as compared to the Amplicor assay. As a consequence, such an underestimation may result in sub-optimal care of patients infected with HIV subtype C.

Outcome of West Nile fever in older adults.

OBJECTIVES: To determine the effect of clinical presentation and cognitive changes on the postdischarge outcome in older adult patients with West Nile fever (WNF). DESIGN: Retrospective, cohort analysis. SETTING: Meir Hospital located in the center of Israel in the Sharon region. PARTICIPANTS: Thirty-two patients aged 65 and older hospitalized during a WNF outbreak. MEASUREMENTS: All patients' charts were analyzed retrospectively with special emphasis on their cognitive and functional state. A follow-up examination of patients with functional decline at discharge was performed after 3 months. RESULTS: A change in consciousness, rather than in cognition, predicted the outcome. The death rate was 22% (7/32); all fatal cases were aged 78 and older. Similarly, the functional decline and residual damage appeared only in the older age group (>or=75). Eighty-eight percent of the survivors returned to their premorbid function. In contrast to other viral infections, chronic conditions in the subjects had no effect on the outcome. CONCLUSIONS: In older adults, WNF carries a high death rate, but the outcome is favorable for the survivors.