Accepted for Publication: October 23, 2013.
Author Contributions: Drs Moehring and Sexton had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Moehring, Schell, Thomann, Hazen, Chen, Sexton.
Acquisition of data: Moehring, Lewis, Isaacs, Schell, Thomann, Althaus, Hazen, LiPuma, Chen, Sexton.
Analysis and interpretation of data: Moehring, Lewis, Thomann, Hazen, Dicks, LiPuma, Chen, Sexton.
Drafting of the manuscript: Moehring, Lewis, Isaacs, Hazen, Sexton.
Critical revision of the manuscript for important intellectual content: Moehring, Lewis, Schell, Thomann, Althaus, Hazen, Dicks, LiPuma, Chen, Sexton.
Statistical analysis: Moehring.
Administrative, technical, or material support: Moehring, Isaacs, Schell, Thomann, Hazen, LiPuma, Chen, Sexton.
Study supervision: Moehring, Hazen, Chen, Sexton.
Published Online: February 3, 2014. doi:10.1001/jamainternmed.2013.13768.
Conflict of Interest Disclosures: None reported.
Previous Presentation: This investigation was previously presented at IDWeek; October 4, 2013; San Francisco, California.
Additional Contributions: The authors sincerely thank the Duke University Hospital infection preventionists, nursing staff, and unit leaders. Special thanks to Duke Clinical Microbiology Laboratory staff for their recognition of the outbreak, dedicated efforts, and extra hours during the investigation. Thank you to the many pharmacy staff who participated in and contributed to this investigation. Thank you to our hospital leadership, pharmacy leadership, and risk management team. We thank Alexander Kallen, MD, MPH (Centers for Disease Control and Prevention, Atlanta, Georgia), and Zack Moore, MD, MPH (North Carolina Department of Health, Raleigh), for their advice during the investigation. These individuals did not receive compensation for their help.