Teena Chopra | Wayne State University (original) (raw)

Papers by Teena Chopra

Infection Control & Hospital Epidemiology, 2016

cultures (7 from stool, 2 from throat swabs). A total of 19 BSIs were associated with mucosal bar... more cultures (7 from stool, 2 from throat swabs). A total of 19 BSIs were associated with mucosal barrier injury (MBI-LCBI: mucosal barrier injury-laboratory-confirmed bloodstream infection). 7 Thus, 17 BSIs were associated with central-line infection, with a CLABSI rate of 1.48 per 1,000 catheter days. In addition, 7 (4%) lines were removed for various reasons (eg, exit-site infection, tip migration, fracture of the line). No CVC was removed because of CLABSI. Despite a high rate of MDRO colonization, a low incidence of catheter-associated bacteremia was observed in patients undergoing stem cell transplant at our center. This finding suggests that in high-intensity clinical settings, despite the high prevalence of MDROs, a combination of rigorous central venous catheter care and concerted infection vigilance ensures low catheter-associated bloodstream infection rates. Coordinated team work among various multidisciplinary teams (ie, maintenance engineering, nursing, housekeeping, infection control, SCT unit doctors and central sterile supply department, transfusion medicine department, patients and relatives) led the way to attaining a satisfactory outcome in this challenging setting. acknowledgments Financial support: No financial support was provided relevant to this article.

American Journal of Infection Control, 2015

Contact precautions (CPs) are recommended to prevent methicillin-resistant Staphylococcus aureus ... more Contact precautions (CPs) are recommended to prevent methicillin-resistant Staphylococcus aureus (MRSA) transmission in institutions. Rising doubts about CP effectiveness and recognition of unintended consequences for patients have raised questions about the benefit. The objective of this study was to evaluate the effectiveness and adverse outcomes associated with CPs for prevention of MRSA transmission. We searched PubMed, Embase, and the Cochrane Library for articles related to effectiveness and adverse outcomes of CPs in patients with MRSA. Criteria for inclusion included the following: articles conducted in the United States, articles performed in an acute care setting, articles that were not a case series or review, and those with standardized collection of data or inclusion of case and control groups. Results were summarized and examined for potential limitations. Recommendations were based on our findings. CPs reduced MRSA transmission in epidemic settings and in instances with high compliance, but a decrease in infection rates was not shown. Unintended consequences of CPs include decreased health care provider (HCP) time spent with patients, low HCP compliance, decreased perceptions of comfort from patients, and greater likelihood of patient complaints and negative psychologic implications. In endemic settings, there are few data to support routine use of CPs to control the spread of MRSA. Education should be performed in hospitals to improve patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; perception of care and understanding of CPs when implemented and HCPs&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; adherence to good hand hygiene and standard precautions practices.

Background: Although CDAD has increased in frequency and severity its epidemiology in HSCT is not... more Background: Although CDAD has increased in frequency and severity its epidemiology in HSCT is not well understood. Our objective was to study the current epidemiology of CDAD in HSCT at our institution from 2005-06. Methods: The study was conducted at Karmanos Cancer Institute and Detroit Medical Center. Definitions: CDAD - patient with diarrhea and positive C. difficile toxin assay result; severe CDAD - ICU admission or surgery or death due to CDAD. Retrospective review was done of the medical records of HSCT who underwent transplantation between 1/1/05 and 12/31/06 and met the definition for CDAD. Epidemiologic surveillance data was used to determine rates of CDAD. Results: CDAD rate/1000 patient-days in non-cancer patients was 0.26 vs. 1.68 in cancer patients and 2.4 in HSCTR. No clusters/outbreaks were identified. Of 361 HSCTs, 216 were allogeneic (ALLO) and 145 autologous (AUTO). Overall 62 episodes of CDAD occurred in 51 (14%) of HSCTs, 4 were severe cases. CDAD occurred in 18...

Background: Advanced age is a risk factor for severe CDI. However the factors that predict severe... more Background: Advanced age is a risk factor for severe CDI. However the factors that predict severe CDI in the elderly are undefined. We performed a matched case-control study of severe CDI in older adults, to determine clinical and laboratory features that predict progression to severe disease. Methods: A retrospective case-control study was performed of older adults (age≥60 years) with severe CDI, hospitalized at 2 acute-care hospitals at the Detroit Medical Center, between January 2006 to December 2008. All patients with diarrhea and a positive Clostridium difficile toxin assay result on stool specimen were identified from the laboratory database. Case patients were ≥60 years of age and had severe CDI defined as: CDI resulting in admission to an intensive care unit, or colectomy, or death <30 days after onset of CDI. Control group were patients age ≥60 years with non-severe CDI. Patient demographics, co-morbidities and clinical and laboratory features were analyzed. Logistic reg...

Introduction: Although HH is critically important in limiting spread of hospital infections, comp... more Introduction: Although HH is critically important in limiting spread of hospital infections, compliance among healthcare workers is poor. One factor complicating the interpretation of HH rates are non-standardized reporting methods. For instance, centers may use observers who work on the same unit (unit based), differing units, or utilize “third party” individuals such as infection control professionals (non-unit based). We hypothesized that observed compliance would be higher when performed by unit based observers as compared to third party individuals. Methods: HH data from 2 hospitals in the DMC was reviewed for the year of 2008. 19 units including acute care, intensive care, and ER were included. Observations were categorized as unit based, if observers worked on the same unit where observations were occurring; and non-unit based if observers did not work on the same unit. HH observations were conducted using standard definitions by trained observers. HH compliance rates between...

Purpose: PAE has consistently been identified as a risk factor for ESBL isolation, but the exact ... more Purpose: PAE has consistently been identified as a risk factor for ESBL isolation, but the exact definition of PAE remains unclear. The purpose of this study was to identify risk factors for ESBLs, with a focus on different definitions of PAE, based on varying time periods of PAE prior to ESBL isolation. Methods: We conducted a retrospective case-control study at a 400-bed community hospital in Detroit, MI. Patients with cultures positive for Klebsiella pneumoniae from January 1- December 31, 2007 were eligible for the study. ESBL cases were compared to patients with non-ESBL-producing Klebsiella pneumoniae (controls). Three PAE definitions were studied: PAEs occurring during 30, 60 and 90 days prior to organism isolation. Results: Eighty-eight cases and 88 controls were studied. The mean cohort age was 63.6 16.9 years, 43% were male and 86% were black. Bivariate analysis demonstrated that prior use of third- or fourth-generation cephalosporins were associated with ESBL isolation re...

Background: Clostridium difficile infection (CDI) occurs in 4-20% of Hematopoietic Stem Cell Tran... more Background: Clostridium difficile infection (CDI) occurs in 4-20% of Hematopoietic Stem Cell Transplant (HSCT) recipients. Asymptomatic carriage of Clostridium difficile (C. diff) is believed to occur in about 7% of healthy adults and 11-25% of hospitalized patients (pts). We performed a prospective study to examine the rates of asymptomatic carriage of C. diff and symptomatic CDI in the HSCT recipients to better understand the epidemiology of CDI in this population. Methods: This study began in December 2010 and was performed at the Karmanos Cancer Center, a 100 bed tertiary care hospital in Detroit, Michigan. Informed consent was obtained from all pts admitted to the HSCT unit before study enrollment. Stool samples were collected within 72 hours of hospital admission and weekly thereafter until hospital discharge. Samples were anaerobically cultured for C. diff using two different culture media: CCFA-VA and CCFA-HB media. All culture positive stool samples were tested by PCR for c...

Background: Scant data exist regarding the factors predictive of BSI due to MDR-AB in hospitalize... more Background: Scant data exist regarding the factors predictive of BSI due to MDR-AB in hospitalized patients. Objective: The objective of this study was to analyze risk factors and outcomes of BSI due to MDR-AB. Methods: A case-control study was conducted at Detroit Medical Center from January 2006 to April 2009 .Patients with positive blood cultures for AB were identified from laboratory data. Cases were patients with MDR-AB BSI defined as: patients with one or more blood cultures positive for AB strains resistant to ampicillin/sulbactam and one or more of the type 2 carbapenems.Controls were patients with non–MDR-AB BSI defined as: patients with one or more positive blood cultures with AB strains, sensitive to a type 2 carbapenem and/or ampicillin/sulbactam. Patient variables collected included demographics, comorbid conditions, functional status and hospital mortality. Logistic regression was used to identify independent predictors of MDR-AB BSI and in-hospital mortality. Results:...

Background: CDI is particularly common in older adults. However, comparison of the risk factors a... more Background: CDI is particularly common in older adults. However, comparison of the risk factors and outcomes of CO-CDI and HO-CDI in the elderly has not been previously evaluated. Objective: To study and compare the epidemiology of HO-CDI and CO-CDI. Methods: A case-control study was performed of older adults (age≥60 years) with CDI, hospitalized at 3 acute- care hospitals at the Detroit Medical Center, between January 2005 and December 2008. All patients with diarrhea and a positive Clostridium difficile toxin assay result on stool specimen were identified from the laboratory database. Case patients were ≥60 years of age and had HO-CDI, defined as: CDI onset occurring after 48 hours of admission. Control group were patients age ≥60 years with CO-CDI, defined as CDI onset within 48 hours of admission. Patient variables collected included demographics, comorbidities, functional status, and development of severe CDI (CDI resulting in admission to an intensive care unit, or colectomy, ...

Background: The epidemiology of 2009 H1N1 influenza (H1N1) and effectiveness of influenza immuniz... more Background: The epidemiology of 2009 H1N1 influenza (H1N1) and effectiveness of influenza immunization in hematopoietic stem cell transplantation (SCT) patients (pts) and non-SCT cancer pts poorly defined. We report our recent experience with influenza at the Karmanos Cancer Center (KCC). Methods: Medical records were reviewed of SCT and non-SCT cancer pts with influenza (2009-2011 seasons). The study was done at the KCC, a 120 bed cancer hospital. Results: 32 pts had symptomatic laboratory-confirmed influenza; 59% SCT and 41% non-SCT cancer pts. Non-H1N1 influenza A 56%, H1N1 28% and influenza B 16% were the viruses identified. Overall, median age was 50 yr (range 21-81), 44% were obese (BMI>30kg/m2), 46% had chronic lung disease, 75% were on immunosuppressive therapy. Cough 81% and fever 66% were the common symptoms. Lymphopenia during influenza was noted in 69%. Lower airway disease was evident in 8/23 (35%) pts with chest radiographs. Nineteen (59%) pts required hospitalizati...

Resistance of Pseudomonas aeruginosa (PA) isolates to imipenem and meropenem (Group 2 carbapenems... more Resistance of Pseudomonas aeruginosa (PA) isolates to imipenem and meropenem (Group 2 carbapenems) has been well documented in acute care hospitals. Literature review suggests a decrease in susceptibility of PA to imipenem and meropenem in these acute care hospitals is associated with an indiscriminate use of group 2 carbapenems as formulary antibiotics. However, there is limited research on the development of resistance to carbapenem antibiotics in PA isolates in long term acute care hospitals (LTACHs). The aim of this study is to analyze the change in susceptibility pattern of Pseudomonas aeruginosa to various antibiotics in a long term acute care hospital in Metropolitan Detroit from 2007 to 2013. Methods: Minimum Inhibitory Concentrations (MICs) of various antimicrobials including imipenem, cefepime, tobramycin and gentamycin to PA was retrieved from the microbiology database from 2007 to 2013 at an LTACH in Detroit. The only carbapenems used as formulary antibiotics at this LTA...

Background: Increases in the incidence of infections caused by multi-drug resistance organisms (M... more Background: Increases in the incidence of infections caused by multi-drug resistance organisms (MDROs) have resulted in detailed recommendations from several national organizations on preventing transmission in the hospital. With the increasing frequency of MDROs, limited infection control resources, and difficulties in achieving compliance from healthcare workers, institutions struggle to define optimal isolation goals. Objective: Our objective was to survey different hospitals to assess contact isolation practices and for trends in practice relevant to newly identified MDROs (i.e. carbapenem-resistant enterobacteriaceae (CRE), carbapenem-resistant and susceptible Acinetobacter baumannii (CRABs/CSABs)) and more traditional pathogens ( i.e. extended spectrum beta lactamase (ESBL) producers, methicillin resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus (VRE)). Methods: 10 institutions were surveyed from 5 states in the US in the spring/summer 2009. Questions w...

Background: Few published data exist regarding the impact of BSI on length of stay (LOS) and hosp... more Background: Few published data exist regarding the impact of BSI on length of stay (LOS) and hospital charges among older adults. The objective of the study was to quantify the impact of nosocomial BSI on LOS and hospital charges in older patients. Methods: A matched outcomes study was conducted at 8 hospitals from Jan 1994 - June 2002. Patients greater than 64 years old with nosocomial BSI (occurring 48 hours after admission) were identified. An elderly control without BSI was matched to each case by hospital, length of stay before BSI, hospital ward and calendar time. Variables were collected from the patient chart, including LOS and hospital charges accrued during the 90 days after initial hospitalization. Linear regression was used to calculate LOS and hospital charges attributable to BSI. Results: 830 BSI cases and 830 controls were analyzed. The mean age of patients was 74.4 years; 50.8% were male and 69.9% were white. 416 (50.1 %) cases and 422 (51.3%) controls had a Charlson...

American Journal of Infection Control, 2014

Carbapenem-resistant Enterobacteriaceae (CRE) isolation is associated with poor outcomes. The mat... more Carbapenem-resistant Enterobacteriaceae (CRE) isolation is associated with poor outcomes. The matched cohort study design enables investigation of specific role of resistance in contributing to patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; outcomes. Patients with CRE were matched to 3 groups: (1) patients with extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL), (2) patients with carbapenem-susceptible non-ESBL Enterobacteriaceae, and (3) uninfected controls. Patients with CRE isolated at Detroit Medical Center (September 1, 2008, to August 31, 2009) were matched (1:1 ratio) to the 3 groups based on (1) bacteria type, (2) hospital/facility, (3) unit/clinic, (4) calendar year, and (5) time at risk (ie, from admission to culture). Multivariable logistic regression models for outcomes were constructed. Ninety-one patients with CRE were enrolled. CRE isolation was not an independent predictor for in-hospital mortality in any of the models (ie, vs uncolonized controls, vs ESBL, vs non-ESBL Enterobacteriaceae, and vs all 3 non-CRE groups combined), despite high significance of association in bivariate analyses. CRE isolation was independently associated with deterioration in functional status [odds ratio, 9; P = .002] and being discharged to a long-term care facility after being admitted to the hospital from home [odds ratio, 13.7; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001]. Underlying condition and comorbidities are the principal factors responsible for in-hospital mortality in CRE infections; however, in-hospital mortality is not independently correlated to the offending pathogen. In addition, we found that the pathogen contributes significantly to patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; degree of morbidity.

Journal of the American Geriatrics Society, 2010

Journal of Infection and Public Health, 2014

The primary objective of this analysis was to evaluate group 2 carbapenem usage and to model the ... more The primary objective of this analysis was to evaluate group 2 carbapenem usage and to model the impact that a formalized de-escalation protocol to ertapenem could potentially have on group 2 carbapenem usage in the hope of alleviating the selective pressure on Acinetobacter and Pseudomonas. This analysis was conducted in three hospitals within the Detroit Medical Center in 2009. Patients were considered candidates for de-escalation of carbapenem therapy when a group 2 carbapenem was utilized to treat Enterobacteriaceae, such as extended spectrum ␤-lactamase (ESBL)-producing organisms, or if cultures were negative in non-intensive care unit (ICU) patients. In total, 179 patients (28%) and 1074 patientdays (29%) were deemed eligible for de-escalation according to our pre-defined criteria. We concluded that preferential utilization of ertapenem in appropriate patients warranting carbapenem therapy has the potential to significantly decrease group 2 carbapenem usage at our institution.

Infectious Disease Clinics of North America, 2009

Infectious Disease Clinics of North America, 2011

Infection Control and Hospital Epidemiology, 2013

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