A5038828923- Antibiotic Use and Resistance
- Bacterial Identification and Susceptibility Testing
- Antibiotics Pharmacokinetics and Efficacy
- Antimicrobial Resistance in Staphylococcus
- Nosocomial Infections in ICU
- Antibiotic Resistance in Bacteria
- Patient Satisfaction in Healthcare
- Urinary Tract Infections Management
- Burn Injury Management and Outcomes
- Cardiac Arrest and Resuscitation
- Pneumonia and Respiratory Infections
- Streptococcal Infections and Treatments
- Neutropenia and Cancer Infections
- Sepsis Diagnosis and Treatment
- Clostridium difficile and Clostridium perfringens research
- Disaster Response and Management
- Neonatal and Maternal Infections
- Neonatal Health and Biochemistry
- Blood disorders and treatments
- Drug-Induced Adverse Reactions
- Surgical site infection prevention
- Pharmaceutical Practices and Patient Outcomes
- Birth, Development, and Health
- Job Satisfaction and Organizational Behavior
- Mycobacterium research and diagnosis
University of Toronto
2010-2021
Sunnybrook Health Science Centre
2012-2021
Health Sciences Centre
2012-2021
Sunnybrook Research Institute
2015-2017
Office of Infectious Diseases
2016
Sunnybrook Hospital
2015
3M (United States)
2009-2014
SKEMA Business School
2012
Children's Hospital
2012
Society for Healthcare Epidemiology of America
2012
We aimed to rigorously evaluate the impact of prospective audit and feedback on broad-spectrum antimicrobial use among critical care patients.Prospective, controlled interrupted time series.Single tertiary center with 3 intensive units.A formal review all patients their third or tenth day antibiotic therapy was conducted, suggestions for optimization were communicated team.The primary outcome (days per 1000 patient-days; secondary outcomes included overall use, gram-negative bacterial...
β-lactam allergy skin testing (BLAST) is recommended by antimicrobial stewardship program (ASP) guidelines, yet few studies have systematically evaluated its impact when delivered at point of care. We conducted a pragmatic multicenter prospective evaluation the use point-of-care BLAST ASPs. In staggered 3-month intervals, ASP teams 3 hospitals received training allergists to offer for eligible patients with infectious diseases receiving nonpreferred therapy due severity their reported...
Prophylactic antimicrobial therapy is frequently prescribed for acute aspiration pneumonitis, with the intent of preventing development pneumonia. However, few clinical studies have examined benefits and harms this practice.A retrospective cohort study design was used to compare outcomes patients pneumonitis who received prophylactic those managed supportive care only during initial 2 days following macroaspiration. The primary outcome in-hospital mortality within 30 days. Secondary included...
A successful day 3 intensive care unit antimicrobial audit-andfeedback program was expanded hospital-wide, with high rates of orders reviewed, suggestions made, and advice accepted, resulting in a reduction targeted broad-spectrum antibiotic use among those qualifying for the intervention. Our objective to rigorously evaluate impact an stewardship audit-and-feedback intervention, via stepped-wedge randomized trial. An effective (ICU) rolled out 6 non-ICU services sequence. The primary...
Abstract Introduction Empiric antimicrobial selection for critical care infections must balance the need timely adequate coverage with resistance pressure exerted by broadspectrum agents. We estimated potential of weighted incidence syndromic combination antibiograms (WISCAs) to improve time infections. In contrast traditional antibiograms, WISCAs display likelihood a specific infectious syndrome (rather than individual pathogens), and also take into account poly-microbial use multi-drug...
Inappropriate antimicrobial use can promote resistance, which is associated with increased patient morbidity and mortality. Identifying the pattern of provide data from targeted stewardship interventions be made. The primary objective was to identify prevalence at a tertiary care teaching hospital both acute long-term patients.A point study conducted on July 19th, 2012. Data utilization, indication for prescribing, duration therapy, frequency infectious disease or consultations were...
Discontinuing routine processing of screening urine cultures prior to elective joint arthroplasty resulted in substantial reduction ordered and antimicrobial prescriptions for asymptomatic bacteriuria, without any significant impact on incidence prosthetic infection. This simple change would be scalable across institutions with potential healthcare savings.
Variability in neonatal vancomycin pharmacokinetics and the lack of consensus for optimal trough concentrations intensive care units pose challenges to dosing neonates. Our objective was determine neonates evaluate regimens identify whether practical initial recommendations that targeted most commonly used could be determined. Fifty who received with at least one set steady-state levels were evaluated retrospectively. Mean pharmacokinetic values determined using first-order equations, Monte...
Abstract Background Timely selection of adequate empiric antibiotics has become increasingly difficult due to rising resistance rates and the competing desire apply antimicrobial stewardship (AMS) principles. Individualized clinical prediction models offer promise reducing broad-spectrum antibiotic use preserving/improving adequacy treatment, but few have been validated in setting. Methods Multivariable were used predict probability susceptibility for gram-negative (GN) bacteria bloodstream...
Antimicrobial resistance (AMR) constitutes an international public health threat widely believed to result from excessive antimicrobial use (AMU). Numerous authorities have recommended stewardship programs (ASPs) curb the selection of AMR, but there is a lack data confirming this benefit.A controlled interrupted time-series study spanning 14 years was performed assess impact comprehensive hospital-based ASP that included pharmacist-led audit and feedback on institutional AMR. Patient-level...
Delaying appropriate antimicrobial therapy for critically ill patients increases the risk of death. Currently, there are insufficient data to guide initial vancomycin dosing undergoing continuous venovenous hemodialysis (CVVHD).To develop practical recommendations vancomycin, based on pharmacokinetics this drug in CVVHD.A chart review was conducted 24 adult who had undergone concurrent CVVHD and therapy. Mean pharmacokinetic parameters were determined, along with that targeted steady-state...
Antimicrobial stewardship may be important in long-term care facilities because of unnecessary or inappropriate antibiotic use observed these residents, coupled with their increased vulnerability to health care-associated infections.To assess a facility order identify potential antimicrobial needs.A retrospective descriptive study was conducted at the Veterans Centre, Sunnybrook Health Sciences Toronto, Ontario. All residents taking one more antibiotics (n = 326) were included as...
Medication errors may occur more frequently at discharge, making discharge counselling a vital facet of medication reconciliation. Discharge is recognized patient safety initiative for which pharmacists have appropriate expertise, but data are lacking about the barriers to provision this service adult inpatients by pharmacists.To determine proportion eligible patients who received counselling, quantify perceived preventing from performing and relative frequency associated time...
Abstract Background A patient’s prior cultures can inform the subsequent risk of infection from resistant organisms, yet prescribers often fail to incorporate these results into their empiric antibiotic selection. Given that timely initiation adequate antibiotics has been associated with improved outcomes, there is an urgent need address this gap. Methods In order better culture in selection antibiotics, we performed a pragmatic, prospective, hospital-wide intervention: (1) prescriptions...
To reduce selective pressure for antimicrobial resistance, empirical use of antipseudomonal antibiotics is often reserved patients with late-onset hospital-acquired infections. We examined the likelihood isolating Pseudomonas aeruginosa as a function time from hospital admission. conducted retrospective cohort study all positive bacterial cultures in tertiary-care between March 2010 and November 2011. The primary outcome was proportion yielding P. aeruginosa. Multivariable logistic...
Endocarditis is a rare but serious infection observed in about 8% of patients infected with Listeria monocytogenes. According to Antolin and others, there had been 68 case reports up 2008. The reported mortality rate for this infection, which has ranged from 37% 50%, decreased appreciably recent decades. monocytogenes an aerobic, gram-positive coccobacillus. organism may be isolated soil, dust, animal feed, water, sewage, the tissues or fluids almost any type animal. It frequently found raw...
Patients with good renal function receiving intermittent-infusion vancomycin (IIV) may require total daily doses ≥4 g to achieve trough concentrations of 15-20 mg/L, increasing the risk vancomycin-associated nephrotoxicity. Continuous-infusion (CIV) be associated a lower nephrotoxicity compared IIV, but studies comparing safety both dosing strategies are lacking.To compare CIV versus IIV when target concentration ranges were same modalities.A retrospective multicentre matched cohort study...