114 results on '"Mayar, Al Mohajer"'
Search Results
2. Analyzing the Relationship Between Socioeconomic Deprivation and Outpatient Medicare Part D Fluroquinolone Claims in Texas
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Mayar Al Mohajer, Edgar Samarasundera, Judite Gonçalves, and Alicia Heath
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Infectious and parasitic diseases ,RC109-216 ,Public aspects of medicine ,RA1-1270 - Abstract
Background: Only a few studies have assessed the relationship between deprivation and excessive antibiotic use. In Texas, antimicrobial prescription is particularly high compared with the rest of the US. This study analyzed the association between local area socioeconomic deprivation and providers’ fluoroquinolone claim rates among beneficiaries 65 years and older in Texas. Method: This ecological study utilized provider- and area-level data from Medicare Part D Prescribers and the Social Deprivation Index (SDI) repositories. To identify geographic patterns and autocorrelation in and between SDI and fluoroquinolone claims, spatial dependence of these two variables was assessed by bivariate Local Indicators of Spatial Association (LISA) cluster mapping along with the global and local Moran’s I analyses. Negative binomial regression models were employed to evaluate the relationship between provider- and area-level characteristics (prescriber’s gender, specialty, rural-urban community area, beneficiaries' demographics, area-level population, and normalized SDI) and fluoroquinolone claim rates per 1,000 beneficiaries. Result: A total of 11,996 providers were included. There was no spatial dependence between SDI and rates of fluoroquinolone claims in Texas (Global Moran’s I =0.01, P=0.618). Bivariant LISA maps showed 85 high-high and 38 low-low spatial clusters. Higher SDI (incidence rate ratio (IRR) 0.98, 95% confidence interval (CI) 0.97-0.99 per 1-unit increment) and male providers (IRR 0.96, 95%CI 0.94-0.99) were associated with lower claim rates. In contrast, several factors were associated with higher claim rates, including non-metropolitan areas (1.04, 95%CI 1.00-1.09), and practices with a high proportion of male patients (IRR 1.12, 95%CI 1.10-1.14), Black patients (IRR 1.05, 95%CI 1.03-1.07), or Medicaid beneficiaries (IRR 1.15, 95%CI 1.12-1.17). Effect modification was observed between SDI and rurality, with higher SDI in non-metropolitan areas associated with higher claim rates, whereas SDI in metropolitan areas was inversely related to claim rates. Conclusion: This study showed that the distribution of high and low SDI and rates of fluoroquinolone claims were more geographically clustered than expected by random chance alone. Lower fluoroquinolone claim rates among Texas Medicare providers were seen in metropolitan areas with higher SDI, indicating potential barriers to care. Conversely, higher claim rates were observed in rural areas with higher SDI, signifying a possible knowledge or attitude gap towards fluoroquinolone use. These findings provide opportunities for public health professionals to explore gaps in the knowledge and attitudes of patients and providers related to antimicrobial use, particularly in rural regions, and investigate barriers to healthcare access in metropolitan areas.
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- 2024
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3. FilmArray Meningitis/Encephalitis Panel Impact on Antibiotic Usage in Patients with Suspected Community-Acquired Meningitis
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Aaron Pathak, Caitlynn Pham, Sabra Shay, Todd Lasco, and Mayar Al Mohajer
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Infectious and parasitic diseases ,RC109-216 ,Public aspects of medicine ,RA1-1270 - Abstract
Background: Cerebrospinal fluid (CSF) cultures are commonly performed to evaluate patients with suspected bacterial meningitis. These cultures, however, can take up to 72 hours, leading to delays in antibiotic de-escalation and increased antimicrobial utilization. The turnaround for the BioFire® FilmArray® Meningitis/Encephalitis(FA/ME) panel is less than an hour, which may facilitate early de-escalation. Our study aimed to assess whether the use of FA/ME panels in combination with CSF cultures could impact antimicrobial therapy compared to cultures alone in patients treated for suspected bacterial meningitis. Methods: Our retrospective study included patients from five hospitals in Texas (2017-2023) who received empiric antibiotics for suspected community-acquired meningitis and underwent a lumbar puncture within 96 hours of admission. Patients with ventricular drains, traumatic brain injury, and non-central nervous system infections were excluded. Cases comprised patients who had an FA/ME panel performed, while controls included patients without the panel. Outcomes were defined as the empiric duration of antimicrobial therapy (days) and total days of antibiotic therapy (DOT). Wilcoxon Rank Sum test and multiple linear regression models were applied to assess the relationship between the use of the FA/ME panel and study outcomes. Independent variables comprised demographics, institution type, acuity, clinical presentation, CSF values, and FA/ME panel use. Imputation was performed using multiple imputation by chained equations. Results: A total of 193 patients were included in our study. Seventy-one patients received the FA/ME panel (along with the CSF culture), while 122 patients received the CSF culture alone (controls). The median empiric duration of antibiotic therapy in the cases and controls were 1.71 days and 1.18 days, respectively (p = .160). The median DOT in the cases and controls were eight days and six days, respectively (p = .045). After adjusting for confounders, the FA/ME panel was not significantly associated with changes in the empiric duration of antibiotic therapy (B= 0.18, p = .669, Figure 1) or DOT (B= 1.28, p = .170, Figure 2).
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- 2024
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4. Clinical utility of metagenomic next-generation sequencing in fever of undetermined origin
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Marilyne Daher, Roumen Iordanov, Mayar Al Mohajer, M. Rizwan Sohail, Kristen Andrews Staggers, and Ahmed Mufeed Hamdi
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Infectious and parasitic diseases ,RC109-216 - Abstract
Background: Metagenomic next-generation sequencing (mNGS) is a novel diagnostic tool increasingly used in the field of infectious diseases. Little guidance is available regarding its appropriate use in different patient populations and clinical syndromes. We aimed to review the clinical utility of mNGS in patients with a specific clinical syndrome and identify factors that may increase its utility. Methods: We retrospectively reviewed charts of 72 non-immunocompromised adults hospitalized with the clinical syndrome of ‘fever of undetermined origin’ and underwent mNGS testing. Standardized criteria from a previously published study were used to determine the clinical impact of mNGS testing. We applied logistic regression to identify factors associated with a positive clinical impact. Results: Of the 72 patients identified, 62.5% were males with a median age of 56. All patients had a fever at the time of evaluation. At least one organism was identified in 65.3% of cases; most commonly were Epstein–Barr virus (13.9%), cytomegalovirus (12.5%), and Rickettsia typhi (11.1%). Of those determined to have an infectious etiology of their febrile syndrome, 89.5% ( n = 34/38) had a positive mNGS. Consistency between the organism(s) on mNGS and the clinically determined infectious etiology was 82.4%. mNGS had a positive clinical impact in 40.3% of cases, a negative impact in 2.8%, and no impact in 56.9% of cases. Besides age, we did not identify other factors associated with a higher likelihood of positive clinical impact. Conclusion: In our review, mNGS had a positive clinical impact in a large proportion of adults with fever of undetermined origin, with minimal negative impact. However, mNGS results should be interpreted carefully given the high rate of detection of pathogens of unclear clinical significance. Randomized clinical trials are needed to assess the clinical utility of this novel diagnostic tool.
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- 2024
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5. Understanding the Gap Between Nursing Workforce in the United States and Population Needs—A Policy Brief
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Mayar Al Mohajer
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nursing ,policy ,shortage ,Medicine - Abstract
Purpose This report is intended to analyze the root causes for the current gap between the nursing workforce and population needs in the United States. It aims to consolidate what is known about these contributing reasons and provide evidence-based recommendations for action.
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- 2023
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6. Designing a Local Policy to Reduce HIV in Mexico City
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Mayar Al Mohajer
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HIV ,Mexico ,strategy ,prevention ,early treatment ,Medicine - Abstract
The Joint United Nations Program on human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) (Joint United Nations Program on HIV/AIDS, UNAIDS) has recommended 90–90–90 goals to increase the number of patients who are aware of their status, on antiretroviral therapy, and have undetectable viral loads. Mexico City has made several achievements to aid in prevention, early diagnosis, and treatment; however, the incidence of HIV has not decreased over the past decade. This article reviews global initiatives that were successful in achieving some or all these metrics and provide a road map for Mexico to reach the desired goals.
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- 2023
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7. Comparison of complication types in patients receiving vesicant intravenous antimicrobials or vasopressors via midlines and peripherally inserted central catheters
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Bryan Grigg, Nishant Varghese, Christi Knapp, Sabra L. Shay, Geraldine Jones, James P. Herlihy, Prasad Manian, Bradley Lembcke, and Mayar Al Mohajer
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Infectious and parasitic diseases ,RC109-216 ,Public aspects of medicine ,RA1-1270 - Abstract
We assessed adverse events in hospitalized patients receiving selected vesicant antibiotics or vasopressors administered through midline catheters or peripherally inserted central catheters (PICC). The rates of catheter-related bloodstream infections, thrombosis, and overall events were similar across the two groups, while occlusion was higher in the PICC group.
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- 2024
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8. The impact of the FilmArray meningitis/encephalitis panel on empiric antibiotic prescriptions in patients with suspected community-acquired meningitis
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Aaron Pathak, Caitlynn Pham, Sabra Shay, Todd Lasco, and Mayar Al Mohajer
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Infectious and parasitic diseases ,RC109-216 ,Public aspects of medicine ,RA1-1270 - Abstract
The BioFire® FilmArray® meningitis/encephalitis (FA/ME) panel provides rapid testing for common cerebrospinal fluid pathogens. We compared empiric antibiotic utilization between patients with suspected community-acquired meningitis with and without an FA/ME panel ordered. No significant differences in antibiotic use were found.
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- 2024
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9. The impact of direct inoculation of ascites into blood culture bottles on ascites culture positivity
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Tyler Brehm, Todd Lasco, and Mayar Al Mohajer
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Infectious and parasitic diseases ,RC109-216 ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Objective: Assess whether direct inoculation of ascites into blood culture bottles would improve ascites culture yield. Design: Pre-post-study. Setting: The study was performed at a quaternary academic medical center in Houston, Texas, including all inpatient and emergency department encounters. Patients: Ascites cultures collected from November 2020 to December 2022 were reviewed and screened for spontaneous bacterial peritonitis. Patients were excluded if a prior ascites culture from the same patient was already included in the study or if there was evidence of secondary bacterial peritonitis. Intervention: In the pre-intervention period, ascites cultures were collected into a sterile container and inoculated onto/into solid and liquid media. In the post-intervention period, ascites cultures were instead directly inoculated into bioMérieux© blood culture bottles at the bedside. Results: 114 patients met inclusion and exclusion criteria, 61 pre-intervention and 53 post-intervention. Overall ascites culture positivity was 15.8% (18/114), 11.5% (7/61) pre-intervention vs 20.8% (11/53) post-intervention. After adjusting for confounders, the intervention had a trend toward a significant effect on ascites culture positivity (P = 0.077). No significant differences were seen in time to positivity, hospital length of stay, or 30-day readmission. Conclusions: Direct inoculation of ascitic fluid into blood culture bottles led to a small increase in culture yield but lacked statistical significance. This lack of significance may be due to the study being underpowered. Further studies are required to investigate if this is due to procedural inefficiencies (eg, inadequate inoculation volumes) or pragmatic clinical practice considerations (ie, high rates of pre-culture antibiotics).
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- 2024
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10. Analyzing the relationship between socioeconomic deprivation and outpatient Medicare Part D fluoroquinolone claim rates in Texas
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Mayar Al Mohajer, Edgar Samarasundera, Judite Gonçalves, and Alicia Heath
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Infectious and parasitic diseases ,RC109-216 ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Introduction: Only a few studies have assessed the relationship between deprivation and excessive antibiotic use. In Texas, antimicrobial prescription rates are particularly high compared with the rest of the US. This study analyzed the association between local area socioeconomic deprivation and providers’ fluoroquinolone claim rates among beneficiaries 65 years and older in Texas. Methods: This ecological study utilized provider- and area-level data from Medicare Part D Prescribers and the Social Deprivation Index (SDI) repositories. Negative binomial regression models were employed to evaluate the relationship between provider- and area-level characteristics (prescriber’s gender, specialty, rural-urban community area, beneficiaries’ demographics, area-level population, and SDI) and fluoroquinolone claim rates per 1,000 beneficiaries. Results: A total of 11,996 providers were included. SDI (IRR 0.98, 95% CI 0.97–0.99) and male providers (IRR 0.96, 95% CI 0.94–0.99) were inversely associated with claim rates. In contrast, several factors were associated with higher claim rates, including non-metropolitan areas (1.04, 95% CI 1.00–1.09), and practices with a high proportion of male (IRR 1.12, 95% CI 1.10–1.14), Black (IRR 1.05, 95% CI 1.03–1.07), or Medicaid beneficiaries (IRR 1.15, 95% CI 1.12–1.17). Effect modification was observed between SDI and rurality, with higher SDI in non-metropolitan areas associated with higher claim rates, whereas SDI in metropolitan areas was inversely related to claim rates. Conclusion: Lower fluoroquinolone claim rates were observed among Texas Medicare providers in metropolitan areas with higher SDI. Conversely, higher rates were observed in rural areas with higher SDI. More studies are needed to understand the underlying causes of this variation and develop effective stewardship interventions.
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- 2024
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11. Detection of invasive Bartonella infections with next-generation sequencing of microbial cell-free DNA
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Fernando H Centeno, Ahmed M. Hamdi, Todd M. Lasco, and Mayar Al Mohajer
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Infectious and parasitic diseases ,RC109-216 ,Public aspects of medicine ,RA1-1270 - Abstract
We report 9 patients with invasive Bartonella infections, including 5 with endocarditis, who were diagnosed with microbial cell-free DNA next-generation sequencing and Bartonella serology studies. Diagnosis with plasma mcfDNA NGS enabled a faster clinical and laboratory diagnosis in 8 patients. Prompt diagnosis impacted antibiotic management in all 9 patients.
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- 2024
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12. The impact of a blood-culture diagnostic stewardship intervention on utilization rates and antimicrobial stewardship
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Kelvin Zhou, Melinda Wang, Sabra Shay, James Herlihy, Muhammad Asim Siddique, Sergio Trevino Castillo, Todd Lasco, Miriam Barrett, and Mayar Al Mohajer
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Infectious and parasitic diseases ,RC109-216 ,Public aspects of medicine ,RA1-1270 - Abstract
Background: Blood cultures are often ordered when an infection is suspected; however, they have a low yield in most cases. The overuse of blood culture is associated with high contamination rates, resulting in excess diagnostics, unnecessary antibiotics, longer hospital stays, and higher hospital costs. We evaluated the safety of a multifaceted intervention, which encompassed education and blood-culture restriction, and its impact on blood-culture utilization and antibiotic use in adult intensive care unit (ICU) patients. Methods: The study was performed between October 2020 and October 2021 in the 12 general medicine and specialty ICUs of a quaternary academic care center. The intervention, implemented in April 2021, included providing education to ICU and infectious disease physicians based on an algorithm adapted from the Johns Hopkins DISTRIBUTE study in addition to restricting blood-culture ordering on these units to these providers. The month of April 2021 was excluded as a washout period. Study outcomes comprised blood-culture utilization, blood-culture positivity, days of therapy (DOT), and length of therapy (LOT), which were compared across the study periods using IRR or the Pearson χ2 test, as appropriate. In addition, 30-day mortality and 30-day ICU readmission were evaluated utilizing multiple COX regression models. Results: In total, 6,303 patients (2,087 MICU, 3,636 SICU, and 580 both) were included in the study, with a median age of 65 years (IQR, 21). Most participants were male (57.5%), with a median length of stay of 175 hours (IQR, 186). After the intervention, blood-culture utilization rates decreased from 15.4% to 12.4% (IRR 0.80, 95% CI, 0.76–0.85) (Fig. 1). There was no difference in blood-culture positivity between the preintervention period (11.05%) and the postintervention period (11.64%; P = .459). Days of therapy decreased from 1,180 to 1,130 per 1,000 patient days (IRR, 0.96; 95% CI, 0.95–0.98), and the length of therapy decreased from 602 to 579 per 1,000 patient days (IRR, 0.96; 95% CI, 0.94–0.99) (Fig. 2). There was no difference in 30-day mortality (P = .241) nor 30-day ICU readmission (P = .888) across the study periods after adjusting for potential confounders (Table 1). Conclusions: Our multifaceted intervention decreased blood-culture and antimicrobial utilization in the ICUs without significantly affecting the positivity rate, mortality, or readmission. This study suggests that educating providers on appropriate blood-culture use along with restriction could safely improve healthcare outcomes. Further studies are warranted to validate our results across various institutions and to evaluate the impact of blood-culture optimization in non-ICU patients.
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- 2023
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13. Impact of gastrointestinal polymerase chain reaction panels on antibiotic utilization in hospitalized adult patients
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Gillean A. Kelly, Roumen Iordanov, Alex Franklin, Amna Ahmed, Krithika Srinivasan, Jesica Hayon, Todd Lasco, Rosie Amini, Sabra Shay, Prathit A. Kulkarni, and Mayar Al Mohajer
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Infectious and parasitic diseases ,RC109-216 ,Public aspects of medicine ,RA1-1270 - Abstract
Multiplex stool polymerase chain reaction (PCR) panels offer rapid comprehensive testing for patients with infectious diarrhea. We compared antibiotic utilization among hospitalized patients with suspected infectious diarrhea who underwent diagnostic testing with either a stool culture or stool PCR panel. No significant differences in antibiotic utilization were identified.
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- 2023
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14. The effect of a plasma next-generation sequencing test on antimicrobial management in immunocompetent and immunocompromised patients—A single-center retrospective study
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Denise Marie A. Francisco, Laila Woc-Colburn, Travis J. Carlson, Todd Lasco, Miriam Barrett, and Mayar Al Mohajer
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Infectious and parasitic diseases ,RC109-216 ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Objective: To describe the use of next-generation sequencing (NGS) and to determine whether NGS leads to changes in antimicrobial management. Design and setting: This retrospective cohort study included patients aged ≥18 years admitted to a single tertiary-care center in Houston, Texas, with an NGS test performed between January 1, 2017, and December 31, 2018. Patients: In total, 167 NGS tests were performed. Most patients were of non-Hispanic ethnicity (n = 129), white (n = 106), and male (n = 116), with a mean age of 52 years (SD, 16). Moreover, 61 patients were immunocompromised: solid-organ transplant (n = 30), patients with human immunodeficiency virus (n = 14), and rheumatology patients on immunosuppressive therapy (n = 12). Results: Of the 167 NGS tests performed, 118 (71%) were positive. Test results associated with a change in antimicrobial management were found in 120 (72%) of 167 cases, with an average of 0.32 (SD, 1.57) fewer antimicrobials after the test. The largest change in antimicrobial management was in glycopeptide use (36 discontinuations) followed by antimycobacterial drug use (27 additions among 8 patients). Also, 49 patients had negative NGS results, but only 36 patients had their antibiotics discontinued. Conclusions: Plasma NGS testing is associated with a change in antimicrobial management in most cases. We observed a decrease in glycopeptide use after NGS results, which highlights physicians’ comfort in withdrawing methicillin-resistant Staphylococcus aureus (MRSA) coverage. In addition, antimycobacterial coverage increased, corresponding with early mycobacterial detection by NGS. Further studies are needed to determine effective ways to use NGS testing as an antimicrobial stewardship tool.
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- 2023
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15. Population Pharmacokinetics of Vancomycin in Pregnant Women
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Rahul K. Goyal, Brady S. Moffett, Jogarao V. S. Gobburu, and Mayar Al Mohajer
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vancomycin ,pregnancy ,therapeutic drug monitoring ,population pharmacokinetic (PK) model ,obsterics ,antibiotics ,Therapeutics. Pharmacology ,RM1-950 - Abstract
Objective: Vancomycin is a glycopeptide antibacterial indicated for serious gram-positive infections. Pharmacokinetics (PK) of vancomycin have not been described in pregnant women. This study aims to characterize the PK disposition of vancomycin in pregnant women based on data acquired from a database of routine hospital care for therapeutic drug monitoring to better inform dosing decisions.Methods: In this study, plasma drug concentration data from 34 pregnant hospitalized women who were administered intravenous vancomycin was analyzed. A population pharmacokinetic (PPK) model was developed using non-linear mixed effects modeling. Model selection was based on statistical criterion, graphical analysis, and physiologic relevance. Using the final model AUC0-24 (PK efficacy index of vancomycin) was compared with non-pregnant population.Results: Vancomycin PK in pregnant women were best described by a two-compartment model with first-order elimination and the following parameters: clearance (inter individual variability) of 7.64 L/hr (32%), central volume of 67.35 L, inter-compartmental clearance of 9.06 L/h, and peripheral volume of 37.5 L in a typical patient with 175 ml/min creatinine clearance (CRCL) and 45 kg fat-free mass (FFM). The calculated geometric mean of AUC0-24 for the pregnant population was 223 ug.h/ ml and 226 ug.h/ ml for the non-pregnant population.Conclusion: Our analysis suggests that vancomycin PK in pregnant women is consistent with non-pregnant adults and the dosing regimens used for non-pregnant patients may also be applicable to pregnant patients.
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- 2022
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16. Association between universal face shield in a quaternary care center and reduction of SARS-COV2 infections among healthcare personnel and hospitalized patients
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Mayar Al Mohajer, Kristen M. Panthagani, Todd Lasco, Bradley Lembcke, and Vagish Hemmige
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Face shields ,PPE ,COVID-19 ,Occupational health ,Infectious and parasitic diseases ,RC109-216 - Abstract
We implemented universal face shield use for all healthcare personnel upon entry to facility in order to counter an increase in SARS-COV2 cases among healthcare personnel and hospitalized patients. There was a marked reduction of infections in both healthcare personnel and hospitalized patients between pre and post intervention. Our results support universal face shield use as part of a multifaceted approach in areas of high SARS-COV2 community transmission.
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- 2021
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17. Impact of a division-wide bundle on hospitalacquired Clostridioides difficile cases, antibiotic days of therapy, testing appropriateness, and associated financial costs
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Elizabeth Wenqian Wang, Ashlee Weekley, Jennifer McCarty, Hoonmo Koo, Bradley Lembcke, and Mayar Al Mohajer
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c. difficile ,cost ,diagnostic stewardship ,dot ,testing ,Medicine - Abstract
Introduction: Updated international guidelines recommend the use of a two-step algorithm (glutamate dehydrogenase [GDH] or nucleic-acid amplification test [NAAT] plus toxin) rather than NAAT alone for the diagnosis of Clostridioides difficile (formerly Clostridium difficile) infections. The goal of our project was to evaluate the impact of a new bundle on the rate of hospital-acquired C. difficile infections (CDIs), hospital-acquired CDI standardized infection ratio (SIR), antibiotic days of therapy (DOT), and financial cost. Materials and Methods: The new bundle was implemented in April 2018. This bundle was implemented across five hospitals in Catholic Health Initiatives (CHI) Texas Division. The bundle included a switch from NAAT to a two-step process (GDH and toxin). We placed the new test in an order panel which included enteric isolation and required indications for C. difficile testing. We used quarterly data pre- and post-intervention to calculate SIR and DOT. Results: In the pre-intervention period, 15.5% of the total 3513 C. difficile NAAT was positive. In the post-intervention period, 5.7% of a total of 2845 GDH and toxin assays was positive for both GDH and toxin (P < 0.0001). SIR, which adjusts for denominator and change in testing methodology, also dropped from 1.02 to 0.43. The estimated cost associated with positive C. difficile cases dropped from 1,932,150 USD to 1,113,800 USD with an estimated yearly cost saving of 794,150 USD. Compliance with enteric isolation improved from 73.1% to 92.5% (P = 0.008). Conclusion: The new testing bundle led to a marked reduction in hospital-acquired CDI and unnecessary treatment, reduction in C. difficile testing, an increase in compliance with enteric isolation, and significant cost savings.
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- 2021
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18. Overprescription of antibiotics in patients with community-acquired pneumonia in the intensive care unit
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Rorak Hooten, Jose Luis Marquez, Kady Goldlist, Rafael Urcis, Matthew Adams, Kathryn Matthias, David Nix, and Mayar Al Mohajer
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antimicrobials ,incentive care unit ,outcomes ,overuse ,respiratory infection ,Medicine - Abstract
Purpose: We aimed to assess factors associated with therapy failure in patients with community-acquired pneumonia in the intensive care unit (ICU). Methods: Electronic charts of patients with International Classification of Diseases, Ninth Revision, codes of pneumonia who were admitted to the ICU at a tertiary academic medical center in Southern Arizona were reviewed. Results: Antipseudomonal coverage and anti-methicillin-resistant Staphylococcus aureus (MRSA) coverage were often prescribed (58.4% and 54.1%, respectively). Antipseudomonal coverage was rarely necessary as pseudomonal pneumonia was found in only one case (0.9%). Antipseudomonal and anti-MRSA coverage was not associated with improved outcomes. Conclusion: Overprescription of antibiotics in this population remains a significant problem. More work is needed to further limit unnecessary antibiotic use.
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- 2019
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19. Successful Detection of Unrecognized Rickettsia typhi in Pregnancy Using Cell-Free Next-Generation Sequencing
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Irene A. Stafford, Fernando H. Centeno, Mayar Al Mohajer, George Parkerson, Laila Woc-Colburn, Angelica Janice Burgos-Lee, Martha Rac, James Dunn, and Kenneth Muldrew
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Gynecology and obstetrics ,RG1-991 - Abstract
Flea-borne (murine) typhus is caused by Rickettsia typhi. Infection in pregnant women can lead to adverse outcomes when diagnosis and treatment is delayed. We describe how next-generation sequencing (NGS) using the Karius® test was used to rapidly diagnose murine typhus in two pregnant women admitted to a large tertiary care center in Houston, Texas, when all initial testing was nondiagnostic.
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- 2020
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20. Significance of bacteriuria in patients with end-stage renal disease on hemodialysis
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Ibrahim Taweel, Norman Beatty, Alexsis Duarte, David Nix, Kathryn Matthias, and Mayar Al Mohajer
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dialysis ,stewardship ,urinary tract infection ,urine ,Medicine - Abstract
The significance of bacteriuria in patients with end-stage renal disease (ESRD) on hemodialysis (HD) is unclear. It is not known whether treatment of asymptomatic bacteriuria is associated with lower rates of urinary tract infection or readmission. Adult patients with ESRD on HD were retrospectively evaluated to assess factors associated with the recurrence of bacteriuria and readmission. We included 68 patients in the analysis. There were 20 patients (29.4%) with urinary symptoms. All symptomatic patients received antibiotic therapy, whereas half of the asymptomatic patients received antibiotics. Antibiotic use was not associated with lower rates of readmission or the recurrence of bacteriuria.
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- 2018
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21. A Community-Based Management of COVID-19 in a Mobile Container Unit
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Elena Petrova, Timothy Farinholt, Tejas P. Joshi, Hannah Moreno, Mayar Al Mohajer, Shital M. Patel, Joseph Petrosino, and Sharmila Anandasabapathy
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mobile clinic ,relocatable medical facility ,underserved community ,coronavirus ,vaccination ,infection control ,Medicine - Abstract
Vaccine uptake is a multifactor measure of successful immunization outcomes that includes access to healthcare and vaccine hesitancy for both healthcare workers and communities. The present coronavirus disease (COVID-19) pandemic has highlighted the need for novel strategies to expand vaccine coverage in underserved regions. Mobile clinics hold the promise of ameliorating such inequities, although there is a paucity of studies that validate environmental infection in such facilities. Here, we describe community-based management of COVID-19 through a Smart Pod mobile clinic deployed in an underserved community area in the United States (Aldine, Harris County, TX, USA). In particular, we validate infection control and biological decontamination of the Smart Pod by testing surfaces and the air-filtration system for the COVID-19 virus and bacterial pathogens. We show the Smart Pod to be efficacious in providing a safe clinical environment for vaccine delivery. Moreover, in the Smart Pod, up-to-date education of community healthcare workers was provided to reduce vaccine hesitancy and improve COVID-19 vaccine uptake. The proposed solution has the potential to augment existing hospital capacity and combat the COVID-19 pandemic locally and globally.
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- 2021
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22. SHEA statement on antibiotic stewardship in hospitals during public health emergencies
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Tamar F. Barlam, Mayar Al Mohajer, Jaffar A. Al-Tawfiq, Antonie J. Auguste, Cheston B. Cunha, Graeme N. Forrest, Alan E. Gross, Rachael A. Lee, Susan K. Seo, Kathryn N. Suh, Stacy Volk, and Joshua K. Schaffzin
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Microbiology (medical) ,Antimicrobial Stewardship ,Infectious Diseases ,Epidemiology ,Humans ,Public Health ,Emergencies ,Hospitals ,Anti-Bacterial Agents - Published
- 2022
23. Coccidioidal meningitis complicated by central nervous system vasculitis in a patient with leukemia
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Dany Tager, Anne Hatch, Jennifer Segar, Brentin Roller, Mayar Al Mohajer, and Tirdad T. Zangeneh
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Coccidioidal meningitis ,Fungal meningitis ,Steroid ,Cerebral vasculitis ,Disseminated coccidioidomycosis ,Medicine (General) ,R5-920 ,Biology (General) ,QH301-705.5 - Abstract
Central Nervous System (CNS) vasculitis is the most common life-threatening complication of coccidioidal meningitis. It is manifested by cerebral ischemia, hemorrhage, and infarction. We report a case of CNS vasculitis in a patient receiving chemotherapy and review of the literature on coccidioidal meningitis. The patient was treated with combination antifungal therapy and a short course of high dose corticosteroids with a modest improvement in her neurological examination after initiation of steroids.
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- 2017
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24. Clinical failure with and without empiric atypical bacteria coverage in hospitalized adults with community-acquired pneumonia: a systematic review and meta-analysis
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Khalid Eljaaly, Samah Alshehri, Ahmed Aljabri, Ivo Abraham, Mayar Al Mohajer, Andre C. Kalil, and David E. Nix
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Community-acquired pneumonia ,Antibiotics ,Atypical ,Macrolides ,Fluoroquinolones ,Infectious and parasitic diseases ,RC109-216 - Abstract
Abstract Background Both typical and atypical bacteria can cause community-acquired pneumonia (CAP); however, the need for empiric atypical coverage remains controversial. Our objective was to evaluate the impact of antibiotic regimens with atypical coverage (a fluoroquinolone or combination of a macrolide/doxycycline with a β-lactam) to a regimen without atypical antibiotic coverage (β-lactam monotherapy) on rates of clinical failure (primary endpoint), mortality, bacteriologic failure, and adverse events, (secondary endpoints). Methods We searched the PubMed, EMBASE and Cochrane Library databases for relevant RCTs of hospitalized CAP adults. We estimated risk ratios (RRs) with 95% confidence intervals (CIs) using a fixed-effect model, but used a random-effects model if significant heterogeneity (I 2 ) was observed. Results Five RCTs with a total of 2011 patients were retained. A statistically significant lower clinical failure rate was observed with empiric atypical coverage (RR, 0.851 [95% CI, 0.732–0.99; P = 0.037]; I 2 = 0%). The secondary outcomes did not differ between the two study groups: mortality (RR = 0.549 [95% CI, 0.259–1.165, P = 0.118], I 2 = 61.434%) bacteriologic failure (RR = 0.816 [95% CI, 0.523–1.272, P = 0.369], I 2 = 0%), diarrhea (RR = 0.746 [95% CI, 0.311–1.790, P = 0.512], I 2 = 65.048%), and adverse events requiring antibiotic discontinuation (RR = 0.83 [95% CI, 0.542–1.270, P = 0.39], I 2 = 0%). Conclusions Empiric atypical coverage was associated with a significant reduction in clinical failure in hospitalized adults with CAP. Reduction in mortality, bacterial failure, diarrhea, and discontinuation due to adverse effects were not significantly different between groups, but all estimates favored atypical coverage. Our findings provide support for the current guidelines recommendations to include empiric atypical coverage.
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- 2017
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25. Knowledge, attitude, and practices associated with the diagnosis and management of skin and soft-tissue infections among medical students, residents, and attending physicians
- Author
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Norman Beatty, Jessica Anthony August, Joe Saenz, David E Nix, Kathryn R Matthias, and Mayar Al Mohajer
- Subjects
assessment ,cellulitis ,education ,guidelines ,survey ,Medicine - Abstract
Skin and soft-tissue infections (SSTIs) are commonly encountered by medical students, residents, and trainees. The Infectious Diseases Society of America (IDSA) has updated its recommendations regarding SSTI diagnosis and management in June 2014. We assessed knowledge, attitude, and practices toward diagnosis and management of SSTIs using an online survey. We disseminated the survey to medical students, residents, and attending physicians practicing in family and internal medicine department at a university-based hospital. A total of 103 surveys were completed out of 121 sent (85.1%) between July 2015 and March 2016. There were nine medical questions in the survey. The mean of correct answers was 4.5/9 ± 2.0. Medical knowledge correlated with the level of education (P < 0.001) but not with subspecialty (P = 0.97). Around 35% were familiar with the updated IDSA guidelines pertaining to SSTIs. The majority (85%) responded that the hospital staff would benefit from additional training and 75% agreed that more antibiotic stewardship education is needed. Our study shows that there are significant opportunities for development among students and physicians who encounter SSTIs.
- Published
- 2018
- Full Text
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26. The Impact of Initial Specimen Diversion Systems on Blood Culture Contamination
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Mayar Al Mohajer and Todd Lasco
- Subjects
Infectious Diseases ,Oncology - Abstract
Blood culture contamination is associated with increased antimicrobial use, length of stay, and hospital cost. To address this problem, blood culture diversion has been developed as an additional measure to reduce contamination to targeted goals. Three different versions were proposed, including an open technique and 2 commercially available devices. This study aims to review the existing literature and analyze evidence for these 3 techniques.
- Published
- 2023
27. 329. Bedside Inoculation of Blood Culture Bottles Does Not Improve Ascites Culture Positivity Rate in Spontaneous Bacterial Peritonitis
- Author
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Tyler Brehm, Mayar Al Mohajer, and Todd M Lasco
- Subjects
Infectious Diseases ,Oncology - Abstract
Background Prior research demonstrates increased positivity rate for ascites cultures in spontaneous bacterial peritonitis (SBP) when directly inoculated into blood culture bottles at bedside, versus the “conventional method” - transportation of ascitic fluid in a sealed syringe to the laboratory, centrifuging, and plating on Chocolate, Blood, and MacConkey’s agars and in a Schaedler broth. We hypothesized that collection of ascites via direct inoculation into blood culture bottles would improve ascites culture positivity rate in SBP when compared to prior methods. Methods In November of 2021, our institution implemented a policy in which all ascites cultures were directly inoculated into blood culture bottles at bedside. We retrospectively reviewed all ascites cultures collected from May of 2021 through April of 2022, including all cultures with an absolute neutrophil count of greater than 250 cells/mm3. We excluded all samples from patients with secondary bacterial peritonitis and all samples collected in November. If a patient had multiple samples that met inclusion criteria, only the first was included for analysis. Our primary outcome was positivity rate of cultures pre- and post-implementation of this new policy. Results 1375 ascites cultures were collected. Of these, 52 met our inclusion criteria. These patients were on average 58 years old (range 33-74), 50% female, with a median MELD of 25.5 (range 8-40). The conventional method was positive in 7/37 (18.9%) cultures, and direct inoculation of blood cultures in 1/15 (6.67%), p = .27. Conclusion As opposed to the previous literature, we detected no difference in positivity rate between the conventional method of ascites culture compared to direct inoculation of blood cultures at the bedside. This difference from prior literature may be due to differences in time to inoculation, our smaller sample size, or overfilling of the bottles during inoculation. Disclosures All Authors: No reported disclosures.
- Published
- 2022
28. 185. Implementation of Multiplex Polymerase Chain Reaction in Clinical Practice: Impact on Antimicrobial Management In Infectious Diarrhea
- Author
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Gillean Kelly, Roumen Iordanov, Alex Franklin, Amna Ahmed, Krithia Srinivasan, Jesica Hayon, Todd M Lasco, Rosie Amini, Sabra Shay, Prathit A Kulkarni, and Mayar Al Mohajer
- Subjects
Infectious Diseases ,Oncology - Abstract
Background Stool culture and stool polymerase chain reaction (PCR) panels are both used to evaluate patients with suspected infectious diarrhea. Stool PCR panels are especially advantageous because of their ability to detect a broad array of infectious pathogens in less than one hour. Our study assessed how the use of stool PCR panels instead of stool culture impacted antibiotic days of therapy (DOT) and length of therapy (LOT) in hospitalized patients with suspected infectious diarrhea. Methods In December 2021, an intervention was implemented in our hospital in which all electronic orders for stool cultures were automatically switched to stool PCR testing. The pre-intervention group was comprised of 75 hospitalized adult patients who had a stool culture obtained from September to November 2021. The post-intervention group was comprised of 81 adult patients who had a stool PCR obtained from December 2021 to February 2022. The DOT and LOT for antibiotics prescribed specifically for infectious diarrhea were determined for each patient; DOT and LOT were compared between the pre- and post- intervention groups. Results The median DOT in the pre- and post-intervention groups was 0 with a range of 0-10 and 0-8, respectively. The median LOT in the pre- and post-intervention groups was 0 (range 0-5 for both groups). No significant difference in the median DOT (Wilcoxon rank sum test, p-value = 0.967) or LOT (Wilcoxon rank sum test, p-value = 0.993) was found between the pre- and post-intervention groups (Figure 1). After adjusting for patient days present, no significant change in DOT or LOT incidence rate was found between the pre- and post-intervention groups. The DOT incidence rate ratio (RR) was 0.71 (95% CI 0.42, 1.22), and the LOT incidence RR was 0.67 (95% CI 0.36, 1.24). Figure 1.DOT and LOT Comparisons between Pre- and Post-Intervention Groups Antibiotic days of therapy (DOT) stratified by study period (top) and antibiotic (LOT) stratified by study period (bottom). Conclusion An intervention of automatically changing stool culture testing to stool PCR testing did not result in a significant change in median DOT or LOT in hospitalized adult patients, nor did it result in a significant change in DOT or LOT incidence rate. These findings could be explained by an insufficient sample size (n = 156), limiting the study’s power. Additionally, most patients in the pre-intervention group received no antibiotics for infectious diarrhea, resulting in a short DOT and LOT at baseline. Disclosures Sabra Shay, BSN, MPH, Premier Inc.: Employee Prathit A. Kulkarni, M.D., Vessel Health, Inc.: Grant/Research Support.
- Published
- 2022
29. Implementing Immediate Hospital-Wide Personal Protective Equipment Training and Validation
- Author
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Melissa D, Rouse, Megan, Fischer, Danielle, Jordan, Josefa, Britt, Takei, Pipkins, Debora, Bundage, Jeannine, Bordelon, and Mayar, Al Mohajer
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Leadership and Management ,Review and Exam Preparation ,Humans ,Fundamentals and skills ,Interdisciplinary Studies ,Quality Improvement ,Personal Protective Equipment ,Hospitals ,Education - Published
- 2022
30. Developing an Interprofessional Health Care Improvement Portfolio: Results From a Consensus Panel Process
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Kyler M. Godwin, Molly J. Horstman, Aanand D. Naik, Samantha Chao, Mary A. Dolansky, and Mayar Al Mohajer
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Medical education ,Consensus ,Quality management ,business.industry ,media_common.quotation_subject ,education ,Documentation ,General Medicine ,Certification ,Quality Improvement ,Coaching ,Education ,Likert scale ,law.invention ,law ,Excellence ,Health care ,CLARITY ,Humans ,Portfolio ,Fellowships and Scholarships ,Psychology ,business ,Delivery of Health Care ,media_common - Abstract
The increased focus on professional-led, continuous health care improvement has not produced formalized processes for identifying, recognizing, and rewarding excellence in quality improvement. Moreover, the team-based nature of improvement requires a mechanism to document interprofessional contributions. In 2018, the authors created a health care improvement portfolio to document and demonstrate individual impact for the purpose of promotion. A draft portfolio was developed from a review of the literature and publicly available quality improvement and educational portfolios. The portfolio was further refined through a 2-round, modified Delphi consensus process with a panel of interprofessional experts across North America. In the first round, 35 panelists gave feedback through open-ended comments on the design and content of the portfolio. In the second round, 34 panelists rated the comprehensiveness and clarity of the portfolio on a Likert scale of 1-9 (1 = lowest, 9 = highest) and provided comments. Consensus was defined as an average score over 8.0. Panelists in the second round achieved consensus, with average scores of 8.4 in comprehensiveness and 8.3 in clarity (range 6-9). The finalized portfolio includes the following sections: personal statement; health care improvement training and certification; leadership and administrative roles; health care improvement project activities; health care improvement coaching, teaching, and curricular activities; health care improvement honors, awards, and recognitions; and supporting documents. The portfolio facilitates the documentation of health care professionals' contributions to and impact in health care improvement and covers the breath of interprofessional health care improvement (i.e., projects, leadership, education, scholarship). The portfolio can be tailored to an individual's area of specific expertise. While this portfolio was originally developed for interprofessional faculty at academic institutions, the content and structure of the portfolio is easily adapted for health care providers in other health care settings.
- Published
- 2021
31. Rare Diagnostic and Clinical Manifestations in an Acute Hepatitis A Infection: A Case Report
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Wesley D Figg, David L Crawford, Tristen N Taylor, and Mayar Al Mohajer
- Subjects
General Engineering - Published
- 2022
32. Invasive Mucormycosis Induced Pneumopericardium: A Rare Cause of Pneumopericardium in an Immunocompromised Patient
- Author
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Sana Khan, Muhammad Waqar Elahi, Waqas Ullah, Hafez Mohammad Ammar Abdullah, Ejaz Ahmad, Mayar Al Mohajer, and Aneela Majeed
- Subjects
Infectious and parasitic diseases ,RC109-216 - Abstract
Mucor and Rhizopus cause life-threatening infections primarily involving the lungs and sinuses, which disseminate very rapidly by necrosis and infarction of the contiguous tissues. We present a case of a 64-year-old African American posttransplant patient who presented with a productive cough and weight loss. He had a past surgical history of renal transplant for renal cell carcinoma and was on dual immunosuppressive therapy, that is, mycophenolate and tacrolimus. During his hospital stay, he developed a pneumopericardium due to the direct extension of a lung lesion. The diagnosis was made by radiological imaging and PCR result which was consistent with Mucor species. He was treated with antifungal therapy. The purpose of this report is to highlight the unusual association of mucormycosis with pneumopericardium.
- Published
- 2017
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33. Association between universal face shield in a quaternary care center and reduction of SARS-COV2 infections among healthcare personnel and hospitalized patients
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Kristen M. Panthagani, Vagish Hemmige, Bradley Lembcke, Mayar Al Mohajer, and Todd Lasco
- Subjects
0301 basic medicine ,Microbiology (medical) ,Face shield ,2019-20 coronavirus outbreak ,business.product_category ,Hospitalized patients ,Health Personnel ,Iatrogenic Disease ,030106 microbiology ,Infectious and parasitic diseases ,RC109-216 ,Article ,Occupational safety and health ,03 medical and health sciences ,COVID-19 Testing ,0302 clinical medicine ,Intervention (counseling) ,Health care ,Humans ,Medicine ,030212 general & internal medicine ,Personal Protective Equipment ,Pre and post ,Inpatients ,Occupational health ,SARS-CoV-2 ,business.industry ,Face shields ,Masks ,COVID-19 ,Interrupted Time Series Analysis ,Care center ,General Medicine ,medicine.disease ,Texas ,Infectious Diseases ,PPE ,Medical emergency ,business - Abstract
We implemented universal face shield for all healthcare personnel upon entry to facility in order to counter an increase in SARS-COV2 cases among healthcare personnel and hospitalized patients. There was a marked reduction of infections in both healthcare personnel and hospitalized patients between pre and post interventions. Our results support the universal face shield use as a part of multifaceted approach in areas of high SARS-COV2 community transmission.
- Published
- 2021
34. Impact of a division-wide bundle on hospital-acquired Clostridioides difficile cases, antibiotic days of therapy, testing appropriateness, and associated financial costs
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Elizabeth Wenqian Wang, Ashlee Weekley, Bradley Lembcke, Jennifer McCarty, Hoonmo Koo, and Mayar Al Mohajer
- Subjects
Financial costs ,medicine.medical_specialty ,medicine.drug_class ,business.industry ,DOT ,Antibiotics ,030204 cardiovascular system & hematology ,Clostridium difficile ,C difficile ,testing ,Cost savings ,03 medical and health sciences ,0302 clinical medicine ,Bundle ,Internal medicine ,cost ,medicine ,diagnostic stewardship ,Medicine ,Original Article ,030212 general & internal medicine ,C. difficile ,business ,Clostridioides - Abstract
Introduction: Updated international guidelines recommend the use of a two-step algorithm (glutamate dehydrogenase [GDH] or nucleic-acid amplification test [NAAT] plus toxin) rather than NAAT alone for the diagnosis of Clostridioides difficile (formerly Clostridium difficile) infections. The goal of our project was to evaluate the impact of a new bundle on the rate of hospital-acquired C. difficile infections (CDIs), hospital-acquired CDI standardized infection ratio (SIR), antibiotic days of therapy (DOT), and financial cost. Materials and Methods: The new bundle was implemented in April 2018. This bundle was implemented across five hospitals in Catholic Health Initiatives (CHI) Texas Division. The bundle included a switch from NAAT to a two-step process (GDH and toxin). We placed the new test in an order panel which included enteric isolation and required indications for C. difficile testing. We used quarterly data pre- and post-intervention to calculate SIR and DOT. Results: In the pre-intervention period, 15.5% of the total 3513 C. difficile NAAT was positive. In the post-intervention period, 5.7% of a total of 2845 GDH and toxin assays was positive for both GDH and toxin (P < 0.0001). SIR, which adjusts for denominator and change in testing methodology, also dropped from 1.02 to 0.43. The estimated cost associated with positive C. difficile cases dropped from 1,932,150 USD to 1,113,800 USD with an estimated yearly cost saving of 794,150 USD. Compliance with enteric isolation improved from 73.1% to 92.5% (P = 0.008). Conclusion: The new testing bundle led to a marked reduction in hospital-acquired CDI and unnecessary treatment, reduction in C. difficile testing, an increase in compliance with enteric isolation, and significant cost savings.
- Published
- 2021
35. Polymicrobial Pituitary Abscess Predominately Involving Escherichia coli in the Setting of an Apoplectic Pituitary Prolactinoma
- Author
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Norman Beatty, Luis Medina-Garcia, Mayar Al Mohajer, and Tirdad T. Zangeneh
- Subjects
Infectious and parasitic diseases ,RC109-216 - Abstract
Pituitary abscess is a rare intracranial infection that can be life-threatening if not appropriately diagnosed and treated upon presentation. The most common presenting symptoms include headache, anterior pituitary hypofunction, and visual field disturbances. Brain imaging with either computed tomography or magnetic resonance imaging usually reveals intra- or suprasellar lesion(s). Diagnosis is typically confirmed intra- or postoperatively when pathological analysis is done. Clinicians should immediately start empiric antibiotics and request a neurosurgical consult when pituitary abscess is suspected. Escherichia coli (E. coli) causing intracranial infections are not well understood and are uncommon in adults. We present an interesting case of an immunocompetent male with a history of hypogonadism presenting with worsening headache and acute right eye vision loss. He was found to have a polymicrobial pituitary abscess predominantly involving E. coli in addition to Actinomyces odontolyticus and Prevotella melaninogenica in the setting of an apoplectic pituitary prolactinoma. The definitive etiology of this infection was not determined but an odontogenic process was suspected. A chronic third molar eruption and impaction in close proximity to the pituitary gland likely led to contiguous spread of opportunistic oral microorganisms allowing for a polymicrobial pituitary abscess formation.
- Published
- 2016
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36. A Community-Based Management of COVID-19 in a Mobile Container Unit
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Shital M. Patel, Timothy Farinholt, Mayar Al Mohajer, Joseph F. Petrosino, Sharmila Anandasabapathy, Hannah Moreno, Tejas P Joshi, and Elena Petrova
- Subjects
relocatable medical facility ,Coronavirus disease 2019 (COVID-19) ,Immunology ,coronavirus ,Article ,Unit (housing) ,underserved community ,Drug Discovery ,Health care ,Pandemic ,medicine ,Infection control ,Pharmacology (medical) ,Pharmacology ,business.industry ,Community-based management ,decontamination ,medicine.disease ,vaccination ,infection control ,Vaccination ,Infectious Diseases ,Mobile clinic ,mobile clinic ,Medicine ,Business ,Medical emergency - Abstract
Vaccine uptake is a multifactor measure of successful immunization outcomes that includes access to healthcare and vaccine hesitancy for both healthcare workers and communities. The present coronavirus disease (COVID-19) pandemic has highlighted the need for novel strategies to expand vaccine coverage in underserved regions. Mobile clinics hold the promise of ameliorating such inequities, although there is a paucity of studies that validate environmental infection in such facilities. Here, we describe community-based management of COVID-19 through a Smart Pod mobile clinic deployed in an underserved community area in the United States (Aldine, Harris County, TX, USA). In particular, we validate infection control and biological decontamination of the Smart Pod by testing surfaces and the air-filtration system for the COVID-19 virus and bacterial pathogens. We show the Smart Pod to be efficacious in providing a safe clinical environment for vaccine delivery. Moreover, in the Smart Pod, up-to-date education of community healthcare workers was provided to reduce vaccine hesitancy and improve COVID-19 vaccine uptake. The proposed solution has the potential to augment existing hospital capacity and combat the COVID-19 pandemic locally and globally.
- Published
- 2021
37. Clinical prediction of bacteremia and early antibiotics therapy in patients with solid tumors
- Author
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Jonathan M. Hyak, Daniel M. Musher, Mayar Al Mohajer, and Benjamin L. Musher
- Subjects
Microbiology (medical) ,Tachycardia ,Adult ,medicine.medical_specialty ,Epidemiology ,medicine.drug_class ,Population ,Antibiotics ,Bacteremia ,Organ transplantation ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Neoplasms ,medicine ,Humans ,030212 general & internal medicine ,education ,Retrospective Studies ,education.field_of_study ,business.industry ,Retrospective cohort study ,Emergency department ,medicine.disease ,Systemic Inflammatory Response Syndrome ,Anti-Bacterial Agents ,Systemic inflammatory response syndrome ,Infectious Diseases ,Blood Culture ,030220 oncology & carcinogenesis ,medicine.symptom ,business - Abstract
Objective:To investigate the relationship between the systemic inflammatory response syndrome (SIRS), early antibiotic use, and bacteremia in solid-tumor patients.Design, setting, and participants:We conducted a retrospective observational study of adults with solid tumors admitted to a tertiary-care hospital through the emergency department over a 2-year period. Patients with neutropenic fever, organ transplant, trauma, or cardiopulmonary arrest were excluded.Methods:Rates of SIRS, bacteremia, and early antibiotics (initiation within 8 hours of presentation) were compared using the χ2 and Student t tests. Binomial regression and receiver operator curves were analyzed to assess predictors of bacteremia and early antibiotics.Results:Early antibiotics were administered in 507 (37%) of 1,344 SIRS-positive cases and 492 (22%) of 2,236 SIRS-negative cases (P < .0001). Of SIRS-positive cases, 70% had blood cultures drawn within 48 hours and 19% were positive; among SIRS negative cases, 35% had cultures and 13% were positive (19% vs 13%; P = .003). Bacteremic cases were more often SIRS positive than nonbacteremic cases (60% vs 50%; P =.003), but they received early antibiotics at similar rates (50% vs 49%, P = .72). Three SIRS components predicted early antibiotics: temperature (OR, 1.7; 95% CI, 1.31–2.29; P = .0001), tachycardia (OR, 1.4; 95% CI, 1.10–1.69; P < .0001), and white blood-cell count (OR, 1.8; 95% CI, 1.56–2.14; P < .0001). Only temperature (OR, 1.6; 95% CI, 1.09–2.41; P = .01) and tachycardia (OR, 1.5; 95% CI, 1.09–2.06; P = .01) predicted bacteremia. SIRS criteria as a composite were poorly predictive of bacteremia (AUC, 0.57).Conclusions:SIRS criteria are frequently used to determine the need for early antibiotics, but they are poor predictors of bacteremia in solid-tumor patients. More reliable models are needed to guide judicious use of antibiotics in this population.
- Published
- 2021
38. Does antimicrobial coating and impregnation of urinary catheters prevent catheter-associated urinary tract infection? A review of clinical and preclinical studies
- Author
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Ahmad Iftikhar, Hamza Hassan, Mayar Al Mohajer, Rabih O. Darouiche, Aneela Majeed, Azka Latif, and Fnu Sagar
- Subjects
medicine.medical_specialty ,Silver ,medicine.drug_class ,Antimicrobial peptides ,Antibiotics ,Biomedical Engineering ,Urinary Catheters ,030204 cardiovascular system & hematology ,Cochrane Library ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Antibiotic resistance ,Anti-Infective Agents ,Coated Materials, Biocompatible ,Randomized controlled trial ,law ,Animals ,Humans ,Medicine ,Intensive care medicine ,business.industry ,Chlorhexidine ,General Medicine ,Antimicrobial ,Catheter ,Catheter-Related Infections ,Urinary Tract Infections ,Surgery ,business ,030217 neurology & neurosurgery ,medicine.drug - Abstract
Introduction: Catheter-associated urinary tract infection (CAUTI) is one of the most common nosocomial infections in hospitals, accounting for 36% of all health care-associated infections. Areas covered: We aimed to address the potential impact of antimicrobial coating of catheter materials for the prevention of CAUTI and to analyze the progress made in this field. We conducted literature searches in the PubMed, Embase, and Cochrane Library databases, and found 578 articles. Data from 60 articles in either the preclinical or clinical stage were analyzed in this expert review. Expert opinion: The literature review revealed many promising methods for preventing CAUTI. Recent studies have suggested the combination of silver-based products and antibiotics, owing to their synergistic effect, to help address the problem of antibiotic resistance. Other coating materials that have been tested include nitric oxide, chlorhexidine, antimicrobial peptides, enzymes, and bacteriophages. Because of heterogeneity among studies, it is difficult to reliably comment on the clinical efficacy of different coating materials. Future research should focus on double-blind randomized clinical trials for evaluating the role of these potential coating agents.
- Published
- 2019
39. Role of Inflammatory Markers in Diagnosing Diabetic Foot Infection
- Author
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Mustafa Nadeem Malik, Aneela Majeed, Mayar Al Mohajer, Umar Zahid, Ahmad Iftikhar, Adeela Mushtaq, and Faryal Razzaq
- Subjects
Microbiology (medical) ,medicine.medical_specialty ,Infectious Diseases ,business.industry ,Internal medicine ,Meta-analysis ,medicine ,medicine.disease ,business ,Diabetic foot - Published
- 2019
40. Hurricane-Associated Mold Exposures Among Patients at Risk for Invasive Mold Infections After Hurricane Harvey — Houston, Texas, 2017
- Author
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Bhavini Patel Murthy, Enock Anassi, Karlyn D. Beer, Lauren M. Leining, Jennifer A. Shuford, Kimberly A Skrobarcek, Jennifer McCarty, Jonathan Strysko, Audrey F. Pennington, Juliana Almeida da Silva, Dimitrios P. Kontoyiannis, Mayar Al Mohajer, Brendan R Jackson, Nancy A. Chow, Mitsuru Toda, Bobbiejean Garcia, Ju-Hyeong Park, Joann Schulte, Luis Ostrosky-Zeichner, Jean M. Cox-Ganser, Robert L. Atmar, Tom Chiller, Ginger L. Chew, and Samantha Solomon
- Subjects
Health (social science) ,Epidemiology ,Health, Toxicology and Mutagenesis ,01 natural sciences ,Risk Assessment ,Disasters ,03 medical and health sciences ,Immunocompromised Host ,0302 clinical medicine ,Health Information Management ,Environmental health ,Health care ,Medicine ,Humans ,030212 general & internal medicine ,Full Report ,0101 mathematics ,Personal protective equipment ,business.industry ,Cyclonic Storms ,010102 general mathematics ,technology, industry, and agriculture ,Fungi ,General Medicine ,Environmental exposure ,Environmental Exposure ,Texas ,humanities ,business ,Risk assessment ,Invasive Fungal Infections - Abstract
In August 2017, Hurricane Harvey caused unprecedented flooding and devastation to the Houston metropolitan area (1). Mold exposure was a serious concern because investigations after Hurricanes Katrina and Rita (2005) had documented extensive mold growth in flood-damaged homes (2,3). Because mold exposure can cause serious illnesses known as invasive mold infections (4,5), and immunosuppressed persons are at high risk for these infections (6,7), several federal agencies recommend that immunosuppressed persons avoid mold-contaminated sites (8,9). To assess the extent of exposure to mold and flood-damaged areas among persons at high risk for invasive mold infections after Hurricane Harvey, CDC and Texas health officials conducted a survey among 103 immunosuppressed residents in Houston. Approximately half of the participants (50) engaged in cleanup of mold and water-damaged areas; these activities included heavy cleanup (23), such as removing furniture or removing drywall, or light cleanup (27), such as wiping down walls or retrieving personal items. Among immunosuppressed persons who performed heavy cleanup, 43% reported wearing a respirator, as did 8% who performed light cleanup. One participant reported wearing all personal protective equipment (PPE) recommended for otherwise healthy persons (i.e., respirator, boots, goggles, and gloves). Immunosuppressed residents who are at high risk for invasive mold infections were exposed to mold and flood-damaged areas after Hurricane Harvey; recommendations from health care providers to avoid exposure to mold and flood-damaged areas could mitigate the risk to immunosuppressed persons.
- Published
- 2019
41. Utility of Whole-Genome Next-Generation Sequencing of Plasma in Identifying Opportunistic Infections in HIV/AIDS
- Author
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Yang Zhou, David K. Hong, Kenneth L. Muldrew, Vagish Hemmige, Sudeb C. Dalai, and Mayar Al Mohajer
- Subjects
0301 basic medicine ,biology ,business.industry ,Public Health, Environmental and Occupational Health ,Toxoplasma gondii ,Cryptosporidium ,medicine.disease ,biology.organism_classification ,Virology ,Genome ,Toxoplasmosis ,DNA sequencing ,Mycobacterium tuberculosis ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,Infectious Diseases ,Acquired immunodeficiency syndrome (AIDS) ,Cell-free fetal DNA ,medicine ,business ,030217 neurology & neurosurgery - Abstract
Background:AIDS-associated Opportunistic Infections (OIs) have significant morbidity and mortality and can be diagnostically challenging, requiring invasive procedures as well as a combination of culture and targeted molecular approaches.Objective:We aimed to demonstrate the clinical utility of Next-generation Sequencing (NGS) in pathogen identification; NGS is a maturing technology enabling the detection of miniscule amounts of cell-free microbial DNA from the bloodstream.Methods:We utilized a novel Next-generation Sequencing (NGS) test on plasma samples to diagnose a series of HIV-associated OIs that were diagnostically confirmed through conventional microbial testing.Results:In all cases, NGS test results were available sooner than conventional testing. This is the first case series demonstrating the utility of whole-genome NGS testing to identify OIs from plasma in HIV/AIDS patients.Conclusion:NGS approaches present a clinically-actionable, comprehensive means of diagnosing OIs and other systemic infections while avoiding the labor, expense, and delays of multiple tests and invasive procedures.
- Published
- 2019
42. Overprescription of antibiotics in patients with community-acquired pneumonia in the intensive care unit
- Author
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Jose Marquez, Rafael Urcis, Mayar Al Mohajer, Rorak Hooten, Kady Goldlist, David E. Nix, Matthew Adams, and Kathryn R. Matthias
- Subjects
medicine.medical_specialty ,medicine.drug_class ,Antibiotics ,Population ,outcomes ,overuse ,law.invention ,Community-acquired pneumonia ,law ,respiratory infection ,medicine ,In patient ,Intensive care medicine ,education ,education.field_of_study ,business.industry ,Antimicrobials ,Brief Report ,Respiratory infection ,medicine.disease ,Intensive care unit ,Pneumonia ,incentive care unit ,Pseudomonal pneumonia ,Medicine ,business - Abstract
Purpose: We aimed to assess factors associated with therapy failure in patients with community-acquired pneumonia in the intensive care unit (ICU). Methods: Electronic charts of patients with International Classification of Diseases, Ninth Revision, codes of pneumonia who were admitted to the ICU at a tertiary academic medical center in Southern Arizona were reviewed. Results: Antipseudomonal coverage and anti-methicillin-resistant Staphylococcus aureus (MRSA) coverage were often prescribed (58.4% and 54.1%, respectively). Antipseudomonal coverage was rarely necessary as pseudomonal pneumonia was found in only one case (0.9%). Antipseudomonal and anti-MRSA coverage was not associated with improved outcomes. Conclusion: Overprescription of antibiotics in this population remains a significant problem. More work is needed to further limit unnecessary antibiotic use.
- Published
- 2019
43. Characteristics of Rickettsia typhi Infections Detected with Next-Generation Sequencing of Microbial Cell-Free Deoxyribonucleic Acid in a Tertiary Care Hospital
- Author
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Fernando H Centeno, Mayar Al Mohajer, Todd M. Lasco, and Asim A. Ahmed
- Subjects
0301 basic medicine ,biology ,business.industry ,medicine.drug_class ,030231 tropical medicine ,Antibiotics ,Tertiary care hospital ,bacterial infections and mycoses ,Murine typhus ,medicine.disease ,biology.organism_classification ,DNA sequencing ,Microbiology ,Serology ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,Infectious Diseases ,Oncology ,Cell-free fetal DNA ,Rickettsia typhi ,medicine ,bacteria ,business - Abstract
We present 10 patients with Rickettsia typhi infection in whom next-generation sequencing of microbial cell-free deoxyribonucleic acid (mcfDNA) was used as a diagnostic tool. Rickettsia typhi mcfDNA was detected in all cases and was more rapid and specific than rickettsial serology. Rickettsia typhi mcfDNA impacted antibiotic management in 50% of patients.
- Published
- 2021
44. Characteristics of
- Author
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Fernando H, Centeno, Todd, Lasco, Asim A, Ahmed, and Mayar, Al Mohajer
- Subjects
animal structures ,AcademicSubjects/MED00290 ,Brief Report ,bacteria ,murine typhus ,next-generation sequencing ,Rickettsia typhi ,bacterial infections and mycoses ,complex mixtures ,clinical characteristics - Abstract
We present 10 patients with Rickettsia typhi infection in whom next-generation sequencing of microbial cell-free deoxyribonucleic acid (mcfDNA) was used as a diagnostic tool. Rickettsia typhi mcfDNA was detected in all cases and was more rapid and specific than rickettsial serology. Rickettsia typhi mcfDNA impacted antibiotic management in 50% of patients.
- Published
- 2021
45. Genital Herpes Disclosure Attitudes Among Men Who Have Sex with Men
- Author
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Mayar Al Mohajer, Russell Wendt, and Paige Padgett Wermuth
- Subjects
Sexual partner ,Male ,medicine.medical_specialty ,Sexual Behavior ,HIV Infections ,Disclosure ,Men who have sex with men ,Sexual and Gender Minorities ,Arts and Humanities (miscellaneous) ,medicine ,Humans ,Homosexuality, Male ,General Psychology ,Reproductive health ,Herpes Genitalis ,business.industry ,Public health ,medicine.disease ,Cross-Sectional Studies ,Sexual Partners ,Sexual behavior ,Attitude ,Sexual orientation ,Genital herpes ,business ,Psychology ,Demography - Abstract
An abundance of literature interested in sexually transmitted infections-related disclosure attitudes among MSM (men who have sex with men) exists. However, comparatively few studies have examined these with respect to genital herpes. This cross-sectional study examined attitudes about herpes-related disclosure among Houston MSM. Convenience sampling at Houston-based MSM venues and events was conducted during December 2018 and January 2019 with 302 participants recruited. Participants were asked if an individual with genital herpes should disclose to others and if they would disclose to others if they had/have genital herpes. Factors associated with decreased belief that someone should disclose a genital herpes infection to others were history of genital herpes (OR 0.14, 95% CI [0.04, 0.55]) and race other than white, black, or Hispanic/Latino (OR 0.34, 95% CI [0.15, 0.77]). History of 0 to 1 sexual partner(s) in the past year was associated with increased belief that an individual should disclose (OR 2.43, 95% CI [1.19, 4.98]), while self-reported history of genital herpes was associated with decreased intent to disclose one’s own infection to potential partners (OR 0.30, 95% CI [0.10, 0.91]). Self-reported history of genital herpes was associated with decreased belief that someone with genital herpes should tell others and with decreased likelihood to disclose one’s own status. Lastly, race other than white, black, or Hispanic/Latino was associated with increased belief that someone with genital herpes should not tell others. Normalization of genital herpes could bolster intent to disclose genital herpes infection and improve sexual outcomes.
- Published
- 2020
46. Using clinical decision support to improve urine culture diagnostic stewardship, antimicrobial stewardship, and financial cost: A multicenter experience
- Author
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Kady Phe, Bradley Lembcke, Kaitlin J Watson, Hannah Ryan Russo, Takei Pipkins, Barbara W. Trautner, Todd M. Lasco, and Mayar Al Mohajer
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Microbiology (medical) ,medicine.medical_specialty ,Epidemiology ,medicine.drug_class ,Urinary system ,Antibiotics ,MEDLINE ,Urine ,01 natural sciences ,Clinical decision support system ,Asymptomatic ,03 medical and health sciences ,Antimicrobial Stewardship ,0302 clinical medicine ,Intervention (counseling) ,Hospitals, Religious ,medicine ,Antimicrobial stewardship ,Humans ,Multicenter Studies as Topic ,030212 general & internal medicine ,0101 mathematics ,business.industry ,010102 general mathematics ,Catholicism ,Decision Support Systems, Clinical ,Texas ,Drug Utilization ,Anti-Bacterial Agents ,Infectious Diseases ,Emergency medicine ,Urinary Tract Infections ,medicine.symptom ,business - Abstract
Objective:Despite evidence to the contrary, many practitioners continue to inappropriately screen for and treat bacteria in the urine of clinically asymptomatic patients. The purpose of this study was to evaluate the impact of a new order set on the number of urine culture performed, antibiotic days of therapy (DOT), catheter-associated urinary tract infections (CAUTI), and associated financial impact.Design:A quasi-experimental before-and-after intervention.Setting:We conducted this study at 5 Catholic Health Initiative (CHI) hospitals in Texas that use the same electronic health record (EHR) system.Patients:The study populations included adult patients who had urine culture performed from June 2017 to June 2019.Intervention:The intervention (implemented June 25, 2018) was the addition of a new order set in the electronic health record that required practitioners to choose an indication for the type of urine study. The primary outcome was number of urine cultures performed adjusted for the number of total patient days.Results:Following implementation of the new order set, the number of urine cultures performed among the 5 sites decreased from 1,175.8 tests per 10,000 patient days before the intervention to 701.4 after the intervention (40.4% reduction;P< .01). Antibiotic DOT for patients with a urinary tract infection indication decreased from 102.5 to 86.9 per 1,000 patient days (15.2% reduction;P< .01). The CAUTI standardized infection ratio was 1.0 before the intervention and 0.8 after the intervention (P= .23). The estimated yearly savings following the intervention was US$535,181.Conclusions:The addition of a new order set resulted in decreases in the number of urine cultures performed and the antibiotic DOT, as well as substantial financial savings.
- Published
- 2020
47. Successful Detection of Unrecognized Rickettsia typhi in Pregnancy Using Cell-Free Next-Generation Sequencing
- Author
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Mayar Al Mohajer, Kenneth L. Muldrew, James J Dunn, Irene A. Stafford, Laila Woc-Colburn, Angelica Janice Burgos-Lee, Martha Rac, George Parkerson, and Fernando H Centeno
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animal structures ,Adverse outcomes ,animal diseases ,030231 tropical medicine ,Case Report ,Cell free ,Murine typhus ,Tertiary care ,DNA sequencing ,03 medical and health sciences ,0302 clinical medicine ,Rickettsia typhi ,Medicine ,030212 general & internal medicine ,Pregnancy ,biology ,business.industry ,Obstetrics and Gynecology ,Gynecology and obstetrics ,medicine.disease ,biology.organism_classification ,bacterial infections and mycoses ,Virology ,RG1-991 ,bacteria ,business ,Typhus - Abstract
Flea-borne (murine) typhus is caused by Rickettsia typhi. Infection in pregnant women can lead to adverse outcomes when diagnosis and treatment is delayed. We describe how next-generation sequencing (NGS) using the Karius® test was used to rapidly diagnose murine typhus in two pregnant women admitted to a large tertiary care center in Houston, Texas, when all initial testing was nondiagnostic.
- Published
- 2020
48. Clinical spectrum of COVID-19 and plasma angiotensin II levels
- Author
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Mayar Al Mohajer, Todd M. Lasco, Gustavo A. Rivero, Sidra Younus, Shital M. Patel, An-Lin Cheng, and Ume L. Abbas
- Published
- 2021
49. 198. Clinical Prediction of Bacteremia and the Need for Early Antibiotic Therapy in Solid Tumor Cancer Patients
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Benjamin L. Musher, Daniel M. Musher, Mayar Al Mohajer, and Jonathan M Hyak
- Subjects
Tachycardia ,medicine.medical_specialty ,medicine.drug_class ,business.industry ,Antibiotics ,Vital signs ,Cancer ,medicine.disease ,Organ transplantation ,Systemic inflammatory response syndrome ,Infectious Diseases ,AcademicSubjects/MED00290 ,Oncology ,Internal medicine ,Bacteremia ,Poster Abstracts ,medicine ,medicine.symptom ,business ,Febrile neutropenia - Abstract
Background Cancer patients (pts) frequently receive empiric antibiotics without clear indication. This retrospective study investigated the relationship between the systemic inflammatory response syndrome (SIRS), early antibiotic (Anb) use, and bacteremia in solid tumor pts presenting to the emergency department (ED). Methods We extracted data from the electronic medical records of adults with solid tumors admitted to a tertiary care hospital through the ED for any reason over a 2 year period. Pts with neutropenic fever, organ transplant, trauma, or cardiopulmonary arrest were excluded. Rates of SIRS and bacteremia among pts receiving early Anb (eAnb, within 8 hours of admission) were compared to all others using χ 2. Binomial regression and receiver operator curves assessed predictors of bacteremia. Results Of 3580 eligible pts, 1344 pts were SIRS positive (≥ 2 criteria) and 2236 were SIRS negative; 501 (37%) and 493 (22%), respectively, received eAnb (p< 0.001). eAnb use increased with additional SIRS criteria (Fig 1). Of SIRS positive pts, 860 (64%) had BCs drawn within 48 hrs of presentation, of which 19% were positive. Of SIRS negative pts, 826 (37%) had cultures drawn within 48 hrs of presentation, of which 14% were positive (19% vs 14%, p=0.004). Of pts who had BCs drawn, the proportion of positive BCs among those who received eAnb and those who did not was identical (16% in each group; p=1). Of 276 pts ultimately proven to have bacteremia within 48 hrs, only 59% were SIRS positive, and only 49% received eAnb in the ED. By regression, only two SIRS components predicted bacteremia, fever (OR 1.8 ± 0.39, p=0.01) and tachycardia (1.4 ± 0.22, p=0.03), and SIRS criteria as a whole were poorly predictive of bacteremia (AUC 0.57, Table 1). A more robust model, which included additional labs and vital signs, was only marginally better (AUC 0.61, Table 2). Figure 1: Proportion of patients receiving early antibiotics by SIRS score Table 1: SIRS as a predictor of bacteremia Table 2: Best predictive model of bacteremia Conclusion Clinicians still use SIRS criteria to determine the need for eAnb. However, SIRS criteria are poor predictors of bacteremia in solid tumor pts, who frequently manifest them due to complications of cancer or cancer-directed therapy rather than infection. Furthermore, patients who are SIRS negative may be bacteremic. More reliable models are needed to guide judicious use of Anb in the solid tumor population. Disclosures All Authors: No reported disclosures
- Published
- 2020
50. Coccidioidal meningitis complicated by central nervous system vasculitis in a patient with leukemia
- Author
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Tirdad T. Zangeneh, Jennifer Segar, Dany Tager, Anne Hatch, Brentin Roller, and Mayar Al Mohajer
- Subjects
0301 basic medicine ,Fungal meningitis ,Pathology ,medicine.medical_specialty ,medicine.medical_treatment ,030106 microbiology ,Cerebral vasculitis ,Infarction ,Case Report ,Neurological examination ,Disseminated coccidioidomycosis ,Microbiology ,03 medical and health sciences ,medicine ,lcsh:QH301-705.5 ,Steroid ,lcsh:R5-920 ,Chemotherapy ,medicine.diagnostic_test ,business.industry ,medicine.disease ,Dermatology ,Infectious Diseases ,lcsh:Biology (General) ,lcsh:Medicine (General) ,Complication ,business ,Vasculitis ,Coccidioidal meningitis - Abstract
Central Nervous System (CNS) vasculitis is the most common life-threatening complication of coccidioidal meningitis. It is manifested by cerebral ischemia, hemorrhage, and infarction. We report a case of CNS vasculitis in a patient receiving chemotherapy and review of the literature on coccidioidal meningitis. The patient was treated with combination antifungal therapy and a short course of high dose corticosteroids with a modest improvement in her neurological examination after initiation of steroids.
- Published
- 2017
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