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Antibiotic Treatment Based On Guidelines For Reducing Length Of Stay (Los) In Patients With Community Acquired Pneumonia (Cap), Fetri Charya Munarsih, Ronald Irwanto Natadidjadja, Syamsudin Syamsudin

Jurnal Penyakit Dalam Indonesia

Introduction. Community acquired pneumonia (CAP) now is known as the most common infection presented. Empiric antibiotic administered followed by observing parameters. This study aimed to know how far the American Thoracic Society/ Infectious Disease Society of America (ATS/IDSA) antibiotic guidelines 2007 based treatment influenced the length of stay (LOS) of CAP subject in a private hospital ward between January 2014-August 2015 Methods. A retrospective cohort was conducted with bivariate analysis and multivariate analysis for reducing the confounding factor. Sample taken with proportional sampling formula at ward in a hospital in Jakarta. Results. The result showed that subjects with unproper empiric …

Mrsa In The United States, Sweden, And Syria, Derek J. Lillestolen

Montview Journal of Research & Scholarship

Methicillin-resistant Staphylococcus aureus (MRSA) is an opportunistic pathogen that is resistant to many broad and narrow-spectrum antibiotics commonly used in the treatment of S. aureus. There has been much fanfare about MRSA, receiving nicknames like “superbug” because of its varying degrees of resistance to the most common broad and narrow-spectrum antibiotics such as penicillin, oxacillin, methicillin and amoxicillin (2). The reality, however, is that MRSA is still susceptible to certain antibiotics and can be treated effectively. This study displays the factors which help and hurt MRSA treatments. There is shown a strong link between the prescription of broad-spectrum antibiotics …

Infections In Older Adults: A Case-Based Discussion Series Emphasizing Antibiotic Stewardship, Alyson Michener, Robin L.P. Jump

Faculty Scholarship

Introduction: Compared with younger populations, adults 65 years and older are more likely to suffer infection-related morbidity and mortality, experience antibiotic-related adverse events, and acquire multidrug-resistant organisms. We developed a series of case-based discussions that stressed antibiotic stewardship while addressing management of common infections in older adults. Methods: Five 1-hour case-based discussions address recognition, diagnosis, and management of infections common in older adults, including those living in long-term care settings: urinary tract infections, upper respiratory tract infections, lower respiratory tract infections, skin and soft tissue infections, and Clostridium difficile infection. The education was implemented at the skilled nursing centers at …

Frequency Of Bloodstream Infection In Febrile Neutropenic Patients, Experience From A Developing Country, Basit Siddiqui, Rabeea Azmat, Shiyam Sunder Tikmani, Shumaila Rafi, Beenish Syed, Muhammad Tahir Khan, Hareem Rehman, Saleemullah Paracha

Section of Nephrology

Introduction: About 20% of febrile neutropenic patients are presented with bloodstream infection which is a leading cause of mortality among these patients. Awareness of the locally prevalent pathogens and their susceptibility pattern is important for proper treatment of infection which improves survival in these patients. The objective of this study was to determine the frequency of bloodstream infection in patients with febrile neutropenia admitted in Abbasi Shaheed Hospital.
Methods; This cross-sectional study was conducted in the Medical wards in Abbasi Shaheed Hospital, Karachi from 21-2-2016 to 20-8-2017. Patients of over 15 years of age of either gender with severe neutropenia …

Invasive Mediastinal Aspergillosis Presenting As Superior Vena Cava Syndrome In An Immunocompetent Patient, Yasmin Rahim, Aisha Memon, Javaid Khan

Section of Pulmonary & Critical Care

Invasive aspergillosis (IA) is a disease of the immunocompromised with a predilection for the lungs, although dissemination to all organs is possible. Its diagnosis remains a challenge due to the absence of specific clinical manifestations and laboratory findings. In most cases, diagnosis is eventually made via invasive methods. It carries with it a high mortality due to late diagnosis and delayed treatment. Here, we report a fascinating case of a young, otherwise healthy, immunocompetent patient that presented to us with superior vena cava syndrome and a mediastinal mass. It was anticipated that a malignancy would be found on further workup …

Integrating Standardized Whole Genome Sequence Analysis With A Global Mycobacterium Tuberculosis Antibiotic Resistance Knowledgebase, Rumina Hasan, Matthew Ezewudo, Amanda Borens, Álvaro Chiner-Oms, Paolo Miotto, Leonid Chindelevitch, Angela M. Starks, Debra Hanna, Richard Liwsk, Matteo Zignol

Department of Pathology and Laboratory Medicine

Drug-resistant tuberculosis poses a persistent public health threat. The ReSeqTB platform is a collaborative, curated knowledgebase, designed to standardize and aggregate global Mycobacterium tuberculosis complex (MTBC) variant data from whole genome sequencing (WGS) with phenotypic drug susceptibility testing (DST) and clinical data. We developed a unified analysis variant pipeline (UVP) ( https://github.com/CPTR-ReSeqTB/UVP ) to identify variants and assign lineage from MTBC sequence data. Stringent thresholds and quality control measures were incorporated in this open source tool. The pipeline was validated using a well-characterized dataset of 90 diverse MTBC isolates with conventional DST and DNA Sanger sequencing data. The UVP exhibited …

Susceptibility Genes To Plant Viruses, Hernan Garcia-Ruiz

Nebraska Center for Virology: Faculty Publications

Plant viruses use cellular factors and resources to replicate and move. Plants respond to viral infection by several mechanisms, including innate immunity, autophagy, and gene silencing, that viruses must evade or suppress. Thus, the establishment of infection is genetically determined by the availability of host factors necessary for virus replication and movement and by the balance between plant defense and viral suppression of defense responses. Host factors may have antiviral or proviral activities. Proviral factors condition susceptibility to viruses by participating in processes essential to the virus. Here, we review current advances in the identification and characterization of host factors …

The Human Cib1-Ever1-Ever2 Complex Governs Keratinocyte-Intrinsic Immunity To Β-Papillomaviruses., Sarah Jill De Jong, Amandine Créquer, Irina Matos, David Hum, Vignesh Gunasekharan, Lazaro Lorenzo, Fabienne Jabot-Hanin, Elias Imahorn, Andres A. Arias, Hassan Vahidnezhad, Leila Youssefian, Janet G. Markle, Etienne Patin, Aurelia D'Amico, Claire Q.F. Wang, Florian Full, Armin Ensser, Tina M. Leisner, Leslie V. Parise, Matthieu Bouaziz, Nataly Portilla Maya, Xavier Rueda Cadena, Bayaki Saka, Amir Hossein Saeidian, Nessa Aghazadeh, Sirous Zeinali, Peter Itin, James G. Krueger, Lou Laimins, Laurent Abel, Elaine Fuchs, Jouni Uitto, Jose Luis Franco, Bettina Burger, Gérard Orth, Emmanuelle Jouanguy, Jean-Laurent Casanova

Department of Dermatology and Cutaneous Biology Faculty Papers

Patients with epidermodysplasia verruciformis (EV) and biallelic null mutations of TMC6 (encoding EVER1) or TMC8 (EVER2) are selectively prone to disseminated skin lesions due to keratinocyte-tropic human β-papillomaviruses (β-HPVs), which lack E5 and E8. We describe EV patients homozygous for null mutations of the CIB1 gene encoding calcium- and integrin-binding protein-1 (CIB1). CIB1 is strongly expressed in the skin and cultured keratinocytes of controls but not in those of patients. CIB1 forms a complex with EVER1 and EVER2, and CIB1 proteins are not expressed in EVER1- or EVER2-deficient cells. The known functions of EVER1 and EVER2 in human keratinocytes are …

A Systematic Review Of The Efficacy And Safety Of Fecal Microbiota Transplant For Clostridium Difficile Infection In Immunocompromised Patients, Oluwaseun Shogbesan, Dilli Ram Poudel, Samjeris Victor, Asad Jehangir, Opeyemi Fadahunsi, Gbenga Shogbesan, Anthony A. Donato

Reading Hospital Internal Medicine Residency

Background: Fecal microbiota transplantation (FMT) has been shown to be effective in recurrent

Methods: We searched MEDLINE and EMBASE for English language articles published on FMT for treatment of CD infection in immunocompromised patients (including patients on immunosuppressant medications, patients with human immunodeficiency virus (HIV), inherited or primary immunodeficiency syndromes, cancer undergoing chemotherapy, or organ transplant, including-bone marrow transplant) of all ages. We excluded inflammatory bowel disease patients that were not on immunosuppressant medications. Resolution and adverse event rates (including secondary infection, rehospitalization, and death) were calculated.

Results: Forty-four studies were included, none of which were randomized designs. A total …

Chikungunya Virus Associated Guillain-Barre Syndrome With Variable Presentation: A Case Series., Salman Farooq, Muhammad Imran, Ejaz Karim, Dureshahwar Kanwar, Muhammad Bilal Tariq

Pakistan Journal of Neurological Sciences (PJNS)

Chikungunya Virus Is A Mosquito-borne Alpha Virus Which Occasionally Causes Neurologic Complications Including Guillain-barre Syndrome, Myelitis, Myopathies And Encephalitis. Pakistan Experienced Its First Chikungunya Outbreak In The Metropolis Of Karachi Officially Confirmed By World Health Organization In December 2016. During This Outbreak, Over 30,000 People Have Been Reported To Be Infected In Different Parts Of Karachi. We Report Four Cases Of Chikungunya Virus Infection Associated Guillain-barre Syndrome Having An Atypical Clinical Presentation And Variable Outcome. Each Case Presented As A Different Variant Of Gbs Including Acute Inflammatory Demyelinating Polyneuropathy, Acute Motor And Sensory Axonal Neuropathy And Pharyngeal-cervical-brachial.

Development And Implementation Of A Mobile Device-Based Pediatric Electronic Decision Support Tool As Part Of A National Practice Standardization Project, Russell J. Mcculloh, Sarah Fouquet, Joshua Herigon, Eric A. Biondi, Brandan Kennedy, Ellen Kerns, Adrienne G. Deporre, Jessica L. Markham, Y Raymond Chan, Krista Nelson, Jason G. Newland

Manuscripts, Articles, Book Chapters and Other Papers

© The Author(s) 2018.

Objective: Implementing evidence-based practices requires a multi-faceted approach. Electronic clinical decision support (ECDS) tools may encourage evidence-based practice adoption. However, data regarding the role of mobile ECDS tools in pediatrics is scant. Our objective is to describe the development, distribution, and usage patterns of a smartphone-based ECDS tool within a national practice standardization project.

Materials and Methods: We developed a smartphone-based ECDS tool for use in the American Academy of Pediatrics, Value in Inpatient Pediatrics Network project entitled "Reducing Excessive Variation in the Infant Sepsis Evaluation (REVISE)." The mobile application (app), PedsGuide, was developed using evidence-based …

Outcomes Of Shoulder Arthroplasty Performed For Postinfectious Arthritis., Eric M. Padegimas, Thema A. Nicholson, Stephen Silva, Matthew L. Ramsey, Gerald R. Williams, Mark D. Lazarus, Surena Namdari

Rothman Institute Papers

Background: The purpose of this study was to evaluate the functional outcomes, infection rate, and complications associated with shoulder arthroplasty for sequelae of prior septic arthritis.

Methods: This is a retrospective cohort study of 17 patients who underwent shoulder arthroplasty for sequelae of septic arthritis. Patients were analyzed for patient-reported outcomes, complications, and reoperations.

Results: The 17 patients in this cohort were an average age of 65.4 ± 12.2 years old, were 58.8% male, and had an average body mass index of 27.9 ± 4.1 kg/m

Conclusions: Shoulder arthroplasty after septic arthritis had inconsistent functional outcomes and high complication rates …

Rapid Development Of Hepatocellular Carcinoma After Eradication Of Hepatitis C Virus With Directly Acting Antiviral Treatment, Fakhar Ali Qazi Arisar, Saeed Hamid

Section of Gastroenterology

Hepatitis C is a major risk factor for the development of hepatocellular carcinoma (HCC), arising typically on a background of liver cirrhosis. Treatment of hepatitis C has been revolutionized by the addition of oral direct-acting antivirals (DAAs) with sustained virological response (SVR) rates above 90%. There is a recent concern under debate about the increased risk of early HCC recurrence in patients with chronic hepatitis C who were treated with direct-acting antivirals. Nonetheless, these reports mostly focused on patients who were cirrhotic and were already treated for HCC. We report 4 cases of treatment naive, chronic hepatitis C patients who …

Microbiological And Clinical Profile Of Infective Endocarditis Patients: An Observational Study Experience From Tertiary Care Center Karachi Pakistan, Uzma Shahid, Hasanat Sharif, Joveria Farooqi, Bushra Jamil, E. Khan

Department of Pathology and Laboratory Medicine

Background:
The study analyzed microbiological and antimicrobial susceptibility profile of organisms isolated from patients with infective endocarditis (2015–17) and compared disease outcomes in cohorts of endocarditis patient with history of prior invasive vascular intervention (high risk group) vs those without (native valve group). We hypothesized that high risk group would be more likely to have severe disease outcomes.
Methods:
This was a prospective cohort study (2015–17). All blood and cardiac tissue samples of enrolled patients suspected of endocarditis according to modified Duke’s criteria were followed for microbiological and antimicrobial susceptibility profile. The high risk group was compared with the native …

Neurological Complications In Patients With Plasmodium Vivax Malaria From Karachi, Pakistan, Mohammad Asim Beg, A Akhlaq, Najia Karim Ghanchi, B Usmani, R Shahzad, A Rahim, Mohammad Wasay

Department of Pathology and Laboratory Medicine

Background: Malaria remains an endemic disease in Pakistan with an estimated healthcare burden of 1.6 million cases annually, with Plasmodium vivax accounting for 67% of reported cases. P. vivax is the most common species causing malaria outside of Africa, with approximately 13.8 million reported cases worldwide.
Method: We report a series of P. vivax cases with cerebral involvement that presented at Aga Khan University Hospital, Karachi, Pakistan.
Results: The majority of the patients presented with high-grade fever accompanied by projectile vomiting and abnormal behaviour, seizures, shock and unconsciousness. Seven of 801 patients with P. vivax monoinfection presented or developed cerebral …

Fungal Osteomyelitis In A Patient With Chronic Granulomatous Disease: Case Report And Review Of The Literature, Muhammad Khalid, Syed Asad Ali

Department of Paediatrics and Child Health

Chronic granulomatous disease (CGD) is the most common of the primary immunodeficiency in children. It is caused by single gene defect resulting in dysfunctional nicotinamide adenine dineucleotide phosphate (NADPH) oxidase complex causing recurrent bacterial and fungal infections. Here we present the case of a 9 year old boy who was a known case of CGD since three years of age. He presented with recent history of fever, left sided pain in the scapular region and difficulty in breathing. Chest imaging revealed developing left upper lobe consolidation and erosion of the 3rd posterior rib. The child underwent video assisted thoracoscopic surgery …

Pathophysiology Of Environmental Enteric Dysfunction And Its Impact On Oral Vaccine Efficacy, Chelsea Marie, Syed Asad Ali, Kanta Chandwe, William Petri Jr A, Paul Kelly

Department of Paediatrics and Child Health

Environmental enteric dysfunction (EED) refers to a subclinical disorder of intestinal function common in tropical countries and in settings of poverty and economic disadvantage. The enteropathy that underlies this syndrome is characterized by mucosal inflammation and villus blunting mediated by T cell activation. Epithelial cell disruption and microbial translocation drive systemic inflammation. EED in young children is associated geographically with growth failure, malnutrition, and greatly impaired responses to oral vaccines, notably rotavirus and poliovirus vaccines. In this review, we describe the pathophysiology of EED and examine the evidence linking EED and oral vaccine failure. This evidence is far from conclusive. …

Invasive Community Acquired Methicillin-Resistant Staphylococcal Aureus (Ca-Mrsa) Infections In Children, Muhammad Khalid, Samina Junejo, Fatima Mir

Department of Paediatrics and Child Health

Staphylococci are gram-positive bacteria divided into coagulase positive and coagulase negative classes, Staphylococcus aureus is the most important bacterium of this class. Epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) has changed a lot. It is no more the problem of only hospitalised patients. Children coming from community has also been increasingly affected by MRSA-called community acquired methicillin-resistant (CA-MRSA) infection. The higher severity of CA-MRSA is due to its ability to produce the toxin Panton-Valentine Leukocidin (PVL) associated with staphylococcal cassette chromosome mec (SCCmec) type IV gene. Here, we are presenting five cases of CA-MRSA infection in children having age range 0.5 …

Mechanisms Adopted By Dengue-2 Viruses To Induce Autophagy In Mammalian Cells, Sounak Ghosh Roy

Dissertations, Theses, and Capstone Projects

Dengue, the most rapidly spreading flavivirus, threatens to affect almost half of the human global population. We previously showed that dengue-2 protects canine kidney cells (MDCK) from cytotoxic chemicals. We showed, independently, that cell protection, as well as viral replication and maturation, are positively regulated by PI3K-dependent autophagy. However, we had not identified the specific pathway that induces autophagy in infected cells. The current study explores the role of a specific branch of the endoplasmic reticulum (ER) stress-mediated Unfolded Protein Response (UPR), the PERK/eIF2α/ATF4 pathway in the induction of autophagy by …

Atherosclerosis In Subjects Newly Diagnosed With Human Immunodeficiency Virus Infection., Tatiana V Kirichenko, Veronika A Myasoedova, Tatiana E Shimonova, Alexandra A Melnichenko, Dmitri Sviridov, Igor A Sobenin, Alexey I Mazus, Alexander N Orekhov, Michael I Bukrinsky

Microbiology, Immunology, and Tropical Medicine Faculty Publications

HIV infection is associated with the increased risk of cardiovascular disease (CVD), even in patients successfully treated with the combination antiretroviral therapy (cART). However, the relationship between HIV, cART, and pathogenesis of CVD remains controversial. In the present study, we evaluated the carotid intima-media thickness (CIMT), a surrogate marker of atherosclerosis, in HIV-infected subjects receiving or not receiving cART. One hundred nine newly diagnosed HIV-infected subjects and one hundred nine uninfected age-matched controls (all males) without the history of CVD, hypertension, or diabetes were recruited into the present study. Cross-sectional analysis at baseline (BL) showed significantly increased levels of triglycerides …

Unleashing Endogenous Tnf-Alpha As A Cancer Immunotherapeutic., Steven F Josephs, Thomas E Ichim, Stephen M Prince, Santosh Kesari, Francesco M Marincola, Anton Rolando Escobedo, Amir Jafri

Articles, Abstracts, and Reports

Tumor necrosis factor (TNF)-alpha was originally identified in the 1970s as the serum mediator of innate immunity capable of inducing hemorrhagic necrosis in tumors. Today, a wide spectrum of biological activities have been attributed to this molecule, and clinical translation has mainly occurred not in using it to treat cancer, but rather to inhibit its effects to treat autoimmunity. Clinical trials utilizing systemic TNF-alpha administration have resulted in an unacceptable level of toxicities, which blocked its development. In contrast, localized administration of TNF-alpha in the form of isolated limb perfusion have yielded excellent results in soft tissue sarcomas. Here we …

Anidulafungin: A Noninferior Alternative To Fluconazole For Treatment Of Esophageal Candidiasis, Blake S. Sanford

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Krause DS, Simjee AE, van Rensburg C, et al. A randomized, double-blind trial of anidulafungin versus fluconazole for the treatment of esophageal candidiasis. Clin Infect Dis. 2004;39(6):770-775. doi: 10.1086/423378.

The Association Of Qsofa, Sofa, And Sirs With Mortality In Emergency Department Pneumonia, Ian D. Mecham, Nathan C. Dean, Emily L. Wilson, Al R. Jephson, Michael J. Lanpsa

The University of Louisville Journal of Respiratory Infections

Objective: To determine the association between 30-day mortality with Systemic Inflammatory Response Syndrome (SIRS), Sequential Organ Failure Assessment (SOFA), and quick SOFA (qSOFA) in emergency department patients with pneumonia. Secondary outcomes included the association of sepsis scores with hospital admission and direct ICU admission.

Methods: This is a secondary analysis of a pneumonia population conducted in the emergency department of 3 tertiary care medical centers and 4 community hospitals. Adult immunocompetent patients diagnosed with pneumonia were included from 3 twelve-month periods spanning December 2009 to October 2015. We generated area under the receiver operating characteristic curve (AUC) values for …

Coping With Chronic Fungal Rhinosinusitis: Diagnosis To Therapy, Veronica Corcino, Leslie Beavin, Shengli Lu, Ashley Ross, Carmen V. Sciortino Jr.

The University of Louisville Journal of Respiratory Infections

No abstract provided.

Use Of Ultrasound For Diagnosis Of Pneumonia In Adults, A Review, Dafang Chen, Rodrigo Cavallazzi

The University of Louisville Journal of Respiratory Infections

Pneumonia is a common lung infection with significant morbidity and mortality. Currently, the diagnosis of pneumonia is made by patient history confirmed with chest radiograph or computed tomography. These modalities, however, have limitations including low accuracy, radiation exposure, and high cost. Lung ultrasound has become more prevalent in evaluating pulmonary conditions and has shown to be highly accurate in the diagnosis of pneumonia. The purpose of this review is to discuss sonographic findings associated with pneumonia, techniques used to obtain quality images, and the evidence in literature supporting the use of lung ultrasound in the diagnosis of pneumonia. Numerous studies …

Comparison Of Mortality And Therapy In Community Acquired Pneumonia, Gina Maki, Daniela Moreno, Anthony Harris, Steven Lawrence, Andrew Masica, Lois Lamerato, Marcus J. Zervos

The University of Louisville Journal of Respiratory Infections

Background: Community associated pneumonia (CAP) is one the most common causes of hospital admissions, exceeding more than one million per year in the United States, contributing to 3.4% of inpatient mortality. Our objective was to compare 30-day mortality using therapies recommended for treatment of CAP.

Methods: A multicenter retrospective analysis from four different hospitals was assessed from 2008 to 2013. The data was obtained from electronic medical records which included more than 70,000 patients. CAP patients were identified using discharge diagnostic codes during the years 2008-2013, as well as receiving therapy with ceftriaxone and azithromycin or a respiratory fluoroquinolone. Demographic …

Congenital Zika Virus Infection In Immunocompetent Mice Causes Postnatal Growth Impediment And Neurobehavioral Deficits, Amber M. Paul, Dhiraj Acharya, Biswas Neupane, E. Ashley Thompson, Gabriel Gonzalez-Fernandez, Katherine M. Copeland

Publications

A small percentage of babies born to Zika virus (ZIKV)-infected mothers' manifest severe defects at birth, including microcephaly. Among those who appeared healthy at birth, there are increasing reports of postnatal growth or developmental defects. However, the impact of congenital ZIKV infection in postnatal development is poorly understood. Here, we report that a mild congenital ZIKV-infection in pups born to immunocompetent pregnant mice did not display apparent defects at birth, but manifested postnatal growth impediments and neurobehavioral deficits, which include reduced locomotor and cognitive deficits that persisted into adulthood. We found that the brains of these pups were smaller, had …

Lafora Disease Masquerading As Hepatic Dysfunction, Faisal Inayat, Waqas Ullah, Hanan T. Lodhi, Zarak H. Khan, Ghulam Ilyas, Nouman Safdar Ali, Hafez Mohammad A. Abdullah

Abington Jefferson Health Papers

Lafora disease is fatal intractable progressive myoclonic epilepsy. It is frequently characterized by epileptic seizures, difficulty walking, muscle spasms, and dementia in late childhood or adolescence. We chronicle here an unusual case of an asymptomatic young male soccer player who presented with elevated liver enzymes. Neurological examination was unremarkable. The diagnostic workup for hepatitis, infectious etiologies, autoimmune disorders, hemochromatosis, Wilson's disease, alpha-1 antitrypsin deficiency, and other related diseases was inconclusive. He subsequently underwent an uneventful percutaneous liver biopsy. Based on the pathognomonic histopathological findings, Lafora disease was considered the likely etiology. The present study is a unique illustration of this …

Fecal Microbiota Transplantation May Have Clinical Utility In Reducing Incidence Of Recurrent Urinary Tract Infection, Jeremy A. Grekin

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Tariq R, Pardi DS, Tosh PK, Walker RC, Razonable RR, Khanna S. Fecal microbiota transplantation for recurrent Clostridium difficile infection reduces recurrent urinary tract infection frequency. Clinical Infectious Diseases. 2017 Oct 30;65(10):1745–1747. doi: 10.1093/cid/cix618

There Is No Mortality Benefit To Using Quinolones Instead Of Azithromycin For Legionella Pneumonia, David B. Witcher

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Gershengorn HB, Keene A, Dzierba AL, Wunsch H. The association of antibiotic treatment regimen and hospital mortality in patients hospitalized with Legionella pneumonia. Clinical Infectious Diseases. 2015;60(11):e66-e79. doi: 10.1093/cid/civ157