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4. Performance of Urinalysis Parameters in Predicting Urinary Tract Infection: Does One Size Fit All?

Author

Advani, Sonali D, North, Rebecca, Turner, Nicholas A, Ahmadi, Sahra, Denniss, Julia, Francis, Adero, Johnson, Rachel, Hasan, Anum, Mirza, Faryal, Pardue, Sarah, Rao, Meghana, Rosshandler, Yasmin, Tang, Helen, Schmader, Kenneth E, and Anderson, Deverick J

Subjects
*URINARY tract infection diagnosis, *PREDICTIVE tests, *SUPPURATION, *RESEARCH funding, *SEX distribution, *RETROSPECTIVE studies, *URINE, *AGE distribution, *URINALYSIS, *MEDICAL records, *ACQUISITION of data, *NITRITES
Abstract

In a multihospital cohort study of 3392 patients, positive urinalysis parameters had poor positive predictive value for diagnosing urinary tract infection (UTI). Combined urinalysis parameters (pyuria or nitrite) performed better than pyuria alone for ruling out UTI. However, performance of all urinalysis parameters was poor in older women. [ABSTRACT FROM AUTHOR]

Published
2024
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6. Bacteremia From a Presumed Urinary Source in Hospitalized Adults With Asymptomatic Bacteriuria

Author

Advani, Sonali D., primary, Ratz, David, additional, Horowitz, Jennifer K., additional, Petty, Lindsay A., additional, Fakih, Mohamad G., additional, Schmader, Kenneth, additional, Mody, Lona, additional, Czilok, Tawny, additional, Malani, Anurag N., additional, Flanders, Scott A., additional, Gandhi, Tejal N., additional, and Vaughn, Valerie M., additional

Published
2024
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9. 2818. Investigating Urinalysis Criteria that Predict UTI: Impact of age, sex, and urine culture thresholds

Author

Advani, Sonali, primary, North, Rebecca M, additional, Turner, Nicholas A, additional, Ahmadi, Sahra, additional, Denniss, Julia, additional, Francis, Adero, additional, Hasan, Anum, additional, Johnson, Rachel M, additional, Mirza, Faryal, additional, Pardue, Sarah, additional, Rao, Meghana V, additional, Rosshandler, Yasmin, additional, Tang, Helen, additional, Schmader, Kenneth E, additional, and Anderson, Deverick J, additional

Published
2023
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12. The next frontier of healthcare-associated infection (HAI) surveillance metrics: Beyond device-associated infections

Author

Advani, Sonali D., Cawcutt, Kelly, Klompas, Michael, Marschall, Jonas, Meddings, Jennifer, and Patel, Payal K.

Abstract

AbstractIn recent years, it has become increasingly evident that surveillance metrics for invasive device-associated infections (ie, central-line–associated bloodstream infections, ventilator-associated pneumonias, and catheter-associated urinary tract infections) do not capture all harms; they capture only a subset of healthcare-associated infections (HAIs). Although prevention of device-associated infections remains critical, we need to address the full spectrum of potential harms from device use and non–device-associated infections. These include complications associated with additional devices, such as peripheral venous and arterial catheters, non–device-associated infections such as nonventilator hospital-acquired pneumonia, and noninfectious device complications such as trauma, thrombosis, and acute lung injury. As authors of the device-associated infection sections in the SHEA/IDSA/APIC Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals, we highlight catheter-associated urinary tract infection as an example of the strengths and limitations of the current emphasis on device-associated infection surveillance, suggest performance metrics that present a more comprehensive picture of patient harm, and provide a high-level overview of similar issues with other infection surveillance measures.

Published
2024
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13. Introduction to A Compendium of Strategies to Prevent Healthcare-Associated Infections In Acute-Care Hospitals: 2022 Updates

Author

Yokoe, Deborah S., primary, Advani, Sonali D., additional, Anderson, Deverick J., additional, Babcock, Hilary M., additional, Bell, Michael, additional, Berenholtz, Sean M., additional, Bryant, Kristina A., additional, Buetti, Niccolò, additional, Calderwood, Michael S., additional, Calfee, David P., additional, Deloney, Valerie M., additional, Dubberke, Erik R., additional, Ellingson, Katherine D., additional, Fishman, Neil O., additional, Gerding, Dale N., additional, Glowicz, Janet, additional, Hayden, Mary K., additional, Kaye, Keith S., additional, Kociolek, Larry K., additional, Landon, Emily, additional, Larson, Elaine L., additional, Malani, Anurag N., additional, Marschall, Jonas, additional, Meddings, Jennifer, additional, Mermel, Leonard A., additional, Patel, Payal K., additional, Perl, Trish M., additional, Popovich, Kyle J., additional, Schaffzin, Joshua K., additional, Septimus, Edward, additional, Trivedi, Kavita K., additional, Weinstein, Robert A., additional, and Maragakis, Lisa L., additional

Published
2023
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14. Executive Summary: A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute-Care Hospitals: 2022 Updates

Author

Yokoe, Deborah S., primary, Advani, Sonali D., additional, Anderson, Deverick J., additional, Babcock, Hilary M., additional, Bell, Michael, additional, Berenholtz, Sean M., additional, Bryant, Kristina A., additional, Buetti, Niccolò, additional, Calderwood, Michael S., additional, Calfee, David P., additional, Dubberke, Erik R., additional, Ellingson, Katherine D., additional, Fishman, Neil O., additional, Gerding, Dale N., additional, Glowicz, Janet, additional, Hayden, Mary K., additional, Kaye, Keith S., additional, Klompas, Michael, additional, Kociolek, Larry K., additional, Landon, Emily, additional, Larson, Elaine L., additional, Malani, Anurag N., additional, Marschall, Jonas, additional, Meddings, Jennifer, additional, Mermel, Leonard A., additional, Patel, Payal K., additional, Perl, Trish M., additional, Popovich, Kyle J., additional, Schaffzin, Joshua K., additional, Septimus, Edward, additional, Trivedi, Kavita K., additional, Weinstein, Robert A., additional, and Maragakis, Lisa L., additional

Published
2023
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15. Antimicrobial Stewardship Training for Infectious Diseases Fellows : Program Directors Identify a Curriculum Need

Author

Luther, Vera P., Shnekendorf, Rachel, Abbo, Lilian M., Advani, Sonali, Armstrong, Wendy S., Barsoumian, Alice E., Beeler, Cole B., Bystritsky, Rachel, Cherabuddi, Kartikeya, Cohen, Seth, Hamilton, Keith W., Ince, Dilek, Justo, Julie Ann, Logan, Ashleigh, III, John B. Lynch, Nori, Priya, Ohl, Christopher A., Patel, Payal K., Pottinger, Paul S., Schwartz, Brian S., Stack, Conor, and Zhou, Yuan

Published
2018

16. Cytomegalovirus Colitis and Colon Adenocarcinoma: A Case of Unusual Co-existence.

Author

JAVALGI, ANITA PANDIT, ADVANI, SONALI TULSI, and ATHANIKAR, VIDISHA S

Subjects
*MULTIDETECTOR computed tomography, *COLON (Anatomy), *SIGMOID colon, *LARGE intestine, *CYTOMEGALOVIRUS diseases, *ALPHAVIRUSES
Abstract

The possible association of Cytomegalovirus (CMV) with human colorectal adenocarcinomas was first reported in 1978 by Huang and Roche, who detected CMV DNA in 4 of 7 colonic adenocarcinomas by membrane complementary Ribonucleic AcidDeoxyribonucleic Acid (RNA-DNA) hybridisation. CMV earns its name from the characteristic cytomegalic appearance of intranuclear inclusions in infected cells, which include endothelial cells, histiocytes, macrophages, and epithelial cells. The most common site of CMV infection in the gastrointestinal tract is the colon (55%), followed by the sigmoid colon and rectum (35%) and the gastric antrum (25%). Here, a middle-aged female presenting with pain in the lower abdomen, which was insidious in onset and gradually progressive. Ultrasonography revealed a large intestine dilated and filled with multiple air-fluid levels, indicating bowel obstruction. Multidetector Computed Tomography (MDCT) showed circumferential wall thickening involving the distal half of the transverse colon and descending colon. The case was subjected to laparotomy. The resected segment of the colon was sent for histopathological evaluation, and microscopic examination showed adenocarcinoma and many mucosal ulcers, which on keen observation revealed viral inclusions. The diagnosis of colon adenocarcinoma, with a pathological staging of pT2N0Mx with CMV infection, was rendered. CMV infection was confirmed by immunohistochemistry. The patient was on post-surgery chemotherapy and receiving ganciclovir. On follow-up, the patient was recovering fine. Histopathology examination and IHC remain the gold standard in diagnosing CMV, and the concurrent occurrence of colitis and carcinoma should be kept in mind to assist in proper management. [ABSTRACT FROM AUTHOR]

Published
2024
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19. Diagnostic stewardship to improve patient outcomes and healthcare-associated infection (HAI) metrics

Author

Singh, Harjot K., Claeys, Kimberly C., Advani, Sonali D., Ballam, Yolanda J., Penney, Jessica, Schutte, Kirsten M., Baliga, Christopher, Milstone, Aaron M., Hayden, Mary K., Morgan, Daniel J., and Diekema, Daniel J.

Abstract

AbstractDiagnostic stewardship seeks to improve ordering, collection, performance, and reporting of tests. Test results play an important role in reportable HAIs. The inclusion of HAIs in public reporting and pay for performance programs has highlighted the value of diagnostic stewardship as part of infection prevention initiatives. Inappropriate testing should be discouraged, and approaches that seek to alter testing solely to impact a reportable metric should be avoided. HAI definitions should be further adapted to new testing technologies, with focus on actionable and clinically relevant test results that will improve patient care.

Published
2024
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30. 1571. Hospital COVID-19 Burden Impact on Inpatient Antibiotic Use Rates

Author

Ashley, Elizabeth Dodds, primary, Lokhnygina, Yuliya, additional, Doughman, Danielle, additional, Foy, Katherine R, additional, Nelson, Alicia D, additional, Dyer, April, additional, Jones, Travis M, additional, Johnson, Melissa D, additional, Davis, Angelina, additional, Advani, Sonali D, additional, Cromer, Andrea, additional, Mavrogiorgos, Nikolaos, additional, Daniels, Lindsay M, additional, Marx, Ashley H, additional, Kalu, Ibukun, additional, Sickbert-Bennett, Emily, additional, Shaefer Spires, S, additional, Anderson, Deverick J, additional, and Moehring, Rebekah W, additional

Published
2022
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35. Your Outpatient has Coronavirus Disease 2019: What Are the Treatment Options in the Current Severe Acute Respiratory Syndrome Coronavirus 2 Variant Climate?

Author

Werbel, William A, Weld, Ethel D, Advani, Sonali D, Patel, Payal K, Sundaram, Maria E, and Phadke, Varun K

Subjects
THERAPEUTIC use of monoclonal antibodies, COVID-19, IMMUNIZATION, ANTIVIRAL agents, RISK assessment, TREATMENT effectiveness, MEDICAL protocols, INFECTION control, RITONAVIR, HOSPITAL care
Abstract

Mutations accumulated by novel Severe Acute Respiratory Syndrome Coronavirus 2 Omicron sublineages contribute to evasion of previously effective monoclonal antibodies for treatment or prevention of Coronavirus Disease 2019 (COVID-19). Other authorized or approved antiviral drugs such as nirmatrelvir/ritonavir, remdesivir, and molnupiravir are, however, predicted to maintain activity against these sublineages and are key tools to reduce severe COVID-19 outcomes in vulnerable populations. A stepwise approach may be taken to target the appropriate antiviral drug to the appropriate patient, beginning with identifying whether a patient is at high risk for hospitalization or other complications of COVID-19. Among higher risk individuals, patient profile (including factors such as age, organ function, and comedications) and antiviral drug access inform suitable antiviral drug selection. When applied in targeted fashion, these therapies serve as a complement to vital ongoing nonpharmaceutical interventions and vaccination strategies that reduce morbidity and maximize protection against COVID-19. [ABSTRACT FROM AUTHOR]

Published
2023
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36. Strategies to prevent catheter-associated urinary tract infections in acute-care hospitals: 2022 Update

Author

Patel, Payal K., Advani, Sonali D., Kofman, Aaron D., Lo, Evelyn, Maragakis, Lisa L., Pegues, David A., Pettis, Ann Marie, Saint, Sanjay, Trautner, Barbara, Yokoe, Deborah S., and Meddings, Jennifer

Abstract

Abstract and purposeThe intent of this document is to highlight practical recommendations in a concise format designed to assist physicians, nurses, and infection preventionists at acute-care hospitals in implementing and prioritizing their catheter-associated urinary tract infection (CAUTI) prevention efforts. This document updates the Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute-Care Hospitalspublished in 2014. It is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission.

Published
2023
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37. Colon surgical-site infections and the impact of “present at the time of surgery (PATOS)” in a large network of community hospitals

Author

Seidelman, Jessica L., Ge, Maojun, Baker, Arthur W., Lewis, Sarah, Advani, Sonali D., Smith, Becky, and Anderson, Deverick J.

Abstract

AbstractObjectives:To describe the epidemiology of complex colon surgical procedures (COLO), stratified by present at time of surgery (PATOS) surgical-site infections (SSIs) and non-PATOS SSIs and their impact on the epidemiology of colon-surgery SSIs.Design:Retrospective cohort study.Methods:SSI data were prospectively collected from patients undergoing colon surgical procedures (COLOs) as defined by the National Healthcare Safety Network (NHSN) at 34 community hospitals in the southeastern United States from January 2015 to June 2019. Logistic regression models identified specific characteristics of complex COLO SSIs, complex non-PATOS COLO SSIs, and complex PATOS COLO SSIs.Results:Over the 4.5-year study period, we identified 720 complex COLO SSIs following 28,188 COLO surgeries (prevalence rate, 2.55 per 100 procedures). Overall, 544 complex COLO SSIs (76%) were complex non-PATOS COLO SSIs (prevalence rate [PR], 1.93 per 100 procedures) and 176 (24%) complex PATOS COLO SSIs (PR, 0.62 per 100 procedures). Age >75 years and operation duration in the >75th percentile were independently associated with non-PATOS SSIs but not PATOS SSIs. Conversely, emergency surgery and hospital volume for COLO procedures were independently associated with PATOS SSIs but not non-PATOS SSIs. The proportion of polymicrobial SSIs was significantly higher for non-PATOS SSIs compared with PATOS SSIs.Conclusions:Complex PATOS COLO SSIs have distinct features from complex non-PATOS COLO SSIs. Removal of PATOS COLO SSIs from public reporting allows more accurate comparisons among hospitals that perform different case mixes of colon surgeries.

Published
2023
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38. 424. The Impact of COVID-19 Response on Infection Prevention Programs and Practices in Southeastern United States

Author

Advani, Sonali D, primary, Advani, Sonali D, additional, Cromer, Andrea, additional, Wood, Brittain A, additional, Baker, Esther, additional, Crawford, Kathryn L, additional, Crane, Linda, additional, Roach, Linda, additional, Padgette, Polly W, additional, Ashley, Elizabeth Dodds, additional, Akinboyo, Ibukunoluwa, additional, Weber, David J, additional, Sickbert-Bennett, Emily, additional, and Anderson, Deverick J, additional

Published
2021
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39. 172. Impact of COVID-19 Pandemic on Healthcare-associated Infections (HAIs) in a Large Network of Hospitals

Author

Advani, Sonali D, primary, Advani, Sonali D, additional, Sickbert-Bennett, Emily, additional, Ashley, Elizabeth Dodds, additional, Cromer, Andrea, additional, Lokhnygina, Yuliya, additional, Nelson, Alicia, additional, Akinboyo, Ibukunoluwa, additional, DiBiase, Lauren, additional, Weber, David J, additional, and Anderson, Deverick J, additional

Published
2021
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42. The Disproportionate Impact of Coronavirus Disease 2019 (COVID-19) Pandemic on Healthcare-Associated Infections in Community Hospitals: Need for Expanding the Infectious Disease Workforce.

Author

Advani, Sonali D, Sickbert-Bennett, Emily, Moehring, Rebekah, Cromer, Andrea, Lokhnygina, Yuliya, Dodds-Ashley, Elizabeth, Kalu, Ibukunoluwa C, DiBiase, Lauren, Weber, David J, Anderson, Deverick J, and Program, for the CDC Prevention Epicenters

Subjects
*HOSPITALS, *RESEARCH, *STATISTICS, *CATHETER-related infections, *CROSS infection, *EMPLOYEE recruitment, *RETROSPECTIVE studies, *REGRESSION analysis, *LABOR supply, *RISK assessment, *CATHETER-associated urinary tract infections, *CLOSTRIDIUM diseases, *VENTILATOR-associated pneumonia, *COVID-19 pandemic, *LONGITUDINAL method, *BLOODBORNE infections
Abstract

Background The coronavirus disease 2019 (COVID-19) pandemic had a considerable impact on US healthcare systems, straining hospital resources, staff, and operations. However, a comprehensive assessment of the impact on healthcare-associated infections (HAIs) across different hospitals with varying level of infectious disease (ID) physician expertise, resources, and infrastructure is lacking. Methods This retrospective longitudinal multicenter cohort study included central-line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), Clostridioides difficile infections (CDIs), and ventilator-associated events (VAEs) from 53 hospitals (academic and community) in Southeastern United States from 1 January 2018 to 31 March 2021. Segmented negative binomial regression generalized estimating equations models estimated changes in monthly incidence rates in the baseline (01/2018–02/2020) compared to the pandemic period (03/2020–03/2021, further divided into three pandemic phases). Results CLABSIs and VAEs increased by 24% and 34%, respectively, during the pandemic period. VAEs increased in all phases of the pandemic, while CLABSIs increased in later phases of the pandemic. CDI trend increased by 4.2% per month in the pandemic period. On stratifying the analysis by hospital characteristics, the impact of the pandemic on healthcare-associated infections was more significant in smaller sized and community hospitals. CAUTIs did not change significantly during the pandemic across all hospital types. Conclusions CLABSIs, VAEs, and CDIs increased significantly during the pandemic, especially in smaller community hospitals, most of which lack ID physician expertise. Future efforts should focus on better understanding challenges faced by community hospitals, strengthening the infection prevention infrastructure, and expanding the ID workforce, particularly to community hospitals. [ABSTRACT FROM AUTHOR]

Published
2023
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47. 106. Pandemic Pinch: The Impact of COVID Response on Antimicrobial Stewardship Program (ASP) Resource Allocation

Author

Ashley, Elizabeth Dodds, primary, Dyer, April, additional, Jones, Travis M, additional, Johnson, Melissa D, additional, Davis, Angelina, additional, Foy, Katherine R, additional, Nelson, Alicia, additional, Advani, Sonali D, additional, Cromer, Andrea, additional, Doughman, Danielle, additional, Akinboyo, Ibukunoluwa, additional, Sickbert-Bennett, Emily, additional, Moehring, Rebekah W, additional, Anderson, Deverick J, additional, and Spires, Steven S, additional

Published
2021
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49. Surgical site infection trends in community hospitals from 2013 to 2018

Author

Seidelman, Jessica L., Baker, Arthur W., Lewis, Sarah S., Advani, Sonali D., Smith, Becky, and Anderson, Deverick

Abstract

AbstractObjective:Sparse recent data are available on the epidemiology of surgical site infections (SSIs) in community hospitals. Our objective was to provide updated epidemiology data on complex SSIs in community hospitals and to characterize trends of SSI prevalence rates over time.Design:Retrospective cohort study.Methods:SSI data were collected from patients undergoing 26 commonly performed surgical procedures at 32 community hospitals in the southeastern United States from 2013 to 2018. SSI prevalence rates were calculated for each year and were stratified by procedure and causative pathogen.Results:Over the 6-year study period, 3,561 complex (deep incisional or organ-space) SSIs occurred following 669,467 total surgeries (prevalence rate, 0.53 infections per 100 procedures). The overall complex SSI prevalence rate did not change significantly during the study period: 0.58 of 100 procedures in 2013 versus 0.53 of 100 procedures in 2018 (prevalence rate ratio [PRR], 0.84; 95% CI, 0.66–1.08; P= .16). Methicillin-sensitive Staphylococcus aureus(MSSA) complex SSIs (n = 480, 13.5%) were more common than complex SSIs caused by methicillin-resistant S. aureus(MRSA; n = 363, 10.2%).Conclusions:The complex SSI rate did not decrease in our cohort of community hospitals from 2013 to 2018, which is a change from prior comparisons. The reason for this stagnation is unclear. Additional research is needed to determine the proportion of or remaining SSIs that are preventable and what measures would be effective to further reduce SSI rates.

Published
2023
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50. The impact of coronavirus disease 2019 (COVID-19) response on hospital infection prevention programs and practices in the southeastern United States

Author

Advani, Sonali D., Cromer, Andrea, Wood, Brittain, Baker, Esther, Crawford, Kathryn L., Crane, Linda, Roach, Linda, Padgette, Polly, Dodds-Ashley, Elizabeth, Kalu, Ibukunoluwa C., Weber, David J., Sickbert-Bennett, Emily, and Anderson, Deverick J.

Abstract

AbstractInitial assessments of coronavirus disease 2019 (COVID-19) preparedness revealed resource shortages and variations in infection prevention policies across US hospitals. Our follow-up survey revealed improvement in resource availability, increase in testing capacity, and uniformity in infection prevention policies. Most importantly, the survey highlighted an increase in staffing shortages and use of travel nursing.

Published
2023
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