Victoria J Fraser

• Washington University in St. Louis

Importance Health care–associated infections (HAIs) are a major cause of morbidity and mortality, but little is known about whether structural factors impacting race and rurality are associated with HAI and subsequent outcomes. Objective To evaluate the association of race and rurality, which are proxies for structural disadvantage, with HAI and s...

Background Antimicrobial resistance (AMR) poses a significant public health threat, and efforts are underway to monitor and reduce unnecessary antibiotic usage. The Standardized Antibiotic Administration Ratio (SAAR) measures unit and hospital consumption of antibiotics by adjusting for facility characteristics. However, SAAR currently does not con...

Importance The results of prediction models that stratify patients with sepsis and risk of resistant gram-negative bacilli (GNB) infections inform treatment guidelines. However, these models do not extrapolate well across hospitals. Objective To assess whether patient case mix and local prevalence rates of resistance contributed to the variable pe...

Objective To measure SARS-CoV-2 anti-nucleocapsid (anti-N) antibody seropositivity among healthcare personnel (HCP) without a history of COVID-19 and to identify HCP characteristics associated with seropositivity. Design Prospective cohort study from September 22, 2020, to March 3, 2022. Setting A tertiary care academic medical center. Participa...

Between May and June 2021, healthcare personnel at two long-term care facilities underwent SARS-CoV-2 anti-nucleocapsid immunoglobulin G testing and completed a survey on COVID-19 exposures and symptoms. Antibody positivity rate was 8.9%. Similar rates of COVID-19 exposure occurred in non-occupational and occupational settings, with high self-repor...

Background Sepsis is a major cause of morbidity and mortality worldwide. When selecting empiric antibiotics for sepsis, clinicians are encouraged to use local resistance rates, but their impact on individual outcomes is unknown. Improved methods to predict outcomes are needed to optimize treatment selection and improve antibiotic stewardship. Meth...

Background Urinary tract infections (UTI) affect approximately 250 million people annually worldwide. Patients often experience a cycle of antimicrobial treatment and recurrent UTI (rUTI) that is thought to be facilitated by a gut reservoir of uropathogenic Escherichia coli (UPEC). Methods 125 patients with UTI caused by an antibiotic-resistant or...

Background There is limited information on racial disparities and healthcare-associated infections (HAIs). The objective of this study was to evaluate the impact of race and rurality on HAIs and outcomes of HAIs including death and intensive care unit (ICU) admission. Methods We established a retrospective cohort of adults ≥ 18 years admitted ≥ 48...

Contact tracing is a powerful tool for mitigating the spread of COVID-19 during the pandemic. Front-line healthcare workers are particularly at high risk of infection in hospital units. This paper presents ContAct TraCing for Hospitals (CATCH), an automated contact tracing system designed specifically for healthcare workers in hospital environments...

Objective To determine the prevalence of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) IgG nucleocapsid (N) antibodies among healthcare personnel (HCP) with no prior history of COVID-19 and to identify factors associated with seropositivity. Design Prospective cohort study. Setting An academic, tertiary-care hospital in St. Louis, Mis...

Background: SARS-CoV-2 vaccines are effective at reducing symptomatic and asymptomatic COVID-19. Limited studies have compared symptoms, threshold cycle (Ct) values from reverse transcription (RT)-PCR testing, and serological testing results between previously vaccinated vs unvaccinated populations with SARS-CoV-2 infection. Methods: Healthcare...

Background: Aminoglycosides and beta-lactams have been a recommended regimen in the treatment of sepsis and septic shock despite lack of mortality benefit. Previous studies have examined emergence of resistance for the same bacterial isolate using old dosing regimens and during a narrow follow up window. We hypothesized that combination regimens e...

Objective: To characterize experiences, beliefs, and perceptions of risk related to coronavirus disease 2019 (COVID-19), infection prevention practices, and COVID-19 vaccination among healthcare personnel (HCP) at nonacute care facilities. Design: Anonymous survey. Setting: Three non-acute-care facilities in St. Louis, Missouri. Participants:...

Background COVID-19 rapidly evolved into a global pandemic. Contact tracing with isolation and quarantine contribute to epidemic control but they are time consuming, costly and may be incomplete. We set out to assess the usability and performance characteristics of Bluetooth Low-Energy (BLE) wireless technology for indoor localization applied to co...

Background The objective of this study is to characterize the experiences, knowledge, beliefs, and perceptions of risk related to COVID-19, infection prevention practices, and COVID-19 vaccination among healthcare personnel (HCP) at three non-acute care facilities. Methods The study protocol was approved by the Washington University IRB. Between A...

Coronavirus disease 2019 (COVID-19) vaccine effectiveness in the early months of vaccine availability was high among healthcare personnel (HCP) at 88.3% for 2-doses. Among those testing positive for severe acute respiratory coronavirus virus 2 (SARS-CoV-2), those with breakthrough infection after vaccination were more likely to have had a non–work-...

Objective To identify characteristics associated with positive severe acute respiratory coronavirus virus 2 (SARS-CoV-2) polymerase chain reaction (PCR) tests in healthcare personnel. Design Retrospective cohort study. Setting A multihospital healthcare system. Participants Employees who reported SARS-CoV-2 exposures and/or symptoms of coronavir...

Background: A greater proportion of patients with surgical risk factors are undergoing immediate breast reconstruction after mastectomy, resulting in the need for better risk prediction to inform decisions about the procedure. The objective of this study was to leverage clinical data to restructure a previously developed risk model to predict seri...

In a prospective cohort of healthcare personnel (HCP), we measured severe acute respiratory syndrome coronavirus virus 2 (SARS-CoV-2) nucleocapsid IgG antibodies after SARS-CoV-2 infection. Among 79 HCP, 68 (86%) were seropositive 14–28 days after their positive PCR test, and 54 (77%) of 70 were seropositive at the 70–180-day follow-up. Many seropo...

Large-scale genomic studies have identified within-host adaptation as a hallmark of bacterial infections. However, the impact of physiological, metabolic, and immunological differences between distinct niches on the pathoadaptation of opportunistic pathogens remains elusive. Here, we profile the within-host adaptation and evolutionary trajectories...

Objective Patients on dialysis are at high risk for severe COVID-19 and associated morbidity and mortality. We examined the humoral response to SARS-CoV-2 mRNA vaccine BNT162b2 in a maintenance dialysis population. Design Single-center cohort study. Setting and participants Adult maintenance dialysis patients at 3 outpatient dialysis units of a l...

Immunocompromised adults can have prolonged acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive RT-PCR results, long after the initial diagnosis of coronavirus disease 2019 (COVID-19). This study aimed to determine if SARS-CoV-2 virus can be recovered in viral cell culture from immunocompromised adults with persistently positive SARS-CoV...

Objectives: To determine the prevalence and factors associated with post-discharge prophylactic antibiotic use after spinal fusion and whether use was associated with decreased risk of surgical site infection (SSI). Methods: Persons aged 10-64 years undergoing spinal fusion between 1 January 2010 and 30 June 2015 were identified in the MarketSca...

Background Immunocompromised (IC) patients (pts) can have prolonged SARS-CoV-2 PCR positivity, even after resolution of COVID-19 symptoms. This study aimed to determine if viable virus could be detected in samples collected > 21 days after an initial positive (pos) SARS-CoV-2 PCR in IC pts. Methods We obtained 20 remnant SARS-CoV-2 PCR pos nasopha...

Background Prophylactic antibiotics are commonly prescribed at discharge for mastectomy, despite guidelines recommending against this practice. We investigated factors associated with postdischarge prophylactic antibiotic use after mastectomy with and without immediate reconstruction and the impact on surgical-site infection (SSI). Study design We...

Key Points Increased risk of SARS-CoV-2 infection was associated with community prevalence. Increased risk of SARS-CoV-2 infection was associated with exposure to infected family members and personal infection prevention measures

Objective Alteration of the colonic microbiota following antimicrobial exposure allows colonization by antimicrobial-resistant organisms (AROs). Ingestion of a probiotic, such as Lactobacillus rhamnosus GG (LGG), could prevent colonization or infection with AROs by promoting healthy colonic microbiota. The purpose of this trial was to determine the...

Simple parametric functional forms, if appropriate, are preferred over more complicated functional forms in clinical prediction models. In this paper, we illustrate our practical approach to obtaining the appropriate functional forms for continuous variables in developing a clinical prediction model for risk of Clostridium difficile infection. Firs...

More than 50% of women with clinically apparent infection after mastectomy did not meet the 2020 National Healthcare Safety Network (NHSN) definition for surgical site infection (SSI). Implant loss was similar whether the 2020 NHSN SSI definition was met or not, suggesting equivalent adverse outcomes regardless of restriction to the surveillance de...

Multiple guidelines recommend discontinuation of prophylactic antibiotics <24 hours after surgery. In a multicenter, retrospective cohort of 2,954 mastectomy patients ± immediate breast reconstruction, we found that utilization of prophylactic postdischarge antibiotics varied dramatically at the surgeon level among general surgeons and was virtuall...

Objective Despite recommendations to discontinue prophylactic antibiotics after incision closure or <24 hours after surgery, prophylactic antibiotics are continued after discharge by some clinicians. The objective of this study was to determine the prevalence and factors associated with postdischarge prophylactic antibiotic use after spinal fusion....

Objective To assess potential transmission of antibiotic-resistant organisms (AROs) using surrogate markers and bacterial cultures. Design Pilot study. Setting A 1,260-bed tertiary-care academic medical center. Participants The study included 25 patients (17 of whom were on contact precautions for AROs) and 77 healthcare personnel (HCP). Method...

Background MDRO present a greater threat to public health than ever before, and antimicrobial options are decreasing. Altered colonic microbiota following antimicrobial exposure allows for subsequent colonization by MDRO. Ingestion of prophylactic Lactobacillus rhamnosus GG (LGG) could be an approach to prevent the spread of, and subsequent infecti...

Background: Reducing inappropriate antibiotic prescriptions (Rxs) is a major quality improvement initiative in the United States. Tracking antibiotic prescribing trends is 1 method of assessing improvement in antibiotic prescribing. The purpose of this study was to assess longitudinal antibiotic prescribing practices among dental specialists. Met...

Laboratory testing to support the care of patients with highly infectious diseases may pose a risk for laboratory workers. However, data on the risk of virus transmission during routine laboratory testing conducted using standard personal protective equipment (PPE) are sparse. Our objective was to measure laboratory contamination during routine ana...

OBJECTIVE To characterize trends in outpatient antibiotic prescriptions in the United States DESIGN Retrospective ecological and temporal trend study evaluating outpatient antibiotic prescriptions from 2013 to 2015 SETTING National administrative claims data from a pharmacy benefits manager PARTICIPANTS. Prescription pharmacy beneficiaries from E...

Importance Few data are available concerning surgical site infection (SSI) and noninfectious wound complications (NIWCs) after delayed (DR) and secondary reconstruction (SR) compared with immediate reconstruction (IR) procedures in the breast. Objective To compare the incidence of SSI and NIWCs after implant and autologous IR, DR, and SR breast pr...

OBJECTIVE Survey results suggest that prolonged administration of prophylactic antibiotics is common after mastectomy with reconstruction. We determined utilization, predictors, and outcomes of postdischarge prophylactic antibiotics after mastectomy with or without immediate breast reconstruction. DESIGN Retrospective cohort. PATIENTS Commerciall...

OBJECTIVE To evaluate healthcare worker (HCW) risk of self-contamination when donning and doffing personal protective equipment (PPE) using fluorescence and MS2 bacteriophage. DESIGN Prospective pilot study. SETTING Tertiary-care hospital. PARTICIPANTS A total of 36 HCWs were included in this study: 18 donned/doffed contact precaution (CP) PPE a...

Background Clostridium difficile infection (CDI) is a frequent cause of diarrhea among allogeneic hematopoietic cell transplant (HCT) recipients. It is unknown whether risk factors for CDI vary by time posttransplant. Methods We performed a 3-year prospective cohort study of CDI in allogeneic HCT recipients. Participants were enrolled during their...

Background There are limited data on risk factors for surgical site infection (SSI) after open or laparoscopic cholecystectomy. Methods A retrospective cohort of commercially-insured persons aged 18–64 years was assembled using ICD-9-CM procedure or CPT-4 codes for cholecystectomy from 12/31/2004–12/31/2010. Complex procedures and patients (e.g.,...

BACKGROUND Few studies have validated ICD-9-CM diagnosis codes for surgical site infection (SSI), and none have validated coding for noninfectious wound complications after mastectomy. OBJECTIVES To determine the accuracy of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes in health insurer...

Purpose: Past studies of sepsis epidemiology did not address misclassification bias due to imperfect verification of sepsis detection methods to estimate the true prevalence. Methods: We examined 273,126 hospitalizations from 2008 to 2012 at a tertiary-care center to develop surveillance-aimed sepsis detection criteria, based on the presence of...

Background Accurate identification of underlying health conditions is important to fully adjust for confounders in studies using insurer claims data. Our objective was to evaluate the ability of four modifications to a standard claims-based measure to estimate the prevalence of select comorbid conditions compared with national prevalence estimates....

Background: The long-term and cumulative effect of multiple episodes of bacteremia and sepsis across multiple hospitalizations on the development of cardiovascular (CV) events is uncertain. Methods: We conducted a longitudinal study of 156 380 hospitalizations in 47 009 patients (≥ 18 years old) who had at least two in-patient admissions at an a...

We assembled a cohort of 21,117 kidney transplant patients from July 2006 to June 2011 with Medicare Part D coverage using US Renal Database System (USRDS) data to determine real-world use of cytomegalovirus (CMV) prophylaxis. CMV prophylaxis was defined as filled prescriptions for daily oral valganciclovir (< 900 mg), ganciclovir (< 3 g) or valacy...

Objective: To examine the association of clinical chorioamnionitis on cesarean delivery in a national sample of hospital discharges. Data source: Hospital discharge data from the 1998-2010 Nationwide Inpatient Sample. Study design: We performed a cross-sectional study and general linear modeling was used to determine the association of clinica...

Background: Noninfectious wound complications (NIWCs) after mastectomy are not routinely tracked and data are generally limited to single-center studies. Our objective was to determine the rates of NIWCs among women undergoing mastectomy and assess the impact of immediate reconstruction (IR). Study design: We established a retrospective cohort u...

Background Little data are available regarding individual patients’ risk of surgical site infection (SSI) following mastectomy with or without immediate reconstruction. Our objective was to develop a risk prediction model for mastectomy-related SSI. Methods Using commercial claims data, we established a cohort of women <65 years of age who underwen...

Objective: To determine the impact of surgical site infections (SSIs) on health care costs following common ambulatory surgical procedures throughout the cost distribution. Background: Data on costs of SSIs following ambulatory surgery are sparse, particularly variation beyond just mean costs. Methods: We performed a retrospective cohort study...

We studied women after breast-conserving surgery and mastectomy with immediate (IR) and delayed reconstruction to determine the risk of surgical site infections (SSIs). The SSI rate was 1.3% for BCS, 5.2% for mastectomy, and 10.3% for mastectomy plus IR with flap. SSI risk was higher for mastectomy and IR with implantation versus delayed reconstruc...

Background Recent reports using administrative claims data suggest the incidence of community- and hospital-onset sepsis is increasing. Whether this reflects changing epidemiology, more effective diagnostic methods, or changes in physician documentation and medical coding practices is unclear. Methods We performed a temporal-trend study from 2008...

Purpose: To quantify the coinciding improvement in the clinical diagnosis of sepsis, its documentation in the electronic health records, and subsequent medical coding of sepsis for billing purposes in recent years. Methods: We examined 98,267 hospitalizations in 66,208 patients who met systemic inflammatory response syndrome criteria at a tertia...

The incidence of central line-associated bloodstream infections (CLABSI) attributed to central venous catheters (CVCs) inserted in the emergency department (ED) is not widely reported. The goal was to report the incidence of ED CLABSI. Secondary goals included determining the effect of a CVC bundle introduced by the hospital infection prevention de...

This was a randomized controlled pilot study of Lactobacillus rhamnosus GG versus standard of care to prevent gastrointestinal multidrug-resistant organism colonization in intensive care unit patients. Among 70 subjects, there were no significant differences in acquisition or loss of any multidrug-resistant organisms ( P >.05) and no probiotic-asso...

The National Healthcare Safety Network (NHSN) classifies surgical procedures into 40 categories. The objective of this study was to determine surgical site infection (SSI) incidence for clinically defined subgroups within 5 heterogeneous NHSN surgery categories. This is a retrospective cohort study using the longitudinal State Inpatient Database. W...

The aim of this study was to evaluate specific medications and patient characteristics as risk factors of falling in the hospital. This is a case-control study comparing demographic, health, mobility, and medication data for 228 patients who fell between June 29, 2007, and November 14, 2007, at a large tertiary care hospital and 690 randomly select...

To investigate whether operative factors are associated with risk of surgical site infection (SSI) after hernia repair. Retrospective cohort study. Patients Commercially insured enrollees aged 6 months-64 years with International Classification of Diseases, Ninth Revision, Clinical Modification procedure or Current Procedural Terminology, fourth ed...

Background: Delayed-onset cytomegalovirus (CMV) disease can occur among liver transplant recipients after stopping CMV prophylaxis. We hypothesized that delayed-onset CMV disease (> 100 days post-transplant) occurs more commonly than early-onset CMV disease and is associated with clinical sepsis and death. Methods: We assembled a large and more rep...

We evaluated a variety of methods to recover S. aureus from inanimate surfaces. Two contact agar plates and three swab sampling methods were tested on porous and non-porous surfaces and bar soap. The cost and ease of use of each method was also evaluated. S. aureus was recovered using all methods on both porous and non-porous surfaces. S. aureus co...

Rationale: The CDC introduced ventilator-associated event (VAE) definitions in January 2013. Little is known about VAE prevention. We hypothesized that daily, coordinated spontaneous awakening trials (SATs) and spontaneous breathing trials (SBTs) might prevent VAEs. Objectives: To assess the preventability of VAEs. Methods: We nested a multice...

Purpose: The aim of this study was to determine the risk of surgical site infection (SSI) after primary breast-conserving surgery (BCS) versus re-excision among women with carcinoma in situ or invasive breast cancer. Methods: We established a retrospective cohort of women aged 18-64 years with International Classification of Diseases, Ninth Revi...

Background: Treatment failure in uncomplicated Staphylococcus aureus bacteremia (SAB) occurs in 20-30% of cases. Published guidelines recommend follow-up blood cultures (cx) to document clearance of SAB within 72 hrs of treatment initiation. We hypothesized that not all patients (pts) with SAB would have follow-up blood cultures done and that pts w...

Importance Household environmental surfaces may serve as vectors for the acquisition and spread of methicillin-resistant Staphylococcus aureus (MRSA) among household members, although few studies have evaluated which objects are important reservoirs of MRSA.Objectives To determine the prevalence of environmental MRSA contamination in households o...

Issue: Transmission of bloodborne pathogens (BBP) from patients to healthcare workers (HCWs) is a significant occupational hazard for HCWs. The greatest risk of infection transmission is through percutaneous exposure to infected blood. According to the CDC, an estimated 385,000 percutaneous injuries occur in HCWs annually. Transmission of hepatitis...

Issue: Transmission of bloodborne pathogens (BBP) from patients to healthcare workers (HCWs) is a significant occupational hazard for HCWs. The greatest risk of infection transmission is through percutaneous exposure to infected blood. According to the CDC, an estimated 385,000 percutaneous injuries occur in HCWs annually. Transmission of hepatitis...

Use of prophylactic anti-CMV therapy for 3 to 6 months after kidney transplantation can result in delayed-onset CMV disease. We hypothesized that delayed-onset CMV disease (occurring >100 days posttransplant) occurs more commonly than early-onset CMV disease and that it is associated with death. We assembled a retrospective cohort of 15,848 adult k...

Objective: Determine whether daily bathing with chlorhexidine-based soap decreased methicillin-resistant Staphylococcus aureus (MRSA) transmission and intensive care unit (ICU)-acquired S. aureus infection among ICU patients. Design: Prospective pre-post-intervention study with control unit. Setting: A 1,250-bed tertiary care teaching hospital...

Background: Both targeted decolonization and universal decolonization of patients in intensive care units (ICUs) are candidate strategies to prevent health care-associated infections, particularly those caused by methicillin-resistant Staphylococcus aureus (MRSA). Methods: We conducted a pragmatic, cluster-randomized trial. Hospitals were random...

Background: The National Healthcare Safety Network (NHSN) does not stratify surgical site infection (SSI) rates after hernia repair based on anatomic site or laparoscopic vs. open approach. We investigated whether site and approach are important determinants of SSI risk for hernia repair. Methods: Using commercial insurer claims data, we conducte...

Objective: The National Healthcare Safety Network classifies breast operations as clean procedures with an expected 1%-2% surgical site infection (SSI) incidence. We assessed differences in SSI incidence following mastectomy with and without immediate reconstruction in a large, geographically diverse population. Design: Retrospective cohort stud...

Enterococci are an important cause of central venous catheter (CVC)-associated bloodstream infections (CA-BSI). It is unclear whether CVC removal is necessary to successfully manage enterococcal CA-BSI. A 12-month retrospective cohort study of adults with enterococcal CA-BSI was conducted at a tertiary care hospital; clinical, microbiological and o...

Background: A majority of patients (pts) receiving implantable cardiac devices in the U.S. are >65 yrs of age. Infections can complicate these procedures, particularly in the elderly. The incidence of device-related infection has not been well-described on a population level, and it is not known if infection rates differ between primary insertion a...

Background: Many states mandate screening of ICU admissions for carriage of MRSA. However, universal decolonization without screening might be a better strategy to reduce MRSA prevalence and prevent infection due to a broader set of pathogens. Methods: We conducted a 3 arm cluster-randomized trial of MRSA prevention strategies. Study design inclu...

To evaluate the use of inpatient pharmacy and administrative data to detect surgical site infections (SSIs) following hysterectomy and colorectal and vascular surgery. Retrospective cohort study. Five hospitals affiliated with academic medical centers. Adults who underwent abdominal or vaginal hysterectomy, colorectal surgery, or vascular surgery p...

To measure prevalence of Staphylococcus aureus colonization in household contacts of children with acute S aureus skin and soft tissue infections (SSTI), determine risk factors for S aureus colonization in household contacts, and assess anatomic sites of S aureus colonization in patients and household contacts. Cross-sectional study. St Louis Child...

To assess Clostridium difficile infection (CDI)-related colectomy rates by CDI surveillance definitions and over time at multiple healthcare facilities. Five university-affiliated acute care hospitals in the United States. Cases of CDI and patients who underwent colectomy from July 2000 through June 2006 were identified from 5 US tertiary care cent...

Automated surveillance using electronically available data has been found to be accurate and save time. An automated Clostridium difficile infection (CDI) surveillance algorithm was validated at 4 Centers for Disease Control and Prevention Epicenter hospitals. Electronic surveillance was highly sensitive, specific, and showed good to excellent agre...

To evaluate the use of routinely collected electronic health data in Medicare claims to identify surgical site infections (SSIs) following hip arthroplasty, knee arthroplasty, and vascular surgery. Retrospective cohort study. Four academic hospitals that perform prospective SSI surveillance. We developed lists of International Classification of Dis...

Community-associated Staphylococcus aureus infections often affect multiple members of a household. We compared 2 approaches to S. aureus eradication: decolonizing the entire household versus decolonizing the index case alone. An open-label, randomized trial enrolled 183 pediatric patients (cases) with community-onset S. aureus skin abscesses and c...

To evaluate whether longitudinal insurer claims data allow reliable identification of elevated hospital surgical site infection (SSI) rates. We conducted a retrospective cohort study of Medicare beneficiaries who underwent coronary artery bypass grafting (CABG) in US hospitals performing at least 80 procedures in 2005. Hospitals were assigned to de...