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Articles 1 - 24 of 24
Full-Text Articles in Infectious Disease
Feasibility Of A Low-Intensity Intervention To Influence Antibiotic Prescribing Rates Use In Outpatient Settings: A Cluster Randomized Controlled Clinical Trial, Brigid M. Wilson, Sunah Song, Robin L.P. Jump, Federico Perez
Feasibility Of A Low-Intensity Intervention To Influence Antibiotic Prescribing Rates Use In Outpatient Settings: A Cluster Randomized Controlled Clinical Trial, Brigid M. Wilson, Sunah Song, Robin L.P. Jump, Federico Perez
Faculty Scholarship
Background. Primary care providers (PCPs) may modify their antibiotic prescription practices if aware of their potentially damaging impact. Methods. We conducted a cluster randomized controlled trial at 12 Veterans Affairs community-based outpatient clinics. PCPs at clinics randomized to the intervention group received quarterly antibiotic use reports with feedback about antibiotics prescribed for acute respiratory infections and adverse event letters alerting about Clostridioides difficile infection or antibiotic-resistant gram-negative bacteria among their patients. The main outcome, antibiotic prescriptions in primary care visits, was compared in the preintervention (April–September 2020), intervention (October 2020 to September 2021), and postintervention periods (September 2021 to September …
Syndromic Antibiograms And Nursing Home Clinicians' Antibiotic Choices For Urinary Tract Infections, Brigid M. Wilson, Taissa A. Bej, Robin L.P. Jump
Syndromic Antibiograms And Nursing Home Clinicians' Antibiotic Choices For Urinary Tract Infections, Brigid M. Wilson, Taissa A. Bej, Robin L.P. Jump
Faculty Scholarship
Importance: Empirical antibiotic prescribing in nursing homes (NHs) is often suboptimal. The potential for antibiograms to improve empirical antibiotic decision-making in NHs remains poorly understood. Objective: To determine whether providing NH clinicians with a urinary antibiogram improves empirical antibiotic treatment of urinary tract infections (UTIs). Design, Setting, and Participants: This was a survey study using clinical vignettes. Participants were recruited via convenience sampling of professional organization listservs of NH clinicians practicing in the US from December 2021 through April 2022. Data were analyzed from July 2022 to June 2023. Interventions: Respondents were randomized to complete vignettes using a traditional antibiogram …
An Implementation Roadmap For Establishing Remote Infectious Disease Specialist Support For Consultation And Antibiotic Stewardship In Resource-Limited Settings, Robin L.P. Jump
Faculty Scholarship
Infectious Disease (ID)-trained specialists, defined as ID pharmacists and ID physicians, improve hospital care by providing consultations to patients with complicated infections and by leading programs that monitor and improve antibiotic prescribing. However, many hospitals and nursing homes lack access to ID specialists. Telehealth is an effective tool to deliver ID specialist expertise to resource-limited settings. Telehealth services are most useful when they are adapted to meet the needs and resources of the local setting. In this step-by-step guide, we describe how a tailored telehealth program can be implemented to provide remote ID specialist support for direct patient consultation and …
Expanding The Definition Beyond Surveillance Criteria Reveals A Large Burden Of Osteomyelitis Caused By Group B Streptococcus In The United States Veterans Health Administration, Taissa A. Bej, Brigid Wilson, Sunah Song, Robin L.P. Jump, Federico Perez
Expanding The Definition Beyond Surveillance Criteria Reveals A Large Burden Of Osteomyelitis Caused By Group B Streptococcus In The United States Veterans Health Administration, Taissa A. Bej, Brigid Wilson, Sunah Song, Robin L.P. Jump, Federico Perez
Faculty Scholarship
Background: Population-based surveillance studies may underestimate osteomyelitis caused by Group B Streptococcus (GBS). We analyzed cases of GBS osteomyelitis, including patients diagnosed using an expanded case definition that incorporates cultures from non-sterile sites, as well as cultures from normally sterile sites. Methods: We retrospectively examined a cohort of veterans with the diagnosis of osteomyelitis between 2008 and 2017. Cases of definite GBS osteomyelitis required GBS isolation from normally sterile sites, (e.g., blood or bone). Cases of probable GBS osteomyelitis permitted GBS isolation from non-sterile sites (e.g., surgical sites, wounds). We compared comorbid conditions, lower extremity amputation and mortality rates in …
Implementation Of An Antibiotic Stewardship Program In Long-Term Care Facilities Across The Us, Robin L.P. Jump
Implementation Of An Antibiotic Stewardship Program In Long-Term Care Facilities Across The Us, Robin L.P. Jump
Faculty Scholarship
Importance: Antibiotic overuse in long-term care (LTC) is common, prompting calls for antibiotic stewardship programs (ASPs) designed for specific use in these settings. The optimal approach to establish robust, sustainable ASPs in LTC facilities is unknown. Objectives: To determine if the Agency for Healthcare Research and Quality (AHRQ) Safety Program for Improving Antibiotic Use, an educational initiative to establish ASPs focusing on patient safety, is associated with reductions in antibiotic use in LTC settings. Design, Setting, and Participants: This quality improvement study including 439 LTC facilities in the US assessed antibiotic therapy data following a pragmatic quality-improvement program, which was …
Similar Mortality Among United States Veterans With Invasive And Noninvasive Pneumonia Due To Group B Streptococcus, Brigid M. Wilson, Sunah Song, Robin L.P. Jump, Federico Perez
Similar Mortality Among United States Veterans With Invasive And Noninvasive Pneumonia Due To Group B Streptococcus, Brigid M. Wilson, Sunah Song, Robin L.P. Jump, Federico Perez
Faculty Scholarship
Background: The nosology of noninvasive pneumonia due to group B Streptococcus (GBS) is not well defined. This study compared clinical characteristics and outcomes of patients with invasive pneumonia and noninvasive pneumonia caused by GBS. Methods: We conducted a retrospective cohort study among Veterans Affairs (VA) healthcare users between 2008 and 2017. Using data from electronic health records, we identified patients who had blood or respiratory cultures that grew GBS and had invasive pneumonia or noninvasive pneumonia. We analyzed patient and infection characteristics associated with all-cause mortality, including among the subset of patients with cultures that were monomicrobial for GBS. Results: …
Desirability Of Outcome Ranking For The Management Of Antimicrobial Therapy (Door Mat) Reveals Improvements In The Treatment Of Bloodstream Infections Caused By Escherichia Coli And Klebsiella Pneumoniae In Patients From The Veterans Health Administration, Federico Perez, Brigid M. Wilson, Elie Saade, Robin L.P. Jump, Robert A. Bonomo
Desirability Of Outcome Ranking For The Management Of Antimicrobial Therapy (Door Mat) Reveals Improvements In The Treatment Of Bloodstream Infections Caused By Escherichia Coli And Klebsiella Pneumoniae In Patients From The Veterans Health Administration, Federico Perez, Brigid M. Wilson, Elie Saade, Robin L.P. Jump, Robert A. Bonomo
Faculty Scholarship
Background: Reductions in the use of broad-spectrum antibiotics is a cornerstone of antimicrobial stewardship. We aim to demonstrate use of the Desirability of Outcome Ranking Approach for the Management of Antimicrobial Therapy (DOOR MAT) to evaluate the treatment of Escherichia coli and Klebsiella pneumoniae bloodstream infections in patients from the Veterans Health Administration (VHA) across a decade. Methods: Using electronic records, we determined empiric and definitive antibiotic treatments, clinical characteristics, and 30-day mortality of patients with monomicrobial E. coli and K. pneumoniae bloodstream infections hospitalized in VHA medical centers from 2009 to 2018. Focusing on patients treated with parenteral β-lactams …
Use Of Electronic Pharmacy Transaction Data And Website Development To Assess Antibiotic Use In Nursing Homes, Sunah Song, Brigid M. Wilson, Robin L.P. Jump
Use Of Electronic Pharmacy Transaction Data And Website Development To Assess Antibiotic Use In Nursing Homes, Sunah Song, Brigid M. Wilson, Robin L.P. Jump
Faculty Scholarship
Background: In 2017, the Centers for Medicare and Medicaid Services required all long-term care facilities, including nursing homes, to have an antibiotic stewardship program. Many nursing homes lack the resources, expertise, or infrastructure to track and analyze antibiotic use measures. Here, we demonstrate that pharmacy invoices are a viable source of data to track and report antibiotic use in nursing homes. Methods: The dispensing pharmacy working with several nursing homes in the same healthcare corporation provided pharmacy invoices from 2014 to 2016 as files formatted as comma separated values. We aggregated these files by aligning elements into a consistent set …
Desirability Of Outcome Ranking For The Management Of Antimicrobial Therapy (Door Mat): A Framework For Assessing Antibiotic Selection Strategies In The Presence Of Drug Resistance, Brigid M. Wilson, Robin L.P. Jump, Federico Perez, Robert A. Bonomo
Desirability Of Outcome Ranking For The Management Of Antimicrobial Therapy (Door Mat): A Framework For Assessing Antibiotic Selection Strategies In The Presence Of Drug Resistance, Brigid M. Wilson, Robin L.P. Jump, Federico Perez, Robert A. Bonomo
Faculty Scholarship
The complexities of antibiotic resistance mean that successful stewardship must consider both the effectiveness of a given antibiotic and the spectrum of that therapy to minimize imposing further selective pressure. To meet this challenge, we propose the Desirability of Outcome Ranking approach for the Management of Antimicrobial Therapy (DOOR MAT), a flexible quantitative framework that evaluates the desirability of antibiotic selection. Herein, we describe the steps required to implement DOOR MAT and present examples to illustrate how the desirability of treatment selection can be evaluated using resistance information. While treatments and the scoring of treatment selections must be adapted to …
Concurrent Atlantoaxial Septic Arthritis And Septic Thrombosis Of The Ophthalmic Vein Due To Staphylococcus Aureus: A Case Report And Review Of The Literature, Robin L.P. Jump
Faculty Scholarship
Atlantoaxial joint septic arthritis and superior ophthalmic vein thrombosis are uncommon manifestations of Staphylococcus aureus infection. A 68-year-old man presented with acute-onset neck pain and diplopia. Imaging studies revealed atlantoaxial septic arthritis and right superior ophthalmic vein thrombosis. Blood cultures grew methicillin-susceptible S. aureus. We review the literature describing these 2 uncommon manifestations of a common pathogen.
Infections In Older Adults: A Case-Based Discussion Series Emphasizing Antibiotic Stewardship, Alyson Michener, Robin L.P. Jump
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 …
Challenges And Strategies For Prevention Of Multidrug-Resistant Organism Transmission In Nursing Homes, Christopher J. Crnich, Robin L.P. Jump
Challenges And Strategies For Prevention Of Multidrug-Resistant Organism Transmission In Nursing Homes, Christopher J. Crnich, Robin L.P. Jump
Faculty Scholarship
Purpose of Review: Nursing home residents are at high risk for colonization and infection with bacterial pathogens that are multidrug-resistant organisms (MDROs). We discuss challenges and potential solutions to support implementing effective infection prevention and control practices in nursing homes. Recent Findings: Challenges include a paucity of evidence that addresses MDRO transmission during the care of nursing home residents, limited staff resources in nursing homes, insufficient infection prevention education in nursing homes, and perceptions by nursing home staff that isolation and contact precautions negatively influence the well being of their residents. Summary: A small number of studies provide evidence that …
Impact Of Tigecycline Versus Other Antibiotics On The Fecal Metabolome And On Colonization Resistance To Clostridium Difficile In Mice, Robin L.P. Jump, David Kraft, Kelly Hurless, Alex Polinkovsky, Curtis J. Donskey
Impact Of Tigecycline Versus Other Antibiotics On The Fecal Metabolome And On Colonization Resistance To Clostridium Difficile In Mice, Robin L.P. Jump, David Kraft, Kelly Hurless, Alex Polinkovsky, Curtis J. Donskey
Faculty Scholarship
Background: The glycylcycline antibiotic tigecycline may have a relatively low propensity to promote Clostridium difficile infection in part because it causes less disruption of the indigenous intestinal microbiota than other broad-spectrum antibiotics. We used a mouse model to compare the effects of tigecycline versus other commonly used antibiotics on colonization resistance to C. difficile and on the metabolic functions of the intestinal microbiota. Methods: To assess in vivo colonization resistance to C. difficile, mice were challenged with oral C. difficile spores 1, 7, or 12 days after completion of 3 days of treatment with subcutaneous saline, tigecycline, ceftriaxone, piperacillin-tazobactam, or …
Oral Cryptococcosis In A Patient With Chronic Lymphocytic Leukemia, Sachin Patel, Maria Navas, Courtney Batt, Robin L.P. Jump
Oral Cryptococcosis In A Patient With Chronic Lymphocytic Leukemia, Sachin Patel, Maria Navas, Courtney Batt, Robin L.P. Jump
Faculty Scholarship
No abstract provided.
A Survey And Analysis Of The American Public's Perceptions And Knowledge About Antibiotic Resistance, Rebecca R. Carter, Jiayang Sun, Robin L.P. Jump
A Survey And Analysis Of The American Public's Perceptions And Knowledge About Antibiotic Resistance, Rebecca R. Carter, Jiayang Sun, Robin L.P. Jump
Faculty Scholarship
Background. Little is known about the American public's perceptions or knowledge about antibiotic-resistant bacteria or antibiotic misuse. We hypothesized that although many people recognize antibiotic resistance as a problem, they may not understand the relationship between antibiotic consumption and selection of resistant bacteria. Methods. We developed and tested a survey asking respondents about their perceptions and knowledge regarding appropriate antibiotic use. Respondents were recruited with the Amazon Mechanical Turk crowdsourcing platform. The survey, carefully designed to assess a crowd-sourced population, asked respondents to explain "antibiotic resistance" in their own words. Subsequent questions were multiple choice. Results. Of 215 respondents, the …
Serratia Fonticola, Pathogen Or Bystander? A Case Series And Review Of The Literature, Roberto Viau, Robin L.P. Jump
Serratia Fonticola, Pathogen Or Bystander? A Case Series And Review Of The Literature, Roberto Viau, Robin L.P. Jump
Faculty Scholarship
Serratia fonticola is an unusual human pathogen, previously described primarily as causing skin and soft tissue infections following trauma. There is little information in the literature about its treatment or susceptibilities. We describe the case of a 67-year-old male with paraplegia who developed urosepsis due to S. fonticola. Blood and urine cultures obtained prior to the initiation of antimicrobials both grew S. fonticola. The patient completed a 15-day course of antimicrobials and had an uneventful recovery.We reviewed 17 other patients with clinical cultures positive for S. fonticola. Of these, 11 isolates were from the genitourinary system, most often as part …
Proteome And Protein Network Analyses Of Memory T Cells Find Altered Translation And Cell Stress Signaling In Treated Human Immunodeficiency Virus Patients Exhibiting Poor Cd4 Recovery, Sausan Azzam, Daniela M. Schlatzer, Sean Maxwell, Xiaolin Li, Douglas Bazdar, Yanwen Chen, Robert Asaad, Jill S. Barnholtz-Sloan, Mark R. Chance, Scott F. Sieg
Proteome And Protein Network Analyses Of Memory T Cells Find Altered Translation And Cell Stress Signaling In Treated Human Immunodeficiency Virus Patients Exhibiting Poor Cd4 Recovery, Sausan Azzam, Daniela M. Schlatzer, Sean Maxwell, Xiaolin Li, Douglas Bazdar, Yanwen Chen, Robert Asaad, Jill S. Barnholtz-Sloan, Mark R. Chance, Scott F. Sieg
Faculty Scholarship
Background. Human immunodeficiency virus (HIV) patients who experience poor CD4 T-cell recovery despite viral suppression during antiretroviral therapy (ART) are known as immunological nonresponders. The molecular mechanism(s) underlying incomplete immune restoration during ART is not fully understood. Methods. Label-free quantitative proteomics on single-cell type central memory T cells were used to reveal relative protein abundance changes between nonresponder, responder (good CD4 recovery during ART), and healthy individuals. Proteome changes were analyzed by protein pathway and network analyses and verified by selected reaction monitoring mass spectrometry. Results. Proteomic analysis across groups detected 155 significant proteins from 1500 nonredundant proteins. Pathway and …
A Virtual Clinic Improves Pneumococcal Vaccination For Asplenic Veterans At High Risk For Pneumococcal Disease, Robin L.P. Jump, Brigid Wilson, Rebecca Carter, Susan Phillips, Federico Perez
A Virtual Clinic Improves Pneumococcal Vaccination For Asplenic Veterans At High Risk For Pneumococcal Disease, Robin L.P. Jump, Brigid Wilson, Rebecca Carter, Susan Phillips, Federico Perez
Faculty Scholarship
We developed a "virtual clinic" to improve pneumococcal vaccination among asplenic adults. Using an electronic medical record, we identified patients, assessed their vaccination status, entered orders, and notified patients and providers. Within 180 days, 38 of 76 patients (50%) received a pneumococcal vaccination. Avirtual clinic may optimize vaccinations among high-risk patients.
Optimizing Antibiotic Stewardship In Nursing Homes: A Narrative Review And Recommendations For Improvement, Robin Jump
Optimizing Antibiotic Stewardship In Nursing Homes: A Narrative Review And Recommendations For Improvement, Robin Jump
Faculty Scholarship
The emerging crisis in antibiotic resistance and concern that we now sit on the precipice of a post-antibiotic era have given rise to advocacy at the highest levels for widespread adoption of programmes that promote judicious use of antibiotics. These antibiotic stewardship programmes, which seek to optimize antibiotic choice when clinically indicated and discourage antibiotic use when clinically unnecessary, are being implemented in an increasing number of acute care facilities, but their adoption has been slower in nursing homes. The antibiotic prescribing process in nursing homes is fundamentally different from that observed in hospital and clinic settings, with formidable challenges …
Are Staphylococcus Intermedius Infections In Humans Cases Of Mistaken Identity? A Case Series And Literature Review, Roberto Viau, Andrea M. Hujer, Kristine M. Hujer, Robert A. Bonomo, Robin L.P. Jump
Are Staphylococcus Intermedius Infections In Humans Cases Of Mistaken Identity? A Case Series And Literature Review, Roberto Viau, Andrea M. Hujer, Kristine M. Hujer, Robert A. Bonomo, Robin L.P. Jump
Faculty Scholarship
Staphylococcus intermedius and Staphylococcus pseudintermedius are difficult to distinguish using conventional microbiological methods. Molecular diagnostic tools change our understanding of the epidemiology of these 2 organisms. In this study, we present (1) a detailed review of the current literature on molecular diagnostics and (2) a case series in which misidentification was proven in 1 case. We conclude that S pseudintermedius is a more common human pathogen than previously recognized.
Metabolomics Analysis Identifies Intestinal Microbiota-Derived Biomarkers Of Colonization Resistance In Clindamycin-Treated Mice, Robin L.P. Jump, Myreen Tomas, Abhishek Deshpande, Curtis J. Donskey
Metabolomics Analysis Identifies Intestinal Microbiota-Derived Biomarkers Of Colonization Resistance In Clindamycin-Treated Mice, Robin L.P. Jump, Myreen Tomas, Abhishek Deshpande, Curtis J. Donskey
Faculty Scholarship
Background: The intestinal microbiota protect the host against enteric pathogens through a defense mechanism termed colonization resistance. Antibiotics excreted into the intestinal tract may disrupt colonization resistance and alter normal metabolic functions of the microbiota. We used a mouse model to test the hypothesis that alterations in levels of bacterial metabolites in fecal specimens could provide useful biomarkers indicating disrupted or intact colonization resistance after antibiotic treatment. Methods: To assess in vivo colonization resistance, mice were challenged with oral vancomycin-resistant Enterococcus or Clostridium difficile spores at varying time points after treatment with the lincosamide antibiotic clindamycin. For concurrent groups of …
Defining The Vulnerable Period For Re-Establishment Of Clostridium Difficile Colonization After Treatment Of C. Difficile Infection With Oral Vancomycin Or Metronidazole, Venkata C.K. Sunkesula, Sirisha Kundrapu, Robin L. Jump, Curtis J. Donskey
Defining The Vulnerable Period For Re-Establishment Of Clostridium Difficile Colonization After Treatment Of C. Difficile Infection With Oral Vancomycin Or Metronidazole, Venkata C.K. Sunkesula, Sirisha Kundrapu, Robin L. Jump, Curtis J. Donskey
Faculty Scholarship
Background:Clostridium difficile is an anaerobic, spore-forming bacterium that is the most common cause of healthcare-associated diarrhea in developed countries. A significant proportion of patients receiving oral vancomycin or metronidazole for treatment of Clostridium difficile infection (CDI) develop recurrences. However, the period of vulnerability to re-establishment of colonization by C. difficile after therapy is not well defined.Principal Findings:In a prospective study of CDI patients, we demonstrated that most vancomycin-treated patients maintained inhibitory concentrations of vancomycin in stool for 4 to 5 days after therapy, whereas metronidazole was only detectable during therapy. From the time of elimination of the antibiotics to 14 …
Multihospital Outbreak Of Clostridium Difficile Infection, Cleveland, Ohio, Usa, Robin L.P. Jump, Ajay K. Sethi, Curtis J. Donskey
Multihospital Outbreak Of Clostridium Difficile Infection, Cleveland, Ohio, Usa, Robin L.P. Jump, Ajay K. Sethi, Curtis J. Donskey
Faculty Scholarship
To determine whether a multihospital Clostridium difficile outbreak was associated with epidemic strains and whether use of particular fl uoroquinolones was associated with increased infection rates, we cultured feces from C. difficile-infected patients. Use of fl uoroquionolones with enhanced antianaerobic activity was not associated with increased infection rates.
Topical Application Of Entry Inhibitors As "Virustats" To Prevent Sexual Transmission Of Hiv Infection, Michael M. Lederman, Robin L.P. Jump, Heather A. Pilch-Cooper, Scott F. Sieg
Topical Application Of Entry Inhibitors As "Virustats" To Prevent Sexual Transmission Of Hiv Infection, Michael M. Lederman, Robin L.P. Jump, Heather A. Pilch-Cooper, Scott F. Sieg
Faculty Scholarship
With the continuing march of the AIDS epidemic and little hope for an effective vaccine in the near future, work to develop a topical strategy to prevent HIV infection is increasingly important. This stated, the track record of large scale "microbicide" trials has been disappointing with nonspecific inhibitors either failing to protect women from infection or even increasing HIV acquisition. Newer strategies that target directly the elements needed for viral entry into cells have shown promise in non-human primate models of HIV transmission and as these agents have not yet been broadly introduced in regions of highest HIV prevalence, they …