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Pop-Vicas AE, Anderson L, Hatas G, Stevens L, Buys A, O’Connor D, Wilson N, Riemersma K, Haddock Soto LA, Richardson A, Clemens C, Packham J, Shirley D, Safdar N. A severe acute respiratory coronavirus virus 2 (SARS-CoV-2) nosocomial cluster with inter-facility spread: Lessons learned. Infect Control Hosp Epidemiol 2024; 45:635-643. [PMID: 38173365 PMCID: PMC11027079 DOI: 10.1017/ice.2023.172] [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] [Received: 02/06/2023] [Revised: 06/06/2023] [Accepted: 06/23/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Despite infection control guidance, sporadic nosocomial coronavirus disease 2019 (COVID-19) outbreaks occur. We describe a complex severe acute respiratory coronavirus virus 2 (SARS-CoV-2) cluster with interfacility spread during the SARS-CoV-2 δ (delta) pandemic surge in the Midwest. SETTING This study was conducted in (1) a hematology-oncology ward in a regional academic medical center and (2) a geographically distant acute rehabilitation hospital. METHODS We conducted contact tracing for each COVID-19 case to identify healthcare exposures within 14 days prior to diagnosis. Liberal testing was performed for asymptomatic carriage for patients and staff. Whole-genome sequencing was conducted for all available clinical isolates from patients and healthcare workers (HCWs) to identify transmission clusters. RESULTS In the immunosuppressed ward, 19 cases (4 patients, 15 HCWs) shared a genetically related SARS-CoV-2 isolate. Of these 4 patients, 3 died in the hospital or within 1 week of discharge. The suspected index case was a patient with new dyspnea, diagnosed during preprocedure screening. In the rehabilitation hospital, 20 cases (5 patients and 15 HCWs) positive for COVID-19, of whom 2 patients and 3 HCWs had an isolate genetically related to the above cluster. The suspected index case was a patient from the immune suppressed ward whose positive status was not detected at admission to the rehabilitation facility. Our response to this cluster included the following interventions in both settings: restricting visitors, restricting learners, restricting overflow admissions, enforcing strict compliance with escalated PPE, access to on-site free and frequent testing for staff, and testing all patients prior to hospital discharge and transfer to other facilities. CONCLUSIONS Stringent infection control measures can prevent nosocomial COVID-19 transmission in healthcare facilities with high-risk patients during pandemic surges. These interventions were successful in ending these outbreaks.
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Affiliation(s)
- Aurora E. Pop-Vicas
- Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Laura Anderson
- Department of Infection Control and Prevention, University of Wisconsin Health University Hospital, Madison, Wisconsin
| | - Gabrielle Hatas
- Department of Infection Control and Prevention, University of Wisconsin Health University Hospital, Madison, Wisconsin
| | - Linda Stevens
- Nursing Quality and Safety, University of Wisconsin Health University Hospital, Madison, Wisconsin
| | - Ashley Buys
- Employee Health Services, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
| | - David O’Connor
- Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, Wisconsin
| | - Nancy Wilson
- Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, Wisconsin
| | - Kasen Riemersma
- Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, Wisconsin
| | - Luis A Haddock Soto
- Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, Wisconsin
| | - Abby Richardson
- University of Wisconsin Health Rehabilitation Hospital, Madison, Wisconsin
| | - Christine Clemens
- University of Wisconsin Health Rehabilitation Hospital, Madison, Wisconsin
| | - Jennylynde Packham
- University of Wisconsin Health Rehabilitation Hospital, Madison, Wisconsin
| | - Daniel Shirley
- Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Nasia Safdar
- Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- William S. Middleton Memorial Veterans’ Affairs Medical Center, Madison, Wisconsin
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Sulaiman J, Thompson J, Qian Y, Vivas E, Diener C, Gibbons SM, Safdar N, Venturelli OS. Elucidating human gut microbiota interactions that robustly inhibit diverse Clostridioides difficile strains across different nutrient landscapes. bioRxiv 2024:2024.04.13.589383. [PMID: 38659900 PMCID: PMC11042340 DOI: 10.1101/2024.04.13.589383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
The human gut pathogen Clostridioides difficile displays extreme genetic variability and confronts a changeable nutrient landscape in the gut. We mapped gut microbiota inter-species interactions impacting the growth and toxin production of diverse C. difficile strains in different nutrient environments. Although negative interactions impacting C. difficile are prevalent in environments promoting resource competition, they are sparse in an environment containing C. difficile-preferred carbohydrates. C. difficile strains display differences in interactions with Clostridium scindens and the ability to compete for proline. C. difficile toxin production displays substantial community-context dependent variation and does not trend with growth-mediated inter-species interactions. C. difficile shows substantial differences in transcriptional profiles in the presence of the closely related species C. hiranonis or C. scindens. In co-culture with C. hiranonis, C. difficile exhibits massive alterations in metabolism and other cellular processes, consistent with their high metabolic overlap. Further, Clostridium hiranonis inhibits the growth and toxin production of diverse C. difficile strains across different nutrient environments and ameliorates the disease severity of a C. difficile challenge in a murine model. In sum, strain-level variability and nutrient environments are major variables shaping gut microbiota interactions with C. difficile.
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Smith M, Crnich C, Donskey C, Evans CT, Evans M, Goto M, Guerrero B, Gupta K, Harris A, Hicks N, Khader K, Kralovic S, McKinley L, Rubin M, Safdar N, Schweizer ML, Tovar S, Wilson G, Zabarsky T, Perencevich EN. Research agenda for transmission prevention within the Veterans Health Administration, 2024-2028. Infect Control Hosp Epidemiol 2024:1-10. [PMID: 38600795 DOI: 10.1017/ice.2024.40] [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: 04/12/2024]
Affiliation(s)
- Matthew Smith
- Center for Access & Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Chris Crnich
- William. S. Middleton Memorial VA Hospital, Madison, WI, USA
| | - Curtis Donskey
- Geriatric Research, Education and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Charlesnika T Evans
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, IL, USA
- Department of Preventive Medicine and Center for Health Services and Outcomes Research, Northwestern University of Feinberg School of Medicine, Chicago, IL, USA
| | - Martin Evans
- MRSA/MDRO Division, VHA National Infectious Diseases Service, Patient Care Services, VA Central Office and the Lexington VA Health Care System, Lexington, KY, USA
| | - Michihiko Goto
- Center for Access & Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Bernardino Guerrero
- Environmental Programs Service (EPS), Veterans Affairs Central Office, Washington, DC, USA
| | - Kalpana Gupta
- VA Boston Healthcare System and Boston University School of Medicine, Boston, MA, USA
| | - Anthony Harris
- Department of Epidemiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Natalie Hicks
- National Infectious Diseases Service, Specialty Care Services, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC, USA
| | - Karim Khader
- DEAS Center of Innovation, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
- Division of Epidemiology, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Stephen Kralovic
- Veterans Health Administration National Infectious Diseases Service, Washington, DC, USA
- Cincinnati VA Medical Center and University of Cincinnati, Cincinnati, OH, USA
| | - Linda McKinley
- William. S. Middleton Memorial VA Hospital, Madison, WI, USA
| | - Michael Rubin
- DEAS Center of Innovation, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
- Division of Epidemiology, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Nasia Safdar
- William. S. Middleton Memorial VA Hospital, Madison, WI, USA
| | - Marin L Schweizer
- William. S. Middleton Memorial VA Hospital, Madison, WI, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, and William S. Middleton Hospital, Madison, WI, USA
| | - Suzanne Tovar
- National Infectious Diseases Service (NIDS), Veterans Affairs Central Office, Washington, DC, USA
| | - Geneva Wilson
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines Jr. Veterans Affairs Hospital, Hines, IL, USA
- Department of Preventive Medicine, Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Trina Zabarsky
- Environmental Programs Service (EPS), Veterans Affairs Central Office, Washington, DC, USA
| | - Eli N Perencevich
- Center for Access & Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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Schmitz E, Anderson L, Hatas G, Stevens L, Osman F, Schweizer M, Safdar N, Shirley D. Population and hospital-level COVID-19 measures are associated with increased risk of hospital-onset COVID-19. Infect Control Hosp Epidemiol 2024:1-3. [PMID: 38495006 DOI: 10.1017/ice.2024.29] [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: 03/19/2024]
Abstract
A review of hospital-onset COVID-19 cases revealed 8 definite, 106 probable, and 46 possible cases. Correlations between hospital-onset cases and both HCW and inpatient cases were noted in 2021. Rises in community measures were associated with rises in hospital-onset cases. Measures of community COVID-19 activity might predict hospital-onset cases.
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Affiliation(s)
- Emily Schmitz
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | | | | | - Fauzia Osman
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Marin Schweizer
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Nasia Safdar
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Daniel Shirley
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- UW Health, Madison, WI, USA
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Holzhausen EA, Peppard PE, Sethi AK, Safdar N, Malecki KC, Schultz AA, Deblois CL, Hagen EW. Associations of gut microbiome richness and diversity with objective and subjective sleep measures in a population sample. Sleep 2024; 47:zsad300. [PMID: 37988614 PMCID: PMC10926107 DOI: 10.1093/sleep/zsad300] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/20/2023] [Indexed: 11/23/2023] Open
Abstract
STUDY OBJECTIVES Alterations in gut microbiota composition have been associated with several conditions, and there is emerging evidence that sleep quantity and quality are associated with the composition of the gut microbiome. Therefore, this study aimed to assess the associations between several measures of sleep and the gut microbiome in a large, population-based sample. METHODS Data were collected from participants in the Survey of the Health of Wisconsin from 2016 to 2017 (N = 720). Alpha diversity was estimated using Chao1 richness, Shannon's diversity, and Inverse Simpson's diversity. Beta diversity was estimated using Bray-Curtis dissimilarity. Models for each of the alpha-diversity outcomes were calculated using linear mixed effects models. Permutational multivariate analysis of variance tests were performed to test whether gut microbiome composition differed by sleep measures. Negative binomial models were used to assess whether sleep measures were associated with individual taxa relative abundance. RESULTS Participants were a mean (SD) age of 55 (16) years and 58% were female. The sample was 83% non-Hispanic white, 10.6% non-Hispanic black, and 3.5% Hispanic. Greater actigraphy-measured night-to-night sleep duration variability, wake-after-sleep onset, lower sleep efficiency, and worse self-reported sleep quality were associated with lower microbiome richness and diversity. Sleep variables were associated with beta-diversity, including actigraphy-measured night-to-night sleep duration variability, sleep latency and efficiency, and self-reported sleep quality, sleep apnea, and napping. Relative abundance of several taxa was associated with night-to-night sleep duration variability, average sleep latency and sleep efficiency, and sleep quality. CONCLUSIONS This study suggests that sleep may be associated with the composition of the gut microbiome. These results contribute to the body of evidence that modifiable health habits can influence the human gut microbiome.
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Affiliation(s)
| | - Paul E Peppard
- Department of Population Health Sciences, University of Wisconsin, Madison, WI, USA
| | - Ajay K Sethi
- Department of Population Health Sciences, University of Wisconsin, Madison, WI, USA
| | - Nasia Safdar
- Department of Medicine and the William S. Middleton Memorial Veterans Hospital, University of Wisconsin, Madison, WI, USA
| | - Kristen C Malecki
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, IL, USA
| | - Amy A Schultz
- Department of Population Health Sciences, University of Wisconsin, Madison, WI, USA
| | | | - Erika W Hagen
- Department of Population Health Sciences, University of Wisconsin, Madison, WI, USA
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Fitzpatrick MA, Solanki P, Wirth M, Weaver FM, Suda KJ, Burns SP, Safdar N, Collins E, Evans CT. Knowledge, perceptions, and beliefs about urinary tract infections in persons with neurogenic bladder and impacts on interventions to promote person-centered care. Spinal Cord 2024:10.1038/s41393-024-00972-z. [PMID: 38454065 DOI: 10.1038/s41393-024-00972-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/09/2024]
Abstract
STUDY DESIGN Qualitative study. OBJECTIVES To explore how knowledge, perceptions, and beliefs about urinary tract infections (UTIs) among persons with neurogenic bladder (NB) may impact health behaviors and provider management and enhance person-centeredness of interventions to improve UTI management. SETTING Three Veterans Affairs (VA) medical centers. METHODS Adults with NB due to spinal cord injury/disorder (SCI/D) or multiple sclerosis (MS) with UTI diagnoses in the prior year participated in focus groups. Transcripts were coded using deductive codes linked to the Health Belief Model and inductive codes informed by grounded theory. RESULTS Twenty-three Veterans (SCI/D, 78%; MS: 18.5%) participated in discussions. Three themes emerged: (1) UTI knowledge; (2) factors affecting the intervention environment; and (3) factors affecting modes of delivery. Knowledge gaps included UTI prevention, specific symptoms most indicative of UTI, and antibiotic side effects. Poor perceptions of providers lacking knowledge about NB and ineffective patient-provider communication were common in the Emergency Department and non-VA facilities, whereas participants had positive perceptions of home-based care. Participants perceived lower severity and frequency of antibiotic risks compared to UTI risks. Participant preferences for education included caregiver involvement, verbal and written materials, and diverse settings like peer groups. CONCLUSIONS Identifying patient perspectives enhances person-centeredness and allows for novel interventions improving patient knowledge and behaviors about UTIs. Partnering with trusted providers and home-based caregivers and improving NB knowledge and communication in certain care settings were important. Patient education should address mental risk representations and incorporate preferences for content delivery to optimize self-efficacy and strengthen cues to action.
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Affiliation(s)
- Margaret A Fitzpatrick
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, USA.
- Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA.
- Center of Innovation for Veteran-Centered and Value-Driven Care, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA.
- Department of Medicine, Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Pooja Solanki
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Marissa Wirth
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Frances M Weaver
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, USA
- Loyola University Chicago Parkinson School of Health Sciences and Public Health, Maywood, IL, USA
| | - Katie J Suda
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Department of Medicine, Center for Research on Healthcare, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Stephen P Burns
- Spinal Cord Injury/Disorders Service, VA Puget Sound Healthcare System, Seattle, WA, USA
- Department of Physical Medicine and Rehabilitation, University of Washington School of Medicine, Seattle, WA, USA
| | - Nasia Safdar
- Department of Medicine, Division of Infectious Diseases, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
- William S. Middleton VA Hospital, Madison, WI, USA
| | - Eileen Collins
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Charlesnika T Evans
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, USA
- Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Cotter EJ, Cotter LM, Riley CN, Dixon J, VanDerwerker N, Ufot AI, Godfrey J, Gold D, Hetzel SJ, Safdar N, Grogan BF. Antimicrobial effects of blue light therapy against cutibacterium acnes: optimal dosing and impact of serial treatments. JSES Int 2024; 8:328-334. [PMID: 38464448 PMCID: PMC10920142 DOI: 10.1016/j.jseint.2023.11.020] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Abstract
Background Blue light therapy (BLT) is a Food and Drug Administration cleared modality used in dermatology as an effective treatment of acne. The primary purpose of this study is to determine if there are dose-dependent antimicrobial effects of BLT against Cutibacterium acnes (C. acnes). Methods A known strain of C. acnes was grown on chocolate agar in a controlled laboratory environment under anaerobic conditions for 1 week. After 1 week, 2-3 colonies of C. acnes were isolated and transferred to broth medium to incubate for 2 or 7 days. Broth vials (treatment arm) then underwent 1 of 6 different blue light dosing treatment regimens and a duplicate broth vial served as a control left open to the same environment. The BLT regimens were a single treatment of 25 J/cm2, 50 J/cm2, 75 J/cm2, 100 J/cm2, 2 serial treatments of 50 J/cm2 separated by 24 hours, or 2 serial treatments of 75 J/cm2 separated by 24 hours. The Omnilux Blue device (415 nm wavelength) was used for all BLT treatments and delivered, on average, 1.68 ± 0.004 J/min. Following treatment, the control and treatment broth samples were plated on chocolate agar and allowed to grow for 7 days. After 7 days, plates were counted and colony forming units (CFUs) were calculated. Six trials were completed for each BLT dosing regimen based on an a priori power analysis of 6 individual 2-sided t-tests. Comparisons in the primary outcome were made via mixed-effects analysis of variance with replicate as a random effect. Results All BLT treatment regimens resulted in significantly fewer CFUs than their aggregate control plate CFUs (P < .05 for all). Furthermore, in 2-way comparison of CFUs between BLT treatment groups, a single treatment of 75 J/cm2 did lead to significantly less growth than 25 J/cm2 (P = .017) and 50 J/cm2 (P = .017). There were no improved antimicrobial effects with serial treatments when comparing 2 doses of 50 J/cm2 with a single dose of 100J/cm2, nor were 2 doses of 75 J/cm2 more efficacious than 100 J/cm2. Using the Omnilux Blue device, it took 44.8 minutes to deliver a 75 J/cm2 dose. Conclusion BLT is an effective antimicrobial agent against this single virulent strain of C. acnes. Treatment dosing of 75 J/cm2 was identified to be the most effective dose per unit time. Serial treatments did not lead to superior antimicrobial effects over a single, high-dose treatment.
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Affiliation(s)
- Eric J. Cotter
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Lisa M. Cotter
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Colleen N. Riley
- Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jonah Dixon
- Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Nicholas VanDerwerker
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Aniekanabasi Ime Ufot
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jared Godfrey
- Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - David Gold
- Department of Physics and Optics, University of Wisconsin-Madison, Madison, WI, USA
| | - Scott J. Hetzel
- Department of Biostatistics and Medical Informatics, University of Wisconsin–Madison, Madison, WI, USA
| | - Nasia Safdar
- Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Brian F. Grogan
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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McKinley LL, Goedken CC, Balkenende EC, Hockett Sherlock SM, Knobloch MJ, Bartel R, Perencevich EN, Reisinger HS, Safdar N. Using a human-factors engineering approach to evaluate environmental cleaning in Veterans' Affairs acute and long-term care facilities: A qualitative analysis. Infect Control Hosp Epidemiol 2024; 45:351-359. [PMID: 37873620 DOI: 10.1017/ice.2023.226] [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: 10/25/2023]
Abstract
BACKGROUND Environmental cleaning is important in the interruption of pathogen transmission. Although prevention initiatives have targeted environmental cleaning, practice variations exist and compliance is low. Evaluation of human factors influencing variations in cleaning practices can be valuable in developing interventions to standardized practices. We conducted a work-system analysis using a human-factors engineering (HFE) framework to identify barriers and facilitators to environmental cleaning practices in acute and long-term care settings within the Veterans' Affairs health system. METHODS We conducted a qualitative study with key stakeholders at 3 VA facilities. We analyzed transcripts for thematic content and mapped themes to the HFE framework. RESULTS Staffing consistency was felt to improve cleaning practices and teamwork. We found that many environmental management service (EMS) staff were veterans who were motivated to serve fellow veterans, especially to prevent infections. However, hiring veterans comes with regulatory hurdles that affect staffing. Sites reported some form of monitoring their cleaning process, but there was variation in method and frequency. The EMS workload was affected by whether rooms were occupied by patients or were semiprivate rooms; both were reportedly more difficult to clean. Room design and surface finishes were identified as important to cleaning efficiency. CONCLUSION HFE work analysis identified barriers and facilitators to environmental cleaning. These findings highlight intervention entry points that may facilitate standardized work practices. There is a need to develop task-specific procedures such as cleaning occupied beds and semiprivate rooms. Future research should evaluate interventions that address these determinants of environmental cleaning.
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Affiliation(s)
- Linda L McKinley
- William S. Middleton Memorial Veterans' Hospital, Madison, Wisconsin
| | - Cassie C Goedken
- Center for Access and Delivery Research and Evaluation (CADRE), Iowa City, Iowa
- Iowa City VA Health Care System, Iowa City, Iowa
| | - Erin C Balkenende
- Center for Access and Delivery Research and Evaluation (CADRE), Iowa City, Iowa
- Iowa City VA Health Care System, Iowa City, Iowa
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Stacey M Hockett Sherlock
- Center for Access and Delivery Research and Evaluation (CADRE), Iowa City, Iowa
- Iowa City VA Health Care System, Iowa City, Iowa
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Mary Jo Knobloch
- Center for Access and Delivery Research and Evaluation (CADRE), Iowa City, Iowa
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Rosie Bartel
- Patient-Centered Outcomes Research Institute (PCORI), Washington, DC
| | - Eli N Perencevich
- Center for Access and Delivery Research and Evaluation (CADRE), Iowa City, Iowa
- Iowa City VA Health Care System, Iowa City, Iowa
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Heather S Reisinger
- Center for Access and Delivery Research and Evaluation (CADRE), Iowa City, Iowa
- Iowa City VA Health Care System, Iowa City, Iowa
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
- Institute for Clinical and Translational Science, Iowa City, Iowa
| | - Nasia Safdar
- William S. Middleton Memorial Veterans' Hospital, Madison, Wisconsin
- University of Wisconsin-Madison, Madison, Wisconsin
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Hernandez SE, Solomon D, Moon J, Parmasad V, Wiegmann D, Bennett NT, Ferren RS, Fitzsimmons AJ, Lepak AJ, O'Horo JC, Pop-Vicas AE, Schulz LT, Safdar N. Understanding clinical implementation coordinators' experiences in deploying evidence-based interventions. Am J Health Syst Pharm 2024; 81:120-128. [PMID: 37897218 DOI: 10.1093/ajhp/zxad272] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Indexed: 10/29/2023] Open
Abstract
PURPOSE The fluoroquinolone restriction for the prevention of Clostridioides difficile infection (FIRST) trial is a multisite clinical study in which sites carry out a preauthorization process via electronic health record-based best-practice alert (BPA) to optimize the use of fluoroquinolone antibiotics in acute care settings. Our research team worked closely with clinical implementation coordinators to facilitate the dissemination and implementation of this evidence-based intervention. Clinical implementation coordinators within the antibiotic stewardship team (AST) played a pivotal role in the implementation process; however, considerable research is needed to further understand their role. In this study, we aimed to (1) describe the roles and responsibilities of clinical implementation coordinators within ASTs and (2) identify facilitators and barriers coordinators experienced within the implementation process. METHODS We conducted a directed content analysis of semistructured interviews, implementation diaries, and check-in meetings utilizing the conceptual framework of middle managers' roles in innovation implementation in healthcare from Urquhart et al. RESULTS Clinical implementation coordinators performed a variety of roles vital to the implementation's success, including gathering and compiling information for BPA design, preparing staff, organizing meetings, connecting relevant stakeholders, evaluating clinical efficacy, and participating in the innovation as clinicians. Coordinators identified organizational staffing models and COVID-19 interruptions as the main barriers. Facilitators included AST empowerment, positive relationships with staff and oversight/governance committees, and using diverse implementation strategies. CONCLUSION When implementing healthcare innovations, clinical implementation coordinators facilitated the implementation process through their roles and responsibilities and acted as strategic partners in improving the adoption and sustainability of a fluoroquinolone preauthorization protocol.
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Affiliation(s)
- Sara E Hernandez
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - Demetrius Solomon
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Jukrin Moon
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - Vishala Parmasad
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Douglas Wiegmann
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Nick T Bennett
- Antimicrobial Stewardship Program, Saint Luke's Health System, Kansas City, MO, USA
| | - Ryan S Ferren
- University of Texas Medical Branch, Galveston, TX, USA
| | - Alec J Fitzsimmons
- Department of Medical Research, Gundersen Health System, La Crosse, WI, USA
| | - Alexander J Lepak
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - John C O'Horo
- Mayo Foundation for Medical Education and Research, Rochester, MN, USA
| | - Aurora E Pop-Vicas
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Lucas T Schulz
- Department of Pharmacy, University of Wisconsin Health, Madison, WI, USA
| | - Nasia Safdar
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
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Sun J, Zheng Q, Anzalone AJ, Abraham AG, Olex AL, Zhang Y, Mathew J, Safdar N, Haendel MA, Segev D, Islam JY, Singh JA, Mannon RB, Chute CG, Patel RC, Kirk GD. Effectiveness of mRNA Booster Vaccine Against Coronavirus Disease 2019 Infection and Severe Outcomes Among Persons With and Without Immune Dysfunction: A Retrospective Cohort Study of National Electronic Medical Record Data in the United States. Open Forum Infect Dis 2024; 11:ofae019. [PMID: 38379569 PMCID: PMC10878052 DOI: 10.1093/ofid/ofae019] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/09/2024] [Indexed: 02/22/2024] Open
Abstract
Background Real-world evidence of coronavirus disease 2019 (COVID-19) messenger RNA (mRNA) booster effectiveness among patients with immune dysfunction are limited. Methods We included data from patients in the United States National COVID Cohort Collaborative (N3C) who completed ≥2 doses of mRNA vaccination between 10 December 2020 and 27 May 2022. Immune dysfunction conditions included human immunodeficiency virus infection, solid organ or bone marrow transplant, autoimmune diseases, and cancer. We defined incident COVID-19 BTI as positive results from laboratory tests or diagnostic codes 14 days after at least 2 doses of mRNA vaccination; and severe COVID-19 BTI as hospitalization, invasive cardiopulmonary support, and/or death. We used propensity scores to match boosted versus nonboosted patients and evaluated hazards of incident and severe COVID-19 BTI using Cox regression after matching. Results Among patients without immune dysfunction, the relative effectiveness of booster (3 doses) after 6 months from the primary (2 doses) vaccination against BTI ranged from 69% to 81% during the Delta-predominant period and from 33% to 39% during the Omicron-predominant period. Relative effectiveness against BTI was lower among patients with immune dysfunction but remained statistically significant in both periods. Boosted patients had lower risk of COVID-19-related hospitalization (hazard ratios [HR] ranged from 0.5 [95% confidence interval {CI}, .48-.53] to 0.63 [95% CI, .56-.70]), invasive cardiopulmonary support, or death (HRs ranged from 0.46 [95% CI, .41-.52] to 0.63 [95% CI, .50-.79]) during both periods. Conclusions Booster vaccines remain effective against severe COVID-19 BTI throughout the Delta- and Omicron-predominant periods, regardless of patients' immune status.
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Affiliation(s)
- Jing Sun
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Qulu Zheng
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Alfred J Anzalone
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Alison G Abraham
- Department of Epidemiology, University of Colorado, Anschutz Medical Campus, Denver, Colorado, USA
| | - Amy L Olex
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Yifan Zhang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jomol Mathew
- Department of Population Health Sciences, University of Wisconsin–Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Nasia Safdar
- Department of Medicine, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Division of Infectious Diseases, William S. Middleton Veterans Affairs Hospital, Madison, Wisconsin, USA
| | - Melissa A Haendel
- Center for Health Artificial Intelligence, University of Colorado, Denver, Colorado, USA
| | - Dorry Segev
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jessica Y Islam
- Center for Immunization and Infection in Cancer, Cancer Epidemiology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
- Department of Oncologic Sciences, University of South Florida, Tampa, Florida, USA
| | - Jasvinder A Singh
- Department of Medicine and Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Roslyn B Mannon
- Division of Nephrology, Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Christopher G Chute
- Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Rena C Patel
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Gregory D Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Hatharaliyadda B, Schmitz M, Mork A, Osman F, Heise C, Safdar N, Pop-Vicas A. Surgical Site Infection Prevention Using "Strike Teams": The Experience of an Academic Colorectal Surgical Department. J Healthc Qual 2024; 46:22-30. [PMID: 38166163 DOI: 10.1097/jhq.0000000000000412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
ABSTRACT Surgical site infections (SSIs) are healthcare-acquired infections with substantial morbidity. Surgical site infection persist because of low adherence to prevention bundles comprising multiple infection control elements. We propose the "Strike Team" as an implementation strategy to improve adherence and reduce SSI in colorectal surgery. At an academic medical center, a multidisciplinary Strike Team met monthly to review colorectal SSI cases, audit and discuss barriers to adherence to SSI prevention bundle, and propose actionable feedback. The latter was shared with frontline clinicians by the Strike Team's surgical leaders in everyday practice. Colorectal SSI rates and bundle adherence data were disseminated quarterly via the hospital intranet and reviewed with surgeons at departmental meetings. Trends in adherence and SSI rates were analyzed by regression analysis using a time series model. While the Strike Team was active, adherence to antibiotic prophylaxis, maintenance of normoglycemia, and standardized intraoperative skin preparation significantly increased (p < .05). There was a trend toward statistically significant reduction in SSI (p = .07), although it was not maintained once the Strike Team activity was disrupted by the COVID-19 pandemic. Colorectal SSI prevention requires a resource-intensive, multidisciplinary approach with numerous strategies to improve adherence to infection control bundles, as illustrated by our SSI Strike Team experience.
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Fitzpatrick MA, Wirth M, Burns SP, Suda KJ, Weaver FM, Collins E, Safdar N, Evans CT. Management of Asymptomatic Bacteriuria and Urinary Tract Infections in Patients With Neurogenic Bladder and Factors Associated With Inappropriate Diagnosis and Treatment. Arch Phys Med Rehabil 2024; 105:112-119. [PMID: 37827486 PMCID: PMC10841968 DOI: 10.1016/j.apmr.2023.09.023] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 05/04/2023] [Accepted: 09/27/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE Inappropriate diagnosis and treatment of asymptomatic bacteriuria (ASB) and urinary tract infection (UTI) are leading causes of antibiotic overuse but have not been well-studied in patients with risks for complicated UTI such as neurogenic bladder (NB). Our aim was to describe ASB and UTI management in patients with NB and assess factors associated with inappropriate management. DESIGN Retrospective cohort study. SETTING Four Department of Veteran's Affairs (VA) medical centers. PARTICIPANTS Adults with NB due to spinal cord injury/disorder (SCI/D), multiple sclerosis (MS), or Parkinson disease (PD) and encounters with an ASB or UTI diagnosis between 2017 and 2018. Clinical and encounter data were extracted from the VA Corporate Data Warehouse and medical record reviews for a stratified sample of 300 encounters from N=291 patients. INTERVENTIONS None. MAIN OUTCOME MEASURES Prevalence of appropriate and inappropriate ASB and UTI diagnosis and treatment was summarized. Multivariable logistic regression models assessed factors associated with inappropriate management. RESULTS N=200 UTI and N=100 ASB encounters were included for the 291 unique patients (SCI/D, 39.9%; MS, 36.4%; PD, 23.7%). Most patients were men (83.3%), >65 years (62%), and used indwelling or intermittent catheterization (68.3%). Nearly all ASB encounters had appropriate diagnosis (98%). 70 (35%) UTI encounters had inappropriate diagnosis, including 55 (27.5%) with true ASB, all with inappropriate treatment. Among the remaining 145 UTI encounters, 54 (27%) had inappropriate treatment. Peripheral vascular disease, chronic kidney disease, and cerebrovascular disease were associated with increased odds of inappropriate management; indwelling catheter (aOR 0.35, P=.01) and Physical Medicine & Rehabilitation provider (aOR 0.29, P<.01) were associated with decreased odds. CONCLUSION Up to half of UTI encounters for patients with NB had inappropriate management, largely due to inappropriate UTI diagnosis in patients with true ASB. Interventions to improve ASB and UTI management in patients with NB should target complex patients with comorbidities being seen by non-rehabilitation providers.
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Affiliation(s)
- Margaret A Fitzpatrick
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr VA Hospital, Hines, IL; Loyola University Chicago Stritch School of Medicine, Maywood, IL.
| | - Marissa Wirth
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr VA Hospital, Hines, IL
| | - Stephen P Burns
- Spinal Cord Injury/Disorders Service, VA Puget Sound Healthcare System, Seattle, WA; Department of Physical Medicine and Rehabilitation, University of Washington School of Medicine, Seattle, WA
| | - Katie J Suda
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA; Department of Medicine, Center for Research on Healthcare, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Frances M Weaver
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr VA Hospital, Hines, IL; Loyola University Chicago Parkinson School of Health Sciences and Public Health, Maywood, IL
| | - Eileen Collins
- College of Nursing, University of Illinois Chicago, Chicago, IL
| | - Nasia Safdar
- Department of Medicine, Division of Infectious Diseases, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI; William S. Middleton VA Hospital, Madison, WI
| | - Charlesnika T Evans
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr VA Hospital, Hines, IL; Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, IL
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13
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Leite de Campos J, Gonçalves JL, Kates A, Steinberger A, Sethi A, Suen G, Shutske J, Safdar N, Goldberg T, Ruegg PL. Variation in partial direct costs of treating clinical mastitis among 37 Wisconsin dairy farms. J Dairy Sci 2023; 106:9276-9286. [PMID: 37641286 DOI: 10.3168/jds.2023-23388] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/12/2023] [Indexed: 08/31/2023]
Abstract
The objective of this observational study was to describe variations in partial direct costs of clinical mastitis (CM) treatments among 37 dairy herds using data obtained from herd management records. Animal health and drug purchase records were retrospectively collected from 37 Wisconsin dairy herds for a period of 1 yr. Each farm was visited to verify case definitions, recording accuracy, and detection criteria of CM cases. Descriptive statistics were used to summarize cost of drugs and milk discard. Differences in costs among protocols, intramammary (IMM) products, parities, days in milk, and recurrence were analyzed using ANOVA. Of 20,625 cases of CM, 31% did not receive antimicrobial treatment. The average cost of drugs and milk discard (including cases that were not treated) was $192.36 ± 8.90 (mean ± SE) per case and ranged among farms from $118.13 to $337.25. For CM cases treated only with IMM antimicrobials, milk discard accounted for 87% of total costs and was highly influenced by duration of therapy. Differences in costs were observed among parities, recurrence, and stage of lactation at case detection. Eight different treatment protocols were observed, but 64% of cases were treated using only IMM antimicrobials. Treatment costs varied among protocols; however, cases treated using both IMM and injectable antimicrobials as well as supportive therapy had the greatest costs as they were also treated for the longest duration. Ceftiofur was used for 82% of cases that received IMM antimicrobials while ampicillin was used for 51% of cases treated using injectable antimicrobials. With the exception of ceftiofur and pirlimycin IMM products, many IMM products were given for durations that exceeded the maximum labeled duration. For cases treated using only IMM therapy, as compared with observed costs, we estimated that partial direct costs could be reduced by $65.20 per case if the minimum labeled durations were used. Overall, partial direct costs per case varied among herds, cow factors, and treatment protocols and were highly influenced by the duration of therapy.
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Affiliation(s)
- J Leite de Campos
- Department of Animal Science, Michigan State University, East Lansing, MI 48824
| | - J L Gonçalves
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824
| | - A Kates
- Department of Medicine, University of Wisconsin-Madison, Madison, WI 53705
| | - A Steinberger
- Department of Bacteriology, University of Wisconsin-Madison, Madison, WI 53706
| | - A Sethi
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI 53726
| | - G Suen
- Department of Bacteriology, University of Wisconsin-Madison, Madison, WI 53706
| | - John Shutske
- Department of Biological Systems Engineering, University of Wisconsin-Madison, Madison, WI 53706
| | - N Safdar
- Department of Medicine, University of Wisconsin-Madison, Madison, WI 53705
| | - Tony Goldberg
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI 53706
| | - P L Ruegg
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824.
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Keating JA, Parmasad V, McKinley L, Safdar N. Integrating infection control and environmental management work systems to prevent Clostridioides difficile infection. Am J Infect Control 2023; 51:1444-1448. [PMID: 37329984 PMCID: PMC10773464 DOI: 10.1016/j.ajic.2023.06.008] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/04/2023] [Accepted: 06/05/2023] [Indexed: 06/19/2023]
Abstract
Effective infection prevention and control within health care settings requires collaboration and coordination between infection control and environmental management teams. However, the work systems of these teams can be difficult to integrate despite their shared goals. We provide results from a qualitative study of Clostridioides difficile infection prevention in Veterans Affairs facilities regarding challenges in coordination between these teams and opportunities to improve coordination and maximize infection prevention activities.
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Affiliation(s)
- Julie A Keating
- William S. Middleton Memorial Veterans Hospital, Madison, WI; Division of Infectious Disease, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Vishala Parmasad
- Division of Infectious Disease, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Linda McKinley
- William S. Middleton Memorial Veterans Hospital, Madison, WI
| | - Nasia Safdar
- William S. Middleton Memorial Veterans Hospital, Madison, WI; Division of Infectious Disease, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI.
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15
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Fitzpatrick MA, Solanki P, Wirth M, Weaver FM, Suda KJ, Burns SP, Safdar N, Collins E, Evans CT. Perceptions, experiences, and beliefs regarding urinary tract infections in patients with neurogenic bladder: A qualitative study. PLoS One 2023; 18:e0293743. [PMID: 37910578 PMCID: PMC10619779 DOI: 10.1371/journal.pone.0293743] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/18/2023] [Indexed: 11/03/2023] Open
Abstract
Although urinary tract infections (UTIs) are common in patients with neurogenic bladder (NB), limited data exist on UTI perceptions, experiences, and beliefs in these patients. We recruited adults with NB due to spinal cord injury/disorder (SCI/D) or multiple sclerosis (MS) at three Veterans Affairs (VA) medical centers to participate in 11 virtual focus groups. Audio transcripts were coded using a mixed approach with primary deductive codes linked to the Health Belief Model, and secondary inductive codes informed by grounded theory. Twenty-three Veterans (SCI/D, 78%; MS, 18.5%) participated between May 2021 and May 2022. Participants' perspectives, experiences, and beliefs about UTI were reflected in three major themes: 1) influence of caregivers; 2) influence of the healthcare environment and provider characteristics; and 3) barriers and facilitators to care. Caregivers promoted care-seeking behavior, enabled in-home care, and enhanced participants' self-efficacy to understand educational material. Participants had poor perceptions of providers who were not knowledgeable about NB or ineffectively communicated. Good relationships with providers who knew the participant well improved self-efficacy to follow provider recommendations. These results suggest that patient-centered interventions to improve UTI management in this population should expand caregiver involvement, enhance patient-provider communication, and target provider types and care settings that lack familiarity with NB.
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Affiliation(s)
- Margaret A. Fitzpatrick
- Center of Innovation for Veteran-Centered and Value-Driven Care, Rocky Mountain Regional VA Medical Center, Aurora, CO, United States of America
- Department of Medicine, Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
| | - Pooja Solanki
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, IL, United States of America
| | - Marissa Wirth
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, IL, United States of America
| | - Frances M. Weaver
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, IL, United States of America
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, United States of America
| | - Katie J. Suda
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States of America
- Department of Medicine, Center for Research on Healthcare, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Stephen P. Burns
- Spinal Cord Injury/Disorders Service, VA Puget Sound Healthcare System, Seattle, WA, United States of America
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, United States of America
| | - Nasia Safdar
- Department of Medicine, Division of Infectious Diseases, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States of America
- Department of Medicine, Division of Infectious Diseases, William S. Middleton VA Hospital, Madison, WI, United States of America
| | - Eileen Collins
- College of Nursing, University of Illinois Chicago, Chicago, IL, United States of America
| | - Charlesnika T. Evans
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, IL, United States of America
- Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
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16
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Parmasad V, Keating J, McKinley L, Evans C, Rubin M, Voils C, Safdar N. Frontline perspectives of C. difficile infection prevention practice implementation within veterans affairs health care facilities: A qualitative study. Am J Infect Control 2023; 51:1124-1131. [PMID: 36977453 DOI: 10.1016/j.ajic.2023.03.014] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/17/2023] [Accepted: 03/19/2023] [Indexed: 03/28/2023]
Abstract
BACKGROUND In 2012, the veteran's affairs (VA) multidrug-resistant organism (MDRO) Program Office launched a national Clostridioides difficile Infection (CDI) Prevention Initiative to address CDI as the most common cause of healthcare associated infections, mandating use of a VA CDI Bundle of prevention practices in inpatient facilities. We draw upon frontline worker perspectives to explore work system barriers and facilitators to the sustained implementation of the VA CDI Bundle using the systems engineering initiative for patient safety (SEIPS) framework. METHODS We interviewed 29 key stakeholders at 4 participating sites between October 2019-July 2021. Participants included infection prevention and control (IPC) leaders, nurses, physicians, and environmental management staff. Interviews were analyzed to identify themes and perceptions of facilitators and barriers to CDI prevention. RESULTS IPC leadership was most likely to know of the specific VA CDI Bundle components. Other participants demonstrated general knowledge of CDI prevention practices, with role-based variation in the depth of awareness of specific practices. Facilitators included leadership support, mandated CDI training and prevention practices, and readily available training from multiple sources. Barriers included limits to communication about facility or unit-level CDI rates, ambiguous communications about CDI prevention practice updates and VA mandates, and role-hierarchies that may limit team members' clinical contributions. DISCUSSION Recommendations include improving centrally-mandated clarity about and standardization of CDI prevention policies, including testing. Regular IPC training updates for all clinical stakeholders are also recommended. CONCLUSIONS A work system analysis using SEIPS identified barriers and facilitators to CDI prevention practices that could be addressed both nationally at the system level and locally at the facility level, specifically in the areas of communication and coordination.
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Affiliation(s)
- Vishala Parmasad
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI; William S. Middleton Memorial Veterans Hospital, Madison, WI.
| | - Julie Keating
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI; William S. Middleton Memorial Veterans Hospital, Madison, WI
| | - Linda McKinley
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI; William S. Middleton Memorial Veterans Hospital, Madison, WI
| | - Charlesnika Evans
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines Jr. Veterans Affairs Hospital, Hines
| | - Michael Rubin
- IDEAS 2.0 Center, George E. Whalen VA Medical Center, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT
| | - Corrine Voils
- William S. Middleton Memorial Veterans Hospital, Madison, WI; Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Nasia Safdar
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI; William S. Middleton Memorial Veterans Hospital, Madison, WI
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Zuniga-Chaves I, Eggers S, Kates AE, Safdar N, Suen G, Malecki KMC. Neighborhood socioeconomic status is associated with low diversity gut microbiomes and multi-drug resistant microorganism colonization. NPJ Biofilms Microbiomes 2023; 9:61. [PMID: 37640705 PMCID: PMC10462741 DOI: 10.1038/s41522-023-00430-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 08/18/2023] [Indexed: 08/31/2023] Open
Abstract
Social disparities continue to limit universal access to health care, directly impacting both lifespan and quality of life. Concomitantly, the gut microbiome has been associated with downstream health outcomes including the global rise in antibiotic resistance. However, limited evidence exists examining socioeconomic status (SES) associations with gut microbiome composition. To address this, we collected information on the community-level SES, gut microbiota, and other individual cofactors including colonization by multidrug-resistant organisms (MDROs) in an adult cohort from Wisconsin, USA. We found an association between SES and microbial composition that is mediated by food insecurity. Additionally, we observed a higher prevalence of MDROs isolated from individuals with low diversity microbiomes and low neighborhood SES. Our integrated population-based study considers how the interplay of several social and economic factors combine to influence gut microbial composition while providing a framework for developing future interventions to help mitigate the SES health gap.
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Affiliation(s)
- Ibrahim Zuniga-Chaves
- Department of Bacteriology, University of Wisconsin-Madison, Madison, WI, USA
- Microbiology Doctoral Training Program, University of Wisconsin-Madison, Madison, WI, USA
| | - Shoshannah Eggers
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Ashley E Kates
- Division of Infectious Disease, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Nasia Safdar
- Division of Infectious Disease, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Garret Suen
- Department of Bacteriology, University of Wisconsin-Madison, Madison, WI, USA.
| | - Kristen M C Malecki
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
- Environmental and Occupational Health Sciences, School of Public Health, University of Chicago Illinois, IL, Chicago, USA.
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Wirth M, Suda KJ, Burns SP, Weaver FM, Collins E, Safdar N, Kartje R, Evans CT, Fitzpatrick MA. Retrospective Cohort Study of Patient-Reported Urinary Tract Infection Signs and Symptoms Among Individuals With Neurogenic Bladder. Am J Phys Med Rehabil 2023; 102:663-669. [PMID: 36927768 PMCID: PMC10363175 DOI: 10.1097/phm.0000000000002204] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE The aim of the study is to characterize patient-reported signs and symptoms of urinary tract infections in patients with neurogenic bladder to inform development of an intervention to improve the accuracy of urinary tract infection diagnosis. DESIGN This is a retrospective cohort study of adults with neurogenic bladder due to spinal cord injury/disorder, multiple sclerosis, and/or Parkinson disease and urinary tract infection encounters at four medical centers between 2017 and 2018. Data were collected through medical record review and analyzed using descriptive statistics and unadjusted logistic regression. RESULTS Of 199 patients with neurogenic bladder and urinary tract infections, 37% were diagnosed with multiple sclerosis, 36% spinal cord injury/disorder, and 27% Parkinson disease. Most patients were men (88%) in inpatient or long-term care settings (60%) with bladder catheters (67%). Fever was the most frequent symptom (32%). Only 38% of patients had a urinary tract-specific symptom; 48% had only nonspecific to the urinary tract symptoms. Inpatient encounter setting (odds ratio, 2.5; 95% confidence interval, 1.2-5.2) was associated with greater odds of only having nonspecific urinary tract symptoms. CONCLUSIONS In patients with neurogenic bladder and urinary tract infection encounters, nonspecific signs and symptoms are most frequently reported. These results can inform interventions to help providers better elicit and document urinary tract-specific symptoms in patients with neurogenic bladder presenting with possible urinary tract infection, particularly among hospitalized patients. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. CME OBJECTIVES Upon completion of this article, the reader should be able to: (1) Describe patient-reported signs and symptoms of urinary tract infection (UTI) in adults with neurogenic bladder (NB) due to spinal cord injury/disorder (SCI/D), multiple sclerosis (MS), and Parkinson disease (PD); (2) Differentiate urinary tract specific symptoms and nonspecific symptoms reported by adults with NB for suspected UTI and recognize how this may impact UTI diagnosis in this population; and (3) Recognize differences in UTI signs and symptoms reported by patients with NB based on patient and encounter characteristics. LEVEL Advanced. ACCREDITATION The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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Affiliation(s)
- Marissa Wirth
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, IL, USA
| | - Katie J. Suda
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Stephen P. Burns
- VA Puget Sound Healthcare System, Seattle, WA, USA
- University of Washington School of Medicine, Seattle, WA, USA
| | - Frances M. Weaver
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, IL, USA
- Loyola University Chicago Parkinson School of Health Sciences and Public Health, Maywood, IL, USA
| | - Eileen Collins
- University of Illinois at Chicago College of Nursing, Chicago, IL, USA
| | - Nasia Safdar
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
- William S. Middleton VA Hospital, Madison, WI, USA
| | - Rebecca Kartje
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, IL, USA
| | - Charlesnika T. Evans
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, IL, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Margaret A. Fitzpatrick
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, IL, USA
- Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
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Suzuki H, Perencevich EN, Hockett Sherlock S, Clore GS, O'Shea AMJ, Forrest GN, Pfeiffer CD, Safdar N, Crnich C, Gupta K, Strymish J, Lira GB, Bradley S, Cadena-Zuluaga J, Rubin M, Bittner M, Morgan D, DeVries A, Miell K, Alexander B, Schweizer ML. Implementation of a Prevention Bundle to Decrease Rates of Staphylococcus aureus Surgical Site Infection at 11 Veterans Affairs Hospitals. JAMA Netw Open 2023; 6:e2324516. [PMID: 37471087 DOI: 10.1001/jamanetworkopen.2023.24516] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2023] Open
Abstract
Importance While current evidence has demonstrated a surgical site infection (SSI) prevention bundle consisting of preoperative Staphylococcus aureus screening, nasal and skin decolonization, and use of appropriate perioperative antibiotic based on screening results can decrease rates of SSI caused by S aureus, it is well known that interventions may need to be modified to address facility-level factors. Objective To assess the association between implementation of an SSI prevention bundle allowing for facility discretion regarding specific component interventions and S aureus deep incisional or organ space SSI rates. Design, Setting, and Participants This quality improvement study was conducted among all patients who underwent coronary artery bypass grafting, cardiac valve replacement, or total joint arthroplasty (TJA) at 11 Veterans Administration hospitals. Implementation of the bundle was on a rolling basis with the earliest implementation occurring in April 2012 and the latest implementation occurring in July 2017. Data were collected from January 2007 to March 2018 and analyzed from October 2020 to June 2023. Interventions Nasal screening for S aureus; nasal decolonization of S aureus carriers; chlorhexidine bathing; and appropriate perioperative antibiotic prophylaxis according to S aureus carrier status. Facility discretion regarding how to implement the bundle components was allowed. Main Outcomes and Measures The primary outcome was deep incisional or organ space SSI caused by S aureus. Multivariable logistic regression with generalized estimating equation (GEE) and interrupted time-series (ITS) models were used to compare SSI rates between preintervention and postintervention periods. Results Among 6696 cardiac surgical procedures and 16 309 TJAs, 95 S aureus deep incisional or organ space SSIs were detected (25 after cardiac operations and 70 after TJAs). While the GEE model suggested a significant association between the intervention and decreased SSI rates after TJAs (adjusted odds ratio, 0.55; 95% CI, 0.31-0.98), there was not a significant association when an ITS model was used (adjusted incidence rate ratio, 0.88; 95% CI, 0.32-2.39). No significant associations after cardiac operations were found. Conclusions and Relevance Although this quality improvement study suggests an association between implementation of an SSI prevention bundle and decreased S aureus deep incisional or organ space SSI rates after TJAs, it was underpowered to see a significant difference when accounting for changes over time.
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Affiliation(s)
- Hiroyuki Suzuki
- Center for Access and Delivery Research & Evaluation (CADRE), Iowa City Veterans' Affairs Health Care System, Iowa City, Iowa
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City
| | - Eli N Perencevich
- Center for Access and Delivery Research & Evaluation (CADRE), Iowa City Veterans' Affairs Health Care System, Iowa City, Iowa
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City
| | - Stacey Hockett Sherlock
- Center for Access and Delivery Research & Evaluation (CADRE), Iowa City Veterans' Affairs Health Care System, Iowa City, Iowa
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City
| | - Gosia S Clore
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City
| | - Amy M J O'Shea
- Center for Access and Delivery Research & Evaluation (CADRE), Iowa City Veterans' Affairs Health Care System, Iowa City, Iowa
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City
| | - Graeme N Forrest
- Division of Infectious Disease, Rush University Medical Center, Chicago, Illinois
| | - Christopher D Pfeiffer
- Infectious Diseases Section, VA Portland Health Care System, Portland, Oregon
- Division of Infectious Diseases, OHSU, Portland, Oregon
| | - Nasia Safdar
- Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
| | - Christopher Crnich
- Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
| | - Kalpana Gupta
- Division of Infectious Diseases, Department of Medicine, Boston VA Healthcare System, Boston, Massachusetts
- Center for Healthcare Organization and Implementation Research (CHOIR), Boston VA Healthcare System, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Judith Strymish
- Division of Infectious Diseases, Department of Medicine, Boston VA Healthcare System, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Gio Baracco Lira
- Division of Infectious Diseases, Miller School of Medicine, University of Miami, Miami, Florida
- Hospital Epidemiology and Occupational Health Service, Miami VA Healthcare System, Miami, Florida
| | - Suzanne Bradley
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
- Infectious Diseases Section, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Jose Cadena-Zuluaga
- South Texas Veterans Health Care System, San Antonio
- Long School of Medicine, UT Health San Antonio, San Antonio, Texas
| | - Michael Rubin
- Department of Veterans' Affairs, VA Salt Lake City Healthcare System, Salt Lake City, Utah
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Marvin Bittner
- Nebraska-Western Iowa Veterans Affairs Health Care System, Omaha, Nebraska
- Department of Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Daniel Morgan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
- VA Maryland Health Care System, Baltimore
| | - Aaron DeVries
- Minneapolis VA Medical Center, Minneapolis, Minnesota
| | - Kelly Miell
- Center for Access and Delivery Research & Evaluation (CADRE), Iowa City Veterans' Affairs Health Care System, Iowa City, Iowa
| | - Bruce Alexander
- Center for Access and Delivery Research & Evaluation (CADRE), Iowa City Veterans' Affairs Health Care System, Iowa City, Iowa
| | - Marin L Schweizer
- Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
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20
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Budi ND, Godfrey JJ, Safdar N, Shukla SK, Rose WE. Efficacy of Omadacycline or Vancomycin Combined With Germinants for Preventing Clostridioides difficile Relapse in a Murine Model. J Infect Dis 2023; 227:622-630. [PMID: 35904942 PMCID: PMC9978312 DOI: 10.1093/infdis/jiac324] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 07/15/2022] [Accepted: 07/27/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Clostridioides difficile infections (CDI) and recurrence (rCDI) are major health care burdens. Recurrence is likely caused by spores in the gastrointestinal tract that germinate after antibiotic therapy. This murine study explores germinant-antibiotic combinations for CDI. METHODS Previously described murine models were evaluated using C. difficile VPI 10463. The severe model compared omadacycline versus vancomycin in survival, weight loss, clinical scoring, and C. difficile toxin production. The nonsevere model compared these antibiotics with and without germinants (solution of sodium taurocholate, taurine, sodium docusate, calcium gluconate). Additionally, colon histopathology, bile acid analysis, environmental/spore shedding, and 16S sequencing was evaluated. RESULTS In the severe model, omadacycline-treated mice had 60% survival versus 13.3% with vancomycin (hazard ratio [HR], 0.327; 95% confidence interval [CI],.126-.848; P = .015) along with decreased weight loss, and disease severity. In the nonsevere model, all mice survived with antibiotic-germinant treatment versus 60% antibiotics alone (HR, 0.109; 95% CI, .02-.410; P = .001). Omadacycline resulted in less changes in bile acids and microbiota composition. Germinant-treated mice showed no signs of rCDI, spore shedding, or significant toxin production at 15 days. CONCLUSIONS In murine models of CDI, omadacycline improved survival versus vancomycin. Germinant-antibiotic combinations were more effective at preventing rCDI compared to antibiotics alone without inducing toxin production.
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Affiliation(s)
- Noah D Budi
- School of Pharmacy, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jared J Godfrey
- Division of Infectious Diseases, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.,William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA
| | - Nasia Safdar
- Division of Infectious Diseases, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.,William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA
| | - Sanjay K Shukla
- Center for Precision Medicine Research, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Warren E Rose
- School of Pharmacy, University of Wisconsin-Madison, Madison, Wisconsin, USA
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21
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McKinley L, Goedken CC, Balkenende E, Clore G, Hockett SS, Bartel R, Bradley S, Judd J, Lyons G, Rock C, Rubin M, Shaughnessy C, Reisinger HS, Perencevich E, Safdar N. Evaluation of daily environmental cleaning and disinfection practices in veterans affairs acute and long-term care facilities: A mixed methods study. Am J Infect Control 2023; 51:205-213. [PMID: 35644297 DOI: 10.1016/j.ajic.2022.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/01/2022] [Revised: 05/16/2022] [Accepted: 05/19/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To describe daily environmental cleaning and disinfection practices and their associations with cleaning rates while exploring contextual factors experienced by healthcare workers involved in the cleaning process. METHODS A convergent mixed methods approach using quantitative observations (ie, direct observation of environmental service staff performing environmental cleaning using a standardized observation form) and qualitative interviews (ie, semistructured interviews of key healthcare workers) across 3 Veterans Affairs acute and long-term care facilities. RESULTS Between December 2018 and May 2019 a total of sixty-two room observations (N = 3602 surfaces) were conducted. The average observed surface cleaning rate during daily cleaning in patient rooms was 33.6% for all environmental surfaces and 60.0% for high-touch surfaces (HTS). Higher cleaning rates were observed with bathroom surfaces (Odds Ratio OR = 3.23), HTSs (OR = 1.57), and reusable medical equipment (RME) (OR = 1.40). Lower cleaning rates were observed when cleaning semiprivate rooms (OR = 0.71) and rooms in AC (OR = 0.56). In analysis stratified by patient presence (ie, present, or absent) in the room during cleaning, patient absence was associated with higher cleaning rates for HTSs (OR = 1.71). In addition, the odds that bathroom surfaces being cleaned more frequently than bedroom surfaces decreased (OR = 1.97) as well as the odds that private rooms being cleaned more frequently than semi-private rooms also decreased (OR = 0.26; 0.07-0.93). Between January and June 2019 eighteen qualitative interviews were conducted and found key themes (ie, patient presence and semiprivate rooms) as potential barriers to cleaning; this supports findings from the quantitative analysis. CONCLUSION Overall observed rates of daily cleaning of environmental surfaces in both acute and long-term care was low. Standardized environmental cleaning practices to address known barriers, specifically cleaning practices when patients are present in rooms and semi-private rooms are needed to achieve improvements in cleaning rates.
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Affiliation(s)
| | - C C Goedken
- Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA, Iowa City, IA
| | - E Balkenende
- Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA, Iowa City, IA; University of Iowa, Iowa City, IA
| | - G Clore
- Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA, Iowa City, IA; University of Iowa, Iowa City, IA
| | - Sherlock S Hockett
- Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA, Iowa City, IA; University of Iowa, Iowa City, IA
| | - R Bartel
- Patient-Centered Outcomes Research Institute (PCORI), Washington DC
| | - S Bradley
- Ann Arbor VA, Ann Arbor, MI; University of Michigan, Ann Arbor, MI
| | - J Judd
- Salt Lake City VA, Salt Lake City, UT; University of Utah, Salt Lake City, UT
| | - Goedken Lyons
- Ann Arbor VA, Ann Arbor, MI; University of Michigan, Ann Arbor, MI
| | - C Rock
- Johns Hopkins University, Baltimore, MD
| | - M Rubin
- Salt Lake City VA, Salt Lake City, UT; University of Utah, Salt Lake City, UT
| | | | - H S Reisinger
- Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA, Iowa City, IA; University of Iowa, Iowa City, IA
| | - E Perencevich
- Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA, Iowa City, IA; University of Iowa, Iowa City, IA
| | - N Safdar
- Madison VA, Madison, WI; University of Wisconsin - Madison, Madison, WI
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22
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Urtecho M, Torres Roldan VD, Nayfeh T, Espinoza Suarez NR, Ranganath N, Sampathkumar P, Chopra V, Safdar N, Prokop LJ, O’Horo JC. Comparing Complication Rates of Midline Catheter vs Peripherally Inserted Central Catheter. A Systematic Review and Meta-analysis. Open Forum Infect Dis 2023; 10:ofad024. [PMID: 36751645 PMCID: PMC9898877 DOI: 10.1093/ofid/ofad024] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 12/05/2022] [Accepted: 01/16/2023] [Indexed: 01/19/2023] Open
Abstract
Background Peripherally inserted central catheters (PICCs) and midlines are commonly used devices for reliable vascular access. Infection and thrombosis are the main adverse effects of these catheters. We aimed to evaluate the relative risk of complications from midlines and PICCs. Methods We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies. The primary outcomes were catheter-related bloodstream infection (CRBSI) and thrombosis. Secondary outcomes evaluated included mortality, failure to complete therapy, catheter occlusion, phlebitis, and catheter fracture. The certainty of evidence was assessed using the GRADE approach. Results Of 8368 citations identified, 20 studies met the eligibility criteria, including 1 RCT and 19 observational studies. Midline use was associated with fewer patients with CRBSI compared with PICCs (odds ratio [OR], 0.24; 95% CI, 0.15-0.38). This association was not observed when we evaluated risk per catheter. No significant association was found between catheters when evaluating risk of localized thrombosis and pulmonary embolism. A subgroup analysis based on location of thrombosis showed higher rates of superficial venous thrombosis in patients using midlines (OR, 2.30; 95% CI, 1.48-3.57). We did not identify any significant difference between midlines and PICCs for the secondary outcomes. Conclusions Our findings suggest that patients who use midlines might experience fewer CRBSIs than those who use PICCs. However, the use of midline catheters was associated with greater risk of superficial vein thrombosis. These findings can help guide future cost-benefit analyses and direct comparative RCTs to further characterize the efficacy and risks of PICCs vs midline catheters.
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Affiliation(s)
- Meritxell Urtecho
- Correspondence: J. C. O’Horo, MD, MPH, Division of Infectious Diseases and Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 (); or M. Urtecho, MD, Mayo Clinic Evidence-based Practice Center Mayo Clinic, 200 First Street SW, Rochester, MN 55905 ()
| | - Victor D Torres Roldan
- Mayo Clinic Evidence-based Practice Center, Rochester, Minnesota, USA,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Tarek Nayfeh
- Mayo Clinic Evidence-based Practice Center, Rochester, Minnesota, USA,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Nischal Ranganath
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Priya Sampathkumar
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Vineet Chopra
- Division of Hospital Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Nasia Safdar
- Division of Infectious Diseases, University of Wisconsin, Madison, Wisconsin, USA
| | - Larry J Prokop
- Department of Library-Public Services, Mayo Clinic, Rochester, Minnesota, USA
| | - John C O’Horo
- Correspondence: J. C. O’Horo, MD, MPH, Division of Infectious Diseases and Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 (); or M. Urtecho, MD, Mayo Clinic Evidence-based Practice Center Mayo Clinic, 200 First Street SW, Rochester, MN 55905 ()
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23
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Goto M, Hasegawa S, Balkenende EC, Clore GS, Safdar N, Perencevich EN. Effectiveness of Ultraviolet-C Disinfection on Hospital-Onset Gram-Negative Rod Bloodstream Infection: A Nationwide Stepped-Wedge Time-Series Analysis. Clin Infect Dis 2023; 76:291-298. [PMID: 36124706 DOI: 10.1093/cid/ciac776] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 07/06/2022] [Revised: 09/09/2022] [Accepted: 09/14/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The effectiveness of enhanced terminal room cleaning with ultraviolet C (UV-C) disinfection in reducing gram-negative rod (GNR) infections has not been well evaluated. We assessed the association of implementation of UV-C disinfection systems with incidence rates of hospital-onset (HO) GNR bloodstream infection (BSI). METHODS We obtained information regarding UV-C use and the timing of implementation through a survey of all Veterans Health Administration (VHA) hospitals providing inpatient acute care. Episodes of HO-GNR BSI were identified between January 2010 and December 2018. Bed days of care (BDOC) was used as the denominator. Over-dispersed Poisson regression models were fitted with hospital-specific random intercept, UV-C disinfection use for each month, baseline trend, and seasonality as explanatory variables. Hospitals without UV-C use were also included to the analysis as a nonequivalent concurrent control group. RESULTS Among 128 VHA hospitals, 120 provided complete survey responses with 40 reporting implementations of UV-C systems. We identified 13 383 episodes of HO-GNR BSI and 24 141 378 BDOC. UV-C use was associated with a lower incidence rate of HO-GNR BSI (incidence rate ratio: 0.813; 95% confidence interval: .656-.969; P = .009). There was wide variability in the effect size of UV-C disinfection use among hospitals. CONCLUSIONS In this large quasi-experimental analysis within the VHA System, enhanced terminal room cleaning with UV-C disinfection was associated with an approximately 19% lower incidence of HO-GNR BSI, with wide variability in effectiveness among hospitals. Further studies are needed to identify the optimal implementation strategy to maximize the effectiveness of UV-C disinfection technology.
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Affiliation(s)
- Michihiko Goto
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA.,Division of Infectious Diseases, Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Shinya Hasegawa
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA.,Division of Infectious Diseases, Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Erin C Balkenende
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA.,Division of General Internal Medicine, Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Gosia S Clore
- Division of General Internal Medicine, Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Nasia Safdar
- Primary and Specialty Medicine Service Line, WIlliam S. Middleton Memorial VA Medical Center, Madison, Wisconsin, USA.,Department of Medicine, Division of Infectious Diseases, University of Wisconsin School of Public Health and Medicine, Madison, Wisconsin, USA
| | - Eli N Perencevich
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA.,Division of General Internal Medicine, Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
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24
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Hanson L, VandeVusse L, Forgie M, Malloy E, Singh M, Scherer M, Kleber D, Dixon J, Hryckowian AJ, Safdar N. A randomized controlled trial of an oral probiotic to reduce antepartum group B Streptococcus colonization and gastrointestinal symptoms. Am J Obstet Gynecol MFM 2023; 5:100748. [PMID: 36108911 DOI: 10.1016/j.ajogmf.2022.100748] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Probiotics have been suggested as a strategy to reduce antenatal group B Streptococcus colonization. Although probiotics are known to improve gastrointestinal symptoms, this has not been studied during pregnancy. OBJECTIVE This study aimed to evaluate the efficacy of a probiotic to reduce: (1) standard-of-care antenatal group B Streptococcus colonization and colony counts and (2) gastrointestinal symptoms of pregnancy. STUDY DESIGN In a double-blind fashion, 109 healthy adult pregnant people were randomized to Florajen3 probiotic or placebo capsules once daily from 28 weeks' gestation until labor onset. Baseline vaginal and rectal study swabs for group B Streptococcus colony-forming units and microbiome analysis were collected at 28 and 36 weeks' gestation. Standard-of-care vaginal to rectal group B Streptococcus swabs were collected from all participants at 36 weeks' gestation and determined the need for intrapartum antibiotic prophylaxis. Data collection included solicitation of adverse events, demographic information, Antepartum Gastrointestinal Symptom Assessment score, yogurt ingestion, sexual activity, and vaginal cleaning practices. RESULTS A total of 83 participants completed the study to 36 weeks' gestation with no adverse events. Standard-of-care group B Streptococcus colonization was 20.4% in the control group and 15.4% in probiotic group participants (-5%; P=.73). The relative risk for positive standard-of-care vaginal-rectal group B Streptococcus colonization was 1.33 (95% confidence interval, 0.5-3.40) times higher in the control group than in the probiotic group (P=.55). There were no differences in median vaginal (P=.16) or rectal (P=.20) group B streptococcus colony-forming units at baseline or at 36 weeks (vaginal P>.999; rectal P=.56). Antepartum Gastrointestinal Symptom Assessment scores were similar at baseline (P=.19), but significantly decreased in probiotic group participants at 36 weeks (P=.02). No covariates significantly altered group B Streptococcus colonization. Significantly more Florajen3 bacteria components were recovered from the vaginal-rectal samples of probiotic group participants (32%; P=.04) compared with controls. CONCLUSION The findings of this study provided insufficient evidence for the clinical application of the Florajen3 probiotic intervention to reduce standard-of-care vaginal-rectal group B Streptococcus colonization. The prevalence of group B Streptococcus was lower than expected in the study population, and intervention adherence was poor. Probiotic bacteria colonization of the genitourinary tract occurred more in intervention group participants than in controls and significantly reduced gastrointestinal symptoms of pregnancy.
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Affiliation(s)
- Lisa Hanson
- Marquette University College of Nursing, Milwaukee, WI (Drs Hanson, VandeVusse, Malloy, and Singh).
| | - Leona VandeVusse
- Marquette University College of Nursing, Milwaukee, WI (Drs Hanson, VandeVusse, Malloy, and Singh)
| | - Marie Forgie
- Advocate Aurora UW Medical Group, Aurora Sinai Medical Center, Milwaukee, WI (Drs Forgie and Malloy)
| | - Emily Malloy
- Advocate Aurora UW Medical Group, Aurora Sinai Medical Center, Milwaukee, WI (Drs Forgie and Malloy); Advocate Aurora Sinai Midwifery and Wellness Center, Milwaukee, WI (Dr Malloy and Ms Scherer)
| | - Maharaj Singh
- Marquette University College of Nursing, Milwaukee, WI (Drs Hanson, VandeVusse, Malloy, and Singh); Advocate Aurora Research Institute, Milwaukee, WI (Dr Singh and Ms Kleber)
| | - MaryAnne Scherer
- Advocate Aurora Sinai Midwifery and Wellness Center, Milwaukee, WI (Dr Malloy and Ms Scherer)
| | - Diana Kleber
- Advocate Aurora Research Institute, Milwaukee, WI (Dr Singh and Ms Kleber)
| | - Jonah Dixon
- University of Wisconsin School of Medicine and Public Health, Madison, WI (Mr Dixon and Dr Safdar)
| | - Andrew J Hryckowian
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin-Madison, Madison, WI (Dr Hryckowian); Department of Medical Microbiology and Immunology, University of Wisconsin-Madison, Madison, WI (Dr Hryckowian)
| | - Nasia Safdar
- University of Wisconsin School of Medicine and Public Health, Madison, WI (Mr Dixon and Dr Safdar)
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25
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Scaria E, Safdar N, Alagoz O. Validating agent-based simulation model of hospital-associated Clostridioides difficile infection using primary hospital data. PLoS One 2023; 18:e0284611. [PMID: 37083629 PMCID: PMC10120937 DOI: 10.1371/journal.pone.0284611] [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] [Received: 12/05/2022] [Accepted: 04/04/2023] [Indexed: 04/22/2023] Open
Abstract
As agent-based models (ABMs) are increasingly used for modeling infectious diseases, model validation is becoming more crucial. In this study, we present an alternate approach to validating hospital ABMs that focuses on replicating hospital-specific conditions and proposes a new metric for validating the social-environmental network structure of ABMs. We adapted an established ABM representing Clostridioides difficile infection (CDI) spread in a generic hospital to a 426-bed Midwestern academic hospital. We incorporated hospital-specific layout, agent behaviors, and input parameters estimated from primary hospital data into the model, referred to as H-ABM. We compared the predicted CDI rate against the observed rate from 2013-2018. We used colonization pressure, a measure of nearby infectious agents, to validate the socio-environmental agent networks in the ABM. Finally, we conducted additional experiments to compare the performance of individual infection control interventions in the H-ABM and the generic model. We find that the H-ABM is able to replicate CDI trends during 2013-2018, including a roughly 46% drop during a period of greater infection control investment. High CDI burden in socio-environmental networks was associated with a significantly increased risk of C. difficile colonization or infection (Risk ratio: 1.37; 95% CI: [1.17, 1.59]). Finally, we found that several high-impact infection control interventions have diminished impact in the H-ABM. This study presents an alternate approach to validation of ABMs when large-scale calibration is not appropriate for specific settings and proposes a new metric for validating socio-environmental network structure of ABMs. Our findings also demonstrate the utility of hospital-specific modeling.
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Affiliation(s)
- Elizabeth Scaria
- Department of Industrial and Systems Engineering, University of Wisconsin- Madison, Madison, WI, United States of America
| | - Nasia Safdar
- Population Health Sciences, School of Medicine and Public Health, University of Wisconsin- Madison, Madison, WI, United States of America
- Division of Infectious Diseases, Department of Medicine, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI, United States of America
- William S. Middleton Memorial Veterans Hospital, Madison, WI, United States of Ameirca
| | - Oguzhan Alagoz
- Department of Industrial and Systems Engineering, University of Wisconsin- Madison, Madison, WI, United States of America
- Population Health Sciences, School of Medicine and Public Health, University of Wisconsin- Madison, Madison, WI, United States of America
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26
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D’Angelo C, Sudakaran S, Asimakopoulos F, Hematti P, El-Gamal D, Safdar N, Callander N. Perturbation of the gut microbiome and association with outcomes following autologous stem cell transplantation in patients with multiple myeloma. Leuk Lymphoma 2023; 64:87-97. [PMID: 36218226 PMCID: PMC9905274 DOI: 10.1080/10428194.2022.2131410] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 09/21/2022] [Accepted: 09/26/2022] [Indexed: 11/07/2022]
Abstract
The gut microbiome is an important feature of host immunity with associations to hematologic malignancies and cellular therapy. We evaluated the gut microbiome and dietary intake in patients with multiple myeloma undergoing autologous stem cell transplantation. Thirty patients were enrolled, and samples were collected at four timepoints: pre-transplant, engraftment, day +100 (D + 100), and 9-12 months post-transplant. Microbiome analysis demonstrated a loss of alpha diversity at the engraftment timepoint driven by decreases in Blautia, Ruminococcus, and Faecalibacterium genera and related to intravenous antibiotic exposure. Higher fiber intake was associated with increased relative abundance of Blautia at the pre-transplant timepoint. Lower alpha diversity at engraftment was associated with a partial response to therapy compared with complete response (CR) or very good partial response (VGPR) (CR/VGPR vs. PR, p < 0.05). We conclude that loss of bacterial diversity at engraftment may be associated with impaired response to stem cell transplantation in multiple myeloma.
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Affiliation(s)
- Christopher D’Angelo
- Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Fotis Asimakopoulos
- Wisconsin Institute for Discovery, University of Wisconsin - Madison, Madison, WI, USA
| | - Peiman Hematti
- Department of Medicine, University of Wisconsin Carbone Cancer Center Madison, WI, USA
| | - Dalia El-Gamal
- Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - Nasia Safdar
- Department of Medicine, University of Wisconsin Carbone Cancer Center Madison, WI, USA
| | - Natalie Callander
- Department of Medicine, University of Wisconsin Carbone Cancer Center Madison, WI, USA
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Taylor L, Tischendorf JS, Schulz L, Safdar N, Lepak A. 927. Successful Implementation of an Inpatient Fluoroquinolone (FQ) Pre-Authorization (PA) Program at a Tertiary Care Academic Center and Associated Changes in Antibiotic Use, Antibiogram Susceptibility, and Provider Behavioral Changes. Open Forum Infect Dis 2022. [PMCID: PMC9752843 DOI: 10.1093/ofid/ofac492.772] [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: 12/23/2022] Open
Abstract
Background In 2017, our adult tertiary care academic hospital in the Midwest implemented an inpatient fluoroquinolone (FQ) prior authorization (PA) policy using the electronic health record (EHR) as a stewardship tool. We examined the changes in antibiotic use, the antibiogram, and antibiotic use at an affiliated hospital without PA but staffed by physicians from the PA site. Methods This quasi-experimental study used a pre-post implementation design to evaluate a PA policy at our University Hospital requiring approval of all inpatient FQ use from the antimicrobial stewardship physician or infectious disease consult teams. Time periods consisted of 2.5 year pre-implementation, 9-month wash-in (pilot on 2 wards), and 5-year post-implementation periods. Monthly antibiotic use in days of therapy per 1000 patient days (DOT/KPD) and antibiogram data, limited to first inpatient culture per patient per week from any anatomic site, were collected. Monthly FQ use from an affiliated hospital without the restriction policy staffed by physicians from the University Hospital was also collected. Changes in antibiotic use were examined using t-test, or Mann-Whitney Rank Sum, and antibiotic susceptibility rates were compared using z-test. Results Following implementation of PA, FQ use decreased by 76% (-53.2 DOT/KPD, p< 0.001) (Fig. 1). FQ use also declined from 26.4 DOT/KPD to 7.7 DOT/KPD (p< 0.001) at the affiliated hospital without PA but staffed by physicians from University Hospital. Changes in gram-negative agents use are shown in Table 1, with greatest increase noted for ceftriaxone (∼50%). The ciprofloxacin inpatient antibiogram improved significantly (Table 2); whereas, a slight decline in susceptibility was noted for ceftriaxone and cefepime.
Fluoroquinolone use across study periods. ![]() Wash-in period included a pilot fluoroquinolone prior authorization in 2 wards. Abbreviations: Days of Therapy (DOT); patient days (PD)
Mean antibiotic days of therapy during each study period. ![]() Successive shortages for cefepime and piperacillin-tazobactam during the wash-in period, as indicated by NA.
Proportion of susceptible isolates pre- and post-implementation of Fluoroquinolone prior-authorization. Pip-tazo, piperacillin-tazobactam; %S, the percent susceptible for Pre- or Post-implementation periods; * indicates significant improvement and ¥ significant decline (p<0.05) pre vs post; R indicates intrinsic resistance. Conclusion FQ PA leads to significant and sustained decline in FQ use, indicating that suitable alternative choices exist for most hospitalized patients. Decreased FQ use was associated with increased use of cephalosporins, mainly ceftriaxone. As might be expected, changes in use were associated with subsequent changes in the antibiogram. This intervention was associated with a significant decline in FQ use at a site without the restriction policy and the EHR modifications, suggesting successful diffusion of educational and behavioral changes. Disclosures Lindsay Taylor, MD, Merck: Grant/Research Support Jessica S. Tischendorf, MD, MS, Merck: Grant/Research Support.
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Affiliation(s)
- Lindsay Taylor
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | | | - Nasia Safdar
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Legenza L, Zunenshine J, Safdar N, Safdar N, Guest C, Jadhav H, Fritsche TR, Lee JDD. 957. Interactive Antibiogram Decision Support Tool Predicated Upon Infection Site and Probable Pathogens. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.800] [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: 12/23/2022] Open
Abstract
Abstract
Background
Current methods for displaying summary antibiograms are static, have limited utility and are not user friendly. We present an interactive web application for visualization of antibiogram data.
Methods
Antibiotic susceptibility data for first, non-duplicate patient infection isolates with source/site data were collected from 2009–2018 at an integrated health system for the visualizations. Iterative user-centered design sessions were held with healthcare providers to guide prototype development, including assessment of source groupings and rational for aggregating data. Three providers participated in initial and follow-up sessions (6 total) with study personnel. Data were aggregated by agreed-upon infection-source and pathogen; antibiotic results with < 30 isolates were excluded.
Results
The multi-year dataset included 119,333 non-duplicative isolates from 194 unique infection sites; nearly half were E. coli (n=50,404). Final infection source groupings with interactive data visualization fields are shown in Figure 1. First an infection source is selected; the visualization then shows pathogen prevalence in descending order. Providers can view susceptibility results for all antibiotics or deselect all and view only those under consideration, such as the four displayed in Figure 1. Resulting bar charts allow providers to view which pathogens tested have greater than 80% or 90% susceptibility to each antibiotic. Susceptibilities for multiple pathogens can also be visualized with the dodged feature (Figure 2). The large dataset collected supports source-specific susceptibility results (e.g. eye infections). The visualization allows providers to see how susceptibility by pathogen may cross clinically meaningful thresholds of 80% and 90% for different infection sources, such as urinary tract compared to bloodstream infections. Feedback from providers on the prototype was overwhelmingly positive. Figure 1.Visualization of urine isolates, E. coli and user selected antibiotics
Final source groupings: Urine, Skin/Soft Tissue, Blood, Respiratory Secretions, Fluid, Ear, Bone, Vaginal/Perianal, Eye, and Abscess. Figure 2.Selected antibiotic susceptibilities for multiple pathogens can be visualized simultaneously with the dodged feature.
Conclusion
Our interactive antibiogram data clinical decision support tool extends the utility of the traditional lab-generated antibiogram. Importantly, future iterations will include visualizing changes by year, by clinical setting (inpatient vs. outpatient) and an assessment of uptake of this tool in the clinical setting.
Disclosures
All Authors: No reported disclosures.
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Affiliation(s)
- Laurel Legenza
- University of Wisconsin-Madison School of Pharmacy , Madison, Wisconsin
| | | | - Nasia Safdar
- University of Wisconsin-Madison School of Medicine , Madison, Wisconsin
| | - Nasia Safdar
- University of Wisconsin-Madison School of Medicine , Madison, Wisconsin
| | - Colin Guest
- University of Wisconsin-Madison , Sharon, Massachusetts
| | | | | | - John D D Lee
- University of Wisconsin-Madison College of Engineering , Madison, Wisconsin
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Ray CE, McKinley L, Keating J, Baubie K, Safdar N. 228. Infection Control Cluster Randomized Control Trials and Healthcare Facility Participation: A Need for Readiness Assessment. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.306] [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: 12/23/2022] Open
Abstract
Abstract
Background
Validated tools to evaluate organizational readiness exist within the implementation science literature, but readiness assessments for healthcare organization participation in cluster randomized control trials (CRCTs) have not been developed. CRCTs have been important for increasing the evidence base for infection control. This study describes complex contextual factors that can impact participation in a multi-site infection control CRCTs within the VA healthcare system.
Methods
To assess study participation eligibility and feasibility, a survey of ten inpatient acute care patient units within five VA healthcare facilities was conducted to evaluate standard eligibility criteria such as facility and patient unit demographics, infection rates, and letters of support from leadership. With study delays we began conducting readiness evaluations through email communications and conference calls. We identified several metrics of readiness including competing priorities, identification of champions/ stakeholder engagement, and research infrastructure.
Results
Our Initial survey metrics received from facilities interested in study participation were efficient in detecting study eligibility but lacked efficiency to detect study feasibility. Later metrics identified barriers to feasible study implementation (i.e., readiness), primarily competing priorities, specifically due to the pandemic. Other barriers included the lack of research infrastructure and lack of champion identification/stakeholder engagement. These contextual factors were generally elicited through ongoing communication rather than from the initial survey assessment.
Conclusion
Organizational readiness can delay or impede important infection control CRCTs. This study exemplifies the complexity of healthcare organizations participation in clinical studies that may not be addressed in existing readiness tools or assessments. The emergence of the covid pandemic amplified the importance of identifying a wide range of contextual factors that need to be captured in ongoing assessments for readiness. An essential first step in developing organizational readiness tools and assessments is to identify and define readiness constructs in complex changing healthcare settings.
Disclosures
All Authors: No reported disclosures.
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Affiliation(s)
- Cara E Ray
- Edward Hines, Jr. VA Medical Center , Chicago, Illinois
| | - Linda McKinley
- Wm. S. Middleton Memorial VA Hospital , Madison, Wisconsin
| | - Julie Keating
- Wm. S. Middleton Memorial VA Hospital , Madison, Wisconsin
| | - Kelsey Baubie
- Wm. S. Middleton Memorial VA Hospital , Madison, Wisconsin
| | - Nasia Safdar
- University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin
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Hammond EN, Kates AE, Putman-Buehler N, Watson L, Godfrey JJ, Brys N, Deblois C, Steinberger AJ, Cox MS, Skarlupka JH, Haleem A, Bentz ML, Suen G, Safdar N. A quality improvement study on the relationship between intranasal povidone-iodine and anesthesia and the nasal microbiota of surgery patients. PLoS One 2022; 17:e0278699. [PMID: 36490265 PMCID: PMC9733847 DOI: 10.1371/journal.pone.0278699] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/22/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The composition of the nasal microbiota in surgical patients in the context of general anesthesia and nasal povidone-iodine decolonization is unknown. The purpose of this quality improvement study was to determine: (i) if general anesthesia is associated with changes in the nasal microbiota of surgery patients and (ii) if preoperative intranasal povidone-iodine decolonization is associated with changes in the nasal microbiota of surgery patients. MATERIALS AND METHODS One hundred and fifty-one ambulatory patients presenting for surgery were enrolled in a quality improvement study by convenience sampling. Pre- and post-surgery nasal samples were collected from patients in the no intranasal decolonization group (control group, n = 54). Pre-decolonization nasal samples were collected from the preoperative intranasal povidone-iodine decolonization group (povidone-iodine group, n = 97). Intranasal povidone-iodine was administered immediately prior to surgery and continued for 20 minutes before patients proceeded for surgery. Post-nasal samples were then collected. General anesthesia was administered to both groups. DNA from the samples was extracted for 16S rRNA sequencing on an Illumina MiSeq. RESULTS In the control group, there was no evidence of change in bacterial diversity between pre- and post-surgery samples. In the povidone-iodine group, nasal bacterial diversity was greater in post-surgery, relative to pre-surgery (Shannon's Diversity Index (P = 0.038), Chao's richness estimate (P = 0.02) and Inverse Simpson index (P = 0.027). Among all the genera, only the relative abundance of the genus Staphylococcus trended towards a decrease in patients after application (FDR adjusted P = 0.06). Abundant genera common to both povidone-iodine and control groups included Staphylococcus, Bradyrhizobium, Corynebacterium, Dolosigranulum, Lactobacillus, and Moraxella. CONCLUSIONS We found general anesthesia was not associated with changes in the nasal microbiota. Povidone-iodine treatment was associated with nasal microbial diversity and decreased abundance of Staphylococcus. Future studies should examine the nasal microbiota structure and function longitudinally in surgical patients receiving intranasal povidone-iodine.
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Affiliation(s)
- Eric N. Hammond
- Institute for Clinical and Translational Research, University of Wisconsin-Madison, Madison, WI, United States of America
- Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - Ashley E. Kates
- Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
- William S. Middleton Memorial Veterans Hospital, Madison, WI, United States of America
| | - Nathan Putman-Buehler
- Department of Biochemistry, College of Agricultural and Life Sciences, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Lauren Watson
- SSM Health, St. Mary’s Hospital, Madison, WI, United States of America
| | - Jared J. Godfrey
- Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
- William S. Middleton Memorial Veterans Hospital, Madison, WI, United States of America
| | - Nicole Brys
- Waisman Center, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Courtney Deblois
- Department of Bacteriology, University of Wisconsin-Madison, Madison, WI, United States of America
- Microbiology Doctoral Training Program, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Andrew J. Steinberger
- Department of Bacteriology, University of Wisconsin-Madison, Madison, WI, United States of America
- Microbiology Doctoral Training Program, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Madison S. Cox
- Department of Bacteriology, University of Wisconsin-Madison, Madison, WI, United States of America
- Microbiology Doctoral Training Program, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Joseph H. Skarlupka
- Department of Bacteriology, University of Wisconsin-Madison, Madison, WI, United States of America
- Microbiology Doctoral Training Program, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Ambar Haleem
- Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - Michael L. Bentz
- Division of Plastic and Reconstructive Surgery and Urology, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - Garret Suen
- Department of Bacteriology, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Nasia Safdar
- Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
- William S. Middleton Memorial Veterans Hospital, Madison, WI, United States of America
- * E-mail:
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Legenza L, Coetzee R, Rose WE, Esack T, Crombie K, Mina M, Safdar N, Barnett SG. Application of consolidated framework for implementation research to improve Clostridioides difficile infection management in district hospitals. Res Social Adm Pharm 2022; 18:4100-4111. [PMID: 35981939 PMCID: PMC9891768 DOI: 10.1016/j.sapharm.2022.07.046] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 06/08/2022] [Accepted: 07/26/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Clostridioides difficile infection (CDI) contributes the global threats of drug resistant infections, healthcare acquired infections and antimicrobial resistance. Yet CDI knowledge among healthcare providers in low-resource settings is limited and CDI testing, treatment, and infection prevention measures are often delayed. OBJECTIVES to develop a CDI intervention informed by the local context within South African public district level hospitals, and analyze the CDI intervention and implementation process. METHODS A CDI checklist intervention was designed and implemented at three district level hospitals in the Western Cape, South Africa that volunteered to participate. Data collection included a retrospective medical records review of patients hospitalized with C. difficile test orders during the 90 days post-implementation. Patient outcomes and checklist components (e.g. antibiotics) were collected. Qualitative interviews (n = 14) and focus groups (n = 6) were conducted with healthcare providers on-site. The Consolidated Framework for Implementation Research (CFIR) and the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) were applied to collected data and observations in order to identify drivers and barriers to implementation and understand differences in uptake. RESULTS One of the three hospitals displayed high intervention uptake. Highly relevant CFIR constructs linked to intervention uptake included tension for change, strong peer intervention champions, champions in influential leadership positions, and the intervention's simplicity (CFIR construct: complexity). Tension for change, a recognized need to improve CDI identification and treatment, at the high uptake hospital was also supported by an academic partnership for antimicrobial stewardship. CONCLUSIONS This research provides a straight-forward health systems strengthening intervention for CDI that is both needed and uncomplicated, in an understudied low resource setting. Intervention uptake was highest in the hospital with tension for change, influential champions, and existing academic partnerships. Implementation in settings with fewer academic connections requires further testing of collaborative implementation strategies and proactive adaptations.
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Affiliation(s)
- Laurel Legenza
- University of Wisconsin-Madison School of Pharmacy, 777 Highland Ave, Madison, WI, 53705, United States; University of the Western Cape School of Pharmacy, Robert Sobukwe, Cape Town, 7535, South Africa.
| | - Renier Coetzee
- University of the Western Cape School of Pharmacy, Robert Sobukwe, Cape Town, 7535, South Africa; University of the Western Cape School of Public Health, Robert Sobukwe, Cape Town, 7535, South Africa
| | - Warren E Rose
- University of Wisconsin-Madison School of Pharmacy, 777 Highland Ave, Madison, WI, 53705, United States
| | - Tasneem Esack
- Victoria Hospital, Wynberg, Cape Town, 7800, South Africa
| | - Kenneth Crombie
- University of Cape Town, Rondebosch, Cape Town, 7700, South Africa
| | - Megan Mina
- University of Cape Town, Rondebosch, Cape Town, 7700, South Africa; General Justice Gizenga Mpanza Regional Hospital, KwaDukuza, KwaZulu-Natal, 4450, South Africa
| | - Nasia Safdar
- University of Wisconsin School of Medicine and Public Health, 750 Highland Ave, Madison, WI, 53726, United States
| | - Susanne G Barnett
- University of Wisconsin-Madison School of Pharmacy, 777 Highland Ave, Madison, WI, 53705, United States
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Amjadi MF, Adyniec RR, Gupta S, Bashar SJ, Mergaert AM, Braun KM, Moreno GK, O’Connor DH, Friedrich TC, Safdar N, McCoy SS, Shelef MA. Anti-membrane Antibodies Persist at Least One Year and Discriminate Between Past Coronavirus Disease 2019 Infection and Vaccination. J Infect Dis 2022; 226:1897-1902. [PMID: 35758987 PMCID: PMC9278254 DOI: 10.1093/infdis/jiac263] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/17/2022] [Accepted: 06/23/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The consequences of past coronavirus disease 2019 (COVID-19) infection for personal and population health are emerging, but accurately identifying distant infection is a challenge. Anti-spike antibodies rise after both vaccination and infection and anti-nucleocapsid antibodies rapidly decline. METHODS We evaluated anti-membrane antibodies in COVID-19 naive, vaccinated, and convalescent subjects to determine if they persist and accurately detect distant infection. RESULTS We found that anti-membrane antibodies persist for at least 1 year and are a sensitive and specific marker of past COVID-19 infection. CONCLUSIONS Thus, anti-membrane and anti-spike antibodies together can differentiate between COVID-19 convalescent, vaccinated, and naive states to advance public health and research.
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Affiliation(s)
- Maya F Amjadi
- Department of Medicine, University of Wisconsin (UW)-Madison, Madison, 53705USA
| | - Ryan R Adyniec
- Department of Medicine, University of Wisconsin (UW)-Madison, Madison, 53705USA
| | - Srishti Gupta
- Department of Medicine, University of Wisconsin (UW)-Madison, Madison, 53705USA
| | - S Janna Bashar
- Department of Medicine, University of Wisconsin (UW)-Madison, Madison, 53705USA
| | - Aisha M Mergaert
- Department of Medicine, University of Wisconsin (UW)-Madison, Madison, 53705USA
- Department of Pathology and Laboratory Medicine, UW-Madison, Madison, 53705USA
| | - Katarina M Braun
- Department of Pathobiological Sciences, UW-Madison, Madison, 53705USA
| | - Gage K Moreno
- Department of Pathology and Laboratory Medicine, UW-Madison, Madison, 53705USA
| | - David H O’Connor
- Department of Pathology and Laboratory Medicine, UW-Madison, Madison, 53705USA
| | | | - Nasia Safdar
- Department of Medicine, University of Wisconsin (UW)-Madison, Madison, 53705USA
| | - Sara S McCoy
- Department of Medicine, University of Wisconsin (UW)-Madison, Madison, 53705USA
| | - Miriam A Shelef
- Department of Medicine, University of Wisconsin (UW)-Madison, Madison, 53705USA
- William S. Middleton Memorial Veterans Hospital, Madison, 53705USA
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Seekatz AM, Safdar N, Khanna S. The role of the gut microbiome in colonization resistance and recurrent Clostridioides difficile infection. Therap Adv Gastroenterol 2022; 15:17562848221134396. [PMID: 36425405 PMCID: PMC9679343 DOI: 10.1177/17562848221134396] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 10/04/2022] [Indexed: 11/21/2022] Open
Abstract
The species composition of the human gut microbiota is related to overall health, and a healthy gut microbiome is crucial in maintaining colonization resistance against pathogens. Disruption of gut microbiome composition and functionality reduces colonization resistance and has been associated with several gastrointestinal and non-gastrointestinal diseases. One prime example is Clostridioides difficile infection (CDI) and subsequent recurrent infections that occur after the development of systemic antibiotic-related dysbiosis. Standard-of-care antibiotics used for both acute and recurrent infections do not address dysbiosis and often worsen the condition. Moreover, monoclonal antibodies, recommended in conjunction with standard-of-care antibiotics for the prevention of recurrent CDI in patients at high risk of recurrence, reduce recurrences but do not address the underlying dysbiosis. Fecal microbiota transplantation (FMT) is an evolving therapeutic strategy in which microbes are harvested from healthy donor stool and transplanted into the gut of a recipient to restore the gut microbiome. Although effective in the prevention of recurrent CDI, some existing challenges include screening and the standardization of stool acquisition and processing. Recent safety alerts by the US Food and Drug Administration raised concern about the possibility of transmission of multidrug-resistant organisms or severe acute respiratory syndrome coronavirus 2 via FMT. Increased knowledge that microbes are beneficial in restoring the gut microbiome has led to the clinical development of several newer biotherapeutic formulations that are more regulated than FMT, which may allow for improved restoration of the gut microbiome and prevention of CDI recurrence. This review focuses on mechanisms by which gut microbiome restoration could influence colonization resistance against the pathogen C. difficile. Plain language summary The Role of the Gut Microbiome in Clostridioides difficile Infection Introduction: A rich and diverse gut microbiome is key to immune system regulation and colonization resistance against pathogens.A disruption in the gut microbiome composition can make the gut more vulnerable to diseases such as Clostridioides difficile infection (CDI), caused by the bacterium C. difficile.CDI management presents a therapeutic dilemma, as it is usually treated with antibiotics that can treat the infection but also can damage the microbiome.Treatment of CDI using antibiotics can further reduce microbial diversity and deplete beneficial bacteria from the gut leading to a condition called dysbiosis.Antibiotic treatment can be followed by therapies that restore the gut microbiota, boost colonization resistance, and prevent the development of antimicrobial resistance.It is important to evaluate treatment options to determine their safety and effectiveness. Methods: The researchers provided an overview of the mechanisms that the gut microbiome uses to prevent colonization of the gut by pathogens.They subsequently reviewed the efficacy and shortcomings of the following treatments for CDI: - Antibiotics- Monoclonal antibodies- Fecal microbiota transplantation (FMT) Results: Commensal intestinal bacteria prevent colonization of the gut by pathogens using mechanisms such as: - Competition for key nutrients- Production of inhibitory bile acids- Short-chain fatty acid production- Lowering the luminal pH- Production of bacteriocinsAntibiotic therapy is recommended as a standard treatment for CDI. However, patients are vulnerable to recurrent CDI after discontinuation of the therapy.Monoclonal antibodies that inactivate C. difficile toxins may be recommended along with antibiotics to prevent recurrent CDI. However, this approach does not restore the microbiome.FMT is one method of microbial restoration, where stool is harvested from a healthy donor and transplanted into a patient's colon.Although FMT has shown some efficacy in the treatment of recurrent CDI, the procedure is not standardized.Safety concerns have been raised about the possibility of transmission of multidrug-resistant pathogens via FMT. Conclusion: Treatment methods that can efficiently restore the diversity of the gut microbiome are crucial in preventing recurrence of CDI.
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Affiliation(s)
| | - Nasia Safdar
- University of Wisconsin, Madison, WI, USA
- William S. Middleton Memorial VA Hospital, Madison, WI, USA
| | - Sahil Khanna
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Halfmann PJ, Minor NR, Haddock III LA, Maddox R, Moreno GK, Braun KM, Baker DA, Riemersa KK, Prasad A, Alman KJ, Lambert MC, Florek K, Bateman A, Westergaard R, Safdar N, Andes DR, Kawaoka Y, Fida M, Yao JD, Friedrich TC, O’Connor DH. Evolution of a globally unique SARS-CoV-2 Spike E484T monoclonal antibody escape mutation in a persistently infected, immunocompromised individual. Virus Evol 2022; 9:veac104. [PMID: 37692895 PMCID: PMC10491860 DOI: 10.1093/ve/veac104] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/29/2022] [Accepted: 11/04/2022] [Indexed: 09/12/2023] Open
Abstract
Prolonged infections in immunocompromised individuals may be a source for novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) variants, particularly when both the immune system and antiviral therapy fail to clear the infection and enable within-host evolution. Here we describe a 486-day case of SARS-CoV-2 infection in an immunocompromised individual. Following monotherapy with the monoclonal antibody Bamlanivimab, the individual's virus acquired resistance, likely via the earliest known occurrence of Spike amino acid variant E484T. Recently, E484T has arisen again as a derivative of E484A in the Omicron Variant of Concern, supporting the hypothesis that prolonged infections can give rise to novel variants long before they become prevalent in the human population.
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Affiliation(s)
- Peter J Halfmann
- Department of Pathobiological Sciences, University of Wisconsin-Madison, 2015 Linden Dr, Madison, WI 53706, USA
| | - Nicholas R Minor
- Department of Pathology and Laboratory Medicine, 3170 UW Medical Foundation Centennial Building (MFCB), 1685 Highland Avenue, Madison, WI 53705, USA
| | - Luis A Haddock III
- Department of Pathobiological Sciences, University of Wisconsin-Madison, 2015 Linden Dr, Madison, WI 53706, USA
| | - Robert Maddox
- Department of Pathology and Laboratory Medicine, 3170 UW Medical Foundation Centennial Building (MFCB), 1685 Highland Avenue, Madison, WI 53705, USA
| | - Gage K Moreno
- Department of Pathology and Laboratory Medicine, 3170 UW Medical Foundation Centennial Building (MFCB), 1685 Highland Avenue, Madison, WI 53705, USA
| | - Katarina M Braun
- Department of Pathobiological Sciences, University of Wisconsin-Madison, 2015 Linden Dr, Madison, WI 53706, USA
| | - David A Baker
- Department of Pathology and Laboratory Medicine, 3170 UW Medical Foundation Centennial Building (MFCB), 1685 Highland Avenue, Madison, WI 53705, USA
| | - Kasen K Riemersa
- Department of Pathobiological Sciences, University of Wisconsin-Madison, 2015 Linden Dr, Madison, WI 53706, USA
| | - Ankur Prasad
- Division of Allergy, Pulmonary and Critical Care Medicine, School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705-2281, USA
| | - Kirsten J Alman
- University of Wisconsin Division of Infectious Disease, Room 5275-07C, 1685 Highland Avenue, Madison, WI 53705, USA
| | - Matthew C Lambert
- University of Wisconsin Division of Infectious Disease, Room 5275-07C, 1685 Highland Avenue, Madison, WI 53705, USA
| | - Kelsey Florek
- Wisconsin State Laboratory of Hygiene, 2601 Agriculture Drive, PO Box 7996, Madison, WI 53707, USA
| | - Allen Bateman
- Wisconsin State Laboratory of Hygiene, 2601 Agriculture Drive, PO Box 7996, Madison, WI 53707, USA
| | - Ryan Westergaard
- Department of Medicine, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705, USA
| | - Nasia Safdar
- Department of Medicine, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705, USA
| | - David R Andes
- Department of Medicine, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705, USA
| | - Yoshihiro Kawaoka
- Department of Pathobiological Sciences, University of Wisconsin-Madison, 2015 Linden Dr, Madison, WI 53706, USA
| | - Madiha Fida
- Division of Infectious Diseases, Mayo Clinic, 200 First St. SW, Rochester, Rochester, Minnesota 55905, USA
| | - Joseph D Yao
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Thomas C Friedrich
- Department of Pathobiological Sciences, University of Wisconsin-Madison, 2015 Linden Dr, Madison, WI 53706, USA
| | - David H O’Connor
- Department of Pathology and Laboratory Medicine, 3170 UW Medical Foundation Centennial Building (MFCB), 1685 Highland Avenue, Madison, WI 53705, USA
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Gonçalves JL, de Campos JL, Steinberger AJ, Safdar N, Kates A, Sethi A, Shutske J, Suen G, Goldberg T, Cue RI, Ruegg PL. Incidence and Treatments of Bovine Mastitis and Other Diseases on 37 Dairy Farms in Wisconsin. Pathogens 2022; 11:1282. [PMID: 36365033 PMCID: PMC9698317 DOI: 10.3390/pathogens11111282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/28/2022] [Accepted: 10/31/2022] [Indexed: 08/31/2023] Open
Abstract
The aim of this research was to describe the incidence and treatments of mastitis and other common bovine diseases using one year of retrospective observational data (n = 50,329 cow-lactations) obtained from herd management software of 37 large dairy farms in Wisconsin. Incidence rate (IR) was defined as the number of first cases of each disease divided by the number of lactations per farm. Clinical mastitis (CM) remains the most diagnosed disease of dairy cows. Across all herds, the mean IR (cases per 100 cow-lactations) was 24.4 for clinical mastitis, 14.5 for foot disorders (FD), 11.2 for metritis (ME), 8.6 for ketosis (KE), 7.4 for retained fetal membranes (RFM), 4.5 for diarrhea (DI), 3.1 for displaced abomasum (DA), 2.9 for pneumonia (PN) and 1.9 for milk fever (MF). More than 30% of cows that had first cases of CM, DA, RFM, DI, and FD did not receive antibiotics. Of those treated, more than 50% of cows diagnosed with PN, ME and CM received ceftiofur as a treatment. The IR of mastitis and most other diseases was greater in older cows (parity ≥ 3) during the first 100 days of lactation and these cows were more likely to receive antibiotic treatments (as compared to younger cows diagnosed in later lactation). Cows of first and second parities in early lactation were more likely to remain in the herd after diagnosis of disease, as compared to older cows and cows in later stages of lactation. Most older cows diagnosed with CM in later lactation were culled before completion of the lactation. These results provide baseline data for disease incidence in dairy cows on modern U.S. dairy farms and reinforce the role of mastitis as an important cause of dairy cow morbidity.
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Affiliation(s)
- Juliano L. Gonçalves
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48864, USA
| | - Juliana L. de Campos
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48864, USA
| | | | - Nasia Safdar
- Department of Bacteriology, University of Wisconsin, Madison, WI 53706, USA
| | - Ashley Kates
- Department of Bacteriology, University of Wisconsin, Madison, WI 53706, USA
| | - Ajay Sethi
- Department of Bacteriology, University of Wisconsin, Madison, WI 53706, USA
| | - John Shutske
- Department of Bacteriology, University of Wisconsin, Madison, WI 53706, USA
| | - Garret Suen
- Department of Bacteriology, University of Wisconsin, Madison, WI 53706, USA
| | - Tony Goldberg
- Department of Bacteriology, University of Wisconsin, Madison, WI 53706, USA
| | - Roger I. Cue
- Department of Animal Science, Macdonald Campus, McGill University, Montreal, QC H9X 3V9, Canada
| | - Pamela L. Ruegg
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48864, USA
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Fitzpatrick F, Safdar N, van Prehn J, Tschudin-Sutter S. How can patients with Clostridioides difficile infection on concomitant antibiotic treatment be best managed? Lancet Infect Dis 2022; 22:e336-e340. [PMID: 35617982 DOI: 10.1016/s1473-3099(22)00274-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/16/2022] [Accepted: 04/20/2022] [Indexed: 06/15/2023]
Abstract
Antibiotics are modifiable risk factors for Clostridioides difficile infection (CDI), driving pathogenesis via gut microbiome disruption. The management of patients with CDI prescribed concomitant non-CDI antibiotics is problematic and influences CDI outcome and recurrence risk. Though an assessment of the ongoing requirement for concomitant antibiotics is essential, discontinuation is often not possible. Antibiotics for other reasons might also need to be commenced during CDI therapy. Attempts to minimise the number and duration of antibiotics with a change to a low-risk class are recommended. Fidaxomicin might be preferable to vancomycin due to it having less effect on the gut microbiome; however, vancomycin is also acceptable. Metronidazole should be avoided and proton pump inhibitors discontinued. Access to fidaxomicin might be limited; hence, it should be prioritised for patients at high risk of recurrence. There is insufficient evidence to support extending anti-CDI therapy duration and concerns regarding microbiome effect remain. The addition of bezlotoxumab might be considered if multiple additional risk factors for recurrent CDI exist, though the amount of evidence is low. Investigational approaches to reduce the effect of concomitant antibiotics on the gut microbiome could further optimise CDI treatment in the presence of concomitant antibiotic use in the future.
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Affiliation(s)
- Fidelma Fitzpatrick
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Microbiology, Beaumont Hospital, Dublin, Ireland; ESCMID (European Society of Clinical Microbiology and Infectious Diseases), Basel, Switzerland
| | - Nasia Safdar
- Department of Medicine, University of Wisconsin-Madison and the William S Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Joffrey van Prehn
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, Netherlands; ESCMID (European Society of Clinical Microbiology and Infectious Diseases), Basel, Switzerland
| | - Sarah Tschudin-Sutter
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland; Department of Acute Medicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland; ESCMID (European Society of Clinical Microbiology and Infectious Diseases), Basel, Switzerland.
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Holzhausen EA, Malecki KC, Sethi AK, Gangnon R, Cadmus-Bertram L, Deblois CL, Suen G, Safdar N, Peppard PE. Assessing the relationship between physical activity and the gut microbiome in a large, population-based sample of Wisconsin adults. PLoS One 2022; 17:e0276684. [PMID: 36288361 PMCID: PMC9605031 DOI: 10.1371/journal.pone.0276684] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/11/2022] [Indexed: 11/18/2022] Open
Abstract
The gut microbiome is an important factor in human health and disease. While preliminary studies have found some evidence that physical activity is associated with gut microbiome richness, diversity, and composition, this relationship is not fully understood and has not been previously characterized in a large, population-based cohort. In this study, we estimated the association between several measures of physical activity and the gut microbiota in a cohort of 720 Wisconsin residents. Our sample had a mean age of 55 years (range: 18, 94), was 42% male, and 83% of participants self-identified as White. Gut microbial composition was assessed using gene sequencing of the V3-V4 region of 16S rRNA extracted from stool. We found that an increase of one standard deviation in weekly minutes spent in active transportation was associated with an increase in alpha diversity, particularly in Chao1's richness (7.57, 95% CI: 2.55, 12.59) and Shannon's diversity (0.04, 95% CI: 0.0008, 0.09). We identified interactions in the association between Inverse Simpson's diversity and physical activity, wherein active transportation for individuals living in a rural environment was associated with additional increases in diversity (4.69, 95% CI: 1.64, 7.73). We also conducted several permutational ANOVAs (PERMANOVA) and negative binomial regression analyses to estimate the relationship between physical activity and microbiome composition. We found that being physically active and increased physical activity time were associated with increased abundance of bacteria in the family Erysipelotrichaceae. Active transportation was associated with increased abundance of bacteria in the genus Phascolarctobacterium, and decreased abundance of Clostridium. Minutes in active transportation was associated with a decreased abundance of the family Clostridiaceae.
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Affiliation(s)
- Elizabeth A. Holzhausen
- Department of Integrative Physiology, University of Colorado-Boulder, Boulder, Colorado, United States of America
- * E-mail:
| | - Kristen C. Malecki
- Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Ajay K. Sethi
- Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Ronald Gangnon
- Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Lisa Cadmus-Bertram
- Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Courtney L. Deblois
- Department of Bacteriology, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Microbiology Doctoral Training Program, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Garret Suen
- Department of Bacteriology, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Nasia Safdar
- Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- The William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, United States of America
| | - Paul E. Peppard
- Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
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Felkner R, Barnett SG, Misch EA, Safdar N, Balasubramanian P. Antimicrobial stewardship in solid organ transplantation: Perspective from a Veterans Affairs Medical Center. Transpl Infect Dis 2022; 24:e13948. [DOI: 10.1111/tid.13948] [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] [Received: 05/24/2022] [Accepted: 06/08/2022] [Indexed: 01/15/2023]
Affiliation(s)
- Rebecca Felkner
- The William S. Middleton Memorial Veterans Hospital Madison Wisconsin USA
| | - Susanne G. Barnett
- The William S. Middleton Memorial Veterans Hospital Madison Wisconsin USA
- University of Wisconsin School of Pharmacy Madison Wisconsin USA
| | - Elizabeth A. Misch
- Division of Infectious Disease, Department of Medicine University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | - Nasia Safdar
- The William S. Middleton Memorial Veterans Hospital Madison Wisconsin USA
- Division of Infectious Disease, Department of Medicine University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
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Ramanathan S, Albarillo FS, Fitzpatrick MA, Suda KJ, Poggensee L, Vivo A, Evans ME, Jones M, Safdar N, Pfeiffer C, Smith B, Wilson G, Evans CT. Infectious Disease Consults of Pseudomonas aeruginosa Bloodstream Infection and Impact on Health Outcomes. Open Forum Infect Dis 2022; 9:ofac456. [DOI: 10.1093/ofid/ofac456] [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] [Received: 07/12/2022] [Accepted: 09/06/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Infectious diseases (ID) consultation improves health outcomes for certain infections but has not been well described for Pseudomonas aeruginosa (PA) blood stream infection (BSI). Therefore, the goal of this study was to examine ID consultation of inpatients with PA BSI and factors impacting outcomes.
Methods
This was a retrospective cohort study from January 1, 2012 - December 31, 2018 of adult hospitalized Veterans with PA BSI and antibiotic treatment 2 days before through 5 days after the culture date. Multidrug resistant (MDR) cultures were defined as resistance to at least 1 agent in ≥ 3 antimicrobial categories tested. Multivariable logistic regression models were fit to assess the impact of ID consults and adequate treatment on mortality.
Results
3,256 patients had PA BSI, of which 367 (11.3%) were multi-drug resistant (MDR). Most were male (97.5%), over 65 years old (71.2%), and white (70.9%). Nearly one-fourth (n = 784, 23.3%) died during hospitalization and 870 (25.8%) died within 30-days of their culture. Adjusted models showed ID consultation was associated with decreased in-hospital (odds ratio (OR) = 0.47, 95% CI: 0.39-0.56) and 30-day mortality (OR = 0.51, 95% CI: 0.42-0.62).
Conclusions
Consultation with ID physicians improves clinical outcomes such as in-hospital and 30-day mortality for patients with PA BSI. ID consultation provides value and should be considered for patients with PA BSI.
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Affiliation(s)
- Swetha Ramanathan
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital , Hines, IL , USA
| | - Fritzie S Albarillo
- Department of Medicine, Division of Infectious Diseases, Loyola University Chicago Stritch School of Medicine , Maywood, IL , USA
| | - Margaret A Fitzpatrick
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital , Hines, IL , USA
- Department of Medicine, Division of Infectious Diseases, Loyola University Chicago Stritch School of Medicine , Maywood, IL , USA
| | - Katie J Suda
- Department of Veterans Affairs, Center of Health Equity Research & Promotion, VA Pittsburgh Healthcare System , Pittsburgh, PA , USA
- Department of Medicine, University of Pittsburgh School of Medicine , Pittsburgh, PA , USA
| | - Linda Poggensee
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital , Hines, IL , USA
| | - Amanda Vivo
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital , Hines, IL , USA
| | - Martin E Evans
- Department of Veterans Affairs, Lexington VA Medical Center , Lexington, KY , USA
| | - Makoto Jones
- Department of Veterans Affairs, VA Salt Lake City Healthcare System , Salt Lake City, UT , USA
- Department of Medicine, Division of Epidemiology, University of Utah , Salt Lake City, UT , USA
| | - Nasia Safdar
- Department of Veterans Affairs, William S. Middleton Memorial VA Hospital , Madison, WI ; USA
- Division of Infectious Diseases, Department of Medicine, University of Wisconsin , Madison, WI ; USA
| | - Chris Pfeiffer
- Department of Veterans Affairs, Portland VA Healthcare System , Portland, OR , USA
- Department of Medicine, Division of Infectious Diseases, Oregon Health Science University , Portland, OR , USA
| | - Bridget Smith
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital , Hines, IL , USA
| | - Geneva Wilson
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital , Hines, IL , USA
| | - Charlesnika T Evans
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital , Hines, IL , USA
- Center for Health Services and Outcomes Research and Department of Preventive Medicine, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine , Chicago, IL , USA
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Malik AA, Shumail S, Jaswal M, Farooq S, Maniar R, Khowaja S, Safdar N, Khan AJ, Hussain H. Use of 3HP for TB preventive treatment in prisons. Int J Tuberc Lung Dis 2022; 26:894-896. [PMID: 35996293 DOI: 10.5588/ijtld.22.0163] [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: 11/10/2022] Open
Affiliation(s)
- A A Malik
- Interactive Research and Development (IRD) Global, Singapore, Internal Medicine, Yale School of Medicine, New Haven, CT, USA, Yale Institute for Global Health, New Haven, CT, USA
| | | | - M Jaswal
- Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - S Khowaja
- Interactive Research and Development (IRD) Global, Singapore
| | - N Safdar
- Interactive Research and Development (IRD) Global, Singapore
| | - A J Khan
- Interactive Research and Development (IRD) Global, Singapore
| | - H Hussain
- Interactive Research and Development (IRD) Global, Singapore
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Bixby M, Gennings C, Malecki KMC, Sethi AK, Safdar N, Peppard PE, Eggers S. Individual Nutrition Is Associated with Altered Gut Microbiome Composition for Adults with Food Insecurity. Nutrients 2022; 14:3407. [PMID: 36014913 PMCID: PMC9416073 DOI: 10.3390/nu14163407] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/13/2022] [Accepted: 08/14/2022] [Indexed: 11/17/2022] Open
Abstract
Diet is widely recognized as a key contributor to human gut microbiome composition and function. However, overall nutrition can be difficult to compare across a population with varying diets. Moreover, the role of food security in the relationship with overall nutrition and the gut microbiome is unclear. This study aims to investigate the association between personalized nutrition scores, variation in the adult gut microbiome, and modification by food insecurity. The data originate from the Survey of the Health of Wisconsin and the Wisconsin Microbiome Study. Individual nutrition scores were assessed using My Nutrition Index (MNI), calculated using data from food frequency questionnaires, and additional health history and demographic surveys. Food security and covariate data were measured through self-reported questionnaires. The gut microbiome was assessed using 16S amplicon sequencing of DNA extracted from stool samples. Associations, adjusted for confounding and interaction by food security, were estimated using Weighted Quantile Sum (WQS) regression models with Random Subset and Repeated Holdout extensions (WQSRSRH), with bacterial taxa used as components in the weighted index. Of 643 participants, the average MNI was 66.5 (SD = 31.9), and 22.8% of participants were food insecure. Increased MNI was significantly associated with altered gut microbial composition (β = 2.56, 95% CI = 0.52−4.61), with Ruminococcus, Oscillospira, and Blautia among the most heavily weighted of the 21 genera associated with the MNI score. In the stratified interaction WQSRSRH models, the bacterial taxa most heavily weighted in the association with MNI differed by food security, but the level of association between MNI and the gut microbiome was not significantly different. More bacterial genera are important in the association with higher nutrition scores for people with food insecurity versus food security, including Streptococcus, Parabacteroides Faecalibacterium, and Desulfovibrio. Individual nutrition scores are associated with differences in adult gut microbiome composition. The bacterial taxa most associated with nutrition vary by level of food security. While further investigation is needed, results showed a higher nutrition score was associated with a wider range of bacterial taxa for food insecure vs. secure, suggesting nutritional quality in food insecure individuals is important in maintaining health and reducing disparities.
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Affiliation(s)
- Moira Bixby
- Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA
| | - Chris Gennings
- Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA
| | - Kristen M. C. Malecki
- Population Health Sciences, University of Wisconsin School of Medicine and Public Health, 610 Walnut St., WARF 707, Madison, WI 53726, USA
| | - Ajay K. Sethi
- Population Health Sciences, University of Wisconsin School of Medicine and Public Health, 610 Walnut St., WARF 707, Madison, WI 53726, USA
| | - Nasia Safdar
- Department of Medicine, Division of Infectious Disease, School of Medicine and Public Health, University of Wisconsin-Madison, UW Med. Fndtn. Centennial Bldg., 1685 Highland Ave, Madison, WI 53705, USA
- William S. Middleton Veterans Affairs Medical Center, 2500 Overlook Terrace, Madison, WI 53705, USA
| | - Paul E. Peppard
- Population Health Sciences, University of Wisconsin School of Medicine and Public Health, 610 Walnut St., WARF 707, Madison, WI 53726, USA
| | - Shoshannah Eggers
- Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA
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Jaswal M, Farooq S, Madhani F, Noorani S, Salahuddin N, Amanullah F, Khowaja S, Safdar N, Khan A, Yuen C, Keshavjee S, Becerra M, Hussain H, Malik AA. Implementing 3HP vs. IPT as TB preventive treatment in Pakistan. Int J Tuberc Lung Dis 2022; 26:741-746. [PMID: 35898140 DOI: 10.5588/ijtld.21.0676] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: We assessed treatment uptake and completion for 6 months of isoniazid (6H) and 3 months of isoniazid plus rifapentine weekly (3HP) in a programmatic setting in Pakistan.METHODS: All household contacts were clinically evaluated to rule out TB disease. 6H was used for TB preventive treatment (TPT) from October 2016 to April 2017; from May to September 2017, 3HP was used for contacts aged ≥2 years. We compared clinical evaluation, TPT uptake and completion rates between contacts aged ≥2 years in the 6H period and in the 3HP period.RESULTS: We identified 3,442 contacts for the 6H regimen. After clinical evaluation, 744/1,036 (72%) started treatment, while 46% completed treatment. In contrast, 3,722 contacts were identified for 3HP. After clinical evaluation, 990/1,366 (72%) started treatment, while 67% completed treatment. Uptake of TPT did not differ significantly between the 6H and 3HP groups (OR 1.03, 95%CI 0.86-1.24). However, people who initiated 3HP had 2.3 times greater odds (95% CI 1.9-2.8) of completing treatment than those who initiated 6H after adjusting for age and sex.CONCLUSION: In programmatic settings in a high-burden country, household contacts of all ages were more likely to complete TPT with shorter weekly regimens, although treatment uptake rate for the two regimens was similar.
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Affiliation(s)
- M Jaswal
- Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - S Farooq
- TB Control Programme, The Indus Hospital and Health Network, Karachi, Pakistan
| | - F Madhani
- Programmes Unit, Aga Khan Health Services, Karachi, Pakistan
| | - S Noorani
- Monitoring & Evaluation, Public Health England, London, UK
| | - N Salahuddin
- TB Control Programme, The Indus Hospital and Health Network, Karachi, Pakistan
| | - F Amanullah
- TB Control Programme, The Indus Hospital and Health Network, Karachi, Pakistan
| | - S Khowaja
- TB Department, Interactive Research and Development (IRD) Global, Singapore
| | - N Safdar
- TB Department, Interactive Research and Development (IRD) Global, Singapore
| | - A Khan
- TB Department, Interactive Research and Development (IRD) Global, Singapore, TB Department, Harvard Medical School, Boston, MA, Infectious Diseases, Harvard Medical School Center for Global Health Delivery, Boston, MA
| | - C Yuen
- TB Department, Harvard Medical School, Boston, MA, Infectious Diseases, Harvard Medical School Center for Global Health Delivery, Boston, MA
| | - S Keshavjee
- TB Department, Harvard Medical School, Boston, MA, Infectious Diseases, Harvard Medical School Center for Global Health Delivery, Boston, MA, TB Department, Partners In Health, Boston, MA, Infectious Diseases, Brigham and Women´s Hospital, Boston, MA
| | - M Becerra
- TB Department, Harvard Medical School, Boston, MA, Infectious Diseases, Harvard Medical School Center for Global Health Delivery, Boston, MA, TB Department, Partners In Health, Boston, MA, Infectious Diseases, Brigham and Women´s Hospital, Boston, MA
| | - H Hussain
- TB Department, Interactive Research and Development (IRD) Global, Singapore
| | - A A Malik
- TB Department, Interactive Research and Development (IRD) Global, Singapore, Internal Medicine, Yale School of Medicine, New Haven, CT, Yale Institute for Global Health, New Haven, CT, USA
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Goedken CC, McKinley L, Balkenende E, Hockett Sherlock S, Knobloch MJ, Perencevich EN, Safdar N, Reisinger HS. "Our job is to break that chain of infection": Challenges environmental management services (EMS) staff face in accomplishing their critical role in infection prevention. Antimicrob Steward Healthc Epidemiol 2022; 2:e129. [PMID: 36483342 PMCID: PMC9726543 DOI: 10.1017/ash.2022.261] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES Contaminated surfaces in healthcare settings contribute to the transmission of nosocomial pathogens. Adequate environmental cleaning is important for preventing the transmission of important pathogens and reducing healthcare-associated infections. However, effective cleaning practices vary considerably. We examined environmental management services (EMS) staff experiences and perceptions surrounding environmental cleaning to describe perceived challenges and ideas to promote an effective environmental services program. DESIGN Qualitative study. PARTICIPANTS Frontline EMS staff. METHODS From January to June 2019, we conducted individual semistructured interviews with key stakeholders (ie, EMS staff) at 3 facilities within the Veterans' Affairs Healthcare System. We used the Systems Engineering Initiative for Patient Safety (SEIPS) framework (ie, people, environment, organization, tasks, tools) to guide this study. Interviews were audio-recorded, transcribed, and analyzed for thematic content. RESULTS In total, 13 EMS staff and supervisors were interviewed. A predominant theme that emerged were the challenges EMS staff saw as hindering their ability to be effective at their jobs. EMS staff interviewed felt they understand their job requirements and are dedicated to their work; however, they described challenges related to feeling undervalued and staffing issues. CONCLUSIONS EMS staff play a critical role in infection prevention in healthcare settings. However, some do not believe their role is recognized or valued by the larger healthcare team and leadership. EMS staff provided ideas for improving feelings of value and job satisfaction, including higher pay, opportunities for certifications and advancement, as well as collaboration or integration with the larger healthcare team. Healthcare organizations should focus on utilizing these suggestions to improve the EMS work climate.
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Affiliation(s)
- Cassie Cunningham Goedken
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa
| | - Linda McKinley
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
| | - Erin Balkenende
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Stacey Hockett Sherlock
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Mary Jo Knobloch
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
- University of Wisconsin–Madison, Madison, Wisconsin
| | - Eli N. Perencevich
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Nasia Safdar
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
- University of Wisconsin–Madison, Madison, Wisconsin
| | - Heather Schacht Reisinger
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
- Institute for Clinical and Translational Science, Iowa City, Iowa
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Kates A, Keating J, Baubie K, Putman-Buehler N, Watson L, Godfrey J, Deblois CL, Suen G, Cook DB, Rabago D, Gangnon R, Safdar N. Examining the association between the gastrointestinal microbiota and Gulf War illness: A prospective cohort study. PLoS One 2022; 17:e0268479. [PMID: 35901037 PMCID: PMC9333223 DOI: 10.1371/journal.pone.0268479] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/01/2022] [Indexed: 12/04/2022] Open
Abstract
Gulf War Illness (GWI) affects 25–35% of the 1991 Gulf War Veteran (GWV) population. Patients with GWI experience pain, fatigue, cognitive impairments, gastrointestinal dysfunction, skin disorders, and respiratory issues. In longitudinal studies, many patients with GWI have shown little to no improvement in symptoms since diagnosis. The gut microbiome and diet play an important role in human health and disease, and preliminary studies suggest it may play a role in GWI. To examine the relationship between the gut microbiota, diet, and GWI, we conducted an eight-week prospective cohort study collecting stool samples, medications, health history, and dietary data. Sixty-nine participants were enrolled into the study, 36 of which met the case definition for GWI. The gut microbiota of participants, determined by 16S rRNA sequencing of stool samples, was stable over the duration of the study and showed no within person (alpha diversity) differences. Between group analyses (beta diversity) identified statistically significant different between those with and without GWI. Several taxonomic lineages were identified as differentially abundant between those with and without GWI (n = 9) including a greater abundance of Lachnospiraceae and Ruminococcaceae in those without GWI. Additionally, there were taxonomic differences between those with high and low healthy eating index (HEI) scores including a greater abundance of Ruminococcaceae in those with higher HEI scores. This longitudinal cohort study of GWVs found that participants with GWI had significantly different microbiomes from those without GWI. Further studies are needed to determine the role these differences may play in the development and treatment of GWI.
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Affiliation(s)
- Ashley Kates
- Research, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, United States of America
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- * E-mail:
| | - Julie Keating
- Research, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, United States of America
| | - Kelsey Baubie
- Research, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, United States of America
| | - Nathan Putman-Buehler
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Lauren Watson
- SSM Health, St. Mary’s Hospital, Madison, Wisconsin, United States of America
| | - Jared Godfrey
- Research, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, United States of America
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Courtney L. Deblois
- Research, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, United States of America
- Department of Bacteriology, College of Agriculture and Life Sciences, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Microbiology Doctoral Training Program, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Garret Suen
- Department of Bacteriology, College of Agriculture and Life Sciences, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Dane B. Cook
- Research, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, United States of America
- Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - David Rabago
- Department of Family and Community Medicine, College of Medicine, Penn State University, Hershey, Pennsylvania, United States of America
| | - Ronald Gangnon
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Nasia Safdar
- Research, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, United States of America
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
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Keating JA, Jasper A, Musuuza J, Templeton K, Safdar N. Supporting Midcareer Women Faculty in Academic Medicine Through Mentorship and Sponsorship. J Contin Educ Health Prof 2022; 42:197-203. [PMID: 35180741 PMCID: PMC10351961 DOI: 10.1097/ceh.0000000000000419] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Midcareer women faculty face unique career challenges that may benefit from mentorship and sponsorship, yet such programs focused on the needs of this career phase are scarce in academic medicine. Many midcareer faculty require intentional and individual career planning to choose a path from the broad array of options in academic medicine. Ambiguous promotion criteria, increased workloads because of service or citizenship tasks, and a lack of sponsorship are among the barriers that inhibit midcareer faculty's growth into the high-visibility roles needed for career advancement. In addition, issues faced by women midcareer faculty members may be further exacerbated by barriers such as biases, a disproportionate share of family responsibilities, and inequities in recognition and sponsorship. These barriers contribute to slower career growth and higher attrition among women midcareer faculty and ultimately an underrepresentation of women among senior leadership in academic medicine. Here, we describe how a mentoring program involving individuals (eg, mentors, mentees, and sponsors) and departments/institutions (eg, deans and career development offices) can be used to support midcareer faculty. We also provide recommendations for building a mentoring program with complementary support from sponsors targeted toward the specific needs of women midcareer faculty. A robust midcareer mentoring program can support the career growth and engagement of individual faculty members and as a result improve the diversity of academic medicine's highest ranks.
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Affiliation(s)
- Julie A Keating
- Dr. Keating: Research Health Scientist, the William S. Middleton Memorial Veterans Hospital, Madison, WI. Dr. Jasper: Research Intern, the Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI. Dr. Musuuza: Research Health Scientist, the William S. Middleton Memorial Veterans Hospital, and Associate Research Specialist, the Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI. Dr. Templeton: Professor and Vice-Chair for Diversity, Equity, and Inclusion in the Orthopedic Surgery, the Department of Orthopedic Surgery, the University of Kansas School of Medicine, Kansas City, KS. Dr. Safdar: Professor of Medicine and Vice Chair of Research, the Department of Medicine, the University of Wisconsin-Madison School of Medicine and Public Health, and the Associate Chief of Staff-Research, the William S. Middleton Memorial Veterans Hospital, Madison, WI
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Russ RK, Schultz TJ, Kalscheur N, Conway JH, Safdar N, Caldera F, Hayney MS. Cross-sectional study of coronavirus disease 2019 (COVID-19) vaccine uptake among healthcare workers. Antimicrob Steward Healthc Epidemiol 2022; 2:e61. [PMID: 36483423 PMCID: PMC9726565 DOI: 10.1017/ash.2022.41] [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] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 06/17/2023]
Affiliation(s)
- Rachel K. Russ
- School of Pharmacy, University of Wisconsin–Madison, Madison, Wisconsin
| | | | | | - James H. Conway
- Department of Pediatrics, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin
| | - Nasia Safdar
- Division of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin
| | - Freddy Caldera
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin School of Medicine & Public Health, 800 University Bay Drive, Madison, Wisconsin
| | - Mary S. Hayney
- School of Pharmacy, University of Wisconsin–Madison, Madison, Wisconsin
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Pisani M, Anderson L, Hatas G, Safdar N. A systems approach to understanding SARS-CoV-2 transmission among healthcare workers in a cluster. Am J Infect Control 2022; 50:459-461. [PMID: 34883160 PMCID: PMC8645508 DOI: 10.1016/j.ajic.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 11/17/2022]
Abstract
Preventing transmission of COVID-19 between healthcare workers is essential to optimize patient, employee, and organizational outcomes. We used a systems engineering approach to analyze contact tracing interviews from a cluster of COVID-19 at our healthcare institution and identified modifiable and non-modifiable causes of transmission. Similar work system analyses may be useful to institutions in identifying multiple factors contributing to infection clusters among healthcare workers, and in developing layered infection prevention methods to further reduce transmission.
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Ramuta MD, Newman CM, Brakefield SF, Stauss MR, Wiseman RW, Kita-Yarbro A, O'Connor EJ, Dahal N, Lim A, Poulsen KP, Safdar N, Marx JA, Accola MA, Rehrauer WM, Zimmer JA, Khubbar M, Beversdorf LJ, Boehm EC, Castañeda D, Rushford C, Gregory DA, Yao JD, Bhattacharyya S, Johnson MC, Aliota MT, Friedrich TC, O'Connor DH, O'Connor SL. SARS-CoV-2 and other respiratory pathogens are detected in continuous air samples from congregate settings. medRxiv 2022. [PMID: 35378751 PMCID: PMC8978944 DOI: 10.1101/2022.03.29.22272716] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Two years after the emergence of SARS-CoV-2, there is still a need for better ways to assess the risk of transmission in congregate spaces. We deployed active air samplers to monitor the presence of SARS-CoV-2 in real-world settings across communities in the Upper Midwestern states of Wisconsin and Minnesota. Over 29 weeks, we collected 527 air samples from 15 congregate settings and detected 106 SARS-CoV-2 positive samples, demonstrating SARS-CoV-2 can be detected in air collected from daily and weekly sampling intervals. We expanded the utility of air surveillance to test for 40 other respiratory pathogens. Surveillance data revealed differences in timing and location of SARS-CoV-2 and influenza A virus detection in the community. In addition, we obtained SARS-CoV-2 genome sequences from air samples to identify variant lineages. Collectively, this shows air surveillance is a scalable, cost-effective, and high throughput alternative to individual testing for detecting respiratory pathogens in congregate settings.
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Carayon P, Thuemling T, Parmasad V, Bao S, O'Horo J, Bennett NT, Safdar N. Implementation of An Antibiotic Stewardship Intervention to Reduce Prescription of Fluoroquinolones: A Human Factors Analysis in Two Intensive Care Units. J Patient Saf Risk Manag 2022; 26:161-171. [PMID: 35146329 DOI: 10.1177/25160435211025417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Antibiotic use is often the target of interventions in health care organizations that aim to decrease healthcare-associated infections (HAI) such as Clostridioides difficile (CDI); this is particularly important for fluoroquinolones (FQ), which are frequently used in critical care settings. In this study, using a multiple case study research approach, we conduct an in-depth analysis of an intervention aimed at limiting ICU prescriber access to FQ in two ICUs of two hospitals. The data collection and analysis were guided by a human factors engineering approach based on the SEIPS (Systems Engineering Initiative for Patient Safety) model and evidence-based implementation principles. Our results show some differences in the implementation of the FQ intervention between the two ICUs, such as level and method of FQ restriction, and training and communication with physicians and pharmacists. In both ICUs, several organizational learning mechanisms helped to quickly identify problems with the intervention and ensure that changes were made in a just-in-time manner (e.g. just-in-time training, removal of FQ in order set for pneumonia). Despite their organizational differences, both sites developed strategies to successfully implement the FQ intervention.
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Affiliation(s)
- Pascale Carayon
- Department of Industrial and Systems Engineering, Wisconsin Institute for Healthcare Systems Engineering; University of Wisconsin-Madison
| | - Teresa Thuemling
- Wisconsin Institute for Healthcare Systems Engineering; University of Wisconsin-Madison
| | | | - Songtao Bao
- School of Journalism and Mass Communication; University of Wisconsin-Madison
| | | | | | - Nasia Safdar
- Department of Medicine; University of Wisconsin-Madison
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50
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Flower M, Mckinley L, Hoel S, Baubie K, Keating JA, Safdar N. The patients engaged in education and research (PEER) health care-associated infection prevention project: A Veteran perspective. Am J Infect Control 2022; 50:235-236. [PMID: 35101179 DOI: 10.1016/j.ajic.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Mark Flower
- William S Middleton Memorial Veterans Hospital, Madison, WI; Growing Rural Outreach through Veteran Engagement (GROVE) Center, Portland, OR; Medical College of Wisconsin, Milwaukee, WI
| | - Linda Mckinley
- William S Middleton Memorial Veterans Hospital, Madison, WI
| | - Sydney Hoel
- University of Wisconsin - Madison Department of Medicine, Madison, WI.
| | - Kelsey Baubie
- William S Middleton Memorial Veterans Hospital, Madison, WI
| | | | - Nasia Safdar
- William S Middleton Memorial Veterans Hospital, Madison, WI; University of Wisconsin - Madison Department of Medicine, Madison, WI
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