A5044909940- Antibiotic Use and Resistance
- Antibiotic Resistance in Bacteria
- Bacterial Identification and Susceptibility Testing
- Antibiotics Pharmacokinetics and Efficacy
- Telemedicine and Telehealth Implementation
- Patient Satisfaction in Healthcare
- SARS-CoV-2 and COVID-19 Research
- COVID-19 Clinical Research Studies
- Healthcare Systems and Technology
- Neutropenia and Cancer Infections
- Vibrio bacteria research studies
- Urinary Tract Infections Management
- Pharmaceutical and Antibiotic Environmental Impacts
- Probiotics and Fermented Foods
- Genomics and Phylogenetic Studies
- Nosocomial Infections in ICU
- Salmonella and Campylobacter epidemiology
- Enterobacteriaceae and Cronobacter Research
- Antimicrobial Resistance in Staphylococcus
- Infection Control and Ventilation
- Toxin Mechanisms and Immunotoxins
- Rabbits: Nutrition, Reproduction, Health
- Medical Malpractice and Liability Issues
- Infections and bacterial resistance
- Agricultural pest management studies
Tufts Medical Center
2020-2023
Tufts University
2021-2023
Levy Economics Institute of Bard College
2021
Louis Stokes Cleveland VA Medical Center
2016-2019
Case Western Reserve University
2014-2018
VA Northeast Ohio Healthcare System
2018
University School
2018
University Hospitals Cleveland Medical Center
2016
MetroHealth
2015
MetroHealth Medical Center
2014-2015
Background. Klebsiella pneumoniae isolates harboring the K. carbapenemase gene (blaKPC) are creating a significant healthcare threat in both acute and long-term care facilities (LTCFs). As part of study conducted 2004 to determine risk stool colonization with extended-spectrum cephalosporin-resistant gram-negative bacteria, 12 that exhibited nonsusceptibility cephalosporins were detected. All gastrointestinal carriage not associated infection. Methods. Reassessment carbapenem minimum...
Serratia fonticola is an unusual human pathogen, previously described primarily as causing skin and soft tissue infections following trauma. There little information in the literature about its treatment or susceptibilities. We describe case of a 67-year-old male with paraplegia who developed urosepsis due to S. fonticola. Blood urine cultures obtained prior initiation antimicrobials both grew The patient completed 15-day course had uneventful recovery. reviewed 17 other patients clinical...
Abstract Staphylococcus intermedius and pseudintermedius are difficult to distinguish using conventional microbiological methods. Molecular diagnostic tools change our understanding of the epidemiology these 2 organisms. In this study, we present (1) a detailed review current literature on molecular diagnostics (2) case series in which misidentification was proven 1 case. We conclude that S is more common human pathogen than previously recognized.
SUMMARY Samples of eight varieties cowpea, both raw and cooked, were analyzed for their chemical composition amino acid content by microbiological methods also subjected to biological trials with rats in order determine nutritive value. Cooking caused losses as follows: 9.2% nitrogen, 17.4% crude fiber, 6270 thiamine, 52% riboflavin, 45% niacin. With the possible exception tryptophan, variation acids was small among all samples, cooked raw, there no difference ether extract ash. The animal...
Abstract Objective To test the feasibility of using telehealth to support antimicrobial stewardship at Veterans Affairs medical centers (VAMCs) that have limited access infectious disease-trained specialists. Design A prospective quasi-experimental pilot study. Setting Two rural VAMCs with acute-care and long-term care units. Intervention At each intervention site, providers, pharmacists, infection preventionists, staff nurses, off-site disease physicians formed a videoconference team (VAST)...
Abstract Starting in 2016, we initiated a pilot tele-antibiotic stewardship program at 2 rural Veterans Affairs medical centers (VAMCs). Antibiotic days of therapy decreased significantly ( P < .05) the acute and long-term care units both intervention sites, suggesting that tele-stewardship can effectively support antibiotic practices VAMCs.
The complexities of antibiotic resistance mean that successful stewardship must consider both the effectiveness a given and spectrum therapy to minimize imposing further selective pressure. To meet this challenge, we propose Desirability Outcome Ranking approach for Management Antimicrobial Therapy (DOOR MAT), flexible quantitative framework evaluates desirability selection. Herein, describe steps required implement DOOR MAT present examples illustrate how treatment selection can be...
Acinetobacter-positive patients had their ambient air tested for up to 10 consecutive days. The was Acinetobacter positive an average of 21% the days; rate contamination higher among colonized in rectum than airways (relative risk [RR], 2.35; P = 0.006). Of 6 air/clinical isolate pairs available, 4 were closely related according rep-PCR results.
Reductions in the use of broad-spectrum antibiotics is a cornerstone antimicrobial stewardship. We aim to demonstrate Desirability Outcome Ranking Approach for Management Antimicrobial Therapy (DOOR MAT) evaluate treatment Escherichia coli and Klebsiella pneumoniae bloodstream infections patients from Veterans Health Administration (VHA) across decade.
Molecular typing using repetitive sequenced-based PCR (rep-PCR) and hsp60 sequencing were applied to a collection of diverse Enterobacter cloacae complex isolates. To determine the most practical method for reference laboratories, we analyzed 71 E. isolates from sporadic outbreak occurrences originating 4 geographic areas. While rep-PCR was more discriminating, provided broader objective geographical tracking similar multilocus sequence (MLST). In addition, suggest that MLST may have higher...
Molecular typing using repetitive sequenced-based PCR (rep-PCR) and hsp60 sequencing were applied to a collection of diverse Enterobacter cloacae complex isolates. To determine the most practical method for reference laboratories, we analyzed 71 E. isolates from sporadic outbreak occurrences originating 4 geographic areas. While rep-PCR was more discriminating, provided broader objective geographical tracking similar multilocus sequence (MLST). In addition, suggest that MLST may have higher...
Introduction. Although more often recognized as a culprit in female urinary tract infection, coagulase-negative staphylococci (CoNS) can cause severe genitourinary infections men. While positive blood cultures with CoNS are usually thought to be contaminants, the setting of genito-urinary infection they represent true infection. Case presentation. We present case 70-year-old male without central venous catheter or who developed Staphylococcus haemolyticus bloodstream secondary...
Treatment of Mycobacterium abscessus-related peritoneal dialysis (PD)-associated peritonitis can be difficult due to the lack supporting data outlining standard care, high levels antibiotic resistance, and adverse effects related therapy. Here, we present a case M abscessus PD-associated treated successfully with clofazimine omadacycline.
Abstract International efforts to curb antimicrobial resistance have focused on drug development and limiting unnecessary use. However, in areas where water, sanitation, hygiene infrastructure is lacking, biosecurity food-animal production poor, pathogen-flow between humans animals could exacerbate the emergence spread of resistant pathogens. Here, we compared mobile elements among Escherichia coli recovered from meat Cambodia, a country with substantial connectivity animals, unregulated...
Abstract Background In the setting of Escherichia coli and Klebsiella pneumoniae BSI, empiric antibiotic therapy is determined by clinical judgement Gram stain (GS) positive blood culture bottle up to 2 days before susceptibility test (AST) results become available. Within hours GS, RMD can detect E. K. predict pattern β-lactams (BL) differing spectrum. this study, our objective was compare “real-life” for BSI administered between GS AST with simulated RMD-guided therapy. Methods We...
DILI, although uncommon, can be a severe and even fatal complication of antibiotic use. The safety novel regimens targeting MDR Gram-negative bacteria (GNB) is an important concern. Cephalosporins such as ceftazidime (CAZ) are rare causes clinically apparent while data regarding DILI with other antibiotics the monobactam aztreonam (ATM) sparse. ATM CAZ partnered many β-lactamase inhibitors (i.e., avibactam, AVI) therapy for infections (CAZ-AVI ATM-AVI) We aimed to compare incidence type...
Abstract Background Telehealth offers the possibility of supporting antibiotic stewardship in settings with limited access to people infectious diseases (ID) expertise. Previously, we described preliminary results from a pilot project that used Veterans Affairs (VA) telehealth system facilitate Videoconference Antimicrobial Stewardship Team (VAST) which connected multidisciplinary team rural VA medical center (VAMC) ID physicians at remote site support stewardship. Here, present 3 distinct...
Prospective audit and feedback is one of the core strategies an antimicrobial stewardship program (ASP). Here, we hypothesized that addition AIR to our extant ASP would enhance appropriate use parenteral (IV) antibiotics (ABs) on a large inpatient medical service. Adult patients medicine wards beginning in October 2017 not followed by infectious diseases (ID) service were included for intervention if they IV ABs ≥48 hours. Recommendations classified into: (1) duration therapy; (2) dose...
Abstract Background Ceftazidime-avibactam (caz-avi), a novel β-lactam/β-lactamase inhibitor, is commonly utilized for carbapenem-resistant gram-negative infections (CR-GNI). However, the benefits vs risks of combining caz-avi with other agents are unclear. Methods In this retrospective cohort study, inpatients CR-GNI treated were identified at 9 U.S. hospitals. The impact monotherapy (MT) or combination therapy (CT; i.e., any concomitant use gram-negative-active antibiotics) was studied...