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Article ; Online: Generalizing the Use of a Procalcitonin-Guided Antibiotic Algorithm to a New Era of SARS-CoV-2 Infection.

Walker, Morgan K / Kadri, Sameer S

2024 Volume 165, Issue 3, Page(s) e85–e86

MeSH term(s)	Humans ; Procalcitonin ; Anti-Bacterial Agents/therapeutic use ; COVID-19 ; SARS-CoV-2 ; Algorithms ; Biomarkers ; Bacterial Infections/drug therapy
Chemical Substances	Procalcitonin ; Anti-Bacterial Agents ; Biomarkers
Language	English
Publishing date	2024-05-06
Publishing country	United States
Document type	Letter
ZDB-ID	1032552-9
ISSN	1931-3543 ; 0012-3692
ISSN (online)	1931-3543
ISSN	0012-3692
DOI	10.1016/j.chest.2023.10.041
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Article ; Online: Carbapenem use in extended-spectrum cephalosporin-resistant Enterobacterales infections in US hospitals and influence of IDSA guidance: a retrospective cohort study.

Walker, Morgan K / Diao, Guoqing / Warner, Sarah / Babiker, Ahmed / Neupane, Maniraj / Strich, Jeffrey R / Yek, Christina / Kadri, Sameer S

The Lancet. Infectious diseases

2024

Abstract: Background: Disparate and rapidly changing practice recommendations from major professional infectious diseases societies for managing non-severe infections caused by extended-spectrum β-lactamase-producing Enterobacterales might hamper carbapenem ... ...

Abstract	Background: Disparate and rapidly changing practice recommendations from major professional infectious diseases societies for managing non-severe infections caused by extended-spectrum β-lactamase-producing Enterobacterales might hamper carbapenem stewardship. We aimed to understand the real-world management of extended-spectrum cephalosporin-resistant (ECR) Enterobacterales infections in US hospitals and factors influencing preference for carbapenems over alternative treatments. Methods: This retrospective cohort study included adults (aged ≥18 years) admitted to hospital with ECR Enterobacterales infections in the PINC AI database. Antibiotic regimens were assessed during empirical and targeted treatment periods and by infection severity and site. Likelihood of receiving targeted carbapenems over time and before or after initial release of the Infectious Diseases Society of America (IDSA) guidance on Sept 8, 2020, was established with generalised estimating equations controlling for patient, hospital, and temporal confounders. Findings: Between Jan 1, 2018, and Dec 31, 2021, 30 041 inpatient encounters with ECR Enterobacterales infections were identified at 168 US hospitals, of which 16 006 (53·3%) encounters were in women and 14 035 (46·7%) were in men, with a mean age of 67·3 years (SD 15·1). Although few patients received carbapenems empirically (5324 [17·7%] of 30 041), many did so as targeted treatment (17 518 [58·3%] of 30 041), including subgroups of patients without septic shock (3031 [45·6%] of 6651) and patients with urinary tract infections without septic shock (1845 [46·8%] of 3943) in whom specific narrower-spectrum alternatives were active. Transitions from non-carbapenem to carbapenem antibiotics occurred most often on the day that the ECR phenotype was reported, regardless of illness severity. Carbapenems were the predominant choice to treat ECR Enterobacterales infections over time (adjusted odds ratio 1·00 [95% CI 1·00-1·00]), with no additional immediate change (1·07 [0·95-1·20]) or sustained change (0·99 [0·98-1·00]) after IDSA guidance release. Interpretation: High carbapenem use in targeting non-severe ECR Enterobacterales infections in US hospitals predates 2020 IDSA guidance and has persisted thereafter. Efforts to increase awareness and implementation of recommendations among clinicians to use carbapenem-sparing alternatives in ECR Enterobacterales infections might decrease global carbapenem selective pressure. Funding: US National Institutes of Health Intramural Research Program, National Institute of Allergy and Infectious Diseases, and US Food and Drug Administration.
Language	English
Publishing date	2024-04-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	2061641-7
ISSN	1474-4457 ; 1473-3099
ISSN (online)	1474-4457
ISSN	1473-3099
DOI	10.1016/S1473-3099(24)00149-X
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Article ; Online: Retrospective identification of infection in the emergency department: A significant challenge in sepsis clinical trials.

O'Neal, Catherine S / Hamer, Diana / Musso, Mandi W / Caffery, Terrell S / Walker, Morgan K / Lavie, Katherine W / Berlinger, Matthew S / Thomas, Christopher B / Alwood, Shannon M / Jagneaux, Tonya / Sanchez, Michael A / O'Neal, Hollis R

The American journal of the medical sciences

2022 Volume 364, Issue 2, Page(s) 163–167

Abstract: Background: This study examined three methods for retrospectively identifying infection in emergency department (ED) patients: modified objective definitions of infection (MODI) from the CDC/NHSN, physician adjudication determination of infection, and ... ...

Abstract	Background: This study examined three methods for retrospectively identifying infection in emergency department (ED) patients: modified objective definitions of infection (MODI) from the CDC/NHSN, physician adjudication determination of infection, and ED treating physician behavior. Methods: This study used a subset of data from a prospective sepsis trial. We used Fleiss's Kappa to compare agreement between two physicians retrospectively adjudicating infection based on the patient's medical record, modified infection definition from the CDC/NHSN, and ED treating physician behavior. Results: Overall, there was similar agreement between physician adjudication of infection and MODI criteria (Kappa=0.59) compared to having two physicians independently identify infection through retrospective chart review (Kappa=0.58). ED treating physician behavior was a poorer proxy for infection when compared to the MODI criteria (0.41) and physician adjudication (Kappa = 0.50). Conclusions: Retrospective identification of infection poses a significant challenge in sepsis clinical trials. Using modified definitions of infection provides a standardized, less time consuming, and equally effective means of identifying infection compared to having multiple physicians adjudicate a patient's chart.
MeSH term(s)	Clinical Trials as Topic ; Emergency Service, Hospital ; Humans ; Prospective Studies ; Retrospective Studies ; Sepsis/diagnosis
Language	English
Publishing date	2022-03-14
Publishing country	United States
Document type	Journal Article
ZDB-ID	82078-7
ISSN	1538-2990 ; 0002-9629
ISSN (online)	1538-2990
ISSN	0002-9629
DOI	10.1016/j.amjms.2022.02.008
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Article ; Online: Risk factors for mortality and progression to severe COVID-19 disease in the Southeast region in the United States: A report from the SEUS Study Group.

Hobbs, Athena L V / Turner, Nicholas / Omer, Imad / Walker, Morgan K / Beaulieu, Ronald M / Sheikh, Muhammad / Spires, S Shaefer / Fiske, Christina T / Dare, Ryan / Goorha, Salil / Thapa, Priyenka / Gnann, John / Wright, Jeffrey / Nelson, George E

Infection control and hospital epidemiology

2021 Volume 42, Issue 12, Page(s) 1464–1472

Abstract: Objective: Identify risk factors that could increase progression to severe disease and mortality in hospitalized SARS-CoV-2 patients in the Southeast region of the United States.: Design, setting, and participants: Multicenter, retrospective cohort ... ...

Abstract	Objective: Identify risk factors that could increase progression to severe disease and mortality in hospitalized SARS-CoV-2 patients in the Southeast region of the United States. Design, setting, and participants: Multicenter, retrospective cohort including 502 adults hospitalized with laboratory-confirmed COVID-19 between March 1, 2020, and May 8, 2020 within 1 of 15 participating hospitals in 5 health systems across 5 states in the Southeast United States. Methods: The study objectives were to identify risk factors that could increase progression to hospital mortality and severe disease (defined as a composite of intensive care unit admission or requirement of mechanical ventilation) in hospitalized SARS-CoV-2 patients in the Southeast United States. Results: In total, 502 patients were included, and 476 of 502 (95%) had clinically evaluable outcomes. The hospital mortality rate was 16% (76 of 476); 35% (177 of 502) required ICU admission and 18% (91 of 502) required mechanical ventilation. By both univariate and adjusted multivariate analyses, hospital mortality was independently associated with age (adjusted odds ratio [aOR], 2.03 for each decade increase; 95% confidence interval [CI], 1.56--2.69), male sex (aOR, 2.44; 95% CI, 1.34-4.59), and cardiovascular disease (aOR, 2.16; 95% CI, 1.15-4.09). As with mortality, risk of severe disease was independently associated with age (aOR, 1.17 for each decade increase; 95% CI, 1.00-1.37), male sex (aOR, 2.34; 95% CI, 1.54-3.60), and cardiovascular disease (aOR, 1.77; 95% CI, 1.09-2.85). Conclusions: In an adjusted multivariate analysis, advanced age, male sex, and cardiovascular disease increased risk of severe disease and mortality in patients with COVID-19 in the Southeast United States. In-hospital mortality risk doubled with each subsequent decade of life.
MeSH term(s)	Adult ; COVID-19 ; Hospital Mortality ; Hospitalization ; Humans ; Intensive Care Units ; Male ; Retrospective Studies ; Risk Factors ; SARS-CoV-2 ; United States/epidemiology
Language	English
Publishing date	2021-01-11
Publishing country	United States
Document type	Journal Article ; Multicenter Study
ZDB-ID	639378-0
ISSN	1559-6834 ; 0195-9417 ; 0899-823X
ISSN (online)	1559-6834
ISSN	0195-9417 ; 0899-823X
DOI	10.1017/ice.2020.1435
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Article ; Online: Validation of a Novel, Rapid Sepsis Diagnostic for Emergency Department Use.

O'Neal, Hollis R / Sheybani, Roya / Janz, David R / Scoggins, Robert / Jagneaux, Tonya / Walker, James E / Henning, Daniel J / Rosenman, Elizabeth / Mahler, Simon A / Regunath, Hariharan / Sampson, Christopher S / Files, D Clark / Fremont, Richard D / Noto, Michael J / Schneider, Erica E / Shealey, Wesley R / Berlinger, Matthew S / Carver, Thomas C / Walker, Morgan K /

Ledeboer, Nathan A / Shah, Ajay M / Tse, Henry T K / DiCarlo, Dino / Rice, Todd W / Thomas, Christopher B

Critical care explorations

2024 Volume 6, Issue 2, Page(s) e1026

Abstract: Objectives: To assess the in vitro IntelliSep test, a microfluidic assay that quantifies the state of immune activation by evaluating the biophysical properties of leukocytes, as a rapid diagnostic for sepsis.: Design: Prospective cohort study.: ... ...

Abstract	Objectives: To assess the in vitro IntelliSep test, a microfluidic assay that quantifies the state of immune activation by evaluating the biophysical properties of leukocytes, as a rapid diagnostic for sepsis. Design: Prospective cohort study. Setting: Five emergency departments (EDs) in Louisiana, Missouri, North Carolina, and Washington. Patients: Adult patients presenting to the ED with signs (two of four Systemic Inflammatory Response Syndrome criteria, where one must be temperature or WBC count) or suspicion (provider-ordered culture) of infection. Interventions: All patients underwent testing with the IntelliSep using ethylene diamine tetraacetic acid-anticoagulated whole blood followed by retrospective adjudication for sepsis by sepsis-3 criteria by a blinded panel of physicians. Measurements and main results: Of 599 patients enrolled, 572 patients were included in the final analysis. The result of the IntelliSep test is reported as the IntelliSep Index (ISI), ranging from 0.1 to 10.0, divided into three interpretation bands for the risk of sepsis: band 1 (low) to band 3 (high). The median turnaround time for ISI results was 7.2 minutes. The ISI resulted band 1 in 252 (44.1%), band 2 in 160 (28.0%), and band 3 in 160 (28.0%). Sepsis occurred in 26.6% (152 of 572 patients). Sepsis prevalence was 11.1% (95% CI, 7.5-15.7%) in band 1, 28.1% (95% CI, 21.3-35.8%) in band 2, and 49.4% (95% CI, 41.4-57.4%) in band 3. The Positive Percent Agreement of band 1 was 81.6% and the Negative Percent Agreement of band 3 was 80.7%, with an area under the receiver operating characteristic curve of 0.74. Compared with band 1, band 3 correlated with adverse clinical outcomes, including mortality, and resource utilization. Conclusions: Increasing ISI interpretation band is associated with increasing probability of sepsis in patients presenting to the ED with suspected infection.
Language	English
Publishing date	2024-02-07
Publishing country	United States
Document type	Journal Article
ISSN	2639-8028
ISSN (online)	2639-8028
DOI	10.1097/CCE.0000000000001026
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Article ; Online: Assessment of a Cellular Host Response Test as a Sepsis Diagnostic for Those With Suspected Infection in the Emergency Department.

O'Neal, Hollis R / Sheybani, Roya / Caffery, Terrell S / Musso, Mandi W / Hamer, Diana / Alwood, Shannon M / Berlinger, Matthew S / Jagneaux, Tonya / LaVie, Katherine W / O'Neal, Catherine S / Sanchez, Michael A / Walker, Morgan K / Shah, Ajay M / Tse, Henry T K / Thomas, Christopher B

Critical care explorations

2021 Volume 3, Issue 6, Page(s) e0460

Abstract: Objectives: Sepsis is a common cause of morbidity and mortality. A reliable, rapid, and early indicator can help improve efficiency of care and outcomes. To assess the IntelliSep test, a novel in vitro diagnostic that quantifies the state of immune ... ...

Abstract	Objectives: Sepsis is a common cause of morbidity and mortality. A reliable, rapid, and early indicator can help improve efficiency of care and outcomes. To assess the IntelliSep test, a novel in vitro diagnostic that quantifies the state of immune activation by measuring the biophysical properties of leukocytes, as a rapid diagnostic for sepsis and a measure of severity of illness, as defined by Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation-II scores and the need for hospitalization. Design setting subjects: Adult patients presenting to two emergency departments in Baton Rouge, LA, with signs of infection (two of four systemic inflammatory response syndrome criteria, with at least one being aberration of temperature or WBC count) or suspicion of infection (a clinician order for culture of a body fluid), were prospectively enrolled. Sepsis status, per Sepsis-3 criteria, was determined through a 3-tiered retrospective and blinded adjudication process consisting of objective review, site-level clinician review, and final determination by independent physician adjudicators. Measurements and main results: Of 266 patients in the final analysis, those with sepsis had higher IntelliSep Index (median = 6.9; interquartile range, 6.1-7.6) than those adjudicated as not septic (median = 4.7; interquartile range, 3.7-5.9; Conclusions: In patients presenting to the emergency department with signs or suspicion of infection, the IntelliSep Index is a promising tool for the rapid diagnosis and risk stratification for sepsis.
Language	English
Publishing date	2021-06-15
Publishing country	United States
Document type	Journal Article
ISSN	2639-8028
ISSN (online)	2639-8028
DOI	10.1097/CCE.0000000000000460
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Article ; Online: Multisectoral collaboration for pandemic response and operational support of critical care and emergency departments

Abstract: Background: In March 2020, an influx of admissions in COVID-19 positive patients threatened to overwhelm healthcare facilities in East Baton Rouge Parish, Louisiana. Exacerbating this problem was a shortage of diagnostic testing capability, resulting in ... ...

Abstract	Background: In March 2020, an influx of admissions in COVID-19 positive patients threatened to overwhelm healthcare facilities in East Baton Rouge Parish, Louisiana. Exacerbating this problem was a shortage of diagnostic testing capability, resulting in a delay in time-to-result return. An improvement in diagnostic testing availability and timeliness was necessary to improve the allocation of resources and ultimate throughput of patients. The management of a COVID-19 positive patient or patient under investigation requires infection control measures that can quickly consume personal protective equipment (PPE) stores and personnel available to treat these patients. Critical shortages of both PPE and personnel also negatively impact care in patients admitted with non-COVID-19 illnesses. Methods: A multisectoral partnership of healthcare providers, facilities and academicians created a molecular diagnostic lab within an academic research facility dedicated to testing inpatients and healthcare personnel for SARS-CoV-2. The purpose of the laboratory was to provide a temporary solution to the East Baton Rouge Parish healthcare community until individual facilities were self-sustaining in testing capabilities. We describe the partnership and the impacts of this endeavor by developing a model derived from a combination of data sources, including electronic health records, hospital operations, and state and local resources. Findings: Our model demonstrates two important principles: the impact of reduced turnaround times (TAT) on potential differences in inpatient population numbers for COVID-19 and savings in PPE attributed to the more rapid TAT. Interpretation: Overall, we provide rationale for and demonstration of the utility of multisectoral partnerships when responding to public health emergencies.
Keywords	covid19
Publisher	MedRxiv; WHO
Document type	Article ; Online
Note	WHO #Covidence: #20156158
DOI	10.1101/2020.07.17.20156158
Database	COVID19

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Article ; Online: Generalizing the Use of a Procalcitonin-Guided Antibiotic Algorithm to a New Era of SARS-CoV-2 Infection.

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Article ; Online: Carbapenem use in extended-spectrum cephalosporin-resistant Enterobacterales infections in US hospitals and influence of IDSA guidance: a retrospective cohort study.

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Article ; Online: Retrospective identification of infection in the emergency department: A significant challenge in sepsis clinical trials.

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Article ; Online: Risk factors for mortality and progression to severe COVID-19 disease in the Southeast region in the United States: A report from the SEUS Study Group.

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Article ; Online: Validation of a Novel, Rapid Sepsis Diagnostic for Emergency Department Use.

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Article ; Online: Assessment of a Cellular Host Response Test as a Sepsis Diagnostic for Those With Suspected Infection in the Emergency Department.

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Article ; Online: Multisectoral collaboration for pandemic response and operational support of critical care and emergency departments

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