Publications by authors named "Eli Wilber"

Background: Diagnostic stewardship is the science of improving diagnostic test use. Whether electronic health record (EHR) design influences clinician diagnostic testing behavior and electronic medical record interventions can improve diagnostic stewardship outcomes are key questions. We leveraged the natural experiment of a recent change in EHR platforms to investigate if changing how 2 commonly misused tests, blood cultures for acid-fast bacilli (AFB) and fungi, are displayed affected their use.

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Article Synopsis
  • A systematic review was conducted to evaluate the effectiveness of SARS-CoV-2 nucleocapsid antigen in blood (antigenemia) as a diagnostic test, highlighting inconsistent findings across various studies.
  • The review included 16 studies, finding high sensitivity (83%) and specificity (98%) in the early days of symptoms, but noted that antigenemia is less common after 28 days.
  • The authors call for better-designed studies to assess the clinical relevance of antigenemia, particularly for immunocompromised patients, due to current limitations in study quality and the absence of data from the Omicron variant period.
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Background: Hospital-onset bacteraemia and fungaemia (HOB) is being explored as a surveillance and quality metric. The objectives of the current study were to determine sources and preventability of HOB in hospitalised patients in the USA and to identify factors associated with perceived preventability.

Methods: We conducted a cross-sectional study of HOB events at 10 academic and three community hospitals using structured chart review.

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Objective: Determine the impact of limited implementation of a rapid blood culture identification (BCID) panel.

Design: Retrospective cohort study.

Methods: From February to April 2022, positive blood cultures identified via e-Plex BCID (Roche, Carlsbad, CA) were compared to those identified using standard microbial identification techniques.

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Initial specimen diversion devices (ISDDs) are a potential solution for reducing blood-culture contamination rates. We report the implementation of an ISDD associated with a sustained reduction in blood-culture contamination rates for >18 months after implementation. We did not observe a clinically significant reduction in inpatient vancomycin usage.

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  • Changing the design of a computerized physician order entry (CPOE) system led to an 87% decrease in the incorrect use of an HIV test.
  • This highlights the importance of CPOE design in effectively managing diagnostics.
  • Working together with infectious disease experts, lab professionals, and IT staff can enhance the quality of care and lower expenses.
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  • Nasopharyngeal RT-PCR testing is the standard method for diagnosing SARS-CoV-2, but it doesn't differentiate between active and resolved infections, necessitating alternative testing methods for better clinical guidance.
  • A study analyzed blood plasma nucleocapsid antigen in patients with confirmed SARS-CoV-2 infection to assess its potential as a biomarker for active infection while requiring both nasal and blood samples for accuracy.
  • The findings suggest that most patients with active infections show detectable antigen in blood, indicating the possibility of using blood tests as a convenient and sensitive alternative to nasal swabs for diagnosing ongoing SARS-CoV-2 infections.
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Mpox (monkeypox) represents a diagnostic challenge due to varied clinical presentations and multiple mimics. A commercially available multiplex polymerase chain reaction panel accurately detects mpox virus as well as common mimics (herpes simplex virus, varicella zoster virus) in clinical specimens and could be used in routine clinical, surveillance, and outbreak settings.

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Immunocompromised patients with prolonged coronavirus disease 2019 symptoms present diagnostic and therapeutic challenges. We measured viral nucleocapsid antigenemia in 3 patients treated with anti-CD20 immunotherapy who acquired severe acute respiratory syndrome coronavirus 2 infection and experienced protracted symptoms. Our results support nucleocapsid antigenemia as a marker of persistent infection and therapeutic response.

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  • A study was conducted to examine how often antibiotics are prescribed to patients tested for COVID-19 in a large public healthcare system in the US.
  • Overall, the rate of antibiotic prescriptions was low at 6.7%, indicating that most patients did not receive antibiotics.
  • Among those who tested positive for SARS-CoV-2, only 3.8% had an antibiotic prescription issued within a week of their test.
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Acute gastroenteritis remains a significant cause of morbidity and mortality in both high- and low-resource settings. The development of nucleic acid-based testing has demonstrated that viruses are a common, yet often undetected, cause of acute gastroenteritis. The development of multiplex pathogen PCR panels makes it possible to detect these viral pathogens with greater sensitivity and rapidity than with previous methods.

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