Mohamad G Fakih

• MD, MPH
• Chief Quality Officer at Ascension Health

Background Diagnostic stewardship complements antimicrobial stewardship by promoting appropriate use of diagnostic tools. While disparities have been reported in antibiotic prescribing and hospital-acquired infections, data are limited on diagnostic test utilization. We evaluated the association of race and social vulnerability index (SVI) on order...

Background Rising antibiotic resistance is a major public health threat. In 2015 our organization responded by establishing antimicrobial stewardship programs in all acute care facilities. A review of the literature has shown concerning disparities in antibiotic use across different populations, potentially contributing to unequal health outcomes....

The COVID-19 pandemic has accelerated changes in health care across the nation. Particularly, infection prevention programs have been subjected to pressures and increased responsibilities with no expansion in support. In addition, there is a rapid trend for health systems to merge to ensure long term sustainability. Based on our experience leading...

Importance Guidelines recommend withholding antibiotics in asymptomatic bacteriuria (ASB), including among patients with altered mental status (AMS) and no systemic signs of infection. However, ASB treatment remains common. Objectives To determine prevalence and factors associated with bacteremia from a presumed urinary source in inpatients with A...

Background The coronavirus disease 2019 (COVID-19) pandemic has had a considerable impact on central line-associated bloodstream infections (CLABSI) in US hospitals. Methods We evaluated the impact of COVID-19 on CLABSI in 86 hospitals of a single system with an active infection prevention program. We compared pandemic CLABSI events and associated...

Background Appendicitis is the most common cause of emergent pediatric surgeries. The standard treatment includes surgical removal of the appendix plus or minus antibiotic therapy. Piperacillin-tazobactam or ceftriaxone/metronidazole are commonly utilized antibiotic regimens. While the latter option may be preferable for antimicrobial stewardship m...

Background Staphylococcus aureus and Candida sp. bloodstream infections (BSI) are associated with considerable mortality. The COVID-19 pandemic presented new challenges in the acute care setting which may affect outcomes in high-risk populations. Methods Retrospective cross-sectional analysis across a large healthcare system of all admitted patien...

Background An estimated one third of antibiotics prescribed in the outpatient setting is considered unnecessary. We evaluated ambulatory antimicrobial use for a single system before and during the COVID-19 pandemic and assessed the impact of a system-based stewardship intervention on overall antibiotic selection and prescribing rates for indication...

Background The National Institute of Health (NIH) COVID-19 Treatment Guidelines support use of remdesivir in hospitalized adults with mild-to-moderate COVID-19 infection for those at risk of progressing to severe COVID-19 and those who require oxygen supplementation, high-flow nasal cannula, or non-invasive ventilation. We implemented a standardize...

Executive summary The coronavirus disease 2019 (COVID-19) pandemic has demonstrated the importance of stewardship of viral diagnostic tests to aid infection prevention efforts in healthcare facilities. We highlight diagnostic stewardship lessons learned during the COVID-19 pandemic and discuss how diagnostic stewardship principles can inform manage...

Objective: To determine the proportion of hospitals that implemented 6 leading practices in their antimicrobial stewardship programs (ASPs). Design: Cross-sectional observational survey. Setting: Acute-care hospitals. Participants: ASP leaders. Methods: Advance letters and electronic questionnaires were initiated February 2020. Primary outco...

Importance: Infection with SARS-CoV-2, which causes COVID-19, is associated with adverse maternal outcomes. While it is known that severity of COVID-19 varies by viral strain, the extent to which this variation is reflected in adverse maternal outcomes, including nonpulmonary maternal outcomes, is not well characterized. Objective: To evaluate t...

Fifty years of evolution in infection prevention and control programs have involved significant accomplishments related to clinical practices, methodologies, and technology. However, regulatory mandates, and resource and research limitations, coupled with emerging infection threats such as the COVID-19 pandemic, present considerable challenges for...

COVID-19 vaccination rates of a large health system reflected their respective service areas but varied by work role. Nurse vaccination rates were higher (56.9%) while nursing support personnel were lower (38.6%) than their communities (51.7%; P <0.001). Physician vaccination rates were highest (71.6%) and not associated with community vaccination...

Background The COVID-19 pandemic has had a considerable impact leading to increases in healthcare-associated infections, particularly bloodstream infections (BSI). Methods We evaluated the impact of COVID-19 in 69 US hospitals on BSIs before and during the pandemic. Events associated with 5 pathogens (Staphylococcus aureus, Escherichia coli, Klebs...

Background Urine cultures are nonspecific for infection and often lead to misdiagnosis of urinary tract infection and unnecessary antibiotics. Diagnostic stewardship is a set of procedures that modifies test ordering, processing, and reporting in order to optimize diagnosis and downstream treatment. This study aimed to develop expert guidance on be...

Background The associated mortality with COVID-19 has improved compared with the early pandemic period. The effect of hospital COVID-19 patient prevalence on COVID-19 mortality has not been well studied. Methods We analysed data for adults with confirmed SARS-CoV-2 infection admitted to 62 hospitals within a multistate health system over 12 months...

This consensus statement by the Society for Healthcare Epidemiology of America (SHEA) and the Society for Post-Acute and Long-Term Care Medicine (AMDA), the Association for Professionals in Epidemiology and Infection Control (APIC), the HIV Medicine Association (HIVMA), the Infectious Diseases Society of America (IDSA), the Pediatric Infectious Dis...

Background The coronavirus disease 2019 (COVID-19) pandemic has had a considerable impact on US hospitalizations, affecting processes and patient population. Methods We evaluated the impact of COVID-19 pandemic in 78 US hospitals on central line associated bloodstream infections (CLABSI) and catheter associated urinary tract infections (CAUTI) eve...

The extensive use of the urinalysis for screening and monitoring in diverse clinical settings usually identifies abnormal urinalysis parameters in patients with no suspicion of urinary tract infection, which in turn triggers urine cultures, inappropriate antimicrobial use, and associated harms like Clostridioides difficile infection. We highlight h...

Background: Interventions to reduce unnecessary device use may select a higher-risk population, leading to a paradoxical increase in SIR for some high-performing facilities. The standardized utilization ratio (SUR) adjusts for device use for different units and facilities. We evaluated the performance of a population SIR (pSIR) metric compared to d...

Background: Acute-care hospitals in the United States are required to submit 6 healthcare-associated infection (HAI) metrics to the CMS for reporting and performance purposes prior to payment. We examined the association between HAI rate trends and hospital-onset bloodstream infection (HO-BSI) rate trends across a large, multihospital health system...

Importance While current reports suggest that a disproportionate share of US coronavirus disease 2019 (COVID-19) cases and deaths are among Black residents, little information is available regarding how race is associated with in-hospital mortality. Objective To evaluate the association of race, adjusting for sociodemographic and clinical factors,...

Overcoming COVID-19: Addressing the Perception of Risk and Transitioning Protective Behaviors to Habits - Mohamad G. Fakih, Lisa Sturm, Rand R. Fakih

Background Staphylococcus aureus is a common pathogen that is implicated with both community and healthcare-associated infections. S. aureus infections lead to sepsis and bacteremia, and are associated with considerable morbidity and mortality despite available antimicrobial therapy. Methods Utilizing a clinical decision support system, patients w...

Background Hospitalized patients with bacteriuria are often identified based on positive urine cultures during the workup of urinary tract infection (UTI). However, the frequency of obtaining urine cultures varies between hospitals and may affect the detection of asymptomatic bacteriuria and symptomatic UTI. Methods We evaluated the frequency of u...

Background Clostridioides difficile infections (CDIs) are the most prevalent healthcare-associated infection in the U.S. Of all CDIs, most are related to healthcare exposures and are potentially preventable by reducing unnecessary antibiotic use and interrupting patient-to-patient transmission of CDI. Methods The adult SAARs for 4 antimicrobial ag...

Background Overuse of fluoroquinolones has been associated with increased rates of Clostridioides difficile infections, MRSA, and resistant Gram-negative infections due to selective pressure on normal flora. In addition, the FDA has issued several safety alerts regarding systemic use of fluoroquinolone antibiotics due to concerns for serious advers...

Background Compliance with evidence-based treatment bundles in patients with sepsis can lead to improved survival in persons with sepsis or septic shock. A way to ensure the adoption of best practices is the early use standardized order sets based on suspected source of infection. Methods The patient population was built by connecting electronic h...

Laboratory-identified bloodstream infections (LAB-ID BSIs) in recently discharged patients are likely to be classified as healthcare-associated community-onset (HCA-CO) infections, even though they may represent hospital-onset (HO) infections. A review of LAB-ID BSIs among patients discharged within 14 days revealed that 109 of 756 cases (14.4%) we...

Background The device standardized infection ratio (SIR) is used to compare unit and hospital performance for different publicly reported infections. Interventions to reduce unnecessary device use may select a higher-risk population, leading to a paradoxical increase in SIR for some high-performing facilities. The standardized utilization ratio (SU...

BACKGROUND In this changing landscape of healthcare, Infection Prevention (IP) programs need to demonstrate their value to their institutions. One way to do this is through the reduction of healthcare associated infections (HAI). This improves patient outcomes and can also provide value through the avoidance of hospital acquired condition (HAC) pen...

Diagnosis of urinary tract infections: need for a reflective rather than reflexive approach - Volume 40 Issue 7 - Mohamad G. Fakih, Sonali D. Advani, Valerie M. Vaughn

Catheter-associated urinary tract infection (CAUTI) has long been considered a preventable healthcare-associated infection. Many federal agencies, the Centers for Medicare and Medicaid Services (CMS), and public and private healthcare organizations have implemented strategies aimed at preventing CAUTIs. To monitor progress in CAUTI prevention, the...

Background The National Healthcare Safety Network (NHSN)’s Targeted Assessment for Prevention (TAP) Strategy is a framework for quality improvement that offers a focused approach to infection prevention. The cumulative attributable difference (CAD) is used as a prioritization metric to identify areas with the highest burden of excess infections. Th...

Background The device standardized infection ratio (SIR) has been used to compare units’ and hospitals’ performance for different publicly reported infections. Interventions to reduce unnecessary device use may select a higher risk population that is not accounted for in the current risk adjustments, leading to a paradoxical increase in SIR for fac...

Background Laboratory-identified bloodstream infections (LAB-ID-BSI) are classified as community onset (CO) if blood culture (BC) is collected within 3 days after facility admission and hospital onset if ≥4 days. This classification is often based on a computer-generated subtraction of the day of admission from day of onset. This method may miss re...

We compared interventions to improve urinary catheter care and urine culturing in adult intensive care units of 2 teaching hospitals. Compared to hospital A, hospital B had lower catheter utilization, more compliance with appropriate indications and maintenance, but higher urine culture use and more positive urine cultures per 1,000 patient days.

To systematically improve the appropriateness of antibiotic prescribing, antimicrobial stewardship programs have been developed. There is a paucity of literature examining how pharmacists perform antimicrobial stewardship using a clinical decision support system in a hospital setting. The purpose of this qualitative study was to develop a model exp...

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

Cambridge Core - Infectious Disease - Practical Healthcare Epidemiology - edited by Ebbing Lautenbach

Of 500 hospital-onset Staphylococcus aureus bacteremia events (58% methicillin-susceptible S. aureus [MSSA]; 42% methicillin-resistant S. aureus [MRSA]), we found no significant differences in S. aureus bacteremia rates between medium-sized and large hospitals. However, the proportion of S. aureus bacteremia caused by MSSA was greater in medium-siz...

BACKGROUND Urinary catheters, many of which are placed in the emergency department (ED) setting, are often inappropriate, and they are associated with infectious and noninfectious complications. Although several studies evaluating the effect of interventions have focused on reducing catheter use in the ED setting, the organizational contexts within...

Background Currently, publicly reported infections include a few types of events, and do not provide a comprehensive picture on overall infection prevention practices. Hospital onset bloodstream infection (HOBSI), regardless of source, reflects invasive infection from an at risk patient population in inpatient healthcare settings. Methods Using on...

Background Hospital Onset (HO) Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is publicly reported and tied to the Hospital-Acquired Conditions Reduction program. It reflects a surrogate of risk of infection of MRSA invasive disease in the hospital setting, and reported as a standardized infection ratio that adjusts for admission MRS...

Background Inappropriate Antimicrobial use, its associated resistance and suboptimal patient outcomes are important quality and safety concerns. Antimicrobial stewardship programs (ASP) can help reduce the risk of development of multi-drug resistant organisms, and Clostridium difficile infections. The Centers for Disease Control and Prevention (CDC...

Background Penicillin allergy is the most common antibiotic allergy noted within medical records, and its inaccurate reporting leads to increased use of alternative antibiotics that may be less effective, broader in spectrum, more toxic, and costly. Methods We retrospectively reviewed the reported allergies to penicillin in patients cared for at 1...

Background Antibiotics are frequently prescribed among senior living residents, with the over diagnosis of infections playing a significant problem. Elderly are vulnerable to the harms of inappropriate antibiotic use. Methods We evaluated the use of systemic antibiotics, the diagnosis of facility-onset urinary tract infection (based on McGeer’s cr...

BACKGROUND The National Healthcare Safety Network (NHSN) catheter-associated urinary tract infection (CAUTI) definition was revised as of January 2015 to exclude funguria and lower bacteriuria levels. We evaluated the effect of the CAUTI definition change on NHSN-defined central-line–associated bloodstream infection (CLABSI) outcomes. METHODS We c...

div class="title">Improving the Culture of Culturing: Critical Asset to Antimicrobial Stewardship - Mohamad G. Fakih, Riad Khatib

Background: The standardized infection ratio (SIR) evaluates individual publicly reported health care-associated infections, but it may not assess overall performance. Methods: We piloted an infection composite score (ICS) in 82 hospitals of a single health system. The ICS is a combined score for central line-associated bloodstream infections, c...

Response to Allen-Bridson and Pollock - Volume 37 Issue 9 - M. Todd Greene, Mohamad G. Fakih, Sanjay Saint

Candidemia rate and species distribution vary according to the type of patients, country of origin and antifungal prophylaxis use. To present current candidemia epidemiological trends. A retrospective examination of candidemia in adults (≥18 years-old) hospitalised from 2007 to 2015. Cases were identified through the microbiology laboratory. Candid...

Background Catheter-associated urinary tract infection (UTI) is a common device-associated infection in hospitals. Both technical factors — appropriate catheter use, aseptic insertion, and proper maintenance — and socioadaptive factors, such as cultural and behavioral changes in hospital units, are important in preventing catheter-associated UTI....

The Centers for Disease Control and Prevention recently updated the surveillance definition of catheter-associated urinary tract infection to include only urine culture bacteria of at least 1×10 5 colony-forming units/mL. Our findings suggest that the new surveillance definition may fail to capture clinically meaningful catheter-associated urinary...

Catheter-associated urinary tract infection (CAUTI) is considered a reasonably preventable event in the hospital setting, and it has been included in the US Department of Health and Human Services National Action Plan to Prevent Healthcare-Associated Infections. While multiple definitions for measuring CAUTI exist, each has important limitations, a...

Background: Obtaining a specimen for urine culture is a key element in evaluating for catheter-associated urinary tract infections (CAUTIs). Evaluating nurses' knowledge regarding appropriate reasons and methods to obtain urine culture specimens are the first steps to improving practice. Methods: Nurses at 5 hospitals completed a 40-question sur...

Ebola as a Test for Emerging Pathogen Preparedness: The Critical Role of Health Systems in Ensuring Support - Volume 36 Issue 6 - Mohamad G. Fakih, Michelle Heavens, Ann Hendrich

Blood cultures are often submitted as series (two to three sets per 24 hours) to maximize sample recovery. We assessed the actual benefit of additional sets. Blood cultures submitted from adults (≥18 years old) over 1 year (1 February 2012 to 31 January 2013) were examined. The medical records of patients with positive cultures were reviewed. Cultu...

Background: Catheter-associated urinary tract infection (CAUTI) is the most common device-associated infection in acute care hospitals. CAUTI prevention centers on promoting appropriate catheter use, compliance with aseptic insertion, and proper maintenance. Additionally, behavioral and cultural changes play an essential role in implementing key CA...

Background: Clostridium difficile infection (CDI) is one of the leading healthcare-associated infections in the United States. Antimicrobial pressure has been linked to increased incidence, severity and recurrences of CDI. As the initial step for development of a system-wide antimicrobial stewardship program for a large health system, we evaluated...

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...

Objective: To examine regional variation in the use and appropriateness of indwelling urinary catheters and catheter-associated urinary tract infection (CAUTI). Design and setting: Cross-sectional study. Participants: US acute care hospitals. Methods: Hospitals were divided into 4 regions according to the US Census Bureau. Baseline data on u...

Preventing catheter-associated urinary tract infection (CAUTI) remains a significant challenge for US hospitals. The ?On the CUSP: Stop CAUTI? initiative represents the single largest national effort (involving >950 hospitals) to mitigate urinary catheter risk. The program brings together key organizations to assist state hospital associations and...

Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). 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 central line-associate...

Purpose Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). 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 central line-a...

Background: Obtaining a specimen for urine culture is a key element in evaluating for catheter-associated urinary tract infections (CAUTIs). Evaluating nurses' knowledge regarding appropriate reasons and methods to obtain urine culture specimens are the first steps to improving practice. Methods: Nurses at 5 hospitals completed a 40-question survey...