Daniel Diekema

Daniel Diekema
University of Iowa | UI · Department of Internal Medicine

MD, MS

About

363
Publications
53,768
Reads
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36,526
Citations
Citations since 2017
29 Research Items
11725 Citations
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Introduction
I am an infectious diseases physician, clinical microbiologist, and hospital epidemiologist at the University of Iowa Healthcare. I am interested in healthcare associated infection prevention, and the role of the diagnostic microbiology laboratory in supporting infection prevention activities.
Additional affiliations
July 1998 - September 2015
University of Iowa
Position
  • Professor (Full)

Publications

Publications (363)
Article
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Mycobacterial infection-related morbidity and mortality in patients following cardiopulmonary bypass surgery is high and and there is a growing need for a consensus-based expert opinion to provide international guidance for diagnosing, preventing and treating in these patients. In this document the International Society for Cardiovascular Infectiou...
Article
BACKGROUND Intra-articular corticosteroid injections are commonly used for the outpatient treatment of osteoarticular pain. Practitioners may choose to administer additional medications such as anesthetics. While medications are compounded in the pharmacy following stringent environmental requirements, occasionally injections with additional compon...
Article
BACKGROUND: Healthcare-associated infections (HAIs) are costly and impact patient morbidity and mortality. Environmental disinfection and cleaning plays a key role in the prevention of HAIs. We aimed to establish an objective evaluation of thoroughness of disinfection and cleaning (TDC) after patient discharge and to evaluate the impact of an asses...
Article
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Bloodstream infection (BSI) organisms were consecutively collected from >200 medical centers in 45 nations between 1997 and 2016. Species identification and susceptibility testing followed Clinical and Laboratory Standards Institute broth microdilution methods at a central laboratory. Clinical data and isolates from 264,901 BSI episodes were collec...
Article
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Background Staphylococcus aureus is among the most common human pathogens, with therapy complicated by the epidemic spread of methicillin-resistant Staphylococcus aureus (MRSA). Methods The SENTRY Antimicrobial Surveillance Program evaluated the in vitro activity of >20 antimicrobials against 191 460 clinical S. aureus isolates collected from 427...
Article
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Background The emergence of antifungal resistance threatens effective treatment of invasive fungal infection (IFI). Invasive candidiasis is the most common health care–associated IFI. We evaluated the activity of fluconazole (FLU) against 20 788 invasive isolates of Candida (37 species) collected from 135 medical centers in 39 countries (1997–2016)...
Article
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A surgical heater–cooler unit has been implicated as the source for Mycobacterium chimaera infections among cardiac surgery patients in several countries. We isolated M. chimaera from heater–cooler units and patient infections in the United States. Whole-genome sequencing corroborated a risk for these units acting as a reservoir for this pathogen.
Article
Impact of expanded influenza post-exposure prophylaxis on healthcare worker absenteeism at a tertiary care center during the 2017–2018 season - Volume 40 Issue 2 - Mireia Puig-Asensio, Margaret Douglas, Stephanie Holley, Mary E. Kukla, Oluchi Abosi, Lisa Mascardo, Brenda Carmody, Courtney Gent, Daniel J. Diekema, Patrick Hartley, Michael B. Edmond,...
Article
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Background In the United States, 1.7 million immunocompromised patients contract a healthcare-associated infection, annually. These infections increase morbidity, mortality and costs of care. A relatively unexplored route of transmission is the generation of bioaerosols during patient care. Transmission of pathogenic microorganisms may result from...
Article
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Background Ultraviolet germicidal irradiation (UVGI) systems are gaining popularity, however objective comparisons of their characteristics are lacking. While environmental cultures and reduction of hospital-associated infections rates are excellent study endpoints, they are impractical for centers with limited resources who want to compare or opti...
Article
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Background Bloodstream infection due to Candida spp. is common and associated with significant mortality and morbidity. Previous population-based studies in 2000s and early 2010s have suggested that the incidence of candidemia might be increasing, presumably due to widespread use of central lines and broad-spectrum antibiotics. However, recent tren...
Article
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Background Our previous multicenter study suggested that a bundled intervention was associated with lower rates of complex S. aureus surgical site infections (SA SSIs) among patients undergoing cardiac or orthopedic operations in community hospitals. We aimed to evaluate the effect of this bundle in patients undergoing neurosurgical (NSG) operation...
Article
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Background A severe 2017–2018 influenza season was expected for the United States. We hypothesized that a surge in influenza cases paired with decreased vaccine effectiveness could increase healthcare worker (HCW) absenteeism. Because of a potential public health emergency during the 2017–2018 season, we offered oseltamivir post-exposure prophylaxi...
Article
Hand hygiene compliance is subject to the Hawthorne effect, which may be attenuated by covert observers and brief observation periods. This study demonstrated that hand hygiene compliance rates were between 8% and 29% greater when reported by infection prevention programs than when reported by covert observers over brief observation periods. © 2018...
Article
INTRODUCTION In 2017, the Journal of Clinical Microbiology published a Point-Counterpoint on the laboratory diagnosis of Clostridium difficile infection (CDI). At that time, Ferric C. Fang, Christopher R. Polage, and Mark H. Wilcox discussed the strategies for diagnosing Clostridium difficile colitis in symptomatic patients (J Clin Microbiol 55:670...
Article
Impact of 2018 Changes in National Healthcare Safety Network Surveillance for Clostridium difficile Laboratory-Identified Event Reporting - Alexandre R. Marra, Michael B. Edmond, Bradley A. Ford, Loreen A. Herwaldt, Abdullah R. Algwizani, Daniel J. Diekema
Article
Research Agenda for Microbiome Based Research for Multidrug-resistant Organism Prevention in the Veterans Health Administration System - Volume 39 Issue 2 - Ashley E. Kates, Jessica S. Tischendorf, Marin Schweizer, Loreen Herwaldt, Matthew Samore, Kimberly C. Dukes, Dale N. Gerding, Daniel J. Diekema, Nasia Safdar
Article
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USA100 strains are significant contributors to the overall burden of health care-associated methicillin-resistant Staphylococcus aureus (MRSA) infections. Strain 209 is a representative MRSA isolate that serves as a model organism for agr type II studies and USA100 virulence assessments. We present a draft genome sequence of this strain.
Article
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Background In December 2016, bacterial contamination of an organ preservation solution (OPS) was reported by Transplant Center A in Iowa. Annually, >20,000 abdominal organs are transplanted in the United States; OPS is used for organ storage. We investigated the scope of OPS contamination and its association with adverse events in patients. Method...
Article
Background: Several single-center studies have suggested that eliminating contact precautions (CPs) for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) control in nonoutbreak settings has no impact on infection rates. We performed a systematic literature review and meta-analysis on the impact of discon...
Article
Importance Staphylococcus aureus bacteremia is common and frequently associated with poor outcomes. Evidence indicates that specific care processes are associated with improved outcomes for patients with S aureus bacteremia, including appropriate antibiotic prescribing, use of echocardiography to identify endocarditis, and consultation with infecti...
Article
No comprehensive guidelines or classification exist for infection prevention strategies for medical procedures performed outside operating rooms. We reviewed the available literature and used our clinical experience to develop a progressive, 5-tiered classification of procedures, encompassing clean, aseptic, sterile-superficial, sterile-invasive, a...
Article
BACKGROUND Despite a reported worldwide increase, the incidence of extended-spectrum β-lactamase (ESBL) Escherichia coli and Klebsiella infections in the United States is unknown. Understanding the incidence and trends of ESBL infections will aid in directing research and prevention efforts. OBJECTIVE To perform a literature review to identify the...
Article
Antimicrobial stewardship programs have emerged as a means to address inappropriate antimicrobial use, manage costs, decrease drug resistance, and prevent medication-related adverse events. The traditional stewardship model relies on pharmacists, infectious disease physicians, or both, providing feedback to clinicians.
Article
This paper focuses on assisting hospitals in establishing a rapid response for identification, notification, and evaluation of exposed patients, and management of HCDs with regards to placement and containment, environmental culturing, and disinfection.The global outbreak of Mycobacteriurm chimaera infections associated with heater-cooler devices (...
Article
While azole drugs targeting the biosynthesis of ergosterol are effective antifungal agents, their extensive use has led to the development of resistant organisms. Infections involving azole resistant forms of the filamentous fungus Aspergillus fumigatus are often associated with genetic changes in the cyp51A gene encoding the lanosterol α14 demethy...
Article
Health care-associated infection (HAI) rates are subject to public reporting and are linked to hospital reimbursement from the Centers for Medicare and Medicaid Services (CMS). The increasing pressure to lower HAI rates comes at a time when advances in the clinical microbiology laboratory (CML) provide more-precise and -sensitive tests, altering HA...
Article
Candida guilliermondii was isolated from sterile specimens with increasing frequency over a several-month period despite a paucity of clinical evidence suggesting true Candida infections. However, a healthcare-associated outbreak was strongly considered due to growth patterns in the microbiology laboratory more consistent with true infection than e...
Article
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Background. There is an ongoing multinational outbreak of invasive M. chimaera (Mc) infections linked to heater-cooler devices (HCDs) used during cardiopulmonary bypass (CPB). We report the experience of 4 US centers. Methods. Cases were persons with a positive culture for Mc (or M. avium complex if species ID not done) from normally sterile sites...
Article
Full-text available
An outbreak of invasive Mycobacterium chimaera infections associated with heater-cooler devices (HCDs) has now affected patients in several countries on different continents. Clinical infections are characterized by delayed diagnosis, inadequate treatment response to antimicrobial agents, and poor prognosis. Outbreak investigators found M. chimaera...
Article
Using an algorithm including both enzyme immunoassay (EIA) and nucleic acid amplification (NAAT) for Clostridium difficile infection (CDI) diagnosis, we found that the use of NAAT versus EIA almost doubled our hospital-onset CDI laboratory-identified (LabID) event standardized infection ratio (SIR). We recommend that the current risk adjustment app...
Article
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We retrospectively analyzed data for 195 respiratory infection patients who had positive Staphyloccocus aureus cultures and who were hospitalized in 2 hospitals in Iowa and Maryland, USA, during 2003-2009. Odds for death for patients who also had influenza-positive test results were >4 times higher than for those who had negative influenza test res...
Article
Using blaZ PCR as the gold standard, the sensitivities of CLSI penicillin zone edge and nitrocefin-based tests for β-lactamase production in Staphylococcus aureus were 64.5% and 35.5%, respectively, with specificity of 99.8% for both methods. In 2013, 13.5% of 3,083 S. aureus isolates from 31 US centers were penicillin susceptible.
Article
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Background: ME1111 is a novel small molecule antifungal agent under development for the topical treatment of onychomycosis. Standardization of the susceptibility testing method for this candidate antifungal is needed. Towards this end, 8 independent laboratories determined the interlaboratory reproducibility of ME1111 susceptibility testing. In ad...
Article
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Background Methicillin-resistant S. aureus (MRSA) pneumonia is associated with poor clinical outcomes. This study examined the association between microbial characteristics and poor outcomes among patients with methicillin-resistant Staphylococcus aureus pneumonia. Findings This retrospective cohort study included 75 patients with MRSA pneumonia w...
Article
Staphylococcus aureus is a leading cause of surgical site infections that results in increased hospital stays due to development of chronic wounds. Little is known about factors involved in S. aureus' ability to prevent wounds from healing. We discovered a novel secreted protein produced by a surgical site isolate of S. aureus that prevents keratin...
Article
Full-text available
Previous studies suggested that a bundled intervention was associated with lower rates of Staphylococcus aureus surgical site infections (SSIs) among patients having cardiac or orthopedic operations. To evaluate whether the implementation of an evidence-based bundle is associated with a lower risk of S aureus SSIs in patients undergoing cardiac ope...
Article
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Background: Hospital Ebola preparation is underway in the United States and other countries; however, the best approach and resources involved are unknown. Objective: To examine costs and challenges associated with hospital Ebola preparation by means of a survey of Society for Healthcare Epidemiology of America (SHEA) members. Design: Electron...
Article
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Background: Previous studies indicate that vancomycin is inferior to beta-lactams for treatment of methicillin-susceptible Staphylococcus aureus (MSSA) bloodstream infections. However, it is unclear if this association is true for empiric and definitive therapy. Here, we compared beta-lactams with vancomycin for empiric and definitive therapy of M...
Article
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In Reply We are aware of the large MOSAR-ICU quasi-experimental trial but disagree that it evaluated the addition of contact precautions to standard precautions. To our reading, the MOSAR study had 2 main phases: (1) comparing enhanced hand hygiene and chlorhexidine bathing with a baseline period and (2) comparing rapid vs conventional screening an...
Article
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A 26-year old woman presented for evaluation of extensive edema, erythema, sinus tract formation and purulent drainage from the left lower extremity after trauma from a wooden object approximately three months prior. Skin biopsies and blood cultures revealed Phaeoacremonium parasiticum consistent with a diagnosis of phaeohyphomycosis. Despite hospi...
Article
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Four laboratories tested three isolates of Candida species and two isolates of Aspergillus fumigatus using 96-well plates containing combinations of amphotericin B, anidulafungin, caspofungin, micafungin, fluconazole, itraconazole, posaconazole, and voriconazole. The majority of summation fractional inhibitory concentration indices (ΣFICI) based on...
Article
Background: Recent data suggest that healthcare-associated invasive methicillin-resistant S. aureus (MRSA) infections are declining in the US (JAMA Intern Med 2013;173:1970). However, such infections are the minority of SA disease. Few studies have examined recent trends in epidemiology of SA clinical isolates that include susceptible, community-on...
Article
Preventing transmission of pathogens in the health care setting with the use of personal protective equipment (PPE) has been an area of longstanding debate in the infection prevention community. Recently, reports of nosocomial transmission of Ebola virus to 2 nurses from the same patient in Texas (despite their use of PPE) has generated great conce...
Conference Paper
Full-text available
Background: Information about the health and economic impact of C. difficile infections (CDI) in the US can inform investments in prevention and treatment interventions. Objective: To estimate the morbidity, mortality, and cost burden of CDI in the US using a systematic literature review, meta-analysis and economic model. Methods: We searched...
Conference Paper
Background: Our recent meta-analysis found that a bundled intervention can reduce rates of S. aureus surgical site infections (SSIs) among patients having cardiac operations (CO) or total hip (THA) or knee (TKA) arthroplasties. The bundle has not been studied in a multicenter trial. Method: We performed a multicenter quasi-experimental study of p...
Conference Paper
Background: Recent data suggest that healthcare-associated invasive methicillin-resistant S. aureus (MRSA) infections are declining in the US (JAMA Intern Med 2013;173:1970). However, such infections are the minority of SA disease. Few studies have examined recent trends in epidemiology of SA clinical isolates that include susceptible, community-on...
Article
Full-text available
Gowns, gloves, and hand hygiene are primary tools for preventing transmission of pathogens in health care settings.¹ The Centers for Disease Control and Prevention (CDC) recommends that these approaches be used for all patients as a part of standard precautions, which include hand hygiene on room entry and exit and after touching the environment or...
Article
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(PDF) LB-1Treatment with Oral ALS-008176, a Nucleoside Analog, Rapidly Reduces RSV Viral Load and Clinical Disease Severity in a Healthy Volunteer Challenge Study. Treatment with Oral ALS-008176, a Nucleoside Analog, RapidlyReduces RSV Viral Load and Clinical Disease Severity in a HealthyVolunteer Challenge Stud
Poster
Full-text available
Background: Information about the health and economic impact of C. difficile infections (CDI) in the US can inform investments in prevention and treatment interventions. Objective: To estimate the morbidity, mortality, and cost burden of CDI in the US using a systematic literature review, meta-analysis and economic model. Methods: We searched MEDLI...
Article
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Ongoing surveillance for Streptococcus pneumoniae (SPN) is needed to assess the impact of the pneumococcal conjugate vaccine introduced in 2010 (PCV13). Forty-two US centers submitted SPN isolates between 10/1/12-03/31/13. Susceptibility testing was performed by use of a broth dilution method as recommended by the CLSI. Serotyping was performed by...
Article
Background The Institute for Healthcare Improvement (IHI) created an evidence-based bundle to help reduce methicillin-resistant Staphylococcus aureus (MRSA) health care–associated infections. The study aim was to identify which components of the IHI’s MRSA bundle that rural hospitals have implemented and to identify barriers that hindered implement...
Article
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This analysis describes the epidemiology and outcomes of invasive candidiasis caused by non-albicans species of Candida in patients enrolled in the Prospective Antifungal Therapy Alliance (PATH Alliance) registry from 2004 to 2008. A total of 2,496 patients with non-albicans species of Candida isolates were identified. The identified species were C...
Article
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Background: Diabetic foot ulcer (DFU) infections are challenging. Staphylococcus aureus is the most commonly isolated pathogen in DFUs. Superantigens (SAgs) are causative in many S. aureus infections. We hypothesized both that DFU S. aureus will produce large SAg numbers, consistent with skin infections, and that certain SAgs will be overrepresent...
Article
Background Nasal carriage of Staphylococcus aureus (SA) is an important risk factor for surgical site infections. The goal of this study was to investigate the concordance between nasal and diabetic foot ulcer (DFU) SA carriage. Methods 79 subjects with DFUs were assessed for nasal and DFU colonization with SA, including Methicillin-resistant-SA (...
Article
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A fully automated antifungal susceptibility test system recently updated to reflect the new species-specific clinical breakpoints (CBPs) of fluconazole for Candida (Vitek 2 AF03 yeast susceptibility test; bioMérieux, Inc., Durham, NC) was compared in three different laboratories with the Clinical and Laboratory Standards Institute (CLSI) reference...
Article
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Background Ivacaftor increases CFTR channel activity and improves pulmonary function for individuals bearing a G551D mutation. Because ivacaftor structurally resembles quinolone antibiotics, we tested the hypothesis that ivacaftor possesses antibacterial properties. Methods Bioluminescence, colony forming unit, and minimal inhibitory concentration...
Article
Despite vigorous infection control measures, Clostridium difficile continues to cause significant disease burden. Antibiotic stewardship programmes (ASPs) may prevent C. difficile infections by limiting exposure to certain antibiotics. Our objective was to perform a meta-analysis of published studies to assess the effect of ASPs on the risk of C. d...
Article
Background: The epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) is changing, with USA300 emerging first in community and then in healthcare settings. We performed nationwide surveillance to assess recent trends in the molecular epidemiology of MRSA. Methods: One hundred consecutive unique clinically significant S. aureus isola...
Article
We performed prospective surveillance for candidemia at 14 Iowa hospitals in 2011-2012. A total of 163 episodes were analyzed. Candida albicans (n = 69 [42%]) and Candida glabrata (n = 58 [36%]) were the most common species. Antifungal resistance was uncommon; 9% of C. glabrata were fluconazole resistant, and 5% (3 isolates) were intermediate or re...
Article
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Since epidemiological cutoff values (ECVs) using CLSI MICs from multiple laboratories are not available for Candida spp. and the echinocandins, we established ECVs for anidulafungin and micafungin on the basis of wild-type (WT) MIC distributions (for organisms in a species-drug combination with no detectable acquired resistance mechanisms) for 8,21...
Article
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Forty-two medical centers from throughout the United States participating in a longitudinal surveillance program were asked to submit 100 consecutive Staphylococcus aureus isolates during July to December 2011. Susceptibility testing using CLSI broth microdilution and mecA detection by PCR analysis was performed on the 4,131 isolates collected. Met...
Article
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Health care-associated infection (HAI) rates are used as measures of a health care facility's quality of patient care. Recently, these outcomes have been used to publicly rank quality efforts and determine facility reimbursement. The value of comparing HAI rates among health care facilities is limited by many factors inherent to HAI surveillance, a...
Article
To develop and implement an objective, reliable approach to surveillance for ventilator-associated events in adult patients. The Centers for Disease Control and Prevention (CDC) convened a Ventilator-Associated Pneumonia (VAP) Surveillance Definition Working Group in September 2011. Working Group members included representatives of stakeholder soci...
Article
This article is an executive summary of a report from the Centers for Disease Control and Prevention Ventilator-Associated Pneumonia Surveillance Definition Working Group, entitled “Developing a new, national approach to surveillance for ventilator-associated events” and published in Critical Care Medicine . The full report provides a comprehensive...
Article
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This study addressed the application of anidulafungin as a surrogate marker to predict the susceptibility of Candida to caspofungin due to unacceptably high interlaboratory variation of caspofungin MIC values. CLSI reference broth microdilution methods and species-specific interpretive criteria were used to test 4,290 strains of Candida (eight spec...
Chapter
Practical Healthcare Epidemiology - edited by Ebbing Lautenbach April 2018
Article
Among 119 echinocandin non-wild-type (non-WT) Candida glabrata strains from two global surveys, mutations in fks hot spots (HSs) were detected in 28 (from 7 countries and 8 U.S. states): 24 strains (85.7%) had non-WT MICs for micafungin, 22 (78.6%) for anidulafungin, and 25 (89.3%) for caspofungin. The most common FKS substitutions among non-WT str...
Article
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In yeast cells such as those of Saccharomyces cerevisiae, expression of ATP-binding cassette (ABC) transporter proteins has been found to be increased and correlates with a concomitant elevation in azole drug resistance. In this study, we investigated the roles of two Aspergillus fumigatus proteins that share high sequence similarity with S. cerevi...
Conference Paper
Background: Bloodstream infections due to Candida cause significant morbidity and mortality. Surveillance for candidemia is necessary to help inform prevention efforts and empiric therapy decisions. We describe the recent epidemiology of candidemia in Iowa. Methods: We performed prospective surveillance for candidemia at 14 Iowa hospitals from Jan...
Conference Paper
Background: Methicillin-resistant Staphylococcus aureus (MRSA) pneumonia is associated with poor outcomes including excess length of stay (LOS) and mortality. If factors associated with unfavorable outcomes can be identified, interventions that target these factors could be implemented. Our aim was to determine which microbial, patient, or treatm...
Conference Paper
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Background: Phage K and Phage Msa are two previously-described lytic phages of Staphylococcus aureus that have been proposed as potential alternatives to antibiotic treatment in the face of increasing antibiotic resistance among these bacteria. However, no previous study has established whether human-associated S. aureus isolates are broadly suscep...
Article
To assess high school athletic programs' infection prevention policies and procedures and to estimate the frequency of skin and soft tissue infections (SSTIs) among Iowa's high school athletes. An on-line survey of high school athletic programs. Nearly 60% of programs responded. Schools in higher classifications were more likely to have a certified...
Article
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Screening of 1,750 pneumococcal isolates for common serotypes by PCR was followed by Quellung reaction analysis of PCR-negative isolates with a comparison to the conventional (Quellung reaction only) approach. PCR agreed with Quellung reaction results for 99% of isolates. The sequential PCR/Quellung reaction algorithm is accurate and more cost-effe...