Deverick J Anderson

• Duke University Medical Center

Background Data on the epidemiology of healthcare facility-associated (HCFA) nontuberculous mycobacteria (NTM) are sparse. We performed a multicenter longitudinal cohort study of HCFA NTM epidemiology. Methods We retrospectively analyzed positive cultures for NTM performed from 2012 through 2020 within a network of 10 US academic hospitals and ass...

Serious superficial incisional surgical site infections (SSISSIs) are a critical subset of SSIs that require surgical intervention or lead to hospital readmission. Analyzing 11,617 SSIs from 47 community hospitals, the inclusion of SSISSIs changed 30/47 hospital rankings (p = 0.02), highlighting the need for inclusion in standardized infection surv...

Background Patient room sinks are frequently identified as potential sources for hospital-associated infections (HAIs), but there are no clear recommendations for interventions to reduce sink-related pathogenic bioburden. We conducted one of the first longitudinal crossover trials to assess the impact of practical sink interventions in an academic...

Background Drivers of inappropriate antimicrobial use (AU) and antimicrobial resistance (AMR) can be linked to deficiencies in prescribers’ knowledge, attitude, and practice (KAP) regarding antibiotics. Currently, KAP information in community hospitals throughout the United States (US) is not well known, and survey information is not standardized....

Background A previous exploratory analysis of surveillance data at our large academic medical center identified higher CLABSI rates among non-Hispanic Black patients compared to White patients. In the context of a growing understanding of the importance of social determinants of health (SDOH), we sought to better describe those patients who acquire...

Background Despite a recent increase in the burden of complicated urinary tract infections (cUTI), contemporary data on healthcare utilization, outcomes and antimicrobial use related to cUTIs are lacking. We describe healthcare utilization, inpatient antibiotic use, and mortality associated with cUTI across a nationwide US hospital network. Method...

Background Different societies and organizations use different surgical site infection (SSI) definitions for surveillance. With multiple definitions in use, validation of surveillance findings becomes paramount, particularly for maintaining surgeon buy-in during data review and developing countermeasures. The goal of our study was to assess concord...

Background qPCR is a highly sensitive method for identifying the presence of potential pathogens. However, its utility as a tool to detect environmental contamination is limited by its inability to differentiate between viable and non-viable target cells.Table 1.Detection of target organisms via qPCR and Culture Methods We completed a prospective...

Background Antibiotic use (AU) at hospital discharge is often inappropriate and can account for the majority of antibiotic exposure attributed to an admission. Tracking and optimizing discharge antibiotic prescriptions (Rx) can be challenging for antimicrobial stewardship programs (ASPs), as inpatient and outpatient AU are not linked in many electr...

Background Guidelines recommend performing hand hygiene (HH) prior to donning non-sterile gloves, yet strong evidence is lacking and overall adherence is low. This study evaluated the impact of different HH and gloving strategies on glove contamination. Methods Healthcare personnel (HCP) were enrolled on inpatient units and then randomized into 3...

Importance The natural history of C. difficile progression in nucleic acid amplification test (NAAT) positive, toxin enzyme immunoassay-negative patients remains poorly described. Better understanding risk for subsequent disease may improve prevention strategies. Objective Describe the natural history of C. difficile NAAT+/toxin- adults. Design A...

Keystone engineers profoundly influence microbial communities by altering their shared environment, often by modifying key resources. Here, we show that in an antibiotic-treated microbial community, bacterial spread is controlled by keystone engineering affecting dispersal—an effect hidden in well-mixed environments. Focusing on two pathogens, non-...

Background Carbapenem-resistant Enterobacterales (CRE) are an urgent threat to healthcare, but the epidemiology of these antimicrobial-resistant organisms may be evolving in some settings since the COVID-19 pandemic. An updated analysis of hospital-acquired CRE (HA-CRE) incidence in community hospitals is needed. Methods We retrospectively analyze...

Objective To evaluate postoperative outcomes among patients undergoing colon surgery who receive perioperative prophylaxis with ertapenem compared to other antibiotic regimens. Design and setting Multicenter retrospective cohort study among adults undergoing colon surgery in seven hospitals across three health systems from 1/1/2010 to 9/1/2015. M...

lactam antibiotics have been prescribed for most bacterial infections since their discovery. However, resistance to β-lactams, mediated by β-lactamase (Bla) enzymes such as extended spectrum β-lactamases (ESBLs), has become widespread. Bla inhibitors can restore the efficacy of β-lactams against resistant bacteria, an approach which preserves exist...

Background The field of healthcare epidemiology is increasingly focused on identifying, characterizing, and addressing social determinants of health (SDOH) to address inequities in healthcare quality. To identify evidence gaps, we examined recent systematic reviews examining the association of race, ethnicity, and SDOH with inpatient quality measur...

The rise of β-lactam resistance necessitates new strategies to combat bacterial infections. We purposefully engineered the β-lactam prodrug AcephPT to exploit β-lactamase activity to selectively suppress resistant bacteria producing extended-spectrum-β-lactamases (ESBLs). Selective targeting of resistant bacteria requires avoiding interaction with...

Background Frequently used physical therapy (PT) equipment is difficult to disinfect due to equipment material and shape. The efficacy of standard disinfection of PT equipment is poorly understood. Methods We completed a 2-phase prospective microbiological analysis of fomites used in PT at our hospital from September 2022 to October 2023. For both...

We identified 23 cases of Mycobacterium immunogenum respiratory acquisition linked to a colonized plumbing system at a new hospital addition. We conducted a genomic and epidemiologic investigation to assess for clonal acquisition of M. immunogenum from hospital water sources and improve understanding of genetic distances between M. immunogenum isol...

Background Lung transplant recipients are at increased risk of Mycobacterium abscessus complex (MABC) acquisition and invasive infection. We analyzed risk factors and outcomes of early post-lung transplant MABC acquisition. Methods We conducted a retrospective matched case-control study of patients who underwent lung transplant from 1/1/2012–12/31...

Importance Despite modest reductions in the incidence of hospital-onset Clostridioides difficile infection (HO-CDI), CDI remains a leading cause of health care–associated infection. As no single intervention has proven highly effective on its own, a multifaceted approach to controlling HO-CDI is needed. Objective To assess the effectiveness of the...

SARS‐CoV‐2 antibody levels may serve as a correlate for immunity and could inform optimal booster timing. The relationship between antibody levels and protection from infection was evaluated in vaccinated individuals from the US National Basketball Association who had antibody levels measured at a single time point from September 12, 2021, to Decem...

Objective To determine whether removal of default duration, embedded in electronic prescription (e-script), influenced antibiotic days of therapy. Design Interrupted time-series analysis. Setting The study was conducted across 2 community hospitals, 1 academic hospital, 3 emergency departments, and 86 ambulatory clinics. Patients Adults prescrib...

Purpose: Patients with suspected UTIs are categorized into 3 clinical phenotypes based on current guidelines: no UTI, asymptomatic bacteriuria (ASB), or UTI. However, all patients may not fit neatly into these groups. Our objective was to characterize clinical presentations of patients who receive urine tests using the "continuum of UTI" approach....

N95 respirator contamination with SARS-CoV-2 during clinical care of patients with COVID-19 is poorly understood. We performed a prospective observational study on healthcare provider’s (HCP) N95 respirators and face shields SARS-CoV-2 contamination during aerosol generating procedures (AGP) on SARS-CoV-2 positive patients housed in a COVID-19 spec...

Background:The origins and timing of inpatient room sink contamination with carbapenem-resistant organisms (CROs) are poorly understood. Methods:We performed a prospective observational study to describe the timing, rate, and frequency of CRO contamination of in-room handwashing sinks in 2 intensive care units (ICU) in a newly constructed hospital...

We performed a literature review to describe the risk of surgical-site infection (SSI) in minimally invasive surgery (MIS) compared to standard open surgery. Most studies reported decreased SSI rates among patients undergoing MIS compared to open procedures. However, many were observational studies and may have been affected by selection bias. MIS...

Background Various water-based heater-cooler devices (HCDs) have been implicated in nontuberculous mycobacteria outbreaks. Ongoing rigorous surveillance for healthcare-associated M. abscessus (HA-Mab) put in place following a prior institutional outbreak of M. abscessus alerted investigators to a cluster of 3 extrapulmonary M. abscessus infections...

Objective We compared the number of blood-culture events before and after the introduction of a blood-culture algorithm and provider feedback. Secondary objectives were the comparison of blood-culture positivity and negative safety signals before and after the intervention. Design Prospective cohort design. Setting Two surgical intensive care uni...

Background Urinalysis (UA) results are used by clinicians and laboratories to aid in the diagnosis of UTI. However, optimal UA parameters have not been systematically investigated or validated for different populations. Our objectives were to assess the performance of UA in predicting UTI and to stratify UA performance by age, sex, and culture thre...

Background Lung transplant recipients are at increased risk of MABC acquisition. The objective of this study was to analyze risk factors and outcomes of early post-transplant MABC acquisition. Methods We conducted a single center retrospective case-control study of patients who underwent lung transplant from 1/1/2012 – 12/31/2021. Cases were patie...

Background Healthcare utilization for complicated urinary tract infections (cUTI) is increasing in recent years, especially among older adults due to comorbidities and immunosuppression. However, healthcare utilization and inpatient antibiotic use for cUTI are poorly described among older adults. Methods This retrospective cohort study included in...

Background Extended spectrum cephalosporin-resistant Enterobacterales (ESCR-E) are increasingly implicated in community-onset urinary tract infections (UTIs). In this study, we assessed risk factors for recurrence among patients with community-onset UTI caused by ESCR-E. Methods This retrospective cohort study included adult patients evaluated Apr...

Background The use of environmental sampling to surveil the healthcare environment for invasive fungal species to prevent or respond to outbreaks is limited due to the absence of established threshold values and standard practices. This study aims to fill this gap by comparing sampling and detection methods in a controlled experimental setting. Me...

Background Numerous studies have reported that rates of nontuberculous mycobacteria (NTM) infections are increasing. However, data on the epidemiology of healthcare facility-associated (HCFA) NTM are sparse. We performed a multicenter longitudinal study to analyze the epidemiology of NTM at a network of U.S. academic hospitals. Methods We retrospe...

Background An estimated 65% of the US population had at least two SARS-CoV-2 infections by November 2022, but the impact of prior infection on disease course in subsequent infections has been debated. Population-level studies can yield conflicting results due to biases that arise from differences in differences in infection history, vaccination sta...

Objective To analyze Clostridioides difficile testing in 3 hospitals in central North Carolina to validate previous racial health-disparity findings. Methods We completed a retrospective analysis of inpatient C. difficile tests from 2015 to 2021 at 3 university-affiliated hospitals in North Carolina. We calculated the number of C. difficile tests...

Background Extended spectrum cephalosporin-resistant Enterobacterales (ESCrE) are an increasingly important cause of community-onset urinary tract infections (UTIs), including recurrent infections. We evaluated risk factors for recurrence among patients with community-onset ESCrE UTI. Methods This retrospective cohort study included adults with co...

Background The National Basketball Association (NBA) suspended operations in response to the COVID-19 pandemic in March 2020. To safely complete the 2019–20 season, the NBA created a closed campus in Orlando, Florida, known as the NBA “Bubble.” More than 5000 individuals lived, worked, and played basketball at a time of high local prevalence of SAR...

Since the initial publication of A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals in 2008, the prevention of healthcare-associated infections (HAIs) has continued to be a national priority. Progress in healthcare epidemiology, infection prevention, antimicrobial stewardship, and implementation science r...

The impact of a prior SARS-CoV-2 infection on the progression of subsequent infections has been unclear. Using a convenience sample of 94,812 longitudinal RT-qPCR measurements from anterior nares and oropharyngeal swabs, we identified 71 individuals with two well-sampled SARS-CoV-2 infections between March 11th, 2020, and July 28th, 2022. We compar...

Background: Frequently used physical therapy (PT) equipment is notably difficult to disinfect due to equipment material and shape, however, the efficacy of standard disinfection of PT equipment is poorly understood. Methods: We completed a prospective observational microbiological analysis of fomites used in adult or pediatric PT at Duke University...

Background: Historically, diagnosis of urinary tract infections (UTIs) has been divided into 3 categories based on symptoms and urine culture results: not UTI, asymptomatic bacteriuria (ASB), or UTI. However, some populations (eg, older adults, catheterized patients) may not present with signs or symptoms referrable to the urinary tract or have chr...

Background: Blood cultures are commonly ordered for patients with low risk of bacteremia. Liberal blood-culture ordering increases the risk of false-positive results, which can lead to increased length of stay, excess antibiotics, and unnecessary diagnostic procedures. We implemented a blood-culture indication algorithm with data feedback and asses...

We calculated the attributable cost of several healthcare-associated infections in a community hospital network: central-line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), hospital-onset Clostridioides difficile infections (CDI-HOs) (43 hospitals); surgical site infections (SSIs) (40 hospitals)....

This study (1) determined the association of time since initial vaccine regimen, booster dose receipt, and COVID-19 history with antibody titer, as well as change in titer levels over a defined period, and (2) determined risk of COVID-19 associated with low titer levels. This observational study used data from staff participating in the National Fo...

We assessed Oxivir Tb wipe disinfectant residue in a controlled laboratory setting to evaluate low environmental contamination of SARS-CoV-2. Frequency of viral RNA detection was not statistically different between intervention and control arms on day 3 (P=0.14). Environmental contamination viability is low; residual disinfectant did not significan...

Importance: Two-step testing for Clostridioides difficile infection (CDI) aims to improve diagnostic specificity, but may also influence reported epidemiology and patterns of treatment. Some providers fear that two-step testing may result in adverse outcomes if C. difficile is under-diagnosed. Objective: Our primary objective was to assess the i...

and purpose The intent of this document is to highlight practical recommendations in a concise format designed to assist acute-care hospitals in implementing and prioritizing their surgical-site infection (SSI) prevention efforts. This document updates the Strategies to Prevent Surgical Site Infections in Acute Care Hospitals published in 2014. ¹ T...

This retrospective review of 4-year surveillance data revealed a higher central line-associated bloodstream infection (CLABSI) rate in non-Hispanic Black patients and higher catheter-associated urinary tract infection (CAUTI) rates in Asian and non-Hispanic Black patients compared with White patients despite similar catheter utilization between the...

In total, 50 healthcare facilities completed a survey in 2021 to characterize changes in infection prevention and control and antibiotic stewardship practices. Notable findings include sustained surveillance for multidrug-resistant organisms but decreased use of human resource-intensive interventions compared to previous surveys in 2013 and 2018 co...

The impact of a prior SARS-CoV-2 infection on the progression of subsequent infections has been unclear. Using a convenience sample of 94,812 longitudinal RT-qPCR measurements from anterior nares and oropharyngeal swabs, we compared the SARS-CoV-2 viral kinetics of first vs. second infections, adjusting for viral variant, vaccination status, and ag...

SARS-CoV-2 antibody titers may serve as a correlate for immunity and could inform optimal booster timing. The relationship between antibody titer and protection from infection was evaluated in 2,323 vaccinated individuals from the National Basketball Association who had antibody levels measured from 9/12/2021 to 12/31/2021. Cox-proportional hazards...

Background: Throughout the COVID-19 pandemic, many hospitals conducted routine testing of hospitalized patients for SARS-CoV-2 infection upon admission. Some of these patients are admitted for reasons unrelated to COVID-19, and incidentally test positive for the virus. Because COVID-19-related hospitalizations have become a critical public health...

BACKGROUND Throughout the COVID-19 pandemic, many hospitals conducted routine testing of hospitalized patients for SARS-CoV-2 infection upon admission. Some of these patients are admitted for reasons unrelated to COVID-19, and incidentally test positive for the virus. Because COVID-19-related hospitalizations have become a critical public health in...

Objective: To determine whether hydroxychloroquine (HCQ) is safe and effective at preventing COVID-19 infections among health care workers (HCW). Methods: IN A 1: :1 randomized, placebo-controlled, double-blind, parallel-group, superiority trial at 34 US clinical centers, 1360 HCW at risk for COVID-19 infection were enrolled between April and No...

Objectives To investigate the feasibility of retrospective prescription-based review and to describe the antibiotic prescribing patterns to provide information for an antimicrobial stewardship programme in Viet Nam Methods This study was conducted in two provincial-level hospitals between February and April 2020. Reviews were done by a clinical te...

Importance: Approximately 0.5% to 3% of patients undergoing surgery will experience infection at or adjacent to the surgical incision site. Compared with patients undergoing surgery who do not have a surgical site infection, those with a surgical site infection are hospitalized approximately 7 to 11 days longer. Observations: Most surgical site...

Background Clinicians and laboratories routinely use urinalysis (UA) parameters to determine whether antimicrobial treatment and/or urine cultures are needed. Yet the performance of individual UA parameters and common thresholds for action are not well defined and may vary across different patient populations. Methods In this retrospective cohort...

Background Increases in central line-associated bloodstream infection (CLABSI) rates have been reported in association with the COVID-19 pandemic, particularly among Candida species and coagulase-negative Staphylococcal species (CoNS). We sought to further validate the impact of the COVID-19 pandemic on CLABSI trends and perform a microbiologic ana...

Background Clinicians and laboratories routinely use urinalysis (UA) results to help determine if urine cultures and/or antimicrobials are indicated. Yet, the performance of individual UA parameters and common clinical thresholds for action are not well defined and may vary across different patient populations. Our objective was to compare the perf...

Background COVID-19 shifted antibiotic stewardship program resources and changed antibiotic use (AU). Shifts in patient populations with COVID surges, including pauses to surgical procedures, and dynamic practice changes makes temporal associations difficult to interpret. Our analysis aimed to address the impact of COVID on AU after adjusting for o...

Background Benchmarking AU is important to identify opportunities and allocate resources within a health system. Patient level factors such as infection diagnosis codes further refine risk adjustments but have not been more widely adopted because of the burden of accurately collecting and submitting granular data. The goal of this study was to eval...

Background The most efficient combination of manual washes (MW) and high-level disinfection (HLD) cycles for the reprocessing of duodenoscopes used for ERCP is unknown. The FDA recently announced the national recommendation for transition to duodenoscopes with disposable components. Methods We studied contamination of Pentax Medical duodenoscopes...

Background Inequities in healthcare among racial and ethnic minorities are globally recognized. The focus has centered on access to healthcare, equitable treatment, and optimizing outcomes. However, there has been relatively little investigation into potential racial and ethnic disparities in HAI. Methods We performed a retrospective cohort analys...

Background Contamination of ambulances and EMS providers is poorly understood. Methods We conducted a prospective observational study to determine contamination of ambulances and EMS providers at two agencies in central North Carolina. Study ambulances and providers were enrolled and sampled prior to the start of day shift on each sampling day. Am...

Background Traditional approaches for surgical site infection (SSI) surveillance have deficiencies that delay detection of SSI outbreaks and other clinically important increases in SSI rates. We investigated whether use of optimised statistical process control (SPC) methods and feedback for SSI surveillance would decrease rates of SSI in a network...

We compared the effectiveness of 4 sampling methods to recover Staphylococcus aureus, Klebsiella pneumoniae and Clostridioides difficile from contaminated environmental surfaces: cotton swabs, RODAC culture plates, sponge sticks with manual agitation, and sponge sticks with a stomacher. Organism type was the most important factor in bacterial recov...

Background: Nontuberculous mycobacteria (NTM) are emerging pathogens increasingly implicated in healthcare facility-associated (HCFA) infections and outbreaks. We analyzed the performance of statistical process control (SPC) methods in detecting HCFA NTM outbreaks. Methods: We retrospectively analyzed 3 NTM outbreaks that occurred from 2013-2016...

Background: The combined impact of immunity and SARS-CoV-2 variants on viral kinetics during infections has been unclear. Methods: We characterized 1,280 infections from the National Basketball Association occupational health cohort identified between June 2020 and January 2022 using serial RT-qPCR testing. Logistic regression and semi-mechanistic...

Importance Environmental contamination is a source of transmission between patients, health care practitioners, and other stakeholders in the acute care setting. Objective To compare the efficacy of an enhanced daily disinfection strategy vs standard disinfection in acute care hospital rooms. Design, Setting, and Participants This randomized clin...

Background: Sepsis guidelines recommend daily review to de-escalate or stop antibiotics in appropriate patients. This randomized controlled trial evaluated an opt-out protocol to decrease unnecessary antibiotics in patients with suspected sepsis. Methods: We evaluated non-ICU adults on broad-spectrum antibiotics despite negative blood cultures a...

Objectives 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 undergoi...

Background The 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 infrastruc...

Objectives To evaluate the pattern of blood-culture utilization among a cohort of 6 hospitals to identify potential opportunities for diagnostic stewardship. Methods We completed a retrospective analysis of blood-culture utilization during adult inpatient or emergency department (ED) encounters in 6 hospitals from May 2019 to April 2020. We invest...

Importance: Person-to-person contact is important for the transmission of health care-associated pathogens. Quantifying these contact patterns is crucial for modeling disease transmission and understanding routes of potential transmission. Objective: To generate and analyze the mixing matrices of hospital patients based on their contacts within...

Background Community-acquired carbapenem-resistant Enterobacterales (CA-CRE) are an important threat. Methods In CRACKLE-2, we defined patients with CA-CRE as admitted from home, without pre-existing conditions, and a positive culture within 48 h of admission. Healthcare-associated CRE (HA-CRE) were those with the lowest likelihood of community ac...

Objective 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 fro...

Policies that promote conversion of antibiotics from intravenous to oral route administration are considered “low hanging fruit” for hospital antimicrobial stewardship programs. We developed a simple metric based on digestive days of therapy divided by total days of therapy for targeted agents and a method for hospital comparisons. External compari...

Background: SARS-CoV-2 N95 mask contamination in healthcare providers (HCPs) treating patients with COVID-19 is poorly understood. Method: We performed a prospective observational study of HCP N95 respirator SARS-CoV-2 contamination during aerosol-generating procedures (AGPs) on SARS-CoV-2–positive patients housed in a COVID-19–specific unit at an...

Background: Enhanced strategies for daily disinfection in acute-care hospital rooms are needed but are poorly understood. Methods: We conducted a randomized control trial pilot study in acute-care hospital rooms at Duke University Health System in Durham, North Carolina, comparing the efficacy of a novel EPA-registered quaternary ammonium disinfect...

Background: Racial and ethnic disparities in healthcare access, medical treatment, and outcomes have been extensively reported. However, the impact of racial and ethnic differences in patient safety, including healthcare-associated infections, has not been well described. Methods: We performed a retrospective review analyzing prospectively collecte...

Background: Central-line–associated bloodstream infections (CLABSIs) arise from bacteria migrating from the skin along the catheter, by direct inoculation, or from pathogens that form biofilms on the interior surface of the catheter. However, given the oxygen-poor environments that obligate anaerobes require, these organisms are unlikely to survive...

Objectives The typical 5-day work week affects healthcare outcomes. Structured work hours have also been implicated in antimicrobial prescribing choice. We developed a visualization tool to aid in evaluating breadth of antibiotic use in various time (day of week and hour of day) and space (patient location) combinations. Methods We evaluated antib...

A retrospective cohort of children admitted to the pediatric intensive care unit (PICU) with cerebral palsy was matched 1:3 by age and admission year to determine odds of methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization. Adjusted odds of MRSA nasal colonization at PICU admission were 2.6-fold higher among children with cerebral...

This study compares the incidence of SARS-CoV-2 infection in players and staff of the National Basketball Association (NBA) who did vs those who did not receive a COVID-19 vaccine booster dose.