1
|
Wiemken TL, Carrico RM. Assisting the infection preventionist: Use of artificial intelligence for health care-associated infection surveillance. Am J Infect Control 2024; 52:625-629. [PMID: 38483430 DOI: 10.1016/j.ajic.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/12/2024] [Accepted: 02/12/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Health care-associated infection (HAI) surveillance is vital for safety in health care settings. It helps identify infection risk factors, enhancing patient safety and quality improvement. However, HAI surveillance is complex, demanding specialized knowledge and resources. This study investigates the use of artificial intelligence (AI), particularly generative large language models, to improve HAI surveillance. METHODS We assessed 2 AI agents, OpenAI's chatGPT plus (GPT-4) and a Mixtral 8×7b-based local model, for their ability to identify Central Line-Associated Bloodstream Infection (CLABSI) and Catheter-Associated Urinary Tract Infection (CAUTI) from 6 National Health Care Safety Network training scenarios. The complexity of these scenarios was analyzed, and responses were matched against expert opinions. RESULTS Both AI models accurately identified CLABSI and CAUTI in all scenarios when given clear prompts. Challenges appeared with ambiguous prompts including Arabic numeral dates, abbreviations, and special characters, causing occasional inaccuracies in repeated tests. DISCUSSION The study demonstrates AI's potential in accurately identifying HAIs like CLABSI and CAUTI. Clear, specific prompts are crucial for reliable AI responses, highlighting the need for human oversight in AI-assisted HAI surveillance. CONCLUSIONS AI shows promise in enhancing HAI surveillance, potentially streamlining tasks, and freeing health care staff for patient-focused activities. Effective AI use requires user education and ongoing AI model refinement.
Collapse
Affiliation(s)
- Timothy L Wiemken
- Saint Louis University School of Medicine, Department of Medicine, Division of Infectious Diseases Allergy & Immunology, Saint Louis, MO.
| | - Ruth M Carrico
- Department of Medicine, Division of Infectious Diseases, University of Louisville School of Medicine, Louisville, KY
| |
Collapse
|
2
|
Andersen KM, Khan FL, Park PW, Wiemken TL, Emir B, Malhotra D, Alhanai T, Ghassemi MM, McGrath LJ. Using a data-driven approach to define post-COVID conditions in US electronic health record data. PLoS One 2024; 19:e0300570. [PMID: 38578822 PMCID: PMC10997091 DOI: 10.1371/journal.pone.0300570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 02/29/2024] [Indexed: 04/07/2024] Open
Abstract
OBJECTIVE To create a data-driven definition of post-COVID conditions (PCC) by directly measure changes in symptomatology before and after a first COVID episode. MATERIALS AND METHODS Retrospective cohort study using Optum® de-identified Electronic Health Record (EHR) dataset from the United States of persons of any age April 2020-September 2021. For each person with COVID (ICD-10-CM U07.1 "COVID-19" or positive test result), we selected up to 3 comparators. The final COVID symptom score was computed as the sum of new diagnoses weighted by each diagnosis' ratio of incidence in COVID group relative to comparator group. For the subset of COVID cases diagnosed in September 2021, we compared the incidence of PCC using our data-driven definition with ICD-10-CM code U09.9 "Post-COVID Conditions", first available in the US October 2021. RESULTS The final cohort contained 588,611 people with COVID, with mean age of 48 years and 38% male. Our definition identified 20% of persons developed PCC in follow-up. PCC incidence increased with age: (7.8% of persons aged 0-17, 17.3% aged 18-64, and 33.3% aged 65+) and did not change over time (20.0% among persons diagnosed with COVID in 2020 versus 20.3% in 2021). For cases diagnosed in September 2021, our definition identified 19.0% with PCC in follow-up as compared to 2.9% with U09.9 code in follow-up. CONCLUSION Symptom and U09.9 code-based definitions alone captured different populations. Maximal capture may consider a combined approach, particularly before the availability and routine utilization of specific ICD-10 codes and with the lack consensus-based definitions on the syndrome.
Collapse
Affiliation(s)
- Kathleen M. Andersen
- Vaccines Real World Evidence, Pfizer Inc, New York, New York, United States of America
| | - Farid L. Khan
- Global Medical Affairs, Pfizer Inc, New York, New York, United States of America
| | - Peter W. Park
- Global Medical Affairs, Pfizer Inc, New York, New York, United States of America
| | - Timothy L. Wiemken
- Global Medical Affairs, Pfizer Inc, New York, New York, United States of America
| | - Birol Emir
- Global Biometrics and Data Management, Pfizer Inc, New York, New York, United States of America
| | - Deepa Malhotra
- Vaccines Real World Evidence, Pfizer Inc, New York, New York, United States of America
| | - Tuka Alhanai
- Ghamut Corporation, East Lansing, Michigan, United States of America
| | | | - Leah J. McGrath
- Vaccines Real World Evidence, Pfizer Inc, New York, New York, United States of America
| |
Collapse
|
3
|
Rudolph AE, Khan FL, Shah A, Singh TG, Wiemken TL, Puzniak LA, Jodar L, McLaughlin JM. Effectiveness of BNT162b2 BA.4/5 Bivalent mRNA Vaccine Against Symptomatic COVID-19 Among Immunocompetent Individuals Testing at a Large US Retail Pharmacy. J Infect Dis 2024; 229:648-659. [PMID: 37925630 PMCID: PMC10938215 DOI: 10.1093/infdis/jiad474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/05/2023] [Accepted: 10/27/2023] [Indexed: 11/05/2023] Open
Abstract
BACKGROUND Data on the effectiveness of BA.4/5 bivalent vaccine stratified by age and prior infection are lacking. METHODS This test-negative study used data from individuals ≥5 years of age testing for SARS-CoV-2 with symptoms (15 September 2022 to 31 January 2023) at a large national retail pharmacy chain. The exposure was receipt of 2-4 wild-type doses and a BNT162b2 BA.4/5 bivalent vaccine (>2 months since last wild-type dose). The outcome was a positive SARS-CoV-2 test. Absolute (vs unvaccinated) and relative (vs 2-4 wild-type doses) vaccine effectiveness (VE) were calculated as (1 - adjusted odds ratio from logistic regression) × 100. VE was stratified by age and self-reported prior infection. RESULTS Overall, 307 885 SARS-CoV-2 tests were included (7916 aged 5-11, 16 329 aged 12-17, and 283 640 aged ≥18 years). SARS-CoV-2 positivity was 39%; 21% were unvaccinated, 70% received 2-4 wild-type doses with no bivalent vaccine, and 9% received a BNT162b2 BA.4/5 bivalent dose. At a median of 1-2 months after BNT162b2 BA.4/5 bivalent vaccination, depending on age group, absolute VE was 22%-60% and was significantly higher among those reporting prior infection (range, 55%-79%) than not (range, no protection to 50%). Relative VE was 31%-64%. CONCLUSIONS BNT162b2 BA.4/5 bivalent showed early additional protection against Omicron-related symptomatic COVID-19, with hybrid immunity offering greater protection.
Collapse
Affiliation(s)
| | | | - Amy Shah
- Walgreens Center for Health and Wellbeing Research, Deerfield, Illinois, USA
| | - Tanya G Singh
- Walgreens Center for Health and Wellbeing Research, Deerfield, Illinois, USA
| | | | | | | | | |
Collapse
|
4
|
Appaneal HJ, LaPlante KL, Lopes VV, Martin C, Puzniak L, Wiemken TL, Zasowski EJ, McLaughlin JM, Caffrey AR. Nirmatrelvir/Ritonavir Utilization for the Treatment of Non-hospitalized Adults with COVID-19 in the National Veterans Affairs (VA) Healthcare System. Infect Dis Ther 2024; 13:155-172. [PMID: 38217842 PMCID: PMC10828173 DOI: 10.1007/s40121-023-00910-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 12/15/2023] [Indexed: 01/15/2024] Open
Abstract
INTRODUCTION Limited data exist regarding real-world utilization of nirmatrelvir/ritonavir. We identified predictors of nirmatrelvir/ritonavir use among Veterans Affairs (VA) outpatients nationally. METHODS We conducted a retrospective cohort study among outpatients with coronavirus disease 2019 (COVID-19) who were eligible to receive nirmatrelvir/ritonavir between January and December of 2022, to identify factors associated with nirmatrelvir/ritonavir use (i.e., demographics, medical history, prior medication and healthcare exposures, frailty, and other clinical characteristics) using multivariable logistic regression. RESULTS We included 309,755 outpatients with COVID-19 who were eligible for nirmatrelvir/ritonavir, of whom 12.2% received nirmatrelvir/ritonavir. Nirmatrelvir/ritonavir uptake increased from 1.1% to 23.2% over the study period. Factors associated with nirmatrelvir/ritonavir receipt included receiving a COVID-19 booster vs. none (adjusted odds ratio [aOR] 2.19 [95% confidence interval [CI] 2.12-2.26]), age ≥ 50 vs. 18-49 years (aORs > 1.5 for all age groups ≥ 50 years), having HIV (aOR 1.36 [1.22-1.51]), being non-frail vs. severely frail (aOR 1.22 [1.13-1.33]), and having rheumatoid arthritis (aOR 1.12 [1.04-1.21). Those with concomitant use of potentially interacting antiarrhythmics (aOR 0.35 [0.28-0.45]), anticoagulants/antiplatelets (aOR 0.42 [0.40-0.45]), and/or psychiatric/sedatives (aOR 0.84 [0.81-0.87]) were less likely to receive nirmatrelvir/ritonavir. CONCLUSIONS Despite increases over time, overall utilization of nirmatrelvir/ritonavir was low. Predictors of nirmatrelvir/ritonavir utilization were consistent with known risk factors for progression to severe COVID-19, including older age and underlying medical conditions. Unvaccinated and undervaccinated patients and those receiving potentially interacting medications for cardiovascular or mental health conditions (antiarrhythmic, alpha-1 antagonist, anticoagulant/antiplatelet, sedative/hypnotic/psychiatric) were less likely to receive nirmatrelvir/ritonavir. Further education of prescribers and patients about nirmatrelvir/ritonavir treatment guidelines is needed to improve overall uptake and utilization in certain high-risk subpopulations.
Collapse
Affiliation(s)
- Haley J Appaneal
- Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, RI, USA
- Center of Innovation in Long-Term Support Services, Providence Veterans Affairs Medical Center, Providence, RI, USA
- College of Pharmacy, University of Rhode Island, 7 Greenhouse Rd, 265B, Kingston, RI, 02881, USA
| | - Kerry L LaPlante
- Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, RI, USA
- Center of Innovation in Long-Term Support Services, Providence Veterans Affairs Medical Center, Providence, RI, USA
- College of Pharmacy, University of Rhode Island, 7 Greenhouse Rd, 265B, Kingston, RI, 02881, USA
| | - Vrishali V Lopes
- Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, RI, USA
| | | | | | | | | | | | - Aisling R Caffrey
- Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, RI, USA.
- Center of Innovation in Long-Term Support Services, Providence Veterans Affairs Medical Center, Providence, RI, USA.
- College of Pharmacy, University of Rhode Island, 7 Greenhouse Rd, 265B, Kingston, RI, 02881, USA.
- School of Public Health, Brown University, Providence, RI, USA.
| |
Collapse
|
5
|
Di Fusco M, Marczell K, Thoburn E, Wiemken TL, Yang J, Yarnoff B. Public health impact and economic value of booster vaccination with Pfizer-BioNTech COVID-19 vaccine, bivalent (original and omicron BA.4/BA.5) in the United States. J Med Econ 2023; 26:509-524. [PMID: 36942976 DOI: 10.1080/13696998.2023.2193067] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
OBJECTIVE To assess the public health impact and economic value of booster vaccination with the Pfizer-BioNTech COVID-19 Vaccine, Bivalent in the United States. METHODS A combined cohort Markov decision tree model estimated the cost-effectiveness and budget impact of booster vaccination compared to no booster vaccination in individuals aged ≥5 years. Analyses prospectively assessed three scenarios (base case, low, high) defined based upon the emergence (or not) of subvariants, using list prices. Age-stratified parameters were informed by literature. The cost-effectiveness analysis estimated cases, hospitalizations and deaths averted, Life Years (LYs) and Quality Adjusted Life Years (QALYs) gained, the incremental cost-effectiveness ratio (ICER), the net monetary benefit (NMB), and the Return on Investment (ROI). The budget impact analyses used the perspective of a hypothetical 1-million-member plan. Sensitivity analyses explored parameter uncertainty. Conservatively, indirect effects and broad societal benefits were not considered. RESULTS The base case predicted that, compared to no booster vaccination, the Pfizer-BioNTech COVID-19 Vaccine, Bivalent could result in ∼3.7 million fewer symptomatic cases, 162 thousand fewer hospitalizations, 45 thousand fewer deaths, 373 thousand fewer discounted QALYs lost, and was cost-saving. Using a conservative value of $50,000 for 1 LY, every $1 invested yielded estimated $4.67 benefits. Unit costs, health outcomes and effectiveness had the greatest impact on results. At $50,000 per QALY gained, the booster generated a 34.2 billion NMB and probabilistic sensitivity analyses indicated a 92% chance of being cost-saving and 98% of being cost-effective. The bivalent was cost-saving or highly cost-effective in high and low scenarios. In a hypothetical 1-million-member health plan population, the vaccine was predicted to be a budget-efficient solution for payers. CONCLUSIONS Booster vaccination with the Pfizer-BioNTech COVID-19 Vaccine, Bivalent for the US population aged ≥5 years could generate notable public health impact and be cost-saving based on the findings of our base case analyses.
Collapse
Affiliation(s)
| | - Kinga Marczell
- Evidera, Bocskai út 134-146, Dorottya Udvar, E épület 2. emelet, Budapest, Hungary
| | | | | | - Jingyan Yang
- Pfizer Inc., New York, NY USA
- Institute for Social and Economic Research and Policy, Columbia University, New York, NY, USA
| | | |
Collapse
|
6
|
Khan FL, Nguyen JL, Singh TG, Puzniak LA, Wiemken TL, Schrecker JP, Taitel MS, Zamparo JM, Jodar L, McLaughlin JM. Estimated BNT162b2 Vaccine Effectiveness Against Infection With Delta and Omicron Variants Among US Children 5 to 11 Years of Age. JAMA Netw Open 2022; 5:e2246915. [PMID: 36515946 PMCID: PMC9856252 DOI: 10.1001/jamanetworkopen.2022.46915] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE Data describing the vaccine effectiveness (VE) and durability of BNT162b2 among children 5 to 11 years of age are needed. OBJECTIVE To estimate BNT162b2 VE against SARS-CoV-2 infection among children aged 5 to 11 years during Delta and Omicron variant-predominant periods and to further assess VE according to prior SARS-CoV-2 infection status and by sublineage during the Omicron variant-predominant period. DESIGN, SETTING, AND PARTICIPANTS This test-negative case-control study was conducted from November 2 to December 9, 2021 (Delta variant), and from January 16 to September 30, 2022 (Omicron variant), among 160 002 children tested at a large national US retail pharmacy chain, for SARS-CoV-2 via polymerase chain reaction (PCR); 62 719 children were tested during the Delta period, and 97 283 were tested during the Omicron period. EXPOSURE Vaccination with BNT162b2 before SARS-CoV-2 testing vs no vaccination. MAIN OUTCOMES AND MEASURES The primary outcome was SARS-CoV-2 infection confirmed by PCR (regardless of the presence of symptoms), and the secondary outcome was confirmed symptomatic infection. Adjusted estimated VE was calculated from multilevel logistic regression models. RESULTS A total of 39 117 children tested positive and 131 686 tested negative for SARS-CoV-2 (total, 170 803; 84 487 [49%] were boys; mean [SD] age was 9 [2] years; 74 236 [43%] were White non-Hispanic or non-Latino; and 37 318 [22%] were Hispanic or Latino). Final VE analyses included 160 002 children without SARS-CoV-2 infection less than 90 days prior. The VE of 2 doses of BNT162b2 against Delta was 85% (95% CI, 80%-89%; median follow-up, 1 month) compared with the Omicron period (20% [95% CI, 17%-23%]; median follow-up, 4 months). The adjusted VE of 2 doses against Omicron at less than 3 months was 39% (95% CI, 36%-42%), and at 3 months or more, it was -1% (95% CI, -6% to 3%). Protection against Omicron was higher among children with vs without infection 90 days or more prior but decreased in all children approximately 3 months after the second dose (58% [95% CI, 49%-66%] with infection vs 37% [95% CI, 34%-41%] without infection at <3 months; 27% [95% CI, 17%-35%] with infection vs -7% [95% CI, -12% to -1%] at ≥3 months without infection). The VE of 2 doses of BNT162b2 at less than 3 months by Omicron sublineage was 40% (95% CI, 36%-43%) for BA.1, 32% (95% CI, 21%-41%) for BA.2/BA.2.12.1, and 50% (95% CI, 37%-60%) for BA.4/BA.5. After 3 months or more, VE was nonsignificant for BA.2/BA.2.12.1 and BA.4/BA.5. The VE of a booster dose was 55% (95% CI, 50%-60%) against Omicron, with no evidence of waning at 3 months or more. CONCLUSIONS AND RELEVANCE This study suggests that, among children aged 5 to 11 years, 2 doses of BNT162b2 provided modest short-term protection against Omicron infection that was higher for those with prior infection; however, VE waned after approximately 3 months in all children. A booster dose restored protection against Omicron and was maintained for at least 3 months. These findings highlight the continued importance of booster vaccination regardless of history of prior COVID-19.
Collapse
Affiliation(s)
- Farid L. Khan
- Medical Development & Scientific Clinical Affairs, Pfizer, Collegeville, Pennsylvania
| | - Jennifer L. Nguyen
- Medical Development & Scientific Clinical Affairs, Pfizer, Collegeville, Pennsylvania
| | - Tanya G. Singh
- Center for Health & Wellbeing Research, Walgreens, Deerfield, Illinois
| | - Laura A. Puzniak
- Medical Development & Scientific Clinical Affairs, Pfizer, Collegeville, Pennsylvania
| | - Timothy L. Wiemken
- Medical Development & Scientific Clinical Affairs, Pfizer, Collegeville, Pennsylvania
| | | | - Michael S. Taitel
- Center for Health & Wellbeing Research, Walgreens, Deerfield, Illinois
| | - Joann M. Zamparo
- Medical Development & Scientific Clinical Affairs, Pfizer, Collegeville, Pennsylvania
| | - Luis Jodar
- Medical Development & Scientific Clinical Affairs, Pfizer, Collegeville, Pennsylvania
| | - John M. McLaughlin
- Medical Development & Scientific Clinical Affairs, Pfizer, Collegeville, Pennsylvania
| |
Collapse
|
7
|
Wiemken TL, McGrath LJ, Andersen KM, Khan F, Malhotra D, Alfred T, Nguyen JL, Puzniak L, Thoburn E, Jodar L, McLaughlin JM. Coronavirus Disease 2019 Severity and Risk of Subsequent Cardiovascular Events. Clin Infect Dis 2022; 76:e42-e50. [PMID: 35984816 PMCID: PMC9907540 DOI: 10.1093/cid/ciac661] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/03/2022] [Accepted: 08/12/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Little is known about the relationship between coronavirus disease 2019 (COVID-19) severity and subsequent risk of experiencing a cardiovascular event (CVE) after COVID-19 recovery. We evaluated this relationship in a large cohort of United States adults. METHODS Using a claims database, we performed a retrospective cohort study of adults diagnosed with COVID-19 between 1 April 2020 and 31 May 2021. We evaluated the association between COVID-19 severity and risk of CVE >30 days after COVID-19 diagnosis using inverse probability of treatment-weighted competing risks regression. Severity was based on level of care required for COVID-19 treatment: intensive care unit (ICU) admission, non-ICU hospitalization, or outpatient care only. RESULTS A total of 1 357 518 COVID-19 patients were included (2% ICU, 3% non-ICU hospitalization, and 95% outpatient only). Compared to outpatients, there was an increased risk of any CVE for patients requiring ICU admission (adjusted hazard ratio [aHR], 1.80 [95% confidence interval {CI}, 1.71-1.89]) or non-ICU hospitalization (aHR, 1.28 [95% CI, 1.24-1.33]). Risk of subsequent hospitalization for CVE was even higher (aHRs, 3.47 [95% CI, 3.20-3.76] for ICU and 1.96 [95% CI, 1.85-2.09] for non-ICU hospitalized vs outpatient only). CONCLUSIONS COVID-19 patients hospitalized or requiring critical care had a significantly higher risk of experiencing and being hospitalized for post-COVID-19 CVE than patients with milder COVID-19 who were managed solely in the outpatient setting, even after adjusting for differences between these groups. These findings underscore the continued importance of preventing severe acute respiratory syndrome coronavirus 2 infection from progressing to severe illness to reduce potential long-term cardiovascular complications.
Collapse
Affiliation(s)
- Timothy L Wiemken
- Correspondence: T. L. Wiemken, Pfizer Inc, 500 Arcola Rd, Collegeville, PA 19426 ()
| | | | | | - Farid Khan
- Pfizer Inc, Collegeville, Pennsylvania, USA
| | | | | | | | | | | | - Luis Jodar
- Pfizer Inc, Collegeville, Pennsylvania, USA
| | | |
Collapse
|
8
|
Wang G, Stapleton JT, Baker AW, Rouphael N, Creech CB, El Sahly HM, Stout JE, Jackson L, Charbek E, Leyva FJ, Tomashek KM, Tibbals M, Miller A, Frey S, Niemotka S, Wiemken TL, Beydoun N, Alaaeddine G, Turner N, Walter EB, Chamberland R, Abate G. Clinical features and treatment outcomes of pulmonary Mycobacterium avium-intracellulare complex with and without co-infections. Open Forum Infect Dis 2022; 9:ofac375. [PMID: 35959208 PMCID: PMC9361173 DOI: 10.1093/ofid/ofac375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 07/25/2022] [Indexed: 11/18/2022] Open
Abstract
Coinfections are more common in patients with cystic fibrosis and bronchiectasis. Infiltrates on imaging studies are seen more commonly in patients with coinfections, but coinfections did not affect treatment outcomes of pulmonary Mycobacterium avium complex.
Collapse
Affiliation(s)
- Grace Wang
- Department of Internal Medicine, Saint Louis University, St Louis, Missouri, USA
| | - Jack T Stapleton
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Arthur W Baker
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Nadine Rouphael
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - C Buddy Creech
- Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Hana M El Sahly
- Baylor College of Medicine, Human Vaccine Institute, Houston, Texas, USA
| | - Jason E Stout
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Lisa Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Edward Charbek
- Department of Internal Medicine, Saint Louis University, St Louis, Missouri, USA
| | - Francisco J Leyva
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Kay M Tomashek
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Melinda Tibbals
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Aaron Miller
- Department of Internal Medicine, Saint Louis University, St Louis, Missouri, USA
| | - Sharon Frey
- Department of Internal Medicine, Saint Louis University, St Louis, Missouri, USA
| | - Samson Niemotka
- Department of Internal Medicine, Saint Louis University, St Louis, Missouri, USA
| | - Timothy L Wiemken
- Department of Internal Medicine, Saint Louis University, St Louis, Missouri, USA
| | - Nour Beydoun
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ghina Alaaeddine
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nicholas Turner
- Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Robin Chamberland
- Department of Pathology, Division of Clinical Pathology, Saint Louis University School of Medicine, St Louis, Missouri, USA
| | - Getahun Abate
- Correspondence: Getahun Abate, MD, PhD, Department of Internal Medicine, Saint Louis University, 1100 S Grand Blvd, Saint Louis, MO 63104, USA ()
| |
Collapse
|
9
|
McLaughlin JM, Wiemken TL, Khan F, Jodar L. US County-level COVID-19 Vaccine Uptake and Rates of Omicron Cases and Deaths. Open Forum Infect Dis 2022; 9:ofac299. [PMID: 35873296 PMCID: PMC9301577 DOI: 10.1093/ofid/ofac299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/14/2022] [Indexed: 11/16/2022] Open
Abstract
The population-level impact of vaccination on Omicron-related disease is not well described. We fit negative binomial models to estimate the relationship between US county-level vaccine coverage and rates of coronavirus disease 2019. Increased booster dose uptake was associated with lower rates of Omicron cases and deaths and is critical to combat future severe acute respiratory syndrome coronavirus 2 waves.
Collapse
|
10
|
Mody L, Akinboyo IC, Babcock HM, Bischoff WE, Cheng VCC, Chiotos K, Claeys KC, Coffey KC, Diekema DJ, Donskey CJ, Ellingson KD, Gilmartin HM, Gohil SK, Harris AD, Keller SC, Klein EY, Krein SL, Kwon JH, Lauring AS, Livorsi DJ, Lofgren ET, Merrill K, Milstone AM, Monsees EA, Morgan DJ, Perri LP, Pfeiffer CD, Rock C, Saint S, Sickbert-Bennett E, Skelton F, Suda KJ, Talbot TR, Vaughn VM, Weber DJ, Wiemken TL, Yassin MH, Ziegler MJ, Anderson DJ. Coronavirus disease 2019 (COVID-19) research agenda for healthcare epidemiology. Infect Control Hosp Epidemiol 2022; 43:156-166. [PMID: 33487199 PMCID: PMC8160487 DOI: 10.1017/ice.2021.25] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 01/07/2021] [Indexed: 02/07/2023]
Abstract
This SHEA white paper identifies knowledge gaps and challenges in healthcare epidemiology research related to coronavirus disease 2019 (COVID-19) with a focus on core principles of healthcare epidemiology. These gaps, revealed during the worst phases of the COVID-19 pandemic, are described in 10 sections: epidemiology, outbreak investigation, surveillance, isolation precaution practices, personal protective equipment (PPE), environmental contamination and disinfection, drug and supply shortages, antimicrobial stewardship, healthcare personnel (HCP) occupational safety, and return to work policies. Each section highlights three critical healthcare epidemiology research questions with detailed description provided in supplementary materials. This research agenda calls for translational studies from laboratory-based basic science research to well-designed, large-scale studies and health outcomes research. Research gaps and challenges related to nursing homes and social disparities are included. Collaborations across various disciplines, expertise and across diverse geographic locations will be critical.
Collapse
Affiliation(s)
- Lona Mody
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States
- Geriatrics Research Education and Clinical Center, Veterans’ Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States
| | - Ibukunoluwa C. Akinboyo
- Division of Infectious Diseases, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, United States
| | - Hilary M. Babcock
- Washington University School of Medicine, St. Louis, Missouri, United States
| | - Werner E. Bischoff
- Wake Forest School of Medicine, Winston Salem, North Carolina, United States
| | - Vincent Chi-Chung Cheng
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
- Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China
| | - Kathleen Chiotos
- Division of Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Kimberly C. Claeys
- University of Maryland School of Pharmacy, Baltimore, Maryland, United States
| | - K. C. Coffey
- University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Daniel J. Diekema
- Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States
| | - Curtis J. Donskey
- Infectious Diseases Section, Louis Stokes Cleveland Veterans’ Affairs Medical Center, Cleveland, Ohio, United States
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
| | - Katherine D. Ellingson
- Department of Epidemiology and Biostatistics, College of Public Health, University of Arizona, Tucson, Arizona, United States
| | - Heather M. Gilmartin
- Veterans’ Affairs Eastern Colorado Healthcare System, Aurora, Colorado, United States
- Colorado School of Public Health, University of Colorado, Aurora, Colorado, United States
| | - Shruti K. Gohil
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, California, United States
- Epidemiology and Infection Prevention, UC Irvine Health, Irvine, California, United States
| | - Anthony D. Harris
- University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Sara C. Keller
- Division of Infectious Diseases, John Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Eili Y. Klein
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland, Unites States
| | - Sarah L. Krein
- Veterans’ Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan, United States
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - Jennie H Kwon
- Washington University School of Medicine, St. Louis, Missouri, United States
| | - Adam S. Lauring
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - Daniel J. Livorsi
- Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States
- Iowa City Veterans’ Affairs Health Care System, Iowa City, Iowa, United States
| | - Eric T. Lofgren
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, United States
| | | | - Aaron M. Milstone
- Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Elizabeth A. Monsees
- Children’s Mercy Kansas City, Kansas City, Missouri, United States
- University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States
| | - Daniel J. Morgan
- University of Maryland School of Medicine, Baltimore, Maryland, United States
- Veterans’ Affairs Maryland Healthcare System, Baltimore, Maryland, United States
| | - Luci P. Perri
- Infection Control Results, Wingate, North Carolina, United States
| | - Christopher D. Pfeiffer
- Veterans’ Affairs Portland Health Care System, Portland, Oregon, United States
- Oregon Health & Science University, Portland, Oregon, United States
| | - Clare Rock
- Division of Infectious Diseases, John Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Sanjay Saint
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States
- Veterans’ Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States
| | - Emily Sickbert-Bennett
- Department of Infection Prevention, University of North Carolina Medical Center, Chapel Hill, North Carolina, United States
| | - Felicia Skelton
- Michael E. DeBakey Veterans’ Affairs Medical Center, Houston, Texas, United States
- H. Ben Taub Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, Texas, United States
| | - Katie J. Suda
- Center for Health Equity Research and Promotion, Veterans’ Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, United States
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Thomas R. Talbot
- Vanderbilt University School of Medicine, Nashville, Tennessee, United States
| | - Valerie M. Vaughn
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - David J. Weber
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Timothy L. Wiemken
- Division of Infectious Diseases, Allergy, and Immunology, Department of Medicine, Saint Louis University School of Medicine, St Louis, Missouri, United States
| | - Mohamed H. Yassin
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Matthew J. Ziegler
- Infectious Diseases Division, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Deverick J. Anderson
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, North Carolina, United States
| |
Collapse
|
11
|
Abate G, Kapoor A, Charbek E, Beck B, Wang Q, Wang GC, Steck M, Zoglman J, Chambeg RR, Frey S, Hoft DF, Wiemken TL. Effects of race on the outcome of COVID-19 in hospitalized patients. J Natl Med Assoc 2022; 114:56-68. [PMID: 35012764 PMCID: PMC8739651 DOI: 10.1016/j.jnma.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/18/2021] [Accepted: 12/07/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS Recent reports indicate that African Americans have higher mortality rates from SARS-CoV-2 coronavirus disease 19 (COVID-19) compared to Caucasians, with more marked differences in the Midwest region of the US. This study was performed to study differences in COVID-19 related mortality and hospital length of stay (LOS) between African Americans and Caucasians in Midwest setting, and identify factors associated with mortality and LOS. METHODS Data were collected from the electronic health records (EHR) of patients admitted to hospitals in Midwest region of the US. EHR of 471 COVID-19 patients were reviewed. RESULTS Approximately 63% were African Americans and 34% Caucasians. One hundred sixteen variables were tested. There was no significant difference in hospital mortality between African Americans and Caucasians (OR 1, 95% CI 0.48-1.94). Older age, Chronic kidney disease, mental status change, mechanical ventilation, vasopressor support, high neutrophil count, elevated AST and ALT, high lung involvement severity score and elevated CRP were associated with mortality in a univariate analysis (P < 0.05). Multivariable modeling indicated that mechanical ventilation was the only factor that predicted mortality (OR 6, 95% CI: 2.94-12.48). The LOS did not differ in African Americans and Caucasians. The use of oxygen via high flow nasal cannula (Survival Estimate 1.6, 95% CI: 1.20-2.26), low estimated glomerular filtration rate (Survival Estimate 1.4, 95% CI: 1.05-1.82) and mechanical ventilation (Survival Estimate 3.5, 95% CI: 2.72-4.37) were predictors of LOS. CONCLUSION This study performed in Midwest setting in the US showed that race did not affect in-hospital mortality and LOS. Our analysis demonstrated new predictors of LOS.
Collapse
Affiliation(s)
- Getahun Abate
- Department of Internal Medicine, Saint Louis University, 1100 South Grand Blvd, Doisy Research Center, 8th floor, Saint Louis, MO 63104 USA.
| | - Aniruddh Kapoor
- Department of Internal Medicine, Saint Louis University, 1100 South Grand Blvd, Doisy Research Center, 8th floor, Saint Louis, MO 63104 USA
| | - Edward Charbek
- Department of Internal Medicine, Saint Louis University, 1100 South Grand Blvd, Doisy Research Center, 8th floor, Saint Louis, MO 63104 USA
| | - Bryan Beck
- Department of Internal Medicine, Saint Louis University, 1100 South Grand Blvd, Doisy Research Center, 8th floor, Saint Louis, MO 63104 USA
| | - Qian Wang
- Department of Internal Medicine, Saint Louis University, 1100 South Grand Blvd, Doisy Research Center, 8th floor, Saint Louis, MO 63104 USA
| | - Grace C Wang
- Department of Internal Medicine, Saint Louis University, 1100 South Grand Blvd, Doisy Research Center, 8th floor, Saint Louis, MO 63104 USA
| | - Mackenzie Steck
- Department of Internal Medicine, Saint Louis University, 1100 South Grand Blvd, Doisy Research Center, 8th floor, Saint Louis, MO 63104 USA
| | - Jason Zoglman
- Department of Internal Medicine, Saint Louis University, 1100 South Grand Blvd, Doisy Research Center, 8th floor, Saint Louis, MO 63104 USA
| | - Robin R Chambeg
- Department of Internal Medicine, Saint Louis University, 1100 South Grand Blvd, Doisy Research Center, 8th floor, Saint Louis, MO 63104 USA; SSM St. Louis Network Microbiology, USA
| | - Sharon Frey
- Department of Internal Medicine, Saint Louis University, 1100 South Grand Blvd, Doisy Research Center, 8th floor, Saint Louis, MO 63104 USA
| | - Daniel F Hoft
- Department of Internal Medicine, Saint Louis University, 1100 South Grand Blvd, Doisy Research Center, 8th floor, Saint Louis, MO 63104 USA
| | - Timothy L Wiemken
- Department of Internal Medicine, Saint Louis University, 1100 South Grand Blvd, Doisy Research Center, 8th floor, Saint Louis, MO 63104 USA
| |
Collapse
|
12
|
Di Fusco M, Marczell K, Deger KA, Moran MM, Wiemken TL, Cane A, de Boisvilliers S, Yang J, Vaghela S, Roiz J. Public health impact of the Pfizer-BioNTech COVID-19 vaccine (BNT162b2) in the first year of rollout in the United States. J Med Econ 2022; 25:605-617. [PMID: 35574613 DOI: 10.1080/13696998.2022.2071427] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND As the body of evidence on COVID-19 and post-vaccination outcomes continues to expand, this analysis sought to evaluate the public health impact of the Pfizer-BioNTech COVID-19 Vaccine, BNT162b2, during the first year of its rollout in the US. METHODS A combined Markov decision tree model compared clinical and economic outcomes of the Pfizer-BioNTech COVID-19 Vaccine (BNT162b2) versus no vaccination in individuals aged ≥12 years. Age-stratified epidemiological, clinical, economic, and humanistic parameters were derived from existing data and published literature. Scenario analysis explored the impact of using lower and upper bounds of parameters on the results. The health benefits were estimated as the number of COVID-19 symptomatic cases, hospitalizations and deaths averted, and Quality Adjusted Life Years (QALYs) saved. The economic benefits were estimated as the amount of healthcare and societal cost savings associated with the vaccine-preventable health outcomes. RESULTS It was estimated that, in 2021, the Pfizer-BioNTech COVID-19 Vaccine (BNT162b2) contributed to averting almost 9 million symptomatic cases, close to 700,000 hospitalizations, and over 110,000 deaths, resulting in an estimated $30.4 billion direct healthcare cost savings, $43.7 billion indirect cost savings related to productivity loss, as well as discounted gains of 1.1 million QALYs. Scenario analyses showed that these results were robust; the use of alternative plausible ranges of parameters did not change the interpretation of the findings. CONCLUSIONS The Pfizer-BioNTech COVID-19 Vaccine (BNT162b2) contributed to generate substantial public health impact and vaccine-preventable cost savings in the first year of its rollout in the US. The vaccine was estimated to prevent millions of COVID-19 symptomatic cases and thousands of hospitalizations and deaths, and these averted outcomes translated into cost-savings in the billions of US dollars and thousands of QALYs saved. As only direct impacts of vaccination were considered, these estimates may be conservative.
Collapse
Affiliation(s)
- Manuela Di Fusco
- Health Economics & Outcomes Research, Pfizer Inc, New York, NY, USA
| | - Kinga Marczell
- Evidence, Value & Access by PPD, Evidera, Budapest, Hungary
| | | | | | | | - Alejandro Cane
- Health Economics & Outcomes Research, Pfizer Inc, New York, NY, USA
| | | | - Jingyan Yang
- Health Economics & Outcomes Research, Pfizer Inc, New York, NY, USA
- Institute for Social and Economic Research and Policy, Columbia University, New York, NY, USA
| | | | - Julie Roiz
- Evidence, Value & Access by PPD, Evidera, London, UK
| |
Collapse
|
13
|
Rutschman AS, Sarnoff JD, Wiemken TL. Vaccine Intellectual Property. Methods Mol Biol 2022; 2412:519-525. [PMID: 34918266 DOI: 10.1007/978-1-0716-1892-9_29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
We analyzed the intellectual property landscape surrounding currently available vaccines, with a focus on patents.
Collapse
|
14
|
Wiemken TL, Salas J, Morley JE, Hoft DF, Jacobs C, Scherrer JF. Comparison of rates of dementia among older adult recipients of two, one, or no vaccinations. J Am Geriatr Soc 2021; 70:1157-1168. [PMID: 34897645 PMCID: PMC9300193 DOI: 10.1111/jgs.17606] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/16/2021] [Accepted: 11/22/2021] [Indexed: 11/27/2022]
Abstract
Background Multiple types of vaccinations are associated with lower risk for dementia, but it is not known if receiving more than one vaccination type is associated with a greater decrease in incident dementia as compared with receiving only one type. We determined if dementia risk is lowest in patients who receive both herpes zoster (HZ) and tetanus, diphtheria, pertussis (Tdap) vaccinations as compared with receipt of only one or the other type of vaccination. Methods Primary analysis in a Veterans Health Administration (VA) cohort was replicated in private sector medical claims data. Eligible patients were ≥65 years of age and free of dementia for 2 years prior to baseline (VHA n = 80,070; MarketScan n = 129,200). At index, patients either had both HZ and Tdap, only HZ, only Tdap, or neither vaccination. Confounding was controlled with generalized boosted propensity scores and inverse probability of treatment weighting. Competing risk (VHA) and Cox proportional hazard (MarketScan) models estimated the association between vaccination status and incident dementia. Results VHA patients' mean age was 76.8 ± 7.6 years, 4.4% were female and 90.9% were White, and MarketScan patients' mean age was 70.5 ± 5.9 and 65.4% were female. In both cohorts, having both HZ and Tdap vaccinations compared with no vaccination was significantly associated with lower dementia risk (VHA HR = 0.50; 95% CI: 0.43–0.59; MarketScan HR = 0.58; 95% CI: 0.38–0.89). In both cohorts, compared with neither vaccination, patients with only one or the other vaccination types had a significantly lower risk for dementia. Incident dementia was lower in patients with both vaccinations versus only one vaccination type. Conclusions and Relevance Receiving two types of vaccinations versus one type was associated with lower dementia risk. Vaccinations may have non‐specific associations with incident dementia. Low cost and accessible, common adult vaccinations may be an overlooked intervention for reducing dementia risk.
Collapse
Affiliation(s)
- Timothy L Wiemken
- Department of Internal Medicine, Division of Infectious Diseases, Allergy, and Immunology, Saint Louis University, School of Medicine, Saint Louis, Missouri, USA.,The Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University, School of Medicine, St. Louis, Missouri, USA
| | - Joanne Salas
- The Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University, School of Medicine, St. Louis, Missouri, USA.,Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA.,Research Service, Harry S. Truman Veterans Administration Medical Center, Columbia, Missouri, USA
| | - John E Morley
- Department of Internal Medicine, Division of Geriatric Medicine, Saint Louis University, School of Medicine, St. Louis, Missouri, USA
| | - Daniel F Hoft
- Department of Internal Medicine, Division of Infectious Diseases, Allergy, and Immunology, Saint Louis University, School of Medicine, Saint Louis, Missouri, USA.,Department of Molecular Microbiology & Immunology, Saint Louis University, Saint Louis, Missouri, USA
| | - Christine Jacobs
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Jeffrey F Scherrer
- The Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University, School of Medicine, St. Louis, Missouri, USA.,Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA.,Research Service, Harry S. Truman Veterans Administration Medical Center, Columbia, Missouri, USA
| |
Collapse
|
15
|
Scherrer JF, Salas J, Wiemken TL, Hoft DF, Jacobs C, Morley JE. Impact of herpes zoster vaccination on incident dementia: A retrospective study in two patient cohorts. PLoS One 2021; 16:e0257405. [PMID: 34788293 PMCID: PMC8597989 DOI: 10.1371/journal.pone.0257405] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 08/31/2021] [Indexed: 12/31/2022] Open
Abstract
Background Herpes zoster (HZ) infection increases dementia risk, but it is not known if herpes zoster vaccination is associated with lower risk for dementia. We determined if HZ vaccination, compared to no HZ vaccination, is associated with lower risk for incident dementia. Methods and findings Data was obtained from Veterans Health Affairs (VHA) medical records (10/1/2008–9/30/2019) with replication in MarketScan® commercial and Medicare claims (1/1/2009-12/31/2018). Eligible patients were ≥65 years of age and free of dementia for two years prior to baseline (VHA n = 136,016; MarketScan n = 172,790). Two index periods (either start of 2011 or 2012) were defined, where patients either had or did not have a HZ vaccination. Confounding was controlled with propensity scores and inverse probability of treatment weighting. Competing risk (VHA) and Cox proportional hazard (MarketScan) models estimated the association between HZ vaccination and incident dementia in all patients and in age (65–69, 70–74, ≥75) and race (White, Black, Other) sub-groups. Sensitivity analysis measured the association between HZ vaccination and incident Alzheimer’s dementia (AD). HZ vaccination at index versus no HZ vaccination throughout follow-up. VHA patients mean age was 75.7 (SD±7.4) years, 4.0% were female, 91.2% white and 20.2% had HZ vaccination. MarketScan patients mean age was 69.9 (SD±5.7) years, 65.0% were female and 14.2% had HZ vaccination. In both cohorts, HZ vaccination compared with no vaccination, was significantly associated with lower dementia risk (VHA HR = 0.69; 95%CI: 0.67–0.72; MarketScan HR = 0.65; 95%CI:0.57–0.74). HZ vaccination was not related to dementia risk in MarketScan patients aged 65–69 years. No difference in HZ vaccination to dementia effects were found by race. HZ vaccination was associated with lower risk for AD. Conclusions HZ vaccination is associated with reduced risk of dementia. Vaccination may provide nonspecific neuroprotection by training the immune system to limit damaging inflammation, or specific neuroprotection that prevents viral cytopathic effects.
Collapse
Affiliation(s)
- Jeffrey F. Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, United States of America
- Harry S. Truman Veterans Administration Medical Center, Columbia, MO, United States of America
- The AHEAD Institute, Saint Louis University School of Medicine, St. Louis, MO, United States of America
- * E-mail:
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, United States of America
- Harry S. Truman Veterans Administration Medical Center, Columbia, MO, United States of America
- The AHEAD Institute, Saint Louis University School of Medicine, St. Louis, MO, United States of America
| | - Timothy L. Wiemken
- The AHEAD Institute, Saint Louis University School of Medicine, St. Louis, MO, United States of America
- Department of Health and Clinical Outcomes Research, School of Medicine, Saint Louis University, Saint Louis, MO, United States of America
- Division of Infectious Diseases, Allergy, and Immunology, Department of Internal Medicine, Department of Medicine, School of Medicine, Saint Louis University, Saint Louis, MO, United States of America
- Saint Louis University Systems Infection Prevention Center, Center for Specialized Medicine, St. Louis, MO, United States of America
| | - Daniel F. Hoft
- Division of Infectious Diseases, Allergy, and Immunology, Department of Internal Medicine, Department of Medicine, School of Medicine, Saint Louis University, Saint Louis, MO, United States of America
- Saint Louis University Systems Infection Prevention Center, Center for Specialized Medicine, St. Louis, MO, United States of America
- Department of Molecular Microbiology & Immunology, Saint Louis University, Saint Louis, MO, United States of America
| | - Christine Jacobs
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, United States of America
- The AHEAD Institute, Saint Louis University School of Medicine, St. Louis, MO, United States of America
| | - John E. Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO, United States of America
| |
Collapse
|
16
|
Wiemken TL, Salas J, Hoft DF, Jacobs C, Morley JE, Scherrer JF. Dementia risk following influenza vaccination in a large veteran cohort. Vaccine 2021; 39:5524-5531. [PMID: 34420785 DOI: 10.1016/j.vaccine.2021.08.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/28/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Two Taiwan based studies indicated influenza vaccinations are associated with lower risk for dementia in patient cohorts with chronic disease. We determined if such associations exist in a large, nationally distributed sample of U.S. patients not selected for chronic disease. METHODS Data was obtained from Veterans Health Administration medical records (9/1/2009 - 8/31/19). Eligible patients were ≥65 years of age and free of dementia for two years prior to enrollment through the end of the first influenza season (9/1/2009 to 3/1/2012). Competing risk models estimated the risk of dementia in those with influenza vaccination (n = 66,822) compared to those without vaccination (n = 56,925). Propensity scores and inverse probability of treatment weighting controlled for confounding. RESULTS On average, patients were 75.5 (±7.3) years of age, 3.8% were female and 91.6% were white race. After controlling for confounding, patients with influenza vaccination were significantly less likely to develop dementia compared to patients without vaccination (HR = 0.86; 95 %CI:0.83-0.88). Patients with 1, 2 or 3-5 vaccines vs. none had similar risks for dementia and patients with ≥ 6 influenza vaccines vs. none had a significant lower risk for dementia (HR = 0.88, 95 %CI: 0.83-0.94). CONCLUSIONS Repeated receipt of influenza vaccinations, compared to remaining unvaccinated, is associated with lower risk for dementia. This is consistent with the hypotheses that vaccinations may reduce risk of dementia by training the immune system and not by preventing specific infectious disease. If vaccines are identified as causative factors in reducing incident dementia, they offer an inexpensive, low-risk intervention with effects greater than any existing preventive measure.
Collapse
Affiliation(s)
- Timothy L Wiemken
- Saint Louis University, School of Medicine, Department of Internal Medicine, Division of Infectious Diseases, Allergy, and Immunology, Saint Louis, MO, United States; The Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University, School of Medicine, 1402 South Grand Blvd, St. Louis, MO, United States.
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University, School of Medicine, 1402 South Grand Blvd, St. Louis, MO, United States; Harry S. Truman Veterans Administration Medical Center, Columbia, MO, United States; The Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University, School of Medicine, 1402 South Grand Blvd, St. Louis, MO, United States
| | - Daniel F Hoft
- Saint Louis University, School of Medicine, Department of Internal Medicine, Division of Infectious Diseases, Allergy, and Immunology, Saint Louis, MO, United States; Saint Louis University, Department of Molecular Microbiology & Immunology, Saint Louis, MO, United States
| | - Christine Jacobs
- Department of Family and Community Medicine, Saint Louis University, School of Medicine, 1402 South Grand Blvd, St. Louis, MO, United States
| | - John E Morley
- Saint Louis University, School of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, 1402 South Grand Blvd, St. Louis, MO, United States
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University, School of Medicine, 1402 South Grand Blvd, St. Louis, MO, United States; Harry S. Truman Veterans Administration Medical Center, Columbia, MO, United States; The Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University, School of Medicine, 1402 South Grand Blvd, St. Louis, MO, United States
| |
Collapse
|
17
|
Wiemken TL, Rutschman AS, Niemotka S, Prener CG. Excess mortality in the United States in 2020: Forecasting and anomaly detection. Am J Infect Control 2021; 49:1189-1190. [PMID: 33774102 DOI: 10.1016/j.ajic.2021.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/26/2021] [Accepted: 03/01/2021] [Indexed: 10/21/2022]
Abstract
All-cause mortality may be better than disease-specific data for computing excess COVID-19 mortality. We documented approximately 350,000 excess deaths using a 20-year forecast of all-cause mortality compared to provisional estimates. We must develop more granular approaches to the collection of mortality data for real-time evaluation of excess deaths.
Collapse
|
18
|
Eden J, Salas J, Santos Rutschman A, Prener CG, Niemotka SL, Wiemken TL. Associations of presidential voting preference and gubernatorial control with county-level COVID-19 case and death rates in the continental United States. Public Health 2021; 198:161-163. [PMID: 34461448 PMCID: PMC8463076 DOI: 10.1016/j.puhe.2021.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/20/2021] [Accepted: 07/24/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To investigate the associations of state gubernatorial party control and 2016 county-level presidential election preference on COVID-19 case and death rates in the United States. STUDY DESIGN This was a secondary analysis of publicly available data. METHODS Data including county-level COVID-19 case and death counts through February 9, 2021, 2020 gubernatorial data, and county-level US Census Bureau data, Broadstreet area deprivation index, and 2016 presidential voting tallies were included. Negative binomial regression estimated the adjusted impact of each variable on COVID-19 case and death rates. RESULTS A total of 3102 counties in the 48 continental United States plus Washington DC were included. County-level case and death rates were higher (12% and 22%, respectively) in Republican vs Democrat controlled states. Case and death rates were higher in counties voting Republican vs Democrat in 2016 and were modified by counties with median ages ≥ 50 years (54% increase in case rate and 91% increase in death rate). CONCLUSIONS These data further support the need for prevention efforts to focus on public health while extricating guidance and prevention from political agendas.
Collapse
Affiliation(s)
- J Eden
- Saint Louis University School of Medicine, Department of Internal Medicine, Division of Infectious Diseases, Allergy, and Immunology, USA
| | - J Salas
- Saint Louis University School of Medicine, Department of Family and Community Medicine, USA; Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, USA
| | - A Santos Rutschman
- Saint Louis University School of Law, Center for Health Law Studies, USA; Saint Louis University Institute for Vaccine Science and Policy, Data Science and Epidemiology, USA
| | - C G Prener
- Saint Louis University School of Arts and Sciences, Department of Sociology and Anthropology, USA
| | - S L Niemotka
- Saint Louis University School of Medicine, Department of Internal Medicine, Division of Infectious Diseases, Allergy, and Immunology, USA; Saint Louis University Institute for Vaccine Science and Policy, Data Science and Epidemiology, USA
| | - T L Wiemken
- Saint Louis University School of Medicine, Department of Internal Medicine, Division of Infectious Diseases, Allergy, and Immunology, USA; Saint Louis University Institute for Vaccine Science and Policy, Data Science and Epidemiology, USA.
| |
Collapse
|
19
|
Diggs LP, Aversa JG, Wiemken TL, Martin SP, Drake JA, Ruff SM, Wach MM, Brown ZJ, Blakely AM, Davis JL, Luu C, Hernandez JM. Patient Comorbidities Drive High Mortality Rates Associated with Major Liver Resections Irrespective of Hospital Volume. Am Surg 2021; 87:1163-1170. [PMID: 33345554 PMCID: PMC9927630 DOI: 10.1177/0003134820973368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Major hepatectomies are utilized to manage primary hepatic malignancies. Reports from high-volume centers (HVCs) with minimal perioperative mortality focus on multiple aspects of perioperative care, although patient-specific factors remain unelucidated. We identified patient factors associated with outcomes and examined whether these contribute to survival differences. METHODS We queried the National Cancer Database (2006-2015) for patients with primary liver malignancies managed with major hepatectomy. Facilities were dichotomized by volume (high volume: >15 hepatectomies/year). Perioperative outcomes were compared based on patient demographic and clinical characteristics as well as center volume. RESULTS 4263 patients were included with 78.5% receiving care in low-volume centers (LVCs). 90-day postoperative mortality was higher in LVCs vs. HVCs (12% vs. 7.5%; P < .001). Factors associated with undergoing surgery in LVCs included: living in areas with lower income (P = .006) and education (P < .001), having nonprivate insurance (P < .001), residing near the care center (P < .001), and having a comorbidity score (CDS) >1 (P = .014). Patients with CDS ≤ 1 had higher 90-day mortality in LVCs (11.3% vs. 6.6%; P < .001) and had similar outcomes in LVCs and HVCs (15.6% vs. 13.7% P = .6). Patients with CDS > 1 were more likely to receive care in LVCs (16.3% vs. 12.7%; P < .001). CONCLUSION Reduced perioperative mortality following major hepatectomy in HVCs is driven by optimal management of patients with low CDS. However, nearly 1 in 5 patients who undergo major hepatectomies have a high CDS and approximately 15% of them succumb in the perioperative period irrespective of the treating centers' experience.
Collapse
Affiliation(s)
- Laurence P. Diggs
- Surgical Oncology Program, Center for Cancer Research, National Institutes of Health, National Cancer Institute, Bethesda, MD, USA,Department of Surgery, Division of General Surgery, Saint Louis University Hospital, St. Louis, MO, USA
| | - John G. Aversa
- Surgical Oncology Program, Center for Cancer Research, National Institutes of Health, National Cancer Institute, Bethesda, MD, USA
| | - Timothy L. Wiemken
- Saint Louis University Center for Health Outcomes Research (SLUCOR), St. Louis, MO, USA
| | - Sean P. Martin
- Surgical Oncology Program, Center for Cancer Research, National Institutes of Health, National Cancer Institute, Bethesda, MD, USA
| | - Justin A. Drake
- Surgical Oncology Program, Center for Cancer Research, National Institutes of Health, National Cancer Institute, Bethesda, MD, USA
| | - Samantha M. Ruff
- Surgical Oncology Program, Center for Cancer Research, National Institutes of Health, National Cancer Institute, Bethesda, MD, USA
| | - Michael M. Wach
- Surgical Oncology Program, Center for Cancer Research, National Institutes of Health, National Cancer Institute, Bethesda, MD, USA
| | - Zachary J. Brown
- Surgical Oncology Program, Center for Cancer Research, National Institutes of Health, National Cancer Institute, Bethesda, MD, USA,Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Andrew M. Blakely
- Surgical Oncology Program, Center for Cancer Research, National Institutes of Health, National Cancer Institute, Bethesda, MD, USA
| | - Jeremy L. Davis
- Surgical Oncology Program, Center for Cancer Research, National Institutes of Health, National Cancer Institute, Bethesda, MD, USA
| | - Carrie Luu
- Department of Surgery, Division of General Surgery, Saint Louis University Hospital, St. Louis, MO, USA
| | - Jonathan M. Hernandez
- Surgical Oncology Program, Center for Cancer Research, National Institutes of Health, National Cancer Institute, Bethesda, MD, USA
| |
Collapse
|
20
|
Affiliation(s)
- Ana Santos Rutschman
- Saint Louis University School of Law, Center for Health Law Studies, Saint Louis University, Saint Louis, MO, United States.,Institute for Vaccine Science and Policy, Saint Louis University, Saint Louis, MO, United States
| | - Timothy L Wiemken
- Institute for Vaccine Science and Policy, Saint Louis University, Saint Louis, MO, United States.,Saint Louis University School of Medicine, Department of Internal Medicine, Division of Infectious Diseases, Allergy, and Immunology, Saint Louis University, Saint Louis, MO, United States.,Systems Infection Prevention Center, Saint Louis University, Saint Louis, MO, United States
| |
Collapse
|
21
|
Abstract
Computational surveillance of pneumonia and influenza mortality in the United States using FluView uses epidemic thresholds to identify high mortality rates but is limited by statistical issues such as seasonality and autocorrelation. We used time series anomaly detection to improve recognition of high mortality rates. Results suggest that anomaly detection can complement mortality reporting.
Collapse
|
22
|
Scherrer JF, Salas J, Wiemken TL, Jacobs C, Morley JE, Hoft DF. Lower Risk for Dementia Following Adult Tetanus, Diphtheria, and Pertussis (Tdap) Vaccination. J Gerontol A Biol Sci Med Sci 2021; 76:1436-1443. [PMID: 33856020 DOI: 10.1093/gerona/glab115] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Adult vaccinations may reduce risk for dementia. However, it has not been established whether tetanus, diphtheria, pertussis (Tdap) vaccination is associated with incident dementia. METHODS Hypotheses were tested in a Veterans Health Affairs (VHA) cohort and replicated in a MarketScan medical claims cohort. Patients were at least 65 years of age and free of dementia for 2 years prior to index date. Patients either had or did not have a Tdap vaccination by the start of either of the 2 index periods (2011 or 2012). Follow-up continued through 2018. Controls had no Tdap vaccination for the duration of follow-up. Confounding was controlled using entropy balancing. Competing risk (VHA) and Cox proportional hazard (MarketScan) models estimated the association between Tdap vaccination and incident dementia in all patients and age subgroups (65-69, 70-74, and ≥75 years). RESULTS VHA patients were, on average, 75.6 (SD ± 7.5) years of age, 4% female, and 91.2% were White. MarketScan patients were 69.8 (SD ± 5.6) years of age, on average and 65.4% were female. After controlling for confounding, patients with, compared to without, Tdap vaccination had a significantly lower risk for dementia in both cohorts (VHA: hazard ratio [HR] = 0.58; 95% confidence interval [CI]:0.54-0.63 and MarketScan: HR = 0.58; 95% CI:0.48-0.70). CONCLUSIONS Tdap vaccination was associated with a 42% lower dementia risk in 2 cohorts with different clinical and sociodemographic characteristics. Several vaccine types are linked to decreased dementia risk, suggesting that these associations are due to nonspecific effects on inflammation rather than vaccine-induced pathogen-specific protective effects.
Collapse
Affiliation(s)
- Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, Missouri, USA.,Harry S. Truman Veterans Administration Medical Center, Columbia, Missouri, USA.,The AHEAD Institute, Saint Louis University School of Medicine, Missouri, USA
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, Missouri, USA.,Harry S. Truman Veterans Administration Medical Center, Columbia, Missouri, USA.,The AHEAD Institute, Saint Louis University School of Medicine, Missouri, USA
| | - Timothy L Wiemken
- The AHEAD Institute, Saint Louis University School of Medicine, Missouri, USA.,Department of Health and Clinical Outcomes Research, Saint Louis University School of Medicine, Missouri, USA.,Division of Infectious Diseases, Allergy, and Immunology, Department of Internal Medicine, Saint Louis University School of Medicine, Missouri, USA.,Saint Louis University Systems Infection Prevention Center, Center for Specialized Medicine, Missouri, USA
| | - Christine Jacobs
- Department of Family and Community Medicine, Saint Louis University School of Medicine, Missouri, USA.,The AHEAD Institute, Saint Louis University School of Medicine, Missouri, USA
| | - John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, Missouri, USA
| | - Daniel F Hoft
- Division of Infectious Diseases, Allergy, and Immunology, Department of Internal Medicine, Saint Louis University School of Medicine, Missouri, USA.,Saint Louis University Systems Infection Prevention Center, Center for Specialized Medicine, Missouri, USA.,Departments of Internal Medicine and Molecular Microbiology and Immunology, Saint Louis University, Missouri, USA
| |
Collapse
|
23
|
Wiemken TL, Rutschman AS. Development of vaccines for influenza disease: Opportunity costs of the COVID-19 pandemic. Vaccine 2021; 39:1025-1026. [PMID: 33461832 PMCID: PMC7794596 DOI: 10.1016/j.vaccine.2021.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 12/17/2020] [Accepted: 01/04/2021] [Indexed: 01/19/2023]
Affiliation(s)
- Timothy L Wiemken
- Saint Louis University School of Medicine, Department of Health and Clinical Outcomes Research, United States; Saint Louis University School of Medicine, Department of Medicine, Division of Infectious Diseases, Allergy, and Immunology, United States; Saint Louis University Health Innovation and Legal Preparedness Partnership, United States.
| | - Ana Santos Rutschman
- Saint Louis University Health Innovation and Legal Preparedness Partnership, United States; Saint Louis University School of Law, Center for Health Law Studies, United States; Saint Louis University School of Law, Center for International and Comparative Law, United States
| |
Collapse
|
24
|
Wiemken TL, Rutschman AS. Methodology minute: a machine learning primer for infection prevention and control. Am J Infect Control 2020; 48:1504-1505. [PMID: 33011334 PMCID: PMC7528905 DOI: 10.1016/j.ajic.2020.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 09/26/2020] [Indexed: 11/24/2022]
Abstract
Use of machine learning (ML) is becoming more common in healthcare. A general understanding of ML is necessary for IPs to make informed decisions about its use. Here, we provide a brief overview of salient concepts in ML for infection prevention.
The use of machine-learning and predictive modeling in infection prevention and control activities is increasing dramatically. In order for infection preventionists to make informed decisions on the performance of any particular model as well as to determine if the output of the model will be useful for their program needs, a suitable understanding of the creation and evaluation of these models is necessary. The purpose of this primer is to introduce the infection preventionist to the most commonly used machine-learning method in infection prevention: supervised learning.
Collapse
|
25
|
Wiemken TL, Wright MO, Johnston KJ. Association of hospital-area deprivation with hospital performance on health care associated infection rates in 2018. Am J Infect Control 2020; 48:1478-1484. [PMID: 32512080 DOI: 10.1016/j.ajic.2020.05.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/28/2020] [Accepted: 05/29/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Healthcare-associated infections (HAIs) are common and often preventable complications of care, with reduction emphasized in national policy. The Centers for Medicare and Medicaid Services introduced an HAI-focused Hospital Acquired Condition Reduction Program in 2015 to penalize poor-performing hospitals. Standardized infection ratios (SIRs) are used for comparisons between healthcare organizations, though they are not adjusted for socioeconomic risks known to impact infection. The objectives of this study were to assess the relationship between hospital-area deprivation with reported SIRs and reimbursement penalties. METHODS This was a cohort study using 2018 Hospital Compare, as well as area deprivation data and other hospital characteristics. Multivariable regression models were used to evaluate associations between hospital-area deprivation and SIR reporting as well as payment reduction, adjusting for case mix index and hospital ownership. RESULTS Of the 2102 unique hospitals in our study, 12.8% reported at least one worse than national benchmark SIR and 23.7% had a payment reduction. After adjustment, there was a 17% increased risk of reporting worse than benchmarked SIRs with quartile increases in deprivation (95% confidence interval: 5%-30%, P = .004). Despite this, there were no significant relationships between reimbursement penalties and ADI (risk ratio: 1.00, 95% confidence interval: 0.997-1.005, P = .567). CONCLUSIONS This study documented a significant relationship between hospital-area deprivation and the risk of reporting worse than national benchmark SIRs. Though this did not appear to translate to Hospital Acquired Condition Reduction Program penalties in this dataset, it reinforces problems with the current use of SIRs for interhospital comparisons.
Collapse
Affiliation(s)
- Timothy L Wiemken
- Saint Louis University Center for Health Outcomes Research, Saint Louis, MO; Division of Infectious Diseases, Allergy, and Immunology, Saint Louis University, Saint Louis, MO.
| | | | - Kenton J Johnston
- Saint Louis University College for Public Health and Social Justice Department of Health Management and Policy, Saint Louis, MO
| |
Collapse
|
26
|
Johnston KJ, Wiemken TL, Hockenberry JM, Figueroa JF, Joynt Maddox KE. Association of Clinician Health System Affiliation With Outpatient Performance Ratings in the Medicare Merit-based Incentive Payment System. JAMA 2020; 324:984-992. [PMID: 32897346 PMCID: PMC7489823 DOI: 10.1001/jama.2020.13136] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Integration of physician practices into health systems composed of hospitals and multispecialty practices is increasing in the era of value-based payment. It is unknown how clinicians who affiliate with such health systems perform under the new mandatory Centers for Medicare & Medicaid Services Merit-based Incentive Payment System (MIPS) relative to their peers. OBJECTIVE To assess the relationship between the health system affiliations of clinicians and their performance scores and value-based reimbursement under the 2019 MIPS. DESIGN, SETTING, AND PARTICIPANTS Publicly reported data on 636 552 clinicians working at outpatient clinics across the US were used to assess the association of the affiliation status of clinicians within the 609 health systems with their 2019 final MIPS performance score and value-based reimbursement (both based on clinician performance in 2017), adjusting for clinician, patient, and practice area characteristics. EXPOSURES Health system affiliation vs no affiliation. MAIN OUTCOMES AND MEASURES The primary outcome was final MIPS performance score (range, 0-100; higher scores intended to represent better performance). The secondary outcome was MIPS payment adjustment, including negative (penalty) payment adjustment, positive payment adjustment, and bonus payment adjustment. RESULTS The final sample included 636 552 clinicians (41% female, 83% physicians, 50% in primary care, 17% in rural areas), including 48.6% who were affiliated with a health system. Compared with unaffiliated clinicians, system-affiliated clinicians were significantly more likely to be female (46% vs 37%), primary care physicians (36% vs 30%), and classified as safety net clinicians (12% vs 10%) and significantly less likely to be specialists (44% vs 55%) (P < .001 for each). The mean final MIPS performance score for system-affiliated clinicians was 79.0 vs 60.3 for unaffiliated clinicians (absolute mean difference, 18.7 [95% CI, 18.5 to 18.8]). The percentage receiving a negative (penalty) payment adjustment was 2.8% for system-affiliated clinicians vs 13.7% for unaffiliated clinicians (absolute difference, -10.9% [95% CI, -11.0% to -10.7%]), 97.1% vs 82.6%, respectively, for those receiving a positive payment adjustment (absolute difference, 14.5% [95% CI, 14.3% to 14.6%]), and 73.9% vs 55.1% for those receiving a bonus payment adjustment (absolute difference, 18.9% [95% CI, 18.6% to 19.1%]). CONCLUSIONS AND RELEVANCE Clinician affiliation with a health system was associated with significantly better 2019 MIPS performance scores. Whether this represents differences in quality of care or other factors requires additional research.
Collapse
Affiliation(s)
- Kenton J. Johnston
- Department of Health Management and Policy, College for Public Health and Social Justice, St Louis University, St Louis, Missouri
- Department of Health and Clinical Outcomes Research, St Louis University, St Louis, Missouri
| | - Timothy L. Wiemken
- Department of Health and Clinical Outcomes Research, St Louis University, St Louis, Missouri
| | - Jason M. Hockenberry
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jose F. Figueroa
- Department of Health Policy and Management, T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Karen E. Joynt Maddox
- Cardiovascular Division, School of Medicine, Washington University in St Louis, St Louis, Missouri
| |
Collapse
|
27
|
Wiemken TL, Shacham E. Identifying potential undocumented COVID-19 using publicly reported influenza-like-illness and laboratory-confirmed influenza disease in the United States: An approach to syndromic surveillance? Am J Infect Control 2020; 48:961-963. [PMID: 32437754 PMCID: PMC7211575 DOI: 10.1016/j.ajic.2020.05.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/06/2020] [Accepted: 05/06/2020] [Indexed: 12/15/2022]
Abstract
In the absence of widespread testing, syndromic surveillance approaches may be useful for understanding potential undocumented coronavirus disease 2019 (COVID-19) in the United States. We used publicly available data from the Centers for Disease Control and Prevention FluView Interactive to evaluate its potential for COVID-19 syndromic surveillance. Unlike the prior 3 influenza seasons, we found a 76% decrease in influenza positive tests and a 27% increase in influenza like illness during the weeks since COVID-19 outbreaks began in the United States, which suggests FluView's potential utility for COVID-19 syndromic surveillance.
Collapse
Affiliation(s)
- Timothy L Wiemken
- Saint Louis University Center for Health Outcomes Research, Saint Louis, MO; Division of Infectious Diseases, Allergy, and Immunology, Saint Louis University, Saint Louis, MO; The Geospatial Institute at Saint Louis University, Saint Louis, MO.
| | - Enbal Shacham
- The Geospatial Institute at Saint Louis University, Saint Louis, MO; Department of Behavioral Science and Health Education, Saint Louis University College for Public Health and Social Justice, Saint Louis, MO
| |
Collapse
|
28
|
Wolfe AE, Moskowitz JE, Franklin CL, Wiemken TL, Ericsson AC. Interactions of Segmented Filamentous Bacteria (Candidatus Savagella) and bacterial drivers in colitis-associated colorectal cancer development. PLoS One 2020; 15:e0236595. [PMID: 32706816 PMCID: PMC7380633 DOI: 10.1371/journal.pone.0236595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/08/2020] [Indexed: 01/19/2023] Open
Abstract
Colorectal cancer (CRC) risk is influenced by host genetics, sex, and the gut microbiota. Using a genetically susceptible mouse model of CRC induced via inoculation with pathobiont Helicobacter spp. and demonstrating variable tumor incidence, we tested the ability of the Th17-enhancing commensal Candidatus Savagella, more commonly denoted as Segmented Filamentous Bacteria (SFB), to influence the incidence and severity of colitis-associated CRC in male and female mice. To document the composition of the gut microbiota during CRC development and identify taxa associated with disease, fecal samples were collected before and throughout disease development and characterized via 16S rRNA sequencing. While there were no significant SFB-dependent effects on disease incidence or severity, SFB was found to exert a sex-dependent protective effect in male mice. Furthermore, SFB stabilized the GM against Helicobacter-induced changes post-inoculation, resulting in a shift in disease association from Helicobacter spp. to Escherichia coli. These data support sex-dependent SFB-mediated effects on CRC risk, and highlight the complex community dynamics within the GM during exposure to inflammatory pathobionts.
Collapse
Affiliation(s)
- Annie E. Wolfe
- Molecular Pathogenesis and Therapeutics, University of Missouri, Columbia, Missouri, United States of America
| | - Jacob E. Moskowitz
- Department of Veterinary Pathobiology, University of Missouri, Columbia, Missouri, United States of America
| | - Craig L. Franklin
- Molecular Pathogenesis and Therapeutics, University of Missouri, Columbia, Missouri, United States of America
- Department of Veterinary Pathobiology, University of Missouri, Columbia, Missouri, United States of America
- University of Missouri Metagenomics Center, Columbia, Missouri, United States of America
- University of Missouri Mutant Mouse Resource and Research Center, Columbia, Missouri, United States of America
- University of Missouri College of Veterinary Medicine, Columbia, Missouri, United States of America
| | - Timothy L. Wiemken
- Saint Louis University Center for Health Outcomes Research, St. Louis, Missouri, United States of America
| | - Aaron C. Ericsson
- Molecular Pathogenesis and Therapeutics, University of Missouri, Columbia, Missouri, United States of America
- Department of Veterinary Pathobiology, University of Missouri, Columbia, Missouri, United States of America
- University of Missouri Metagenomics Center, Columbia, Missouri, United States of America
- University of Missouri Mutant Mouse Resource and Research Center, Columbia, Missouri, United States of America
- University of Missouri College of Veterinary Medicine, Columbia, Missouri, United States of America
- * E-mail:
| |
Collapse
|
29
|
Abstract
Machine learning approaches to modeling of epidemiologic data are becoming increasingly more prevalent in the literature. These methods have the potential to improve our understanding of health and opportunities for intervention, far beyond our past capabilities. This article provides a walkthrough for creating supervised machine learning models with current examples from the literature. From identifying an appropriate sample and selecting features through training, testing, and assessing performance, the end-to-end approach to machine learning can be a daunting task. We take the reader through each step in the process and discuss novel concepts in the area of machine learning, including identifying treatment effects and explaining the output from machine learning models.
Collapse
Affiliation(s)
- Timothy L. Wiemken
- Center for Health Outcomes Research, Saint Louis University, Saint Louis, Missouri 63104, USA
| | - Robert R. Kelley
- Department of Computer Science, Bellarmine University, Louisville, Kentucky 40205, USA
| |
Collapse
|
30
|
Wiemken TL, Carrico RM, Furmanek SP, Guinn BE, Mattingly WA, Peyrani P, Ramirez JA. Socioeconomic Position and the Incidence, Severity, and Clinical Outcomes of Hospitalized Patients With Community-Acquired Pneumonia. Public Health Rep 2020; 135:364-371. [PMID: 32228396 DOI: 10.1177/0033354920912717] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The influence of socioeconomic disparities on adults with pneumonia is not well understood. The objective of our study was to evaluate the relationship between community-level socioeconomic position, as measured by an area deprivation index, and the incidence, severity, and outcomes among adults with community-acquired pneumonia (CAP). METHODS This was an ancillary study of a population-based, prospective cohort study of patients hospitalized with CAP in Louisville, Kentucky, from June 1, 2013, through May 31, 2015. We used a race-specific, block group-level area deprivation index as a proxy for community-level socioeconomic position and evaluated it as a predictor of CAP incidence, CAP severity, early clinical improvement, 30-day mortality, and 1-year mortality. RESULTS The cohort comprised 6349 unique adults hospitalized with CAP. CAP incidence per 100 000 population increased significantly with increasing levels of area deprivation, from 303 in tertile 1 (low deprivation), to 467 in tertile 2 (medium deprivation), and 553 in tertile 3 (high deprivation) (P < .001). Adults in medium- and high-deprivation areas had significantly higher odds of severe CAP (tertile 2 odds ratio [OR] = 1.2 [95% confidence interval (CI), 1.06-1.39]; tertile 3 OR = 1.4 [95% CI, 1.18-1.64] and 1-year mortality (tertile 2 OR = 1.3 [95% CI, 1.11-1.54], tertile 3 OR = 1.3 [95% CI, 1.10-1.64]) than adults in low-deprivation areas. CONCLUSIONS Compared with adults residing in low-deprivation areas, adults residing in high-deprivation areas had an increased incidence of CAP, and they were more likely to have severe CAP. Beyond 30 days of care, we identified an increased long-term mortality for persons in high-deprivation areas. Community-level socioeconomic position should be considered an important factor for research in CAP and policy decisions.
Collapse
Affiliation(s)
- Timothy L Wiemken
- 7547 Center for Health Outcomes Research, Saint Louis University, St. Louis, MO, USA
| | - Ruth M Carrico
- 5170 Division of Infectious Diseases, Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Stephen P Furmanek
- 5170 Division of Infectious Diseases, Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Brian E Guinn
- 5170 Division of Infectious Diseases, Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - William A Mattingly
- 5170 Division of Infectious Diseases, Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Paula Peyrani
- 5170 Division of Infectious Diseases, Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Julio A Ramirez
- 5170 Division of Infectious Diseases, Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| |
Collapse
|
31
|
Wiemken TL, Rutschman AS, Niemotka SL, Hoft D. Thresholds versus Anomaly Detection for Surveillance of Pneumonia and Influenza Mortality. Emerg Infect Dis 2020. [DOI: 10.3201/eid2611.2007006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
32
|
Watson WH, Ritzenthaler JD, Peyrani P, Wiemken TL, Furmanek S, Reyes Vega AM, Burke TJ, Zheng Y, Ramirez JA, Roman J. Plasma cysteine/cystine and glutathione/glutathione disulfide redox potentials in HIV and COPD patients. Free Radic Biol Med 2019; 143:55-61. [PMID: 31369840 PMCID: PMC6848776 DOI: 10.1016/j.freeradbiomed.2019.07.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/10/2019] [Accepted: 07/28/2019] [Indexed: 12/16/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is prevalent in patients infected with HIV. The purpose of this study was to test the hypothesis that systemic oxidation correlates with loss of lung function in subjects with COPD, and that HIV infection can contribute to creating such an environment. Subjects were recruited at the University of Louisville in the following groups: HIV-infected (n = 36), COPD (n = 32), HIV and COPD (n = 28), and uninfected controls with normal lung function (n = 34). HIV infection was assessed by viral load and CD4 cell counts. Pulmonary function was determined by spirometry, and plasma was collected for measurement of cysteine (Cys), cystine (CySS), glutathione (GSH) and GSH disulfide (GSSG) by HPLC followed by estimation of redox potentials (Eh) using the Nernst equation. Results showed that patients with COPD had more oxidized plasma Eh Cys/CySS than patients with normal lung function, but plasma Eh GSH/GSSG was unaltered. In addition, there was a correlation between the extent of plasma Eh Cys/CySS oxidation and loss of lung function, and this correlation remained even after correcting for age, sex, race and body mass index. HIV infection per se was not associated with increased oxidation of plasma Eh Cys/CySS, but plasma Eh Cys/CySS was more oxidized in patients with lower CD4-positve T cell counts. In patients with both HIV infection and COPD, there was a significant correlation between CD4 cell counts and lung function. Thus, systemic oxidation correlated with decreased lung function in subjects with COPD and decreased CD4 counts in subjects infected with HIV. Thus, factors contributing to plasma Eh Cys/CySS may represent novel mechanisms underlying the increased prevalence of COPD in people living with HIV.
Collapse
Affiliation(s)
- Walter H Watson
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Louisville School of Medicine, USA; Department of Pharmacology & Toxicology, University of Louisville School of Medicine, USA.
| | - Jeffrey D Ritzenthaler
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Louisville School of Medicine, USA
| | - Paula Peyrani
- Department of Medicine, Division of Infectious Diseases, University of Louisville School of Medicine, USA
| | - Timothy L Wiemken
- Department of Medicine, Division of Infectious Diseases, University of Louisville School of Medicine, USA
| | - Stephen Furmanek
- Department of Medicine, Division of Infectious Diseases, University of Louisville School of Medicine, USA
| | - Andrea M Reyes Vega
- Department of Medicine, Division of Infectious Diseases, University of Louisville School of Medicine, USA
| | - Tom J Burke
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Louisville School of Medicine, USA
| | - Yuxuan Zheng
- Department of Pharmacology & Toxicology, University of Louisville School of Medicine, USA
| | - Julio A Ramirez
- Department of Medicine, Division of Infectious Diseases, University of Louisville School of Medicine, USA; Robley Rex VA Medical Center, Louisville, KY, USA
| | - Jesse Roman
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Louisville School of Medicine, USA; Robley Rex VA Medical Center, Louisville, KY, USA
| |
Collapse
|
33
|
McLaughlin JM, Jiang Q, Isturiz RE, Sings HL, Swerdlow DL, Gessner BD, Carrico RM, Peyrani P, Wiemken TL, Mattingly WA, Ramirez JA, Jodar L. Effectiveness of 13-Valent Pneumococcal Conjugate Vaccine Against Hospitalization for Community-Acquired Pneumonia in Older US Adults: A Test-Negative Design. Clin Infect Dis 2019; 67:1498-1506. [PMID: 29790925 PMCID: PMC6206101 DOI: 10.1093/cid/ciy312] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 04/12/2018] [Indexed: 12/02/2022] Open
Abstract
Background Following universal recommendation for use of 13-valent pneumococcal conjugate vaccine (PCV13) in US adults aged ≥65 years in September 2014, we conducted the first real-world evaluation of PCV13 vaccine effectiveness (VE) against hospitalized vaccine-type community-acquired pneumonia (CAP) in this population. Methods Using a test-negative design, we identified cases and controls from a population-based surveillance study of adults in Louisville, Kentucky, who were hospitalized with CAP. We analyzed a subset of CAP patients enrolled 1 April 2015 through 30 April 2016 who were aged ≥65 years and consented to have their pneumococcal vaccination history confirmed by health insurance records. Cases were defined as hospitalized CAP patients with PCV13 serotypes identified via culture or serotype-specific urinary antigen detection assay. Remaining CAP patients served as test-negative controls. Results Of 2034 CAP hospitalizations, we identified PCV13 serotypes in 68 (3.3%) participants (ie, cases), of whom 6 of 68 (8.8%) had a positive blood culture. Cases were less likely to be immunocompromised (29.4% vs 46.4%, P = .02) and overweight or obese (41.2% vs 58.6%, P = .01) compared to controls, but were otherwise similar. Cases were less likely to have received PCV13 than controls (3/68 [4.4%] vs 285/1966 [14.5%]; unadjusted VE, 72.8% [95% confidence interval, 12.8%−91.5%]). No confounding was observed during adjustment for patient characteristics, including immunocompromised status, body mass index, and history of influenza and pneumococcal polysaccharide vaccination (adjusted VE range, 71.1%−73.3%). Conclusions Our study is the first to demonstrate real-world effectiveness of PCV13 against vaccine-type CAP in adults aged ≥65 years following introduction into a national immunization program.
Collapse
Affiliation(s)
| | - Qin Jiang
- Pfizer Vaccines, Collegeville, Pennsylvania
| | | | | | | | | | - Ruth M Carrico
- Department of Medicine, Division of Infectious Diseases, School of Medicine, University of Louisville, Kentucky
| | - Paula Peyrani
- Department of Medicine, Division of Infectious Diseases, School of Medicine, University of Louisville, Kentucky
| | - Timothy L Wiemken
- Department of Epidemiology and Population Health, School of Public Health and Information Sciences, University of Louisville, Kentucky
| | - William A Mattingly
- Department of Medicine, Division of Infectious Diseases, School of Medicine, University of Louisville, Kentucky
| | - Julio A Ramirez
- Department of Medicine, Division of Infectious Diseases, School of Medicine, University of Louisville, Kentucky
| | - Luis Jodar
- Pfizer Vaccines, Collegeville, Pennsylvania
| |
Collapse
|
34
|
Abstract
Background Skin antisepsis occurs in every healthcare environment. From basic hand hygiene, to antiseptic bathing and pre surgical care with alcohol/chlorhexidine, use of antimicrobial agents to reduce the skin microflora has skyrocketed in the past several years. Although used in hopes of reducing the likelihood of infection in patients, many products have been identified as the source of infection in several outbreaks, sometimes due to the nonsterile nature of the many readily available antiseptics. Body Intrinsic contamination of antiseptics during the manufacturing process is common. In fact, since the majority of these products are sold as nonsterile, they are allowed some level of microbial contamination based on the United States Pharmacopeia documents 61 and 62. Unfortunately, sometimes this contamination is with microorganisms resistant to the antiseptic and/or with those pathogenic to humans. In this scenario, healthcare-associated infections may occur, leaving the patient at higher risk of mortality and increasing costs of care substantially. Although antibiotic stewardship programs throughout the world suggest targeting use of antibiotics to limit resistance, few healthcare environments include other antimicrobial agents (such as antiseptics) in their programs. Conclusion Due to the potential for contamination with pathogenic organisms and the increased likelihood of selecting for resistant organisms with widespread use of broad-spectrum agents with non-specific mechanisms of action, a discussion around including skin antiseptics in stewardship programs is necessary, particularly those labeled as nonsterile. At minimum, debating the pros and cons of targeting use of daily antiseptic bathing in hospitalized patients should occur. Through mindfully incorporating any antimicrobial agent, sterile or not, into our repertoire of anti-infectives, we can save patient lives, reduce infection, and save costs.
Collapse
Affiliation(s)
- Timothy L Wiemken
- Center for Health Outcomes Research, Saint Louis University, 3545 Lafayette Ave, #411, St. Louis, MO, 63108, USA.
| |
Collapse
|
35
|
Isturiz RE, Ramirez J, Self WH, Grijalva CG, Counselman FL, Volturo G, Ostrosky-Zeichner L, Peyrani P, Wunderink RG, Sherwin R, Overcash JS, Oliva SP, File T, Wiemken TL, McLaughlin JM, Pride MW, Gray S, Alexander R, Ford KD, Jiang Q, Jodar L. Pneumococcal epidemiology among us adults hospitalized for community-acquired pneumonia. Vaccine 2019; 37:3352-3361. [PMID: 31072732 DOI: 10.1016/j.vaccine.2019.04.087] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/12/2019] [Accepted: 04/16/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Few studies have measured the burden of adult pneumococcal disease after the introduction of 13-valent pneumococcal conjugate vaccine (PCV13) into the US infant vaccination schedule. Further, most data regarding pneumococcal serotypes are derived from invasive pneumococcal disease (IPD), which represents only a fraction of all adult pneumococcal disease burden. Understanding which pneumococcal serotypes cause pneumonia in adults is critical for informing current immunization policy. The objective of this study was to measure the proportion of radiographically-confirmed (CXR+) community-acquired pneumonia (CAP) caused by PCV13 serotypes in hospitalized US adults. METHODS This observational, prospective surveillance study recruited hospitalized adults aged ≥18 years from 21 acute care hospitals across 10 geographically-dispersed cities in the United States between October 2013 and September 2016. Clinical and demographic data were collected during hospitalization. Vital status was ascertained 30 days after enrollment. Pneumococcal serotypes were detected via culture from the respiratory tract and normally-sterile sites (including blood and pleural fluid). Additionally, a novel, Luminex-based serotype-specific urinary antigen detection (UAD) assay was used to detect serotypes included in PCV13. RESULTS Of 15,572 enrolled participants, 12,055 eligible patients with CXR+CAP were included in the final analysis population. Mean age was 64.1 years and 52.7% were aged ≥65 years. Common comorbidities included chronic obstructive pulmonary disease (43.0%) and diabetes mellitus (28.6%). PCV13 serotypes were detected in 552/12,055 (4.6%) of all patients and 265/6347 (4.2%) of those aged ≥65 years. Among patients aged 18-64 years PCV13 serotypes were detected in 3.8-5.3% of patients depending on their risk status. CONCLUSIONS After implementation of a pneumococcal conjugate vaccination program in US children, and despite the herd protection observed in US adults, a persistent burden of PCV13-type CAP remains in this population.
Collapse
Affiliation(s)
| | - Julio Ramirez
- Saint Louis University Center for Health Outcomes Research, St. Louis, MO, USA
| | - Wesley H Self
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Carlos G Grijalva
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Francis L Counselman
- Department of Emergency Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Gregory Volturo
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | | | | | | | - Robert Sherwin
- Department of Emergency Medicine, Wayne State University, Detroit, MI, USA
| | | | - Senen Pena Oliva
- Saint Louis University Center for Health Outcomes Research, St. Louis, MO, USA
| | - Thomas File
- Summa Health, Northeast Ohio Medical University, Akron, OH, USA
| | - Timothy L Wiemken
- Saint Louis University Center for Health Outcomes Research, St. Louis, MO, USA
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Wiemken TL, Hei H. Journal Club: Clothing and shoes of personnel as a potential vector for transfer of health care-associated pathogens to the community. Am J Infect Control 2019; 47:580-581. [PMID: 31023458 DOI: 10.1016/j.ajic.2019.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 02/28/2019] [Indexed: 11/26/2022]
|
37
|
Wiemken TL. Updates to our web-based infection prevention data toolkits. Am J Infect Control 2019; 47:112. [PMID: 30471968 DOI: 10.1016/j.ajic.2018.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 09/11/2018] [Indexed: 10/27/2022]
|
38
|
Arnold FW, Lopardo G, Wiemken TL, Kelley R, Peyrani P, Mattingly WA, Feldman C, Gnoni M, Maurici R, Ramirez JA. Macrolide therapy is associated with lower mortality in community-acquired bacteraemic pneumonia. Respir Med 2018; 140:115-121. [PMID: 29957272 DOI: 10.1016/j.rmed.2018.05.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 05/23/2018] [Accepted: 05/28/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Community-acquired pneumonia (CAP) has a potential complication of bacteremia. The objective of this study was to define the clinical outcomes of patients with CAP and bacteremia treated with and without a macrolide. MATERIALS AND METHODS Secondary analysis of the Community-Acquired Pneumonia Organization database of hospitalized patients with CAP. Patients with a positive blood culture were categorized based on the presence or absence of a macrolide in their initial antimicrobial regimen, and severity of their CAP. Outcomes included in-hospital all-cause mortality, 30-day mortality, length of stay, and time to clinical stability. RESULTS Among 549 patients with CAP and bacteremia, 247 (45%) were treated with a macrolide and 302 (55%) were not. The primary pathogen was Streptococcus pneumoniae (74%). Poisson regression with robust error variance models were used to compare the adjusted effects of each study group on the outcomes. The unadjusted 30-day mortality was 18.4% in the macrolide group, and 29.6% in the non-macrolide group (adjusted relative risk (aRR)0.81; 95% confidence interval (CI)0.50-1.33; P = 0.41). Unadjusted in-hospital all-cause mortality was 7.3% in the macrolide group, and 18.9% in the non-macrolide group (aRR 0.54, 95% CI 0.30-0.98; P = 0.043). Length of stay and time to clinical stability were not significantly different. CONCLUSIONS In-hospital mortality, but not 30-day mortality, was significantly better in the macrolide group. Our data support the use of a macrolide in hospitalized patients with CAP and bacteraemia.
Collapse
Affiliation(s)
- Forest W Arnold
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Louisville, Louisville, KY, United States.
| | - Gustavo Lopardo
- Hospital Professor Bernardo Houssay, Buenos Aires, Argentina.
| | - Timothy L Wiemken
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Louisville, Louisville, KY, United States.
| | - Robert Kelley
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Louisville, Louisville, KY, United States.
| | - Paula Peyrani
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Louisville, Louisville, KY, United States.
| | - William A Mattingly
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Louisville, Louisville, KY, United States.
| | - Charles Feldman
- Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Martin Gnoni
- Good Samaritan Hospital, Cincinnati, OH, United States.
| | - Rosemeri Maurici
- University Hospital, Federal University of Santa Catarina, Santa Catarina, Brazil.
| | - Julio A Ramirez
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Louisville, Louisville, KY, United States.
| | | |
Collapse
|
39
|
Kim RY, Ng AM, Persaud AK, Furmanek SP, Kothari YN, Price JD, Wiemken TL, Saad MA, Guardiola JJ, Cavallazzi RS. Antibiotic Timing and Outcomes in Sepsis. Am J Med Sci 2018; 355:524-529. [DOI: 10.1016/j.amjms.2018.02.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 02/18/2018] [Accepted: 02/19/2018] [Indexed: 11/26/2022]
|
40
|
Ramirez JA, Peyrani P, Mattingly WA, Arnold FW, Wiemken TL, Kelley RR, Wolf LA, Carrico RM, Clinical Research Coordinating Center Team. Research Support Infrastructure: Implementing A Clinical Research Coordinating Center. JRI 2018. [DOI: 10.18297/jri/vol2/iss1/8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
41
|
Chandler T, Furmanek SP, English CL, Glick C, Trail W, Daniels L, Owolabi U, Carrico R, Ramirez JA, Wiemken TL. Effectiveness of the Influenza Vaccine in Preventing Hospitalizations of Patients with Influenza Community-Acquired Pneumonia. JRI 2018. [DOI: 10.18297/jri/vol2/iss1/6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
42
|
Wiemken TL, Furmanek SP, Mattingly WA, Wright MO, Persaud AK, Guinn BE, Carrico RM, Arnold FW, Ramirez JA. Methods for computational disease surveillance in infection prevention and control: Statistical process control versus Twitter's anomaly and breakout detection algorithms. Am J Infect Control 2018; 46:124-132. [PMID: 28916373 DOI: 10.1016/j.ajic.2017.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/04/2017] [Accepted: 08/05/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although not all health care-associated infections (HAIs) are preventable, reducing HAIs through targeted intervention is key to a successful infection prevention program. To identify areas in need of targeted intervention, robust statistical methods must be used when analyzing surveillance data. The objective of this study was to compare and contrast statistical process control (SPC) charts with Twitter's anomaly and breakout detection algorithms. METHODS SPC and anomaly/breakout detection (ABD) charts were created for vancomycin-resistant Enterococcus, Acinetobacter baumannii, catheter-associated urinary tract infection, and central line-associated bloodstream infection data. RESULTS Both SPC and ABD charts detected similar data points as anomalous/out of control on most charts. The vancomycin-resistant Enterococcus ABD chart detected an extra anomalous point that appeared to be higher than the same time period in prior years. Using a small subset of the central line-associated bloodstream infection data, the ABD chart was able to detect anomalies where the SPC chart was not. DISCUSSION SPC charts and ABD charts both performed well, although ABD charts appeared to work better in the context of seasonal variation and autocorrelation. CONCLUSIONS Because they account for common statistical issues in HAI data, ABD charts may be useful for practitioners for analysis of HAI surveillance data.
Collapse
|
43
|
Faryar KA, Freeman CL, Persaud AK, Furmanek SP, Guinn BE, Mattingly WA, Wiemken TL, Buckner KA, Huecker MR. The Effects of Kentucky's Comprehensive Opioid Legislation on Patients Presenting with Prescription Opioid or Heroin Abuse to One Urban Emergency Department. J Emerg Med 2017; 53:805-814. [PMID: 29102093 DOI: 10.1016/j.jemermed.2017.08.066] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/28/2017] [Accepted: 08/11/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Prescription opioid abuse has increased to epidemic proportions in the United States. Kentucky, along with other states, passed comprehensive legislation to monitor and curb opioid prescribing. OBJECTIVES This paper characterizes patients who presented to the emergency department (ED) after abusing prescription opioids and heroin prior to and after the passage of House Bill 1 (HB1) in April 2012. METHODS Based on a retrospective review of ED visits from 2009-2014 in one urban adult facility, patients were included if the chief complaint or diagnosis was directly related to prescription opioid or heroin abuse. The primary outcome is the number and type of substance abused by each ED patient. RESULTS From 2009-2014, 2945 patients presented to the ED after prescription opioid or heroin abuse. The number of prescription opioid patients decreased from 215 (of 276 patients) in 2009 to 203 (of 697 patients) in 2014; 77.9% of patients abused opioids in 2009, vs. 29% in 2014 (a 63% decrease). The number of heroin patients increased from 61 in 2009 to 494 in 2014; 22% of patients in 2009 abused heroin, vs. 71% in 2014 (a 221% increase). Both piecewise regression and autoregressive integrated moving average trend models showed an increased trend in patient heroin abuse beginning in 2011-2012. CONCLUSIONS Our facility experienced a decrease in the number of patients who abused prescription opioids and an increase in the number of patients who abused heroin over the study period. The transition seemed to occur just prior to, or concurrent with, enforcement of statewide opioid legislation.
Collapse
Affiliation(s)
- Kiran A Faryar
- Department of Emergency Medicine, University of Louisville School of Medicine, Louisville, Kentucky
| | - Clifford L Freeman
- Department of Emergency Medicine, University of Louisville School of Medicine, Louisville, Kentucky
| | - Annuradha K Persaud
- Division of Infectious Diseases Clinical Research Support Program, University of Louisville School of Medicine, Louisville, Kentucky
| | - Stephen P Furmanek
- Division of Infectious Diseases Clinical Research Support Program, University of Louisville School of Medicine, Louisville, Kentucky
| | - Brian E Guinn
- Division of Infectious Diseases Clinical Research Support Program, University of Louisville School of Medicine, Louisville, Kentucky
| | - William A Mattingly
- Division of Infectious Diseases Clinical Research Support Program, University of Louisville School of Medicine, Louisville, Kentucky
| | - Timothy L Wiemken
- Division of Infectious Diseases Clinical Research Support Program, University of Louisville School of Medicine, Louisville, Kentucky
| | - Kimberley A Buckner
- Division of Infectious Diseases Clinical Research Support Program, University of Louisville School of Medicine, Louisville, Kentucky
| | - Martin R Huecker
- Department of Emergency Medicine, University of Louisville School of Medicine, Louisville, Kentucky
| |
Collapse
|
44
|
Furmanek S, English CL, Chandler T, Wiemken TL. Most Common Statistical Methodologies in Recent Clinical Studies of Community-Acquired Pneumonia. JRI 2017. [DOI: 10.18297/jri/vol1/iss4/9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
45
|
Alexander R, Peyrani P, Ramirez JA, Self WH, Grijalva C, Counselman F, Volturo GA, Kabler H, Ostrosky-Zeichner L, Wunderink R, Sherwin RL, Pena S, File T, Wiemken TL, Gray S, Pride M, Ford KD, Jiang Q, Isturiz R. Rationale and Methods of the Study Protocol: Streptococcus pneumoniae Serotypes in Adults 18 Years and Older with Radiographically-Confirmed Community-Acquired Pneumonia (CAP). JRI 2017. [DOI: 10.18297/jri/vol1/iss4/8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
46
|
Morello Gearhart A, Cavallazzi R, Peyrani P, Wiemken TL, Furmanek SP, Reyes-Vega A, Gauhar U, Rivas-Perez H, Roman J, Ramirez JA, Fernandez-Botran R. Lung Cytokines and Systemic Inflammation in Patients with COPD. JRI 2017. [DOI: 10.18297/jri/vol1/iss4/4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
47
|
Mattingly WA, Furmanek S, Sinclair CM, Wiemken TL. Distributing Data and Analysis Software Containers for Better Data Sharing in Clinical Research. JRI 2017. [DOI: 10.18297/jri/vol1/iss4/6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
48
|
Van Heiden S, Carrico R, Wiemken TL, Alexander R, McLaughlin JM, Jiang Q, Peyrani P, Mattingly WA, Furmanek SP, English CL, Pena S, Isturiz R, Ramirez JA. Level of Recall Bias Regarding Pneumococcal Vaccination History among Adults Hospitalized with Community-Acquired Pneumonia: Results from the University of Louisville Pneumonia Study. JRI 2017. [DOI: 10.18297/jri/vol1/iss4/3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
49
|
El-Kersh K, Jalil B, McClave SA, Cavallazzi R, Guardiola J, Guilkey K, Persaud AK, Furmanek SP, Guinn BE, Wiemken TL, Alhariri BC, Kellie SP, Saad M. Enteral nutrition as stress ulcer prophylaxis in critically ill patients: A randomized controlled exploratory study. J Crit Care 2017; 43:108-113. [PMID: 28865339 DOI: 10.1016/j.jcrc.2017.08.036] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 08/07/2017] [Accepted: 08/22/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE We investigated whether early enteral nutrition alone may be sufficient prophylaxis against stress-related gastrointestinal (GI) bleeding in mechanically ventilated patients. MATERIALS AND METHODS Prospective, double blind, randomized, placebo-controlled, exploratory study that included mechanically ventilated patients in medical ICUs of two academic hospitals. Intravenous pantoprazole and early enteral nutrition were compared to placebo and early enteral nutrition as stress-ulcer prophylaxis. The incidences of clinically significant and overt GI bleeding were compared in the two groups. RESULTS 124 patients were enrolled in the study. After exclusion of 22 patients, 102 patients were included in analysis: 55 patients in the treatment group and 47 patients in the placebo group. Two patients (one from each group) showed signs of overt GI bleeding (overall incidence 1.96%), and both patients experienced a drop of >3 points in hematocrit in a 24-hour period indicating a clinically significant GI bleed. There was no statistical significant difference in the incidence of overt or significant GI bleeding between groups (p=0.99). CONCLUSION We found no benefit when pantoprazole is added to early enteral nutrition in mechanically ventilated critically ill patients. The routine prescription of acid-suppressive therapy in critically ill patients who tolerate early enteral nutrition warrants further evaluation.
Collapse
Affiliation(s)
- Karim El-Kersh
- University of Louisville School of Medicine, Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Louisville, KY, United States.
| | - Bilal Jalil
- University of Louisville School of Medicine, Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Louisville, KY, United States
| | - Stephen A McClave
- University of Louisville School of Medicine, Department of Internal Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, KY, United States
| | - Rodrigo Cavallazzi
- University of Louisville School of Medicine, Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Louisville, KY, United States
| | - Juan Guardiola
- University of Louisville School of Medicine, Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Louisville, KY, United States
| | - Karen Guilkey
- University of Louisville School of Medicine, Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Louisville, KY, United States
| | - Annuradha K Persaud
- University of Louisville School of Medicine, Department of Internal Medicine, Division of Infectious Disease, University of Louisville, KY, United States
| | - Stephen P Furmanek
- University of Louisville School of Medicine, Department of Internal Medicine, Division of Infectious Disease, University of Louisville, KY, United States
| | - Brian E Guinn
- University of Louisville School of Medicine, Department of Internal Medicine, Division of Infectious Disease, University of Louisville, KY, United States
| | - Timothy L Wiemken
- University of Louisville School of Medicine, Department of Internal Medicine, Division of Infectious Disease, University of Louisville, KY, United States
| | - Bashar Chihada Alhariri
- University of Louisville School of Medicine, Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Louisville, KY, United States
| | - Scott P Kellie
- University of Louisville School of Medicine, Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Louisville, KY, United States
| | - Mohamed Saad
- University of Louisville School of Medicine, Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Louisville, KY, United States
| |
Collapse
|
50
|
Ramirez JA, Wiemken TL, Peyrani P, Arnold FW, Kelley R, Mattingly WA, Nakamatsu R, Pena S, Guinn BE, Furmanek SP, Persaud AK, Raghuram A, Fernandez F, Beavin L, Bosson R, Fernandez-Botran R, Cavallazzi R, Bordon J, Valdivieso C, Schulte J, Carrico RM. Adults Hospitalized With Pneumonia in the United States: Incidence, Epidemiology, and Mortality. Clin Infect Dis 2017; 65:1806-1812. [DOI: 10.1093/cid/cix647] [Citation(s) in RCA: 252] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 07/25/2017] [Indexed: 12/26/2022] Open
Affiliation(s)
| | | | - Paula Peyrani
- Department of Medicine, Division of Infectious Diseases
| | | | - Robert Kelley
- Department of Medicine, Division of Infectious Diseases
| | | | | | - Senen Pena
- Department of Medicine, Division of Infectious Diseases
| | - Brian E Guinn
- Department of Medicine, Division of Infectious Diseases
| | | | | | | | | | - Leslie Beavin
- Department of Medicine, Division of Infectious Diseases
| | - Rahel Bosson
- Department of Medicine, Division of Infectious Diseases
| | | | - Rodrigo Cavallazzi
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Disorders Medicine, University of Louisville, Kentucky
| | - Jose Bordon
- Infectious Diseases, Providence Hospital, Washington, District of Columbia
| | | | - Joann Schulte
- Louisville Metro Department of Public Health and Wellness, Kentucky
| | | | | |
Collapse
|