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Dar S, Merza N, Haider M, Zafar Y, Din N, Ligresti R, Sebti R. Necrotizing Pancreatitis Infected with Stenotrophomonas maltophilia: An Emerging Rare Multidrug-Resistant Organism. Case Rep Gastrointest Med 2023; 2023:8071158. [PMID: 37397505 PMCID: PMC10313464 DOI: 10.1155/2023/8071158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 11/11/2022] [Accepted: 01/11/2023] [Indexed: 07/04/2023] Open
Abstract
Stenotrophomonas maltophilia (SM) is a multidrug-resistant, Gram-negative (GN) bacillus that is an increasingly recognized nosocomial and environment pathogen. It is intrinsically resistant to carbapenems, a drug commonly utilized in the management of necrotizing pancreatitis (NP). We report a 21-year-old immunocompetent female with NP complicated by pancreatic fluid collection (PFC) infected with SM. One-third of patients with NP will develop infections by GN bacteria, while broad-spectrum antibiotics, including carbapenems, cover most infections, trimethoprim-sulfamethoxazole (TMP-SMX) is the first-line treatment antibiotic for SM. This case is critical because it highlights a rare pathogen that should be considered a causal pathogen in patients who do not respond to their care plan.
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Affiliation(s)
- Sophia Dar
- Department of Internal Medicine, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Nooraldin Merza
- Department of Medicine, Wayne State University, Detroit, MI, USA
| | - Maryam Haider
- Department of Internal Medicine DMC, Wayne State University, Sinai Grace Hospital, Detroit, MI, USA
| | - Yousaf Zafar
- Department of Medicine, University of Mississippi Medical Center, Oxford, MS, USA
| | - Noren Din
- Department of Internal Medicine DMC, Wayne State University, Sinai Grace Hospital, Detroit, MI, USA
| | - Rosario Ligresti
- Division of Gastroetnerology, The Pancreas Center, Hackensack University Medical Center, Hackensack University School of Medicine, National Pancreas Foundation, Hackensack, NJ, USA
| | - Rani Sebti
- Department of Medicine, Hackensack University School of Medicine, Division of Infectious Disease, Hackensack University Medical Center, Hackensack, NJ, USA
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Donato ML, Park S, Baker M, Korngold R, Morawski A, Geng X, Tan M, Ip A, Goldberg S, Rowley S, Chow K, Brown E, Zenreich J, McKiernan P, Buttner K, Ullrich A, Long L, Feinman R, Ricourt A, Kemp M, Vendivil M, Suh H, Balani B, Cicogna C, Sebti R, Al-Khan A, Sperber S, Desai S, Fanning S, Arad D, Go R, Tam E, Rose K, Sadikot S, Siegel D, Gutierrez M, Feldman T, Goy A, Pecora A, Biran N, Leslie L, Gillio A, Timmapuri S, Boonstra M, Singer S, Kaur S, Richards E, Perlin DS. Clinical and laboratory evaluation of patients with SARS-CoV-2 pneumonia treated with high-titer convalescent plasma. JCI Insight 2021; 6:143196. [PMID: 33571168 PMCID: PMC8026191 DOI: 10.1172/jci.insight.143196] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 02/10/2021] [Indexed: 01/08/2023] Open
Abstract
Here, we report on a phase IIa study to determine the intubation rate, survival, viral clearance, and development of endogenous Abs in patients with COVID-19 pneumonia treated with convalescent plasma (CCP) containing high levels of neutralizing anti-SARS-CoV-2 Abs. Radiographic and laboratory evaluation confirmed all 51 treated patients had COVID-19 pneumonia. Fresh or frozen CCP from donors with high titers of neutralizing Abs was administered. The nonmechanically ventilated patients (n = 36) had an intubation rate of 13.9% and a 30-day survival rate of 88.9%, and the overall survival rate for a comparative group based on network data was 72.5% (1625/2241). Patients had negative nasopharyngeal swab rates of 43.8% and 73.0% on days 10 and 30, respectively. Patients mechanically ventilated had a day-30 mortality rate of 46.7%; the mortality rate for a comparative group based on network data was 71.0% (369/520). All evaluable patients were found to have neutralizing Abs on day 3 (n = 47), and all but 1 patient had Abs on days 30 and 60. The only adverse event was a mild rash. In this study on patients with COVID-19 disease, we show therapeutic use of CCP was safe and conferred transfer of Abs, while preserving endogenous immune response.
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Affiliation(s)
- Michele L Donato
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Steven Park
- Hackensack Meridian Health Center for Discovery and Innovation, Nutley, New Jersey, USA
| | - Melissa Baker
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Robert Korngold
- Hackensack Meridian Health Center for Discovery and Innovation, Nutley, New Jersey, USA
| | - Alison Morawski
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Xue Geng
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University, Washington, DC, USA
| | - Ming Tan
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University, Washington, DC, USA
| | - Andrew Ip
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Stuart Goldberg
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Scott Rowley
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Kar Chow
- Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Emily Brown
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Joshua Zenreich
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Phyllis McKiernan
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Kathryn Buttner
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Anna Ullrich
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Laura Long
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Rena Feinman
- Hackensack Meridian Health Center for Discovery and Innovation, Nutley, New Jersey, USA
| | - Andrea Ricourt
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Marlo Kemp
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Mariefel Vendivil
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Hyung Suh
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Bindu Balani
- Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Cristina Cicogna
- Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Rani Sebti
- Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Abdulla Al-Khan
- Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Steven Sperber
- Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Samit Desai
- Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Stacey Fanning
- Hackensack Meridian Health Center for Discovery and Innovation, Nutley, New Jersey, USA
| | - Danit Arad
- Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Ronaldo Go
- Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Elizabeth Tam
- Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Keith Rose
- Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Sean Sadikot
- Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - David Siegel
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Martin Gutierrez
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Tatyana Feldman
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Andre Goy
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Andrew Pecora
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Noa Biran
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Lori Leslie
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Alfred Gillio
- Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Sarah Timmapuri
- Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Michele Boonstra
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Sam Singer
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Sukhdeep Kaur
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Ernest Richards
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - David S Perlin
- Hackensack Meridian Health Center for Discovery and Innovation, Nutley, New Jersey, USA
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Ip A, Berry DA, Hansen E, Goy AH, Pecora AL, Sinclaire BA, Bednarz U, Marafelias M, Berry SM, Berry NS, Mathura S, Sawczuk IS, Biran N, Go RC, Sperber S, Piwoz JA, Balani B, Cicogna C, Sebti R, Zuckerman J, Rose KM, Tank L, Jacobs LG, Korcak J, Timmapuri SL, Underwood JP, Sugalski G, Barsky C, Varga DW, Asif A, Landolfi JC, Goldberg SL. Hydroxychloroquine and tocilizumab therapy in COVID-19 patients-An observational study. PLoS One 2020; 15:e0237693. [PMID: 32790733 PMCID: PMC7425928 DOI: 10.1371/journal.pone.0237693] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/01/2020] [Indexed: 01/08/2023] Open
Abstract
Hydroxychloroquine has been touted as a potential COVID-19 treatment. Tocilizumab, an inhibitor of IL-6, has also been proposed as a treatment of critically ill patients. In this retrospective observational cohort study drawn from electronic health records we sought to describe the association between mortality and hydroxychloroquine or tocilizumab therapy among hospitalized COVID-19 patients. Patients were hospitalized at a 13-hospital network spanning New Jersey USA between March 1, 2020 and April 22, 2020 with positive polymerase chain reaction results for SARS-CoV-2. Follow up was through May 5, 2020. Among 2512 hospitalized patients with COVID-19 there have been 547 deaths (22%), 1539 (61%) discharges and 426 (17%) remain hospitalized. 1914 (76%) received at least one dose of hydroxychloroquine and 1473 (59%) received hydroxychloroquine with azithromycin. After adjusting for imbalances via propensity modeling, compared to receiving neither drug, there were no significant differences in associated mortality for patients receiving any hydroxychloroquine during the hospitalization (HR, 0.99 [95% CI, 0.80-1.22]), hydroxychloroquine alone (HR, 1.02 [95% CI, 0.83-1.27]), or hydroxychloroquine with azithromycin (HR, 0.98 [95% CI, 0.75-1.28]). The 30-day unadjusted mortality for patients receiving hydroxychloroquine alone, azithromycin alone, the combination or neither drug was 25%, 20%, 18%, and 20%, respectively. Among 547 evaluable ICU patients, including 134 receiving tocilizumab in the ICU, an exploratory analysis found a trend towards an improved survival association with tocilizumab treatment (adjusted HR, 0.76 [95% CI, 0.57-1.00]), with 30 day unadjusted mortality with and without tocilizumab of 46% versus 56%. This observational cohort study suggests hydroxychloroquine, either alone or in combination with azithromycin, was not associated with a survival benefit among hospitalized COVID-19 patients. Tocilizumab demonstrated a trend association towards reduced mortality among ICU patients. Our findings are limited to hospitalized patients and must be interpreted with caution while awaiting results of randomized trials. Trial Registration: Clinicaltrials.gov Identifier: NCT04347993.
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Affiliation(s)
- Andrew Ip
- Division of Outcomes and Value Research, John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, New Jersey, United States of America
| | - Donald A. Berry
- Berry Consultants LLC, Austin, Texas, United States of America,M.D. Anderson Cancer Center of the University of Texas, Houston, Texas, United States of America
| | - Eric Hansen
- COTA, Boston, Massachusetts, United States of America
| | - Andre H. Goy
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, New Jersey, United States of America
| | - Andrew L. Pecora
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, New Jersey, United States of America
| | - Brittany A. Sinclaire
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, New Jersey, United States of America
| | - Urszula Bednarz
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, New Jersey, United States of America
| | - Michael Marafelias
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, New Jersey, United States of America
| | - Scott M. Berry
- Berry Consultants LLC, Austin, Texas, United States of America
| | | | | | - Ihor S. Sawczuk
- Hackensack Meridian Health, Hackensack New Jersey and Hackensack Meridian School of Medicine, Nutley, New Jersey, United States of America
| | - Noa Biran
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, New Jersey, United States of America
| | - Ronaldo C. Go
- Hackensack Meridian Health, Hackensack New Jersey and Hackensack Meridian School of Medicine, Nutley, New Jersey, United States of America
| | - Steven Sperber
- Hackensack Meridian Health, Hackensack New Jersey and Hackensack Meridian School of Medicine, Nutley, New Jersey, United States of America
| | - Julia A. Piwoz
- Hackensack Meridian Health, Hackensack New Jersey and Hackensack Meridian School of Medicine, Nutley, New Jersey, United States of America
| | - Bindu Balani
- Hackensack Meridian Health, Hackensack New Jersey and Hackensack Meridian School of Medicine, Nutley, New Jersey, United States of America
| | - Cristina Cicogna
- Hackensack Meridian Health, Hackensack New Jersey and Hackensack Meridian School of Medicine, Nutley, New Jersey, United States of America
| | - Rani Sebti
- Hackensack Meridian Health, Hackensack New Jersey and Hackensack Meridian School of Medicine, Nutley, New Jersey, United States of America
| | - Jerry Zuckerman
- Hackensack Meridian Health, Hackensack New Jersey and Hackensack Meridian School of Medicine, Nutley, New Jersey, United States of America
| | - Keith M. Rose
- Hackensack Meridian Health, Hackensack New Jersey and Hackensack Meridian School of Medicine, Nutley, New Jersey, United States of America
| | - Lisa Tank
- Hackensack Meridian Health, Hackensack New Jersey and Hackensack Meridian School of Medicine, Nutley, New Jersey, United States of America
| | - Laurie G. Jacobs
- Hackensack Meridian Health, Hackensack New Jersey and Hackensack Meridian School of Medicine, Nutley, New Jersey, United States of America
| | - Jason Korcak
- Hackensack Meridian Health, Hackensack New Jersey and Hackensack Meridian School of Medicine, Nutley, New Jersey, United States of America
| | - Sarah L. Timmapuri
- Hackensack Meridian Health, Hackensack New Jersey and Hackensack Meridian School of Medicine, Nutley, New Jersey, United States of America
| | - Joseph P. Underwood
- Hackensack Meridian Health, Hackensack New Jersey and Hackensack Meridian School of Medicine, Nutley, New Jersey, United States of America
| | - Gregory Sugalski
- Hackensack Meridian Health, Hackensack New Jersey and Hackensack Meridian School of Medicine, Nutley, New Jersey, United States of America
| | - Carol Barsky
- Hackensack Meridian Health, Hackensack New Jersey and Hackensack Meridian School of Medicine, Nutley, New Jersey, United States of America
| | - Daniel W. Varga
- Hackensack Meridian Health, Hackensack New Jersey and Hackensack Meridian School of Medicine, Nutley, New Jersey, United States of America
| | - Arif Asif
- Hackensack Meridian Health, Hackensack New Jersey and Hackensack Meridian School of Medicine, Nutley, New Jersey, United States of America
| | - Joseph C. Landolfi
- Hackensack Meridian Health, Hackensack New Jersey and Hackensack Meridian School of Medicine, Nutley, New Jersey, United States of America
| | - Stuart L. Goldberg
- Division of Outcomes and Value Research, John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, New Jersey, United States of America,* E-mail:
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Hedvat J, Lake P, Swamy S, Zecchini J, Pereiras M, Sebti R. 2648. Terminating the Troll of Transplantation: Letermovir for Cytomegalovirus Prophylaxis. Open Forum Infect Dis 2019. [PMCID: PMC6810011 DOI: 10.1093/ofid/ofz360.2326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Letermovir is a novel antiviral that was approved for cytomegalovirus (CMV) prophylaxis after allogeneic hematopoietic stem cell transplant (allo-HSCT). The objective was to assess the real-world outcomes of CMV prophylaxis with letermovir compared with preemptive therapy (PT) alone. Methods This retrospective pre- and post-study evaluated the clinical impact of using letermovir prophylaxis in CMV-seropositive allo-HSCT recipients at our institution. The electronic medical record was used to identify patients that received PT alone from July 2016 to November 2017 and letermovir prophylaxis from November 2017 to March 2019. The primary endpoint was the proportion of patients with CMV infection requiring PT through week 24 after transplant. Secondary endpoints included the proportion of patients with CMV infection requiring PT through week 14 after transplant, time to CMV infection requiring PT, incidence of CMV disease, CMV-related hospitalization and all-cause mortality through week 14 and 24 after transplant. Safety data included incidence and time to engraftment and adverse effects due to letermovir. Chi-squared and t-test were utilized for categorical and continuous data respectively. Results The baseline characteristics were similar (Table 1) and 78.7% of patients were high risk for CMV. Fewer patients in the letermovir group (n = 50) than in the historic control group (n = 100) had CMV infection requiring PT through week 24 after transplant (9 [18%] vs. 63 [63%], P < 0.001). The mean time to CMV infection requiring PT through week 24 after transplant was 93.4 days (28–161) in the letermovir group vs. 37.4 days (11–126) in the historic control group (P < 0.001). The all-cause mortality and incidence of CMV-related hospitalization were not statistically different between the two groups through week 24 after transplant (Table 2). The incidence and time to engraftment were not statistically different between the two groups (Table 3). Conclusion Letermovir prophylaxis in the real-world setting resulted in less CMV infection requiring PT when compared with a historic control of patients receiving PT alone. The majority of patients in the letermovir group experienced delayed-onset CMV reactivation. Letermovir was well-tolerated with no apparent myelosuppressive toxicities. ![]()
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Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Jason Hedvat
- Hackensack University Medical Center, Tenafly, New Jersey
| | - Patrick Lake
- Hackensack University Medical Center, Tenafly, New Jersey
| | - Siddharth Swamy
- Ernest Mario School of Pharmacy, Rutgers University/Hackensack University Medical Center, Jersey City, New Jersey
| | - Julia Zecchini
- Hackensack University Medical Center, Tenafly, New Jersey
| | - Maribel Pereiras
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, New Jersey
| | - Rani Sebti
- Hackensack University Medical Center, Tenafly, New Jersey
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Megherea O, Patel R, Lake P, Bicking K, Sebti R. 137. Impact of Rapid Susceptibility Testing on Outcomes in Patients with Bacteremia. Open Forum Infect Dis 2019. [PMCID: PMC6810107 DOI: 10.1093/ofid/ofz360.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Early organism identification via rapid diagnostics has been shown to reduce time to effective antimicrobial therapy and improve patient outcomes in patients with bacteremia, but antimicrobial susceptibility testing is still required to optimize therapy. The objective of this study was to determine the impact of an institution-specific rapid susceptibility testing method on outcomes in patients with bacteremia.
Methods
This was a retrospective pre- and post-intervention study of 100 adult patients with bacteremia. Patients were excluded if they had polymicrobial infection, fungemia, blood cultures collected at outside hospitals, or if they expired prior to susceptibility results. Patients were identified through a report containing positive blood cultures from October 2017 to February 2018 (pre-intervention [PrI]) and October 2018 to February 2019 (post-intervention [PoI]). The primary endpoint was the rate of clinical failure (a composite of 28-day mortality or bacteremia persisting greater than 6 days). Secondary endpoints included microbiologic outcomes, time to effective and optimal therapy, length of stay (LOS) and therapy adjustments.
Results
Baseline characteristics were similar between groups; a third of the patients were immunosuppressed (Table 1). The most common sources of infection were urinary and intra-abdominal, and the most common organisms identified were E.coli and Klebsiella spp. No significant difference in the rate of clinical failure was identified between PrI and PoI (24% vs. 18%, P = 0.6242) (Table 2). In the PoI, the time to identification, susceptibility results, and effective therapy was significantly shorter with similar time to optimal therapy and LOS. In the PoI, antimicrobial stewardship program (ASP) interventions were made significantly sooner after susceptibility results.
Conclusion
In this small, retrospective, single-center study, the implementation of a rapid susceptibility testing method was associated with reduced time to susceptibility results and more rapid interventions by the ASP, but no difference in the rate of clinical failure or time to optimal therapy was identified.
Disclosures
All authors: No reported disclosures.
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Affiliation(s)
- Oxana Megherea
- Hackensack University Medical Center, Newtown, Pennsylvania
| | - Ruchi Patel
- Hackensack University Medical Center, Newtown, Pennsylvania
| | - Patrick Lake
- Hackensack University Medical Center, Newtown, Pennsylvania
| | - Keri Bicking
- Hackensack University Medical Center, Newtown, Pennsylvania
| | - Rani Sebti
- Hackensack University Medical Center, Newtown, Pennsylvania
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McCoy D, Sebti R, Kuyumjian AG. An Evaluation of Selected Indications and Appropriateness of Ampicillin/Sulbactam, an Unrestricted Antimicrobial, at a Single Center. P T 2017; 42:189-194. [PMID: 28250702 PMCID: PMC5312635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND With antimicrobial resistance on the rise and few new agents in development, it is important to exercise prudent judgment when utilizing antimicrobials. The Antimicrobial Stewardship Program (ASP) is responsible for facilitating the appropriate use of antimicrobials at the institution. Restricted antimicrobials and select additional antimicrobials are monitored by the ASP team to determine if the indications chosen by the ordering prescribers correspond to and are appropriate for the patients' infections. The purpose of this study was to review ampicillin/sulbactam, an unrestricted antimicrobial, due to its declining effectiveness against Escherichia coli. METHODS A retrospective chart review was conducted with adult inpatients receiving ampicillin/sulbactam. One hundred consecutive orders for ampicillin/sulbactam were reviewed. RESULTS The greatest number of orders for ampicillin/sulbactam came from the Emergency Trauma, Medicine, and Surgery services. The indications selected by the ordering providers were: skin and soft tissue infection (33 orders), community-acquired respiratory infection (22 orders), other (14 orders), intra-abdominal infection due to susceptible organism (13 orders), urinary tract infection (nine orders), head/neck infection (five orders), infection due to human or animal bite (three orders), and diabetic foot infection (one order). CONCLUSIONS The correct indication was selected in 78% of orders that were reviewed for correctness. Empiric ampicillin/sulbactam was appropriate in 51% of orders, with the majority of inappropriate empiric usage being intra-abdominal and urinary tract infections.
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Procopio G, McCoy D, Kuyumjian A, Finefrock D, Zodda D, Ogedegbe C, Sebti R, Feldman J. Assessing the Impact of an Adult Emergency Department Antibiotic Guide and Education on Emergency Medicine Residents for Judicious Empiric Therapy Selection. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Gabrielle Procopio
- Pharmacy Practice and Administration, Ernest Mario School of Pharmacy at Rutgers, the State University of New Jersey, Piscataway, New Jersey
| | - Dorothy McCoy
- Pharmacy Practice and Administration, Ernest Mario School of Pharmacy at Rutgers, the State University of New Jersey, Piscataway, New Jersey
| | - Arpi Kuyumjian
- Pharmacy, Hackensack University Medical Center, Hackensack, New Jersey
| | - Douglas Finefrock
- Emergency Medicine, Hackensack University Medical Center, Hackensack, New Jersey
| | - David Zodda
- Emergency Medicine, Hackensack University Medical Center, Hackensack, New Jersey
| | - Chinwe Ogedegbe
- Emergency Medicine, Hackensack University Medical Center, Hackensack, New Jersey
| | - Rani Sebti
- Infectious Diseases, Hackensack University Medical Center, Hackensack, New Jersey
| | - Joseph Feldman
- Emergency Medicine, Hackensack University Medical Center, Hackensack, New Jersey
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Bains S, Goy A, Fuchs B, Gadaleta G, Singavi A, Hurtubise B, Sebti R, Feldman T, Goldberg S, Pecora A, Mato AR. Febrile neutropenia in hematologic malignancies: Validation of a model to select patients manageable in the outpatient setting safely. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e19641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e19641 Background: Febrile neutropenia (FN) is usually treated in an inpatient setting with empiric IV antibiotics. Accurate identification of low-risk hematologic malignancy (HM) pts (highest risk for life-threatening events) appropriate for outpatient management may reduce healthcare costs without impacting outcomes adversely. Prior studies using predictive models to identify low risk FN pts have not been validated in HM pts. Aim: To identify low risk HM pts as candidates for safe outpatient management. Methods: To determine parameters associated with an uncomplicated FN course in HM pts we tested the association between Talcott’s criteria (Talcott et al JCO Oct 2011) and additional candidate risk factors with the development of a medical event (ME) requiring urgent intervention. We conducted a retrospective cohort study of stable HM pts, admitted for FN management. Utilizing Cox regression, we examined the following factors: Talcott criteria, age, insurance status, prophylactic G-CSF/antibiotics, vitals signs and organ function. Results: We identified 97 consecutively admitted pts who met eligibility criteria of whom 27 pts developed a ME during the admission (validated by 2 investigators blinded to exposure status). In univariate analysis, Talcott’s criteria successfully identified pts at low risk for developing a ME (HR .4, p=.04 CI .17-.97). Additionally a preserved DPB (>65 mmHg) was also protective (HR .22 p<.01 CI .11-.51). Talcott’s criteria and DBP remained independent predictors of uncomplicated FN in a multivariate cox regression (AUROC curve=75%). Conclusions: This study provides support for the use of Talcott’s criteria in HM pts. The addition of DBP to Talcott’s model further improves its ability to identify low risk HM pts. Once prospectively validated, this approach may have important clinical and financial implications. [Table: see text]
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Affiliation(s)
| | - Andre Goy
- John Theurer Cancer Center, Hackensack, NJ
| | - Barry Fuchs
- University of Pennsylvania Medical Center, Philadelphia, PA
| | | | | | | | - Rani Sebti
- John Theurer Cancer Center, Hackensack, NJ
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McCoy D, Wong E, Kuyumjian AG, Wynd MA, Sebti R, Munk GB. Treatment of respiratory syncytial virus infection in adult patients with hematologic malignancies based on an institution-specific guideline. Transpl Infect Dis 2010; 13:117-21. [PMID: 20804534 DOI: 10.1111/j.1399-3062.2010.00561.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A total of 26 adults with hematologic malignancies and/or hematopoietic stem cell transplant were treated for respiratory syncytial virus (RSV) infection based on an institutional guideline. Thirteen patients received aerosolized ribavirin, and 13 received aerosolized ribavirin and intravenous palivizumab. Two deaths, not attributed to RSV infection, occurred within 90 days of diagnosis.
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Affiliation(s)
- D McCoy
- Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Hackensack, New Jersey, USA.
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Wong E, Kuyumjian A, Wynd M, Surowiec D, DeSevo G, Patel A, Munk G, Sebti R. Treatment of Respiratory Syncytial Virus Infection in Adult Patients with Hematologic Malignancies on An Institution-Specific Guideline. Biol Blood Marrow Transplant 2009. [DOI: 10.1016/j.bbmt.2008.12.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Jaffe D, Jakubowski A, Sepkowitz K, Sebti R, Kiehn TE, Pamer E, Papanicolaou GA. Prevention of peritransplantation viridans streptococcal bacteremia with early vancomycin administration: a single-center observational cohort study. Clin Infect Dis 2004; 39:1625-32. [PMID: 15578362 DOI: 10.1086/425612] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2004] [Accepted: 07/14/2004] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Viridans streptococcal bacteremia (VSB) after allogeneic hematopoietic stem cell transplantation (HSCT) is associated with substantial mortality. Prevention of this serious complication is therefore a high priority. The objective of this study was to evaluate the effect of early vancomycin administration on rates and outcomes of VSB. METHODS We analyzed the effect of early vancomycin on the incidence of VSB in a cohort of 430 consecutive HSCTs performed during the period of 1 January 1998 to 30 September 2002. The primary end point was time to diagnosis of VSB. Early vancomycin was defined as >or=2 doses of vancomycin between days -7 through +7 after HSCT or diagnosis of VSB, whichever occurred first. Risk factors for VSB were identified in univariate and multivariate Cox proportional hazard models. RESULTS The incidence of VSB in the cohort was 7.4%. The incidence of VSB in patients who did not receive early vancomycin was 24.8%, compared with 0.3% in patients who did (P<.001). Additional risk factors were female sex, conditioning with total body irradiation, and diagnosis of chronic myelogenous leukemia. CONCLUSIONS The attributable mortality rate for VSB in our cohort was 21%. Early vancomycin was associated with decreased VSB (hazard ratio, 0.02; 95% confidence interval, 0.003-0.19) after controlling for age, sex, underlying disease, and transplantation variables. The benefits of vancomycin prophylaxis for the prevention of VSB and associated mortality need to be evaluated in a prospective clinical trial.
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Affiliation(s)
- Dana Jaffe
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA
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