A5071896389- Antibiotic Use and Resistance
- Antibiotics Pharmacokinetics and Efficacy
- Antimicrobial Resistance in Staphylococcus
- Pneumonia and Respiratory Infections
- Urinary Tract Infections Management
- Telemedicine and Telehealth Implementation
- Bacterial Identification and Susceptibility Testing
- Pediatric Urology and Nephrology Studies
- Patient Satisfaction in Healthcare
- Healthcare Systems and Technology
- Pharmacological Effects and Toxicity Studies
- Analytical Methods in Pharmaceuticals
- Urinary Bladder and Prostate Research
- Epilepsy research and treatment
- Antibiotic Resistance in Bacteria
- Neuroscience and Music Perception
- Thermal Regulation in Medicine
- Neutropenia and Cancer Infections
- Health Systems, Economic Evaluations, Quality of Life
- Neural dynamics and brain function
- Diverse Music Education Insights
- Pharmaceutical Practices and Patient Outcomes
- Infection Control in Healthcare
- Music and Audio Processing
- Pelvic floor disorders treatments
Intermountain Healthcare
2018-2025
Intermountain Medical Center
2017-2025
Loma Linda University
2016-2021
University of Florida
2018
Columbus Oncology and Hematology Associates
2018
Cotton (United States)
2017
Louis Stokes Cleveland VA Medical Center
2014
Abstract Background Shorter antibiotic courses are non-inferior to longer for treatment of uncomplicated gram-negative bacteremia (GNB). This study evaluated the impact a pharmacist-driven stewardship effort use clinical decision support software (CDSS; ILÚM Insight, Infectious Diseases Connect, Inc.) plus an evidence-based algorithm on duration therapy (DOT) GNB in UPMC health system, USA. Methods retrospective cohort utilized CDSS alerts Enterobacterales adults from March August 2022...
Data are lacking to guide management of asymptomatic bacteriuria (ASB) in elderly patients with a fall. Comparing treated versus non-treated patients, we identified clear harm and no benefit from antibiotic treatment. Our data support IDSA recommendations withhold antibiotics ASB evaluate alternative causes falls.
Of 313 patients whose outpatient parenteral antimicrobial therapy was managed by an ID physician, only 39 [12.5%, 95% CI (8.8%-16.1%)] had clinical decisions influenced erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), or both. ESR/CRP ordering associated with $530 in excess cost per treatment course (average duration 5.1 weeks) representing a diagnostic stewardship opportunity.
The objective of this retrospective study was to compare the rates treatment failure, which a composite clinical and microbiologic patients receiving vancomycin β-lactam those only for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. Patients 16 89 years age with MRSA bacteremia admitted university-affiliated hospital from 1 January 2014 31 December 2016 were screened inclusion. eligible if they received >48 h (combination group) or (standard within 48 after onset. A total 182...
Telehealth improves access to infectious diseases (ID) and antibiotic stewardship (AS) services in small community hospitals (SCHs), but the optimal model has not been defined. We describe implementation impact of an integrated ID telehealth (IDt) service for 16 SCHs Intermountain Healthcare system.
Robust data are lacking regarding the optimal route, duration, and antibiotic choice for gram-negative bloodstream infection from a complicated urinary tract source (GN-BSI/cUTI). In this multicenter observational cohort study, we simulated 4-arm registry trial using causal inference method to compare effectiveness of following regimens GN-BSI/cUTI: complete course an intravenous β-lactam (IVBL) or oral stepdown therapy within 7 days fluoroquinolones (FQs), trimethoprim-sulfamethoxazole...
Limited data exist regarding optimal dosing of ceftazidime/avibactam (C/A) in patients with unique physiology, who were excluded from published clinical trials. Data are also lacking efficacy C/A infections due to multidrug-resistant gram-negative pathogens. To expand knowledge these areas, we present pharmacokinetic two Klebsiella pneumoniae carbapenemase (KPC)-producing K. bloodstream infections, both whom had renal impairment, and one was morbidly obese. initiated at higher doses than...
Abstract Dosing vancomycin in critically ill patients often results subtherapeutic and supratherapeutic trough concentrations. In this retrospective study, we compared the time to goal attainment incidence of acute kidney injury intensive care unit (ICU) whose was dosed by a pharmacy pharmacokinetic (PK) dosing monitoring service standard care. Three‐hundred fifty adult ICU at Level 1 trauma, teaching hospital who received for >24 hours from February 1, 2016, November 30, were screened....
Background: Urinary tract infections (UTIs) are over-diagnosed and over-treated in the emergency department (ED) leading to unnecessary antibiotic exposure avoidable side effects. However, data describing effective large-scale antimicrobial stewardship program (ASP) interventions improve UTI asymptomatic bacteriuria (ASB) management ED lacking. Methods: We implemented a multifaceted intervention across 23 community hospital EDs Utah Idaho consisting of in-person education for prescribers,...
OBJECTIVE Optimization of vancomycin dosing is difficult in children, given rapid drug clearance and patient heterogeneity. We sought to evaluate the impact using individual pharmacokinetic parameters on time goal trough concentration pediatric oncology patients. METHODS A retrospective review was conducted assess unit at Loma Linda University Children's Hospital between January 2013 August (standard group [SDG]). These patients were compared those a prospective arm that used...
Standard piperacillin–tazobactam (P-T) dosing may be suboptimal in obesity, but high-dose regimens have not been studied. We prospectively evaluated the pharmacokinetics and pharmacodynamics of standard- P-T obese adult inpatients. Those receiving standard-dose with BMI ≥ 30 kg/m2 weighing 105–139 kg or 140 were given up to 6.75 g 9 every 6 h, respectively. Patients monitored closely for safety. Elimination phase blood samples drawn 28 patients on standard high doses calculate...
Abstract Background Infectious diseases (ID) and antimicrobial stewardship (AS) improve Staphylococcus aureus bacteremia (SAB) outcomes. However, many small community hospitals (SCHs) lack on-site access to these services, it is not known if ID telehealth (IDt) offers the same benefit for SAB. We evaluated impact of an integrated IDt service on SAB outcomes in 16 SCHs. Methods An offering physician consultation plus pharmacist surveillance was implemented October 2016. Patients treated SCHs...
Antibiotic stewardship interventions are urgently needed to reduce antibiotic overuse in hospitalized COVID-19 patients, particularly small community hospitals (SCHs), who often lack access infectious diseases (ID) and resources. We implemented multidisciplinary tele-COVID rounds plus tele-antibiotic surveillance 17 SCHs standardize COVID management evaluate concurrent antibiotics for discontinuation. use was compared the 4 months preintervention versus 10 postintervention. Interrupted...
Fluoroquinolones (FQs) are effective for oral step-down therapy gram-negative bloodstream infections but associated with unfavorable toxic effects. Robust data lacking trimethoprim-sulfamethoxazole (TMP-SMX) and high-bioavailability β-lactams (HBBLs). In this multicenter observational cohort study, we simulated a 3-arm registry trial using causal inference methods to compare the effectiveness of FQs, TMP-SMX, or HBBLs therapy. The study included adults treated between January 2016 December...
Innovative strategies are needed for ASP implementation in SCHs (<200 beds). Most lack ASPs that meet Joint Commission (JC) requirements and CDC core elements. Telehealth can help extend infectious diseases expertise stewardship resources to such facilities. The Infectious Diseases (IDt) program provides consultation support 16 Intermountain (18-150 Key stakeholders were identified at each site establish formal ASPs. An IDt physician pharmacist attended local meetings as members provide...
Narrative Abstract The optimal management of bacteriuria/pyuria clinically undetermined significance (BPCUS) is unknown. Among 220 emergency department patients prescribed antibiotics for BPCUS, we found frequent readmissions, which were mitigated by outpatient follow-up visits. Observation and an unknown diagnosis should be emphasized over due to high likelihood readmissions.