About

David A Pegues, MD, is a Professor of Medicine (Infectious Diseases) at the Hospital of the University of Pennsylvania. He serves as Associate Medical Director of the Antimicrobial Management Program and Medical Director of Healthcare Epidemiology and Infection Control at the same institution. His clinical expertise includes transplant infectious diseases, healthcare-associated infections such as catheter-associated urinary tract infections, and Salmonellosis. His research interests focus on developing clinical decision support tools to improve diagnostic testing stewardship and reduce inappropriate device utilization. He evaluates novel technologies and implementation strategies aimed at reducing environmental microbial contamination and infection risk in healthcare settings. Additionally, his work involves the prevention and control of device-associated infections in high-risk patient populations, including those undergoing dialysis, oncology treatments, and solid organ transplants.

Research topics

• Internal medicine
• Medicine
• Engineering
• Environmental science
• Virology
• Physics
• Mechanical engineering
• Oceanography
• Geology

Selected publications

• Survey of hemodialysis patients’ knowledge of their infection risk and acceptability of an intranasal decolonization intervention

  Infection Control and Hospital Epidemiology · 2026-02-04

  articleOpen access

  Abstract Objective: While infection is a leading cause of mortality among patients on hemodialysis, there are limited data on patients’ infection prevention knowledge and attitudes. We aimed to assess hemodialysis patients’ knowledge of their elevated infection risk, their willingness to actively prevent infections, and the acceptability of a long-term intranasal decolonization intervention. Design: We surveyed patients as part of a stepped wedge cluster randomized trial evaluating intranasal povidone-iodine (PVI) decolonization. Setting: Sixteen outpatient hemodialysis centers affiliated with 5 academic medical centers. Participants: Patients undergoing outpatient hemodialysis. Methods: Patients were asked to complete a pre-intervention survey (9 questions) and two intervention surveys (13 questions; only patients interested in PVI) at 1 month and 6 months after starting PVI. We used the chi-squared test to compare responses over time. Results: 469 (∼25%) participants completed at least one survey. Most (55%) participants underestimated their infection risk compared with an average person in the United States. The percentage of participants willing to expend “a lot of effort” to prevent an infection decreased from 79% (pre-intervention) to 63% (final survey) ( p < 0.01). Among the 102 participants using PVI at 6 months, 87% said PVI felt neutral or pleasant and 75% used PVI for the past 3 dialysis sessions. Only 9.4% reported side effects. Conclusions: Patients on hemodialysis underestimate their infection risk. Most patients found intranasal PVI to be acceptable. Future research should aim to improve patient education on their infection risk and remove barriers to adherence with infection prevention interventions. Clinical trial information: NCT04210505, https://clinicaltrials.gov/

  PublisherOA PDFDOI

• Screening and targeted prophylaxis for Clostridioides difficile infection

  Clinical Microbiology and Infection · 2025-08-13 · 2 citations

  articleOpen access

  OBJECTIVE: Patients receiving immunosuppression for oncology treatment and solid organ transplantation are at high risk for developing hospital-onset Clostridioides difficile infection (HO-CDI). We studied the impact of a prophylactic enteral vancomycin intervention on the reduction of HO-CDI during high-risk inpatient admissions among immunocompromised patients. METHODS: The screening and targeted prophylaxis (STOP) intervention was implemented over a 2-year period. Patients admitted for solid organ transplant, autologous stem cell transplant, chimeric antigen receptor T-cell, or treatment for leukaemia were screened for colonization with C. difficile. Colonized patients were placed in contact isolation and were advised to start anti-C.difficile antibiotic prophylaxis. To assess the effect of this intervention on both C.difficile testing and incident HO-CDI, comparison was made to historical controls in the 2 years before implementation of the STOP intervention, both unweighted and weighted by treatment category and separately by treatment category and severity of illness. RESULTS: From November 2021 to December 2023, 696 patients were screened for C difficile, among whom 11.1% (77/696) were found to be colonized and received the prophylactic intervention. Compared with treatment-weighted controls, the odds of HO-CDI were significantly lower in the intervention group (6/696 [0.88%] vs. 81/1450 [5.6%]; odds ratio [OR], 0.15; 95% Credible Interval [CrI], 0.06-0.30). Significant reductions in 90-day CDI (OR 0.40, 95% CrI 0.25-0.64), stool output (incidence rate ratio, 0.84; 95% CrI, 0.77-0.92), and length of stay (-2.5 days; 95% CrI, -3.4 to -1.5) were also observed in the intervention group. There was no detected difference in vancomycin-resistant Enterococci infection (OR, 0.77; 95% CrI, 0.33-1.75) or mortality (OR, 0.44; 95% CrI, 0.11-1.49). DISCUSSION: The STOP intervention was effective at reducing HO-CDI, length of stay, and symptoms of C difficile in this high-risk cohort.

  PublisherDOI

• P-315. Safety and Effectiveness of Nasal Povidone-Iodine Decolonization Among Patients on Hemodialysis: A Multicenter Stepped-Wedge Cluster Randomized Trial

  Open Forum Infectious Diseases · 2025-01-29

  articleOpen access

  Abstract Background The SHEA/IDSA/APIC Strategies to Prevent MRSA Transmission and Infection Practice Recommendations advised that facilities consider decolonizing patients on hemodialysis. We implemented a nasal decolonization intervention in which patients self-administered povidone-iodine (PVI) at each dialysis session. We aimed to assess intervention safety and effectiveness. Methods We performed a stepped wedge cluster randomized trial at 16 outpatient hemodialysis units affiliated with 5 academic medical centers between 2020-2023. Adverse events were self-reported at 1 and 6 months. While the analysis was at the hemodialysis unit level, patients were required to give verbal informed consent for PVI use. Outcomes included National Healthcare Safety Network reportable dialysis events aggregated at hemodialysis unit level, including bloodstream infections (BSI), access-related BSI, and central venous catheter (CVC) BSI for all pathogens and for Staphylococcus aureus (SA). The primary outcome was SA BSI. A generalized linear mixed model with a negative binomial distribution, log link function, and an offset for person-months with a random intercept for each hemodialysis unit was performed. Results Overall, 1,351 patients received hemodialysis at these centers each month. Of those, 362 patients verbally consented to use PVI. Among these, 3.9% reported side effects: nasal drip, congestion or burning/stinging, unpleasant smell, headache, or minor nose bleed. A reported side effect ‘yellow tears’ was assessed via chart review and resolved by discontinuing PVI. There were no statistically significant associations between unit level randomization to the PVI intervention and infections. However, there was a non-statistically significant trend toward a protective association between unit-level randomization to PVI and SA infections, particularly SA CVC BSI.(Table) Conclusion Long-term nasal decolonization with PVI was safe with few adverse events. Unit level randomization to the PVI intervention did not significantly decrease unit-level infections. Given low patient enrollment and added infection prevention interventions due to COVID-19, the study could not determine if PVI decolonization could decrease BSI rates in the hemodialysis setting. Disclosures Marin Schweizer, PhD, 3M: Grant/Research Support Anitha Vijayan, MD, Baxter: Honoraria|NxStage: Advisor/Consultant|Qanta: Honoraria David A. Pegues, MD, DaVita/Total Renal Care: Advisor/Consultant Daniel Diekema, MD, Affinity Biosensors: Grant/Research Support|bioMerieux, Inc: Grant/Research Support Loreen Herwaldt, MD, 3M: Grant/Research Support|PDI: Grant/Research Support

  PublisherDOI

• Active Surveillance Culturing of Clostridioides difficile and Multi-Drug Resistant Organisms: Methicillin-Resistant Staphylococcus aureus, Carbapenem-Resistant Enterobacterales, and Candida auris

  2024-05-09 · 3 citations

  report

  The overall purpose of this rapid response is to summarize the most relevant and recent literature on the use and utility of active surveillance for detecting asymptomatic colonization with target MDROs, and to highlight how active surveillance can inform infection control interventions to reduce subsequent transmission and risk of clinical infection.

  PublisherDOI

• Survey of Hemodialysis Patients’ Knowledge of Their Infection Risk and Acceptability of a Nasal Decolonization Intervention

  Antimicrobial Stewardship & Healthcare Epidemiology · 2024-07-01

  articleOpen access

  Background: Patients undergoing hemodialysis are at high risk for healthcare-associated infections; they are at 100 times the risk of Staphylococcus aureus bloodstream infections (BSI) compared with U.S. adults not on hemodialysis. Prior studies found that nasal decolonization with mupirocin prevented S. aureus BSI among hemodialysis patients. We implemented a nasal decolonization intervention in which patients self-administered povidone-iodine (PVI) at each dialysis session. We aimed to assess: 1) hemodialysis patients’ knowledge of their infection risk and their willingness to take an active role in infection prevention; 2) the acceptability of the PVI nasal decolonization intervention. Methods: We performed a stepped wedge cluster randomized trial at 16 outpatient hemodialysis centers. Patients were surveyed: before starting PVI, 1 month after their center started using PVI, and ~6 months after starting PVI. We used a chi-square test to compare results. Results: 469 patients completed at least 1 survey: 400 pre-intervention, 237 at 1 month and 201 at 6 months. Overall, 56% of patients thought that their risk of infection was average or below average compared with an average person in the U.S. (Figure). Over 98% agreed with the statement “One of the most important things I can do for my health is to take an active role in my health care." In the pre-intervention survey, 73% were willing to do “a lot of effort” to prevent an infection. This proportion was similar (73%) in the 2nd survey, but decreased to 63% in the final survey (p < 0 .01). Among 106 patients who reported starting PVI, 85% reported that PVI felt neutral or pleasant, 9.4% reported a side effect, and 79% reported using it during the past 3 dialysis sessions. Among 102 patients who reported using PVI at 6 months, 87% said it felt neutral/pleasant, 3.9% reported a side effect and 75% reported using it during the past 3 dialysis sessions. Side effects included nasal dripping, congestion or burning/stinging, unpleasant smell, headache, yellow tears, and minor nose bleeding. Conclusions: Hemodialysis patients are not aware of their high risk of infection. Although many were willing to expend a lot of effort to prevent an infection, this willingness decreased during an infection prevention intervention. There were few PVI side effects and most patients stated that PVI felt neutral/pleasant, yet many patients chose to not use PVI. Future research should aim to improve patient education on their risk of infection and assess barriers to adherence with infection prevention interventions. Disclosure: Marin Schweizer: Speaker- 3M; Contracted research-3M; Anitha Vijayan: Honoraria - Quanta, Baxter, Fresenius Consulting, Astute, NxStage

  PublisherOA PDFDOI

• Disinfection of central venous access device needleless connectors: A human factors analysis

  Infection Control and Hospital Epidemiology · 2024-02-23 · 2 citations

  articleOpen accessSenior author

  OBJECTIVE: Evidence-based central-line-associated bloodstream infection (CLABSI) prevention guidelines recommend the use of an antiseptic scrub to disinfect needleless connectors before device access. Guideline noncompliance may render disinfection ineffective. The goal of this study was to observe needleless-connector disinfection practices and to identify perceived facilitators and barriers to best practices of needleless-connector access. METHODS: A human factors mixed-methods study involving nursing focus groups of perceived barriers and facilitators and clinical observations of compliance with instructions and protocols for use of 3.15% chlorhexidine gluconate/70% isopropyl alcohol (CHG/IPA) and 70% isopropyl alcohol (IPA) antisepsis products for central venous access device (CVAD) needleless-connector disinfection was conducted in intensive care units (ICUs) at 2 academic medical centers. RESULTS: Access to the antiseptic product and lesser workload were identified as best-practice facilitators. Barriers were the time required per needleless-connector access and knowledge deficits. Of the 48 observed access events, 77% resulted in needleless-connector disinfection. The observed mean needleless-connector scrubbing times when using IPA were substantially below the recommended time. Drying time after product use was negligible. CONCLUSIONS: Lack of access to the disinfection product, emergency situations, and high workload were barriers to needleless-connector disinfection. Observed scrubbing and drying times were shorter than recommended, especially for IPA wipes. These needleless-connector disinfection deficits may increase the risk of CLABSI. Ongoing education and periodic competency evaluation of needleless-connector disinfection, improvement of supply management, and staffing workload are required to imbed and sustain best practices. Further study involving a larger sample size in diverse patient populations is warranted.

  PublisherOA PDFDOI

• Implementing nasal povidone-iodine decolonization to reduce infections in hemodialysis units: a qualitative assessment

  Infection Control and Hospital Epidemiology · 2024-05-23 · 3 citations

  articleOpen access

  BACKGROUND: bloodstream infections. Our pragmatic clinical trial implemented nasal povidone-iodine (PVI) decolonization for the prevention of bloodstream infections in the novel setting of hemodialysis units. OBJECTIVE: We aimed to identify pragmatic strategies for implementing PVI decolonization among patients in outpatient hemodialysis units. DESIGN: Qualitative descriptive study. SETTING: Outpatient hemodialysis units affiliated with five US academic medical centers. Units varied in size, patient demographics, and geographic location. INTERVIEWEES: Sixty-six interviewees including nurses, hemodialysis technicians, research coordinators, and other personnel. METHODS: We conducted interviews with personnel affiliated with all five academic medical centers and conducted thematic analysis of transcripts. RESULTS: Hemodialysis units had varied success with patient recruitment, but interviewees reported that patients and healthcare personnel (HCP) found PVI decolonization acceptable and feasible. Leadership support, HCP engagement, and tailored patient-focused tools or strategies facilitated patient engagement and PVI implementation. Interviewees reported both patients and HCP sometimes underestimated patients' infection risks and experienced infection-prevention fatigue. Other HCP barriers included limited staffing and poor staff engagement. Patient barriers included high health burdens, language barriers, memory issues, and lack of social support. CONCLUSION: Our qualitative study suggests that PVI decolonization would be acceptable to patients and clinical personnel, and implementation is feasible for outpatient hemodialysis units. Hemodialysis units could facilitate implementation by engaging unit leaders, patients and personnel, and developing education for patients about their infection risk.

  PublisherOA PDFDOI

• Antibiotic practice and stewardship in the management of neutropenic fever: a survey of US institutions

  Infection Control and Hospital Epidemiology · 2024-08-01 · 4 citations

  articleOpen access

  OBJECTIVE: To describe neutropenic fever management practices among healthcare institutions. DESIGN: Survey. PARTICIPANTS: Members of the Society for Healthcare Epidemiology of America Research Network (SRN) representing healthcare institutions within the United States. METHODS: An electronic survey was distributed to SRN representatives, with questions pertaining to demographics, antimicrobial prophylaxis, supportive care, and neutropenic fever management. The survey was distributed from fall 2022 through spring 2023. RESULTS: 40 complete responses were recorded (54.8% response rate), with respondent institutions accounting for approximately 15.7% of 2021 US hematologic malignancy hospitalizations and 14.9% of 2020 US bone marrow transplantations. Most entities have institutional guidelines for neutropenic fever management (35, 87.5%) and prophylaxis (31, 77.5%), and first-line treatment included IV antipseudomonal antibiotics (35, 87.5% cephalosporin; 5, 12.5% penicillin; 0, 0% carbapenem).We observed significant heterogeneity in treatment course decisions, with roughly half (18, 45.0%) of respondents continuing antibiotics until neutrophil recovery, while the remainder having criteria for de-escalation prior to neutrophil recovery. Respondents were more willing to de-escalate prior to neutrophil recovery in patients with identified clinical (27, 67.5% with pneumonia) or microbiological (30, 75.0% with bacteremia) sources after dedicated treatment courses. CONCLUSIONS: We found substantial variation in the practice of de-escalation of empiric antibiotics relative to neutrophil recovery, highlighting a need for more robust evidence for and adoption of this practice. No respondents use carbapenems as first-line therapy, comparing favorably to prior survey studies conducted in other countries.

  PublisherOA PDFDOI

• Antibiotic Prescribing Patterns for Respiratory Tract Illnesses Following the Conclusion of an Education and Feedback Intervention in Primary Care

  Clinical Infectious Diseases · 2024-01-25 · 9 citations

  articleOpen access

  BACKGROUND: A study previously conducted in primary care practices found that implementation of an educational session and peer comparison feedback was associated with reduced antibiotic prescribing for respiratory tract diagnoses (RTDs). Here, we assess the long-term effects of this intervention on antibiotic prescribing following cessation of feedback. METHODS: RTD encounters were grouped into tiers based on antibiotic prescribing appropriateness: tier 1, almost always indicated; tier 2, possibly indicated; and tier 3, rarely indicated. A χ2 test was used to compare prescribing between 3 time periods: pre-intervention, intervention, and post-intervention (14 months following cessation of feedback). A mixed-effects multivariable logistic regression analysis was performed to assess the association between period and prescribing. RESULTS: We analyzed 260 900 RTD encounters from 29 practices. Antibiotic prescribing was more frequent in the post-intervention period than in the intervention period (28.9% vs 23.0%, P < .001) but remained lower than the 35.2% pre-intervention rate (P < .001). In multivariable analysis, the odds of prescribing were higher in the post-intervention period than the intervention period for tier 2 (odds ratio [OR], 1.19; 95% confidence interval [CI]: 1.10-1.30; P < .05) and tier 3 (OR, 1.20; 95% CI: 1.12-1.30) indications but was lower compared to the pre-intervention period for each tier (OR, 0.66; 95% CI: 0.59-0.73 tier 2; OR, 0.68; 95% CI: 0.61-0.75 tier 3). CONCLUSIONS: The intervention effects appeared to last beyond the intervention period. However, without ongoing provider feedback, there was a trend toward increased prescribing. Future studies are needed to determine optimal strategies to sustain intervention effects.

  PublisherOA PDFDOI

• Strategies to prevent catheter-associated urinary tract infections in acute-care hospitals: 2022 Update

  Infection Control and Hospital Epidemiology · 2023-08-01 · 99 citations

  articleOpen access

  Abstract and purpose The intent of this document is to highlight practical recommendations in a concise format designed to assist physicians, nurses, and infection preventionists at acute-care hospitals in implementing and prioritizing their catheter-associated urinary tract infection (CAUTI) prevention efforts. This document updates the Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute-Care Hospitals published in 2014. It is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission.

  PublisherOA PDFDOI

Recent grants

• NIH Grant F32AI008873

  NIH · $106k

Frequent coauthors

• Matthew J. Ziegler

  54 shared

• Deborah S. Yokoe

  Lindsay Unified School District

  54 shared

• Michael Klompas

  Harvard Pilgrim Health Care

  49 shared

• David P. Calfee

  Communities In Schools of Orange County

  39 shared

• Evelyn Lo

  New York Proton Center

  39 shared

• Lisa L. Maragakis

  Johns Hopkins Medicine

  39 shared

• Ann Arbor

  Klinikum Saarbrücken

  36 shared

• Carol Chenoweth

  University of Michigan–Ann Arbor

  36 shared

Labs

• David A Pegues LabPI