Browsing by Author "Nelson, Richard E."

Now showing 1 - 4 of 4
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    Incidence and Outcomes Associated With Clostridium difficile Infections: A Systematic Review and Meta-analysis
    (JAMA Network, 2020-01-03) Marra, Alexandre R.; Perencevich, Eli N.; Nelson, Richard E.; Samore, Matthew; Khader, Karim; Chiang, Hsiu-Yin; Chorazy, Margaret L.; Herwaldt, Loreen A.; Diekema, Daniel J.; Kuxhausen, Michelle F.; Blevins, Amy E.; Ward, Melissa A.; McDanel, Jennifer S.; Nair, Rajeshwari; Balkenende, Erin; Schweizer, Marin L.; Ruth Lilly Medical Library, School of Medicine
    Importance: An understanding of the incidence and outcomes of Clostridium difficile infection (CDI) in the United States can inform investments in prevention and treatment interventions. Objective: To quantify the incidence of CDI and its associated hospital length of stay (LOS) in the United States using a systematic literature review and meta-analysis. Data Sources: MEDLINE via Ovid, Cochrane Library Databases via Wiley, Cumulative Index of Nursing and Allied Health Complete via EBSCO Information Services, Scopus, and Web of Science were searched for studies published in the United States between 2000 and 2019 that evaluated CDI and its associated LOS. Study Selection: Incidence data were collected only from multicenter studies that had at least 5 sites. The LOS studies were included only if they assessed postinfection LOS or used methods accounting for time to infection using a multistate model or compared propensity score-matched patients with CDI with control patients without CDI. Long-term-care facility studies were excluded. Of the 119 full-text articles, 86 studies (72.3%) met the selection criteria. Data Extraction and Synthesis: Two independent reviewers performed the data abstraction and quality assessment. Incidence data were pooled only when the denominators used the same units (eg, patient-days). These data were pooled by summing the number of hospital-onset CDI incident cases and the denominators across studies. Random-effects models were used to obtain pooled mean differences. Heterogeneity was assessed using the I2 value. Data analysis was performed in February 2019. Main Outcomes and Measures: Incidence of CDI and CDI-associated hospital LOS in the United States. Results: When the 13 studies that evaluated incidence data in patient-days due to hospital-onset CDI were pooled, the CDI incidence rate was 8.3 cases per 10 000 patient-days. Among propensity score-matched studies (16 of 20 studies), the CDI-associated mean difference in LOS (in days) between patients with and without CDI varied from 3.0 days (95% CI, 1.44-4.63 days) to 21.6 days (95% CI, 19.29-23.90 days). Conclusions and Relevance: Pooled estimates from currently available literature suggest that CDI is associated with a large burden on the health care system. However, these estimates should be interpreted with caution because higher-quality studies should be completed to guide future evaluations of CDI prevention and treatment interventions.
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    Incidence and Outcomes Associated With Infections Caused by Vancomycin-Resistant Enterococci in the United States: Systematic Literature Review and Meta-Analysis
    (Cambridge, 2017-02) Chiang, Hsiu-Yin; Perencevich, Eli N.; Nair, Rajeshwari; Nelson, Richard E.; Samore, Matthew; Khader, Karim; Chorazy, Margaret L.; Herwaldt, Loreen A.; Blevins, Amy E.; Ward, Melissa A.; Schweizer, Marin L.; Department of Medicine, School of Medicine
    Information about the health and economic impact of infections caused by vancomycin-resistant enterococci (VRE) can inform investments in infection prevention and development of novel therapeutics. To systematically review the incidence of VRE infection in the United States and the clinical and economic outcomes. We searched various databases for US studies published from January 1, 2000, through June 8, 2015, that evaluated incidence, mortality, length of stay, discharge to a long-term care facility, readmission, recurrence, or costs attributable to VRE infections. We included multicenter studies that evaluated incidence and single-center and multicenter studies that evaluated outcomes. We kept studies that did not have a denominator or uninfected controls only if they assessed postinfection length of stay, costs, or recurrence. We performed meta-analysis to pool the mortality data. Five studies provided incidence data and 13 studies evaluated outcomes or costs. The incidence of VRE infections increased in Atlanta and Detroit but did not increase in national samples. Compared with uninfected controls, VRE infection was associated with increased mortality (pooled odds ratio, 2.55), longer length of stay (3-4.6 days longer or 1.4 times longer), increased risk of discharge to a long-term care facility (2.8- to 6.5-fold) or readmission (2.9-fold), and higher costs ($9,949 higher or 1.6-fold more). VRE infection is associated with large attributable burdens, including excess mortality, prolonged in-hospital stay, and increased treatment costs. Multicenter studies that use suitable controls and adjust for time at risk or confounders are needed to estimate the burden of VRE infections.
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    A systematic review of the epidemiology of carbapenem-resistant Enterobacteriaceae in the United States
    (BMC, 2018-04-24) Livorsi, Daniel J.; Chorazy, Margaret L.; Schweizer, Marin L.; Balkenende, Erin C.; Blevins, Amy E.; Nair, Rajeshwari; Samore, Matthew H.; Nelson, Richard E.; Khader, Karim; Perencevich, Eli N.; Ruth Lilly Medical Library, School of Medicine
    Background: Carbapenem-resistant Enterobacteriaceae (CRE) pose an urgent public health threat in the United States. An important step in planning and monitoring a national response to CRE is understanding its epidemiology and associated outcomes. We conducted a systematic literature review of studies that investigated incidence and outcomes of CRE infection in the US. Methods: We performed searches in MEDLINE via Ovid, CDSR, DARE, CENTRAL, NHS EED, Scopus, and Web of Science for articles published from 1/1/2000 to 2/1/2016 about the incidence and outcomes of CRE at US sites. Results: Five studies evaluated incidence, but many used differing definitions for cases. Across the entire US population, the reported incidence of CRE was 0.3-2.93 infections per 100,000 person-years. Infection rates were highest in long-term acute-care (LTAC) hospitals. There was insufficient data to assess trends in infection rates over time. Four studies evaluated outcomes. Mortality was higher in CRE patients in some but not all studies. Conclusion: While the incidence of CRE infections in the United States remains low on a national level, the incidence is highest in LTACs. Studies assessing outcomes in CRE-infected patients are limited in number, small in size, and have reached conflicting results. Future research should measure a variety of clinical outcomes and adequately adjust for confounders to better assess the full burden of CRE.
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    The translation-to-policy learning cycle to improve public health
    (Wiley, 2024-10-11) Kilbourne, Amy M.; Braganza, Melissa Z.; Bravata, Dawn M.; Tsai, Jack; Nelson, Richard E.; Meredith, Alex; Myrie, Kenute; Ramoni, Rachel; Medicine, School of Medicine
    Objective: Learning Health Systems (LHSs) have not directly informed evidence-based policymaking. The Translation-to-Policy (T2P) Learning Cycle aligns scientists, end-users, and policymakers to support a repeatable roadmap of innovation and quality improvement to optimize effective policies toward a common public health goal. We describe T2P learning cycle components and provide examples of their application. Methods: The T2P Learning Cycle is based on the U.S. Department of Veterans Affairs (VA) Office of Research and Development and Quality Enhancement Research Initiative (QUERI), which supports research and quality improvement addressing national public health priorities to inform policy and ensure programs are evidence-based and work for end-users. Incorporating LHS infrastructure, the T2P Learning Cycle is responsive to the Foundations for Evidence-based Policymaking Act, which requires U.S. government agencies to justify budgets using evidence. Results: The learning community (patients, providers, clinical/policy leaders, and investigators) drives the T2P Learning Cycle, working toward one or more specific, shared priority goals, and supports a repeatable cycle of evidence-building and evaluation. Core T2P Learning Cycle functions observed in the examples from housing/economic security, precision oncology, and aging include governance and standard operating procedures to promote effective priority-setting; complementary research and quality improvement initiatives, which inform ongoing data curation at the learning system level; and sustainment of continuous improvement and evidence-based policymaking. Conclusions: The T2P Learning Cycle integrates research translation with evidence-based policymaking, ensuring that scientific innovations address public health priorities and serve end-users through a repeatable process of research and quality improvement that ensures policies are scientifically based, effective, and sustainable.