A5029829854- Antibiotic Use and Resistance
- Pneumonia and Respiratory Infections
- Streptococcal Infections and Treatments
- Antimicrobial Resistance in Staphylococcus
- Bacterial Identification and Susceptibility Testing
- Emergency and Acute Care Studies
- Respiratory and Cough-Related Research
- Patient Satisfaction in Healthcare
- Appendicitis Diagnosis and Management
- Infective Endocarditis Diagnosis and Management
- Neonatal and Maternal Infections
- Pediatric Urology and Nephrology Studies
- Healthcare Systems and Technology
- Sepsis Diagnosis and Treatment
- Antibiotics Pharmacokinetics and Efficacy
- Orthopedic Infections and Treatments
- Intraperitoneal and Appendiceal Malignancies
- Pharmaceutical studies and practices
- Nosocomial Infections in ICU
- Intestinal Malrotation and Obstruction Disorders
- Respiratory viral infections research
- Bacterial Infections and Vaccines
- Kawasaki Disease and Coronary Complications
- Urinary Tract Infections Management
- Diet and metabolism studies
George Washington University
2018-2025
Children's National
2016-2025
National Hospital
2019-2025
Milken Institute
2020-2025
National Research Institute
2024
University of Alabama at Birmingham
2024
Ain Shams University
2018-2023
New York Proton Center
2022-2023
Communities In Schools of Orange County
2022-2023
Manhattan Institute for Policy Research
2022-2023
In 2002, we reported our preliminary experience using the ketogenic diet (KD) for predominantly intractable infantile spasms (IS) in 23 infants. Since that time, have increased use of KD this condition including those with new-onset IS.Infants were referred and prospectively started on traditional from 1996 to 2009 at institution. Included subjects had documented clinical IS, hypsarrhythmia electroencephalography (EEG), parental consent start KD. Efficacy was assessed through phone...
Abstract Objective: Characterization and assessment of Department Defense’s (DoD’s) Antibiotic Stewardship Programs (ASPs) to determine adherence Centers for Disease Control Prevention (CDC) Core Elements compare national Design: Retrospective, observational with supplemental survey Methods: Facility characteristics CDC (CE) data 2017–2021 were retrieved from the National Healthcare Safety Network’s (NHSN) annual hospital DoD Defense Health Agency Resistance Patient Portal. An online was...
OBJECTIVE: Kidney stones are an adverse event with the ketogenic diet (KD), occurring in ∼6% of children who started on this therapy for intractable epilepsy. Potassium citrate (Polycitra K) is a daily oral supplement that alkalinizes urine and solubilizes calcium, theoretically reducing risk kidney stones. METHODS: Children KD from 2000 to 2008 at Johns Hopkins Hospital, least 1 month follow-up, were evaluated (N = 313). From 2005, treated Polycitra K 2 mEq/kg per day only setting...
Abstract Background Studies estimate that 30%–50% of antibiotics prescribed for hospitalized patients are inappropriate, but pediatric data limited. Characterization inappropriate prescribing practices children is needed to guide antimicrobial stewardship. Methods Cross-sectional analysis antibiotic at 32 children’s hospitals in the United States. Subjects included with ≥ 1 order 8:00 am on day per calendar quarter, over 6 quarters (quarter 3 2016–quarter 4 2017). Antimicrobial stewardship...
Abstract Background Children and young adults were initially reported as largely spared from severe complications of SARS-CoV-2 infection, but the impact to this population has been significant. Methods This observational retrospective cohort study includes 420 symptomatic children with lab confirmed infection treated between March 15 June 16, 2020 at Children’s National Hospital in Washington DC. We identified compared cohorts non-hospitalized (N=324) hospitalized (N=96) patients, including...
BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is associated with high rates of treatment failure in adults. The epidemiology, clinical outcomes, and risk factors for MRSA children are poorly understood. METHODS: Multicenter, retrospective cohort study ≤18 years hospitalized across 3 tertiary care children’s hospitals from 2007 to 2014. Treatment was defined as persistent >3 days, recurrence within 30 or attributable 30-day mortality. Potential failure,...
Abstract Objective: Successfully educating urgent care patients on appropriate use and risks of antibiotics can be challenging. We assessed the conscious subconscious impact various educational materials (informational handout, priming poster, commitment poster) had patients’ knowledge expectations regarding antibiotics. Design: Stratified Block Randomized Control Trial. Setting: Urgent centers (UCCs) in Colorado, Florida, Georgia, New Jersey. Participants: patients. Methods: randomized 29...
Abstract Objective: Urgent care centers (UCCs) have reported high rates of antibiotic prescribing for acute respiratory tract infections. Prior UCC studies generally been limited to single networks. Broadly generalizable stewardship efforts targeting common diagnoses are needed. This study examines the effectiveness an intervention in reducing inappropriate bronchitis and viral upper infections (URTIs) UCCs. Design: A quality improvement comparing UCCs after introduction intervention....
Abstract Background Urgent care centers (UCCs) have previously been associated with high rates of inappropriate antibiotic prescribing without supporting appropriate diagnoses. Prior stewardship studies in urgent settings generally limited to pediatric clinics and diagnoses or conducted within single networks. Broadly generalizable efforts targeting common across ages are needed. Methods This quality improvement study's participants were UCC clinicians from a national collaborative 49 UCCs...
Abstract Background The utility of follow-up blood cultures (FUBCs) in children with a gram-negative rod (GNR) bacteremia is unclear. A prior pediatric study showed that FUBC positivity rate was 21%. Many adult studies have demonstrated not always necessary the setting UTI. Primary objectives were to determine 1. follow up gram negative 2. To understand clinical risk factors associated bacteremia.Figure 1Flowchart depicting chart analysis Methods retrospective cohort patients < 21...
Introduction Pediatric low-grade glioma (LGG) is a World Health Organization (WHO) Global Initiative for Childhood Cancer (GICC) index tumor constituting up to third of pediatric central nervous system (CNS) tumors. The baseline characteristics, survival, and management resources LGG in Africa are unknown. We aimed evaluate the neuro-oncology multidisciplinary team resources, epidemiology, survival outcomes document information prior GICC implementation. Methods study consisted two parts:...
ABSTRACT Background Campylobacter jejuni is a leading pathogen causing gastroenteritis in humans. Invasive C. strains crossing the gut-blood barrier can cause bacteremia. Despite its microaerophilicity (preferring <5% O 2 atmosphere), hyper-aerotolerant (HAT) has recently been isolated from intestines poultry and Elevated aerotolerance may enhance survival ecosystem, thereby promoting transmission. However, invasive HAT isolates of have not reported bacteremia Case Summary A strain...
Abstract Objective: Evaluate Department of Defense (DoD) antimicrobial stewardship programs (ASPs) by assessing the relationship between key clinical outcome metrics (antibiotic use, incidence resistant pathogens, and Clostridioides difficile infections) CDC Core Element (CE) adherence. Design: Retrospective, cross-sectional study DoD hospitals in 2018 2021 Methods: National Healthcare Safety Network Standardized Antimicrobial Administration Ratios (SAARs) were used to measure antibiotic use...
OBJECTIVE In children with urinary tract anomalies, febrile infections (UTIs) are associated increased risks of sepsis, hospitalization, and kidney injury. However, the best treatment strategies unknown. We aimed to describe antibiotic practices outcomes for UTIs in anomalies evaluate whether variability UTI exists between hospitals. METHODS conducted a multicenter retrospective cohort study seen emergency departments (EDs) 6 free-standing US children’s hospitals from January 1, 2017,...
To describe patterns of clinical Spanish use by pediatric residents, and to compare self-assessment language proficiency against an objective test.In 2010, the authors e-mailed a survey all 247 residents at three institutions, inviting those with any level ability participate. Participants completed reporting proficiency, interpreter use, comfort using in range scenarios. Clinical scenarios were grouped analyzed degree complexity. Self-reported was compared tested as measured 20-minute...
Background Italian pediatric antimicrobial prescription rates are among the highest in Europe. As a first step an Antimicrobial Stewardship Program, we implemented Clinical Pathway (CP) for Community Acquired Pneumonia with aim of decreasing overall antibiotics, especially broad-spectrum. Materials and methods The CP was on 10/01/2015. We collected antibiotic prescribing outcomes data from children aged 3 months-15 years diagnosed CAP 10/15/2014 to 04/15/2015 (pre-intervention period)...
OBJECTIVES Children with certain congenital anomalies of the kidney and urinary tract neurogenic bladder (CAKUT/NGB) are at higher risk treatment failure for infections (UTIs) than children normal genitourinary anatomy, but literature describing outcomes is limited. The objectives this study were to describe rate in CAKUT/NGB compare duration antibiotics between those without failure. METHODS Multicenter retrospective cohort 0 17 years old who presented emergency department fever or...
To measure the impact of an objective evaluation provider Spanish-language skills on self-reported language proficiency and comfort using Spanish in a range clinical scenarios.We enrolled pediatric residents with any ability from 3 residency programs. Participants completed baseline survey, testing, posttest survey. We gathered demographics, ability, various scenarios, which were grouped analyzed by degree complexity. Between surveys, testing service administered 20-minute, telephone-based...
Although Italian pediatric antimicrobial prescription rates are among the highest in Europe, little action has been taken to improve appropriateness of prescriptions. The primary aim this study was assess changes antibiotic before and after acute otitis media (AOM) group A streptococcus (GAS) pharyngitis Clinical Pathway (CP) implementation; secondary aims were compare treatment failures change total antibiotics costs CP implementation.Pre-post quasi-experimental comparing 6-month period...
Vancomycin remains one of the most commonly prescribed antibiotics in NICUs despite recommendations to limit its use for known resistant infections. Baseline data revealing substantially higher vancomycin our NICU compared peer institutions informed quality improvement initiative. Our aim was reduce prescribing rate neonates hospitalized by 50% within 1 year and sustain year.In 60-bed level IV an academic referral center, we used a framework develop key drivers interventions including (1)...
In a multicenter retrospective study, we sought to determine the optimal vancomycin trough concentration that would impact duration of methicillin-resistant Staphylococcus aureus bacteremia in children. We found median <10 µg/mL within first 72 hours may be associated with longer compared ≥10 µg/mL.