A5056065643- Antibiotic Use and Resistance
- Patient Satisfaction in Healthcare
- Bacterial Identification and Susceptibility Testing
- Antimicrobial Resistance in Staphylococcus
- Urinary Tract Infections Management
- Pneumonia and Respiratory Infections
- Antibiotic Resistance in Bacteria
- Healthcare Systems and Technology
- Emergency and Acute Care Studies
- Clostridium difficile and Clostridium perfringens research
- Telemedicine and Telehealth Implementation
- Orthopedic Infections and Treatments
- Palliative Care and End-of-Life Issues
- Infection Control in Healthcare
- Sepsis Diagnosis and Treatment
- Surgical site infection prevention
- Pharmaceutical Practices and Patient Outcomes
- Patient-Provider Communication in Healthcare
- Antibiotics Pharmacokinetics and Efficacy
- Healthcare cost, quality, practices
- Health Policy Implementation Science
- Primary Care and Health Outcomes
- Neutropenia and Cancer Infections
- Infectious Diseases and Tuberculosis
- Infective Endocarditis Diagnosis and Management
Iowa City VA Health Care System
2016-2025
University of Iowa
2016-2025
University of Iowa Health Care
2025
New York Proton Center
2015-2023
Communities In Schools of Orange County
2022-2023
Manhattan Institute for Policy Research
2022-2023
Oregon Medical Research Center
2022-2023
Lindsay Unified School District
2022-2023
University of Pittsburgh
2022
Ann Arbor Center for Independent Living
2022
OBJECTIVE To understand the professional and psychosocial factors that influence physician antibiotic prescribing habits in inpatient setting. DESIGN We conducted semi-structured interviews with 30 physicians. Interviews consisted of open-ended questions flexible probes based on participant responses. were audio recorded, transcribed, de-identified, reviewed for accuracy completeness. Data analyzed using emergent thematic analysis. SETTING Two teaching hospitals Indianapolis, Indiana...
To treat patients with methicillin-susceptible Staphylococcus aureus (MSSA) infections, β-lactams are recommended for definitive therapy; however, the comparative effectiveness of individual is unknown. This study compared therapy cefazolin vs nafcillin or oxacillin among MSSA infections complicated by bacteremia. retrospective included admitted to 119 Veterans Affairs hospitals from 2003 2010. Patients were if they had a blood culture positive and received cefazolin, nafcillin, oxacillin....
Staphylococcus aureus bacteremia is common and frequently associated with poor outcomes. Evidence indicates that specific care processes are improved outcomes for patients S bacteremia, including appropriate antibiotic prescribing, use of echocardiography to identify endocarditis, consultation infectious diseases (ID) specialists. Whether these has increased in routine or whether led large-scale improvements survival unknown.To examine the association evidence-based mortality.This...
We sought to define the prevalence of blaZ gene types and inoculum effect cefazolin among methicillin-susceptible Staphylococcus aureus (MSSA) bloodstream infections. The was present in 142/185 (77%) isolates. A total 50 (27%) isolates had a ≥4-fold increase MIC from standard high inoculum, 8 (4%) demonstrated nonsusceptible MIC, all type strains. efficacy presence requires further study.
Implementation science experts define champions as "supporting, marketing, and driving through an implementation, overcoming indifference or resistance that the intervention may provoke in organization." Many hospitals use designated clinical champions-often called "hand hygiene (HH) champions"-typically to improve hand compliance. We conducted ethnographic examination of how infection control teams Veterans Health Administration (VHA) term "HH champion" they role.An study was with frontline...
The Veterans Health Administration (VHA) introduced the Methicillin-Resistant Staphylococcus aureus (MRSA) Prevention Initiative in March 2007. Although initiative has been perceived as a vertical intervention focusing on MRSA, it also expanded infection prevention and control programs resources. We aimed to assess horizontal effect of hospital-onset (HO) gram-negative rod (GNR) bacteremia.This retrospective cohort included all patients who had HO bacteremia due Escherichia coli, Klebsiella...
Abstract Background Patients with methicillin-resistant Staphylococcus aureus bloodstream infections (MRSA BSI) usually receive initial treatment vancomycin but may be switched to daptomycin for definitive therapy, especially if failure is suspected. Our objective was evaluate the effectiveness of switching from compared remaining on among patients MRSA BSI. Methods admitted 124 Veterans Affairs Hospitals who experienced BSI and were treated during 2007–2014 included. The association between...
Days of therapy (DOT), the most widely used benchmarking metric for antibiotic consumption, may not fully measure stewardship efforts to promote use narrow-spectrum agents and inadvertently discourage combination regimens when single-agent alternatives have greater adverse effects. To overcome limitations DOT, we developed a novel metric, days spectrum coverage (DASC), compared hospital performances using this with DOT.We evaluated 77 antibiotics in 16 categories antibacterial activity...
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Even though antimicrobial days of therapy did not significantly decrease during a period robust stewardship activities at our center, we detected significant downward trend in spectrum, as measured by antibiotic spectrum coverage (DASC). The DASC metric may help more broadly monitor the effect activities.
Gram-negative bacteremia (GN-BSI) can cause significant morbidity and mortality, but the benefit of infectious diseases consultation (IDC) is not well defined. A 24-site observational cohort study unique hospitalized patients with 4861 GN-BSI episodes demonstrated a 40% decreased risk 30-day mortality in IDC compared to those without IDC.
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<h3>Importance</h3> The American Urological Association guidelines recommend 24 or fewer hours of antimicrobial prophylaxis for most urologic procedures. Continuing therapy beyond may carry more risks than advantages. <h3>Objectives</h3> To assess guideline discordance common endoscopic procedures, and to identify opportunities improving prescribing through future stewardship interventions. <h3>Design, Setting, Participants</h3> This multicenter cohort study conducted manual audits medical...
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BACKGROUND Greater adherence to antibiotic‐prescribing guidelines may promote more judicious antibiotic use, which could benefit individual patients and society at large. OBJECTIVE To assess physician knowledge acceptance of through the use case vignettes. DESIGN We conducted semistructured interviews with 30 inpatient physicians. Participants were asked respond 3 hypothetical vignettes: (1) a skin soft tissue infection (SSTI), (2) suspected hospital‐acquired pneumonia (HAP), (3)...
<h3>Importance</h3> Audit and feedback based on direct observation is a common strategy to improve hand hygiene compliance, but the optimal design delivery of this intervention are poorly defined. <h3>Objective</h3> To describe barriers encountered by audit-and-feedback programs for across acute care hospitals within Veterans Health Administration. <h3>Design, Setting, Participants</h3> A qualitative study was conducted at geographically diverse convenience sample 10 Participants included...
<h3>Importance</h3> <i>Staphylococcus aureus</i>bacteremia (SAB) is common and associated with poor long-term outcomes. Previous studies have demonstrated an association between infectious diseases (ID) consultation improved short-term (ie, within 90 days) outcomes for patients SAB, but associations are unknown. <h3>Objective</h3> To investigate the of ID 5 years) postdischarge among SAB. <h3>Design, Setting, Participants</h3> This cohort study included all (N = 31 002) a first episode SAB...
Many clinical guidelines recommend that clinicians use antibiograms to inform empiric antimicrobial therapy. However, hospital are typically generated by crude aggregation of microbiologic data, and little is known about an antibiogram's reliability in predicting resistance (AMR) risk at the patient-level. We aimed assess diagnostic accuracy as a tool for selecting therapy Escherichia coli Klebsiella spp. individual patients.
Abstract Background Studies have shown that both patient- and hospital-level factors can influence the evaluation of antimicrobial consumption, appropriate risk adjustments are necessary for reliable benchmarking. The curation candidate variables through experts be helpful in gaining trust users. We conducted a modified two-stage Delphi method to build consensus on should considered developing risk-adjustment model benchmarking metrics hospital consumption. Summary Expert Consensus Candidate...