Browsing by Author "Beeler, Cole"
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Item 765. Development of an Adaptable Roadmap for Implementation of the Infectious Diseases Society of America Core Antimicrobial Stewardship Curriculum in Infectious Diseases Fellowship Programs(Oxford University Press, 2023-11-27) Hojat, Leila S.; Patel, Payal K.; Nori, Priya; Hamilton, Keith W.; Justo, Julie Ann; Spicer, Jennifer O.; Logan, Ashleigh; Bennani, Kenza; Lee, Matthew S.; Bryson-Cahn, Chloe; Stohs, Erica J.; Willis, Zachary; Moenster, Ryan P.; Van Schooneveld, Trevor C.; Brennan-Krohn, Thea; Beeler, Cole; Kang, Amy Y.; Al Lawani, Hawra; Cherabuddi, Kartik; Fong, Gary; Ince, Dilek; Holubar, Marisa; Paras, Molly L.; Gaston, David; Shnekendorf, Rachel A.; Williams, Rostam; Luther, Vera; Medicine, School of MedicineBackground: The Infectious Diseases Society of America (IDSA) developed and disseminated a Core Antimicrobial Stewardship (AS) Curriculum intended to formalize AS training in infectious diseases (ID) fellowship programs in 2018. This study identified individual program approaches to curriculum implementation and intended to use this information to develop an implementation guide tailored to specific program needs. Methods: We distributed surveys to all fellowship program directors (PDs) who had previously implemented the Core AS Curriculum. Questions were designed to identify ID program structure, curriculum participants, curriculum sections and materials utilized, and resources and barriers to implementation. Both structured and qualitative responses were captured. The results were summarized descriptively and organized into a framework connecting barriers to proposed solutions. Results: PDs from 34 unique programs who had administered the Core Curriculum to an estimated 405 ID fellows responded to the survey, out of the 159 institutions invited (21.4%). Most represented adult programs which had administered the curriculum for at least 2 years (Table 1). Additional learners often included ID faculty and pharmacy trainees, and teachers were mostly AS program leadership. Most PDs reported limited faculty time as a barrier to implementation, whereas dedicated AS curricular time was a resource available to most programs (Figure 1). Approaches to curriculum implementation based on survey responses relating to each fellowship program feature were suggested, some of which applied to multiple program features (Figure 2). Qualitative feedback was generally positive, and most PDs indicated that they intended to continue to implement the curriculum. Additional materials such as a facilitator guide and demonstrations were proposed as other components which could assist with curriculum implementation. Roadmap with infectious diseases fellowship program features (rounded green boxes) connected to identified potential approaches to curriculum implementation (rectangular blue boxes). Program features are categorized as relating to conference structure, program resources, or program barriers. Suggested approaches with potential application to multiple program features are highlighted in orange. Conclusion: The IDSA Core AS curriculum provides an effective means of formalizing basic AS education into ID fellowship training. Curriculum implementation can be optimized by tailoring to training program resources and unique features. An implementation roadmap may be a useful tool to assist ID fellowship PDs with this task.Item Assessment of a Universal Preprocedural Screening Program for COVID-19(Cambridge, 2021) Dbeibo, Lana; Kuebler, Kari; Keen, Alyson; George, Annie; Kelley, Kristen; Sadowski, Josh; Basham, Laura; Beeson, Terrie; Schmidt, C. Max; Beeler, Cole; Webb, Douglas; Medicine, School of MedicineObjectives Study objectives were to: (1) Determine the value of a COVID-19 universal preprocedural screening program; and (2) Using the results of asymptomatic positive screens, determine the safety of resuming elective procedures. Design This was a descriptive study detailing the process and findings from implementation of a COVID-19 universal preprocedural screening program. Setting An adult academic tertiary center in Indiana. Patients Patients were included in the analysis if they were screened 96 hours prior to or within 24 hours after undergoing a procedure in the operating room, cardiac catheterization lab, or endoscopy. Methods A report was generated from the electronic health record of patients undergoing procedures from a six week period of time (May 4th-June 14th, 2020). Health records for positive screens were reviewed and classified as symptomatic if they met either criteria: (1) screen performed due to presence of COVID-19 symptoms; (2) documentation of symptoms at the time of the screen. Patients with a positive screen that did not meet symptomatic criteria were classified as asymptomatic. Descriptive statistics were used to calculate frequencies and percentages for the included sample. Results The initial sample included 2,194 patients, comprised of 46 positive and 2,148 negative screens. Out of the 46 patients who had a positive test, 17 were asymptomatic, resulting in an asymptomatic rate of 0.79% (17/2165). Conclusion Findings validated the value of the program through identification of a low rate of asymptomatic positive screens and procedural team adoption and sustainment. Findings may help inform decision making of like organizations attempting to enhance safety while resuming elective procedures.Item “Clinical Characteristics, Outcomes and Prognosticators in Adult Patients Hospitalized with COVID-19”(Elsevier, 2020-07-08) Gavin, Warren; Campbell, Elliott; Zaidi, Adeel; Gavin, Neha; Dbeibo, Lana; Beeler, Cole; Kuebler, Kari; Abdel-Rahman, Ahmed; Luetkemeyer, Mark; Kara, Areeba; Medicine, School of MedicineBackground: COVID-19 is a novel disease caused by SARS-CoV-2. Methods: We conducted a retrospective evaluation of patients admitted with COVID-19 to one site in March 2020. Patients were stratified into three groups: survivors who did not receive mechanical ventilation (MV), survivors who received MV and those who received MV and died during hospitalization. Results: There were 140 hospitalizations; 22 deaths (mortality rate 15.7%), 83 (59%) survived and did not receive MV, 35 (25%) received MV and survived; 18 (12.9%) received MV and died. Thee mean age of each group was 57.8 , 55.8 and 72.7 years respectively (p=.0001). Of those who received MV and died, 61% were male (p=.01). More than half the patients ( n=90, 64%) were African American. First measured d-dimer >575.5 ng/mL, procalcitonin > 0.24 ng/mL, LDH > 445.6 units/L and BNP > 104.75 pg/mL had odds ratios of 10.5, 5 , 4.5 and 2.9 respectively forMV (p < .05 for all). Peak BNP > 167.5 pg/mL had an odds ratio of 6.7 for inpatient mortalitywhen mechanically ventilated (p= .02).Conclusions: Age and gender may impact outcomes in COVID-19. D-dimer, procalcitonin, LDH and BNP may serve as early indicators of disease trajectory.Item Clinical comparison and agreement of PCR, antigen, and viral culture for the diagnosis of COVID-19: Clinical Agreement Between Diagnostics for COVID19(Elsevier, 2022) Agard, Amanda; Elsheikh, Omar; Bell, Drew; Relich, Ryan F.; Schmitt, Bryan H.; Sadowski, Josh; Fadel, William; Webb, Douglas H.; Dbeibo, Lana; Kelley, Kristen; Carozza, Mariel; Lei, Guang-Shen; Calkins, Paul; Beeler, Cole; Medicine, School of MedicineThe aim of this study is to compare the COVID-19 nasopharyngeal PCR (NP PCR) to antigen, nasal PCR, and viral culture. One-hundred-and-fourteen risk-stratified patients were tested by culture, nasal PCR, NP PCR, and Ag testing. Twenty (48%) of the high risk and 23 (32%) of the low risk were NP PCR positive. Compared with NP PCR, the sensitivity of nasal PCR, Sofia Ag, BinaxNOW Ag, and culture were 44%, 31%, 37%, and 15%. In the high risk group, the sensitivity of these tests improved to 71%, 37%, 50%, and 22%. Agreement between tests was highest between nasal PCR and both antigen tests. Patients who were NP PCR positive but antigen negative were more likely to have remote prior COVID-19 infection (p<0.01). Nasal PCR and antigen positive patients were more likely to have symptoms (p = 0.01).Item Evaluation of the Infectious Diseases Society of America’s Core Antimicrobial Stewardship Curriculum for Infectious Diseases Fellows(Oxford Academic, 2021-06) 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.; Shnekendorf, Rachel; Stack, Conor; Van Schooneveld, Trevor C.; Willis, Zachary I.; Zhou, Yuan; Luther, Vera P.; Medicine, School of MedicineBackground 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.Item Implementing the Infectious Diseases Society of America Antimicrobial Stewardship Core Curriculum: Survey Results and Real-World Strategies to Guide Fellowship Programs(Oxford University Press, 2024-10-02) Hojat, Leila S.; Patel, Payal K.; Ince, Dilek; Kang, Amy Y.; Fong, Gary; Cherabuddi, Kartik; Nori, Priya; Al Lawati, Hawra; Stohs, Erica J.; Beeler, Cole; Van Schooneveld, Trevor C.; Lee, Matthew S.; Hamilton, Keith W.; Justo, Julie Ann; Spicer, Jennifer O.; Logan, Ashleigh; Bennani, Kenza; Williams, Rostam; Shnekendorf, Rachel; Bryson-Cahn, Chloe; Willis, Zachary I.; Moenster, Ryan P.; Brennan-Krohn, Thea; Paras, Molly L.; Holubar, Marisa; Gaston, David C.; Advani, Sonali D.; Luther, Vera P.; Medicine, School of MedicineBackground: 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.Item Microbiology of bile aspirates obtained at ERCP in patients with suspected acute cholangitis(Thieme, 2022) Gromski, Mark A.; Gutta, Aditya; Lehman, Glen A.; Tong, Yan; Fogel, Evan L.; Watkins, James L.; Easler, Jeffrey J.; Bick, Benjamin L.; McHenry, Lee; Beeler, Cole; Relich, Ryan F.; Schmitt, Bryan H.; Sherman, Stuart; Medicine, School of MedicineBackground: The cornerstone of treatment for acute cholangitis is source control with biliary drainage and early antibiotics. The primary aim of this study was to describe the microbiology of bile aspirate pathogens obtained at the time of endoscopic retrograde cholangiopancreatography (ERCP) in patients suspected of having acute cholangitis. Methods: In this single-center retrospective study, patients were included if a bile aspirate was collected at ERCP for suspicion of acute cholangitis, from 1 January 2010 to 31 December 2016. Results: There were 721 ERCP procedures for suspected acute cholangitis with bile culture results, with 662 positive bile cultures (91.8 %). Pathogens included: Enterococcus species (spp.) 448 (67.7 %); Klebsiella spp. 295 (44.6 %); Escherichia coli 269 (40.6 %); Pseudomonas spp. 52 (7.9 %); and anaerobes 64 (9.7 %). Susceptibility of Klebsiella pneumoniae and E.coli isolates to ciprofloxacin was 88 % and 64 %, respectively. Extended-spectrum beta-lactamases and carbapenem resistance were found in 7.9 % and 3.6 % of Enterobacteriaceae, respectively. There were 437 concurrent blood cultures, of which 174 were positive (39.8 % of cultures drawn). Prior biliary endoscopic sphincterotomy (ES) was evident in 459 ERCP cases (63.7 %), and was associated with increased frequency of Klebsiella spp., Pseudomonas aeruginosa, Enterobacter spp., and Enterococcus spp. Prior biliary ES significantly increased the probability of vancomycin-resistant Enterococcus (VRE). Conclusions: The vast majority of bile cultures (91.8 %) were positive. The susceptibilities of E.coli and K.pneumoniae to ciprofloxacin are lower than historically noted. A notable portion of cultures contained pathogenic drug-resistant organisms. Prior biliary ES is associated with a higher frequency of certain organisms and higher frequency of VRE.Item Orthopoxvirus Testing Challenges for Persons in Populations at Low Risk or Without Known Epidemiologic Link to Monkeypox — United States, 2022(U.S. Department of Health & Human Services, 2022-09-09) 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, Siobhán M.; O’Laughlin, Kevin; Rao, Agam K.; McCollum, Andrea M.; Negrón, María E.; Hutson, Christina L.; Salzer, Johanna S.; CDC Monkeypox Emergency Response Team; Medicine, School of MedicineItem Rabbit anti‐thymocyte globulin administration to treat rejection in simultaneous pancreas and kidney transplant recipients with recent COVID‐19 infection(Wiley, 2020) Barros, Nicolas; Sharfuddin, Asif A.; Powelson, John; Yaqub, Muhammad; Adebiyi, Oluwafisayo O.; Beeler, Cole; Lutz, Andrew; Fridell, Jonathan A.; Medicine, School of MedicineTransplant recipients may be more susceptible to COVID‐19 and itsrelated complications.1‐3Despite most patients being managed with reduction of immunosuppression, the risk of rejection or graft loss does not seem to be increased during COVID‐19.Item Seroprevalence of SARS-CoV-2 Antibodies Among Healthcare Workers With Differing Levels of COVID-19 Patient Exposure(Cambridge University Press, 2020-08-03) Hunter, Benton R.; Dbeibo, Lana; Weaver, Christopher; Beeler, Cole; Saysana, Michele; Zimmerman, Michelle; Weaver, Lindsay; Emergency Medicine, School of MedicineHealthcare employees were tested for antibodies against SARS-CoV-2. Among 734 employees, the prevalence of SARS-CoV-2 antibodies was 1.6%. Employees with heavy COVID-19 exposure had similar antibody prevalence as those with limited or no exposure. Guidelines for PPE use seem effective for preventing COVID-19 infection in healthcare workers.