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  1. Article ; Online: Understanding and Improving Vaccine Effectiveness Estimates in the Age of Widespread Background Immunity: A Step Toward Improved Science Communication.

    Nirenberg, Edward / Perencevich, Eli N

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

    2023  Volume 76, Issue 9, Page(s) 1535–1538

    Abstract: Medical decision making and scientific communication around coronavirus disease 2019 (COVID-19) vaccines and booster doses requires proper understanding of how vaccine effectiveness estimates are determined and the potential biases inherent in current ... ...

    Abstract Medical decision making and scientific communication around coronavirus disease 2019 (COVID-19) vaccines and booster doses requires proper understanding of how vaccine effectiveness estimates are determined and the potential biases inherent in current estimates. The importance of background immunity from prior infection is reviewed along with ideas for improving the vaccine effectiveness estimates.
    MeSH term(s) Humans ; COVID-19/prevention & control ; Vaccine Efficacy ; COVID-19 Vaccines ; Clinical Decision-Making ; Communication ; Vaccination
    Chemical Substances COVID-19 Vaccines
    Language English
    Publishing date 2023-03-23
    Publishing country United States
    Document type Review ; Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
    ZDB-ID 1099781-7
    ISSN 1537-6591 ; 1058-4838
    ISSN (online) 1537-6591
    ISSN 1058-4838
    DOI 10.1093/cid/ciad124
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  2. Article ; Online: Metformin and Infections: What Is the Next Step in This Decades-Long Story?

    Goto, Michihiko / Perencevich, Eli N

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

    2022  Volume 76, Issue 7, Page(s) 1245–1246

    MeSH term(s) Humans ; Metformin/therapeutic use ; Veterans ; Diabetes Mellitus ; Hypoglycemic Agents/therapeutic use ; Pneumonia
    Chemical Substances Metformin (9100L32L2N) ; Hypoglycemic Agents
    Language English
    Publishing date 2022-12-16
    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/ciac903
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  3. Article ; Online: Diagnostic Accuracy of Hospital Antibiograms in Predicting the Risk of Antimicrobial Resistance in Enterobacteriaceae Isolates: A Nationwide Multicenter Evaluation at the Veterans Health Administration.

    Hasegawa, Shinya / Livorsi, Daniel J / Perencevich, Eli N / Church, Jonas N / Goto, Michihiko

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

    2024  Volume 77, Issue 11, Page(s) 1492–1500

    Abstract: Background: Many clinical guidelines recommend that clinicians use antibiograms to inform empiric antimicrobial therapy. However, hospital antibiograms are typically generated by crude aggregation of microbiologic data, and little is known about an ... ...

    Abstract Background: Many clinical guidelines recommend that clinicians use antibiograms to inform empiric antimicrobial therapy. However, hospital antibiograms are typically generated by crude aggregation of microbiologic data, and little is known about an antibiogram's reliability in predicting antimicrobial resistance (AMR) risk at the patient-level. We aimed to assess the diagnostic accuracy of antibiograms as a tool for selecting empiric therapy for Escherichia coli and Klebsiella spp. for individual patients.
    Methods: We retrospectively generated hospital antibiograms for the nationwide Veterans Health Administration (VHA) facilities from 2000 to 2019 using all clinical culture specimens positive for E. coli and Klebsiella spp., then assessed the diagnostic accuracy of an antibiogram to predict resistance for isolates in the following calendar year using logistic regression models and predefined 5-step interpretation thresholds.
    Results: Among 127 VHA facilities, 1 484 038 isolates from 704 779 patients for E. coli and 671 035 isolates from 340 504 patients for Klebsiella spp. were available for analysis. For E. coli and Klebsiella spp., the discrimination abilities of hospital-level antibiograms in predicting individual patient AMR were mostly poor, with the areas under the receiver operating curve at 0.686 and 0.715 for ceftriaxone, 0.637 and 0.675 for fluoroquinolones, and 0.576 and 0.624 for trimethoprim-sulfamethoxazole, respectively. The sensitivity and specificity of the antibiogram varied widely by antimicrobial groups and interpretation thresholds with substantial trade-offs.
    Conclusions: Conventional hospital antibiograms for E. coli and Klebsiella spp. have limited performance in predicting AMR for individual patients, and their utility in guiding empiric therapy may be low.
    MeSH term(s) Humans ; Anti-Bacterial Agents/pharmacology ; Anti-Bacterial Agents/therapeutic use ; Escherichia coli ; Retrospective Studies ; Reproducibility of Results ; Veterans Health ; Drug Resistance, Bacterial ; Hospitals ; Microbial Sensitivity Tests ; Klebsiella ; Risk Factors
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2024-03-28
    Publishing country United States
    Document type Multicenter Study ; Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 1099781-7
    ISSN 1537-6591 ; 1058-4838
    ISSN (online) 1537-6591
    ISSN 1058-4838
    DOI 10.1093/cid/ciad467
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  4. Article ; Online: Public Health Interventions for COVID-19: Emerging Evidence and Implications for an Evolving Public Health Crisis.

    Hartley, David M / Perencevich, Eli N

    JAMA

    2020  Volume 323, Issue 19, Page(s) 1908–1909

    MeSH term(s) Betacoronavirus ; COVID-19 ; China ; Coronavirus Infections/epidemiology ; Humans ; Pandemics ; Pneumonia, Viral/epidemiology ; Public Health ; SARS-CoV-2
    Keywords covid19
    Language English
    Publishing date 2020-04-09
    Publishing country United States
    Document type Editorial ; Comment
    ZDB-ID 2958-0
    ISSN 1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
    ISSN (online) 1538-3598
    ISSN 0254-9077 ; 0002-9955 ; 0098-7484
    DOI 10.1001/jama.2020.5910
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  5. Article ; Online: Contact Precautions and Methicillin-Resistant Staphylococcus aureus-Modeling Our Way to Safety.

    Goto, Michihiko / Harris, Anthony D / Perencevich, Eli N

    JAMA network open

    2021  Volume 4, Issue 3, Page(s) e211574

    MeSH term(s) Hospitals ; Humans ; Infection Control ; Methicillin-Resistant Staphylococcus aureus ; Staphylococcal Infections/epidemiology ; Staphylococcal Infections/prevention & control ; Veterans
    Language English
    Publishing date 2021-03-01
    Publishing country United States
    Document type Journal Article ; Comment
    ISSN 2574-3805
    ISSN (online) 2574-3805
    DOI 10.1001/jamanetworkopen.2021.1574
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  6. Article ; Online: Tracking antimicrobial stewardship activities beyond days of therapy (DOT): Comparison of days of antibiotic spectrum coverage (DASC) and DOT at a single center.

    Suzuki, Hiroyuki / Heintz, Brett H / Livorsi, Daniel J / Perencevich, Eli N / Goto, Michihiko

    Infection control and hospital epidemiology

    2023  Volume 44, Issue 6, Page(s) 934–937

    Abstract: Even though antimicrobial days of therapy did not significantly decrease during a period of robust stewardship activities at our center, we detected a significant downward trend in antimicrobial spectrum, as measured by days of antibiotic spectrum ... ...

    Abstract Even though antimicrobial days of therapy did not significantly decrease during a period of robust stewardship activities at our center, we detected a significant downward trend in antimicrobial spectrum, as measured by days of antibiotic spectrum coverage (DASC). The DASC metric may help more broadly monitor the effect of stewardship activities.
    MeSH term(s) Humans ; Antimicrobial Stewardship ; Anti-Bacterial Agents/therapeutic use ; Anti-Infective Agents
    Chemical Substances Anti-Bacterial Agents ; Anti-Infective Agents
    Language English
    Publishing date 2023-01-10
    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.2022.312
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  7. Article ; Online: Is the number of prescriptions an appropriate metric for outpatient antimicrobial consumption? A comparison between the prescription counts and days supplied.

    Kakiuchi, Satoshi / Perencevich, Eli N / Livorsi, Daniel J / Goto, Michihiko

    Infection control and hospital epidemiology

    2022  Volume 44, Issue 6, Page(s) 941–944

    Abstract: The optimal metric for outpatient antimicrobial stewardship has not been well defined. The number of antibiotic prescriptions per clinic visit does not account for the therapeutic duration. We found only moderate association between prescription-based ... ...

    Abstract The optimal metric for outpatient antimicrobial stewardship has not been well defined. The number of antibiotic prescriptions per clinic visit does not account for the therapeutic duration. We found only moderate association between prescription-based metrics and days-supplied-based metrics. Outpatient antibiotic consumption metrics should incorporate the duration of therapy.
    MeSH term(s) Humans ; Outpatients ; Anti-Infective Agents/therapeutic use ; Anti-Bacterial Agents/therapeutic use ; Prescriptions ; Ambulatory Care
    Chemical Substances Anti-Infective Agents ; Anti-Bacterial Agents
    Language English
    Publishing date 2022-08-23
    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.2022.189
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  8. Article ; Online: Impacts of Hurricane Matthew Exposure on Infections and Antimicrobial Prescribing in North Carolina Veterans.

    Carrel, Margaret / Clore, Gosia S / Goto, Michihiko / Kim, Seungwon / Perencevich, Eli N / Vaughan-Sarrazin, Mary

    Disaster medicine and public health preparedness

    2023  Volume 17, Page(s) e357

    Abstract: The impact of hurricane-related flooding on infectious diseases in the US is not well understood. Using geocoded electronic health records for 62,762 veterans living in North Carolina counties impacted by Hurricane Matthew coupled with flood maps, we ... ...

    Abstract The impact of hurricane-related flooding on infectious diseases in the US is not well understood. Using geocoded electronic health records for 62,762 veterans living in North Carolina counties impacted by Hurricane Matthew coupled with flood maps, we explore the impact of hurricane and flood exposure on infectious outcomes in outpatient settings and emergency departments as well as antimicrobial prescribing. Declines in outpatient visits and antimicrobial prescribing are observed in weeks 0-2 following the hurricane as compared with the baseline period and the year prior, while increases in antimicrobial prescribing are observed 3+ weeks following the hurricane. Taken together, hurricane and flood exposure appear to have had minor impacts on infectious outcomes in North Carolina veterans, not resulting in large increases in infections or antimicrobial prescribing.
    MeSH term(s) Humans ; Cyclonic Storms ; North Carolina/epidemiology ; Veterans ; Floods ; Communicable Diseases ; Anti-Infective Agents
    Chemical Substances Anti-Infective Agents
    Language English
    Publishing date 2023-03-20
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2375268-3
    ISSN 1938-744X ; 1935-7893
    ISSN (online) 1938-744X
    ISSN 1935-7893
    DOI 10.1017/dmp.2023.9
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  9. Article ; Online: Clinicians' interpretation of thresholds in hospital antibiograms for gram-negative rod infections: A survey and contingent valuation study of hospitalists.

    Hasegawa, Shinya / Harris, Che M / Gupta, Vineet / Pappas, Matthew / Vaughn, Valerie M / Perencevich, Eli N / Dukes, Kimberly C / Goto, Michihiko

    Journal of hospital medicine

    2024  Volume 19, Issue 4, Page(s) 297–301

    Abstract: Clinical guidelines suggest that hospital antibiograms are a key component when deciding empiric therapy, but little is known about how often clinicians use antibiograms and how they influence clinicians' empiric therapy decisions. We surveyed ... ...

    Abstract Clinical guidelines suggest that hospital antibiograms are a key component when deciding empiric therapy, but little is known about how often clinicians use antibiograms and how they influence clinicians' empiric therapy decisions. We surveyed hospitalists at seven healthcare systems in the United States on their reported practices related to antibiograms and their hypothetical prescribing for four clinical scenarios associated with gram-negative rod pathogens. Each was given a randomly assigned antibiogram susceptibility percentage, and we used contingent valuation analysis to assess whether the antibiogram susceptibility percentage was associated with prescribing practices. Of the 193 survey responders, only 52 (26.9%) respondents reported using antibiograms more than monthly. Across all four clinical scenarios, there was no evidence that antibiogram susceptibility levels influenced antibiotic prescribing practices. With limited utilization and no evidence that they influenced practice, antibiograms may have a limited role in hospitalist care delivery for common gram-negative rod infections.
    MeSH term(s) Humans ; United States ; Hospitalists ; Anti-Bacterial Agents/therapeutic use ; Gram-Negative Bacteria ; Microbial Sensitivity Tests ; Surveys and Questionnaires ; Hospitals
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2024-02-14
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2233783-0
    ISSN 1553-5606 ; 1553-5592
    ISSN (online) 1553-5606
    ISSN 1553-5592
    DOI 10.1002/jhm.13303
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  10. Article ; Online: Assessing the potential for improved predictive capacity of antimicrobial resistance in outpatient Staphylococcus aureus isolates using seasonal and spatial antibiograms.

    Carrel, Margaret / Shi, Qianyi / Clore, Gosia S / Hasegawa, Shinya / Smith, Matthew / Perencevich, Eli N / Goto, Michihiko

    Antimicrobial resistance and infection control

    2024  Volume 13, Issue 1, Page(s) 34

    Abstract: Background: While the use of cumulative susceptibility reports, antibiograms, is recommended for improved empiric therapy and antibiotic stewardship, the predictive ability of antibiograms has not been well-studied. While enhanced antibiograms have been ...

    Abstract Background: While the use of cumulative susceptibility reports, antibiograms, is recommended for improved empiric therapy and antibiotic stewardship, the predictive ability of antibiograms has not been well-studied. While enhanced antibiograms have been shown to better capture variation in susceptibility profiles by characteristics such as infection site or patient age, the potential for seasonal or spatial variation in susceptibility has not been assessed as important in predicting likelihood of susceptibility.
    Methods: Utilizing Staphylococcus aureus isolates obtained in outpatient settings from a nationwide provider of care, the Veterans Health Administration, and a local provider of care, the University of Iowa Hospitals and Clinics, standard, seasonal and spatial antibiograms were created for five commonly used antibiotic classes: cephalosporins, clindamycin, macrolides, tetracycline, trimethoprim/sulfamethoxazole.
    Results: A total of 338,681 S. aureus isolates obtained in VHA outpatient settings from 2010 to 2019 and 6,817 isolates obtained in UIHC outpatient settings from 2014 to 2019 were used to generate and test antibiograms. Logistic regression modeling determined the capacity of these antibiograms to predict isolate resistance to each antibiotic class. All models had low predictive capacity, with areas under the curve of < 0.7.
    Conclusions: Standard antibiograms are poor in predicting S. aureus susceptibility to antibiotics often chosen by clinicians, and seasonal and spatial antibiograms do not provide an improved tool in anticipating non-susceptibility. These findings suggest that further refinements to antibiograms may be necessary to improve their utility in informing choice of effective antibiotic therapy.
    MeSH term(s) Humans ; Anti-Bacterial Agents/pharmacology ; Anti-Bacterial Agents/therapeutic use ; Staphylococcus aureus ; Outpatients ; Seasons ; Drug Resistance, Bacterial ; Staphylococcal Infections/drug therapy ; Microbial Sensitivity Tests
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2024-03-22
    Publishing country England
    Document type Journal Article
    ZDB-ID 2666706-X
    ISSN 2047-2994 ; 2047-2994
    ISSN (online) 2047-2994
    ISSN 2047-2994
    DOI 10.1186/s13756-024-01388-3
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