Washington University Prevention Epicenter

Overview

The Washington University (WU)/Barnes-Jewish/Christian (BJC) Prevention Epicenter conducts research to prevent healthcare-associated infections (HAIs) and antimicrobial resistance (AR) in healthcare settings and the community. Studies are conducted with administrative data, electronic health records, patients and biospecimens. Researchers develop and test interventions to improve antibiotic use (AU) and disinfection methods, and to identify new biomarkers to combat AR, reduce infections and improve public health.

The WU/BJC Prevention Epicenter works collaboratively with CDC and other Prevention Epicenters to perform research and translate discoveries into novel strategies to prevent HAIs and AR. The WU/BJC Prevention Epicenter is widely recognized for HAI and AR research and leadership. BJC is an integrated healthcare delivery system, including 15 hospitals, long-term care facilities and outpatient practices. BJC includes two academic hospitals, including Barnes-Jewish and St. Louis Children's Hospitals, and 13 suburban and rural hospitals. The WU/BJC Prevention Epicenter also has a research team with expertise in infectious diseases, epidemiology, informatics, microbiology, critical care, microbiome and metabolism to study HAI and AR in diverse settings.

The Epicenter currently uses a variety of clinical and epidemiologic study methods to examine risk factors, outcomes and prevention of HAIs in diverse settings and to perform translational research to understand:

• The epidemiology and transmission dynamics of antimicrobial-resistant infections.
• Role of the fecal microbiome in the development and spread of antimicrobial-resistant bacteria.
• Unique biomarkers and metabolic profiles to diagnose urinary tract infections.
• New strategies to improve antibiotic stewardship.
• Bundled interventions to prevent surgical site infections.

One of the goals of this multicenter research team is to develop improved systems to detect and prevent HAIs and AR. As an example, the Epicenter developed standardized reporting procedures to more efficiently collect and report risk-stratified HAI surveillance data (risk stratification uses data to better understand how to compare facilities and providers [based on patient and facility characteristics]) using active surveillance, electronic medical record data and administrative data. This data has led to improved interventions to prevent HAIs in the most vulnerable patients, including older adults, immuno-suppressed patients, intensive care unit (ICU) patients, patients with invasive devices, such as central venous catheters and mechanical ventilation, and surgical patients.

The Epicenter has also developed interventions that have dramatically reduced the rates of catheter-related bloodstream infections and ventilator-associated pneumonia in ICU patients over the past 10 years.

Current core research study areas

This Prevention Epicenter has a high-impact, five-year research project plan with novel strategies to evaluate and predict inappropriate antibiotic use and AR regionally and nationally, reduce surgical site infections, test new initiatives to improve outpatient antibiotic prescribing, identify differences between hospital and community-associated Clostridioides difficile (C. diff), and reduce AR organism reservoirs in hospitals.

Core research study areas include:

• Evaluating the use, effectiveness and safety of antimicrobials in community-acquired pneumonia (CAP) using national administrative data.
• The impact of an existing Anesthesia Control Tower (ACT) intervention to improve intraoperative care (patient care during an operation) on infectious outcomes.
• Stewardship initiative to limit post-discharge preventive AU after mastectomy.
• Identifying fecal microbiome and metabolite markers of community-associated C. diff colonization and infection (CDI).
• Defining the prevalence of antimicrobial-resistant organisms (ARO) in the hospital ICU environment and their relationship to ARO in clinical culture isolates and measuring the impact of an environmental hygiene intervention on ARO concentration in ICU sink drains, the surrounding environment and bioaerosols (tiny airborne particles).

Current multicenter collaborative research projects

• Novel Microbiological and Metabolomic Approaches to Detect Implant-Associated Infections in Women Post Mastectomy.
• Metabolomic Differentiation to Aid in Diagnosis of C. diff Infection (MD Dx CDI study).
• Clinical, Metagenomic and Metabolomic Predictors of Infections and Asymptomatic Colonization due to Community-Associated ESBL-producing Enterobacterales (PREDICT CA-ESBL).

Principal investigator

Victoria Fraser, MD

Co-investigators

Hilary Babcock, MD, MPH, Anne Butler, PhD, Gautam Dantas, PhD, Erik Dubberke, MD, MPH, Michael Durkin, MD, Jeff Henderson, MD, Kevin Hsueh, MD, Jenny Kwon, DO, Jonas Marschall, MD, Margaret Olsen, PhD, Cristina Vaquez-Guillamet, MD, David Warren, MD, MPH