Study finds higher risk of group A Strep skin infections among homeless
A study conducted in San Francisco found that homeless residents were more than four times as likely to have group A Streptococcus (GAS) skin infections as people with stable housing, researchers reported yesterday in JAMA Dermatology.
The retrospective, cross-sectional study analyzed inpatients seen by dermatology services at two San Francisco hospitals for bacterial skin and other soft-tissue infections (SSTIs) from March 2018 through March 2020. Patients were classified as persons experiencing homelessness (PEH) if they reported no primary address or an institutional primary address within the past 12 months. Researchers used logistic regression to determine associations between housing status and both GAS SSTI and methicillin-resistant Staphylococcus aureus (MRSA) SSTI.
Of the 181 patients included in the study, 52 were PEH and 129 had stable housing. Among PEH, 42% had GAS-positive cultures and 33% had MRSA-positive cultures, compared with 15% and 23% of patients with stable housing, respectively. After controlling for confounders, PEH had significantly higher odds of GAS SSTI (odds ratio [OR], 4.25; 95% confidence interval [CI], 1.86 to 9.70; P = .001) and non-significantly higher odds of MRSA SSTI (OR, 1.49; 95% CI, 0.68 to 3.27; P = .33).
The analysis also found that PEH had significantly higher rates of first-line MRSA antibiotic coverage than patients with stable housing (90% vs 70%) and non-significantly reduced rates of first-line GAS coverage (30% vs 47%), a finding the study authors say suggests providers may prioritize MRSA among homeless patients presenting with SSTI.
"Given that 42% of PEH had cultures that tested positive for GAS and PEH had 4.25 times higher odds of GAS SSTI, the present study results suggest that health care professionals may need to consider GAS more strongly among PEH presenting with SSTI," they wrote.
Feb 9 JAMA Dermatol study
UK white paper suggests ways to transform infection management
A newly formed coalition of pharmaceutical and diagnostics companies and research organizations yesterday published a white paper with recommendations to transform the way infections are detected, monitored, managed, and prevented across all facets of England's National Health Service, with a focus on mitigating the harms from antimicrobial resistance (AMR).
The paper from the Infection Management Coalition (IMC) presents 29 recommendations to nurture a patient-centered, holistic approach to infection management and help achieve the UK government's 20-year vision of a world in which AMR is effectively contained. The groups say the recommendations support development of a roadmap that will help "accelerate the creation of a system which is resilient and mature with regard to: outbreak and pandemic preparedness; infection prevention; rapid recognition, diagnosis and treatment of time-critical viral and bacterial infections; and to, ultimately, deliver effective AMS [antimicrobial stewardship]."
The recommendations presented in the paper include the development and implementation of a data registry for patients entering the healthcare system with an infection that would track the medicines used and monitor outcomes and recovery, along with a requirement that clinicians input infection data into electronic patient records so that the systems know exactly which antibiotics work for patients.
The paper also calls for greater integration of point-of-care diagnostics; allowing sepsis, infection, and AMR to be registered as actual causes of death; development of more robust surveillance systems to track infections and resistant pathogens; creation of a 5-year national plan to explore development of new antibiotics and cutting-edge diagnostics; and establishing the "human face" of AMR.
"Infection is managed across all specialties in healthcare because it is common and has diverse implications," the paper states. "To address AMR and to maintain antimicrobial stewardship, we need to approach infection management holistically."
Feb 9 IMC white paper