Penn CDC Prevention Epicenters Program
Southeastern Pennsylvania Adult and Pediatric Prevention Epicenter Network Overview
The Penn CDC Prevention Epicenter Site represents a broad collaboration across multiple institutions in southeastern Pennsylvania with a dual focus on adult and pediatric patient populations. Penn Epicenter investigators bring expertise in diverse fields including infectious diseases, internal medicine, pediatrics, geriatrics, critical care, pulmonary medicine, emergency medicine, epidemiology, biostatistics, bioinformatics, health economics, and microbiology. Penn epicenter studies are based primarily within the University of Pennsylvania Health System and the Children's Hospital of Philadelphia network.
Penn epicenter studies are based primarily within the University of Pennsylvania Health System and the Children's Hospital of Philadelphia network.
Healthcare-associated infections (HAIs) are a leading cause of morbidity and mortality in the United States and worldwide. The proportion of HAIs due to multidrug-resistant organisms (MDROs) has also significantly increased. Concerted efforts are needed to more clearly define the epidemiology and impact of emerging HAIs and antibiotic resistant organisms, as well as identify novel strategies to address these urgent problems. Since 2011, the Centers for Disease Control and Prevention (CDC) Epicenter site at the University of Pennsylvania (Penn) and the Children’s Hospital of Philadelphia (CHOP) (i.e., the Penn-CHOP Epicenter) has been engaged in numerous studies focused on HAIs and antibiotic resistance. The considerable research funding and infrastructure provided by the CDC’s Prevention Epicenters Program has served to facilitate significant scientific achievements for the Penn-CHOP Epicenter. Indeed, through June of 2016, CDC support has resulted in over 50 peer-reviewed publications and 60 scientific abstracts from the Penn-CHOP Epicenter group. The studies currently ongoing seek to build on this strong foundation by addressing numerous critical areas including: 1) risk factors for, and clinical impact of, emerging HAIs; 2) the role of novel diagnostic algorithms in optimizing antibiotic use; 3) the impact of innovative antimicrobial stewardship metrics and interventions; 4) emerging treatment strategies for high impact HAIs; 5) the effect of strategies focused on reducing the environmental burden of MDROs; and 6) socio-behavioral determinants of effective implementation of infection prevention and antimicrobial stewardship strategies. In these areas, the Penn-CHOP Epicenter will continue its dual focus on both adults and children.
Research Study Area
Use of biomarkers to improve antimicrobial prescribing; Colonization with antimicrobial resistant organisms; antimicrobial stewardship strategies; epidemiology of household transmission of methicillin-resistant Staphylococcus aureus (MRSA); treatment of multidrug resistant gram-negative organisms; strategies to improve the utility of public reporting of healthcare acquired infections.
Current Core Epicenter Projects
The current 4-year CDC Prevention Epicenter program at Penn is comprised of a Core Project (which includes 4 primary studies) and 3 Collaborative Projects of differing scopes (i.e., small, medium, and large) each of which include multiple other CDC Prevention Epicenter partners. These projects are:
Core Project – “Southeastern Pennsylvania Adult and Pediatric Prevention Epicenter Network”
Study #1: “Role of Biomarkers in Antibiotic Use in the Post-Operative Setting”
Study #2: “Fecal Microbial Transplantation in Severe Clostridium difficile”
Study #3: “Development and Impact of Novel Antimicrobial Stewardship Metrics”
Study #4: “Healthcare-Associated Viral Infections in Hospitalized Children”
Small Collaborative Project – “A Qualitative Study to Identify Meaningful Communication Strategies for Delivering Antimicrobial Stewardship Recommendations and Decisions in U.S. Hospitals”
Medium Collaborative Project – “Reducing Vancomycin Use in the Neonatal Intensive Care Unit
Large Collaborative Project – “Impact of Intensive Monitoring Methods for Terminal Room Cleaning on Rates of Multidrug-Resistant Organisms in the Intensive Care Unit”
Research Projects Led by Penn
The overall objective of the current CDC-supported Epicenter project at Penn is to reduce unnecessary use of antibiotics in the intensive care unit (ICU). The purpose of Phase I of the study is to identify the biomarker, or combination of biomarkers, that provides optimal test characteristics in identifying adults and children/neonates with presumed sepsis who have a very low likelihood of bacterial infection. Results of Phase I will result in development of a biomarker-based algorithm to inform need for antibiotic use in ICU patients. In Phase II, the impact of this biomarker-based algorithm on reducing antibiotic use in the ICU will be determined. Costs or savings associated with the algorithm will also be assessed.
Numerous other projects are currently underway at Penn that are closely linked to the epicenter mission. For example, Penn Epicenter investigators are leading a multicenter study investigating longitudinal household transmission of methicillin-resistant Staphylococcus aureus (MRSA). This study is also assessing the impact of a decolonization protocol in curbing MRSA transmission in households. Other projects are focusing on the epidemiology and outcome of fluoroquinolone-resistant Escherichia coli infections in hospital and long term care settings as well as infection prevention and active surveillance strategies for curbing emergence of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae in the hospital setting. Finally, ongoing work is examining the optimal duration of antimicrobial therapy for urinary tract infections in the pediatric population.
Antimicrobial Stewardship Initiative
A new antimicrobial stewardship initiative was commenced with CDC funding in 2013 and has been spearheaded by Keith Hamilton, MD and Jeff Gerber, MD, MSCE. The goal of this initiative was to develop an antimicrobial stewardship tool that could be incorporated at the point-of-care. Following extensive development and pilot testing, the antimicrobial checklist was finalized in 2014. Further work is planned to evaluate more fully the impact of implementation of the checklist.
- Ebbing Lautenbach, MD, MPH, MSCE
- Jeff Gerber, MD, PhD, MSCE
- Fran Balamuth, MD, PhD
- Warren Bilker, PhD
- Valerie Cluzet, MD
- Susan Coffin, MD, MPH
- Jalpa Doshi, PhD
- Kristen Feemster, MD, MSHP
- Neil Fishman, MD
- Barry Fuchs, MD
- Keith Hamilton, MD
- Jennifer Han, MD, MSCE
- Brendan J. Kelly, MD, MSCE
- Meeta Prasad Kerlin, MD, MSCE
- Darren Linkin, MD, MSCE
- Mark Mikkelsen, MD, MSCE
- Irving Nachamkin, DrPH, MPH
- David Pegues, MD, MS
- Julia Sammons, MD
- Julie Szymczak, PhD