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Ruddy S, Bapna M, Karnik K, Yung L, Rodriguez G, Urban C, Yoon J, Prasad N, Segal-Maurer S, Turett G. Novel case of combination antibiotic therapy for treatment of a complicated polymicrobial urinary tract infection with one organism harboring a metallo-β-lactamase (MBL) in a pregnant patient. IDCases 2024; 36:e01946. [PMID: 38646598 PMCID: PMC11031789 DOI: 10.1016/j.idcr.2024.e01946] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 02/23/2024] [Accepted: 04/14/2024] [Indexed: 04/23/2024] Open
Abstract
Carbapenem resistance due to metallo-beta-lactamases (MBLs) is a global phenomenon and an important challenge for antibiotic therapy (Boyd et al., 2020 [1]). While previous reports have demonstrated both in vitro and in vivo synergy using the combination of ceftazidime-avibactam and aztreonam against Stenotrophomonas maltophilia, an MBL-harboring organism, this treatment strategy has not been reported during pregnancy (Mojic et al., 2017 [2], [3], Mojica et al., 2016 [4], Alexander et al., 2020 [5]). We describe a 33-year-old pregnant female with polymicrobial, bilateral pyelonephritis caused by Stenotrophomonas maltophilia and other gram-negative bacteria. The organisms were eradicated with the combination of ceftazidime-avibactam and aztreonam followed by successful delivery with no observed adverse effects in either mother or child post-partum.
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Affiliation(s)
- S. Ruddy
- Department of Medicine, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, NY 11355, United States of America
- The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, NY 11355, United States of America
| | - M. Bapna
- Department of Medicine, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, NY 11355, United States of America
- The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, NY 11355, United States of America
| | - K. Karnik
- Department of Medicine, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, NY 11355, United States of America
- The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, NY 11355, United States of America
| | - L. Yung
- Department of Medicine, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, NY 11355, United States of America
- The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, NY 11355, United States of America
- Weill Cornell Medicine, Cornell University, New York, NY 10065, United States of America
| | - G. Rodriguez
- The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, NY 11355, United States of America
- Columbia University School of Nursing, New York, NY, 10032, United States of America
| | - C. Urban
- Department of Medicine, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, NY 11355, United States of America
- The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, NY 11355, United States of America
- Weill Cornell Medicine, Cornell University, New York, NY 10065, United States of America
| | - J. Yoon
- Department of Medicine, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, NY 11355, United States of America
- The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, NY 11355, United States of America
- Weill Cornell Medicine, Cornell University, New York, NY 10065, United States of America
| | - N. Prasad
- Department of Medicine, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, NY 11355, United States of America
- The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, NY 11355, United States of America
- Weill Cornell Medicine, Cornell University, New York, NY 10065, United States of America
| | - S. Segal-Maurer
- Department of Medicine, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, NY 11355, United States of America
- The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, NY 11355, United States of America
- Weill Cornell Medicine, Cornell University, New York, NY 10065, United States of America
| | - G. Turett
- Department of Medicine, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, NY 11355, United States of America
- The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, NY 11355, United States of America
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Mansuri Z, Patel S, Patel P, Jayeola O, Das A, Shah J, Gul M, Karnik K, Ganti A, Shah K. Increased Prevalence of Psychosis in Patients Who Get Admitted with Acute Myocardial Infarction with Worse Outcomes. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
ObjectiveTo determine trends and impact on outcomes of acute myocardial infarction (AMI) in patients with pre-existing psychosis.BackgroundWhile post-AMI psychosis has been extensively studied, contemporary studies including temporal trends on impact of pre-AMI Psychosis on AMI and post-AMI outcomes are lacking.MethodsWe used Nationwide Inpatient Sample (NIS) from Healthcare Cost and Utilization Project(HCUP) from 2002 to 2012. We identified AMI and psychosis as primary and secondary diagnosis respectively using validated International Classification of Diseases, 9th Revision, and Clinical Modification (ICD9CM) codes, and Cochrane-Armitage trend test and multivariate regression to generate adjusted odds ratios (aOR).ResultsWe analyzed total of 7,174,274 AMI hospital admissions from 2002 to 2012 of which 1.77% had psychosis. Proportion of hospitalizations with psychosis increased from 6.94% to 11.85% (P-trend < 0.001). Utilization of percutaneous coronary intervention (PCI) was lower in patients with psychosis (29.98% vs. 40.36%, P < 0.001). Utilization of coronary artery bypass grafting (CABG) was lower in patients with psychosis (8.01% vs. 9.18%, P < 0.001). In-hospital mortality was significantly lower in patients with psychosis (aOR 0.677; 95% CI 0.630–0.727; P < 0.001) but discharge to specialty care higher (aOR 1.870; 95%CI 1.786–1.958; P < 0.001). In addition, median length of hospitalization (3.77 vs. 2.90 days; P < 0.001) was higher in hospitalizations with psychosis.ConclusionsOur study displayed increasing proportion of patients with psychosis admitted due to AMI in last decade with lower mortality but higher morbidity post-infarction, and significantly less utilization of PCI and CABG. There was also increased length of stay patients with MDD. There is need to explore reasons behind this disparity in outcomes and PCI and CABG utilization to improve post-AMI outcomes in this vulnerable population.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Mansuri Z, Patel S, Patel P, Jayeola O, Das A, Shah J, Gul M, Ganti A, Karnik K, Patel R. Increased Prevalence of Major Depressive Disorder in Patients who Get Admitted with Atrial Fibrillation with Worse Outcomes. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
ObjectiveTo determine trends and impact on outcomes of atrial fibrillation (AF) in patients with pre-existing major depressive disorder(MDD).BackgroundWhile post-AF MDD has been extensively studied, contemporary studies including temporal trends on impact of pre-AF MDD on AF and post-AF outcomes are lacking.MethodsWe used Nationwide Inpatient Sample (NIS) from Healthcare Cost and Utilization Project (HCUP) from 2002 to 2012. We identified AF and MDD as primary and secondary diagnosis respectively using validated International Classification of Diseases, 9th Revision, and Clinical Modification (ICD9CM) codes, and used Cochrane-Armitage trend test and multivariate regression to generate adjusted odds ratios (aOR).ResultsWe analyzed total of 3,887,827 AF hospital admissions from 2002 to 2012 of which 6.78% had MDD. Proportion of hospitalizations with MDD increased from 4.93% to 14.19% (P-trend < 0.001). Utilization of atrial cardioversion was lower in patients with MDD (34.37% vs. 40.52%, P < 0.001). In-hospital mortality was significantly lower in patients with MDD (aOR0.749; 95% CI 0.664–0.846; P < 0.001) but discharge to specialty care was higher (aOR 1.695; 95%CI 1.650–1.741; P < 0.001). In addition, median length of hospitalization (2.5 vs. 2.13 days; P < 0.001) and median cost of hospitalization (28,246 vs. 22,663; P < 0.001) was higher in hospitalizations with MDD.ConclusionsOur study displayed an increasing proportion of patients with MDD admitted due to AF in the last decade with lower mortality but higher morbidity post-AF. In addition, there was significantly less utilization of atrial cardioversion in this population along with higher median length and cost of hospitalization. There is a need to explore the reasons behind this disparity in outcomes and atrial cardioversion utilization in order to improve post-AF outcomes in this vulnerable population.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Mansuri Z, Patel S, Patel P, Jayeola O, Das A, Shah J, Gul M, Karnik K, Ganti A, Patel R. Temporal Trends in Drug Abuse in Adults with Acute Myocardial Infarction Show Worse Outcomes. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
ObjectiveTo determine temporal trends, invasive treatment utilization and impact on outcomes of pre-infarction drug abuse (DA) on acute myocardial infarction (AMI) in adults.BackgroundDA is important risk factor for AMI. However, temporal trends in drug abuse on AMI hospitalization outcomes in adults are lacking.MethodsWe used Nationwide Inpatient Sample (NIS) from Healthcare Cost and Utilization Project (HCUP) from 2002 to 2012. We identified AMI and DA as primary and secondary diagnosis respectively using validated International Classification of Diseases, 9th Revision, and Clinical Modification (ICD9CM) codes, and used the CochraneArmitage trend test and multivariate regression to generate adjusted odds ratios (aOR).ResultsWe analyzed total of 7,174,274 AMI hospital admissions from 2002 to 2012 of which 1.67% had DA. Proportion of hospitalizations with DA increased from 5.63% to 12.08% (P trend < 0.001). Utilization of coronary artery bypass grafting (CABG) was lower in patients with DA (7.83% vs. 9.18%, P < 0.001). In-hospital mortality was significantly lower in patients with DA (aOR 0.811; 95% CI 0.693–0.735; P < 0.001) but discharge to specialty care was higher (aOR 1.076; 95% CI 1.025–1.128; P < 0.001). The median cost of hospitalization (40,834 vs. 37,253; P < 0.001) was higher in hospitalizations with DA.ConclusionsWe demonstrate an increasing proportion of adults admitted with AMI have DA over the decade. However, DA has paradoxical association with mortality in adults. DA is associated with lower CABG utilization and higher discharge to specialty care, with a higher mean cost of hospitalization. The reasons for the paradoxical association of DA with mortality and worse morbidity outcomes need to be explored in greater detail.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Rathod M, Mansuri Z, Shambhu S, Karnik K, Sutaria A, Mansuri U. Trends of hospitalization for schizophreniform disorder in USA: A nationwide analysis. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
ObjectivesSchizophreniform disorder (SD) is an important cause of morbidity and mortality in hospitalized patients. While SD has been extensively studied in the past, the contemporary data for impact of SD on cost of hospitalization are largely lacking.MethodsWe queried the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (HCUP-NIS) dataset between 1998–2011 using the ICD-9 codes. Severity of comorbid conditions was defined by Deyo modification of Charlson comorbidity index. Primary outcome was in-hospital mortality and secondary outcome was total charges for hospitalization. Using SAS 9.2, Chi2 test, t-test and Cochran-Armitage test were used to test significance.ResultsA total of 8645 patients were analyzed; 36.21% were female and 63.79% were male (P < 0.0001); 49.04% were white, 39.06% black and 19.9% of other race (P < 0.0001). Rate of hospitalization decreased from 599.22/million to 394.47/million from 1998–2011. Overall mortality was 0.23% and mean cost of hospitalization was 17930.23. The in-hospital mortality reduced from 0.21% to 0.15% (P < 0.0001) and mean cost of hospitalization increased from 9662.88$ to 27,749.68$ from 1998–2011. Total spending on SD related admissions have increased from $47.59 million/year to $853.83 million/year.ConclusionsWhile mortality has slightly decreased from 1998 to 2011, the cost has significantly increased from $47.59 million/year to $853.83 million/year, which leads to an estimated $806.24 million/year additional burden to US health care system from 1998 to 2011. In the era of cost conscious care, preventing SD related hospitalization could save billions of dollars every year. Focused efforts are needed to establish preventive measures for SD related hospitalization.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Mansuri Z, Mansuri U, Rathod M, Shambhu S, Karnik K. Trends of hospitalization for bipolar I in USA: A nationwide analysis. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
ObjectivesBipolar I (B-I) is an important cause of morbidity and mortality in hospitalized patients. While B-I has been extensively studied in the past, the contemporary data for impact of B-I on cost of hospitalization are largely lacking.MethodsWe queried the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (HCUP-NIS) dataset between 1998–2011 using the ICD-9 codes. Severity of comorbid conditions was defined by Deyo modification of Charlson comorbidity index. Primary outcome was in-hospital mortality and secondary outcome was total charges for hospitalization. Using SAS 9.2, Chi2 test, t-test and Cochran-Armitage test were used to test significance.ResultsA total of 1,80,681 were analyzed; 56.29% were female and 43.71% were male (P < 0.0001); 70.63% were white, 17.14% black and 12.23% of other race (P < 0.0001). Rate of hospitalization increased from 7469.65/million to 9375.27/million from 1998–2011. Overall mortality was 0.12% and mean cost of hospitalization was 19,821.50$. The in-hospital mortality increased from 0.13% to 0.16% (P < 0.0001) and mean cost of hospitalization increased from 12,091.31$ to 29,292.97$. Total yearly spending on B-I related admissions increased from $0.72 million/year to $2.16 billion/year.ConclusionsWhile mortality has slightly increased from 1998 to 2011, the cost has significantly increased from $0.72 million/year to $2.16 billion/year, which leads to an estimated $1.46 billion/year additional burden to US health care system. In the era of cost conscious care, preventing B-I related Hospitalization could save billions of dollars every year. Focused efforts are needed to establish preventive measures for B-I related hospitalization.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Abstract
Recently society has been witnessing the rise of a new era in the prevention and treatment of the metabolic syndrome and cardiovascular disease: the Polyera. This new era started when a promising concept - the Polypill - was introduced by Wald et al. in 2003. The Polypill is a theoretical combination of six pharmacological compounds (a statin, three different antihypertensives, aspirin, and folic acid) that in combination could reduce cardiovascular disease by more than 80%. Although the Polypill could theoretically be a highly effective intervention, it is not yet available in the market and its effectiveness remains unproven. In the population at large, cheap prizes may come at prohibitive costs. With frail elderly and population prevalences of co-morbidity far higher than in drug trials, rare adverse effects may be frequent. In December 2004, a more natural, safer, and probably tastier alternative to the Polypill - the Polymeal - was introduced. Contrary to the Polypill, the Polymeal combined 6 different foods (fruits and vegetables, almonds, chocolate, wine, fish, and garlic) that taken together in a regular basis could cut cardiovascular disease risk by over 75%. Polyproducts from the polyera in true populations might hide unexpected polyinteractions. In the polyera, polytrials will need to establish benefits, harms, and costs.
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Affiliation(s)
- O H Franco
- Unilever Corporate Research, Colworth Park, Sharnbrook, Bedfordshire, MK441LQ, UK.
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