Scholars@Duke
Rebekah Wrenn

Rebekah Wrenn

Medical Associate Professor in the Department of Medicine
Medicine, Infectious Diseases
rebekah.wrenn@duke.edu
DUMC Box 3089, Durham, NC 27710

Selected Publications

A comparison of blood culture diagnostic stewardship across three emergency departments in a healthcare network.

Journal Article Am J Emerg Med · July 2025 BACKGROUND: Blood culture (BCx) diagnostic stewardship is essential for reducing unnecessary treatments, minimizing false-positive results, and improving patient outcomes and hospital resource utilization. The objective of this study was to compare the eff ... Full text Link to item Cite

Salvage treatment of Pneumocystis jirovecii pneumonia with micafungin and clindamycin: a case report

Journal Article Ame Medical Journal · March 30, 2025 Background: Pneumocystis jirovecii pneumonia (PJP) causes significant morbidity and mortality in immunocompromised patients. Current therapeutic options for PJP may be limited by toxicities, and alternate therapeutic options with fewer side effects are lim ... Full text Cite

Impact of an Algorithm to Triage Patients Discharged From the Emergency Department With Blood Cultures Positive for Staphylococcus aureus or Coagulase-Negative Staphylococcus.

Journal Article J Am Coll Emerg Physicians Open · February 2025 OBJECTIVES: Blood cultures obtained in the emergency department (ED) may become positive after discharge. Healthcare professionals must determine if these results represent true infection or a likely contaminant. An institutional algorithm was developed to ... Full text Link to item Cite

How Often Is Rifampin Therapy Initiated and Completed in Patients With Periprosthetic Joint Infections?

Journal Article Clin Orthop Relat Res · January 23, 2025 BACKGROUND: Rifampin therapy is indicated for the treatment of staphylococcal periprosthetic joint infection (PJI) in patients who have undergone debridement, antibiotics, and implant retention (DAIR) or one-stage revision as per the Infectious Diseases So ... Full text Link to item Cite

Outcomes of Staphylococcal Periprosthetic Joint Infections Treated With Rifampin and the Potential Role of Rifabutin as a Substitute When High-risk Drug-drug Interactions Exist.

Journal Article Orthopedics · 2025 BACKGROUND: This study evaluated outcomes of patients meeting Infectious Disease Society of America guidelines for rifampin therapy in treating staphylococcal periprosthetic joint infection (PJI) and explored the role of rifabutin as a substitute when rifa ... Full text Link to item Cite

Direct oral amoxicillin challenge in a tertiary care center: validating PEN-FAST in inpatient and outpatient populations with low-risk penicillin allergies.

Journal Article Antimicrob Steward Healthc Epidemiol · 2025 Ten percent of hospitalized patients have documented penicillin allergies, over 90% of which are mislabeled and lead to the use of less-preferred alternative antibiotics. The results of this single-center review provide an outlook at successes and opportun ... Full text 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

Blood culture algorithm implementation in emergency department patients as a diagnostic stewardship intervention.

Journal Article Am J Infect Control · September 2024 OBJECTIVE: Blood cultures (BCx) are important for selecting appropriate antibiotic treatment. Ordering BCx for conditions with a low probability of bacteremia has limited utility, thus improved guidance for ordering BCx is needed. Inpatient studies have im ... Full text Link to item Cite

Clinical outcomes in patients with piperacillin/tazobactam-non-susceptible but ceftriaxone-susceptible E. coli or K. pneumoniae bloodstream infection.

Journal Article J Antimicrob Chemother · June 3, 2024 BACKGROUND: A small proportion of Escherichia coli and Klebsiella pneumoniae demonstrate in vitro non-susceptibility to piperacillin/tazobactam but retain susceptibility to ceftriaxone. Uncertainty remains regarding how best to treat these isolates. OBJECT ... 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

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

Inpatient clinicians' approach to diagnosis of urinary tract infections in older adults using the COM-B model: a qualitative assessment.

Journal Article Antimicrob Steward Healthc Epidemiol · 2024 Our interviews of inpatient clinicians (physicians, physician assistants) modeled after the Capability, Opportunity, and Motivation Model of Behavior model revealed opportunity and motivation as important drivers for overdiagnosis and overprescribing for a ... 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

Comparison of Open-Access, Trough-Only Online Calculators Versus Trapezoidal Method for Calculation of Vancomycin Area Under the Curve (AUC).

Journal Article Ann Pharmacother · August 2023 BACKGROUND: Vancomycin area-under-the-curve (AUC) monitoring is associated with reduced nephrotoxicity but may increase cost and workload for personnel compared to trough monitoring. OBJECTIVE: The purpose of this study was to compare the accuracy of vanco ... 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

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

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

A Turtle Disaster: Salmonella enteritidis Cardiovascular Implantable Electronic Device Infection.

Journal Article Open Forum Infect Dis · December 2022 Cardiovascular implantable electronic device (CIED) infections have high mortality and morbidity. CIED infections secondary to gram-negative pathogens are rare, and there are few data regarding their treatment. We report a case of a 60-year-old male who de ... 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

Impact of COVID-19 pandemic on pharmacist-led allergy assessments and penicillin skin testing.

Journal Article J Pharm Pract Res · August 2022 Allergy assessments and penicillin skin testing are associated with reductions in high-Clostridioides difficile infection (CDI)-risk antibiotic use and lower hospital-acquired CDI rates; however, these activities require substantial personnel and resource ... Full text Link to item Cite

Sustained reduction in catheter-associated urinary tract infections using multi-faceted strategies led by champions: A quality improvement initiative.

Journal Article Infect Control Hosp Epidemiol · July 2022 We reviewed the sustainability of a multifaceted intervention on catheter-associated urinary tract infection (CAUTI) in 3 intensive care units. During the 4-year postintervention period, we observed reductions in urine culture rates (from 80.9 to 47.5 per ... Full text Open Access 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

COVID-19 Trials: Who Participates and Who Benefits?

Journal Article South Med J · April 2022 OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has disproportionately afflicted vulnerable populations. Older adults, particularly residents of nursing facilities, represent a small percentage of the population but account for 40% of mortalit ... Full text Open Access 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

Novel method of calculating adjusted antibiotic use by microbiological burden.

Journal Article Infection control and hospital epidemiology · June 2021 ObjectiveTo determine the usefulness of adjusting antibiotic use (AU) by prevalence of bacterial isolates as an alternative method for risk adjustment beyond hospital characteristics.DesignRetrospective, observational, cross-sectional stu ... Full text 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

Mortality outcomes with hydroxychloroquine and chloroquine in COVID-19 from an international collaborative meta-analysis of randomized trials.

Journal Article Nat Commun · April 15, 2021 Substantial COVID-19 research investment has been allocated to randomized clinical trials (RCTs) on hydroxychloroquine/chloroquine, which currently face recruitment challenges or early discontinuation. We aim to estimate the effects of hydroxychloroquine a ... Full text Open Access Link to item Cite

Characterization of Isavuconazole serum concentrations after enteral feeding tube administration in a hospitalized cohort: A case series.

Journal Article J Clin Pharm Ther · April 2021 WHAT IS KNOWN AND OBJECTIVE: Invasive fungal infections often occur in patients with comorbidities that complicate oral administration. Serum concentrations of isavuconazole were characterized after enteral tube administration. CASE DESCRIPTION: Thirteen o ... Full text Link to item Cite

Liposomal Amphotericin B Infusion-Related Dystonia.

Journal Article Ann Pharmacother · October 2020 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

Multidisciplinary Approach to Clostridium difficile Infection in Adult Surgical Patients.

Journal Article Journal of the American College of Surgeons · April 2019 BackgroundIn 2017, our hospital was identified as a high outlier for postoperative Clostridium difficile infections (CDIs) in the American College of Surgeons NSQIP semi-annual report. The Department of Surgery initiated a CDI task force with repr ... Full text 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