As antibiotic resistance transformed into a global public health emergency, resources based on real world electronic health record (EHR) data were essential for the development of tools that can identify clinical intervention opportunities. We developed the Antimicrobial Resistance Microbiological Dataset (ARMD-UTSW), a standardized, deidentified collection of records from a large, urban, quaternary health system. ARMD-UTSW includes longitudinal microbiological culture results, patient demographics, diagnoses and comorbidities, medications, infections, and laboratory results from over 200,000 patients from 2005 to 2025. By standardizing data values such as gender, age ranges, organisms, culture types, and medication names, researchers can apply a variety of analytic methods with minimal data transformation. Details surrounding the deidentification and standardization of the dataset are included in the accompanying documentation. The goal of this paper is to share our dataset with others as the dissemination of our real-world clinical data will advance understanding of the growing problem of antibiotic resistance and ways to combat it.

During a period of universal admission respiratory virus testing, many events (5%-14%) that might have been classified as healthcare-associated respiratory viral infections (HARVI) during routine operations were found to be community-acquired. These findings emphasize unique challenges for HARVI surveillance and the impact that testing strategies have on reported rates.

Background:Outpatient parenteral antimicrobial therapy (OPAT) decreases length of stay and inpatient costs while benefiting patients. However, costs in the ambulatory setting are poorly quantified. To address this gap, we examined both inpatient costs avoided and uncompensated labor associated with OPAT delivered via 3 administration models: self-administration (S-OPAT), home care agencies/hemodialysis centers (HH-OPAT), and skilled nursing facilities (SNF-OPAT). Methods:The length and type of treatment and postdischarge nonbillable encounters were reviewed via the electronic health record for all adult patients admitted to a large urban hospital and discharged on OPAT during two 3-month periods. Average daily inpatient care costs for Texas state hospitals and antibiotic wholesale acquisition costs were used to estimate OPAT costs and savings. Antibiotics with different formulations were converted to equivalent daily doses and their corresponding costs were averaged to estimate a daily cost. Results:Among 342 patient records examined during the study periods, which accounted for 8656 inpatient days avoided, there were 211.1 nonbillable encounters per 100 patient-days of OPAT for patients discharged in SNF-OPAT, 9.1 in HH-OPAT, and 6.4 in S-OPAT (P = .028). The estimated cost avoided per 100 patient-days was $376 400 or approximately $5 430 197 per month. Conclusions:A substantial burden of uncompensated labor was associated with all OPAT modalities; however, coordinating care with skilled nursing facilities was significantly more demanding when adjusted for days of OPAT. All OPAT models generated significant institutional savings, which are typically overestimated as they fail to account for the uncompensated support provided by the ambulatory care staff.

Analyzing data from a national deidentified electronic health record-based data set using a matched case-control study design, we found that antibiotic use and severity of illness were independent risk factors for healthcare-associated candidemia in adult patients hospitalized with SARS-CoV-2 infection. Interleukin-6 inhibitor and corticosteroid use were not independent risk factors.

Objective: Describe and compare the prevalence of symptomatic and asymptomatic or recently resolved respiratory infections in hospitalized children.Design: Cross-sectional study.Setting: Three hospital primary-to-quaternary care pediatric healthcare system.Patients: People less than 22 years old who underwent admission screening for respiratory viruses using a multitarget polymerase chain reaction (PCR) panel from August 2020 through April 2022.Methods: The symptom status of each patient was recorded by the ordering provider. The prevalence of each virus was described comparing symptomatic and asymptomatic patients. Results for each virus were stratified by age group and trends were examined over time.Results: Of the 32,812 eligible PCR panels collected, 12,965 (39.5%), 18,651 (56.8%), and 1,196 (3.6%) were obtained from patients who were symptomatic, asymptomatic, or had missing or unknown symptom status, respectively. Symptomatic patients were much more likely to test positive for a respiratory virus (67.3% vs 27.0%). The most common viruses detected in asymptomatic patients were rhinovirus/enterovirus (18.0%), SARS-CoV-2 (3.6%), and parainfluenza viruses (2.3%). The odds ratio of testing positive when symptomatic was significantly greater than unity for all viruses but varied by virus and age group. The proportion of positive tests for each virus was dynamic and changed with intermittent epidemics, or viral "waves."Conclusions: More than one-quarter of children without respiratory symptoms admitted to a pediatric healthcare system had PCR-detectable respiratory viruses. Children with symptoms of a respiratory infection are nevertheless much more likely to have a respiratory virus detected by PCR.

Background:Outpatient parenteral antimicrobial therapy (OPAT) is a safe and cost-effective transitional care approach administered via different delivery models. No standards exist for appropriate OPAT program staffing. We examined outcomes of patients receiving OPAT via different care models to identify strategies to improve safety while reducing health care overuse.Methods:Retrospective demographic, clinical, and outcome data of patients discharged with OPAT were reviewed in 2 periods (April-June 2021 and January-March 2022; ie, when staffing changed) and stratified by care model: self-administered OPAT, health care OPAT, and skilled nursing facility OPAT.Results:Of 342 patients, 186 (54%) received OPAT in 2021 and 156 (46%) in 2022. Hospital length of stay rose from 12.4 days to 14.3 in 2022. In a Cox proportional hazards regression model, visits to the emergency department (ED) within 30 days of OPAT initiation (hazard ratio, 1.76; 95% CI, 1.13-2.73; P = .01) and readmissions (hazard ratio, 2.34; 95% CI, 1.22-4.49; P = .01) increased in 2022 vs 2021, corresponding to decreases in OPAT team staffing. Higher readmissions in the 2022 cohort were for reasons unrelated to OPAT (P = .01) while readmissions related to OPAT did not increase (P = .08).Conclusions:In a well-established OPAT program, greater health care utilization-length of stay, ED visits, and readmissions-were seen during periods of higher staff turnover and attrition. Rather than blunt metrics such as ED visits and readmissions, which are influenced by multiple factors besides OPAT, our findings suggest the need to develop OPAT-specific outcome measures as a quality assessment tool and to establish optimal OPAT program staffing ratios.

Background The increased prevalence of antimicrobial-resistant (AMR) infections is a significant global health threat, resulting in increased disease, deaths, and costs. The drivers of AMR are complex and potentially impacted by socioeconomic factors. We investigated the relationships between geographic and socioeconomic factors and AMR.Methods We collected select patient bacterial culture results from 2015 to 2020 from electronic health records of 2 expansive healthcare systems within the Dallas-Fort Worth, Texas, metropolitan area. Among individuals with electronic health records who resided in the 4 most populous counties in Dallas-Fort Worth, culture data were aggregated. Case counts for each organism studied were standardized per 1000 persons per area population. Using residential addresses, the cultures were geocoded and linked to socioeconomic index values. Spatial autocorrelation tests identified geographic clusters of high and low AMR organism prevalence and correlations with established socioeconomic indices.Results We found significant clusters of AMR organisms in areas with high levels of deprivation, as measured by the area deprivation index (ADI). We found a significant spatial autocorrelation between ADI and the prevalence of AMR organisms, particularly for AmpC beta-lactamase and methicillin-resistant Staphylococcus aureus, with 14% and 13%, respectively, of the variability in prevalence rates being attributable to their relationship with the ADI values of the neighboring locations.Conclusions We found that areas with a high ADI are more likely to have higher rates of AMR organisms. Interventions that improve socioeconomic factors such as poverty, unemployment, decreased access to healthcare, crowding, and sanitation in these areas of high prevalence may reduce the spread of AMR. Antimicrobial resistance (AMR) and its spread poses a significant threat to health worldwide. By identifying locations with high AMR prevalence through geospatial analyses, we discovered patterns of co-occurrence between socioeconomic factors, indicated by the area deprivation index, and AMR prevalence.

Background: The interplay between SARS-CoV-2 and contemporaneous bacterial or fungal culture growth may have crucial implications for clinical outcomes of hospitalized patients. This study aimed to quantify the effect of microbiological culture positivity on mortality among hospitalized patients with SARS-CoV-2.Methods: In this retrospective cohort study, we included adult hospitalized patients from OPTUM COVID-19 specific data set, who tested positive for SARS-CoV-2 within 14 days of hospitalization between 01/20/2020 and 01/20/2022. We examined outcomes of individuals with organisms growing on cultures from the bloodstream infections (BSIs), urinary tract, and respiratory tract, and a composite of the three sites. We used propensity score matching on covariates included demographics, comorbidities, and hospitalization clinical parameters. In a sensitivity analysis, we included same covariates but excluded critical care variables such as length of stay, intensive care unit stays, mechanical ventilation, and extracorporeal membrane oxygenation.Results: The cohort included 104,560 SARS-CoV-2 positive adult hospitalized patients across the United States. The unadjusted mortality odds increased significantly with BSIs (98.7%) and with growth on respiratory cultures (RC) (176.6%), but not with growth on urinary cultures (UC). Adjusted analyses showed that BSIs and positive RC independently contribute to mortality, even after accounting for critical care variables.Conclusions: In SARS-CoV-2-positive hospitalized patients, positive bacterial and fungal microbiological cultures, especially BSIs and RC, are associated with an increased risk of mortality even after accounting for critical care variables associated with disease severity. These findings underscore the importance of stringent infection control and the effective management of secondary infections to improve patient outcomes.

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Objective: Social media's arrival eased the sharing of mis- and disinformation. False information proved challenging throughout the coronavirus disease 2019 (COVID-19) pandemic with many clinicians and researchers analyzing the "infodemic." We systemically reviewed and synthesized COVID-19 mis- and disinformation literature, identifying the prevalence and content of false information and exploring mitigation and prevention strategies.Design: We identified and analyzed publications on COVID-19-related mis- and disinformation published from March 1, 2020, to December 31, 2022, in PubMed. We performed a manual topic review of the abstracts along with automated topic modeling to organize and compare the different themes. We also conducted sentiment (ranked -3 to +3) and emotion analysis (rated as predominately happy, sad, angry, surprised, or fearful) of the abstracts.Results: We reviewed 868 peer-reviewed scientific publications of which 639 (74%) had abstracts available for automatic topic modeling and sentiment analysis. More than a third of publications described mitigation and prevention-related issues. The mean sentiment score for the publications was 0.685, and 56% of studies had a negative sentiment (fear and sadness as the most common emotions).Conclusions: Our comprehensive analysis reveals a significant proliferation of dis- and misinformation research during the COVID-19 pandemic. Our study illustrates the pivotal role of social media in amplifying false information. Research into the infodemic was characterized by negative sentiments. Combining manual and automated topic modeling provided a nuanced understanding of the complexities of COVID-19-related misinformation, highlighting themes such as the source and effect of misinformation, and strategies for mitigation and prevention.

In the current mpox outbreak, infections are usually self-limited. We describe 3 patients with uncontrolled HIV and mpox infections lasting months, causing debilitating lesions, complications, and death, despite initiating anti-mpox and antiretroviral therapy. Delayed treatment of mpox with antiviral agents may contribute to poor outcomes in severely immunocompromised patients.

Background: Antistaphylococcal penicillins and cefazolin are the treatments of choice for methicillin-susceptible Staphylococcus aureus (MSSA) infections, requiring multiple doses daily. At Parkland, eligible uninsured patients with MSSA bloodstream infections (BSI) receive self-administered outpatient parenteral antimicrobial therapy (S-OPAT). Ceftriaxone was used in a cohort of S-OPAT patients for ease of once-daily dosing. Objective: A retrospective study was conducted to evaluate clinical outcomes for patients discharged with ceftriaxone versus cefazolin to treat MSSA BSI. Methods: A retrospective cohort noninferiority study design was used to assess treatment efficacy of ceftriaxone versus cefazolin among Parkland S-OPAT patients treated from April 2012 to March 2020. Demographic, clinical, and treatment-related adverse events data were collected. Clinical outcomes included treatment failure as defined by repeat positive blood culture or retreatment within 6 months, all-cause 30-day readmission rates, and central line–associated bloodstream infection (CLABSI) rates. Results: Of 368 S-OPAT patients with MSSA BSI, 286 (77.7%) received cefazolin, and 82 (22.3%) received ceftriaxone. Demographics and comorbidities were similar for both groups. There were no treatment failures in the ceftriaxone group compared with 4 (1%) in the cefazolin group ( P = 0.58). No difference in 30-day readmission rate between groups was found. The CLABSI rates were lower in ceftriaxone group (2%) compared with cefazolin (11%; P = 0.02). Limitations include retrospective cohort design. Conclusions: Ceftriaxone was found to be noninferior to cefazolin in this study. Our findings suggest that ceftriaxone is a safe and effective treatment of MSSA BSI secondary to osteoarticular or skin and soft tissue infections when used in the S-OPAT setting. Poster abstract: OFID on 2018 Nov; 5(Suppl 1): S316: doi: 10.1093/ofid/ofy210.894.

AbstractBackgroundViral respiratory infections (VRIs) are common and are occupational risks for healthcare personnel (HCP). VRIs can also be acquired at home and other settings among HCPs. We sought to determine if preschool-aged household contacts are a risk factor for VRIs among HCPs working in outpatient settings.MethodsWe conducted a secondary analysis of data from a cluster randomized trial at 7 medical centers in the United States over 4 influenza seasons from 2011–2012 to 2014–2015. Adult HCPs who routinely came within 6 feet of patients with respiratory infections were included. Participants were tested for respiratory viruses whenever symptomatic and at 2 random times each season when asymptomatic. The exposure of interest was the number of household contacts 0–5 years old (preschool-aged) at the beginning of each HCP-season. The primary outcome was the rate of polymerase chain reaction–detected VRIs, regardless of symptoms. The VRI incidence rate ratio (IRR) was calculated using a mixed-effects Poisson regression model that accounted for clustering at the clinic level.ResultsAmong the 4476 HCP-seasons, most HCPs were female (85.4%) and between 30 and 49 years of age (54.6%). The overall VRI rate was 2.04 per 100 person-weeks. In the adjusted analysis, HCPs having 1 (IRR, 1.22 [95% confidence interval {CI}, 1.05–1.43]) and ≥2 (IRR, 1.35 [95% CI, 1.09–1.67]) preschool-aged household contacts had higher VRI rates than those with zero preschool-aged household contacts.ConclusionsPreschool-aged household contacts are a risk factor for developing VRIs among HCPs working in outpatient settings.

AbstractObjective:To determine the difference in the incidence of healthcare-associated respiratory viral infection (HARVI) in a pediatric hospital depending on the definition used.Design:Descriptive historical cohort study.Setting and participants:Patients aged 0–21 years old who were admitted between July 2013 and June 2018 to a 490-bed primary to quaternary-care pediatric hospital serving northern Texas.Methods:HARVI was defined using microbiologic confirmation, development of new symptoms while hospitalized, and exposure time greater than the minimum incubation period for each specific virus. Events that occurred following the maximum incubation period for that virus were classified as definite, otherwise they were classified as possible. This definition was compared to definitions using alternate timing of onset and symptomatology requirements. Data pertaining to demographics, diagnoses, and illness severity were collected.Results:In total, 498 HARVIs (320 definite and 178 possible) were identified, with an incidence rate of 0.98 per 1,000 patient days (0.63 and 0.35, respectively). Rhinovirus or enterovirus and respiratory syncytial virus were the most identified viruses (58% and 10%, respectively). The median time from admission until HARVI was 10.5 days (interquartile range [IQR], 5–30 days). When alternate definitions were employed, the incidence of HARVI ranged from 0.96 to 2.00 per 1,000 admitted patient days.Conclusions:HARVI remain a common nosocomial infection in pediatric hospitals and the measured incidence is dependent on the definition used. Because of the endemic and pandemic potential of respiratory viruses, standardized definitions are needed to facilitate intra- and interhospital comparisons.

AbstractBackgroundSocial media platforms like Twitter provide important insights into the public's perceptions of global outbreaks like monkeypox. By analyzing tweets, we aimed to identify public knowledge and opinions on the monkeypox virus and related public health issues.MethodsWe analyzed English-language tweets using the keyword “monkeypox” from 1 May to 23 July 2022. We reported gender, ethnicity, and race of Twitter users and analyzed tweets to identify predominant sentiment and emotions. We performed topic modeling and compared cohorts of users who self-identify as LGBTQ+ (an abreviation for lesbian, gay, bisexual, transgender, queer, and/or questioning) allies versus users who do not, and cohorts identified as “bots” versus humans.ResultsA total of 48 330 tweets were written by LGBTQ+ self-identified advocates or allies. The mean sentiment score for all tweets was −0.413 on a −4 to +4 scale. Negative tweets comprised 39% of tweets. The most common emotions expressed were fear and sadness. Topic modeling identified unique topics among the 4 cohorts analyzed.ConclusionsThe spread of mis- and disinformation about monkeypox was common in our tweet library. Various conspiracy theories about the origins of monkeypox, its relationship to global economic concerns, and homophobic and racial comments were common. Conversely, many other tweets helped to provide information about monkeypox vaccines, disease symptoms, and prevention methods. Discussion of rising monkeypox case numbers globally was also a large aspect of the conversation.ConclusionsWe demonstrated that Twitter is an effective means of tracking sentiment about public healthcare issues. We gained insight into a subset of people, self-identified LGBTQ+ allies, who were more affected by monkeypox.

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Background:Surgical-site infections (SSIs) can be catastrophic. Bundles of evidence-based practices can reduce SSIs but can be difficult to implement and sustain. Objective:We sought to understand the implementation of SSI prevention bundles in 6 US hospitals. Design:Qualitative study. Methods:We conducted in-depth semistructured interviews with personnel involved in bundle implementation and conducted a thematic analysis of the transcripts. Setting:The study was conducted in 6 US hospitals: 2 academic tertiary-care hospitals, 3 academic-affiliated community hospitals, 1 unaffiliated community hospital. Participants:In total, 30 hospital personnel participated. Participants included surgeons, laboratory directors, clinical personnel, and infection preventionists. Results:Bundle complexity impeded implementation. Other barriers varied across services, even within the same hospital. Multiple strategies were needed, and successful strategies in one service did not always apply in other areas. However, early and sustained interprofessional collaboration facilitated implementation. Conclusions:The evidence-based SSI bundle is complicated and can be difficult to implement. One implementation process probably will not work for all settings. Multiple strategies were needed to overcome contextual and implementation barriers that varied by setting and implementation climate. Appropriate adaptations for specific settings and populations may improve bundle adoption, fidelity, acceptability, and sustainability.

OBJECTIVES Throughout the pandemic, children with COVID-19 have experienced hospitalization, ICU admission, invasive respiratory support, and death. Using a multisite, national dataset, we investigate risk factors associated with these outcomes in children with COVID-19. METHODS Our data source (Optum deidentified COVID-19 Electronic Health Record Dataset) included children aged 0 to 18 years testing positive for COVID-19 between January 1, 2020, and January 20, 2022. Using ordinal logistic regression, we identified factors associated with an ordinal outcome scale: nonhospitalization, hospitalization, or a severe composite outcome (ICU, intensive respiratory support, death). To contrast hospitalization for COVID-19 and incidental positivity on hospitalization, we secondarily identified patient factors associated with hospitalizations with a primary diagnosis of COVID-19. RESULTS In 165 437 children with COVID-19, 3087 (1.8%) were hospitalized without complication, 2954 (1.8%) experienced ICU admission and/or intensive respiratory support, and 31 (0.02%) died. We grouped patients by age: 0 to 4 years old (35 088), and 5 to 11 years old (75 574), 12 to 18 years old (54 775). Factors positively associated with worse outcomes were preexisting comorbidities and residency in the Southern United States. In 0- to 4-year-old children, there was a nonlinear association between age and worse outcomes, with worse outcomes in 0- to 2-year-old children. In 5- to 18-year-old patients, vaccination was protective. Findings were similar in our secondary analysis of hospitalizations with a primary diagnosis of COVID-19, though region effects were no longer observed. CONCLUSIONS Among children with COVID-19, preexisting comorbidities and residency in the Southern United States were positively associated with worse outcomes, whereas vaccination was negatively associated. Our study population was highly insured; future studies should evaluate underinsured populations to confirm generalizability.

Since the initial publication of A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals in 2008, the prevention of healthcare-associated infections (HAIs) has continued to be a national priority. Progress in healthcare epidemiology, infection prevention, antimicrobial stewardship, and implementation science research has led to improvements in our understanding of effective strategies for HAI prevention. Despite these advances, HAIs continue to affect ∼1 of every 31 hospitalized patients, leading to substantial morbidity, mortality, and excess healthcare expenditures, and persistent gaps remain between what is recommended and what is practiced.The widespread impact of the coronavirus disease 2019 (COVID-19) pandemic on HAI outcomes in acute-care hospitals has further highlighted the essential role of infection prevention programs and the critical importance of prioritizing efforts that can be sustained even in the face of resource requirements from COVID-19 and future infectious diseases crises.The Compendium: 2022 Updates document provides acute-care hospitals with up-to-date, practical expert guidance to assist in prioritizing and implementing HAI prevention efforts. It is the product of a highly collaborative effort led by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Disease Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission, with major contributions from representatives of organizations and societies with content expertise, including the Centers for Disease Control and Prevention (CDC), the Pediatric Infectious Disease Society (PIDS), the Society for Critical Care Medicine (SCCM), the Society for Hospital Medicine (SHM), the Surgical Infection Society (SIS), and others.