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Morgan Bustamante BL, Fejerman L, May L, Martínez-López B. Community-acquired Staphylococcus aureus skin and soft tissue infection risk assessment using hotspot analysis and risk maps: the case of California emergency departments. BMC Public Health 2024; 24:123. [PMID: 38195461 PMCID: PMC10775506 DOI: 10.1186/s12889-023-17336-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/25/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Community-acquired Staphylococcus aureus (CA-Sa) skin and soft tissue infections (SSTIs) are historically associated with densely populated urban areas experiencing high poverty rates, intravenous drug use, and homelessness. However, the epidemiology of CA-Sa SSTIs in the United States has been poorly understood since the plateau of the Community-acquired Methicillin-resistant Staphylococcus aureus epidemic in 2010. This study examines the spatial variation of CA-Sa SSTIs in a large, geographically heterogeneous population and identifies neighborhood characteristics associated with increased infection risk. METHODS Using a unique neighborhood boundary, California Medical Service Study Areas, a hotspot analysis, and estimates of neighborhood infection risk ratios were conducted for all CA-Sa SSTIs presented in non-Federal California emergency departments between 2016 and 2019. A Bayesian Poisson regression model evaluated the association between neighborhood-level infection risk and population structure, neighborhood poverty rates, and being a healthcare shortage area. RESULTS Emergency departments in more rural and mountainous parts of California experienced a higher burden of CA-Sa SSTIs between 2016 and 2019. Neighborhoods with high infection rates were more likely to have a high percentage of adults living below the federal poverty level and be a designated healthcare shortage area. Measures of population structure were not associated with infection risk in California neighborhoods. CONCLUSIONS Our results highlight a potential change in the epidemiology of CA-Sa SSTIs in California emergency departments. Future studies should investigate the CA-Sa burden in other geographies to identify whether this shift in epidemiology holds across other states and populations. Further, a more thorough evaluation of potential mechanisms for the clustering of infections seen across California neighborhoods is needed.
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Affiliation(s)
- Brittany L Morgan Bustamante
- Public Health Sciences, School of Medicine, University of California, Davis, Davis, CA, USA.
- Center for Animal Disease Modeling and Surveillance, Department of Veterinary Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, CA, USA.
| | - Laura Fejerman
- Public Health Sciences, School of Medicine, University of California, Davis, Davis, CA, USA
| | - Larissa May
- Emergency Medicine, School of Medicine, University of California, Davis, Davis, CA, USA
| | - Beatriz Martínez-López
- Center for Animal Disease Modeling and Surveillance, Department of Veterinary Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, CA, USA
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Morgan Bustamante BL, Chigerwe M, Martínez-López B, Aly SS, McArthur G, ElAshmawy WR, Fritz H, Williams DR, Wenz J, Depenbrock S. Antimicrobial Susceptibility in Respiratory Pathogens and Farm and Animal Variables in Weaned California Dairy Heifers: Logistic Regression and Bayesian Network Analyses. Antibiotics (Basel) 2024; 13:50. [PMID: 38247609 PMCID: PMC10812578 DOI: 10.3390/antibiotics13010050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/21/2023] [Accepted: 12/28/2023] [Indexed: 01/23/2024] Open
Abstract
Weaned dairy heifers are a relatively understudied production group. Bovine respiratory disease (BRD) is the most common cause of antimicrobial drug (AMD) use, morbidity, and mortality in this production group. The study of antimicrobial resistance (AMR) is complicated because many variables that may affect AMR are related. This study generates hypotheses regarding the farm- and animal-level variables (e.g., vaccination, lane cleaning, and AMD use practices) that may be associated with AMR in respiratory isolates from weaned dairy heifers. A cross-sectional study was performed using survey data and respiratory isolates (Pasteurella multocida, Mannheimia haemolytica, and Histophilus somni) collected from 341 weaned dairy heifers on six farms in California. Logistic regression and Bayesian network analyses were used to evaluate the associations between farm- and animal-level variables with minimum inhibitory concentration (MIC) classification of respiratory isolates against 11 AMDs. Farm-level variables associated with MIC classification of respiratory isolates included the number of source farms of a calf-rearing facility, whether the farm practiced onsite milking, the use of lagoon water for flush lane cleaning, and respiratory and pinkeye vaccination practices. Animal-level variables associated with a MIC classification included whether the calf was BRD-score-positive and time since the last phenicol treatment.
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Affiliation(s)
- Brittany L. Morgan Bustamante
- Public Health Sciences, School of Medicine, University of California, Davis, Davis, CA 95616, USA
- Center for Animal Disease Modeling and Surveillance, Department of Veterinary Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, CA 95616, USA
| | - Munashe Chigerwe
- Department of Veterinary Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, CA 95616, USA
| | - Beatriz Martínez-López
- Center for Animal Disease Modeling and Surveillance, Department of Veterinary Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, CA 95616, USA
| | - Sharif S. Aly
- Veterinary Medicine Teaching and Research Center, School of Veterinary Medicine, University of California, Davis, Tulare, CA 93274, USA
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California, Davis, Davis, CA 95616, USA
| | - Gary McArthur
- Swinging Udders Veterinarian Services, Galt, CA 95632, USA
| | - Wagdy R. ElAshmawy
- Veterinary Medicine Teaching and Research Center, School of Veterinary Medicine, University of California, Davis, Tulare, CA 93274, USA
- Department of Internal Medicine and Infectious Diseases, Faculty of Veterinary Medicine, Cairo University, Giza 12613, Egypt
| | - Heather Fritz
- California Animal Health and Food Safety Laboratory System, School of Veterinary Medicine, University of California, Davis, Davis, CA 95616, USA
| | - Deniece R. Williams
- Veterinary Medicine Teaching and Research Center, School of Veterinary Medicine, University of California, Davis, Tulare, CA 93274, USA
| | - John Wenz
- Field Disease Investigation Unit, College of Veterinary Medicine, Washington State University, Pullman, WA 99163, USA
| | - Sarah Depenbrock
- Department of Veterinary Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, CA 95616, USA
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Morgan Bustamante BL, May L, Fejerman L, Martínez-López B. A Bayesian multilevel analysis exploring population-level effects mediating the relationship between area-level poverty and community-acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA) infection across California communities. Health Place 2023; 83:103094. [PMID: 37515963 DOI: 10.1016/j.healthplace.2023.103094] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/06/2023] [Accepted: 07/19/2023] [Indexed: 07/31/2023]
Abstract
Poverty is an often-cited driver of health disparities, and associations between poverty and community-acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA) infection are well documented. However, the pathways through which poverty influences infection have not been thoroughly examined. This project aims to identify mediating variables, or mechanisms, explaining why area-level poverty is associated with CA-MRSA infection in Californians. Bayesian multilevel models accounting for spatial confounding were developed to test whether the association between area-level poverty and CA-MRSA infection is mediated by living in a primary care shortage area (HCSA), living near an adult correctional facility, and residential environmental degradation. The association between area-level poverty and CA-MRSA infection can be partially explained by spatial autocorrelation, living in an HCSA, and environmental degradation in the neighborhood. Combined, the mediators explain approximately 6% of the odds of CA-MRSA infection for individuals living in neighborhoods with high poverty rates and 50% of the statistical association between area-level poverty and CA-MRSA infection. The statistical association between area-level poverty and infection was completely explained by the mediators for individuals living in neighborhoods with low poverty rates.
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Affiliation(s)
- Brittany L Morgan Bustamante
- Public Health Sciences, School of Medicine, University of California, Davis, CA, United States; Center for Animal Disease Modeling and Surveillance, Department of Veterinary Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA, United States.
| | - Larissa May
- Department, School of Medicine, University of California, Davis, CA, United States
| | - Laura Fejerman
- Public Health Sciences, School of Medicine, University of California, Davis, CA, United States
| | - Beatriz Martínez-López
- Center for Animal Disease Modeling and Surveillance, Department of Veterinary Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA, United States
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Ford JS, Morgan Bustamante BL, Virk MK, Ramirez N, Matsumoto CG, Lee DJ, MacDonald S, May L. Use of clinical decision support for antibiotic stewardship in the emergency department and outpatient clinics: An interrupted time-series analysis. Antimicrob Steward Healthc Epidemiol 2023; 3:e80. [PMID: 37205319 PMCID: PMC10186615 DOI: 10.1017/ash.2023.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 05/21/2023]
Abstract
Objective To evaluate the impact of implementing clinical decision support (CDS) tools for outpatient antibiotic prescribing in the emergency department (ED) and clinic settings. Design We performed a before-and-after, quasi-experimental study that employed an interrupted time-series analysis. Setting The study institution was a quaternary, academic referral center in Northern California. Participants We included prescriptions for patients in the ED and 21 primary-care clinics within the same health system. Intervention We implemented a CDS tool for azithromycin on March 1, 2020, and a CDS tool for fluoroquinolones (FQs; ie, ciprofloxacin, levofloxacin, and moxifloxacin) on November 1, 2020. The CDS added friction to inappropriate ordering workflows while adding health information technology (HIT) features to easily perform recommended actions. The primary outcome was the number of monthly prescriptions for each antibiotic type, by implementation period (before vs after). Results Immediately after azithromycin-CDS implementation, monthly rates of azithromycin prescribing decreased significantly in both the ED (-24%; 95% CI, -37% to -10%; P < .001) and outpatient clinics (-47%; 95% CI, -56% to -37%; P < .001). In the first month after FQ-CDS implementation in the clinics, there was no significant drop in ciprofloxacin prescriptions; however, there was a significant decrease in ciprofloxacin prescriptions over time (-5% per month; 95% CI, -6% to -3%; P < .001), suggesting a delayed effect of the CDS. Conclusion Implementing CDS tools was associated with an immediate decrease in azithromycin prescriptions, in both the ED and clinics. CDS may serve as a valuable adjunct to existing antimicrobial stewardship programs.
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Affiliation(s)
- James S. Ford
- Department of Emergency Medicine, University of California–San Francisco, San Francisco, California
| | | | - Mehr Kaur Virk
- Department of Emergency Medicine, University of California Davis, School of Medicine. Sacramento, California
| | - Nancy Ramirez
- Department of Emergency Medicine, University of California Davis, School of Medicine. Sacramento, California
| | - Cynthia G. Matsumoto
- Office of Population Health and Accountable Care, University of California Davis, Sacramento, California
| | - Daniel Jin Lee
- Department of Emergency Medicine, University of California Davis, School of Medicine. Sacramento, California
| | - Scott MacDonald
- Department of Clinical Informatics, University of California Davis Health, Sacramento, California
| | - Larissa May
- Department of Emergency Medicine, University of California Davis, School of Medicine. Sacramento, California
- Author for correspondence: Larissa May, University of California–Davis Medical Center, 2315 Stockton Blvd, Sacramento, CA95817. E-mail:
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