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Tsai YV, Bookstaver PB, Kohn J, Justo JA, Childress D, Stramel S, Slain D, Tu P, Wingler MJB, Jones BM, Anderson DT, Seddon MM, Cretella DA, Eudy J, Winders H, Antosz K, Bailey P, Al-Hasan MN. The prevalence of gram-negative bacteria with difficult-to-treat resistance and utilization of novel β-lactam antibiotics in the southeastern United States. Antimicrob Steward Healthc Epidemiol 2024; 4:e35. [PMID: 38500714 PMCID: PMC10945936 DOI: 10.1017/ash.2024.26] [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] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/02/2024] [Accepted: 02/04/2024] [Indexed: 03/20/2024]
Abstract
Objective To evaluate temporal trends in the prevalence of gram-negative bacteria (GNB) with difficult-to-treat resistance (DTR) in the southeastern United States. Secondary objective was to examine the use of novel β-lactams for GNB with DTR by both antimicrobial use (AU) and a novel metric of adjusted AU by microbiological burden (am-AU). Design Retrospective, multicenter, cohort. Setting Ten hospitals in the southeastern United States. Methods GNB with DTR including Enterobacterales, Pseudomonas aeruginosa, and Acinetobacter spp. from 2015 to 2020 were tracked at each institution. Cumulative AU of novel β-lactams including ceftolozane/tazobactam, ceftazidime/avibactam, meropenem/vaborbactam, imipenem/cilastatin/relebactam, and cefiderocol in days of therapy (DOT) per 1,000 patient-days was calculated. Linear regression was utilized to examine temporal trends in the prevalence of GNB with DTR and cumulative AU of novel β-lactams. Results The overall prevalence of GNB with DTR was 0.85% (1,223/143,638) with numerical increase from 0.77% to 1.00% between 2015 and 2020 (P = .06). There was a statistically significant increase in DTR Enterobacterales (0.11% to 0.28%, P = .023) and DTR Acinetobacter spp. (4.2% to 18.8%, P = .002). Cumulative AU of novel β-lactams was 1.91 ± 1.95 DOT per 1,000 patient-days. When comparing cumulative mean AU and am-AU, there was an increase from 1.91 to 2.36 DOT/1,000 patient-days, with more than half of the hospitals shifting in ranking after adjustment for microbiological burden. Conclusions The overall prevalence of GNB with DTR and the use of novel β-lactams remain low. However, the uptrend in the use of novel β-lactams after adjusting for microbiological burden suggests a higher utilization relative to the prevalence of GNB with DTR.
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Affiliation(s)
| | - P. Brandon Bookstaver
- Prisma Health-Midlands, Columbia, SC, USA
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, USA
| | | | - Julie Ann Justo
- Prisma Health-Midlands, Columbia, SC, USA
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, USA
| | | | - Stefanie Stramel
- Department of Pharmacy, Memorial Hermann Memorial City Medical Center, Houston, TX, USA
| | - Douglas Slain
- Department of Clinical Pharmacy and Section of Infectious Diseases, West Virginia University, Morgantown, WV, USA
| | - Patrick Tu
- Department of Pharmacy, Charlie Norwood VA Medical Center, Augusta, GA, USA
| | - Mary Joyce B. Wingler
- Department of Antimicrobial Stewardship, University of Mississippi Medical Center, Jackson, MS, USA
| | | | - Daniel T. Anderson
- Department of Pharmacy, Augusta University Medical Center, Augusta, GA, USA
| | | | - David A. Cretella
- Department of Antimicrobial Stewardship, University of Mississippi Medical Center, Jackson, MS, USA
| | - Joshua Eudy
- Department of Pharmacy, Augusta University Medical Center, Augusta, GA, USA
| | | | - Kayla Antosz
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, USA
| | - Pamela Bailey
- Prisma Health-Midlands, Columbia, SC, USA
- Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, SC, USA
| | - Majdi N. Al-Hasan
- Prisma Health-Midlands, Columbia, SC, USA
- Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, SC, USA
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Mondal U, Warren E, Bookstaver PB, Kohn J, Al-Hasan MN. Incidence and predictors of complications in Gram-negative bloodstream infection. Infection 2024:10.1007/s15010-024-02202-3. [PMID: 38436912 DOI: 10.1007/s15010-024-02202-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/29/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND The incidence of metastatic complications in Gram-negative bloodstream infection (GN-BSI) remains undefined. This retrospective cohort study examines the incidence and predictors of complications within 90 days of GN-BSI. METHODS Patients with GN-BSIs hospitalized at two Prisma Health-Midlands hospitals in Columbia, South Carolina, USA from 1 January 2012 through 30 June 2015 were included. Complications of GN-BSI included endocarditis, septic arthritis, osteomyelitis, spinal infections, deep-seated abscesses, and recurrent GN-BSI. Kaplan-Meier analysis and multivariate Cox proportional hazards regression were used to examine incidence and risk factors of complications, respectively. RESULTS Among 752 patients with GN-BSI, median age was 66 years and 380 (50.5%) were women. The urinary tract was the most common source of GN-BSI (378; 50.3%) and Escherichia coli was the most common bacteria (375; 49.9%). Overall, 13.9% of patients developed complications within 90 days of GN-BSI. The median time to identification of these complications was 5.2 days from initial GN-BSI. Independent risk factors for complications were presence of indwelling prosthetic material (hazards ratio [HR] 1.73, 95% confidence intervals [CI] 1.08-2.78), injection drug use (HR 6.84, 95% CI 1.63-28.74), non-urinary source (HR 1.98, 95% CI 1.18-3.23), BSI due to S. marcescens, P. mirabilis or P. aeruginosa (HR 1.78, 95% CI 1.05-3.03), early clinical failure criteria (HR 1.19 per point, 95% CI 1.03-1.36), and persistent GN-BSI (HR 2.97, 95% CI 1.26-6.99). CONCLUSIONS Complications of GN-BSI are relatively common and may be predicted based on initial clinical response to antimicrobial therapy, follow-up blood culture results, and other host and microbiological factors.
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Affiliation(s)
- Utpal Mondal
- Department of Medicine, Division of Infectious Diseases, Audie L. Murphy VA Medical Center, San Antonio, TX, USA
- Department of Medicine, Long School of Medicine, University of Texas Health Science Center, San Antonio, TX, USA
| | - Erin Warren
- Department of Pharmacy, Prisma Health-Midlands, Columbia, SC, USA
| | - P Brandon Bookstaver
- Department of Pharmacy, Prisma Health-Midlands, Columbia, SC, USA
- Department of Clinical Pharmacy and Outcomes Science, University of South Carolina College of Pharmacy, Columbia, SC, USA
| | - Joseph Kohn
- Department of Pharmacy, Prisma Health-Midlands, Columbia, SC, USA
| | - Majdi N Al-Hasan
- Department of Medicine, University of South Carolina School of Medicine, Columbia, SC, USA.
- Department of Internal Medicine, Division of Infectious Diseases, Prisma Health-Midlands, Columbia, SC, USA.
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Bailey P, Chen S, Al-Hasan MN, Olatosi B, Li X, Zhang J. Ecologic analysis of antimicrobial use in South Carolina hospitals during 2020-2022. Antimicrob Steward Healthc Epidemiol 2023; 3:e232. [PMID: 38156220 PMCID: PMC10753502 DOI: 10.1017/ash.2023.496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/20/2023] [Accepted: 10/20/2023] [Indexed: 12/30/2023]
Abstract
Background Factors influencing excessive antimicrobial utilization in hospitalized patients remain poorly understood, particularly with the COVID-19 pandemic. Methods In this retrospective cohort, we compared administrative data regarding antimicrobial prescriptions in hospitalized patients in South Carolina from March 2020 through September 2022. The study examined variables associated with antimicrobial use across demographics, COVID status, and length of stay, among other variables. Results Significant relationships were seen with antimicrobial use in COVID-19 positive patients (OR 2.00, 95% Confidence Interval (CI): 1.9-2.1), young adults (OR 1.08, 95% CI: 0.99-1.12, COVID-19 positive Blacks and Hispanics (OR 1.06, 95% CI: 1.01-1.11, OR 1.05, 95% CI: 0.89-1.23), and COVID-19 positive patients with ≥2 comorbid conditions (OR 1.55, 95% CI: 1.43-1.68). Discussion Further analysis in more than one healthcare system should explore these ecologic relationships further to understand if these are common trends to inform ongoing stewardship interventions.
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Affiliation(s)
- Pamela Bailey
- Department of Internal Medicine, Division of Infectious Diseases, Prisma Health—Midlands, Columbia, SC, USA
- University of South Carolina School of Medicine, Columbia, SC, USA
| | - Shujie Chen
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Big Data Health Science Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Majdi N. Al-Hasan
- Department of Internal Medicine, Division of Infectious Diseases, Prisma Health—Midlands, Columbia, SC, USA
- University of South Carolina School of Medicine, Columbia, SC, USA
| | - Bankole Olatosi
- Big Data Health Science Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Xiaoming Li
- Big Data Health Science Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina; Columbia, SC, USA
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Big Data Health Science Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Pizzuti M, Tsai YV, Winders HR, Bookstaver PB, Al-Hasan MN. Application of Precision Medicine Concepts in Ambulatory Antibiotic Management of Acute Pyelonephritis. Pharmacy (Basel) 2023; 11:169. [PMID: 37987379 PMCID: PMC10661281 DOI: 10.3390/pharmacy11060169] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/11/2023] [Accepted: 10/19/2023] [Indexed: 11/22/2023] Open
Abstract
Acute pyelonephritis (APN) is a relatively common community-acquired infection, particularly in women. The early appropriate antibiotic treatment of this potentially life-threatening infection is associated with improved outcomes. The international management guidelines for complicated urinary tract infections and APN recommend using oral antibiotics with <10% resistance among urinary pathogens. However, increasing antibiotic resistance rates among Escherichia coli and other Enterobacterales to fluoroquinolones, trimethoprim-sulfamethoxazole (TMP-SMX), and beta-lactams has left patients without reliable oral antibiotic treatment options for APN. This narrative review proposes using precision medicine concepts to improve empirical antibiotic therapy for APN in ambulatory settings. Whereas resistance rates to a particular antibiotic class may exceed 10% at the population-based level, the predicted antibiotic resistance rates based on patient-specific risk factors fall under 10% in many patients with APN on the individual level. The utilization of clinical tools for the prediction of fluoroquinolones, TMP-SMX, and third-generation cephalosporin resistance improves the ambulatory antibiotic management of APN. It may also reduce the need to switch antibiotic therapy later based on the in vitro antibiotic susceptibility testing results of bacterial isolates in urinary cultures. This approach may mitigate the burden of increasing antibiotic resistance in the community by ensuring that the initial antibiotic prescribed has the highest likelihood of treating APN appropriately.
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Affiliation(s)
- Morgan Pizzuti
- Department of Pharmacy, Prisma Health-Midlands, Columbia, SC 29203, USA; (H.R.W.); (P.B.B.)
| | | | - Hana R. Winders
- Department of Pharmacy, Prisma Health-Midlands, Columbia, SC 29203, USA; (H.R.W.); (P.B.B.)
| | - Paul Brandon Bookstaver
- Department of Pharmacy, Prisma Health-Midlands, Columbia, SC 29203, USA; (H.R.W.); (P.B.B.)
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC 29208, USA
| | - Majdi N. Al-Hasan
- Department of Internal Medicine, Division of Infectious Diseases, Prisma Health-Midlands, Columbia, SC 29203, USA;
- Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, SC 29209, USA
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Sartelli M, Barie PS, Coccolini F, Abbas M, Abbo LM, Abdukhalilova GK, Abraham Y, Abubakar S, Abu-Zidan FM, Adebisi YA, Adamou H, Afandiyeva G, Agastra E, Alfouzan WA, Al-Hasan MN, Ali S, Ali SM, Allaw F, Allwell-Brown G, Amir A, Amponsah OKO, Al Omari A, Ansaloni L, Ansari S, Arauz AB, Augustin G, Awazi B, Azfar M, Bah MSB, Bala M, Banagala ASK, Baral S, Bassetti M, Bavestrello L, Beilman G, Bekele K, Benboubker M, Beović B, Bergamasco MD, Bertagnolio S, Biffl WL, Blot S, Boermeester MA, Bonomo RA, Brink A, Brusaferro S, Butemba J, Caínzos MA, Camacho-Ortiz A, Canton R, Cascio A, Cassini A, Cástro-Sanchez E, Catarci M, Catena R, Chamani-Tabriz L, Chandy SJ, Charani E, Cheadle WG, Chebet D, Chikowe I, Chiara F, Cheng VCC, Chioti A, Cocuz ME, Coimbra R, Cortese F, Cui Y, Czepiel J, Dasic M, de Francisco Serpa N, de Jonge SW, Delibegovic S, Dellinger EP, Demetrashvili Z, De Palma A, De Silva D, De Simone B, De Waele J, Dhingra S, Diaz JJ, Dima C, Dirani N, Dodoo CC, Dorj G, Duane TM, Eckmann C, Egyir B, Elmangory MM, Enani MA, Ergonul O, Escalera-Antezana JP, Escandon K, Ettu AWOO, Fadare JO, Fantoni M, Farahbakhsh M, Faro MP, Ferreres A, Flocco G, Foianini E, Fry DE, Garcia AF, Gerardi C, Ghannam W, Giamarellou H, Glushkova N, Gkiokas G, Goff DA, Gomi H, Gottfredsson M, Griffiths EA, Guerra Gronerth RI, Guirao X, Gupta YK, Halle-Ekane G, Hansen S, Haque M, Hardcastle TC, Hayman DTS, Hecker A, Hell M, Ho VP, Hodonou AM, Isik A, Islam S, Itani KMF, Jaidane N, Jammer I, Jenkins DR, Kamara IF, Kanj SS, Jumbam D, Keikha M, Khanna AK, Khanna S, Kapoor G, Kapoor G, Kariuki S, Khamis F, Khokha V, Kiggundu R, Kiguba R, Kim HB, Kim PK, Kirkpatrick AW, Kluger Y, Ko WC, Kok KYY, Kotecha V, Kouma I, Kovacevic B, Krasniqi J, Krutova M, Kryvoruchko I, Kullar R, Labi KA, Labricciosa FM, Lakoh S, Lakatos B, Lansang MAD, Laxminarayan R, Lee YR, Leone M, Leppaniemi A, Hara GL, Litvin A, Lohsiriwat V, Machain GM, Mahomoodally F, Maier RV, Majumder MAA, Malama S, Manasa J, Manchanda V, Manzano-Nunez R, Martínez-Martínez L, Martin-Loeches I, Marwah S, Maseda E, Mathewos M, Maves RC, McNamara D, Memish Z, Mertz D, Mishra SK, Montravers P, Moro ML, Mossialos E, Motta F, Mudenda S, Mugabi P, Mugisha MJM, Mylonakis E, Napolitano LM, Nathwani D, Nkamba L, Nsutebu EF, O’Connor DB, Ogunsola S, Jensen PØ, Ordoñez JM, Ordoñez CA, Ottolino P, Ouedraogo AS, Paiva JA, Palmieri M, Pan A, Pant N, Panyko A, Paolillo C, Patel J, Pea F, Petrone P, Petrosillo N, Pintar T, Plaudis H, Podda M, Ponce-de-Leon A, Powell SL, Puello-Guerrero A, Pulcini C, Rasa K, Regimbeau JM, Rello J, Retamozo-Palacios MR, Reynolds-Campbell G, Ribeiro J, Rickard J, Rocha-Pereira N, Rosenthal VD, Rossolini GM, Rwegerera GM, Rwigamba M, Sabbatucci M, Saladžinskas Ž, Salama RE, Sali T, Salile SS, Sall I, Kafil HS, Sakakushev BE, Sawyer RG, Scatizzi M, Seni J, Septimus EJ, Sganga G, Shabanzadeh DM, Shelat VG, Shibabaw A, Somville F, Souf S, Stefani S, Tacconelli E, Tan BK, Tattevin P, Rodriguez-Taveras C, Telles JP, Téllez-Almenares O, Tessier J, Thang NT, Timmermann C, Timsit JF, Tochie JN, Tolonen M, Trueba G, Tsioutis C, Tumietto F, Tuon FF, Ulrych J, Uranues S, van Dongen M, van Goor H, Velmahos GC, Vereczkei A, Viaggi B, Viale P, Vila J, Voss A, Vraneš J, Watkins RR, Wanjiru-Korir N, Waworuntu O, Wechsler-Fördös A, Yadgarova K, Yahaya M, Yahya AI, Xiao Y, Zakaria AD, Zakrison TL, Zamora Mesia V, Siquini W, Darzi A, Pagani L, Catena F. Ten golden rules for optimal antibiotic use in hospital settings: the WARNING call to action. World J Emerg Surg 2023; 18:50. [PMID: 37845673 PMCID: PMC10580644 DOI: 10.1186/s13017-023-00518-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/23/2023] [Indexed: 10/18/2023] Open
Abstract
Antibiotics are recognized widely for their benefits when used appropriately. However, they are often used inappropriately despite the importance of responsible use within good clinical practice. Effective antibiotic treatment is an essential component of universal healthcare, and it is a global responsibility to ensure appropriate use. Currently, pharmaceutical companies have little incentive to develop new antibiotics due to scientific, regulatory, and financial barriers, further emphasizing the importance of appropriate antibiotic use. To address this issue, the Global Alliance for Infections in Surgery established an international multidisciplinary task force of 295 experts from 115 countries with different backgrounds. The task force developed a position statement called WARNING (Worldwide Antimicrobial Resistance National/International Network Group) aimed at raising awareness of antimicrobial resistance and improving antibiotic prescribing practices worldwide. The statement outlined is 10 axioms, or "golden rules," for the appropriate use of antibiotics that all healthcare workers should consistently adhere in clinical practice.
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Broermann LE, Al-Hasan MN, Withers S, Benbow KL, Ramsey T, McTavish M, Winders HR. Intravenous versus Partial Oral Antibiotic Therapy in the Treatment of Uncomplicated Bloodstream Infection Due to Streptococcus Species. Microorganisms 2023; 11:2313. [PMID: 37764157 PMCID: PMC10536542 DOI: 10.3390/microorganisms11092313] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/24/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
This retrospective cohort study examines effectiveness of partial oral antibiotic regimens in uncomplicated bloodstream infections (BSIs) due to Streptococcus species compared to standard intravenous therapy. Adult patients with uncomplicated streptococcal BSIs from April 2016 to June 2020 in seven hospitals in South Carolina, USA, were evaluated. Multivariate Cox proportional hazards regression was used to examine the time to treatment failure within 90 days of a BSI after adjustment for the propensity to receive partial oral therapy. Multivariate linear regression was used to examine the hospital length of stay (HLOS). Among the 222 patients included, 99 received standard intravenous antibiotics and 123 received partial oral therapy. Of the standard intravenous therapy group, 46/99 (46.5%) required outpatient parenteral antibiotic therapy (OPAT). There was no difference in the risk of treatment failure between partial oral and standard intravenous therapy (hazards ratio 0.53, 95% CI 0.18, 1.60; p = 0.25). Partial oral therapy was independently associated with a shorter HLOS after adjustments for the propensity to receive partial oral therapy and other potential confounders (-2.23 days, 95% CI -3.53, -0.94; p < 0.001). Transitioning patients to oral antibiotics may be a reasonable strategy in the management of uncomplicated streptococcal BSIs. Partial oral therapy does not seem to have a higher risk of treatment failure and may spare patients from prolonged hospitalizations and OPAT complications.
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Affiliation(s)
- Lynn E. Broermann
- University of South Carolina College of Pharmacy, Columbia, SC 29208, USA; (L.E.B.); (K.L.B.); (T.R.); (M.M.)
| | - Majdi N. Al-Hasan
- Department of Medicine, University of South Carolina School of Medicine, Columbia, SC 29209, USA
- Department of Internal Medicine, Division of Infectious Diseases, Prisma Health Midlands, Columbia, SC 29203, USA
| | | | - Kristina L. Benbow
- University of South Carolina College of Pharmacy, Columbia, SC 29208, USA; (L.E.B.); (K.L.B.); (T.R.); (M.M.)
| | - Taylor Ramsey
- University of South Carolina College of Pharmacy, Columbia, SC 29208, USA; (L.E.B.); (K.L.B.); (T.R.); (M.M.)
| | - Meghan McTavish
- University of South Carolina College of Pharmacy, Columbia, SC 29208, USA; (L.E.B.); (K.L.B.); (T.R.); (M.M.)
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Haimerl BJ, Encinas R, Justo JA, Kohn J, Bookstaver PB, Winders HR, Al-Hasan MN. Optimization of Empirical Antimicrobial Therapy in Enterobacterales Bloodstream Infection Using the Extended-Spectrum Beta-Lactamase Prediction Score. Antibiotics (Basel) 2023; 12:1003. [PMID: 37370322 DOI: 10.3390/antibiotics12061003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/26/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Clinical tools for the prediction of antimicrobial resistance have been derived and validated without examination of their implementation in clinical practice. This study examined the impact of utilization of the extended-spectrum beta-lactamase (ESBL) prediction score on the time to initiation of appropriate antimicrobial therapy for bloodstream infection (BSI). The quasi-experimental cohort study included hospitalized adults with BSI due to ceftriaxone-resistant (CRO-R) Enterobacterales at three community hospitals in Columbia, South Carolina, USA before (January 2010 to December 2013) and after (January 2014 to December 2019) implementation of an antimicrobial stewardship intervention. In total, 45 and 101 patients with BSI due to CRO-R Enterobacterales were included before and after the intervention, respectively. Overall, the median age was 66 years, 85 (58%) were men, and 86 (59%) had a urinary source of infection. The mean time to appropriate antimicrobial therapy was 78 h before and 46 h after implementation of the antimicrobial stewardship intervention (p = 0.04). Application of the ESBL prediction score as part of an antimicrobial stewardship intervention was associated with a significant reduction in time to appropriate antimicrobial therapy in patients with BSI due to CRO-R Enterobacterales. Utilization of advanced rapid diagnostics may be necessary for a further reduction in time to appropriate antimicrobial therapy in this population.
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Affiliation(s)
- Brian J Haimerl
- Department of Medicine, University of South Carolina School of Medicine, Columbia, SC 29209, USA
| | - Rodrigo Encinas
- Department of Medicine, University of South Carolina School of Medicine, Columbia, SC 29209, USA
| | - Julie Ann Justo
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC 29208, USA
- Department of Pharmacy, Prisma Health-Midlands, Columbia, SC 29203, USA
| | - Joseph Kohn
- Department of Pharmacy, Prisma Health-Midlands, Columbia, SC 29203, USA
| | - P Brandon Bookstaver
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC 29208, USA
- Department of Pharmacy, Prisma Health-Midlands, Columbia, SC 29203, USA
| | - Hana Rac Winders
- Department of Pharmacy, Prisma Health-Midlands, Columbia, SC 29203, USA
| | - Majdi N Al-Hasan
- Department of Medicine, University of South Carolina School of Medicine, Columbia, SC 29209, USA
- Department of Internal Medicine, Division of Infectious Diseases, Prisma Health-Midlands, Columbia, SC 29203, USA
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Bailey P, Al-Hasan MN. Weighing the odds of bloodstream infection. What is the perfect model to predict this risk? Clin Microbiol Infect 2023; 29:4-6. [PMID: 36162725 DOI: 10.1016/j.cmi.2022.09.013] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 01/26/2023]
Affiliation(s)
- Pamela Bailey
- University of South Carolina School of Medicine, Columbia, SC, USA; Department of Medicine, Division of Infectious Diseases, Prisma Health-Midlands, Columbia, SC, USA
| | - Majdi N Al-Hasan
- University of South Carolina School of Medicine, Columbia, SC, USA; Department of Medicine, Division of Infectious Diseases, Prisma Health-Midlands, Columbia, SC, USA.
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Broermann L, Al-Hasan MN, Al-Hasan MN, Withers S, Benbow KL, Ramsey T, Ogren K, McTavish M, Webster W, Winders HR. 1843. Intravenous versus Partial Oral Antibiotic Therapy in the Treatment of Uncomplicated Bloodstream Infection due to Streptococcus species. Open Forum Infect Dis 2022. [PMCID: PMC9752618 DOI: 10.1093/ofid/ofac492.1472] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Effectiveness of oral antibiotics for transition of therapy in uncomplicated bloodstream infections (BSI) due to Streptococcus species remains unclear. This retrospective cohort study examines effectiveness of partial oral antibiotic regimens in patients with uncomplicated BSI due to Streptococcus species compared to standard intravenous (IV) only therapy. Methods Adult patients with uncomplicated BSI due to Streptococcus species from April 2016 through June 2020 in 7 hospitals within Prisma Health in South Carolina were evaluated. Patients who died within 7 days of BSI were excluded to reduce the impact of survival bias. Multivariate Cox proportional hazards regression was used to examine time to treatment failure, defined as a composite of all-cause mortality and BSI recurrence within 90 days. Results A total of 222 patients with Streptococcus species BSI were included in the analysis. Overall, the median age was 62 years, and 116 (52.3%) were men. Beta-hemolytic streptococci (87; 39.2%) were the most common bloodstream isolates, followed by S. pneumoniae (76; 34.2%) and viridans group streptococci (59; 26.6%). Among this cohort, 99 patients received only IV antibiotics, and the remaining 123 received partial oral therapy. The median duration of therapy in both groups was 14 days, and median duration of IV antibiotics prior to oral transition was 4 days. Most patients in the partial oral group were transitioned to either oral beta-lactams (62; 50.4%) or fluoroquinolones (47; 38.2%). Of the IV only group, 46 (46.5%) required outpatient IV antibiotics. Treatment failure rates were 12.0% and 4.4% in the IV only and partial oral therapy groups, respectively (p=0.04). After adjustments for age, chronic comorbidities, and initial response to therapy within the first 72-96 hours, there was no difference in the risk of treatment failure in the partial oral compared to IV only group (hazards ratio 0.55, 95% CI 0.19-1.64; p=0.28). Conclusion Transitioning patients from IV to oral antibiotics may be a reasonable strategy in the management of uncomplicated BSI due to Streptococcus species. Partial oral therapy does not seem to have a higher treatment failure rate than standard IV only therapy and may spare many patients from outpatient IV antibiotics. Disclosures All Authors: No reported disclosures.
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Affiliation(s)
- Lynn Broermann
- University of South Carolina College of Pharmacy, Greenville, South Carolina
| | - Majdi N Al-Hasan
- University of South Carolina School of Medicine, Columbia, South Carolina
| | - Majdi N Al-Hasan
- University of South Carolina School of Medicine, Columbia, South Carolina
| | | | - Kristina L Benbow
- University of South Carolina College of Pharmacy, Greenville, South Carolina
| | - Taylor Ramsey
- University of South Carolina College of Pharmacy, Greenville, South Carolina
| | - Katelyn Ogren
- University of South Carolina, Mooresboro, North Carolina
| | - Meghan McTavish
- University of South Carolina College of Pharmacy, Greenville, South Carolina
| | - William Webster
- University of South Carolina School of Medicine, Columbia, South Carolina
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10
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Vivian Tsai Y, Brandon Bookstaver P, Kohn J, Ann Justo J, Ann Justo J, Childress D, Stramel S, Slain D, Tu P, Wingler MJB, Jones BM, Anderson D, Seddon MM, Gibson G, Cretella DA, Eudy J, Winders HR, Antosz K, Bailey P, Al-Hasan MN, Al-Hasan MN. 409. Temporal Trends in Antibiotic Use of New β-lactams for Gram-Negative Bacteria with Difficult-to-Treat Resistance in the Southeastern United States. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.486] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Several new β-lactam antibiotics were recently developed for treatment of serious infections due to gram-negative bacteria (GNB) with difficult-to-treat resistance (DTR). This multicenter retrospective cohort study examined temporal trends in prevalence of GNB with DTR and the use of new β-lactams in the southeastern United States.
Methods
The prevalence of GNB with DTR, including Enterobacterales, Pseudomonas aeruginosa, and Acinetobacter species was determined in 9 hospitals geographically spread within the Southeastern Research Group Endeavor (SERGE-45) between 2015 to 2020. Antibiotic use (AU) of new β-lactams was also obtained from the 9 hospitals during the study period. New β-lactams included ceftolozane/tazobactam, ceftazidime/avibactam, meropenem/vaborbactam, imipenem/cilastatin/relebactam, and cefiderocol. Logistic regression analysis was utilized to examine temporal trends in prevalence of GNB with DTR and cumulative AU of new β-lactams.
Results
The overall prevalence of GNB with DTR in the 9 hospitals was 0.78% with a numerical increase from 0.67% to 0.97% between 2015 and 2020 (p=0.067) [Figure]. DTR was more prevalent among Acinetobacter spp., followed by P. aeruginosa, and Enterobacterales (11.8%, 3.5%, and 0.2%, respectively). There was a significant increase in the prevalence of DTR isolates among Acinetobacter spp. from 2.7% to 20.7% (p< 0.001) and Enterobacterales from 0.07% to 2.6% (p=0.025), but not P. aeruginosa (p=0.46) between 2015 and 2020. The cumulative AU of new β-lactams in the 9 hospitals was 2 days of therapy per 1000 patient-days. There was numerical increase in AU of these agents from 0.03 to 2.22 days of therapy per 1000 patient days during the 6-year study period (p=0.096) [Figure].
Conclusion
The overall prevalence of GNB with DTR and cumulative use of new β-lactams remain relatively low in the southeastern United States. However, the upward trend in prevalence of DTR isolates, particularly among Acinetobacter spp. and Enterobacterales, is concerning and may drive future increased use of β-lactams. Additional efforts to benchmark the use and appropriateness of new β-lactams are crucial to preserve their efficacy against bacteria with DTR.
Disclosures
P. Brandon Bookstaver, PharmD, Spero Therapeutics: Advisor/Consultant Julie Ann Justo, PharmD, MS, FIDSA, BCPS-AQ ID, bioMerieux: Honoraria|bioMerieux: Honoraria|Entasis Therapeutics: Advisor/Consultant|Entasis Therapeutics: Advisor/Consultant|Gilead Sciences: Advisor/Consultant|Gilead Sciences: Advisor/Consultant|Merck & Co: Advisor/Consultant|Merck & Co: Advisor/Consultant|Shionogi: Advisor/Consultant|Shionogi Inc.: Advisor/Consultant|Spero Therapeutics: Honoraria|Spero Therapeutics: Honoraria|Vaxart: Stocks/Bonds Julie Ann Justo, PharmD, MS, FIDSA, BCPS-AQ ID, bioMerieux: Honoraria|bioMerieux: Honoraria|Entasis Therapeutics: Advisor/Consultant|Entasis Therapeutics: Advisor/Consultant|Gilead Sciences: Advisor/Consultant|Gilead Sciences: Advisor/Consultant|Merck & Co: Advisor/Consultant|Merck & Co: Advisor/Consultant|Shionogi: Advisor/Consultant|Shionogi Inc.: Advisor/Consultant|Spero Therapeutics: Honoraria|Spero Therapeutics: Honoraria|Vaxart: Stocks/Bonds Bruce M. Jones, Pharm.D., FIDSA, BCPS, AbbVie: Advisor/Consultant|AbbVie: Honoraria|La Jolla: Honoraria|Melinta: Advisor/Consultant|Paratek: Honoraria|Regeneron: Honoraria.
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Affiliation(s)
- Y Vivian Tsai
- Prisma Health Richland - University of South Carolina , Columbia, South Carolina
| | - P Brandon Bookstaver
- Prisma Health Richland - University of South Carolina , Columbia, South Carolina
| | - Joseph Kohn
- Prisma Health Midlands , Columbia, South Carolina
| | - Julie Ann Justo
- University of South Carolina College of Pharmacy , Columbia, South Carolina
| | - Julie Ann Justo
- University of South Carolina College of Pharmacy , Columbia, South Carolina
| | | | | | - Douglas Slain
- West Virginia University , Morgantown, West Virginia
| | - Patrick Tu
- Charlie Norwood VA Medical Center , North Augusta, South Carolina
| | | | - Bruce M Jones
- St. Joseph's/Candler Health System , Savannah , Georgia
| | | | - Megan M Seddon
- Sarasota Memorial Health Care System , Sarasota, Florida
| | - Geneen Gibson
- St. Joseph's/Candler Health System , Savannah , Georgia
| | | | - Joshua Eudy
- Augusta University Health , Augusta , Georgia
| | | | - Kayla Antosz
- University of South Carolina College of Pharmacy , Columbia, South Carolina
| | - Pamela Bailey
- University of South Carolina School of Medicine , Columbia, South Carolina
| | - Majdi N Al-Hasan
- University of South Carolina School of Medicine , Columbia, South Carolina
| | - Majdi N Al-Hasan
- University of South Carolina School of Medicine , Columbia, South Carolina
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11
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Mondal U, Warren E, Justo JA, Justo JA, Kohn J, Brandon Bookstaver P, Al-Hasan MN, Al-Hasan MN. 1841. Incidence and Predictors of Complications in Gram Negative Bloodstream Infection. Open Forum Infect Dis 2022. [PMCID: PMC9752556 DOI: 10.1093/ofid/ofac492.1470] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background The incidence of complications in Gram negative bloodstream infection (GN-BSI) is not clearly defined. This retrospective cohort study evaluates the incidence of complications within 90 days of GN-BSI and examines the predictors for these complications. Methods Hospitalized adult patients with monomicrobial GN-BSI at Prisma Health-Midlands hospitals in South Carolina between 1/1/2012 and 6/30/2015 were evaluated. Complications of GN-BSI were defined as endocarditis, septic arthritis, osteomyelitis, spinal infections, deep seated abscesses, and recurrent GN-BSI within 90 days of the initial episode. Clinical and microbiological variables were assessed as potential risk factors for complications, including initial response to antimicrobial therapy within the first 72-96 hours of GN-BSI using the early clinical failure criteria. Kaplan-Meier analysis and multivariate Cox proportional hazards regression were used to examine the incidence and risk factors of complicated GN-BSI, respectively. Results A total 752 patients with GN-BSI were included in the study. The median age was 66 years and 380 (50.6%) were women. The urinary tract was the most common source of GN-BSI (378; 50.2%) and Escherichia coli was the most common bacteria (375; 49.9%). Overall, 13.9% developed complications within 90 days of GN-BSI. The median time to identification of these complications was 5.2 days from the index GN-BSI (interquartile range 1-28 days). The incidence of complications was notably higher in BSI due to Serratia species (39.7%), Proteus mirabilis (35.7%), and Pseudomonas aeruginosa (21.5%) than other bacteria (11.1%; log-rank p< 0.001). Independent risk factors for complications included early clinical failure criteria, non-urinary source, presence of indwelling prosthetic devices, BSI due to Serratia species, P. mirabilis or P. aeruginosa, and persistent GN-BSI (Table).
![]() Conclusion At least 13.9% of patients developed complications within 90 days of GN-BSI. Risk of development of complications may be predicted by specific host and microbiological factors. Stratification of patients based on these risk factors may aid in identifying patients requiring further diagnostic work up for early detection of complications. Disclosures Julie Ann Justo, PharmD, MS, FIDSA, BCPS-AQ ID, bioMerieux: Honoraria|bioMerieux: Honoraria|Entasis Therapeutics: Advisor/Consultant|Entasis Therapeutics: Advisor/Consultant|Gilead Sciences: Advisor/Consultant|Gilead Sciences: Advisor/Consultant|Merck & Co: Advisor/Consultant|Merck & Co: Advisor/Consultant|Shionogi: Advisor/Consultant|Shionogi Inc.: Advisor/Consultant|Spero Therapeutics: Honoraria|Spero Therapeutics: Honoraria|Vaxart: Stocks/Bonds Julie Ann Justo, PharmD, MS, FIDSA, BCPS-AQ ID, bioMerieux: Honoraria|bioMerieux: Honoraria|Entasis Therapeutics: Advisor/Consultant|Entasis Therapeutics: Advisor/Consultant|Gilead Sciences: Advisor/Consultant|Gilead Sciences: Advisor/Consultant|Merck & Co: Advisor/Consultant|Merck & Co: Advisor/Consultant|Shionogi: Advisor/Consultant|Shionogi Inc.: Advisor/Consultant|Spero Therapeutics: Honoraria|Spero Therapeutics: Honoraria|Vaxart: Stocks/Bonds P. Brandon Bookstaver, PharmD, Spero Therapeutics: Advisor/Consultant.
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Affiliation(s)
- Utpal Mondal
- University of South Carolina/Prisma Health, Columbia, South Carolina
| | - Erin Warren
- Prisma Health Richland Hospital, Prosperity, South Carolina
| | - Julie Ann Justo
- University of South Carolina College of Pharmacy, Columbia, South Carolina
| | - Julie Ann Justo
- University of South Carolina College of Pharmacy, Columbia, South Carolina
| | - Joseph Kohn
- Prisma Health Midlands, Columbia, South Carolina
| | | | - Majdi N Al-Hasan
- University of South Carolina School of Medicine, Columbia, South Carolina
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12
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Vivian Tsai Y, Brandon Bookstaver P, Kohn J, Justo JA, Justo JA, Childress D, Stramel S, Slain D, Tu P, Wingler MJB, Jones BM, Anderson D, Seddon MM, Gibson G, Cretella DA, Eudy J, Winders HR, Antosz K, Bailey P, Al-Hasan MN, Al-Hasan MN. 408. Benchmarking the Use of New β-lactams Utilizing a Novel Metric of Microbiological Burden. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.485] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Several methods are used to account for various hospital characteristics when comparing antimicrobial use (AU) between heterogenous hospitals. Recently, a new antimicrobial stewardship metric that adjusts AU by microbiological burden (a-AU) of the bacteria was proposed (Figure 1). It accounts for the resistant phenotypes observed at a given institution, allowing for a more balanced comparison of AU across hospitals. This multicenter retrospective cohort study examined the use of new β-lactams for Gram-negative bacteria (GNB) with difficult-to-treat resistance (DTR) by both AU and adjusted (a-AU) metrics in the southeastern United States.
Methods
AU of new β-lactams was determined in 9 hospitals within the Southeastern Research Group Endeavor (SERGE-45) between 2015 to 2020. New β-lactams included ceftolozane/tazobactam, ceftazidime/avibactam, meropenem/vaborbactam, imipenem/cilastatin/relebactam, and cefiderocol. AU was adjusted for prevalence of GNB with DTR including Enterobacterales, Pseudomonas aeruginosa, and Acinetobacter species. DTR was defined as nonsusceptibility to all of the following: cefepime or ceftazidime, levofloxacin or ciprofloxacin, meropenem or imipenem, and piperacillin/tazobactam if tested. Hospitals were ranked by AU and a-AU from lowest to highest. Descriptive statistics were utilized.
Results
The cumulative mean AU and a-AU from 2015 to 2020 were 1.96 (range 0.10 to 6.44) and 2.3 (range 0.20 to 8.05) days of therapy (DOT)/1000 patient days, respectively (Figure 2). After adjusting for the prevalence of GNB with DTR, 6 hospitals moved by at least 1 position in ranking (2 hospitals moved up; 4 hospitals moved down) and 1 hospital moved by at least 2 positions in ranking.
Conclusion
Overall, the AU of new β-lactams increased after adjusting for the local microbiological burden suggests a potential higher use of antibiotics in relationship to the observed prevalence of GNB with DTR. More than half of the hospitals had a shift in ranking after microbiological adjustment reflecting a more balanced comparison of antibiotic use across heterogenous hospitals.
Disclosures
P. Brandon Bookstaver, PharmD, Spero Therapeutics: Advisor/Consultant Julie Ann Justo, PharmD, MS, FIDSA, BCPS-AQ ID, bioMerieux: Honoraria|bioMerieux: Honoraria|Entasis Therapeutics: Advisor/Consultant|Entasis Therapeutics: Advisor/Consultant|Gilead Sciences: Advisor/Consultant|Gilead Sciences: Advisor/Consultant|Merck & Co: Advisor/Consultant|Merck & Co: Advisor/Consultant|Shionogi: Advisor/Consultant|Shionogi Inc.: Advisor/Consultant|Spero Therapeutics: Honoraria|Spero Therapeutics: Honoraria|Vaxart: Stocks/Bonds Julie Ann Justo, PharmD, MS, FIDSA, BCPS-AQ ID, bioMerieux: Honoraria|bioMerieux: Honoraria|Entasis Therapeutics: Advisor/Consultant|Entasis Therapeutics: Advisor/Consultant|Gilead Sciences: Advisor/Consultant|Gilead Sciences: Advisor/Consultant|Merck & Co: Advisor/Consultant|Merck & Co: Advisor/Consultant|Shionogi: Advisor/Consultant|Shionogi Inc.: Advisor/Consultant|Spero Therapeutics: Honoraria|Spero Therapeutics: Honoraria|Vaxart: Stocks/Bonds Bruce M. Jones, Pharm.D., FIDSA, BCPS, AbbVie: Advisor/Consultant|AbbVie: Honoraria|La Jolla: Honoraria|Melinta: Advisor/Consultant|Paratek: Honoraria|Regeneron: Honoraria.
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Affiliation(s)
- Y Vivian Tsai
- Prisma Health Richland - University of South Carolina , Columbia, South Carolina
| | - P Brandon Bookstaver
- Prisma Health Richland - University of South Carolina , Columbia, South Carolina
| | - Joseph Kohn
- Prisma Health Midlands , Columbia, South Carolina
| | - Julie Ann Justo
- University of South Carolina College of Pharmacy , Columbia, South Carolina
| | - Julie Ann Justo
- University of South Carolina College of Pharmacy , Columbia, South Carolina
| | | | | | - Douglas Slain
- West Virginia University , Morgantown, West Virginia
| | - Patrick Tu
- Charlie Norwood VA Medical Center , North Augusta, South Carolina
| | | | - Bruce M Jones
- St. Joseph's/Candler Health System , Savannah , Georgia
| | | | - Megan M Seddon
- Sarasota Memorial Health Care System , Sarasota, Florida
| | - Geneen Gibson
- St. Joseph's/Candler Health System , Savannah , Georgia
| | | | - Joshua Eudy
- Augusta University Health , Augusta , Georgia
| | | | - Kayla Antosz
- University of South Carolina College of Pharmacy , Columbia, South Carolina
| | - Pamela Bailey
- University of South Carolina School of Medicine , Columbia, South Carolina
| | - Majdi N Al-Hasan
- University of South Carolina School of Medicine , Columbia, South Carolina
| | - Majdi N Al-Hasan
- University of South Carolina School of Medicine , Columbia, South Carolina
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13
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Battle SE, Al-Hasan MN. Paradoxical outcomes of gram-negative bloodstream infection in solid organ transplant recipients. Transpl Infect Dis 2022; 24:e13964. [PMID: 36411497 DOI: 10.1111/tid.13964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/08/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Sarah E Battle
- Department of Medicine, University of South Carolina School of Medicine, Columbia, South Carolina, USA.,Department of Medicine, Division of Infectious Diseases, Prisma Health-Midlands, Columbia, South Carolina, USA
| | - Majdi N Al-Hasan
- Department of Medicine, University of South Carolina School of Medicine, Columbia, South Carolina, USA.,Department of Medicine, Division of Infectious Diseases, Prisma Health-Midlands, Columbia, South Carolina, USA
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14
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Younas M, Royer J, Winders HR, Weissman SB, Bookstaver PB, Ann Justo J, Waites KS, Bell L, Al-Hasan MN. Temporal Association between Influenza Vaccination Coverage and Ambulatory Antibiotic Use in Children. Pediatr Infect Dis J 2022; 41:600-602. [PMID: 35363650 DOI: 10.1097/inf.0000000000003533] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In this population-based retrospective cohort study, increased influenza vaccination coverage was temporally associated with a reduction in ambulatory antibiotic use in children. After adjustment for yearly vaccine effectiveness, antibiotic prescription rate declined by 3/1000 person-months for each 1% increase in influenza vaccination coverage between 2012 and 2017 in South Carolina (P < 0.001).
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Affiliation(s)
- Mariam Younas
- Division of Infectious Diseases, Department of Internal Medicine, University of South Carolina School of Medicine.,Department of Medicine, Prisma Health-Midlands, Columbia, South Carolina.,Department of Internal Medicine, Hurley Medical Center - Michigan State University College of Human Medicine, Flint, Michigan
| | - Julie Royer
- Health and Demographics Division, South Carolina Revenue and Fiscal Affairs Office Rembert Dennis Bldg
| | - Hana R Winders
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy.,Department of Pharmacy, Prisma Health Richland Hospital
| | - Sharon B Weissman
- Division of Infectious Diseases, Department of Internal Medicine, University of South Carolina School of Medicine.,Department of Medicine, Prisma Health-Midlands, Columbia, South Carolina
| | - P Brandon Bookstaver
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy.,Department of Pharmacy, Prisma Health Richland Hospital
| | - Julie Ann Justo
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy.,Department of Pharmacy, Prisma Health Richland Hospital
| | - Katie S Waites
- South Carolina Department of Health and Environmental Control, Columbia, South Carolina, USA
| | - Linda Bell
- South Carolina Department of Health and Environmental Control, Columbia, South Carolina, USA
| | - Majdi N Al-Hasan
- Division of Infectious Diseases, Department of Internal Medicine, University of South Carolina School of Medicine.,Department of Medicine, Prisma Health-Midlands, Columbia, South Carolina
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15
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Sartelli M, Labricciosa FM, Coccolini F, Coimbra R, Abu-Zidan FM, Ansaloni L, Al-Hasan MN, Ansari S, Barie PS, Caínzos MA, Ceresoli M, Chiarugi M, Claridge JA, Cicuttin E, Dellinger EP, Fry DE, Guirao X, Hardcastle TC, Hecker A, Leppäniemi AK, Litvin A, Marwah S, Maseda E, Mazuski JE, Memish ZA, Kirkpatrick AW, Pagani L, Podda M, Rasa HK, Sakakushev BE, Sawyer RG, Tumietto F, Xiao Y, Aboubreeg WF, Adamou H, Akhmeteli L, Akin E, Alberio MG, Alconchel F, Magagi IA, Araúz AB, Argenio G, Atanasov BC, Atici SD, Awad SS, Baili E, Bains L, Bala M, Baraket O, Baral S, Belskii VA, Benboubker M, Ben-Ishay O, Bordoni P, Boumédiène A, Brisinda G, Cavazzuti L, Chandy SJ, Chiarello MM, Cillara N, Clarizia G, Cocuz ME, Cocuz IG, Conti L, Coppola R, Cui Y, Czepiel J, D'Acapito F, Damaskos D, Das K, De Simone B, Delibegovic S, Demetrashvili Z, Detanac DS, Dhingra S, Di Bella S, Dimitrov EN, Dogjani A, D'Oria M, Dumitru IM, Elmangory MM, Enciu O, Fantoni M, Filipescu D, Fleres F, Foghetti D, Fransvea P, Gachabayov M, Galeiras R, Gattuso G, Ghannam WM, Ghisetti V, Giraudo G, Gonfa KB, Gonullu E, Hamad YTEY, Hecker M, Isik A, Ismail N, Ismail A, Jain SA, Kanj SS, Kapoor G, Karaiskos I, Kavalakat AJ, Kenig J, Khamis F, Khokha V, Kiguba R, Kim JI, Kobe Y, Kok KYY, Kovacevic BM, Kryvoruchko IA, Kuriyama A, Landaluce-Olavarria A, Lasithiotakis K, Lohsiriwat V, Lostoridis E, Luppi D, Vega GMM, Maegele M, Marinis A, Martines G, Martínez-Pérez A, Massalou D, Mesina C, Metan G, Miranda-Novales MG, Mishra SK, Mohamed MIH, Mohamedahmed AYY, Mora-Guzmán I, Mulita F, Musina AM, Navsaria PH, Negoi I, Nita GE, O'Connor DB, Ordoñez CA, Pantalone D, Panyko A, Papadopoulos A, Pararas N, Pata F, Patel T, Pellino G, Perra T, Perrone G, Pesce A, Pintar T, Popivanov GI, Porcu A, Quiodettis MA, Rahim R, Mitul AR, Reichert M, Rems M, Campbell GYR, Rocha-Pereira N, Rodrigues G, Villamil GER, Rossi S, Sall I, Kafil HS, Sasia D, Seni J, Seretis C, Serradilla-Martín M, Shelat VG, Siribumrungwong B, Slavchev M, Solaini L, Tan BK, Tarasconi A, Tartaglia D, Toma EA, Tomadze G, Toro A, Tovani-Palone MR, van Goor H, Vasilescu A, Vereczkei A, Veroux M, Weckmann SA, Widmer LW, Yahya A, Zachariah SK, Zakaria AD, Zubareva N, Zuidema WP, Di Carlo I, Cortese F, Baiocchi GL, Maier RV, Catena F. It is time to define an organizational model for the prevention and management of infections along the surgical pathway: a worldwide cross-sectional survey. World J Emerg Surg 2022; 17:17. [PMID: 35300731 PMCID: PMC8928018 DOI: 10.1186/s13017-022-00420-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 02/28/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The objectives of the study were to investigate the organizational characteristics of acute care facilities worldwide in preventing and managing infections in surgery; assess participants' perception regarding infection prevention and control (IPC) measures, antibiotic prescribing practices, and source control; describe awareness about the global burden of antimicrobial resistance (AMR) and IPC measures; and determine the role of the Coronavirus Disease 2019 pandemic on said awareness. METHODS A cross-sectional web-based survey was conducted contacting 1432 health care workers (HCWs) belonging to a mailing list provided by the Global Alliance for Infections in Surgery. The self-administered questionnaire was developed by a multidisciplinary team. The survey was open from May 22, 2021, and June 22, 2021. Three reminders were sent, after 7, 14, and 21 days. RESULTS Three hundred four respondents from 72 countries returned a questionnaire, with an overall response rate of 21.2%. Respectively, 90.4% and 68.8% of participants stated their hospital had a multidisciplinary IPC team or a multidisciplinary antimicrobial stewardship team. Local protocols for antimicrobial therapy of surgical infections and protocols for surgical antibiotic prophylaxis were present in 76.6% and 90.8% of hospitals, respectively. In 23.4% and 24.0% of hospitals no surveillance systems for surgical site infections and no monitoring systems of used antimicrobials were implemented. Patient and family involvement in IPC management was considered to be slightly or not important in their hospital by the majority of respondents (65.1%). Awareness of the global burden of AMR among HCWs was considered very important or important by 54.6% of participants. The COVID-19 pandemic was considered by 80.3% of respondents as a very important or important factor in raising HCWs awareness of the IPC programs in their hospital. Based on the survey results, the authors developed 15 statements for several questions regarding the prevention and management of infections in surgery. The statements may be the starting point for designing future evidence-based recommendations. CONCLUSION Adequacy of prevention and management of infections in acute care facilities depends on HCWs behaviours and on the organizational characteristics of acute health care facilities to support best practices and promote behavioural change. Patient involvement in the implementation of IPC is still little considered. A debate on how operationalising a fundamental change to IPC, from being solely the HCWs responsibility to one that involves a collaborative relationship between HCWs and patients, should be opened.
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Affiliation(s)
| | | | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Raul Coimbra
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System Medical Center, Riverside, USA
| | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Luca Ansaloni
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Majdi N Al-Hasan
- Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, USA
| | - Shamshul Ansari
- Department of Microbiology, Chitwan Medical College and Teaching Hospital, Bharatpur, Chitwan, Nepal
| | - Philip S Barie
- Department of Surgery, Weill Cornell Medicine, New York, USA
| | | | - Marco Ceresoli
- Department of General and Emergency Surgery, Milano-Bicocca University, School of Medicine and Surgery, Milan, Italy
| | - Massimo Chiarugi
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Jeffrey A Claridge
- MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Enrico Cicuttin
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | | | - Donald E Fry
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Xavier Guirao
- Surgical Endocrine Head and Neck Unit, Department of General Surgery, Parc Tauli, Hospital Universitari, Sabadell, Spain
| | - Timothy Craig Hardcastle
- Trauma and Burn Service, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - Andreas Hecker
- Department of Surgery, University Hospital of Giessen, Giessen, Germany
| | - Ari K Leppäniemi
- Abdominal Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Andrey Litvin
- Department of Surgical Disciplines, Immanuel Kant Baltic Federal University, Regional Clinic Hospital, Kaliningrad, Russia
| | - Sanjay Marwah
- Department of Surgery, BDS Post-Graduate Institute of Medical Sciences, Rohtak, India
| | - Emilio Maseda
- Surgical Critical Care, Department of Anesthesia, Hospital Valdecilla, Santander, Spain
| | - John E Mazuski
- Department of Surgery, Washington University in Saint Louis, Saint Louis, USA
| | - Ziad Ahmed Memish
- Research and Innovation Center, King Saud Medical City, College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | - Andrew W Kirkpatrick
- General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, Canada
| | - Leonardo Pagani
- Antimicrobial Stewardship Program, Bolzano Central Hospital, Bolzano, Italy
| | - Mauro Podda
- Department of Emergency Surgery, Cagliari University Hospital "D. Casula", AOU Cagliari, Cagliari, Italy
| | | | - Boris E Sakakushev
- General Surgery, UMHAT St George Plovdiv, RIMU/Research Institute at Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Robert G Sawyer
- Department of Surgery, Homer Stryker, M.D., School of Medicine, Western Michigan University, Kalamazoo, USA
| | - Fabio Tumietto
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Yonghong Xiao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | | | | | - Lali Akhmeteli
- Department of Surgery, TSMU First University Clinic, Tbilisi, Georgia
| | - Emrah Akin
- Department of Surgery, Sakarya University Educational and Research Hospital, Sakarya, Turkey
| | | | - Felipe Alconchel
- Department of Surgery and Transplantation, Virgen de La Arrixaca University Hospital, El Palmar, Spain
| | | | - Ana Belén Araúz
- Infectious Diseases Unit, Hospital Santo Tomás, Panama City, Panama
| | - Giulio Argenio
- Emergency Surgery Unit, AOU San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Salerno, Italy
| | - Boyko C Atanasov
- Department of Surgery, UMHAT Eurohospital Plovdiv, RIMU/Research Institute at Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Semra Demirli Atici
- Department of Surgery, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - Selmy Sabry Awad
- Department of Trauma and Acute Care Surgery, Mansoura University Hospital, Mansoura University, Mansoura, Egypt
| | - Efstratia Baili
- Second Department of Surgery, IASO General Hospital, Athens, Greece
| | - Lovenish Bains
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
| | - Miklosh Bala
- Department of Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Oussama Baraket
- Department of Surgery, Department of Surgery, Bizerte Hospital, Tunis El Manar University, Tunis, Tunisia
| | - Suman Baral
- Department of Surgery, Dirghayu Pokhara Hospital, Pokhara, Nepal
| | - Vladislav A Belskii
- Department of Anesthesiology and Intensive Care, Privolzhskiy District Medical Center, Nizhny Novgorod, Russia
| | - Moussa Benboubker
- HAIs Control Committee, HASSAN II University Hospital Fez, Fez, Morocco
| | - Offir Ben-Ishay
- Department of Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Pierpaolo Bordoni
- Department of Surgery, ASST Valtellina e Alto Lario, Sondrio Hospital, Sondrio, Italy
| | | | - Giuseppe Brisinda
- Medical and Surgical Sciences Department, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Laura Cavazzuti
- Medical Directorate, Arcispedale Santa Maria Nuova Hospital, Local Health Authority-IRCSS of Reggio Emilia, Reggio Emilia, Italy
| | - Sujith J Chandy
- Department of Pharmacology and Clinical Pharmacology, Christian Medical College, Vellore, India
| | - Maria Michela Chiarello
- Department of Surgery, Ospedale San Giovanni di Dio, Azienda Sanitaria Provinciale, Crotone, Italy
| | - Nicola Cillara
- Department of Surgery, PO Santissima Trinità ASSL Cagliari, Cagliari, Italy
| | - Guglielmo Clarizia
- Department of Surgery, ASST Valtellina e Alto Lario, Sondrio Hospital, Sondrio, Italy
| | - Maria-Elena Cocuz
- Faculty of Medicine, University Transilvania of Brasov, Brasov, Romania
| | - Iuliu Gabriel Cocuz
- Pathophysiology Department, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, George Emil Palade of Targu Mures, Targu Mures, Romania
| | - Luigi Conti
- Department of Surgery, Ospedale G. Da Saliceto, AUSL Piacenza, Piacenza, Italy
| | | | - Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China
| | - Jacek Czepiel
- Department of Infectious and Tropical Diseases, Jagiellonian University Medical College, Krakaw, Poland
| | - Fabrizio D'Acapito
- Department of Surgery, Forlì Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì, Italy
| | | | - Koray Das
- Department of Surgery, University of Health Sciences, Adana City Training and Research Hospital, Adana, Turkey
| | - Belinda De Simone
- Emergency and Metabolic Minimally Invasive Surgery, Poissy-Saint-Germain-en-Laye Hospital, Yvelines, France
| | - Samir Delibegovic
- Department of Surgery, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Zaza Demetrashvili
- Department of Surgery, Kipshidze Central University Hospital, Tbilisi, Georgia
| | - Dzemail S Detanac
- Department of Surgery, General Hospital Novi Pazar, Novi Pazar, Serbia
| | - Sameer Dhingra
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), Hajipur, Bihar, India
| | - Stefano Di Bella
- Clinical Department of Medical, Surgical and Health Sciences, Trieste University, Trieste, Italy
| | - Evgeni N Dimitrov
- Department of Surgical Diseases, University Hospital "Prof. Dr. Stoyan Kirkovich", Stara Zagora, Bulgaria
| | - Agron Dogjani
- Department of Surgery, University of Medicine of Tirana, Tirana, Albania
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste, Trieste, Italy
| | | | | | - Octavian Enciu
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Massimo Fantoni
- Dipartimento Di Scienze Di Laboratorio E Infettivologiche, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Daniela Filipescu
- Cardiac Anaesthesia and Intensive Care 2, Emergency Institute of Cardiovascular Diseases, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Francesco Fleres
- Department of Surgery, ASST Valtellina e Alto Lario, Sondrio Hospital, Sondrio, Italy
| | | | - Pietro Fransvea
- Medical and Surgical Sciences Department, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Mahir Gachabayov
- Department of Abdominal Surgery, Vladimir City Emergency Hospital, Vladimir, Russia
| | - Rita Galeiras
- Critical Care Unit, Complexo Hospitalario Universitario, La Coruna, Spain
| | - Gianni Gattuso
- Department of Infectious Diseases, Carlo Poma" Hospital ASST, Mantova, Italy
| | - Wagih M Ghannam
- Department of Surgery, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Valeria Ghisetti
- Laboratory of Microbiology and Virology, Amedeo di Savoia Hospital and ASL Città di Torino, Turin, Italy
| | - Giorgio Giraudo
- Department of Surgery, Aso Santa Croce e Carle, Cuneo, Italy
| | - Kebebe Bekele Gonfa
- Department of Surgery, Madda Walabu University Goba Referral Hospital, Bala-Robe, Ethiopia
| | - Emre Gonullu
- Department of Surgery, Sakarya University, Adapazarı, Turkey
| | | | - Matthias Hecker
- Medical Clinic II, University Hospital Giessen, Glessen, Germany
| | - Arda Isik
- Department of Surgery, Istanbul Medeniyet University, Istanbul, Turkey
| | - Nizar Ismail
- Trauma and Orthopaedics, Stoke Mandeville Hospital, Aylesbury, UK
| | - Azzain Ismail
- Trauma and Orthopaedics Woodend Hospital, Aberdeen, UK
| | | | - Souha S Kanj
- Infectious Diseases Division, American University of Beirut Medical Center, Beirut, Lebanon
| | - Garima Kapoor
- Department of Microbiology, Gandhi Medical College, Bhopal, India
| | - Ilias Karaiskos
- 1St Department of Internal Medicine-Infectious Diseases, Hygeia Hospital, Marousi, Greece
| | - Alfie J Kavalakat
- Department of Surgery, Jubilee Mission Medical College and RI, Thrissur, India
| | - Jakub Kenig
- Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Faryal Khamis
- Infectious Diseases and Internal Medicine Department, Royal Hospital, Muscat, Oman
| | - Vladimir Khokha
- Department of Emergency Surgery, City Hospital, Mozyr, Belarus
| | - Ronald Kiguba
- Pharmacology and Therapeutics, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Jae Il Kim
- Department of Surgery, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | - Yoshiro Kobe
- Department of Surgery, Chiba Emergency Medical Center, Chiba, Japan
| | - Kenneth Yuh Yen Kok
- Discipline of Medicine, Pengiran Anak Puteri Rashidah Sa'adatul Bolkiah Institute of Health Sciences, Brunei Darussalam University, Darussalam, Brunei
| | | | | | - Akira Kuriyama
- Emergency and Critical Care Center, Kurashiki Central Hospital, Kurashiki, Japan
| | | | | | - Varut Lohsiriwat
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Davide Luppi
- Department of Surgery, ASMN IRCCS, Reggio Emilia, Italy
| | - Gustavo Miguel Machain Vega
- General Surgery, Universidad Nacional de Asunción-Facultad de Ciencias Medicas, Hospital de Clínicas, Asuncion, Paraguay
| | - Marc Maegele
- Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University Witten/Herdecke, Cologne, Germany
| | | | - Gennaro Martines
- Department of Surgery, Azienda Ospedaliero Universitaria Policlinico, Bari, Italy
| | - Aleix Martínez-Pérez
- Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Damien Massalou
- Acute Care Surgery, Centre Hospitalier Universitaire de Nice, Nice University Hospital, Nice, France
| | - Cristian Mesina
- Department of Surgery, Emergency County Hospital of Craiova, Craiova, Romania
| | - Gökhan Metan
- Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - María Guadalupe Miranda-Novales
- Infectious Diseases Department, Paediatric Hospital, Analysis and Synthesis Research Unit, Social Security Mexican Institute, Mexico City, Mexico
| | - Shyam Kumar Mishra
- Clinical Microbiology, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | | | | | - Ismael Mora-Guzmán
- Department of Surgery, Hospital General La Mancha Centro, Alcazar de San Juan, Spain
| | - Francesk Mulita
- Department of Surgery, General University Hospital of Patras, Rio, Greece
| | - Ana-Maria Musina
- Department of Surgery, University of Medicine and Pharmacy Grigore T Popa, Iasi, Romania
| | - Pradeep H Navsaria
- Trauma Centre, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Ionut Negoi
- Department of Surgery, Emergency Hospital of Bucharest, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | | | | | - Desiré Pantalone
- Emergency Surgery Department, AOU Careggi-Università di Firenze, Florence, Italy
| | - Arpád Panyko
- IVth Department of Surgery, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | | | - Nikolaos Pararas
- Surgical Department, Dr. Sulaiman Al Habib Hospital, Alfaisal University, Riyadh, Saudi Arabia
| | - Francesco Pata
- Department of Surgery, Nicola Giannettasio Hospital, Corigliano-Rossano, Italy
| | - Tapan Patel
- Department of Surgery, Baroda Medical College, Vadodara, India
| | - Gianluca Pellino
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Teresa Perra
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Azienda Ospedaliero Universitaria di Sassari, Sassari, Italy
| | - Gennaro Perrone
- Department of Emergency Surgery, Parma University Hospital, Parma, Italy
| | - Antonio Pesce
- Department of Surgery, Azienda USL of Ferrara-University of Ferrara, Ferrara, Italy
| | - Tadeja Pintar
- Abdominal Surgery Department, UMC Ljubljana, Ljubljana, Slovenia
| | | | - Alberto Porcu
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Azienda Ospedaliero Universitaria di Sassari, Sassari, Italy
| | | | - Razrim Rahim
- Department of Surgery, Universiti Sains Islam Malaysia, Nilai, Malaysia
| | - Ashrarur Rahman Mitul
- Unit of Pediatric Surgery, Bangladesh Shishu Hospital and Institute, Dhaka, Bangladesh
| | - Martin Reichert
- Department of Surgery, University Hospital of Giessen, Giessen, Germany
| | - Miran Rems
- Department for General and Abdominal Surgery, General Hospital Jesenice, Jesenice, Slovenia
| | | | | | - Gabriel Rodrigues
- Department of Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Gustavo Eduardo Roncancio Villamil
- Department of Medicine, Division of Infectious Diseases, Universidad Pontificia Bolivariana, Medellín, Colombia
- Research Group on Cardiovascular and Pulmonary Diseases, Clínica Cardio VID, Medellín, Colombia
| | - Stefano Rossi
- Emergency Surgery Department, San Filippo Neri Hospital, Rome, Italy
| | - Ibrahima Sall
- Department of Surgery, Military Teaching Hospital, Hôpital Principal de Dakar, Dakar, Senegal
| | - Hossein Samadi Kafil
- Drug Applied Research Center, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Diego Sasia
- Department of Surgery, Aso Santa Croce e Carle, Cuneo, Italy
| | - Jeremiah Seni
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | | | - Mario Serradilla-Martín
- Department of Surgery, Instituto de Investigación Sanitaria Aragón, Miguel Servet University Hospital, Zaragoza, Spain
| | - Vishal G Shelat
- Department of Surgery, Tan Tock Seng Hospital, Novena, Singapore
| | | | - Mihail Slavchev
- Department of Surgery, University Hospital Eurohospital, Plovdiv, Bulgaria
| | - Leonardo Solaini
- Department of Medical and Surgical Sciences, University of Bologna, Forlì, Italy
| | - Boun Kim Tan
- Infection Prevention and Control Unit, Centre des Massues, French Red Cross, Lyon, France
| | - Antonio Tarasconi
- Department of Emergency Surgery, Parma University Hospital, Parma, Italy
| | - Dario Tartaglia
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Elena Adelina Toma
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Gia Tomadze
- Department of Surgery, Tbilisi State Medical University, Tbilisi, Georgia
| | - Adriana Toro
- Department of General Surgery, E. Muscatello Augusta Hospital, Augusta, Italy
| | - Marcos Roberto Tovani-Palone
- Department of Pathology and Legal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Harry van Goor
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Alin Vasilescu
- Department of Surgery, St. Spiridon University Hospital "Grigore T Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Andras Vereczkei
- Department of Surgery, Medical Center University of Pécs, Pécs, Hungary
| | - Massimiliano Veroux
- Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Catania, Italy
| | | | - Lukas Werner Widmer
- Department of Visceral Surgery and Medicine, Bern University Hospital, Bern, Switzerland
| | | | - Sanoop K Zachariah
- Department of Surgery, Kerala Institute of Medical Sciences, Thiruvananthapuram, Kerala, India
| | - Andee Dzulkarnaen Zakaria
- Department of Surgery, School of Medical Sciences and University Hospital Sains Malaysia, Sains Malaysia University, Penang, Malaysia
| | - Nadezhda Zubareva
- Department of General Surgery, Perm State Medical University N.a. Academician E.A. Wagner, Perm, Russia
| | - Wietse P Zuidema
- Department of Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Isidoro Di Carlo
- Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Catania, Italy
| | - Francesco Cortese
- Emergency Surgery Department, San Filippo Neri Hospital, ASL Roma 1, Rome, Italy
| | - Gian Luca Baiocchi
- Department of Surgery, AAST Cremona, Cremona, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Ronald V Maier
- Harborview Medical Center, Department of Surgery, University of Washington, Seattle, WA, USA
| | - Fausto Catena
- Department of Surgery, Bufalini" Hospital, Cesena, Italy
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16
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Powers CE, Bookstaver PB, Caulder C, Bouknight A, Justo JA, Kohn J, Winders HR, Al-Hasan MN. Evaluation of early clinical failure criteria in Enterococcus species bloodstream infection. Infection 2022; 50:873-877. [PMID: 35044633 DOI: 10.1007/s15010-022-01754-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/03/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE Early clinical failure criteria (ECFC) were recently introduced to predict unfavorable outcomes in patients with Gram-negative bloodstream infections (BSI). ECFC include hypotension, tachycardia, tachypnea or mechanical ventilation, altered mental status, and leukocytosis evaluated at 72-96 h after BSI. The aim of this retrospective cohort study was to assess performance of ECFC in predicting 28-day mortality in Enterococcus species BSI. METHODS Hospitalized adults with Enterococcus species BSI at Prisma Health hospitals from 1 January 2015 to 31 July 2018 were identified. Multivariate logistic regression was used to determine the association between ECFC and 28-day mortality. Area under the receiver operating characteristic (AUROC) curve was used to measure model discrimination. RESULTS Among 157 patients, 28 (18%) died within 28 days of BSI. After adjustments in multivariate model, the risk of 28-day mortality increased in the presence of each additional ECFC (OR 1.6, 95% CI 1.2-2.3, p = 0.005). Infective endocarditis (OR 3.9, 95% CI 1.4-10.7, p = 0.01) was independently associated with 28-day mortality. AUROC curve of ECFC model in predicting 28-day mortality was 0.74 with ECFC of 2 identified as the best breakpoint. Mortality was 8% in patients with ECFC < 2 compared to 33% in those with ECFC ≥ 2 (p < 0.001). CONCLUSION ECFC had good discrimination in predicting 28-day mortality in patients with Enterococcus species BSI. These criteria may have utility in future clinical investigations.
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Affiliation(s)
- Caroline E Powers
- Department of Pharmacy, Prisma Health Richland Hospital, Columbia, SC, USA. .,Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
| | - P Brandon Bookstaver
- Department of Pharmacy, Prisma Health Richland Hospital, Columbia, SC, USA.,Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, USA
| | - Celeste Caulder
- Department of Pharmacy, Prisma Health Richland Hospital, Columbia, SC, USA.,Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, USA
| | - Abigail Bouknight
- Department of Pharmacy, Prisma Health Richland Hospital, Columbia, SC, USA
| | - Julie Ann Justo
- Department of Pharmacy, Prisma Health Richland Hospital, Columbia, SC, USA.,Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, USA
| | - Joseph Kohn
- Department of Pharmacy, Prisma Health Richland Hospital, Columbia, SC, USA
| | - Hana Rac Winders
- Department of Pharmacy, Prisma Health Richland Hospital, Columbia, SC, USA
| | - Majdi N Al-Hasan
- Department of Medicine, University of South Carolina School of Medicine, Columbia, SC, USA
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17
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Jones J, Sanasi-Bhola K, Al-Hasan MN, Reihart L, Justo JA, Bookstaver PB. Candida parapsilosis bloodstream infection in an immunocompromised host with discordant multiplex polymerase chain reaction and conventional blood culture results: a case report. Ther Adv Infect Dis 2022; 9:20499361221138446. [DOI: 10.1177/20499361221138446] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/26/2022] [Indexed: 11/28/2022] Open
Abstract
Prompt treatment of candidemia, especially in immunocompromised hosts, is known to improve outcomes. We present a case of discordance among results of Gram stain, multiplex polymerase chain reaction (PCR)-based rapid diagnostic technology, and conventional cultures that subsequently resulted in delayed therapy and hospitalization. An immunocompromised patient presented to the outpatient oncology clinic with signs and symptoms of systemic infection. Blood cultures were obtained, and Gram stain showed gram-negative rods, while multiplex PCR results (BioFire® FilmArray® BCID 1) returned positive for both Enterobacter cloacae and Candida parapsilosis. Conventional cultures only grew E. cloacae. Because of the discordant results, the primary team elected to give ertapenem monotherapy and defer antifungal therapy. The patient’s symptoms progressed, and 11 days later, the patient was admitted with subsequent positive blood cultures for C. parapsilosis. The patient required a 9-day hospitalization due to complications associated with candidemia. This case highlights the value of understanding and interpretation of rapid diagnostics, shared decision-making in antimicrobial management of high-risk patients, and the important responsibility of antimicrobial stewardship teams across the continuum of care.
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Affiliation(s)
- Jordan Jones
- College of Pharmacy, University of South Carolina, 715 Sumter Street, Columbia, SC 29208, USA
| | - Kamla Sanasi-Bhola
- Department of Medicine, Division of Infectious Diseases, University of South Carolina School of Medicine, Columbia, SC, USA
| | - Majdi N. Al-Hasan
- Department of Medicine, Division of Infectious Diseases, University of South Carolina School of Medicine, Columbia, SC, USA
| | - Layne Reihart
- Department of Pharmacy, Prisma Health Richland Hospital, Columbia, SC, USA
| | - Julie Ann Justo
- Department of Clinical Pharmacy & Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, USA
| | - P. Brandon Bookstaver
- Associate Professor, Department of Clinical Pharmacy & Outcomes Sciences, College of Pharmacy, University of South Carolina, 715 Sumter Street, Columbia, SC 29208, USA
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18
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Battle SE, Shuping M, Withers S, Justo JA, Bookstaver PB, Al-Hasan MN. Prediction of mortality in Staphylococcus aureus bloodstream infection using quick Pitt bacteremia score. J Infect 2021; 84:131-135. [PMID: 34896517 DOI: 10.1016/j.jinf.2021.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/30/2021] [Accepted: 12/07/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The quick Pitt bacteremia score (qPitt) predicts mortality in patients with serious infections due to gram-negative bacteria. This retrospective cohort study examines utility of qPitt to predict mortality in patients with Staphylococcus aureus bloodstream infection (SAB). METHODS Multivariate logistic regression was used to examine risk factors for 28-day mortality in hospitalized adults with SAB at four Prisma Health hospitals in South Carolina, USA from January 2015 to December 2017. Area under receiver operating characteristic curve (AUROC) was used to examine model discrimination. RESULTS Among 692 patients with SAB, 305 (44%) had methicillin-resistant S. aureus (MRSA), and 129 (19%) died within 28 days. After adjustment for age, comorbidities, and MRSA, each component of the qPitt was associated with 28-day mortality. There was a 3-fold increase in the risk of 28-day mortality for each one-point increase in qPitt. Predicted 28-day mortality was 3%, 9%, 22%, 45%, and 70% for qPitt of 0, 1, 2, 3, and ≥4, respectively. AUROC of the qPitt in predicting 28-day, 14-day, and in-hospital mortality were 0.80, 0.81, and 0.80, respectively. CONCLUSIONS The qPitt predicts mortality with good discrimination in SAB. These results support using qPitt as a measure of acute severity of illness in future studies.
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Affiliation(s)
- Sarah E Battle
- University of South Carolina School of Medicine, Columbia, SC, United States of America; Department of Medicine, Division of Infectious Diseases, Prisma Health-Midlands, Columbia, SC, United States of America.
| | - Matthew Shuping
- University of South Carolina College of Pharmacy, Columbia, SC, United States of America
| | - Sarah Withers
- Department of Pharmacy, Prisma Health-Upstate, Greenville, SC, United States of America
| | - Julie A Justo
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, United States of America; Department of Pharmacy, Prisma Health-Midlands, Columbia, SC, United States of America
| | - P Brandon Bookstaver
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, United States of America; Department of Pharmacy, Prisma Health-Midlands, Columbia, SC, United States of America
| | - Majdi N Al-Hasan
- University of South Carolina School of Medicine, Columbia, SC, United States of America; Department of Medicine, Division of Infectious Diseases, Prisma Health-Midlands, Columbia, SC, United States of America
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19
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Winders HR, Bailey P, Kohn J, Faulkner-Fennell CM, Utley S, Lantz E, Sarbacker L, Justo JA, Bookstaver PB, Weissman S, Ruegner H, Al-Hasan MN. Change in Antimicrobial Use During COVID-19 Pandemic in South Carolina Hospitals: A Multicenter Observational Cohort Study. Int J Antimicrob Agents 2021; 58:106453. [PMID: 34655733 PMCID: PMC8513515 DOI: 10.1016/j.ijantimicag.2021.106453] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 03/11/2021] [Revised: 07/19/2021] [Accepted: 10/02/2021] [Indexed: 02/07/2023]
Abstract
Objectives This retrospective cohort study examined the impact of the pandemic on antimicrobial use (AU) in South Carolina hospitals. Methods Antimicrobial use in days of therapy (DOT) per 1000 days-present was evaluated in 17 hospitals in South Carolina. Matched-pairs mean difference was used to compare AU during the pandemic (March–June 2020) with that during the same months in 2019 in hospitals that did and did not admit patients with COVID-19. Results There was a 6.6% increase in overall AU in the seven hospitals that admitted patients with COVID-19 (from 530.9 to 565.8; mean difference (MD) 34.9 DOT/1000 days-present; 95% CI 4.3, 65.6; P = 0.03). There was no significant change in overall AU in the remaining 10 hospitals that did not admit patients with COVID-19 (MD 6.0 DOT/1000 days-present; 95% CI –55.5, 67.6; P = 0.83). Most of the increase in AU in the seven hospitals that admitted patients with COVID-19 was observed in broad-spectrum antimicrobial agents. A 16.4% increase was observed in agents predominantly used for hospital-onset infections (from 122.3 to 142.5; MD 20.1 DOT/1000 days-present; 95% CI 11.1, 29.1; P = 0.002). There was also a 9.9% increase in the use of anti-methicillin-resistant Staphylococcus aureus (MRSA) agents (from 66.7 to 73.3; MD 6.6 DOT/1000 days-present; 95% CI 2.3, 10.8; P = 0.01). Conclusion The COVID-19 pandemic appears to drive overall and broad-spectrum antimicrobial use in South Carolina hospitals admitting patients with COVID-19. Additional antimicrobial stewardship resources are needed to curtail excessive antimicrobial use in hospitals to prevent subsequent increases in antimicrobial resistance and Clostridioides difficile infection rates, given the continuing nature of the pandemic.
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Affiliation(s)
- Hana R Winders
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, USA; Department of Pharmacy, Prisma Health-Midlands, Columbia, SC, USA
| | - Pamela Bailey
- University of South Carolina School of Medicine, Columbia, SC, USA; Department of Medicine, Division of Infectious Diseases, Prisma Health-Midlands, Columbia, SC, USA.
| | - Joseph Kohn
- Department of Pharmacy, Prisma Health-Midlands, Columbia, SC, USA
| | | | - Sara Utley
- Department of Pharmacy, Roper St. Francis Healthcare, Charleston, SC, USA
| | - Evan Lantz
- Department of Pharmacy, Spartanburg Regional Healthcare System, Spartanburg, SC, USA
| | - Lloyd Sarbacker
- Department of Pharmacy, Bon Secours St. Francis, Greenville, SC, USA
| | - Julie Ann Justo
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, USA; Department of Pharmacy, Prisma Health-Midlands, Columbia, SC, USA
| | - P Brandon Bookstaver
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, USA; Department of Pharmacy, Prisma Health-Midlands, Columbia, SC, USA
| | - Sharon Weissman
- University of South Carolina School of Medicine, Columbia, SC, USA; Department of Medicine, Division of Infectious Diseases, Prisma Health-Midlands, Columbia, SC, USA
| | - Hannah Ruegner
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, USA; South Carolina Department of Health and Environmental Control, Columbia, SC, USA
| | - Majdi N Al-Hasan
- University of South Carolina School of Medicine, Columbia, SC, USA; Department of Medicine, Division of Infectious Diseases, Prisma Health-Midlands, Columbia, SC, USA
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20
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Coccolini F, Cicuttin E, Cremonini C, Tartaglia D, Viaggi B, Kuriyama A, Picetti E, Ball C, Abu-Zidan F, Ceresoli M, Turri B, Jain S, Palombo C, Guirao X, Rodrigues G, Gachabayov M, Machado F, Eftychios L, Kanj SS, Di Carlo I, Di Saverio S, Khokha V, Kirkpatrick A, Massalou D, Forfori F, Corradi F, Delibegovic S, Machain Vega GM, Fantoni M, Demetriades D, Kapoor G, Kluger Y, Ansari S, Maier R, Leppaniemi A, Hardcastle T, Vereczkei A, Karamagioli E, Pikoulis E, Pistello M, Sakakushev BE, Navsaria PH, Galeiras R, Yahya AI, Osipov AV, Dimitrov E, Doklestić K, Pisano M, Malacarne P, Carcoforo P, Sibilla MG, Kryvoruchko IA, Bonavina L, Kim JI, Shelat VG, Czepiel J, Maseda E, Marwah S, Chirica M, Biancofiore G, Podda M, Cobianchi L, Ansaloni L, Fugazzola P, Seretis C, Gomez CA, Tumietto F, Malbrain M, Reichert M, Augustin G, Amato B, Puzziello A, Hecker A, Gemignani A, Isik A, Cucchetti A, Nacoti M, Kopelman D, Mesina C, Ghannam W, Ben-Ishay O, Dhingra S, Coimbra R, Moore EE, Cui Y, Quiodettis MA, Bala M, Testini M, Diaz J, Girardis M, Biffl WL, Hecker M, Sall I, Boggi U, Materazzi G, Ghiadoni L, Matsumoto J, Zuidema WP, Ivatury R, Enani MA, Litvin A, Al-Hasan MN, Demetrashvili Z, Baraket O, Ordoñez CA, Negoi I, Kiguba R, Memish ZA, Elmangory MM, Tolonen M, Das K, Ribeiro J, O’Connor DB, Tan BK, Van Goor H, Baral S, De Simone B, Corbella D, Brambillasca P, Scaglione M, Basolo F, De’Angelis N, Bendinelli C, Weber D, Pagani L, Monti C, Baiocchi G, Chiarugi M, Catena F, Sartelli M. A pandemic recap: lessons we have learned. World J Emerg Surg 2021; 16:46. [PMID: 34507603 PMCID: PMC8430288 DOI: 10.1186/s13017-021-00393-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 08/29/2021] [Indexed: 02/08/2023] Open
Abstract
On January 2020, the WHO Director General declared that the outbreak constitutes a Public Health Emergency of International Concern. The world has faced a worldwide spread crisis and is still dealing with it. The present paper represents a white paper concerning the tough lessons we have learned from the COVID-19 pandemic. Thus, an international and heterogenous multidisciplinary panel of very differentiated people would like to share global experiences and lessons with all interested and especially those responsible for future healthcare decision making. With the present paper, international and heterogenous multidisciplinary panel of very differentiated people would like to share global experiences and lessons with all interested and especially those responsible for future healthcare decision making.
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Affiliation(s)
- Federico Coccolini
- grid.144189.10000 0004 1756 8209General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124 Pisa, Italy
| | - Enrico Cicuttin
- grid.144189.10000 0004 1756 8209General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124 Pisa, Italy
| | - Camilla Cremonini
- grid.144189.10000 0004 1756 8209General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124 Pisa, Italy
| | - Dario Tartaglia
- grid.144189.10000 0004 1756 8209General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124 Pisa, Italy
| | - Bruno Viaggi
- grid.24704.350000 0004 1759 9494Infectious Disease Department, Careggi Hospital, Florence, Italy
| | - Akira Kuriyama
- grid.415565.60000 0001 0688 6269Emergency and Critical Care Center, Kurashiki Central Hospital, Kurashiki, Japan
| | - Edoardo Picetti
- grid.411482.aDepartment of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | - Chad Ball
- grid.414959.40000 0004 0469 2139Hepatobiliary and Pancreatic Surgery Trauma and Acute Care Surgery, Foothills Medical Center, Calgary, AB Canada
| | - Fikri Abu-Zidan
- grid.43519.3a0000 0001 2193 6666Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, UAE
| | - Marco Ceresoli
- grid.18887.3e0000000417581884General Surgery Department, Monza University Hospital, Monza, Italy
| | - Bruno Turri
- grid.414682.d0000 0004 1758 8744General Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Sumita Jain
- grid.416077.30000 0004 1767 3615Department of Surgery, SMS Medical College and Hospital, Jaipur, India
| | - Carlo Palombo
- grid.5395.a0000 0004 1757 3729Cardiology Division 1, Department of Surgical, Medical, Molecular Pathology, and Critical Medicine, School of Medicine, University of Pisa, Pisa, Italy
| | - Xavier Guirao
- grid.428313.f0000 0000 9238 6887Department of Surgery, Parc Tauli, Hospital Universitari, Sabadell, Spain
| | - Gabriel Rodrigues
- grid.415066.00000 0004 1805 8200Department of General Surgery, Kasturba Medical College and Hospital, Manipal, Karnataka India
| | - Mahir Gachabayov
- Department of Abdominal Surgery, Vladimir City Emergency Hospital, Vladimir City, Russia
| | - Fernando Machado
- General Surgery Department, Montevideo Hospital, Montevideo, Paraguay
| | | | - Souha S. Kanj
- grid.411654.30000 0004 0581 3406Antimicrobial Stewardship Program, American University of Beirut Medical Center, Beirut, Lebanon
| | - Isidoro Di Carlo
- grid.8158.40000 0004 1757 1969Department of Surgical Sciences and Advanced Technologies, General Surgery, University of Catania, Cannizzaro Hospital, Catania, Italy
| | - Salomone Di Saverio
- General Surgery, ASUR Marche 5, San Benedetto del Tronto General Hospital, San Benedetto del Tronto, Italy
| | | | - Andrew Kirkpatrick
- grid.414959.40000 0004 0469 2139General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, AB Canada
| | - Damien Massalou
- grid.410528.a0000 0001 2322 4179Acute Care Surgery, University Hospital of Nice (CHU de Nice)/Université Côte d’Azur, Nice, France
| | - Francesco Forfori
- grid.144189.10000 0004 1756 8209ICU Department, Pisa University Hospital, Pisa, Italy
| | - Francesco Corradi
- grid.144189.10000 0004 1756 8209ICU Department, Pisa University Hospital, Pisa, Italy
| | - Samir Delibegovic
- grid.412410.20000 0001 0682 9061General Surgery, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Gustavo M. Machain Vega
- grid.412213.70000 0001 2289 5077Servicio de Cirugia General, Universidad Nacional de Asuncion, Hospital de Clinicas Ii Cátedra de Clinica Quirúrgica, Asunción, Paraguay
| | - Massimo Fantoni
- grid.411075.60000 0004 1760 4193Dipartimento Di Scienze Di Laboratorio E Infettivologiche, Fondazione Policlinico Universitario Agostino Gemelli Irccs, Roma, Italy
| | - Demetrios Demetriades
- grid.411409.90000 0001 0084 1895Division of Trauma, Emergency Surgery, and Surgical Critical Care, LAC+USC Medical Center, Los Angeles, USA
| | - Garima Kapoor
- grid.415285.fDepartment of Microbiology, Gandhi Medical College, Bhopal, India
| | - Yoram Kluger
- General Surgery Department, Rambam Medical Centre, Tel Aviv, Israel
| | - Shamshul Ansari
- grid.488411.00000 0004 5998 7153Department of Microbiology, Chitwan Medical College and Teaching Hospital, Bharatpur, Chitwan, Nepal
| | - Ron Maier
- grid.34477.330000000122986657Harborview Medical Center, University of Washington, Seattle, WA USA
| | - Ari Leppaniemi
- grid.15485.3d0000 0000 9950 5666HUS Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Timothy Hardcastle
- Trauma and Burns, Inkosi Albert Luthuli Central Hospital and DoH-KZN, Mayville, South Africa
| | - Andras Vereczkei
- grid.9679.10000 0001 0663 9479Department of Surgery, Medical School, University of Pécs, Pecs, Hungary
| | - Evika Karamagioli
- grid.5216.00000 0001 2155 0800Medical School, National and Kapodistrian University of Athens, (NKUA), Athens, Greece
| | - Emmanouil Pikoulis
- grid.5216.00000 0001 2155 0800Medical School, National and Kapodistrian University of Athens, (NKUA), Athens, Greece
| | - Mauro Pistello
- grid.5395.a0000 0004 1757 3729Department of Translational Research, University of Pisa, Pisa, Italy
| | - Boris E. Sakakushev
- grid.35371.330000 0001 0726 0380Research Institute at Medical University Plovdiv/University Hospital St George, Plovdiv, Bulgaria
| | - Pradeep H. Navsaria
- grid.7836.a0000 0004 1937 1151Trauma Center, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, 7925 South Africa
| | - Rita Galeiras
- grid.488921.eCritical Care Unit, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña, A Coruña, Spain
| | - Ali I. Yahya
- General Surgery Department, Zliten Medical Center, Zliten, Libya
| | - Aleksei V. Osipov
- Division of Emergency Surgery, Saint-Petersburg Research Institute of Emergency Medicine, Saint-Petersburg, Russian Federation
| | - Evgeni Dimitrov
- Department of Surgical Diseases, University Hospital “Prof. Dr. Stoyan Kirkovich”, 2A Gen. Stoletov Str., 6000 Stara Zagora, Bulgaria
| | | | - Michele Pisano
- 1St General Surgery Unit, Department of Emergency, ASST Papa Giovanni, Bergamo, Italy
| | - Paolo Malacarne
- grid.144189.10000 0004 1756 8209Department of Anaesthesia and Critical Care Medicine, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Paolo Carcoforo
- grid.416315.4General and Emergency Surgery Unit, Sant’Anna University-Hospital, Ferrara, Italy
| | - Maria Grazia Sibilla
- grid.416315.4General and Emergency Surgery Unit, Sant’Anna University-Hospital, Ferrara, Italy
| | - Igor A. Kryvoruchko
- grid.445504.40000 0004 0529 6576Department of Surgery No2, Kharkiv National Medical University, Kharkiv, Ukraine
| | - Luigi Bonavina
- grid.4708.b0000 0004 1757 2822Division of General and Foregut Surgery, University of Milan, IRCCS Policlinico San Donato, Milan, Italy
| | - Jae Il Kim
- grid.411633.20000 0004 0371 8173Department of Surgery, Inje University, Ilsan Paik Hospital, Goyang-si, South Korea
| | - Vishal G. Shelat
- grid.240988.fDepartment of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Jacek Czepiel
- grid.5522.00000 0001 2162 9631Department of Infectious and Tropical Diseases, Jagiellonian University Medical College, Kraków, Poland
| | - Emilio Maseda
- Surgical Critical Care, Department of Anesthesia, Hospital Valdecilla Santander, Santander, Spain
| | - Sanjay Marwah
- grid.412572.70000 0004 1771 1642Post-Graduate Institute of Medical Sciences, Rohtak, 124001 India
| | - Mircea Chirica
- grid.410529.b0000 0001 0792 4829Department of Digestive Surgery, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
| | - Giandomenico Biancofiore
- grid.5395.a0000 0004 1757 3729Operative Unit of Anesthesia and Transplant Resuscitation, University of Pisa, Pisa, Italy
| | - Mauro Podda
- grid.7763.50000 0004 1755 3242Department of Emergency Surgery, Cagliari University Hospital, Cagliari, Italy
| | - Lorenzo Cobianchi
- grid.419425.f0000 0004 1760 3027Department of Clinical, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
- grid.8982.b0000 0004 1762 5736Department of Clinical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Luca Ansaloni
- grid.419425.f0000 0004 1760 3027Department of Clinical, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
- grid.8982.b0000 0004 1762 5736Department of Clinical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Paola Fugazzola
- grid.419425.f0000 0004 1760 3027Department of Clinical, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
- grid.8982.b0000 0004 1762 5736Department of Clinical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Charalampos Seretis
- grid.412924.80000 0004 0446 0530Department of General Surgery, George Eliot Hospital NHS Trust, Warwickshire, UK
| | | | - Fabio Tumietto
- Azienda Ospedaliero Universitaria Di Bologna, Unità Operativa Malattie Infettive, Bologna, Italy
| | - Manu Malbrain
- Internal Medicine – Intensive Care, AZ Jan Palfijn Gent, Gent, Belgium
- grid.411484.c0000 0001 1033 7158First Department of Anaesthesia and Intensive Therapy, Medical University of Lublin, Lublin, Poland
| | - Martin Reichert
- grid.411067.50000 0000 8584 9230Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Giessen, Germany
| | - Goran Augustin
- grid.412688.10000 0004 0397 9648Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Bruno Amato
- grid.4691.a0000 0001 0790 385XDepartment of Public Health, Medical School, University of Naples Federico II, Naples, Italy
| | - Alessandro Puzziello
- grid.11780.3f0000 0004 1937 0335Dipartimento Di Medicina, Chirurgia E Odontoiatria, Campus Universitario di Baronissi - Università Di Salerno, Salerno, Italy
| | - Andreas Hecker
- grid.411067.50000 0000 8584 9230Department of General and Thoracic Surgery, University Hospital of Giessen, Marburg, Germany
| | - Angelo Gemignani
- grid.5395.a0000 0004 1757 3729Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Arda Isik
- grid.411776.20000 0004 0454 921XGeneral Surgery Department, Istanbul Medeniyet University, Istanbul, Turkey
| | - Alessandro Cucchetti
- grid.6292.f0000 0004 1757 1758Department of Medical and Surgical Sciences – DIMEC, Alma Mater Studiorum - University of Bologna, Bologna, Italy
- grid.415079.e0000 0004 1759 989XGeneral Surgery of the Morgagni - Pierantoni Hospital, Forlì, Italy
| | - Mirco Nacoti
- grid.460094.f0000 0004 1757 8431Pediatric Intensive Care Unit, Department of Anesthesia and Intensive Care, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Doron Kopelman
- grid.469889.20000 0004 0497 6510Hepato-Billiary-Pancreatic (HPB) Surgery Center, Emek Medical Center, Afula, Israel
| | - Cristian Mesina
- grid.452359.cEmergency County Hospital of Craiova, Craiova, Romania
| | - Wagih Ghannam
- grid.10251.370000000103426662Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Offir Ben-Ishay
- grid.6451.60000000121102151The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Rambam Health Care Campus, Haifa, Israel
| | - Sameer Dhingra
- grid.419631.80000 0000 8877 852XDepartment of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), Hajipur Vaishali, Bihar, India
| | - Raul Coimbra
- grid.488519.90000 0004 5946 0028Department of Surgery, Riverside University Health System, Moreno Valley, CA USA
- grid.43582.380000 0000 9852 649XSchool of Medicine, Loma Linda University, Loma Linda, CA USA
| | - Ernest E. Moore
- grid.239638.50000 0001 0369 638XShock Trauma Center at Denver Health, Denver, CO USA
| | - Yunfeng Cui
- grid.265021.20000 0000 9792 1228Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China
| | | | - Miklosh Bala
- grid.17788.310000 0001 2221 2926Trauma and Acute Care Surgery Unit, Hadassah - Hebrew University Medical Center, Jerusalem, Israel
| | - Mario Testini
- grid.7644.10000 0001 0120 3326Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy
| | - Jose Diaz
- grid.411024.20000 0001 2175 4264University of Maryland School of Medicine, Baltimore, MD USA
| | - Massimo Girardis
- grid.413363.00000 0004 1769 5275Intensive Care Unit, University Hospital of Modena, Modena, Italy
| | | | - Matthias Hecker
- grid.411067.50000 0000 8584 9230Department of Respiratory and Critical Care Medicine, University Hospital Giessen, Giessen, Germany
| | - Ibrahima Sall
- grid.414281.aDepartment of General Surgery, Military Teaching Hospital, Hôpital Principal de Dakar, Dakar, Senegal
| | - Ugo Boggi
- grid.5395.a0000 0004 1757 3729Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Gabriele Materazzi
- grid.5395.a0000 0004 1757 3729Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Lorenzo Ghiadoni
- grid.144189.10000 0004 1756 8209Emergency Medical Department, Pisa University Hospital, Pisa, Italy
| | - Junichi Matsumoto
- grid.412764.20000 0004 0372 3116Department of Emergency and Critical Care Medicine, Saint-Marianna University School of Medicine, Kawasaki, Japan
| | - Wietse P. Zuidema
- grid.509540.d0000 0004 6880 3010Department of Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Rao Ivatury
- grid.224260.00000 0004 0458 8737Professor Emeritus, Virginia Commonwealth University, Richmond, VA USA
| | - Mushira A. Enani
- grid.415277.20000 0004 0593 1832Infectious Diseases Section, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Andrey Litvin
- grid.410686.d0000 0001 1018 9204Immanuel Kant Baltic Federal University, Regional Clinic Hospital, Kaliningrad, Russia
| | - Majdi N. Al-Hasan
- grid.254567.70000 0000 9075 106XDepartment of Internal Medicine, University of South Carolina School of Medicine, Prisma Health-Midlands, Columbia, SC USA
| | - Zaza Demetrashvili
- grid.412274.60000 0004 0428 8304Department of Surgery, Tbilisi State Medical University, Kipshidze Central University Hospital, Tbilisi, Georgia
| | - Oussama Baraket
- Department of Surgery, Bizerte Hospital, Bizerte, Tunisia
- grid.265234.40000 0001 2177 9066Faculty of Medicine, Tunis University, Tunis ElManar, Tunisia
| | - Carlos A. Ordoñez
- grid.8271.c0000 0001 2295 7397Division of Trauma and Acute Care Surgery, Department of Surgery, Universidad del Valle, Cali, Colombia
| | - Ionut Negoi
- grid.8194.40000 0000 9828 7548General Surgery Department, Emergency Hospital of Bucharest, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Ronald Kiguba
- grid.11194.3c0000 0004 0620 0548Department of Pharmacology and Therapeutics, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ziad A. Memish
- grid.411335.10000 0004 1758 7207King Saud Medical City, Ministry of Health and College of Medicine, AlFaisal University, Riyadh, Kingdom of Saudi Arabia
| | | | - Matti Tolonen
- grid.15485.3d0000 0000 9950 5666HUS Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Korey Das
- General Surgery, University of Health Sciences, Adana City Training and Research Hospital, Adana, Turkey
| | - Julival Ribeiro
- grid.414433.5Infection Control Coordinator, Hospital de Base Do Distrito Federal /IGESDF, Brasilia, Brazil
| | - Donal B. O’Connor
- grid.8217.c0000 0004 1936 9705Department of Surgery, Trinity College Dublin, Dublin, Ireland
| | - Boun Kim Tan
- Infection Prevention and Control Unit, Centre des Massues, French-Red Cross, Lyon, France
| | - Harry Van Goor
- grid.10417.330000 0004 0444 9382Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Suman Baral
- General Surgery, Dirghayu Pokhara Hospital, Pokhara, Nepal
| | - Belinda De Simone
- grid.418056.e0000 0004 1765 2558Department of Emergency, Digestive and Metabolic Minimally Invasive Surgery, Centre Hospitalier Intercommunal de Poissy, Saint Germain en Laye, France
| | | | | | - Michelangelo Scaglione
- grid.144189.10000 0004 1756 8209Orthopedic and Traumatology Department, Pisa University Hospital, Pisa, Italy
| | - Fulvio Basolo
- grid.5395.a0000 0004 1757 3729Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Nicola De’Angelis
- grid.412116.10000 0001 2292 1474General Surgery, Department, Henri Mondor Hospital, Paris, France
| | - Cino Bendinelli
- grid.414724.00000 0004 0577 6676Department of Surgery, John Hunter Hospital, Newcastle, Australia
- grid.266842.c0000 0000 8831 109XUniversity of Newcastle, Callaghan, Australia
| | - Dieter Weber
- grid.1012.20000 0004 1936 7910General Surgery, Royal Perth Hospital, The University of Western Australia, Perth, Australia
| | - Leonardo Pagani
- grid.415844.8Infectious Diseases Unit, Bolzano Central Hospital, Bolzano, Italy
| | - Cinzia Monti
- Radiology Department, Gavazzeni Hospital, Bergamo, Italy
| | - Gianluca Baiocchi
- grid.419450.dGeneral Surgery Department, Cremona Hospital, Cremona, Italy
| | - Massimo Chiarugi
- grid.144189.10000 0004 1756 8209General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124 Pisa, Italy
| | - Fausto Catena
- grid.414682.d0000 0004 1758 8744General Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
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21
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Al-Hasan MN. Gram-negative Bacteria With Difficult-to-Treat Resistance: A Moving Target. Clin Infect Dis 2021; 72:2121-2123. [PMID: 32249916 DOI: 10.1093/cid/ciaa384] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 04/02/2020] [Indexed: 01/25/2023] Open
Affiliation(s)
- Majdi N Al-Hasan
- Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, South Carolina, USA.,Prisma Health-Midlands, Columbia, South Carolina, USA
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22
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Amipara R, Winders HR, Justo JA, Bookstaver PB, Kohn J, Al-Hasan MN. Impact of follow up blood cultures on outcomes of patients with community-onset gram-negative bloodstream infection. EClinicalMedicine 2021; 34:100811. [PMID: 33870154 PMCID: PMC8042341 DOI: 10.1016/j.eclinm.2021.100811] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/04/2021] [Accepted: 03/10/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The role of follow up blood cultures (FUBC) in the management of gram-negative bloodstream infection (GN-BSI) remains controversial. This retrospective cohort study examines the association between obtaining FUBC and mortality in GN-BSI. METHODS Hospitalized adults with community-onset GN-BSI at Prisma Health-Midlands hospitals in South Carolina, USA from January 1, 2010 to June 30, 2015 were identified. Patients who died or were discharged from hospital within 72 h were excluded to minimize impact of survival and selection biases on results, respectively. Multivariate Cox proportional hazards regression was used to examine association between obtaining FUBC and 28-day all-cause mortality after adjustment for the propensity to obtain FUBC. FINDINGS Among 766 patients with GN-BSI, 219 (28.6%) had FUBC obtained and 15 of 219 (6.8%) FUBC were persistently positive. Overall, median age was 67 years, 438 (57%) were women, 457 (60%) had urinary source of infection, and 426 (56%) had BSI due to Escherichia coli. Mortality was significantly lower in patients who had FUBC obtained than in those who did not have FUBC (6.3% vs. 11.7%, log-rank p = 0.03). Obtaining FUBC was independently associated with reduced mortality (hazards ratio 0.47, 95% confidence intervals: 0.23-0.87; p = 0.02) after adjustments for age, chronic comorbidities, acute severity of illness, appropriateness of empirical antimicrobial therapy, and propensity to obtain FUBC. INTERPRETATION Improved survival in hospitalized patients with GN-BSI who had FUBC is consistent with the results of recent publications from Italy and North Carolina supporting utilization of FUBC in management of GN-BSI. FUNDING This study had no funding source.
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Affiliation(s)
- Rajiv Amipara
- Department of Medicine, Division of Infectious Diseases, University of South Carolina School of Medicine, Columbia, SC, USA
- Department of Medicine, Division of Infectious Diseases, Prisma Health-Midlands, Columbia, SC, USA
| | - Hana Rac Winders
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, USA
- Department of Pharmacy, Prisma Health-Midlands, Columbia, SC, USA
| | - Julie Ann Justo
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, USA
- Department of Pharmacy, Prisma Health-Midlands, Columbia, SC, USA
| | - P. Brandon Bookstaver
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, USA
- Department of Pharmacy, Prisma Health-Midlands, Columbia, SC, USA
| | - Joseph Kohn
- Department of Pharmacy, Prisma Health-Midlands, Columbia, SC, USA
| | - Majdi N. Al-Hasan
- Department of Medicine, Division of Infectious Diseases, University of South Carolina School of Medicine, Columbia, SC, USA
- Department of Medicine, Division of Infectious Diseases, Prisma Health-Midlands, Columbia, SC, USA
- Corresponding author at: University of South Carolina School of Medicine, 2 Medical Park, Suite 502, Columbia, SC 29203, USA.
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Vo VAD, Khalil MK, Al-Hasan MN. Risk and clinical outcomes of acute myocardial infarction and acute ischemic stroke following gram-negative bloodstream infection. Int J Cardiol Hypertens 2021; 8:100079. [PMID: 33598654 PMCID: PMC7868809 DOI: 10.1016/j.ijchy.2021.100079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/15/2021] [Accepted: 01/18/2021] [Indexed: 10/26/2022]
Abstract
Objectives This retrospective cohort study examines incidence, risk factors, and clinical outcomes of acute myocardial infarction (AMI) and acute ischemic stroke (AIS) within one year of gram-negative bloodstream infection (GN-BSI) based on predefined clinical criteria. Methods Hospitalized adults with GN-BSI at Prisma Health-Midlands hospitals in South Carolina, USA from 2010 through 2015 were identified. Kaplan-Meier analysis was used to determine incidence of AMI and AIS within one year after GN-BSI. Multivariate Cox proportional hazards regression models were used to examine risk factors for AMI or AIS and impact on 1-year mortality. Results Among 1292 patients with GN-BSI, 263 and 17 developed AMI and AIS within 1-year with incidences of 23.4% and 1.9%, respectively. Majority of AMI were type 2 (164; 62%); 99 patients had type 1 AMI with incidence of 8.9%. Age >65 years (hazard ratio [HR] 1.52, 95% CI: 1.17-1.99), prior coronary artery disease or stroke (HR 1.74, 95% CI: 1.34-2.25), hypertension (HR 1.55, 95% CI: 1.13-2.15), end-stage renal disease (HR 1.52, 95% CI: 1.09-2.08), and quick Pitt bacteremia score (HR 1.55 per point, 95% CI: 1.40-1.72) were predictors of AMI/AIS. Development of type 1 AMI or AIS after GN-BSI was independently associated with increased 1-year mortality (HR 1.47, 95% CI: 1.03-2.07). Conclusions AMI and AIS occur frequently within one year of GN-BSI and have negative impact on 1-year survival. Future randomized clinical trials are needed to determine the most effective clinical interventions for prevention of AMI/AIS following BSI in high risk patients and improve survival after these events.
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Affiliation(s)
- Vinh-An D Vo
- University of South Carolina School of Medicine, Columbia, SC, USA
| | - Mazen K Khalil
- University of South Carolina School of Medicine, Columbia, SC, USA.,Department of Internal Medicine, Division of Cardiology, Prisma Health Midlands, Columbia, SC, USA
| | - Majdi N Al-Hasan
- University of South Carolina School of Medicine, Columbia, SC, USA.,Department of Internal Medicine, Division of Infectious Diseases, Prisma Health Midlands, Columbia, SC, USA
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Al-Hasan MN, Baddour LM. Resilience of the Pitt Bacteremia Score: 3 Decades and Counting. Clin Infect Dis 2020; 70:1834-1836. [PMID: 31219546 DOI: 10.1093/cid/ciz535] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 06/18/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- Majdi N Al-Hasan
- University of South Carolina School of Medicine, Columbia
- Department of Medicine, Division of Infectious Diseases, Palmetto Health University of South Carolina Medical Group, Columbia
| | - Larry M Baddour
- Departments of Medicine and Cardiovascular Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
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Abstract
Chronic obstructive pulmonary disease (COPD) has considerable morbidity and mortality in the older adult population. The role of antibiotics in the management of acute exacerbations of COPD (AECOPD) is currently evolving. Despite only mild benefits, most patients with AECOPD in ambulatory settings receive antibiotics based on clinical criteria. Utilization of point-of-care C-reactive protein (CRP) has reduced antibiotic prescriptions by 20% without compromising clinical outcomes. A strict protocol allowing antibiotic use only in patients with clinical criteria and CRP ≥ 20 mg/L has the potential to reduce antibiotic prescriptions for AECOPD in ambulatory settings by nearly 50%. Amoxicillin and doxycycline are commonly prescribed for AECOPD based on a favorable benefit-to-risk ratio. Prophylactic antibiotics have also been used in selected patients with severe COPD and frequent exacerbations. The use of continuous or intermittent azithromycin has demonstrated efficacy in reducing the frequency of AECOPD in this population; however, this approach has potential for the development of antibiotic resistance and adverse effects. The use of azithromycin prophylaxis in older patients with frequent AECOPD should be determined on a case-by-case basis after careful review, discussion, and counseling of the potential benefits and risks. The role of continuous doxycycline and pulsed moxifloxacin prophylaxis for frequent AECOPD remains controversial.
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Affiliation(s)
- Majdi N Al-Hasan
- Department of Medicine, Division of Infectious Diseases, University of South Carolina School of Medicine, Columbia, SC, USA. .,Prisma Health University of South Carolina Medical Group, Columbia, SC, USA.
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O'Neal M, Murray H, Dash S, Al-Hasan MN, Justo JA, Bookstaver PB. Evaluating appropriateness and diagnostic stewardship opportunities of multiplex polymerase chain reaction gastrointestinal testing within a hospital system. Ther Adv Infect Dis 2020; 7:2049936120959561. [PMID: 33014363 PMCID: PMC7513010 DOI: 10.1177/2049936120959561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 07/03/2020] [Accepted: 08/27/2020] [Indexed: 12/31/2022] Open
Abstract
Objective: This single-center, retrospective, observational cohort study evaluates the
appropriateness of the BioFire® FilmArray® Gastrointestinal (GI) multiplex
PCR panel testing at a community-teaching hospital. Methods: All adult, hospitalized patients at Prisma Health Richland Hospital with a
documented GI multiplex PCR panel from 1 April 2015 through 28 February 2018
were included in the analysis. Inappropriate use of the GI panel was defined
as a test obtained without documented diarrhea, greater than 2 days of
hospitalization, redundant use with other diagnostic tests (e.g.
Clostridioides difficile PCR), or laxative use in the
preceding 48 h. Antibiotic use and host variables were compared between
groups with positive and negative results. Results: During the study period, 442 GI panels were obtained, among which 268 (61%)
were deemed inappropriate. Primary reasons for inappropriate testing were
lack of documented diarrhea (n = 92), greater than 2 days
of hospitalization (n = 116), having a duplicate C.
difficile PCR test ordered (n = 118), or
laxative use in the 48 h before testing (n = 36). A total
of 141 (32%) GI panels were positive. The most frequently identified
pathogens were C. difficile (51.1%,
n = 72), Enteropathogenic Escherichia coli
(17.7%, n = 25), and Norovirus GI/GII (12.1%,
n = 17). Patients with negative GI panel results were
initiated on antibiotics significantly less frequently than those with
positive GI panels (62.5% versus 80.2%,
p < 0.00001). Conclusion: Stewardship opportunities exist to optimize the diagnostic application of the
GI multiplex PCR panel.
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Affiliation(s)
- Melissa O'Neal
- University of South Carolina College of Pharmacy, 715 Sumter Street, Columbia, SC 29208, USA
| | - Hanna Murray
- University of South Carolina College of Pharmacy, Columbia, SC, USA
| | - Sangita Dash
- University of South Carolina School of Medicine, Columbia, SC, USA
| | - Majdi N Al-Hasan
- University of South Carolina School of Medicine, Columbia, SC, USA
| | - Julie Ann Justo
- University of South Carolina College of Pharmacy, Columbia, SC, USA
| | - P Brandon Bookstaver
- University of South Carolina College of Pharmacy, 715 Sumter Street, Columbia, SC 29208, USA
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Seddon MM, Bookstaver PB, Justo JA, Kohn J, Rac H, Haggard E, Mediwala KN, Dash S, Al-Hasan MN. Role of Early De-escalation of Antimicrobial Therapy on Risk of Clostridioides difficile Infection Following Enterobacteriaceae Bloodstream Infections. Clin Infect Dis 2020; 69:414-420. [PMID: 30312362 DOI: 10.1093/cid/ciy863] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 10/04/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND There is a paucity of data on the effect of early de-escalation of antimicrobial therapy on rates of Clostridioides difficile infection (CDI). This retrospective cohort study evaluated impact of de-escalation from antipseudomonal β-lactam (APBL) therapy within 48 hours of Enterobacteriaceae bloodstream infections (BSIs) on 90-day risk of CDI. METHODS Adult patients hospitalized for >48 hours for treatment of Enterobacteriaceae BSI at Palmetto Health hospitals in Columbia, South Carolina, from 1 January 2011 through 30 June 2015 were identified. Multivariable Cox proportional hazards regression was used to examine time to CDI in patients who received >48 hours or ≤48 hours of APBL for empirical therapy of Enterobacteriaceae BSI after adjustment for the propensity to receive >48 hours of APBL. RESULTS Among 808 patients with Enterobacteriaceae BSI, 414 and 394 received >48 and ≤48 hours of APBL, respectively. Incidence of CDI was higher in patients who received >48 hours than those who received ≤48 hours of APBL (7.0% vs 1.8%; log-rank P = .002). After adjustment for propensity to receive >48 hours of APBL and other variables in the multivariable model, receipt of >48 hours of APBL (hazard ratio [HR], 3.56 [95% confidence interval {CI}, 1.48-9.92]; P = .004) and end-stage renal disease (HR, 4.27 [95% CI, 1.89-9.11]; P = .001) were independently associated with higher risk of CDI. CONCLUSIONS The empirical use of APBL for >48 hours was an independent risk factor for CDI. Early de-escalation of APBL using clinical risk assessment tools or rapid diagnostic testing may reduce the incidence of CDI in hospitalized adults with Enterobacteriaceae BSIs.
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Affiliation(s)
- Megan M Seddon
- University of South Carolina College of Pharmacy, Columbia.,Palmetto Health Richland, Columbia
| | - P Brandon Bookstaver
- University of South Carolina College of Pharmacy, Columbia.,Palmetto Health Richland, Columbia
| | - Julie Ann Justo
- University of South Carolina College of Pharmacy, Columbia.,Palmetto Health Richland, Columbia
| | | | - Hana Rac
- University of South Carolina College of Pharmacy, Columbia
| | | | | | - Sangita Dash
- University of South Carolina School of Medicine, Palmetto Health University of South Carolina Medical Group, Columbia.,Department of Medicine, Division of Infectious Diseases, Palmetto Health University of South Carolina Medical Group, Columbia
| | - Majdi N Al-Hasan
- University of South Carolina School of Medicine, Palmetto Health University of South Carolina Medical Group, Columbia.,Department of Medicine, Division of Infectious Diseases, Palmetto Health University of South Carolina Medical Group, Columbia
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Derrick C, Bookstaver PB, Lu ZK, Bland CM, King ST, Stover KR, Rumley K, MacVane SH, Swindler J, Kincaid S, Branan T, Cluck D, Britt B, Pillinger KE, Jones BM, Fleming V, DiMondi VP, Estrada S, Crane B, Odle B, Al-Hasan MN, Justo JA. Multicenter, Observational Cohort Study Evaluating Third-Generation Cephalosporin Therapy for Bloodstream Infections Secondary to Enterobacter, Serratia, and Citrobacter Species. Antibiotics (Basel) 2020; 9:antibiotics9050254. [PMID: 32423104 PMCID: PMC7277875 DOI: 10.3390/antibiotics9050254] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 04/16/2020] [Revised: 05/09/2020] [Accepted: 05/12/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES There is debate on whether the use of third-generation cephalosporins (3GC) increases the risk of clinical failure in bloodstream infections (BSIs) caused by chromosomally-mediated AmpC-producing Enterobacterales (CAE). This study evaluates the impact of definitive 3GC therapy versus other antibiotics on clinical outcomes in BSIs due to Enterobacter, Serratia, or Citrobacter species. METHODS This multicenter, retrospective cohort study evaluated adult hospitalized patients with BSIs secondary to Enterobacter, Serratia, or Citrobacter species from 1 January 2006 to 1 September 2014. Definitive 3GC therapy was compared to definitive therapy with other non-3GC antibiotics. Multivariable Cox proportional hazards regression evaluated the impact of definitive 3GC on overall treatment failure (OTF) as a composite of in-hospital mortality, 30-day hospital readmission, or 90-day reinfection. RESULTS A total of 381 patients from 18 institutions in the southeastern United States were enrolled. Common sources of BSIs were the urinary tract and central venous catheters (78 (20.5%) patients each). Definitive 3GC therapy was utilized in 65 (17.1%) patients. OTF occurred in 22/65 patients (33.9%) in the definitive 3GC group vs. 94/316 (29.8%) in the non-3GC group (p = 0.51). Individual components of OTF were comparable between groups. Risk of OTF was comparable with definitive 3GC therapy vs. definitive non-3GC therapy (aHR 0.93, 95% CI 0.51-1.72) in multivariable Cox proportional hazards regression analysis. CONCLUSIONS These outcomes suggest definitive 3GC therapy does not significantly alter the risk of poor clinical outcomes in the treatment of BSIs secondary to Enterobacter, Serratia, or Citrobacter species compared to other antimicrobial agents.
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Affiliation(s)
- Caroline Derrick
- Department of Medicine, University of South Carolina School of Medicine Columbia, SC 29203, USA; (C.D.); (M.N.A.-H.)
| | - P. Brandon Bookstaver
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC 29208, USA; (P.B.B.); (Z.K.L.)
- Prisma Health Richland, Columbia, SC 29203, USA
| | - Zhiqiang K. Lu
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC 29208, USA; (P.B.B.); (Z.K.L.)
| | - Christopher M. Bland
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Savannah, GA 31324, USA;
- St. Joseph’s/Candler Health System, Savannah, GA 31405, USA;
| | - S. Travis King
- Department of Pharmacy Practice, University of Mississippi School of Pharmacy, Jackson, MS 39216, USA; (S.T.K.); (K.R.S.)
| | - Kayla R. Stover
- Department of Pharmacy Practice, University of Mississippi School of Pharmacy, Jackson, MS 39216, USA; (S.T.K.); (K.R.S.)
| | - Kathey Rumley
- Vidant Medical Center, Greenville, NC 27835, USA;
- Department of Pharmacy Practice, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC 27506, USA;
| | - Shawn H. MacVane
- Department of Pharmacy, Medical University of South Carolina, Charleston, SC 29425, USA;
| | - Jenna Swindler
- McLeod Regional Medical Center, Florence, SC 29506, USA;
| | - Scott Kincaid
- University of Kentucky Healthcare, Lexington, KY 40536, USA;
| | - Trisha Branan
- College of Pharmacy, University of Georgia, Athens, GA 30602, USA; (T.B.); (V.F.)
| | - David Cluck
- Department of Pharmacy Practice, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN 37614, USA; (D.C.); (B.O.)
| | | | | | - Bruce M. Jones
- St. Joseph’s/Candler Health System, Savannah, GA 31405, USA;
| | - Virginia Fleming
- College of Pharmacy, University of Georgia, Athens, GA 30602, USA; (T.B.); (V.F.)
| | - V. Paul DiMondi
- Department of Pharmacy Practice, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC 27506, USA;
- WakeMed Health and Hospitals, Raleigh, NC 27610, USA
| | | | - Brad Crane
- Blount Memorial Hospital, Maryville, TN 37804, USA;
| | - Brian Odle
- Department of Pharmacy Practice, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN 37614, USA; (D.C.); (B.O.)
| | - Majdi N. Al-Hasan
- Department of Medicine, University of South Carolina School of Medicine Columbia, SC 29203, USA; (C.D.); (M.N.A.-H.)
| | - Julie Ann Justo
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC 29208, USA; (P.B.B.); (Z.K.L.)
- Prisma Health Richland, Columbia, SC 29203, USA
- Correspondence:
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Shealy SC, Brigmon MM, Justo JA, Bookstaver PB, Kohn J, Al-Hasan MN. Impact of Reappraisal of Fluoroquinolone Minimum Inhibitory Concentration Susceptibility Breakpoints in Gram-Negative Bloodstream Isolates. Antibiotics (Basel) 2020; 9:antibiotics9040189. [PMID: 32316502 PMCID: PMC7235854 DOI: 10.3390/antibiotics9040189] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 03/11/2020] [Revised: 04/09/2020] [Accepted: 04/13/2020] [Indexed: 02/06/2023] Open
Abstract
The Clinical Laboratory Standards Institute lowered the fluoroquinolone minimum inhibitory concentration (MIC) susceptibility breakpoints for Enterobacteriaceae and glucose non-fermenting Gram-negative bacilli in January 2019. This retrospective cohort study describes the impact of this reappraisal on ciprofloxacin susceptibility overall and in patients with risk factors for antimicrobial resistance. Gram-negative bloodstream isolates collected from hospitalized adults at Prisma Health-Midlands hospitals in South Carolina, USA, from January 2010 to December 2014 were included. Matched pairs mean difference (MD) with 95% confidence intervals (CI) were calculated to examine the change in ciprofloxacin susceptibility after MIC breakpoint reappraisal. Susceptibility of Enterobacteriaceae to ciprofloxacin declined by 5.2% (95% CI: −6.6, −3.8; p < 0.001) after reappraisal. The largest impact was demonstrated among Pseudomonas aeruginosa bloodstream isolates (MD −7.8, 95% CI: −14.6, −1.1; p = 0.02) despite more conservative revision in ciprofloxacin MIC breakpoints. Among antimicrobial resistance risk factors, fluoroquinolone exposure within the previous 90 days was associated with the largest change in ciprofloxacin susceptibility (MD −9.3, 95% CI: −16.1, −2.6; p = 0.007). Reappraisal of fluoroquinolone MIC breakpoints has a variable impact on the susceptibility of bloodstream isolates by microbiology and patient population. Healthcare systems should be vigilant to systematically adopt this updated recommendation in order to optimize antimicrobial therapy in patients with bloodstream and other serious infections.
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Affiliation(s)
- Stephanie C. Shealy
- Department of Pharmacy, Prisma Health Richland Hospital, Columbia, SC 29203, USA; (S.C.S.); (J.A.J.); (P.B.B.); (J.K.)
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC 29208, USA
| | - Matthew M. Brigmon
- Department of Medicine, Baylor Scott and White, Texas A&M Health Science Center College of Medicine, Temple, TX 76502, USA;
| | - Julie Ann Justo
- Department of Pharmacy, Prisma Health Richland Hospital, Columbia, SC 29203, USA; (S.C.S.); (J.A.J.); (P.B.B.); (J.K.)
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC 29208, USA
| | - P. Brandon Bookstaver
- Department of Pharmacy, Prisma Health Richland Hospital, Columbia, SC 29203, USA; (S.C.S.); (J.A.J.); (P.B.B.); (J.K.)
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC 29208, USA
| | - Joseph Kohn
- Department of Pharmacy, Prisma Health Richland Hospital, Columbia, SC 29203, USA; (S.C.S.); (J.A.J.); (P.B.B.); (J.K.)
| | - Majdi N. Al-Hasan
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC 29208, USA
- Department of Medicine, University of South Carolina School of Medicine, Columbia, SC 29209, USA
- Prisma Health-Midlands, Columbia, SC 29203, USA
- Correspondence: ; Tel.: +1-803-540-1062; Fax: +1-803-540-1079
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Vo VA, Khalil M, Al-Hasan MN. RISK OF ACUTE MYOCARDIAL INFARCTIONS AND ACUTE ISCHEMIC STROKES FOLLOWING GRAM-NEGATIVE BLOODSTREAM INFECTIONS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)30741-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Al-Hasan MN, Gould AP, Drennan C, Hill O, Justo JA, Kohn J, Bookstaver PB. Empirical fluoroquinolones versus broad-spectrum beta-lactams for Gram-negative bloodstream infections in the absence of antimicrobial resistance risk factors. J Glob Antimicrob Resist 2019; 22:87-93. [PMID: 31887412 DOI: 10.1016/j.jgar.2019.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/17/2019] [Accepted: 12/19/2019] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES Increasing antimicrobial resistance rates limit empirical antimicrobial treatment options for Gram-negative bloodstream infections (GN-BSI). However, antimicrobial resistance may be predicted based on patient-specific risk factors using precision medicine concepts. This retrospective, 1:2 matched cohort examined clinical outcomes in hospitalized adults without major risk factors for antimicrobial resistance receiving empirical fluoroquinolones or broad-spectrum beta-lactams (BSBL) for GN-BSI at Prisma Health-Midlands hospitals in Columbia, SC, USA from January 2010 through June 2015. METHODS Multivariable logistic regression was used to examine early treatment failure at 72-96 h from GN-BSI. Cox proportional hazards regression was used to examine 28-day mortality and hospital length of stay (HLOS). RESULTS Among 74 and 148 patients receiving empirical fluoroquinolones and BSBL for GN-BSI, respectively, median age was 68 years, 159 (72%) were women, and 152 (68%) had a urinary source of infection. Early treatment failure rates were comparable in fluoroquinolone and BSBL groups (27% vs. 30%, respectively, odds ratio 0.82, 95% confidence intervals [CI] 0.43-1.54, P = 0.53), as well as 28-day mortality (8.9% vs. 9.7%, respectively, hazards ratio [HR] 0.74, 95% CI 0.26-1.90, P = 0.54). Median HLOS was 6.1 days in the fluoroquinolone group and 7.1 days in the BSBL group (HR 0.73, 95% CI 0.54-0.99, P = 0.04). Transition from intravenous to oral therapy occurred sooner in the fluoroquinolone group than in the BSBL group (3.0 vs. 4.9 days, P < 0.001). CONCLUSIONS In the absence of antimicrobial resistance risk factors, fluoroquinolones provide an additional empirical treatment option to BSBL for GN-BSI. Shorter HLOS in the fluoroquinolone group may be due to earlier transition from intravenous to oral antimicrobial therapy.
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Affiliation(s)
- Majdi N Al-Hasan
- School of Medicine, University of South Carolina, Columbia, SC, USA; Palmetto Health-USC Medical Group, University of South Carolina, Columbia, SC, USA.
| | | | - Chelsea Drennan
- College of Pharmacy, University of South Carolina, Columbia, SC, USA
| | - Olivia Hill
- College of Pharmacy, University of South Carolina, Columbia, SC, USA
| | - Julie Ann Justo
- College of Pharmacy, University of South Carolina, Columbia, SC, USA; Prisma Health Richland Hospital, Columbia, SC, USA
| | - Joseph Kohn
- Prisma Health Richland Hospital, Columbia, SC, USA
| | - P Brandon Bookstaver
- College of Pharmacy, University of South Carolina, Columbia, SC, USA; Prisma Health Richland Hospital, Columbia, SC, USA
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32
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Al-Hasan MN, Baddour LM. Erratum. Clin Infect Dis 2019; 69:2238. [DOI: 10.1093/cid/ciz1041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Younas M, Royer J, Weissman SB, Waites KS, Dash S, Rac H, Bookstaver PB, Justo JA, Bell L, Maki A, Al-Hasan MN. Burden of community-associated Clostridioides difficile infection in southeastern United States: a population-based study. Infection 2019; 48:129-132. [DOI: 10.1007/s15010-019-01368-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 10/16/2019] [Indexed: 01/03/2023]
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DeMarsh M, Bookstaver PB, Gordon C, Lim J, Griffith N, Bookstaver NK, Justo JA, Kohn J, Al-Hasan MN. Prediction of trimethoprim/sulfamethoxazole resistance in community-onset urinary tract infections. J Glob Antimicrob Resist 2019; 21:218-222. [PMID: 31683038 DOI: 10.1016/j.jgar.2019.10.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/23/2019] [Accepted: 10/23/2019] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES This study aimed to predict trimethoprim/sulfamethoxazole (SXT) resistance in patients with community-onset urinary tract infection (UTI) due to Enterobacteriaceae based on patient-specific risk factors. METHODS This was a retrospective case-control study in Prisma Health facilities in central South Carolina, USA, including three community hospitals, affiliated emergency departments and ambulatory clinics, including adult patients with community-onset UTI due to Enterobacteriaceae (1 April 2015 to 29 February 2016). Multivariate logistic regression was used to examine risk factors for SXT resistance. RESULTS Among 351 unique patients with community-onset UTI, 71 (20.2%) had SXT-resistant Enterobacteriaceae urinary isolates. Overall, median age was 64 years and 252 (71.8%) were female. A multivariate model identified prior urinary infection/colonisation with SXT-resistant Enterobacteriaceae (OR=8.58, 95% CI 3.92-18.81; P<0.001) and SXT use within past 12 months (OR=2.58, 95% CI 1.13-5.89; P=0.02) as predictors of SXT resistance among urinary isolates. Most patients with UTI (285; 81.2%) had no risk factors for SXT resistance. SXT resistance rates increased from 13% in the absence of risk factors to 31% in patients with prior SXT use, 66% in those with prior urinary infection/colonisation with SXT-resistant Enterobacteriaceae and 73% in the presence of both risk factors. CONCLUSION SXT resistance in Enterobacteriaceae urinary isolates may be predicted based on prior urine culture results and SXT use within the previous year. Utilisation of a patient-specific antibiogram may allow empirical SXT use in patients with community-onset UTI in the absence of risk factors for resistance.
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Affiliation(s)
- Madeline DeMarsh
- Department of Pharmacy, Prisma Health Richland, Columbia, SC, USA
| | - P Brandon Bookstaver
- Department of Pharmacy, Prisma Health Richland, Columbia, SC, USA; Department of Clinical Pharmacy & Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, USA
| | - Caroline Gordon
- Department of Clinical Pharmacy & Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, USA
| | - Juanne Lim
- Department of Clinical Pharmacy & Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, USA
| | - Nicole Griffith
- Department of Clinical Pharmacy & Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, USA
| | | | - Julie Ann Justo
- Department of Pharmacy, Prisma Health Richland, Columbia, SC, USA; Department of Clinical Pharmacy & Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, USA
| | - Joseph Kohn
- Department of Pharmacy, Prisma Health Richland, Columbia, SC, USA
| | - Majdi N Al-Hasan
- University of South Carolina School of Medicine, Columbia, SC, USA; Department of Medicine, Division of Infectious Diseases, Prisma Health University of South Carolina Medical Group, Columbia, SC, USA.
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Al-Hasan MN, Albrecht H, Bookstaver PB, Kohn J, Justo JA. Duration of Antimicrobial Therapy for Enterobacteriaceae Bacteremia: Using Convenient End Points for Convenient Conclusions. Clin Infect Dis 2019; 66:1978-1979. [PMID: 29365087 DOI: 10.1093/cid/ciy043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Majdi N Al-Hasan
- School of Medicine, University of South Carolina, University of South Carolina
- Department of Medicine, Palmetto Health USC Medical Group, University of South Carolina
| | - Helmut Albrecht
- School of Medicine, University of South Carolina, University of South Carolina
- Department of Medicine, Palmetto Health USC Medical Group, University of South Carolina
| | - P Brandon Bookstaver
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina
- Department of Pharmacy, Palmetto Health Richland, Columbia, South Carolina
| | - Joseph Kohn
- Department of Pharmacy, Palmetto Health Richland, Columbia, South Carolina
| | - Julie Ann Justo
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina
- Department of Pharmacy, Palmetto Health Richland, Columbia, South Carolina
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Affiliation(s)
- Allan S Brett
- From the Divisions of General Internal Medicine (A.S.B.) and Infectious Diseases (M.N.A.-H.), Department of Medicine, University of South Carolina School of Medicine, Columbia
| | - Majdi N Al-Hasan
- From the Divisions of General Internal Medicine (A.S.B.) and Infectious Diseases (M.N.A.-H.), Department of Medicine, University of South Carolina School of Medicine, Columbia
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Ramsey EG, Royer J, Bookstaver PB, Justo JA, Kohn J, Albrecht H, Al-Hasan MN. Seasonal variation in antimicrobial resistance rates of community-acquired Escherichia coli bloodstream isolates. Int J Antimicrob Agents 2019; 54:1-7. [DOI: 10.1016/j.ijantimicag.2019.03.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 02/21/2019] [Accepted: 03/09/2019] [Indexed: 12/23/2022]
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Foster RA, Troficanto C, Bookstaver PB, Kohn J, Justo JA, Al-Hasan MN. Utility of Combination Antimicrobial Therapy in Adults with Bloodstream Infections due to Enterobacteriaceae and Non-Fermenting Gram-Negative Bacilli Based on In Vitro Analysis at Two Community Hospitals. Antibiotics (Basel) 2019; 8:antibiotics8010015. [PMID: 30744080 PMCID: PMC6466593 DOI: 10.3390/antibiotics8010015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/05/2019] [Accepted: 02/06/2019] [Indexed: 12/02/2022] Open
Abstract
This study examined the utility of combination therapy for bloodstream isolates of Enterobacteriaceae and non-fermenting Gram-negative bacilli (NFGN) from adults at two community hospitals from January 2010 through to June 2015. Changes to in vitro antimicrobial susceptibilities by adding ciprofloxacin or gentamicin to third-generation cephalosporins (3GC) were examined overall and in patients with risk factors for 3GC resistance. Overall ceftriaxone susceptibility among Enterobacteriaceae was 996/1063 (94%) and 247/295 (84%) in patients with 3GC resistance risk factors. Susceptibilities increased marginally by adding ciprofloxacin or gentamicin (mean difference 2.4% (95% CI 1.5, 3.4) and 3.0% (95% CI 2.0, 4.0), respectively, overall and 5.4% (95% CI 2.8, 8.0) and 7.1% (95% CI 4.2, 10.1), respectively, in patients with risk factors). Eighty-three of 105 (79%) NFGN were susceptible to ceftazidime overall and 20/29 (69%) in patients with prior beta-lactam use. Overall mean increase in susceptibilities was 15.2% (95% CI: 8.3, 22.2) and 17.1% (95% CI: 9.8, 24.5) for ciprofloxacin and gentamicin combinations, respectively; and 27.6% (95% CI: 10.3, 44.9) for either one with recent beta-lactam use. In this setting, empirical combination therapy had limited utility for Enterobacteriaceae bloodstream isolates but provided significant additional antimicrobial coverage to ceftazidime for NFGN, particularly in patients with prior beta-lactam use.
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Affiliation(s)
- Rachel A Foster
- Department of Pharmacy, Intermountain Healthcare, Murray, UT 84107, USA.
| | - Casey Troficanto
- Department of Pharmacy, Prisma Health Baptist Hospital, Columbia, SC 29220, USA.
| | - P Brandon Bookstaver
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC 29208, USA.
- Department of Pharmacy, Prisma Health Richland Hospital, Columbia, SC 29203, USA.
| | - Joseph Kohn
- Department of Pharmacy, Prisma Health Richland Hospital, Columbia, SC 29203, USA.
| | - Julie Ann Justo
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC 29208, USA.
- Department of Pharmacy, Prisma Health Richland Hospital, Columbia, SC 29203, USA.
| | - Majdi N Al-Hasan
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC 29208, USA.
- University of South Carolina School of Medicine, Columbia, SC 29209, USA.
- Department of Medicine, Division of Infectious Diseases, Palmetto Health University of South Carolina Medical Group, Columbia, SC 29203, USA.
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Rac H, Gould A, Bookstaver PB, Justo JA, Kohn J, Al-Hasan MN. 1043. Evaluation of Early Clinical Failure Criteria for Gram-Negative Bloodstream Infections. Open Forum Infect Dis 2018. [PMCID: PMC6255120 DOI: 10.1093/ofid/ofy210.880] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Early identification of patients at high risk of morbidity and mortality following Gram-negative bloodstream infections (GN-BSI) based on initial clinical course may prompt adjustments to optimize diagnostic and treatment plans. This retrospective cohort study aims to develop early clinical failure criteria (ECFC) to predict unfavorable outcomes in patients with GN-BSI. Methods Adults with community-onset GN-BSI who survived hospitalization for at least 96 hours at Palmetto Health hospitals in Columbia, SC, USA from January 1, 2010 to June 30, 2015 were identified. Multivariate logistic regression was used to examine association between clinical variables within 72–96 hours of BSI and unfavorable outcomes (28-day mortality or hospital length of stay >14 days). Results Among 766 patients with GN-BSI, 225 (29%) had unfavorable outcomes. After adjustments for Charlson Comorbidity Index and appropriateness of empirical antimicrobial therapy in multivariate model, predictors of unfavorable outcomes included systolic blood pressure <100 mmHg or vasopressor use (adjusted odds ratio [aOR] 1.8, 95% confidence interval [CI] 1.1–2.5), heart rate >100/minute (aOR 1.7, 95% CI 1.1–2.5), respiratory rate ≥22/minute or mechanical ventilation (aOR 2.1, 95% CI 1.4–3.3), altered mental status (aOR 4.5, 95% CI 2.8–7.1), and peripheral WBC count >12 × 103/mm3 (aOR 2.7, 95% CI 1.8–4.1) at 72–96 hours from index BSI. Area under receiver operating characteristic curve of ECFC model in predicting unfavorable outcomes was 0.77 (0.84 and 0.71 in predicting 28-day mortality and prolonged hospitalization separately, respectively). Predicted 28-day mortality increased from 1% in patients with no ECFC to 3%, 7%, 16%, 32%, and 54% in presence of each additional criterion (P < 0.001). Predicted hospital length of stay was 7.5 days in patients without any ECFC and increased by 4.0 days (95% CI 3.1–4.9, P < 0.001) in presence of each additional criterion. Conclusion Risk of 28-day mortality or prolonged hospitalization can be estimated within 72–96 hours of GN-BSI using ECFC. These criteria may have utility in future clinical research in assessing response to antimicrobial therapy based on a standard evidence-based definition of early clinical failure. Disclosures P. B. Bookstaver, CutisPharma: Scientific Advisor, <$1,000. Melinta Therapeutics: Speaker’s Bureau, <$1,000.
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Affiliation(s)
- Hana Rac
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, South Carolina
| | - Alyssa Gould
- Novant Health Presbyterian Medical Center, Novant Health, Charlotte, North Carolina
| | - P Brandon Bookstaver
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, South Carolina
- Palmetto Health Richland, Columbia, South Carolina
| | - Julie Ann Justo
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, South Carolina
- Palmetto Health Richland, Columbia, South Carolina
| | - Joseph Kohn
- Palmetto Health Richland, Columbia, South Carolina
| | - Majdi N Al-Hasan
- Department of Medicine, Palmetto Health/ Univserity of South Carolina Medical Group, Columbia, South Carolina
- University of South Carolina School of Medicine, Columbia, South Carolina
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Younas M, Royer J, Rac H, Justo JA, Bookstaver PB, Weissman S, Maki A, Bell L, Waites KS, Dash S, Al-Hasan MN. 975. Clostridium difficile Infection and Antibiotic Prescription Rates in the Community: Explaining the Gender Gap. Open Forum Infect Dis 2018. [PMCID: PMC6252878 DOI: 10.1093/ofid/ofy209.091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Previous studies have reported higher incidence rates of community-associated Clostridium difficile infection (CA-CDI) in women than in men. This cross-sectional population-based study examines whether this difference in CA-CDI rates across genders is driven by or independent of antibiotic use. Methods Medicaid and State Employee Health Plan pharmacy claims for outpatient oral antibiotics and associated medical claims were utilized for estimation of community antibiotic prescription rates in South Carolina population 18 to 64 years of age from January 1, 2015 to December 31, 2015. CA-CDI cases were identified from National Healthcare Safety Network (NHSN) and South Carolina Infectious Disease and Outbreak Network (SCION) through complete enumeration of South Carolina population of the same age and study period as above. Incidence rates of CA-CDI were reported in both men and women 18–39 and 40–64 years of age before and after adjustments for antibiotic prescription rates in the same gender and age group. The 95% confidence intervals (CI) were calculated to examine statistical difference in incidence rates across genders within the same age group. Results During the calendar year 2015, a total of 1,564 CA-CDI cases were identified in South Carolina residents 18–64 years of age. The incidence rate of CA-CDI per 100,000 person-years was higher in women than in men in age groups 18–39 years (37.3 [95% CI: 32.8–41.8] vs. 21.0 [95% CI: 17.6–24.4]) and 40–64 years (86.4 [95% CI: 80.1–92.8] vs. 56.6 [95% CI: 51.2–61.9]. Similarly, antibiotic prescription rates per 100 person-years were higher in women than men in the 2 respective age groups (118.8 [95% CI: 118.3–119.3] vs. 54.3 [95% CI: 53.9–54.8] and 130.4 [95% CI: 129.8–130.9] vs. 83.8 [95% CI: 83.3–84.4]. After adjustments for antibiotic prescriptions, there was no significant difference in the incidence rates of CA-CDI per 100,000 prescriptions between women and men 18–39 years of age (31.4 [95% CI: 27.6–35.2] vs. 38.6 [95% CI: 32.4–44.8] and 40–64 years old (66.3 [95% CI 61.5–71.2] vs. 67.5 [95% CI: 61.1–73.8]). Conclusion Higher crude incidence rates of CA-CDI in women are likely due to higher outpatient antibiotic prescription rates in women when compared with men. Disclosures P. B. Bookstaver, CutisPharma: Scientific Advisor, <$1,000. Melinta Therapeutics: Speaker’s Bureau, <$1,000.
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Affiliation(s)
- Mariam Younas
- University of South Carolina School of Medicine, Columbia, South Carolina
- Department of Medicine, Palmetto Health/ Univserity of South Carolina Medical Group, Columbia, South Carolina
| | - Julie Royer
- South Carolina Revenue and Fiscal Affairs Office, Columbia, South Carolina
| | - Hana Rac
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, South Carolina
| | - Julie Ann Justo
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, South Carolina
| | - P Brandon Bookstaver
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, South Carolina
| | - Sharon Weissman
- University of South Carolina School of Medicine, Columbia, South Carolina
| | - Anton Maki
- South Carolina Department of Health and Environmental Control, Columbia, South Carolina
| | - Linda Bell
- South Carolina Department of Health and Environmental Control, Columbia, South Carolina
| | - Katie Stilwell Waites
- South Carolina Department of Health and Environmental Control, Columbia, South Carolina
| | - Sangita Dash
- University of South Carolina School of Medicine, Columbia, South Carolina
- Department of Medicine, Palmetto Health/ Univserity of South Carolina Medical Group, Columbia, South Carolina
| | - Majdi N Al-Hasan
- University of South Carolina School of Medicine, Columbia, South Carolina
- Department of Medicine, Palmetto Health/ Univserity of South Carolina Medical Group, Columbia, South Carolina
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Younas M, Royer J, Weissman S, Bell L, Maki A, Waites KS, Dash S, Al-Hasan MN. 475. Burden of Clostridium difficile Infection in South Carolina: A Population-Based Study. Open Forum Infect Dis 2018. [PMCID: PMC6254548 DOI: 10.1093/ofid/ofy210.484] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Methods Results Conclusion Disclosures
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Affiliation(s)
- Mariam Younas
- University of South Carolina School of Medicine, Columbia, South Carolina
- Department of Medicine, Palmetto Health/Univserity of South Carolina Medical Group, Columbia, South Carolina
| | - Julie Royer
- South Carolina Revenue and Fiscal Affairs Office, Columbia, South Carolina
| | - Sharon Weissman
- University of South Carolina School of Medicine, Columbia, South Carolina
- Department of Medicine, Palmetto Health/Univserity of South Carolina Medical Group, Columbia, South Carolina
| | - Linda Bell
- South Carolina Department of Health and Environmental Control, Columbia, South Carolina
| | - Anton Maki
- South Carolina Department of Health and Environmental Control, Columbia, South Carolina
| | - Katie Stilwell Waites
- South Carolina Department of Health and Environmental Control, Columbia, South Carolina
| | - Sangita Dash
- University of South Carolina School of Medicine, Columbia, South Carolina
- Department of Medicine, Palmetto Health/Univserity of South Carolina Medical Group, Columbia, South Carolina
| | - Majdi N Al-Hasan
- University of South Carolina School of Medicine, Columbia, South Carolina
- Department of Medicine, Palmetto Health/Univserity of South Carolina Medical Group, Columbia, South Carolina
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Al-Hasan MN, Justo JA. Ignoring the Elephant: Does the Infectious Diseases Society of America Support Sepsis-3 or Pre-sepsis Criteria? Clin Infect Dis 2018; 68:1431. [DOI: 10.1093/cid/ciy678] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Majdi N Al-Hasan
- University of South Carolina School of Medicine, Columbia, South Carolina
- Department of Medicine, Palmetto Health University of South Carolina Medical Group, Columbia, South Carolina
| | - Julie Ann Justo
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, South Carolina
- Department of Pharmacy, Palmetto Health Richland, Columbia, South Carolina
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Al-Jaghbeer MJ, Justo JA, Owens W, Kohn J, Bookstaver PB, Hucks J, Al-Hasan MN. Risk factors for pneumonia due to beta-lactam-susceptible and beta-lactam-resistant Pseudomonas aeruginosa: a case–case–control study. Infection 2018; 46:487-494. [DOI: 10.1007/s15010-018-1147-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 05/05/2018] [Indexed: 12/18/2022]
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Sartelli M, Kluger Y, Ansaloni L, Carlet J, Brink A, Hardcastle TC, Khanna A, Chicom-Mefire A, Rodríguez-Baño J, Nathwani D, Mendelson M, Watkins RR, Pulcini C, Beović B, May AK, Itani KMF, Mazuski JE, Fry DE, Coccolini F, Raşa K, Montravers P, Eckmann C, Abbo LM, Abubakar S, Abu-Zidan FM, Adesunkanmi AK, Al-Hasan MN, Althani AA, Ticas JEA, Ansari S, Ansumana R, da Silva ARA, Augustin G, Bala M, Balogh ZJ, Baraket O, Bassett,i M, Bellanova G, Beltran MA, Ben-Ishay O, Biffl WL, Boermeester MA, Brecher SM, Bueno J, Cainzos MA, Cairns K, Camacho-Ortiz A, Ceresoli M, Chandy SJ, Cherry-Bukowiec JR, Cirocchi R, Colak E, Corcione A, Cornely OA, Cortese F, Cui Y, Curcio D, Damaskos D, Daş K, Delibegovic S, Demetrashvili Z, De Simone B, de Souza HP, De Waele J, Dhingra S, Diaz JJ, Di Carlo I, Di Marzo F, Di Saverio S, Dogjani A, Dorj G, Dortet L, Duane TM, Dupont H, Egiev VN, Eid HO, Elmangory M, Marei HES, Enani MA, Escandón-Vargas K, Faro Junior MP, Ferrada P, Foghetti D, Foianini E, Fraga GP, Frattima S, Gandhi C, Gattuso G, Giamarellou E, Ghnnam W, Gkiokas G, Girardis M, Goff DA, Gomes CA, Gomi H, Gronerth RIG, Guirao X, Guzman-Blanco M, Haque M, Hecker A, Hell M, Herzog T, Hicks L, Kafka-Ritsch R, Kao LS, Kanj SS, Kaplan LJ, Kapoor G, Karamarkovic A, Kashuk J, Kenig J, Khamis F, Khokha V, Kiguba R, Kirkpatrick AW, Kørner H, Koike K, Kok KYY, Kon K, Kong V, Inaba K, Ioannidis O, Isik A, Iskandar K, Labbate M, Labricciosa FM, Lagrou K, Lagunes L, Latifi R, Lasithiotakis K, Laxminarayan R, Lee JG, Leone M, Leppäniemi A, Li Y, Liang SY, Liau KH, Litvin A, Loho T, Lowman W, Machain GM, Maier RV, Manzano-Nunez R, Marinis A, Marmorale C, Martin-Loeches I, Marwah S, Maseda E, McFarlane M, de Melo RB, Melotti MR, Memish Z, Mertz D, Mesina C, Menichetti F, Mishra SK, Montori G, Moore EE, Moore FA, Naidoo N, Napolitano L, Negoi I, Nicolau DP, Nikolopoulos I, Nord CE, Ofori-Asenso R, Olaoye I, Omari AH, Ordoñez CA, Ouadii M, Ouedraogo AS, Pagani L, Paiva JA, Parreira JG, Pata F, Pereira J, Pereira NR, Petrosillo N, Picetti E, Pintar T, Ponce-de-Leon A, Popovski Z, Poulakou G, Preller J, Guerrero AP, Pupelis G, Quiodettis M, Rawson TM, Reichert M, Reinhart K, Rems M, Rello J, Rizoli S, Roberts J, Rubio-Perez I, Ruppé E, Sakakushev B, Sall I, Kafil HS, Sanders J, Sato N, Sawyer RG, Scalea T, Scibé R, Scudeller L, Lohse HS, Sganga G, Shafiq N, Shah JN, Spigaglia P, Suroowan S, Tsioutis C, Sifri CD, Siribumrungwong B, Sugrue M, Talving P, Tan BK, Tarasconi A, Tascini C, Tilsed J, Timsit JF, Tumbarello M, Trung NT, Ulrych J, Uranues S, Velmahos G, Vereczkei AG, Viale P, Estape JV, Viscoli C, Wagenlehner F, Wright BJ, Xiao Y, Yuan KC, Zachariah SK, Zahar JR, Mergulhão P, Catena F. A Global Declaration on Appropriate Use of Antimicrobial Agents across the Surgical Pathway. Surg Infect (Larchmt) 2017; 18:846-853. [PMID: 29173054 DOI: 10.1089/sur.2017.219] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
This declaration, signed by an interdisciplinary task force of 234 experts from 83 different countries with different backgrounds, highlights the threat posed by antimicrobial resistance and the need for appropriate use of antibiotic agents and antifungal agents in hospitals worldwide especially focusing on surgical infections. As such, it is our intent to raise awareness among healthcare workers and improve antimicrobial prescribing. To facilitate its dissemination, the declaration was translated in different languages.
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Al-Hasan MN, Acker EC, Kohn JE, Bookstaver PB, Justo JA. Impact of Penicillin Allergy on Empirical Carbapenem Use in Gram-Negative Bloodstream Infections: An Antimicrobial Stewardship Opportunity. Pharmacotherapy 2017; 38:42-50. [DOI: 10.1002/phar.2054] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Majdi N. Al-Hasan
- University of South Carolina School of Medicine; Columbia South Carolina
- Department of Medicine; Palmetto Health USC Medical Group; Columbia South Carolina
| | - Emily C. Acker
- Department of Pharmacy; Cincinnati Children's Hospital; Cincinnati Ohio
| | - Joseph E. Kohn
- Department of Pharmacy; Palmetto Health Richland; Columbia South Carolina
| | - Paul Brandon Bookstaver
- Department of Pharmacy; Palmetto Health Richland; Columbia South Carolina
- Department of Clinical Pharmacy and Outcomes Sciences; University of South College of Pharmacy; Columbia South Carolina
| | - Julie Ann Justo
- Department of Pharmacy; Palmetto Health Richland; Columbia South Carolina
- Department of Clinical Pharmacy and Outcomes Sciences; University of South College of Pharmacy; Columbia South Carolina
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Battle SE, Augustine MR, Bookstaver PB, Watson CM, Owens W, Kohn J, Baddour LM, Al-Hasan MN. A Simplified Pitt Bacteremia Score (qPitt) to Predict Mortality in Patients with Gram-negative Bloodstream Infection. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.1445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Sharma N, Clark A, Derrick C, Al-Hasan MN, Weissman S, Sanasi-Bhola K. Microbiologic Predictors of Pelvic Osteomyelitis Related to Decubitus Ulcers. Open Forum Infect Dis 2017. [PMCID: PMC5631697 DOI: 10.1093/ofid/ofx163.083] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Management of pelvic osteomyelitis related to decubitus ulcers (PODU) remains challenging, whereas definitive therapy is based on blood, bone, or deep tissue cultures, empirical therapy prior to culture results may be indicated in patients with sepsis or cellulitis surrounding PODU. The objective of this retrospective case series is to develop an institutional protocol for empirical therapy of PODU when indicated based on local microbiology results. Methods Hospitalized adults with PODU from 1 August 2005 to 1 August 2015 at Palmetto Health hospitals in Columbia, SC were identified. PODU was defined based on clinical, radiographic, and microbiology criteria. Descriptive statistical methods (Fisher’s exact) were used for preliminary analysis. Results Seventy-five cases with PODU were included with a mean age of 53 years and male predominance (48; 64%). The most common comorbidities were paraplegia (45, 60%), diabetes (23, 31%) and previous strokes (17, 23%). Forty-nine cases (65%) received antibiotics within a year of PODU. Prior infections or colonization with P. aeruginosa within the past year was present in 24/75 (32%) cases. Most cases had multiple sources of cultures: blood (61; 81%), bone/deep tissue (37; 49%), and/or superficial (73; 97%). Among a total of 99 clinical isolates, 56 (57%) were Gram-positive cocci (GPC) and 43 (43%) were Gram-negative bacilli (GNB). The most common organisms were Enterobacteriaceae (26; 26%), coagulase negative staphylococci (CONS) (20, 20%), Stapylococcus aureus (19, 19%), [12 (12%) methicillin-resistant S. aureus], and P. aeruginosa (9, 9%). Of the Enterobacteriaceae, 69% (18/26) were susceptible to ciprofloxacin and 88% (23/26) to ceftriaxone. All cases (9/9) of PODU due to P. aeruginosa had a prior infection/colonization with P. aeruginosa within 1 year as compared with 15/66 (23%) in those with PODU due to other organisms (P = 0.001). Conclusion The microbiology of PODU is diverse (including GPC and GNB). Prior positive P. aeruginosa culture was a predictor of P. aeruginosa PODU. When empirical antimicrobial therapy is indicated, data support the use of intravenous vancomycin plus ceftriaxone in the absence of prior infection/colonization with P. aeruginosa, or intravenous vancomycin plus an anti-pseudomonal agent in the presence of prior P. aeruginosa within the past year. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Neha Sharma
- University of South Carolina School of Medicine, Columbia, South Carolina
| | - Abbye Clark
- University of South Carolina School of Medicine, Columbia, South Carolina
| | - Caroline Derrick
- University of South Carolina School of Medicine, Columbia, South Carolina
| | - Majdi N Al-Hasan
- University of South Carolina School of Medicine, Columbia, South Carolina
| | - Sharon Weissman
- University of South Carolina School of Medicine, Columbia, South Carolina
| | - Kamla Sanasi-Bhola
- University of South Carolina School of Medicine, Columbia, South Carolina
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Justo JA, Bookstaver PB, Kohn J, Albrecht H, Al-Hasan MN. Combination therapy vs. monotherapy for Gram-negative bloodstream infection: matching by predicted prognosis. Int J Antimicrob Agents 2017; 51:488-492. [PMID: 28919195 DOI: 10.1016/j.ijantimicag.2017.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/15/2017] [Accepted: 09/10/2017] [Indexed: 10/18/2022]
Abstract
The utility of empirical combination antimicrobial therapy for Gram-negative bloodstream infection (BSI) remains unclear. This retrospective, quasi-experimental matched cohort study examined the impact of empirical combination therapy on mortality in patients with Gram-negative BSI. Hospitalized adults with Gram-negative BSI from 1 January 2010 to 31 December 2013 at Palmetto Health Hospitals in Columbia, SC, USA were identified. Patients receiving combination therapy or beta-lactam monotherapy were matched 1:1 based on age, sex and Bloodstream Infection Mortality Risk Score (BSIMRS). Multivariate Cox proportional hazards regression with propensity score adjustment was used to examine overall 28-day mortality and within predefined BSIMRS categories (<5 and ≥5). A total of 380 patients receiving combination therapy or monotherapy for Gram-negative BSI were included in the study. Median age was 66 years and 204 (54%) were female. Overall, 28-day mortality in patients who received combination therapy and monotherapy was 13% and 15%, respectively (P = 0.51). After stratification by BSIMRS, mortality in both combination therapy and monotherapy groups was 1.1% in patients with BSIMRS <5 (P = 0.98) and 27% and 32%, respectively, in patients with BSIMRS ≥5 (P = 0.47). After adjusting for propensity to receive combination therapy, risk of mortality was not significantly different for combination therapy compared to monotherapy (hazard ratio [HR] 0.90, 95% confidence interval [CI] 0.51-1.60). This finding persisted for both subgroups of BSIMRS <5 (HR 0.96, 95% CI 0.04-24.28) and BSIMRS ≥5 (HR 0.83, 95% CI 0.46-1.48). There is no survival benefit from empirical combination therapy over monotherapy in patients with Gram-negative BSI, regardless of predicted prognosis at initial presentation.
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Affiliation(s)
- Julie Ann Justo
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, USA; Department of Pharmacy, Palmetto Health Richland, Columbia, SC, USA
| | - P Brandon Bookstaver
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, USA; Department of Pharmacy, Palmetto Health Richland, Columbia, SC, USA
| | - Joseph Kohn
- Department of Pharmacy, Palmetto Health Richland, Columbia, SC, USA
| | - Helmut Albrecht
- University of South Carolina School of Medicine, Columbia, SC, USA; Department of Medicine, Palmetto Health USC Medical Group, Columbia, SC, USA
| | - Majdi N Al-Hasan
- University of South Carolina School of Medicine, Columbia, SC, USA; Department of Medicine, Palmetto Health USC Medical Group, Columbia, SC, USA.
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Nimmich EB, Bookstaver PB, Kohn J, Justo JA, Hammer KL, Albrecht H, Al-Hasan MN. Development of Institutional Guidelines for Management of Gram-Negative Bloodstream Infections: Incorporating Local Evidence. Hosp Pharm 2017; 52:691-697. [PMID: 29276241 DOI: 10.1177/0018578717720506] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Appropriate empirical antimicrobial therapy is associated with improved outcomes of patients with Gram-negative bloodstream infections (BSI). Objective: Development of evidence-based institutional management guidelines for empirical antimicrobial therapy of Gram-negative BSI. Methods: Hospitalized adults with Gram-negative BSI in 2011-2012 at Palmetto Health hospitals in Columbia, SC, USA, were identified. Logistic regression was used to examine the association between site of infection acquisition and BSI due to Pseudomonas aeruginosa or chromosomally mediated AmpC-producing Enterobacteriaceae (CAE). Antimicrobial susceptibility rates of bloodstream isolates were stratified by site of acquisition and acute severity of illness. Retained antimicrobial regimens had predefined susceptibility rates ≥90% for noncritically ill and ≥95% for critically ill patients. Results: Among 390 patients, health care-associated (odds ratio [OR]: 3.0, 95% confidence interval [CI]: 1.5-6.3] and hospital-acquired sites of acquisition (OR: 3.7, 95% CI: 1.6-8.4) were identified as risk factors for BSI due to P aeruginosa or CAE, compared with community-acquired BSI (referent). Based on stratified bloodstream antibiogram, ceftriaxone met predefined susceptibility criteria for community-acquired BSI in noncritically ill patients (95%). Cefepime and piperacillin-tazobactam monotherapy achieved predefined susceptibility criteria in noncritically ill (95% both) and critically ill patients with health care-associated and hospital-acquired BSI (96% and 97%, respectively) and critically ill patients with community-acquired BSI (100% both). Conclusions: Incorporation of site of acquisition, local antimicrobial susceptibility rates, and acute severity of illness into institutional guidelines provides objective evidence-based approach for optimizing empirical antimicrobial therapy for Gram-negative BSI. The suggested methodology provides a framework for guideline development in other institutions.
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Affiliation(s)
| | - P Brandon Bookstaver
- College of Pharmacy, University of South Carolina, Columbia, USA.,Palmetto Health Richland, Columbia, SC, USA
| | | | - Julie Ann Justo
- College of Pharmacy, University of South Carolina, Columbia, USA.,Palmetto Health Richland, Columbia, SC, USA
| | | | - Helmut Albrecht
- University of South Carolina School of Medicine, Columbia, USA.,Palmetto Health USC Medical Group, Columbia, USA
| | - Majdi N Al-Hasan
- University of South Carolina School of Medicine, Columbia, USA.,Palmetto Health USC Medical Group, Columbia, USA
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Nelson AN, Justo JA, Bookstaver PB, Kohn J, Albrecht H, Al-Hasan MN. Optimal duration of antimicrobial therapy for uncomplicated Gram-negative bloodstream infections. Infection 2017; 45:613-620. [PMID: 28478600 DOI: 10.1007/s15010-017-1020-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/25/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Optimal antimicrobial treatment duration for Gram-negative bloodstream infection (BSI) remains unclear. This retrospective cohort study examined effectiveness of short (7-10 days) and long (>10 days) courses of antimicrobial therapy for uncomplicated Gram-negative BSI. METHODS Hospitalized adults with uncomplicated Gram-negative BSI at Palmetto Health hospitals in Columbia SC, USA from January 1, 2010 to December 31, 2013 were identified. Multivariate Cox proportional hazards regression with propensity score adjustment was used to examine risk of treatment failure in the two groups. RESULTS During the study period, 117 and 294 patients received short and long courses of antimicrobial therapy for uncomplicated Gram-negative BSI, respectively. Overall, the median age was 67 years, 258 (63%) were women, 282 (69%) had urinary source of infection, and 271 (66%) had BSI due to Escherichia coli. The median duration of antimicrobial therapy was 8.5 and 13.3 days in the short and long treatment groups, respectively. After adjustment for the propensity to use a short course of therapy, risk of treatment failure was higher in patients receiving short compared to long courses of antimicrobial agents (HR 2.60, 95% CI: 1.20-5.53, p = 0.02). Other risk factors for treatment failure included liver cirrhosis (HR 5.83, 95% CI: 1.89-15.02, p = 0.004) and immune compromised status (HR 4.30, 95% CI: 1.57-10.80, p = 0.006). Definitive antimicrobial therapy with intravenous or highly bioavailable oral agents was associated with reduced risk of treatment failure (HR 0.33, 95% CI: 0.14-0.73, p = 0.006). CONCLUSIONS The current results support common clinical practice of 2 weeks of antimicrobial therapy for uncomplicated Gram-negative BSI.
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Affiliation(s)
- Avery N Nelson
- University of South Carolina School of Medicine, 2 Medical Park, Suite 502, Columbia, SC, 29203, USA
| | - Julie Ann Justo
- Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, University of South Carolina, Columbia, SC, USA
- Department of Pharmacy, Palmetto Health Richland, Columbia, SC, USA
| | - P Brandon Bookstaver
- Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, University of South Carolina, Columbia, SC, USA
- Department of Pharmacy, Palmetto Health Richland, Columbia, SC, USA
| | - Joseph Kohn
- Department of Pharmacy, Palmetto Health Richland, Columbia, SC, USA
| | - Helmut Albrecht
- University of South Carolina School of Medicine, 2 Medical Park, Suite 502, Columbia, SC, 29203, USA
- Department of Medicine, Palmetto Health USC Medical Group, Columbia, SC, USA
| | - Majdi N Al-Hasan
- University of South Carolina School of Medicine, 2 Medical Park, Suite 502, Columbia, SC, 29203, USA.
- Department of Medicine, Palmetto Health USC Medical Group, Columbia, SC, USA.
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