Hospital Epidemiology and Antimicrobial Stewardship
The goal of the Healthcare Epidemiology and Antimicrobial Stewardship (HE-AS) Track within the Boston Medical Center (BMC) Infectious Disease Fellowship Program is to prepare trainees for a career in academic hospital epidemiology and antimicrobial stewardship, incorporating practical hands-on skills training while providing mentorship and resources towards focused academic research. In the absence of a formal ACGME-approved training program in HE-AS, this dedicated advanced training program will position our trainees as competitive candidates for academic HE-AS positions and, for some, form the foundation for a successful research career. It leverages existing strengths of the BUSM ID Fellowship Program and BMC and VA Boston Healthcare System (VABHS) faculty. In fact, our faculty are recognized leaders in HE-AS and have chaired important guideline panels and committees for ID and hospital epidemiology professional societies. In addition to our resources at BMC and the VABHS, we have strong professional connections with the Massachusetts Department of Public Health. Our HE-AS track also leverages the high priority of health equity and community medicine at BMC to include projects that seek to provide equitable care for all our patients. The advanced track includes a third year of training, based at the VABHS.
- Provide practical training in healthcare epidemiology/antibiotic stewardship
- Provide instruction in disciplines of epidemiology and biostatistics, implementation and improvement science, and qualitative research methods.
- Provide research mentorship
A. Core experience: Practical training in antibiotic stewardship /healthcare epidemiology (Year 2 of fellowship training):
The trainee will learn how to perform the core activities of the hospital epidemiologist or antimicrobial steward through active participation as a member of both the infection control and antimicrobial stewardship teams. Those activities will begin in the second year of fellowship training (first year of the HE-AS track) and, for trainees in the advanced track, will continue throughout the two-year training period with progressive responsibility and independence.
Components of the training:
1. Hands-on participation in HE-AS activities at VABHS and BMC: During the second year of fellowship training, AS hands-on participation and training are primarily based at BMC. HE activities take place at both BMC and the VABHS.
- Activities will include disease surveillance, outbreak investigation, federal and state reporting, participation in AS rounds with the MD-ID pharmacist team, clinical guidelines development, drug use evaluations, and implementation of new AS strategies.
2. Active participation in HE-AS committees and Quality Improvement
3. Training in HE-AS and biostatistics online and a BMC-based training curriculum on research methods, implementation and improvement science, and qualitative research. Fellows will have an opportunity to attend an in-person training conference
4. Completion of the IDSA Core Antimicrobial Stewardship (CAS) Curriculum
5. Participation in a scholarly project relevant to HE-AS (this can be an academic extension of the quality improvement project or a separate endeavor) with the goal of preparing an abstract for presentation at a national meeting, and submission of a manuscript to a peer-reviewed journal.
B. Advanced Training Experience (Year 3 of fellowship training):
In addition to the components that are contained within the core experience, fellows opting for advanced training will have a program individualized to his/her career goals. This third year of fellowship is based at the VABHS.
Fellows may choose to focus on one of two tracks: Clinical Practitioner Track or Mentored Research track. The Clinical Practitioner Track will focus on practical training in HE-AS to prepare the trainee for a position as a hospital epidemiologist or antimicrobial steward upon graduation. The trainee in the Mentored Research Track will also receive practical training in HE-AS but the major focus will be creation and completion of a scholarly project that can serve as the basis for a career-development grant proposal. The trainee will designate a primary mentor (either clinical or research- focused depending on the track), with secondary mentor(s) as needed.
Fellows have rich opportunities to participate in scholarly projects at both BMC and the VABHS. Both institutions have grant-funded ongoing investigations that fellows can join, rich datasets that can be used to ask original research questions, and resources available to provide epidemiology, biostatistics, implementation science and mixed methods projects expertise and support. The BU profiles of the faculty summarize individual research interests and publications. Examples of fellow- and trainee-led publications in peer-reviewed journals are listed below.
Core faculty in Hospital Epidemiology and Antimicrobial Stewardship
Tamar Barlam, MD, MSc – Professor of Medicine, Boston University Chobanian & Avedisian School of Medicine; Chief, Section of Infectious Diseases; Director, Antimicrobial Stewardship Program and Hospital Epidemiology, BMC
Kalpana Gupta, MD – Professor of Medicine, Boston University Chobanian & Avedisian School of Medicine; Chief, Infectious Diseases VABHS and Director of the advanced HE-AS Track
Mari-Lynn Drainoni, PhD – Research Professor of Health Policy and Management, Boston University School of Public Health; Research Professor of Medicine, Boston University Chobanian & Avedisian School of Medicine; Research Health Scientist, Center for Health Quality, Outcomes, and Economic Research at the Edith Norse Rogers Memorial Veterans Hospital.
Cassandra Pierre, MD, MSc–Assistant Professor of Medicine, Boston University Chobanian & Avedisian School of Medicine; Associate Hospital Epidemiologist; Medical Director of Public Health Programs.
Alison Nelson, DO – Assistant Professor of Medicine, Boston University Chobanian & Avedisian School of Medicine; Assistant Hospital Epidemiologist, BMC; Assistant Director, Antimicrobial Stewardship Program, BMC
Judith Strymish, MD – Boston VA Hospital, Antibiotic Stewardship Champion, Assistant Professor of Medicine, Harvard Medical School
Katherine Linsenmeyer, MD – Associate Hospital Epidemiologist, Assistant Professor of Medicine, Boston University Chobanian & Avedisian School of Medicine
*The hospital epidemiologists at the VA and BMC will be actively involved in infection control and hospital epidemiology hands-on training
Publications with trainees (trainees names are underlined)
- Kabbani D, Weir S, Berg G, Chien G, Strymish J, Gupta K. Cohorting based on nasal MRSA status: An opportunity to share more than a room. Am J Infect Control2013;41(5):401-4.
- Valencia-Rey P, Strymish J, Robillard E, Evans M, Weinberg J, Gupta K. Survival time of methicillin resistant Staphylococcus aureus-free status after institutional clearance. Infect Control Hosp Epidemiol 2014;
- : Valencia-Rey P, Weinberg J, Miller NS, Barlam TF. Coagulase-negative staphylococcal bloodstream infections: Does vancomycin remain appropriate empiric therapy? J Infect. 2015 Jul;71(1):53-60. doi: 10.1016/j.jinf.2015.02.007
- Linsenmeyer K, Strymish J, Weir S, Berg G, Brecher S, Gupta K. Activity of Fosfomycin against Extended-Spectrum-β-Lactamase-Producing Uropathogens in Patients in the Community and Hospitalized Patients.. Antimicrobial Agents & Chemotherapy. 2015 Nov 23. pii: AAC.02614-15
- Linsenmeyer K, Strymish J, Gupta K. Two Simple Rules for Improving Accuracy of Empiric Treatment for Multidrug Resistant Urinary Tract Infections. Antimicrobial Agents andChemotherapy. 2015 Dec;59(12):7593-6. doi: 10.1128/AAC.01638-15
- Linsenmeyer K, Gupta K, Strymish J, Dhanani M, Brecher S, Breu AC. Culture if Spikes? The Utility and Yield of Blood Cultures. J Hosp Med. 2016 Jan 13. doi: 10.1002/jhm.2541
- Acuna-Villaorduna C, Branch-Elliman W, Strymish J, Gupta K. Active identification of patients who are methicillin-resistant Staphylococcus aureus colonized is not associated with longer duration of vancomycin therapy. Am J Infect Control. 2017 Oct 01; 45(10):1081-1085.View Related Profiles. PMID: 28629753
- Asundi A, Stanislawski M, Mehta P, Barón AE, Gold H, Mull H, Ho PM, Gupta K, Branch-Elliman W. Prolonged antimicrobial prophylaxis following cardiac device procedures increases preventable harm: insights from the VA CART program. Infect Control Hosp Epidemiol. 2018 09; 39(9):1030-1036.View Related Profiles. PMID: 30226128
- Gallegos Salazar J, O’Brien W, Strymish JM, Itani K, Branch-Elliman W, Gupta K. Association of Screening and Treatment for Preoperative Asymptomatic Bacteriuria With Postoperative Outcomes Among US Veterans. JAMA Surg. 2019 03 01; 154(3):241-248.View Related Profiles. PMID: 30540346; PMCID: PMC6439639; DOI: 10.1001/jamasurg.2018.4759;
- Luo R, Barlam TF. Ten-year review of Clostridium difficile infection in acute care hospitals in the USA, 2005-2014. Journal of Hospital Infection 2018;98(1):40-43. PMID 29017933.
- Luo R, Weinberg JM, Barlam TF. The impact of Clostridium difficile infection on future outcomes of solid organ transplant recipients. Infection Control and Hospital Epidemiology 2018;39(5):565-570.
- Morgan JR, Barlam TF, Drainoni ML. A qualitative study of the real world experiences of infectious diseases fellows regarding antibiotic stewardship. Open Forum Infectious Diseases 2018:5(9), ofy102, https://doi.org/10.1093/ofid/ofy102 PMID 3028012010.
- Asundi A, Stanislawski M, Mehta P, Baron AE, Mull HJ, Ho PM, Zimetbaum PJ, Gupta K, Branch-Elliman W. Real-world effectiveness of infection prevention interventions for reducing procedure-related cardiac device infections: Insights from the veterans affairs clinical assessment reporting and tracking program. Infect Control Hosp Epidemiol. 2019 08; 40(8):855-862.View Related Profiles. PMID: 31159895; PMCID: PMC7239318; DOI: 10.1017/ice.2019.127
- Morgan JR, Carey KM, Barlam TF, Christiansen CL, Drainoni ML. Inappropriate antibiotic prescribing for acute bronchitis and subsequent episodes of care. Pediatric Infectious Diseases Journal 2019; 38(3):271-274. PMID: 29794648.
- Burrowes SAB, Rader A, Ni P, Drainoni ML, Barlam TF. Low Uptake of Rapid Diagnostic Tests for Respiratory Tract Infections in an Urban Safety Net Hospital. Open Forum Infect Dis. 2020 Mar; 7(3). doi: 10.1093/ofid/ofaa057. PMID: 32166096.
- Asundi A, Stanislawski M, Mehta P, Mull HJ, Schweizer ML, Barón AE, Ho PM, Gupta K, Branch-Elliman W. Development and Validation of a Semi-Automated Surveillance Algorithm for Cardiac Device Infections: Insights from the VA CART program. Sci Rep. 2020 03 24; 10(1):5276.View Related Profiles. PMID: 32210289; PMCID: PMC7093485; DOI: 10.1038/s41598-020-62083-y;
- . Burrowes SAB, Drainoni M-L, Tjilos M, Butler JM, Damschroder LJ, Goetz MB, Madaras-Kelly K, Reardon CM, Samore MH, Shen J, Stenehjem E, Zhang Y, Barlam TF. Survey of physician and pharmacist steward perceptions of their antibiotic stewardship