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Kaul CM, Haller M, Yang J, Solomon S, Khan MR, Pitts RA, Phillips MS. The authors' reply to Jensen et al's Letter to the Editor. Infect Control Hosp Epidemiol 2024:1-2. [PMID: 38623842 DOI: 10.1017/ice.2024.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Affiliation(s)
- Christina M Kaul
- Division of Infectious Diseases, NYU Grossman School of Medicine, New York, NY, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Matthew Haller
- NYU Grossman School of Medicine, New York, NY, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Jenny Yang
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Sadie Solomon
- Department of Hospital Epidemiology, NYU Langone Health, New York, NY, USA
| | - Maria R Khan
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Robert A Pitts
- Division of Infectious Diseases, NYU Grossman School of Medicine, New York, NY, USA
| | - Michael S Phillips
- Division of Infectious Diseases, NYU Grossman School of Medicine, New York, NY, USA
- Department of Hospital Epidemiology, NYU Langone Health, New York, NY, USA
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Kaul CM, Haller M, Yang J, Solomon S, Khan MR, Pitts RA, Phillips MS. Factors associated with loss to follow-up in outpatient parenteral antimicrobial therapy: A retrospective cohort study. Infect Control Hosp Epidemiol 2024; 45:387-389. [PMID: 37782035 PMCID: PMC10933499 DOI: 10.1017/ice.2023.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/10/2023] [Accepted: 08/21/2023] [Indexed: 10/03/2023]
Abstract
We assessed factors associated with increased risk to loss of follow-up with infectious diseases staff in OPAT patients. Discharge to subacute healthcare facilities is strongly associated with loss to follow-up. We did not identify sociodemographic disparities. Poor communication between OPAT providers and subacute healthcare facilities remains a serious issue.
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Affiliation(s)
- Christina M. Kaul
- Division of Infectious Diseases, NYU Grossman School of Medicine, New York, New York
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | | | - Jenny Yang
- Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Sadie Solomon
- Department of Hospital Epidemiology, NYU Langone Health, New York, New York
| | - Maria R. Khan
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - Robert A. Pitts
- Division of Infectious Diseases, NYU Grossman School of Medicine, New York, New York
| | - Michael S. Phillips
- Division of Infectious Diseases, NYU Grossman School of Medicine, New York, New York
- Department of Hospital Epidemiology, NYU Langone Health, New York, New York
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Kaul CM, Moore BE, Kaplan-Lewis E, Casey E, Pitts RA, Pagan Pirallo P, Lim S, Kapadia F, Cohen GM, Khan M, Mgbako O. EquiPrEP: An implementation science protocol for promoting equitable access and uptake of long-acting injectable HIV pre-exposure prophylaxis (LAI-PrEP). PLoS One 2023; 18:e0291657. [PMID: 37725628 PMCID: PMC10508596 DOI: 10.1371/journal.pone.0291657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/03/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Long-acting injectable HIV pre-exposure prophylaxis (LAI-PrEP) was approved by the U.S. Food and Drug Administration in December 2021. This initial phase of implementation represents a prime opportunity to ensure equitable LAI-PrEP provision to communities often underrepresented in PrEP care before disparities in access and uptake emerge. Herein, we describe the EquiPrEP Project which utilizes an equity-oriented implementation science framework to optimize LAI-PrEP rollout in an urban safety-net clinic in New York City. METHODS The primary objectives of this project are to: (1) increase LAI-PrEP initiation overall; (2) increase uptake among groups disproportionately impacted by the HIV epidemic; (3) preserve high PrEP retention while expanding use; and (4) identify barriers and facilitators to LAI-PrEP use. EquiPrEP will enroll 210 PrEP-eligible participants into LAI-PrEP care with planned follow-up for one year. We will recruit from the following priority populations: Black and/or Latine men who have sex with men, Black and/or Latine cisgender women, and transgender women and nonbinary individuals. To evaluate implementation of LAI-PrEP, we will utilize equity-focused iterations of the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework and the Consolidated Framework for Implementation Research (CFIR), in addition to longitudinal surveys and qualitative interviews. DISCUSSION Novel LAI-PrEP formulations carry tremendous potential to revolutionize the field of HIV prevention. Implementation strategies rooted in equity are needed to ensure that marginalized populations have access to LAI-PrEP and to address the structural factors that hinder initiation and retention in care.
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Affiliation(s)
- Christina M. Kaul
- Office of Ambulatory Care and Population Health, HIV Services, NYC Health + Hospitals, New York, New York, United States of America
- Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Brandi E. Moore
- Department of Epidemiology, New York University School of Global Public Health, New York, New York, United States of America
| | - Emma Kaplan-Lewis
- Office of Ambulatory Care and Population Health, HIV Services, NYC Health + Hospitals, New York, New York, United States of America
| | - Eunice Casey
- Office of Ambulatory Care and Population Health, HIV Services, NYC Health + Hospitals, New York, New York, United States of America
| | - Robert A. Pitts
- Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, United States of America
- NYC Health + Hospitals/Bellevue, New York, New York, United States of America
| | - Patricia Pagan Pirallo
- Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Sahnah Lim
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Farzana Kapadia
- Department of Epidemiology, New York University School of Global Public Health, New York, New York, United States of America
| | - Gabriel M. Cohen
- Office of Ambulatory Care and Population Health, HIV Services, NYC Health + Hospitals, New York, New York, United States of America
- Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, United States of America
- NYC Health + Hospitals/Bellevue, New York, New York, United States of America
| | - Maria Khan
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Ofole Mgbako
- Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, United States of America
- NYC Health + Hospitals/Bellevue, New York, New York, United States of America
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States of America
- NYU Langone Institute for Excellence in Health Equity, NYU Grossman School of Medicine, New York, New York, United States of America
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Kaul CM, Cohen GM, Silverstein M, Wallach AB, Diago-Navarro E, Holzman RS, Foote MK. Understanding the Relationship Between Antiviral Prescription Data and COVID-19 Incidence in New York City: A Retrospective Cohort Study. Open Forum Infect Dis 2023; 10:ofad281. [PMID: 37333721 PMCID: PMC10270561 DOI: 10.1093/ofid/ofad281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/21/2023] [Indexed: 06/20/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has caused more than 675 million confirmed cases and nearly 7 million deaths worldwide [1]. While testing for COVID-19 was initially centered in health care facilities, with required reporting to health departments, it is increasingly being performed in the home with rapid antigen testing [2]. Most at-home tests are self-interpreted and not reported to a provider or health department, which could lead to delayed reporting or underreporting of cases [3]. As such, there is a strong possibility that reported cases may become a less reliable indicator of transmission over time.
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Affiliation(s)
- Christina M Kaul
- Correspondence: Christina M. Kaul, MD, MS, NYU Grossman School of Medicine, 462 1st Avenue, NBV 16S 5-13, New York, NY 10016 (); or Mary K. Foote, MD, MPH, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Queens, NY 11101 ()
| | | | - Matthew Silverstein
- New York City Department of Health and Mental Hygiene, New York, New York, USA
| | | | | | | | - Mary K Foote
- Correspondence: Christina M. Kaul, MD, MS, NYU Grossman School of Medicine, 462 1st Avenue, NBV 16S 5-13, New York, NY 10016 (); or Mary K. Foote, MD, MPH, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Queens, NY 11101 ()
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Srinivasan D, Kaul CM, Buttar AB, Nottingham FI, Greene JB. Disseminated Herpes Simplex Virus-2 (HSV-2) as a Cause of Viral Hepatitis in an Immunocompetent Host. Am J Case Rep 2021; 22:e932474. [PMID: 34341324 PMCID: PMC8349572 DOI: 10.12659/ajcr.932474] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Patient: Male, 57-year-old Final Diagnosis: Hepatitis • herpes Symptoms: Fever Medication: — Clinical Procedure: — Specialty: General and Internal Medicine
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Affiliation(s)
- Dushyanth Srinivasan
- Division of Hospital Medicine, Department of Medicine, New York University (NYU) Grossman School of Medicine, New York City, NY, USA
| | - Christina M Kaul
- Division of Infectious Diseases and Immunology, Department of Medicine, New York University (NYU) Grossman School of Medicine, New York City, NY, USA
| | - Amna B Buttar
- Division of Geriatric Medicine, Department of Medicine, New York University (NYU) Grossman School of Medicine, New York City, NY, USA
| | - Fatima I Nottingham
- Division of Hospital Medicine, Department of Medicine, New York University (NYU) Grossman School of Medicine, New York City, NY, USA
| | - Jeffrey B Greene
- Division of Infectious Diseases and Immunology, Department of Medicine, New York University (NYU) Grossman School of Medicine, New York City, NY, USA
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Kaul CM, Molina E, Armellino D, Schilling ME, Jarrett M. 180. Leveraging the Electronic Medical Record as a Method of Antibiotic Stewardship. Open Forum Infect Dis 2020. [PMCID: PMC7777790 DOI: 10.1093/ofid/ofaa439.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Overutilization of antibiotics remains an issue in the inpatient setting. What is more, many protocols geared toward curbing improper antibiotic use rely heavily on resource- and personnel-intensive interventions. Thus, the potential for using the EMR to facilitate antibiotic stewardship remains largely unexplored. Methods We implemented a novel change for ordering certain antibiotics in our EMR: ceftriaxone, daptomycin, ertapenem, imipenem, meropenem, and piperacillin-tazobactam. When ordering one of these antibiotics, providers had to note a usage indication, which assigned a usage duration as per our Antibiotic Stewardship Committee guidelines. Pre-intervention, manual discontinuation was required if a provider did not enter a duration. The intervention was enacted August 2019 in 13 hospitals. Data was collected from January 2018 to February 2020. Antibiotic usage was reported monthly as rate per 1000-patient days. Monthly pre- and post-intervention rates were averaged, respectively. Paired samples t-tests were used to compare pre- and post-intervention rates per unit type per hospital. A p-value of less than 0.05 was considered significant. Units with minimal usage, as defined by a pre- or post-intervention mean of 0, were excluded from analysis. Example of Ordering an Antibiotic Prior to Intervention ![]()
Example of Ordering an Antibiotic After Intervention ![]()
Results Ertapenem was noted to have a statistically significant decrease in utilization in seven units at three hospitals. Piperacillin-tazobactam was found to have a decrease in utilization in 19 units at eight hospitals. Daptomycin was found to have a decrease in utilization in one unit. Significant decreases in the utilization of ceftriaxone, imipenem, and meropenem were not noted. Example of Statistically Significant Decreased Utilization in Piperacillin-Tazobactam on a Medical-Surglcal Unit ![]()
Conclusion Our study showed a statistically significant decrease in use of ertapenem, piperacillin-tazobactam and daptomycin using a simple built-in EMR prompt that curtails provider error. This should allow for an increased ease of integration, as the protocol does not require a host of resources for maintenance. Of note is decreased utilization of piperacillin-tazobactam and ertapenem across multiple hospitals, most notably on the medical and surgical wards. Thus, usage of the EMR without personnel-intensive protocols is a viable method for augmenting antibiotic stewardship in health systems. Disclosures All Authors: No reported disclosures
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Kaul CM, Kim A. 445. A Case of Disseminated Microsporidia Manifesting as Skin Lesions in a Patient with Acute Lymphoblastic Leukemia. Open Forum Infect Dis 2019. [PMCID: PMC6810416 DOI: 10.1093/ofid/ofz360.518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background We present a case of a 65-year-old male with a history of acute B-cell lymphoblastic leukemia (ALL) who presented with fevers and skin lesions. The patient achieved remission after induction chemotherapy. Nineteen months after diagnosis, while on maintenance therapy, the patient presented as noted above. He was instructed to hold maintenance therapy and sent to the hospital. Methods Results On examination, the patient was febrile. He had papules present on the forehead, chest, arms, legs, and back. Physical examination was otherwise unremarkable. Labs were notable for a white blood cell count of 3600/uL (absolute neutrophil 3100/uL) and creatine kinase (CK) of 593 U/L. Blood and urine cultures, Histoplasma, Varicella, Toxoplasma, HIV, and an acute hepatitis panel were negative. CT of the chest, abdomen, and pelvis was unremarkable. He was empirically started on micafungin and valacyclovir. However, he continued to have fevers and myalgias. Wound culture was negative for fungus after four weeks of growth. Skin biopsy immunostains were consistent with an unknown protozoan. Specimens were sent to an outside facility and yielded a diagnosis of Anncaliia algerae. Antibiotics were changed to albendazole and voriconazole, with subsequent improvement in all symptoms. Conclusion Microsporidia most commonly infect immunocompromised hosts. Clinical manifestations of microsporidiosis are extremely diverse. Oftentimes, symptoms are not present in those found to be infected with Microsporidia. A disseminated disease has been identified but remains rare. Although Microsporidia have been identified as a cause of infection in immunocompromised patients, there are few reports of infection in those diagnosed with cancer, and only a few cases have been due to Anncaliia algerae. In studies pertaining to ALL patients, roughly one-fifth of patients were identified as being infected with Microsporidia, but most did not have symptoms. This is the first reported case of disseminated Microsporidia in a patient with ALL and the first disseminated infection presenting as a skin manifestation. Of identified cases of disseminated Microsporidial infection, mortality was high. Thus, prompt recognition of Microsporidia as a cause of infection in patients with ALL is of utmost importance. ![]()
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Disclosures All authors: No reported disclosures.
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