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36 results on '"Mercuro, Nicholas J."'

2. Prevalence and Predictors of Pseudomonas aeruginosa Among Hospitalized Patients With Diabetic Foot Infections

Author

Veve, Michael P, Mercuro, Nicholas J, Sangiovanni, Ryan J, Santarossa, Maressa, and Patel, Nimish

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Diabetes, Clinical Research, Infection, Good Health and Well Being, diabetic foot infection, Pseudomonas aeruginosa, antimicrobial stewardship, Clinical sciences, Medical microbiology
Abstract

BackgroundDiabetic foot infections (DFIs) are commonly associated with antibiotic overuse. Empiric DFI treatment often includes coverage for Pseudomonas aeruginosa (PsA), but the frequency of PsA DFIs is poorly understood. The study objectives were to quantify the prevalence of and determine predictors for PsA DFIs.MethodsThis multicenter, retrospective cohort included hospitalized patients with DFI from 2013 through 2020 who were age ≥18 years; diabetes mellitus diagnosis; and DFI based on International Classification of Diseases, Tenth Revision coding, antibiotic treatment, and DFI culture with organism growth. Osteomyelitis was excluded. Patient characteristics were described and compared; the primary outcome was presence of PsA on DFI culture. Predictors of PsA DFI were identified using multivariable logistic regression.ResultsTwo hundred ninety-two patients were included. The median age was 61 (interquartile range [IQR], 53-69) years; the majority were men (201 [69%]) and White (163 [56%]). The most commonly isolated organisms were methicillin-susceptible Staphylococcus aureus (35%) and streptococci (32%); 147 (54%) cultures were polymicrobial. Two hundred fifty-seven (88%) patients received empiric antibiotics active against PsA, but only 27 (9%) patients had PsA DFI. Immunocompromised status (adjusted odds ratio [aOR], 4.6 [95% confidence interval {CI}, 1.3-16.7]) and previous outpatient DFI antibiotic treatment failure (aOR, 4.8 [95% CI, 1.9-11.9]) were associated with PsA DFI.ConclusionsPsA DFI is uncommon, but most patients receive empiric antipseudomonal antibiotics. Empiric broad-spectrum antibiotics are warranted given the frequency of mixed infections, but patient-specific risk factors should be considered before adding antipseudomonal coverage.

Published
2022

12. Pharmacist-Driven Transitions of Care Practice Model for Prescribing Oral Antimicrobials at Hospital Discharge

Author

Mercuro, Nicholas J., primary, Medler, Corey J., additional, Kenney, Rachel M., additional, MacDonald, Nancy C., additional, Neuhauser, Melinda M., additional, Hicks, Lauri A., additional, Srinivasan, Arjun, additional, Divine, George, additional, Beaulac, Amy, additional, Eriksson, Erin, additional, Kendall, Ronald, additional, Martinez, Marilen, additional, Weinmann, Allison, additional, Zervos, Marcus, additional, and Davis, Susan L., additional

Published
2022
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26. It is time to define antimicrobial never events

Author

Liu, Jiajun, primary, Kaye, Keith S., additional, Mercuro, Nicholas J., additional, Davis, Susan L., additional, Patel, Twisha S., additional, Petty, Lindsay A., additional, Pais, Gwendolyn M., additional, and Scheetz, Marc H., additional

Published
2018
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34. Antimicrobial never events: Objective application of a framework to assess vancomycin appropriateness

Author

Liu, Jiajun, Mercuro, Nicholas J., Davis, Susan L., Palmo, Tenzin, Kashyap, Shivek, Patel, Twisha S., Petty, Lindsay A., Yarnold, Paul R., Kaye, Keith S., and Scheetz, Marc H.

Abstract

AbstractTo address appropriateness of antibiotic use, we implemented an electronic framework to evaluate antibiotic “never events” (NEs) at 2 medical centers. Patient-level vancomycin administration records were classified as NEs or non-NEs. The objective framework allowed capture of true-positive vancomycin NEs in one-third of patients identified by the electronic strategy.

Published
2021
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35. Stewardship opportunities in viral pneumonia: Why not the immunocompromised?

Author

Kenney, Rachel M., Mercuro, Nicholas J., Davis, Susan L., Samuel, Linoj, Tibbetts, Robert J., and Alangaden, George J.

Subjects
*IMMUNOCOMPROMISED patients, *STEWARDSHIP theory, *VIRAL pneumonia, *POLYMERASE chain reaction, *IMMUNOSUPPRESSION
Abstract

Abstract: Antimicrobial management of viral pneumonia has proven to be a challenge in hospitalized immunocompromised patients. A host of factors contribute to the dilemma, such as diagnostic uncertainty, lack of organism identification, and clinical status of the patient. Respiratory virus panel (RVP) use was compared between 131 immunocompromised patients who received send‐out (n = 56) vs in‐house (n = 75) testing. Antimicrobial optimization interventions consisted of antiviral addition/discontinuation, antibiotic discontinuation/de‐escalation, or modification of immunosuppressive regimen. After implementation of an in‐house test with audit and feedback, turnaround time of the RVP was reduced from 46.7 to 5.5 hours (P < .001) and time to intervention was reduced from 52.1 to 13.9 hours (P < .001), yet the frequency of antimicrobial optimization interventions was unchanged (30.7% vs 35.7%). Differences were not observed in duration of empiric antibiotic therapy or length of stay. The overall discontinuation rate for patients tested with a RVP was low (4.6%), and those with positive RVP (n = 43) had antibiotics stopped in 14% of cases. Bacterial pneumonia coinfection was confirmed in 2 patients. Further systematic efforts should be taken to reduce antibiotic use in viral pneumonia and identify the major barriers in the immunocompromised population. [ABSTRACT FROM AUTHOR]

Published
2018
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36. It is time to define antimicrobial never events

Author

Liu, Jiajun, Kaye, Keith S., Mercuro, Nicholas J., Davis, Susan L., Patel, Twisha S., Petty, Lindsay A., Pais, Gwendolyn M., and Scheetz, Marc H.

Abstract

AbstractInappropriate antibiotic use is associated with increased antimicrobial resistance and adverse events that can lead to further downstream patient harm. Preventative strategies must be employed to improve antibiotic use while reducing avoidable harm. We use the term “antibiotic never events” to globally recognize and define the most inappropriate antibiotic use.

Published
2019
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