Carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant Pseudomonas aeruginosa (CRPA) are a growing threat. The objective of this study was to describe CRAB CRPA epidemiology identify factors associated with mortality length stay (LOS) post-culture.This national retrospective cohort Veterans or positive cultures from 2013 2018, conducted at Hines Affairs Hospital. Carbapenem resistance defined as non-susceptibility imipenem, meropenem and/or doripenem. Multivariable...

Although infections caused by Acinetobacter baumannii are often healthcare-acquired, difficult to treat, and associated with high mortality, epidemiologic data for this organism limited. We describe the epidemiology, clinical characteristics, outcomes patients extensively drug-resistant (XDRAB).Retrospective cohort study.Department of Veterans' Affairs Medical Centers (VAMCs).Patients XDRAB cultures (defined as nonsusceptible at least 1 agent in all but 2 or fewer classes) VAMCs between 2012...

To understand barriers and facilitators to evidence-based prescribing of antibiotics in the outpatient dental setting.Semistructured interviews.Outpatient setting.Dentists from 40 Veterans' Health Administration (VA) facilities across United States.Dentists were identified based on their patterns recruited participate a semistructured interview perceptions toward prescribing. All interviews recorded, transcribed, double-coded for analysis, with high reliability between coders. We general...

Infectious diseases (ID) consultation improves health outcomes for certain infections but has not been well described Pseudomonas aeruginosa (PA) bloodstream infection (BSI). Therefore, the goal of this study was to examine ID inpatients with PA BSI and factors impacting outcomes.This a retrospective cohort from January 1, 2012, December 31, 2018, adult hospitalized veterans antibiotic treatment 2 days before through 5 after culture date. Multidrug-resistant (MDR) cultures were defined as...

To evaluate opportunities for assessing penicillin allergies among patients presenting to dental clinics.Retrospective cross-sectional study.VA clinics.Adult with a documented allergy who received an antibiotic from dentist between January 1, 2015, and December 31, 2018, were included.Chart reviews completed on random samples of 100 noncephalosporin 200 cephalosporin. Each was categorized by severity. These categories used determine patient eligibility 3 testing groups based peer-reviewed...

Background: In rural areas, antimicrobial stewardship programs often have limited access to infectious disease (ID) expertise. Videoconference Antimicrobial Stewardship Teams (VASTs) pair Veterans Affairs (VA) medical centers with an ID expert discuss treatment of patients concerns for infection. a pilot study, VASTs were effective at improving use. Here, we evaluated 12-month operating costs staffing 3 VASTs. Methods: We used the following data describe 12 months clinical encounters from...

Abstract Objective: Stenotrophomonas maltophilia is a multidrug-resistant gram-negative bacillus that can cause serious infections but has limited treatment options. This study aims to establish trends in the of S. bloodstream (BSI) across United States Department Veterans Affairs (VA) facilities. Methods: Data was evaluated over 10-year timeframe (2012 2021) this retrospective cohort study. with ≥ 1 blood culture within VA medical encounter were included. Microbiology, pharmacy, and patient...

Context Antimicrobial Stewardship Programs (ASPs) are crucial to optimizing antibiotic use. ASPs implemented in the Veterans Health Administration (VAs), but they do not target needs of populations at high risk for resistant infections, such as spinal cord injury and disorder (SCI/D).

Abstract Background Infections caused by carbapenem-resistant Enterobacteriaceae (CRE) and carbapenemase-producing (CP) CRE are difficult to treat, resulting in high mortality healthcare settings every year. The Veterans Health Administration (VHA) disseminated guidelines 2015 an updated directive 2017 for control of focused on laboratory testing, prevention, management. Consolidated Framework Implementation Research (CFIR) framework was used analyze qualitative interview data identify...

The U.S. Department of Veterans Affairs (VA) is the largest integrated healthcare system in United States and provides dental care to approximately one-half million veterans annually. In response opioid crisis, VA released several risk mitigation strategies. Although prescribing by dentists has decreased on whole, implementation experiences at level remains unclear. Our objective was explore barriers facilitators that affect decision making for management acute pain among dentists. Dentists...

Background: Antimicrobial stewardship programs (ASPs) seek to reduce the prevalence of antimicrobial-resistant and healthcare-associated infections. There are limited infectious disease (ID) physicians pharmacists support these ASPs, particularly in rural areas. The Veterans Health Administration has a robust telehealth program place. Our previous work demonstrated feasibility using modalities ASPs at Affairs medical centers (VAMCs) by pairing them with an ID expert from larger,...

Abstract Background Telehealth offers an opportunity for rural healthcare settings to connect with infectious disease (ID) experts augment clinical care of people suspected infections and support antimicrobial stewardship efforts. We are currently disseminating a project that uses Veterans Affairs (VA) telehealth systems multidisciplinary teams from VA medical centers ID at geographically distant locations form Videoconference Antimicrobial Stewardship Teams (VASTs). Here, we used diagnosis...

Abstract Objective: To describe antimicrobial therapy used for multidrug-resistant (MDR) Acinetobacter spp. bacteremia in Veterans and impacts on mortality. Methods: This was a retrospective cohort study of hospitalized Affairs patients from 2012 to 2018 with positive MDR blood culture who received treatment 2 days prior through 5 after the date. Only first per patient used. The association between characteristics assessed using bivariate analyses. Multivariable logistic regression models...

Abstract Background Residents of VA Community Living Centers (CLC) and Spinal Cord Injury units (SCI) are commonly colonized or infected with multidrug-resistant organisms (MDROs). The mechanisms by which MDROs spread between residents in CLC/SCI settings remain poorly understood. Our objective was to develop methods better understand how CLCs/SCIs. Methods Preliminary data from two the four medical centers participating an ongoing study included these analyses. A structured sociometric...

Abstract Background Infections caused by carbapenem-resistant Enterobacteriaceae (CRE) and carbapenemase-producing (CP) CRE are difficult to treat, resulting in a high mortality annually. In 2017, VA released guidelines for CRE/CP-CRE laboratory testing, prevention, management. We used the Consolidated Framework Implementation Research (CFIR) understand factors influencing implementation of guideline at Medical Centers (VAMCs). Methods Between 9/17–8/18, 43 semi-structured interviews were...

Background: Infections caused by Acinetobacter spp are often healthcare acquired, difficult to treat, and associated with high mortality. Extensively drug-resistant (XDR) nonsusceptible at least 1 agent in all but 2 or fewer antimicrobial classes. Epidemiologic outcome data for XDR limited have largely been reported outside the United States. This national cohort study describes epidemiology, clinical characteristics, outcomes patients VA health care. Methods: was a retrospective including...

Abstract Background: Infections caused by carbapenem-resistant Enterobacteriaceae (CRE) and carbapenemase-producing (CP) CRE are difficult to treat, resulting in high mortality healthcare settings every year. The Veteran’s Health Administration (VHA) disseminated guidelines 2015 an updated directive 2017 for control of focused on laboratory testing, prevention, management. Consolidated Framework Implementation Research (CFIR) framework was used examine contextual factors identify best...

Abstract Background : Infections caused by carbapenem-resistant Enterobacteriaceae (CRE) and carbapenemase-producing (CP) CRE are difficult to treat, resulting in high mortality healthcare settings every year. The Veteran’s Health Administration (VHA) disseminated guidelines 2015 an updated directive 2017 for control of focused on laboratory testing, prevention, management. Consolidated Framework Implementation Research (CFIR) framework was used analyze qualitative interview data identify...

Abstract Background Infections caused by carbapenem-resistant Enterobacteriaceae (CRE) and carbapenemase-producing (CP) CRE are difficult to treat, resulting in high mortality healthcare settings every year. The Veteran’s Health Administration (VHA) disseminated guidelines 2015 an updated directive 2017 for control of focused on laboratory testing, prevention, management. Consolidated Framework Implementation Research (CFIR) framework was used examine contextual factors identify best...

Background: Gram-negative bacteria cause a variety of hospital-associated infections (HAIs). Of concern is Pseudomonas aeruginosa , which leading HAIs. Early and adequate therapy P. blood stream infection (BSI) associated with decreased mortality. Additionally, infectious disease consultation has also shown to improve health outcomes, streamline care, decrease costs. Therefore, the goal this study was describe treatment BSI impact consultations on outcomes. Methods: In retrospective cohort...