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6. Implementing the Infectious Diseases Society of America Antimicrobial Stewardship Core Curriculum: Survey Results and Real-World Strategies to Guide Fellowship Programs.

Author

Hojat, Leila S, Patel, Payal K, Ince, Dilek, Kang, Amy Y, Fong, Gary, Cherabuddi, Kartik, Nori, Priya, Lawati, Hawra Al, Stohs, Erica J, Beeler, Cole, Schooneveld, Trevor C Van, Lee, Matthew S, Hamilton, Keith W, Justo, Julie Ann, Spicer, Jennifer O, Logan, Ashleigh, Bennani, Kenza, Williams, Rostam, Shnekendorf, Rachel, and Bryson-Cahn, Chloe

Subjects
CURRICULUM implementation, REQUIRED courses (Education), CURRICULUM planning, MEDICAL fellowships, ANTIMICROBIAL stewardship
Abstract

Background The Infectious Diseases Society of America (IDSA) developed the Core Antimicrobial Stewardship (AS) Curriculum to meet the increasing demand for infectious diseases (ID) providers with AS expertise. Notable diversity in implementation approaches has been observed among ID fellowship programs using the curriculum. We sought to describe individual approaches and develop a curriculum implementation roadmap. Methods We surveyed ID fellowship programs that had previously implemented the IDSA Core AS curriculum. The survey included questions regarding program characteristics, curriculum participants and presentation format, resources and barriers, and implementation strategies. Commonly reported program features were summarized in the context of the self-reported implementation strategies. Implementation guides were developed based on the most common characteristics observed. Results Of 159 programs that had purchased the curriculum, 37 responded, and 34 (21%) were included in the analysis. The curriculum was primarily taught by AS physicians (85%) and AS pharmacists (47%). The most common conference structure was a longitudinal conference series (32%), and eLearning was the most common presentation format. Limited AS faculty time (76%) and limited first-year fellow availability (62%) were frequently reported as barriers, and dedicated AS curricular time was a resource available to most programs (67%); implementation guides were created for these 3 program features. Conclusions Programs reported a variety of implementation barriers and resources, with several common themes emerging, allowing for the development of tailored curriculum planners for 3 commonly observed program characteristics. This work will equip fellowship programs with curriculum implementation strategies and guide future enhancements of the IDSA Core and Advanced AS curricula. [ABSTRACT FROM AUTHOR]

Published
2024
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10. 765. Development of an Adaptable Roadmap for Implementation of the Infectious Diseases Society of America Core Antimicrobial Stewardship Curriculum in Infectious Diseases Fellowship Programs

Author

Hojat, Leila S, primary, Patel, Payal K, additional, Nori, Priya, additional, Hamilton, Keith W, additional, Justo, Julie Ann, additional, Spicer, Jennifer O, additional, Logan, Ashleigh, additional, Bennani, Kenza, additional, Lee, Matthew S, additional, Bryson-Cahn, Chloe, additional, Stohs, Erica J, additional, Willis, Zachary, additional, Moenster, Ryan P, additional, Van Schooneveld, Trevor C, additional, Brennan-Krohn, Thea, additional, Beeler, Cole, additional, Kang, Amy Y, additional, Al Lawani, Hawra, additional, Cherabuddi, Kartik, additional, Fong, Gary, additional, Ince, Dilek, additional, Holubar, Marisa, additional, Paras, Molly L, additional, Gaston, David, additional, Shnekendorf, Rachel A, additional, Williams, Rostam, additional, and Luther, Vera, additional

Published
2023
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11. 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

15. Orthopoxvirus Testing Challenges for Persons in Populations at Low Risk or Without Known Epidemiologic Link to Monkeypox--United States, 2022

Author

Minhaj, Faisal S., Petras, Julia K., Brown, Jennifer A., Mangla, Anil T., Russo, Kelly, Willut, Christina, Lee, Michelle, Beverley, Jason, Harold, Rachel, Milroy, Lauren, Pope, Brian, Gould, Emily, Beeler, Cole, Schneider, Jack, Mostafa, Heba H., Godfred-Cato, Shana, Click, Eleanor S., Borah, Brian F., Galang, Romeo R., Cash-Goldwasser, Shama, Wong, Joshua M., McCormick, David W., Yu, Patricia A., Shelus, Victoria, Carpenter, Ann, Schatzman, Sabrina, Lowe, David, Townsend, Michael B., Davidson, Whitni, Wynn, Nhien T., Satheshkumar, Panayampalli S., O'Connor, Siobhan M., O'Laughlin, Kevin, Rao, Agam K., McCollum, Andrea M., Negron, Maria E., Hutson, Christina L., and Salzer, Johanna S.

Subjects
Human monkeypox, Health
Abstract

On September 2, 2022, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr). Since May 2022, approximately 20,000 cases of monkeypox have been identified in [...]

Published
2022

18. Microbiology of bile aspirates obtained at ERCP in patients with suspected acute cholangitis

Author

Gromski, Mark A., additional, Gutta, Aditya, additional, Lehman, Glen A., additional, Tong, Yan, additional, Fogel, Evan L., additional, Watkins, James L., additional, Easler, Jeffrey J., additional, Bick, Benjamin L., additional, McHenry, Lee, additional, Beeler, Cole, additional, Relich, Ryan F., additional, Schmitt, Bryan H., additional, and Sherman, Stuart, additional

Published
2022
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19. Clinical Comparison and Agreement of PCR, Antigen, and Viral Culture for the Diagnosis of COVID-19

Author

Agard, Amanda, primary, Elsheikh, Omar, additional, Bell, Drew, additional, Relich, Ryan, additional, Schmitt, Bryan, additional, Sadowski, Josh, additional, Fadel, William, additional, Webb, Douglas, additional, Dbeibo, Lana, additional, Kelley, Kristen, additional, Carozza, Mariel, additional, Lei, Guang-Shen, additional, Calkins, Paul, additional, and Beeler, Cole, additional

Published
2022
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21. Evaluation of the Infectious Diseases Society of America’s Core Antimicrobial Stewardship Curriculum for Infectious Diseases Fellows

Author

Spicer, Jennifer O, primary, Armstrong, Wendy S, additional, Schwartz, Brian S, additional, Abbo, Lilian M, additional, Advani, Sonali D, additional, Barsoumian, Alice E, additional, Beeler, Cole, additional, Bennani, Kenza, additional, Holubar, Marisa, additional, Huang, Misha, additional, Ince, Dilek, additional, Justo, Julie Ann, additional, Lee, Matthew S L, additional, Logan, Ashleigh, additional, MacDougall, Conan, additional, Nori, Priya, additional, Ohl, Christopher, additional, Patel, Payal K, additional, Pottinger, Paul S, additional, Shnekendorf, Rachel, additional, Stack, Conor, additional, Van Schooneveld, Trevor C, additional, Willis, Zachary I, additional, Zhou, Yuan, additional, and Luther, Vera P, additional

Published
2021
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22. Investing in the Future: A Role for Professional Societies to Prepare the Next Generation of Healthcare Leaders Through Curriculum Development and Dissemination

Author

Luther, Vera P, primary, Shnekendorf, Rachel, additional, Logan, Ashleigh, additional, Advani, Sonali D, additional, Barsoumian, Alice E, additional, Beeler, Cole, additional, Bennani, Kenza, additional, Cherabuddi, Kartikeya, additional, Holubar, Marisa, additional, Huang, Misha, additional, Ince, Dilek, additional, Justo, Julie Ann, additional, Lee, Matthew S L, additional, MacDougall, Conan, additional, Nori, Priya, additional, Ohl, Christopher A, additional, Patel, Payal K, additional, Pottinger, Paul S, additional, Spicer, Jennifer O, additional, Stack, Conor, additional, Van Schooneveld, Trevor C, additional, and Willis, Zachary I, additional

Published
2021
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29. 1111. #BeASteward: Transforming Infectious Diseases Fellows Into Antimicrobial Stewards Using the IDSA Antimicrobial Stewardship Curriculum

Author

Luther, Vera, primary, Shnekendorf, Rachel A, additional, Jennifer, Spicer O, additional, Logan, Ashleigh, additional, Barsoumian, Alice, additional, Schwartz, Brian, additional, Bryson-Cahn, Chloe, additional, Ohl, Christopher, additional, Beeler, Cole, additional, MacDougall, Conan, additional, Stack, Conor, additional, Ince, Dilek, additional, Lynch, John B, additional, Justo, Julie Ann, additional, Cherabuddi, Kartikeya, additional, Hamilton, Keith W, additional, Bennani, Kenza, additional, Abbo, Lilian M, additional, Holubar, Marisa, additional, Lee, Matthew S L, additional, Huang, Misha, additional, Pottinger, Paul, additional, Patel, Payal K, additional, Nori, Priya, additional, Bystritsky, Rachel, additional, Cohen, Seth, additional, Advani, Sonali D, additional, Van Schooneveld, Trevor C, additional, Armstrong, Wendy, additional, Zhou, Yuan, additional, and Willis, Zach, additional

Published
2020
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31. Utilizing a real-time discussion approach to improve the appropriateness of Clostridioides difficile testing and the potential unintended consequences of this strategy

Author

Dbeibo, Lana, primary, Brinkman, Allison, additional, Beeler, Cole, additional, Fadel, William, additional, Snyderman, William, additional, Hatfield, Nicole, additional, Sadowski, Joshua, additional, Wang, Yun, additional, Kelley, Kristen, additional, Webb, Douglas, additional, Azar, Jose, additional, and Kara, Areeba, additional

Published
2020
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32. Evaluation of the Infectious Diseases Society of America's Core Antimicrobial Stewardship Curriculum for Infectious Diseases Fellows.

Author

Spicer, Jennifer O, Armstrong, Wendy S, Schwartz, Brian S, Abbo, Lilian M, Advani, Sonali D, Barsoumian, Alice E, Beeler, Cole, Bennani, Kenza, Holubar, Marisa, Huang, Misha, Ince, Dilek, Justo, Julie Ann, Lee, Matthew S L, Logan, Ashleigh, MacDougall, Conan, Nori, Priya, Ohl, Christopher, Patel, Payal K, Pottinger, Paul S, and Shnekendorf, Rachel

Subjects
ANTIMICROBIAL stewardship, COMMUNICABLE diseases, HOSPITAL medical staff, EVALUATION of human services programs, CONFIDENCE, ANTI-infective agents, CURRICULUM, EXECUTIVES, SATISFACTION, HUMAN services programs, DESCRIPTIVE statistics, STUDENTS, MEDICAL fellowships, MEDICAL education
Abstract

Background Antimicrobial stewardship (AS) programs are required by Centers for Medicare and Medicaid Services and should ideally have infectious diseases (ID) physician involvement; however, only 50% of ID fellowship programs have formal AS curricula. The Infectious Diseases Society of America (IDSA) formed a workgroup to develop a core AS curriculum for ID fellows. Here we study its impact. Methods ID program directors and fellows in 56 fellowship programs were surveyed regarding the content and effectiveness of their AS training before and after implementation of the IDSA curriculum. Fellows' knowledge was assessed using multiple-choice questions. Fellows completing their first year of fellowship were surveyed before curriculum implementation ("pre-curriculum") and compared to first-year fellows who complete the curriculum the following year ("post-curriculum"). Results Forty-nine (88%) program directors and 105 (67%) fellows completed the pre-curriculum surveys; 35 (64%) program directors and 79 (50%) fellows completed the post-curriculum surveys. Prior to IDSA curriculum implementation, only 51% of programs had a "formal" curriculum. After implementation, satisfaction with AS training increased among program directors (16% to 68%) and fellows (51% to 68%). Fellows' confidence increased in 7/10 AS content areas. Knowledge scores improved from a mean of 4.6 to 5.1 correct answers of 9 questions (P  = .028). The major hurdle to curriculum implementation was time, both for formal teaching and for e-learning. Conclusions Effective AS training is a critical component of ID fellowship training. The IDSA Core AS Curriculum can enhance AS training, increase fellow confidence, and improve overall satisfaction of fellows and program directors. [ABSTRACT FROM AUTHOR]

Published
2022
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33. Achieving Clostridioides difficile infection Health and Human Services 2020 goals: Using agile implementation to bring evidence to the bedside

Author

Dbeibo, Lana, primary, Kelley, Kristen, additional, Beeler, Cole, additional, Kara, Areeba, additional, Monahan, Patrick, additional, Perkins, Anthony J., additional, Wang, Yun, additional, Brinkman, Allison, additional, Snyderman, William, additional, Hatfield, Nicole, additional, Wrin, Justin, additional, Miller, Joan, additional, Webb, Douglas, additional, and Azar, Jose, additional

Published
2019
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34. 1112. Improving Urine Culturing Practices in a Neurocritical Care Unit through a Multidisciplinary Algorithm-Based Approach

Author

Hazen, Dana, primary, Snyderman, William, additional, Sadowski, Josh, additional, Kelley, Kristen, additional, Beeler, Cole, additional, Webb, Douglas, additional, Dbeibo, Lana, additional, Page, Shannon, additional, Desai, Armisha, additional, Rodgers, Richard, additional, Brewer, Brian, additional, Singh, Ranjeet, additional, and Bortenschlager, Lawrence, additional

Published
2019
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37. Management of fever and neutropenia in the adult patient with acute myeloid leukemia.

Author

Peseski, Andrew M., McClean, Mitchell, Green, Steven D., Beeler, Cole, and Konig, Heiko

Abstract

Febrile neutropenia represents one of the most common treatment-associated complications in the management of acute myeloid leukemia (AML) and is considered an oncologic emergency. Rapid and detailed workup as well as the initiation of empiric broad-spectrum antibiotic therapy are critical to avoid sepsis and to reduce mortality. Although a definitive source of infection is frequently not identified, the severely immunosuppressed status of the AML patient undergoing cytotoxic therapy results in a high risk for a wide array of bacterial, fungal, and viral etiologies. The authors herein review the diagnostic and therapeutic approach to the neutropenic leukemia patient based on the current knowledge. Special consideration is given to the rapidly changing therapeutic landscape in AML, creating new challenges in the management of infectious complications. Multidrug-resistant organisms pose a major challenge in the management of neutropenic fever patients with hematologic malignancies – including AML. Future directions to improve outcomes demand innovative treatment approaches as well as advances in biomarker research to facilitate diagnosis and disease monitoring. Recent achievements in AML-targeted therapy led to an increased incidence of differentiation syndrome, a potentially life-threatening side effect that frequently resembles clinical infection and requires prompt recognition and aggressive intervention. [ABSTRACT FROM AUTHOR]

Published
2021
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40. Utilizing a real-time discussion approach to improve the appropriateness of Clostridioides difficiletesting and the potential unintended consequences of this strategy

Author

Dbeibo, Lana, Brinkman, Allison, Beeler, Cole, Fadel, William, Snyderman, William, Hatfield, Nicole, Sadowski, Joshua, Wang, Yun, Kelley, Kristen, Webb, Douglas, Azar, Jose, and Kara, Areeba

Abstract

AbstractWe report electronic medical record interventions to reduce Clostridioides difficiletesting risk ‘alert fatigue.’ We used a behavioral approach to diagnostic stewardship and observed a decrease in the number of tests ordered of ~4.5 per month (P< .0001). Although the number of inappropriate tests decreased during the study period, delayed testing increased.

Published
2020
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42. Development and implementation of a pharmacist-managed outpatient parenteral antimicrobial therapy program.

Author

EUN KYOUNG CHUNG, BEELER, COLE B., MULOMA, EVA W., OSTERHOLZER, DANIELLE, DAMER, KENDRA M., and ERDMAN, SHARON M.

Subjects
*ALGORITHMS, *ANTIBIOTICS, *HOSPITALS, *OUTPATIENT services in hospitals, *MEDICAL practice, *PHARMACISTS, *OCCUPATIONAL roles, *DISCHARGE planning, *HUMAN services programs, *MEDICATION reconciliation
Abstract

Purpose. The development and implementation of a pharmacist-managed outpatient parenteral antimicrobial therapy (OPAT) program in a county teaching hospital are described. Summary. A pharmacist-managed OPAT program was developed and implemented at a county teaching hospital to provide consistent evaluation, approval, and monitoring of patients requiring OPAT for the treatment of infection. The developmental and implementation stages of the OPAT program included (1) a needs assessment, (2) the identification of resources necessary for program operation, (3) delineation of general OPAT program operations and activities of individual OPAT clinicians, (4) the development of patient selection criteria, including a plan of care algorithm, and (5) acquisition of administrative support to approve the program. In this program, the OPAT pharmacist plays an integral role in the management and oversight of OPAT patients, working under a collaborative agreement with infectious diseases physicians. The OPAT pharmacist assists with appropriate patient and regimen selection, confirmation of orders on discharge, assuring that laboratory tests for safety surveillance are performed and evaluated, performing routine monitoring for adverse events and line complications, and assuring the removal of the vascular access device upon the completion of OPAT. Conclusion: The OPAT program provides structured monitoring, patient follow-up, and led to improvements in patient outcome with minimization of treatment and line-related adverse events. [ABSTRACT FROM AUTHOR]

Published
2016
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43. The Impact of Changing to an Algorithm-Based Clostridioides difficileTest on the Decision to Treat Clostridioides difficile

Author

Dbeibo, Lana, Williams, Joy, Sadowski, Josh, Fadel, William, Winn, Vera, Beeler, Cole, Kelley, Kristen, Webb, Douglas Houston, and Kara, Areeba

Abstract

Background:Polymerase chain reaction (PCR) testing for the diagnosis of Clostridioides difficileinfection (CDI) detects the presence of the organism; a positive result therefore cannot differentiate between colonization and the pathogenic presence of the bacterium. This may result in overdiagnosis, overtreatment, and risking disruption of microbial flora, which may perpetuate the CDI cycle. Algorithm-based testing offers an advantage over PCR testing as it detects toxin, which allows differentiation between colonization and infection. Although previous studies have demonstrated the clinical utility of this testing algorithm in differentiating infection from colonization, it is unknown whether the test changes CDI treatment decisions. Our facility switched from PCR to an algorithm-based testing method for CDI in June 2018. Objective:In this study, we evaluated whether clinicians’ decisions to treat patients are impacted by a test result that implies colonization (GDH+/Tox−/PCR+ test), and we examined the impact of this decision on patient outcomes. Methods:This is a retrospective cohort study of inpatients with a positive C. difftest between June 2017 and June 2019. The primary outcome was the proportion of patients treated for CDI. We compared this outcome in 3 groups of patients: those with a positive PCR test (June 2017–June 2018), those who had a GDH+/Tox−/PCR+ or a GDH+/Tox+ test result (June 2018–June 2019). Secondary outcomes included toxic megacolon, critical care admission, and mortality in patients with GDH+/Tox−/PCR+ who were treated versus those who were untreated. Results:Of patients with a positive PCR test, 86% were treated with CDI-specific antibiotics, whereas 70.4% with GDH+/Tox+ and 29.25% with GDH+/Tox−/PCR+ result were treated (P< .0001). Mortality was not different between patients with GDH+/Tox−/PCR+ who were treated versus those who were untreated (2.7% vs 3.4%; P= .12), neither was critical care admission within 2 or 7 days of test result (2% vs 1.4%; P= .15) and (4.1% vs 5.4%, P= .39), respectively. There were no cases of toxic megacolon during the study period. Conclusions:The change to an algorithm-based C. difficiletesting method had a significant impact on the clinicians’ decisions to treat patients with a positive test, as most patients with a GDH+/Tox−/PCR+ result did not receive treatment. These patients did not suffer more adverse outcomes compared to those who were treated, which has implications for testing practices. It remains to be explored whether clinicians are using clinical criteria to decide whether or not to treat patients with a positive algorithm-based test, as opposed to the more reflexive treatment of patients with a positive PCR test.Funding:NoneDisclosures:None

Published
2020
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44. Achieving Clostridioides difficile infection Health and Human Services 2020 goals: Using agile implementation to bring evidence to the bedside.

Author

Dbeibo L, Kelley K, Beeler C, Kara A, Monahan P, Perkins AJ, Wang Y, Brinkman A, Snyderman W, Hatfield N, Wrin J, Miller J, Webb D, and Azar J

Subjects
Artificial Intelligence, Catheter-Related Infections epidemiology, Clostridium Infections epidemiology, Evidence-Based Practice organization & administration, Humans, Indiana, Catheter-Related Infections prevention & control, Clostridium Infections prevention & control, Health Plan Implementation methods
Published
2020
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