1
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Fowler VG, Das AF, Lipka-Diamond J, Ambler JE, Schuch R, Pomerantz R, Cassino C, Jáuregui-Peredo L, Moran GJ, Rupp ME, Lachiewicz AM, Kuti JL, Wise RA, Kaye KS, Zervos MJ, Nichols WG. Exebacase in Addition to Standard-of-Care Antibiotics for Staphylococcus aureus Bloodstream Infections and Right-Sided Infective Endocarditis: A Phase 3, Superiority-Design, Placebo-Controlled, Randomized Clinical Trial (DISRUPT). Clin Infect Dis 2024:ciae043. [PMID: 38297916 DOI: 10.1093/cid/ciae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/08/2024] [Accepted: 01/19/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Novel treatments are needed for Staphylococcus aureus bacteremia, particularly for methicillin-resistant S. aureus (MRSA). Exebacase is a first-in-class antistaphylococcal lysin that is rapidly bactericidal and synergizes with antibiotics. METHODS In DISRUPT, a superiority-design phase 3 study, patients with S. aureus bacteremia/endocarditis were randomly assigned to receive a single dose of IV exebacase or placebo in addition to standard-of-care antibiotics. The primary efficacy outcome was clinical response at Day 14 in the MRSA population. RESULTS A total of 259 patients were randomized before the study was stopped for futility based on the recommendation of the unblinded Data Safety Monitoring Board. Clinical response rates at Day 14 in the MRSA population (n = 97) were 50.0% (exebacase + antibiotics; 32/64) vs. 60.6% (antibiotics alone; 20/33) (P = 0.392). Overall, rates of adverse events were similar across groups. No adverse events of hypersensitivity related to exebacase were reported. CONCLUSIONS Exebacase + antibiotics failed to improve clinical response at Day 14 in patients with MRSA bacteremia/endocarditis. This result was unexpected based on phase 2 data that established proof-of-concept for exebacase + antibiotics in patients with MRSA bacteremia/endocarditis. In the antibiotics alone group, the clinical response rate was higher than that seen in phase 2. Heterogeneity within the study population and a relatively small sample size in either the phase 2 or phase 3 studies may have increased the probability of imbalances in the multiple components of Day 14 clinical outcome. This study provides lessons for future superiority studies in S. aureus bacteremia/endocarditis.
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Affiliation(s)
| | | | | | | | | | | | - Cara Cassino
- Stony Point Life Sciences Consulting, Benson, VT, USA
| | | | | | - Mark E Rupp
- University of Nebraska Medical Center, Omaha, NE, USA
| | - Anne M Lachiewicz
- University of North Carolina Health Care System, Chapel Hill, NC, USA
| | | | - Robert A Wise
- Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Keith S Kaye
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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2
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Fillman KM, Ryder JH, Brailita DM, Rupp ME, Cavalieri RJ, Fey PD, Lyden ER, Hankins RJ. Disinfection of vascular catheter connectors that are protected by antiseptic caps is unnecessary. Infect Control Hosp Epidemiol 2024; 45:35-39. [PMID: 37466074 DOI: 10.1017/ice.2023.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
OBJECTIVE Determination of whether vascular catheter disinfecting antiseptic-containing caps alone are effective at decreasing microbial colonization of connectors compared to antiseptic-containing caps plus a 5-second alcohol manual disinfection. SETTING The study was conducted in a 718-bed, tertiary-care, academic hospital. PATIENTS A convenience sample of adult patients across intensive care units and acute care wards with peripheral and central venous catheters covered with antiseptic-containing caps. METHODS Quality improvement study completed over 5 days. The standard-of-care group consisted of catheter connectors with antiseptic-containing caps cleaned with a 5-second alcohol wipe scrub prior to culture. The comparison group consisted of catheter connectors with antiseptic-containing caps without a 5-second alcohol wipe scrub prior to culture. The connectors were pressed directly onto blood agar plates and incubated. Plates were assessed for growth after 48-72 hours. RESULTS In total, 356 catheter connectors were cultured: 165 in the standard-of-care group, 165 in the comparison group, and 26 catheters connectors without an antiseptic-containing cap, which were designated as controls. Overall, 18 catheter connectors (5.06%) yielded microbial growth. Of the 18 connectors with microbial growth, 2 (1.21%) were from the comparison group, 1 (0.61%) was from the standard-of-care group, and 15 were controls without an antiseptic-containing cap. CONCLUSIONS Bacterial colonization rates were similar between the catheter connectors cultured with antiseptic-containing caps alone and catheter connectors with antiseptic-containing caps cultured after a 5-second scrub with alcohol. This finding suggests that the use of antiseptic-containing caps precludes the need for additional disinfection.
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Affiliation(s)
| | - Jonathan H Ryder
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Daniel M Brailita
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Mark E Rupp
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - R Jennifer Cavalieri
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Paul D Fey
- Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Elizabeth R Lyden
- Epidemiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Richard J Hankins
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
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3
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Rupp ME, Van Schooneveld TC, Starlin R, Quick J, Snyder GM, Passaretti CL, Stevens MP, Cawcutt K. Hospital return-to-work practices for healthcare providers infected with severe acute respiratory coronavirus virus 2 (SARS-CoV-2). Infect Control Hosp Epidemiol 2023; 44:2081-2084. [PMID: 37350274 DOI: 10.1017/ice.2023.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
A survey of academic medical-center hospital epidemiologists indicated substantial deviation from Centers for Disease Control and Prevention guidance regarding healthcare providers (HCPs) recovering from coronavirus disease 2019 (COVID-19) returning to work. Many hospitals continue to operate under contingency status and have HCPs return to work earlier than recommended.
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Affiliation(s)
- Mark E Rupp
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | | | - Richard Starlin
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Jessica Quick
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Graham M Snyder
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Catherine L Passaretti
- Center for the Study of Microbial Ecology and Emerging Diseases, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- Division of Infectious Diseases, Atrium Health, Charlotte, North Carolina
| | - Michael P Stevens
- Division of Infectious Diseases, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Kelly Cawcutt
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
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4
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Khan SL, Haynatzki G, Medcalf SJ, Rupp ME. Clinical outcomes associated with blood-culture contamination are not affected by utilization of a rapid blood-culture identification system. Infect Control Hosp Epidemiol 2023; 44:1569-1575. [PMID: 36939089 DOI: 10.1017/ice.2022.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
OBJECTIVE Contaminated blood cultures result in extended hospital stays and extended durations of antibiotic therapy. Rapid molecular-based blood culture testing can speed positive culture detection and improve clinical outcomes, particularly when combined with an antimicrobial stewardship program. We investigated the impact of a multiplex polymerase chain reaction (PCR) FilmArray Blood Culture Identification (BCID) system on clinical outcomes associated with contaminated blood cultures. METHODS We conducted a retrospective cohort study involving secondary data analysis at a single institution. In this before-and-after study, patients with contaminated blood cultures in the period before PCR BCID was implemented (ie, the pre-PCR period; n = 305) were compared to patients with contaminated blood cultures during the period after PCR BCID was implemented (ie, the post-PCR implementation period; n = 464). The primary exposure was PCR status and the main outcomes of the study were length of hospital stay and days of antibiotic therapy. RESULTS We did not detect a significant difference in adjusted mean length of hospital stay before (10.8 days; 95% confidence interval [CI], 9.8-11.9) and after (11.2 days; 95% CI, 10.2-12.3) the implementation of the rapid BCID panel in patients with contaminated blood cultures (P = .413). Likewise, adjusted mean days of antibiotic therapy between patients in pre-PCR group (5.1 days; 95% CI, 4.5-5.7) did not significantly differ from patients in post-PCR group (5.3 days; 95% CI, 4.8-5.9; P = .543). CONCLUSION The introduction of a rapid PCR-based blood culture identification system did not improve clinical outcomes, such as length of hospital stay and duration of antibiotic therapy, in patients with contaminated blood cultures.
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Affiliation(s)
- Sidra Liaquat Khan
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Gleb Haynatzki
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Sharon J Medcalf
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Mark E Rupp
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
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5
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Ryder JH, Van Schooneveld TC, Abdalhamid B, Wood MG, Wahlig TA, Starlin R, Gillett G, Balfour T, Pflueger L, Rupp ME. Nosocomial outbreak of SARS-CoV-2 delta variant among vaccinated healthcare workers and immunocompromised patients on a solid-organ transplant unit: Complexities of an epidemiologic and genomic investigation. Infect Control Hosp Epidemiol 2023; 44:1355-1357. [PMID: 36082695 PMCID: PMC9551180 DOI: 10.1017/ice.2022.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/25/2022] [Accepted: 08/29/2022] [Indexed: 11/18/2022]
Abstract
In September 2021, a cluster of 6 patients with nosocomial coronavirus disease 2019 (COVID-19) were identified in a transplant unit. A visitor and 11 healthcare workers also tested positive for severe acute respiratory coronavirus virus 2 (SARS-CoV-2). Genomic sequencing identified 3 separate introductions of SARS-CoV-2 with related transmission among the identified patients and healthcare workers.
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Affiliation(s)
- Jonathan H. Ryder
- Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Trevor C. Van Schooneveld
- Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Baha Abdalhamid
- Nebraska Public Health Laboratory, Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Macy G. Wood
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Taylor A. Wahlig
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Richard Starlin
- Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Gayle Gillett
- Department of Infection Control and Epidemiology, Nebraska Medicine, Omaha, Nebraska
| | | | | | - Mark E. Rupp
- Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
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6
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Affiliation(s)
- Taylor L Burke
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - M E Rupp
- Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA
| | - P D Fey
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA.
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7
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Abstract
Despite a large volume of research in prevention, central line-associated bloodstream infections and catheter-related bloodstream infections continue to cause significant morbidity, mortality, and increased health care costs. Strategies in prevention, including decision about catheter placement, insertion bundles, adherence to standard of care guidelines, and technologic innovations, shown to decrease rates of catheter-related bloodstream infections and central line-associated bloodstream infections are described in this update. The coronavirus disease 2019 pandemic has resulted in increased health care-acquired infections, including central line-associated bloodstream infections.
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Affiliation(s)
- Laura M Selby
- Division of Infectious Diseases, University of Nebraska Medical Center, 985400 Nebraska Medical Center, Omaha, NE 68198, USA
| | - Mark E Rupp
- Division of Infectious Diseases, University of Nebraska Medical Center, 985400 Nebraska Medical Center, Omaha, NE 68198, USA
| | - Kelly A Cawcutt
- Division of Infectious Diseases, University of Nebraska Medical Center, 985400 Nebraska Medical Center, Omaha, NE 68198, USA.
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8
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Van Kalsbeek D, Enroth K, Lyden E, Rupp ME, Smith CJ. Improving hospital-based point-of-care ultrasound cleaning practices using targeted interventions: a pre-post study. Ultrasound J 2021; 13:43. [PMID: 34664118 PMCID: PMC8522855 DOI: 10.1186/s13089-021-00244-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 10/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) devices are becoming more widely used in healthcare and have the potential to act as fomites. The objective of this project was to study the thoroughness of cleaning of POCUS machines before and after a quality improvement initiative. We designed a mixed-methods, pre/post study which took place over the course of one year at a university-affiliated health center. Cleaning rates of four ultrasound machines used by hospital medicine and critical care medicine services were evaluated using fluorescent marking. Interventions targeted physicians' knowledge of best practices and improved access to cleaning supplies. Pre- and post-intervention cleaning rates were compared using a generalized linear model. The impact of the corona virus disease of 2019 (COVID-19) pandemic on baseline cleaning rates was also evaluated. Physicians' attitudes and knowledge of cleaning practices were evaluated via unpaired pre/post surveys. RESULTS There was significant improvement in thoroughness of cleaning following intervention (pre 0.62, SE 0.05; post 0.89, SE 0.07), p < 0.0001). There was no difference in baseline cleaning rates before (0.63, SE 0.09) and after (0.61, SE 0.1) the onset of the COVID-19 pandemic (p = 0.78). Post-intervention surveying found improved understanding of guideline-based cleaning practice, better performance on knowledge-based questions, and fewer reported barriers to machine cleaning. CONCLUSION Thoroughness of cleaning of POCUS machines can be improved with practical interventions that target knowledge and access to cleaning supplies.
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Affiliation(s)
- Daniel Van Kalsbeek
- Department of Internal Medicine, 982055 Nebraska Medical Center, Omaha, NE, 68198-2055, USA.
| | - Karl Enroth
- Department of Internal Medicine, 982055 Nebraska Medical Center, Omaha, NE, 68198-2055, USA
| | - Elizabeth Lyden
- Department of Biostatistics, 984375 Nebraska Medical Center, Omaha, NE, 68198-4375, USA
| | - Mark E Rupp
- Department of Internal Medicine, Division of Infectious Diseases, 985400 Nebraska Medical Center, Omaha, NE, 68198-5400, USA
| | - Christopher J Smith
- Department of Internal Medicine, Division of Hospital Medicine, 986430 Nebraska Medical Center, Omaha, NE, 68198-6430, USA
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9
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Angell KE, Lawler JV, Hewlett AL, Rupp ME, Bergman SJ, Van Schooneveld TC, Broadhurst MJ, Brett-Major DM. Antibacterial use in the age of SARS-CoV-2. JAC Antimicrob Resist 2021; 3:dlab073. [PMID: 34223134 PMCID: PMC8210028 DOI: 10.1093/jacamr/dlab073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 04/23/2021] [Indexed: 01/28/2023] Open
Abstract
Background Balancing the use of antibacterial therapy against selection for resistance in this pandemic era has introduced both questions and guidelines. In this project, we explored how prescription of empirical antibacterial therapy differs between those with and without SARS-CoV-2 infection. Methods Multivariable logistic regression was used to determine whether COVID-19 status and other factors play a role in the prescription of antibacterial therapy in an inpatient setting at a large referral academic medical centre. Further analysis was conducted to determine whether these factors differ between those testing positive and negative for SARS-CoV-2. Results Of 405 patients in the cohort, 175 received antibacterial therapy and 296 tested positive for SARS-CoV-2. A positive SARS-CoV-2 test carried an OR of 0.3 (95% CI: 0.19, 0.49) for receiving antibacterial treatment in the first 48 h after admission (P < 0.0001) adjusting for age and procalcitonin results. Patients were 1% and 3% less likely to receive antibacterials for every year increase in age in the overall group and among those testing negative for SARS-CoV-2, respectively. Younger age was found to impact use of antibacterial therapy in both the overall analysis as well as the SARS-CoV-2 negative subgroup (P = 0.03 and P = 0.01). High procalcitonin values were found to be associated with increased antibacterial therapy use in both the overall and stratified analyses. Conclusions Antibacterial therapy prescription differs by COVID-19 disease status, and procalcitonin results are most highly associated with antibacterial use across strata.
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Affiliation(s)
- Kathleen E Angell
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - James V Lawler
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE, USA.,Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Angela L Hewlett
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Mark E Rupp
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Scott J Bergman
- Antimicrobial Stewardship Program, Nebraska Medicine, Omaha, NE, USA
| | - Trevor C Van Schooneveld
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - M Jana Broadhurst
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE, USA.,Department of Pathology and Microbiology, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - David M Brett-Major
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.,Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE, USA
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10
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Rearigh LM, Hewlett AL, Fey PD, Broadhurst MJ, Brett-Major DM, Rupp ME, Van Schooneveld TC. Utility of repeat testing for COVID-19: Laboratory stewardship when the stakes are high. Infect Control Hosp Epidemiol 2021; 42:338-340. [PMID: 32741393 PMCID: PMC7511838 DOI: 10.1017/ice.2020.397] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 01/19/2023]
Abstract
As the coronavirus disease 2019 (COVID-19) continues to circulate, testing strategies are of the utmost importance. Given national shortages of testing supplies, personal protective equipment, and other hospital resources, diagnostic stewardship is necessary to aid in resource management. We report the low utility of serial testing in a low-prevalence setting.
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Affiliation(s)
- Lindsey M. Rearigh
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Angela L. Hewlett
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Paul D. Fey
- Division of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - M. Jana Broadhurst
- Division of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - David M. Brett-Major
- Department of Epidemiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Mark E. Rupp
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
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11
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Fowler VG, Das AF, Lipka-Diamond J, Schuch R, Pomerantz R, Jáuregui-Peredo L, Bressler A, Evans D, Moran GJ, Rupp ME, Wise R, Corey GR, Zervos M, Douglas PS, Cassino C. Exebacase for patients with Staphylococcus aureus bloodstream infection and endocarditis. J Clin Invest 2021; 130:3750-3760. [PMID: 32271718 DOI: 10.1172/jci136577] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 03/31/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUNDNovel therapeutic approaches are critically needed for Staphylococcus aureus bloodstream infections (BSIs), particularly for methicillin-resistant S. aureus (MRSA). Exebacase, a first-in-class antistaphylococcal lysin, is a direct lytic agent that is rapidly bacteriolytic, eradicates biofilms, and synergizes with antibiotics.METHODSIn this superiority-design study, we randomly assigned 121 patients with S. aureus BSI/endocarditis to receive a single dose of exebacase or placebo. All patients received standard-of-care antibiotics. The primary efficacy endpoint was clinical outcome (responder rate) on day 14.RESULTSClinical responder rates on day 14 were 70.4% and 60.0% in the exebacase + antibiotics and antibiotics-alone groups, respectively (difference = 10.4, 90% CI [-6.3, 27.2], P = 0.31), and were 42.8 percentage points higher in the prespecified exploratory MRSA subgroup (74.1% vs. 31.3%, difference = 42.8, 90% CI [14.3, 71.4], ad hoc P = 0.01). Rates of adverse events (AEs) were similar in both groups. No AEs of hypersensitivity to exebacase were reported. Thirty-day all-cause mortality rates were 9.7% and 12.8% in the exebacase + antibiotics and antibiotics-alone groups, respectively, with a notable difference in MRSA patients (3.7% vs. 25.0%, difference = -21.3, 90% CI [-45.1, 2.5], ad hoc P = 0.06). Among MRSA patients in the United States, median length of stay was 4 days shorter and 30-day hospital readmission rates were 48% lower in the exebacase-treated group compared with antibiotics alone.CONCLUSIONThis study establishes proof of concept for exebacase and direct lytic agents as potential therapeutics and supports conduct of a confirmatory study focused on exebacase to treat MRSA BSIs.TRIAL REGISTRATIONClinicaltrials.gov NCT03163446.FUNDINGContraFect Corporation.
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Affiliation(s)
- Vance G Fowler
- Duke University Medical Center, Durham, North Carolina, USA.,Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Anita F Das
- AD Stat Consulting, Guerneville, California, USA
| | | | | | | | | | - Adam Bressler
- Infectious Disease Specialists of Atlanta, Georgia, USA
| | - David Evans
- The Ohio State University, Columbus, Ohio, USA
| | | | - Mark E Rupp
- University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Robert Wise
- Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | - G Ralph Corey
- Duke University Medical Center, Durham, North Carolina, USA
| | | | - Pamela S Douglas
- Duke University Medical Center, Durham, North Carolina, USA.,Duke Clinical Research Institute, Durham, North Carolina, USA
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12
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Ferguson C, Chung P, Lodhi H, Bergman S, Cavalieri RJ, Neukirch A, Ortmeier RJ, Rupp ME, Rupp ME, Van Schooneveld TC, Ashraf MS. 132. Assessment of the Long-Term Effects of Training Consultant Pharmacists to Promote Antimicrobial Stewardship in Long-Term Care Facilities. Open Forum Infect Dis 2020. [PMCID: PMC7777745 DOI: 10.1093/ofid/ofaa439.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background We implemented a one-year antimicrobial stewardship training program that lasted through 2018 where we assisted 9 long-term care facility (LTCF) consultant pharmacists in promoting antibiotic stewardship programs (ASP) in 32 LTCF (Figure 1). Surveys were conducted during and after the training program to assess performance. Methods Infection Preventionists (IP), Directors of Nursing (DON) and Medical Directors (MD) of the LTCF received mail surveys in 2018 and online surveys in 2019. It included questions assessing the respondents’ perceptions of their ASP, barriers to ASP implementation and stewardship related knowledge, and the skills and contributions of their consultant pharmacists. Qualitative analyses categorized reported barriers into common themes. Fisher exact test compared perceptions of consultant pharmacists’ performance and frequently reported barriers during training and after the intervention was completed. Results Representatives (IP, DON and/or MD) of 18 facilities responded to the surveys at both time points of the study, with 34 individual surveys in 2018 and 25 in 2019. Most rated their consultant pharmacists as knowledgeable and helpful who regularly provided feedback and suggestions both during and after the training (Table 1). Fifty-six percent of facilities reported that their consultant pharmacists were similarly involved, and 12% felt they were more involved, in ASP implementation in 2019 compared to 2018. Top 3 reported barriers to ASP implementations were the same during 2018 and 2019 (Table 2). Overall, 84% of facilities in 2019 believed that the consultant pharmacists “definitely helped” their ASP efforts, and 80% of facilities desired to continue the partnership into the future. ![]()
Table 1. Comparison of Consultant Pharmacists’ Performance Evaluations During (2018) and After (2019) Completion of Training ![]()
Figure 3. Barriers to ASP implementation reported during (2018) and after (2019) training. ![]()
Conclusion This study demonstrates that training consultant pharmacists resulted in meaningful actions and prolonged engagement in ASP activities. Efforts should be directed on making similar training programs available nationwide for consultant pharmacists working in LTCF. Disclosures Muhammad Salman Ashraf, MBBS, Merck & Co. Inc (Grant/Research Support)
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Affiliation(s)
| | - Philip Chung
- Department of Pharmaceutical Care, Nebraska Medicine, Omaha, Nebraska
| | | | | | - R Jennifer Cavalieri
- University of Nebraska Medical Center - Infectious Diseases Division of the Department of Internal Medicine, Omaha, Nebraska
| | | | | | - Mark E Rupp
- University of Nebraska Medical Center, Omaha, Nebraska
| | - Mark E Rupp
- University of Nebraska Medical Center, Omaha, Nebraska
| | | | - Muhammad Salman Ashraf
- University of Nebraska Medical Center - Infectious Diseases Division of the Department of Internal Medicine, Omaha, Nebraska
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13
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McHale T, Medder J, Geske J, Rupp ME, Van Schooneveld TC. The Effect of Insurance on Appropriate Hospital Discharge Antibiotics for Patients With Staphylococcus aureus Bacteremia. Open Forum Infect Dis 2020; 8:ofaa568. [PMID: 33511223 PMCID: PMC7817079 DOI: 10.1093/ofid/ofaa568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/16/2020] [Indexed: 11/13/2022] Open
Abstract
Background Inappropriate antimicrobial therapy of Staphylococcus aureus bacteremia (SAB) is associated with worsened outcomes. The impact of insurance coverage on appropriate selection of antibiotics at discharge is poorly understood. Methods We used a retrospective cohort design to evaluate whether patients with SAB at a large academic medical center over 2 years were more likely to receive inappropriate discharge antibiotics, depending on their category of insurance. Insurance was classified as Medicare, Medicaid, commercial, and none. Logistic regression was used to determine the odds of being prescribed inappropriate discharge therapy. Results A total of 273 SAB patients met inclusion criteria, with 14.3% receiving inappropriate discharge therapy. In the unadjusted model, there was 2-fold increased odds of being prescribed inappropriate therapy for Medicare, Medicaid, and no insurance, compared with commercial insurance, respectively (odds ratio [OR], 2.08; 95% CI, 1.39–3.13). After controlling for discharge with nursing assistance and infectious diseases (ID) consult, there were 1.6-fold increased odds (OR, 1.57; 95% CI, 0.998–2.53; P = .064) of being prescribed inappropriate therapy for Medicare, Medicaid, and no insurance, compared with commercial insurance, respectively. We found that being discharged home without nursing assistance resulted in 4-fold increased odds of being prescribed inappropriate therapy (OR, 4.16; 95% CI, 1.77–9.77; P < .01), and failing to consult an ID team resulted in 59-fold increased odds of being prescribed inappropriate therapy (OR, 59.2; 95% CI, 11.4–306.9; P < .001). Conclusions We found strong evidence that noncommercial insurance, discharging without nursing assistance, and failure to consult ID are risk factors for being prescribed inappropriate antimicrobial therapy for SAB upon hospital discharge.
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Affiliation(s)
- Thomas McHale
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Jim Medder
- Department of Family Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Jenenne Geske
- Department of Family Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Mark E Rupp
- Division of Infectious Disease, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Trevor C Van Schooneveld
- Division of Infectious Disease, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
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14
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Markin NW, Cawcutt KA, Sayyed SH, Rupp ME, Lisco SJ. Transesophageal Echocardiography Probe Sheath to Decrease Provider and Environment Contamination. Anesthesiology 2020; 133:475-477. [PMID: 32358249 PMCID: PMC7223580 DOI: 10.1097/aln.0000000000003370] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2020] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is available in the text.
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Affiliation(s)
| | - Kelly A. Cawcutt
- University of Nebraska Medical Center, Omaha, Nebraska (N.W.M.).
| | - Samer H. Sayyed
- University of Nebraska Medical Center, Omaha, Nebraska (N.W.M.).
| | - Mark E. Rupp
- University of Nebraska Medical Center, Omaha, Nebraska (N.W.M.).
| | - Steven J. Lisco
- University of Nebraska Medical Center, Omaha, Nebraska (N.W.M.).
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15
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Brett-Major DM, Schnaubelt ER, Creager HM, Lowe A, Cieslak TJ, Dahlke JM, Johnson DW, Fey PD, Hansen KF, Hewlett AL, Gordon BG, Kalil AC, Khan AS, Kortepeter MG, Kratochvil CJ, Larson L, Levy DA, Linder J, Medcalf SJ, Rupp ME, Schwedhelm MM, Sullivan J, Vasa AM, Wadman MC, Lookadoo RE, Lowe JMJ, Lawler JV, Broadhurst MJ. Advanced Preparation Makes Research in Emergencies and Isolation Care Possible: The Case of Novel Coronavirus Disease (COVID-19). Am J Trop Med Hyg 2020; 102:926-931. [PMID: 32228780 PMCID: PMC7204595 DOI: 10.4269/ajtmh.20-0205] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 03/23/2020] [Indexed: 11/29/2022] Open
Abstract
The optimal time to initiate research on emergencies is before they occur. However, timely initiation of high-quality research may launch during an emergency under the right conditions. These include an appropriate context, clarity in scientific aims, preexisting resources, strong operational and research structures that are facile, and good governance. Here, Nebraskan rapid research efforts early during the 2020 coronavirus disease pandemic, while participating in the first use of U.S. federal quarantine in 50 years, are described from these aspects, as the global experience with this severe emerging infection grew apace. The experience has lessons in purpose, structure, function, and performance of research in any emergency, when facing any threat.
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Affiliation(s)
| | - Elizabeth R. Schnaubelt
- University of Nebraska Medical Center/Nebraska Medicine,
Omaha, Nebraska
- United States Air Force School of Aerospace Medicine,
Dayton, Ohio
| | - Hannah M. Creager
- University of Nebraska Medical Center/Nebraska Medicine,
Omaha, Nebraska
| | - Abigail Lowe
- University of Nebraska Medical Center/Nebraska Medicine,
Omaha, Nebraska
| | | | - Jacob M. Dahlke
- University of Nebraska Medical Center/Nebraska Medicine,
Omaha, Nebraska
| | - Daniel W. Johnson
- University of Nebraska Medical Center/Nebraska Medicine,
Omaha, Nebraska
| | - Paul D. Fey
- University of Nebraska Medical Center/Nebraska Medicine,
Omaha, Nebraska
| | - Keith F. Hansen
- University of Nebraska Medical Center/Nebraska Medicine,
Omaha, Nebraska
| | - Angela L. Hewlett
- University of Nebraska Medical Center/Nebraska Medicine,
Omaha, Nebraska
| | - Bruce G. Gordon
- University of Nebraska Medical Center/Nebraska Medicine,
Omaha, Nebraska
| | - Andre C. Kalil
- University of Nebraska Medical Center/Nebraska Medicine,
Omaha, Nebraska
| | - Ali S. Khan
- University of Nebraska Medical Center/Nebraska Medicine,
Omaha, Nebraska
| | - Mark G. Kortepeter
- University of Nebraska Medical Center/Nebraska Medicine,
Omaha, Nebraska
| | | | - LuAnn Larson
- University of Nebraska Medical Center/Nebraska Medicine,
Omaha, Nebraska
| | - Deborah A. Levy
- University of Nebraska Medical Center/Nebraska Medicine,
Omaha, Nebraska
| | - James Linder
- University of Nebraska Medical Center/Nebraska Medicine,
Omaha, Nebraska
| | - Sharon J. Medcalf
- University of Nebraska Medical Center/Nebraska Medicine,
Omaha, Nebraska
| | - Mark E. Rupp
- University of Nebraska Medical Center/Nebraska Medicine,
Omaha, Nebraska
| | | | - James Sullivan
- University of Nebraska Medical Center/Nebraska Medicine,
Omaha, Nebraska
| | - Angela M. Vasa
- University of Nebraska Medical Center/Nebraska Medicine,
Omaha, Nebraska
| | - Michael C. Wadman
- University of Nebraska Medical Center/Nebraska Medicine,
Omaha, Nebraska
| | - Rachel E. Lookadoo
- University of Nebraska Medical Center/Nebraska Medicine,
Omaha, Nebraska
| | | | - James V. Lawler
- University of Nebraska Medical Center/Nebraska Medicine,
Omaha, Nebraska
| | - M. Jana Broadhurst
- University of Nebraska Medical Center/Nebraska Medicine,
Omaha, Nebraska
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16
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Doern GV, Carroll KC, Diekema DJ, Garey KW, Rupp ME, Weinstein MP, Sexton DJ. Practical Guidance for Clinical Microbiology Laboratories: A Comprehensive Update on the Problem of Blood Culture Contamination and a Discussion of Methods for Addressing the Problem. Clin Microbiol Rev 2019; 33:e00009-19. [PMID: 31666280 PMCID: PMC6822992 DOI: 10.1128/cmr.00009-19] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
In this review, we present a comprehensive discussion of matters related to the problem of blood culture contamination. Issues addressed include the scope and magnitude of the problem, the bacteria most often recognized as contaminants, the impact of blood culture contamination on clinical microbiology laboratory function, the economic and clinical ramifications of contamination, and, perhaps most importantly, a systematic discussion of solutions to the problem. We conclude by providing a series of unanswered questions that pertain to this important issue.
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Affiliation(s)
- Gary V Doern
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Karen C Carroll
- Division of Medical Microbiology, Department of Pathology, John Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniel J Diekema
- Division of Infectious Diseases, Department of Medicine and Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Kevin W Garey
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, Texas, USA
| | - Mark E Rupp
- Division of Infectious Diseases, Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Melvin P Weinstein
- Department of Pathology and Laboratory Medicine, Department of Medicine, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Daniel J Sexton
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
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17
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Hankins R, Majorant OD, Rupp ME, Cavalieri RJ, Fey PD, Lyden E, Cawcutt KA. Microbial colonization of intravascular catheter connectors in hospitalized patients. Am J Infect Control 2019; 47:1489-1492. [PMID: 31345614 DOI: 10.1016/j.ajic.2019.05.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/25/2019] [Accepted: 05/26/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Central line-associated bloodstream infections may be due to catheter connector colonization and intraluminal migration of pathogens. We assessed the colonization of the split septum catheter connector system, and subsequently the luer lock catheter connector system. METHODS This was a prospective, 2 phase, quality improvement study at a tertiary referral center. Each phase of the study was performed over 3 consecutive days in hospitalized patients receiving an active infusion; first with a split septum lever lock connector and second with a luer lock connector and alcohol port protector. The connectors were inoculated onto blood agar plates and incubated. Plates were assessed for microbial growth after 48-72 hours. RESULTS In phase I, 98 (41.9%) of 234 split septum connectors yielded microbial growth. In phase II, 56 (23.1%) of 243 luer lock connectors yielded microbial growth. In phase II only, there was a significant increased rate of contamination in peripheral catheters compared with all other catheters, and the rate of contamination on the acute care wards was significantly higher when compared with the intensive care units. CONCLUSIONS Bacterial colonization of the lever lock system was unacceptably high among all catheter types and hospital locations. Transition to luer lock catheter connectors and alcohol port protectors decreased the colonization; however, colonization still remained substantial. Causation of colonization cannot be determined with these results.
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Affiliation(s)
- Richard Hankins
- Department of Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE
| | - O Denisa Majorant
- Department of Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE
| | - Mark E Rupp
- Department of Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE
| | - R Jennifer Cavalieri
- Department of Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE
| | - Paul D Fey
- Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE
| | - Elizabeth Lyden
- Epidemiology, University of Nebraska Medical Center, Omaha, NE
| | - Kelly A Cawcutt
- Department of Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE.
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18
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Chung P, Tyner K, Bergman S, Micheels T, Rupp ME, Schwedhelm M, Tierney M, Van Schooneveld TC, Ashraf MS. 2044. An Assessment and Feedback Model Bringing Antimicrobial Stewardship Program Expertise to Long-Term Care Facilities. Open Forum Infect Dis 2019. [PMCID: PMC6809258 DOI: 10.1093/ofid/ofz360.1724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Long-term care facilities (LTCF) often struggle with implementation of antimicrobial stewardship programs (ASP) that meet all CDC core elements (CE). The CDC recommends partnership with infectious diseases (ID)/ASP experts to guide ASP implementation. The Nebraska Antimicrobial Stewardship Assessment and Promotion Program (ASAP) is an initiative funded by NE DHHS via a CDC grant to assist healthcare facilities with ASP implementation. Methods ASAP performed on-site baseline evaluation of ASP in 5 LTCF (42–293 beds) in the spring of 2017 using a 64-item questionnaire based on CDC CE. After interviewing ASP members, ASAP provided prioritized facility-specific recommendations for ASP implementation. LTCF were periodically contacted in the next 12 months to provide implementation support and evaluate progress. The number of CE met, recommendations implemented, antibiotic starts (AS) and days of therapy (DOT)/1000 resident-days (RD), and incidence of facility-onset Clostridioides difficile infections (FO-CDI) were compared 6 to 12 months before and after on-site visits. Paired t-test and Wilcoxon signed rank test were used for statistical analyses. Results Multidisciplinary ASP existed in all 5 facilities at baseline with medical directors (n = 2) or directors of nursing (n = 3) designated as team leads. Median CE implemented increased from 3 at baseline to 6 at the end of follow-up (P = 0.06). No LTCF had all 7 CE at baseline. By the end of one year, 2 facilities implemented all 7 CE with the remaining implementing 6 CE. LTCF not meeting all CE were only deficient in reporting ASP metrics to providers and staff. Among the 38 recommendations provided by ASAP, 82% were partially or fully implemented. Mean AS/1000 RD reduced by 19% from 10.1 at baseline to 8.2 post-intervention (P = 0.37) and DOT/1000 RD decreased by 21% from 91.7 to 72.5 (P = 0.20). The average incidence of FO-CDI decreased by 75% from 0.53 to 0.13 cases/10,000 RD (P = 0.25). Conclusion Assessment of LTCF ASP along with feedback for improvement by ID/ASP experts resulted in more programs meeting all 7 CE. Favorable reductions in antimicrobial use and CDI rates were also observed. Moving forward, the availability of these services should be expanded to all LTCFs struggling with ASP implementation. Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | | | | | | | - Mark E Rupp
- University of Nebraska Medical Center, Omaha, Nebraska
| | | | - Maureen Tierney
- Nebraska Department of Health and Human Services, Omaha, Nebraska
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19
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Chung P, Nailon R, Salman Ashraf M, Bergman S, Micheels T, Rupp ME, Schwedhelm M, Tierney M, Tyner K, Van Schooneveld TC, Marcelin JR, Marcelin JR. 1880. Reducing Antibiotic Prescribing for Acute Bronchitis in Outpatient Settings Using a Multifaceted Approach. Open Forum Infect Dis 2019. [PMCID: PMC6809336 DOI: 10.1093/ofid/ofz359.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Nebraska (NE) ranks among the highest states for per capita antibiotic (AB) use in outpatient (OP) settings. Nebraska Medicine (NM) partnered with NE Antimicrobial Stewardship Assessment and Promotion Program (ASAP), a program funded by NE DHHS via a CDC grant, to reduce AB prescribing for acute bronchitis in OP settings. Methods The antimicrobial stewardship (AS) pilot program targeted NM OP clinics during winter 2018. All OP facility clinicians were notified of the availability of online AS educational videos. In addition, 5 primary care clinics (PCC) received clinician-directed interventions that included acute respiratory infection management pocket guides and posters for display in workrooms. Another 5 PCC received both clinician- and patient-directed interventions (examination room patient empowerment posters, Be Antibiotic Aware pledge cards and brochures). We compared AB prescribing rates for acute bronchitis between January and April 2017 and January and April 2018 among the 2 PCC groups and a control group of 5 immediate care clinics/emergency departments (ICC/ED). Clinicians in all 10 PCC were surveyed to assess usefulness of the AS campaign. Results A total of 593 acute bronchitis diagnosis encounters were included. AB prescribing rates for acute bronchitis for the 15 sites decreased from 53.7% to 43.6% (P = 0.02). Prescribing rates were unchanged in ICC/ED that received only notification of online educational videos (40.8% vs. 41.5%, P = 1.00) but were reduced in clinics that received clinician-directed (74.5% vs. 33.3%, P < 0.01) and patient-directed (61.1% vs. 48.8%, P = 0.07) interventions. Azithromycin was the most commonly prescribed AB (31.5% in 2017 and 29.8% in 2018). After the AS campaign, only the clinician-directed intervention group saw a reduction in azithromycin prescribing (33.3% vs. 13.9%, P < 0.05). Out of 51 clinicians who completed the survey, 45.1% felt campaign tools facilitated meaningful discussion with patients. Workroom posters and pocket guides were reported by 47.1% and 39.2% to be somewhat or extremely helpful, respectively. Conclusion This OP AS campaign led to a significant reduction in AB prescribing. Successful OP AS campaigns need multifaceted approaches but targeted clinician interventions appear most beneficial. Disclosures All Authors: No reported Disclosures.
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Affiliation(s)
| | | | | | | | | | - Mark E Rupp
- University of Nebraska Medical Center, Omaha, Nebraska
| | | | - Maureen Tierney
- Nebraska Department of Health and Human Services, Omaha, Nebraska
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20
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Chung P, Neukirch A, Ortmeier RJ, Bergman S, Rupp ME, Van Schooneveld TC, Ashraf MS. 2055. Action: A Year in the Lives of Consultant Pharmacists Working on Antimicrobial Stewardship in Long-Term Care Facilities. Open Forum Infect Dis 2019. [PMCID: PMC6810587 DOI: 10.1093/ofid/ofz360.1735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The CDC recommends consultant pharmacists (CP) support antimicrobial stewardship (AS) activities in long-term care facilities (LTCF) by reviewing antimicrobial appropriateness. We initiated a project training CP from a regional long-term care pharmacy to support AS implementation in LTCF.
Methods
CP were trained to evaluate the appropriateness of all systemic antimicrobial therapy (AT) and provide prescriber feedback during their monthly drug regimen review (DRR). An electronic database was developed to facilitate data reporting. Antimicrobial use (AU) and adverse events (AE) from 32 LTCF were analyzed for 2018 using descriptive statistics.
Results
A total of 5327 courses of AT with a median duration of 7 days (IQR 5–10) were reviewed. The majority of AT was started in the LTCF (55%) but was also initiated in hospitals (24%), clinics (11%) and emergency departments (2%). Of 2926 AT started in LTCF, 36% were based on nurse evaluation (NE) while 33% began after prescriber evaluation (PE). Fluoroquinolones (FQ) and first-generation cephalosporins were the most commonly prescribed agents (Table 1). Treatment or prophylaxis of urinary tract infections accounted for 40% of AU (Figure 1). Diagnostic testing was associated with 37% of AT courses. Urine cultures were the most frequent test performed (81%). Overall, 41% of AT was determined to be inappropriate resulting in > 800 feedback letters sent to prescribers. Unnecessary antibiotic starts (based on revised Mc Geer or Loeb’s criteria) were identified as the most common reason (Figure 2). AT appropriateness varied depending on the setting in which it was initiated. A majority (87%) of AT initiated in hospitals was found to be appropriate with 56% and 46% appropriate for ED and clinic starts. Appropriateness of LTCF initiated AT was 49% (59% after PE and 42% after NE). AE were associated with 3% of AT with allergic reactions and Clostridioides difficile infections occurring with 0.4% and 0.7% of AT, respectively. AE were most frequently associated with folate antagonists (5%) and FQ (3%).
Conclusion
This study demonstrates many AU improvement opportunities exist in LTCF and CP can play an important role in identifying them if trained in AS principles. CP should review all AU for appropriateness and provide data to inform AS efforts in LTCF.
Disclosures
All authors: No reported disclosures.
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Affiliation(s)
| | | | | | | | - Mark E Rupp
- University of Nebraska Medical Center, Omaha, Nebraska
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21
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Karnatak R, Rupp ME, Cawcutt K. Innovations in Quality Improvement of Intravascular Catheter-Related Bloodstream Infections. Curr Treat Options Infect Dis 2019. [DOI: 10.1007/s40506-019-0180-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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22
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McHale T, Medder J, Lyden E, Geske J, Rupp ME, Van Schooneveld T. 158. The Effect of Insurance Coverage on Appropriate Selection of Hospital Discharge Antibiotics for Staphylococcus aureus Bacteremia. Open Forum Infect Dis 2018; 5. [PMCID: PMC6252825 DOI: 10.1093/ofid/ofy209.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Methods Results Conclusion Disclosures
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Affiliation(s)
- Thomas McHale
- University of Nebraska Medical Center, Omaha, Nebraska
| | - Jim Medder
- University of Nebraska Medical Center, Omaha, Nebraska
| | - Elizabeth Lyden
- Epidemiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Jenenne Geske
- Family Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Mark E Rupp
- Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
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23
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Lodhi HT, Bergman S, Chung P, Rupp ME, Vanschooneveld T, Ashraf MS. 1838. Digging Deeper: A Closer Look at Core Elements of Antibiotic Stewardship for Long-Term Care Facilities. Open Forum Infect Dis 2018. [PMCID: PMC6252997 DOI: 10.1093/ofid/ofy210.1494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The CDC encourages all long-term care facilities (LTCF) to develop antibiotic stewardship programs (ASP) consisting of seven core elements (CE). These CE include leadership commitment, accountability, drug expertise, action, tracking, reporting and education. However, action include three essential sub-elements (SE): policy development, practice implementation and pharmacist involvement. Similarly, tracking has two major SE; antibiotic use and outcome measures. Typically, a multi-component CE is considered met if any of the SE is present. We evaluated application of a strict definition that requires all major SE to be present for the action and tracking CE to be considered met. Methods A group of consultant pharmacists (CP) was trained to evaluate and lead ASP in their LTCF. Baseline ASP evaluation was conducted by CP in 29 LTCF using the CDC CE checklist between November 2017 and January 2018. CE credits were assigned to LTCF ASP using conventional (any SE) and strict definitions (all SE required). Results were compared among LTCF ASP using both definitions. Results None of the LTCF has all seven CE regardless of the definition. A median of two CE (range 1–6) were present based on conventional definition (CD) and 1 (range 0–5) using the strict definition (SD). Less than a quarter of LTCF (n = 6, 20.6%) met five or more CE with the CD and only one (3.5%) using the SD. Interestingly, when utilizing the CD, all (100%) LTCF met at least one CE as compared with only 16 (55.1%) when using the SD. The action CE is most frequently met when using CD and least frequently met when using SD (Figure 1). CP reviewing a proportion of antibiotic orders as a part of their monthly drug regimen review was the most common action and was met by 89.7% of LTCF. Only 2 (6.9%) LTCF had stewardship policies and 4 (13.8%) had implemented at least one stewardship practice. Similarly, 20 (69.0%) LTCF had tracking based on the CD with a majority (55.2%) tracking outcome measures and some (41.4%) tracking antibiotic use. However, only a quarter (27.6%) of LTCF were tracking both outcomes and antibiotic use. ![]()
Conclusion Many LTCF have some components of action and tracking CE in place but are missing important SE. Data on CE should be collected in a manner that makes it easier to identify these deficiencies during LTCF ASP evaluation. Disclosures T. Vanschooneveld, Merck: Grant Investigator, Grant recipient. M. S. Ashraf, Merck & Co. Inc.: Grant Investigator, Research grant.
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Affiliation(s)
- Hanan Tahir Lodhi
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Scott Bergman
- Department of Pharmaceutical Care, Nebraska Medicine, Omaha, Nebraska
| | - Philip Chung
- Nebraska Antimicrobial Stewardship Assessment and Promotion Program, Nebraska Medicine, Omaha, Nebraska
| | - Mark E Rupp
- Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Trevor Vanschooneveld
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
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24
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Fitzgerald T, Nailon R, Tyner K, Beach S, Drake M, Micheels T, Rupp ME, Schwedhelm M, Tierney M, Ashraf MS. 1236. Infection Control Risk Mitigation and Implementation of Best Practice Recommendations in Long-Term Care Facilities. Open Forum Infect Dis 2018. [PMCID: PMC6254387 DOI: 10.1093/ofid/ofy210.1069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Nebraska (NE) Infection Control Assessment and Promotion Program (ICAP) is a quality improvement initiative supported by the NE Department of Health and Human Services. This initiative utilizes subject matter experts (SMEs) including infectious diseases physicians and certified infection preventionists (IP) to assess and improve infection prevention and control programs (IPCP) in various healthcare settings. NE ICAP conducted on-site surveys and observations of IPCP in many volunteer facilities to include long-term care facilities (LTCF) between November 2015 and July 2017. SMEs provided on-site coaching and made best practice recommendations (BPR) for priority implementation. Impact of this intervention on LTCF IPCP was examined. Methods Using a standardized questionnaire, follow-up phone calls were made with LTCF to evaluate implementation of the BPR one-year post-assessment. Descriptive analyses were performed to examine BPR implementation in LTCF that had follow-up between 4/4/17 to 4/17/18 and to identify factors that promoted or impeded BPR implementation. Results Overall, 45 LTCF were assessed. The top 5 IC categories requiring improvement were audit and feedback practices (28 of 45, 62%), PPE supplies at point of use (62%), IC risk assessments (58%), TB risk assessments (56%), and supply and linen storage practices (56%). Follow-up assessments were completed for 270 recommendations in 25 LTCF. Recommendations reviewed ranged from three to 26 per LTCF (median = 15). The majority of the 270 recommendations (n = 162, 60%) had been either completely (35%) or partially (25%) implemented by the time of the follow-up calls. The ICAP visit itself was reported as the most helpful resource for BPR implementation (77 of 162). Lack of staffing was the most commonly mentioned barrier to implementation when LTCF implemented BPR partially or implementation was not planned (37 of 85). BPR Implementation most frequently involved additional staff training (64 of 162), review of policies and procedures (38 of 162), and implementing audit (34 of 162) and/or feedback (23 of 162) programs. Conclusion Numerous IC gaps exist in LTCF. Peer-to-peer feedback and coaching by SMEs facilitated implementation of many BPR directed toward mitigating identified IC gaps. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Teresa Fitzgerald
- Nebraska Infection Control Assessment and Promotion Program, Nebraska Medicine, Omaha, Nebraska
| | - Regina Nailon
- Nursing Research and Quality Outcomes, Nebraska Medicine, Omaha, Nebraska
| | - Kate Tyner
- Nebraska Infection Control Assessment and Promotion Program, Nebraska Medicine, Omaha, Nebraska
| | - Sue Beach
- Nebraska Infection Control Assessment and Promotion Program, Nebraska Medicine, Omaha, Nebraska
| | - Margaret Drake
- Division of Epidemiology, Nebraska Department of Public Health, Lincoln, Nebraska
| | - Teresa Micheels
- Infection Control and Epidemiology, Nebraska Medicine, Omaha, Nebraska
| | - Mark E Rupp
- Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Michelle Schwedhelm
- Nebraska Infection Control Assessment and Promotion Program, Nebraska Medicine, Omaha, Nebraska
| | - Maureen Tierney
- Public Health, Division of Epidemiology, Nebraska Department of Public Health, Lincoln, Nebraska
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Simms A, Fey PD, Lyden E, Hewlett A, Rupp ME. 291. Effect of Previous Antibiotic Exposure on the Yield of Bone Biopsy Culture in Patients With Osteomyelitis. Open Forum Infect Dis 2018. [PMCID: PMC6254193 DOI: 10.1093/ofid/ofy210.302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Bone biopsy and culture are gold standards for the diagnosis of osteomyelitis and are key factors in defining the etiology and treatment of osteomyelitis. There is concern that recent antibiotic exposure will decrease the sensitivity of microbiologic cultures. Methods A retrospective analysis was performed of patients who underwent bone biopsy for evaluation of osteomyelitis at the University of Nebraska Medical Center from 2014 to 2017. Microbiological culture data were compared with the number of days of antibiotic treatment the patient received prior to biopsy. Days of antibiotic use was divided into quartiles and the Cochran-Armitage test was used to test whether antibiotic exposure was associated with culture yield. Fisher’s exact test and the Mann–Whitney test were used to compare anatomic location, diagnostic method, tobacco use, median WBC, ESR, CRP with culture positivity. Multivariable logistic regression was used to determine independent predictors of culture positivity. Results A total of 211 patients were studied. Descriptive statistics: 63% male, 85% Caucasian, median age: 55 years, duration of osteomyelitis prior to biopsy: median 39 days (mean 139 days). Location of osteomyelitis: lower extremity 48%, sacral/pelvic 19%, skull/facial 12%, spine 11%, upper extremity/chest 9%. Within 2 weeks prior to biopsy, the median value of the maximum WBC count, ESR, and CRP was 10.5, 66, and 5.7, respectively. A significant negative linear trend between culture positivity and days of antibiotic exposure (P < 0.0001) was observed (Figure 1). The rate of culture positivity was 85.07% for patients diagnosed with osteomyelitis who did not receive antibiotics and dropped to 78.57%, 73.08%, and 50% for patients who received 1–3 days, 4–14 days, and >14 days of antibiotics, respectively. Other independent predictors of culture positivity included elevated CRP (P = 0.0017) and clinical diagnosis of osteomyelitis (vs. histologic or radiographic) (P = 0.0042). ![]()
Conclusion There is a clear negative linear correlation between pre-bone biopsy antibiotic exposure and culture positivity in patients diagnosed with osteomyelitis. In addition, elevated CRP and method of osteomyelitis diagnosis independently correlate with culture positivity. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Andrew Simms
- University of Nebraska Medical Center, Omaha, Nebraska
| | - Paul D Fey
- Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Elizabeth Lyden
- Epidemiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Angela Hewlett
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Mark E Rupp
- Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
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Tyner K, Nailon R, Drake M, Fitzgerald T, Beach S, Lyden E, Rupp ME, Schwedhelm M, Tierney M, Ashraf MS. 1239. Frequently Identified Infection Control Gaps in Outpatient Hemodialysis Centers. Open Forum Infect Dis 2018. [PMCID: PMC6253288 DOI: 10.1093/ofid/ofy210.1072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Little is known about infection control (IC) practice gaps in outpatient hemodialysis centers (OHDC). Hence, we examined the frequency of IC gaps and the factors associated with them. Methods The Nebraska (NE) Infection Control Assessment and Promotion Program (ICAP) in collaboration with NE Department of Health and Human Services conducted on-site visits to assess infection prevention and control programs (IPCP) in 15 OHDC between June 2016 and March 2018. The CDC Infection Prevention and Control Assessment Tool for Hemodialysis Facilities was used for IPCP evaluation. A total of 124 questions, 76 of which represented best practice recommendations (BPR) were analyzed in 10 IC domains. Gap frequencies were calculated for each BPR. Fisher’s exact test was used to study the association of the identified gaps with typical patient census of the facilities and chain affiliation (CA). Results Of the 15 OHDC, seven were large centers (typically following >50 patients) and 11 were part of national chains. Important IC gaps exist in all OHDC. A median of 64 (range 57–70) of 76 BPR were being followed by OHDC or were nonapplicable to them. The IC Program and Infrastructure domain had the highest frequency of IC gaps (Figure 1). Figure 2 describes the top 5 IC gaps. Smaller OHDC (sODHC) and those without CA performed better in a few areas. For example, a higher proportion of sODHC had work exclusion policies that encourage reporting of illness without any penalty when compared with larger OHDC (75% vs. 0, P = 0.01). Similarly, a higher proportion of sOHDC provided space and encouraged persons with symptoms of respiratory infection to sit as far away from others as possible in nonclinical areas (63% vs. 0, P < 0.05). None of the nonchain OHDC had shared computer charting terminals when compared with 64% of OHDC with CA (P = 0.08) and a majority of nonchain OHDC provided space and encouraged persons to maintain distance with others when having respiratory symptoms as opposed to a minority of OHDC with CA (75% vs. 18%, 0.08). Conclusion Important IC gaps exist in OHDC and require mitigation. Informing OHDC of existing IC gaps may help in BPR implementation. Larger scale studies should focus on identifying factors promoting certain BPR implementation in smaller and nonchain OHDC. ![]()
Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Kate Tyner
- Nebraska Infection Control Assessment and Promotion Program, Nebraska Medicine, Omaha, Nebraska
| | - Regina Nailon
- Nursing Research and Quality Outcomes, Nebraska Medicine, Omaha, Nebraska
| | - Margaret Drake
- Division of Epidemiology, Nebraska Department of Public Health, Lincoln, Nebraska
| | - Teresa Fitzgerald
- Nebraska Infection Control Assessment and Promotion Program, Nebraska Medicine, Omaha, Nebraska
| | - Sue Beach
- Nebraska Infection Control Assessment and Promotion Program, Nebraska Medicine, Omaha, Nebraska
| | - Elizabeth Lyden
- Department of Epidemiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Mark E Rupp
- Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Michelle Schwedhelm
- Nebraska Infection Control Assessment and Promotion Program, Nebraska Medicine, Omaha, Nebraska
| | - Maureen Tierney
- Department of Public Health, Division of Epidemiology, Nebraska Department of Public Health, Lincoln, Nebraska
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Chung P, Bergman S, Neukirch A, Lodhi HT, Rupp ME, Vanschooneveld T, Ashraf MS. 1837. Comparison of Antibiotic Use in Post-Acute and Long-Term Care Facilities Based on Proportion of Short Stay Residents Using a Long-Term Care Pharmacy Database. Open Forum Infect Dis 2018. [PMCID: PMC6253162 DOI: 10.1093/ofid/ofy210.1493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background CMS requires participating long-term care facilities (LTCF) to have an antibiotic stewardship program (ASP). Common barriers encountered by LTCF include lack of antibiotic use (AU) data and inability to benchmark use. We initiated a project that utilized a long-term care pharmacy (LTCPh) database to obtain and compare AU data across enrolled LTCF. Methods We partnered with a regional LTCPh that dispenses and reviews medications for 40 LTCF, of which 32 agreed to participate. Prescriptions filled by the pharmacy were used to calculate antibiotic (AB) starts and days of therapy (DOT). Start and end dates were used to calculate DOT, if available. For those without an end date (<10%), duration was obtained by manual review of administration records. Bed-size and proportion of short-stay (Medicare-A) beds were estimated for each LTCF based on a cross-sectional evaluation of billing records at the LTCPh. Baseline resident-days (RD) during 2017 were obtained from each LTCF. The influence of short-stay residents on AB start rates and DOT was evaluated by grouping LTCF in three cohorts based on estimated proportion of short-stay residents. Results Data from 29 (90.6%) LTCF were included in the final analysis; 3 were excluded due to lack of RD data. Median bed-size was 57 (range 17–253). Overall, 13.9% of LTCF residents were in the short-stay category. Fifteen LTCF were estimated to have 5% to 20% of RD attributable to short-stay residents, six had <5% while eight had >20%. Antibiotic starts/1000 RD varied from 3.84 to 19.38 and DOT/1000 RD from 34.86 to 252.09, and showed strong correlation (Figure 1). The proportion of short-stay beds correlates better with AB starts/1,000 RD than DOT/1,000 RD (Figure 2). LTCF cohort with >20% short-stay residents had higher mean AB starts/1000 RD compared with LTCF with 5%-20% and <5% short-stay residents (13.08, 9.78, 7.45, respectively; P < 0.05 by one-way ANOVA). However, a similar trend was not noted for DOT/1000 RD (179.30, 128.29, 128.12, respectively; P = 0.12). ![]()
Conclusion LTCPh can play an important role in supporting ASP in LTCF by providing AU data for benchmarking. Antibiotic use in LTCF is highly variable and may be influenced by the proportion of beds dedicated to short-stay residents amongst other factors. Disclosures S. Bergman, Merck: Grant Investigator, Grant recipient. T. Vanschooneveld, Merck: Grant Investigator, Grant recipient. M. S. Ashraf, Merck & Co. Inc.: Grant Investigator, Research grant.
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Affiliation(s)
- Philip Chung
- Nebraska Antimicrobial Stewardship Assessment and Promotion Program, Nebraska Medicine, Omaha, Nebraska
| | - Scott Bergman
- Department of Pharmaceutical Care, Nebraska Medicine, Omaha, Nebraska
| | - Alex Neukirch
- College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska
| | - Hanan Tahir Lodhi
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Mark E Rupp
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Trevor Vanschooneveld
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
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Holland TL, Raad I, Boucher HW, Anderson DJ, Cosgrove SE, Aycock PS, Baddley JW, Chaftari AM, Chow SC, Chu VH, Carugati M, Cook P, Corey GR, Crowley AL, Daly J, Gu J, Hachem R, Horton J, Jenkins TC, Levine D, Miro JM, Pericas JM, Riska P, Rubin Z, Rupp ME, Schrank J, Sims M, Wray D, Zervos M, Fowler VG. Effect of Algorithm-Based Therapy vs Usual Care on Clinical Success and Serious Adverse Events in Patients with Staphylococcal Bacteremia: A Randomized Clinical Trial. JAMA 2018; 320:1249-1258. [PMID: 30264119 PMCID: PMC6233609 DOI: 10.1001/jama.2018.13155] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The appropriate duration of antibiotics for staphylococcal bacteremia is unknown. OBJECTIVE To test whether an algorithm that defines treatment duration for staphylococcal bacteremia vs standard of care provides noninferior efficacy without increasing severe adverse events. DESIGN, SETTING, AND PARTICIPANTS A randomized trial involving adults with staphylococcal bacteremia was conducted at 16 academic medical centers in the United States (n = 15) and Spain (n = 1) from April 2011 to March 2017. Patients were followed up for 42 days beyond end of therapy for those with Staphylococcus aureus and 28 days for those with coagulase-negative staphylococcal bacteremia. Eligible patients were 18 years or older and had 1 or more blood cultures positive for S aureus or coagulase-negative staphylococci. Patients were excluded if they had known or suspected complicated infection at the time of randomization. INTERVENTIONS Patients were randomized to algorithm-based therapy (n = 255) or usual practice (n = 254). Diagnostic evaluation, antibiotic selection, and duration of therapy were predefined for the algorithm group, whereas clinicians caring for patients in the usual practice group had unrestricted choice of antibiotics, duration, and other aspects of clinical care. MAIN OUTCOMES AND MEASURES Coprimary outcomes were (1) clinical success, as determined by a blinded adjudication committee and tested for noninferiority within a 15% margin; and (2) serious adverse event rates in the intention-to-treat population, tested for superiority. The prespecified secondary outcome measure, tested for superiority, was antibiotic days among per-protocol patients with simple or uncomplicated bacteremia. RESULTS Among the 509 patients randomized (mean age, 56.6 [SD, 16.8] years; 226 [44.4%] women), 480 (94.3%) completed the trial. Clinical success was documented in 209 of 255 patients assigned to algorithm-based therapy and 207 of 254 randomized to usual practice (82.0% vs 81.5%; difference, 0.5% [1-sided 97.5% CI, -6.2% to ∞]). Serious adverse events were reported in 32.5% of algorithm-based therapy patients and 28.3% of usual practice patients (difference, 4.2% [95% CI, -3.8% to 12.2%]). Among per-protocol patients with simple or uncomplicated bacteremia, mean duration of therapy was 4.4 days for algorithm-based therapy vs 6.2 days for usual practice (difference, -1.8 days [95% CI, -3.1 to -0.6]). CONCLUSIONS AND RELEVANCE Among patients with staphylococcal bacteremia, the use of an algorithm to guide testing and treatment compared with usual care resulted in a noninferior rate of clinical success. Rates of serious adverse events were not significantly different, but interpretation is limited by wide confidence intervals. Further research is needed to assess the utility of the algorithm. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01191840.
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Affiliation(s)
- Thomas L. Holland
- Duke University Medical Center, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
| | - Issam Raad
- The University of Texas MD Anderson Cancer Center, Houston
| | | | | | - Sara E. Cosgrove
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | | | | | - Vivian H. Chu
- Duke University Medical Center, Durham, North Carolina
| | - Manuela Carugati
- Duke University Medical Center, Durham, North Carolina
- San Gerardo Hospital, Monza, Italy
| | - Paul Cook
- Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | | | | | - Jennifer Daly
- University of Massachusetts Medical School, Worcester
| | - Jiezhun Gu
- Duke Clinical Research Institute, Durham, North Carolina
| | - Ray Hachem
- The University of Texas MD Anderson Cancer Center, Houston
| | - James Horton
- Carolinas Medical Center, Charlotte, North Carolina
| | | | | | - Jose M. Miro
- Hospital Clinic–IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Juan M. Pericas
- Hospital Clinic–IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Paul Riska
- Albert Einstein College of Medicine, Bronx, New York
| | - Zachary Rubin
- David Geffen School of Medicine, University of California at Los Angeles
| | | | - John Schrank
- Greenville Health System, Greenville, South Carolina
| | | | - Dannah Wray
- Medical University of South Carolina, Charleston
| | | | - Vance G. Fowler
- Duke University Medical Center, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
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Rupp ME, Cavalieri RJ, Marolf C, Lyden E. Reduction in Blood Culture Contamination Through Use of Initial Specimen Diversion Device. Clin Infect Dis 2018; 65:201-205. [PMID: 28379370 PMCID: PMC5849098 DOI: 10.1093/cid/cix304] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 03/29/2017] [Indexed: 11/14/2022] Open
Abstract
Background Blood culture contamination is a clinically significant problem that results in patient harm and excess cost. Methods In a prospective, controlled trial at an academic center Emergency Department, a device that diverts and sequesters the initial 1.5-2 mL portion of blood (which presumably carries contaminating skin cells and microbes) was tested against standard phlebotomy procedures in patients requiring blood cultures due to clinical suspicion of serious infection. Results In sum, 971 subjects granted informed consent and were enrolled resulting in 904 nonduplicative subjects with 1808 blood cultures. Blood culture contamination was significantly reduced through use of the initial specimen diversion device™ (ISDD) compared to standard procedure: (2/904 [0.22%] ISDD vs 16/904 [1.78%] standard practice, P = .001). Sensitivity was not compromised: true bacteremia was noted in 65/904 (7.2%) ISDD vs 69/904 (7.6%) standard procedure, P = .41. No needlestick injuries or potential bloodborne pathogen exposures were reported. The monthly rate of blood culture contamination for all nurse-drawn and phlebotomist-drawn blood cultures was modeled using Poisson regression to compare the 12-month intervention period to the 6 month before and after periods. Phlebotomists (used the ISDD) experienced a significant decrease in blood culture contamination while the nurses (did not use the ISDD) did not. In sum, 73% of phlebotomists completed a post-study anonymous survey and widespread user satisfaction was noted. Conclusions Use of the ISDD was associated with a significant decrease in blood culture contamination in patients undergoing blood cultures in an Emergency Department setting. Clinical Trials Registration NCT02102087.
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Affiliation(s)
| | | | | | - Elizabeth Lyden
- Department of Epidemiology, University of Nebraska Medical Center, Omaha
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Sandkovsky U, Schwedhelm M, Grayer S, Adelgren E, Rupp ME. Small Changes Make a Big Difference in the Fit of N95 Respirators. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Holland TL, Boucher HW, Raad I, Anderson DJ, Cosgrove SE, Aycock S, Baddley JW, Chow SC, Chu VH, Cook PP, Corey GR, Daly JS, Hachem RY, Chaftari AM, Horton JM, Jenkins TC, Gu J, Levine DP, Miro JM, Riska P, Rubin ZA, Rupp ME, Schrank J, Sims M, Wray D, Zervos MJ, Fowler V. Doing the Same with Less: A Randomized, Multinational, Open-Label, Adjudicator-Blinded Trial of an Algorithm vs. Standard of Care to Determine Treatment Duration for Staphylococcal Bacteremia. Open Forum Infect Dis 2017. [PMCID: PMC5632232 DOI: 10.1093/ofid/ofx162.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The appropriate duration of antibiotics for staphylococcal bloodstream infection (BSI) is unknown. An algorithm to identify patients with staphylococcal BSI who can be safely treated with shorter courses of therapy would improve care and reduce total antibiotic use.
Methods
Adult patients with staphylococcal BSI were randomized to treatment based on algorithm-based therapy (ABT) or to standard of care (SOC). Co-primary outcomes were clinical success, as determined by a blinded Adjudication Committee, and serious adverse event (SAE) rates. The prespecified secondary outcome measure was antibiotic days by treatment group, among patients without complicated BSI. Prespecified durations of therapy in ABT were: S. aureus BSI (SAB): uncomplicated: 14 days; complicated: 4–6 weeks. Coagulase-negative staphylococci BSI (CoNSB): simple (1 positive blood culture) (0–3 days), uncomplicated (>1 positive blood culture) (5 days), complicated (7–28 days). Outcomes were compared using intention-to-treat principles. The target sample size was 500 patients, to ensure 90% power for establishing noninferiority within a margin of 15%.
Results
Between April 2011 and March 2017, 509 adults with suspected staphylococcal BSI at 16 sites in the US and Spain were randomized to ABT (N = 255) or SOC (N = 254). There were 116 patients with SAB (23%) and 385 (76%) with CoNSB (Figure 1). Overall success rate in the ABT group was 82.0% vs. 81.5% in the SOC group, difference 0.5%, 95% CI −5.2% to 6.1%. SAEs were reported in 32.9% of ABT vs. 28.3% of SOC patients (OR 1.2, 95% CI 0.9 to 1.8). Among evaluable patients without complicated BSI, mean duration of therapy was 4.4 days in the ABT group vs. 6.4 days in the SOC group (difference −2.0 days, 95% CI −3.3 to −-0.7, P = 0.003). Among patients with uncomplicated SAB, treatment durations were similar (15.3 days in ABT vs. 16.3 days in SOC, difference −1 day, 95% CI −3.89 to 1.91, P = 0.497), whereas for uncomplicated CoNSB, duration was shorter in the ABT group (5.3 days in ABT vs. 8.4 days in SOC, difference −3 days, 95% CI −4.87 to −1.34, P < 0.001).
Conclusion
The use of a treatment algorithm for staphylococcal BSI was associated with significant reductions in duration of antibiotic therapy in patients without complicated BSI, without significant differences in overall success or SAEs.
Disclosures
V. Fowler Jr., NIH: Investigator, Contract HHSN272200900023C
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Affiliation(s)
| | | | - Issam Raad
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Deverick J Anderson
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
| | | | - Suzanne Aycock
- Duke Clinical Research Institute, Durham, North Carolina
| | - John W Baddley
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Vivian H Chu
- Duke University Medical Center, Durham, North Carolina
| | - Paul P Cook
- Infectious Diseases, Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - G Ralph Corey
- Duke University Medical Center, Durham, North Carolina
| | - Jennifer S Daly
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Ray Y Hachem
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | | | - Jiezhun Gu
- Duke Clinical Research Institute, Durham, North Carolina
| | | | - Jose M Miro
- Hospital Clinic-IDIBAPS, Barcelona, Spain
- Hospital Clínic-IDIBAPS. University of Barcelona, Barcelona, Spain
| | - Paul Riska
- Albert Einstein College of Medicine, Bronx, New York
| | - Zachary A Rubin
- David Geffen School of Medicine/University of California, Los Angeles, Los Angeles, California
| | - Mark E Rupp
- Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - John Schrank
- Greenville Health System, Greenville, South Carolina
| | | | - Dannah Wray
- Medical University of South Carolina, Charleston, South Carolina
| | | | - Vance Fowler
- Duke University Medical Center, Durham, North Carolina
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Tyner K, Nailon R, Beach S, Drake M, Fitzgerald T, Lyden E, Rupp ME, Schwedhelm M, Tierney M, Ashraf MS. Frequently Identified Infection Control Gaps Related to Hand Hygiene in Long-Term Care Facilities. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.1018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Little is known about hand hygiene (HH) policies and practices in long-term care facilities (LTCF). Hence, we decided to study the frequency of HH-related infection control (IC) gaps and the factors associated with it.
Methods
The Nebraska (NE) Infection Control Assessment and Promotion Program (ICAP) in collaboration with NE Department of Health and Human Services conducted in-person surveys and on-site observations to assess infection prevention and control programs (IPCP) in 30 LTCF from 11/2015 to 3/2017. The Centers for Disease Control and Prevention (CDC) Infection Prevention and Control Assessment tool for LTCF was used for on-site interviews and the Centers for Medicare and Medicaid (CMS) Hospital IC Worksheet was used for observations. Gap frequencies were calculated for questions (6 on CDC survey and 8 on CMS worksheet) representing best practice recommendations (BPR). The factors studied for the association with the gaps included LTCF bed size (BS), hospital affiliation (HA), having trained infection preventionists (IP), and weekly hours (WH)/ 100 bed spent by IP on IPCP. Fisher’s exact test and Mann Whitney test were used for statistical analyses.
Results
HH-related IC gap frequencies from on-site interviews are displayed in Figure 1. Only 6 (20%) LTCF reported having all 6 BPR in place and 10 (33%) having 5 BPR. LTCF with fewer gaps (5 to 6 BPR in place) appear more likely to have HA as compared with the LTCF with more gaps but the difference didn’t reach statistical significance (37.5% vs. 7.1%, P = 0.09). When analyzed separately for each gap, it was found that LTCF with HA are more likely to have a policy on preferential use of alcohol based hand rubs than the ones without HA. (85.7%, vs. 26.1% P = 0.008). Several IC gaps were also identified during observations (Figure 2) with one of them being overall HH compliance of <80%. LTCF that have over 90% HH compliance are more likely to have higher median IP WH/100 beds dedicated towards IPCP as compared with the LTCFs with less than 90% compliance (16.4 vs. 4.4, P < 0.05).
Conclusion
Many HH-related IC gaps still exist in LTCF and require mitigation. Mitigation strategies may include encouraging LTCF to collaborate with IP at local acute care hospitals for guidance on IC activities and to increase dedicated IP times towards IPCP in LTCF.
Disclosures
All authors: No reported disclosures.
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Affiliation(s)
- Kate Tyner
- Nebraska Infection Control Assessment and Promotion Program, Nebraska Medicine, Omaha, Nebraska
| | - Regina Nailon
- Nebraska Infection Control Assessment and Promotion Program, Nebraska Medicine, Omaha, Nebraska
| | - Sue Beach
- Nebraska Infection Control Assessment and Promotion Program, Nebraska Medicine, Omaha, Nebraska
| | - Margaret Drake
- Nebraska Infection Control Assessment and Promotion Program, Nebraska Medicine, Omaha, Nebraska
| | - Teresa Fitzgerald
- Nebraska Infection Control Assessment and Promotion Program, Nebraska Medicine, Omaha, Nebraska
| | - Elizabeth Lyden
- Epidemiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Mark E Rupp
- Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Michelle Schwedhelm
- Nebraska Infection Control Assessment and Promotion Program, Nebraska Medicine, Omaha, Nebraska
| | - Maureen Tierney
- Division of Epidemiology, Nebraska Department of Public Health, Lincoln, Nebraska
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Abstract
Catheter-related bloodstream infections (CRBSI) are responsible for significant morbidity, mortality, and excess health care costs. It is increasingly evident that many CRBSI can be prevented with current knowledge and techniques. Preventive measures can be broadly grouped into clinical practice-based interventions and technologic innovations. Clinical practice-based interventions require changes in human behavior and can be subdivided into interventions before and at the time of insertion and postinsertion. Despite recent successes with prevention of CRBSI, pertinent questions regarding pathogenesis and prevention remain unanswered and work on improved surveillance, devices less prone to infection, and more effective prevention techniques are needed.
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Affiliation(s)
- Mark E Rupp
- Division of Infectious Diseases, University of Nebraska Medical Center, 985400 Nebraska Medical Center, Omaha, NE 68198, USA.
| | - Denisa Majorant
- Division of Infectious Diseases, University of Nebraska Medical Center, 984031 Nebraska Medical Center, Omaha, NE 68198, USA
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Tyner K, Nailon R, Beach S, Drake M, Fitzgerald T, Lyden E, Rupp ME, Schwedhelm M, Tierney M, Ashraf MS. Environmental Cleaning and Disinfection in Long-Term Care Facilities: Opportunities for Improvement. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Fitzgerald T, Nailon R, Tyner K, Beach S, Drake M, Lyden E, Rupp ME, Schwedhelm M, Tierney M, Ashraf MS. Infection Control in Long-Term Care Facilities: Frequently Identified Gaps in Infrastructure, Surveillance and Safety. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Rupp ME, Crosara SLR, Van Schooneveld TC, Fitzgerald T, Goetschkes K. Factitious Catheter-Associated Urinary Tract Infections in a Neuroscience Intensive Care Unit. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mark E. Rupp
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
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37
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Cawcutt K, Hankins R, Cavalieri RJ, Fey PD, Lyden E, Rupp ME. Microbial Colonization of an Intravascular Catheter Connector in Hospitalized Patients With Active Intravenous Infusions. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kelly Cawcutt
- University of Nebraska Medical Center, Omaha, Nebraska
| | | | - R Jennifer Cavalieri
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Paul D. Fey
- Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Elizabeth Lyden
- Epidemiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Mark E. Rupp
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
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38
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Schooneveld TCV, Rupp ME, Lyden E, Cavalieri RJ, Marolf C, Rolek K. Randomized Trial of Team Pharmacist-Led Antimicrobial Time Out. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Mark E. Rupp
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Elizabeth Lyden
- Epidemiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - R Jennifer Cavalieri
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Cole Marolf
- University of Nebraska Medical Center, Omaha, Nebraska
| | - Kiri Rolek
- University of Nebraska Medical Center College of Pharmacy, Omaha, Nebraska
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39
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Rupp ME, Cavalieri RJ, Marolf C, Lyden E. Initial Specimen Diversion Device Prevents Blood Culture Contamination. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Mark E. Rupp
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - R. Jennifer Cavalieri
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Cole Marolf
- University of Nebraska Medical Center, Omaha, Nebraska
| | - Elizabeth Lyden
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
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40
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Van Schooneveld TC, Turille N, Lyden E, Clevenger R, Schwedhelm M, Rupp ME. Implementation of an Inpatient Urine Culture Algorithm Decreased Catheter-Associated Urinary Tract Infections. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Nicole Turille
- Quality and Patient Safety, Nebraska Medicine, Omaha, Nebraska
| | - Elizabeth Lyden
- Epidemiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Ryan Clevenger
- Infection Control and Epidemiology, Nebraska Medicine, Omaha, Nebraska
| | | | - Mark E. Rupp
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
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41
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Marolf C, Fey PD, Alter R, Lyden E, Rupp ME. Susceptibility of Nosocomial Staphylococcus aureus to Chlorhexidine After Implementation of a Hospital-Wide Antiseptic Bathing Regimen. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Cole Marolf
- University of Nebraska Medical Center, Omaha, Nebraska
| | - Paul D. Fey
- Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Roxanne Alter
- University of Nebraska Medical Center, Omaha, Nebraska
| | - Elizabeth Lyden
- Epidemiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Mark E. Rupp
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
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42
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Rupp ME, Fitzgerald T, Van Schooneveld T, Hewlett A, Clevenger R, Lyden E. Cessation of Contact Isolation for Endemic Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococcus Is Not Associated With Increased Infections. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Mark E. Rupp
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | | | | | - Angela Hewlett
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Ryan Clevenger
- Infection Control and Epidemiology, Nebraska Medicine, Omaha, Nebraska
| | - Elizabeth Lyden
- Epidemiology, University of Nebraska Medical Center, Omaha, Nebraska
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43
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Huynh T, Stecher M, Mckinnon J, Jung N, Rupp ME. Safety and Tolerability of 514G3, a True Human Anti-Protein A Monoclonal Antibody for the Treatment of S. aureus Bacteremia. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1057] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Toan Huynh
- Carolinas Healthcare System/F.H. Sammy Ross Trauma Center, Charlotte, NC
| | | | - John Mckinnon
- Medicine / Infectious Diseases, Henry Ford Hospital, Detroit, MI
| | | | - Mark E. Rupp
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE
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Rupp ME, Stecher M, Mckinnon J, Jung N, Huynh T. Pharmacokinetics of a Novel Monoclonal Antibody Targeting Staphylococcal Protein A in Patients Hospitalized With S. aureus Bacteremia. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Mark E. Rupp
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | | | - John Mckinnon
- Medicine / Infectious Diseases, Henry Ford Hospital, Detroit, MI
| | | | - Toan Huynh
- Carolinas Healthcare System/F.H. Sammy Ross Trauma Center, Charlotte, NC
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Santibañez S, Polgreen PM, Beekmann SE, Rupp ME, Del Rio C. Infectious Disease Physicians' Perceptions About Ebola Preparedness Early in the US Response: A Qualitative Analysis and Lessons for the Future. Health Secur 2016; 14:345-50. [DOI: 10.1089/hs.2016.0038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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46
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Rupp ME, Weseman RA, Marion N, Iwen PC. Evaluation of Bacterial Contamination of a Sterile, Non-Air-Dependent Enteral Feeding System in Immunocompromised Patients. Nutr Clin Pract 2016. [DOI: 10.1177/088453369901400309] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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47
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Wong ES, Rupp ME, Mermel L, Perl TM, Bradley S, Ramsey KM, Ostrowsky B, Valenti AJ, Jernigan JA, Voss A, Tapper ML. Public Disclosure of Healthcare-Associated Infections: The Role of the Society for Healthcare Epidemiology of America. Infect Control Hosp Epidemiol 2016; 26:210-2. [PMID: 15756894 DOI: 10.1086/502528] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Prior to 2004, only two states, Pennsylvania and Illinois, had enacted legislation requiring healthcare facilities to collect nosocomial or healthcare-associated infection (HAI) data intended for public disclosure. In 2004, two additional states, Missouri and Florida, passed disclosure laws. Currently, several other states are considering similar legislation. In California, Senate Bill 1487 requiring hospitals to collect HAI data and report them to the Office of Statewide Health Planning was passed by the legislature, but was not signed into law by Governor Schwarzenegger, effectively vetoing it. The impetus for these laws is complex. Support comes from consumer advocates, who argue that the public has the right to be informed, and from others who view HAI as preventable and hope that public disclosure would provide an incentive to healthcare providers and institutions to improve their care.
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Affiliation(s)
- Edward S Wong
- Society for Healthcare Epidemiology of America, 66 Canal Center Plaza, Suite 600, Alexandria, VA 22314, USA
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48
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Rupp ME. Do chlorhexidine patient baths prevent catheter-associated urinary tract infections? Lancet Infect Dis 2015; 16:8-9. [PMID: 26631834 DOI: 10.1016/s1473-3099(15)00244-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 07/29/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Mark E Rupp
- Division of Infectious Diseases, University of Nebraska Medical Center, Nebraska Medical Center, Omaha, NE 68198-5400, USA.
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49
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Polgreen PM, Santibanez S, Koonin LM, Rupp ME, Beekmann SE, Del Rio C. Infectious Disease Physician Assessment of Hospital Preparedness for Ebola Virus Disease. Open Forum Infect Dis 2015; 2:ofv087. [PMID: 26180836 PMCID: PMC4499670 DOI: 10.1093/ofid/ofv087] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 06/09/2015] [Indexed: 11/13/2022] Open
Abstract
Background. The first case of Ebola diagnosed in the United States and subsequent cases among 2 healthcare workers caring for that patient highlighted the importance of hospital preparedness in caring for Ebola patients. Methods. From October 21, 2014 to November 11, 2014, infectious disease physicians who are part of the Emerging Infections Network (EIN) were surveyed about current Ebola preparedness at their institutions. Results. Of 1566 EIN physician members, 869 (55.5%) responded to this survey. Almost all institutions represented in this survey showed a substantial degree of preparation for the management of patients with suspected and confirmed Ebola virus disease. Despite concerns regarding shortages of personal protective equipment, approximately two thirds of all respondents reported that their facilities had sufficient and ready availability of hoods, full body coveralls, and fluid-resistant or impermeable aprons. The majority of respondents indicated preference for transfer of Ebola patients to specialized treatment centers rather than caring for them locally. In general, we found that larger hospitals and teaching hospitals reported higher levels of preparedness. Conclusions. Prior to the Centers for Disease Control and Prevention's plan for a tiered approach that identified specific roles for frontline, assessment, and designated treatment facilities, our query of infectious disease physicians suggested that healthcare facilities across the United States were making preparations for screening, diagnosis, and treatment of Ebola patients. Nevertheless, respondents from some hospitals indicated that they were relatively unprepared.
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Affiliation(s)
- Philip M Polgreen
- Emerging Infections Network , University of Iowa Carver College of Medicine , Iowa City, Iowa
| | - Scott Santibanez
- Centers for Disease Control and Prevention , Atlanta, Georgia ; Rollins School of Public Health of Emory University and Emory University School of Medicine , Atlanta, Georgia
| | - Lisa M Koonin
- Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Mark E Rupp
- Department of Internal Medicine , University of Nebraska Medical Center , Omaha, Nebraska
| | - Susan E Beekmann
- Emerging Infections Network , University of Iowa Carver College of Medicine , Iowa City, Iowa
| | - Carlos Del Rio
- Rollins School of Public Health of Emory University and Emory University School of Medicine , Atlanta, Georgia
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50
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Kalil AC, Rupp ME, Florescu DF. Reply to Thomason et al and Bahr et al. Clin Infect Dis 2015; 60:1870-1. [PMID: 25740797 DOI: 10.1093/cid/civ169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Diana F Florescu
- Divisions of Infectious Diseases Transplant Surgery, University of Nebraska Medical Center, Omaha
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