Scholars@Duke
Rebekah Moehring

Rebekah Moehring

Associate Professor of Medicine
Medicine, Infectious Diseases
rebekah.moehring@duke.edu
PO Box 102359, DUMC, Durham, NC 27710
Dept of Medicine, Box 102359, Durham, NC 27710

Selected Publications

Long-term trends in the incidence of hospital-acquired carbapenem-resistant Enterobacterales and antimicrobial utilization in a network of community hospitals in the Southeastern United States from 2013 to 2023.

Journal Article Infect Control Hosp Epidemiol · December 3, 2024 BACKGROUND: Carbapenem-resistant Enterobacterales (CRE) are an urgent threat to healthcare, but the epidemiology of these antimicrobial-resistant organisms may be evolving in some settings since the COVID-19 pandemic. An updated analysis of hospital-acquir ... 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

Proposing the "Continuum of UTI" for a Nuanced Approach to Diagnosis and Management of Urinary Tract Infections.

Journal Article J Urol · May 2024 PURPOSE: Patients with suspected UTIs are categorized into 3 clinical phenotypes based on current guidelines: no UTI, asymptomatic bacteriuria (ASB), or UTI. However, all patients may not fit neatly into these groups. Our objective was to characterize clin ... Full text Link to item Cite

Racial disparities in Clostridioides difficile testing in three southeastern US hospitals.

Journal Article Infect Control Hosp Epidemiol · April 2024 OBJECTIVE: To analyze Clostridioides difficile testing in 3 hospitals in central North Carolina to validate previous racial health-disparity findings. METHODS: We completed a retrospective analysis of inpatient C. difficile tests from 2015 to 2021 at 3 uni ... Full text Link to item Cite

Implementation of a diagnostic stewardship intervention to improve blood-culture utilization in 2 surgical ICUs: Time for a blood-culture change.

Journal Article Infect Control Hosp Epidemiol · April 2024 OBJECTIVE: We compared the number of blood-culture events before and after the introduction of a blood-culture algorithm and provider feedback. Secondary objectives were the comparison of blood-culture positivity and negative safety signals before and afte ... Full text 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

Antimicrobial stewardship knowledge, attitudes, and practices (KAP) among nurses.

Journal Article Antimicrob Steward Healthc Epidemiol · 2024 We performed a knowledge, attitudes, and practice (KAP) survey of bedside nurses to evaluate perceptions of antimicrobial use and aid in the design of nursing-based antimicrobial stewardship interventions. The survey highlighted discrepancies in knowledge ... 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

Development of Inpatient Stewardship Metrics: Is It Time for Public Reporting?

Journal Article Infect Dis Clin North Am · December 2023 Given the complexity and nuance needed to make antimicrobial prescribing decisions, metrics aiming to assess these decisions can be complex in method, require resource investment for measurement, and demand thoughtfulness in how to use data for program imp ... 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

Harvesting the low-hanging fruit? Comparative assessment of intravenous to oral route antimicrobial conversion policy implementation.

Journal Article Infect Control Hosp Epidemiol · June 2023 Policies that promote conversion of antibiotics from intravenous to oral route administration are considered "low hanging fruit" for hospital antimicrobial stewardship programs. We developed a simple metric based on digestive days of therapy divided by tot ... 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

The Disproportionate Impact of Coronavirus Disease 2019 (COVID-19) Pandemic on Healthcare-Associated Infections in Community Hospitals: Need for Expanding the Infectious Disease Workforce.

Journal Article Clin Infect Dis · February 8, 2023 BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic had a considerable impact on US healthcare systems, straining hospital resources, staff, and operations. However, a comprehensive assessment of the impact on healthcare-associated infections (HAI ... 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

Optimizing reflex urine cultures: Using a population-specific approach to diagnostic stewardship.

Journal Article Infect Control Hosp Epidemiol · February 2023 BACKGROUND: Clinicians and laboratories routinely use urinalysis (UA) parameters to determine whether antimicrobial treatment and/or urine cultures are needed. Yet the performance of individual UA parameters and common thresholds for action are not well de ... Full text Link to item Cite

Asymptomatic screening for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) as an infection prevention measure in healthcare facilities: Challenges and considerations.

Journal Article Infect Control Hosp Epidemiol · January 2023 Testing of asymptomatic patients for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) (ie, "asymptomatic screening) to attempt to reduce the risk of nosocomial transmission has been extensive and resource intensive, and such testing is of unclear ... Full text Link to item Cite

Challenges in hospital-acquired coronavirus disease 2019 (COVID-19) surveillance and attribution of infection source.

Journal Article Infect Control Hosp Epidemiol · December 2022 We performed surveillance for hospital-acquired COVID-19 (HA-COVID-19) and compared time-based, electronic definitions to real-time adjudication of the most likely source of acquisition. Without real-time adjudication, nearly 50% of HA-COVID-19 cases ident ... Full text Link to item Cite

Impact of Education and Data Feedback on Antibiotic Prescribing for Urinary Tract Infections in the Emergency Department: An Interrupted Time-Series Analysis.

Journal Article Clin Infect Dis · September 30, 2022 BACKGROUND: Urinary tract infections (UTIs) are often misdiagnosed or treated with exceedingly broad-spectrum antibiotics, leading to negative downstream effects. We aimed to implement antimicrobial stewardship (AS) strategies targeting UTI prescribing in ... Full text Link to item Cite

The Impact of Centers for Medicare & Medicaid Services SEP-1 Core Measure Implementation on Antibacterial Utilization: A Retrospective Multicenter Longitudinal Cohort Study With Interrupted Time-Series Analysis.

Journal Article Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · August 2022 BackgroundThe impact of the US Centers for Medicare & Medicaid Services (CMS) Severe Sepsis and Septic Shock: Management Bundle (SEP-1) core measure on overall antibacterial utilization is unknown.MethodsWe performed a retrospective multi ... Full text Cite

Use of Contact Networks to Estimate Potential Pathogen Risk Exposure in Hospitals.

Journal Article JAMA Netw Open · August 1, 2022 IMPORTANCE: Person-to-person contact is important for the transmission of health care-associated pathogens. Quantifying these contact patterns is crucial for modeling disease transmission and understanding routes of potential transmission. OBJECTIVE: To ge ... Full text Link to item Cite

The impact of patient-reported penicillin or cephalosporin allergy on surgical site infections.

Journal Article Infect Control Hosp Epidemiol · July 2022 OBJECTIVE: To determine the impact of a documented penicillin or cephalosporin allergy on the development of surgical site infections (SSIs). BACKGROUND: Appropriate preoperative antibiotic prophylaxis reduces SSI risk, but documented antibiotic allergies ... Full text Link to item Cite

Impact of Antibiotic Stewardship Rounds in the Intensive Care Setting: A Prospective Cluster-Randomized Crossover Study.

Journal Article Clin Infect Dis · June 10, 2022 BACKGROUND: Few groups have formally studied the effect of dedicated antibiotic stewardship rounds (ASRs) on antibiotic use (AU) in intensive care units (ICUs). METHODS: We implemented weekly ASRs using a 2-arm, cluster-randomized, crossover study in 5 ICU ... Full text Link to item Cite

Impact of Education and Data Feedback on Guideline-Concordant Prescribing for Urinary Tract Infections in the Outpatient Setting.

Journal Article Open Forum Infect Dis · March 2022 BACKGROUND: Urinary tract infections (UTIs) are the most common outpatient indication for antibiotics and an important target for antimicrobial stewardship (AS) activities. With The Joint Commission standards now requiring outpatient AS, data supporting ef ... Full text Link to item Cite

Development of an Electronic Definition for De-escalation of Antibiotics in Hospitalized Patients.

Journal Article Clin Infect Dis · December 6, 2021 BACKGROUND: Antimicrobial stewardship programs (ASPs) promote the principle of de-escalation: moving from broad- to narrow-spectrum agents and stopping antibiotics when no longer indicated. A standard, objective definition of de-escalation applied to elect ... 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

Curvularia alcornii Aortic Pseudoaneurysm Following Aortic Valve Replacement: Case Report and Review of the Literature.

Journal Article Open Forum Infect Dis · November 2021 We report the first case of Curvularia alcornii aortic pseudoaneurysm following bioprosthetic aortic valve replacement in an immunocompetent host. Infection was complicated by septic emboli to multiple organs. Despite aggressive surgical intervention and a ... Full text Open Access Link to item Cite

Tap Water Avoidance Decreases Rates of Hospital-onset Pulmonary Nontuberculous Mycobacteria.

Journal Article Clin Infect Dis · August 2, 2021 We analyzed the impact of a hospital tap water avoidance protocol on respiratory isolation of nontuberculous mycobacteria (NTM). After protocol implementation, hospital-onset episodes of respiratory NTM isolation on high-risk units decreased from 41.0 to 9 ... Full text Link to item Cite

Leveraging Existing and Soon-to-Be-Available Novel Diagnostics for Optimizing Outpatient Antibiotic Stewardship in Patients With Respiratory Tract Infections.

Journal Article Clin Infect Dis · June 15, 2021 Respiratory tract infections (RTIs) drive many outpatient encounters and, despite being predominantly viral, are associated with high rates of antibiotic prescriptions. With rising antibacterial resistance, optimization of prescribing of antibiotics in out ... Full text Link to item Cite

Evaluation of a Pharmacist-Led Penicillin Allergy Assessment Program and Allergy Delabeling in a Tertiary Care Hospital.

Journal Article JAMA Netw Open · May 3, 2021 IMPORTANCE: Penicillin allergies are frequently mislabeled, which may contribute to use of less-preferred alternative antibiotics. OBJECTIVE: To evaluate a pharmacist-led allergy assessment program's association with antimicrobial use and clinical outcomes ... Full text Link to item Cite

Estimated Methicillin-Resistant Staphylococcus aureus Decolonization in Intensive Care Units Associated With Single-Application Chlorhexidine Gluconate or Mupirocin.

Journal Article JAMA Netw Open · March 1, 2021 IMPORTANCE: Chlorhexidine gluconate (CHG) and mupirocin are widely used to decolonize patients with methicillin-resistant Staphylococcus aureus (MRSA) and reduce risks associated with infection in hospitalized populations. Quantifying the association of an ... Full text Link to item Cite

Development of a Machine Learning Model Using Electronic Health Record Data to Identify Antibiotic Use Among Hospitalized Patients.

Journal Article JAMA Netw Open · March 1, 2021 IMPORTANCE: Comparisons of antimicrobial use among hospitals are difficult to interpret owing to variations in patient case mix. Risk-adjustment strategies incorporating larger numbers of variables haves been proposed as a method to improve comparisons for ... Full text Link to item 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

Navigating reflex urine culture practices in community hospitals: Need for a validated approach.

Journal Article Am J Infect Control · December 2020 We performed a descriptive study of reflex urine culture (RUC) practices across 51 community hospitals in southeastern United States. We found that 26 unique reflexing criteria were used in 28 hospitals. Only 14% hospitals of hospitals that offered RUC res ... Full text Link to item Cite

Identifying predictors of antimicrobial exposure in hospitalized patients using a machine learning approach.

Journal Article J Appl Microbiol · March 2020 AIMS: Analysis and tracking of antimicrobial utilization (AU) are crucial in antimicrobial stewardship efforts which are used to find effective interventions for controlling antimicrobial resistance. In antimicrobial stewardship, standard risk adjustment m ... Full text Link to item Cite

Impact of Location of Acquisition of Gram-Positive Bloodstream Infections on Clinical Outcomes Among Patients Admitted to Community Hospitals.

Journal Article Infect Drug Resist · 2020 PURPOSE: We investigated the association between location of acquisition (LOA) of gram-positive (GP) bloodstream infections (BSI) in community hospitals and clinical outcomes. METHODS: We performed a multicenter cohort study of adult inpatients with GP BSI ... Full text Link to item Cite

Reflex Urine Culture Practices in a Regional Community Hospital Network

Conference Infection Control & Hospital Epidemiology · 2020 Background: Reflex urine cultures (RUCs) have the potential to reduce unnecessary urine cultures and antibiotic use. However, urinalysis parameters that best predict true infection are unknown. In this study, we surveyed different RUC practices in laborato ... Full text Link to item Cite

Epidemiology of Posttransrectal Prostate Biopsy Bloodstream Infections and Impact of a Screening Program

Conference Infection Control & Hospital Epidemiology · 2020 Background: Antibiotic prophylaxis choice for transrectal prostate biopsy (TRPB) has been affected by the emergence of fluoroquinolone-resistant Escherichia coli (FQRE). Prebiopsy FQRE screening and targeted antibiotic prophylaxis may reduce post-TRPB bloo ... Full text Link to item Cite

Measuring Empiric Antibiotic Spectrum Patterns Across Space and Time

Conference Infection Control & Hospital Epidemiology · 2020 Background: Quantitative evaluation of antibiotic spectrum is an important, underutilized metric in measuring antibiotic use (AU) and may assist antimicrobial stewards in identifying targets and strategy for intervention. We evaluated the spectrum of initi ... Full text Link to item Cite

Research needs in antibiotic stewardship.

Journal Article Infect Control Hosp Epidemiol · December 2019 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

Epidemiologic Trends in Clostridioides difficile Infections in a Regional Community Hospital Network.

Journal Article JAMA Netw Open · October 2, 2019 IMPORTANCE: Clostridioides difficile infection (CDI) remains a leading cause of health care facility-associated infection. A greater understanding of the regional epidemiologic profile of CDI could inform targeted prevention strategies. OBJECTIVES: To asse ... Full text Open Access Link to item Cite

A visual analytics framework for analysis of patient trajectories

Conference ACM-BCB 2019 - Proceedings of the 10th ACM International Conference on Bioinformatics, Computational Biology and Health Informatics · September 4, 2019 The problem of analyzing patient trajectories is fundamental to our ability to understand and characterize diseases and how we treat them in our hospitals, and to devise and explore effective alternative strategies for healthcare. In this paper, we present ... Full text Cite

Feasibility of Core Antimicrobial Stewardship Interventions in Community Hospitals.

Journal Article JAMA Netw Open · August 2, 2019 IMPORTANCE: The feasibility of core Infectious Diseases Society of America-recommended antimicrobial stewardship interventions in community hospitals is unknown. OBJECTIVE: To determine the feasibility and results of implementing 2 core stewardship interve ... Full text Link to item Cite

Total duration of antimicrobial therapy resulting from inpatient hospitalization.

Journal Article Infect Control Hosp Epidemiol · August 2019 OBJECTIVE: To assess the feasibility of electronic data capture of postdischarge durations and evaluate total durations of antimicrobial exposure related to inpatient hospital stays. DESIGN: Multicenter, retrospective cohort study. SETTING: Two community h ... Full text Link to item Cite

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

Journal Article Current Treatment Options in Infectious Diseases · June 2019 Full text Cite

Essential Resources and Strategies for Antibiotic Stewardship Programs in the Acute Care Setting.

Journal Article Clin Infect Dis · September 28, 2018 BACKGROUND: Antibiotic stewardship programs improve clinical outcomes and patient safety and help combat antibiotic resistance. Specific guidance on resources needed to structure stewardship programs is lacking. This manuscript describes results of a surve ... Full text Link to item Cite

Infections in Older Adults: A Case-Based Discussion Series Emphasizing Antibiotic Stewardship.

Journal Article MedEdPORTAL · September 21, 2018 INTRODUCTION: Compared with younger populations, adults 65 years and older are more likely to suffer infection-related morbidity and mortality, experience antibiotic-related adverse events, and acquire multidrug-resistant organisms. We developed a series o ... Full text Open Access Link to item Cite

Effectiveness of targeted enhanced terminal room disinfection on hospital-wide acquisition and infection with multidrug-resistant organisms and Clostridium difficile: a secondary analysis of a multicentre cluster randomised controlled trial with crossover design (BETR Disinfection).

Journal Article Lancet Infect Dis · August 2018 BACKGROUND: The hospital environment is a source of pathogen transmission. The effect of enhanced disinfection strategies on the hospital-wide incidence of infection has not been investigated in a multicentre, randomised controlled trial. We aimed to asses ... Full text Link to item Cite

Feasibility and Value of Developing a Regional Antibiogram for Community Hospitals.

Journal Article Infect Control Hosp Epidemiol · June 2018 OBJECTIVETo determine the feasibility and value of developing a regional antibiogram for community hospitals.DESIGNMulticenter retrospective analysis of antibiograms.SETTING AND PARTICIPANTSA total of 20 community hospitals in central and eastern North Car ... Full text Link to item Cite

Denominator Matters in Estimating Antimicrobial Use: A Comparison of Days Present and Patient Days.

Journal Article Infect Control Hosp Epidemiol · May 2018 Patient days and days present were compared to directly measured person time to quantify how choice of different denominator metrics may affect antimicrobial use rates. Overall, days present were approximately one-third higher than patient days. This diffe ... Full text Link to item Cite

Influence of Reported Penicillin Allergy on Mortality in MSSA Bacteremia.

Journal Article Open Forum Infect Dis · March 2018 BACKGROUND: Penicillin allergy frequently impacts antibiotic choice. As beta-lactams are superior to vancomycin in treating methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia, we examined the effect of reported penicillin allergy on clinical o ... Full text Open Access Link to item Cite

Implementation Lessons Learned From the Benefits of Enhanced Terminal Room (BETR) Disinfection Study: Process and Perceptions of Enhanced Disinfection with Ultraviolet Disinfection Devices.

Journal Article Infect Control Hosp Epidemiol · February 2018 OBJECTIVE To summarize and discuss logistic and administrative challenges we encountered during the Benefits of Enhanced Terminal Room (BETR) Disinfection Study and lessons learned that are pertinent to future utilization of ultraviolet (UV) disinfection d ... Full text Link to item Cite

The Antimicrobial Scrub Contamination and Transmission (ASCOT) Trial: A Three-Arm, Blinded, Randomized Controlled Trial With Crossover Design to Determine the Efficacy of Antimicrobial-Impregnated Scrubs in Preventing Healthcare Provider Contamination.

Journal Article Infect Control Hosp Epidemiol · October 2017 OBJECTIVE To determine whether antimicrobial-impregnated textiles decrease the acquisition of pathogens by healthcare provider (HCP) clothing. DESIGN We completed a 3-arm randomized controlled trial to test the efficacy of 2 types of antimicrobial-impregna ... Full text Link to item Cite

Enhanced terminal room disinfection and acquisition and infection caused by multidrug-resistant organisms and Clostridium difficile (the Benefits of Enhanced Terminal Room Disinfection study): a cluster-randomised, multicentre, crossover study.

Journal Article Lancet · February 25, 2017 BACKGROUND: Patients admitted to hospital can acquire multidrug-resistant organisms and Clostridium difficile from inadequately disinfected environmental surfaces. We determined the effect of three enhanced strategies for terminal room disinfection (disinf ... Full text Link to item Cite

Expert Consensus on Metrics to Assess the Impact of Patient-Level Antimicrobial Stewardship Interventions in Acute-Care Settings.

Journal Article Clin Infect Dis · February 1, 2017 Antimicrobial stewardship programs (ASPs) positively impact patient care, but metrics to assess ASP impact are poorly defined. We used a modified Delphi approach to select relevant metrics for assessing patient-level interventions in acute-care settings fo ... Full text Link to item Cite

Identification of novel risk factors for community-acquired Clostridium difficile infection using spatial statistics and geographic information system analyses.

Journal Article PLoS One · 2017 BACKGROUND: The rate of community-acquired Clostridium difficile infection (CA-CDI) is increasing. While receipt of antibiotics remains an important risk factor for CDI, studies related to acquisition of C. difficile outside of hospitals are lacking. As a ... Full text Open Access Link to item Cite

A Multicenter Pragmatic Interrupted Time Series Analysis of Chlorhexidine Gluconate Bathing in Community Hospital Intensive Care Units.

Journal Article Infect Control Hosp Epidemiol · July 2016 OBJECTIVE To determine whether daily chlorhexidine gluconate (CHG) bathing of intensive care unit (ICU) patients leads to a decrease in hospital-acquired infections (HAIs), particularly infections caused by methicillin-resistant Staphylococcus aureus (MRSA ... Full text Link to item Cite

Epidemiology of Surgical Site Infection in a Community Hospital Network.

Journal Article Infect Control Hosp Epidemiol · May 2016 OBJECTIVE: To describe the epidemiology of complex surgical site infection (SSI) following commonly performed surgical procedures in community hospitals and to characterize trends of SSI prevalence rates over time for MRSA and other common pathogens METHOD ... Full text Link to item Cite

Results of a Veterans Affairs employee education program on antimicrobial stewardship for older adults.

Journal Article Am J Infect Control · March 1, 2016 We describe a course in the Veterans Affairs (VA) Employee Education System designed to engage nursing staff working in VA long-term care facilities as partners in antimicrobial stewardship. We found that the course addressed an important knowledge gap. Ou ... Full text Link to item Cite

An Automated Surveillance Strategy to Identify Infectious Complications After Cardiac Implantable Electronic Device Procedures.

Journal Article Open Forum Infect Dis · December 2015 Background.  The optimum approach for infectious complication surveillance for cardiac implantable electronic device (CIED) procedures is unclear. We created an automated surveillance tool for infectious complications after CIED procedures. Methods.  Adult ... Full text Open Access Link to item Cite

Short Operative Duration and Surgical Site Infection Risk in Hip and Knee Arthroplasty Procedures.

Journal Article Infect Control Hosp Epidemiol · December 2015 OBJECTIVE: To determine the association (1) between shorter operative duration and surgical site infection (SSI) and (2) between surgeon median operative duration and SSI risk among first-time hip and knee arthroplasties. DESIGN: Retrospective cohort study ... Full text Link to item Cite

Seasonal Variation of Common Surgical Site Infections: Does Season Matter?

Journal Article Infect Control Hosp Epidemiol · September 2015 OBJECTIVE: To evaluate seasonal variation in the rate of surgical site infections (SSI) following commonly performed surgical procedures. DESIGN: Retrospective cohort study. METHODS: We analyzed 6 years (January 1, 2007, through December 31, 2012) of data ... Full text Link to item Cite

Challenges in Preparation of Cumulative Antibiogram Reports for Community Hospitals.

Journal Article J Clin Microbiol · September 2015 Knowledge of local antimicrobial resistance is critical for management of infectious diseases. Community hospitals' compliance with Clinical and Laboratory Standards Institute (CLSI) guidance for creation of cumulative antibiograms is uncertain. This descr ... Full text Link to item Cite

Postoperative infection in spine surgery: does the month matter?

Journal Article J Neurosurg Spine · July 2015 OBJECT: The relationship between time of year and surgical site infection (SSI) following neurosurgical procedures is poorly understood. Authors of previous reports have demonstrated that rates of SSI following neurosurgical procedures performed during the ... Full text Link to item Cite

Point-of-prescription interventions to improve antimicrobial stewardship.

Journal Article Clin Infect Dis · April 15, 2015 Antimicrobial stewardship is pivotal to improving patient outcomes, reducing adverse events, decreasing healthcare costs, and preventing further emergence of antimicrobial resistance. In an era in which antimicrobial resistance is increasing, judicious ant ... Full text Link to item Cite

Delay in diagnosis of invasive surgical site infections following knee arthroplasty versus hip arthroplasty.

Journal Article Clin Infect Dis · April 1, 2015 BACKGROUND: The timing of diagnosis of invasive surgical site infection (SSI) following joint replacement surgery is an important criterion used to determine subsequent medical and surgical management. METHODS: We compared time to diagnosis of invasive SSI ... Full text Link to item Cite

The potential impact of excluding funguria from the surveillance definition of catheter-associated urinary tract infection.

Journal Article Infect Control Hosp Epidemiol · April 2015 Funguria rarely represents true infection in the urinary tract. Excluding yeast from the catheter-associated urinary tract infection (CAUTI) surveillance definition reduced CAUTI rates by nearly 25% in community hospitals and at an academic, tertiary-care ... Full text Link to item Cite

Knowledge, beliefs, and confidence regarding infections and antimicrobial stewardship: a survey of Veterans Affairs providers who care for older adults.

Journal Article Am J Infect Control · March 1, 2015 We conducted an anonymous survey of providers who care for older adults from 10 Veterans Affairs long-term-care facilities to assess their knowledge, beliefs, and confidence toward treating infections and antimicrobial stewardship. The average score on 5 q ... Full text Link to item Cite

A comparison between National Healthcare Safety Network laboratory-identified event reporting versus traditional surveillance for Clostridium difficile infection.

Journal Article Infect Control Hosp Epidemiol · February 2015 OBJECTIVE Hospitals in the National Healthcare Safety Network began reporting laboratory-identified (LabID) Clostridium difficile infection (CDI) events in January 2013. Our study quantified the differences between the LabID and traditional surveillance me ... Full text Link to item Cite

Epidemiology of methicillin-resistant Staphylococcus aureus pneumonia in community hospitals.

Journal Article Infect Control Hosp Epidemiol · December 2014 OBJECTIVE: Describe the epidemiology of healthcare-related (ie, healthcare-associated and hospital-acquired) pneumonia due to methicillin-resistant Staphylococcus aureus (MRSA) among hospitalized patients in community hospitals. DESIGN: Retrospective cohor ... Full text Link to item Cite

Methicillin-resistant Staphylococcus aureus bloodstream infection surveillance: National Healthcare Safety Network's laboratory-identified event reporting versus traditional laboratory-confirmed bloodstream infection surveillance.

Journal Article Infect Control Hosp Epidemiol · October 2014 Hospitals must report cases of methicillin-resistant Staphylococcus aureus bloodstream infection (BSI) using a new laboratory-identified (LabID) event reporting module. BSI rates obtained using LabID differ from rates of BSI obtained from traditional surve ... Full text Link to item Cite

Rising rates of carbapenem-resistant enterobacteriaceae in community hospitals: a mixed-methods review of epidemiology and microbiology practices in a network of community hospitals in the southeastern United States.

Journal Article Infect Control Hosp Epidemiol · August 2014 OBJECTIVE: Describe the epidemiology of carbapenem-resistant Enterobacteriaceae (CRE) and examine the effect of lower carbapenem breakpoints on CRE detection. DESIGN: Retrospective cohort. SETTING: Inpatient care at community hospitals. PATIENTS: All patie ... Full text Link to item Cite

Hospital-acquired Clostridium difficile infections: estimating all-cause mortality and length of stay.

Journal Article Epidemiology · July 2014 BACKGROUND: Clostridium difficile is a health care-associated infection of increasing importance. The purpose of this study was to estimate the time until death from any cause and time until release among patients with C. difficile, comparing the burden of ... Full text Link to item Cite

Surveying the surveillance: surgical site infections excluded by the January 2013 updated surveillance definitions.

Journal Article Infect Control Hosp Epidemiol · May 2014 The updated 2013 Centers for Disease Control and Prevention/National Healthcare Safety Network definitions for surgical site infections (SSIs) reduced the duration of prolonged surveillance from 1 year to 90 days and defined which procedure types require p ... Full text Link to item Cite

Outbreak of bacteremia due to Burkholderia contaminans linked to intravenous fentanyl from an institutional compounding pharmacy.

Journal Article JAMA Intern Med · April 2014 IMPORTANCE Many health care facilities compound medications on site to fulfill local demands when customized formulations are needed, national supply is critically low, or costs for manufactured pharmaceuticals are excessive. Small, institutional compoundi ... Full text Link to item Cite

A mathematical model to evaluate the routine use of fecal microbiota transplantation to prevent incident and recurrent Clostridium difficile infection.

Journal Article Infect Control Hosp Epidemiol · January 2014 OBJECTIVE: Fecal microbiota transplantation (FMT) has been suggested as a new treatment to manage Clostridium difficile infection (CDI). With use of a mathematical model of C. difficile within an intensive care unit (ICU), we examined the potential impact ... Full text Link to item Cite

Bloodstream infections in community hospitals in the 21st century: a multicenter cohort study.

Journal Article PLoS One · 2014 BACKGROUND: While the majority of healthcare in the US is provided in community hospitals, the epidemiology and treatment of bloodstream infections in this setting is unknown. METHODS AND FINDINGS: We undertook this multicenter, retrospective cohort study ... Full text Open Access Link to item Cite

Impact of change to molecular testing for Clostridium difficile infection on healthcare facility-associated incidence rates.

Journal Article Infect Control Hosp Epidemiol · October 2013 BACKGROUND: Change from nonmolecular to molecular testing techniques is thought to contribute to the increasing trend in incidence of Clostridium difficile infection (CDI); however the degree of effect attributed to this versus other time-related epidemiol ... Full text Link to item Cite

Comparison of non-intensive care unit (ICU) versus ICU rates of catheter-associated urinary tract infection in community hospitals.

Journal Article Infect Control Hosp Epidemiol · July 2013 We describe and compare the epidemiology of catheter-associated urinary tract infection (CAUTI) occurring in non-intensive care unit (ICU) versus ICU wards in a network of community hospitals over a 2-year period. Overall, 72% of cases of CAUTI occurred in ... Full text Link to item Cite

Central line-associated infections as defined by the Centers for Medicare and Medicaid Services' Hospital-acquired condition versus standard infection control surveillance: why hospital compare seems conflicted.

Journal Article Infect Control Hosp Epidemiol · March 2013 OBJECTIVE: To evaluate the concordance of case-finding methods for central line-associated infection as defined by Centers for Medicare and Medicaid Services (CMS) hospital-acquired condition (HAC) compared with traditional infection control (IC) methods. ... Full text Link to item Cite

Observing and improving hand hygiene compliance: implementation and refinement of an electronic-assisted direct-observer hand hygiene audit program.

Journal Article Infect Control Hosp Epidemiol · February 2013 We implemented a direct-observer hand hygiene audit program that used trained observers, wireless data entry devices, and an intranet portal. We improved the reliability and utility of the data by standardizing audit processes, regularly retraining auditor ... Full text Link to item Cite

Delays in appropriate antibiotic therapy for gram-negative bloodstream infections: a multicenter, community hospital study.

Journal Article PLoS One · 2013 BACKGROUND: Gram-negative bacterial bloodstream infection (BSI) is a serious condition with estimated 30% mortality. Clinical outcomes for patients with severe infections improve when antibiotics are appropriately chosen and given early. The objective of t ... Full text Open Access Link to item Cite

Antimicrobial stewardship as part of the infection prevention effort.

Journal Article Curr Infect Dis Rep · December 2012 Antimicrobial stewardship programs (ASPs) optimize antimicrobial use to decrease the incidence of infection with multidrug-resistant organisms (MDRO) and the emergence of drug resistance, to improve patient outcomes and safety, and to decrease hospital cos ... Full text Link to item Cite

Prosthetic joint infection: Case study and review of diagnosis and management

Journal Article Infectious Diseases in Clinical Practice · September 1, 2012 Surgical site infections are an infrequent but devastating complication of surgeries involving placement of prosthetic joints. Management of prosthetic joint infections can be prolonged and complicated, requiring close collaboration between infectious dise ... Full text Cite

"What the eyes don't see, the heart doesn't grieve over": epidemiology and risk factors for bloodstream infections following cardiac catheterization.

Journal Article Infect Control Hosp Epidemiol · August 2012 No standard definition exists for surveillance and characterization of the epidemiology of bloodstream infections (BSIs) after cardiac catheterization (CC) procedures. We proposed a novel case definition and determined the epidemiology and risk factors of ... Full text Link to item Cite

"But my patients are different!": risk adjustment in 2012 and beyond.

Journal Article Infect Control Hosp Epidemiol · October 2011 Full text Link to item Cite