Physicians' attitude and knowledge regarding antibiotic use and resistance in ambulatory settings.

Background: The aim of this survey was to assess the attitudes of physicians toward antibiotic prescribing and explore their knowledge about antimicrobial resistance (AMR) in ambulatory care settings.

Methods: We conducted a cross-sectional survey that was administered to physicians who work primarily in ambulatory care settings in the United States. The survey was self-administered, voluntary, and anonymous, and was delivered through electronic mail and online forums using a 35-item questionnaire.

Epidemiology of Carbapenem-Resistant Enterobacteriaceae at a Long-term Acute Care Hospital.

Background: Residents of long-term acute care hospitals (LTACHs) are considered important reservoirs of multidrug-resistant organisms, including Carbapenem-resistant Enterobacteriaceae (CRE). We conducted this study to define the characteristics of CRE-infected/colonized patients admitted to an LTACH and the molecular characteristics of the CRE isolates.

Methods: This retrospective study was conducted to collect information on demographic and comorbid conditions in CRE-colonized/infected patients admitted to a 77-bed LTACH in Detroit between January 2011 and July 2012.

A Rare Case of Mediastinal Bronchogenic Cyst Infected by .

Bronchogenic cysts are rare congenital malformations which arise from abnormal budding of the primitive tracheobronchial tube and can localize to either the mediastinum or lung parenchyma. They remain clinically silent in most adults unless they become infected or are large enough to compress adjacent structures. Infections involving bronchogenic cysts are often polymicrobial.

Implementing an antibiotic stewardship program at a long-term acute care hospital in Detroit, Michigan.

Background: The objective of the study was to assess health care providers' (HCPs) knowledge and attitude toward antimicrobial resistance (AMR) and implement an antimicrobial stewardship program (ASP) in a long-term acute care hospital (LTACH).

Methods: A questionnaire on antibiotic use and resistance was administered to HCP in an LTACH in Detroit, Michigan, between August 2011 and October 2011. Concurrently, a retrospective review of common antibiotic prescription practices and costs was conducted.

Prevalence of Clostridium difficile infection in acute care hospitals, long-term care facilities, and outpatient clinics: Is Clostridium difficile infection underdiagnosed in long-term care facility patients?

Clostridium difficile infection is a common cause of diarrhea in long-term care facility (LTCF) patients. The high prevalence of C difficile infection in LTCFs noted in our study calls for a critical need to educate LTCF staff to send diarrheal stool for C difficile testing to identify more cases and prevent transmission.

Predictors of Clostridium difficile infection-related mortality among older adults.

Background: Over 90% of annual deaths caused by Clostridium difficile infection (CDI) occur in persons aged ≥65 years. However, no large-scale studies have been conducted to investigate predictors of CDI-related mortality among older adults.

Methods: This case-control study included 540 CDI patients aged ≥60 years admitted to a tertiary care hospital in Detroit, Michigan, between January 2005 and December 2012.

Risk factors associated with interfacility transfers among patients with Clostridium difficile infection.

Background: Preventing the transmission of Clostridium difficile infection (CDI) over the continuum of care presents an important challenge for infection control.

Methods: A prospective case-control study was conducted on patients admitted with CDI to a tertiary care hospital in Detroit between August 2012 and September 2013. Patients were then followed for 1 year by telephone interviews and the hospital administrative database.

Risk factors and acute in-hospital costs for infected pressure ulcers among gunshot-spinal cord injury victims in southeastern Michigan.

Background: Management of pressure ulcers (PrUs) in patients with gunshot-spinal cord injuries (SCIs) presents unique medical and economic challenges for practitioners.

Methods: A retrospective chart review was conducted at 3 acute care hospitals in metropolitan Detroit for patients admitted with PrUs due to gunshot-SCIs between January 2004 and December 2008. Multivariate analysis using logistic regression was conducted to choose for the independent predictors of infected PrUs.

Burden of Clostridium difficile infection on hospital readmissions and its potential impact under the Hospital Readmission Reduction Program.

Background: Both Clostridium [corrected] difficile infection (CDI) rates in hospitals and interest in reducing 30-day readmission rates have increased dramatically in the United States. The objective of this study was to characterize the burden of CDI on 30-day hospital readmissions at a tertiary care health-system.

Methods: A patient discharge database was used to identify patients with a CDI diagnosis (ICD-9 code 008.

Risk factors and outcomes for patients with bloodstream infection due to Acinetobacter baumannii-calcoaceticus complex.

Identifying patients at risk for bloodstream infection (BSI) due to Acinetobacter baumannii-Acinetobacter calcoaceticus complex (ABC) and providing early appropriate therapy are critical for improving patient outcomes. A retrospective matched case-control study was conducted to investigate the risk factors for BSI due to ABC in patients admitted to the Detroit Medical Center (DMC) between January 2006 and April 2009. The cases were patients with BSI due to ABC; the controls were patients not infected with ABC.

Understanding health care personnel's attitudes toward mandatory influenza vaccination.

Background: This study investigated the factors influencing influenza vaccination rates among health care personnel (HCP) and explored HCP's attitudes toward a policy of mandatory vaccination.

Methods: In September 2012, a 33-item Web-based questionnaire was administered to 3,054 HCP employed at a tertiary care hospital in metropolitan Detroit.

Results: There was a significant increase in the rate of influenza vaccination, from 80% in the 2010-2011 influenza season (before the mandated influenza vaccine) to 93% in 2011-2012 (after the mandate) (P < .

Epidemiology of bloodstream infections caused by Acinetobacter baumannii and impact of drug resistance to both carbapenems and ampicillin-sulbactam on clinical outcomes.

Acinetobacter baumannii has become a leading cause of bloodstream infections (BSI) in health care settings. Although the incidence of infection with carbapenem- and ampicillin-sulbactam-resistant (CASR) A. baumannii has increased, there is a scarcity of studies which investigate BSI caused by CASR A.