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5. Did Clostridioides difficile testing and infection rates change during the COVID-19 pandemic?

Author

Hawes, Armani Minasian, Desai, Angel, and Patel, Payal K

Subjects
Humans, Clostridium Infections, Anti-Bacterial Agents, Pandemics, Antimicrobial Stewardship, Clostridioides difficile, COVID-19, Antibiotic resistance, Stewardship, Digestive Diseases, Biodefense, Vaccine Related, Prevention, Infectious Diseases, Emerging Infectious Diseases, Infection, Good Health and Well Being, Microbiology, Medical Microbiology
Abstract

Testing for and incidence of Clostridioides difficile infection (CDI) was examined at a single center before and during the first surge of the COVID-19 pandemic. Incidence of CDI remained stable but testing statistically significantly decreased during the first surge despite an increase in antibiotic use. There were no new CDI-focused antimicrobial stewardship interventions introduced during this time.

Published
2021

6. Organizational readiness assessment in acute and long-term care has important implications for antibiotic stewardship for asymptomatic bacteriuria

Author

Goebel, Melanie C, Trautner, Barbara W, Wang, Yiqun, Van, John N, Dillon, Laura M, Patel, Payal K, Drekonja, Dimitri M, Graber, Christopher J, Shukla, Bhavarth S, Lichtenberger, Paola, Helfrich, Christian D, Sales, Anne, and Grigoryan, Larissa

Subjects
Health Services and Systems, Nursing, Health Sciences, Clinical Research, Antimicrobial Stewardship, Bacteriuria, Humans, Leadership, Long-Term Care, Surveys and Questionnaires, Guideline implementation, Urinary tract infections, Health services research, Public Health and Health Services, Epidemiology, Clinical sciences, Public health
Abstract

BackgroundPrior to implementing an antibiotic stewardship intervention for asymptomatic bacteriuria (ASB), we assessed institutional barriers to change using the Organizational Readiness to Change Assessment.MethodsSurveys were self-administered on paper in inpatient medicine and long-term care units at 4 Veterans Affairs facilities. Participants included providers, nurses, and pharmacists. The survey included 7 subscales: evidence (perceived strength of evidence) and six context subscales (favorability of organizational context). Responses were scored on a 5-point Likert-type scale.ResultsOne hundred four surveys were completed (response rate = 69.3%). Overall, the evidence subscale had the highest score; the resources subscale (mean 2.8) was significantly lower than other subscales (P < .001). Scores for budget and staffing resources were lower than scores for training and facility resources (P < .001 for both). Pharmacists had lower scores than providers for the staff culture subscale (P = .04). The site with the lowest scores for resources (mean 2.4) also had lower scores for leadership and lower pharmacist effort devoted to stewardship.ConclusionsAlthough healthcare professionals endorsed the evidence about nontreatment of ASB, perceived barriers to antibiotic stewardship included inadequate resources and leadership support. These findings provide targets for tailoring the stewardship intervention to maximize success.

Published
2020

9. Teamwork and safety climate affect antimicrobial stewardship for asymptomatic bacteriuria

Author

Drekonja, Dimitri M, Grigoryan, Larissa, Lichtenberger, Paola, Graber, Christopher J, Patel, Payal K, Van, John N, Dillon, Laura M, Wang, Yiqun, Gauthier, Timothy P, Wiseman, Steve W, Shukla, Bhavarth S, Naik, Aanand D, Hysong, Sylvia J, Kramer, Jennifer R, and Trautner, Barbara W

Subjects
Health Services and Systems, Nursing, Health Sciences, Patient Safety, Clinical Research, Infectious Diseases, Infection, Antimicrobial Stewardship, Asymptomatic Infections, Attitude of Health Personnel, Bacteriuria, Hospitals, Veterans, Humans, Inappropriate Prescribing, Patient Care Team, Practice Patterns, Nurses', Practice Patterns, Physicians', Prospective Studies, Safety Management, Surveys and Questionnaires, United States, Unnecessary Procedures, Medical and Health Sciences, Epidemiology, Biomedical and clinical sciences, Health sciences
Abstract

ObjectiveIn preparation for a multisite antibiotic stewardship intervention, we assessed knowledge and attitudes toward management of asymptomatic bacteriuria (ASB) plus teamwork and safety climate among providers, nurses, and clinical nurse assistants (CNAs).DesignProspective surveys during January-June 2018.SettingAll acute and long-term care units of 4 Veterans' Affairs facilities.MethodsThe survey instrument included 2 previously tested subcomponents: the Kicking CAUTI survey (ASB knowledge and attitudes) and the Safety Attitudes Questionnaire (SAQ).ResultsA total of 534 surveys were completed, with an overall response rate of 65%. Cognitive biases impacting management of ASB were identified. For example, providers presented with a case scenario of an asymptomatic patient with a positive urine culture were more likely to give antibiotics if the organism was resistant to antibiotics. Additionally, more than 80% of both nurses and CNAs indicated that foul smell is an appropriate indication for a urine culture. We found significant interprofessional differences in teamwork and safety climate (defined as attitudes about issues relevant to patient safety), with CNAs having highest scores and resident physicians having the lowest scores on self-reported perceptions of teamwork and safety climates (P < .001). Among providers, higher safety-climate scores were significantly associated with appropriate risk perceptions related to ASB, whereas social norms concerning ASB management were correlated with higher teamwork climate ratings.ConclusionsOur survey revealed substantial misunderstanding regarding management of ASB among providers, nurses, and CNAs. Educating and empowering these professionals to discourage unnecessary urine culturing and inappropriate antibiotic use will be key components of antibiotic stewardship efforts.

Published
2019

10. Transition to Oral Antibiotic Therapy for Hospitalized Adults With Gram-Negative Bloodstream Infections

Author

Engers, Drew W., primary, Tamma, Pranita D., additional, Fiawoo, Suiyini, additional, Fong, Karen, additional, Jariwala, Ripal, additional, Jenkins, Timothy C., additional, Kendall, Ronald E., additional, Lee, Jae Hyoung, additional, McCreary, Erin K., additional, Patel, Payal K., additional, Shihadeh, Katherine C., additional, Slish, Judianne, additional, Van Schooneveld, Trevor C., additional, and Malani, Anurag N., additional

Published
2024
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14. Excellence in Antibiotic Stewardship: A Mixed-Methods Study Comparing High-, Medium-, and Low-Performing Hospitals.

Author

Vaughn, Valerie M, Krein, Sarah L, Hersh, Adam L, Buckel, Whitney R, White, Andrea T, Horowitz, Jennifer K, Patel, Payal K, Gandhi, Tejal N, Petty, Lindsay A, Spivak, Emily S, Bernstein, Steven J, Malani, Anurag N, Johnson, Leonard B, Neetz, Robert A, Flanders, Scott A, Galyean, Patrick, Kimball, Elisabeth, Bloomquist, Kennedi, Zickmund, Tobias, and Zickmund, Susan L

Subjects
CORPORATE culture, COMMUNICABLE diseases, SCALE analysis (Psychology), INTERPROFESSIONAL relations, FLUOROQUINOLONES, RESEARCH funding, ANTIMICROBIAL stewardship, EXCELLENCE, INTERVIEWING, QUESTIONNAIRES, HOSPITALS, JUDGMENT sampling, DESCRIPTIVE statistics, TREATMENT duration, PROFESSIONS, SOUND recordings, RESEARCH methodology, PHYSICIANS, DATA analysis software
Abstract

Background Despite antibiotic stewardship programs existing in most acute care hospitals, there continues to be variation in appropriate antibiotic use. While existing research examines individual prescriber behavior, contextual reasons for variation are poorly understood. Methods We conducted an explanatory, sequential mixed-methods study of a purposeful sample of 7 hospitals with varying discharge antibiotic overuse. For each hospital, we conducted surveys, document analysis, and semi-structured interviews with antibiotic stewardship and clinical stakeholders. Data were analyzed separately and mixed during the interpretation phase, where each hospital was examined as a case, with findings organized across cases using a strengths, weaknesses, opportunities, and threats framework to identify factors accounting for differences in antibiotic overuse across hospitals. Results Surveys included 85 respondents. Interviews included 90 respondents (31 hospitalists, 33 clinical pharmacists, 14 stewardship leaders, 12 hospital leaders). On surveys, clinical pharmacists at hospitals with lower antibiotic overuse were more likely to report feeling: respected by hospitalist colleagues (P =.001), considered valuable team members (P =.001), and comfortable recommending antibiotic changes (P =.02). Based on mixed-methods analysis, hospitals with low antibiotic overuse had 4 distinguishing characteristics: (1) robust knowledge of and access to antibiotic stewardship guidance; (2) high-quality clinical pharmacist–physician relationships; (3) tools and infrastructure to support stewardship; and (4) highly engaged infectious diseases physicians who advocated stewardship principles. Conclusions This mixed-methods study demonstrates the importance of organizational context for high performance in stewardship and suggests that improving antimicrobial stewardship requires attention to knowledge, interactions, and relationships between clinical teams and infrastructure that supports stewardship and team interactions. [ABSTRACT FROM AUTHOR]

Published
2024
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18. Excellence in Antibiotic Stewardship: A Mixed-Methods Study Comparing High-, Medium-, and Low-Performing Hospitals

Author

Vaughn, Valerie M, primary, Krein, Sarah L, additional, Hersh, Adam L, additional, Buckel, Whitney R, additional, White, Andrea T, additional, Horowitz, Jennifer K, additional, Patel, Payal K, additional, Gandhi, Tejal N, additional, Petty, Lindsay A, additional, Spivak, Emily S, additional, Bernstein, Steven J, additional, Malani, Anurag N, additional, Johnson, Leonard B, additional, Neetz, Robert A, additional, Flanders, Scott A, additional, Galyean, Patrick, additional, Kimball, Elisabeth, additional, Bloomquist, Kennedi, additional, Zickmund, Tobias, additional, Zickmund, Susan L, additional, and Szymczak, Julia E, additional

Published
2023
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21. 765. Development of an Adaptable Roadmap for Implementation of the Infectious Diseases Society of America Core Antimicrobial Stewardship Curriculum in Infectious Diseases Fellowship Programs

Author

Hojat, Leila S, primary, Patel, Payal K, additional, Nori, Priya, additional, Hamilton, Keith W, additional, Justo, Julie Ann, additional, Spicer, Jennifer O, additional, Logan, Ashleigh, additional, Bennani, Kenza, additional, Lee, Matthew S, additional, Bryson-Cahn, Chloe, additional, Stohs, Erica J, additional, Willis, Zachary, additional, Moenster, Ryan P, additional, Van Schooneveld, Trevor C, additional, Brennan-Krohn, Thea, additional, Beeler, Cole, additional, Kang, Amy Y, additional, Al Lawani, Hawra, additional, Cherabuddi, Kartik, additional, Fong, Gary, additional, Ince, Dilek, additional, Holubar, Marisa, additional, Paras, Molly L, additional, Gaston, David, additional, Shnekendorf, Rachel A, additional, Williams, Rostam, additional, and Luther, Vera, additional

Published
2023
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22. Defining access without excess: expanding appropriate use of antibiotics targeting multidrug-resistant organisms

Author

Patel, Twisha S, primary, Sati, Hatim, additional, Lessa, Fernanda C, additional, Patel, Payal K, additional, Srinivasan, Arjun, additional, Hicks, Lauri A, additional, Neuhauser, Melinda M, additional, Tong, Deborah, additional, van der Heijden, Maarten, additional, Alves, Solange C, additional, Getahun, Haileyesus, additional, and Park, Benjamin J, additional

Published
2023
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23. Introduction to A Compendium of Strategies to Prevent Healthcare-Associated Infections In Acute-Care Hospitals: 2022 Updates

Author

Yokoe, Deborah S., primary, Advani, Sonali D., additional, Anderson, Deverick J., additional, Babcock, Hilary M., additional, Bell, Michael, additional, Berenholtz, Sean M., additional, Bryant, Kristina A., additional, Buetti, Niccolò, additional, Calderwood, Michael S., additional, Calfee, David P., additional, Deloney, Valerie M., additional, Dubberke, Erik R., additional, Ellingson, Katherine D., additional, Fishman, Neil O., additional, Gerding, Dale N., additional, Glowicz, Janet, additional, Hayden, Mary K., additional, Kaye, Keith S., additional, Kociolek, Larry K., additional, Landon, Emily, additional, Larson, Elaine L., additional, Malani, Anurag N., additional, Marschall, Jonas, additional, Meddings, Jennifer, additional, Mermel, Leonard A., additional, Patel, Payal K., additional, Perl, Trish M., additional, Popovich, Kyle J., additional, Schaffzin, Joshua K., additional, Septimus, Edward, additional, Trivedi, Kavita K., additional, Weinstein, Robert A., additional, and Maragakis, Lisa L., additional

Published
2023
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24. Antimicrobial Stewardship Training for Infectious Diseases Fellows : Program Directors Identify a Curriculum Need

Author

Luther, Vera P., Shnekendorf, Rachel, Abbo, Lilian M., Advani, Sonali, Armstrong, Wendy S., Barsoumian, Alice E., Beeler, Cole B., Bystritsky, Rachel, Cherabuddi, Kartikeya, Cohen, Seth, Hamilton, Keith W., Ince, Dilek, Justo, Julie Ann, Logan, Ashleigh, III, John B. Lynch, Nori, Priya, Ohl, Christopher A., Patel, Payal K., Pottinger, Paul S., Schwartz, Brian S., Stack, Conor, and Zhou, Yuan

Published
2018

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

Author

Advani, Sonali D., Cawcutt, Kelly, Klompas, Michael, Marschall, Jonas, Meddings, Jennifer, and Patel, Payal K.

Abstract

AbstractIn 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) do not capture all harms; they capture only a subset of healthcare-associated infections (HAIs). Although prevention of device-associated infections remains critical, we need to address the full spectrum of potential harms from device use and non–device-associated infections. These include complications associated with additional devices, such as peripheral venous and arterial catheters, non–device-associated infections such as nonventilator hospital-acquired pneumonia, and noninfectious device complications such as trauma, thrombosis, and acute lung injury. As authors of the device-associated infection sections in the SHEA/IDSA/APIC Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals, we highlight catheter-associated urinary tract infection as an example of the strengths and limitations of the current emphasis on device-associated infection surveillance, suggest performance metrics that present a more comprehensive picture of patient harm, and provide a high-level overview of similar issues with other infection surveillance measures.

Published
2024
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29. Impact of an antibiotic stewardship initiative on urgent-care respiratory prescribing across patient race, ethnicity, and language

Author

Seibert, Allan M., Hersh, Adam L., Patel, Payal K., Hicks, Lauri A., Fino, Nora, Stanfield, Valoree, and Stenehjem, Edward A.

Abstract

AbstractWe conducted a post hoc analysis of an antibiotic stewardship intervention implemented across our health system’s urgent-care network to determine whether there was a differential impact among patient groups. Respiratory urgent-care antibiotic prescribing decreased for all racial, ethnic, and preferred language groups, but disparities in antibiotic prescribing persisted.

Published
2024
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30. Drivers of inappropriate use of antimicrobials in South Asia: A systematic review of qualitative literature

Author

Murray, Jennifer L, primary, Leung, Daniel T., additional, Hanson, Olivia R., additional, Ahmed, Sharia M., additional, Pavia, Andrew T., additional, Khan, Ashraful I., additional, Szymczak, Julia E., additional, Vaughn, Valerie M., additional, Patel, Payal K., additional, Biswas, Debashish, additional, and Watt, Melissa H., additional

Published
2023
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31. A Statewide Quality Initiative to Reduce Unnecessary Antibiotic Treatment of Asymptomatic Bacteriuria

Author

Vaughn, Valerie M., primary, Gupta, Ashwin, additional, Petty, Lindsay A., additional, Malani, Anurag N., additional, Osterholzer, Danielle, additional, Patel, Payal K., additional, Younas, Mariam, additional, Bernstein, Steven J., additional, Burdick, Stephanie, additional, Ratz, David, additional, Szymczak, Julia E., additional, McLaughlin, Elizabeth, additional, Czilok, Tawny, additional, Basu, Tanima, additional, Horowitz, Jennifer K., additional, Flanders, Scott A., additional, and Gandhi, Tejal N., additional

Published
2023
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32. Executive Summary: A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute-Care Hospitals: 2022 Updates

Author

Yokoe, Deborah S., primary, Advani, Sonali D., additional, Anderson, Deverick J., additional, Babcock, Hilary M., additional, Bell, Michael, additional, Berenholtz, Sean M., additional, Bryant, Kristina A., additional, Buetti, Niccolò, additional, Calderwood, Michael S., additional, Calfee, David P., additional, Dubberke, Erik R., additional, Ellingson, Katherine D., additional, Fishman, Neil O., additional, Gerding, Dale N., additional, Glowicz, Janet, additional, Hayden, Mary K., additional, Kaye, Keith S., additional, Klompas, Michael, additional, Kociolek, Larry K., additional, Landon, Emily, additional, Larson, Elaine L., additional, Malani, Anurag N., additional, Marschall, Jonas, additional, Meddings, Jennifer, additional, Mermel, Leonard A., additional, Patel, Payal K., additional, Perl, Trish M., additional, Popovich, Kyle J., additional, Schaffzin, Joshua K., additional, Septimus, Edward, additional, Trivedi, Kavita K., additional, Weinstein, Robert A., additional, and Maragakis, Lisa L., additional

Published
2023
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42. Your Outpatient has Coronavirus Disease 2019: What Are the Treatment Options in the Current Severe Acute Respiratory Syndrome Coronavirus 2 Variant Climate?

Author

Werbel, William A, Weld, Ethel D, Advani, Sonali D, Patel, Payal K, Sundaram, Maria E, and Phadke, Varun K

Subjects
THERAPEUTIC use of monoclonal antibodies, COVID-19, IMMUNIZATION, ANTIVIRAL agents, RISK assessment, TREATMENT effectiveness, MEDICAL protocols, INFECTION control, RITONAVIR, HOSPITAL care
Abstract

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 approved antiviral drugs such as nirmatrelvir/ritonavir, remdesivir, and molnupiravir are, however, predicted to maintain activity against these sublineages and are key tools to reduce severe COVID-19 outcomes in vulnerable populations. A stepwise approach may be taken to target the appropriate antiviral drug to the appropriate patient, beginning with identifying whether a patient is at high risk for hospitalization or other complications of COVID-19. Among higher risk individuals, patient profile (including factors such as age, organ function, and comedications) and antiviral drug access inform suitable antiviral drug selection. When applied in targeted fashion, these therapies serve as a complement to vital ongoing nonpharmaceutical interventions and vaccination strategies that reduce morbidity and maximize protection against COVID-19. [ABSTRACT FROM AUTHOR]

Published
2023
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44. 1592. SHEA Featured Oral Abstract: Reducing Unnecessary Antibiotic Treatment for Asymptomatic Bacteriuria: A Statewide Collaborative Quality Initiative

Author

Vaughn, Valerie, primary, Gupta, Ashwin, additional, Petty, Lindsay A, additional, Malani, Anurag N, additional, Osterholzer, Danielle, additional, Patel, Payal K, additional, Younas, Mariam, additional, Bernstein, Steven, additional, Ratz, David, additional, McLaughlin, Elizabeth, additional, Czilok, Tawny, additional, Horowitz, Jennifer, additional, Flanders, Scott A, additional, and Gandhi, Tejal N, additional

Published
2022
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46. Identifying context-specific domains for assessing antimicrobial stewardship programmes in Asia: protocol for a scoping review

Author

Vu, Huong Thi Lan, primary, Hamers, Raph L, additional, Limato, Ralalicia, additional, Limmathurotsakul, Direk, additional, Karkey, Abhilasha, additional, Dodds Ashley, Elizabeth, additional, Anderson, Deverick, additional, Patel, Payal K, additional, Patel, Twisha S, additional, Lessa, Fernanda C, additional, and van Doorn, H Rogier, additional

Published
2022
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47. Analysis of an Antibiotic Stewardship Program for Asymptomatic Bacteriuria in the Veterans Affairs Health Care System

Author

Grigoryan, Larissa, primary, Naik, Aanand D., additional, Lichtenberger, Paola, additional, Graber, Christopher J., additional, Patel, Payal K., additional, Drekonja, Dimitri M., additional, Gauthier, Timothy P., additional, Shukla, Bhavarth, additional, Sales, Anne E., additional, Krein, Sarah L., additional, Van, John N., additional, Dillon, Laura M., additional, Hysong, Sylvia J., additional, Kramer, Jennifer R., additional, Walder, Annette, additional, Ramsey, David, additional, and Trautner, Barbara W., additional

Published
2022
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49. Outbreak Response and Incident Management: SHEA Guidance and Resources for Healthcare Epidemiologists in United States Acute-Care Hospitals

Author

Banach, David B., Johnston, B. Lynn, Al-Zubeidi, Duha, Bartlett, Allison H., Bleasdale, Susan Casey, Deloney, Valerie M., Enfield, Kyle B., Guzman-Cottrill, Judith A., Lowe, Christopher, Ostrosky-Zeichner, Luis, Popovich, Kyle J., Patel, Payal K., Ravin, Karen, Rowe, Theresa, Shenoy, Erica S., Stienecker, Roger, Tosh, Pritish K., and Trivedi, Kavita K.

Published
2017
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50. Strategies to prevent catheter-associated urinary tract infections in acute-care hospitals: 2022 Update

Author

Patel, Payal K., Advani, Sonali D., Kofman, Aaron D., Lo, Evelyn, Maragakis, Lisa L., Pegues, David A., Pettis, Ann Marie, Saint, Sanjay, Trautner, Barbara, Yokoe, Deborah S., and Meddings, Jennifer

Abstract

Abstract and purposeThe 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 infection (CAUTI) prevention efforts. This document updates the Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute-Care Hospitalspublished in 2014. It is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission.

Published
2023
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