Epidemiology of nontuberculous mycobacterial infections in the U.S. Veterans Health Administration.

Objective: We identified patients with non-tuberculous mycobacterial (NTM) disease in the US Veterans Health Administration (VHA), examined the distribution of diseases by NTM species, and explored the association between NTM disease and the frequency of clinic visits and mortality.

Methods: We combined mycobacterial isolate (from natural language processing) with ICD-9-CM diagnoses from VHA data between 2008 and 2012 and then applied modified ATS/IDSA guidelines for NTM diagnosis. We performed validation against a reference standard of chart review.

The Drivers of Acute and Long-term Care Clostridium difficile Infection Rates: A Retrospective Multilevel Cohort Study of 251 Facilities.

Background: Drivers of differences in Clostridium difficile incidence across acute and long-term care facilities are poorly understood. We sought to obtain a comprehensive picture of C. difficile incidence and risk factors in acute and long-term care.

Taking an Antibiotic Time-out: Utilization and Usability of a Self-Stewardship Time-out Program for Renewal of Vancomycin and Piperacillin-Tazobactam.

Background: Antibiotic time-outs can promote critical thinking and greater attention to reviewing indications for continuation.

Objective: We pilot tested an antibiotic time-out program at a tertiary care teaching hospital where vancomycin and piperacillin-tazobactam continuation past day 3 had previously required infectious diseases service approval.

Methods: The time-out program consisted of 3 components: (1) an electronic antimicrobial dashboard that aggregated infection-relevant clinical data; (2) a templated note in the electronic medical record that included a structured review of antibiotic indications and that provided automatic approval of continuation of therapy when indicated; and (3) an educational and social marketing campaign.

Importation, Antibiotics, and Clostridium difficile Infection in Veteran Long-Term Care: A Multilevel Case-Control Study.

Background: Although clinical factors affecting a person's susceptibility to Clostridium difficile infection are well-understood, little is known about what drives differences in incidence across long-term care settings.

Objective: To obtain a comprehensive picture of individual and regional factors that affect C difficile incidence.

Design: Multilevel longitudinal nested case-control study.

Propofol is associated with favorable outcomes compared with benzodiazepines in ventilated intensive care unit patients.

Rationale: Mechanically ventilated intensive care unit (ICU) patients are frequently managed using a continuous-infusion sedative. Although recent guidelines suggest avoiding benzodiazepines for sedation, this class of drugs is still widely used. There are limited data comparing sedative agents in terms of clinical outcomes in an ICU setting.

Parenteral to oral conversion of fluoroquinolones: low-hanging fruit for antimicrobial stewardship programs?

Objective: To estimate avoidable intravenous (IV) fluoroquinolone use in Veterans Affairs (VA) hospitals.

Design: A retrospective analysis of bar code medication administration (BCMA) data.

Setting: Acute care wards of 128 VA hospitals throughout the United States.