Scholars@Duke
Michael Yarrington

Michael Yarrington

Associate Professor of Medicine
Medicine, Infectious Diseases
michael.yarrington@duke.edu
182 Hanes House, Durham, NC 27710
182 Hanes House, Box 102359, Durham, NC 27710

Scholarly Works - Journal articles

From bottlenecks to better practices: systemwide electronic clinical decision support for blood culture stewardship.

Journal article Infect Control Hosp Epidemiol · July 27, 2026 A systemwide electronic clinical decision support (CDS) tool for blood culture ordering reduced utilization by 12% across three hospitals (IRR 0.88, P < .01), but the effect waned over time. Low-yield ordering persisted, and contamination rates increased. ... Full text Link to item Cite

Using Encounter-Level Data for Risk-Adjustment of Antimicrobial Use Comparisons: Feasibility and Variable Selection.

Journal article Clin Infect Dis · July 8, 2026 BACKGROUND: External comparisons of hospital antimicrobial use (AU), risk-adjusted using encounter characteristics, may better inform antimicrobial stewardship program strategy. Barriers to encounter-level modeling include feasibility of data collection an ... Full text Link to item Cite

Racial disparities in healthcare-associated infections: a systematic review and meta-analysis.

Journal article Infect Control Hosp Epidemiol · April 24, 2026 OBJECTIVE: Racial and ethnic disparities in healthcare-associated infections (HAIs) could have significant implications for hospital-based incentive programs. We sought to quantify racial and ethnic disparities in HAIs across inpatients in the United State ... Full text Link to item Cite

Risk factors for progression from Clostridioides difficile colonization (NAAT+/toxin-) to infection (toxin+) following symptomatic retesting.

Journal article Infect Control Hosp Epidemiol · March 2026 OBJECTIVE: To identify host and clinical risk factors contributing to the development of Clostridioides difficile infection (CDI) among colonized patients. DESIGN: Retrospective, matched case-control study. SETTING: Duke University Health System, including ... Full text Link to item Cite

Emphasizing the O in OPAT: A Pathway for Clinic-Initiated Outpatient Parenteral Antimicrobial Therapy (CI-OPAT) at an Academic Center.

Journal article Open Forum Infect Dis · March 2026 Our infectious diseases (ID) clinic began a clinic-initiated outpatient parenteral antimicrobial therapy (CI-OPAT) program to avoid unnecessary emergency department visits or inpatient admissions. In this single-center retrospective case series, we describ ... Full text Link to item Cite

An analytic approach considering two temporal mechanisms driving breakthrough viral infections after vaccination.

Journal article Vaccine · September 17, 2025 Real world data is an increasingly utilized resource for post-market monitoring of vaccines and provides insight into real world effectiveness. However, heterogeneous mechanisms may drive observed breakthrough infections among vaccinated individuals, such ... Full text Link to item Cite

Invasive surgical site infections after lung transplantation: contemporary risk factors and associated clinical outcomes.

Journal article JHLT Open · August 2025 BACKGROUND: Invasive primary surgical site infections (IP-SSI) complicate lung transplant (LT) surgery. Identification of IP-SSI risk factors is critical to IP-SSI prevention. METHODS: This single-center retrospective cohort study of adult patients who und ... Full text Open Access Link to item Cite

Cardiac Kaposi Sarcoma Complicated by Kaposi Sarcoma Inflammatory Cytokine Syndrome: A Case Report.

Journal article Cureus · January 2025 Kaposi sarcoma (KS), caused by human herpesvirus-8 (HHV-8), is among the most common malignancies in people living with HIV. Kaposi sarcoma is an angiogenic endothelial cell neoplasm and an acquired immunodeficiency syndrome (AIDS)-defining illness. Kaposi ... Full text Link to item Cite

Variation in subsequent viral load testing and outcomes by visit type patterns in the first year of the COVID-19 pandemic at a large academic medical center in North Carolina.

Journal article Mhealth · 2025 While telehealth was widely used to provide human immunodeficiency virus (HIV) care during the coronavirus disease 2019 (COVID-19) pandemic, research evaluating viral suppression by visit type is conflicting. This study assessed variation in viral load (VL ... Full text Link to item Cite

Telehealth and in-person HIV care during the COVID-19 pandemic at a large academic medical center in North Carolina.

Journal article PLoS One · 2025 BACKGROUND: To maintain HIV care during the COVID-19 pandemic, many HIV clinics across the United States adopted telehealth. However, not everyone participated in telehealth equally. This study assessed the use and disparities in telehealth and in-person H ... Full text Link to item Cite

Risk Factors for Invasive Surgical Site Infections Among Adult Single Liver Transplant Recipients at Duke University Hospital in the Period 2015-2020.

Journal article Transplant Direct · December 2024 BACKGROUND: Invasive primary surgical site infections (IP-SSI) are a severe complication of liver transplant surgery. Identification of risk factors for IP-SSI is critical to IP-SSI prevention. METHODS: All adult single liver transplants performed at Duke ... Full text Open Access Link to item Cite

Beyond Infection: Mortality and End-of-Life Care Associated With Infectious Disease Consultation in an Academic Health System.

Journal article Clin Infect Dis · October 15, 2024 BACKGROUND: Infectious diseases (ID) physicians are increasingly faced with the challenge of caring for patients with terminal illnesses or incurable infections. METHODS: This was a retrospective cohort of all patients with an ID consult within an academic ... Full text Link to item Cite

Late surgical site infections among solid organ transplant recipients: an unrecognized clinical entity.

Journal article Infect Control Hosp Epidemiol · October 2024 This study identified 26 late invasive primary surgical site infection (IP-SSI) within 4-12 months of transplantation among 2073 SOT recipients at Duke University Hospital over the period 2015-2019. Thoracic organ transplants accounted for 25 late IP-SSI. ... Full text Link to item Cite

The devil's in the defaults: An interrupted time-series analysis of the impact of default duration elimination on exposure to fluoroquinolone therapy.

Journal article Infect Control Hosp Epidemiol · June 2024 OBJECTIVE: To determine whether removal of default duration, embedded in electronic prescription (e-script), influenced antibiotic days of therapy. DESIGN: Interrupted time-series analysis. SETTING: The study was conducted across 2 community hospitals, 1 a ... Full text Link to item Cite

Risk Factors for and Outcomes Following Early Acquisition of Mycobacterium abscessus Complex After Lung Transplantation.

Journal article Open Forum Infect Dis · May 2024 BACKGROUND: Lung transplant recipients are at increased risk of Mycobacterium abscessus complex (MABC) acquisition and invasive infection. We analyzed risk factors and outcomes of early post-lung transplant MABC acquisition. METHODS: We conducted a retrosp ... Full text Link to item Cite

Risk factors, management, and clinical outcomes of invasive Mycoplasma and Ureaplasma infections after lung transplantation.

Journal article Am J Transplant · April 2024 Mollicute infections, caused by Mycoplasma and Ureaplasma species, are serious complications after lung transplantation; however, understanding of the epidemiology and outcomes of these infections remains limited. We conducted a single-center retrospective ... Full text Open Access Link to item Cite

Teams in Transition: Increasing Role of Advanced Practice Providers in Antimicrobial Use and Infectious Diseases Consultation.

Journal article Open Forum Infect Dis · April 2024 BACKGROUND: Advanced practice providers (APPs) have taken on increasing responsibilities as primary team members in acute care hospitals, but the impact of this practice shift on antimicrobial prescribing and infectious diseases (ID) consultation requests ... Full text Link to item Cite

Limitations of antifungal prophylaxis in preventing invasive Candida surgical site infections after liver transplant surgery.

Journal article Antimicrob Agents Chemother · March 6, 2024 Invasive primary Candida surgical site infections (IP-SSIs) are a common complication of liver transplantation, and targeted antifungal prophylaxis is an efficient strategy to limit their occurrence. We performed a retrospective single-center cohort study ... Full text Link to item Cite

Effect of automated identification of antimicrobial stewardship opportunities for suspected urinary tract infections.

Journal article Antimicrob Steward Healthc Epidemiol · 2024 OBJECTIVE: We aimed to determine whether automated identification of antibiotic targeting suspected urinary tract infection (UTI) shortened the time to antimicrobial stewardship (AS) intervention. DESIGN: Retrospective before-and-after study. SETTING: Tert ... Full text Link to item Cite

Informing estimates of probability of Clostridioides difficile infection for testing and treatment: expert consensus from a modified-Delphi procedure.

Journal article Antimicrob Steward Healthc Epidemiol · 2024 BACKGROUND: Clostridioides difficile infection (CDI) may be misdiagnosed if testing is performed in the absence of signs or symptoms of disease. This study sought to support appropriate testing by estimating the impact of signs, symptoms, and healthcare ex ... Full text Link to item Cite

Using clinical decision support to improve urine testing and antibiotic utilization.

Journal article Infect Control Hosp Epidemiol · October 2023 OBJECTIVE: Urine cultures collected from catheterized patients have a high likelihood of false-positive results due to colonization. We examined the impact of a clinical decision support (CDS) tool that includes catheter information on test utilization and ... Full text Open Access Link to item Cite

Disparities in Mpox Vaccination Among Priority Populations During the 2022 Outbreak.

Journal article Open Forum Infect Dis · September 2023 BACKGROUND: The 2022 mpox outbreak disproportionately affected men who have sex with men and persons living with HIV (PLWH). A 2-dose mpox vaccine series was deployed in mid-2022. Structural racism and insurance status may have affected equitable vaccinati ... Full text Link to item Cite

Comparing Natural Language Processing and Structured Medical Data to Develop a Computable Phenotype for Patients Hospitalized Due to COVID-19: Retrospective Analysis.

Journal article JMIR Med Inform · August 22, 2023 BACKGROUND: Throughout the COVID-19 pandemic, many hospitals conducted routine testing of hospitalized patients for SARS-CoV-2 infection upon admission. Some of these patients are admitted for reasons unrelated to COVID-19 and incidentally test positive fo ... Full text Link to item Cite

Concurrent Sexually Transmitted Infection Testing Among Patients Tested for Mpox at a Tertiary Healthcare System.

Journal article Open Forum Infect Dis · August 2023 Coinfection with sexually transmitted infections (STIs) and mpox is common. We evaluated concurrent STI testing among Duke Health patients tested for mpox. We found that most patients tested for mpox were not comprehensively tested for STIs, despite concur ... Full text Link to item Cite

Electronic health record-based readmission risk model performance for patients undergoing outpatient parenteral antibiotic therapy (OPAT).

Journal article PLOS Digit Health · August 2023 BACKGROUND: Outpatient Parenteral Antibiotic Therapy (OPAT) provides coordinated services to deliver parenteral antibiotics outside of the acute care setting. However, the reduction in monitoring and supervision may impact the risks of readmission to the h ... Full text Link to item Cite

Comparing Natural Language Processing and Structured Medical Data to Develop a Computable Phenotype for Patients Hospitalized Due to COVID-19: Retrospective Analysis.

Journal article JMIR Med Inform · June 17, 2023 BACKGROUND: Throughout the COVID-19 pandemic, many hospitals conducted routine testing of hospitalized patients for SARS-CoV-2 infection upon admission. Some of these patients are admitted for reasons unrelated to COVID-19, and incidentally test positive f ... Full text Link to item Cite

Measuring empiric antibiotic spectrum-A journey through space and time.

Journal article Infect Control Hosp Epidemiol · April 2023 OBJECTIVES: The typical 5-day work week affects healthcare outcomes. Structured work hours have also been implicated in antimicrobial prescribing choice. We developed a visualization tool to aid in evaluating breadth of antibiotic use in various time (day ... Full text Link to item Cite

Impact of Policy Change on Access to Medication for Opioid Use Disorder in Primary Care.

Journal article South Med J · April 2023 OBJECTIVES: The opioid overdose epidemic is escalating. Increasing access to medications for opioid use disorder in primary care is crucial. The impact of the US Department of Health and Human Services' policy change removing the buprenorphine waiver train ... Full text Link to item Cite

Evaluation of an Opt-Out Protocol for Antibiotic De-Escalation in Patients With Suspected Sepsis: A Multicenter, Randomized, Controlled Trial.

Journal article Clin Infect Dis · February 8, 2023 BACKGROUND: Sepsis guidelines recommend daily review to de-escalate or stop antibiotics in appropriate patients. This randomized, controlled trial evaluated an opt-out protocol to decrease unnecessary antibiotics in patients with suspected sepsis. METHODS: ... Full text Link to item Cite

Evaluation of hospital blood culture utilization rates to identify opportunities for diagnostic stewardship.

Journal article Infect Control Hosp Epidemiol · February 2023 OBJECTIVES: To evaluate the pattern of blood-culture utilization among a cohort of 6 hospitals to identify potential opportunities for diagnostic stewardship. METHODS: We completed a retrospective analysis of blood-culture utilization during adult inpatien ... Full text Link to item Cite

Utility of a risk assessment model in predicting 30 day unplanned hospital readmission in adult patients receiving outpatient parenteral antimicrobial therapy.

Journal article JAC Antimicrob Resist · February 2023 OBJECTIVES: Outpatient parenteral antimicrobial therapy (OPAT) is associated with high hospital readmission rates. A 30 day unplanned readmission risk prediction model for OPAT patients has been developed in the UK. Given significant differences in patient ... Full text Link to item Cite

1570. Cumulative Antibiotic Exposure and Risk for Candidemia

Journal article Open Forum Infectious Diseases · December 15, 2022 AbstractBackgroundBroad-spectrum antibiotic use is a known risk factor for candidemia, but the duration and type of antibiotic exposur ... Full text Cite

Epidemiology of surgical site infections after solid organ transplants in the period 2015-2019: A single-center retrospective cohort study.

Journal article Am J Transplant · December 2022 Surgical site infections (SSI) are severe complications of solid organ transplant (SOT). This retrospective study assessed the epidemiology of and outcomes associated with invasive primary SSI (IP-SSI) occurring within 3 months of transplantation in adult ... Full text Open Access Link to item Cite

Curating a knowledge base for individuals with coinfection of HIV and SARS-CoV-2: a study protocol of EHR-based data mining and clinical implementation.

Journal article BMJ Open · September 13, 2022 INTRODUCTION: Despite a higher risk of severe COVID-19 disease in individuals with HIV, the interactions between SARS-CoV-2 and HIV infections remain unclear. To delineate these interactions, multicentre Electronic Health Records (EHR) hold existing promis ... Full text Link to item Cite

Effects of a Collaborative, Community Hospital Network for Antimicrobial Stewardship Program Implementation.

Journal article Clin Infect Dis · November 2, 2021 BACKGROUND: Individual hospitals may lack expertise, data resources, and educational tools to support antimicrobial stewardship programs (ASP). METHODS: We established a collaborative, consultative network focused on hospital ASP implementation. Services i ... Full text Link to item Cite

Blood Culture Utilization at Six Southeastern US Hospitals

Journal article Antimicrobial Stewardship & Healthcare Epidemiology · July 2021 Group Name: Duke Center for Antimicrobial Stewardship and Infection PreventionBackground: Blood cultures are an essential diagnostic test, but over- and underutilization may cause harm. ... Full text Cite

A modified Delphi approach to develop a trial protocol for antibiotic de-escalation in patients with suspected sepsis.

Journal article Antimicrob Steward Healthc Epidemiol · 2021 BACKGROUND: Early administration of antibiotics in sepsis is associated with improved patient outcomes, but safe and generalizable approaches to de-escalate or discontinue antibiotics after suspected sepsis events are unknown. METHODS: We used a modified D ... Full text Link to item Cite

Impact of FDA black box warning on fluoroquinolone and alternative antibiotic use in southeastern US hospitals.

Journal article Infect Control Hosp Epidemiol · November 2019 We analyzed antibiotic use data from 29 southeastern US hospitals over a 5-year period to determine changes in antibiotic use after the fluoroquinolone US Food and Drug Administration (FDA) advisory update in 2016. Fluoroquinolone use declined both before ... Full text Link to item Cite

996. Impact of Penicillin Allergy Labels on Carbapenem Use in a Multi-Center Study

Journal article Open Forum Infectious Diseases · October 23, 2019 AbstractBackgroundAntibiotic allergy labels lead to excess exposure to broad-spectrum antibiotics and can result in patient harm. We a ... Full text Cite

Basic, Advanced, and Novel Metrics to Guide Antibiotic Use Assessments

Journal article Current Treatment Options in Infectious Diseases · May 28, 2019 Full text Cite

Inappropriate Clostridium difficile Testing and Consequent Overtreatment and Inaccurate Publicly Reported Metrics.

Journal article Infect Control Hosp Epidemiol · December 2016 BACKGROUND The nationally reported metric for Clostridium difficile infection (CDI) relies solely on laboratory testing, which can result in overreporting due to asymptomatic C. difficile colonization. OBJECTIVE To review the clinical scenarios of cases of ... Full text Link to item Cite

Integrative gene expression profiling reveals G6PD-mediated resistance to RNA-directed nucleoside analogues in B-cell neoplasms.

Journal article PLoS One · 2012 The nucleoside analogues 8-amino-adenosine and 8-chloro-adenosine have been investigated in the context of B-lineage lymphoid malignancies by our laboratories due to the selective cytotoxicity they exhibit toward multiple myeloma (MM), chronic lymphocytic ... Full text Link to item Cite

Cellular arrays for large-scale analysis of transcription factor activity.

Journal article Biotechnol Bioeng · February 2011 Identifying molecular mechanisms or therapeutic targets is typically based on large-scale cellular analysis that measures the abundance of mRNA or protein; however, abundance does not necessarily correlate with activity. We report a method for direct large ... Full text Link to item Cite