Miriam E. Tucker

The 2009 pandemic influenza A(H1N1) virus has declined but continues to circulate, particularly in the southeastern United States.

Influenza-associated hospitalizations and deaths are still being reported, and the 2009 H1N1 vaccine is still recommended, the Centers for Disease Control and Prevention said (MMWR 2010;59:423-30).

From Aug. 30, 2009, through March 27, 2010, 21% of 422,648 specimens collected in the United States were positive for influenza. Nearly all (99.7%) were influenza A; of the 66,978 subtyped, nearly all (99.4%) were 2009 H1N1 viruses.

From Feb. 14 to March 27, H1N1 continued to account for nearly all cases. In that period, states in the Southeast—Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee—accounted for approximately 55% of the influenza positives reported but only 20% of the specimens tested, the CDC said. Georgia in particular has seen a steady rise in hospitalizations from mid February through March 27, with a median of 38 reported hospitalizations during the first 5 weeks. However, hospitalizations then dropped to just 16 during the week ending March 27.

A total of 64 oseltamivir-resistant 2009 H1N1 viruses have been identified in the United States since April 2009, with 55 of those identified since Aug. 30, 2009.

The percentage of outpatient visits for influenza-like illness peaked at 7.7% in the week ending Oct. 24, 2009, and has declined since. The rate was 1.6% for the week ending March 27, 2010.

The CDC is continuing to monitor and report influenza activity weekly at www.cdc.gov/flu/weekly

The 2009 pandemic influenza A(H1N1) virus has declined but continues to circulate, particularly in the southeastern United States.

Influenza-associated hospitalizations and deaths are still being reported, and the 2009 H1N1 vaccine is still recommended, the Centers for Disease Control and Prevention said (MMWR 2010;59:423-30).

From Aug. 30, 2009, through March 27, 2010, 21% of 422,648 specimens collected in the United States were positive for influenza. Nearly all (99.7%) were influenza A; of the 66,978 subtyped, nearly all (99.4%) were 2009 H1N1 viruses.

From Feb. 14 to March 27, H1N1 continued to account for nearly all cases. In that period, states in the Southeast—Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee—accounted for approximately 55% of the influenza positives reported but only 20% of the specimens tested, the CDC said. Georgia in particular has seen a steady rise in hospitalizations from mid February through March 27, with a median of 38 reported hospitalizations during the first 5 weeks. However, hospitalizations then dropped to just 16 during the week ending March 27.

A total of 64 oseltamivir-resistant 2009 H1N1 viruses have been identified in the United States since April 2009, with 55 of those identified since Aug. 30, 2009.

The percentage of outpatient visits for influenza-like illness peaked at 7.7% in the week ending Oct. 24, 2009, and has declined since. The rate was 1.6% for the week ending March 27, 2010.

The CDC is continuing to monitor and report influenza activity weekly at www.cdc.gov/flu/weekly

The 2009 pandemic influenza A(H1N1) virus has declined but continues to circulate, particularly in the southeastern United States.

Influenza-associated hospitalizations and deaths are still being reported, and the 2009 H1N1 vaccine is still recommended, the Centers for Disease Control and Prevention said (MMWR 2010;59:423-30).

From Aug. 30, 2009, through March 27, 2010, 21% of 422,648 specimens collected in the United States were positive for influenza. Nearly all (99.7%) were influenza A; of the 66,978 subtyped, nearly all (99.4%) were 2009 H1N1 viruses.

From Feb. 14 to March 27, H1N1 continued to account for nearly all cases. In that period, states in the Southeast—Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee—accounted for approximately 55% of the influenza positives reported but only 20% of the specimens tested, the CDC said. Georgia in particular has seen a steady rise in hospitalizations from mid February through March 27, with a median of 38 reported hospitalizations during the first 5 weeks. However, hospitalizations then dropped to just 16 during the week ending March 27.

A total of 64 oseltamivir-resistant 2009 H1N1 viruses have been identified in the United States since April 2009, with 55 of those identified since Aug. 30, 2009.

The percentage of outpatient visits for influenza-like illness peaked at 7.7% in the week ending Oct. 24, 2009, and has declined since. The rate was 1.6% for the week ending March 27, 2010.

The CDC is continuing to monitor and report influenza activity weekly at www.cdc.gov/flu/weekly

BALTIMORE – Chamomile extract therapy demonstrated both anxiolytic and antidepressive effects in a two-part randomized, controlled, blinded study of 57 patients with mild to moderate generalized anxiety disorder.

The initial study, published in 2009, is thought to be the first controlled clinical trial of oral chamomile (Matricaria recutita) extract for GAD. A substudy presented in a poster at the annual meeting of the Anxiety Disorders Association of America (ADAA), investigated the effect of chamomile on depressive symptoms in GAD patients who had comorbid depression, a history of depression, or no depression.

Because not all patients are willing or able to use psychopharmacologic treatment, “the identification of a safe and effective herbal remedy for treating anxious and depressive symptoms would be of public health relevance,” Matthew A. Shore and his associates said in their poster.

Chamomile has long been used as a traditional remedy for its calming effect and has demonstrated pharmacologic activity in animal models of anxiety. Its anxiolytic and antidepressive properties may relate to modulation of central noradrenalin, dopamine, and serotonin, and gamma-aminobutyric acid neurotransmission and hypothalamic-pituitary-adrenocorticalaxis activity, said Mr. Shore and his associates, of the University of Pennsylvania, Philadelphia.

The original study, led by Dr. Jay D. Amsterdam, was summarized by coauthor Irene Soeller, a nurse practitioner, in a session on alternative/complementary medicine at the ADAA meeting. The 57 GAD patients all had minimum baseline Hamilton Anxiety Rating (HAM-A) scores of 9 or more. Patients with other DSM-IV axis 1 disorders, such as minor depression, were not excluded as long as the comorbid condition was not the primary diagnosis.

Those with major depressive disorder, bipolar disorder, or other serious psychiatric diagnoses were excluded (J. Clin. Psychopharmacol. 2009;29:378–82).

Twenty-eight of the patients were randomized to chamomile extract and 29 to placebo for 8 weeks. Identically appearing and smelling capsules contained either pharmaceutical-grade chamomile extract or placebo. Initial dose was one capsule (220 mg for the chamomile) daily for the first week, increasing to two capsules daily for week two. After that, patients with a 50% or less reduction in HAM-A scores at each week were increased to three capsules at week 3 and four at week 4, and then up to five capsules at weeks 5-8 if response was still less than 50%.

At 8 weeks, there was a significantly greater reduction in the mean total HAM-A score for chamomile versus placebo–the primary outcome–with a mean difference of 3.17 points between the two groups.

There was also a somewhat greater proportion of overall HAM-A responders to chamomile versus placebo (57% vs. 38%), and the overall percentage change was numerically greater for chamomile than placebo on the HAM-A (53% vs. 35%), the Beck Anxiety Index (42% vs. 21%) and the Psychological General Well-Being Index (28% vs. 18%).

In all three groups combined, there was a significantly greater reduction over time in total Hamilton Depression Rating (HAM-D) 17 scores and in core HAM-D depression items (including depressed mood, guilt, and suicidal ideation) for chamomile versus placebo, with a P value of less than .05 on both measures.

These studies were funded by grants from the National Center for Complementary and Alternative Medicine (part of the National Institutes of Health). Both Mr. Shore and Ms. Soeller stated that they have no other financial disclosures.

Dr. Amsterdam received grant support from Stanley Medical Research Institute, Lilly Research Laboratories, Sanofi Aventis Inc., and Novartis Inc. Dr. Amsterdam is not a member of any industry-sponsored advisory board or speakers bureau and has no significant financial interest in any pharmaceutical company.

BALTIMORE – Chamomile extract therapy demonstrated both anxiolytic and antidepressive effects in a two-part randomized, controlled, blinded study of 57 patients with mild to moderate generalized anxiety disorder.

The initial study, published in 2009, is thought to be the first controlled clinical trial of oral chamomile (Matricaria recutita) extract for GAD. A substudy presented in a poster at the annual meeting of the Anxiety Disorders Association of America (ADAA), investigated the effect of chamomile on depressive symptoms in GAD patients who had comorbid depression, a history of depression, or no depression.

Because not all patients are willing or able to use psychopharmacologic treatment, “the identification of a safe and effective herbal remedy for treating anxious and depressive symptoms would be of public health relevance,” Matthew A. Shore and his associates said in their poster.

Chamomile has long been used as a traditional remedy for its calming effect and has demonstrated pharmacologic activity in animal models of anxiety. Its anxiolytic and antidepressive properties may relate to modulation of central noradrenalin, dopamine, and serotonin, and gamma-aminobutyric acid neurotransmission and hypothalamic-pituitary-adrenocorticalaxis activity, said Mr. Shore and his associates, of the University of Pennsylvania, Philadelphia.

The original study, led by Dr. Jay D. Amsterdam, was summarized by coauthor Irene Soeller, a nurse practitioner, in a session on alternative/complementary medicine at the ADAA meeting. The 57 GAD patients all had minimum baseline Hamilton Anxiety Rating (HAM-A) scores of 9 or more. Patients with other DSM-IV axis 1 disorders, such as minor depression, were not excluded as long as the comorbid condition was not the primary diagnosis.

Those with major depressive disorder, bipolar disorder, or other serious psychiatric diagnoses were excluded (J. Clin. Psychopharmacol. 2009;29:378–82).

Twenty-eight of the patients were randomized to chamomile extract and 29 to placebo for 8 weeks. Identically appearing and smelling capsules contained either pharmaceutical-grade chamomile extract or placebo. Initial dose was one capsule (220 mg for the chamomile) daily for the first week, increasing to two capsules daily for week two. After that, patients with a 50% or less reduction in HAM-A scores at each week were increased to three capsules at week 3 and four at week 4, and then up to five capsules at weeks 5-8 if response was still less than 50%.

At 8 weeks, there was a significantly greater reduction in the mean total HAM-A score for chamomile versus placebo–the primary outcome–with a mean difference of 3.17 points between the two groups.

There was also a somewhat greater proportion of overall HAM-A responders to chamomile versus placebo (57% vs. 38%), and the overall percentage change was numerically greater for chamomile than placebo on the HAM-A (53% vs. 35%), the Beck Anxiety Index (42% vs. 21%) and the Psychological General Well-Being Index (28% vs. 18%).

In all three groups combined, there was a significantly greater reduction over time in total Hamilton Depression Rating (HAM-D) 17 scores and in core HAM-D depression items (including depressed mood, guilt, and suicidal ideation) for chamomile versus placebo, with a P value of less than .05 on both measures.

These studies were funded by grants from the National Center for Complementary and Alternative Medicine (part of the National Institutes of Health). Both Mr. Shore and Ms. Soeller stated that they have no other financial disclosures.

Dr. Amsterdam received grant support from Stanley Medical Research Institute, Lilly Research Laboratories, Sanofi Aventis Inc., and Novartis Inc. Dr. Amsterdam is not a member of any industry-sponsored advisory board or speakers bureau and has no significant financial interest in any pharmaceutical company.

BALTIMORE – Chamomile extract therapy demonstrated both anxiolytic and antidepressive effects in a two-part randomized, controlled, blinded study of 57 patients with mild to moderate generalized anxiety disorder.

The initial study, published in 2009, is thought to be the first controlled clinical trial of oral chamomile (Matricaria recutita) extract for GAD. A substudy presented in a poster at the annual meeting of the Anxiety Disorders Association of America (ADAA), investigated the effect of chamomile on depressive symptoms in GAD patients who had comorbid depression, a history of depression, or no depression.

Because not all patients are willing or able to use psychopharmacologic treatment, “the identification of a safe and effective herbal remedy for treating anxious and depressive symptoms would be of public health relevance,” Matthew A. Shore and his associates said in their poster.

Chamomile has long been used as a traditional remedy for its calming effect and has demonstrated pharmacologic activity in animal models of anxiety. Its anxiolytic and antidepressive properties may relate to modulation of central noradrenalin, dopamine, and serotonin, and gamma-aminobutyric acid neurotransmission and hypothalamic-pituitary-adrenocorticalaxis activity, said Mr. Shore and his associates, of the University of Pennsylvania, Philadelphia.

The original study, led by Dr. Jay D. Amsterdam, was summarized by coauthor Irene Soeller, a nurse practitioner, in a session on alternative/complementary medicine at the ADAA meeting. The 57 GAD patients all had minimum baseline Hamilton Anxiety Rating (HAM-A) scores of 9 or more. Patients with other DSM-IV axis 1 disorders, such as minor depression, were not excluded as long as the comorbid condition was not the primary diagnosis.

Those with major depressive disorder, bipolar disorder, or other serious psychiatric diagnoses were excluded (J. Clin. Psychopharmacol. 2009;29:378–82).

Twenty-eight of the patients were randomized to chamomile extract and 29 to placebo for 8 weeks. Identically appearing and smelling capsules contained either pharmaceutical-grade chamomile extract or placebo. Initial dose was one capsule (220 mg for the chamomile) daily for the first week, increasing to two capsules daily for week two. After that, patients with a 50% or less reduction in HAM-A scores at each week were increased to three capsules at week 3 and four at week 4, and then up to five capsules at weeks 5-8 if response was still less than 50%.

At 8 weeks, there was a significantly greater reduction in the mean total HAM-A score for chamomile versus placebo–the primary outcome–with a mean difference of 3.17 points between the two groups.

There was also a somewhat greater proportion of overall HAM-A responders to chamomile versus placebo (57% vs. 38%), and the overall percentage change was numerically greater for chamomile than placebo on the HAM-A (53% vs. 35%), the Beck Anxiety Index (42% vs. 21%) and the Psychological General Well-Being Index (28% vs. 18%).

In all three groups combined, there was a significantly greater reduction over time in total Hamilton Depression Rating (HAM-D) 17 scores and in core HAM-D depression items (including depressed mood, guilt, and suicidal ideation) for chamomile versus placebo, with a P value of less than .05 on both measures.

These studies were funded by grants from the National Center for Complementary and Alternative Medicine (part of the National Institutes of Health). Both Mr. Shore and Ms. Soeller stated that they have no other financial disclosures.

Dr. Amsterdam received grant support from Stanley Medical Research Institute, Lilly Research Laboratories, Sanofi Aventis Inc., and Novartis Inc. Dr. Amsterdam is not a member of any industry-sponsored advisory board or speakers bureau and has no significant financial interest in any pharmaceutical company.

ATLANTA — Preoperative patient factors were moderately predictive of surgical site infection risk in a retrospective case-control study of 253 patients undergoing elective vascular surgery.

Previous scoring systems also have been predictive of risk for surgical site infections (SSIs), but these are based on a combination of pre-, peri-, and postoperative factors. Thus, the scores aren't helpful for gauging risk in individual patients prior to surgery.

Knowing risk before surgery could allow the pursuit of nonsurgical options as well as guide infection prevention processes in patients who are shown to be at high risk, Dr. Surbhi Leekha and her associates said in a poster at the Decennial International Conference on Healthcare-Associated Infections.

Further, the most commonly used risk stratification tool, the National Nosocomial Infections Surveillance System (NNIS) risk index (Am. J. Med. 1991;91:152S-7S), does not perform well for “clean” procedures such as cardiovascular surgery, said Dr. Leekha and her associates, of the Mayo Clinic, Rochester, Minn.

The study population included patients who had undergone elective vascular (abdominal aortic and peripheral arterial) surgery at the Mayo Clinic from 2003 through 2007. A total of 87 patients who developed SSIs requiring hospitalization were included, and were matched with 166 controls who had undergone the same type of procedure on the same day but did not develop an infection.

There were no significant differences between cases and controls in age, sex, diabetes, smoking, alcohol use, chronic kidney disease, liver disease, weight loss, immunosuppressive therapy, and presence of skin ulcers. In multivariate analysis, preoperative variables that were significantly associated with SSI risk included critical ischemia (odds ratio 2.91), previous SSI (OR 6.29 with previous surgery, OR 1.40 with no previous surgery), previous peripheral revascularization (OR 2.55), and chronic obstructive pulmonary disease (OR 2.22).

A preop score model was developed in which 1 point each was given for COPD, critical ischemia, and previous peripheral revascularization and 2 points for previous SSI. The concordance statistic (c-statistic) for the preop score model was 0.73, compared with 0.50 for the NNIS score, Dr. Leekha and her associates reported.

A c-statistic of 1.0 indicates that the predictions are perfectly concordant with the actual outcomes, while 0.5 indicates that the predictions are no better than random chance. Thus, “based on these data, NNIS performs no better than a coin toss,” Dr. Leekha said in a follow-up interview.

The NNIS, the national standard for all types of surgeries, has been shown to perform poorly for cardiac surgery. Its performance for vascular surgery appears to be similar, possibly because the patients are similar in two of the three NNIS components—type of surgery (type 1/clean) and American Society of Anesthesiologists score of III or IV, she explained in the interview.

In their poster, Dr. Leekha and her associates recommended that patients predicted to be at high risk should be observed for wound problems and early intervention/wound care, but added that prospective validation of this tool is still required.

Disclosures: Dr. Leekha stated she had nothing to disclose.

ATLANTA — Preoperative patient factors were moderately predictive of surgical site infection risk in a retrospective case-control study of 253 patients undergoing elective vascular surgery.

Previous scoring systems also have been predictive of risk for surgical site infections (SSIs), but these are based on a combination of pre-, peri-, and postoperative factors. Thus, the scores aren't helpful for gauging risk in individual patients prior to surgery.

Knowing risk before surgery could allow the pursuit of nonsurgical options as well as guide infection prevention processes in patients who are shown to be at high risk, Dr. Surbhi Leekha and her associates said in a poster at the Decennial International Conference on Healthcare-Associated Infections.

Further, the most commonly used risk stratification tool, the National Nosocomial Infections Surveillance System (NNIS) risk index (Am. J. Med. 1991;91:152S-7S), does not perform well for “clean” procedures such as cardiovascular surgery, said Dr. Leekha and her associates, of the Mayo Clinic, Rochester, Minn.

The study population included patients who had undergone elective vascular (abdominal aortic and peripheral arterial) surgery at the Mayo Clinic from 2003 through 2007. A total of 87 patients who developed SSIs requiring hospitalization were included, and were matched with 166 controls who had undergone the same type of procedure on the same day but did not develop an infection.

There were no significant differences between cases and controls in age, sex, diabetes, smoking, alcohol use, chronic kidney disease, liver disease, weight loss, immunosuppressive therapy, and presence of skin ulcers. In multivariate analysis, preoperative variables that were significantly associated with SSI risk included critical ischemia (odds ratio 2.91), previous SSI (OR 6.29 with previous surgery, OR 1.40 with no previous surgery), previous peripheral revascularization (OR 2.55), and chronic obstructive pulmonary disease (OR 2.22).

A preop score model was developed in which 1 point each was given for COPD, critical ischemia, and previous peripheral revascularization and 2 points for previous SSI. The concordance statistic (c-statistic) for the preop score model was 0.73, compared with 0.50 for the NNIS score, Dr. Leekha and her associates reported.

A c-statistic of 1.0 indicates that the predictions are perfectly concordant with the actual outcomes, while 0.5 indicates that the predictions are no better than random chance. Thus, “based on these data, NNIS performs no better than a coin toss,” Dr. Leekha said in a follow-up interview.

The NNIS, the national standard for all types of surgeries, has been shown to perform poorly for cardiac surgery. Its performance for vascular surgery appears to be similar, possibly because the patients are similar in two of the three NNIS components—type of surgery (type 1/clean) and American Society of Anesthesiologists score of III or IV, she explained in the interview.

In their poster, Dr. Leekha and her associates recommended that patients predicted to be at high risk should be observed for wound problems and early intervention/wound care, but added that prospective validation of this tool is still required.

Disclosures: Dr. Leekha stated she had nothing to disclose.

ATLANTA — Preoperative patient factors were moderately predictive of surgical site infection risk in a retrospective case-control study of 253 patients undergoing elective vascular surgery.

Previous scoring systems also have been predictive of risk for surgical site infections (SSIs), but these are based on a combination of pre-, peri-, and postoperative factors. Thus, the scores aren't helpful for gauging risk in individual patients prior to surgery.

Knowing risk before surgery could allow the pursuit of nonsurgical options as well as guide infection prevention processes in patients who are shown to be at high risk, Dr. Surbhi Leekha and her associates said in a poster at the Decennial International Conference on Healthcare-Associated Infections.

Further, the most commonly used risk stratification tool, the National Nosocomial Infections Surveillance System (NNIS) risk index (Am. J. Med. 1991;91:152S-7S), does not perform well for “clean” procedures such as cardiovascular surgery, said Dr. Leekha and her associates, of the Mayo Clinic, Rochester, Minn.

The study population included patients who had undergone elective vascular (abdominal aortic and peripheral arterial) surgery at the Mayo Clinic from 2003 through 2007. A total of 87 patients who developed SSIs requiring hospitalization were included, and were matched with 166 controls who had undergone the same type of procedure on the same day but did not develop an infection.

There were no significant differences between cases and controls in age, sex, diabetes, smoking, alcohol use, chronic kidney disease, liver disease, weight loss, immunosuppressive therapy, and presence of skin ulcers. In multivariate analysis, preoperative variables that were significantly associated with SSI risk included critical ischemia (odds ratio 2.91), previous SSI (OR 6.29 with previous surgery, OR 1.40 with no previous surgery), previous peripheral revascularization (OR 2.55), and chronic obstructive pulmonary disease (OR 2.22).

A preop score model was developed in which 1 point each was given for COPD, critical ischemia, and previous peripheral revascularization and 2 points for previous SSI. The concordance statistic (c-statistic) for the preop score model was 0.73, compared with 0.50 for the NNIS score, Dr. Leekha and her associates reported.

A c-statistic of 1.0 indicates that the predictions are perfectly concordant with the actual outcomes, while 0.5 indicates that the predictions are no better than random chance. Thus, “based on these data, NNIS performs no better than a coin toss,” Dr. Leekha said in a follow-up interview.

The NNIS, the national standard for all types of surgeries, has been shown to perform poorly for cardiac surgery. Its performance for vascular surgery appears to be similar, possibly because the patients are similar in two of the three NNIS components—type of surgery (type 1/clean) and American Society of Anesthesiologists score of III or IV, she explained in the interview.

In their poster, Dr. Leekha and her associates recommended that patients predicted to be at high risk should be observed for wound problems and early intervention/wound care, but added that prospective validation of this tool is still required.

Disclosures: Dr. Leekha stated she had nothing to disclose.

Major Finding: Prevalence of MRSA infection at NorthShore University HealthSystem dropped from a baseline of 8.9 per 10,000 patient-days to 3.3 per 10,000 at 4 years after universal MRSA surveillance with decolonization and contact isolation of those found to be colonized.

Data Source: Observational 4-year study done at a three-hospital, 850-bed health organization.

Disclosures: Dr. Peterson has received research grants from and/or consulted for Cepheid, NorthShore, BD-GeneOhm, MicroPhage, Nanosphere, the National Institute for Allergy and Infectious Diseases, Roche, 3M, and Washington Square Health Foundation, mainly in the area of new test development.

ATLANTA — Universal admission surveillance for methicillin-resistant Staphylococcus aureus at three Illinois hospitals significantly reduced both MRSA and overall S. aureus infection over a 4-year period.

The observational study findings are an expansion of 21-month data that showed reductions of MRSA infection from 8.9/10,000 patient-days at baseline to 3.9/10,000 with universal MRSA real-time polymerase chain reaction–based nasal surveillance followed by topical decolonization and contact isolation of patients who test positive (Ann. Intern. Med. 2008;148:409–18).

The update included data from the baseline period, all intensive care unit admissions for 1 year, and all hospital admissions for 4 years with universal MRSA surveillance at the three-hospital, 850-bed NorthShore University HealthSystem, which averages 40,000 annual admissions. One-year ICU prevalence, reported previously, was 7.4/10,000 patient-days, and the prevalence after 4 years with universal surveillance was 3.3/10,000, Dr. Lance R. Peterson said at the Decennial International Conference on Healthcare-Associated Infections.

The prevalence density of MRSA decreased at each of the four body sites assessed—bloodstream, respiratory, urinary tract, and surgical site—in each of the time periods, said Dr. Peterson, of NorthShore University HealthSystem, Evanston, Ill.

The percentage of exogenous MRSA fell over the 4 years from 48% to 33%, implying fewer patients were acquiring MRSA in the hospital. Over the same period, there was a 70% reduction in total MRSA disease during hospitalization and at 30 days post hospitalization. The proportion of all S. aureus infections that were methicillin-resistant also declined significantly, from 52% at baseline to 31% at 4 years, Dr. Peterson reported.

Based on a previous cost analysis of 178 MRSA cases and 5,796 controls, the excess expense of MRSA infection was estimated at $24,000, compared with no infection. During the first 4 years of NorthShore's containment program, 406 MRSA infections and 72 deaths were avoided, with a net expense reduction of $8.8 million, he said.

Previous studies have suggested that the success of a MRSA surveillance program depends on disease/colonization prevalence, scope of surveillance, test sensitivity, rapidity of results reporting, and length of the intervention period. The cost-benefit ratio of any program depends on the degree to which it is successful, Dr. Peterson said.

“If you implement a MRSA control program that includes surveillance and there is no desired impact, you may need to do more, such as expand the population tested or increase the sensitivity and speed of testing,” he noted.

The role of adding decolonization in the acute care setting is still unclear, he said. In this study, mupirocin and chlorhexidine decolonization in patients testing positive did not affect the risk of eventual disease, although it did appear to prolong the median number of days to develop infection, from 15.5 days to 50 days. Mupirocin resistance is now at 10%, however, which “is certainly a challenge we'll have to deal with as we go forward,” he concluded.

Major Finding: Prevalence of MRSA infection at NorthShore University HealthSystem dropped from a baseline of 8.9 per 10,000 patient-days to 3.3 per 10,000 at 4 years after universal MRSA surveillance with decolonization and contact isolation of those found to be colonized.

Data Source: Observational 4-year study done at a three-hospital, 850-bed health organization.

Disclosures: Dr. Peterson has received research grants from and/or consulted for Cepheid, NorthShore, BD-GeneOhm, MicroPhage, Nanosphere, the National Institute for Allergy and Infectious Diseases, Roche, 3M, and Washington Square Health Foundation, mainly in the area of new test development.

ATLANTA — Universal admission surveillance for methicillin-resistant Staphylococcus aureus at three Illinois hospitals significantly reduced both MRSA and overall S. aureus infection over a 4-year period.

The observational study findings are an expansion of 21-month data that showed reductions of MRSA infection from 8.9/10,000 patient-days at baseline to 3.9/10,000 with universal MRSA real-time polymerase chain reaction–based nasal surveillance followed by topical decolonization and contact isolation of patients who test positive (Ann. Intern. Med. 2008;148:409–18).

The update included data from the baseline period, all intensive care unit admissions for 1 year, and all hospital admissions for 4 years with universal MRSA surveillance at the three-hospital, 850-bed NorthShore University HealthSystem, which averages 40,000 annual admissions. One-year ICU prevalence, reported previously, was 7.4/10,000 patient-days, and the prevalence after 4 years with universal surveillance was 3.3/10,000, Dr. Lance R. Peterson said at the Decennial International Conference on Healthcare-Associated Infections.

The prevalence density of MRSA decreased at each of the four body sites assessed—bloodstream, respiratory, urinary tract, and surgical site—in each of the time periods, said Dr. Peterson, of NorthShore University HealthSystem, Evanston, Ill.

The percentage of exogenous MRSA fell over the 4 years from 48% to 33%, implying fewer patients were acquiring MRSA in the hospital. Over the same period, there was a 70% reduction in total MRSA disease during hospitalization and at 30 days post hospitalization. The proportion of all S. aureus infections that were methicillin-resistant also declined significantly, from 52% at baseline to 31% at 4 years, Dr. Peterson reported.

Based on a previous cost analysis of 178 MRSA cases and 5,796 controls, the excess expense of MRSA infection was estimated at $24,000, compared with no infection. During the first 4 years of NorthShore's containment program, 406 MRSA infections and 72 deaths were avoided, with a net expense reduction of $8.8 million, he said.

Previous studies have suggested that the success of a MRSA surveillance program depends on disease/colonization prevalence, scope of surveillance, test sensitivity, rapidity of results reporting, and length of the intervention period. The cost-benefit ratio of any program depends on the degree to which it is successful, Dr. Peterson said.

“If you implement a MRSA control program that includes surveillance and there is no desired impact, you may need to do more, such as expand the population tested or increase the sensitivity and speed of testing,” he noted.

The role of adding decolonization in the acute care setting is still unclear, he said. In this study, mupirocin and chlorhexidine decolonization in patients testing positive did not affect the risk of eventual disease, although it did appear to prolong the median number of days to develop infection, from 15.5 days to 50 days. Mupirocin resistance is now at 10%, however, which “is certainly a challenge we'll have to deal with as we go forward,” he concluded.

Major Finding: Prevalence of MRSA infection at NorthShore University HealthSystem dropped from a baseline of 8.9 per 10,000 patient-days to 3.3 per 10,000 at 4 years after universal MRSA surveillance with decolonization and contact isolation of those found to be colonized.

Data Source: Observational 4-year study done at a three-hospital, 850-bed health organization.

Disclosures: Dr. Peterson has received research grants from and/or consulted for Cepheid, NorthShore, BD-GeneOhm, MicroPhage, Nanosphere, the National Institute for Allergy and Infectious Diseases, Roche, 3M, and Washington Square Health Foundation, mainly in the area of new test development.

ATLANTA — Universal admission surveillance for methicillin-resistant Staphylococcus aureus at three Illinois hospitals significantly reduced both MRSA and overall S. aureus infection over a 4-year period.

The observational study findings are an expansion of 21-month data that showed reductions of MRSA infection from 8.9/10,000 patient-days at baseline to 3.9/10,000 with universal MRSA real-time polymerase chain reaction–based nasal surveillance followed by topical decolonization and contact isolation of patients who test positive (Ann. Intern. Med. 2008;148:409–18).

The update included data from the baseline period, all intensive care unit admissions for 1 year, and all hospital admissions for 4 years with universal MRSA surveillance at the three-hospital, 850-bed NorthShore University HealthSystem, which averages 40,000 annual admissions. One-year ICU prevalence, reported previously, was 7.4/10,000 patient-days, and the prevalence after 4 years with universal surveillance was 3.3/10,000, Dr. Lance R. Peterson said at the Decennial International Conference on Healthcare-Associated Infections.

The prevalence density of MRSA decreased at each of the four body sites assessed—bloodstream, respiratory, urinary tract, and surgical site—in each of the time periods, said Dr. Peterson, of NorthShore University HealthSystem, Evanston, Ill.

The percentage of exogenous MRSA fell over the 4 years from 48% to 33%, implying fewer patients were acquiring MRSA in the hospital. Over the same period, there was a 70% reduction in total MRSA disease during hospitalization and at 30 days post hospitalization. The proportion of all S. aureus infections that were methicillin-resistant also declined significantly, from 52% at baseline to 31% at 4 years, Dr. Peterson reported.

Based on a previous cost analysis of 178 MRSA cases and 5,796 controls, the excess expense of MRSA infection was estimated at $24,000, compared with no infection. During the first 4 years of NorthShore's containment program, 406 MRSA infections and 72 deaths were avoided, with a net expense reduction of $8.8 million, he said.

Previous studies have suggested that the success of a MRSA surveillance program depends on disease/colonization prevalence, scope of surveillance, test sensitivity, rapidity of results reporting, and length of the intervention period. The cost-benefit ratio of any program depends on the degree to which it is successful, Dr. Peterson said.

“If you implement a MRSA control program that includes surveillance and there is no desired impact, you may need to do more, such as expand the population tested or increase the sensitivity and speed of testing,” he noted.

The role of adding decolonization in the acute care setting is still unclear, he said. In this study, mupirocin and chlorhexidine decolonization in patients testing positive did not affect the risk of eventual disease, although it did appear to prolong the median number of days to develop infection, from 15.5 days to 50 days. Mupirocin resistance is now at 10%, however, which “is certainly a challenge we'll have to deal with as we go forward,” he concluded.

Major Finding: Only when an ICU had a central line bundle policy, monitored compliance, and had 95% or greater compliance did CLABSI rates decrease significantly.

Data Source: Survey of 312 ICUs at 250 U.S. hospitals.

Disclosures: Dr. Furuya had no disclosures.

ATLANTA — Overall compliance with a central line bundle did not significantly affect the rate of central line–associated bloodstream infections unless it reached 95% or higher in a nationwide sample of 312 intensive care units, but compliance with individual elements of the bundle appeared to lower infection rates somewhat.

The findings should not be interpreted to mean that bundles are ineffective. “This study raises the intriguing possibility that complying with all bundle elements is no better than complying with at least one bundle element…. In other words, it's okay to miss an element as long as compliance with other elements is high,” Dr. E. Yoko Furuya said during a special presentation of the four best submitted abstracts at the Decennial International Conference on Healthcare-Associated Infections.

The central line bundle—consisting of hand hygiene, maximal barrier precautions, chlorhexidine skin antisepsis, optimal catheter site selection (avoiding femoral vein in adults), and daily review of line necessity—has been promoted by the Institute for Healthcare Improvement and other national/scientific organizations as a strategy for reducing the rates of central line–associated bloodstream infection (CLABSI) events. However, limited data have been available regarding exactly how the bundle works.

“With the new Joint Commission mandate for universal central line 'checklists,' CL bundle use will increase, but will this lead to lower CLABSI rates? It's really not clear,” said Dr. Furuya, medical director of infection prevention and control at New York–Presbyterian Hospital.

The data come from a cross-sectional survey of ICUs in the National Healthcare Safety Network (NHSN) hospitals that are participating in the Prevention of Nosocomial Infections and Cost Effectiveness (P-NICE) study. Funded by the National Institutes of Health, the P-NICE study aims to determine the level of infection-control department staffing and the extent of ICU interventions in U.S. hospitals. In the online survey, directors and managers of hospital infection-control departments were asked to report whether the ICU had a written central line bundle policy; whether compliance was monitored and, if so, how often; and the ICU's NHSN-reported CLABSI rate.

“While the bundle is an all-or-nothing approach, we wanted to deconstruct the bundle and look at the effectiveness of individual bundle elements on rates of CLABSIs,” said Dr. Furuya, also with Columbia University, New York.

Hand hygiene compliance was controlled for, since it is considered to affect all health care–associated infections and not specifically CLABSIs. Also controlled for were ICU type, infection-control department characteristics, hospital bed size, region, and teaching status. Separate analyses were conducted with and without chlorhexidine antisepsis because some data suggest it may be less effective against gram-negative and fungal pathogens and because its use has been linked to methicillin resistance in Staphylococcus aureus, she said.

A total of 250 hospitals reported on central line bundle data for 415 ICUs, of which 312 also included CLABSI rates. Of those 312, 44% were in the northeastern United States, and 26% were in the south. The majority (76%) were from states with mandatory CLABSI reporting. More than half of the 250 hospitals (58%) had 201–500 beds, and 54% of the 415 ICUs were medical/surgical.

Of the 240 hospitals reporting hand hygiene compliance, just 7% reported complying “all of the time” (95%–100%), 43% reported “usually” (75%–94%) complying, and 33% said they only “sometimes” (25%–74%) comply. The overall mean CLABSI rate was 2.1/1,000 central line–days, which is similar to the overall NHSN average, she noted.

Just under half of the 415 ICUs (49%) had written central line bundle policies, and only 45% reported monitoring for compliance. Of those 91, only 38% reported correct implementation of all the bundle elements 95% or more of the time. When not all bundle elements were fully implemented, maximal barrier precautions were most often implemented, while daily line checks and optimal site selection were least commonly implemented.

No associations were found between CLABSI rates and having a bundle policy, monitoring compliance, or low compliance with the central line bundle. In fact, only when an ICU had a policy, monitored compliance, and had 95% or greater compliance did CLABSI rates decrease significantly, Dr. Furuya reported.

In a series of multivariate analyses, no individual bundle element was associated with decreased CLABSI rates; however, when zero compliance was compared with moving from compliance with any one element to any two or more elements, there was a significant decrease in rates. Complying with any one of three bundle elements also resulted in decreased rates and complying with all bundle elements was not necessary to show a significant decrease in infections.

Indeed, for all elements except chlorhexidine antisepsis, there was a nonsignificant trend toward lowering CLABSI rates. It's unclear whether the lack of chlorhexidine effect may be related to an increasing prevalence of gram-negative and fungal infections causing CLABSIs or to chlorhexidine not being applied optimally, Dr. Furuya noted.

“I think we don't fully understand the implications of what we found with chlorhexidine. I think what we did find is that if you're very compliant with some elements of the bundle you may still reduce CLABSI rates, and even if you're missing one or more elements, then perhaps it doesn't make a difference,” she commented.

Further study, including direct observation of adherence to bundles, will be required to determine what impact, if any, very high rates of bundle adherence might have on reducing CLABSI rates. Future planned stages of the P-NICE study will interview personnel about compliance and will examine data over a longer period, she said.

Major Finding: Only when an ICU had a central line bundle policy, monitored compliance, and had 95% or greater compliance did CLABSI rates decrease significantly.

Data Source: Survey of 312 ICUs at 250 U.S. hospitals.

Disclosures: Dr. Furuya had no disclosures.

ATLANTA — Overall compliance with a central line bundle did not significantly affect the rate of central line–associated bloodstream infections unless it reached 95% or higher in a nationwide sample of 312 intensive care units, but compliance with individual elements of the bundle appeared to lower infection rates somewhat.

The findings should not be interpreted to mean that bundles are ineffective. “This study raises the intriguing possibility that complying with all bundle elements is no better than complying with at least one bundle element…. In other words, it's okay to miss an element as long as compliance with other elements is high,” Dr. E. Yoko Furuya said during a special presentation of the four best submitted abstracts at the Decennial International Conference on Healthcare-Associated Infections.

The central line bundle—consisting of hand hygiene, maximal barrier precautions, chlorhexidine skin antisepsis, optimal catheter site selection (avoiding femoral vein in adults), and daily review of line necessity—has been promoted by the Institute for Healthcare Improvement and other national/scientific organizations as a strategy for reducing the rates of central line–associated bloodstream infection (CLABSI) events. However, limited data have been available regarding exactly how the bundle works.

“With the new Joint Commission mandate for universal central line 'checklists,' CL bundle use will increase, but will this lead to lower CLABSI rates? It's really not clear,” said Dr. Furuya, medical director of infection prevention and control at New York–Presbyterian Hospital.

The data come from a cross-sectional survey of ICUs in the National Healthcare Safety Network (NHSN) hospitals that are participating in the Prevention of Nosocomial Infections and Cost Effectiveness (P-NICE) study. Funded by the National Institutes of Health, the P-NICE study aims to determine the level of infection-control department staffing and the extent of ICU interventions in U.S. hospitals. In the online survey, directors and managers of hospital infection-control departments were asked to report whether the ICU had a written central line bundle policy; whether compliance was monitored and, if so, how often; and the ICU's NHSN-reported CLABSI rate.

“While the bundle is an all-or-nothing approach, we wanted to deconstruct the bundle and look at the effectiveness of individual bundle elements on rates of CLABSIs,” said Dr. Furuya, also with Columbia University, New York.

Hand hygiene compliance was controlled for, since it is considered to affect all health care–associated infections and not specifically CLABSIs. Also controlled for were ICU type, infection-control department characteristics, hospital bed size, region, and teaching status. Separate analyses were conducted with and without chlorhexidine antisepsis because some data suggest it may be less effective against gram-negative and fungal pathogens and because its use has been linked to methicillin resistance in Staphylococcus aureus, she said.

A total of 250 hospitals reported on central line bundle data for 415 ICUs, of which 312 also included CLABSI rates. Of those 312, 44% were in the northeastern United States, and 26% were in the south. The majority (76%) were from states with mandatory CLABSI reporting. More than half of the 250 hospitals (58%) had 201–500 beds, and 54% of the 415 ICUs were medical/surgical.

Of the 240 hospitals reporting hand hygiene compliance, just 7% reported complying “all of the time” (95%–100%), 43% reported “usually” (75%–94%) complying, and 33% said they only “sometimes” (25%–74%) comply. The overall mean CLABSI rate was 2.1/1,000 central line–days, which is similar to the overall NHSN average, she noted.

Just under half of the 415 ICUs (49%) had written central line bundle policies, and only 45% reported monitoring for compliance. Of those 91, only 38% reported correct implementation of all the bundle elements 95% or more of the time. When not all bundle elements were fully implemented, maximal barrier precautions were most often implemented, while daily line checks and optimal site selection were least commonly implemented.

No associations were found between CLABSI rates and having a bundle policy, monitoring compliance, or low compliance with the central line bundle. In fact, only when an ICU had a policy, monitored compliance, and had 95% or greater compliance did CLABSI rates decrease significantly, Dr. Furuya reported.

In a series of multivariate analyses, no individual bundle element was associated with decreased CLABSI rates; however, when zero compliance was compared with moving from compliance with any one element to any two or more elements, there was a significant decrease in rates. Complying with any one of three bundle elements also resulted in decreased rates and complying with all bundle elements was not necessary to show a significant decrease in infections.

Indeed, for all elements except chlorhexidine antisepsis, there was a nonsignificant trend toward lowering CLABSI rates. It's unclear whether the lack of chlorhexidine effect may be related to an increasing prevalence of gram-negative and fungal infections causing CLABSIs or to chlorhexidine not being applied optimally, Dr. Furuya noted.

“I think we don't fully understand the implications of what we found with chlorhexidine. I think what we did find is that if you're very compliant with some elements of the bundle you may still reduce CLABSI rates, and even if you're missing one or more elements, then perhaps it doesn't make a difference,” she commented.

Further study, including direct observation of adherence to bundles, will be required to determine what impact, if any, very high rates of bundle adherence might have on reducing CLABSI rates. Future planned stages of the P-NICE study will interview personnel about compliance and will examine data over a longer period, she said.

Major Finding: Only when an ICU had a central line bundle policy, monitored compliance, and had 95% or greater compliance did CLABSI rates decrease significantly.

Data Source: Survey of 312 ICUs at 250 U.S. hospitals.

Disclosures: Dr. Furuya had no disclosures.

ATLANTA — Overall compliance with a central line bundle did not significantly affect the rate of central line–associated bloodstream infections unless it reached 95% or higher in a nationwide sample of 312 intensive care units, but compliance with individual elements of the bundle appeared to lower infection rates somewhat.

The findings should not be interpreted to mean that bundles are ineffective. “This study raises the intriguing possibility that complying with all bundle elements is no better than complying with at least one bundle element…. In other words, it's okay to miss an element as long as compliance with other elements is high,” Dr. E. Yoko Furuya said during a special presentation of the four best submitted abstracts at the Decennial International Conference on Healthcare-Associated Infections.

The central line bundle—consisting of hand hygiene, maximal barrier precautions, chlorhexidine skin antisepsis, optimal catheter site selection (avoiding femoral vein in adults), and daily review of line necessity—has been promoted by the Institute for Healthcare Improvement and other national/scientific organizations as a strategy for reducing the rates of central line–associated bloodstream infection (CLABSI) events. However, limited data have been available regarding exactly how the bundle works.

“With the new Joint Commission mandate for universal central line 'checklists,' CL bundle use will increase, but will this lead to lower CLABSI rates? It's really not clear,” said Dr. Furuya, medical director of infection prevention and control at New York–Presbyterian Hospital.

The data come from a cross-sectional survey of ICUs in the National Healthcare Safety Network (NHSN) hospitals that are participating in the Prevention of Nosocomial Infections and Cost Effectiveness (P-NICE) study. Funded by the National Institutes of Health, the P-NICE study aims to determine the level of infection-control department staffing and the extent of ICU interventions in U.S. hospitals. In the online survey, directors and managers of hospital infection-control departments were asked to report whether the ICU had a written central line bundle policy; whether compliance was monitored and, if so, how often; and the ICU's NHSN-reported CLABSI rate.

“While the bundle is an all-or-nothing approach, we wanted to deconstruct the bundle and look at the effectiveness of individual bundle elements on rates of CLABSIs,” said Dr. Furuya, also with Columbia University, New York.

Hand hygiene compliance was controlled for, since it is considered to affect all health care–associated infections and not specifically CLABSIs. Also controlled for were ICU type, infection-control department characteristics, hospital bed size, region, and teaching status. Separate analyses were conducted with and without chlorhexidine antisepsis because some data suggest it may be less effective against gram-negative and fungal pathogens and because its use has been linked to methicillin resistance in Staphylococcus aureus, she said.

A total of 250 hospitals reported on central line bundle data for 415 ICUs, of which 312 also included CLABSI rates. Of those 312, 44% were in the northeastern United States, and 26% were in the south. The majority (76%) were from states with mandatory CLABSI reporting. More than half of the 250 hospitals (58%) had 201–500 beds, and 54% of the 415 ICUs were medical/surgical.

Of the 240 hospitals reporting hand hygiene compliance, just 7% reported complying “all of the time” (95%–100%), 43% reported “usually” (75%–94%) complying, and 33% said they only “sometimes” (25%–74%) comply. The overall mean CLABSI rate was 2.1/1,000 central line–days, which is similar to the overall NHSN average, she noted.

Just under half of the 415 ICUs (49%) had written central line bundle policies, and only 45% reported monitoring for compliance. Of those 91, only 38% reported correct implementation of all the bundle elements 95% or more of the time. When not all bundle elements were fully implemented, maximal barrier precautions were most often implemented, while daily line checks and optimal site selection were least commonly implemented.

No associations were found between CLABSI rates and having a bundle policy, monitoring compliance, or low compliance with the central line bundle. In fact, only when an ICU had a policy, monitored compliance, and had 95% or greater compliance did CLABSI rates decrease significantly, Dr. Furuya reported.

In a series of multivariate analyses, no individual bundle element was associated with decreased CLABSI rates; however, when zero compliance was compared with moving from compliance with any one element to any two or more elements, there was a significant decrease in rates. Complying with any one of three bundle elements also resulted in decreased rates and complying with all bundle elements was not necessary to show a significant decrease in infections.

Indeed, for all elements except chlorhexidine antisepsis, there was a nonsignificant trend toward lowering CLABSI rates. It's unclear whether the lack of chlorhexidine effect may be related to an increasing prevalence of gram-negative and fungal infections causing CLABSIs or to chlorhexidine not being applied optimally, Dr. Furuya noted.

“I think we don't fully understand the implications of what we found with chlorhexidine. I think what we did find is that if you're very compliant with some elements of the bundle you may still reduce CLABSI rates, and even if you're missing one or more elements, then perhaps it doesn't make a difference,” she commented.

Further study, including direct observation of adherence to bundles, will be required to determine what impact, if any, very high rates of bundle adherence might have on reducing CLABSI rates. Future planned stages of the P-NICE study will interview personnel about compliance and will examine data over a longer period, she said.

Major Finding: Between 2005 and 2009, the proportion of hospitals that participate in a state or regional collaborative effort to reduce hospital-acquired infections jumped from 42% to 68%.

Data Source: Survey of 600 randomly selected U.S. hospitals.

Disclosures: Study was funded by the Department of Veterans Affairs, the National Institute of Nursing Research, and the Blue Cross/Blue Shield Foundation of Michigan. Dr. Krein stated that she had nothing to disclose.

ATLANTA — Between 2005 and 2009 there were significant increases in the use of some—but not all—recommended infection-prevention practices, according to survey results from 600 U.S. hospitals.

On Oct. 1, 2008, the Centers for Medicare and Medicaid Services (CMS) stopped reimbursing U.S. hospitals for the additional cost of certain infections deemed to be preventable. At least 20% of all health care–associated infections (HAIs) are believed to be preventable, with estimates for specific types of infections ranging from 10% to 70%, Sarah L. Krein, Ph.D., said at the Decennial International Conference on Healthcare-Associated Infections.

“We're making progress, but effectively translating recommended infection-prevention practices into clinical settings remains a challenge,” said Dr. Krein, who is a registered nurse and a research associate professor at the University of Michigan, Ann Arbor, and the VA Ann Arbor Healthcare System.

The study sought to determine the impact of the CMS rule by surveying infection preventionists at 600 randomly selected U.S. hospitals with more than 50 beds in March 2005 and again in March 2009. The response rate was about 70% for both years.

From 2005 to 2009, the proportion of hospitals that have hospitalist physicians increased from 57% to 75%, and the proportion that participate in a state or regional collaborative effort to reduce HAIs jumped from 42% to 68%.

Respondents were asked how frequently a specific practice was used for hospitalized adults on a scale of 1–5. The practices were all included in recent recommendations by the Centers for Disease Control and Prevention, the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, and the Association for Professionals in Infection Control and Epidemiology. The analysis was weighted so that the results represent the population of U.S. hospitals from which the initial sample was selected.

In both years, practices aimed at reducing central line–associated bloodstream infection (CLABSI) and ventilator-associated pneumonia (VAP) were implemented more often than those targeting catheter-associated urinary tract infection (CAUTI), even though the CMS nonpayment rule applies to CAUTI but not yet to VAP or CLABSI.

For CLABSI prevention, there were significant increases between 2005 and 2009 in those reporting “almost always” or “always” using maximum sterile barriers (71% to 90%), chlorhexidine as a site disinfectant (69% to 95%), and antimicrobial dressing (25% to 54%).

With regard to VAP, there were moderate increases in use of semirecumbent positioning (82% to 95%) and antimicrobial mouth rinse (41% to 58%), with a more dramatic increase in use of subglottic secretion drainage (21% to 42%).

For CAUTI, there were slight increases in use of bladder ultrasound (29% to 39%) and antimicrobial urinary catheters (30% to 45%) and a more dramatic increase in use of reminders/stop orders (9% to 20%).

Respondents were also asked for their perception of the effect of the CMS payment change on the importance of preventing the three types of infections. Those reporting a “moderate” or “large” increase in importance were 58% for CLABSI, 54% for VAP, and 65% for CAUTI, a finding that is “noteworthy, considering the data,” Dr. Krein commented.

She noted that CAUTI prevention practices in particular require both additional evidence to support their use and more effective strategies to facilitate their implementation.

CAUTI was not considered as high a priority by hospital staff, despite the fact that it is included in the CMS nonpayment rule while VAP and CLABSI are not, she said: “UTIs are still viewed as benign in many cases.”

Most practices were aimed at reducing central line infections and ventilator-asociated pneumonia.

Source DR. KREIN

Major Finding: Between 2005 and 2009, the proportion of hospitals that participate in a state or regional collaborative effort to reduce hospital-acquired infections jumped from 42% to 68%.

Data Source: Survey of 600 randomly selected U.S. hospitals.

Disclosures: Study was funded by the Department of Veterans Affairs, the National Institute of Nursing Research, and the Blue Cross/Blue Shield Foundation of Michigan. Dr. Krein stated that she had nothing to disclose.

ATLANTA — Between 2005 and 2009 there were significant increases in the use of some—but not all—recommended infection-prevention practices, according to survey results from 600 U.S. hospitals.

On Oct. 1, 2008, the Centers for Medicare and Medicaid Services (CMS) stopped reimbursing U.S. hospitals for the additional cost of certain infections deemed to be preventable. At least 20% of all health care–associated infections (HAIs) are believed to be preventable, with estimates for specific types of infections ranging from 10% to 70%, Sarah L. Krein, Ph.D., said at the Decennial International Conference on Healthcare-Associated Infections.

“We're making progress, but effectively translating recommended infection-prevention practices into clinical settings remains a challenge,” said Dr. Krein, who is a registered nurse and a research associate professor at the University of Michigan, Ann Arbor, and the VA Ann Arbor Healthcare System.

The study sought to determine the impact of the CMS rule by surveying infection preventionists at 600 randomly selected U.S. hospitals with more than 50 beds in March 2005 and again in March 2009. The response rate was about 70% for both years.

From 2005 to 2009, the proportion of hospitals that have hospitalist physicians increased from 57% to 75%, and the proportion that participate in a state or regional collaborative effort to reduce HAIs jumped from 42% to 68%.

Respondents were asked how frequently a specific practice was used for hospitalized adults on a scale of 1–5. The practices were all included in recent recommendations by the Centers for Disease Control and Prevention, the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, and the Association for Professionals in Infection Control and Epidemiology. The analysis was weighted so that the results represent the population of U.S. hospitals from which the initial sample was selected.

In both years, practices aimed at reducing central line–associated bloodstream infection (CLABSI) and ventilator-associated pneumonia (VAP) were implemented more often than those targeting catheter-associated urinary tract infection (CAUTI), even though the CMS nonpayment rule applies to CAUTI but not yet to VAP or CLABSI.

For CLABSI prevention, there were significant increases between 2005 and 2009 in those reporting “almost always” or “always” using maximum sterile barriers (71% to 90%), chlorhexidine as a site disinfectant (69% to 95%), and antimicrobial dressing (25% to 54%).

With regard to VAP, there were moderate increases in use of semirecumbent positioning (82% to 95%) and antimicrobial mouth rinse (41% to 58%), with a more dramatic increase in use of subglottic secretion drainage (21% to 42%).

For CAUTI, there were slight increases in use of bladder ultrasound (29% to 39%) and antimicrobial urinary catheters (30% to 45%) and a more dramatic increase in use of reminders/stop orders (9% to 20%).

Respondents were also asked for their perception of the effect of the CMS payment change on the importance of preventing the three types of infections. Those reporting a “moderate” or “large” increase in importance were 58% for CLABSI, 54% for VAP, and 65% for CAUTI, a finding that is “noteworthy, considering the data,” Dr. Krein commented.

She noted that CAUTI prevention practices in particular require both additional evidence to support their use and more effective strategies to facilitate their implementation.

CAUTI was not considered as high a priority by hospital staff, despite the fact that it is included in the CMS nonpayment rule while VAP and CLABSI are not, she said: “UTIs are still viewed as benign in many cases.”

Most practices were aimed at reducing central line infections and ventilator-asociated pneumonia.

Source DR. KREIN

Major Finding: Between 2005 and 2009, the proportion of hospitals that participate in a state or regional collaborative effort to reduce hospital-acquired infections jumped from 42% to 68%.

Data Source: Survey of 600 randomly selected U.S. hospitals.

Disclosures: Study was funded by the Department of Veterans Affairs, the National Institute of Nursing Research, and the Blue Cross/Blue Shield Foundation of Michigan. Dr. Krein stated that she had nothing to disclose.

ATLANTA — Between 2005 and 2009 there were significant increases in the use of some—but not all—recommended infection-prevention practices, according to survey results from 600 U.S. hospitals.

On Oct. 1, 2008, the Centers for Medicare and Medicaid Services (CMS) stopped reimbursing U.S. hospitals for the additional cost of certain infections deemed to be preventable. At least 20% of all health care–associated infections (HAIs) are believed to be preventable, with estimates for specific types of infections ranging from 10% to 70%, Sarah L. Krein, Ph.D., said at the Decennial International Conference on Healthcare-Associated Infections.

“We're making progress, but effectively translating recommended infection-prevention practices into clinical settings remains a challenge,” said Dr. Krein, who is a registered nurse and a research associate professor at the University of Michigan, Ann Arbor, and the VA Ann Arbor Healthcare System.

The study sought to determine the impact of the CMS rule by surveying infection preventionists at 600 randomly selected U.S. hospitals with more than 50 beds in March 2005 and again in March 2009. The response rate was about 70% for both years.

From 2005 to 2009, the proportion of hospitals that have hospitalist physicians increased from 57% to 75%, and the proportion that participate in a state or regional collaborative effort to reduce HAIs jumped from 42% to 68%.

Respondents were asked how frequently a specific practice was used for hospitalized adults on a scale of 1–5. The practices were all included in recent recommendations by the Centers for Disease Control and Prevention, the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, and the Association for Professionals in Infection Control and Epidemiology. The analysis was weighted so that the results represent the population of U.S. hospitals from which the initial sample was selected.

In both years, practices aimed at reducing central line–associated bloodstream infection (CLABSI) and ventilator-associated pneumonia (VAP) were implemented more often than those targeting catheter-associated urinary tract infection (CAUTI), even though the CMS nonpayment rule applies to CAUTI but not yet to VAP or CLABSI.

For CLABSI prevention, there were significant increases between 2005 and 2009 in those reporting “almost always” or “always” using maximum sterile barriers (71% to 90%), chlorhexidine as a site disinfectant (69% to 95%), and antimicrobial dressing (25% to 54%).

With regard to VAP, there were moderate increases in use of semirecumbent positioning (82% to 95%) and antimicrobial mouth rinse (41% to 58%), with a more dramatic increase in use of subglottic secretion drainage (21% to 42%).

For CAUTI, there were slight increases in use of bladder ultrasound (29% to 39%) and antimicrobial urinary catheters (30% to 45%) and a more dramatic increase in use of reminders/stop orders (9% to 20%).

Respondents were also asked for their perception of the effect of the CMS payment change on the importance of preventing the three types of infections. Those reporting a “moderate” or “large” increase in importance were 58% for CLABSI, 54% for VAP, and 65% for CAUTI, a finding that is “noteworthy, considering the data,” Dr. Krein commented.

She noted that CAUTI prevention practices in particular require both additional evidence to support their use and more effective strategies to facilitate their implementation.

CAUTI was not considered as high a priority by hospital staff, despite the fact that it is included in the CMS nonpayment rule while VAP and CLABSI are not, she said: “UTIs are still viewed as benign in many cases.”

Most practices were aimed at reducing central line infections and ventilator-asociated pneumonia.

Source DR. KREIN

Major Finding: After adjustment for age and antibiotic use, the relative risk of diarrhea in C. difficile–colonized patients was more than 3-fold greater (odds ratio 3.3) than in noncolonized patients; the risk for clinical diagnosis and treatment was 10-fold greater (OR 10.1).

Data Source: A follow-up study of 320 hospitalized patients.

Disclosures: Dr. Leekha reported having nothing to disclose.

ATLANTA — Hospitalized patients who were asymptomatically colonized with toxigenic Clostridium difficile had a significantly greater risk of developing clinically significant C. difficile infection and diarrhea, compared with noncolonized patients, in a study of 320 adults admitted to one hospital.

The finding is contrary to previous reports and should be explored further, Dr. Surbhi Leekha said at the Decennial International Conference on Healthcare-Associated Infections.

“The take-home is that there may be an association between initial colonization at the time of hospitalization and the subsequent development of diarrhea, but we cannot determine based on these results whether the increased risk is a direct consequence of that colonization or whether colonization is a marker for other [factors] with that patient, such as severity of illness, immune status, or recurrent hospitalization, that in turn predispose to CDI,” she concluded.

Asymptomatic colonization with C. difficile occurs in approximately 8%–20% of hospitalized patients, who then can serve as “reservoirs” contributing to nosocomial transmission. At least three prior studies have suggested that these patients are not at risk for symptomatic disease and may even be at lower risk, provided a “critical period” of about 1–2 weeks has passed following acquisition of the organism (Clin. Infect. Dis. 1994;18:181–7; Lancet 1990;336:97–100; Lancet 1998;351:633–6).

A previous part of the current study had enrolled 320 adults admitted to Saint Marys Hospital, Rochester, Minn., who had stool specimens tested for toxigenic C. difficile using polymerase chain reaction assay within 5 days of admission between March 1 and April 30, 2009. Of these patients, 30 (9.4%) were found to be colonized without symptoms. Factors associated with C. difficile colonization included recent hospitalization (relative risk 2.3) and chronic dialysis (RR 7.6). Dr. Leekha, of the Mayo Clinic, Rochester, reported those findings at the 2009 meeting of the Infectious Diseases Society of America.

The current follow-up was done 3–4 months after determination of C. difficile colonization status. Of the 320 asymptomatic patients who had a history of C. difficile infection (CDI), 12 were excluded. Of the remaining 308, follow-up information was obtained via telephone calls and chart reviews for 272 patients. Of those, 25 were colonized and 247 were not.

Those who were colonized were significantly more likely to have been hospitalized recently (64% vs. 36%), to be on chronic hemodialysis (12% vs. 2%), to be on proton pump inhibitors (52% vs. 37%), and to have recent corticosteroid use (32% vs. 15%). Antibiotic use and subsequent hospitalization during the follow-up period did not differ significantly between the two groups, Dr. Leekha reported.

Diarrhea developed in 32 (12%) of the 272 patients, including 7 of the 25 who were colonized (28%) and 25 of the 247 who were not (10%).

Clinical diagnosis and treatment for CDI occurred in 8 of the 272 patients (3%), including 4 of the 25 C. difficile–colonized patients (16%) and 4 of the 247 noncolonized patients (2%). After adjustment for age and antibiotic use, the relative risk of diarrhea for colonized patients was more than 3-fold greater (odds ratio 3.3), compared with noncolonized patients; the risk for clinical diagnosis and treatment was 10-fold greater (OR 10.1), she said.

Of the eight patients who were treated for CDI, two—one colonized, one not—did not have diarrhea and therefore would probably not have been tested for C. difficile in a usual clinical setting. All four of the treated noncolonized patients had used systemic antibiotics within 2 weeks of symptom onset. But interestingly, of the four treated colonized patients, one had not used antibiotics within 2 weeks and one had undergone outpatient ocular surgery and had used only ocular antibiotics. Whether those play a role in CDI is unknown, Dr. Leekha commented.

It also is not known why the findings of this study differ from those of previous studies, which had suggested a “protective effect” of colonization. Carriers were found to have had higher levels of toxin A IgG, compared with those with symptoms, which was postulated to play a role. Further elucidation of host factors is needed, she said.

Major Finding: After adjustment for age and antibiotic use, the relative risk of diarrhea in C. difficile–colonized patients was more than 3-fold greater (odds ratio 3.3) than in noncolonized patients; the risk for clinical diagnosis and treatment was 10-fold greater (OR 10.1).

Data Source: A follow-up study of 320 hospitalized patients.

Disclosures: Dr. Leekha reported having nothing to disclose.

ATLANTA — Hospitalized patients who were asymptomatically colonized with toxigenic Clostridium difficile had a significantly greater risk of developing clinically significant C. difficile infection and diarrhea, compared with noncolonized patients, in a study of 320 adults admitted to one hospital.

The finding is contrary to previous reports and should be explored further, Dr. Surbhi Leekha said at the Decennial International Conference on Healthcare-Associated Infections.

“The take-home is that there may be an association between initial colonization at the time of hospitalization and the subsequent development of diarrhea, but we cannot determine based on these results whether the increased risk is a direct consequence of that colonization or whether colonization is a marker for other [factors] with that patient, such as severity of illness, immune status, or recurrent hospitalization, that in turn predispose to CDI,” she concluded.

Asymptomatic colonization with C. difficile occurs in approximately 8%–20% of hospitalized patients, who then can serve as “reservoirs” contributing to nosocomial transmission. At least three prior studies have suggested that these patients are not at risk for symptomatic disease and may even be at lower risk, provided a “critical period” of about 1–2 weeks has passed following acquisition of the organism (Clin. Infect. Dis. 1994;18:181–7; Lancet 1990;336:97–100; Lancet 1998;351:633–6).

A previous part of the current study had enrolled 320 adults admitted to Saint Marys Hospital, Rochester, Minn., who had stool specimens tested for toxigenic C. difficile using polymerase chain reaction assay within 5 days of admission between March 1 and April 30, 2009. Of these patients, 30 (9.4%) were found to be colonized without symptoms. Factors associated with C. difficile colonization included recent hospitalization (relative risk 2.3) and chronic dialysis (RR 7.6). Dr. Leekha, of the Mayo Clinic, Rochester, reported those findings at the 2009 meeting of the Infectious Diseases Society of America.

The current follow-up was done 3–4 months after determination of C. difficile colonization status. Of the 320 asymptomatic patients who had a history of C. difficile infection (CDI), 12 were excluded. Of the remaining 308, follow-up information was obtained via telephone calls and chart reviews for 272 patients. Of those, 25 were colonized and 247 were not.

Those who were colonized were significantly more likely to have been hospitalized recently (64% vs. 36%), to be on chronic hemodialysis (12% vs. 2%), to be on proton pump inhibitors (52% vs. 37%), and to have recent corticosteroid use (32% vs. 15%). Antibiotic use and subsequent hospitalization during the follow-up period did not differ significantly between the two groups, Dr. Leekha reported.

Diarrhea developed in 32 (12%) of the 272 patients, including 7 of the 25 who were colonized (28%) and 25 of the 247 who were not (10%).

Clinical diagnosis and treatment for CDI occurred in 8 of the 272 patients (3%), including 4 of the 25 C. difficile–colonized patients (16%) and 4 of the 247 noncolonized patients (2%). After adjustment for age and antibiotic use, the relative risk of diarrhea for colonized patients was more than 3-fold greater (odds ratio 3.3), compared with noncolonized patients; the risk for clinical diagnosis and treatment was 10-fold greater (OR 10.1), she said.

Of the eight patients who were treated for CDI, two—one colonized, one not—did not have diarrhea and therefore would probably not have been tested for C. difficile in a usual clinical setting. All four of the treated noncolonized patients had used systemic antibiotics within 2 weeks of symptom onset. But interestingly, of the four treated colonized patients, one had not used antibiotics within 2 weeks and one had undergone outpatient ocular surgery and had used only ocular antibiotics. Whether those play a role in CDI is unknown, Dr. Leekha commented.

It also is not known why the findings of this study differ from those of previous studies, which had suggested a “protective effect” of colonization. Carriers were found to have had higher levels of toxin A IgG, compared with those with symptoms, which was postulated to play a role. Further elucidation of host factors is needed, she said.

Major Finding: After adjustment for age and antibiotic use, the relative risk of diarrhea in C. difficile–colonized patients was more than 3-fold greater (odds ratio 3.3) than in noncolonized patients; the risk for clinical diagnosis and treatment was 10-fold greater (OR 10.1).

Data Source: A follow-up study of 320 hospitalized patients.

Disclosures: Dr. Leekha reported having nothing to disclose.

ATLANTA — Hospitalized patients who were asymptomatically colonized with toxigenic Clostridium difficile had a significantly greater risk of developing clinically significant C. difficile infection and diarrhea, compared with noncolonized patients, in a study of 320 adults admitted to one hospital.

The finding is contrary to previous reports and should be explored further, Dr. Surbhi Leekha said at the Decennial International Conference on Healthcare-Associated Infections.

“The take-home is that there may be an association between initial colonization at the time of hospitalization and the subsequent development of diarrhea, but we cannot determine based on these results whether the increased risk is a direct consequence of that colonization or whether colonization is a marker for other [factors] with that patient, such as severity of illness, immune status, or recurrent hospitalization, that in turn predispose to CDI,” she concluded.

Asymptomatic colonization with C. difficile occurs in approximately 8%–20% of hospitalized patients, who then can serve as “reservoirs” contributing to nosocomial transmission. At least three prior studies have suggested that these patients are not at risk for symptomatic disease and may even be at lower risk, provided a “critical period” of about 1–2 weeks has passed following acquisition of the organism (Clin. Infect. Dis. 1994;18:181–7; Lancet 1990;336:97–100; Lancet 1998;351:633–6).

A previous part of the current study had enrolled 320 adults admitted to Saint Marys Hospital, Rochester, Minn., who had stool specimens tested for toxigenic C. difficile using polymerase chain reaction assay within 5 days of admission between March 1 and April 30, 2009. Of these patients, 30 (9.4%) were found to be colonized without symptoms. Factors associated with C. difficile colonization included recent hospitalization (relative risk 2.3) and chronic dialysis (RR 7.6). Dr. Leekha, of the Mayo Clinic, Rochester, reported those findings at the 2009 meeting of the Infectious Diseases Society of America.

The current follow-up was done 3–4 months after determination of C. difficile colonization status. Of the 320 asymptomatic patients who had a history of C. difficile infection (CDI), 12 were excluded. Of the remaining 308, follow-up information was obtained via telephone calls and chart reviews for 272 patients. Of those, 25 were colonized and 247 were not.

Those who were colonized were significantly more likely to have been hospitalized recently (64% vs. 36%), to be on chronic hemodialysis (12% vs. 2%), to be on proton pump inhibitors (52% vs. 37%), and to have recent corticosteroid use (32% vs. 15%). Antibiotic use and subsequent hospitalization during the follow-up period did not differ significantly between the two groups, Dr. Leekha reported.

Diarrhea developed in 32 (12%) of the 272 patients, including 7 of the 25 who were colonized (28%) and 25 of the 247 who were not (10%).

Clinical diagnosis and treatment for CDI occurred in 8 of the 272 patients (3%), including 4 of the 25 C. difficile–colonized patients (16%) and 4 of the 247 noncolonized patients (2%). After adjustment for age and antibiotic use, the relative risk of diarrhea for colonized patients was more than 3-fold greater (odds ratio 3.3), compared with noncolonized patients; the risk for clinical diagnosis and treatment was 10-fold greater (OR 10.1), she said.

Of the eight patients who were treated for CDI, two—one colonized, one not—did not have diarrhea and therefore would probably not have been tested for C. difficile in a usual clinical setting. All four of the treated noncolonized patients had used systemic antibiotics within 2 weeks of symptom onset. But interestingly, of the four treated colonized patients, one had not used antibiotics within 2 weeks and one had undergone outpatient ocular surgery and had used only ocular antibiotics. Whether those play a role in CDI is unknown, Dr. Leekha commented.

It also is not known why the findings of this study differ from those of previous studies, which had suggested a “protective effect” of colonization. Carriers were found to have had higher levels of toxin A IgG, compared with those with symptoms, which was postulated to play a role. Further elucidation of host factors is needed, she said.

Major Finding: During the screening period, 5 infants (0.15%) became infected in the NICU, compared with 29 (1.11%) during the period when screening was not performed.

Data Source: A retrospective study of 5,893 infants seen over two 42-month periods.

Disclosures: None reported.

BETHESDA, MD. — Nasal screening for methicillin-resistant Staphylococcus aureus significantly reduced the infection rate in a neonatal intensive care unit, in a retrospective study of 5,893 infants.

Some states have enacted legislation for mandatory screening for nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA) among inpatients in high-risk inpatient units, but there is still ongoing debate about the value of such screening, Dr. Jeremias L. Murillo said in a poster presented at the annual conference on antimicrobial resistance sponsored by the National Foundation for Infectious Diseases.

Records from January 2006 to June 2009, when all patients admitted to the NICU were screened for nasal carriage of MRSA, were compared with those from an equivalent 42-month period from July 2002 to December 2005, when no nasal screenings were performed.

All MRSA infections were identified from a microbiology database and confirmed by chart review.

Nasal screenings were performed via rapid polymerase chain reaction testing, and infants found positive were decolonized with topical mupirocin, with contact isolation maintained until decolonization was completed.

There were no significant differences in birth weight or gestational age between the 3,269 infants who were screened and the 2,624 who were not. A total of 5 infants (0.15%) became infected in the NICU during the screening period, compared with 29 (1.11%) during the period when screening was not performed, Dr. Murillo of Children's Hospital of New Jersey and Beth Israel Medical Center, Newark, reported.

In an interview, Dr. Murillo noted that in 2002 it took an average of 72 days from the time of admission before the infants became infected, compared with only 14 days in 2005, which was just before his hospital began screening.

“We felt that the shortened time frame was because the babies were coming into the NICU already colonized with MRSA and were therefore getting infected earlier,” he said.

Some infants had positive nasal swabs—indicating that they were colonized but not infected—at the time of delivery, he added.

Replication of these findings with a large multicenter trial comparing screening versus nonscreening units should settle the MRSA screening debate once and for all, Dr. Murillo said.

Major Finding: During the screening period, 5 infants (0.15%) became infected in the NICU, compared with 29 (1.11%) during the period when screening was not performed.

Data Source: A retrospective study of 5,893 infants seen over two 42-month periods.

Disclosures: None reported.

BETHESDA, MD. — Nasal screening for methicillin-resistant Staphylococcus aureus significantly reduced the infection rate in a neonatal intensive care unit, in a retrospective study of 5,893 infants.

Some states have enacted legislation for mandatory screening for nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA) among inpatients in high-risk inpatient units, but there is still ongoing debate about the value of such screening, Dr. Jeremias L. Murillo said in a poster presented at the annual conference on antimicrobial resistance sponsored by the National Foundation for Infectious Diseases.

Records from January 2006 to June 2009, when all patients admitted to the NICU were screened for nasal carriage of MRSA, were compared with those from an equivalent 42-month period from July 2002 to December 2005, when no nasal screenings were performed.

All MRSA infections were identified from a microbiology database and confirmed by chart review.

Nasal screenings were performed via rapid polymerase chain reaction testing, and infants found positive were decolonized with topical mupirocin, with contact isolation maintained until decolonization was completed.

There were no significant differences in birth weight or gestational age between the 3,269 infants who were screened and the 2,624 who were not. A total of 5 infants (0.15%) became infected in the NICU during the screening period, compared with 29 (1.11%) during the period when screening was not performed, Dr. Murillo of Children's Hospital of New Jersey and Beth Israel Medical Center, Newark, reported.

In an interview, Dr. Murillo noted that in 2002 it took an average of 72 days from the time of admission before the infants became infected, compared with only 14 days in 2005, which was just before his hospital began screening.

“We felt that the shortened time frame was because the babies were coming into the NICU already colonized with MRSA and were therefore getting infected earlier,” he said.

Some infants had positive nasal swabs—indicating that they were colonized but not infected—at the time of delivery, he added.

Replication of these findings with a large multicenter trial comparing screening versus nonscreening units should settle the MRSA screening debate once and for all, Dr. Murillo said.

Major Finding: During the screening period, 5 infants (0.15%) became infected in the NICU, compared with 29 (1.11%) during the period when screening was not performed.

Data Source: A retrospective study of 5,893 infants seen over two 42-month periods.

Disclosures: None reported.

BETHESDA, MD. — Nasal screening for methicillin-resistant Staphylococcus aureus significantly reduced the infection rate in a neonatal intensive care unit, in a retrospective study of 5,893 infants.

Some states have enacted legislation for mandatory screening for nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA) among inpatients in high-risk inpatient units, but there is still ongoing debate about the value of such screening, Dr. Jeremias L. Murillo said in a poster presented at the annual conference on antimicrobial resistance sponsored by the National Foundation for Infectious Diseases.

Records from January 2006 to June 2009, when all patients admitted to the NICU were screened for nasal carriage of MRSA, were compared with those from an equivalent 42-month period from July 2002 to December 2005, when no nasal screenings were performed.

All MRSA infections were identified from a microbiology database and confirmed by chart review.

Nasal screenings were performed via rapid polymerase chain reaction testing, and infants found positive were decolonized with topical mupirocin, with contact isolation maintained until decolonization was completed.

There were no significant differences in birth weight or gestational age between the 3,269 infants who were screened and the 2,624 who were not. A total of 5 infants (0.15%) became infected in the NICU during the screening period, compared with 29 (1.11%) during the period when screening was not performed, Dr. Murillo of Children's Hospital of New Jersey and Beth Israel Medical Center, Newark, reported.

In an interview, Dr. Murillo noted that in 2002 it took an average of 72 days from the time of admission before the infants became infected, compared with only 14 days in 2005, which was just before his hospital began screening.

“We felt that the shortened time frame was because the babies were coming into the NICU already colonized with MRSA and were therefore getting infected earlier,” he said.

Some infants had positive nasal swabs—indicating that they were colonized but not infected—at the time of delivery, he added.

Replication of these findings with a large multicenter trial comparing screening versus nonscreening units should settle the MRSA screening debate once and for all, Dr. Murillo said.

Major Finding: At 8 weeks, the mean total HAM-A score for 28 patients given chamomile extract was 3.17 points lower than the score for 29 patients given placebo.

Data Source: A randomized, blinded, placebo-controlled clinical trial in 57 patients with mild to moderate generalized anxiety disorder, with and without depression.

Disclosures: The study was funded by the National Center for Complementary and Alternative Medicine. The lead investigator and both presenters of the study have no relevant financial disclosures. Dr. Amsterdam has received grant support from Stanley Medical Research Institute, Lilly Research Laboratories, Sanofi-Aventis, and Novartis.

BALTIMORE — Chamomile extract therapy showed both anxiolytic and antidepressive effects in a two-part randomized, controlled, blinded study of 57 patients with mild-to-moderate generalized anxiety disorder.

The initial study, published in 2009, is thought to be the first-controlled clinical trial of oral chamomile (Matricaria recutita) extract for GAD. A substudy presented in a poster at the annual meeting of the Anxiety Disorders Association of America (ADAA) investigated the effect of chamomile on depressive symptoms in GAD patients who had comorbid depression, a history of depression, or no depression.

Because not all patients can use psychopharmacologic treatment, “the identification of a safe and effective herbal remedy for treating anxious and depressive symptoms would be of public health relevance,” Matthew A. Shore and his associates said in their poster.

Chamomile has long been used as a traditional remedy for its calming effect, and has shown pharmacologic activity in animal models of anxiety. Its anxiolytic and antidepressive properties may relate to modulation of central noradrenalin, dopamine, and serotonin, and gamma-aminobutyric acid neurotransmission and hypothalamic-pituitary-adrenocortical axis activity, said Mr. Shore and his associates, of the University of Pennsylvania, Philadelphia.

The original study, led by Dr. Jay D. Amsterdam, was summarized by coauthor Irene Soeller, a nurse practitioner, in a session on alternative/complementary medicine at the ADAA meeting. The 57 GAD patients all had minimum baseline Hamilton Anxiety (HAM-A) scores of 9 or more. Patients with other DSM-IV axis 1 disorders, such as minor depression, were not excluded as long as the comorbid condition was not the primary diagnosis. Those with major depressive disorder, bipolar disorder, or other serious psychiatric diagnoses were excluded (J. Clin. Psychopharmacol. 2009;29:378-82).

A total of 28 patients were randomized to chamomile extract and 29 to placebo for 8 weeks. Identically appearing and smelling capsules contained either pharmaceutical-grade chamomile extract or placebo. Initial dose was one capsule (220 mg for the chamomile) daily for the first week, increasing to two capsules daily for week 2. After that, patients with a 50% or less reduction in HAM-A scores at each week were increased to three capsules at week 3 and four at week 4—up to five capsules at weeks 5–8 if response was still less than 50%.

At 8 weeks, there was a significantly greater reduction in the mean total HAM-A score for chamomile vs. placebo—the primary outcome—with a mean difference of 3.17 points between the two groups.

The study was not powered to detect statistically significant group differences in secondary outcome measures. However, there were clinically meaningful changes in the same direction as the primary measure, including a greater reduction in mean total Beck Anxiety Inventory (BAI) scores with chamomile (difference of 2.09 points), a greater increase in mean Psychological General Well-Being (PGWB) scores (6.33), and a greater reduction in the Clinical Global Impressions–Severity of Illness score (0.43).

There was also a somewhat greater proportion of overall HAM-A responders to chamomile vs. placebo (57% vs. 38%), and the overall percentage change was numerically greater for chamomile than placebo on the HAM-A (53% vs. 35%), the BAI (42% vs. 21%), and the PGWB (28% vs. 18%).

There was a somewhat greater reduction over time in resting pulse rate with chamomile, but no difference in resting systolic or diastolic blood pressure or weight, Dr. Amsterdam, Ms. Soeller, and their associates reported.

Two patients discontinued treatment because of adverse events. One had an allergic reaction to the placebo, and one had abdominal discomfort while taking chamomile. There were a total of 33 reported adverse events: 11 on chamomile and 22 on placebo. The proportions of patients reporting one, two, or three adverse events did not differ significantly, and there was actually a lower incidence of adverse event rates at higher chamomile doses, they said.

The follow-up study divided the 57 GAD patients into three groups: 19 with comorbid depression, 16 with a past history of depression, and 22 with no current or previous depression.

In all three groups combined, there was a significantly greater reduction over time in total Hamilton Depression (HAM-D) 17 scores and in core HAM-D depression items (including depressed mood, guilt, and suicidal ideation) for chamomile vs. placebo, with a P value of less than .05 on both measures.

Nonsignificant yet clinically meaningful reductions were seen with chamomile vs. placebo in HAM-D 17 score in the group with current comorbid depression (P = .062) and in core HAM-D depression items in the patients without current or past depression (P = .06).

No significant changes over time for chamomile vs. placebo were seen in core HAM-D anxiety items, including agitation, somatic anxiety, and psychic anxiety, Mr. Shore and his associates reported.

As a next step, a 36-week study is planned to see whether chamomile extract therapy can prolong the time before relapse of anxiety symptoms among 180 patients who have recovered from GAD, Ms. Soeller said in an interview.

Chamomile may provide relief for anxiety and depression.

Source ©Piotr Nieciecki/Fotolia.com

Major Finding: At 8 weeks, the mean total HAM-A score for 28 patients given chamomile extract was 3.17 points lower than the score for 29 patients given placebo.

Data Source: A randomized, blinded, placebo-controlled clinical trial in 57 patients with mild to moderate generalized anxiety disorder, with and without depression.

Disclosures: The study was funded by the National Center for Complementary and Alternative Medicine. The lead investigator and both presenters of the study have no relevant financial disclosures. Dr. Amsterdam has received grant support from Stanley Medical Research Institute, Lilly Research Laboratories, Sanofi-Aventis, and Novartis.

BALTIMORE — Chamomile extract therapy showed both anxiolytic and antidepressive effects in a two-part randomized, controlled, blinded study of 57 patients with mild-to-moderate generalized anxiety disorder.

The initial study, published in 2009, is thought to be the first-controlled clinical trial of oral chamomile (Matricaria recutita) extract for GAD. A substudy presented in a poster at the annual meeting of the Anxiety Disorders Association of America (ADAA) investigated the effect of chamomile on depressive symptoms in GAD patients who had comorbid depression, a history of depression, or no depression.

Because not all patients can use psychopharmacologic treatment, “the identification of a safe and effective herbal remedy for treating anxious and depressive symptoms would be of public health relevance,” Matthew A. Shore and his associates said in their poster.

Chamomile has long been used as a traditional remedy for its calming effect, and has shown pharmacologic activity in animal models of anxiety. Its anxiolytic and antidepressive properties may relate to modulation of central noradrenalin, dopamine, and serotonin, and gamma-aminobutyric acid neurotransmission and hypothalamic-pituitary-adrenocortical axis activity, said Mr. Shore and his associates, of the University of Pennsylvania, Philadelphia.

The original study, led by Dr. Jay D. Amsterdam, was summarized by coauthor Irene Soeller, a nurse practitioner, in a session on alternative/complementary medicine at the ADAA meeting. The 57 GAD patients all had minimum baseline Hamilton Anxiety (HAM-A) scores of 9 or more. Patients with other DSM-IV axis 1 disorders, such as minor depression, were not excluded as long as the comorbid condition was not the primary diagnosis. Those with major depressive disorder, bipolar disorder, or other serious psychiatric diagnoses were excluded (J. Clin. Psychopharmacol. 2009;29:378-82).

A total of 28 patients were randomized to chamomile extract and 29 to placebo for 8 weeks. Identically appearing and smelling capsules contained either pharmaceutical-grade chamomile extract or placebo. Initial dose was one capsule (220 mg for the chamomile) daily for the first week, increasing to two capsules daily for week 2. After that, patients with a 50% or less reduction in HAM-A scores at each week were increased to three capsules at week 3 and four at week 4—up to five capsules at weeks 5–8 if response was still less than 50%.

At 8 weeks, there was a significantly greater reduction in the mean total HAM-A score for chamomile vs. placebo—the primary outcome—with a mean difference of 3.17 points between the two groups.

The study was not powered to detect statistically significant group differences in secondary outcome measures. However, there were clinically meaningful changes in the same direction as the primary measure, including a greater reduction in mean total Beck Anxiety Inventory (BAI) scores with chamomile (difference of 2.09 points), a greater increase in mean Psychological General Well-Being (PGWB) scores (6.33), and a greater reduction in the Clinical Global Impressions–Severity of Illness score (0.43).

There was also a somewhat greater proportion of overall HAM-A responders to chamomile vs. placebo (57% vs. 38%), and the overall percentage change was numerically greater for chamomile than placebo on the HAM-A (53% vs. 35%), the BAI (42% vs. 21%), and the PGWB (28% vs. 18%).

There was a somewhat greater reduction over time in resting pulse rate with chamomile, but no difference in resting systolic or diastolic blood pressure or weight, Dr. Amsterdam, Ms. Soeller, and their associates reported.

Two patients discontinued treatment because of adverse events. One had an allergic reaction to the placebo, and one had abdominal discomfort while taking chamomile. There were a total of 33 reported adverse events: 11 on chamomile and 22 on placebo. The proportions of patients reporting one, two, or three adverse events did not differ significantly, and there was actually a lower incidence of adverse event rates at higher chamomile doses, they said.

The follow-up study divided the 57 GAD patients into three groups: 19 with comorbid depression, 16 with a past history of depression, and 22 with no current or previous depression.

In all three groups combined, there was a significantly greater reduction over time in total Hamilton Depression (HAM-D) 17 scores and in core HAM-D depression items (including depressed mood, guilt, and suicidal ideation) for chamomile vs. placebo, with a P value of less than .05 on both measures.

Nonsignificant yet clinically meaningful reductions were seen with chamomile vs. placebo in HAM-D 17 score in the group with current comorbid depression (P = .062) and in core HAM-D depression items in the patients without current or past depression (P = .06).

No significant changes over time for chamomile vs. placebo were seen in core HAM-D anxiety items, including agitation, somatic anxiety, and psychic anxiety, Mr. Shore and his associates reported.

As a next step, a 36-week study is planned to see whether chamomile extract therapy can prolong the time before relapse of anxiety symptoms among 180 patients who have recovered from GAD, Ms. Soeller said in an interview.

Chamomile may provide relief for anxiety and depression.

Source ©Piotr Nieciecki/Fotolia.com

Major Finding: At 8 weeks, the mean total HAM-A score for 28 patients given chamomile extract was 3.17 points lower than the score for 29 patients given placebo.

Data Source: A randomized, blinded, placebo-controlled clinical trial in 57 patients with mild to moderate generalized anxiety disorder, with and without depression.

Disclosures: The study was funded by the National Center for Complementary and Alternative Medicine. The lead investigator and both presenters of the study have no relevant financial disclosures. Dr. Amsterdam has received grant support from Stanley Medical Research Institute, Lilly Research Laboratories, Sanofi-Aventis, and Novartis.

BALTIMORE — Chamomile extract therapy showed both anxiolytic and antidepressive effects in a two-part randomized, controlled, blinded study of 57 patients with mild-to-moderate generalized anxiety disorder.

The initial study, published in 2009, is thought to be the first-controlled clinical trial of oral chamomile (Matricaria recutita) extract for GAD. A substudy presented in a poster at the annual meeting of the Anxiety Disorders Association of America (ADAA) investigated the effect of chamomile on depressive symptoms in GAD patients who had comorbid depression, a history of depression, or no depression.

Because not all patients can use psychopharmacologic treatment, “the identification of a safe and effective herbal remedy for treating anxious and depressive symptoms would be of public health relevance,” Matthew A. Shore and his associates said in their poster.

Chamomile has long been used as a traditional remedy for its calming effect, and has shown pharmacologic activity in animal models of anxiety. Its anxiolytic and antidepressive properties may relate to modulation of central noradrenalin, dopamine, and serotonin, and gamma-aminobutyric acid neurotransmission and hypothalamic-pituitary-adrenocortical axis activity, said Mr. Shore and his associates, of the University of Pennsylvania, Philadelphia.

The original study, led by Dr. Jay D. Amsterdam, was summarized by coauthor Irene Soeller, a nurse practitioner, in a session on alternative/complementary medicine at the ADAA meeting. The 57 GAD patients all had minimum baseline Hamilton Anxiety (HAM-A) scores of 9 or more. Patients with other DSM-IV axis 1 disorders, such as minor depression, were not excluded as long as the comorbid condition was not the primary diagnosis. Those with major depressive disorder, bipolar disorder, or other serious psychiatric diagnoses were excluded (J. Clin. Psychopharmacol. 2009;29:378-82).

A total of 28 patients were randomized to chamomile extract and 29 to placebo for 8 weeks. Identically appearing and smelling capsules contained either pharmaceutical-grade chamomile extract or placebo. Initial dose was one capsule (220 mg for the chamomile) daily for the first week, increasing to two capsules daily for week 2. After that, patients with a 50% or less reduction in HAM-A scores at each week were increased to three capsules at week 3 and four at week 4—up to five capsules at weeks 5–8 if response was still less than 50%.

At 8 weeks, there was a significantly greater reduction in the mean total HAM-A score for chamomile vs. placebo—the primary outcome—with a mean difference of 3.17 points between the two groups.

The study was not powered to detect statistically significant group differences in secondary outcome measures. However, there were clinically meaningful changes in the same direction as the primary measure, including a greater reduction in mean total Beck Anxiety Inventory (BAI) scores with chamomile (difference of 2.09 points), a greater increase in mean Psychological General Well-Being (PGWB) scores (6.33), and a greater reduction in the Clinical Global Impressions–Severity of Illness score (0.43).

There was also a somewhat greater proportion of overall HAM-A responders to chamomile vs. placebo (57% vs. 38%), and the overall percentage change was numerically greater for chamomile than placebo on the HAM-A (53% vs. 35%), the BAI (42% vs. 21%), and the PGWB (28% vs. 18%).

There was a somewhat greater reduction over time in resting pulse rate with chamomile, but no difference in resting systolic or diastolic blood pressure or weight, Dr. Amsterdam, Ms. Soeller, and their associates reported.

Two patients discontinued treatment because of adverse events. One had an allergic reaction to the placebo, and one had abdominal discomfort while taking chamomile. There were a total of 33 reported adverse events: 11 on chamomile and 22 on placebo. The proportions of patients reporting one, two, or three adverse events did not differ significantly, and there was actually a lower incidence of adverse event rates at higher chamomile doses, they said.

The follow-up study divided the 57 GAD patients into three groups: 19 with comorbid depression, 16 with a past history of depression, and 22 with no current or previous depression.

In all three groups combined, there was a significantly greater reduction over time in total Hamilton Depression (HAM-D) 17 scores and in core HAM-D depression items (including depressed mood, guilt, and suicidal ideation) for chamomile vs. placebo, with a P value of less than .05 on both measures.

Nonsignificant yet clinically meaningful reductions were seen with chamomile vs. placebo in HAM-D 17 score in the group with current comorbid depression (P = .062) and in core HAM-D depression items in the patients without current or past depression (P = .06).

No significant changes over time for chamomile vs. placebo were seen in core HAM-D anxiety items, including agitation, somatic anxiety, and psychic anxiety, Mr. Shore and his associates reported.

As a next step, a 36-week study is planned to see whether chamomile extract therapy can prolong the time before relapse of anxiety symptoms among 180 patients who have recovered from GAD, Ms. Soeller said in an interview.

Chamomile may provide relief for anxiety and depression.

Source ©Piotr Nieciecki/Fotolia.com

Major Finding: At 8 weeks, the mean total HAM-A score for 28 patients given chamomile extract was 3.17 points lower than the score for 29 patients given placebo.

Data Source: A randomized, blinded, placebo-controlled clinical trial in 57 patients with mild to moderate generalized anxiety disorder, with and without depression.

Disclosures: The study was funded by the National Institute of Mental Health. The lead investigator and both presenters of the study have no relevant financial disclosures.

BALTIMORE — Chamomile extract therapy demonstrated both anxiolytic and antidepressive effects in a two-part randomized, controlled, blinded study of 57 patients with mild to moderate generalized anxiety disorder.

The initial study, published in 2009, is thought to be the first controlled clinical trial of oral chamomile (Matricaria recutita) extract for GAD. A substudy presented in a poster at the annual meeting of the Anxiety Disorders Association of America (ADAA) investigated the effect of chamomile on depressive symptoms in GAD patients who had comorbid depression, a history of depression, or no depression.

Since not all patients are willing or able to use psychopharmacologic treatment, “identification of a safe and effective herbal remedy for treating anxious and depressive symptoms would be of public health relevance,” Matthew A. Shore and his associates said in their poster.

Chamomile has long been used as a traditional remedy for its calming effect, and has demonstrated pharmacologic activity in animal models of anxiety, said Mr. Shore and his associates of the University of Pennsylvania, Philadelphia.

The original study, led by Dr. Jay D. Amsterdam, was summarized by coauthor Irene Soeller, a nurse practitioner, at the ADAA meeting. The 57 GAD patients all had minimum baseline Hamilton Anxiety Rating (HAM-A) scores of 9 or more. Patients with other DSM-IV axis 1 disorders, such as minor depression, were not excluded as long as the comorbid condition was not the primary diagnosis. Those with major depressive disorder, bipolar disorder, or other serious psychiatric diagnoses were excluded (J. Clin. Psychopharmacol. 2009;29:378–82).

Twenty-eight of the patients were randomized to chamomile extract and 29 to placebo for 8 weeks. Identically appearing and smelling capsules contained either pharmaceutical-grade chamomile extract or placebo. Initial dose was one capsule (220 mg for the chamomile) daily for the first week, increasing to two capsules daily for week two. After that, patients with a 50% or less reduction in HAM-A scores at each week were increased to three capsules at week 3 and four at week 4, and then up to five capsules at weeks 5–8 if response was still less than 50%.

At 8 weeks, there was a significantly greater reduction in the mean total HAM-A score for chamomile versus placebo—the primary outcome—with a mean difference of 3.17 points between the two groups.

The study was not powered to detect statistically significant group differences in secondary outcome measures. However, there were clinically meaningful changes in the same direction as the primary measure, including a somewhat greater reduction in mean total Beck Anxiety Inventory (BAI) scores with chamomile (difference of 2.09 points), a somewhat greater increase in mean Psychological General Well-Being (PGWB) scores (6.33) and a somewhat greater reduction in the Clinical Global Impression-Severity score (0.43).

There was also a somewhat greater proportion of overall HAM-A responders to chamomile vs. placebo (57% vs. 38%), and the overall percentage change was numerically greater for chamomile than placebo on both the HAM-A (53% vs. 35%), the BAI (42% vs. 21%) and the PGWB (28% vs. 18%).

Two patients discontinued treatment because of adverse events. One had an allergic reaction to the placebo, and one had abdominal discomfort while taking chamomile. There were a total of 33 reported adverse events, 11 on chamomile and 22 on placebo. The proportions of patients reporting one, two, or three adverse events did not differ significantly, and there was actually a lower incidence of adverse event rates at higher chamomile doses, they said.

The follow-up study divided the 57 GAD patients into three groups: 19 with comorbid depression, 16 with a past history of depression, and 22 with no current or previous depression.

In all three groups combined, there was a significantly greater reduction over time in total Hamilton Depression Rating (HAM-D) 17 scores and in core HAM-D depression items (including depressed mood, guilt, and suicidal ideation) for chamomile versus placebo, with a P value of less than .05 on both measures.

Nonsignificant yet clinically meaningful reductions were seen with chamomile vs. placebo in HAM-D 17 score in the group with current comorbid depression (P = .062) and in core HAM-D depression items in the patients without current or past depression (P = .06).

No significant changes over time for chamomile vs. placebo were seen in core HAM-D anxiety items, including agitation, somatic anxiety, and psychic anxiety, Mr. Shore and his associates reported.

Chamomile has been used for its calming effect in traditional medicine.

Source © Piotr Nieciecki/Fotolia.com

Major Finding: At 8 weeks, the mean total HAM-A score for 28 patients given chamomile extract was 3.17 points lower than the score for 29 patients given placebo.

Data Source: A randomized, blinded, placebo-controlled clinical trial in 57 patients with mild to moderate generalized anxiety disorder, with and without depression.

Disclosures: The study was funded by the National Institute of Mental Health. The lead investigator and both presenters of the study have no relevant financial disclosures.

BALTIMORE — Chamomile extract therapy demonstrated both anxiolytic and antidepressive effects in a two-part randomized, controlled, blinded study of 57 patients with mild to moderate generalized anxiety disorder.

The initial study, published in 2009, is thought to be the first controlled clinical trial of oral chamomile (Matricaria recutita) extract for GAD. A substudy presented in a poster at the annual meeting of the Anxiety Disorders Association of America (ADAA) investigated the effect of chamomile on depressive symptoms in GAD patients who had comorbid depression, a history of depression, or no depression.

Since not all patients are willing or able to use psychopharmacologic treatment, “identification of a safe and effective herbal remedy for treating anxious and depressive symptoms would be of public health relevance,” Matthew A. Shore and his associates said in their poster.

Chamomile has long been used as a traditional remedy for its calming effect, and has demonstrated pharmacologic activity in animal models of anxiety, said Mr. Shore and his associates of the University of Pennsylvania, Philadelphia.

The original study, led by Dr. Jay D. Amsterdam, was summarized by coauthor Irene Soeller, a nurse practitioner, at the ADAA meeting. The 57 GAD patients all had minimum baseline Hamilton Anxiety Rating (HAM-A) scores of 9 or more. Patients with other DSM-IV axis 1 disorders, such as minor depression, were not excluded as long as the comorbid condition was not the primary diagnosis. Those with major depressive disorder, bipolar disorder, or other serious psychiatric diagnoses were excluded (J. Clin. Psychopharmacol. 2009;29:378–82).

Twenty-eight of the patients were randomized to chamomile extract and 29 to placebo for 8 weeks. Identically appearing and smelling capsules contained either pharmaceutical-grade chamomile extract or placebo. Initial dose was one capsule (220 mg for the chamomile) daily for the first week, increasing to two capsules daily for week two. After that, patients with a 50% or less reduction in HAM-A scores at each week were increased to three capsules at week 3 and four at week 4, and then up to five capsules at weeks 5–8 if response was still less than 50%.

At 8 weeks, there was a significantly greater reduction in the mean total HAM-A score for chamomile versus placebo—the primary outcome—with a mean difference of 3.17 points between the two groups.

The study was not powered to detect statistically significant group differences in secondary outcome measures. However, there were clinically meaningful changes in the same direction as the primary measure, including a somewhat greater reduction in mean total Beck Anxiety Inventory (BAI) scores with chamomile (difference of 2.09 points), a somewhat greater increase in mean Psychological General Well-Being (PGWB) scores (6.33) and a somewhat greater reduction in the Clinical Global Impression-Severity score (0.43).

There was also a somewhat greater proportion of overall HAM-A responders to chamomile vs. placebo (57% vs. 38%), and the overall percentage change was numerically greater for chamomile than placebo on both the HAM-A (53% vs. 35%), the BAI (42% vs. 21%) and the PGWB (28% vs. 18%).

Two patients discontinued treatment because of adverse events. One had an allergic reaction to the placebo, and one had abdominal discomfort while taking chamomile. There were a total of 33 reported adverse events, 11 on chamomile and 22 on placebo. The proportions of patients reporting one, two, or three adverse events did not differ significantly, and there was actually a lower incidence of adverse event rates at higher chamomile doses, they said.

The follow-up study divided the 57 GAD patients into three groups: 19 with comorbid depression, 16 with a past history of depression, and 22 with no current or previous depression.

In all three groups combined, there was a significantly greater reduction over time in total Hamilton Depression Rating (HAM-D) 17 scores and in core HAM-D depression items (including depressed mood, guilt, and suicidal ideation) for chamomile versus placebo, with a P value of less than .05 on both measures.

Nonsignificant yet clinically meaningful reductions were seen with chamomile vs. placebo in HAM-D 17 score in the group with current comorbid depression (P = .062) and in core HAM-D depression items in the patients without current or past depression (P = .06).

No significant changes over time for chamomile vs. placebo were seen in core HAM-D anxiety items, including agitation, somatic anxiety, and psychic anxiety, Mr. Shore and his associates reported.

Chamomile has been used for its calming effect in traditional medicine.

Source © Piotr Nieciecki/Fotolia.com

Major Finding: At 8 weeks, the mean total HAM-A score for 28 patients given chamomile extract was 3.17 points lower than the score for 29 patients given placebo.

Data Source: A randomized, blinded, placebo-controlled clinical trial in 57 patients with mild to moderate generalized anxiety disorder, with and without depression.

Disclosures: The study was funded by the National Institute of Mental Health. The lead investigator and both presenters of the study have no relevant financial disclosures.

BALTIMORE — Chamomile extract therapy demonstrated both anxiolytic and antidepressive effects in a two-part randomized, controlled, blinded study of 57 patients with mild to moderate generalized anxiety disorder.

The initial study, published in 2009, is thought to be the first controlled clinical trial of oral chamomile (Matricaria recutita) extract for GAD. A substudy presented in a poster at the annual meeting of the Anxiety Disorders Association of America (ADAA) investigated the effect of chamomile on depressive symptoms in GAD patients who had comorbid depression, a history of depression, or no depression.

Since not all patients are willing or able to use psychopharmacologic treatment, “identification of a safe and effective herbal remedy for treating anxious and depressive symptoms would be of public health relevance,” Matthew A. Shore and his associates said in their poster.

Chamomile has long been used as a traditional remedy for its calming effect, and has demonstrated pharmacologic activity in animal models of anxiety, said Mr. Shore and his associates of the University of Pennsylvania, Philadelphia.

The original study, led by Dr. Jay D. Amsterdam, was summarized by coauthor Irene Soeller, a nurse practitioner, at the ADAA meeting. The 57 GAD patients all had minimum baseline Hamilton Anxiety Rating (HAM-A) scores of 9 or more. Patients with other DSM-IV axis 1 disorders, such as minor depression, were not excluded as long as the comorbid condition was not the primary diagnosis. Those with major depressive disorder, bipolar disorder, or other serious psychiatric diagnoses were excluded (J. Clin. Psychopharmacol. 2009;29:378–82).

Twenty-eight of the patients were randomized to chamomile extract and 29 to placebo for 8 weeks. Identically appearing and smelling capsules contained either pharmaceutical-grade chamomile extract or placebo. Initial dose was one capsule (220 mg for the chamomile) daily for the first week, increasing to two capsules daily for week two. After that, patients with a 50% or less reduction in HAM-A scores at each week were increased to three capsules at week 3 and four at week 4, and then up to five capsules at weeks 5–8 if response was still less than 50%.

At 8 weeks, there was a significantly greater reduction in the mean total HAM-A score for chamomile versus placebo—the primary outcome—with a mean difference of 3.17 points between the two groups.

The study was not powered to detect statistically significant group differences in secondary outcome measures. However, there were clinically meaningful changes in the same direction as the primary measure, including a somewhat greater reduction in mean total Beck Anxiety Inventory (BAI) scores with chamomile (difference of 2.09 points), a somewhat greater increase in mean Psychological General Well-Being (PGWB) scores (6.33) and a somewhat greater reduction in the Clinical Global Impression-Severity score (0.43).

There was also a somewhat greater proportion of overall HAM-A responders to chamomile vs. placebo (57% vs. 38%), and the overall percentage change was numerically greater for chamomile than placebo on both the HAM-A (53% vs. 35%), the BAI (42% vs. 21%) and the PGWB (28% vs. 18%).

Two patients discontinued treatment because of adverse events. One had an allergic reaction to the placebo, and one had abdominal discomfort while taking chamomile. There were a total of 33 reported adverse events, 11 on chamomile and 22 on placebo. The proportions of patients reporting one, two, or three adverse events did not differ significantly, and there was actually a lower incidence of adverse event rates at higher chamomile doses, they said.

The follow-up study divided the 57 GAD patients into three groups: 19 with comorbid depression, 16 with a past history of depression, and 22 with no current or previous depression.

In all three groups combined, there was a significantly greater reduction over time in total Hamilton Depression Rating (HAM-D) 17 scores and in core HAM-D depression items (including depressed mood, guilt, and suicidal ideation) for chamomile versus placebo, with a P value of less than .05 on both measures.

Nonsignificant yet clinically meaningful reductions were seen with chamomile vs. placebo in HAM-D 17 score in the group with current comorbid depression (P = .062) and in core HAM-D depression items in the patients without current or past depression (P = .06).

No significant changes over time for chamomile vs. placebo were seen in core HAM-D anxiety items, including agitation, somatic anxiety, and psychic anxiety, Mr. Shore and his associates reported.

Chamomile has been used for its calming effect in traditional medicine.

Source © Piotr Nieciecki/Fotolia.com