14 results on '"Krystina L. Woods"'
Search Results
2. Listeria Rhomboencephalitis in an Immunocompetent Host
- Author
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Krystina L Woods, Shana Patterson, Dewitt Pyburn, Raymonde Jean, Christine Stavropoulos, and Bryan Tolentino
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Microbiology (medical) ,biology ,business.industry ,Host (biology) ,Sulfamethoxazole ,Treatment options ,biology.organism_classification ,Trimethoprim ,Microbiology ,Infectious Diseases ,Ampicillin ,medicine ,Listeria ,business ,medicine.drug - Published
- 2021
3. MP29-13 LONG-TERM DILIGENT CATHETER MONITORING MINIMIZES CATHETER ASSOCIATED URINARY TRACT INFECTION (CAUTI) RATES
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Barbara A. Smith, Olena Dzenkevych, Angela Gabasan, Lindsey Gottlieb, Krystina L Woods, Andrew B. Katims, and Jay A. Motola
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Catheter ,medicine.medical_specialty ,business.industry ,Urology ,Urinary system ,Medicine ,business ,Complication ,Surgery ,Catheter-associated urinary tract infection - Abstract
INTRODUCTION AND OBJECTIVE:CAUTIs are thought to be an avoidable complication and account for 75% of urinary tract infections (UTI). CAUTI risk increases 5%/day (d) of catheterization. For >10 year...
- Published
- 2021
4. What Is the Prevalence of Measles Immunity among Pregnant Women?
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Melissa Chu Lam, Zainab Al-Ibraheemi, Emma T. Geduldig, Jessica Overbey, Krystina L Woods, Emily Schmidt-Beuchat, Lois Brustman, and Katie Hyewon Choi
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Adult ,Pediatrics ,medicine.medical_specialty ,Measles-Mumps-Rubella Vaccine ,Antibodies, Viral ,Rubella ,Measles ,Serology ,03 medical and health sciences ,Rubella vaccine ,0302 clinical medicine ,Immune system ,Immunity ,Pregnancy ,medicine ,Prevalence ,Humans ,030304 developmental biology ,0303 health sciences ,business.industry ,Obstetrics and Gynecology ,medicine.disease ,Vaccination ,Cross-Sectional Studies ,Morbillivirus ,ROC Curve ,030220 oncology & carcinogenesis ,Immunoglobulin G ,Pediatrics, Perinatology and Child Health ,Female ,Pregnant Women ,business ,medicine.drug - Abstract
Objective This study aimed to estimate the prevalence of measles immunity in a cohort of pregnant women in New York City and determine if there is a positive correlation of measles immunity with patient demographics, rubella immunity, number of measles, mumps, and rubella vaccine (MMR) doses received, and age at last vaccination. Study Design This is a cross-sectional study of pregnant patients seen at a single institution from January 2019 to May 2019. Patients were classified as measles and rubella immune or nonimmune using commercial immunoglobulin G (IgG) tests. Patient characteristics were compared using t-tests, Chi-square tests, or Fisher's exact tests as appropriate. The association of age at last vaccination with immunity status was assessed using multivariable logistic regression adjusted for age at presentation. The utility of rubella IgG for distinguishing measles immunity was assessed using receiver operating characteristic curve analysis. Results Serologic immunity for measles and rubella was obtained for 1,366 patients. Of these, 1,047 (77%) were measles immune and 1,291 (95%) were rubella immune. Patients born after 1989 were less likely to be immune to measles, while multiparity and private insurance were associated with increased measles immunity. Documentation of MMR vaccination was available for 140 (10%) patients. Of these, 44 (31%) were serologically nonimmune to measles and 9 (6.4%) were nonimmune to rubella. In patients known to have received one dose of MMR, 62% (24/39) were immune to measles with an improvement to 72% (69/96) among those who received two or more doses. Age at last vaccination was not associated with measles immunity. Rubella IgG level was a poor predictor of positive measles titer (area under the curve = 0.59). Conclusion Approximately one of every four pregnant patients is serologically measles nonimmune, even among women with documented MMR vaccination or documented rubella immunity. These findings raise concerns that relying on vaccination history or rubella immune status may not be sufficient to assure protection from infection with measles. If further suggests that measles serology should be added to routine prenatal laboratory testing to identify nonimmune patients that may benefit from postpartum vaccination. Key Points
- Published
- 2020
5. 1300. ACOG Committee Opinion #797 and the Dose of Intrapartum Vancomycin: a Potential Danger to Mother and Newborn Alike
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Krystina L Woods, Kristina M Feldman, Arsheena Yassin, and Andras Farkas
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Obstetrics ,Gestational age ,Regimen ,Infectious Diseases ,AcademicSubjects/MED00290 ,Oncology ,Therapeutic drug monitoring ,Poster Abstracts ,Medicine ,Vancomycin ,business ,Labor duration ,Prenatal exposure ,medicine.drug ,Clearance - Abstract
Background Intra-partum (IP) IV vancomycin (VAN) 20 mg/kg every 8 hours is proposed by #797 for the prevention of early onset neonatal group B streptococcal disease (GBS), a recommendation for which the basis of scientific merit is poor. The goal of our study was to analyze the sparsely sampled published data and raise awareness about the underlying risk of VAN toxicity with this dosing approach. Methods Plasma and cord-blood concentration-time data of IV VAN given to mothers in the IP period was analyzed. 5000 Monte Carlo runs were conducted to simulate maternal/fetal exposure (AUC0-24; 24-48) for doses of 1500, 1750 and 2000 mgs q8h and for possible birth times at two-hour intervals. Neonatal VAN clearance was not possible to determine; hence, we used a validated PK model to calculate exposure for the first 24h of life for gestational ages (GA) of 33 to 40 weeks. The AUC range of 400 – 600, and > 600 mg*h/L were considered for indices of efficacy and toxicity, respectively. Results Estimates from 30 pairs of serum and cord-blood concentrations analyzed with a 2-compartment model are shown in Table 1. Maternal VAN exposures seem acceptable up to 2 IP doses given with mean (SD) AUC0-24 of 394 (140), 474 (167), and 540 (193) mg*h/L for the 1500, 1750 and 2000 mg regimens. Most mothers (up to 83%) who receive three or more doses will be subjected to nephrotoxic exposures (Figure 1.). Neonatal evaluations indicate similarly low PTAs for the three dosing regimens when the efficacy target is considered (Figure 2. A). On the other hand, the PTAs for potentially nephrotoxic exposure is expected to reach undesirable levels when three or more doses were to be administered. The risk is profoundly high in GA of 33 to 35 weeks and birth times beyond 20 hours after the initiation of intra-partum prophylaxis (Figure 2. B). Figure 1. Figure 2.A Figure 2.B Conclusion Current recommendations by #797 for dosing of vancomycin pose significant risk to mother and newborn alike, especially in cases with lengthy duration of labor. Based on our results, maternal therapeutic drug monitoring for all cases requiring more than two doses should be considered. With the proposed dosing regimen going un-adjusted, 1 out of 4 newborns and 4 out of 5 mothers may be subjected to nephrotoxic exposures in prolonged labor. Table 1. Disclosures All Authors: No reported disclosures
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- 2020
6. 1554. Epidemiology of Adult Bacterial Hand Infections at Two Urban Hospitals
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Andras Farkas, Hendrik Sy, Justin Carale, Jiashan Xu, Elena Khachaturyan, Krystina L Woods, Arsheena Yassin, Chris Taduran, and Christine Stavropoulos
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medicine.medical_specialty ,Infectious Diseases ,AcademicSubjects/MED00290 ,Oncology ,business.industry ,Environmental health ,Epidemiology ,Poster Abstracts ,medicine ,business - Abstract
Background Hand infections represent a major source of morbidity, which can result in hand stiffness and amputation. Early appropriate empiric antibiotic regimen may reduce the associated morbidity, hence the importance to examine local epidemiology. The aim of this study was to define the current epidemiology of adult hand infections at two urban hospitals in New York City. Methods We performed a double center, retrospective study of adult patients hospitalized from March 2018 to May 2020. Patients with positive cultures associated with the hand infections were included. Retrospectively, 100 patients were reviewed. Data on baseline demographic, clinical, surgical, microbiology, and treatment parameters were collected. Results Of the 100 patients, 76% were male, with median age of 47.5 years (35, 58.25) and average C-reactive protein (CRP) of 50.66 mg/L (± 64.64) on admission (see Table 1). Previous hospitalization within 1 year (38%), previous surgical procedures (39%) and recent IV medication use (26%) were common. 130 bacterial isolates were identified (see Table 2). The most frequent organisms were Gram-positive, with Methicillin susceptible Staphylococcus aureus (MSSA, 25.38%), Streptococcus species (20.08%), and Methicillin resistant Staphylococcus aureus (MRSA, 15.38%) being the most common. Gram-negative organisms were infrequent, with Haemophilus parainfluenzae (3.85%), Enterobacter cloacae (3.85) and Pseudomonas aeruginosa (3.08%) being the most prevalent. Of the 100 patients, 27% had polymicrobial infections, associated with trauma (6%), illicit IV use (6%) and unknown (7%) etiologies. Table 1: Baseline demographics and co-morbid conditions Table 2: Types and numbers of organisms in relation to etiologies Conclusion Within our population, the most common organisms associated with hand infections were Gram-positive, with Staphylococcus aureus and Streptococcus species being the most prevalent. Gram-negative pathogens were infrequently isolated. The results within this study can provide guidance to clinicians on assessing the appropriate empiric antibiotic regimen in patients with hand infections, and can serve as a basis for further studies identifying risk factors associated with isolation of organisms associated with hand infections. Disclosures All Authors: No reported disclosures
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- 2020
7. MP66-06 HOW DOES LONG-TERM DILIGENT CATHETER MONITORING CHANGE CATHETER ASSOCIATED URINARY TRACT INFECTION (CAUTI) RATES?
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Olena Dzenkevych, Angela Gabasan, Jay A. Motola, Krystina L Woods, Deborah Schwing, Barbara A. Smith, and Eric Bortnick
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Catheter ,medicine.medical_specialty ,business.industry ,Urology ,Urinary system ,Medicine ,Complication ,business ,Catheter-associated urinary tract infection ,Surgery - Abstract
INTRODUCTION AND OBJECTIVE:CAUTIs are thought to be an avoidable complication and account for 75% of urinary tract infections (UTI). The CAUTI risk increases 5% /day (d) of catheterization. For ove...
- Published
- 2020
8. 50: What is the prevalence of measles immunity among pregnant women?
- Author
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Emma T. Geduldig, Zainab Al-Ibraheemi, Lois Brustman, Melissa T. Chu Lam, Krystina L Woods, Emily Schmidt-Beuchat, and Katie Hyewon Choi
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Pediatrics ,medicine.medical_specialty ,Immunity ,business.industry ,medicine ,Obstetrics and Gynecology ,medicine.disease ,business ,Measles - Published
- 2020
9. 1322. Quantifying the Effects of Frequently Prescribed Antimicrobials with Perceived Potential for QT Interval Prolongation during the COVID-19 Era
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Krystina L Woods, Francesco Ciummo, Arsheena Yassin, Andras Farkas, Hendrik Sy, Christian Olivo Freites, and Ami Shah
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medicine.medical_specialty ,Cumulative dose ,business.industry ,Confounding ,Random effects model ,QT interval ,Infectious Diseases ,AcademicSubjects/MED00290 ,Oncology ,Levofloxacin ,Internal medicine ,Relative risk ,Concomitant ,Poster Abstracts ,medicine ,Cardiology ,business ,Fluconazole ,medicine.drug - Abstract
Background Countless diseases and medications have been implicated in the past as causing prolongation of the QT interval. Their unique role through the means of quantifying the definite magnitude of relative risk they contribute during hospitalization still requires further investigation. The aim of this study was to describe the impact of commonly used anti-infectives on the QT interval in hospitalized patients during the COVID-19 era. Methods Demographic information, medical history, laboratory data, medication administration history and ECG recording data was collected from the electronic records of adult patients admitted to two urban hospitals. A mixed effects approach with four sub-models for the QT interval comprised of: heart rate, circadian rhythm, gender, and the drug (regressed as the cumulative mg dose administered over time) and disease effects was used. Fixed and random effects with between occasion variability were estimated for the parameters with a Bayesian approach using the STAN software. Results Data from 2180 patients were used with baseline characteristics shown in Table 1. Observed vs. predicted plots based on the training (Figure 1.A) and validation data set (Figure 1.B) showed excellent fit. The parameters for QTc0, α, gender, and circadian rhythm were identified within the range previously described (Table 2.). Similarly, the model correctly identified the impact of acute or chronic diseases on the QT interval. Model coefficient estimates [mean (95% CI) of 0.010 (0.006, 0.15) and 0.0045 (0.0013, 0.01100) msec/mg cumulative dose, respectively] suggest that patients treated with conventional regimens of fluconazole and levofloxacin are most likely to present with a QT interval increase > 5 msec, the cutoff threshold of regulatory concern. Figure 1. A-B Table 1. Table 2. Conclusion The model developed accurately identified the impact baseline risk factors and concomitant medications have on the QT interval. When adjusted for these confounding variables, estimates of QT interval prolongation show that treatment with fluconazole and levofloxacin pose a considerable risk; while treatment with azithromycin or hydroxychloroquine is of moderate risk for QT interval prolongation. Disclosures All Authors: No reported disclosures
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- 2020
10. 539. Prevalence of Symptomatic and Asymptomatic COVID-19 Infection in Pregnant Women and Their Infants in an Urban Hospital
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Deborah Schwing, Brian Wagner, Bernard Camins, Angela C. Gabasan, Lisa Eiland, and Krystina L Woods
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Pregnancy ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Obstetrics ,medicine.medical_treatment ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Disease ,medicine.disease ,Asymptomatic ,AcademicSubjects/MED00290 ,Infectious Diseases ,Oncology ,Labor induction ,Poster Abstracts ,Pandemic ,medicine ,medicine.symptom ,business ,Urban hospital - Abstract
Background COVID-19 is an emerging pathogen that has caused a global pandemic, with New York City as one of its epicenters. Data are still forthcoming if pregnant women are more vulnerable to COVID-19, as they are with influenza. Additionally, it is not known if infants born to COVID-19 positive women are at risk of being infected at birth. Methods In March 2020, our hospital instituted a policy of testing all pregnant women presenting for active labor and scheduled C-section or induction of labor, with a nasopharyngeal swab that was sent for RT-PCR qualitative SARS-CoV-2 assay (Roche Cobas® 6800). Upon birth, infants were also tested, unless the parent did not give consent. We retrospectively reviewed the COVID-19 test results of all pregnant women and their infants, from March 23 through May 31, 2020 using our infection control surveillance system (VigiLanz®). We also reviewed the electronic medical record (EPIC®) for documentation of any symptoms consistent with COVID-19 infection either prior to hospitalization or during the hospital stay. Results A total of 415 women and 72 infants were tested for SARS-CoV-2. Of the 415 women tested, 41 (9.9%) were positive. Of the 72 infants tested, 2 (2.8%) were positive and concordant with their birth parent. Only 1 (2.4%) of the women who tested positive was symptomatic. The remaining 40 (97.6%) women did not report any symptoms of COVID-19 during labor. Neither of the two positive infants displayed any signs or symptoms of COVID-19. Of the 41 women who were positive, 5 did not consent to have their infant tested. The one symptomatic woman who tested positive for COVID-19 had an infant who tested negative by PCR. Conclusion During the first wave of the COVID-19 pandemic, we found 9.9% (41/415) of pregnant women presenting for labor tested positive for SARS-CoV-2. Among the 41 women who tested positive, only 1 (2.4%) had symptoms on presentation and only 2 newborn infants tested positive. Our data suggests that pregnant women may not be at increased risk for complications from COVID-19 disease and are not likely to transmit the disease to their infants during labor. Disclosures All Authors: No reported disclosures
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- 2020
11. 1545. Development of a Linear Mixed-Effect Pharmacodynamic Model to Quantify the Effects of Frequently Prescribed Antimicrobials on QT Interval Prolongation in Hospitalized Patients
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Christian Olivo Freites, Francesco Ciummo, Arsheena Yassin, Joseph Sassine, Gergely Daróczi, Ami Shah, Andras Farkas, and Krystina L Woods
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medicine.medical_specialty ,business.industry ,Prolongation ,Torsades de pointes ,Azithromycin ,medicine.disease ,QT interval ,Abstracts ,Infectious Diseases ,Oncology ,Levofloxacin ,Pharmacodynamics ,Internal medicine ,Poster Abstracts ,Mixed effects ,Medicine ,business ,Fluconazole ,medicine.drug - Abstract
Background Torsades de pointes is a life-threatening ventricular tachycardia associated with prolongation of the QT interval. Many diseases and medications have been implicated as potentially prolonging the QT interval, but little data exists regarding the means of quantifying this risk. The aim of this study was to describe the impact of commonly used antimicrobials on the QT interval in hospitalized patients. Methods Demographic, diseases, laboratory, medication administration history and ECG recording data were collected from the electronic records of adult patients admitted, from July 2018 to December 2018, to two urban hospitals. A model for the QT interval comprised of four sub-models: gender, heart rate, circadian rhythm, and the drug and disease effects. Fixed and random effects with between occasion variability were estimated for the parameters. A Bayesian approach using the NUTS in STAN was used via the brms package in the R® software. Results Data from 1,353 patients were used with baseline characteristics shown in Table 1. Observed vs. predicted plots based on the training (Figure 1A) and validation data set (Figure 1B) showed a great fit. The parameters for QTc0, α, gender, and circadian rhythm were accurately identified (Table 2). Similarly, the model correctly described the expected impact of acute or chronic diseases on the QT interval. Uncertainty interval estimates (Figure 2) show that patients treated with fluconazole and levofloxacin are likely to present with a QT interval [mean (95% CI) of 6.84 (0.22,21.45) and 5.05 (0.15, 16.70), respectively], that is > 5 ms longer vs. no treatment, the minimum cutoff that should evoke further risk assessment of QT interval prolongation. Conclusion The model developed correctly describes the impact baseline risk factors have on the QT interval. Point estimates of QT interval prolongation show that patients treated with fluconazole and levofloxacin may be at considerable risk; while those treated with azithromycin or ciprofloxacin are more likely to be at an insignificant risk for QT interval prolongation during hospital admission. Further workup to quantify the impact of concomitant treatment with these and other at-risk medications is underway. Disclosures All authors: No reported disclosures.
- Published
- 2019
12. Mandatory Pre-Authorization or 'Hard Stop Order' to Decrease Inappropriate Testing for Clostridium difficile Infection. A Testing Stewardship at 2 Hospitals
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Olena Dzenkevych, Emilia Mia Sordillo, Barbara A. Smith, Krystina L Woods, Bernard C. Camins, Deborah Schwing, Michelle Ordoveza, and Angela C. Gabasan
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Epidemiology ,business.industry ,Health Policy ,Public Health, Environmental and Occupational Health ,Authorization ,Electronic medical record ,Clostridium difficile ,Ordering Physician ,medicine.disease ,Infectious Diseases ,Administrative support ,Health care ,Medicine ,Infection control ,Medical emergency ,business ,Pre and post - Abstract
BACKGROUND Despite implementation of the Clostridium difficile Infection (CDI) algorithm in 2016, inappropriate testing remains an issue. To further reduce this problem, Mandatory Pre-Authorization (MPrA) or Hard Stop Order (HSO) was implemented in March 2017. MPrA/HSO requires the ordering physician to apply the criteria set in the algorithm and obtain approval from an Infectious Disease (ID) physician. The test is stopped if the criteria are not met and without approval. The objective of this review is to examine the effectiveness of the MPrA/HSO in our hospitals. METHODS An order set was built in the electronic medical record (EMR) identifying the ordering physician and ID attending approving the test. Educational sessions, posters and pocket size algorithm were provided. Orders without ID approval were referred back to the ordering physician or escalated to the Chief of Service or to the Director of Infection Prevention. Exclusion for the MPrA/HSO were Emergency Room patients suspected with CDI. National Healthcare Safety Network (NHSN) data from February 2016 to March 2018 were retrospectively analyzed. RESULTS Comparison of Pre and Post implementation data showed a decline of 68% in CDI testing for Hospital A and 61% for Hospital B. The Hospital-Onset CDI dipped to 74% in Hospital A and 61% in Hospital B and inappropriate testing decreased by 75% and 100% respectively. >97% met testing criteria and ID approval. Pre and Post MPrA/HSO Standard Infection Ratio (SIR) were statistically significant. CONCLUSIONS Testing stewardship accomplished a reduction of CDI testing without a corresponding increase in CDI, and without evidence of missed cases. Our goal of reducing inappropriate testing is achieved, thereby improving patient outcome as unnecessary isolation and exposure to antibiotics are avoided. Administrative support, interdisciplinary teamwork and integration of the MPrA/HSO in the EMR are essential in the success of this initiative.
- Published
- 2019
13. Nested case-control study of the emergence of tigecycline resistance in multidrug-resistant Klebsiella pneumoniae
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Mary Waldron, Tomasz Z. Jodlowski, William Riley, Donna Mildvan, Jörg J. Ruhe, Masayuki Nigo, Catalina Salinas Cevallos, Krystina L. Woods, Sanjana Koshy, Tessa Gomez, Manuel Revuelta, Gweneth Francis, David C. Perlman, and Vicente Maco Flores
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Male ,Time Factors ,antibiotic resistance ,Klebsiella pneumoniae ,cephalosporin ,vancomycin ,Minocycline ,Tigecycline ,Logistic regression ,drug treatment failure ,quinolone derivative ,metronidazole ,Drug Resistance, Multiple, Bacterial ,purl.org/pe-repo/ocde/ford#3.02.21 [https] ,antibiotic therapy ,Pharmacology (medical) ,Aged, 80 and over ,clinical article ,Middle Aged ,Anti-Bacterial Agents ,multidrug resistant Klebsiella pneumoniae ,Infectious Diseases ,monotherapy ,Female ,tigecycline ,Charlson Comorbidity Index ,medicine.drug ,drug exposure ,bacterium culture ,Microbial Sensitivity Tests ,linezolid ,Biology ,Independent predictor ,Epidemiology and Surveillance ,Microbiology ,carbapenem ,medicine ,Humans ,follow up ,controlled study ,human ,Aged ,Pharmacology ,bacterium isolate ,molecular typing ,polymyxin ,Odds ratio ,case control study ,clindamycin ,biology.organism_classification ,bacterial strain ,Confidence interval ,Klebsiella Infections ,Logistic Models ,Case-Control Studies ,Nested case-control study ,aminoglycoside ,urinary tract infection ,Multidrug resistant Klebsiella pneumoniae ,Follow-Up Studies ,aztreonam - Abstract
We performed a nested case-control study (ratio of 1:4) on the emergence of tigecycline-resistant multidrug-resistant Klebsiella pneumoniae (TR-MDRKP) isolates among patients who initially presented with a tigecycline-susceptible MDRKP isolate. Out of 260 patients, 24 (9%) had a subsequent clinical culture positive for a TR-MDRKP isolate within the 90-day follow-up period. On logistic regression analyses, receipt of tigecycline (adjusted odds ratio [OR], 5.06; 95% confidence interval [CI], 1.80 to 14.23; P = 0.002) was the only independent predictor of subsequent isolation of a TR strain.
- Published
- 2013
14. Community-Associated Escherichia coli Harboring CTX-M β-Lactamases from Urine Cultures from Pediatric Patients
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Sofia Padkowsky, Krystina L. Woods, James R. Johnson, Saadia Zahid, Wehbeh Wehbeh, Rita Colon-Urban, Carl Urban, Mahmoud Hassanein, Connie Clabots, Noriel Mariano, and Brian D. Johnston
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Male ,Pharmacology ,β lactamases ,Infant ,Microbial Sensitivity Tests ,Urine ,Biology ,medicine.disease_cause ,beta-Lactamases ,Electrophoresis, Gel, Pulsed-Field ,Microbiology ,Community associated ,Community-Acquired Infections ,Infectious Diseases ,Child, Preschool ,Escherichia coli ,medicine ,Humans ,Female ,Pharmacology (medical) ,Letters to the Editor ,Child ,Escherichia coli Infections - Abstract
Escherichia coli isolates harboring CTX-M β-lactamases have rarely been obtained from children in the United States. Here we report eight such isolates from seven community-dwelling pediatric patients and their microbiological and clinical correlates. Pediatric E. coli isolates identified as
- Published
- 2012
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