Edward J Septimus

Edward J Septimus
Texas A&M University System Health Science Center | TAMHSC · Internal Medicine

About

167
Publications
19,985
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9,140
Citations
Citations since 2016
38 Research Items
6635 Citations
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201620172018201920202021202202004006008001,0001,200

Publications

Publications (167)
Article
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The COVID-19 pandemic presents a serious public health challenge in all countries. However, repercussions of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections on future global health are still being investigated, including the pandemic’s potential effect on the emergence and spread of global antimicrobial resistance (AMR). Cri...
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Background: The Centers for Medicare and Medicaid Services (CMS) use colon surgical site infection (SSI) rates to rank hospitals and apply financial penalties. CMS's risk adjustment model omits potentially impactful variables that might disadvantage hospitals with complex surgical populations. Methods: We analyzed adult patients who underwent co...
Article
Variability in hospital-level sepsis mortality rates may be due to differences in case mix, quality of care, or diagnosis and coding practices. Centers for Disease Control and Prevention's Adult Sepsis Event definition could facilitate objective comparisons of sepsis mortality rates between hospitals but requires rigorous risk-adjustment tools. We...
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Background: The Antimicrobial Use (AU) Option of the Centers for Disease Control and Prevention's National Healthcare Safety Network (NHSN) is a surveillance resource that can provide actionable data for antibiotic stewardship programs. Such data are used to enable measurements of AU across hospitals and before, during, and after stewardship inter...
Article
Background Universal skin and nasal decolonisation reduces multidrug-resistant pathogens and bloodstream infections in intensive care units. The effect of universal decolonisation on pathogens and infections in non-critical-care units is unknown. The aim of the ABATE Infection trial was to evaluate the use of chlorhexidine bathing in non-critical-c...
Article
Background Hospitalized patients who are colonized with methicillin-resistant Staphylococcus aureus (MRSA) are at high risk for infection after discharge. Methods We conducted a multicenter, randomized, controlled trial of postdischarge hygiene education, as compared with education plus decolonization, in patients colonized with MRSA (carriers). D...
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Background Procalcitonin is a hormone precursor that has been identified as a marker for bacterial infections. Procalcitonin increases as the body mounts an inflammatory response against infection, then returns to its normal range once the response subsides. Studies have shown that reduced procalcitonin levels may support antibiotic discontinuation...
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Background Antibiotic prescription rates for treating exacerbations of chronic obstructive pulmonary disease (COPD) have been reported as high as 90% in the United States. Research has shown that over 50% of COPD exacerbations are due to viral etiologies. Elevations in procalcitonin (PCT) levels can be seen in bacterial infections and can help guid...
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Background This study assessed physicians’ current practice patterns in prevention and management of Clostridium difficile infection (CDI). Methods A 25-question clinical practice assessment survey was made available to infectious disease (ID) specialists without monetary compensation or charge. Questions evaluated knowledge, competence, and barri...
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Background Administrative claims data are commonly used for sepsis surveillance, research, and quality improvement. However, variations in diagnosis, documentation, and coding practices may confound efforts to benchmark hospital sepsis outcomes using claims data. Methods We evaluated the sensitivity of claims data for sepsis and organ dysfunction...
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Objectives: Administrative claims data are commonly used for sepsis surveillance, research, and quality improvement. However, variations in diagnosis, documentation, and coding practices for sepsis and organ dysfunction may confound efforts to estimate sepsis rates, compare outcomes, and perform risk adjustment. We evaluated hospital variation in...
Article
Background: Antimicrobial stewardship is recommended as a crucial mechanism to reduce the emergence of antimicrobial resistance. The purpose of this article was to describe implementation of antimicrobial management programs (AMPs) across a large health system of community hospitals. Methods: The initiative was structured in 4 phases. Although e...
Article
Antimicrobial resistance (AR) is one of the most serious public health threats today, which has been accelerated by the overuse and misuse of antimicrobials in humans and animals plus inadequate infection prevention. Numerous studies have shown a relationship between antimicrobial use and resistance. Antimicrobial stewardship (AS) programs have bee...
Article
Antimicrobial Stewardship and Infection Prevention—Leveraging the Synergy: A Position Paper Update - Volume 39 Issue 4 - Mary Lou Manning, Edward J. Septimus, Elizabeth S. Dodds Ashley, Sara E. Cosgrove, Mohamad G. Fakih, Steve J. Schweon, Frank E. Myers, Julia A. Moody
Article
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Background: The Global Point Prevalence Survey (Global-PPS) established an international network of hospitals to measure antimicrobial prescribing and resistance worldwide. We aimed to assess antimicrobial prescribing and resistance in hospital inpatients. Methods: We used a standardised surveillance method to collect detailed data about antimic...
Chapter
Methicillin-resistant Staphylococcus aureus (MRSA) remains an important public health threat. MRSA is one of the most important common causes of healthcare-associated infections (HAIs) in most hospitals. 47.9% of Staphylococcus aureus HAIs are due to MRSA. In addition, MRSA infections can result in substantial morbidity and mortality and lead it in...
Article
In this multicenter retrospective cohort study of over 1 million patients at 150 US hospitals, proton pump inhibitors increased the odds of a patient having hospital-onset Clostridium difficile infection as did third and fourth generation cephalosporins, carbapenems, and piperacillin/tazobactam. These findings support appropriate prescribing of aci...
Article
The Center for Medicare and Medicaid Services adopted the Early Management Bundle, Severe Sepsis/Septic Shock (SEP-1) performance measure to the Hospital Inpatient Quality Reporting Program in July 2015 to help address the high mortality and high cost associated with sepsis. The SEP-1 performance measure requires, among other critical interventions...
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Background Universal decolonization with daily chlorhexidine (CHG) bathing with and without nasal decolonization has significantly reduced positive MRSA clinical cultures and bloodstream infections in adult ICUs in several clinical trials. We evaluated whether decolonization was similarly effective in a lower risk hospitalized population. Methods...
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Background The clinical research enterprise is not producing the evidence decision makers arguably need in a timely and cost effective manner; research currently involves the use of labor-intensive parallel systems that are separate from clinical care. The emergence of pragmatic clinical trials (PCTs) poses a possible solution: these large-scale tr...
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Importance Estimates from claims-based analyses suggest that the incidence of sepsis is increasing and mortality rates from sepsis are decreasing. However, estimates from claims data may lack clinical fidelity and can be affected by changing diagnosis and coding practices over time. Objective To estimate the US national incidence of sepsis and tre...
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Reports have suggested declines in incidence of invasive methicillin-resistant Staphylococcus aureus (MRSA) infections. Our analysis of data from the National Inpatient Sample shows that the decrease in MRSA-related hospitalizations between 2010 and 2014 was primarily due to declines in skin- and soft-tissue infections. Invasive MRSA-related hospit...
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Background: Despite the well-known fact that antibiotics (AB) are not effective against viruses, many patients ask for - and all too often doctors provide - AB for treating URTIs. Over-prescribing of AB is one of the key causes for the development of bacterial resistance, which the U.S. Centers for Disease Control and Prevention (CDC) calls "one o...
Article
Whether targeted or universal decolonization strategies for control of methicillin-resistant Staphylococcus aureus (MRSA) select for resistance to decolonizing agents is unresolved. The REDUCE MRSA trial provided an opportunity to investigate this question. REDUCE-MRSA was a 3-arm, cluster-randomized trial of screening and isolation without decolon...
Article
Evidence-based guidelines for implementation and measurement of antibiotic stewardship interventions in inpatient populations including long-term care were prepared by a multidisciplinary expert panel of the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. The panel included clinicians and investigators...
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Background: Challenges exist in implementing evidence-based strategies, reaching high compliance, and achieving desired outcomes. The rapid adoption of a publicly available toolkit featuring routine universal decolonization of intensive care unit (ICU) patients may affect catheter-related blood stream infections. Methods: Implementation of unive...
Article
Evidence-based guidelines for implementation and measurement of antibiotic stewardship interventions in inpatient populations including long-term care were prepared by a multidisciplinary expert panel of the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. The panel included clinicians and investigators...
Article
Colonization with health care-associated pathogens such as Staphylococcus aureus , enterococci, Gram-negative organisms, and Clostridium difficile is associated with increased risk of infection. Decolonization is an evidence-based intervention that can be used to prevent health care-associated infections (HAIs). This review evaluates agents used fo...
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Healthcare-associated infections (HAIs) are a leading cause of morbidity and mortality in hospitalized patients. Up to 15% of patients develop an infection while hospitalized in the United States, which accounts for approximately 1.7 million HAIs, 99,000 deaths annually and over 10 billion dollars in costs per year. A significant percentage of HAIs...
Article
Background: Urinary tract infections (UTIs) are common health-care-associated infections. Bacteriuria commonly precedes UTI and is often treated with antibiotics, particularly in hospital intensive care units (ICUs). In 2013, a cluster-randomised trial (REDUCE MRSA Trial [Randomized Evaluation of Decolonization vs Universal Clearance to Eradicate...
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BACKGROUND To design better antimicrobial stewardship programs, detailed data on the primary drivers and patterns of antibiotic use are needed. OBJECTIVE To characterize the indications for antibiotic therapy, agents used, duration, combinations, and microbiological justification in 6 acute-care US facilities with varied location, size, and type o...
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Institutional review boards, which are charged with overseeing research, must classify the riskiness of proposed research according to a federal regulation known as the Common Rule (45 CFR 46, Subpart A) and by regulations governing the US Food and Drug Administration codified in 21 CFR 50. If an institutional review board determines that a clinica...
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Pragmatic clinical trials are increasingly common because they have the potential to yield findings that are directly translatable to real-world healthcare settings. Pragmatic clinical trials need to integrate research into clinical workflow without placing an undue burden on the delivery system. This requires a research partnership between investi...
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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...
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#### Summary points Pragmatic clinical trials are comparative effectiveness studies conducted in real-world settings to answer questions relevant to patients, clinicians, and healthcare decision makers. In contrast, explanatory clinical trials study how treatments or interventions work in carefully controlled settings and study populations, often...
Article
Arnauld Nicogossian, Edward J. Septimus, Otmar Kloiber, Bonnie Stabile,and Thomas ZimmermanThe resurgence and rapid spread of Ebola in Africa, and the Enterovirus(EV-D68) respiratory infection among U.S. children, have heightened concerns ofpolicy makers and medical communities. Ebola, spread only through direct contactwith body fluids, results in a...
Article
Overuse and misuse of antibiotics have contributed to the growing problem of antimicrobial resistance and serious side effects including Clostridium difficile infection. The Centers for Disease Control and Prevention estimates that more than 2 million people are infected by multidrug-resistant organisms every year. They propose that promoting antim...
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Purpose: To describe antimicrobial stewardship programs (ASPs) of acute and long-term acute care (LTAC) hospitals in Houston, Texas. Methods: Two-part survey to clinical pharmacists and pharmacy directors. All acute care and LTAC facilities from the Harris County Medical Society database were invited to participate. Results: In part 1 of the t...
Conference Paper
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Background: Modifying or discontinuing empiric antimicrobials when warranted by clinical signs and culture results has been recommended as a strategy to limit antimicrobial overuse and bacterial resistance. Methods: : To describe factors associated with adjustments to inpatient antimicrobial therapy we created a retrospective cohort of 1,200 adul...
Conference Paper
Background: We conducted a 3 arm cluster randomized trial of three MRSA prevention strategies in 74 ICUs at 43 hospitals which demonstrated universal decolonization with chlorhexidine and mupirocin in adult ICUs resulted in a 44% reduction in risk of bloodstream infection due to all pathogens.(N Engl J Med 2013; 368:2255-2268) Implementing novel ev...
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: Bacteriuria commonly precedes UTI, and is often treated with antibiotics, especially in ICU patients. The impact of body surface decolonization on bacteriuria and candiduria is unknown. Methods: Secondary analysis of a 3 arm cluster randomized trial of 43 hospitals (74 adult ICUs). Arms included 1) MRSA screening and isolation, 2) tar...
Conference Paper
Background: The Study to Optimally Prevent SSIs in Select Cardiac & Orthopedic Procedures (STOP SSIs) tested an evidence-based bundle to reduce the incidence of surgical site infections caused by S. aureusin patients having cardiac operations or hip or knee arthroplasty. Twenty hospitals in a national health system implemented the bundle. Methods...
Conference Paper
Background: The degree to which targeted or universal decolonization strategies for control of MRSA select for resistance to decolonizing agents is unresolved. Methods: MRSA isolates were collected during baseline and intervention periods from 74 ICUs in a 43 hospital, 3-arm, cluster-randomized trial of screening and isolation (arm 1), targeted d...
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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
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Background. HIV/hepatitis C virus (HCV) coinfection is associated with reduced bone mineral density (BMD) and increased fracture rates, particularly in women. However, the structural underpinnings for the skeletal fragility in coinfected women have not been characterized. We used peripheral quantitative computed tomography (pQCT) and whole-body dua...
Article
Objective To estimate and compare the impact on healthcare costs of 3 alternative strategies for reducing bloodstream infections in the intensive care unit (ICU): methicillin-resistant Staphylococcus aureus (MRSA) nares screening and isolation, targeted decolonization (ie, screening, isolation, and decolonization of MRSA carriers or infections), an...
Article
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Objective To determine rates of blood culture contamination comparing 3 strategies to prevent intensive care unit (ICU) infections: screening and isolation, targeted decolonization, and universal decolonization. Design Pragmatic cluster-randomized trial. Setting Forty-three hospitals with 74 ICUs; 42 of 43 were community hospitals. Patients Pati...
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Approaches for Preventing Healthcare-Associated Infections: Go Long or Go Wide? - Volume 35 Issue S2 - Edward Septimus, Robert A. Weinstein, Trish M. Perl, Donald A. Goldmann, Deborah S. Yokoe
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Since the publication of “A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals” in 2008, prevention of healthcare-associated infections (HAIs) has become a national priority. Despite improvements, preventable HAIs continue to occur. The 2014 updates to the Compendium were created to provide acute care hospi...
Article
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Preventing healthcare-associated infections (HAIs) is a national priority. Although substantial progress has been achieved, considerable deficiencies remain in our ability to efficiently and effectively translate existing knowledge about HAI prevention into reliable, sustainable, widespread practice. "A Compendium of Strategies to Prevent Healthcar...