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6. COVID-19: An Emerging Threat to Antibiotic Stewardship in the Emergency Department

Author

Pulia, Michael S., Wolf, Ian, Schulz, Lucas T., Pop-Vicas, Aurora, Schwei, Rebecca J., and Lindenauer, Peter K.

Subjects
Antibiotic Stewardship, Emergency Medicine, COVID-19
Abstract

While current research efforts focus primarily on identifying patient level interventions that mitigate the direct impact of COVID-19, it is important to consider the collateral effects of COVID-19 on antimicrobial resistance. Early reports suggest high rates of antibiotic utilization in COVID-19 patients despite their lack of direct activity against viral pathogens. The ongoing pandemic is exacerbating known barriers to optimal antibiotic stewardship in the ED, representing an additional direct threat to patient safety and public health. There is an urgent need for research analyzing overall and COVID-19 specific antibiotic prescribing trends in the ED. Optimizing ED stewardship during COVID-19 will likely require a combination of traditional stewardship approaches (e.g. academic detailing, provider education, care pathways) and effective implementation of host response biomarkers and rapid COVID-19 diagnostics. Antibiotic stewardship interventions with demonstrated efficacy in mitigating the impact of COVID-19 on ED prescribing should be widely disseminated and inform the ongoing pandemic response.

Published
2020

8. Evaluation of Gram Stain-Guided Antibiotic Therapy for Methicillin-Resistant Staphylococcus aureus Pneumonia in Intensive Care Unit Patients.

Author

Van Epps, Johanna, Lepak, Alexander J., Schulz, Lucas T., and Fish, Jeffrey

Subjects
GRAM'S stain, METHICILLIN-resistant staphylococcus aureus, INTENSIVE care patients, INTENSIVE care units, POLYMERASE chain reaction
Abstract

Background: Despite high negative predictive values (NPVs) seen with methicillin-resistant Staphylococcus aureus (MRSA) nares polymerase chain reaction (PCR) assays, utilization of both respiratory sample Gram stain and MRSA nares PCR in patients with pneumonia may contribute to overuse of laboratory resources. The purpose of this study was to evaluate if a Gram stain demonstrating no Gram-positive organisms from a respiratory sample is sufficient to allow for de-escalation of vancomycin therapy. Methods: This single center study retrospectively identified intensive care unit (ICU) patients started on vancomycin for presumed pneumonia at University of Wisconsin (UW) Health in Madison, WI between August 2022 and March 2023. Patients with respiratory sample demonstrating no Gram-positives on Gram stain met inclusion criteria if the sample was ordered within 24 h of vancomycin initiation. The primary outcome was NPV of respiratory sample Gram stain demonstrating no Gram-positive organisms with respect to MRSA detection of the respiratory culture. Secondary outcomes included the NPV of combined MRSA nares PCR plus respiratory sample Gram stain, and difference in time to event in patients that had both a respiratory sample and MRSA nares PCR ordered. Results: A total of 370 patients were screened for study eligibility; of which 99 patients met inclusion criteria. NPV of respiratory sample Gram stain was 99% for MRSA culture. The combined NPV of respiratory sample Gram stain plus MRSA nares PCR was 98.9% for MRSA culture (n = 88). Respiratory sample was ordered 2.3 h faster compared to MRSA nares PCR (4.3 vs 6.6 h, P =.036). Respiratory sample Gram stain resulted 4.5 h faster compared to MRSA nares PCR (10.7 vs 15.2 h, P =.002). Conclusion: Respiratory sample Gram stains demonstrating no Gram-positive organisms may be used to de-escalate vancomycin and deprioritize the use of MRSA nares PCR. [ABSTRACT FROM AUTHOR]

Published
2024
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15. Significance of curvature for balancing polymer melt channels in injection molding manifold systems and extrusion dies.

Author

Schulz, Lucas, Ulbrich, Chris, and Schiffers, Reinhard

Subjects
*POLYMER melting, *CURVATURE, *MELT spinning, *INJECTION molding, *PRESSURE drop (Fluid dynamics)
Abstract

Natural rheologic balancing is being state-of-the-art in developing polymer melt channels for extrusion dies or hot runners in injection molding. For this, flow path lengths and channel diameters in a manifold system are defined identical on all paths and thus those channels are considered to be identical in pressure drop and cavity filling, respectively in mass flow distribution. However, the changes in direction of the melt flow due to the deflection of the melt are in most cases neglected but have a significant impact on the flow field in downstream components. Strong deflections, as they occur in conventional manifold systems, can be avoided by the use of additive manufacturing methods. However, the bionic design leads to curved melt channels which, when naturally balanced, may differ completely from one another regarding their overall course and curvature. Therefore, unequal mass flow distributions or cavity fillings occur in such geometries. The aim of this paper is to investigate the influence of channel curvature on the balancing of additively manufactured melt channels. For this purpose, a test specimen is designed and the curvature collectives along the neutral fibers are evaluated. The overall objective is a more specific balancing with respect to the mass flow distribution. The results indicate the necessity of considering the channels' curvature in the designing process in order to achieve a homogeneous melt distribution. [ABSTRACT FROM AUTHOR]

Published
2024
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19. Diagnostic testing and antibiotic utilization among inpatients evaluated for coronavirus disease 2019 (COVID-19) pneumonia

Author

Wimmer, Megan R., primary, Griffin, Meggie, additional, Peterson-Weber, Alex, additional, Schulz, Lucas T., additional, Hamel, Ashlee G., additional, Schwei, Rebecca J., additional, Fong, Karen, additional, Burgess, Donna R., additional, Brett, Meghan, additional, Hale, Cory M., additional, Holubar, Marisa, additional, Jain, Rupali, additional, Larry, Rachel, additional, Spivak, Emily S., additional, Newland, Helen, additional, Njoku, Jessica, additional, Postelnick, Michael, additional, Walraven, Carla, additional, and Pulia, Michael S., additional

Published
2023
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22. Understanding clinical implementation coordinators’ experiences in deploying evidence-based interventions

Author

Hernandez, Sara E, primary, Solomon, Demetrius, additional, Moon, Jukrin, additional, Parmasad, Vishala, additional, Wiegmann, Douglas, additional, Bennett, Nick T, additional, Ferren, Ryan S, additional, Fitzsimmons, Alec J, additional, Lepak, Alexander J, additional, O’Horo, John C, additional, Pop-Vicas, Aurora E, additional, Schulz, Lucas T, additional, and Safdar, Nasia, additional

Published
2023
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24. Evaluating distributive mixing potential by mean distance of streamlines and a passive scalar.

Author

Schulz, Lucas, Vorjohann, Felix, Janßen, Mirco, and Schiffers, Reinhard

Subjects
*SHEAR (Mechanics), *FLOW simulations, *POLYMER melting, *TEMPERATURE distribution, *COMPUTER simulation
Abstract

In single-screw extrusion, a uniform melt temperature distribution as well as a sufficient material homogenization are essential for an excellent quality of the final product. Therefore, mixing elements are used at the end of the extruder screw to generate the needed shearing and deformation of the polymer melt. CFD-simulations (Computational Fluid Dynamics) are the most common tool for the design and optimization of mixing elements, but the modeling and evaluation of distributive mixing processes in numerical simulations is a well-known problem. In this study, two different approaches for the prediction of the distributive mixing quality were evaluated: the change of the mean distance of streamlines on pre-defined cross-sections and a passive scalar integrated into the numerical solver. For this purpose, various flow simulations of a Block-Head-Mixer were performed and compared. The results show that the passive scalar has advantages over the evaluation by mean distance of streamline positions, especially regarding the integration into the simulation environment and when used for longer mixing sections. [ABSTRACT FROM AUTHOR]

Published
2023
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25. Examining the effects of organizational influencers on the implementation of clinical innovations: A qualitative analysis

Author

Solomon, Demetrius, primary, Parmasad, Vishala, additional, Wiegmann, Douglas, additional, Moon, Jukrin, additional, Schulz, Lucas, additional, Lepak, Alexander, additional, Pop-Vicas, Aurora, additional, Ferren, Ryan, additional, OHoro, John, additional, Bennett, Nicholas, additional, Fitzsimmons, Alec, additional, Safdar, Nasia, additional, and Hernandez, Sara, additional

Published
2023
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30. Diagnostic testing and antibiotic utilization among inpatients evaluated for coronavirus disease 2019 (COVID-19) pneumonia

Author

Wimmer, Megan R., Griffin, Meggie, Peterson-Weber, Alex, Schulz, Lucas T., Hamel, Ashlee G., Schwei, Rebecca J., Fong, Karen, Burgess, Donna R., Brett, Meghan, Hale, Cory M., Holubar, Marisa, Jain, Rupali, Larry, Rachel, Spivak, Emily S., Newland, Helen, Njoku, Jessica, Postelnick, Michael, Walraven, Carla, and Pulia, Michael S.

Abstract

AbstractWe evaluated diagnostic test and antibiotic utilization among 252 patients from 11 US hospitals who were evaluated for coronavirus disease 2019 (COVID-19) pneumonia during the severe acute respiratory coronavirus virus 2 (SARS-CoV-2) omicron variant pandemic wave. In our cohort, antibiotic use remained high (62%) among SARS-CoV-2–positive patients and even higher among those who underwent procalcitonin testing (68%).

Published
2024
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50. The impact of coronavirus disease 2019 (COVID-19) on the antimicrobial stewardship pharmacist workforce: A multicenter survey

Author

Wimmer, Megan R., primary, Schulz, Lucas T., additional, Hamel, Ashlee G., additional, Schwei, Rebecca J., additional, Fong, Karen, additional, Burgess, Donna R., additional, Brett, Meghan, additional, Hale, Cory M., additional, Holubar, Marisa, additional, Jain, Rupali, additional, Larry, Rachel, additional, Spivak, Emily S., additional, Newland, Helen, additional, Njoku, Jessica, additional, Postelnick, Michael, additional, Walraven, Carla, additional, and Pulia, Michael S., additional

Published
2022
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