A5030155907- Antibiotic Use and Resistance
- Antimicrobial Resistance in Staphylococcus
- Antifungal resistance and susceptibility
- Neutropenia and Cancer Infections
- Antibiotics Pharmacokinetics and Efficacy
- Fungal Infections and Studies
- Clostridium difficile and Clostridium perfringens research
- Patient Satisfaction in Healthcare
- Bacterial Identification and Susceptibility Testing
- Antibiotic Resistance in Bacteria
- Sepsis Diagnosis and Treatment
- Urinary Tract Infections Management
- Healthcare Systems and Technology
- Pneumonia and Respiratory Infections
- Cytomegalovirus and herpesvirus research
- Long-Term Effects of COVID-19
- Colorectal Cancer Surgical Treatments
- Immunodeficiency and Autoimmune Disorders
- Orthopedic Infections and Treatments
- Surgical site infection prevention
- Mycobacterium research and diagnosis
- Viral-associated cancers and disorders
- Blood disorders and treatments
- Cardiac, Anesthesia and Surgical Outcomes
- Clinical Reasoning and Diagnostic Skills
Providence Health & Services
2025
Pacific University Oregon
2019-2023
Providence St. Vincent Medical Center
2022
Pacific University
2022
Oregon Health & Science University
2016-2019
Oregon State University
2016-2019
Engineering Associates (United States)
2018
Jacobs (United States)
2016
Adams State University
2016
Abstract Objectives To identify the frequency with which antibiotics are prescribed in absence of a documented indication ambulatory care setting, to quantify potential effect on assessments appropriateness antibiotics, and understand patient, provider, visit level characteristics associated antibiotic prescribing without indication. Design Cross sectional study. Setting 2015 National Ambulatory Medical Care Survey. Participants 28 332 sample visits representing 990.9 million nationwide....
In Pseudomonas aeruginosa, fluoroquinolone exposure promotes resistance to carbapenems through upregulation of efflux pumps and transcriptional downregulation the porin OprD. Evidence this effect among hematologic malignancy (HM) patients or hematopoietic cell transplant (HCT) recipients receiving prophylaxis for neutropenia is lacking.We retrospectively evaluated episodes P. aeruginosa bloodstream infections in HM HCT over a 7-year period at our institution. We determined association time...
Abstract Background The impact of remdesivir (RDV) on mortality rates in coronavirus disease 2019 (COVID-19) is controversial, and the effect subgroups baseline severity has been incompletely explored. purpose this study was to assess association RDV with patients COVID-19. Methods In retrospective cohort we compared persons receiving those best supportive care (BSC). Patients hospitalized between 28 February May 2020 laboratory-confirmed severe acute respiratory syndrome 2 infection were...
Abstract Background Antimicrobial use surveillance data within National Healthcare Safety Network (NHSN) uses patient care location mapping to define locations and inform risk adjustment. During the COVID-19 public health emergency, many hospitals changed how beds were utilized. This study compares changes over time a statewide hospital antimicrobial stewardship collaborative during emergency.Figure 1.Frequency of Facilities by Change in Total Beds from 2019 In this analysis, each facility's...
To evaluate clinical and economic outcomes associated with the use of isavuconazole as antifungal prophylaxis in high-risk immunocompromised patients.Retrospective, single-centre cohort study patients who received prophylaxis. Outcomes assessed included breakthrough IFI, early discontinuation for any reason prescribed at discharge. The impact on inpatient drug expenditure was evaluated using current posaconazole costs per observed days therapy (DOT) during period.One hundred thirty-eight...
This study aimed to assess understanding of antibiotic resistance and evaluate use themes among the general public. In March 2018, respondents that were ≥21 years old residing in United States recruited from ResearchMatch.org surveyed collect data on respondent expectations, knowledge, opinions regarding prescribing antibiotics resistance. Content analysis was used code open-ended definitions into central themes. Chi-square tests differences between use. Among 657 respondents, nearly all...
Posaconazole is used for prophylaxis invasive fungal infections (IFIs) among patients with hematologic malignancies. We compared the incidence of breakthrough IFIs and early discontinuation between receiving delayed-release tablet oral suspension formulations posaconazole.
OBJECTIVE To assess general medical residents’ familiarity with antibiograms using a self-administered survey DESIGN Cross-sectional, single-center PARTICIPANTS Residents in internal medicine, family and pediatrics at an academic center METHODS Participants were administered anonymous our institution during regularly scheduled educational conferences between January May 2012. Questions collected data regarding demographics, professional training; further open-ended questions assessed...
Antimicrobial susceptibility testing (AST) is often needed prior to antimicrobial optimization for patients with gram-negative bloodstream infections (GN-BSIs). Rapid AST (rAST) in combination stewardship (AS) may decrease time administration of narrower antibiotics.This was a prospective, nonblinded, randomized trial evaluating the impact phenotypic rAST method vs conventional (cAST) hospitalized GN-BSI and source control. The primary outcome narrowest effective therapy.Two hundred...
Abstract Background Treating viral upper respiratory infections (URI) with antibiotics is a major contributor to the rise of antimicrobial resistance. Major drivers unnecessary prescribing are patient’s expectation receive an antibiotic for acute illness and physician’s desire provide satisfactory care. Our objective was determine whether receiving prescription URI associated increased patient satisfaction. Methods We identified emergency department (ED) ambulatory visit (AC) visits...
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Abstract Background Current Infectious Disease Society of America guidelines recommend anti-methicillin-resistant Staphylococcus aureus(MRSA) agents for treatment community-acquired pneumonia (CAP) only in specific high-risk patients. There are limited data on duration vancomycin use that is appropriate hospitalized patients with CAP. The objective this study was to evaluate the CAP among inpatients. Methods We conducted a retrospective cohort inpatients at Oregon Health and Science...
Abstract Background Urine cultures to confirm a urinary tract infection (UTI) are not consistently collected in the primary care setting; thus estimates of prevalence resistance uropathogens may be biased. As part an ongoing study, microbiologic were for all patients presenting with uncomplicated UTI at clinics over six-month period assess potential misclassification frequency resistance. Methods Data from electronic health record repository used identify clinic encounters women diagnosis...
Outcomes of CMV infection among HSCT recipients likely vary by patient population and treatment modality. However, data on these outcomes have been reported relatively few centers. This was a retrospective cohort study allogenic age ≥18 years at Oregon Health Science University Hospital (OHSU) between 2010–2015. During the period, OHSU standard practice to preemptively treat CMV-viremic patients (quantitative PCR assay ≥ 200 copies/mL or consecutive assays <200 copies/mL) with first-line...
Fluoroquinolone (FQ) exposure has been reported to induce Pseudomonas aeruginosa cross-resistance specifically carbapenems (CP) in vitro but vivo data are lacking. The purpose of this study was determine the impact FQ prophylaxis for high-risk neutropenia on emergence CP-resistant P. infections. We conducted a retrospective review bacteremia adult patients with hematologic malignancies at Oregon Health and Science University (OHSU) between January 01, 2015 May 2017. Levofloxacin administered...
Isavuconazole (ISA) is a once-daily, extended-spectrum triazole approved for treatment of invasive aspergillosis and mucormycosis. The pharmacokinetic profile, daily dosing, lack therapeutic drug monitoring (TDM) reduced cost make ISA promising option use as prophylaxis fungal infections (IFIs). We report our experience with IFI in high-risk hematologic malignancy patients. In August 2016, replaced posaconazole (POS) at 576-bed academic medical center order to contain costs. was restricted...
Abstract Background Posaconazole is effective prophylaxis for invasive fungal infections (IFIs). We compared incidence of breakthrough IFI (bIFI) and early posaconazole discontinuation between patients receiving delayed-release tablet oral suspension formulations. Methods This was a retrospective cohort study at Oregon Health & Science University Hospital 1/1/2010 6/30/2016. Oral the preferred formulation until 2/2014; afterwards preferred. included all courses primary each patient...
Patients undergoing hematopoietic stem cell transplant (HSCT) are at high risk of developing Clostridium difficile infection (CDI), in part due to routine exposure broad-spectrum antimicrobial therapy for prevention infection. Limited data suggest oral vancomycin (VAN) may be effective preventing recurrent CDI (rCDI) among patients with a history receiving systemic therapy. However, there is no published literature supporting this strategy prevent rCDI HSCT. We conducted single-center...
Antibiotic use metrics are utilized by antimicrobial stewardship programs to benchmark performance against peer institutions and inform efforts. Benchmarking requires risk adjustment for patient- facility-level factors so that remaining differences attributable only prescribing practices. Antibiotics the treatment of methicillin-resistant Staphylococcus aureus (MRSA) one most frequently used drug classes. Our objective was identify predictors anti-MRSA antibiotic in a nationwide network...
Up to 44% of women who experience a urinary tract infection (UTI) develop recurrent (rUTI) within one year. Insufficient evidence about risk factors for recurrence limits clinicians’ ability identify at rUTI may benefit from further interventions. We conducted retrospective cohort study age ≥18 years presented treatment UTI Oregon Health & Science University ambulatory care clinics between 2011 and 2016. Pregnant as well those with recent catheter, genitourinary (GU) procedure, or...
Abstract Background Assessing appropriateness of hospital antibiotic use is typically a labor-intensive task for antimicrobial stewardship teams and relies heavily on clinician judgement rather than systematic process. Vancomycin frequently used agent that common target. We developed an algorithm to automatically classify the vancomycin days therapy (DOTs) based upon electronic health record data. Methods constructed retrospective cohort Oregon Health Science University (OHSU) Hospital...
Abstract Background Dalbavancin is an intravenous (IV) long acting lipoglycopeptide approved for use in acute bacterial skin and structure infections (ABSSSI). However, given the prolonged half-life, there interest using this agent as alternative therapy patients unable or unwilling to comply with conventional IV therapy. These include off-label treatment of deeper-seated such infective endocarditis osteomyelitis. This case series assesses efficacy safety dalbavancin its role serious...