208 results on '"Talan DA"'
Search Results
102. Urinary infection in male patients with acute nephrolithiasis: should we hunt for a rare bird? In reply.
- Author
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Abrahamian FM and Talan DA
- Subjects
- Female, Humans, Male, Nephrolithiasis complications, Pyuria etiology, Urinary Tract Infections etiology
- Published
- 2014
- Full Text
- View/download PDF
103. Management of skin abscesses in the era of methicillin-resistant Staphylococcus aureus.
- Author
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Singer AJ and Talan DA
- Subjects
- Abscess diagnosis, Combined Modality Therapy, Humans, Staphylococcal Skin Infections diagnosis, Therapeutic Irrigation, Abscess therapy, Anti-Bacterial Agents therapeutic use, Drainage, Methicillin-Resistant Staphylococcus aureus, Staphylococcal Skin Infections therapy
- Published
- 2014
- Full Text
- View/download PDF
104. Association of pyuria and clinical characteristics with the presence of urinary tract infection among patients with acute nephrolithiasis.
- Author
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Abrahamian FM, Krishnadasan A, Mower WR, Moran GJ, and Talan DA
- Subjects
- Acute Disease, Adult, Female, Humans, Male, Nephrolithiasis diagnosis, Prospective Studies, Risk Factors, Sex Factors, Urinary Tract Infections diagnosis, Nephrolithiasis complications, Pyuria etiology, Urinary Tract Infections etiology
- Abstract
Study Objective: Pyuria is a useful indicator of urinary tract infection among patients with compatible symptoms; however, its utility has not been adequately investigated among patients with acute nephrolithiasis. Therefore, we examine performance characteristics of pyuria and other clinical and laboratory correlates for urinary tract infection among patients with acute nephrolithiasis., Methods: A single-center prospective observational study examining the performance characteristics of pyuria and other clinical correlates for urinary tract infection was conducted among patients older than 17 years and presenting with acute nephrolithiasis confirmed by computed tomography and for whom urine culture was obtained., Results: Of 360 patients with acute nephrolithiasis, 28 (7.8%) had urinary tract infection, defined as growth of a single uropathogen at greater than or equal to 10(3) colony-forming units/mL. For the presence of urinary tract infection, pyuria level greater than 5 WBCs/high-power field (hpf) had a sensitivity of 86% and specificity of 79%; greater than 20 WBCs/hpf had a sensitivity of 68% and specificity of 93%. In 307 patients who lacked history of fever or measured temperature greater than 37.9°C (100.2°F), pyuria level greater than 5 WBCs/hpf had a sensitivity of 79% and specificity of 81% for urinary tract infection; greater than 20 WBCs/hpf had a sensitivity of 57% and specificity of 94%. Patients with urinary tract infection more often were female; had a history of dysuria, frequent urination, chills, urinary tract infection, or subjective fever; or had measured temperature of greater than 37.9°C (100.2°F)., Conclusion: About 8% of patients presenting with acute nephrolithiasis have urinary tract infection, in many without clinical findings of infection, and pyuria has only a moderate accuracy in identifying urinary tract infection in this setting. Clinical features of urinary tract infection, a greater degree of pyuria, and female sex increases the likelihood of infection., (Copyright © 2013 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.)
- Published
- 2013
- Full Text
- View/download PDF
105. Infectious disease/CDC update. Update on emerging infections: news from the Centers for Disease Control and Prevention.
- Author
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Talan DA and Moran GJ
- Subjects
- Female, Humans, Male, Coronaviridae isolation & purification, Coronaviridae Infections epidemiology, Respiratory Tract Infections epidemiology
- Published
- 2013
- Full Text
- View/download PDF
106. A call to action for antimicrobial stewardship in the emergency department: approaches and strategies.
- Author
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May L, Cosgrove S, L'Archeveque M, Talan DA, Payne P, Jordan J, and Rothman RE
- Subjects
- Communicable Diseases drug therapy, Communicable Diseases microbiology, Cross Infection drug therapy, Cross Infection prevention & control, Drug Utilization standards, Female, Humans, Male, Microbial Sensitivity Tests, Practice Patterns, Physicians', Quality Control, United States, Anti-Infective Agents therapeutic use, Drug Resistance, Microbial, Emergency Service, Hospital standards, Guideline Adherence, Practice Guidelines as Topic
- Published
- 2013
- Full Text
- View/download PDF
107. Acute bacterial skin infections: developments since the 2005 Infectious Diseases Society of America (IDSA) guidelines.
- Author
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Moran GJ, Abrahamian FM, Lovecchio F, and Talan DA
- Subjects
- Acute Disease, Anti-Bacterial Agents therapeutic use, Emergency Medicine, Humans, Practice Guidelines as Topic, Skin Diseases, Bacterial diagnosis, Skin Diseases, Bacterial drug therapy, Societies, Medical, Soft Tissue Infections diagnosis, Soft Tissue Infections drug therapy, Soft Tissue Infections epidemiology, Staphylococcal Infections diagnosis, Staphylococcal Infections drug therapy, Emergency Service, Hospital, Methicillin-Resistant Staphylococcus aureus, Skin Diseases, Bacterial epidemiology, Staphylococcal Infections epidemiology
- Abstract
Background: Patients with acute bacterial skin and skin structure infections (ABSSSI) commonly present to Emergency Departments (EDs) where physicians encounter a wide spectrum of disease severity. The prevalence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has increased in the past decade, and CA-MRSA is now a predominant cause of purulent ABSSSI in the United States (US)., Objectives: This article reviews significant developments since the most recent Infectious Diseases Society of America (IDSA) guidelines for the management of ABSSSI in the CA-MRSA era, focusing on recent studies and recommendations for managing CA-MRSA, newer antimicrobials with improved MRSA activity, new diagnostic technologies, and options for outpatient parenteral antimicrobial therapy (OPAT)., Discussion: The increasing prevalence of CA-MRSA has led the IDSA and other organizations to recommend empiric coverage of CA-MRSA for purulent ABSSSI. The availability of rapid MRSA detection assays from skin and soft tissue swabs could potentially facilitate earlier selection of targeted antimicrobial therapy. Several newer intravenous antibiotics with expanded MRSA coverage, including ceftaroline fosamil, daptomycin, linezolid, and telavancin, may be utilized for treatment of ABSSSI. OPAT may be an option for intravenous administration of antibiotics in selected patients and may prevent or shorten hospitalizations, decrease readmission rates, and reduce nosocomial infections and complications., Conclusion: The growing prevalence of CA-MRSA associated with ABSSSI in the US has a significant impact on clinical management decisions in the ED. Recent availability of new diagnostic testing and therapeutic options may help meet the demand for effective antistaphylococcal agents., (Copyright © 2013 Elsevier Inc. All rights reserved.)
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- 2013
- Full Text
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108. Procalcitonin of questionable value.
- Author
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Talan DA
- Subjects
- Humans, Anti-Bacterial Agents therapeutic use, Bacterial Infections drug therapy, Calcitonin blood, Protein Precursors blood
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- 2012
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109. Emergency medicine and hospital medicine: a call for collaboration.
- Author
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Pollack CV Jr, Amin A, and Talan DA
- Subjects
- Efficiency, Organizational standards, Humans, United States, Cooperative Behavior, Emergency Medicine organization & administration, Emergency Medicine standards, Hospitalists organization & administration, Hospitalists standards, Interdisciplinary Communication, Quality Assurance, Health Care organization & administration, Quality Assurance, Health Care standards
- Abstract
Background: In the United States, emergency physicians and hospitalists are increasingly responsible for managing hospitalized patients. These specialists share a common practice space and similar shift work schedules. Together they govern decisions about use of the most expensive care setting in medicine-the hospital., Discussion: Unfortunately, in most institutions there is little collaboration between emergency physicians and hospitalists, resulting in missed opportunities to improve the quality of care and reduce its cost. In this call to action, we challenge emergency physicians and hospitalists to work together to develop protocols for consistent, evidence-based, and expeditious care of patients admitted from the ED; to collaborate in the care of ED patients who can safely be discharged home; to pursue joint quality, hospital leadership, and cost-effectiveness projects; to work in partnership to assure adequate staffing of hospital-based specialists; and to cooperate in the professional, front-line assessment of clinically and fiscally driven policies aimed at assessing the appropriateness of hospital admissions and readmissions., Summary: Hospital care is increasingly driven by emergency physicians and hospitalists. We envision a vital role for ongoing collaboration between them in achieving the goals of patient care, education, and quality and safety outcomes., (Copyright © 2012 Elsevier Inc. All rights reserved.)
- Published
- 2012
- Full Text
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110. Prevalence of methicillin-resistant staphylococcus aureus as an etiology of community-acquired pneumonia.
- Author
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Moran GJ, Krishnadasan A, Gorwitz RJ, Fosheim GE, Albrecht V, Limbago B, and Talan DA
- Subjects
- Humans, Community-Acquired Infections epidemiology, Community-Acquired Infections microbiology, Methicillin-Resistant Staphylococcus aureus isolation & purification, Pneumonia, Staphylococcal epidemiology, Pneumonia, Staphylococcal microbiology
- Abstract
Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of skin infections. Recent case series describe severe community-acquired pneumonia (CAP) caused by MRSA, but the prevalence and risk factors are unknown., Methods: We prospectively enrolled adults hospitalized with CAP from 12 university-affiliated emergency departments during the winter-spring of 2006 and 2007. Clinical information and culture results were collected, and factors associated with MRSA were assessed., Results: Of 627 patients, 595 (95%) had respiratory (50%) and/or blood cultures (92%) performed. A pathogen was identified in 102 (17%); MRSA was identified in 14 (2.4%; range by site, 0%-5%) patients and in 5% of patients admitted to the intensive care unit. Two (14%) MRSA pneumonia patients died. All 9 MRSA isolates tested were pulsed-field type USA300. Features significantly associated with isolation of MRSA (as compared with any other or no pathogen) included patient history of MRSA; nursing home admission in the previous year; close contact in the previous month with someone with a skin infection; multiple infiltrates or cavities on chest radiograph; and comatose state, intubation, receipt of pressors, or death in the emergency department., Conclusions: Methicillin-resistant Staphylococcus aureus remains an uncommon cause of CAP. Detection of MRSA was associated with more severe clinical presentation.
- Published
- 2012
- Full Text
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111. Bacterial cause of suspected meningitis cannot be safely excluded without cerebrospinal fluid analysis.
- Author
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Talan DA
- Subjects
- Diagnosis, Differential, Emergency Service, Hospital, Humans, Meningitis, Bacterial diagnosis, Meningitis, Viral diagnosis, Meningitis, Bacterial cerebrospinal fluid
- Published
- 2012
- Full Text
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112. Association Between Appendectomy and Clostridium difficile Infection.
- Author
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Merchant R, Mower WR, Ourian A, Abrahamian FM, Moran GJ, Krishnadasan A, and Talan DA
- Abstract
Background: Recent theory proposes that the appendix functions as a reservoir for commensal bacteria, and serves to re-inoculate the colon with normal flora in the event of pathogen exposure or purging of intestinal flora. If true, we reasoned that flora from a normal appendix could provide protection against Clostridium difficile. We conducted this investigation to examine the protective effect of an intact appendix and test the hypothesis that prior appendectomy will be more common among patients with a positive test for C. difficile as compared with patients who test negative., Methods: We contacted patients who had undergone C. difficile testing and asked them whether or not they had a prior appendectomy. Using their responses and results from Toxin A & B EIA tests, we calculated the difference in appendectomy rates between those who tested positive for C. difficile, and those who tested negative. We considered a positive 15% absolute difference to represent a significant increase in appendectomy rate., Results: We enrolled 257 patients. Among the 136 who tested positive for C. difficile, 27 (19.9%) had prior appendectomies, while among 121 patients testing negative for C. difficile, 38 (31.4%) had prior appendectomies, yielding a difference in appendectomy rates of -11.6% (95% Confidence Interval: -21.6% to -0.9%)., Conclusions: The rate of prior appendectomy was actually lower among patients with a positive C. difficile test as compared to those with a negative test. Conversely, patients who tested positive for C. difficile were more likely to have an intact appendix than those who tested negative. These results suggest that rather than being protective, an intact appendix appears to promote C. difficile acquisition, carriage, and disease., Keywords: Clostridium difficile; Appendix; Appendectomy; Microbial reservoir; Infection.
- Published
- 2012
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113. Treatment of laryngeal hereditary angioedema.
- Author
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Richman MJ, Talan DA, and Lumry WR
- Subjects
- Angioedemas, Hereditary therapy, Child, Complement C1 Inactivator Proteins therapeutic use, Diagnosis, Differential, Female, Humans, Laryngeal Edema therapy, Treatment Outcome, Angioedemas, Hereditary diagnosis, Laryngeal Edema diagnosis
- Abstract
Background: In the emergency department, patients with laryngeal swelling and an inconclusive patient history may receive treatment for allergy-mediated angioedema. Intubation may be necessary if the patient does not respond to treatment. Because angioedema subtypes respond to different interventions, a correct diagnosis is vital., Objectives: Review the differential diagnosis of angioedema and characteristics differentiating subtypes. Discuss therapies for angioedema subtypes. Introduce therapies for prevention and acute treatment of hereditary angioedema (HAE)., Case Report: A 10-year-old girl presented with laryngeal swelling unresponsive to diphenhydramine, methylprednisolone, and epinephrine. It was later revealed that she had a family history of HAE, was C1 inhibitor deficient, and enrolled in a clinical study of acute HAE treatment. She was given 1000 units of nanofiltered C1 inhibitor and was able to swallow within 30 min. She was prescribed routine prophylaxis with C1 inhibitor concentrate and has had no subsequent severe HAE swelling attacks., Conclusion: This case illustrates the need for providers to consider HAE in light of available diagnostic testing and recent Food and Drug Administration approval of specific therapies for HAE., (Copyright © 2012 Elsevier Inc. All rights reserved.)
- Published
- 2012
- Full Text
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114. The association of antimicrobial resistance with cure and quality of life among women with acute uncomplicated cystitis.
- Author
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Abrahamian FM, Krishnadasan A, Mower WR, Moran GJ, Coker JR, and Talan DA
- Subjects
- Adolescent, Adult, Enterobacteriaceae isolation & purification, Female, Humans, Interviews as Topic, Phenazopyridine administration & dosage, Prospective Studies, Quality of Life, Treatment Outcome, Trimethoprim, Sulfamethoxazole Drug Combination administration & dosage, Young Adult, Anti-Infective Agents administration & dosage, Cystitis drug therapy, Cystitis microbiology, Drug Resistance, Bacterial, Enterobacteriaceae drug effects, Enterobacteriaceae Infections drug therapy, Enterobacteriaceae Infections microbiology
- Abstract
Background: The association of in vitro resistance with bacteriologic, clinical, and health-related quality of life (HRQoL) outcomes for acute uncomplicated cystitis is unclear., Methods: We conducted a prospective study of women aged 18-40 years with acute uncomplicated cystitis symptoms for ≤7 days who subsequently grew an Enterobacteriaceae sp. and initially received trimethoprim/sulfamethoxazole (TMP/SMX) and phenazopyridine. We conducted telephone follow-up evaluating clinical cure at 1-3 days and in-person follow-up evaluating clinical, bacteriologic, and HRQoL outcomes at 3-7 days and 4-6 weeks post-treatment., Results: An Enterobacteriaceae sp. was isolated in 139 (96.5%) patients (25.2% TMP/SMX-resistant). At 1-3 days post-treatment, clinical cure occurred in 56/81 (69.1%) and 14/31 (45.2%) of cases with susceptible and resistant strains, respectively (difference 23.9%; 95% confidence interval [CI], 1.5-46.4%). At 3-7 days post-treatment, bacteriologic cure occurred in 70/73 (95.9%) and 15/25 (60%) of cases with susceptible and resistant strains, respectively (difference 35.9%; 95% CI, 13.5-58.3%). Sustained clinical cure rates at 3-7 days and 4-6 weeks post-treatment were 65.4 and 56.8% with susceptible strains, and 45.2 and 45.2% with resistant strains, respectively. The HRQoL scale assessing role limitations due to physical health problems was lower in TMP/SMX-resistant versus TMP/SMX-susceptible infections, with twice as many hours of missed activities reported (mean, 18.4 vs. 9.1 h). Differences in HRQoL appeared to be largely related to differences in clinical cure rates., Conclusions: Among women treated for acute uncomplicated cystitis with TMP/SMX, in vitro TMP/SMX resistance was associated with lower bacteriologic and clinical cure rates, and had greater impact on the time lost from daily activities compared to those with TMP/SMX-susceptible infections.
- Published
- 2011
- Full Text
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115. Antibiotic prescribing practices of emergency physicians and patient expectations for uncomplicated lacerations.
- Author
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Ong S, Moran GJ, Krishnadasan A, and Talan DA
- Abstract
Introduction: Prophylactic antibiotics have not been found to have a benefit in the setting of uncomplicated lacerations. We evaluated the proportion of patients with uncomplicated lacerations who are prescribed prophylactic antibiotics in the emergency department (ED), factors that physicians considered when prescribing antibiotics, and factors associated with patient satisfaction., Methods: Adults and children presenting to 10 academic EDs with acute lacerations were enrolled. Enrolled patients were interviewed before and after their physician encounter in the ED and 2 weeks later. Physicians were interviewed in the ED after the patient encounter about factors that influenced their management decisions, including their perceptions of patients' expectations. We included patients with uncomplicated lacerations (without contamination, infection, bone, tendon, or joint involvement) for analysis., Results: Of 436 patients enrolled, 260 had uncomplicated lacerations, and of these, 55 (21%) were treated with antibiotics in the ED or by prescription. Physicians were more likely to use antibiotics when the wound was more than 8 hours old, involved a puncture or amputation, and when the patient lacked medical insurance. A treatment course of 7 days or greater was given to 24 of 45 patients (53%) receiving outpatient prescriptions. Patient satisfaction was not associated with antibiotic use., Conclusion: Antibiotics were used for about one fifth of ED patients with uncomplicated lacerations despite a lack of evidence for efficacy.
- Published
- 2011
- Full Text
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116. Comparison of Staphylococcus aureus from skin and soft-tissue infections in US emergency department patients, 2004 and 2008.
- Author
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Talan DA, Krishnadasan A, Gorwitz RJ, Fosheim GE, Limbago B, Albrecht V, and Moran GJ
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Anti-Bacterial Agents pharmacology, Bacterial Toxins genetics, Cluster Analysis, Electrophoresis, Gel, Pulsed-Field, Emergency Service, Hospital, Female, Genotype, Humans, Male, Methicillin-Resistant Staphylococcus aureus isolation & purification, Microbial Sensitivity Tests, Middle Aged, Molecular Typing, Prevalence, United States epidemiology, Young Adult, Community-Acquired Infections epidemiology, Community-Acquired Infections microbiology, Methicillin-Resistant Staphylococcus aureus classification, Soft Tissue Infections epidemiology, Soft Tissue Infections microbiology, Staphylococcal Skin Infections epidemiology, Staphylococcal Skin Infections microbiology
- Abstract
Background: In the past decade, new methicillin-resistant Staphylococcus aureus (MRSA) strains have emerged as a predominant cause of community-associated skin and soft-tissue infections (SSTIs). Little information exists regarding trends in MRSA prevalence and molecular characteristics or regarding antimicrobial susceptibility profiles of S. aureus isolates., Methods: We enrolled adults with acute, purulent SSTIs presenting to a US network of 12 emergency departments during August 2008. Cultures and clinical information were collected. S. aureus isolates were characterized by antimicrobial susceptibility testing, pulsed-field gel electrophoresis, and toxin genes detection. The prevalence of S. aureus and MRSA and isolate genetic characteristics and susceptibilities were compared with those from a similar study conducted in August 2004., Results: The prevalence of MRSA was 59% among all SSTIs during both study periods; however, the prevalence by site varied less in 2008 (38%-84%), compared with 2004 (15%-74%). Pulsed-field type USA300 continued to account for almost all MRSA isolates (98%). Susceptibility to trimethoprim-sulfamethoxazole, clindamycin, and tetracycline among MRSA isolates remained greater than 90% in 2008. A higher proportion of MRSA infections were treated with an agent to which the infecting isolate was susceptible in vitro in 2008 (97%), compared with 2004 (57%)., Conclusions: Similar to 2004, MRSA remained the most common identifiable cause of purulent SSTIs among patients presenting to a network of US emergency departments in 2008. The infecting MRSA isolates continued to be predominantly pulsed-field type USA300 and susceptible to recommended non-β-lactam oral agents. Clinician prescribing practices have shifted from MRSA-inactive to MRSA-active empirical antimicrobial regimens.
- Published
- 2011
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117. Processes and models for HIV screening in the emergency department: can and should we do this?
- Author
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Moran GJ and Talan DA
- Subjects
- HIV Infections prevention & control, Humans, Informed Consent, Mass Screening methods, Models, Organizational, Emergency Service, Hospital, HIV Infections diagnosis
- Published
- 2011
- Full Text
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118. Emergency department ultrasound infection control: do unto (and into) others.
- Author
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Talan DA and Partida CN
- Subjects
- Cross Infection etiology, Humans, Methicillin-Resistant Staphylococcus aureus, Staphylococcal Skin Infections etiology, Staphylococcal Skin Infections prevention & control, Ultrasonography instrumentation, Cross Infection prevention & control, Disinfection methods, Emergency Service, Hospital standards, Equipment Contamination prevention & control, Ultrasonography adverse effects
- Published
- 2011
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119. Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children.
- Author
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Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ, Kaplan SL, Karchmer AW, Levine DP, Murray BE, J Rybak M, Talan DA, and Chambers HF
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Humans, Infant, Infant, Newborn, Methicillin-Resistant Staphylococcus aureus drug effects, Middle Aged, Staphylococcal Infections microbiology, United States, Vancomycin therapeutic use, Young Adult, Anti-Bacterial Agents therapeutic use, Methicillin-Resistant Staphylococcus aureus isolation & purification, Staphylococcal Infections diagnosis, Staphylococcal Infections drug therapy
- Abstract
Evidence-based guidelines for the management of patients with methicillin-resistant Staphylococcus aureus (MRSA) infections were prepared by an Expert Panel of the Infectious Diseases Society of America (IDSA). The guidelines are intended for use by health care providers who care for adult and pediatric patients with MRSA infections. The guidelines discuss the management of a variety of clinical syndromes associated with MRSA disease, including skin and soft tissue infections (SSTI), bacteremia and endocarditis, pneumonia, bone and joint infections, and central nervous system (CNS) infections. Recommendations are provided regarding vancomycin dosing and monitoring, management of infections due to MRSA strains with reduced susceptibility to vancomycin, and vancomycin treatment failures.
- Published
- 2011
- Full Text
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120. Lack of antibiotic efficacy for simple abscesses: have matters come to a head?
- Author
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Talan DA
- Subjects
- Drainage, Humans, Randomized Controlled Trials as Topic, Treatment Outcome, Abscess drug therapy, Anti-Bacterial Agents therapeutic use, Skin Diseases, Bacterial drug therapy, Trimethoprim, Sulfamethoxazole Drug Combination therapeutic use
- Published
- 2010
- Full Text
- View/download PDF
121. Structure and function of emergency care research networks: strengths, weaknesses, and challenges.
- Author
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Papa L, Kuppermann N, Lamond K, Barsan WG, Camargo CA Jr, Ornato JP, Stiell IG, and Talan DA
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- Congresses as Topic, Cooperative Behavior, Goals, Humans, Interdisciplinary Communication, Quality Assurance, Health Care, Research Support as Topic, Societies, Medical, Surveys and Questionnaires, United States, Biomedical Research organization & administration, Emergency Medical Services organization & administration
- Abstract
The ability of emergency care research (ECR) to produce meaningful improvements in the outcomes of acutely ill or injured patients depends on the optimal configuration, infrastructure, organization, and support of emergency care research networks (ECRNs). Through the experiences of existing ECRNs, we can learn how to best accomplish this. A meeting was organized in Washington, DC, on May 28, 2008, to discuss the present state and future directions of clinical research networks as they relate to emergency care. Prior to the conference, at the time of online registration, participants responded to a series of preconference questions addressing the relevant issues that would form the basis of the breakout session discussions. During the conference, representatives from a number of existing ECRNs participated in discussions with the attendees and provided a description of their respective networks, infrastructure, and challenges. Breakout sessions provided the opportunity to further discuss the strengths and weaknesses of these networks and patterns of success with respect to their formation, management, funding, best practices, and pitfalls. Discussions centered on identifying characteristics that promote or inhibit successful networks and their interactivity, productivity, and expansion. Here the authors describe the current state of ECRNs and identify the strengths, weaknesses, and potential pitfalls of research networks. The most commonly cited strengths of population- or disease-based research networks identified in the preconference survey were access to larger numbers of patients; involvement of physician experts in the field, contributing to high-level study content; and the collaboration among investigators. The most commonly cited weaknesses were studies with too narrow a focus and restrictive inclusion criteria, a vast organizational structure with a risk of either too much or too little central organization or control, and heterogeneity of institutional policies and procedures among sites. Through the survey and structured discussion process involving multiple stakeholders, the authors have identified strengths and weaknesses that are consistent across a number of existing ECRNs. By leveraging the strengths and addressing the weaknesses, strategies can be adopted to enhance the scientific value and productivity of these networks and give direction to future ECRNs.
- Published
- 2009
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122. Decision instrument for the isolation of pneumonia patients with suspected pulmonary tuberculosis admitted through US emergency departments.
- Author
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Moran GJ, Barrett TW, Mower WR, Krishnadasan A, Abrahamian FM, Ong S, Nakase JY, Pinner RW, Kuehnert MJ, Jarvis WR, and Talan DA
- Subjects
- Adult, Chi-Square Distribution, Female, Hospitals, Urban, Humans, Male, Middle Aged, Pneumonia diagnostic imaging, Predictive Value of Tests, Prospective Studies, Radiography, Sensitivity and Specificity, Tuberculosis, Pulmonary diagnostic imaging, United States, Decision Support Techniques, Patient Isolation, Pneumonia complications, Tuberculosis, Pulmonary complications, Tuberculosis, Pulmonary transmission
- Abstract
Study Objective: Many patients with pneumonia are admitted to respiratory isolation for possible tuberculosis (TB), but most do not have active TB. We created a decision instrument to predict which pneumonia patients do not need admission to a TB isolation bed., Methods: The design was a prospective case series conducted in 11 university-affiliated, urban, US emergency departments (EDs) (EMERGEncy ID NET). Participants were patients admitted to the hospital through the ED with a diagnosis of pneumonia or suspected TB. The main outcome measure was derivation and validation of a sensitive decision instrument to identify patients not having TB (and not requiring isolation) according to clinical data and chest radiographs., Results: Of 5,079 pneumonia patients, 224 (4.4%) had pulmonary TB according to sputum cultures or tissue staining. The instrument derived to predict which patients did not have pulmonary TB included no TB history or previous positive tuberculin skin test result, nonimmigrant, not homeless, not recently incarcerated, no recent weight loss, and no apical infiltrate or cavitary lesion on plain chest radiograph. When tested on the validation subgroup, the decision instrument exhibited a negative predictive value of 99.7% (95% confidence interval [CI] 99.1% to 99.9%), and a sensitivity of 96.4% (95% CI 91.1% to 99.0%)., Conclusion: A decision instrument can accurately predict which patients with pneumonia do not require admission to TB isolation rooms.
- Published
- 2009
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123. MRSA community-acquired pneumonia: should we be worried?
- Author
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Moran GJ and Talan DA
- Subjects
- Community-Acquired Infections drug therapy, Community-Acquired Infections epidemiology, Humans, Methicillin-Resistant Staphylococcus aureus, Pneumonia, Bacterial drug therapy, Staphylococcal Infections drug therapy, United States epidemiology, Pneumonia, Bacterial epidemiology, Staphylococcal Infections epidemiology
- Published
- 2009
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124. Prevalence and risk factor analysis of trimethoprim-sulfamethoxazole- and fluoroquinolone-resistant Escherichia coli infection among emergency department patients with pyelonephritis.
- Author
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Talan DA, Krishnadasan A, Abrahamian FM, Stamm WE, and Moran GJ
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Ciprofloxacin pharmacology, Cross-Sectional Studies, Drug Resistance, Bacterial, Emergencies, Escherichia coli drug effects, Escherichia coli Infections drug therapy, Escherichia coli Infections etiology, Female, Fluoroquinolones pharmacology, Humans, Levofloxacin, Middle Aged, Ofloxacin pharmacology, Pyelonephritis drug therapy, Pyelonephritis etiology, Risk Factors, Trimethoprim, Sulfamethoxazole Drug Combination pharmacology, United States epidemiology, Escherichia coli Infections epidemiology, Pyelonephritis epidemiology
- Abstract
Background: High rates of resistance to trimethoprim-sulfamethoxazole (TMP-SMX) among uropathogenic Escherichia coli are recognized, and concerns exist about emerging fluoroquinolone resistance., Methods: Adults presenting to 11 US emergency departments with (1) flank pain and/or costovertebral tenderness, (2) temperature >38 degrees C, and (3) a presumptive diagnosis of pyelonephritis were enrolled; patients for whom 1 uropathogen grew on culture were analyzed. Epidemiologic and clinical data were collected at the time of care. The prevalence of E. coli in vitro antibiotic resistance and risk factors associated with TMP-SMX-resistant E. coli infection were determined., Results: Among 403 women with uncomplicated pyelonephritis caused by E. coli, the mean site rate of E. coli resistance to TMP-SMX was 24% (range, 13%-45%). Mean site rates of E. coli resistance to ciprofloxacin and levofloxacin were 1% and 3%, respectively. Only TMP-SMX exposure within 2 days before presentation and Hispanic ethnicity were associated with E. coli resistance to TMP-SMX (compared with resistance rates of approximately 20% among women lacking these risk factors); antibiotic exposure within 3-60 days before presentation, health care setting exposure within 30 days before presentation, history of urinary tract infections, and age >55 years were not associated with E. coli resistance to TMP-SMX. Among 207 patients with complicated pyelonephritis, mean site rates of E. coli resistance to ciprofloxacin and levofloxacin were 5% and 6%, respectively., Conclusions: These results suggest that the prevalence of TMP-SMX-resistant infection among patients with uncomplicated pyelonephritis is > or =20% in many areas of the United States, and risk stratification cannot identify patients at low risk of infection. Rates of fluoroquinolone-resistant E. coli infection appear to be low among patients with uncomplicated pyelonephritis but higher among those with complicated infections. Fluoroquinolones should remain to be the preferred empirical treatment for women with uncomplicated pyelonephritis.
- Published
- 2008
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125. Infectious disease emergencies. Preface.
- Author
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Talan DA, Moran GJ, and Abrahamian FM
- Subjects
- Anti-Bacterial Agents therapeutic use, Emergency Service, Hospital, Humans, Sepsis drug therapy, Sepsis microbiology, Communicable Diseases therapy, Emergency Medicine methods
- Published
- 2008
- Full Text
- View/download PDF
126. Management of skin and soft-tissue infections in the emergency department.
- Author
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Abrahamian FM, Talan DA, and Moran GJ
- Subjects
- Anti-Infective Agents administration & dosage, Diagnosis, Differential, Humans, Infection Control methods, Methicillin Resistance, Staphylococcal Infections microbiology, Staphylococcus aureus drug effects, Emergency Medicine methods, Skin Diseases, Infectious diagnosis, Skin Diseases, Infectious microbiology, Skin Diseases, Infectious therapy, Soft Tissue Infections diagnosis, Soft Tissue Infections microbiology, Soft Tissue Infections therapy, Staphylococcal Infections diagnosis
- Abstract
Skin and soft-tissue infections are among the most common infections encountered by emergency physicians. This article is written from the perspective of the initial evaluation and management of skin and soft-tissue infections in the emergency department. Management pitfalls and clinical dilemmas pertinent to emergency physicians that are not often encountered by infectious disease specialists are highlighted. Special emphasis is placed on the utility of wound and blood cultures, disposition, methicillin-resistant Staphylococcus aureus infections, animal and human bites, and necrotizing skin and soft-tissue infections.
- Published
- 2008
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127. Antimicrobial prophylaxis for wounds and procedures in the emergency department.
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Moran GJ, Talan DA, and Abrahamian FM
- Subjects
- Bacterial Infections drug therapy, Humans, Rabies drug therapy, Tetanus drug therapy, Tetanus prevention & control, Tetanus Toxoid therapeutic use, Wounds and Injuries microbiology, Anti-Infective Agents therapeutic use, Antibiotic Prophylaxis methods, Bacterial Infections prevention & control, Emergency Medicine methods, Wounds and Injuries drug therapy
- Abstract
Emergency physicians are often confronted with situations in which a patient with an acute injury is at high risk for an infection. Although most traumatic wounds have a low risk for developing infection, certain types of high-risk trauma justify antimicrobial prophylaxis. This article reviews antimicrobial wound infection prophylaxis for high-risk traumatic wounds, including the prevention of rabies and tetanus. Prophylaxis to prevent infections related to invasive procedures in the emergency department is also addressed.
- Published
- 2008
- Full Text
- View/download PDF
128. Biological terrorism.
- Author
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Moran GJ, Talan DA, and Abrahamian FM
- Subjects
- Anti-Infective Agents therapeutic use, Humans, Infection Control methods, Sentinel Surveillance, Bacterial Infections diagnosis, Bacterial Infections microbiology, Bacterial Infections therapy, Bioterrorism classification, DNA Virus Infections diagnosis, DNA Virus Infections therapy, DNA Virus Infections virology, Disaster Planning methods, Emergency Medicine methods, RNA Virus Infections diagnosis, RNA Virus Infections therapy, RNA Virus Infections virology
- Abstract
A biological terrorism event could have a large impact on the general population and health care system. The impact of an infectious disaster will most likely be great to emergency departments, and the collaboration between emergency and infectious disease specialists will be critical in developing an effective response. A bioterrorism event is a disaster that requires specific preparations beyond the usual medical disaster planning. An effective response would include attention to infection control issues and plans for large-scale vaccination or antimicrobial prophylaxis. This article addresses some general issues related to preparing an effective response to a biological terrorism event. It will also review organisms and toxins that could be used in biological terrorism, including clinical features, management, diagnostic testing, and infection control.
- Published
- 2008
- Full Text
- View/download PDF
129. MRSA: deadly super bug or just another staph?
- Author
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Talan DA
- Subjects
- Community-Acquired Infections epidemiology, Community-Acquired Infections microbiology, Confounding Factors, Epidemiologic, Emergency Service, Hospital trends, Humans, Incidence, Soft Tissue Infections epidemiology, Soft Tissue Infections microbiology, Staphylococcal Infections epidemiology, Staphylococcal Skin Infections epidemiology, Staphylococcal Skin Infections microbiology, United States epidemiology, Methicillin Resistance, Staphylococcal Infections microbiology, Staphylococcus aureus
- Published
- 2008
- Full Text
- View/download PDF
130. Emergency department management of meningitis and encephalitis.
- Author
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Fitch MT, Abrahamian FM, Moran GJ, and Talan DA
- Subjects
- Anti-Infective Agents therapeutic use, Humans, Physical Examination methods, Emergency Medicine methods, Encephalitis, Viral cerebrospinal fluid, Encephalitis, Viral diagnosis, Encephalitis, Viral drug therapy, Encephalitis, Viral microbiology, Meningitis, Bacterial cerebrospinal fluid, Meningitis, Bacterial diagnosis, Meningitis, Bacterial drug therapy, Meningitis, Bacterial microbiology
- Abstract
Bacterial meningitis and viral encephalitis are infectious disease emergencies that can cause significant patient morbidity and mortality. Clinicians use epidemiologic, historical, and physical examination findings to identify patients at risk for these infections, and central nervous system (CNS) imaging and lumbar puncture (LP) may be needed to further evaluate for these diagnoses. The diagnosis of bacterial meningitis can be challenging, as patients often lack some of the characteristic findings of this disease with presentations that overlap with more common disorders seen in the emergency department. This article addresses considerations in clinical evaluation, need for CNS imaging before LP, interpretation of cerebrospinal fluid results, standards for and effects of timely antibiotic administration, and recommendations for specific antimicrobial therapy and corticosteroids.
- Published
- 2008
- Full Text
- View/download PDF
131. Severe sepsis and septic shock in the emergency department.
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Talan DA, Moran GJ, and Abrahamian FM
- Subjects
- Adrenal Cortex Hormones administration & dosage, Anti-Infective Agents therapeutic use, Emergency Service, Hospital, Hemodynamics, Humans, Practice Guidelines as Topic, Protein C administration & dosage, Randomized Controlled Trials as Topic, Sepsis microbiology, Shock, Septic diagnosis, Shock, Septic microbiology, Shock, Septic therapy, Emergency Medicine methods, Sepsis diagnosis, Sepsis therapy
- Abstract
Increased attention has focused recently on the acute management of severe sepsis and septic shock, conditions that represent the end-stage systemic deterioration of overwhelming infection. Clinical trials have identified new therapies and management approaches that, when applied early, appear to reduce mortality. Practice guidelines have been advanced by critical care societies, and many of the proposed interventions involve therapies other than antimicrobials directed at hemodynamic resuscitation or addressing adverse effects of the inflammatory cascade. Although many emergency departments (EDs) are now adopting treatment protocols for sepsis that are based on published treatment guidelines, recent research calls many of the initial recommendations into question, and validation trials of some of these approaches are ongoing. This article reviews the initial evaluation and treatment considerations of sepsis in the ED setting.
- Published
- 2008
- Full Text
- View/download PDF
132. Urinary tract infections in the emergency department.
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Abrahamian FM, Moran GJ, and Talan DA
- Subjects
- Anti-Infective Agents therapeutic use, Catheters, Indwelling microbiology, Cystitis diagnosis, Diagnosis, Differential, Emergency Service, Hospital, Humans, Emergency Medicine methods, Urinary Tract Infections diagnosis, Urinary Tract Infections drug therapy, Urinary Tract Infections microbiology
- Abstract
Urinary tract infection (UTI) is a commonly encountered clinical condition in the emergency department. Emergency physicians evaluate and treat UTIs in a wide spectrum of disease severity and patient populations. This article is written from the perspective of evaluating and managing UTIs in the emergency department. It highlights the pitfalls and clinical dilemmas pertinent to emergency physicians that are not often encountered by infectious disease specialists.
- Published
- 2008
- Full Text
- View/download PDF
133. Diagnosis and management of pneumonia in the emergency department.
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Moran GJ, Talan DA, and Abrahamian FM
- Subjects
- Anti-Infective Agents therapeutic use, Decision Making, Hospitalization, Humans, Pneumonia microbiology, Sputum microbiology, Emergency Medicine methods, Pneumonia diagnosis, Pneumonia drug therapy
- Abstract
Pneumonia is a condition that is often treated by emergency physicians. This article reviews the diagnosis and management of pneumonia in the emergency department and highlights dilemmas in diagnostic testing, use of blood and sputum cultures, hospital admission decisions, infection control, quality measures for pneumonia care, and empiric antimicrobial therapy.
- Published
- 2008
- Full Text
- View/download PDF
134. Antibiotic use for emergency department patients with upper respiratory infections: prescribing practices, patient expectations, and patient satisfaction.
- Author
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Ong S, Nakase J, Moran GJ, Karras DJ, Kuehnert MJ, and Talan DA
- Subjects
- Acute Disease, Adolescent, Adult, Child, Clinical Competence, Confidence Intervals, Drug Utilization, Female, Health Knowledge, Attitudes, Practice, Humans, Male, Middle Aged, Odds Ratio, Prospective Studies, Surveys and Questionnaires, Anti-Bacterial Agents administration & dosage, Drug Prescriptions statistics & numerical data, Emergency Service, Hospital, Patient Satisfaction, Practice Patterns, Physicians' statistics & numerical data, Respiratory Tract Infections drug therapy
- Abstract
Study Objective: Physicians often prescribe antibiotics to patients even when there is no clear indication for their use. Previous studies examining antibiotic use in acute bronchitis and upper respiratory infections have been conducted in primary care settings. We evaluate the factors that physicians in the emergency department (ED) consider when prescribing antibiotics (eg, patient expectations) and the factors associated with patient satisfaction., Methods: Ten academic EDs enrolled adults and children presenting with symptoms consistent with upper respiratory infection. Enrolled patients were interviewed before their physician encounter and were reinterviewed before discharge and 2 weeks later. Physicians were interviewed about factors that influenced their management decisions, including their perceptions of patients' expectations. Patients with a single diagnosis of uncomplicated acute bronchitis or upper respiratory infection were included for analysis., Results: Of 272 patients enrolled, 68% of bronchitis patients and 9% of upper respiratory infection patients received antibiotics. Physicians were more likely to prescribe antibiotics when they believed that patients expected them (odds ratio [OR] 5.3; 95% confidence interval [CI] 2.9 to 9.6), although they were able to correctly identify only 27% of the patients who expected antibiotics. Satisfaction with the ED visit was reported by 87% of patients who received antibiotics and 89% of those not receiving antibiotics. Satisfaction with the visit was reported by 92% of patients who believed they had a better understanding of their illness but only by 72% of those who thought they had no better understanding (OR 4.4; 95% CI 2.0 to 8.4)., Conclusion: Physicians in our academic EDs prescribed antibiotics to 68% of acute bronchitis patients and to fewer than 10% of upper respiratory infection patients. Physicians were more likely to prescribe antibiotics to patients who they believed expected them, although they correctly identified only about 1 in 4 of those patients. Patient satisfaction was not related to receipt of antibiotics but was related to the belief they had a better understanding of their illness.
- Published
- 2007
- Full Text
- View/download PDF
135. Update on emerging infections: news from the Centers for Disease Control and Prevention. Public health surveillance for smallpox--United States, 2003-2005.
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Moran GJ and Talan DA
- Published
- 2007
- Full Text
- View/download PDF
136. Update on emerging infections from the Centers for Disease Control and Prevention. Hantavirus pulmonary syndrome--five states, 2006.
- Author
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Brillman J, Talan DA, Moran GJ, and Pinner R
- Published
- 2006
137. Update on emerging infections from the Centers for Disease Control and Prevention. Multistate outbreak of mumps--United States, January 1-May 2, 2006.
- Author
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Waxman MA, Abrahamian FM, Talan DA, Moran GJ, and Pinner R
- Published
- 2006
- Full Text
- View/download PDF
138. Severe sepsis and septic shock: review of the literature and emergency department management guidelines.
- Author
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Nguyen HB, Rivers EP, Abrahamian FM, Moran GJ, Abraham E, Trzeciak S, Huang DT, Osborn T, Stevens D, and Talan DA
- Subjects
- Adrenal Cortex Hormones therapeutic use, Algorithms, Cardiovascular Agents therapeutic use, Drug Therapy, Combination, Humans, Practice Guidelines as Topic, Protein C therapeutic use, Recombinant Proteins therapeutic use, Respiration, Artificial, Sepsis diagnosis, Sepsis epidemiology, Sepsis etiology, Anti-Bacterial Agents therapeutic use, Sepsis therapy, Shock, Septic therapy
- Abstract
Severe sepsis and septic shock are as common and lethal as other acute life-threatening conditions that emergency physicians routinely confront such as acute myocardial infarction, stroke, and trauma. Recent studies have led to a better understanding of the pathogenic mechanisms and the development of new or newly applied therapies. These therapies place early and aggressive management of severe sepsis and septic shock as integral to improving outcome. This independent review of the literature examines the recent pathogenic, diagnostic, and therapeutic advances in severe sepsis and septic shock for adults, with particular relevance to emergency practice. Recommendations are provided for therapies that have been shown to improve outcomes, including early goal-directed therapy, early and appropriate antimicrobials, source control, recombinant human activated protein C, corticosteroids, and low tidal volume mechanical ventilation.
- Published
- 2006
- Full Text
- View/download PDF
139. Methicillin-resistant Staphylococcus aureus in community-acquired skin infections.
- Author
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Moran GJ, Amii RN, Abrahamian FM, and Talan DA
- Subjects
- Adult, Anti-Bacterial Agents pharmacology, Community-Acquired Infections microbiology, Female, Humans, Los Angeles, Male, Microbial Sensitivity Tests, Middle Aged, Prevalence, Staphylococcal Skin Infections microbiology, Community-Acquired Infections epidemiology, Emergency Service, Hospital, Methicillin Resistance, Staphylococcal Skin Infections epidemiology, Staphylococcus aureus drug effects
- Abstract
Community-associated methicillin-resistant Staphylococcus aureus (MRSA) is the most common pathogen among patients with skin and soft tissue infections seeking treatment at a Los Angeles (USA) area emergency department. The proportion caused by MRSA increased from 29% in 2001 to 2002 to 64% in 2003 to 2004. No clinical or historical features reliably predict MRSA etiology.
- Published
- 2005
- Full Text
- View/download PDF
140. Extended-release ciprofloxacin (Cipro XR) for treatment of urinary tract infections.
- Author
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Talan DA, Naber KG, Palou J, and Elkharrat D
- Subjects
- Ciprofloxacin administration & dosage, Delayed-Action Preparations, Escherichia coli Infections drug therapy, Trimethoprim, Sulfamethoxazole Drug Combination therapeutic use, Bacterial Infections drug therapy, Ciprofloxacin therapeutic use, Urinary Tract Infections drug therapy
- Abstract
Symptomatic urinary tract infections (UTIs) constitute a major health problem throughout the Western world. In the USA, UTIs are responsible for 7-8 million outpatient visits each year and for over one-third of all hospital-acquired infections. Empiric antimicrobial therapy for UTIs, which are primarily caused by Escherichia coli, is increasingly being complicated by the emergence of resistance to the most widely used agents. Recent studies indicate that the prevalence of E. coli resistance to trimethoprim/sulphamethoxazole (TMP/SMX), the current first-line therapy for UTIs, exceeds 20% in many North American regions. Importantly, antibiotic resistance often translates into clinical failure. The use of antibiotics with favourable pharmacokinetic/pharmacodynamic profiles and convenient dosing schedules, which effectively increase bacterial eradication and patient compliance, can help to curb the current epidemic of resistance and reduce the rate of clinical failure associated with resistance. Fluoroquinolones have well-established efficacy in the treatment of multiple bacterial infections and, over the years, the rates of resistance to these antibiotics have remained very low. Fluoroquinolones are currently recommended for therapy of uncomplicated UTIs when the local incidence of TMP/SMX resistance is >or=10-20%, as well as for the treatment of complicated UTIs and acute pyelonephritis. Ciprofloxacin, one of the most widely used fluoroquinolones, has a potent bactericidal effect across the full spectrum of uropathogens, as well as a long and excellent efficacy and safety record in the management of UTI and other infections. A recently developed extended (modified)-release formulation of ciprofloxacin (Cipro XR or Cipro XL) provides higher maximum plasma concentrations with lower inter-patient variability than the conventional, immediate-release, twice-daily formulation. Additionally, therapeutic drug levels with extended-release ciprofloxacin are achieved rapidly and maintained over the course of 24 h, allowing once-daily dosing. Clinical trials in patients with cystitis and those with complicated UTIs or acute uncomplicated pyelonephritis indicate that extended-release ciprofloxacin is at least as effective as the immediate-release formulation. These studies have also confirmed good tolerability and safety of extended-release ciprofloxacin, similar to the immediate-release formulation. Therefore, extended-release ciprofloxacin is a convenient, well-tolerated and effective therapy for UTIs that may improve patients' compliance with treatment and thus decrease the risk of treatment failure and the spread of antibiotic resistance.
- Published
- 2004
- Full Text
- View/download PDF
141. Tetanus immunity and physician compliance with tetanus prophylaxis practices among emergency department patients presenting with wounds.
- Author
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Talan DA, Abrahamian FM, Moran GJ, Mower WR, Alagappan K, Tiffany BR, Pollack CV Jr, Steele MT, Dunbar LM, Bajani MD, Weyant RS, and Ostroff SM
- Subjects
- Adolescent, Adult, Aged, Female, Hospitals, University, Humans, Immunoglobulins therapeutic use, Male, Middle Aged, Prospective Studies, Tetanus prevention & control, United States, Vaccination statistics & numerical data, Wounds and Injuries blood, Emergency Service, Hospital, Guideline Adherence statistics & numerical data, Immunization, Secondary statistics & numerical data, Tetanus immunology, Tetanus Antitoxin blood, Tetanus Toxoid administration & dosage, Tetanus Toxoid immunology, Wounds and Injuries immunology
- Abstract
Study Objective: We determine tetanus seroprotection rates and physician compliance with tetanus prophylaxis recommendations among patients presenting with wounds., Methods: A prospective observational study of patients aged 18 years or older who presented to 5 university-affiliated emergency departments (EDs) because of wounds was conducted between March 1999 and August 2000. Serum antitoxin levels were measured by enzyme immunoassay with seroprotection defined as more than 0.15 IU/mL. Seroprotection rates, risk factors for lack of seroprotection, and rates of physician compliance with tetanus prophylaxis recommendations by the Advisory Committee on Immunization Practices were determined., Results: The seroprotection rate among 1,988 patients was 90.2% (95% confidence interval 88.8% to 91.5%). Groups with significantly lower seroprotection rates were persons aged 70 years or older, 59.5% (risk ratio [RR] 5.2); immigrants from outside North America or Western Europe, 75.3% (RR 3.7); persons with a history of inadequate immunization, 86.3% (RR 2.9); and persons without education beyond grade school, 76.5% (RR 2.5). Despite a history of adequate immunization, 18% of immigrants lacked seroprotection. Overall, 60.9% of patients required tetanus immunization, of whom 57.6% did not receive indicated immunization. Among patients with tetanus-prone wounds, appropriate prophylaxis (ie, tetanus immunoglobulin and toxoid) was provided to none of 504 patients who gave a history of inadequate primary immunization (of whom 15.1% had nonprotective antibody titers) and to 218 (79%) of 276 patients who required only a toxoid booster., Conclusion: Although seroprotection rates are generally high in the United States, the risk of tetanus persists in the elderly, immigrants, and persons without education beyond grade school. There is substantial underimmunization in the ED (particularly with regard to use of tetanus immunoglobulin), leaving many patients, especially those from high-risk groups, unprotected. Better awareness of tetanus prophylaxis recommendations is necessary, and future tetanus prophylaxis recommendations may be more effective if they are also based on demographic risk factors.
- Published
- 2004
- Full Text
- View/download PDF
142. Once daily, extended release ciprofloxacin for complicated urinary tract infections and acute uncomplicated pyelonephritis.
- Author
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Talan DA, Klimberg IW, Nicolle LE, Song J, Kowalsky SF, and Church DA
- Subjects
- Acute Disease, Adolescent, Adult, Aged, Aged, 80 and over, Delayed-Action Preparations, Double-Blind Method, Drug Administration Schedule, Female, Humans, Male, Middle Aged, Prospective Studies, Urinary Tract Infections complications, Anti-Infective Agents administration & dosage, Ciprofloxacin administration & dosage, Pyelonephritis drug therapy, Urinary Tract Infections drug therapy
- Abstract
Purpose: We assessed the efficacy and safety of 1,000 mg extended release ciprofloxacin orally once daily vs conventional 500 mg ciprofloxacin orally twice daily, each for 7 to 14 days, in patients with a complicated urinary tract infection (cUTI) or acute uncomplicated pyelonephritis (AUP)., Materials and Methods: In this prospective, randomized, double-blind, North American multicenter clinical trial adults were stratified based on clinical presentation of cUTI or AUP and randomized to extended release ciprofloxacin or ciprofloxacin twice daily. Efficacy valid patients had positive pretherapy urine cultures (105 or greater cFU/ml) and pyuria within 48 hours of study entry. Bacteriological and clinical outcomes were assessed at the test of cure visit (5 to 11 days after therapy) and the late followup visit (28 to 42 days after therapy)., Results: The intent to treat population comprised 1,035 patients (extended release ciprofloxacin in 517 and twice daily in 518), of whom 435 were efficacy valid (cUTI in 343 and AUP in 92). For efficacy valid patients (cUTI and AUP combined) bacteriological eradication rates at test of cure were 89% (183 of 206) vs 85% (195 of 229) (95% CI -2.4%, 10.3%) and clinical cure rates were 97% (198 of 205) vs 94% (211 of 225) (95% CI -1.2%, 6.9%) for extended release vs twice daily ciprofloxacin. Late followup outcomes were consistent with test of cure findings. Eradication rates for Escherichia coli, which accounted for 58% of pathogens, were 97% or greater per group. Drug related adverse event rates were similar for extended release and twice daily ciprofloxacin (13% and 14%, respectively)., Conclusions: Extended release ciprofloxacin at a dose of 1,000 mg once daily was as safe and effective as conventional treatment with 500 mg ciprofloxacin twice daily, each given orally for 7 to 14 days in adults with cUTI or AUP. It provides a convenient, once daily, empirical treatment option.
- Published
- 2004
- Full Text
- View/download PDF
143. Antibiotic use for emergency department patients with acute diarrhea: Prescribing practices, patient expectations, and patient satisfaction.
- Author
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Karras DJ, Ong S, Moran GJ, Nakase J, Kuehnert MJ, Jarvis WR, and Talan DA
- Subjects
- Acute Disease, Adolescent, Adult, Aged, Bacterial Infections complications, Bacterial Infections diagnosis, Bacterial Infections drug therapy, Child, Child, Preschool, Clinical Competence, Cohort Studies, Diarrhea etiology, Drug Utilization, Female, Health Knowledge, Attitudes, Practice, Humans, Infant, Infant, Newborn, Male, Middle Aged, Prospective Studies, United States, Anti-Bacterial Agents therapeutic use, Diarrhea drug therapy, Drug Prescriptions statistics & numerical data, Emergency Service, Hospital statistics & numerical data, Patient Satisfaction statistics & numerical data, Practice Patterns, Physicians' statistics & numerical data
- Abstract
Study Objective: Physicians commonly prescribe antibiotics to meet patient expectations, even when antimicrobials are unnecessary. We evaluated factors emergency physicians consider in prescribing antibiotics to patients with diarrhea and examined patient expectations, physician-perceived patient expectations, and patient satisfaction., Methods: Adults and children presenting with acute diarrhea to 1 of 10 academic emergency departments (EDs) were enrolled in this prospective observational cohort study. Adult patients and guardians of enrolled children were asked about treatment expectations before their physician encounter and about satisfaction with their medical care at discharge. Physicians were asked about factors influencing management decisions and their perceptions of patients' expectations., Results: Of 104 patients enrolled, 25% received antibiotics. Physicians were more likely to prescribe antibiotics when features suggestive of bacterial enteritis were present (unadjusted odds ratio [OR] 2.5; 95% confidence interval [CI] 1.1 to 3.9). Physicians were also more likely to prescribe antibiotics when they believed patients expected them (unadjusted OR 2.3; 95% CI 1.1 to 4.4) but correctly identified such expectations in only 33% of instances. Satisfaction with care was reported by 100% of patients receiving antibiotics and 90% of those not receiving antibiotics (95% CI for difference of 10%, 3% to 17%)., Conclusion: Physicians in academic EDs prescribe antibiotics for acute diarrhea to about 1 patient in 4 and are more likely to do so if signs or symptoms compatible with bacterial enteritis are present. Physicians' assessments of patients' expectations for therapy were accurate in only 1 of 3 patients but were nevertheless associated with antibiotic prescription. Patient satisfaction was weakly associated with receipt of antibiotics.
- Published
- 2003
- Full Text
- View/download PDF
144. Clinical presentation and bacteriologic analysis of infected human bites in patients presenting to emergency departments.
- Author
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Talan DA, Abrahamian FM, Moran GJ, Citron DM, Tan JO, and Goldstein EJ
- Subjects
- Adolescent, Adult, Anti-Bacterial Agents therapeutic use, Bacterial Infections drug therapy, Bites, Human drug therapy, Child, Female, Humans, Male, Middle Aged, Prospective Studies, Wound Infection drug therapy, Bacteria, Aerobic isolation & purification, Bacteria, Anaerobic isolation & purification, Bites, Human microbiology, Wound Infection microbiology
- Abstract
Previous studies of infected human bites have been limited by small numbers of patients and suboptimal microbiologic methodology. We conducted a multicenter prospective study of 50 patients with infected human bites. Seventy percent of the patients and assailants were young adult men. Fifty-six percent of injuries were clenched-fist injuries and 44% were occlusional bites. Most injuries were to the hands. Fifty-four percent of patients were hospitalized. The median number of isolates per wound culture was 4 (3 aerobes and 1 anaerobe); aerobes and anaerobes were isolated from 54% of wounds, aerobes alone were isolated from 44%, and anaerobes alone were isolated from 2%. Isolates included Streptococcus anginosus (52%), Staphylococcus aureus (30%), Eikenella corrodens (30%), Fusobacterium nucleatum (32%), and Prevotella melaninogenica (22%). Candida species were found in 8%. Fusobacterium, Peptostreptococcus, and Candida species were isolated more frequently from occlusional bites than from clenched-fist injuries. Many strains of Prevotella and S. aureus were beta-lactamase producers. Amoxicillin-clavulanic acid and moxifloxacin demonstrated excellent in vitro activity against common isolates.
- Published
- 2003
- Full Text
- View/download PDF
145. Update on emerging infections: news from the Centers for Disease Control and Prevention. Syndromic surveillance for bioterrorism following the attacks on the World Trade Center--New York City, 2001.
- Author
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Moran GJ and Talan DA
- Published
- 2003
- Full Text
- View/download PDF
146. Once-daily, high-dose levofloxacin versus ticarcillin-clavulanate alone or followed by amoxicillin-clavulanate for complicated skin and skin-structure infections: a randomized, open-label trial.
- Author
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Graham DR, Talan DA, Nichols RL, Lucasti C, Corrado M, Morgan N, and Fowler CL
- Subjects
- Amoxicillin-Potassium Clavulanate Combination administration & dosage, Amoxicillin-Potassium Clavulanate Combination adverse effects, Anti-Infective Agents administration & dosage, Anti-Infective Agents adverse effects, Clavulanic Acids administration & dosage, Clavulanic Acids adverse effects, Drug Therapy, Combination administration & dosage, Drug Therapy, Combination adverse effects, Female, Humans, Male, Middle Aged, Ofloxacin administration & dosage, Ofloxacin adverse effects, Ticarcillin administration & dosage, Ticarcillin adverse effects, Treatment Outcome, Amoxicillin-Potassium Clavulanate Combination therapeutic use, Anti-Infective Agents therapeutic use, Clavulanic Acids therapeutic use, Drug Therapy, Combination therapeutic use, Levofloxacin, Ofloxacin therapeutic use, Skin Diseases drug therapy, Ticarcillin therapeutic use
- Abstract
This study tested whether levofloxacin, at a new high dose of 750 mg, was effective for the treatment of complicated skin and skin-structure infections (SSSIs). Patients with complicated SSSIs (n=399) were randomly assigned in a ratio of 1:1 to 2 treatment arms: levofloxacin (750 mg given once per day intravenously [iv], orally, or iv/orally) or ticarcillin-clavulanate (TC; 3.1 g given iv every 4-6 hours) followed, at the investigator's discretion, by amoxicillin-clavulanate (AC; 875 mg given orally every 12 hours). In the clinically evaluable population, therapeutic equivalence was demonstrated between the levofloxacin and TC/AC regimens (success rates of 84.1% and 80.3%, respectively). In the microbiologically evaluable population, the overall rate of eradication was 83.7% in the levofloxacin treatment group and 71.4% in the TC/AC treatment group (95% confidence interval, -24.3 to -0.2). Both levofloxacin and TC/AC were well tolerated. These data demonstrate that levofloxacin (750 mg once per day) is safe and at least as effective as TC/AC for complicated SSSIs.
- Published
- 2002
- Full Text
- View/download PDF
147. Neurocysticercosis in radiographically imaged seizure patients in U.S. emergency departments.
- Author
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Ong S, Talan DA, Moran GJ, Mower W, Newdow M, Tsang VC, and Pinner RW
- Subjects
- Animals, Antibodies, Helminth blood, Demography, Emergency Medical Services, Female, Hispanic or Latino, Humans, Immunoblotting, Magnetic Resonance Imaging, Male, Neurocysticercosis diagnostic imaging, Neurocysticercosis parasitology, Prospective Studies, Seizures diagnostic imaging, Seizures parasitology, Seroepidemiologic Studies, Southwestern United States epidemiology, Tomography, X-Ray Computed, Neurocysticercosis epidemiology, Seizures epidemiology, Taenia isolation & purification
- Abstract
Neurocysticercosis appears to be on the rise in the United States, based on immigration patterns and published cases series, including reports of domestic acquisition. We used a collaborative network of U.S. emergency departments to characterize the epidemiology of neurocysticercosis in seizure patients. Data were collected prospectively at 11 university-affiliated, geographically diverse, urban U.S. emergency departments from July 1996 to September 1998. Patients with a seizure who underwent neuroimaging were included. Of the 1,801 patients enrolled in the study, 38 (2.1%) had seizures attributable to neurocysticercosis. The disease was detected in 9 of the 11 sites and was associated with Hispanic ethnicity, immigrant status, and exposure to areas where neurocysticercosis is endemic. This disease appears to be widely distributed and highly prevalent in certain populations (e.g., Hispanic patients) and areas (e.g., Southwest).
- Published
- 2002
- Full Text
- View/download PDF
148. Clinical perspectives on new antimicrobials: focus on fluoroquinolones.
- Author
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Talan DA
- Subjects
- Animals, Anti-Infective Agents adverse effects, Anti-Infective Agents pharmacokinetics, Anti-Infective Agents therapeutic use, Consumer Product Safety, Drug Resistance, Microbial, Humans, Moxifloxacin, Respiratory Tract Infections drug therapy, Respiratory Tract Infections microbiology, Anti-Infective Agents pharmacology, Aza Compounds, Fluoroquinolones, Quinolines
- Abstract
Respiratory tract infections are the most common infectious presentation in the community and hospital settings and are a major cause of morbidity and mortality worldwide. Recently, newer fluoroquinolones have been recommended for the treatment of these infections. Among them, moxifloxacin shows improved activity against gram-positive pathogens, has maintained potency against gram-negative organisms, and shows activity against atypical pathogens and anaerobes. Moxifloxacin also has excellent in vitro activity against strains resistant to penicillin, erythromycin, and other fluoroquinolones, such as levofloxacin. Moxifloxacin has demonstrated clinical efficacy rates of 90%-95% in clinical trials in community-acquired pneumonia, acute exacerbations of chronic bronchitis, and acute sinusitis. In these trials, moxifloxacin demonstrated no serious or unexpected adverse effects. Development of resistance appears to be slower for moxifloxacin than for several other fluoroquinolones, making moxifloxacin a good treatment choice. The pharmacodynamics of moxifloxacin support once-daily oral therapy of short duration, providing convenience, compliance, and safety advantages.
- Published
- 2001
- Full Text
- View/download PDF
149. Update on emerging infections from the Centers for Disease Control and Prevention. Varicella outbreaks among Mexican adults--Alabama, 2000.
- Author
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Talan DA and Moran GJ
- Subjects
- Adolescent, Adult, Alabama, Cross-Sectional Studies, Female, Humans, Incidence, Male, Chickenpox epidemiology, Disease Outbreaks statistics & numerical data, Mexican Americans statistics & numerical data
- Published
- 2001
- Full Text
- View/download PDF
150. Why did the chicken cross the road? ... to get the antibiotics.
- Author
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Talan DA and Moran GJ
- Subjects
- Adult, Anti-Bacterial Agents adverse effects, Bronchitis drug therapy, Common Cold drug therapy, Drug Resistance, Microbial, Humans, Middle Aged, Anti-Bacterial Agents administration & dosage, Emergency Service, Hospital
- Published
- 2000
- Full Text
- View/download PDF
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