Bernard Camins's research while affiliated with Icahn School of Medicine at Mount Sinai and other places
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Publications (80)
Clinical pharmacist-driven antimicrobial stewardship programs (ASPs) have been successfully implemented. Although relevant guidance and several studies suggest that clinical pharmacists be integrated into the current ASP team model, barriers still exist in Asia, primarily due to lack of dedicated personnel and lack of career advancement. We review...
Background: Accurately tracing nosocomial transmission of coronavirus disease 2019 (COVID-19) is critical to developing effective infection prevention policies. Given the high prevalence and variable incubation period of SARS-CoV-2 infection, the utility of traditional contact tracing is limited. We describe a nosocomial outbreak in which whole-gen...
Background: Occupational and non-occupational risk factors for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been reported in healthcare workers (HCWs), but studies evaluating risk factors for infection among physician trainees are lacking. We aimed to identify sociodemographic, occupational, and community risk factors...
Background
During the first three months of the COVID 19 pandemic, our facility cared for an influx of patients. At the peak, the daily census exceeded 200 patients with COVID 19. Surveillance for healthcare acquired infections (HAIs) continued throughout this time. Despite the acuity of the patients and the frequent use of antibiotics, the rates o...
Occupational and non-occupational risk factors for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been reported in healthcare workers (HCWs), but studies evaluating risk factors for infection among physician trainees are lacking. We aimed to identify sociodemographic, occupational, and community risk factors among physi...
Risk factors for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are not well-defined in resident physicians and fellows (trainees). We aimed to identify sociodemographic, occupational and community factors associated with SARS-CoV-2 infection among trainees during the first wave of the coronavirus disease 2019 (COVID-19) pan...
Background
COVID-19 is an emerging pathogen that has caused a global pandemic, with New York City as one of its epicenters. Data are still forthcoming if pregnant women are more vulnerable to COVID-19, as they are with influenza. Additionally, it is not known if infants born to COVID-19 positive women are at risk of being infected at birth.
Method...
Background: Mount Sinai Beth Israel is a 350-bed, acute-care hospital located on Manhattan’s Lower East Side. In 2014, the hospital had reached a high (9.8 cases per 10,000 patient days ) hospital-onset (HO) C. difficile rate. By 2015, this rate had decreased to 5.6 cases per 10,000 patient days because of compliance with established C. difficile b...
Background: Pre-emptive management of the water supply can reduce hospital-onset legionellosis associated with building water systems. In 2014, an outbreak of Legionella pneumonia occurred in a 1,150-bed academic medical center (with ∼0.557 km ² or ∼6 million ft ² of space) among hematology-oncology patients. A comprehensive water safety and manage...
Quick identification and isolation of patients with highly infectious diseases is extremely important in healthcare settings today. This study focused on the creation of a digital screening tool using a free and publicly available digital survey application to screen patients during a measles outbreak in New York City. The results indicate that dig...
Background
Enterococcus species frequently cause healthcare-associated bacteremia, with high attributable mortality. The benefit of consultation with infectious disease (ID) specialists has been previously illustrated with Staphylococcus aureus bacteremia. Whether ID consultation (IDC) improves mortality in enterococcal bacteremia is unknown.
Meth...
Background
Clostridioides difficile infection (CDI) Laboratory (Lab) identified (ID) events are reportable to CMS through the CDC’s NHSN. Prevention of transmission has been the main component of interventions; however, avoiding false-positive laboratory diagnoses can also lead to decreased incidence.
Methods
A retrospective analysis of HO-CDI Lab...
BACKGROUND
Despite implementation of the Clostridium difficile Infection (CDI) algorithm in 2016, inappropriate testing remains an issue. To further reduce this problem, Mandatory Pre-Authorization (MPrA) or Hard Stop Order (HSO) was implemented in March 2017. MPrA/HSO requires the ordering physician to apply the criteria set in the algorithm and o...
Objective:
To determine frequency of hospital-acquired viral respiratory infections (HA-VRI) and associated outcomes in a NICU.
Study design:
Prospective cohort study conducted from 4 October 2016 to 21 March 2017. Infants hospitalized from birth in the NICU had a weekly nasal swab collected for testing using a multiplex PCR assay capable of det...
Infection prevention in the operating room anesthesia work area – CORRIGENDUM - Volume 40 Issue 4
Infection prevention in the operating room anesthesia work area - Volume 40 Issue 1 - L. Silvia Munoz-Price, Andrew Bowdle, B. Lynn Johnston, Gonzalo Bearman, Bernard C. Camins, E. Patchen Dellinger, Marjorie A. Geisz-Everson, Galit Holzmann-Pazgal, Rekha Murthy, David Pegues, Richard C. Prielipp, Zachary A. Rubin, Joshua Schaffzin, Deborah Yokoe,...
Background
Clostridium difficile infection (CDI) Laboratory identified events are reportable to CMS through the CDC’s NHSN. Diagnostic stewardship has been shown to decrease the incidence by decreasing false-positive incidence. Bowel management systems (BMS) have been associated with transient loss of tone of anal sphincter muscles that result in d...
Objective
Due to concerns over increasing fluoroquinolone (FQ) resistance among gram-negative organisms, our stewardship program implemented a preauthorization use policy. The goal of this study was to assess the relationship between hospital FQ use and antibiotic resistance.
Design
Retrospective cohort.
Setting
Large academic medical center.
Me...
Candidemia has a high attributable mortality. The objective of this study was to determine the impact of infectious disease consultation on mortality and clinical outcomes in candidemia. Infectious disease consultation was associated with better adherence to guidelines and improved survival, even in patients with high APACHE II scores.
Background:
The Centers for Disease Control and Prevention replaced the definition for ventilator-associated pneumonia with an algorithm comprised of three categories-ventilator associated condition (VAC), infection -related ventilator associated complication (IVAC) and possible ventilator associated pneumonia (PVAP). We sought to compare the outc...
The 2015 changes in the catheter-associated urinary tract infection definition led to an increase in central line-associated bloodstream infections (CLABSIs) and catheter-related candidemia in some health systems due to the change in CLABSI attribution. However, our rates remained unchanged in 2015 and further declined in 2016 with the implementati...
Aims:
Cannulated surgical instruments may retain biologic debris after routine cleaning and sterilization. Residual debris after cleaning is assumed to be sterile; however, there is no experimental basis for this assumption. The purpose of this study was to determine the sterility of retained biodebris found within cannulated surgical instruments...
Background
Enterococcal bloodstream infections (EBSI) have been attributed with significant morbidity and mortality. The objective of this study was to determine whether IDC is associated with improved mortality in patients hospitalized with EBSI.
Methods
This is a cross-sectional study of patients admitted to the University of Alabama Health Syst...
Background:
The Centers for Disease Control and Prevention (CDC) replaced its definition for ventilator-associated pneumonia (VAP) in 2013. The aim of the current study is to compare the outcome of burn patients with ventilator associated events (VAEs).
Methods:
Burn patients with at least two days of ventilator support were identified from the...
Background
Patients with hematologic malignancies are prone to colonization and infection with vancomycin-resistant Enterococcus (VRE), and VRE blood stream infections (BSI) in this population have been associated with a 30-day all-cause mortality approaching 40%. Daptomycin nonsusceptible Enterococci(DNSE) are on the rise, with institutional rates...
Background
The National Healthcare Safety Network (NHSN) revised their catheter-associated urinary tract infection (CAUTI) definition in January 2015 to exclude funguria. This definition change led to an increase in diagnosis of catheter-related fungemia in other health systems, due to the exclusion of CAUTI as an attributable source. We evaluated...
Background
Antibiotic use is a well-known risk factor for acquisition of drug-resistant bacteria and community antibiotic prescribing can drive high rates of resistance within the hospital setting. Owing to concerns over increasing fluoroquinolone (FQ) resistance among Gram-negative organisms at UAB Hospital, our stewardship program implemented a p...
Objectives:
The National Healthcare Safety Network (NHSN) replaced its old definition for ventilator associated pneumonia (VAP) with ventilator associated events (VAEs) in 2013. Little data is available comparing the two definitions in burn patients.
Methods:
Data from 2011-2014 were collected on burn patients mechanically ventilated for at leas...
Background
The Centers for Disease Control and Prevention’s (CDC) NHSN replaced its old definition for ventilator-associated pneumonia (VAP) with the ventilator-associated events (VAEs) algorithm in 2013. We sought to compare the outcome of trauma patients meeting the definitions for VAP in the two modules.
Methods
Trauma patients with blunt or pe...
Impact of Changes to the National Healthcare Safety Network (NHSN) Definition on Catheter-Associated Urinary Tract Infection (CAUTI) Rates in Intensive Care Units at an Academic Medical Center - Volume 38 Issue 5 - Sonali D. Advani, Rachael A. Lee, Mariann Schmitz, Bernard C. Camins
We report an epidemiological investigation of a cluster of Brevundimonas diminuta isolates cultured from sterile sites. Inoculation of supplement medium yielded growth of B. diminuta . Molecular typing indicated likely contamination of the lot. No B. diminuta was further isolated after replacement of the supplement with a new lot number.
Infect Con...
We report on a quality improvement initiative for hand hygiene adherence using the patient-as-observer method in the ambulatory setting. There were 604,661 observations recorded with improvement of adherence from 88% to 95% or greater; alcohol-based hand sanitizer purchasing correlated with this increase. This sustainable method effectively ensures...
Background:
Whether contact precautions (CP) are required to control the endemic transmission of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) in acute care hospitals is controversial in light of improvements in hand hygiene, MRSA decolonization, environmental cleaning and disinfection, fomite elimin...
OBJECT
External ventricular drains (EVDs) are commonly used for CSF diversion but pose a risk of ventriculitis, with rates varying in frequency from 2% to 45%. Results of studies examining the utility of prolonged systemic antibiotic therapy for the prevention of EVD-related infection have been contradictory, and no study to date has examined wheth...
Antimicrobial stewardship is pivotal to improving patient outcomes, reducing adverse events, decreasing healthcare costs, and preventing further emergence of antimicrobial resistance. In an era in which antimicrobial resistance is increasing, judicious antimicrobial use is the responsibility of every healthcare provider. While antimicrobial steward...
Background: Home parenteral nutrition (HPN) is increasingly used for nutrition support after patients are discharged from the hospital. Catheter-related bloodstream infections (CR-BSI) are a common and potentially fatal complication of HPN. The risk factors for development of CR-BSI in the outpatient setting are poorly understood. Methods: We condu...
Despite improvements in the delivery of care, the annual all-cause mortality rate for end-stage renal disease (ESRD) patients is still around 220 deaths per 1000 at risk patient-years. Infection-related causes are second only to cardiovascular events as a cause for mortality among ESRD patients. Almost two-thirds of all ESRD patients will require h...
Decolonization measures, including mupirocin and chlorhexidine, are often prescribed to prevent Staphylococcus aureus skin and soft tissue infections (SSTI). The objective of this study was to determine the prevalence of high-level mupirocin
and chlorhexidine resistance in S. aureus strains recovered from patients with SSTI before and after mupiroc...
Background: Candida species are common pathogens causing bloodstream infections (BSI) among hospitalized patients, and have also been associated with morbidity and mortality. Several studies have demonstrated that central venous catheter (CVC) access significantly increases the risk for Candida BSIs. The objective of this study was to determine ris...
To describe the tolerance to long-term telavancin therapy among inpatients as it relates to nephrotoxicity.
Retrospective cohort study of adult patients who received telavancin at the Barnes-Jewish Hospital from 1 September 2009 to 1 December 2010. Patients who received less than three doses of telavancin, were on haemodialysis prior to telavancin...
Background:
Current IDSA guidelines suggest that incision and drainage alone may be adequate for management of uncomplicated community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) skin abscess. However, treatment failure and recurrent abscesses are reported in patients not receiving antibiotics. As MRSA colonization is a risk...
Despite a paucity of evidence, decolonization measures are prescribed for outpatients with recurrent Staphylococcus aureus skin and soft-tissue infection (SSTI).
Compare the effectiveness of 4 regimens for eradicating S. aureus carriage.
Open-label, randomized controlled trial. Colonization status and recurrent SSTI were ascertained at 1 and 4 mont...
There are limited data on fluoroquinolone resistance and its impact on mortality in cases of Escherichia coli bloodstream infection (BSI).
To determine risk factors for in-hospital mortality among patients with E coli BSIs.
A retrospective case-control study.
A 1250-bed tertiary academic medical center.
Patients with fluoroquinolone-resistant E col...
To outline methods for deriving and validating intensive care unit (ICU) antimicrobial utilization (AU) measures from computerized data and to describe programming problems that emerged.
Retrospective evaluation of computerized pharmacy and administrative data.
ICUs from 4 academic medical centers over 36 months.
Investigators separately developed...
Improvements in infection prevention practices over the past several decades have enhanced outcomes following aesthetic surgery. However, surgical site infections (SSI) continue to result in increased morbidity, mortality, and cost of care. The true incidence rate of SSI in aesthetic surgery is unknown due to the lack of a national surveillance sys...
Emerging infections caused by vancomycin-intermediate Staphylococcus aureus (VISA) isolates are more likely to be associated with treatment failures than infections caused by other types of S. aureus. We present a case of pacemaker lead infective endocarditis caused by a non-daptomycin-susceptible strain of VISA. After
8 weeks of parenteral telavan...
Catheter-related bloodstream infections (CRBSIs) account for the majority of hemodialysis-related infections. There are no published data on the efficacy of the chlorhexidine-impregnated foam dressing at reducing the rate of CRBSI among patients undergoing hemodialysis.
A prospective, nonblinded, crossover intervention trial to determine the effica...
Background:
Community-associated Staphylococcus aureus (CA-SA) causes recurrent skin and soft tissue infections (SSTI). Eradication of CA-SA colonization may prevent recurrent skin infections. However, decolonization regimens traditionally used in the healthcare setting have not been evaluated in the community.
Objective:
To evaluate the effi...
Background: Little is known about antimicrobial utilization (AU) rates or the magnitude of variation in AU between intensive care units (ICUs) in American hospitals.
Objective: To program electronic hospital pharmacy and administrative data to derive validated measures of variation in AU among 13 selected ICUs in 4 teaching hospitals over a 36-mo...
Vancomycin-resistant Enterococcus (VRE) bloodstream infections (BSIs) are associated with increased morbidity and mortality.
To determine the hospital costs and length of stay attributable to VRE BSI and vancomycin-sensitive Enterococcus (VSE) BSI and the independent effect of vancomycin resistance on hospital costs.
A retrospective cohort study wa...
Background: Colonization with CA-MRSA is associated with development of skin and soft tissue infections. The objective of this study was to determine the prevalence of CA-MRSA colonization at three different body sites in patients presenting with skin and soft tissue infections.
Methods: Swabs of the anterior nares, axilla, and groin were collected...
Multidisciplinary antimicrobial utilization teams (AUTs) have been proposed as a mechanism for improving antimicrobial use, but data on their efficacy remain limited.
To determine the impact of an AUT on antimicrobial use at a teaching hospital.
Randomized controlled intervention trial.
A 953-bed, public, university-affiliated, urban teaching hospi...
Background: Colonization with strains of methicillin-resistant Staphylococcus aureus (MRSA) associated with community acquisition is a significant risk factor for the development of skin and soft tissue infections. The objective of this study was to document the presence and body sites of S. aureus colonization in patients presenting with cutaneous...
Background: We found that 59% of adult ED patients with skin abscesses are colonized with Staphylococcus aureus. Medical equipment can serve as a vector for fomites. We use bedside Ultrasound for abscess evaluation. The objective of this study was to investigate whether Ultrasound probes (USP) are vectors in the transmission of MRSA between patient...
The incidence and factors associated with inappropriate use of antifungal medications were studied in a Thai tertiary care center. The incidence of inappropriate antifungal use was 74% (in 42 of 57 patients). Isolation of Candida species from urine (P = .004) was a risk factor, whereas receipt of an infectious diseases consultation (P = .004) was p...
Because of increasing antimicrobial resistance in hospitals, antimicrobial cycling programs have been introduced in an effort to decrease rates of antimicrobial resistance (1-4). By limiting the exposure of bacteria to a certain class of antimicrobials, the development of resistance to the same class of antimicrobials may be delayed or avoided. Unf...
Background: Although prosthetic joint infection (PJI) is relatively rare, it remains a cause of significant morbidity and healthcare costs. Recurrence of arthroplasty infection can be devastating. The objective of this study was to identify factors related to recurrence after treatment for total knee arthroplasty infection.
Methods: This retrospect...
Background:
ICU studies show that inadequate therapy for candidemia increases risks for inpatients. It is unclear if these findings are applicable to all patients, especially with newer antifungal therapies.
Methods:
All patients diagnosed with candidemia from 2004 - 2005 at Barnes-Jewish Hospital were retrospectively reviewed. Logistic regression...
Background:
Vancomycin-resistant Enterococcus organisms (VRE) have emerged as common nosocomial pathogens, but few population-based data are available on the impact of invasive VRE infections.
Methods:
We assessed the incidence of invasive VRE infections and predictors of mortality among patients identified during prospective, population-based s...
Clostridium difficile spores can contaminate the hospital environment. Little is known about the prevalence and strain variability of C. difficile environmental contamination in health care facilities. The objective of this study was to assess C. difficile environmental contamination at various health care facilities in a metropolitan area and dete...
Background: Candida bloodstream infections (BSI) are a significant cause of morbidity & mortality in intensive care units (ICU). The attributable cost of to Candida BSI is largely unexplored. Hospital administrative data can be used to determine the cost of Candida BSI in ICU pts.
Methods: ICD-9 diagnosis & procedure codes & microbiologic results w...
Background:Prior studies have identified fluoroquinolone use as an independent predictor of development of fluoroquinolone-resistant E. coli (FREC) bloodstream infection (BSI). However, control patients were suboptimally selected. Experts discourage use of patients with a sensitive phenotype infection as controls to determine risk factors for devel...
Background: Bloodstream infections (BSI) increase the cost of hospitalization. Most cost estimates are generally obtained from intensive care unit (ICU) patients. Little data exists on cost of BSI outside the ICU.
Methods: This study was conducted at a 1250-bed, academic medical center. All ICU and non-ICU surgical pts admitted to the hospital for...
Background:
Hemodialysis-associated bloodstream infections (BSI) are a significant cause of morbidity and mortality. They account for 75% of infection-related deaths among end stage renal disease (ESRD) patients.
Methods: From 3/04-7/04, there was an increase in the number of hemodialysis-associated BSIs at an outpatient dialysis center. A retrospe...
The Joint Commission on Accreditation of Healthcare Organizations has made the reduction of health care-associated infections one of its National Patient Safety Goals for 2005.
A 57-year-old man who underwent coronary artery bypass graft surgery was discharged from the hospital without any complications. During his routine follow-up surgery clinic...
Introduction: Overuse of antibiotics is a major public health problem leading to antibiotic resistance. Antimicrobial utilization teams (AUT) have been suggested as a means for improving antibiotic use, but data remain limited regarding their impact. Objective: Determine the impact of an AUT on improving antimicrobial use in an urban teaching hospi...
Citations
... Enterococci are challenging nosocomial pathogens known to cause bloodstream and medical device infections (MDI) [1][2][3][4][5][6]. E. faecium is infamous for its antimicrobial resistance phenotypes, with greater than 80% of isolates demonstrating vancomycin resistance. ...
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... This incidence of HARVI was similar to reports at other pediatric hospitals ranging from 0.51 to 1.91 per 1,000 patient days. 5,6,11,12,22,23 The frequency at which HARVIs occur likely depends on several factors including the number of high-risk patients at the institution and the infection prevention interventions in place. The comparison of these data was difficult because they used different definitions of HARVI. ...
... There are several strategies to reduce perioperative infection rates. Intraoperative normothermia (>35.5 8C) and normoglycemia (glucose levels <180 mg/dl and avoiding hypoglycemia), proper hand hygiene, the use of double-layer globe to use the outer layer to cover the laryngoscope, maintaining a tidy and clean working area and proper antibiotic prophylaxis, have an impact on perioperative HAIs [48,49]. In the postoperative period, early weaning strategies may reduce ventilator-associated pneumonia and vascular catheter care procedures with the use of 70% isopropyl swap cleaning is recommended to reduce Staphylococcus aureus infections [50]. ...
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... The University of Alabama-Birmingham (UAB) Hospital restricted FQs in 2005, largely restoring susceptibility to the class over a 10-year period [51]. Using a quasi-experimental ITS, Idigo and colleagues investigated the impact of FQ preauthorization on DOT per 1000 patient days (DOT/1000 PD) for 3 rd and 4 th generation cephalosporins from January 1998 to December 2016 [52]. ...
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... Infectious diseases (ID) specialists, defined as physicians and pharmacists who are formally trained in ID, improve inpatient care outcomes [1][2][3][4][5][6][7][8]. This is accomplished by (1) ID physicians providing consultative care for patients with complicated infections [1][2][3][4]8] and (2) ID specialists leading programs that monitor and improve antibiotic prescribing, that is, antibiotic stewardship programs (ASPs) [5][6][7]. ...
... Mortality attributed to DRIs is strongly associated with the type of device, ranging from <5% for devices such as Foley catheters to >25% for central venous catheters (CVCs) [14]. e three most common DRIs are centerline-associated bloodstream infection (CRBSIs), ventilator-associated pneumonia, and Foley catheter-associated urinary tract infection [15]. Among these infections, CRBSIs are highly prevalent [16]. ...
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... Then, it is noted that, besides the recommendation of early start of the cleaning of the surgical instrument, its immediate transport is fundamental (7)(8)(9) , in up to 2 hours, to start the processing in the central material and sterilization in order to achieve effective cleaning and, in turn, the safety of the surgical patient. In a study that evaluated orthopedic surgical instruments experimentally contaminated by bone fragments and microorganisms, it was observed that a prolonged period of contamination before processing (180 minutes) resulted in the recovery of bacteria, even after steam sterilization saturated under pressure (28) . ...
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... Interestingly, we also find that typically non-enteric organisms S. epidermidis and P. aeruginosa were not only present in the gut, but strains within the gut microbiota and bloodstream were concordant. Gut colonization by S. epidermidis and P. aeruginosa is unexpected given current National Health and Safety guidelines delimiting enteric versus non-enteric organisms (Taur et al. 2012;Ubeda et al. 2010; "Centers for Disease Control and Prevention" 2018; Advani et al. 2017). Yet, colonization by atypical organisms may not be surprising given the degree of disruption of the intestinal microbiota by antibiotics, chemotherapy, and radiation. ...
... In 2013, the Centers for Disease Control and Prevention, through its National Healthcare Safety Network, replaced its old, more clinical definition for ventilator-associated pneumonia (VAP) with a new ventilator-associated condition algorithm. 40,41 Ventilator-associated condition was created to overcome some of the limitations of traditional VAP definitions, including their complexity, subjectivity, and insensitivity to complications other than pneumonia. 41 Younan et al 40 subsequently reported a weak agreement between the old and new definitions of VAP in 266 severe burn patients, with an observed kappa statistic of only 0.34 (95% CI, 0.23-0.45). ...
... VAP mortality rates range from 20% to 70% with healthcare costs of $20,000 to $40,000 per patient (4,8), making it a primary focus for risk-reduction strategies (9). In recent years preventive measures have been implemented and disseminated to reduce both its incidence and its consequences (10) and VAP has become a mean for tracking quality of care for ventilated patients (11). ...