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6 results on '"Eli Raykhshtat"'

1. Exposure to Non-Antimicrobial Drugs and Risk of Infection with Antibiotic-Resistant Enterobacteriaceae

Author

Meital Elbaz, Esther Stein, Eli Raykhshtat, Ahuva Weiss-Meilik, Regev Cohen, and Ronen Ben-Ami

Subjects
antimicrobial resistance, modeling, non-antimicrobial drugs, Therapeutics. Pharmacology, RM1-950
Abstract

Antimicrobial resistance (AMR) has consistently been linked to antibiotic use. However, the roles of commonly prescribed non-antimicrobial drugs as drivers of AMR may be under-appreciated. Here, we studied a cohort of patients with community-acquired pyelonephritis and assessed the association of exposure to non-antimicrobial drugs at the time of hospital admission with infection with drug-resistant organisms (DRO). Associations identified on bivariate analyses were tested using a treatment effects estimator that models both outcome and treatment probability. Exposure to proton-pump inhibitors, beta-blockers, and antimetabolites was significantly associated with multiple resistance phenotypes. Clopidogrel, selective serotonin reuptake inhibitors, and anti-Xa agents were associated with single-drug resistance phenotypes. Antibiotic exposure and indwelling urinary catheters were covariates associated with AMR. Exposure to non-antimicrobial drugs significantly increased the probability of AMR in patients with no other risk factors for resistance. Non-antimicrobial drugs may affect the risk of infection with DRO through multiple mechanisms. If corroborated using additional datasets, these findings offer novel directions for predicting and mitigating AMR.

Published
2023
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2. Using the kinetics of C-reactive protein response to improve the differential diagnosis between acute bacterial and viral infections

Author

Shlomo Berliner, Itzhak Shapira, Daniel Bernstein, Shani Shenhar-Tsarfaty, Eli Raykhshtat, Asaf Wasserman, Dan Coster, Ahuva Meilik, Eyal Fisher, Ori Rogowski, Ron Shamir, David Zeltser, and Pinchas Halpern

Subjects
Adult, Male, 0301 basic medicine, Microbiology (medical), medicine.medical_specialty, 030106 microbiology, Sensitivity and Specificity, Gastroenterology, Viral infection, Cohort Studies, Diagnosis, Differential, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, Internal medicine, medicine, Humans, In patient, 030212 general & internal medicine, Adaptor Proteins, Signal Transducing, Aged, Retrospective Studies, Aged, 80 and over, biology, Adult patients, business.industry, C-reactive protein, Retrospective cohort study, Bacterial Infections, General Medicine, Emergency department, LIM Domain Proteins, Middle Aged, Infectious Diseases, Virus Diseases, Area Under Curve, Acute Disease, biology.protein, Female, Differential diagnosis, Carrier Proteins, business
Abstract

Differential diagnosis between acute viral and bacterial infection is an emerging common challenge for a physician in the emergency department. Serum C-reactive protein (CRP) is used to support diagnosis of bacterial infection, but in patients admitted with low CRP, its ability to discriminate between viral and bacterial infections is limited. We aimed to use two consecutive CRP measurements in order to improve differential diagnosis between bacterial and viral infection. A single-center retrospective cohort (n = 1629) study of adult patients admitted to the emergency department with a subsequent microbiological confirmation of either viral or bacterial infection. Trend of CRP was defined as the absolute difference between the first two measurements of CRP divided by the time between them, and we investigated the ability of this parameter to differentiate between viral and bacterial infection. In patients with relatively low initial CRP concentration (

Published
2019
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3. The potential benefit of a second C-reactive protein measurement in patients with gram-negative bacteraemia presenting to the emergency medicine department

Author

Pinchas Halpern, Tal Levinson, Itzhak Shapira, Amos Adler, Eli Raykhshtat, Shlomo Berliner, Ilana Goldiner, Asaf Wasserman, Ahuva Meilik, Natalie Tamir, Shani Shenhar-Tsarfaty, Yael Paran, David Zeltzer, and Ori Rogowski

Subjects
Adult, Male, medicine.medical_specialty, Health, Toxicology and Mutagenesis, Clinical Biochemistry, Inflammation, Bacteremia, 030204 cardiovascular system & hematology, Biochemistry, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Gram-Negative Bacteria, medicine, Humans, In patient, biology, business.industry, C-reactive protein, Middle Aged, Anti-Bacterial Agents, C-Reactive Protein, 030220 oncology & carcinogenesis, biology.protein, Emergency Medicine, Female, medicine.symptom, C-reactive protein measurement, business, Emergency Service, Hospital
Abstract

Low C-reactive protein in acute bacterial infections could convey the erroneous impression of a mild infection. We focussed on gram-negative bacteraemia, a phenomenon frequently seen at the emergency room.Of 2200 patients with gram-negative bacteraemia, 460 patients with first C-reactive protein30 mg/L and 460 patients with C-reactive protein187 mg/L were reviewed. Following exclusions, we finally investigated 229 and 289 patients with low and high C-reactive protein concentrations, respectively.The cohort was divided into low and high C-reactive protein groups. Median first C-reactive protein was 13.6 and 219.9 mg/L, respectively (interquartile range 6.4-21.6 and 195-270.1). Compared to patients with first high C-reactive protein, patients with first low C-reactive protein concentrations had a significant five-fold higher C-reactive protein level with their second test.Patients with gram-negative bacteraemia can present with C-reactive protein within the range of apparently healthy individuals. A second C-reactive protein might help to avoid an erroneous decision regarding the severity of the infection.

Published
2020

4. Anemia measurements to distinguish between viral and bacterial infections in the emergency department

Author

Shlomo Berliner, Eli Raykhshtat, Shani Shenhar-Tsarfaty, Ahuva Meilik, Daniel Trotzky, Yael Steuerman, Ori Rogowski, Asaf Wasserman, Irit Gat-Viks, David Zeltser, Itzhak Shapira, and Pinchas Halpern

Subjects
0301 basic medicine, Microbiology (medical), Erythrocyte Indices, medicine.medical_specialty, Anemia, Iron, 030106 microbiology, Diagnosis, Differential, 03 medical and health sciences, 0302 clinical medicine, Medical microbiology, Internal medicine, medicine, Humans, 030212 general & internal medicine, Proportional Hazards Models, Retrospective Studies, biology, business.industry, C-reactive protein, Red blood cell distribution width, Retrospective cohort study, General Medicine, Emergency department, Bacterial Infections, Length of Stay, medicine.disease, Ferritin, Infectious Diseases, C-Reactive Protein, Virus Diseases, Ferritins, biology.protein, Hemoglobin, business, Emergency Service, Hospital, Biomarkers
Abstract

The clinical diagnosis of acute infections in the emergency department is a challenging task due to the similarity in symptom presentation between virally and bacterially infected individuals, while the use of routine laboratory tests for pathogen identification is often time-consuming and may contain contaminants. We investigated the ability of various anemia-related parameters, including hemoglobin, red cell distribution width (RDW), and iron, to differentiate between viral and bacterial infection in a retrospective study of 3883 patients admitted to the emergency department with a confirmed viral (n = 1238) or bacterial (n = 2645) infection based on either laboratory tests or microbiological cultures. The ratio between hemoglobin to RDW was found to be significant in distinguishing between virally and bacterially infected patients and outperformed other anemia measurements. Moreover, the predictive value of the ratio was high even in patients presenting with low C-reactive protein values (

Published
2019

5. The implementation of rapid microbial identification via MALDI-ToF reduces mortality in gram-negative but not gram-positive bacteremia

Author

Eli Raykhshtat, Hila Zadka, Amos Adler, Nancy Bishouty, Ahuva Weiss-Meilik, and Boris Uralev

Subjects
0301 basic medicine, Microbiology (medical), Male, Microbiological Techniques, Patient Transfer, medicine.medical_specialty, Polymicrobial infection, Multivariate analysis, Gram-positive bacteria, 030106 microbiology, Bacteremia, Gram-Positive Bacteria, 03 medical and health sciences, 0302 clinical medicine, Medical microbiology, Internal medicine, Gram-Negative Bacteria, medicine, Humans, 030212 general & internal medicine, Hospital Mortality, Gram, Aged, Retrospective Studies, Aged, 80 and over, biology, Adult patients, business.industry, Mortality rate, General Medicine, Length of Stay, Middle Aged, medicine.disease, biology.organism_classification, Infectious Diseases, Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization, Female, business
Abstract

Our goals were to study the effect of rapid microbial identification (RMI) of positive blood culture on patient’s outcome and to identify specific microbiological characteristics related to clinical benefit of RMI. This was a retrospective-cohort study of hospitalized, adult patients with bacteremia. The outcome of patients with bacteremia episodes was compared before vs. after the initiation of RMI. RMI was done by matrix-assisted laser desorption/ionization time-of-flight testing of microcolonies. The study included 1460 and 2710 cases in the pre- and post-intervention periods, respectively. There were similar rates of gram-negative, gram-positive, anaerobes, and polymicrobial infections, but higher rate of contaminants in the intervention period (39.9 vs. 43.7%, p = 0.019). The median time-to-identification decreased from 47.5 to 21.3 h (p

Published
2019

6. Septic patients presenting with apparently normal C-reactive protein

Author

Ruth Karov, David Zeltzer, Itzhak Shapira, Shani Shenhar-Tsarfaty, Ahuva Meilik, Ori Rogowski, Daniel Trotzky, Shlomo Berliner, Asaf Wasserman, Eli Raykhshtat, Ilana Goldiner, Pinchas Halpern, and Yael Paran

Subjects
velocity, medicine.medical_specialty, medicine.drug_class, Antibiotics, Observational Study, Disease, C-reactive protein, Tertiary Care Centers, sepsis, Sepsis, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Electronic Health Records, Humans, Hospital Mortality, 030212 general & internal medicine, Retrospective Studies, immunosuppression, biology, business.industry, Medical record, Mortality rate, Retrospective cohort study, General Medicine, medicine.disease, 030220 oncology & carcinogenesis, Healthy individuals, biology.protein, Emergency Service, Hospital, business, Research Article
Abstract

The presentation of septic patients with low C-reactive protein (CRP) concentrations to the emergency room (ER) might convey an erroneous impression regarding the severity of the disease. We analyzed a retrospective study of septic patients admitted to the internal medicine departments of a relatively large tertiary medical center, following admission to the ER. These patients had CRP concentrations of

Published
2019
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