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Sonali Advani

Adjunct Associate Professor in the Department of Medicine
Medicine, Infectious Diseases
Hanes House Room 154, Box 102359, Durham, NC 27710

Selected Publications


A call to action: the SHEA research agenda to combat healthcare-associated infections.

Journal Article Infection control and hospital epidemiology · October 2024 Full text Cite

Implementing the Infectious Diseases Society of America Antimicrobial Stewardship Core Curriculum: Survey Results and Real-World Strategies to Guide Fellowship Programs

Journal Article Open Forum Infectious Diseases · October 1, 2024 Background: The Infectious Diseases Society of America (IDSA) developed the Core Antimicrobial Stewardship (AS) Curriculum to meet the increasing demand for infectious diseases (ID) providers with AS expertise. Notable diversity in implementation approache ... Full text Cite

Performance of Urinalysis Parameters in Predicting Urinary Tract Infection: Does One Size Fit All?

Journal Article Clin Infect Dis · September 26, 2024 In a multihospital cohort study of 3392 patients, positive urinalysis parameters had poor positive predictive value for diagnosing urinary tract infection (UTI). Combined urinalysis parameters (pyuria or nitrite) performed better than pyuria alone for ruli ... Full text Link to item Cite

What Should I Know About Recurrent UTIs in Older Women?

Journal Article JAMA Intern Med · August 1, 2024 Full text Link to item Cite

The next frontier of healthcare-associated infection (HAI) surveillance metrics: Beyond device-associated infections.

Journal Article Infect Control Hosp Epidemiol · June 2024 In recent years, it has become increasingly evident that surveillance metrics for invasive device-associated infections (ie, central-line-associated bloodstream infections, ventilator-associated pneumonias, and catheter-associated urinary tract infections) ... 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

Diagnostic stewardship to improve patient outcomes and healthcare-associated infection (HAI) metrics.

Journal Article Infect Control Hosp Epidemiol · April 2024 Diagnostic stewardship seeks to improve ordering, collection, performance, and reporting of tests. Test results play an important role in reportable HAIs. The inclusion of HAIs in public reporting and pay for performance programs has highlighted the value ... Full text Link to item Cite

Bacteremia From a Presumed Urinary Source in Hospitalized Adults With Asymptomatic Bacteriuria.

Conference JAMA Netw Open · March 4, 2024 IMPORTANCE: Guidelines recommend withholding antibiotics in asymptomatic bacteriuria (ASB), including among patients with altered mental status (AMS) and no systemic signs of infection. However, ASB treatment remains common. OBJECTIVES: To determine preval ... Full text Link to item Cite

Five steps to high quality antimicrobial stewardship research.

Journal Article Antimicrob Steward Healthc Epidemiol · 2024 The escalating threat of antimicrobial resistance (AMR) necessitates impactful, reproducible, and scalable antimicrobial stewardship strategies. This review addresses the critical need to enhance the quality of antimicrobial stewardship intervention resear ... 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

Evidence gaps among systematic reviews examining the relationship of race, ethnicity, and social determinants of health with adult inpatient quality measures.

Journal Article Antimicrob Steward Healthc Epidemiol · 2024 BACKGROUND: The field of healthcare epidemiology is increasingly focused on identifying, characterizing, and addressing social determinants of health (SDOH) to address inequities in healthcare quality. To identify evidence gaps, we examined recent systemat ... 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

Behavioral Strategies in Diagnostic Stewardship.

Journal Article Infect Dis Clin North Am · December 2023 Diagnostic stewardship refers to the responsible and judicious use of diagnostic tests to reduce low value care and improve patient outcomes. This article provides an overview of behavioral strategies, their relevance to diagnostic stewardship and highligh ... Full text Link to item Cite

Disparities in central line-associated bloodstream infection and catheter-associated urinary tract infection rates: An exploratory analysis.

Journal Article Infect Control Hosp Epidemiol · November 2023 This retrospective review of 4-year surveillance data revealed a higher central line-associated bloodstream infection (CLABSI) rate in non-Hispanic Black patients and higher catheter-associated urinary tract infection (CAUTI) rates in Asian and non-Hispani ... 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

Introduction to A Compendium of Strategies to Prevent Healthcare-Associated Infections In Acute-Care Hospitals: 2022 Updates.

Journal Article Infect Control Hosp Epidemiol · October 2023 Since the initial publication of A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals in 2008, the prevention of healthcare-associated infections (HAIs) has continued to be a national priority. Progress in healthca ... Full text Link to item Cite

Colon surgical-site infections and the impact of "present at the time of surgery (PATOS)" in a large network of community hospitals.

Journal Article Infect Control Hosp Epidemiol · August 2023 OBJECTIVES: To describe the epidemiology of complex colon surgical procedures (COLO), stratified by present at time of surgery (PATOS) surgical-site infections (SSIs) and non-PATOS SSIs and their impact on the epidemiology of colon-surgery SSIs. DESIGN: Re ... Full text Link to item Cite

Strategies to prevent catheter-associated urinary tract infections in acute-care hospitals: 2022 Update.

Journal Article Infect Control Hosp Epidemiol · August 2023 The intent of this document is to highlight practical recommendations in a concise format designed to assist physicians, nurses, and infection preventionists at acute-care hospitals in implementing and prioritizing their catheter-associated urinary tract i ... Full text Link to item Cite

Your Outpatient has Coronavirus Disease 2019: What Are the Treatment Options in the Current Severe Acute Respiratory Syndrome Coronavirus 2 Variant Climate?

Journal Article Clin Infect Dis · July 5, 2023 Mutations accumulated by novel Severe Acute Respiratory Syndrome Coronavirus 2 Omicron sublineages contribute to evasion of previously effective monoclonal antibodies for treatment or prevention of Coronavirus Disease 2019 (COVID-19). Other authorized or a ... Full text Link to item Cite

Surgical site infection trends in community hospitals from 2013 to 2018.

Journal Article Infect Control Hosp Epidemiol · April 2023 OBJECTIVE: Sparse recent data are available on the epidemiology of surgical site infections (SSIs) in community hospitals. Our objective was to provide updated epidemiology data on complex SSIs in community hospitals and to characterize trends of SSI preva ... 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

The impact of coronavirus disease 2019 (COVID-19) response on hospital infection prevention programs and practices in the southeastern United States.

Journal Article Infect Control Hosp Epidemiol · February 2023 Initial assessments of coronavirus disease 2019 (COVID-19) preparedness revealed resource shortages and variations in infection prevention policies across US hospitals. Our follow-up survey revealed improvement in resource availability, increase in testing ... 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

Using the COM-B model to identify barriers to and facilitators of evidence-based nurse urine-culture practices.

Journal Article Antimicrob Steward Healthc Epidemiol · 2023 Our surveys of nurses modeled after the Capability, Opportunity, and Motivation Model of Behavior (COM-B model) revealed that opportunity and motivation factors heavily influence urine-culture practices (behavior), in addition to knowledge (capability). Un ... Full text Open Access Link to item Cite

Beyond implementation: Uncovering the parallels between de-implementation and antimicrobial stewardship.

Journal Article Antimicrob Steward Healthc Epidemiol · 2023 De-implementation is defined as the process of discontinuing, removing, reducing, or replacing a harmful, ineffective, or low-value clinical practice or intervention. The goal of de-implementation strategies is to minimize patient harm, maximize use of res ... Full text Link to item Cite

Disparities in healthcare utilization and outcomes for older adults with infected stones

Conference JOURNAL OF THE AMERICAN GERIATRICS SOCIETY · 2023 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

Comparison of metrics used to track central-line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) across a regional network.

Journal Article Infect Control Hosp Epidemiol · November 2022 The paradoxical relationship between standardized infection ratio and standardized utilization ratio for catheter-associated urinary tract infections (CAUTIs) in contrast to central-line-associated bloodstream infections (CLABSIs), in addition to CAUTI def ... Full text Link to item Cite

Antimicrobial stewardship in solid organ transplant recipients: Current challenges and proposed metrics.

Journal Article Transpl Infect Dis · October 2022 BACKGROUND: Solid organ transplant (SOT) recipients are challenging populations for antimicrobial stewardship interventions due to a variety of reasons, including immunosuppression, consequent risk of opportunistic and donor-derived infections, high rates ... Full text Link to item Cite

Clin-Star corner: What's new at the interface of geriatrics, infectious diseases, and antimicrobial stewardship.

Journal Article J Am Geriatr Soc · August 2022 Antibiotics are among the leading causes of adverse drug events in older adults. Short-course antibiotic therapy has been shown to work as well as the traditional longer durations for many types of infections. Antibiotic stewardship interventions including ... 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 Infection control and hospital epidemiology · 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 Cite

Evaluation of the Infectious Diseases Society of America's Core Antimicrobial Stewardship Curriculum for Infectious Diseases Fellows.

Journal Article Clin Infect Dis · March 23, 2022 BACKGROUND: Antimicrobial stewardship (AS) programs are required by Centers for Medicare and Medicaid Services and should ideally have infectious diseases (ID) physician involvement; however, only 50% of ID fellowship programs have formal AS curricula. The ... Full text Link to item Cite

Investigating Risk Factors for Urine Culture Contamination in Outpatient Clinics: A New Avenue for Diagnostic Stewardship.

Journal Article Antimicrob Steward Healthc Epidemiol · 2022 Mixed flora in urine cultures usually occur due to pre-analytic contamination. In our outpatient urology clinic, we found a high prevalence of mixed flora (46.2%), which was associated with female sex and older age. Patient education did not impact the rat ... Full text Link to item Cite

Navigating the 2021 update to the IDSA/SHEA Clostridioides difficile guidelines: An ethical approach to equitable patient care.

Journal Article Antimicrob Steward Healthc Epidemiol · 2022 The 2021 focused update to the Infections Diseases Society of America/Society for Healthcare Epidemiology of America (IDSA/SHEA) guidelines for management of Clostridioides difficile infection (CDI) prioritizes the use of fidaxomicin over vancomycin for th ... Full text Link to item Cite

Comparison of traditional instruction versus nontraditional learning to improve trainee knowledge of urine culture practices in catheterized patients.

Journal Article Antimicrob Steward Healthc Epidemiol · 2022 We surveyed trainees about their urine culture practices and assessed the impact of an educational intervention delivered electronically and in-person. Trainee scores improved across all levels of training and across all questions on the post-intervention ... Full text Link to item Cite

Quality Improvement Interventions and Implementation Strategies for Urine Culture Stewardship in the Acute Care Setting: Advances and Challenges.

Journal Article Curr Infect Dis Rep · October 2021 PURPOSE OF REVIEW: The goal of this article is to highlight how and why urinalyses and urine cultures are misused, review quality improvement interventions to optimize urine culture utilization, and highlight how to implement successful, sustainable interv ... Full text Link to item Cite

Investing in the Future: A Role for Professional Societies to Prepare the Next Generation of Healthcare Leaders Through Curriculum Development and Dissemination.

Journal Article Clin Infect Dis · September 7, 2021 Professional societies serve many functions that benefit constituents; however, few professional societies have undertaken the development and dissemination of formal, national curricula to train the future workforce while simultaneously addressing signifi ... Full text Link to item Cite

Incidence, risk factors, and outcome of Clostridioides difficile infection following urological surgeries.

Journal Article World J Urol · August 2021 PURPOSE: To assess the incidence, risk factors, and clinical outcomes associated with (Clostridioides difficile infection) CDI following urological surgery, which is the leading cause of nosocomial diarrhea and a growing public health burden. METHODS: We q ... Full text Link to item Cite

Assessing severe acute respiratory coronavirus virus 2 (SARS-CoV-2) preparedness in US community hospitals: A forgotten entity.

Journal Article Infect Control Hosp Epidemiol · May 2021 We performed a cross-sectional survey of infection preventionists in 60 US community hospitals between April 22 and May 8, 2020. Several differences in hospital preparedness for SARS-CoV-2 emerged with respect to personal protective equipment conservation ... Full text Link to item Cite

Deconstructing the urinalysis: A novel approach to diagnostic and antimicrobial stewardship.

Journal Article Antimicrobial stewardship & healthcare epidemiology : ASHE · January 2021 The extensive use of the urinalysis for screening and monitoring in diverse clinical settings usually identifies abnormal urinalysis parameters in patients with no suspicion of urinary tract infection, which in turn triggers urine cultures, inappropriate a ... Full text 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

Comparison of Metrics Used to Track CLABSIs and CAUTIs Across a Regional Network

Conference Infection Control & Hospital Epidemiology · October 2020 Background: The standardized infection ratio (SIR) is the nationally adopted metric used to track and compare catheter-associated urinary tract infections (CAUTIs) and central-line– associated bloodstream infections (CLABSIs) ... Full text Cite

Universal masking in hospitals in the COVID-19 era: Is it time to consider shielding?

Journal Article Infect Control Hosp Epidemiol · September 2020 With concerns for presymptomatic transmission of COVID-19 and increasing burden of contact tracing and employee furloughs, several hospitals have supplemented pre-existing infection prevention measures with universal masking of all personnel in hospitals. ... Full text Link to item Cite

Shifting focus toward healthcare-associated bloodstream infections: The need for neonatal intensive care unit-specific NHSN definitions.

Journal Article Infect Control Hosp Epidemiol · February 2020 OBJECTIVE: Healthcare-associated bloodstream infections (HABSIs) are a significant cause of mortality and morbidity in the neonatal intensive care unit (NICU) population. Our objectives were to review the epidemiology of HABSIs in our NICU and to examine t ... 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

Knowledge and Practices of Physicians and Nurses Related to Urine Cultures in Catheterized Patients: An Assessment of Adherence to IDSA Guidelines.

Journal Article Open Forum Infect Dis · August 1, 2019 BACKGROUND: A positive urine culture often drives initiation of antimicrobials even in the absence of symptoms. Our objectives were to evaluate the knowledge and practice patterns related to ordering urine cultures in patients with indwelling urinary cathe ... Full text Link to item Cite

The evolution of catheter-associated urinary tract infection (CAUTI): Is it time for more inclusive metrics?

Journal Article Infect Control Hosp Epidemiol · June 2019 Catheter-associated urinary tract infection (CAUTI) has long been considered a preventable healthcare-associated infection. Many federal agencies, the Centers for Medicare and Medicaid Services (CMS), and public and private healthcare organizations have im ... Full text Link to item Cite

Antimicrobial Stewardship Training for Infectious Diseases Fellows: Program Directors Identify a Curriculum Need.

Journal Article Clin Infect Dis · September 28, 2018 A needs assessment survey of infectious diseases (ID) training program directors identified gaps in educational resources for training and evaluating ID fellows in antimicrobial stewardship. An Infectious Diseases Society of America-sponsored core curricul ... Full text Link to item Cite

Two Cases and a Review of Graft-Versus-Host Disease and the Role of Hepatitis C Treatment in Liver Transplant Patients.

Journal Article Prog Transplant · September 2018 Graft-versus-host disease (GvHD) is a rare but fatal complication after solid organ transplantation arising in 1% to 2% of cases. We report 2 cases of GvHD after orthotopic liver transplantation. Both patients had a history of hepatitis C virus (HCV) infec ... Full text Link to item Cite

The Impact of 2015 NHSN Catheter-associated Urinary Tract Infection (CAUTI) Definition Change on Central Line-associated Bloodstream Infection (CLABSI) Rates and CLABSI Prevention Efforts at an Academic Medical Center.

Journal Article Infect Control Hosp Epidemiol · July 2018 The 2015 changes in the catheter-associated urinary tract infection definition led to an increase in central line-associated bloodstream infections (CLABSIs) and catheter-related candidemia in some health systems due to the change in CLABSI attribution. Ho ... Full text Link to item Cite

Increased Fluoroquinolone-Susceptibility and Preserved Nitrofurantoin-Susceptibility among Escherichia coli Urine Isolates from Women Long-Term Care Residents: A Brief Report.

Journal Article Open Access J Gerontol Geriatr Med · April 2018 Suspected urinary tract infection is a common indication for antimicrobial therapy in long-term care residents. We sought to characterize antimicrobial susceptibilities among urine isolates collected from women long-term care residents enrolled in a clinic ... Full text Link to item Cite

Frequency of Infection during Fever Episodes among Long-Term Care Residents.

Journal Article J Gerontol Geriatr Res · 2018 BACKGROUND: Empirical data regarding the frequency of infection during fever episodes among women in long-term care facilities are lacking. METHODS: We conducted a case-series analysis of women long-term care residents enrolled in a randomized trial evalua ... Full text Link to item Cite

2015 NHSN CAUTI Definition Change and Its Impact on CLABSI Rates at an Academic Medical Center

Journal Article Open forum infectious diseases · January 2017 Abstract Background The National Healthcare Safety Network (NHSN) revised their catheter-associated urinary tract infection (CAUTI) definition in January 2015 to exclude funguria. This definition change led to an increase in diagnosis of catheter ... Cite

Peripherally Inserted Central Venous Catheter Complications in Children Receiving Outpatient Parenteral Antibiotic Therapy (OPAT).

Journal Article Infect Control Hosp Epidemiol · April 2016 OBJECTIVE To identify the frequency of and risk factors associated with complications necessitating removal of the peripherally inserted central catheters (PICCs) in patients receiving outpatient parenteral antibiotic therapy (OPAT) and to determine the ap ... Full text Link to item Cite

Catheter dwell time and CLABSIs in neonates with PICCs: a multicenter cohort study.

Journal Article Pediatrics · December 2013 OBJECTIVE: To determine whether the daily risk of central line-associated bloodstream infections (CLABSIs) increases over the dwell time of peripherally inserted central catheters (PICCs) in high-risk neonates. METHODS: Multicenter retrospective cohort inc ... Full text Link to item Cite

Postdischarge surveillance to identify subsequent methicillin-resistant Staphylococcus aureus infections in colonized children.

Journal Article Am J Infect Control · October 2013 Some hospitals screen and identify high risk patients for methicillin-resistant Staphylococcus aureus (MRSA) colonization. We performed postdischarge surveillance, including a telephone survey, and estimated a 9.5% incidence of infection in MRSA-colonized ... Full text Link to item Cite

Absorption and tolerability of aqueous chlorhexidine gluconate used for skin antisepsis prior to catheter insertion in preterm neonates.

Journal Article J Perinatol · October 2013 OBJECTIVE: To assess chlorhexidine absorption and skin tolerability in premature infants, following skin antisepsis with 2% aqueous chlorhexidine gluconate (CHG) prior to peripherally inserted central catheter (PICC) placement. STUDY DESIGN: Neonates less ... Full text Link to item Cite

Risk factors for peripherally inserted central venous catheter complications in children.

Journal Article JAMA Pediatr · May 2013 IMPORTANCE: Peripherally inserted central venous catheters (PICCs) are prone to infectious, thrombotic, and mechanical complications. These complications are associated with morbidity, so data are needed to inform quality improvement efforts. OBJECTIVES: T ... Full text Link to item Cite

Detecting respiratory viruses in asymptomatic children.

Journal Article Pediatr Infect Dis J · December 2012 BACKGROUND: Viral respiratory infections are among the most common reasons for hospitalization of children in the United States. Our objective was to compare molecular and conventional methods in a cohort of hospitalized children with and without symptoms ... Full text Link to item Cite

Diagnostic performance of two highly multiplexed respiratory virus assays in a pediatric cohort.

Journal Article J Clin Virol · October 2012 BACKGROUND: Rapid detection of respiratory viruses is important for management and infection control in hospitalized patients. Multiplex nucleic acid tests (NATs) have begun to replace conventional methods as gold standards for respiratory virus detection. ... Full text Link to item Cite

Central line-associated bloodstream infection in hospitalized children with peripherally inserted central venous catheters: extending risk analyses outside the intensive care unit.

Journal Article Clin Infect Dis · May 2011 BACKGROUND: Increasingly, peripherally inserted central venous catheters (PICCs) are placed for prolonged intravenous access. Few data exist regarding risk factors for central line-associated bloodstream infection (CLABSI) complicating PICCs in hospitalize ... Full text Link to item Cite