Skip to main content Accessibility help
×
Home

Summer Peaks in the Incidences of Gram-Negative Bacterial Infection Among Hospitalized Patients

Published online by Cambridge University Press:  02 January 2015


Eli N. Perencevich
Affiliation:
Veterans Affairs Maryland Health Care System, Baltimore, Maryland Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Maryland
Jessina C. McGregor
Affiliation:
College of Pharmacy, Oregon State University, Portland, Oregon
Michelle Shardell
Affiliation:
Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Maryland
Jon P. Furuno
Affiliation:
Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Maryland
Anthony D. Harris
Affiliation:
Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Maryland
J. Glenn Morris
Affiliation:
Emerging Pathogens Institute, University of Florida, Gainesville, Florida
David N. Fisman
Affiliation:
Research Institute of the Hospital for Sick Children, Toronto, Ontario, Canada
Judith A. Johnson
Affiliation:
Emerging Pathogens Institute, University of Florida, Gainesville, Florida
Corresponding

Abstract

Objective.

Recognition of seasonal trends in hospital infections may improve diagnosis, use of empirical therapy, and infection prevention interventions. There are very few data available regarding the seasonal variability of these infections. We quantified the seasonal variation in the incidences of hospital infection caused by common bacterial pathogens and estimated the association between temperature changes and infection rates.

Methods.

A cohort of all adult patients admitted to the University of Maryland Medical Center during the period from 1998 through 2005 was analyzed. Time-series analyses were used to estimate the association of the number of infections per month caused by Pseudomonas aeruginosa, Acinetobacter baumannii, Enterobacter cloacae, Escherichia coli, Staphylococcus aureus, and enterococci with season and temperature, while controlling for long-term trends.

Results.

There were 218,594 admissions to the index hospital, and analysis of 26,624 unique clinical cultures that grew the organisms of interest identified increases in the mean monthly rates of infection caused by P. aeruginosa (28% of isolates recovered; P < .01), E. cloacae (46%; P < .01), E. coli (12%; P < .01), and A. baumannii (21%; P = .06). For each 10°F increase, we observed a 17% increase in the monthly rates of infection caused by P. aeruginosa (P = .01) and A. baumanii (P = .05).

Conclusion.

Significantly higher rates of gram-negative infection were observed during the summer months, compared with other seasons. For some pathogens, higher temperatures were associated with higher infection rates, independent of seasonality. These findings have important implications for infection prevention, such as enhanced surveillance during the warmer months, and for choice of empirical antimicrobial therapy among hospitalized adults. Future, quasi-experimental investigations of gram-negative infection prevention initiatives should control for seasonal variation.


Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

Access options

Get access to the full version of this content by using one of the access options below.

References

1. Harris, AD, Bradham, DD, Baumgarten, M, Zuckerman, IH, Fink, JC, Perencevich, EN. The use and interpretation of quasi-experimental studies in infectious diseases. Clin Infect Dis 2004;38:15861591.Google ScholarPubMed
2. Harris, AD, Lautenbach, E, Perencevich, E. A systematic review of quasi-experimental study designs in the fields of infection control and antibiotic resistance. Clin Infect Dis 2005;41:7782.Google ScholarPubMed
3. McDonald, LC, Banerjee, SN, Jarvis, WR; Nosocomial Infections Surveillance System. Seasonal variation of Acinetobacter infections: 1987-1996. Clin Infect Dis 1999;29:11331137.CrossRefGoogle ScholarPubMed
4. Retailliau, HF, Hightower, AW, Dixon, RE, Allen, JR. Acinetobacter calcoaceticus: a nosocomial pathogen with an unusual seasonal pattern. J Infect Dis 1979;139:371375.CrossRefGoogle ScholarPubMed
5. Furuno, JP, McGregor, JC, Harris, AD, et al. Identifying groups at high risk for carriage of antibiotic-resistant bacteria. Arch Intern Med 2006;166:580585.CrossRefGoogle ScholarPubMed
6. Harris, AD, Perencevich, E, Roghmann, MC, Morris, G, Kaye, KS, Johnson, JA. Risk factors for piperacillin-tazobactam-resistant Pseudomonas aeruginosa among hospitalized patients. Antimicrob Agents Chemother 2002;46:854858.CrossRefGoogle ScholarPubMed
7. Harris, AD, Samore, MH, Lipsitch, M, Kaye, KS, Perencevich, E, Carmeli, Y. Control-group selection importance in studies of antimicrobial resistance: examples applied to Pseudomonas aeruginosa, enterococci, and Escherichia coli . Clin Infect Dis 2002;34:15581563.CrossRefGoogle Scholar
8. Kim, PW, Harris, AD, Roghmann, MC, Morris, JG Jr, Strinivasan, A, Perencevich, EN. Epidemiological risk factors for isolation of ceftriaxone-resistant versus -susceptible Citrobacter freundii in hospitalized patients. Antimicrob Agents Chemother 2003;47:28822887.Google ScholarPubMed
9. NCCLS. Analysis and presentation of cumulative susceptibility test data: approved guideline. NCCLS document. Wayne, PA: NCCLS, 2002:M39A.Google Scholar
10. National Weather Service. Eastern Region Headquarters. Available at: http://www.erh.noaa.gov/. Accessed October 4, 2006.Google Scholar
11. Fisman, DN, Lim, S, Wellenius, GA, et al. It's not the heat, it's the humidity: wet weather increases legionellosis risk in the greater Philadelphia metropolitan area. J Infect Dis 2005;192:20662073.CrossRefGoogle Scholar
12. McCullagh, P, Nelder, JA. Generalized Linear Models. 2nd ed. Boca Raton, FL: Chapman & Hall/CRC Press; 1989.CrossRefGoogle Scholar
13. de Boor, C. A Practical Guide to Splines. New York: Springer; 1978.CrossRefGoogle Scholar
14. Kelsall, JE, Samet, JM, Zeger, SL, Xu, J. Air pollution and mortality in Philadelphia, 1974-1988. Am J Epidemiol 1997;146:750762.CrossRefGoogle Scholar
15. R: a language and environment for statistical computing [computer program]. Version 2.4.0. Vienna; 2004.Google Scholar
16. Naumova, EN. Mystery of seasonality: getting the rhythm of nature. J Public Health Policy 2006;27:212.CrossRefGoogle ScholarPubMed
17. Dowell, SF, Ho, MS. Seasonality of infectious diseases and severe acute respiratory syndrome—what we don't know can hurt us. Lancet Infect Dis 2004;4:704708.CrossRefGoogle ScholarPubMed
18. Smith, TL, Pullen, GT, Crouse, V, Rosenberg, J, Jarvis, WR. Bloodstream infections in pediatric oncology outpatients: a new healthcare systems challenge. Infect Control Hosp Epidemiol 2002;23:239243.CrossRefGoogle ScholarPubMed
19. Hawke, M, Wong, J, Krajden, S. Clinical and microbiological features of otitis externa. J Otolaryngol 1984;13:289295.Google Scholar
20. van Asperen, IA, de Rover, CM, Schijven, JF, et al. Risk of otitis externa after swimming in recreational fresh water lakes containing Pseudomonas aeruginosa . BMJ 1995;311:14071410.CrossRefGoogle Scholar
21. Barben, J, Hafen, G, Schmid, J. Pseudomonas aeruginosa in public swimming pools and bathroom water of patients with cystic fibrosis. J Cyst Fibros 2005;4:227231.CrossRefGoogle Scholar
22. Ogden, ID, MacRae, M, Strachan, NJC. Is the prevalence and shedding concentrations of E. coli O157 in beef cattle in Scotland seasonal? FEMS Microbiol Lett 2004;233:297300.CrossRefGoogle ScholarPubMed
23. Boyce, TG, Swerdlow, DL, Griffin, PM. Escherichia coli O157:H7 and the hemolytic-uremic syndrome. N Engl J Med 1995;333:364368.CrossRefGoogle ScholarPubMed
24. Scholes, D, Hooton, TM, Roberts, PL, Stapleton, AE, Gupta, K, Stamm, WE. Risk factors for recurrent urinary tract infection in young women. J Infect Dis 2000;182:11771182.CrossRefGoogle ScholarPubMed
25. Fortenberry, JD, Orr, DP, Zimet, GD, Blythe, MJ. Weekly and seasonal variation in sexual behaviors among adolescent women with sexually transmitted diseases. J Adolesc Health 1997;20:420425.CrossRefGoogle ScholarPubMed
26. Rojansky, N, Brzezinski, A, Schenker, JG. Seasonality in human reproduction: an update. Hum Reprod 1992;7:735745.CrossRefGoogle ScholarPubMed
27. Haines, A, Patz, JA. Health effects of climate change. JAMA 2004;291:99103.CrossRefGoogle ScholarPubMed

Altmetric attention score


Full text views

Full text views reflects PDF downloads, PDFs sent to Google Drive, Dropbox and Kindle and HTML full text views.

Total number of HTML views: 3
Total number of PDF views: 39 *
View data table for this chart

* Views captured on Cambridge Core between September 2016 - 3rd December 2020. This data will be updated every 24 hours.

Hostname: page-component-79f79cbf67-hp6v8 Total loading time: 1.591 Render date: 2020-12-03T09:00:39.643Z Query parameters: { "hasAccess": "0", "openAccess": "0", "isLogged": "0", "lang": "en" } Feature Flags last update: Thu Dec 03 2020 08:07:08 GMT+0000 (Coordinated Universal Time) Feature Flags: { "metrics": true, "metricsAbstractViews": false, "peerReview": true, "crossMark": true, "comments": true, "relatedCommentaries": true, "subject": true, "clr": false, "languageSwitch": true }

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Summer Peaks in the Incidences of Gram-Negative Bacterial Infection Among Hospitalized Patients
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Summer Peaks in the Incidences of Gram-Negative Bacterial Infection Among Hospitalized Patients
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Summer Peaks in the Incidences of Gram-Negative Bacterial Infection Among Hospitalized Patients
Available formats
×
×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *