A5013763639- Antibiotic Use and Resistance
- Urinary Tract Infections Management
- Bacterial Identification and Susceptibility Testing
- Pneumonia and Respiratory Infections
- Patient Satisfaction in Healthcare
- Pediatric Urology and Nephrology Studies
- Clostridium difficile and Clostridium perfringens research
- Nosocomial Infections in ICU
- Antimicrobial Resistance in Staphylococcus
- Emergency and Acute Care Studies
- Neutropenia and Cancer Infections
- COVID-19 Clinical Research Studies
- Healthcare cost, quality, practices
- Pneumocystis jirovecii pneumonia detection and treatment
- Pelvic floor disorders treatments
- Antibiotics Pharmacokinetics and Efficacy
- Fungal Infections and Studies
- Respiratory Support and Mechanisms
- SARS-CoV-2 and COVID-19 Research
- Urinary Bladder and Prostate Research
- Pharmaceutical Practices and Patient Outcomes
- Long-Term Effects of COVID-19
- Microscopic Colitis
- Streptococcal Infections and Treatments
- Antibiotic Resistance in Bacteria
University of Michigan
2017-2025
Michigan Medicine
2017-2024
Museum of Heilongjiang Province
2021
Triangle
2021
Biology of Infection
2019
Engineering Associates (United States)
2017-2019
University of Chicago
2015-2017
University of Chicago Medical Center
2014-2016
Abstract Background Severe coronavirus disease 2019 (COVID-19) can manifest in rapid decompensation and respiratory failure with elevated inflammatory markers, consistent cytokine release syndrome for which IL-6 blockade is an approved treatment. Methods We assessed effectiveness safety of tocilizumab a single-center cohort patients COVID-19 requiring mechanical ventilation. The primary endpoint was survival probability postintubation; secondary analyses included ordinal illness severity...
Antibacterials may be initiated out of concern for bacterial coinfection in coronavirus disease 2019 (COVID-19). We determined prevalence and predictors empiric antibacterial therapy community-onset coinfections hospitalized patients with COVID-19.
Importance Little is known about incidence of, risk factors for, and harms associated with inappropriate diagnosis of community-acquired pneumonia (CAP). Objective To characterize CAP in hospitalized patients. Design, Setting, Participants This prospective cohort study, including medical record review patient telephone calls, took place across 48 Michigan hospitals. Trained abstractors retrospectively assessed patients treated for between July 1, 2017, March 31, 2020. Patients were eligible...
Treatment of asymptomatic bacteriuria (ASB) with antibiotics is a common factor in inappropriate antibiotic use, but risk factors and outcomes associated treatment ASB hospitalized patients are not well defined.To evaluate among the possible association between clinical outcomes.A retrospective cohort study was conducted from January 1, 2016, through February 2018, at 46 hospitals participating Michigan Hospital Medicine Safety Consortium. A total 2733 medical ASB, defined as positive urine...
ABSTRACT Background Severe COVID-19 can manifest in rapid decompensation and respiratory failure with elevated inflammatory markers. This presentation is consistent cytokine release syndrome chimeric antigen receptor T cell therapy, for which IL-6 blockade approved treatment. Methods We assessed effectiveness safety of tocilizumab a single-center cohort patients requiring mechanical ventilation. The primary endpoint was survival probability post-intubation; secondary analyses included an...
Hospitalized patients with asymptomatic bacteriuria (ASB) often receive unnecessary antibiotic treatment, which increases resistance and adverse events.To determine whether diagnostic stewardship (avoiding urine cultures) or (reducing treatment after an culture) is associated better outcomes in reducing use for ASB.This 3-year, prospective quality improvement study included hospitalized general care medicine a positive culture among 46 hospitals participating collaborative initiative, the...
Abstract Background Inappropriate diagnosis of infections results in antibiotic overuse and may delay underlying conditions. Here we describe the development characteristics 2 safety measures inappropriate urinary tract infection (UTI) community-acquired pneumonia (CAP), most common inpatient on general medicine services. Methods Measures were developed from guidelines literature adapted based data patients hospitalized with UTI CAP 49 Michigan hospitals feedback end-users, a technical...
Effect of Bamlanivimab Alone vs With Etesevimab on Viral Load in Patients Mild to Moderate COVID-19
Abstract Background Antibiotics are commonly prescribed to patients as they leave the hospital. We aimed create a comprehensive metric characterize antibiotic overuse after discharge among hospitalized treated for pneumonia or urinary tract infection (UTI), and determine whether varied across hospitals conditions. Methods In retrospective cohort study of UTI in 46 between 1 July 2017–30 2019, we quantified proportion discharged with overuse, defined unnecessary use, excess duration,...
Abstract Immunocompromised patients with B-cell deficiencies are at risk for prolonged symptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We describe 4 treated malignancies B-cell-depleting therapies who developed persistent SARS-CoV-2 infection and had resolution of symptoms following an extended course nirmatrelvir/ritonavir.
Importance Guidelines recommend withholding antibiotics in asymptomatic bacteriuria (ASB), including among patients with altered mental status (AMS) and no systemic signs of infection. However, ASB treatment remains common. Objectives To determine prevalence factors associated bacteremia from a presumed urinary source inpatients or without AMS estimate avoided if 2% risk were used as threshold to prompt empiric antibiotic ASB. Design, Setting, Participants This cohort study assessed...
Abstract Background Inappropriate treatment of asymptomatic bacteriuria (ASB) among hospitalized patients leads to longer length stay (LOS) without improving outcomes. ASB is common in individuals with neurogenic bladder (NB); however, little known about the epidemiology, treatment, and outcomes inpatients NB ASB. Methods Between 1/1/2017-12/31/2023, abstractors collected deidentified data—including signs/symptoms urinary tract infections (UTI) 30-day outcomes—from a positive urine culture...
Abstract Background Patients with structural lung disease (SLD) are more susceptible to community-acquired pneumonia (CAP) and at higher risk for resistant organisms. CAP studies often exclude patients SLD making it difficult determine when treat empirically broad-spectrum antibiotics (BSA). Here, we describe the epidemiology of in inpatients moderate severe SLD. Methods Between 1/2017 12/2023, analyzed data from 68 Michigan hospitals. was defined as documented or chronic obstructive...
Background. Methicillin-resistant Staphylococcus aureus (MRSA) USA300 is the leading cause of MRSA infections in United States and has caused an epidemic skin soft-tissue infections. Recurrent with are common, yet intrahost evolution during persistence on individual not been studied. This gap hinders ability to clinically manage recurrent reconstruct transmission networks. Methods. To characterize bacterial evolution, we examined clinical courses 4 subjects 3–6 infections, using patient...
To describe patient characteristics, symptoms, patterns of care and outcomes for patients hospitalised with COVID-19 in Michigan.
Urinary tract infection (UTI) and community-acquired pneumonia (CAP) are the most common infections treated in hospitals. UTI CAP also commonly overdiagnosed, resulting unnecessary antibiotic use diagnostic delays. While much is known individually about overdiagnosis of CAP, it not whether hospitals with higher one have other. Correlation these two conditions may indicate underlying hospital-level contributors, which turn represent targets for intervention. To evaluate association we first...
Abstract Background Recurrent Clostridioides difficile infection (rCDI) occurs frequently, and concomitant antibiotic (CA) during the initial episode for treatment of non-CDI is a major risk factor. We sought to address comparative efficacy fidaxomicin versus vancomycin in setting CA CDI episode. Methods conducted randomized, controlled, open-label trial at 2 hospitals Ann Arbor, Michigan. consecutively consented enrolled hospitalized patients ≥18 years old with diarrhea, positive test C....
Background The Infectious Diseases Society of America (IDSA) guidelines recommend collecting blood cultures for the first 3 days febrile neutropenia (FN) in clinically stable oncology patient with persistent fevers. Nonetheless, many physicians send daily beyond days, and impact that practice is uncertain. Procedure We reviewed pediatric FN episodes from July 2009 to May 2014 at University Chicago Comer Children's Hospital. For each positive culture, we determined if it was a pathogen or...
Abstract Background Reducing antibiotic use in patients with asymptomatic bacteriuria (ASB) has been inpatient focused. However, testing and treatment is often started the emergency department (ED). Thus, for hospitalized ASB, we sought to identify patterns of initiated by medicine (EM) clinicians association outcomes. Methods We conducted a 43-hospital, cohort study adults admitted through ED ASB (February 2018–February 2020). Using generalized estimating equation models, assessed (1)...
Abstract Background Strategies to optimize antibiotic prescribing at discharge are not well understood. Methods In fall 2019, we surveyed 39 Michigan hospitals on their stewardship strategies. The association of reported strategies with overuse (unnecessary, excess, suboptimal fluoroquinolones) for community-acquired pneumonia (CAP) and urinary tract infection (UTI) was evaluated in 2 ways: (1) all assumed equal weight (2) were weighted based the ROAD (Reducing Overuse Antibiotics Discharge)...
Cobicistat is a pharmacokinetic booster in several fixed-dose combination products for treatment of human immunodeficiency virus (HIV) infection. As potent inhibitor cytochrome P450 (CYP) 3A enzymes, significant drug-drug interactions are expected between cobicistat and medications that metabolized primarily through the CYP3A pathway, including calcineurin inhibitors (e.g., tacrolimus cyclosporine). We describe case toxicity due to supratherapeutic concentrations when Stribild (elvitegravir,...
Abstract Background Community-acquired pneumonia (CAP) is a common cause for hospitalization and antibiotic overuse. We aimed to improve duration CAP across 41 hospitals participating in the Michigan Hospital Medicine Safety Consortium (HMS). Methods This prospective collaborative quality initiative included patients hospitalized with uncomplicated who qualified 5-day duration. Between 23 February 2017 5 2020, HMS targeted appropriate treatment through benchmarking, sharing best practices,...