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8. Antibiotic De-Escalation Practices in the Intensive Care Unit: A Multicenter Observational Study

Author

Patanwala, Asad E, Abu Sardaneh, Arwa, Alffenaar, Jan-Willem C, Choo, Chui Lynn, Dey, Alexandra L, Duffy, Eamon J, Green, Sarah E, Hills, Thomas E, Howle, Lisa M, Joseph, Jessica A, Khuon, Maxkirivan C, Koppen, Cassandra S, Pang, Francis, Park, Jung Yeun, Parlicki, Mark A, Shah, Isha S, Tran, Kylie, Tran, Priscilla, Wills, Mardi A, Xu, Jessica H, and Youssef, Marian

Abstract

Background: There is little known about antibiotic de-escalation (ADE) practices in the intensive care unit (ICU).Objective: The objective was to determine the proportion of patients who received ADE within 24 hours of actionable cultures and identify predictors of timely ADE.Methods: Multicenter cohort study in ICUs of 15 hospitals in Australia and New Zealand. Adult patients were included if they were started on broad-spectrum antibiotics within 24 hours of ICU admission. The ADE was defined as switching from a broad-spectrum agent to a narrower-spectrum agent or antibiotic cessation. The primary outcome was ADE within 24 hours of an actionable culture, where ADE was possible.Results: The 446 patients included in the study had a mean age of 63 ± 16 years, 60% were male, 32% were mechanically ventilated, and 19% were immunocompromised. Of these, 161 (36.1%) were not eligible for ADE and 37 (8.3%) for whom ADE within 24 hours of actionable culture could not be determined. In the remaining 248 patients, ADE occurred ≤24 hours in 60.5% (n = 150/248) after actionable cultures. In the multivariable logistic regression analysis, ADE was less likely to occur within 24 hours for patients with negative cultures (odds ratio [OR] = 0.48, 95% confidence interval [CI] = 0.25-0.92, P= 0.03).Conclusion and Relevance: Timely ADE may not occur in 40% of patients in the ICU and is less likely to occur in patients with negative cultures. Timely ADE can be improved, and patients with negative cultures should be targeted as part of antimicrobial stewardship efforts.

Published
2024
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9. The rise (and risks) of mandatory arbitration agreements.

Author

Mankes, Michael and Green, Sarah E.

Subjects
Class action lawsuits -- Prevention, Labor arbitration -- Evaluation
Abstract

Byline: Michael Mankes and Sarah E. Green With the explosion of employment litigation - in particular, wage and hour lawsuits - many employers are turning to mandatory arbitration agreements as [...]

Published
2016

10. Enhancement of macrophage inflammatory responses by CCL2 is correlated with increased miR-9 expression and downregulation of the ERK1/2 phosphatase Dusp6.

Author

IVCarson, William F., Salter-Green, Sarah E., Scola, Melissa M., Joshi, Amrita, Gallagher, Katherine A., and Kunkel, Steven L.

Subjects
*CHEMOKINE receptors, *MACROPHAGES, *MICRORNA, *GENE expression, *SERINE/THREONINE kinases, *DOWNREGULATION, *STATISTICAL correlation
Abstract

Macrophage polarization plays a central role in both protective immunity and immunopathology. While the role of cytokines in driving macrophage polarization is well characterized, less is understood about the role of chemokines. The purpose of this study was to determine if C C chemokine 2 (CCL2/MCP1) could influence macrophage polarization in response to subsequent activation with cytokines and microbial products. Treatment of bone marrow-derived macrophages with CCL2 alone did not result in increased expression of either classical or alternatively-activated macrophage genes as compared to standard skewing cytokines or Toll-like receptor agonists. However, subsequent stimulation of CCL2 pre-treated macrophages with classical activation stimuli resulted in enhanced expression of genes associated with classical activation. This enhancement correlated with increased phosphorylation of ERK1/2 kinases, a decrease in expression of the ERK phosphatase Dusp6 and enhanced expression of miR-9. These results indicate that CCL2 supports the classical activation of macrophages, with miR-9 mediated down-regulation of Dusp6 and enhanced ERK-mediated signal transduction possibly mediating this enhanced pro-inflammatory gene expression. [ABSTRACT FROM AUTHOR]

Published
2017
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13. Earth Science

Author

Green, Sarah E.

Subjects
Literature, poetry, Zagajewski, Bishop, Wetzsteon, Frost, Corso, luck, love, neighborhoods, Cambridge, Ohio
Abstract

“I Am Not Sentimental” looks at poems by Elizabeth Bishop, Adam Zagajewski, Robert Frost, Gregory Corso, and Rachel Wetzsteon, all of which have in common the speaker’s grappling with diametrically opposed ideas (ways of living, ways of seeing.) Though the speakers make divergent choices, in every case the poem is able to sincerely and substantively engage both sides of a dichotomy, before settling on a conclusive course of action or perception. This openness to paradox and/or counter-argument heightens the poems' poignancy, immediacy, and intellectual liveliness, creating the sense that in every case the poet is thinking in real time and as surprised by the outcome as the reader. “Earth Science” is a collection of poems that explores the ways in which life surprises us by disrupting simple categories: stranger and neighbor, lover and enemy, luck and loss.

Published
2015

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