Objective

We sought to examine whether hospital and provider volumes and cesarean section rates influenced early postpartum invasive methicillin-resistant Staphylococcus aureus (MRSA) infection.

Methods

We used data from the Nationwide Inpatient Sample, a representative sample of US community hospitals. Multivariate hierarchical regression models were used to estimate odds ratios adjusted for hospital total discharges, nurse:patient ratio, urbanicity, teaching status, bed size, ownership, and geographic region and patient age, race, expected payer, and comorbidities.

Results

The total sample size for the hospital analysis was 3,487,350 deliveries, which included 555 cases of MRSA infection. The total sample size for the provider analysis was 1,186,703 deliveries, with 221 cases of MRSA infection. Hospital and provider patient (deliveries) volumes and cesarean section rates were not associated with early postpartum invasive MRSA infection.

Conclusions

Barring major bias in our estimates, our results suggest that transmission from providers may not be a predominant route of postpartum MRSA infection in US hospitals.

Objective

We sought to examine whether hospital and provider volumes and cesarean section rates influenced early postpartum invasive methicillin-resistant Staphylococcus aureus (MRSA) infection.

Methods

We used data from the Nationwide Inpatient Sample, a representative sample of US community hospitals. Multivariate hierarchical regression models were used to estimate odds ratios adjusted for hospital total discharges, nurse:patient ratio, urbanicity, teaching status, bed size, ownership, and geographic region and patient age, race, expected payer, and comorbidities.

Results

The total sample size for the hospital analysis was 3,487,350 deliveries, which included 555 cases of MRSA infection. The total sample size for the provider analysis was 1,186,703 deliveries, with 221 cases of MRSA infection. Hospital and provider patient (deliveries) volumes and cesarean section rates were not associated with early postpartum invasive MRSA infection.

Conclusions

Barring major bias in our estimates, our results suggest that transmission from providers may not be a predominant route of postpartum MRSA infection in US hospitals.

Background

We sought to characterize the relationship between individual group B streptococcus (GBS) colonization and pre-discharge postpartum methicillin resistant Staphylococcus aureus (MRSA) infection in United States women delivering at term. We also sought to examine the association between hospital GBS colonization prevalence and MRSA infection.

Materials and methods

Data was from the Nationwide Inpatient Sample, a representative sample of United States community hospitals. Hierarchical regression models were used to estimate odds ratios adjusted for patient age, race, expected payer, and prepregnancy diabetes and hospital teaching status, urbanicity, ownership, size, and geographic region. We used multiple imputation for missing covariate data.

Results

There were 3,136,595 deliveries and 462 cases of MRSA infection included in this study. The odds ratio for individual GBS colonization was 1.2 (95% confidence interval: 0.9 to 1.5). For a five-percent increase in the hospital prevalence of GBS colonization, the odds ratio was 0.9 (95% CI: 0.1 to 5.6).

Conclusions

The odds ratio estimate for the association of hospital GBS prevalence with MRSA infection is too imprecise to make conclusions about its magnitude and direction. Barring major bias in our estimates, individual GBS carriage does not appear to be strongly associated with predischarge postpartum MRSA infection.

The Pacific Island countries of the Western Pacific Region have some of the highest rates of sexually transmitted Chlamydia trachomatis and Neisseria gonorrhoeae infections in the world. Despite this, there are few research studies that include Pacific Islanders. We conducted a narrative review of original research and surveys, including World Health Organization and Pacific Community reports, to determine the prevalence, management, and treatment of C. trachomatis and N. gonorrhoeae compared to HIV and syphilis from 1980 to 2022. Available epidemiologic data on C. trachomatis and N. gonorrhoeae indicated an extremely high prevalence-approximately 30% and 13%, respectively-among Pacific Islanders during this timeframe. These neglected sexually transmitted infections represent a significant burden and health disparity. Robust epidemiologic research is needed to identify modifiable risk factors for designing interventions and control strategies. Appropriate policies along with regional and international advocacy and aid are required to improve reproductive health among these vulnerable, understudied populations to avert preventable infections and sequelae.

BACKGROUND: The coronavirus disease 2019 pandemic impact on sexually transmitted infections in countries practicing syndromic management remains unknown. We conducted cross-sectional surveys in Fiji to assess increases and risk factors for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) infections pre- and postpandemic. METHODS: We enrolled women, men who have sex only with women (MSW), and men who have sex with men (MSM) aged 18-40 years, collected sociodemographic/behavioral data, and tested vaginal, urethral, and rectal samples using Xpert-CT/NG. Risk factors were evaluated using regression models. RESULTS: Of 1955 participants, 6.4% (95% confidence interval [CI], 5.4%-7.6%) had gonorrhea, increasing significantly postpandemic >2-fold among women aged 25-40 years and >4-fold among MSM, MSW, and men aged 18-24 and 25-40 years; 20.0% (95% CI, 18.3%-21.8%) had chlamydia, increasing significantly postpandemic among younger women and approximately 2- to 4-fold among MSW and younger and older men. Increases were driven by urethral/vaginal infections. Coinfections increased significantly postpandemic among older women. Postpandemic gonorrhea was associated with difficulty obtaining condoms (adjusted relative risk [aRR], 2.7 [95% CI, 1.0-8.0]) and ≥2 partners (aRR, 2.6 [95% CI, 1.0-7.1]) among younger women, and iTaukei ethnicity (aRR, 4.7 [95% CI, 1.4-16.5]) and heavy alcohol use (aRR, 7.1 [95% CI, 2.5-19.7]) among older women. Postpandemic chlamydia was associated with having a casual sex partner among younger (aRR, 1.7 [95% CI, 1.0-2.9]) and older (aRR, 1.9 [95% CI, 1.1-3.4]) women and with being unmarried (aRR, 1.7 [95% CI, 1.0-2.7]). iTaukei men had increased risk postpandemic for gonorrhea (aRR, 3.7 [95% CI, 1.3-10.6]) and chlamydia (aRR, 2.5 [95% CI, 1.3-4.9]). More than 50% of infected participants did not meet syndromic treatment criteria and would have remained untreated. CONCLUSIONS: Postpandemic increases in gonorrhea and chlamydia-with risk factors varying by pathogen, gender, and age-require immediate interventions to reduce infection and transmission in Fiji.

Dye staining of applicators has been shown to be a reliable and objective method to test vaginal insertion in clinical microbicide trials, but different plastics, dyes, and product formulations may impact the accuracy of this method. Reportedly used applicators returned from 3 clinical trials were stained with 1% trypan blue. In a phase 1 study (VivaGel), using gel-filled HTI polypropylene applicators, 1271 (97%) of applicators stained positive. In a phase 1 and a phase 2a study (LACTIN-V) using linear low-density polyethylene applicators to deliver a dry powder formulation, 57 (95%) and 135 (86%) tested positive, respectively. Dye staining of vaginal applicators is an objective low-cost measure suitable for low-resource settings.