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  1. Article ; Online: Antimicrobial stewardship knowledge, attitudes, and practices (KAP) among nurses.

    Perez, Reinaldo / Hayes, Jillian E / Winters, Ali R / Wrenn, Rebekah H / Moehring, Rebekah W

    Antimicrobial stewardship & healthcare epidemiology : ASHE

    2024  Volume 4, Issue 1, Page(s) e51

    Abstract: We performed a knowledge, attitudes, and practice (KAP) survey of bedside nurses to evaluate perceptions of antimicrobial use and aid in the design of nursing-based antimicrobial stewardship interventions. The survey highlighted discrepancies in ... ...

    Abstract We performed a knowledge, attitudes, and practice (KAP) survey of bedside nurses to evaluate perceptions of antimicrobial use and aid in the design of nursing-based antimicrobial stewardship interventions. The survey highlighted discrepancies in knowledge and practice as well as opportunities to improve communication with nursing colleagues.
    Language English
    Publishing date 2024-04-18
    Publishing country England
    Document type Journal Article
    ISSN 2732-494X
    ISSN (online) 2732-494X
    DOI 10.1017/ash.2024.63
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  2. Article: Teams in Transition: Increasing Role of Advanced Practice Providers in Antimicrobial Use and Infectious Diseases Consultation.

    Perez, Reinaldo / Yarrington, Michael E / Deri, Connor R / Smith, Michael J / Hayes, Jillian / Wrenn, Rebekah H / Moehring, Rebekah W

    Open forum infectious diseases

    2024  Volume 11, Issue 4, Page(s) ofae141

    Abstract: Background: Advanced practice providers (APPs) have taken on increasing responsibilities as primary team members in acute care hospitals, but the impact of this practice shift on antimicrobial prescribing and infectious diseases (ID) consultation ... ...

    Abstract Background: Advanced practice providers (APPs) have taken on increasing responsibilities as primary team members in acute care hospitals, but the impact of this practice shift on antimicrobial prescribing and infectious diseases (ID) consultation requests is unknown. Here we describe longitudinal trends in antimicrobial days of therapy (DOT) and ID consultation by attributed provider type in 3 hospitals.
    Methods: We performed a retrospective time series analysis of antimicrobial use and ID consultation from July 2015 to June 2022 at a major university hospital and 2 community hospitals. We evaluated antimicrobial DOT and ID consultation over time and assessed attribution to 3 groups of providers: attending physicians, trainees, and APPs. We used multinomial logistic regression to measure changes in percentage of DOT and ID consultation across the clinician groups over time using physicians as the referent.
    Results: Baseline distribution of antimicrobial DOT and ID consultation varied by practice setting, but all subgroups showed increases in the proportion attributable to APPs. Large increases were seen in the rate of ID consultation, increasing by >30% during the study period. At our university hospital, by study end >40% of new ID consults and restricted antimicrobial days were attributed to APPs.
    Conclusions: Hospitals had differing baseline patterns of DOT attributed to provider groups, but all experienced increases in DOT attributed to APPs. Similar increases were seen in changes to ID consultation. APPs have increasing involvement in antimicrobial use decisions in the inpatient setting and should be engaged in future antimicrobial stewardship initiatives.
    Language English
    Publishing date 2024-04-04
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2757767-3
    ISSN 2328-8957
    ISSN 2328-8957
    DOI 10.1093/ofid/ofae141
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  3. Article ; Online: The devil's in the defaults: An interrupted time-series analysis of the impact of default duration elimination on exposure to fluoroquinolone therapy.

    Wrenn, Rebekah H / Slaton, Cara N / Diez, Tony / Turner, Nicholas A / Yarrington, Michael E / Anderson, Deverick J / Moehring, Rebekah W

    Infection control and hospital epidemiology

    2024  , Page(s) 1–7

    Abstract: Objective: To determine whether removal of default duration, embedded in electronic prescription (e-script), influenced antibiotic days of therapy.: Design: Interrupted time-series analysis.: Setting: The study was conducted across 2 community ... ...

    Abstract Objective: To determine whether removal of default duration, embedded in electronic prescription (e-script), influenced antibiotic days of therapy.
    Design: Interrupted time-series analysis.
    Setting: The study was conducted across 2 community hospitals, 1 academic hospital, 3 emergency departments, and 86 ambulatory clinics.
    Patients: Adults prescribed a fluoroquinolone with a duration <31 days.
    Interventions: Removal of standard 10-day fluoroquinolone default duration and addition of literature-based duration guidance in the order entry on December 19, 2017. The study period included data for 12 months before and after the intervention.
    Results: The study included 35,609 fluoroquinolone e-scripts from the preintervention period and 31,303 fluoroquinolone e-scripts from the postintervention period, accounting for 520,388 cumulative fluoroquinolone DOT. Mean durations before and after the intervention were 7.8 (SD, 4.3) and 7.7 (SD, 4.5), a nonsignificant change. E-scripts with a 10-day duration decreased prior to and after the default removal. The inpatient setting showed a significant 8% drop in 10-day e-scripts after default removal and a reduced median duration by 1 day; 10-day scripts declined nonsignificantly in ED and ambulatory settings. In the ambulatory settings, both 7- and 14-day e-script durations increased after default removal.
    Conclusion: Removal of default 10-day antibiotic durations did not affect overall mean duration but did shift patterns in prescribing, depending on practice setting. Stewardship interventions must be studied in the context of practice setting. Ambulatory stewardship efforts separate from inpatient programs are needed because interventions cannot be assumed to have similar effects.
    Language English
    Publishing date 2024-02-13
    Publishing country United States
    Document type Journal Article
    ZDB-ID 639378-0
    ISSN 1559-6834 ; 0195-9417 ; 0899-823X
    ISSN (online) 1559-6834
    ISSN 0195-9417 ; 0899-823X
    DOI 10.1017/ice.2024.16
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  4. Article ; Online: Compiling Observational Research During a Pandemic: A Necessary Bridge.

    Moehring, Rebekah W / Holland, Thomas L

    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

    2020  Volume 72, Issue 11, Page(s) e750–e752

    MeSH term(s) Antibodies, Monoclonal, Humanized ; COVID-19/drug therapy ; Humans ; Pandemics ; SARS-CoV-2
    Chemical Substances Antibodies, Monoclonal, Humanized ; tocilizumab (I031V2H011)
    Language English
    Publishing date 2020-12-10
    Publishing country United States
    Document type Editorial ; Comment
    ZDB-ID 1099781-7
    ISSN 1537-6591 ; 1058-4838
    ISSN (online) 1537-6591
    ISSN 1058-4838
    DOI 10.1093/cid/ciaa1705
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  5. Article ; Online: Measuring empiric antibiotic spectrum-A journey through space and time.

    Yarrington, Michael E / Wrenn, Rebekah H / Spivey, Justin / Sarubbi, Christina / Anderson, Deverick J / Moehring, Rebekah W

    Infection control and hospital epidemiology

    2022  Volume 44, Issue 4, Page(s) 565–569

    Abstract: Objectives: The typical 5-day work week affects healthcare outcomes. Structured work hours have also been implicated in antimicrobial prescribing choice. We developed a visualization tool to aid in evaluating breadth of antibiotic use in various time ( ... ...

    Abstract Objectives: The typical 5-day work week affects healthcare outcomes. Structured work hours have also been implicated in antimicrobial prescribing choice. We developed a visualization tool to aid in evaluating breadth of antibiotic use in various time (day of week and hour of day) and space (patient location) combinations.
    Methods: We evaluated antibiotic administration data from a tertiary-care academic medical center between July 1, 2018, and July 1, 2020. We calculated a cumulative empiric antibiotic spectrum score by adapting a previously validated antibiotic spectrum index (ASI) and applying that score to empiric antibiotic use. We visualized these data as a heat map based on various day-of-week-time combinations and then compared the distribution of scores between weekday nights, weekend days, and weekend nights to the typical workweek hours (weekday days, weekday days) using the Mann-Whitney
    Results: The analysis included 76,535 antibiotic starts across 53,900 unique patient admissions over 2 years. The mean cumulative ASI was higher in all 3 night and weekend combinations (weekday nights, 7.3; weekend days, 7.6; weekend nights, 7.5) compared to the weekday daytime hours (weekday days, 7.1) and the distribution of scores was different in all groups compared to the weekday daytime reference. The cumulative ASI was also higher in intensive care units.
    Conclusions: Empiric antibiotic prescribing patterns differed across space and time; broader antibiotic choices occurred in the intensive care units and on nights and weekends. Visualization of these patterns aids in antimicrobial prescribing pattern recognition and may assist in finding opportunities for additional antimicrobial stewardship interventions.
    MeSH term(s) Humans ; Anti-Bacterial Agents ; Time Factors ; Patient Admission ; Intensive Care Units ; Health Facilities
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2022-06-28
    Publishing country United States
    Document type Journal Article
    ZDB-ID 639378-0
    ISSN 1559-6834 ; 0195-9417 ; 0899-823X
    ISSN (online) 1559-6834
    ISSN 0195-9417 ; 0899-823X
    DOI 10.1017/ice.2022.151
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  6. Article ; Online: Pandemic hits: Evaluation of an antimicrobial stewardship program website for hospital communication during the coronavirus disease 2019 (COVID-19) pandemic.

    Perez, Reinaldo / Yarrington, Michael E / Adams, Martha B / Deri, Connor R / Drew, Richard H / Smith, Michael J / Spivey, Justin / Wrenn, Rebekah H / Moehring, Rebekah W

    Infection control and hospital epidemiology

    2023  Volume 44, Issue 10, Page(s) 1701–1703

    MeSH term(s) Humans ; COVID-19 ; Antimicrobial Stewardship ; Pandemics/prevention & control ; Hospitals ; Communication
    Language English
    Publishing date 2023-04-12
    Publishing country United States
    Document type Journal Article
    ZDB-ID 639378-0
    ISSN 1559-6834 ; 0195-9417 ; 0899-823X
    ISSN (online) 1559-6834
    ISSN 0195-9417 ; 0899-823X
    DOI 10.1017/ice.2023.43
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  7. Article ; Online: Optimizing reflex urine cultures: Using a population-specific approach to diagnostic stewardship.

    Advani, Sonali D / Turner, Nicholas A / Schmader, Kenneth E / Wrenn, Rebekah H / Moehring, Rebekah W / Polage, Christopher R / Vaughn, Valerie M / Anderson, Deverick J

    Infection control and hospital epidemiology

    2023  Volume 44, Issue 2, Page(s) 206–209

    Abstract: Background: Clinicians and laboratories routinely use urinalysis (UA) parameters to determine whether antimicrobial treatment and/or urine cultures are needed. Yet the performance of individual UA parameters and common thresholds for action are not well ...

    Abstract Background: Clinicians and laboratories routinely use urinalysis (UA) parameters to determine whether antimicrobial treatment and/or urine cultures are needed. Yet the performance of individual UA parameters and common thresholds for action are not well defined and may vary across different patient populations.
    Methods: In this retrospective cohort study, we included all encounters with UAs ordered 24 hours prior to a urine culture between 2015 and 2020 at 3 North Carolina hospitals. We evaluated the performance of relevant UA parameters as potential outcome predictors, including sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV). We also combined 18 different UA criteria and used receiver operating curves to identify the 5 best-performing models for predicting significant bacteriuria (≥100,000 colony-forming units of bacteria/mL).
    Results: In 221,933 encounters during the 6-year study period, no single UA parameter had both high sensitivity and high specificity in predicting bacteriuria. Absence of leukocyte esterase and pyuria had a high NPV for significant bacteriuria. Combined UA parameters did not perform better than pyuria alone with regard to NPV. The high NPV ≥0.90 of pyuria was maintained among most patient subgroups except females aged ≥65 years and patients with indwelling catheters.
    Conclusion: When used as a part of a diagnostic workup, UA parameters should be leveraged for their NPV instead of sensitivity. Because many laboratories and hospitals use reflex urine culture algorithms, their workflow should include clinical decision support and or education to target symptomatic patients and focus on populations where absence of pyuria has high NPV.
    MeSH term(s) Female ; Humans ; Pyuria/diagnosis ; Bacteriuria/diagnosis ; Urinary Tract Infections/diagnosis ; Retrospective Studies ; Urinalysis ; Reflex ; Urine
    Language English
    Publishing date 2023-01-10
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 639378-0
    ISSN 1559-6834 ; 0195-9417 ; 0899-823X
    ISSN (online) 1559-6834
    ISSN 0195-9417 ; 0899-823X
    DOI 10.1017/ice.2022.315
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  8. Article ; Online: Racial disparities in

    Warren, Bobby G / Burch, Christopher D / Barrett, Aaron / Graves, Amanda / Gettler, Erin / Turner, Nicholas A / Moehring, Rebekah W / Anderson, Deverick J

    Infection control and hospital epidemiology

    2023  Volume 45, Issue 4, Page(s) 429–433

    Abstract: Objective: To analyze : Methods: We completed a retrospective analysis of inpatient : Results: In total, 35,160 : Conclusion: White patients received ... ...

    Abstract Objective: To analyze
    Methods: We completed a retrospective analysis of inpatient
    Results: In total, 35,160
    Conclusion: White patients received more
    MeSH term(s) Humans ; Clostridioides difficile ; Retrospective Studies ; Hospitals ; Comorbidity ; White
    Language English
    Publishing date 2023-11-20
    Publishing country United States
    Document type Journal Article
    ZDB-ID 639378-0
    ISSN 1559-6834 ; 0195-9417 ; 0899-823X
    ISSN (online) 1559-6834
    ISSN 0195-9417 ; 0899-823X
    DOI 10.1017/ice.2023.244
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  9. Article ; Online: Implementation of Antimicrobial Stewardship Programs in Small Community Hospitals: Recognizing the Barriers and Meeting the Challenge.

    Sexton, Daniel J / Moehring, Rebekah W

    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

    2017  Volume 65, Issue 4, Page(s) 697–698

    MeSH term(s) Anti-Bacterial Agents ; Antimicrobial Stewardship ; Hospitals, Community
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2017-05-04
    Publishing country United States
    Document type Journal Article ; Research Support, U.S. Gov't, P.H.S. ; Comment
    ZDB-ID 1099781-7
    ISSN 1537-6591 ; 1058-4838
    ISSN (online) 1537-6591
    ISSN 1058-4838
    DOI 10.1093/cid/cix409
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  10. Article ; Online: Evaluation of hospital blood culture utilization rates to identify opportunities for diagnostic stewardship.

    Warren, Bobby G / Yarrington, Michael E / Polage, Christopher R / Anderson, Deverick J / Moehring, Rebekah W

    Infection control and hospital epidemiology

    2022  Volume 44, Issue 2, Page(s) 200–205

    Abstract: Objectives: To evaluate the pattern of blood-culture utilization among a cohort of 6 hospitals to identify potential opportunities for diagnostic stewardship.: Methods: We completed a retrospective analysis of blood-culture utilization during adult ... ...

    Abstract Objectives: To evaluate the pattern of blood-culture utilization among a cohort of 6 hospitals to identify potential opportunities for diagnostic stewardship.
    Methods: We completed a retrospective analysis of blood-culture utilization during adult inpatient or emergency department (ED) encounters in 6 hospitals from May 2019 to April 2020. We investigated 2 measures of blood-culture utilization rates (BCURs): the total number of blood cultures, defined as a unique accession number per 1,000 patient days (BCX) and a new metric of blood-culture events per 1,000 patient days to account for paired culture practices. We defined a blood-culture event as an initial blood culture and all subsequent samples for culture drawn within 12 hours for patients with an inpatient or ED encounter. Cultures were evaluated by unit type, positivity and contamination rates, and other markers evaluating the quality of blood-culture collection.
    Results: In total, 111,520 blood cultures, 52,550 blood culture events, 165,456 inpatient admissions, and 568,928 patient days were analyzed. Overall, the mean BCUR was 196 blood cultures per 1,000 patient days, with 92 blood culture events per 1,000 patient days (range, 64-155 among hospitals). Furthermore, 7% of blood-culture events were single culture events, 55% began in the ED, and 77% occurred in the first 3 hospital days. Among all blood cultures, 7.7% grew a likely pathogen, 2.1% were contaminated, and 5.9% of first blood cultures were collected after the initiation of antibiotics.
    Conclusions: Blood-culture utilization varied by hospital and was heavily influenced by ED culture volumes. Hospital comparisons of blood-culture metrics can assist in identifying opportunities to optimize blood-culture collection practices.
    MeSH term(s) Adult ; Humans ; Blood Culture ; Retrospective Studies ; Emergency Service, Hospital ; Hospitals ; Hospitalization
    Language English
    Publishing date 2022-08-08
    Publishing country United States
    Document type Journal Article ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 639378-0
    ISSN 1559-6834 ; 0195-9417 ; 0899-823X
    ISSN (online) 1559-6834
    ISSN 0195-9417 ; 0899-823X
    DOI 10.1017/ice.2022.191
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