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1.
Medicine (Baltimore) ; 101(49): e32276, 2022 Dec 09.
Article in English | MEDLINE | ID: mdl-36626517

ABSTRACT

This study aimed to evaluate the risk of serum tobramycin concentrations exceeding therapeutic levels after administration of calcium sulfate (CaSO4) beads containing either 240 mg or 400 mg tobramycin and 1000 mg vancomycin. This single-center, prospective. This single-center, prospective study included included Piedmont Columbus, Regional orthopedic surgery patients. Following the implantation of tobramycin into CaSO4 beads, serially measured serum tobramycin concentrations were evaluated after 6, 12, 24, and 48 hours. In addition to that, serum tobramycin concentration was evaluated after 5 days. None of the patients who received 240 mg tobramycin-impregnated beads had a tobramycin level >2 µg/mL. Six hours after implantation, the tobramycin level in 2 out of 2 (100%) patients who received 400 mg of tobramycin-impregnated beads was >2 µg/mL. One day following the surgery, the median serum creatinine was 0.85 mg/dL, with an interquartile range of 0.73 to 1.04 mg/dL. No cases of acute kidney injury were observed. This cohort demonstrated that non-nephrotoxic serum tobramycin levels could be achieved in CaSO4 beads mixed with 240 mg or 400 mg of tobramycin.


Subject(s)
Anti-Bacterial Agents , Tobramycin , Humans , Prospective Studies , Anti-Bacterial Agents/therapeutic use , Vancomycin , Kidney/physiology
2.
Microb Drug Resist ; 27(8): 1037-1043, 2021 Aug.
Article in English | MEDLINE | ID: mdl-33544027

ABSTRACT

Staphylococcus aureus bacteremia is a life-threatening condition associated with a substantial financial burden on the health care system. The use of the GeneXpert® methicillin-resistant S. aureus (MRSA)/S. aureus blood culture (BC) test for the identification of S. aureus may influence antibiotic stewardship and clinical outcomes. This study assessed the clinical and financial impact of utilizing GeneXpert MRSA/SA in combination with criterion-based testing. The outcomes between October 1, 2018, and June 30, 2019, were evaluated in 65 adult patients who had positive BCs with Gram-positive cocci in clusters. GeneXpert MRSA/SA significantly shortened the time to optimal antimicrobial therapy by 1.7 days (2.5 vs. 44 hr, p < 0.0001). The cost saved because of interventions based on GeneXpert testing results was $4,121. GeneXpert testing has shortened the time to optimal therapy and positively impacted cost, although it had no significant effect on length of hospital stay and mortality rate.


Subject(s)
Antimicrobial Stewardship/methods , Bacteremia/microbiology , Methicillin-Resistant Staphylococcus aureus/drug effects , Methicillin-Resistant Staphylococcus aureus/genetics , Staphylococcal Infections/diagnosis , Adult , Aged , Aged, 80 and over , Bacteremia/drug therapy , Blood Culture , Female , Genetic Techniques , Humans , Male , Middle Aged , Staphylococcal Infections/drug therapy , Time-to-Treatment
3.
Cureus ; 13(12): e20171, 2021 Dec.
Article in English | MEDLINE | ID: mdl-35003997

ABSTRACT

Diffuse alveolar hemorrhage (DAH) is a rare syndrome resulting from the accumulation of intra-alveolar red blood cells originating most often from the alveolar capillaries and, less frequently, from precapillary arterioles or postcapillary venules. The causes of DAH can be divided into infectious and noninfectious. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus that has not been previously identified in humans, and it is responsible for coronavirus disease-19 (COVID-19) infection. Here, we present a case of DAH that is believed to be a consequence of COVID-19 infection in a female patient with no known past medical history. The patient was found to be positive for perinuclear anti-neutrophil cytoplasmic antibodies (P-ANCA) and anti-glomerular basement membrane antibodies. The patient was diagnosed with ANCA-associated vasculitis with glomerulonephritis and was treated successfully with methylprednisolone 500 mg intravenous (IV) daily for three days, followed by rituximab 375 mg/m2 IV once weekly for four weeks. The long-term complications of COVID-19 are not entirely known and are still being investigated. The association between COVID-19 infection and DAH is not fully known. However, the inflammatory process of COVID-19 infection may have a role in vasculitis, leading to DAH.

4.
J Glob Antimicrob Resist ; 24: 23-26, 2021 03.
Article in English | MEDLINE | ID: mdl-33279686

ABSTRACT

OBJECTIVES: Recent studies have shown that methicillin-resistantStaphylococcus aureus (MRSA) bacteraemia with vancomycin minimum inhibitory concentration (MIC) >1 µg/mL is associated with a higher rate of treatment failure and a higher mortality rate. Daptomycin is an alternative to vancomycin but has not been as well studied. The aim of this literature review was to evaluate the effect of daptomycin MIC on the outcomes of S. aureus bacteraemia. METHODS: We conducted a literature search for the period January 2010 to January 2019 using the MEDLINE and Embase databases. RESULTS: Four studies were included in the review. The outcomes were clinical cure and 30- or 60-day mortality. In two retrospective studies, 60-70% ofS. aureus isolates had a low daptomycin MIC (≤0.5 µg/mL) and patients with MRSA bacteraemia who were treated with daptomycin had a lower mortality rate. In another study, patients with methicillin-susceptible S. aureus bacteraemia with low daptomycin MICs had a lower risk of developing septic thrombophlebitis. One study showed that patients with MRSA bacteraemia had a higher mortality rate if the daptomycin MIC was >0.5 µg/mL. CONCLUSION: The included studies in this review suggest a possible association between high daptomycin MIC and unfavourable clinical outcomes ofS. aureus bacteraemia. Further prospective studies are required to evaluate the impact of the daptomycin MIC on the clinical outcomes of S. aureus bacteraemia.


Subject(s)
Bacteremia , Daptomycin , Staphylococcal Infections , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Bacteremia/drug therapy , Daptomycin/pharmacology , Daptomycin/therapeutic use , Humans , Methicillin-Resistant Staphylococcus aureus/drug effects , Microbial Sensitivity Tests , Staphylococcal Infections/drug therapy , Staphylococcus aureus/drug effects , Treatment Outcome
5.
J Emerg Med ; 59(3): 452-458, 2020 Sep.
Article in English | MEDLINE | ID: mdl-32684382

ABSTRACT

BACKGROUND: Human rabies can be prevented through postexposure prophylaxis (PEP). Although the case fatality rate is high, there are only one to three human cases per year in the United States. Despite the low incidence, the cost of rabies diagnostics, prevention, and control is significant. Recommendations exist regarding which patients should receive PEP, though several studies demonstrate a high frequency of unnecessary prescribing of PEP. OBJECTIVE: The purpose of this study is to determine if an animal bite protocol improves compliance with state and national recommendations regarding treatment of patients presenting to the emergency department (ED). Potential cost savings will also be evaluated. METHODS: An institutional review board-approved, single-center, retrospective chart review was conducted from January 1, 2017 to March 18, 2018 to evaluate patients presenting to the ED with an animal bite prior to and after implementation of a protocol. The primary outcome was defined as the percentage of PEP offered as indicated by the protocol. Secondary outcomes included the appropriateness of not offering PEP and estimated cost savings after protocol implementation. RESULTS: PEP was indicated four times out of 29 offers pre-protocol and three times out of five offers post-protocol (p = 0.0476). There was no difference in the appropriateness of not offering PEP (pre-protocol 105/107 times vs. 29/29 times; p = 0.9998). Cost savings was associated with protocol implementation. CONCLUSION: A pharmacist-driven protocol can beneficially influence prescribing habits after potential rabies exposure and is associated with cost savings.


Subject(s)
Bites and Stings , Rabies Vaccines , Rabies , Animals , Humans , Pharmacists , Post-Exposure Prophylaxis , Rabies/prevention & control , Retrospective Studies
6.
Case Rep Infect Dis ; 2020: 3089023, 2020.
Article in English | MEDLINE | ID: mdl-32158569

ABSTRACT

One of the most effective strategies in reducing the risk of Clostridium difficile infection (CDI) recurrence is fecal microbiota transplantation (FMT). However, several adverse events have been reported post FMT, and data on the efficacy and safety of FMT in immunocompromised patients with hematological malignancies are rare. This report presents FMT treatment for refractory CDI in a severely immunocompromised patient. A 69-year-old female presented to the emergency department complaining of foul smelling, intractable, watery diarrhea and generalized abdominal pain. She was recently diagnosed with high-risk myelodysplastic Syndrome (MDS) requiring daily blood transfusions and reported multiple CDI episodes in the past treated successfully with metronidazole and vancomycin as mono- or combotherapy. During this admission, treatment with oral vancomycin (high dose) and intravenous metronidazole was unsuccessful, so FMT was administered. The patient recovered well despite an absolute neutrophil count (ANC) < 0.25 × 109/L, and chemotherapy was initiated soon after. FMT was successful and safe in this patient, with no relapse and adverse events seen in 8 weeks of follow-up via phone calls and office visits.

7.
Am J Case Rep ; 20: 508-510, 2019 Apr 12.
Article in English | MEDLINE | ID: mdl-30978177

ABSTRACT

BACKGROUND Glomerulonephritis (GN) associated with post staphylococcus infection (PSIGN) and high serum immunoglobulin A (IgA) has been reported recently. Patients with GN after infection with underlying IgA nephropathy create a challenge to determine the etiology of GN. Therefore, treatment should be accordingly, with steroids used if the IgA nephropathy flare-up is determined to be the etiology. The aim of this case report was to shed light on the difference between PSIGN and IgA nephropathy flare-ups in patients with a history of IgA nephropathy, and how to treat patient cases accordingly. CASE REPORT An 81-year-old male presented to our Emergency Department complaining of increasing pain, swelling, and redness of his left knee since 2 days ago. He had a history of recent methicillin sensitive Staphylococcus aureus (MSSA) left knee arthroplasty infection that was treated with cefazolin, and he had a history of IgA nephropathy diagnosed 1 year ago. CONCLUSIONS In our patient case, renal biopsy studies were not enough to differentiate between PSIGN and IgA nephropathy flare-ups, thus, clinical presentation was important. PSIGN was found to have a delayed onset compared to IgA nephropathy. Lower serum complement 3 (C3) level, heavier proteinuria, and acute renal failure are common with PSIGN compared to IgA nephropathy. Identifying the etiology and treating our patient accordingly with immunosuppressive therapy had a positive impact on the patient, restoring renal function without further damage.


Subject(s)
Glomerulonephritis, IGA/diagnosis , Staphylococcal Infections/complications , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Cefazolin/therapeutic use , Diagnosis, Differential , Glomerulonephritis/diagnosis , Humans , Male , Staphylococcal Infections/drug therapy , Staphylococcus aureus
8.
Am J Case Rep ; 19: 1350-1353, 2018 Nov 13.
Article in English | MEDLINE | ID: mdl-30420589

ABSTRACT

BACKGROUND Actinomyces species are normal flora of the upper respiratory, female genital, and gastrointestinal tract. Actinomyces species are generally considered to have a low virulence potential. Here we report one case of Actinomyces viscosus isolated from a neonatal blood culture as a consequence of extreme prematurity in the presence of HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome. CASE REPORT A 23-week gestational age female infant was born to a 32-year-old mother. The pregnancy was complicated by severe HELLP syndrome leading to cesarean section at 23-week gestation. The initial blood culture grew anaerobic gram-positive branching rods consistent with Actinomyces species. Due to patient instability, antibiotic was started and continued for a total of 13 days. On day of life 26, the reference laboratory identified the organism as A. viscosus by 16S ribosomal RNA. CONCLUSIONS In this case, Actinomyces species was a consequence of HELLP syndrome and consecutive extreme prematurity. Further research to look more closely at Actinomyces species isolated from neonatal blood culture will help to elucidate the true significance of these isolates.


Subject(s)
Actinomyces/isolation & purification , Actinomycosis/drug therapy , Anti-Bacterial Agents/therapeutic use , HELLP Syndrome/microbiology , Infant, Extremely Premature , Actinomyces/drug effects , Actinomycosis/diagnosis , Cesarean Section , Female , Gestational Age , HELLP Syndrome/diagnosis , HELLP Syndrome/drug therapy , Humans , Pregnancy , Pregnancy Outcome , Pregnancy Trimester, Second
9.
Am J Health Syst Pharm ; 75(9): e184-e188, 2018 May 01.
Article in English | MEDLINE | ID: mdl-29691260

ABSTRACT

PURPOSE: The safety and effectiveness of ceftolozane-tazobactam for the treatment of multidrug-resistant (MDR) Pseudomonas aeruginosa pneumonia in a patient receiving intermittent hemodialysis are reported. CASE REPORT: A 79-year-old African-American man arrived at an emergency trauma center from a nursing home via ambulance with shortness of breath and potential nasogastric tube misplacement. His medical history included end-stage renal disease (ESRD) for which he was receiving intermittent hemodialysis 3 times per week, hypertension, sacral ulcer, coronary artery bypass graft surgery, and P. aeruginosa colonization of his airway. His white blood cell count was elevated, and a chest radiograph revealed atelectasis or infiltrates. As a result, aspiration pneumonia was suggested, and empirical vancomycin and piperacillin-tazobactam were initiated. A few days later, his sputum culture grew MDR P. aeruginosa. Empirical antibiotics were then discontinued, and targeted therapy with ceftolozane-tazobactam i.v. was initiated. A loading dose of ceftolozane-tazobactam 1.5 g i.v. was administered, followed by a maintenance dosage of 300 mg every 8 hours. Following the fifth dose, random ceftolozane-tazobactam plasma concentrations were measured and noncompartmental pharmacokinetics were calculated. After completing a 13-day course of ceftolozane-tazobactam, the patient was discharged from the hospital in stable condition and did not experience any adverse events with ceftolozane-tazobactam. CONCLUSION: In a patient with ESRD receiving intermittent hemodialysis, a ceftolozane-tazobactam loading dose of 1.5 g i.v. followed by a maintenance dosage of 300 mg every 8 hours appeared to be safe and effective in the treatment of nosocomial pneumonia caused by MDR P. aeruginosa.


Subject(s)
Anti-Bacterial Agents/administration & dosage , Cephalosporins/administration & dosage , Pseudomonas Infections/drug therapy , Tazobactam/administration & dosage , Aged , Anti-Bacterial Agents/pharmacokinetics , Cephalosporins/pharmacokinetics , Drug Resistance, Multiple, Bacterial , Humans , Kidney Failure, Chronic/therapy , Male , Microbial Sensitivity Tests , Pneumonia, Bacterial/drug therapy , Pneumonia, Bacterial/microbiology , Pseudomonas Infections/microbiology , Pseudomonas aeruginosa/drug effects , Renal Dialysis/methods , Tazobactam/pharmacokinetics , Treatment Outcome
10.
Am J Case Rep ; 18: 1315-1319, 2017 Dec 09.
Article in English | MEDLINE | ID: mdl-29222405

ABSTRACT

BACKGROUND Native vertebral osteomyelitis (NVO) is a common form of hematogenous osteomyelitis, with Staphylococcus aureus (S. aureus) being the most commonly isolated organism. Dalbavancin is approved by the US Food and Drug Administration (FDA) for the treatment of acute bacterial skin and skin structure infections (ABSSSI) and has a sufficiently promising pharmacokinetic and pharmacodynamic profile to be considered for the treatment of vertebral osteomyelitis. We describe here what is probably the first reported case of using multiple weekly dalbavancin to treat a complicated methicillin-resistant Staphylococcus aureus (MRSA) bacteremia and vertebral osteomyelitis. CASE REPORT A 58-year-old man with a long history of recurrent MRSA bacteremia, who failed multiple courses of vancomycin and daptomycin, presented with recurrent MRSA bacteremia complicated by diskitis and osteomyelitis of the lumbar vertebrae. The patient was treated with dalbavancin 1000 mg intravenously weekly for two weeks followed by 500 mg weekly for six additional weeks. He improved clinically, his back pain resolved, and C-reactive protein (CRP) decreased to normal. Three months after the last dose of dalbavancin therapy, he underwent angiography for peripheral artery diseases, after which he developed a fever, mild leukocytosis, an elevated CRP, and the repeat blood cultures were positive for MRSA. No apparent adverse events were observed during dalbavancin therapy. CONCLUSIONS In this case, multiple weekly dalbavancin infusions appeared to be safe in the treatment of vertebral osteomyelitis caused by MRSA, but did not seem to prevent infection recurrence. However, reinfection with a new strain from the angiography catheter insertion is highly likely. Clinical studies are needed to further assess the safety and effectiveness of multiple weekly dalbavancin dosing in the management of vertebral osteomyelitis.


Subject(s)
Anti-Bacterial Agents/administration & dosage , Methicillin-Resistant Staphylococcus aureus , Osteomyelitis/drug therapy , Osteomyelitis/microbiology , Staphylococcal Infections/drug therapy , Teicoplanin/analogs & derivatives , Dose-Response Relationship, Drug , Drug Administration Schedule , Humans , Lumbar Vertebrae/microbiology , Male , Middle Aged , Teicoplanin/administration & dosage
11.
Am J Case Rep ; 18: 674-676, 2017 Jun 16.
Article in English | MEDLINE | ID: mdl-28620153

ABSTRACT

BACKGROUND Capnocytophaga ochracea is a gram-negative anaerobic organism commonly found in human oral flora. It is characteristically sensitive to beta-lactams and resistant to aminoglycosides. CASE REPORT A 23-year-old woman presented with lower abdominal pain and was admitted for premature labor at 24-weeks of gestation. At presentation, the cervix was closed and the membrane was intact; however, contractions continued, the membrane subsequently ruptured before receiving any steroids or magnesium, and the mother gave birth to a 540-gram female baby. At birth, Apgar scores were 1 at 5 minutes, 1 at 10 minutes, and 2 at 15 minutes. On the fifth day of life, the blood culture grew Capnocytophaga species. Consequently, Cefotaxime was started and ampicillin continued for a total of 14 days; however, on the 6th day, the head ultrasound showed grade 4 intraventricular hemorrhage and a Do Not Resuscitate (DNR) order was placed in the chart. The patient's health continued to deteriorate, having multiple episodes of bradycardia and desaturation until cardiac arrest on the 17th day. CONCLUSIONS Capnocytophaga ochracea was isolated from the blood culture of a preterm neonate. It was thought to be the cause of the premature labor and subsequent neonatal septicemia. This case report suggests that the prevalence of Capnocytophaga infections is most likely underestimated and that additional premature labors and abortions could have been caused by Capnocytophaga infections that were never detected. Hence, more studies are needed to investigate the route of transmission.


Subject(s)
Capnocytophaga/isolation & purification , Gram-Negative Bacterial Infections/diagnosis , Neonatal Sepsis/microbiology , Obstetric Labor, Premature , Cerebral Intraventricular Hemorrhage/etiology , Fatal Outcome , Female , Heart Arrest/etiology , Humans , Infant, Newborn , Infant, Premature, Diseases/etiology , Pregnancy
12.
Can J Infect Dis Med Microbiol ; 2017: 8648137, 2017.
Article in English | MEDLINE | ID: mdl-28638417

ABSTRACT

PURPOSE: To evaluate whether introducing rapid diagnostic testing in conjunction with implementing a stratification algorithm for testing eligibility would be an appropriate clinical and cost saving approach. METHOD: An internal concurrent 4-month observational study was performed. Positive blood cultures continued to be worked up in accordance with standard of care. An additional call to the infectious disease (ID) pharmacy service occurred for all positive blood cultures with Gram-positive cocci in clusters (GPCC). The ID pharmacy service investigated each case using a prespecified stratification algorithm to minimize unnecessary use of rapid identification testing. RESULTS: 43 patients with GPCC were screened. Only nine patients met inclusion criteria for QuickFISH™ testing. The average expected time avoided to optimize antibiotic therapy is 35 ± 16 hours. If the QuickFISH test had been indiscriminately implemented for all cases, the cost for performing this test would have been $5,590. However, using the prespecified algorithm, only 9 patients were tested for a projected cost of $1,170. CONCLUSION: Introducing rapid diagnostic testing in conjunction with implementing patient stratification algorithm for rapid identification of GPCC from blood cultures in addition to the ID pharmacy intervention will provide a positive impact on the clinical and economic outcomes in our health care setting.

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