Ari Robicsek's research while affiliated with Providence Clinical Research and other places

Publications (124)

Article
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Among 134,223 patients with COVID-19, we assessed how risk of hospitalization changed at different intervals in the pandemic, controlling for prior COVID-19 immunity. In multivariable analysis, outpatients with COVID-19 during the Omicron predominant time period had significantly lower odds of hospitalization compared to pre-Delta (aOR 0.26, 95% CI...
Article
Background Research suggests the protection offered by COVID-19 vaccines might wane over time, prompting consideration of booster vaccinations. Data on which vaccines offer the most robust protection over time, and which patients are most vulnerable to attenuating protection, could help inform potential booster programmes. In this study, we used co...
Article
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Background: The early months of the COVID-19 pandemic were fraught with much uncertainty and some resource constraint. We assessed the change in survival to hospital discharge over time for intensive care unit patients with COVID-19 during the first 3 months of the pandemic and the presence of any surge effects on patient outcomes. Methods: Retr...
Article
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Background The impact of remdesivir (RDV) on COVID-19 mortality is controversial, and the mortality effect in sub-groups of baseline disease severity has been incompletely explored. The purpose of this study was to assess the association of RDV with mortality in patients with COVID-19. Methods In this retrospective cohort study we compared persons...
Article
Background: The extent to which the COVID-19 pandemic has affected outcomes for patients with unplanned hospitalizations is unclear. Objective: To examine changes in in-hospital mortality for patients without COVID-19 during the first 10 months of the pandemic (March 4, 2020 to December 31, 2020). Design, setting, and participants: Observation...
Article
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In March 2020, NorthShore University Health System laboratories mobilized to develop and validate polymerase chain reaction based testing for detection of SARS-CoV-2. Using laboratory data, NorthShore University Health System created the Data Coronavirus Analytics Research Team to track activities affected by SARS-CoV-2 across the organization. Ope...
Preprint
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Background The early months of the COVID-19 pandemic were fraught with much uncertainty and some resource constraint. We assessed the change in survival to hospital discharge over time for intensive care unit patients with COVID-19 during the first three months of the pandemic and the presence of any surge effects on patient outcomes.Methods Retros...
Preprint
Full-text available
Background The early months of the COVID-19 pandemic were fraught with much uncertainty and some resource constraint. We assessed the change in survival to hospital discharge over time for intensive care unit patients with COVID-19 during the first three months of the pandemic and the presence of any surge effects on patient outcomes.Methods Retros...
Article
Background: The weighted incidence syndromic combination antibiogram (WISCA) is an antimicrobial stewardship tool that utilizes electronic medical record data to provide real-time clinical decision support regarding empiric antibiotic prescription in the hospital setting. The aim of this study was to determine the impact of WISCA utilization for e...
Article
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Utilizing 34,348 SARS CoV-2 NAAT results from two health systems, we estimated the clinical sensitivity of a single SARS CoV-2 NAAT. We found that SARS CoV-2 NAAT has 82-97% sensitivity for diagnosing COVID-19 among symptomatic patients.
Article
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Prolonged Shedding of SARS-CoV-2 RNA among Patients with COVID-19 - Jessica Ridgway, Nirav Shah, Ari Robicsek
Article
Objectives: Early empiric antibiotic therapy in patients can improve clinical outcomes in Gram-negative bacteraemia. However, the widespread prevalence of antibiotic-resistant pathogens compromises our ability to provide adequate therapy while minimizing use of broad antibiotics. We sought to determine whether readily available electronic medical...
Article
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Background Longer surgical total procedure times (TPT) have been associated with increased postoperative complications. It is unclear what the effect of TPT is on length-of-stay (LOS) or 30-day readmission rate (RAR). Methods We performed a retrospective study of patients undergoing knee arthroplasty (KA), colectomy, and craniectomy at NorthShore...
Article
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Background Patients with postoperative fevers tend to receive empiric antibiotics and a diagnostic workup even though postoperative fevers are frequently physiologic. The yield of postoperative workups ranges from 2–24%. Studying the effectiveness of antibiotic use and diagnostic testing across surgeries may provide insight to improve value of care...
Article
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Background Appropriate empiric antibiotic therapy in patients with bloodstream infections due to Gram-negative pathogens can improve outcomes. The utility of prior microbiologic results for determining empiric treatment in blood stream infections is unclear. Methods We performed a multi-center cohort study of patients with Gram-negative bacteremia...
Article
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Background Current trends estimate a 33% increase in obesity and 130% increase in severe obesity by the year 2030. It is unclear what the effect of obesity is on postoperative fevers, postoperative complications, and diagnostic workup rates. Methods We evaluated 5,330 patients undergoing knee arthroplasty, colectomy, or craniectomy from October 20...
Article
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Background Fever is common in the postoperative setting and frequently physiologic. Despite this, roughly half of febrile patients undergo testing for infectious complications, of which only a few reveal infection. We analyzed whether temperature trajectories could help optimize postoperative (post-op) risk assessment in total knee arthroplasty (TK...
Article
Objectives: Appropriate empiric antibiotic therapy in patients with bloodstream infections due to Gram-negative pathogens can improve outcomes. We evaluated the utility of prior microbiologic results for guiding empiric treatment in Gram-negative bloodstream infections. Methods: We conducted a multi-center observational cohort study, in two larg...
Article
OBJECTIVE Syndromic surveillance for influenza-like illness (ILI) is predominantly performed in the outpatient setting. The objective of this study was to compare patterns of ILI activity in outpatient, emergency department (ED), and inpatient settings using an electronic syndromic surveillance algorithm. DESIGN Retrospective cohort study over 7.5...
Article
Background: Antibiotic resistance is a challenge in long-term care facilities (LTCFs). The objective of this study was to demonstrate that a novel, minimally invasive program not interfering with activities of daily living or socialization could lower methicillin-resistant Staphylococcus aureus (MRSA) disease. Methods: This was a prospective, cl...
Article
Background: Influenza acts synergistically with bacterial co-pathogens. Few studies have described co-infection in a large cohort with severe influenza infection. Objectives: To describe the spectrum and clinical impact of co-infections. Study design: Retrospective cohort study of patients with severe influenza infection from September 2013 th...
Data
Among patients who received an antibiotic, first antibiotic prescribed after antibiotic allergy documentation by age group1,2. *p < 0.001. 1 Rows do not add up to 100 because other antibiotic classes not displayed. 2 Only patients who received an antibiotic after allergy documentation were included. For patients who did not have a beta-lactam aller...
Article
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Allergy documentation is frequently inconsistent and incomplete. The impact of this variability on subsequent treatment is not well described.To determine how allergy documentation affects subsequent antibiotic choice.Retrospective, cohort study.232,616 adult patients seen by 199 primary care providers (PCPs) between January 1, 2009 and January 1,...
Data
Among unique patients with characteristics of beta-lactam allergy documentation, the first antibiotic received at the first inpatient or outpatient clinical encounter with a diagnosis of cellulitis (by ICD9 code)1,2. *p < 0.001; ǂ p < 0.01.1 Rows do not add up to 100 because other antibiotic classes not displayed. 2 For patients with a beta-lactam...
Article
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significant predictors in all clusters, and included age (Group 2, likelihood estimate (LE) -0.030, p<0.001, Group 3, LE -0.027, p<0.001 and Group 4, LE -0.034, p<0.001; reference Group 1) and BMI (Group 2, LE 0.034, p<0.001, Group 3, LE 0.063, p<0.001 and Group 4, LE 0.71, p<0.001; reference Group 1). Conclusions: Patients display different temper...
Article
This was an observational study comparing MRSA transmission with no decolonization of medical patients to required decolonization of all MRSA carriers during two consecutive periods: baseline with no decolonization of medical patients (16 months), and universal MRSA carrier decolonization (13 months). The setting was a one-hospital, 156 bed facilit...
Article
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BACKGROUND Influenza A (H1N1) pdm09 became the predominant circulating strain in the United States during the 2013–2014 influenza season. Little is known about the epidemiology of severe influenza during this season. METHODS A retrospective cohort study of severely ill patients with influenza infection in intensive care units in 33 US hospitals fr...
Article
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We evaluated the LightCycler MRSA Advanced Test (Roche Molecular Diagnostics, Pleasanton, CA), the BD MAX MRSA assay (Becton Dickinson, Franklin Lakes, NJ), and the Xpert MRSA assay (Cepheid, Sunnyvale, CA) on nasal samples using the same population. Admission and discharge nasal swabs were collected from inpatients using a double-headed swab. One...
Article
This study demonstrates that it is possible to identify primary care physicians (PCPs) who perform better or worse than expected in managing diabetes. Study subjects were 14 033 adult diabetics and their 133 PCPs. Logistic regression was used to predict the odds that a patient would have uncontrolled diabetes (defined as HbA1c ≥8%) based on patient...
Article
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Clinical decision support (CDS) systems are an increasingly used form of technology designed to guide health care providers toward established protocols and best practices with the intent of improving patient care. Utilization of CDS for infection prevention is not widespread and is particularly focused on antimicrobial stewardship. This article pr...
Article
Background: Despite American Society of Clinical Oncology (ASCO) and National Comprehensive Cancer Network (NCCN) guidelines recommending that oncologists discuss advance care planning (ACP) with patients with stage IV cancer early in treatment, in standard practice ACP remains a late step of a terminal illness. ACP preserves comfort and dignity a...
Conference Paper
Background: To reduce MRSA clinical disease in Long Term Care Facilities (LTCFs), we evaluated a novel program that was minimally invasive and did not interfere with activities of daily living (ADL) or socialization of patient-residents. We hypothesized that reducing MRSA disease without contact precautions is possible and that demonstration of thi...
Conference Paper
Background: The objective of this study was to evaluate performance metrics and associated patient outcomes of an automated surveillance system, the blood Nosocomial Infection Marker (NIM). Methods: We reviewed records of 237 patients with and 36,927 patients without blood NIM using the National Healthcare Safety Network (NHSN) definition for la...
Conference Paper
Background: A patient's epidemiological context can aid clinical decision making. NorthShore University HealthSystem is evaluating a novel, real-time, local, syndromic surveillance tool. Methods: The What's Going Around (WGA) tool collects data daily from electronic health records (EHR), processes the data through algorithms and generates a syndr...
Article
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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
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Contamination of supply carts stored within rooms of patients on contact isolation for multidrug-resistant organisms was assessed. Despite the presence of environmentally persistent organisms, very little contamination occurred to these carts or the supplies stored within them. A single isolate containing a multidrug-resistant Acinetobacter baumann...
Article
We tested intensive care unit patients for colonization with multidrug-resistant Gram-negative bacilli (MDR GNB) and compared the results with those of concurrent clinical cultures. The sensitivity of the surveillance test for detecting MDR GNB was 58.8% (95% confidence interval, 48.6 to 68.5%). Among 133 patients with positive surveillance tests,...
Article
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Background: A patient's prior urine cultures are often considered when choosing empiric antibiotic therapy for a suspected urinary tract infection. We sought to evaluate how well previous urine cultures predict the identity and susceptibility of organisms in a patient's subsequent urine cultures. Methods: We conducted a multinational, multicente...
Article
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Control of methicillin-resistant Staphylococcus aureus (MRSA) is difficult in select populations. We used molecular typing to study the effect of universal surveillance and decolonization of carriers, without isolation, on MRSA transmission in a specialized unit. Patients admitted to the unit were screened for nasal MRSA at admission and discharge....
Article
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Purpose: The goal of this study was to develop a technology-based strategy to identify patients with undiagnosed hypertension in 23 primary care practices and integrate this innovation into a continuous quality improvement initiative in a large, integrated health system. Methods: In phase 1, we reviewed electronic health records (EHRs) using alg...
Article
We assessed Escherichia coli ST131 and its H30 and H30-Rx subclones for virulence genes, antimicrobial resistance, and extended-spectrum beta-lactamase (ESBL) type. Although both subclones were associated with ESBL production, H30-Rx isolates had higher resistance scores and were associated specifically with CTX-M-15. Three virulence genes (iha, sa...
Article
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Background: Methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization among inpatients is a well-established risk factor for MRSA infection during the same hospitalization, but the long-term risk of MRSA infection is uncertain. We performed a retrospective cohort study to determine the one-year risk of MRSA infection among inpatients w...
Article
169 Background: To increase and systematize outpatient ACP, our quality improvement team developed enhancements in 2 oncologists’ cohorts of newly diagnosed, incurable cancer patients (pts). At 1 st consultation, an ACP form is given to pts; a nurse assesses knowledge about medical POAs and goals of care. Pts return for chemotherapy teaching and AC...
Conference Paper
Title: What's Going Around? The Use of Electronic Health Records to Perform Context-Specific Real-Time Syndromic Surveillance Background: Knowledge of a patient's epidemiological context can aid clinicians in diagnosis and treatment of conditions such as Influenza-Like Illness (ILI). Syndromic surveillance is currently performed by public health...
Conference Paper
Background: We evaluated the incidence of post-TRUSB infectious complications (IC) at NSUHS following a previous modification of prophylaxis to determine whether patients would further benefit from adopting targeted antimicrobial prophylaxis (AP) using rectal swab cultures prior to TRUSB. Methods: We performed a cohort study of men who underw...
Article
Background: Screening for methicillin-resistant Staphylococcus aureus (MRSA) is intended to reduce nosocomial spread by identifying patients colonized by MRSA. Given the widespread use of this screening, we evaluated its potential clinical utility in predicting the resistance of clinical isolates of S. aureus. Methods: We conducted a 2-year retr...
Article
Objective: To identify predictors of community-onset extended-spectrum β-lactamase (ESBL)-producing Escherichia coli infection. Design: Prospective case-control study. Setting: Acute care hospitals and ambulatory clinics in the Chicago, Illinois, region. Patients: Adults with E. coli clinical isolates cultured in ambulatory settings or withi...
Article
Objective: A major challenge in treating Clostridium difficile infection (CDI) is relapse. Many new therapies are being developed to help prevent this outcome. We sought to establish risk factors for relapse and determine whether fields available in an electronic health record (EHR) could be used to identify high-risk patients for targeted relapse...
Article
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Background: Fluoroquinolone-resistant Escherichia coli are increasingly prevalent. Their clonal origins--potentially critical for control efforts--remain undefined. Methods: Antimicrobial resistance profiles and fine clonal structure were determined for 236 diverse-source historical (1967-2009) E. coli isolates representing sequence type ST131 a...
Article
311 Background: NorthShore University HealthSystem has created, via the Electronic Health Record (EHR), quarterly reports to measure quality of care for patients who die of cancer during the reporting time frame. Specific reports for 22 oncology providers and measurements across the population will be derived. Reports are automated with seamless da...
Article
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Background: Catheter hub decontamination requires a thorough scrub and compliance varies. This study evaluates the effectiveness of a disinfection cap with 70% alcohol in preventing contamination/infection. Methods: A 3-phased, multifacility, quasi-experimental study of adult patients with central lines divided into P1 (baseline), when the stand...
Article
Objectives: The subjectivity and complexity of surveillance definitions for ventilator-associated pneumonia preclude meaningful internal or external benchmarking and therefore hamper quality improvement initiatives for ventilated patients. We explored the feasibility of creating objective surveillance definitions for ventilator-associated pneumoni...
Article
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Little is known about the influence of contextual factors on a physician's likelihood to prescribe antimicrobials for febrile respiratory illness (FRI). Context includes epidemiologic context (for example, a pandemic period) and personal context (for example, recent exposure to other patients with FRI). To examine the association between contextual...
Article
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Interventions for reducing methicillin-resistant Staphylococcus aureus (MRSA) healthcare-associated disease require outcome assessment; this is typically done by manual chart review to determine infection, which can be labor intensive. The purpose of this study was to validate electronic tools for MRSA healthcare-associated infection (HAI) trending...
Article
Reducing health care-associated urinary tract infection (UTI) is a National Patient Safety Goal. The purpose of this investigation was to establish a colony count threshold to predict clinically significant UTIs that develop in hospitalized patients. A total of 185 cases were reviewed sequentially by 2 physicians. The information extracted included...
Article
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Escherichia coli sequence type 131 (ST131), an emerging disseminated public health threat, causes multidrug-resistant extraintestinal infections. Among 579 diverse E. coli ST131 isolates from 1967-2009, we compared pulsotypes (>94% similar XbaI pulsed-field gel electrophoresis profiles) by collection year, geographic origin, source, and antimicrobi...
Article
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Healthcare providers need a better empiric antibiotic prescribing aid than the traditional antibiogram, which supplies no information on the relative frequency of organisms recovered in a given infection and which is uninformative in situations where multiple antimicrobials are used or multiple organisms are anticipated. We aimed to develop and dem...