A5025263192- Antibiotic Use and Resistance
- Antimicrobial Resistance in Staphylococcus
- COVID-19 Clinical Research Studies
- Mechanical Circulatory Support Devices
- Antibiotics Pharmacokinetics and Efficacy
- Pneumonia and Respiratory Infections
- Respiratory Support and Mechanisms
- Long-Term Effects of COVID-19
- Bacterial Identification and Susceptibility Testing
- Heart Failure Treatment and Management
- Streptococcal Infections and Treatments
- Respiratory viral infections research
- Cystic Fibrosis Research Advances
- Sepsis Diagnosis and Treatment
- Microscopic Colitis
- Clostridium difficile and Clostridium perfringens research
- Urinary Tract Infections Management
- Potassium and Related Disorders
- Electrolyte and hormonal disorders
- Extracellular vesicles in disease
- Pediatric Urology and Nephrology Studies
- Viral gastroenteritis research and epidemiology
- Antibiotic Resistance in Bacteria
- Orthopedic Infections and Treatments
- Cardiac Arrest and Resuscitation
Galveston College
2025
University of Michigan
2014-2023
Michigan Medicine
2018-2021
C. S. Mott Children's Hospital
2020
Texas Children's Hospital
2016-2017
Baylor College of Medicine
2017
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...
Although coronavirus disease 2019 (COVID-19) is mild in nearly all children, a small proportion of pediatric patients develop severe or critical illness. Guidance therefore needed regarding use agents with potential activity against acute respiratory syndrome 2 pediatrics.
Abstract Background Although coronavirus disease 2019 (COVID-19) is a mild infection in most children, small proportion develop severe or critical illness. Data describing agents with potential antiviral activity continue to expand such that updated guidance needed regarding use of these children. Methods A panel pediatric infectious diseases physicians and pharmacists from 20 geographically diverse North American institutions was convened. Through series teleconferences web-based surveys,...
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...
Most antibiotic use occurs in ambulatory settings. No benchmarks exist for pediatric institutions to assess their outpatient and compare prescribing rates peers. We aimed share reports benchmarking metrics nationally. invited from the Sharing Antimicrobial Reports Pediatric Stewardship OutPatient (SHARPS-OP) Collaborative contribute quarterly aggregate on January 2019 June 2022. Outpatient settings included emergency departments (ED), urgent care centers (UCC), primary clinics (PCC)...
Abstract Objective: To evaluate whether incorporating mandatory prior authorization for Clostridioides difficile testing into antimicrobial stewardship pharmacist workflow could reduce in patients with alternative etiologies diarrhea. Design: Single center, quasi-experimental before-and-after study. Setting: Tertiary-care, academic medical center Ann Arbor, Michigan. Patients: Adult and pediatric admitted between September 11, 2019 December 10, were included if they had an order placed 1 of...
OBJECTIVES Patients supported on extracorporeal membrane oxygenation (ECMO) have an increased incidence of seizures. Phenobarbital (PB) and fosphenytoin (fos-PHT) are common antiepileptic drugs (AEDs) used to manage seizures in the pediatric population; however, it is unknown what effect ECMO has serum concentrations AEDs. The purpose this study evaluate AED concentrations. METHODS A retrospective, matched-cohort was performed patients younger than 18 years who received were treated with...
Abstract Background Infectious diseases (ID) consultation and optimal antibiotic therapy improve outcomes in Staphylococcus aureus bacteremia (SAB). Data on strategies to adherence these practices children are limited. Methods This was a quasi-experimental study evaluating the impact of an electronic medical record (EMR)–based best practice advisory (BPA) for SAB, recommending ID consult based rapid mecA gene detection. Inpatients < 21 years old with SAB before (January 2015–July...
Hydralazine is a direct peripheral arterial vasodilator used for acute hypertension. Usually administered as bolus dose, continuous infusion has been described during pregnancy preeclampsia and eclampsia in limited reports cardiac surgeries afterload reduction. This case describes the use of hydralazine reduction an infant receiving extracorporeal membrane oxygenation (ECMO) post-cardiac surgery. Postsurgery, patient's mean pressures (MAPs) could not be controlled despite escalating doses...
Evaluation of antibiotic prescribing practices in the emergency department (ED) for urinary tract infections (UTI) is needed given new accreditation standards outpatient antimicrobial stewardship. Prescribing ED UTIs have not been well defined. We aimed to describe patterns among varied provider types ED, with goal targeting interventions minimize use broad-spectrum antibiotics and avoid unnecessarily long durations. This retrospective, single-center study included adults presenting...
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Abstract Background Emergency medicine physicians are among the top five specialties prescribing antibiotics. New accreditation standards for outpatient antimicrobial stewardship now in effect, thus evaluation of antibiotic practices emergency department (ED) is needed. Upper respiratory infections (URIs) have been shown to be a common culprit inappropriate use and leading primary diagnoses seen at ED visits. We aimed assess management URIs adult pediatric EDs by diagnosis provider type,...
Abstract Background Infectious diseases (ID) consultation and use of optimal antibiotic therapy have been shown to improve outcomes patients with Staphylococcus aureus bloodstream infection (SA-BSI). We investigated the ability an electronic medical record (EMR)-based best practice advisory (BPA) enhance adherence these practices for pediatric SA-BSI. Methods An EMR-based BPA SA-BSI (Figure 1) was implemented on 8/1/2017, recommending ID based mecA gene rapid testing (vancomycin if...
Abstract Background Most antibiotics are prescribed outside of the hospital, and up to 50% unnecessary or inappropriate. Studies ambulatory stewardship interventions have primarily targeted respiratory infections. We investigated impact an electronic medical record (EMR)-embedded clinical decision support tool on antibiotic duration for outpatient pediatric skin soft tissue infection (SSTI). Methods Institutional SSTI treatment guidelines adult patients were developed in 7/2019, followed...
Abstract Background Hospitalized patients with diabetic foot infections (DFI) are commonly stable upon admission and lack signs of sepsis, necrotizing fasciitis, critical limb ischemia, or bacteremia. Patients admitted for key components DFI care: non-urgent procedures source control; radiographic imaging; cultures; consultation infectious diseases (ID), podiatry, vascular surgery; peripherally inserted central catheter (PICC) access. We aimed to identify the proportion low acuity who were...