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CDA 10-030 – HSR&D Study

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CDA 10-030
Actionable Knowledge to Guide Antibiotic Stewardship
Makoto M Jones MD
VA Salt Lake City Health Care System, Salt Lake City, UT
Salt Lake City, UT
Funding Period: May 2011 - April 2020

BACKGROUND/RATIONALE:
Title: Actionable Knowledge to Guide Antimicrobial Stewardship
Background: Antibiotic resistance among bacteria has become a major national and global concern, including in the VA medical system. Its rise increases the risk of a mismatch between antibiotic coverage and the disease-causing pathogen, resulting in excess morbidity, cost, and death. VHA Directive 1031 mandated antibiotic stewardship programs to address these concerns; however, they must navigate between two sometimes opposing interests: patient (successful treatment) and public interests (lower resistance). Furthermore, stewardship interventions need to be adapted to local patterns of antibiotic use and resistance-a process for which the evidence base is poor. This proposal will characterize stewardship information needs, build the evidence base, and use informatics methods to support antibiotic decision-making that benefit both individual Veterans and Veteran as a whole.

OBJECTIVE(S):
Research Aims: (1) Characterize the information needs and decision-making patterns of stewards when making antibiotic recommendations. (2) Identify predictors of antibiotic coverage and emergence of resistance from local antibiotic use and resistance data. (3) Develop a clinical decision-support system that nudges and prompts stewards to use local hospital data and test the influence on stewards.

METHODS:
Aim 1 will use naturalistic decision-making methods to map the decision-making process in a way that identifies information needs and informs the design of a decision-support tool. Aim 2 will use statistical models to find predictors of antibiotic coverage and resistance. Aim 3 will develop a prototype decision-support system and test its effect on how stewards handle resistance issues in a randomized-controlled trial. In year three, I will collaborate with implementation scientists and apply for an investigator-initiated research (IIR) award to pursue my career aims and introduce stewardship tools in a multi-center study.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
In recent years, we have demonstrated that both antimicrobial use and resistance have been improving in VA, which translates to better care for Veterans. This project has supported the development of data tools in this field for most VA medical centers, improving our understanding of what antimicrobial stewards need and delivering it to them. VA researchers now have greater capacity to do better antimicrobial research in greater quantity and faster than most of the premier institutions in the country. VA HSR&D research has the capability of leading the world in antimicrobial stewardship.

PUBLICATIONS:

Journal Articles

  1. Jones MM, Winthrop KL, Nelson SD, Duvall SL, Patterson OV, Nechodom KE, Findley KE, Radonovich LJ, Samore MH, Fennelly KP. Epidemiology of nontuberculous mycobacterial infections in the U.S. Veterans Health Administration. PLoS ONE. 2018 Jun 13; 13(6):e0197976.
  2. Goto M, McDanel JS, Jones MM, Livorsi DJ, Ohl ME, Beck BF, Richardson KK, Alexander B, Perencevich EN. Antimicrobial Nonsusceptibility of Gram-Negative Bloodstream Isolates, Veterans Health Administration System, United States, 2003-2013. Emerging Infectious Diseases. 2017 Nov 1; 23(11):1815-1825.
  3. McDanel JS, Roghmann MC, Perencevich EN, Ohl ME, Goto M, Livorsi DJ, Jones M, Albertson JP, Nair R, O'Shea AMJ, Schweizer ML. Comparative Effectiveness of Cefazolin Versus Nafcillin or Oxacillin for Treatment of Methicillin-Susceptible Staphylococcus aureus Infections Complicated by Bacteremia: A Nationwide Cohort Study. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2017 Jul 1; 65(1):100-106.
  4. Fitzpatrick MA, Suda KJ, Safdar N, Burns SP, Jones MM, Poggensee L, Ramanathan S, Evans CT. Changes in bacterial epidemiology and antibiotic resistance among veterans with spinal cord injury/disorder over the past 9 years. The journal of spinal cord medicine. 2018 Mar 1; 41(2):199-207.
  5. Fitzpatrick MA, Suda KJ, Safdar N, Goldstein B, Jones MM, Poggensee L, Ramanathan S, LeWan R, Evans CT. Unique Risks and Clinical Outcomes Associated With Extended-Spectrum ß-Lactamase Enterobacteriaceae in Veterans With Spinal Cord Injury or Disorder: A Case-Case-Control Study. Infection control and hospital epidemiology. 2016 Jul 1; 37(7):768-76.
  6. Brown KA, Jones M, Daneman N, Adler FR, Stevens V, Nechodom KE, Goetz MB, Samore MH, Mayer J. Importation, Antibiotics, and Clostridium difficile Infection in Veteran Long-Term Care: A Multilevel Case-Control Study. Annals of internal medicine. 2016 Jun 21; 164(12):787-94.
  7. Nelson RE, Jones M, Leecaster M, Samore MH, Ray W, Huttner A, Huttner B, Khader K, Stevens VW, Gerding D, Schweizer ML, Rubin MA. An Economic Analysis of Strategies to Control Clostridium Difficile Transmission and Infection Using an Agent-Based Simulation Model. PLoS ONE. 2016 Mar 31; 11(3):e0152248.
  8. Jones BE, Sauer B, Jones MM, Campo J, Damal K, He T, Ying J, Greene T, Goetz MB, Neuhauser MM, Hicks LA, Samore MH. Variation in Outpatient Antibiotic Prescribing for Acute Respiratory Infections in the Veteran Population: A Cross-sectional Study. Annals of internal medicine. 2015 Jul 21; 163(2):73-80.
  9. Huttner B, Jones M, Rubin MA, Neuhauser MM, Gundlapalli A, Samore M. Drugs of last resort? The use of polymyxins and tigecycline at US Veterans Affairs medical centers, 2005-2010. PLoS ONE. 2013 Jun 24; 7(5):e36649.
  10. Graber CJ, Madaras-Kelly K, Jones MM, Neuhauser MM, Goetz MB. Unnecessary antimicrobial use in the context of Clostridium difficile infection: a call to arms for the Veterans Affairs Antimicrobial Stewardship Task Force. Infection control and hospital epidemiology. 2013 Jun 1; 34(6):651-3.
  11. Nelson RE, Jones M, Rubin MA. Decolonization with Mupirocin and Subsequent Risk of Methicillin-Resistant Staphylococcus aureus Carriage in Veterans Affairs Hospitals. Infectious Diseases and Therapy. 2012 Dec 1; 1(1):1.
  12. Jones M, DuVall SL, Spuhl J, Samore MH, Nielson C, Rubin M. Identification of methicillin-resistant Staphylococcus aureus within the nation's Veterans Affairs medical centers using natural language processing. BMC medical informatics and decision making. 2012 Jul 11; 12(1):34.
  13. Huttner B, Jones M, Rubin MA, Madaras-Kelly K, Nielson C, Goetz MB, Neuhauser MM, Samore MH. Double trouble: how big a problem is redundant anaerobic antibiotic coverage in Veterans Affairs medical centres? The Journal of antimicrobial chemotherapy. 2012 Jun 1; 67(6):1537-9.
  14. Jones M, Samore MH, Carter M, Rubin MA. Long-term care facilities in Utah: a description of human and information technology resources applied to infection control practice. American journal of infection control. 2012 Jun 1; 40(5):446-50.
  15. Jones M, Huttner B, Madaras-Kelly K, Nechodom K, Nielson C, Bidwell Goetz M, Neuhauser MM, Samore MH, Rubin MA. Parenteral to oral conversion of fluoroquinolones: low-hanging fruit for antimicrobial stewardship programs? Infection control and hospital epidemiology. 2012 Apr 1; 33(4):362-7.
Center Products

  1. Gawron A, Gundlapalli AV, Gawron LM, Samore MH, Rubin MA, Jones MM, Weir CR. Natural Language Processing (NLP) Clinical Extraction Method. 2017 Jul 1.
  2. Weir CR, Samore MH, Chapman WW, Jones MM. Population health Dashboards. 2017 Jul 1.
VA Cyberseminars

  1. Jones MM, Rubin MA. Actionable Information for Antimicrobial Stewardship: How data can combat antimicrobial-resistant Bacteria in Veterans. CDA (HSR&D career Development Award Enhancement Initiative) [Cyberseminar]. HSR&D. 2017 May 9.
Conference Presentations

  1. Nelson RE, Slayton RB, Stevens V, Jones MM, Khader K, Jerigan J, Rubin MA, Samore MH. The risk of mortality following healthcare associated infections due to Gram negative bacteria. Poster session presented at: Infectious Diseases Week; 2015 Oct 7; San Diego, CA.
  2. Nelson RE, Jones MM, Leecaster M, Ray W, Huttner B, Huttner A, Khader K, Campo J, Gerding D, Samore MH, Rubin MA. Using an Agent-Based Simulation Model to Conduct an Economic Analysis of Strategies to Control Clostridium difficile Transmission and infection. Poster session presented at: ID Week: A Joint Meeting of IDSA, SHEA, HIVMA, and PIDS; 2013 Oct 2; San Francisco, CA.
  3. Rubin MA, Jones MM, Samore MH. Parenteral to oral conversion of fluoroquinolones: low-hanging fruit for antimicrobial stewardship programs? Poster session presented at: VA HSR&D / QUERI National Meeting; 2012 Jul 16; National Harbor, MD.


DRA: Health Systems, Infectious Diseases
DRE: Epidemiology, Prevention, Technology Development and Assessment
Keywords: Career Development
MeSH Terms: none