Harvesting the Low Hanging Fruit: A Benchmarking Tool for Implementation of Intravenous to Oral Antibiotic Switch Programs in 14 Southeastern Community Hospitals.

Pharmacokinetics/pharmacodynamics of antimicrobials, antifungal use in compromised hosts, antimicrobial stewardship, prediction and therapy of multidrug-resistant pathogens, aerosolized antimicrobials

During the past 8 years my research interests have changed from a focus on tick-borne disease and endocarditis to a primary focus on healthcare-associated infections (HAIs). Specifically, I have been interested in HAIs in community hospitals. Using prospective data collected as part of our surveillance activities in the Duke Infection Control Outreach Network (DICON), I and my colleagues have focused on these specific areas of research:

• The accuracy and reliability of surveillance definitions used to document and trend rates of HAIs
• Outcomes of HAIs (both financial and clinical) with particular emphasis on bloodstream and surgical site infections
• Trends in HAIs due to pathogens resistant to common antimicrobial agents
• Temporal and geographic variations in the occurrence of pathogens such as methicillin-resistant S. aureus, E coli and Klebsiella pneumonia
• The prevention and control of HAIs with particular emphasis on the potential role of the environment in the transmission of HAIs

As the principal investigator on one of the 5 national epicenter grants funded by the Centers for Disease control I, along with my co-investigators from the Duke and University of North Carolina Division of Infectious Disease, are involved in a 5-year prospective study of the potential benefit of enhanced cleaning methods (such as the use of ultraviolet light emitters) in the prevention of HAIs. This study involves 9 hospitals in North Carolina and Virginia and will include a trial of 4 different cleaning methods utilized sequentially but randomly in these study hospitals over a 28-month time period. Additionally the Duke Epicenter is also undertaking prospective trials investigating the utility and reliability of new (streamlined) definitions of ventilator-associated pneumonia.


Key words that characterize my work: surgical site infections and nosocomial infections.

My research is focused on optimizing the use of antimicrobials and preventing healthcare-associated infections via interventions made by antimicrobial stewardship programs in acute care hospitals. I aim to develop, implement, and evaluate the utility of outcomes important in assessing the success of hospital antimicrobial stewardship programs, which will then serve as a means to optimize program development. I am also an active clinician with expertise in the diagnosis and treatment of infectious diseases. I am uniquely positioned to study antimicrobial stewardship program optimization in my role as Co-director for Research of the Duke Antimicrobial Stewardship Outreach Network. This network’s mission is to develop practical approaches and support for implementation of antimicrobial stewardship in the community hospital setting, which includes outcomes assessments that utilize benchmarking to network data. This network is made up of >30 community hospitals which share a common data infrastructure, access to comparative antimicrobial use data, consultation with Duke liaison pharmacists and physicians, and educational materials. In addition, I serve as medical director of the Duke University Hospital Antimicrobial Stewardship and Evaluation Team (ASET) and actively practice front-line stewardship at my home institution.