A5073280480- Antibiotic Use and Resistance
- Infection Control in Healthcare
- Infection Control and Ventilation
- Clostridium difficile and Clostridium perfringens research
- SARS-CoV-2 and COVID-19 Research
- Antibiotic Resistance in Bacteria
- Urinary Tract Infections Management
- Nosocomial Infections in ICU
- Patient Satisfaction in Healthcare
- COVID-19 Clinical Research Studies
- COVID-19 epidemiological studies
- Pneumonia and Respiratory Infections
- Bacterial Identification and Susceptibility Testing
- Antimicrobial Resistance in Staphylococcus
- Vaccine Coverage and Hesitancy
- Microscopic Colitis
- Neonatal and Maternal Infections
- Long-Term Effects of COVID-19
- Telemedicine and Telehealth Implementation
- Renal cell carcinoma treatment
- Medical Device Sterilization and Disinfection
- COVID-19 and healthcare impacts
- Pediatric Urology and Nephrology Studies
- COVID-19 and Mental Health
- Streptococcal Infections and Treatments
Louis Stokes Cleveland VA Medical Center
2016-2025
Geriatric Research Education and Clinical Center
2016-2025
VA Northeast Ohio Healthcare System
2016-2025
Case Western Reserve University
2018-2025
University School
2018-2025
University of Cincinnati
2016-2024
University of Cincinnati Medical Center
2016-2024
University Hospitals of Cleveland
2024
Communities In Schools of Orange County
2022-2023
Manhattan Institute for Policy Research
2022-2023
<h3>Importance</h3> Contamination of the skin and clothing health care personnel during removal personal protective equipment (PPE) contributes to dissemination pathogens places at risk for infection. <h3>Objectives</h3> To determine frequency sites contamination on PPE evaluate effect an intervention contamination. <h3>Design, Setting, Participants</h3> We conducted a point-prevalence study quasi-experimental from October 28, 2014, through March 31, 2015. Data analysis began November 17,...
Based upon knowledge of the hydrolytic profile major β-lactamases found in Gram-negative bacteria, we tested efficacy combination ceftazidime-avibactam (CAZ-AVI) with aztreonam (ATM) against carbapenem-resistant enteric bacteria possessing metallo-β-lactamases (MBLs). Disk diffusion and agar-based antimicrobial susceptibility testing were initially performed to determine vitro a unique CAZ-AVI ATM 21 representative Enterobacteriaceae isolates complex molecular background that included...
Upregulation of pro-inflammatory cytokines has not only been associated with increased morbidity and mortality in older adults but also linked to frailty. In the current study we aimed compare relative relationship age frailty on inflammation thrombosis veterans. We analyzed 117 subjects (age range 62–95 years; median 81) divided into 3 cohorts: non-frail, pre-frail frail based Fried phenotype Serum inflammatory markers were determined using commercially available ELISA kits. Frail (PF) had...
After BNT162b2 messenger RNA vaccination, antibody levels to spike, receptor-binding domain, and virus neutralization were examined in 149 nursing home residents 110 healthcare worker controls. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-naive residents' median post-second vaccine dose titers are one-quarter that of SARS-CoV-2-naive workers.
Nursing home (NH) residents have borne a disproportionate share of SARS-CoV-2 morbidity and mortality. Vaccines limited hospitalisation death from earlier variants in this vulnerable population. With the rise Omicron future variants, it is vital to sustain broaden vaccine-induced protection. We examined effect boosting with BNT162b2 mRNA vaccine on humoral immunity Omicron-specific neutralising activity among NH healthcare workers (HCWs). longitudinally enrolled 85 (median age 77) 48 HCWs...
Introduction of monovalent COVID-19 mRNA vaccines in late 2020 helped to mitigate disproportionate COVID-19-related morbidity and mortality U.S. nursing homes (1); however, reduced effectiveness during the period Omicron variant predominance led recommendations for booster doses with bivalent that include an BA.4/BA.5 spike protein component broaden immune response improve vaccine against circulating variants (2). Recent studies suggest provide substantial additional protection SARS-CoV-2...
Healthcare personnel often use incorrect technique for donning and doffing of personal protective equipment (PPE).We tested the hypothesis that medical students receive insufficient training on correct methods PPE.We conducted a cross-sectional survey clinical rotations at two teaching hospitals to determine type they received in PPE technique. The performed simulations contaminated removal with fluorescent lotion gloves were assessed skin and/or clothing contamination. To obtain additional...
Burkholderia multivorans is a significant health threat to persons with cystic fibrosis (CF). Infections are difficult treat as this pathogen inherently resistant multiple antibiotics. Susceptibility testing of isolates obtained from CF respiratory cultures revealed that single agents selected different antibiotic classes were unable inhibit growth. However, all found be susceptible ceftazidime when combined the novel non-β-lactam β-lactamase inhibitor, avibactam (all minimum inhibitor...
Abstract Previously, by targeting penicillin-binding protein 3, Pseudomonas-derived cephalosporinase (PDC), and MurA with ceftazidime-avibactam-fosfomycin, antimicrobial susceptibility was restored among multidrug-resistant (MDR) Pseudomonas aeruginosa. Herein, ceftazidime-avibactam-fosfomycin combination therapy against MDR P. aeruginosa clinical isolate CL232 further evaluated. Checkerboard analysis revealed synergy between ceftazidime-avibactam fosfomycin. Accordingly, the resistance...
Bivalent SARS-CoV-2 vaccines were developed to counter increasing susceptibility emerging variants. We evaluated the durability of immunity and protection following first bivalent vaccination among nursing home residents. anti-spike neutralization titers from blood in 653 community residents before after each monovalent booster, a vaccine. Concurrent clinical outcomes using electronic health record data separate cohort 3783 Veterans Affairs (VA) homes who had received at least primary series...
We analyzed carbapenem-resistant Enterobacteriaceae (CRE) trends among patients from the US Veterans Health Administration (VHA). After emergence of CRE in eastern United States, resistance rates remained stable Klebsiella pneumoniae but increased Enterobacter cloacae complex, suggesting a "second epidemic". VHA offers vantage point for monitoring nationwide trends.
OBJECTIVE To determine the impact of an environmental disinfection intervention on incidence healthcare-associated Clostridium difficile infection (CDI). DESIGN A multicenter randomized trial. SETTING In total,16 acute-care hospitals in northeastern Ohio participated study. INTERVENTION We conducted a 12-month trial to compare standard cleaning enhanced that included monitoring services (EVS) personnel performance with feedback EVS and control staff. assessed thoroughness based fluorescent...
In the setting of coronavirus disease 2019 pandemic, efficient methods are needed to decontaminate shared portable devices and large open areas such as waiting rooms. We found that wheelchairs, equipment, room chairs were frequently contaminated with potential pathogens. After minimal manual precleaning visible soiling, application a dilute sodium hypochlorite disinfectant using an electrostatic sprayer provided rapid effective decontamination eliminated benign virus bacteriophage MS2 from...
Preoperative estimation of new baseline glomerular filtration rate after partial nephrectomy or radical for renal cell carcinoma has important clinical implications. However, current predictive models are either complex lack external validity. We aimed to develop and validate a simple equation estimate postoperative rate.For development internal validation the equation, cohort 7,860 patients with undergoing nephrectomy/radical (2005-2015) at Veterans Affairs National Health System was...
Antibody decline occurred from 2 weeks to 6 months post-BNT162b2 mRNA vaccination in nursing home (NH) residents and healthcare workers. Antispike, receptor-binding domain, neutralization levels dropped >81% irrespective of prior infection. Notably, 69% infection-naive NH had neutralizing antibodies at or below the assay's limit detection.
Abstract Background Limited information is available on the natural history of Clostridioides difficile colonization and infection in patients with new acquisition C. healthcare settings. Methods In 3 hospitals affiliated long-term care facilities, we collected serial perirectal cultures from no diarrhea enrollment to identify toxigenic carriage determined duration burden carriage. Asymptomatic was defined as transient if only 1 culture positive, negative before after, or persistent 2 more...
We examined whether the second monovalent SARS-CoV-2 mRNA booster increased antibody levels and their neutralizing activity to Omicron variants in nursing home residents (NH) healthcare workers (HCW). sampled 376 NH 63 HCW after primary vaccination, first boosters, for response pseudovirus neutralization assay against wild-type (WT) (Wuhan-Hu-1) strain, BA.1 BA.5 variants. Antibody progressively with each but subsequently waned over 3–6 months. residents, both those without prior infection,...
β-Lactamase inhibitors (BLIs) restore the efficacy of otherwise obsolete β-lactams. However, commercially available BLIs are not effective against metallo-β-lactamases (MBLs), which continue to be disseminated globally. One group most clinically important MBLs is VIM family. The discovery VIM-24, a natural variant VIM-2, possessing an R228L substitution and novel phenotype, compelled us explore role this position its effects on substrate specificity. We employed mutagenesis, biochemical...
Burkholderia cepacia complex (Bcc) are a group of multidrug-resistant gram-negative bacteria rarely reported in patients without cystic fibrosis (CF) or immunocompromising conditions. We investigated Bcc bloodstream infections (BSIs) cohort non-CF from the US Veterans Health Administration (VHA). Using VHA databases, we identified with BSI at facilities nationwide 1999 through 2015. ascertained clinical characteristics, treatments, and outcomes factors associated 30-day mortality logistic...
Abstract Background Overcoming β-lactam resistance in pathogens such as Pseudomonas aeruginosa is a major clinical challenge. Rapid molecular diagnostics (RMDs) have the potential to inform selection of empiric therapy patients infected by P. aeruginosa. Methods In this study, we used heterogeneous collection 197 that included multidrug-resistant isolates determine whether 2 representative RMDs (Acuitas Resistome test and VERIGENE gram-negative blood culture test) could identify...
The Specialty Care Access Network–Extension for Community Health Outcomes (SCAN-ECHO) is a video teleconferencing–based training program where primary care providers are trained by specialty team to provide care. A multidisciplinary of pain management specialists at the Cleveland Veterans Affairs Medical Center established such management; description and preliminary effectiveness assessment this presented. Primary provider participants in Network completed pre- post-training questionnaires....