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Increased mortality in hospital- compared to community-onset carbapenem-resistant enterobacterales infections
(2024)
Angelique E Boutzoukas
;
Natalie Mackow
;
Abhigya Giri
;
Lauren Komarow
;
Carol Hill
<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>The CDC reported a 35% increase in hospital-onset (HO) carbapenem-resistant Enterobacterales (CRE) infections during the COVID-19 pandemic. We evaluated patient outcomes following HO and community-onset (CO) CRE bloodstream infections (BSI).</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Patients prospectively enrolled in CRACKLE-2 from 56 hospitals in 10 countries between 30 April 2016 and 30 November 2019 with a CRE BSI were eligible. Infections were defined as CO or HO by CDC guidelines, and clinical characteristics and outcomes were compared. The primary outcome was desirability of outcome ranking (DOOR) 30 days after index culture. Difference in 30-day mortality was calculated with 95% CI.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Among 891 patients with CRE BSI, 65% were HO (582/891). Compared to those with CO CRE, patients with HO CRE were younger [median 60 (Q1 42, Q3 70) years versus 65 (52, 74); P &lt; 0.001], had fewer comorbidities [median Charlson comorbidity index 2 (1, 4) versus 3 (1, 5); P = 0.002] and were more acutely ill (Pitt bacteraemia score ≥4: 47% versus 32%; P &lt; 0.001). The probability of a better DOOR outcome in a randomly selected patient with CO BSI compared to a patient with HO BSI was 60.6% (95% CI: 56.8%–64.3%). Mortality at 30-days was 12% higher in HO BSI (192/582; 33%) than CO BSI [66/309 (21%); P &lt; 0.001].</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>We found a disproportionately greater impact on patient outcomes with HO compared to CO CRE BSIs; thus, the recently reported increases in HO CRE infections by CDC requires rigorous surveillance and infection prevention methods to prevent added mortality.</jats:p> </jats:sec>
Scopus© Citations 1 3
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Clinical Outcomes and Bacterial Characteristics of Carbapenem-resistant <i>Acinetobacter Baumannii</i> Among Patients From Different Global Regions
(2023)
Minggui Wang
;
Lizhao Ge
;
Liang Chen
;
Lauren Komarow
;
Blake Hanson
<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>Carbapenem-resistant Acinetobacter baumannii (CRAb) is 1 of the most problematic antimicrobial-resistant bacteria. We sought to elucidate the international epidemiology and clinical impact of CRAb.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>In a prospective observational cohort study, 842 hospitalized patients with a clinical CRAb culture were enrolled at 46 hospitals in five global regions between 2017 and 2019. The primary outcome was all-cause mortality at 30 days from the index culture. The strains underwent whole-genome analysis.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Of 842 cases, 536 (64%) represented infection. By 30 days, 128 (24%) of the infected patients died, ranging from 1 (6%) of 18 in Australia-Singapore to 54 (25%) of 216 in the United States and 24 (49%) of 49 in South-Central America, whereas 42 (14%) of non-infected patients died. Bacteremia was associated with a higher risk of death compared with other types of infection (40 [42%] of 96 vs 88 [20%] of 440). In a multivariable logistic regression analysis, bloodstream infection and higher age-adjusted Charlson comorbidity index were independently associated with 30-day mortality. Clonal group 2 (CG2) strains predominated except in South-Central America, ranging from 216 (59%) of 369 in the United States to 282 (97%) of 291 in China. Acquired carbapenemase genes were carried by 769 (91%) of the 842 isolates. CG2 strains were significantly associated with higher levels of meropenem resistance, yet non-CG2 cases were over-represented among the deaths compared with CG2 cases.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>CRAb infection types and clinical outcomes differed significantly across regions. Although CG2 strains remained predominant, non-CG2 strains were associated with higher mortality.</jats:p> <jats:p>Clinical Trials Registration. NCT03646227.</jats:p> </jats:sec>
3Scopus© Citations 102
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A Multidimensional Approach to Measuring Quality of Employment (QoE) Deprivation in Six Central American Countries
(2021)
Pablo González
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Kirsten Sehnbruch
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APABLAZA SALINAS, MAURICIO IVÁN
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Rocío Méndez Pineda
;
Veronica Arriagada
<jats:title>Abstract</jats:title><jats:p>This paper proposes a methodology for measuring Quality of Employment (QoE) deprivation from a multidimensional perspective in six Central American countries (Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, and Panama) using a dataset specifically designed to measure employment conditions. Building on previous work on multidimensional poverty and employment indicators, the paper uses the Alkire/Foster (AF) method to construct a synthetic indicator of the QoE <jats:italic>at an individual level.</jats:italic> It selects four dimensions that must be considered as essential to QoE deprivation: income, job stability, job security and employment conditions. These dimensions then subdivide into several indicators, a threshold for each indicator and dimension is established before defining an overall cut-off line that allows for the calculation of composite levels of deprivation. The results generated by this indicator show that Central American countries can be divided into three distinct and robust performance groups in terms of their QoE deprivation. Overall, approximately 60% of the deprivation levels are attributable to non-income variables, such as occupational status and job tenure. The methodology used can allow policymakers to identify and focus on the most vulnerable workers in a labour market and highlights the fact that having a formal written contract is no guarantee of good job quality, particularly in the case of women.</jats:p>
Scopus© Citations 27 4
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New Strategies to Explain Organizational Resilience on the Firms: A Cross-Countries Configurations Approach
(2022)
Jorge Heredia
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Cathy Rubiños
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William Vega
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Walter Heredia
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Alejandro Flores
Organizations need to develop their resilience to foster future success to survive complex environments. This research conducts a comparative analysis to understand firms’ strategies in a “black swan” event. We use the “strategy tripod” to operationalize resilience theory and explain the configurations or pathways that lead to high organizational resilience in a crisis context. The data correspond to 1936 firms drawn from the “Enterprise Survey 2020 for Innovation and Entrepreneurship in China (ESIEC)”, and to 66 Central American firms drawn from the “World Bank 2020 Enterprise Surveys” are also analyzed. The methodological approach fuzzy set qualitative comparative analysis (fsQCA) is applied. We discuss and analyze the strategies of companies in this “new normal”; our results establish that in the case of emerging economies, organizational innovation seems to be a necessary condition for becoming an organizational resilience to a black swan crisis (finding from both cases). We also found that labor flexibility and emotional intelligence for the case of firms from China, and adequate control of the turbulence environment for the cases of Central America, were also necessary conditions for each region. We further argue that digitalization depends on access to government support for its success. China reinforces its strategies in an intensification of human resources flexibility. In addition, they are better prepared for the “black swan” crisis, allowing them to adapt quickly and generate business model innovation to mitigate the effects of the pandemic in this “new normal.” In contrast, Central America needs rapid organization for organizational resilience.
Scopus© Citations 43 1

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