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Healthcare Epidemiology

Healthcare Epidemiology

This work aims to evaluate the carriage and transmission of multidrug-resistant bacteria in healthcare settings in order to inform optimal policies to prevent acquisition and infection with these high-consequence pathogens.

We have studied Methicillin-resistant Staphylococcus aureus (MRSA) epidemiology in highly vulnerable patient populations, including the neonatal intensive care unit.  One of our primary goals has been to assess the impact of a leading MRSA control strategy, decolonization, in this setting.  To do so we have used mathematical models that explicitly characterize the infectious process in healthcare settings, account for the dependent nature of hospital-based infectious outcomes, address interval-censored observation of colonization status, and facilitate simulation of hypothetical prevention strategies.

We are also investigating asymptomatic gastrointestinal carriage of carbapenem-resistant Enterobacteriaceae (CRE) in intensive care unit patients in order to establish whether carriage risk factors, and propensity for intra-facility spread, differ by CRE resistance mechanism. The broad, long-term goals of this research are to advance our understanding of the epidemiology of CRE colonization and the implications of CRE resistance mechanisms to routes of nosocomial acquisition in order to guide CRE control policies and resource prioritization in U.S. healthcare facilities.

An additional interest of our work is the utilization of machine learning methodologies to address diagnostic and hospital epidemiology policy questions. For example, we have developed a classification and regression tree (CART)-derived decision tree to identify highly drug-resistant bacteremias in order to guide empiric antibiotic treatment while awaiting microbiological confirmation.

Updates #HAI

  • 3 years 7 months ago
    RT @JustinLessler: Congratulations to @rpierc13. The newest PhD out of @JHIDDynamics and @JohnsHopkinsEPI! #HAI #WonderWoman https://t.co/kxJzC2iJrz
  • 4 years 2 months ago
    Congrats to @rpierc13 on her paper on risk of MRSA in the NICU with @JustinLessler and @AaronMilstone. https://t.co/mrLCkYBeaa #HAI
  • 4 years 6 months ago
    Congratulations to Katie Goodman on her paper in Clinical Infectious Diseases https://t.co/1tC9ZqskIv #HAI

Publications

Gram-Negative and Fungal Infections Following Mupirocin-Based Methicillin-Resistant Staphylococcus aureus Decolonization in Neonates.
Pierce R, Bryant K, Elward A, Lessler J, Milstone AM.
Open Forum Infect Dis, 2016: 3 (Suppl 1): 694, 10.1093/ofid/ofw172.557
A Clinical Decision Tree to Predict Whether a Bacteremic Patient is Infected With an ESBL-Producing Organism.
Goodman KE, Lessler J, Cosgrove SE, Harris AD, Lautenbach E, Han JH, Milstone AM, Masey C, Tamma PD; Antibacterial Resistance Leadership Group.
Clin Infect Dis, 2016: 10.1093/cid/ciw425
Expanding the statistical toolbox: analytic approaches for cohort studies with healthcare-associated infectious outcomes.
Pierce RA, Lessler J, Milstone AM.
Curr Opin Infect Dis, 2015: 28: 384-91, 10.1097/QCO.0000000000000179
Rapid 13C Urea Breath Test to Identify Helicobacter pylori Infection in Emergency Department Patients with Upper Abdominal Pain.
Meltzer AC, Pierce R, Cummings DA, Pines JM, May L, Smith MA, Marcotte J, McCarthy ML.
West J Emerg Med, 2013: 14: 278-82, 10.5811/westjem.2012.12.15173
Identifying the probable timing and setting of respiratory virus infections.
Lessler J, Brookmeyer R, Reich NG, Nelson KE, Cummings DA, Perl TM.
Infect Control Hosp Epidemiol, 2010: 31: 809-15, 10.1086/655023
An evaluation of classification rules based on date of symptom onset to identify health-care associated infections.
Lessler J, Brookmeyer R, Perl TM.
Am J Epidemiol, 2007: 166: 1220-9, 10.1093/aje/kwm188

Contact

Tel: 410-955-3551

Email: iddynam [at] jhu.edu

Infectious Disease Dynamics Group
c/o Justin Lessler
Johns Hopkins Bloomberg School of Public Health
615 North Wolfe Street, E6545
Baltimore MD 21205

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