A5035873625- Antibiotic Use and Resistance
- Bacterial Identification and Susceptibility Testing
- Urinary Tract Infections Management
- Antimicrobial Resistance in Staphylococcus
- Patient Satisfaction in Healthcare
- Streptococcal Infections and Treatments
- Antibiotics Pharmacokinetics and Efficacy
- Pneumocystis jirovecii pneumonia detection and treatment
- Primary Care and Health Outcomes
- Antibiotic Resistance in Bacteria
- Pneumonia and Respiratory Infections
- Clostridium difficile and Clostridium perfringens research
- Nosocomial Infections in ICU
- Sepsis Diagnosis and Treatment
- Innovations in Medical Education
- SARS-CoV-2 and COVID-19 Research
- Clinical Reasoning and Diagnostic Skills
- SARS-CoV-2 detection and testing
- Thermal Regulation in Medicine
- HIV/AIDS Research and Interventions
- Healthcare cost, quality, practices
- Infective Endocarditis Diagnosis and Management
- COVID-19 Clinical Research Studies
- HIV-related health complications and treatments
- Antifungal resistance and susceptibility
VA Greater Los Angeles Healthcare System
2016-2025
University of California, Los Angeles
2015-2024
Museum of Heilongjiang Province
2021
Novant Health Forsyth Medical Center
2020
Jackson Memorial Hospital
2020
Center for the Study of Healthcare Provider Behavior
2018
West Los Angeles College
2017
United States Department of Veterans Affairs
2016
Society for Healthcare Epidemiology of America
2013
San Francisco General Hospital
2007-2011
The epidemic character of community-associated methicillin-resistant Staphylococcus aureus, especially the geographically widespread clone USA300, is poorly understood. USA300 isolates carry a type IV staphylococcal chromosomal cassette mec (SCCmec) element conferring beta-lactam antibiotic class resistance and putative pathogenicity island, arginine catabolic mobile (ACME). Physical linkage between SCCmec ACME suggests that selection for may be interconnected. We constructed isogenic...
Background: Infection with multidrug-resistant, community-associated, methicillin-resistant Staphylococcus aureus (MRSA) has been reported but seems to be isolated. Objective: To determine the incidence of a multidrug-resistant MRSA clone (USA300) in San Francisco, and risk factors for infection. Design: Population-based survey cross-sectional study using chart review. Setting: 9 hospitals Francisco (population-based survey) 2 outpatient clinics Boston (cross-sectional study). Patients:...
Methicillin-resistant Staphylococcus aureus (MRSA) infections have become a major public health problem in both the community and hospitals. Few studies characterized incidence clonal composition of disease-causing strains an entire population. Our objective was to perform population-based survey clinical molecular epidemiology MRSA disease San Francisco, California.We prospectively collected 3985 isolates associated demographic information over 12-month period (2004-2005) at 9...
This report describes how universal, serial reverse transcription–polymerase chain reaction testing of residents in a long-term care skilled nursing facility Los Angeles, California, helped to interrupt transmission coronavirus disease 2019 the facility.
Background. Since its emergence in 2000, epidemic spread of the methicillin-resistant Staphylococcus aureus (MRSA) clone USA300 has led to a high burden skin and soft tissue infections (SSTIs) United States, yet impact on MRSA bloodstream (BSIs) is poorly characterized. Methods. To assess clonality isolates causing SSTI BSI during period, stratified, random sample 1350 unique infection (from total 7252) recovered at Community Health Network San Francisco from 2000 2008 were selected for...
Objectives The prevalence of emphysema is higher among HIV-infected (HIV+) individuals compared to HIV-uninfected persons. While greater tobacco use contributes, HIV-related effects on immunity likely confer additional risk. Low peripheral blood CD4+ CD8+ T-lymphocyte (CD4/CD8) ratio may reflect chronic inflammation in HIV and be a marker lung disease this population. Therefore, we sought determine whether the CD4/CD8 was associated with obstructive pulmonary (COPD), particularly subtype,...
BACKGROUND Antimicrobial stewardship programs (ASPs) are variably implemented. OBJECTIVE To characterize variations of antimicrobial structure and practices across all inpatient Veterans Affairs facilities in 2012 correlate key characteristics with usage. DESIGN A web-based survey regarding activities was administered to each facility’s designated contact. Bivariate associations between facility use during were determined. SETTING Total 130 services. RESULTS Of responding facilities, 29...
<h3>Importance</h3> SARS-CoV-2 entry requires the TMPRSS2 cell surface protease. Antiandrogen therapies reduce expression of TMPRSS2. <h3>Objective</h3> To determine if temporary androgen suppression induced by degarelix improves clinical outcomes inpatients hospitalized with COVID-19. <h3>Design, Setting, and Participants</h3> The Hormonal Intervention for Treatment in Veterans With COVID-19 Requiring Hospitalization (HITCH) phase 2, placebo-controlled, double-blind, randomized trial...
Abstract We describe a case of treatment failure caused by strain USA300 community-associated methicillin-resistant Staphylococcus aureus (MRSA) with intermediate susceptibility to vancomycin and reduced daptomycin. The was isolated from the bone 56-year-old man lumbar osteomyelitis after 6-week course for catheter-associated septic thrombophlebitis.
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Abstract Background Interferon-gamma release assays (IGRAs) are used for tuberculosis (TB) screening. The Quantiferon-TB Gold Plus (QFT-Plus) assesses T-cell reactivity to two distinct sets of TB antigens; the test is considered positive if either assay returns positive. Many studies suggest retesting patients with low level positivity prior proceeding treatment given high rates reversion in this group. significance and reproducibility when antigen minus nil (TB Ag-Nil) one other negative...
Background Stewardship of antimicrobial agents is an essential function hospital pharmacies. The ideal pharmacist staffing model for stewardship programs not known. Objective To inform decisions teams, we aimed to compare program with a dedicated Infectious Diseases (ID) (Dedicated ID Pharmacist Hospital) relying on ward pharmacists activities (Geographic Model Hospital). Methods We reviewed randomly selected sample 290 cases inpatient parenteral antibiotic use. electronic medical record was...
Antimicrobial stewardship to combat the spread of antibiotic-resistant bacteria has become a national priority. This project focuses on reducing inappropriate use antimicrobials for asymptomatic bacteriuria (ASB), very common condition that leads antimicrobial overuse in acute and long-term care. We previously conducted successful intervention, entitled "Kicking Catheter Associated Urinary Tract Infection (CAUTI): No Knee-Jerk Antibiotics Campaign," decrease guideline-discordant ordering...
Abstract Antibiotic prescribing practices across the Veterans’ Health Administration (VA) experienced significant shifts during coronavirus disease 2019 (COVID-19) pandemic. From 2015 to 2019, antibiotic use between January and May decreased from 638 602 days of therapy (DOT) per 1,000 present (DP), while corresponding months in 2020 saw utilization rise 628 DOT DP.
Antimicrobial stewards may benefit from comparative data to inform interventions that promote optimal inpatient antimicrobial use.Antimicrobial 8 geographically dispersed Veterans Affairs (VA) facilities participated in the development of use visualization tools allowed for comparison similar complexity. The consisted an interactive web-based dashboard and, later, a standardized usage report updated at user-selected intervals. Stewards monthly learning collaboratives. percent change average...
Abstract BACKGROUND: Vancomycin troughs of 15‐20 mg/L are recommended in the treatment invasive staphylococcal disease, higher levels than previously recommended. OBJECTIVE/SETTING: We sought to determine if there was an association between vancomycin trough and nephrotoxicity, defined as 0.5 or 50% increase serum creatinine, at a large Veterans Affairs medical center. PATIENTS AND METHODS: reviewed records 348 inpatients our institution who received ≥5 days during 2 time periods when dosing...