Bio

Clinical Focus


  • Pediatric Infectious Diseases

Academic Appointments


Administrative Appointments


  • Co-chair, Central Line-Associated Bloodstream Infections Committtee at LPCH (2012 - Present)
  • Co-Chair, Catheter-Associated Urinary Tract Infections Committee at LPCH (2013 - Present)
  • Associate Medical Director, Infection Prevention and Control at LPCH (2014 - Present)

Boards, Advisory Committees, Professional Organizations


  • Member, Infectious Diseases Society of America (2008 - Present)
  • Member, Society for Healthcare Epidemiology of America (2012 - Present)
  • Member, Pediatric Infectious Diseases Society (2012 - Present)

Professional Education


  • Fellowship: Stanford University Pediatric Infectious Disease Fellowship (2011) CA
  • Residency: University of Illinois at Chicago Pediatric Residency (2008) IL
  • Board Certification: American Board of Pediatrics, Pediatric Infectious Diseases (2011)
  • Board Certification: American Board of Pediatrics, Pediatrics (2008)
  • Medical Education: Jawaharlal Nehru Medical College (2003) India

Publications

All Publications


  • Reduction of Central Line-associated Bloodstream Infection Through Focus on the Mesosystem: Standardization, Data, and Accountability. Pediatric quality & safety Mathew, R., Simms, A., Wood, M., Taylor, K., Ferrari, S., Rhein, M., Margallo, D., Bain, L. C., Valencia, A. K., Bargmann-Losche, J., Donnelly, L. F., Lee, G. M. 2020; 5 (2): e272

    Abstract

    Introduction: Efforts to reduce central line-associated bloodstream infection (CLABSI) rates require strong microsystems for success. However, variation in practices across units leads to challenges in ensuring accountability. We redesigned the organization's mesosystem to provide oversight and alignment of microsystem efforts and ensure accountability in the context of the macrosystem. We implemented an A3 framework to achieve reductions in CLABSI through adherence to known evidence-based bundles.Methods: We conducted this CLABSI reduction improvement initiative at a 395-bed freestanding, academic, university-affiliated children's hospital. A mesosystem-focused A3 emphasized bundle adherence through 3 key drivers (1) practice standardization, (2) data transparency, and (3) accountability. We evaluated the impact of this intervention on CLABSI rates during the pre-intervention (01/15-09/17) and post-intervention (07/18-06/19) periods using a Poisson model controlling for baseline trends.Results: Our quarterly CLABSI rates during the pre-intervention period ranged from 1.0 to 2.3 CLABSIs per 1,000 central line-days. With the mesosystem in place, CLABSI rates ranged from 0.4 to 0.7 per 1,000 central line days during the post-intervention period. Adjusting for secular trends, we observed a statistically significant decrease in the post versus pre-intervention CLABSI rate of 71%.Conclusion: Our hospital-wide CLABSI rate declined for the first time in many years after the redesign of the mesosystem and a focus on practice standardization, data transparency, and accountability. Our approach highlights the importance of alignment across unit-level microsystems to ensure high-fidelity implementation of practice standards throughout the healthcare-delivery system.

    View details for DOI 10.1097/pq9.0000000000000272

    View details for PubMedID 32426638

  • Differences in Central Line-Associated Bloodstream Infection Rates Based on the Criteria Used to Count Central Line Days. JAMA Scheinker, D., Ward, A., Shin, A. Y., Lee, G. M., Mathew, R., Donnelly, L. F. 2020; 323 (2): 183–85

    View details for DOI 10.1001/jama.2019.18616

    View details for PubMedID 31935018

  • COVID-19 and Kawasaki Disease: Novel Virus and Novel Case. Hospital pediatrics Jones, V. G., Mills, M., Suarez, D., Hogan, C. A., Yeh, D., Bradley Segal, J., Nguyen, E. L., Barsh, G. R., Maskatia, S., Mathew, R. 2020

    View details for DOI 10.1542/hpeds.2020-0123

    View details for PubMedID 32265235

  • Health Care-Associated Infections Among Critically Ill Children in the US, 2013-2018. JAMA pediatrics Hsu, H. E., Mathew, R., Wang, R., Broadwell, C., Horan, K., Jin, R., Rhee, C., Lee, G. M. 2020

    Abstract

    Central catheter-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) increase morbidity, mortality, and health care costs in pediatric patients.To examine changes over time in CLABSI and CAUTI rates between 2013 and 2018 in neonatal intensive care units (NICUs) and pediatric intensive care units (PICUs) using prospective surveillance data from community hospitals, children's hospitals, and pediatric units within general hospitals.This time series study included 176 US hospitals reporting pediatric health care-associated infection surveillance data to the National Healthcare Safety Network from January 1, 2013, to June 30, 2018. Patients aged 18 years or younger admitted to PICUs or level III NICUs were included in the analysis.The primary outcomes were device-associated rates of CLABSI in NICUs and PICUs and CAUTI in PICUs (infections per 1000 device-days). Secondary outcomes included population-based rates (infections per 10 000 patient-days) and device utilization (device-days per patient-days). Regression models were fit using generalized estimating equations to assess yearly changes in CLABSI and CAUTI rates, adjusted for birth weight (≤1500 vs >1500 g) in neonatal models.Of the 176 hospitals, 132 hospitals with NICUs and 114 hospitals with PICUs contributed data. Of these, NICUs reported 6 064 172 patient-days and 1 363 700 central line-days and PICUs reported 1 999 979 patient-days, 925 956 central catheter-days, and 327 599 indwelling urinary catheter-days. In NICUs, there were no significant changes in yearly trends in device-associated (incidence rate ratio [IRR] per year, 0.99; 95% CI, 0.95-1.03) and population-based (IRR, 0.96; 95% CI, 0.92-1.00) CLABSI rates or central catheter utilization (odds ratio [OR], 0.97; 95% CI, 0.95-1.00). Results were similar in PICUs, with device-associated (IRR, 1.03; 95% CI, 0.99-1.07) and population-based (IRR, 1.03; 95% CI, 0.99-1.07) CLABSI rates and central catheter utilization (OR, 0.99; 95% CI, 0.97-1.01) remaining stable. While device-associated CAUTI rates in PICUs also remained unchanged over time (IRR, 0.97; 95% CI, 0.91-1.03), population-based CAUTI rates significantly decreased by 8% per year (IRR, 0.92; 95% CI, 0.86-0.98) and indwelling urinary catheter utilization significantly decreased by 6% per year (OR, 0.94; 95% CI, 0.91-0.96).Recent trends in CLABSI rates noted in this study among critically ill neonates and children in a large cohort of US hospitals indicate that past gains have held, without evidence of further improvements, suggesting novel approaches for CLABSI prevention are needed. Modest improvements in population-based CAUTI rates likely reflect more judicious use of urinary catheters.

    View details for DOI 10.1001/jamapediatrics.2020.3223

    View details for PubMedID 33017011

  • Mucormycosis diagnosed during induction chemotherapy in five pediatric patients with acute lymphoblastic leukemia. Pediatric blood & cancer Aftandilian, C., Eguiguren, L., Mathew, R., Messner, A. 2019: e27834

    Abstract

    Mucormycosis in pediatric oncology patients is a rare invasive fungal infection associated with significant morbidity and mortality. We describe five patients diagnosed with mucormycosis during induction chemotherapy for acute lymphoblastic leukemia at our institution. All of the patients in our series survived, some in spite of having disseminated disease. Most of the patients' chemotherapy was modified with the aim of controlling their leukemia while minimizing immunosuppression until their fungal infection was under control. Although mucormycosis is frequently fatal, rapid diagnosis and a multidisciplinary approach can lead to excellent outcomes, even in patients undergoing intensive chemotherapy.

    View details for DOI 10.1002/pbc.27834

    View details for PubMedID 31131954

  • Foregone Inclusion: Neonatal CMV Hepatitis and Cholestasis. Digestive diseases and sciences Martin, M., Holmes, S., Sim, J., Hassan, M., Mathew, R., Bensen, R., Barakat, M. 2019

    View details for DOI 10.1007/s10620-019-05691-7

    View details for PubMedID 31187327

  • Complicated pneumonia: current concepts and state of the art. Current opinion in pediatrics Tracy, M. C., Mathew, R. 2018

    Abstract

    This review aims to provide clinicians engaged in the care of infants and children an update on the current understanding of the epidemiology, etiology, diagnostic evaluation, and clinical management of complicated pneumonia. The review provides timely information surrounding areas of consensus and ongoing research.The epidemiology and etiologies of complicated pneumonia continue to evolve over the past several decades in context of the introduction of new vaccines. We review uncommon and emerging pathogens. Immunocompromised patients are particularly at risk for complications. The 2011 clinical practice guidelines for pediatric community-acquired pneumonia from The Pediatric Infectious Diseases Society/Infectious Diseases Society of America and the British Thoracic Society are changing approaches to evaluation and management. The efficacy of new diagnostic laboratory studies, and imaging techniques, continues to be studied. Antibiotics are the mainstay of treatment, with several new options to consider. Techniques for the drainage of parapneumonic effusions continue to optimize.Although much is known about complicated pneumonia, it remains a significant burden. New diagnostic and therapeutic interventions hold much promise. This review seeks to provide clinicians with evidence that motivates a reasoned approach to the evaluation and management of complicated pneumonia.

    View details for PubMedID 29528891

  • Pleural Effusion and Fever in an Immunocompromised Patient. Journal of the Pediatric Infectious Diseases Society Kay, A. W., Itoh, M., Valdez, J., Chen, S. F., Mathew, R., Gans, H. A. 2015; 4 (1): e6-9

    View details for DOI 10.1093/jpids/piu018

    View details for PubMedID 26407371

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