About

Darren R. Linkin, MD, MSCE, is an Associate Professor of Medicine in the Infectious Diseases department at the Hospital of the University of Pennsylvania and the Veteran's Administration Medical Center. He serves as a Healthcare Epidemiologist at the Corporal Michael J. Crescenz VA Medical Center and is an Infectious Diseases Attending Physician there. Dr. Linkin's research interests focus on hospital infection control, particularly influenza vaccination and the epidemiology of healthcare-associated infections. He is an expert inpatient infectious diseases consultant, known for solving complex or 'unsolvable' cases, and has extensive experience in healthcare epidemiology, especially within the VA system. Over nearly two decades, his work has contributed to improving safety systems, reducing healthcare-associated infections, and optimizing staff and patient safety through investigations and system improvements. He has also been involved in regional and national consultations, especially related to influenza vaccine research, and has a significant record of publications in infectious disease and epidemiology.

Research topics

• Medicine
• Family medicine
• Internal medicine
• Intensive care medicine
• Medical emergency

Selected publications

• ICE volume 42 issue 2 Cover and Front matter

  Infection Control and Hospital Epidemiology · 2021-02-01 · 1 citations

  articleOpen access

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• ‘Stat’ workflow modifications to expedite care after needlestick injuries

  Occupational Medicine · 2020-12-09 · 1 citations

  articleOpen access

  BACKGROUND: Post-exposure prophylaxis (PEP) for human immunodeficiency virus (HIV) is recommended to start within hours of needlestick injuries (NSIs) among healthcare workers (HCWs). Delays associated with awaiting the results of testing from the source patient (whose blood was involved in the NSI) can lead to psychological consequences for the exposed HCW as well as symptomatic toxicities from empiric PEP. AIMS: After developing a 'stat' (immediate) workflow that prioritized phlebotomy and resulting of source patient bloodwork for immediate handling and processing, we retrospectively investigated whether our new workflow had (i) decreased HIV order-result interval times for source patient HIV bloodwork and (ii) decreased the frequency of HIV PEP prescriptions being dispensed to exposed HCWs. METHODS: We retrospectively analysed NSI records to identify source patient HIV order-result intervals and PEP dispensing frequencies across a 6-year period (encompassing a 54-month pre-intervention period and 16-month post-intervention period). RESULTS: We identified 251 NSIs, which occurred at similar frequencies before versus after our intervention (means 3.54 NSIs and 3.75 NSIs per month, respectively). Median HIV order-result intervals decreased significantly (P < 0.05) from 195 to 156 min after our intervention, while the proportion of HCWs who received one or more doses of PEP decreased significantly (P < 0.001) from 50% (96/191) to 23% (14/60). CONCLUSION: Using a 'stat' workflow to prioritize source patient testing after NSIs, we achieved a modest decrease in order-result intervals and a dramatic decrease in HIV PEP dispensing rates. This simple intervention may improve HCWs' physical and psychological health during a traumatic time.

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• Attributable Cost of Healthcare-Associated Methicillin-Resistant <i>Staphylococcus aureus</i> Infection in a Long-term Care Center

  Clinical Infectious Diseases · 2020-10-14 · 4 citations

  article

  BACKGROUND: Studies have shown that healthcare-associated infections (HAIs) due to methicillin-resistant Staphylococcus aureus (MRSA) can lead to substantial healthcare costs in acute care settings. However, little is known regarding the consequences of these infections on patients in long-term care centers (LTCCs). The purpose of this study was to estimate the attributable cost of MRSA HAIs in LTCCs within the Department of Veterans Affairs (VA). METHODS: We performed a retrospective cohort study of patients admitted to VA LTCCs between 1 January 2009 and 30 September 2015. MRSA HAIs were defined as a positive clinical culture at least 48 hours after LTCC admission so as to exclude community-acquired infections. Positive cultures were further classified by site (sterile or nonsterile). We used multivariable generalized linear models and 2-part models to compare the LTCC and acute care costs between patients with and without an MRSA HAI. RESULTS: In our primary analysis, there was no difference in LTCC costs between patients with and without a MRSA HAI. There was, however, a significant increase in the odds of being transferred to an acute care facility (odds ratio, 4.40 [95% confidence interval {CI}, 3.40-5.67]) and in acute care costs ($9711 [95% CI, $6961-$12 462]). CONCLUSIONS: Our findings of high cost and increased risk of transfer from LTCC to acute care are important because they highlight the substantial clinical and economic impact of MRSA infections in this population.

  PublisherDOI

• Conditional reflex to urine culture: Evaluation of a diagnostic stewardship intervention within the Veterans’ Affairs and Centers for Disease Control and Prevention Practice-Based Research Network

  Infection Control and Hospital Epidemiology · 2020-08-25 · 44 citations

  articleOpen access

  OBJECTIVE: In the absence of pyuria, positive urine cultures are unlikely to represent infection. Conditional urine reflex culture policies have the potential to limit unnecessary urine culturing. We evaluated the impact of this diagnostic stewardship intervention. DESIGN: We conducted a retrospective, quasi-experimental (nonrandomized) study, with interrupted time series, from August 2013 to January 2018 to examine rates of urine cultures before versus after the policy intervention. We compared 3 intervention sites to 3 control sites in an aggregated series using segmented negative binomial regression. SETTING: The study included 6 acute-care hospitals within the Veterans' Health Administration across the United States. PARTICIPANTS: Adult patients with at least 1 urinalysis ordered during acute-care admission, excluding pregnant patients or those undergoing urological procedures, were included. METHODS: At the intervention sites, urine cultures were performed if a preceding urinalysis met prespecified criteria. No such restrictions occurred at the control sites. The primary outcome was the rate of urine cultures performed per 1,000 patient days. The safety outcome was the rate of gram-negative bloodstream infection per 1,000 patient days. RESULTS: The study included 224,573 urine cultures from 50,901 admissions in 24,759 unique patients. Among the intervention sites, the overall average number of urine cultures performed did not significantly decrease relative to the preintervention period (5.9% decrease; P = 0.8) but did decrease by 21% relative to control sites (P < .01). We detected no significant difference in the rates of gram-negative bloodstream infection among intervention or control sites (P = .49). CONCLUSIONS: Conditional urine reflex culture policies were associated with a decrease in urine culturing without a change in the incidence of gram-negative bloodstream infection.

  PublisherOA PDFDOI

• Mitigation of a Coronavirus Disease 2019 Outbreak in a Nursing Home Through Serial Testing of Residents and Staff

  Clinical Infectious Diseases · 2020-07-16 · 37 citations

  articleOpen access

  Nursing homes and long-term care facilities represent highly vulnerable environments for respiratory disease outbreaks, such as coronavirus disease 2019 (COVID-19). We describe a COVID-19 outbreak in a nursing home that was rapidly contained by using a universal testing strategy of all residents and nursing home staff.

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• Patient Safety

  Cambridge University Press eBooks · 2018-04-26

  book-chapter1st authorCorresponding

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• Methicillin-Resistant Staphylococcus aureus (MRSA) Isolation—Is the Bang Worth the Buck?

  American Journal of Infection Control · 2017-06-01

  articleSenior author
  PublisherDOI

• Factors associated with persistent colonisation with methicillin-resistant<i>Staphylococcus aureus</i>

  Epidemiology and Infection · 2017-02-21 · 4 citations

  articleOpen access

  We conducted a prospective cohort study between 1 January 2010 and 31 December 2012 at five adult and paediatric academic medical centres to identify factors associated with persistent methicillin-resistant Staphylococcus aureus (MRSA) colonisation. Adults and children presenting to ambulatory settings with a MRSA skin and soft tissue infection (i.e. index cases), along with household members, performed self-sampling for MRSA colonisation every 2 weeks for 6 months. Clearance of colonisation was defined as two consecutive negative sampling periods. Subjects without clearance by the end of the study were considered persistently colonised and compared with those who cleared colonisation. Of 243 index cases, 48 (19·8%) had persistent colonisation and 110 (45·3%) cleared colonisation without recurrence. Persistent colonisation was associated with white race (odds ratio (OR), 4·90; 95% confidence interval (CI), 1·38-17·40), prior MRSA infection (OR 3·59; 95% CI 1·05-12·35), colonisation of multiple sites (OR 32·7; 95% CI 6·7-159·3). Conversely, subjects with persistent colonisation were less likely to have been treated with clindamycin (OR 0·28; 95% CI 0·08-0·99). Colonisation at multiple sites is a risk factor for persistent colonisation and may require more targeted decolonisation efforts. The specific effect of clindamycin on MRSA colonisation needs to be elucidated.

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• Sustained Elimination of Immediate Use Steam Sterilization—Bridging the Implementation Gap

  American Journal of Infection Control · 2017-06-01

  articleSenior author
  PublisherDOI

• Evaluation of the effect of cellular SMS reminders on consistency of antiretroviral therapy pharmacy pickups in HIV-infected adults in Botswana: a randomized controlled trial

  Health Psychology and Behavioral Medicine · 2017-01-01 · 19 citations

  articleOpen accessSenior author

  OBJECTIVE: Several studies have demonstrated that cellular phone short message service (SMS) improve antiretroviral adherence for people living with HIV in Africa, although less data are available to support using SMS reminders to improve timeliness of antiretroviral therapy (ART) pharmacy pick up. This study tested the efficacy of SMS reminders on timeliness of ART pharmacy pickups at an urban clinic in Gaborone, Botswana. DESIGN: A randomized-controlled trial evaluating the effect of SMS reminders on ART collection for patients with HIV on treatment. METHODS: One hundred and eight treatment-experienced adult patients were enrolled and randomly assigned to a control group or an intervention group. Participants in the intervention group received SMS reminders that were sent in advance of monthly ART refills that needed to be collected. The primary outcome was 100% timeliness of pharmacy ART pickups. Secondary outcomes included frequency of physician visits, CD4 cell counts and viral loads. RESULTS: = 0.064). In secondary analysis, there were no significant changes in the CD4 counts and viral loads over the course of the study. CONCLUSIONS: Timeliness of ART pickup was not significantly improved by SMS reminders. Additionally, the intervention had no impact on immunologic or virologic outcomes in treatment-experienced patients.

  PublisherOA PDFDOI

Recent grants

• NIH Grant R21AI075303

  NIH · $429k · 2010

• NIH Grant K23AI060887

  NIH · $662k · 2009

Frequent coauthors

• Ebbing Lautenbach

  69 shared

• Neil O. Fishman

  Hospital of the University of Pennsylvania

  54 shared

• Knashawn H. Morales

  University of California, Davis

  48 shared

• Lawrence Ward

  Bayhealth Foundation

  36 shared

• Mindy J. Perilla

  36 shared

• C. Victor Spain

  36 shared

• William Pugliese

  28 shared

• Ann Arbor

  Klinikum Saarbrücken

  28 shared