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1. Nasal Iodophor Antiseptic vs Nasal Mupirocin Antibiotic in the Setting of Chlorhexidine Bathing to Prevent Infections in Adult ICUs

Author

Huang, Susan S, Septimus, Edward J, Kleinman, Ken, Heim, Lauren T, Moody, Julia A, Avery, Taliser R, McLean, Laura, Rashid, Syma, Haffenreffer, Katherine, Shimelman, Lauren, Staub-Juergens, Whitney, Spencer-Smith, Caren, Sljivo, Selsebil, Rosen, Ed, Poland, Russell E, Coady, Micaela H, Lee, Chi Hyun, Blanchard, Eunice J, Reddish, Kimberly, Hayden, Mary K, Weinstein, Robert A, Carver, Brandon, Smith, Kimberly, Hickok, Jason, Lolans, Karen, Khan, Nadia, Sturdevant, S Gwynn, Reddy, Sujan C, Jernigan, John A, Sands, Kenneth E, Perlin, Jonathan B, and Platt, Richard

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Oncology and Carcinogenesis, Infectious Diseases, Prevention, Antimicrobial Resistance, Emerging Infectious Diseases, Clinical Research, Clinical Trials and Supportive Activities, Infection, Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Administration, Intranasal, Anti-Bacterial Agents, Anti-Infective Agents, Anti-Infective Agents, Local, Baths, Chlorhexidine, Cross Infection, Intensive Care Units, Iodophors, Methicillin-Resistant Staphylococcus aureus, Mupirocin, Pragmatic Clinical Trials as Topic, Sepsis, Staphylococcal Infections, Staphylococcus aureus, United States, Medical and Health Sciences, General & Internal Medicine, Biomedical and clinical sciences, Health sciences
Abstract

ImportanceUniversal nasal mupirocin plus chlorhexidine gluconate (CHG) bathing in intensive care units (ICUs) prevents methicillin-resistant Staphylococcus aureus (MRSA) infections and all-cause bloodstream infections. Antibiotic resistance to mupirocin has raised questions about whether an antiseptic could be advantageous for ICU decolonization.ObjectiveTo compare the effectiveness of iodophor vs mupirocin for universal ICU nasal decolonization in combination with CHG bathing.Design, setting, and participantsTwo-group noninferiority, pragmatic, cluster-randomized trial conducted in US community hospitals, all of which used mupirocin-CHG for universal decolonization in ICUs at baseline. Adult ICU patients in 137 randomized hospitals during baseline (May 1, 2015-April 30, 2017) and intervention (November 1, 2017-April 30, 2019) were included.InterventionUniversal decolonization involving switching to iodophor-CHG (intervention) or continuing mupirocin-CHG (baseline).Main outcomes and measuresICU-attributable S aureus clinical cultures (primary outcome), MRSA clinical cultures, and all-cause bloodstream infections were evaluated using proportional hazard models to assess differences from baseline to intervention periods between the strategies. Results were also compared with a 2009-2011 trial of mupirocin-CHG vs no decolonization in the same hospital network. The prespecified noninferiority margin for the primary outcome was 10%.ResultsAmong the 801 668 admissions in 233 ICUs, the participants' mean (SD) age was 63.4 (17.2) years, 46.3% were female, and the mean (SD) ICU length of stay was 4.8 (4.7) days. Hazard ratios (HRs) for S aureus clinical isolates in the intervention vs baseline periods were 1.17 for iodophor-CHG (raw rate: 5.0 vs 4.3/1000 ICU-attributable days) and 0.99 for mupirocin-CHG (raw rate: 4.1 vs 4.0/1000 ICU-attributable days) (HR difference in differences significantly lower by 18.4% [95% CI, 10.7%-26.6%] for mupirocin-CHG, P

Published
2023

2. The impact of surgical volume on hospital ranking using the standardized infection ratio.

Author

Ye, Shangyuan, Li, Daniel, Yu, Tingting, Caroff, Daniel A, Guy, Jeffrey, Poland, Russell E, Sands, Kenneth E, Septimus, Edward J, Huang, Susan S, Platt, Richard, and Wang, Rui

Subjects
Humans, Surgical Wound Infection, Digestive System Surgical Procedures, Retrospective Studies, Aged, Hospitals, Medicare, United States, Digestive Diseases, Clinical Research, Patient Safety, Perinatal Period - Conditions Originating in Perinatal Period, Pediatric, Health Services, Infection
Abstract

The Centers for Medicare and Medicaid Services require hospitals to report on quality metrics which are used to financially penalize those that perform in the lowest quartile. Surgical site infections (SSIs) are a critical component of the quality metrics that target healthcare-associated infections. However, the accuracy of such hospital profiling is highly affected by small surgical volumes which lead to a large amount of uncertainty in estimating standardized hospital-specific infection rates. Currently, hospitals with less than one expected SSI are excluded from rankings, but the effectiveness of this exclusion criterion is unknown. Tools that can quantify the classification accuracy and can determine the minimal surgical volume required for a desired level of accuracy are lacking. We investigate the effect of surgical volume on the accuracy of identifying poorly performing hospitals based on the standardized infection ratio and develop simulation-based algorithms for quantifying the classification accuracy. We apply our proposed method to data from HCA Healthcare (2014-2016) on SSIs in colon surgery patients. We estimate that for a procedure like colon surgery with an overall SSI rate of 3%, to rank hospitals in the HCA colon SSI dataset, hospitals that perform less than 200 procedures have a greater than 10% chance of being incorrectly assigned to the worst performing quartile. Minimum surgical volumes and predicted events criteria are required to make evaluating hospitals reliable, and these criteria vary by overall prevalence and between-hospital variability.

Published
2023

3. The Impact of COVID-19 on Healthcare-Associated Infections

Author

Baker, Meghan A, Sands, Kenneth E, Huang, Susan S, Kleinman, Ken, Septimus, Edward J, Varma, Neha, Blanchard, Jackie, Poland, Russell E, Coady, Micaela H, Yokoe, Deborah S, Fraker, Sarah, Froman, Allison, Moody, Julia, Goldin, Laurel, Isaacs, Amanda, Kleja, Kacie, Korwek, Kimberly M, Stelling, John, Clark, Adam, Platt, Richard, and Perlin, Jonathan B

Subjects
Hematology, Vaccine Related, Antimicrobial Resistance, Emerging Infectious Diseases, Prevention, Biodefense, Sepsis, Infectious Diseases, Patient Safety, Infection, Good Health and Well Being, Bacteremia, COVID-19, COVID-19 Testing, Catheter-Related Infections, Cross Infection, Delivery of Health Care, Humans, Methicillin-Resistant Staphylococcus aureus, Pandemics, Pneumonia, Ventilator-Associated, Urinary Tract Infections, Vancomycin-Resistant Enterococci, healthcare-associated infections, central line-associated blood stream infection, catheter-associated urinary tract infection, CDC Prevention Epicenters Program, Biological Sciences, Medical and Health Sciences, Microbiology
Abstract

BackgroundThe profound changes wrought by coronavirus disease 2019 (COVID-19) on routine hospital operations may have influenced performance on hospital measures, including healthcare-associated infections (HAIs). We aimed to evaluate the association between COVID-19 surges and HAI and cluster rates.MethodsIn 148 HCA Healthcare-affiliated hospitals, from 1 March 2020 to 30 September 2020, and a subset of hospitals with microbiology and cluster data through 31 December 2020, we evaluated the association between COVID-19 surges and HAIs, hospital-onset pathogens, and cluster rates using negative binomial mixed models. To account for local variation in COVID-19 pandemic surge timing, we included the number of discharges with a laboratory-confirmed COVID-19 diagnosis per staffed bed per month.ResultsCentral line-associated blood stream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), and methicillin-resistant Staphylococcus aureus (MRSA) bacteremia increased as COVID-19 burden increased. There were 60% (95% confidence interval [CI]: 23-108%) more CLABSI, 43% (95% CI: 8-90%) more CAUTI, and 44% (95% CI: 10-88%) more cases of MRSA bacteremia than expected over 7 months based on predicted HAIs had there not been COVID-19 cases. Clostridioides difficile infection was not significantly associated with COVID-19 burden. Microbiology data from 81 of the hospitals corroborated the findings. Notably, rates of hospital-onset bloodstream infections and multidrug resistant organisms, including MRSA, vancomycin-resistant enterococcus, and Gram-negative organisms, were each significantly associated with COVID-19 surges. Finally, clusters of hospital-onset pathogens increased as the COVID-19 burden increased.ConclusionsCOVID-19 surges adversely impact HAI rates and clusters of infections within hospitals, emphasizing the need for balancing COVID-related demands with routine hospital infection prevention.

Published
2022

4. The Impact of COVID-19 on Healthcare-Associated Infections.

Author

Baker, Meghan A, Sands, Kenneth E, Huang, Susan S, Kleinman, Ken, Septimus, Edward J, Varma, Neha, Blanchard, Jackie, Poland, Russell E, Coady, Micaela H, Yokoe, Deborah S, Fraker, Sarah, Froman, Allison, Moody, Julia, Goldin, Laurel, Isaacs, Amanda, Kleja, Kacie, Korwek, Kimberly M, Stelling, John, Clark, Adam, Platt, Richard, Perlin, Jonathan B, and CDC Prevention Epicenters Program

Subjects
CDC Prevention Epicenters Program, COVID-19, Catheter-Associated Urinary Tract Infection, Central Line-Associated Blood Stream Infection, Healthcare-Associated Infections, Microbiology, Biological Sciences, Medical and Health Sciences
Abstract

BackgroundThe profound changes wrought by COVID-19 on routine hospital operations may have influenced performance on hospital measures, including healthcare-associated infections (HAIs). We aimed to evaluate the association between COVID-19 surges and HAI and cluster rates.MethodsIn 148 HCA Healthcare-affiliated hospitals, 3/1/2020-9/30/2020, and a subset of hospitals with microbiology and cluster data through 12/31/2020, we evaluated the association between COVID-19 surges and HAIs, hospital-onset pathogens, and cluster rates using negative binomial mixed models. To account for local variation in COVID-19 pandemic surge timing, we included the number of discharges with a laboratory-confirmed COVID-19 diagnosis per staffed bed per month.ResultsCentral line-associated blood stream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), and methicillin-resistant Staphylococcus aureus (MRSA) bacteremia increased as COVID-19 burden increased. There were 60% (95% CI, 23-108%) more CLABSI, 43% (95% CI, 8-90%) more CAUTI, and 44% (95% CI, 10-88%) more cases of MRSA bacteremia than expected over 7 months based on predicted HAIs had there not been COVID-19 cases. Clostridioides difficile infection was not significantly associated with COVID-19 burden. Microbiology data from 81 of the hospitals corroborated the findings. Notably, rates of hospital-onset bloodstream infections and multidrug resistant organisms, including MRSA, vancomycin-resistant enterococcus and Gram-negative organisms were each significantly associated with COVID-19 surges. Finally, clusters of hospital-onset pathogens increased as the COVID-19 burden increased.ConclusionCOVID-19 surges adversely impact HAI rates and clusters of infections within hospitals, emphasizing the need for balancing COVID-related demands with routine hospital infection prevention.

Published
2021

5. Infectious Diseases Society of America Position Paper: Recommended Revisions to the National Severe Sepsis and Septic Shock Early Management Bundle (SEP-1) Sepsis Quality Measure

Author

Rhee, Chanu, Chiotos, Kathleen, Cosgrove, Sara E, Heil, Emily L, Kadri, Sameer S, Kalil, Andre C, Gilbert, David N, Masur, Henry, Septimus, Edward J, Sweeney, Daniel A, Strich, Jeffrey R, Winslow, Dean L, and Klompas, Michael

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Sepsis, Hematology, Prevention, Infectious Diseases, Infection, Inflammatory and immune system, Good Health and Well Being, Aged, Anti-Bacterial Agents, Communicable Diseases, Humans, Medicare, Quality Indicators, Health Care, Reproducibility of Results, Shock, Septic, United States, sepsis, septic shock, SEP-1, severe sepsis, IDSA, Biological Sciences, Medical and Health Sciences, Microbiology, Clinical sciences
Abstract

The Centers for Medicare & Medicaid Services' Severe Sepsis and Septic Shock Early Management Bundle (SEP-1) measure has appropriately established sepsis as a national priority. However, the Infectious Diseases Society of America (IDSA and five additional endorsing societies) is concerned about SEP-1's potential to drive antibiotic overuse because it does not account for the high rate of sepsis overdiagnosis and encourages aggressive antibiotics for all patients with possible sepsis, regardless of the certainty of diagnosis or severity of illness. IDSA is also concerned that SEP-1's complex "time zero" definition is not evidence-based and is prone to inter-observer variation. In this position paper, IDSA outlines several recommendations aimed at reducing the risk of unintended consequences of SEP-1 while maintaining focus on its evidence-based elements. IDSA's core recommendation is to limit SEP-1 to septic shock, for which the evidence supporting the benefit of immediate antibiotics is greatest. Prompt empiric antibiotics are often appropriate for suspected sepsis without shock, but IDSA believes there is too much heterogeneity and difficulty defining this population, uncertainty about the presence of infection, and insufficient data on the necessity of immediate antibiotics to support a mandatory treatment standard for all patients in this category. IDSA believes guidance on managing possible sepsis without shock is more appropriate for guidelines that can delineate the strengths and limitations of supporting evidence and allow clinicians discretion in applying specific recommendations to individual patients. Removing sepsis without shock from SEP-1 will mitigate the risk of unnecessary antibiotic prescribing for noninfectious syndromes, simplify data abstraction, increase measure reliability, and focus attention on the population most likely to benefit from immediate empiric broad-spectrum antibiotics.

Published
2021

10. Pragmatic clinical trials embedded in healthcare systems: generalizable lessons from the NIH Collaboratory

Author

Weinfurt, Kevin P, Hernandez, Adrian F, Coronado, Gloria D, DeBar, Lynn L, Dember, Laura M, Green, Beverly B, Heagerty, Patrick J, Huang, Susan S, James, Kathryn T, Jarvik, Jeffrey G, Larson, Eric B, Mor, Vincent, Platt, Richard, Rosenthal, Gary E, Septimus, Edward J, Simon, Gregory E, Staman, Karen L, Sugarman, Jeremy, Vazquez, Miguel, Zatzick, Douglas, and Curtis, Lesley H

Subjects
Comparative Effectiveness Research, Clinical Research, Brain Disorders, Health Services, Clinical Trials and Supportive Activities, 8.1 Organisation and delivery of services, Health and social care services research, Generic health relevance, Cost-Benefit Analysis, Decision Making, Delivery of Health Care, Electronic Health Records, Humans, National Institutes of Health (U.S.), Pragmatic Clinical Trials as Topic, Research Design, Research Report, United States, Embedded clinical trials, Pragmatic research, Pragmatic clinical research, Cluster randomized trials, Stakeholder engagement, Public Health and Health Services, General & Internal Medicine
Abstract

BackgroundThe clinical research enterprise is not producing the evidence decision makers arguably need in a timely and cost effective manner; research currently involves the use of labor-intensive parallel systems that are separate from clinical care. The emergence of pragmatic clinical trials (PCTs) poses a possible solution: these large-scale trials are embedded within routine clinical care and often involve cluster randomization of hospitals, clinics, primary care providers, etc. Interventions can be implemented by health system personnel through usual communication channels and quality improvement infrastructure, and data collected as part of routine clinical care. However, experience with these trials is nascent and best practices regarding design operational, analytic, and reporting methodologies are undeveloped.MethodsTo strengthen the national capacity to implement cost-effective, large-scale PCTs, the Common Fund of the National Institutes of Health created the Health Care Systems Research Collaboratory (Collaboratory) to support the design, execution, and dissemination of a series of demonstration projects using a pragmatic research design.ResultsIn this article, we will describe the Collaboratory, highlight some of the challenges encountered and solutions developed thus far, and discuss remaining barriers and opportunities for large-scale evidence generation using PCTs.ConclusionA planning phase is critical, and even with careful planning, new challenges arise during execution; comparisons between arms can be complicated by unanticipated changes. Early and ongoing engagement with both health care system leaders and front-line clinicians is critical for success. There is also marked uncertainty when applying existing ethical and regulatory frameworks to PCTS, and using existing electronic health records for data capture adds complexity.

Published
2017

11. Data Sharing and Embedded Research.

Author

Simon, Gregory E, Coronado, Gloria, DeBar, Lynn L, Dember, Laura M, Green, Beverly B, Huang, Susan S, Jarvik, Jeffrey G, Mor, Vincent, Ramsberg, Joakim, Septimus, Edward J, Staman, Karen L, Vazquez, Miguel A, Vollmer, William M, Zatzick, Douglas, Hernandez, Adrian F, and Platt, Richard

Subjects
Biomedical Research, Clinical Trials as Topic, Confidentiality, Data Interpretation, Statistical, Humans, Information Dissemination, Clinical Sciences, Public Health and Health Services
Published
2017

12. Implementing an Antibiotic Stewardship Program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America

Author

Barlam, Tamar F, Cosgrove, Sara E, Abbo, Lilian M, MacDougall, Conan, Schuetz, Audrey N, Septimus, Edward J, Srinivasan, Arjun, Dellit, Timothy H, Falck-Ytter, Yngve T, Fishman, Neil O, Hamilton, Cindy W, Jenkins, Timothy C, Lipsett, Pamela A, Malani, Preeti N, May, Larissa S, Moran, Gregory J, Neuhauser, Melinda M, Newland, Jason G, Ohl, Christopher A, Samore, Matthew H, Seo, Susan K, and Trivedi, Kavita K

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Health Services, Clinical Research, Patient Safety, Infectious Diseases, Emerging Infectious Diseases, Management of diseases and conditions, 7.3 Management and decision making, Infection, Good Health and Well Being, Anti-Infective Agents, Drug Utilization Review, Drug and Narcotic Control, Epidemiology, Humans, Infectious Disease Medicine, Program Evaluation, United States, antibiotic stewardship, antibiotic stewardship programs, antibiotics, implementation, Biological Sciences, Medical and Health Sciences, Microbiology, Clinical sciences
Abstract

Evidence-based guidelines for implementation and measurement of antibiotic stewardship interventions in inpatient populations including long-term care were prepared by a multidisciplinary expert panel of the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. The panel included clinicians and investigators representing internal medicine, emergency medicine, microbiology, critical care, surgery, epidemiology, pharmacy, and adult and pediatric infectious diseases specialties. These recommendations address the best approaches for antibiotic stewardship programs to influence the optimal use of antibiotics.

Published
2016

13. 2476. Universal detection of healthcare-related bacterial transmissions using de novo assembly with short-read whole genome sequencing

Author

Pak, Theodore R, primary, Baker, Meghan, additional, McSweeney, Rebecca, additional, Sands, Kenneth E, additional, Moody, Julia, additional, Sljivo, Selsebil, additional, Isaacs, Amanda, additional, Septimus, Edward J, additional, Coady, Micaela H, additional, Poland, Russell, additional, Blanchard, Eunice, additional, Carver, Brandon, additional, Smith, Kimberly N, additional, McLean, Laura E, additional, Guy, Jeffrey, additional, Huang, Susan S, additional, and Grad, Yonatan H, additional

Published
2023
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14. Improving Sepsis Outcomes in the Era of Pay-for-Performance and Electronic Quality Measures: A Joint IDSA/ACEP/PIDS/SHEA/SHM/SIDP Position Paper

Author

Rhee, Chanu, primary, Strich, Jeffrey R, additional, Chiotos, Kathleen, additional, Classen, David C, additional, Cosgrove, Sara E, additional, Greeno, Ron, additional, Heil, Emily L, additional, Kadri, Sameer S, additional, Kalil, Andre C, additional, Gilbert, David N, additional, Masur, Henry, additional, Septimus, Edward J, additional, Sweeney, Daniel A, additional, Terry, Aisha, additional, Winslow, Dean L, additional, Yealy, Donald M, additional, and Klompas, Michael, additional

Published
2023
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16. Does Chlorhexidine Bathing in Adult Intensive Care Units Reduce Blood Culture Contamination? A Pragmatic Cluster-Randomized Trial

Author

Septimus, Edward J, Hayden, Mary K, Kleinman, Ken, Avery, Taliser R, Moody, Julia, Weinstein, Robert A, Hickok, Jason, Lankiewicz, Julie, Gombosev, Adrijana, Haffenreffer, Katherine, Kaganov, Rebecca E, Jernigan, John A, Perlin, Jonathan B, Piatt, Richard, and Huang, Susan S

Subjects
Prevention, Clinical Research, Clinical Trials and Supportive Activities, Emerging Infectious Diseases, Aged, Baths, Chlorhexidine, Cross Infection, Disinfectants, Female, Humans, Intensive Care Units, Male, Methicillin-Resistant Staphylococcus aureus, Middle Aged, Nasal Cavity, Sepsis, Staphylococcal Infections, Medical and Health Sciences, Epidemiology
Abstract

ObjectiveTo determine rates of blood culture contamination comparing 3 strategies to prevent intensive care unit (ICU) infections: screening and isolation, targeted decolonization, and universal decolonization.DesignPragmatic cluster-randomized trial.SettingForty-three hospitals with 74 ICUs; 42 of 43 were community hospitals.PatientsPatients admitted to adult ICUs from July 1, 2009, to September 30, 2011.MethodsAfter a 6-month baseline period, hospitals were randomly assigned to 1 of 3 strategies, with all participating adult ICUs in a given hospital assigned to the same strategy. Arm 1 implemented methicillin-resistant Staphylococcus aureus (MRSA) nares screening and isolation, arm 2 targeted decolonization (screening, isolation, and decolonization of MRSA carriers), and arm 3 conducted no screening but universal decolonization of all patients with mupirocin and chlorhexidine (CHG) bathing. Blood culture contamination rates in the intervention period were compared to the baseline period across all 3 arms.ResultsDuring the 6-month baseline period, 7,926 blood cultures were collected from 3,399 unique patients: 1,099 sets in arm 1, 928 in arm 2, and 1,372 in arm 3. During the 18-month intervention period, 22,761 blood cultures were collected from 9,878 unique patients: 3,055 sets in arm 1, 3,213 in arm 2, and 3,610 in arm 3. Among all individual draws, for arms 1, 2, and 3, the contamination rates were 4.1%, 3.9%, and 3.8% for the baseline period and 3.3%, 3.2%, and 2.4% for the intervention period, respectively. When we evaluated sets of blood cultures rather than individual draws, the contamination rate in arm 1 (screening and isolation) was 9.8% (N = 108 sets) in the baseline period and 7.5% (N = 228) in the intervention period. For arm 2 (targeted decolonization), the baseline rate was 8.4% (N = 78) compared to 7.5% (N = 241) in the intervention period. Arm 3 (universal decolonization) had the greatest decrease in contamination rate, with a decrease from 8.7% (N = 119) contaminated blood cultures during the baseline period to 5.1% (N = 184) during the intervention period. Logistic regression models demonstrated a significant difference across the arms when comparing the reduction in contamination between baseline and intervention periods in both unadjusted (P = .02) and adjusted (P = .02) analyses. Arm 3 resulted in the greatest reduction in blood culture contamination rates, with an unadjusted odds ratio (OR) of 0.56 (95% confidence interval [CI], 0.044-0.71) and an adjusted OR of 0.55 (95% CI, 0.43-0.71).ConclusionIn this large cluster-randomized trial, we demonstrated that universal decolonization with CHG bathing resulted in a significant reduction in blood culture contamination.

Published
2014

19. Improving Sepsis Outcomes in the Era of Pay-for-Performance and Electronic Quality Measures: A Joint IDSA/ACEP/PIDS/SHEA/SHM/SIDP Position Paper.

Author

Rhee, Chanu, Strich, Jeffrey R, Chiotos, Kathleen, Classen, David C, Cosgrove, Sara E, Greeno, Ron, Heil, Emily L, Kadri, Sameer S, Kalil, Andre C, Gilbert, David N, Masur, Henry, Septimus, Edward J, Sweeney, Daniel A, Terry, Aisha, Winslow, Dean L, Yealy, Donald M, and Klompas, Michael

Subjects
MORTALITY prevention, MEDICARE, HOSPITAL care, TREATMENT effectiveness, BLOOD plasma substitutes, SEPTIC shock, SEPSIS, LABOR incentives, PAY for performance, COMORBIDITY
Abstract

The Centers for Medicare & Medicaid Services (CMS) introduced the Severe Sepsis/Septic Shock Management Bundle (SEP-1) as a pay-for-reporting measure in 2015 and is now planning to make it a pay-for-performance measure by incorporating it into the Hospital Value-Based Purchasing Program. This joint IDSA/ACEP/PIDS/SHEA/SHM/SIPD position paper highlights concerns with this change. Multiple studies indicate that SEP-1 implementation was associated with increased broad-spectrum antibiotic use, lactate measurements, and aggressive fluid resuscitation for patients with suspected sepsis but not with decreased mortality rates. Increased focus on SEP-1 risks further diverting attention and resources from more effective measures and comprehensive sepsis care. We recommend retiring SEP-1 rather than using it in a payment model and shifting instead to new sepsis metrics that focus on patient outcomes. CMS is developing a community-onset sepsis 30-day mortality electronic clinical quality measure (eCQM) that is an important step in this direction. The eCQM preliminarily identifies sepsis using systemic inflammatory response syndrome (SIRS) criteria, antibiotic administrations or diagnosis codes for infection or sepsis, and clinical indicators of acute organ dysfunction. We support the eCQM but recommend removing SIRS criteria and diagnosis codes to streamline implementation, decrease variability between hospitals, maintain vigilance for patients with sepsis but without SIRS, and avoid promoting antibiotic use in uninfected patients with SIRS. We further advocate for CMS to harmonize the eCQM with the Centers for Disease Control and Prevention's (CDC) Adult Sepsis Event surveillance metric to promote unity in federal measures, decrease reporting burden for hospitals, and facilitate shared prevention initiatives. These steps will result in a more robust measure that will encourage hospitals to pay more attention to the full breadth of sepsis care, stimulate new innovations in diagnosis and treatment, and ultimately bring us closer to our shared goal of improving outcomes for patients. [ABSTRACT FROM AUTHOR]

Published
2024
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22. Infectious Diseases Physicians : Leading the Way in Antimicrobial Stewardship

Author

Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and the Society for Healthcare Epidemiology of America, Ostrowsky, Belinda, Banerjee, Ritu, Bonomo, Robert A., Cosgrove, Sara E., Davidson, Lisa, Doron, Shira, Gilbert, David N., Jezek, Amanda, Lynch, John B., Septimus, Edward J., Siddiqui, Javeed, and Iovine, Nicole M.

Published
2018

25. Antimicrobial consumption and resistance in adult hospital inpatients in 53 countries: results of an internet-based global point prevalence survey

Author

Koraqi, Andi, Hoxha, Iris, Tafaj, Silva, Lacej, Denada, Hojman, Martin, Quiros, Rodolfo Ernesto, Ghazaryan, Lilit, Cairns, Kelly A, Cheng, Allen, Horne, Kylie C, Doukas, Fiona F, Gottlieb, Thomas, Alsalman, Jameela, Magerman, Koen, Marielle, Gounongbe YT, Ljubovic, Amela Dedeic, Coelho, André Afonso Machado, Gales, Ana Cristina, Keuleyan, Emma, Sabuda, Deana, Boswell, Jennifer Lee, Conly, John M, Rojas, Alvaro, Carvajal, Camila, Labarca, Jaime, Solano, Antonio, Valverde, Carlos Ramírez, Villalobos-Vindas, Juan M, Pristas, Irina, Plecko, Vanda, Paphitou, Niki, Shaqiri, Erjona, Rummukainen, Maija-Liisa, Pagava, Karaman, Korinteli, Irma, Brandt, Tobias, Messler, Sabine, Enimil, Anthony, Iosifidis, Elias, Roilides, Emmanuel, Sow, Mamadou Saliou, Sengupta, Sharmila, George, Joby V, Poojary, Aruna, Patil, Priyanka, Soltani, Jafar, Jafarpour, Zahra, Ameen, Hadi, Fitzgerald, David, Maor, Yasmin, Chowers, Michal, Temkin, Elizabeth, Esposito, Susanna, Arnoldo, Luca, Brusaferro, Silvio, Gu, Yoshiaki, El-Hajji, Feras Darwish, Kim, Nam Joong, Kambaralieva, Baktygul, Pavare, Jana, Zarakauska, Lelde, Usonis, Vytautas, Burokiene, Sigita, Ivaskeviciene, Inga, Mijovic, Gordana, Duborija-Kovacevic, Natasa, Bondesio, Kristen, Iregbu, Kenneth, Oduyebo, Oyinlola, Raka, Denis, Raka, Lul, Rachina, Svetlana, Enani, Mushira Abdulaziz, Al Shehri, Mohamed, Carevic, Biljana, Dragovac, Gorana, Obradovic, Dusanka, Stojadinovic, Aleksandra, Radulovic, Lili, Wu, Jia EN, Wei Teng Chung, Gladys, Chen, Hui Hiong, Tambyah, Paul Anantharajah, Lye, David, Tan, Sock Hoon, Ng, Tat Ming, Tay, Hui Lin, Ling, Moi Lin, Chlebicki, Maciej Piotr, Kwa, Andrea L, Lee, Winnie, Beović, Bojana, Dramowski, Angela, Finlayson, Heather, Taljaard, Jantjie, Ojeda-Burgos, Guillermo, Retamar, Pilar, Lucas, Johan, Pot, Wolter, Verduin, Cees, Kluytmans, Jan, Scott, Michael, Aldeyab, Mamoon A, McCullagh, Bernadette, Gormley, Cairine, Sharpe, David, Gilchrist, Mark, Whitney, Laura, Laundy, Matthew, Lockwood, Debbie, Drysdale, Simon B, Boudreaux, Jennifer, Septimus, Edward J, Greer, Nickie, Gawrys, Gerard, Rios, Edgar, May, Suzanne, Versporten, Ann, Zarb, Peter, Caniaux, Isabelle, Gros, Marie-Françoise, Drapier, Nico, Miller, Mark, Jarlier, Vincent, Nathwani, Dilip, and Goossens, Herman

Published
2018
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27. Variation in Identifying Sepsis and Organ Dysfunction Using Administrative Versus Electronic Clinical Data and Impact on Hospital Outcome Comparisons*

Author

Rhee, Chanu, Jentzsch, Maximilian S., Kadri, Sameer S., Seymour, Christopher W., Angus, Derek C., Murphy, David J., Martin, Greg S., Dantes, Raymund B., Epstein, Lauren, Fiore, Anthony E., Jernigan, John A., Danner, Robert L., Warren, David K., Septimus, Edward J., Hickok, Jason, Poland, Russell E., Jin, Robert, Fram, David, Schaaf, Richard, Wang, Rui, and Klompas, Michael

Published
2019
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28. 2313. CLUSTER Trial An 82 U.S. Hospital Cluster Randomized Trial (CRT) to Assess the Impact of an Automated Statistical Outbreak Detection Tool and Response Protocol to Limit Hospital Transmission

Author

Baker, Meghan A, primary, Septimus, Edward J, additional, Kleinman, Ken, additional, Moody, Julia, additional, Sands, Kenneth E, additional, Varma, Neha, additional, Isaacs, Amanda, additional, McLean, Laura E, additional, Coady, Micaela H, additional, Blanchard, Jackie, additional, Poland, Russell, additional, Yokoe, Deborah S, additional, Stelling, John, additional, Haffenreffer, Katherine, additional, Clark, Adam, additional, Avery, Taliser, additional, Sljivo, Selsebil, additional, Weinstein, Robert A, additional, Smith, Kimberly, additional, Carver, Brandon, additional, Meador, Brittany, additional, Spencer-Smith, Caren, additional, Washington, Chamaine, additional, Bhattarai, Megha, additional, Shimelman, Lauren, additional, Perlin, Jonathan B, additional, Platt, Richard, additional, and Huang, Susan S, additional

Published
2022
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32. A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals: 2014 Updates

Author

Yokoe, Deborah S., Anderson, Deverick J., Berenholtz, Sean M., Calfee, David P., Dubberke, Erik R., Ellingson, Katherine D., Gerding, Dale N., Haas, Janet P., Kaye, Keith S., Klompas, Michael, Lo, Evelyn, Marschall, Jonas, Mermel, Leonard A., Nicolle, Lindsay E., Salgado, Cassandra D., Bryant, Kristina, Classen, David, Crist, Katrina, Deloney, Valerie M., Fishman, Neil O., Foster, Nancy, Goldmann, Donald A., Humphreys, Eve, Jernigan, John A., Padberg, Jennifer, Perl, Trish M., Podgorny, Kelly, Septimus, Edward J., VanAmringe, Margaret, Weaver, Tom, Weinstein, Robert A., Wise, Robert, and Maragakis, Lisa L.

Published
2014
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40. Contributors

Author

Aagaard, Kjersti, primary, Abrahamian, Fredrick M., additional, Allos, Ban Mishu, additional, Andes, David R., additional, Aoki, Fred Y., additional, Apicella, Michael A., additional, Ard, Kevin L., additional, Arias, Cesar A., additional, Aronoff, David M., additional, Augenbraun, Michael H., additional, Averhoff, Francisco, additional, Azar, Dimitri T., additional, Baddour, Larry M., additional, Baden, Lindsey R., additional, Baker, Carol J., additional, Ballard, Ronald C., additional, Barber, Gerard R., additional, Barnes, Scott D., additional, Barouch, Dan H., additional, Barrett, Alan D., additional, Barshak, Miriam Baron, additional, Basavaraju, Sridhar V., additional, Batteiger, Byron E., additional, Baum, Stephen G., additional, Bayer, Arnold S., additional, Beckham, J. David, additional, Beekmann, Susan E., additional, Bell, Beth P., additional, Bennett, John E., additional, Bente, Dennis A., additional, Berbari, Elie F., additional, Berman, Jonathan, additional, Bertino, Joseph S., additional, Bhimraj, Adarsh, additional, Birdsall, Holly H., additional, Bisno, Alan L., additional, Blackburn, Brian G., additional, Blanton, Lucas S., additional, Blaser, Martin J., additional, Bleck, Thomas P., additional, Blijlevens, Nicole M.A., additional, Bobak, David A., additional, Bonnez, William, additional, Boothroyd, John C., additional, Borio, Luciana L., additional, Bosque, Patrick J., additional, Bower, John, additional, Bradsher, Robert W., additional, Brook, Itzhak, additional, Brown, Kevin E., additional, Brown, Patricia D., additional, Brown-Elliott, Barbara A., additional, Bruhn, Roberta L., additional, Bryant, Amy E., additional, Burd, Eileen M., additional, Burns, Jane C., additional, Bush, Larry M., additional, Calderwood, Stephen B., additional, Cano, Luz Elena, additional, Carpenter, Charles C.J., additional, Caserta, Mary T., additional, Castagnola, Elio, additional, Chaisson, Richard E., additional, Chambers, Henry F., additional, Chapman, Stephen J., additional, Chappell, James D., additional, Chen, Lea Ann, additional, Chen, Sharon C-A, additional, Chow, Anthony W., additional, Clark, Rebecca A., additional, Cohen, Jeffrey I., additional, Cohen, Myron S., additional, Cohen-Poradosu, Ronit, additional, Cohn, Susan E., additional, Connors, Mark, additional, Corey, Lawrence, additional, Cottrell, Mackenzie L., additional, Cover, Timothy L., additional, Cox, Heather L., additional, Craig, William A., additional, Crossley, Kent B., additional, Crumpacker, Clyde S., additional, Curran, James W., additional, Currie, Bart J., additional, D'Agata, Erika, additional, Damon, Inger K., additional, Darouiche, Rabih O., additional, DeBiasi, Roberta L., additional, Deepe, George S., additional, del Rio, Carlos, additional, Delemos, Andrew S., additional, DeLeo, Frank R., additional, DeMuri, Gregory P., additional, Densen, Peter, additional, Dermody, Terence S., additional, Dewar, Robin, additional, Diaz, James H., additional, Dieffenbach, Carl W., additional, Dienstag, Jules L., additional, Doi, Yohei, additional, Dolin, Raphael, additional, Donnelly, J. Peter, additional, Donnenberg, Michael S., additional, Donowitz, Gerald R., additional, Dormitzer, Philip R., additional, Drake, James M., additional, Dumler, J. Stephen, additional, Dummer, J. Stephen, additional, DuPont, Herbert L., additional, Durack, David T., additional, Durand, Marlene L., additional, Edelstein, Paul H., additional, Edmond, Michael B., additional, Edwards, John E., additional, Edwards, Morven S., additional, Eliopoulos, George M., additional, Ellison, Richard T., additional, Endy, Timothy P., additional, Engleberg, N. Cary, additional, Erdem, Hakan, additional, Ernst, Joel D., additional, Ernst, Peter B., additional, Fairhurst, Rick M., additional, Fairley, Jessica K., additional, Falkow, Stanley, additional, Falsey, Ann R., additional, Fauci, Anthony S., additional, Fekete, Thomas, additional, Fey, Paul D., additional, Fine, Steven M., additional, Fitzgerald, Daniel W., additional, Flores, Anthony R., additional, Forster, Derek, additional, Fowler, Vance G., additional, Freedman, David O., additional, Friedlander, Arthur M., additional, Galgiani, John N., additional, Gallin, John I., additional, Gallo, Robert C., additional, Gandhi, Tejal N., additional, Garrett, Wendy S., additional, Gaydos, Charlotte A., additional, Geisbert, Thomas W., additional, Gelfand, Jeffrey A., additional, Gelone, Steven P., additional, Gerding, Dale N., additional, Gershon, Anne A., additional, Gilsdorf, Janet R., additional, Goldstein, Ellie J.C., additional, Gordin, Fred M., additional, Graman, Paul S., additional, Grayson, M. Lindsay, additional, Greene, Jeffrey Bruce, additional, Griffin, Patricia M., additional, Griffith, David E., additional, Guerrant, Richard L., additional, Gul, H. Cem, additional, Haake, David A., additional, Haas, David W., additional, Haines, Charles, additional, Hall, Caroline Breese, additional, Hallak, Joelle, additional, Halperin, Scott A., additional, Hammerschlag, Margaret R., additional, Haque, Rashidul, additional, Harris, Jason B., additional, Hawkins, Claudia, additional, Hay, Roderick J., additional, Hedberg, Craig W., additional, Henderson, David K., additional, Henderson, Donald A., additional, High, Kevin P., additional, Hill, Adrian V.S., additional, Hill, David R., additional, Hinman, Alan R., additional, Hirsch, Martin S., additional, Hodowanec, Aimee, additional, Hohl, Tobias M., additional, Holland, Steven M., additional, Holzman, Robert S., additional, Hook, Edward W., additional, Hooper, David C., additional, Hooton, Thomas M., additional, Horowitz, Harold W., additional, Horsburgh, C. Robert, additional, Horton, James M., additional, Hospenthal, Duane R., additional, Hsueh, Kevin, additional, Hughes, James M., additional, Hynes, Noreen A., additional, Iovine, Nicole M., additional, Iredell, Jonathan R., additional, Ison, Michael G., additional, Janda, J. Michael, additional, Janoff, Edward N., additional, Johannsen, Eric C., additional, Kashuba, Angela D.M., additional, Kasper, Dennis L., additional, Kaye, Donald, additional, Kaye, Keith S., additional, Kaye, Kenneth M., additional, Kazura, James W., additional, Keystone, Jay S., additional, Khabbaz, Rima, additional, Khan, David A., additional, Khudyakov, Yury, additional, Kim, Rose, additional, King, Charles H., additional, Kirchhoff, Louis V., additional, Klein, Jerome O., additional, Klompas, Michael, additional, Knoll, Bettina M., additional, Knowlton, Kirk U., additional, Koehler, Jane E., additional, Kohlhoff, Stephan A., additional, Könönen, Eija, additional, Kontoyiannis, Dimitrios P., additional, Koralnik, Igor J., additional, Korpe, Poonum S., additional, Koshy, Anita A., additional, Kovacs, Joseph A., additional, Kozarsky, Phyllis, additional, Krieger, John, additional, Kroger, Andrew T., additional, Kuehnert, Matthew J., additional, Kumar, Nalin M., additional, Kuruvilla, Merin Elizabeth, additional, LaRocque, Regina C., additional, Leggett, James E., additional, Legido-Quigley, Helena, additional, Levett, Paul N., additional, Levine, Donald P., additional, Levison, Matthew E., additional, Levitt, Alexandra, additional, Lewis, Russell E., additional, Liles, W. Conrad, additional, Lima, Aldo A.M., additional, Limaye, Ajit P., additional, Lipkin, W. Ian, additional, Litman, Nathan, additional, Lorber, Bennett, additional, Luna, Ruth Ann, additional, MacDougall, Conan, additional, Roy, Rob, additional, Mackowiak, Philip A., additional, Madoff, Lawrence C., additional, Magill, Alan J., additional, Maguire, James H., additional, Maldarelli, Frank, additional, Markoff, Lewis, additional, Marrazzo, Jeanne M., additional, Marrie, Thomas J., additional, Marth, Thomas, additional, Martin, David H., additional, Martin, Gregory J., additional, Marty, Francisco M., additional, Maslow, Melanie Jane, additional, Masur, Henry, additional, Mawle, Alison, additional, Mayer, Kenneth H., additional, McBride, John T., additional, McCarthy, James S., additional, McCormack, William M., additional, McGowan, Catherine C., additional, McIntosh, Kenneth, additional, Mead, Paul S., additional, Mikulska, Malgorzata, additional, Miller, Robert F., additional, Miller, Samuel I., additional, Mitchell, David H., additional, Modlin, John F., additional, Mody, Rajal K., additional, Moellering, Robert C., additional, Moffa, Matthew, additional, Moir, Susan, additional, Montoya, José G., additional, Moore, Thomas A., additional, Moreillon, Philippe, additional, Morris, J. Glenn, additional, Morse, Caryn Gee, additional, Moseley, Robin, additional, Munford, Robert S., additional, Murphy, Edward L., additional, Murphy, Timothy F., additional, Murray, Barbara E., additional, Murray, Clinton K., additional, Murray, Patrick R., additional, Musher, Daniel M., additional, Nagel, Jerod L., additional, Nannini, Esteban C., additional, Narezkina, Anna, additional, Nash, Theodore E., additional, Nauseef, William M., additional, Nayak, Jennifer L., additional, Neill, Marguerite A., additional, O'Donnell, Judith A., additional, Ohl, Christopher A., additional, Okhuysen, Pablo C., additional, Onderdonk, Andrew B., additional, Opal, Steven M., additional, Orenstein, Walter A., additional, Osmon, Douglas R., additional, Osterholm, Michael T., additional, Ostroff, Stephen M., additional, Oxman, Michael N., additional, Paessler, Slobodan, additional, Page, Andrea V., additional, Pai, Manjunath P., additional, Palmore, Tara N., additional, Palraj, Raj, additional, Pappas, Peter G., additional, Pasternack, Mark S., additional, Patterson, Thomas F., additional, Pavan-Langston, Deborah, additional, Pegues, David A., additional, Penn, Robert L., additional, Perfect, John R., additional, Perlman, Stanley, additional, Petersen, Brett W., additional, Peterson, Phillip K., additional, Petri, William A., additional, Petti, Cathy A., additional, Philips, Jennifer A., additional, Philley, Julie V., additional, Phillips, Michael, additional, Pickering, Larry K., additional, Piot, Peter, additional, Pogue, Jason M., additional, Pop-Vicas, Aurora, additional, Portal-Celhay, Cynthia, additional, Powers, John H., additional, Price, Richard N., additional, Que, Yok-Ai, additional, Radolf, Justin D., additional, Ram, Sanjay, additional, Raoult, Didier, additional, Ravdin, Jonathan I., additional, Ray, Stuart C., additional, Reboli, Annette C., additional, Reitz, Marvin S., additional, Relman, David A., additional, Renault, Cybèle A., additional, Restrepo, Angela, additional, Rex, John H., additional, Rhee, Elizabeth G., additional, Roberts, Norbert J., additional, Romero, José R., additional, Rothman, Alan L., additional, Roy, Craig R., additional, Ruoff, Kathryn L., additional, Rupp, Mark E., additional, Rupprecht, Charles E., additional, Russo, Thomas A., additional, Rutala, William A., additional, Ryan, Edward T., additional, Safdar, Amar, additional, Sajadi, Mohammad M., additional, Salazar, Juan C., additional, Sarria, Juan Carlos, additional, Savoia, Maria C., additional, Sax, Paul E., additional, Scheld, W. Michael, additional, Schiffer, Joshua T., additional, Schlossberg, David, additional, Schneider, Thomas, additional, Schuchat, Anne, additional, Schwebke, Jane R., additional, Sears, Cynthia L., additional, Segal, Leopoldo N., additional, Sendi, Parham, additional, Sepkowitz, Kent A., additional, Septimus, Edward J., additional, Seregin, Alexey, additional, Shulman, Stanford T., additional, Siberry, George K., additional, Siddiqi, Omar K., additional, Sifri, Costi D., additional, Simberkoff, Michael S., additional, Simonetti, Francesco R., additional, Singh, Kamaljit, additional, Singh, Nina, additional, Singh, Upinder, additional, Sinner, Scott W., additional, Sivapalasingam, Sumathi, additional, Slater, Leonard N., additional, Smulian, A. George, additional, Sobel, Jack D., additional, Sohail, M. Rizwan, additional, Soper, David E., additional, Sorrell, Tania C., additional, Steckelberg, James M., additional, Steere, Allen C., additional, Steigbigel, Neal H., additional, Steinberg, James P., additional, Stephens, David S., additional, Sterling, Timothy R., additional, Stevens, David A., additional, Stevens, Dennis L., additional, Strahilevitz, Jacob, additional, Stratton, Charles W., additional, Suffredini, Anthony F., additional, Suh, Kathryn N., additional, Sulkowski, Mark S., additional, Swartz, Morton N., additional, Talbot, Thomas R., additional, Tan, C. Sabrina, additional, Tan, Ming, additional, Thio, Chloe Lynne, additional, Thomas, David L., additional, Thomas, Lora D., additional, Thomas, Stephen J., additional, Thorner, Anna R., additional, María Tobón, Angela, additional, Tramont, Edmund C., additional, Treanor, John J., additional, Trubiano, Jason, additional, Tsibris, Athe M.N., additional, Tunkel, Allan R., additional, Turner, Ronald B., additional, Tyler, Kenneth L., additional, Uluer, Ahmet, additional, van de Beek, Diederik, additional, van der Velden, Walter J.F.M., additional, Vannier, Edouard G., additional, Van, Trevor C., additional, Versalovic, James, additional, Viscoli, Claudio, additional, Wald, Ellen R., additional, Waldor, Matthew K., additional, Walker, David H., additional, Wallace, Richard J., additional, Walsh, Edward E., additional, Walsh, Stephen R., additional, Walzer, Peter D., additional, Wanke, Christine A., additional, Warren, Cirle A., additional, Washburn, Ronald G., additional, Waters, Valerie, additional, Weber, David J., additional, Weiden, Michael D., additional, Weinberg, Geoffrey A., additional, Weisdorf, Daniel J., additional, Weiss, Louis M., additional, Welch, David F., additional, Wellems, Thomas E., additional, Wenzel, Richard P., additional, Wharton, Melinda, additional, White, A. Clinton, additional, Whitley, Richard J., additional, Wilson, Walter R., additional, Wortmann, Glenn W., additional, Wright, William F., additional, Young, Jo-Anne H., additional, Young, Vincent B., additional, Yun, Nadezhda, additional, Zimmerli, Werner, additional, Zinner, Stephen H., additional, and Zurlo, John J., additional

Published
2015
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42. Impact of Coronavirus Disease 2019 (COVID-19) on Healthcare-Associated Infections.

Author

Baker, Meghan A, Sands, Kenneth E, Huang, Susan S, Kleinman, Ken, Septimus, Edward J, Varma, Neha, Blanchard, Jackie, Poland, Russell E, Coady, Micaela H, Yokoe, Deborah S, Fraker, Sarah, Froman, Allison, Moody, Julia, Goldin, Laurel, Isaacs, Amanda, Kleja, Kacie, Korwek, Kimberly M, Stelling, John, Clark, Adam, and Platt, Richard

Subjects
HOSPITALS, VANCOMYCIN resistance, COVID-19, CATHETER-related infections, CONFIDENCE intervals, MICROBIOLOGY, CROSS infection, METHICILLIN-resistant staphylococcus aureus, CATHETER-associated urinary tract infections, MULTIDRUG resistance, ENTEROCOCCUS, DESCRIPTIVE statistics, LONGITUDINAL method, BLOODBORNE infections
Abstract

Background The profound changes wrought by coronavirus disease 2019 (COVID-19) on routine hospital operations may have influenced performance on hospital measures, including healthcare-associated infections (HAIs). We aimed to evaluate the association between COVID-19 surges and HAI and cluster rates. Methods In 148 HCA Healthcare-affiliated hospitals, from 1 March 2020 to 30 September 2020, and a subset of hospitals with microbiology and cluster data through 31 December 2020, we evaluated the association between COVID-19 surges and HAIs, hospital-onset pathogens, and cluster rates using negative binomial mixed models. To account for local variation in COVID-19 pandemic surge timing, we included the number of discharges with a laboratory-confirmed COVID-19 diagnosis per staffed bed per month. Results Central line-associated blood stream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), and methicillin-resistant Staphylococcus aureus (MRSA) bacteremia increased as COVID-19 burden increased. There were 60% (95% confidence interval [CI]: 23–108%) more CLABSI, 43% (95% CI: 8–90%) more CAUTI, and 44% (95% CI: 10–88%) more cases of MRSA bacteremia than expected over 7 months based on predicted HAIs had there not been COVID-19 cases. Clostridioides difficile infection was not significantly associated with COVID-19 burden. Microbiology data from 81 of the hospitals corroborated the findings. Notably, rates of hospital-onset bloodstream infections and multidrug resistant organisms, including MRSA, vancomycin-resistant enterococcus, and Gram-negative organisms, were each significantly associated with COVID-19 surges. Finally, clusters of hospital-onset pathogens increased as the COVID-19 burden increased. Conclusions COVID-19 surges adversely impact HAI rates and clusters of infections within hospitals, emphasizing the need for balancing COVID-related demands with routine hospital infection prevention. [ABSTRACT FROM AUTHOR]

Published
2022
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43. Spectrum of bacille Calmette-Guerin (BCG) infection after intravesical BCG immunotherapy. (Major Article)

Author

Gonzalez, Omar Y., Musher, Daniel M., Brar, Indira, Furgeson, Seth, Boktour, Maha R., Septimus, Edward J., Hamill, Richard J., and Graviss, Edward A.

Subjects
BCG -- Research, Bladder cancer -- Complications, Urinary tract infections -- Physiological aspects, Mycobacterium bovis -- Observations, Adenocarcinoma -- Care and treatment, Immunotherapy -- Complications, Health, Health care industry
Published
2003

44. CONTRIBUTORS

Author

Adkinson, N. Franklin, primary, Allen, David M., additional, Allos, Ban Mishu, additional, Amsden, Guy W., additional, Anderson, David A., additional, Andes, David R., additional, Aoki, Fred Y., additional, Apfalter, Petra M., additional, Apicella, Michael A., additional, Arias, Cesar A., additional, Augenbraun, Michael H., additional, Azar, Dimitri T., additional, Baddour, Larry M., additional, Baden, Lindsey R., additional, Baker, Carol J., additional, Ballard, Ronald C., additional, Ballow, Charles H., additional, Barnes, Scott D., additional, Baron, Miriam J., additional, Barouch, Dan H., additional, Barrett, Alan, additional, Bassin, Sarice L., additional, Batteiger, Byron E., additional, Baum, Stephen G., additional, Bayer, Arnold S., additional, Beckham, J. David, additional, Beekmann, Susan E., additional, Bell, Beth P., additional, Bennett, John E., additional, Berbari, Elie F., additional, Berman, Jonathan D., additional, Bertino, Joseph S., additional, Birdsall, Holly H., additional, Bisno, Alan L., additional, Biswas, Hope H., additional, Blackburn, Brian G., additional, Blaser, Martin J., additional, Blazes, David L., additional, Bleck, Thomas P., additional, Blijlevens, Nicole M.A., additional, Bobak, David A., additional, Bonnez, William, additional, Boothroyd, John C., additional, Borio, Luciana, additional, Bosque, Patrick J., additional, Boucher, Richard C., additional, Brause, Barry D., additional, Brown, Kevin E., additional, Brown, Patricia D., additional, Brown-Elliott, Barbara A., additional, Burd, Eileen M., additional, Burns, James E., additional, Bush, Larry M., additional, Calfee, David P., additional, Caplan, Ellis S., additional, Carael, Michel, additional, Carpenter, Charles C.J., additional, Caserta, Mary T., additional, Castagnola, Elio, additional, Chaisson, Richard E., additional, Chambers, Henry F., additional, Chapman, Stanley W., additional, Chappell, James D., additional, Chen, Sharon C-A., additional, Chopra, Sanjiv, additional, Chow, Anthony W., additional, Chroneou, Alexandra, additional, Cianciotto, Nicholas P., additional, Clark, Rebecca A., additional, Clark, Robert A., additional, Cohen, Jeffrey I., additional, Cohen, Myron S., additional, Cohen-Poradosu, Ronit, additional, Cohn, Susan E., additional, Connors, Mark, additional, Cono, Joanne, additional, Corey, Lawrence, additional, Cornett, Patricia A., additional, Cox, Heather L., additional, Craig, William A., additional, Craven, Donald E., additional, Crossley, Kent B., additional, Crump, John A., additional, Crumpacker, Clyde S., additional, Curran, James W., additional, Currie, Bart J., additional, Curry, Michael P., additional, Damon, Inger K., additional, Darouiche, Rabih O., additional, DeBiasi, Roberta L., additional, Deepe, George S., additional, del Rio, Carlos, additional, DeMuri, Gregory P., additional, Dennis, David T., additional, Densen, Peter, additional, De Pauw, Ben E., additional, Dermody, Terence S., additional, Dewar, Robin, additional, Diaz, James H., additional, Dieffenbach, Carl W., additional, Dienstag, Jules L., additional, Dolin, Raphael, additional, Donaldson, Scott H., additional, Donnelly, J. Peter, additional, Donnenberg, Michael S., additional, Donowitz, Gerald R., additional, Dormitzer, Philip R., additional, Drake, James M., additional, Dumler, J. Stephen, additional, Dummer, J. Stephen, additional, DuPont, Herbert L., additional, Durack, David T., additional, Durand, Marlene L., additional, Edelstein, Paul H., additional, Edmond, Michael B., additional, Edwards, John E., additional, Edwards, Morven S., additional, Eliopoulos, George M., additional, Engleberg, N. Cary, additional, Ernst, Joel D., additional, Fairhurst, Rick M., additional, Fairley, Jessica K., additional, Falkow, Stanley, additional, Falsey, Ann R., additional, Fauci, Anthony S., additional, Feinstone, Stephen M., additional, Fekete, Thomas, additional, Fey, Paul D., additional, Fine, Steven M., additional, Finegold, Sydney M., additional, Fishman, Neil O., additional, Fitzgerald, Daniel W., additional, Flores, Anthony R., additional, Fowler, Vance G., additional, Freedman, David O., additional, Friedlander, Arthur M., additional, Galgiani, John N., additional, Gallin, John I., additional, Gallo, Robert C., additional, Garrett, Wendy S., additional, Gelfand, Jeffrey A., additional, Gelone, Steven P., additional, Gershon, Anne A., additional, Gilbert, David N., additional, Gilligan, Peter H., additional, Glickman, Michael S., additional, Göbel, Ulf B., additional, Goldstein, Deborah, additional, Goldstein, Ellie J.C., additional, Gordin, Fred M., additional, Gotuzzo, Eduardo, additional, Graman, Paul S., additional, Graves, Margot, additional, Griffin, Patricia M., additional, Griffith, David E., additional, Guerrant, Richard L., additional, Haake, David A., additional, Haas, David W., additional, Hall, Caroline Breese, additional, Halperin, Scott, additional, Hammerschlag, Margaret R., additional, Handsfield, H. Hunter, additional, Haque, Rashidul, additional, Hartman, Barry J., additional, Hay, Roderick J., additional, Hayden, Frederick G., additional, Hedberg, Craig W., additional, Henderson, David K., additional, Henderson, Donald A., additional, Hendley, J. Owen, additional, Hewlett, Erik L., additional, High, Kevin P., additional, Hill, Adrian V.S., additional, Hill, David R., additional, Hinman, Alan R., additional, Hirsch, Martin S., additional, Hodges, Lisa S., additional, Holland, Steven M., additional, Hook, Edward W., additional, Hooper, David C., additional, Hooton, Thomas M., additional, Horsburgh, C. Robert, additional, Hospenthal, Duane R., additional, Hughes, James M., additional, Hughes, Molly A., additional, Huston, Christopher D., additional, Hynes, Noreen A., additional, Iredell, Jonathan R., additional, Janda, J. Michael, additional, Johannsen, Eric C., additional, Johnson, Warren D., additional, Kashuba, Angela D.M., additional, Kasper, Dennis L., additional, Kaye, Donald, additional, Kaye, Keith S., additional, Kaye, Kenneth M., additional, Kazura, James W., additional, Kenny, George E., additional, Keystone, Jay S., additional, Khabbaz, Rima F., additional, King, Charles H., additional, Kirchhoff, Louis V., additional, Klein, Jerome O., additional, Knoll, Bettina M., additional, Knowlton, Kirk U., additional, Kohlhoff, Stephan A., additional, Könönen, Eija, additional, Kontoyiannis, Dimitrios P., additional, Koralnik, Igor J., additional, Koshy, Anita A., additional, Kotton, Camille Nelson, additional, Kovacs, Joseph A., additional, Kozarsky, Phyllis, additional, Koziel, Margaret James, additional, Krieger, John N., additional, Kuehnert, Matthew J., additional, LeDuc, James W., additional, Lee, Laura M., additional, Leggett, James E., additional, Lescano, Andres G., additional, Levett, Paul N., additional, Levine, Donald P., additional, Levison, Matthew E., additional, Lewis, Russell E., additional, Liles, W. Conrad, additional, Lima, Aldo A.M., additional, Litman, Nathan, additional, Lorber, Bennett, additional, Lutwick, Larry I., additional, MacGregor, Rob Roy, additional, Mackowiak, Philip A., additional, Madoff, Lawrence C., additional, Magill, Alan J., additional, Maguire, James H., additional, Maldarelli, Frank, additional, Mandell, Lionel A., additional, Mann, Barbara J., additional, Markoff, Lewis, additional, Marrazzo, Jeanne M., additional, Marrie, Thomas J., additional, Marth, Thomas, additional, Martin, Gregory J., additional, Maschmeyer, Georg, additional, Masur, Henry, additional, Mawle, Alison, additional, Mayer, Kenneth H., additional, McBride, John T., additional, McCormack, William M., additional, McIntosh, Kenneth, additional, Mead, Paul S., additional, Meyer, Daniel K., additional, Meyers, Burt R., additional, Miller, Mark A., additional, Miller, Samuel I., additional, Mitchell, David H., additional, Modlin, John F., additional, Moellering, Robert C., additional, Moir, Susan, additional, Montgomery, Joel M., additional, Montoya, José G., additional, Moore, Thomas A., additional, Moreillon, Philippe, additional, Morrell, Dean S., additional, Morris, J. Glenn, additional, Morse, Caryn Gee, additional, Moseley, Robin, additional, Muder, Robert R., additional, Munford, Robert S., additional, Murphy, Edward L., additional, Murphy, Timothy F., additional, Murray, Barbara E., additional, Murray, Clinton K., additional, Murray, Patrick R., additional, Musher, Daniel M., additional, Nannini, Esteban C., additional, Nash, Theodore E., additional, Nauseef, William M., additional, Neill, Marguerite A., additional, O'Donnell, Judith A., additional, Ohl, Christopher A., additional, Okhuysen, Pablo C., additional, Onderdonk, Andrew B., additional, Opal, Steven M., additional, Orenstein, Walter A., additional, Osman, Douglas R., additional, Osterholm, Michael T., additional, Ostroff, Stephen M., additional, Oxman, Michael N., additional, Page, Andrea V., additional, Palmore, Tara N., additional, Pamer, Eric G., additional, Pappas, Peter G., additional, Pasternack, Mark S., additional, Patterson, Thomas F., additional, Pavan-Langston, Deborah, additional, Pegues, David A., additional, Penn, Robert L., additional, Perfect, John R., additional, Perlman, Stanley, additional, Peters, C.J., additional, Peterson, Phillip K., additional, Petri, William A., additional, Petti, Cathy A., additional, Pickering, Larry K., additional, Pier, Gerald B., additional, Pillai, Satish K., additional, Piot, Peter, additional, Plaeger, Susan F., additional, Polk, Ronald E., additional, Pop-Vicas, Aurora, additional, Powers, John H., additional, Punturieri, Antonello, additional, Que, Yok-ai, additional, Rabinowitz, Ronald P., additional, Rabizadeh, Shervin, additional, Ramphal, Reuben, additional, Raoult, Didier, additional, Ravdin, Jonathan I., additional, Ray, Stuart C., additional, Reboli, Annette C., additional, Reddy, Pavani, additional, Reichman, Richard C., additional, Reitz, Marvin S., additional, Relman, David A., additional, Renault, Cybèle A., additional, Restrepo, Angela, additional, Rex, John H., additional, Reynolds, Herbert Y., additional, Rhee, Elizabeth G., additional, Rhee, Kyu Y., additional, Rotz, Lisa D., additional, Ruoff, Kathryn L., additional, Rupp, Mark E., additional, Rupprecht, Charles E., additional, Russo, Thomas A., additional, Rutala, William A., additional, Salvatore, Mirella, additional, Saulsbury, Frank T., additional, Savoia, Maria C., additional, Sax, Paul E., additional, Scheld, W. Michael, additional, Schiffer, Joshua T., additional, Schlossberg, David, additional, Schneider, Thomas, additional, Schwebke, Jane R., additional, Sears, Cynthia L., additional, Seas, Carlos, additional, Sepkowitz, Kent A., additional, Septimus, Edward J., additional, Siberry, George K., additional, Sifri, Costi D., additional, Singh, Nina, additional, Singh, Upinder, additional, Sinner, Scott W., additional, Sivapalasingam, Sumathi, additional, Slater, Leonard N., additional, Smulian, A. George, additional, Sobel, Jack D., additional, Sodha, Samir V., additional, Sohail, M. Rizwan, additional, Solomon, Tom, additional, Song, Yuli, additional, Soper, David E., additional, Sorrell, Tania C., additional, Sparling, P. Frederick, additional, Stamm, Walter E., additional, Steckelberg, James M., additional, Steere, Allen C., additional, Steigbigel, Neal H., additional, Steinberg, James P., additional, Steiner, Theodore S., additional, Sterling, Timothy R., additional, Stevens, David A., additional, Stevens, Dennis L., additional, Strahilevitz, Jacob, additional, Stratton, Charles W., additional, Suffredini, Anthony F., additional, Suh, Kathryn N., additional, Sulkowski, Mark S., additional, Sullivan, Donna C., additional, Swartz, Morton N., additional, Talbot, Thomas R., additional, Tan, C. Sabrina, additional, Thielman, Nathan M., additional, Thio, Chloe Lynn, additional, Thomas, David L., additional, Thomas, Lora D., additional, Thorner, Anna R., additional, Tice, Alan D., additional, Tobón, Angela María, additional, Tramont, Edmund C., additional, Treanor, John J., additional, N. 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Clinton, additional, Whitley, Richard J., additional, Wilson, Kenneth H., additional, Wilson, Walter R., additional, Witebsky, Frank G., additional, Wolfgang, Matthew C., additional, Wright, Peter F., additional, Young, Edward J., additional, Young, Jo-Anne H., additional, Zhang, Jie Lin, additional, Zinner, Stephen H., additional, and Zurlo, John J., additional

Published
2010
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49. Infectious Diseases Society of America Position Paper: Recommended Revisions to the National Severe Sepsis and Septic Shock Early Management Bundle (SEP-1) Sepsis Quality Measure

Author

Rhee, Chanu, primary, Chiotos, Kathleen, additional, Cosgrove, Sara E, additional, Heil, Emily L, additional, Kadri, Sameer S, additional, Kalil, Andre C, additional, Gilbert, David N, additional, Masur, Henry, additional, Septimus, Edward J, additional, Sweeney, Daniel A, additional, Strich, Jeffrey R, additional, Winslow, Dean L, additional, and Klompas, Michael, additional

Published
2020
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