Browsing by Author "Sexton, Daniel J"
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Item Open Access An Integrated Clinical Microbiology Service Ensures Optimal Early Empirical Antimicrobial Therapy for Methicillin-Resistant Staphylococcus aureus Bloodstream Infection Reply(INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY, 2010-09) Herzke, Carrie; Chen, Luke F; Anderson, Deverick J; Choi, Yong; Sexton, Daniel J; Kaye, Keith SItem Open Access Bloodstream infections in community hospitals in the 21st century: a multicenter cohort study.(PLoS One, 2014) Anderson, Deverick J; Moehring, Rebekah W; Sloane, Richard; Schmader, Kenneth E; Weber, David J; Fowler, Vance G; Smathers, Emily; Sexton, Daniel JBACKGROUND: While the majority of healthcare in the US is provided in community hospitals, the epidemiology and treatment of bloodstream infections in this setting is unknown. METHODS AND FINDINGS: We undertook this multicenter, retrospective cohort study to 1) describe the epidemiology of bloodstream infections (BSI) in a network of community hospitals and 2) determine risk factors for inappropriate therapy for bloodstream infections in community hospitals. 1,470 patients were identified as having a BSI in 9 community hospitals in the southeastern US from 2003 through 2006. The majority of BSIs were community-onset, healthcare associated (n = 823, 56%); 432 (29%) patients had community-acquired BSI, and 215 (15%) had hospital-onset, healthcare-associated BSI. BSIs due to multidrug-resistant pathogens occurred in 340 patients (23%). Overall, the three most common pathogens were S. aureus (n = 428, 28%), E. coli (n = 359, 24%), coagulase-negative Staphylococci (n = 148, 10%), though type of infecting organism varied by location of acquisition (e.g., community-acquired). Inappropriate empiric antimicrobial therapy was given to 542 (38%) patients. Proportions of inappropriate therapy varied by hospital (median = 33%, range 21-71%). Multivariate logistic regression identified the following factors independently associated with failure to receive appropriate empiric antimicrobial therapy: hospital where the patient received care (p<0.001), assistance with ≥3 ADLs (p = 0.005), Charlson score (p = 0.05), community-onset, healthcare-associated infection (p = 0.01), and hospital-onset, healthcare-associated infection (p = 0.02). Important interaction was observed between Charlson score and location of acquisition. CONCLUSIONS: Our large, multicenter study provides the most complete picture of BSIs in community hospitals in the US to date. The epidemiology of BSIs in community hospitals has changed: community-onset, healthcare-associated BSI is most common, S. aureus is the most common cause, and 1 of 3 patients with a BSI receives inappropriate empiric antimicrobial therapy. Our data suggest that appropriateness of empiric antimicrobial therapy is an important and needed performance metric for physicians and hospital stewardship programs in community hospitals.Item Open Access Current definitions of central line-associated bloodstream infection: is the emperor wearing clothes?(Infect Control Hosp Epidemiol, 2010-12) Sexton, Daniel J; Chen, Luke F; Anderson, Deverick JItem Open Access Delays in appropriate antibiotic therapy for gram-negative bloodstream infections: a multicenter, community hospital study.(PLoS One, 2013) Moehring, Rebekah W; Sloane, Richard; Chen, Luke F; Smathers, Emily C; Schmader, Kenneth E; Fowler, Vance G; Weber, David J; Sexton, Daniel J; Anderson, Deverick JBACKGROUND: Gram-negative bacterial bloodstream infection (BSI) is a serious condition with estimated 30% mortality. Clinical outcomes for patients with severe infections improve when antibiotics are appropriately chosen and given early. The objective of this study was to estimate the association of prior healthcare exposure on time to appropriate antibiotic therapy in patients with gram-negative BSI. METHOD: We performed a multicenter cohort study of adult, hospitalized patients with gram-negative BSI using time to event analysis in nine community hospitals from 2003-2006. Event time was defined as the first administration of an antibiotic with in vitro activity against the infecting organism. Healthcare exposure status was categorized as community-acquired, healthcare-associated, or hospital-acquired. Time to appropriate therapy among groups of patients with differing healthcare exposure status was assessed using Kaplan-Meier analyses and multivariate Cox proportional hazards models. RESULTS: The cohort included 578 patients with gram-negative BSI, including 320 (55%) healthcare-associated, 217 (38%) community-acquired, and 41 (7%) hospital-acquired infections. 529 (92%) patients received an appropriate antibiotic during their hospitalization. Time to appropriate therapy was significantly different among the groups of healthcare exposure status (log-rank p=0.02). Time to first antibiotic administration regardless of drug appropriateness was not different between groups (p=0.3). The unadjusted hazard ratios (HR) (95% confidence interval) were 0.80 (0.65-0.98) for healthcare-associated and 0.72 (0.63-0.82) for hospital-acquired, relative to patients with community-acquired BSI. In multivariable analysis, interaction was found between the main effect and baseline Charlson comorbidity index. When Charlson index was 3, adjusted HRs were 0.66 (0.48-0.92) for healthcare-associated and 0.57 (0.44-0.75) for hospital-acquired, relative to patients with community-acquired infections. CONCLUSIONS: Patients with healthcare-associated or hospital-acquired BSI experienced delays in receipt of appropriate antibiotics for gram-negative BSI compared to patients with community-acquired BSI. This difference was not due to delayed initiation of antibiotic therapy, but due to the inappropriate choice of antibiotic.Item Open Access Harvesting the Low Hanging Fruit: A Benchmarking Tool for Implementation of Intravenous to Oral Antibiotic Switch Programs in 14 Southeastern Community Hospitals.(Open forum infectious diseases, 2015-12-09) Garner, Bronwen; Lokhnygina, Yuliya; Dodds-Ashley, Elizabeth; Johnson, Melissa; Drew, Richard H; Davis, Angelina; Sexton, Daniel J; Anderson, Deverick; Moehring, Rebekah WItem Open Access Identification of novel risk factors for community-acquired Clostridium difficile infection using spatial statistics and geographic information system analyses.(PLoS One, 2017) Anderson, Deverick J; Rojas, Leoncio Flavio; Watson, Shera; Knelson, Lauren P; Pruitt, Sohayla; Lewis, Sarah S; Moehring, Rebekah W; Sickbert Bennett, Emily E; Weber, David J; Chen, Luke F; Sexton, Daniel J; CDC Prevention Epicenters ProgramBACKGROUND: The rate of community-acquired Clostridium difficile infection (CA-CDI) is increasing. While receipt of antibiotics remains an important risk factor for CDI, studies related to acquisition of C. difficile outside of hospitals are lacking. As a result, risk factors for exposure to C. difficile in community settings have been inadequately studied. MAIN OBJECTIVE: To identify novel environmental risk factors for CA-CDI. METHODS: We performed a population-based retrospective cohort study of patients with CA-CDI from 1/1/2007 through 12/31/2014 in a 10-county area in central North Carolina. 360 Census Tracts in these 10 counties were used as the demographic Geographic Information System (GIS) base-map. Longitude and latitude (X, Y) coordinates were generated from patient home addresses and overlaid to Census Tracts polygons using ArcGIS; ArcView was used to assess "hot-spots" or clusters of CA-CDI. We then constructed a mixed hierarchical model to identify environmental variables independently associated with increased rates of CA-CDI. RESULTS: A total of 1,895 unique patients met our criteria for CA-CDI. The mean patient age was 54.5 years; 62% were female and 70% were Caucasian. 402 (21%) patient addresses were located in "hot spots" or clusters of CA-CDI (p<0.001). "Hot spot" census tracts were scattered throughout the 10 counties. After adjusting for clustering and population density, age ≥ 60 years (p = 0.03), race (<0.001), proximity to a livestock farm (0.01), proximity to farming raw materials services (0.02), and proximity to a nursing home (0.04) were independently associated with increased rates of CA-CDI. CONCLUSIONS: Our study is the first to use spatial statistics and mixed models to identify important environmental risk factors for acquisition of C. difficile and adds to the growing evidence that farm practices may put patients at risk for important drug-resistant infections.Item Open Access Universal masking is an effective strategy to flatten the severe acute respiratory coronavirus virus 2 (SARS-CoV-2) healthcare worker epidemiologic curve.(Infection control and hospital epidemiology, 2020-12) Seidelman, Jessica L; Lewis, Sarah S; Advani, Sonali D; Akinboyo, Ibukunoluwa C; Epling, Carol; Case, Matthew; Said, Kristen; Yancey, William; Stiegel, Matthew; Schwartz, Antony; Stout, Jason; Sexton, Daniel J; Smith, Becky AItem Open Access Variation in the type and frequency of postoperative invasive Staphylococcus aureus infections according to type of surgical procedure.(Infect Control Hosp Epidemiol, 2010-07) Anderson, Deverick J; Arduino, Jean Marie; Reed, Shelby D; Sexton, Daniel J; Kaye, Keith S; Grussemeyer, Chelsea A; Peter, Senaka A; Hardy, Chantelle; Choi, Yong Il; Friedman, Joelle Y; Fowler, Vance GOBJECTIVE: To determine the epidemiological characteristics of postoperative invasive Staphylococcus aureus infection following 4 types of major surgical procedures.design. Retrospective cohort study. SETTING: Eleven hospitals (9 community hospitals and 2 tertiary care hospitals) in North Carolina and Virginia. PATIENTS: Adults undergoing orthopedic, neurosurgical, cardiothoracic, and plastic surgical procedures. METHODS: We used previously validated, prospectively collected surgical surveillance data for surgical site infection and microbiological data for bloodstream infection. The study period was 2003 through 2006. We defined invasive S. aureus infection as either nonsuperficial incisional surgical site infection or bloodstream infection. Nonparametric bootstrapping was used to generate 95% confidence intervals (CIs). P values were generated using the Pearson chi2 test, Student t test, or Wilcoxon rank-sum test, as appropriate. RESULTS: In total, 81,267 patients underwent 96,455 procedures during the study period. The overall incidence of invasive S. aureus infection was 0.47 infections per 100 procedures (95% CI, 0.43-0.52); 227 (51%) of 446 infections were due to methicillin-resistant S.aureus. Invasive S. aureus infection was more common after cardiothoracic procedures (incidence, 0.79 infections per 100 procedures [95%CI, 0.62-0.97]) than after orthopedic procedures (0.37 infections per 100 procedures [95% CI, 0.32-0.42]), neurosurgical procedures (0.62 infections per 100 procedures [95% CI, 0.53-0.72]), or plastic surgical procedures (0.32 infections per 100 procedures [95% CI, 0.17-0.47]) (P < .001). Similarly, S. aureus bloodstream infection was most common after cardiothoracic procedures (incidence, 0.57 infections per 100 procedures [95% CI, 0.43-0.72]; P < .001, compared with other procedure types), comprising almost three-quarters of the invasive S. aureus infections after these procedures. The highest rate of surgical site infection was observed after neurosurgical procedures (incidence, 0.50 infections per 100 procedures [95% CI, 0.42-0.59]; P < .001, compared with other procedure types), comprising 80% of invasive S.aureus infections after these procedures. CONCLUSION: The frequency and type of postoperative invasive S. aureus infection varied significantly across procedure types. The highest risk procedures, such as cardiothoracic procedures, should be targeted for ongoing preventative interventions.Item Open Access Whole Genome Sequencing of a Methicillin-Resistant Staphylococcus aureus Pseudo-Outbreak in a Professional Football Team.(Open Forum Infect Dis, 2014-12) Anderson, Deverick J; Harris, Simon R; Godofsky, Eliot; Toriscelli, Todd; Rude, Thomas H; Elder, Kevin; Sexton, Daniel J; Pellman, Elliot J; Mayer, Thom; Fowler, Vance G; Peacock, Sharon JTwo American football players on the same team were diagnosed with methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infections on the same day. Our investigation, including whole genome sequencing, confirmed that players did not transmit MRSA to one another nor did they acquire the MRSA from a single source within the training facility.