Clinical and Laboratory Features of Community-Associated Methicillin-ResistantStaphylococcus aureus:Is It Really New?

2006 ◽  
Vol 27 (2) ◽  
pp. 133-138 ◽  
Author(s):  
Leonard B. Johnson ◽  
Sajjad Saeed ◽  
Joan Pawlak ◽  
Odette Manzor ◽  
Louis D. Saravolatz
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Response To Therapy ◽  
Laboratory Analysis ◽  
Molecular Characteristics ◽  
Molecular Features ◽  
Type Iv ◽  
Single Clone ◽  
Systemic Antibiotics ◽  
Staphylococcal Cassette Chromosome

Objective.To review the epidemiologic and molecular characteristics of community-associated methicillin-resistantStaphylococcus aureus(CA-MRSA) in Detroit, Michigan, to assess the risk factors for infection and the response to therapy.Design.Prospective clinical and laboratory study of 2003-2004 CA-MRSA isolates. Molecular features were compared with CA-MRSA isolates from 1980.Setting.A 600-bed urban academic medical center.Patients.Twenty-three patients with CA-MRSA infections from 2003-2004 were evaluated. In addition, laboratory analysis was performed on 13 CA-MRSA isolates from 1980.Main Outcome Measures.Laboratory analysis of isolates included antimicrobial susceptibility testing, pulsed-field genotyping, testing for Panton-Valentine leukocidin (PVL) genes, and staphylococcal cassette chromosomemectyping.Results.Patients were predominantly young African American males and presented with skin and soft-tissue infections. All isolates were resistant to erythromycin and highly susceptible to other agents. Patients were generally treated successfully with combination incision and drainage and systemic antibiotics. Among the 23 isolates, 20 (87%) were the same strain. This strain carried the staphylococcal cassette chromosomemectype IV and PVL genes and is genetically identical to USA 300. Thirteen isolates of patients from our community who presented with CA-MRSA infections in 1980 represented a single clone that is unique compared with the 2003-2004 isolates. This strain carried staphylococcal cassette chromosomemectype IVA but did not carry the PVL genes.Conclusions.In our community, CA-MRSA is largely due to a single clone with a type IVmecgene and PVL gene. The type IV staphylococcal cassette chromosomemectype can be demonstrated in CA-MRSA isolates from a remote period, suggesting that earlier outbreaks were not related to healthcare exposure.

Prevalence of Nasal Colonization Among Patients With Community-Associated Methicillin-ResistantStaphylococcus aureusInfection and Their Household Contacts

2007 ◽  
Vol 28 (8) ◽  
pp. 966-969 ◽  
Author(s):  
Uzma Zafar ◽  
Leonard B. Johnson ◽  
Michel Hanna ◽  
Kathleen Riederer ◽  
Mamta Sharma ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Medical Center ◽  
Academic Medical Center ◽  
Nasal Colonization ◽  
Household Contacts ◽  
Type Iv ◽  
Single Clone ◽  
Household Members ◽  
Mrsa Strains ◽  
Multiple Strains

Objective.To evaluate the prevalence of colonization among patients with community-associated methicillin-resistantStaphylococcus aureus(CA-MRSA) infection and their household contacts.Design.Prospective, observational laboratory study of nasal colonization among patients and their household members from September 15, 2004, to February 20, 2006.Setting.A 600-bed, urban, academic medical center.Patients.Fifty-one patients who presented with CA-MRSA infections and 49 household members had cultures of nasal swab specimens performed.Results.Skin and soft-tissue infections were seen in 50 patients (98%) and 2 household members. Twenty-one (41%) of 51 patients and 10 (20%) of 49 household members were colonized with MRSA. An additional 5 patients (10%) and 12 household members (24%) were colonized with methicillin-susceptibleStaphylococcus aureus.Most MRSA isolates (95%; infective and colonizing) carried the staphylococcal cassette chromosomemectype IV complex, and 67% represented a single clone, identical to USA 300. Of the colonized household members, 5 had isolates related to the patients' infective isolate.Conclusions.The frequency of CA-MRSA colonization among household members of patients with CA-MRSA infections is higher than rates reported among the general population. Among colonized household members, only half of the MRSA strains were related to the patients' infective isolate. Within the same household, multiple strains of CA-MRSA may be present.

Prevalence of Colonization With Community-Associated Methicillin-ResistantStaphylococcus aureusAmong End-Stage Renal Disease Patients and Healthcare Workers

2009 ◽  
Vol 30 (1) ◽  
pp. 4-8 ◽  
Author(s):  
Leonard B. Johnson ◽  
Jinson Jose ◽  
Farah Yousif ◽  
Joan Pawlak ◽  
Louis D. Saravolatz
Keyword(s):  
Healthcare Workers ◽  
Medical Center ◽  
Academic Medical Center ◽  
High Rate ◽  
Molecular Characteristics ◽  
Dialysis Patients ◽  
Type Iv ◽  
Mrsa Strains ◽  
Stage Renal Disease ◽  
Healthcare Associated

Objective.To evaluate the prevalence, epidemiologic features, and molecular characteristics of colonization with community-associated methicillin-resistantStaphylococcus aureus(CA-MRSA) among hospitalized dialysis patients and their healthcare workers (HCWs).Design.Prospective observational clinical and laboratory study of nasal colonization.Setting.A 600-bed urban academic medical center.Subjects.One hundred twenty hospitalized dialysis inpatients and 100 HCWs.Results.Of 120 patients, 40 (33%) were colonized withS. aureus; 26 (65%) of these 40 were colonized with MRSA. Among the 26 MRSA isolates, 10 (38.5%) carried staphylococcal cassette chromosome (SCC)mectype IV (ie, CA-MRSA), and 7 of these 10 carried the genes for the Panton-Valentine leukocidin (PVL) toxin. Patients colonized with healthcare-associated MRSA strains and those colonized with CA-MRSA strains were similar, except for a higher frequency of a history of congestive heart failure among those with healthcare-associated MRSA strains (P= .014). Among 10 patients who presented with or developed anS. aureusinfection while hospitalized, 8 were colonized withS. aureus, 7 with MRSA, and 3 with SCCmectype IV strains. Among 100 HCWs, 31 were colonized withS. aureus, including 6 with MRSA; 2 of the MRSA isolates belonged to CA-MRSA strains, and soft-tissue infections were reported in one of the HCWs and in the family member of the other HCW colonized with these strains.Conclusions.There is a high rate of colonization with MRSA and CA-MRSA among hospitalized dialysis patients and their HCWs. As other studies have found, it appears that individuals are being colonized with both CA-MRSA strains and healthcare-associated MRSA strains.

Clinical and pathological features of breast cancer in Arab compared to Jewish women in Northern Israel

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e22201-e22201
Author(s):  
J. Zidan ◽  
M. Geslikov
Keyword(s):  
Breast Cancer ◽  
Medical Center ◽  
Cancer Prognosis ◽  
Response To Treatment ◽  
Molecular Characteristics ◽  
Arab Women ◽  
Jewish Women ◽  
Molecular Features ◽  
Advanced Tumor ◽  
Younger Age

e22201 Background: Breast cancer (BC) is the most common malignancy in both Jewish and Arab women in Israel. Although the incidence of BC is lower in Arab women it is diagnosed in younger age and seems to have worse prognosis. Recent data have suggested considerable molecular differences in BC from various ethnical groups. Molecular features are increasingly used for predicting cancer prognosis and response to treatment. The purpose of this study to compare clinical, pathological and molecular characteristics of BC in Arab and Jewish women in the Upper Galilee Methods: The files of 481 patients (pts) with breast cancer (BC) treated at the Oncology Institute, Ziv Medical Center between 2001 and 2007 were reviewed retrospectively. Type of breast operation and both clinical and all pathological findings of patients were summarized and correlated to the ethnicity of women. Results: Of the total 481 pts 380 were Jewish and 100 were Arab women. The main age at diagnosis was 49,4 years for Arabs and 59,5 years for Jews (p<0,01). At diagnosis 3% of Arab pts had DCIS compared to 7,4% in Jewish pts, stage I in 19% and 49,9%, stage II in 36% and 31,7%, stage III in 33,3% and 7,6%, stage IV in 9% and 3,7% of Arab and Jewish pts respectively (p<0,05). Well differentiated, moderately and poorly differentiated in 12%, 59% and 29% compared with 43,9%, 41,4% and 12,5% in Arabs versus Jews. Estrogen receptor was 69% in Arabs and 79% in Jews. HER-2 overexpression evaluated by IHC and CISH was diagnosed in 39% of Arab pts and in 24% Jewish pts (p<0,05). Lumpectomy was done in 36% in Arabs versus 64% in Jews (p<0,05). Conclusions: Our data demonstrate younger age and more advanced tumor at diagnosis in Arab compared to Jewish women. All pathological and molecular figures were more aggressive in Arab compared to Jewish women in Israel. Mammography for screening may be started at age 40 years in Arab women and treatment could be more aggressive. No significant financial relationships to disclose.

Comparison of Point-of-Care Testing Methods and Laboratory Analysis for Assessing Urine Specific Gravity and pH of Children Undergoing Chemotherapy

2020 ◽  
Vol 38 (1) ◽  
pp. 6-15
Author(s):  
Karen Kalbfeld ◽  
Janet A. Parkosewich ◽  
Wei Teng ◽  
Marjorie Funk
Keyword(s):  
Specific Gravity ◽  
Medical Center ◽  
Point Of Care ◽  
Academic Medical Center ◽  
Chemotherapeutic Agents ◽  
Laboratory Analysis ◽  
Urine Specific Gravity ◽  
Testing Methods ◽  
Urine Ph ◽  
Urine Testing

Background To reduce the risk of renal toxicity, urine specific gravity (SG) and pH (potential of hydrogen) parameters should be met before nephrotoxic chemotherapeutic agents are administered. The purpose of this study was to compare laboratory urine SG and pH values with those obtained with urine point-of-care (POC) testing methods commonly used when caring for children receiving nephrotoxic chemotherapeutic agents. Method A method-comparison design was used to compare the values of three POC methods for SG (dipstick, automated dipstick reader, refractometer) and three pH (dipstick, automated dipstick reader, litmus paper) methods with laboratory analysis of 86 urine samples from 43 children hospitalized on a pediatric hematology oncology unit in a large academic medical center. The Bland–Altman method was used to calculate bias and precision between POC and laboratory values. Results Except for the SG refractometer, bias values from Bland–Altman graphs demonstrated poor agreement between POC and laboratory urine SG and pH results. The precision values between these methods indicated overestimation or underestimation of hydration or urine pH status. Compared with laboratory methods, 31% of POC visual reading of dipstick SG values were falsely low—putting the patient at risk of not receiving necessary hydration and subsequent nephrotoxicity. Discussion In conclusion, most POC urine testing methods for SG and pH are not accurate compared with laboratory analysis. Because laboratory analyses can take longer than POC methods to obtain results, clinicians need to collaborate with laboratory medicine to ensure that an expedited process is in place in order to prevent chemotherapy administration delays.

scholarly journals SAT-423 Anti-thyroid Drug Response in Graves’ Disease: Predictors of Biochemically Persistent Disease

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Omar M El Kawkgi ◽  
Dingfeng Li ◽  
Sebastian Vallejo ◽  
Eddy Lincango ◽  
Sneha Mohan ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Univariate Analysis ◽  
Treatment Decision ◽  
The United States ◽  
Response To Therapy ◽  
Graves Disease ◽  
Persistent Disease ◽  
Treatment Decision Making ◽  
Guide Treatment Decision

Abstract Introduction: Anti-thyroid Drugs (ATD) have become the most frequently used treatment for Graves’ disease (GD) in the United States. However, the response to this therapy is variable. Factors that predict biochemically responsive vs. biochemically persistent disease remain unknown. Identifying predictors of disease poorly responsive to ATD can help guide treatment decision making, follow up planning and prognosis. Methods: From a database of patients with GD treated with ATD and receiving care at an academic medical center between 2009–2019, we selected adults with incident GD treated with ≥14 days of ATD. Results: 172 patients (from a database of 730 patients with GD on ATD) were sampled for the purpose of this pilot and 97 of these met inclusion criteria. Patients had a median age of 50 (18–90); female, 70.1%; never smokers, 64.9%; median goiter size of 40 g (15–100); and median TRAb on presentation of 8.1 mIU/L (1.0- 60). Graves’ orbitopathy (GO) was present in 13.4% at baseline. Patients (100%) were started on methimazole at a median dose of 20 mg (2.5–60). The median time from presentation until biochemical improvement (defined as the first instance of FT4 ≤1.7 ng/dL) was 120.9 days (18–1525), and to biochemical euthyroidism (normal TSH & FT4) was 251 days (41–1259) including a median of 3 (0–17) dose adjustments. In a univariate analysis, response to ATD was divided into two groups; biochemically responsive and biochemically persistent disease (based on reaching biochemical improvement in ≤6 months, or &gt;6 months respectively). Biochemically persistent disease was more common in those with GO at presentation (38.5% vs.11.1%) (p .024). There was a trend towards greater prevalence of biochemically persistent disease in those with TRAb ≥ 8.0 mIU/L (46.2% vs. 27.8%) (p .204), and goiter estimated 30 grams or above by physical examination (30.8% vs. 19.4%) (p .460). Biochemically responsive disease was associated with higher frequency of hypothyroidism during treatment (p .047). Conclusion: Our preliminary results illustrate the spectrum of response to ATD and predictors of biochemically persistent disease. We aim to expand this analysis utilizing a large database. As use of ATD increases, clinicians and patients can apply this data to estimate response to therapy, and identify patients that may require more aggressive therapy, thereby tailoring management plans.

scholarly journals Immunohistochemical and Molecular Features of Melanomas Exhibiting Intratumor and Intertumor Histomorphologic Heterogeneity

Cancers ◽  
2019 ◽  
Vol 11 (11) ◽  
pp. 1714
Author(s):  
Haider A. Mejbel ◽  
Sri Krishna C. Arudra ◽  
Dinesh Pradhan ◽  
Carlos A. Torres-Cabala ◽  
Priyadharsini Nagarajan ◽  
...  
Keyword(s):  
Genetic Heterogeneity ◽  
Poor Response ◽  
Response To Therapy ◽  
Intratumor Heterogeneity ◽  
Molecular Characteristics ◽  
Diagnostic Challenge ◽  
Molecular Features ◽  
Tumor Survival ◽  
Heterogeneous Neoplasm ◽  
Formalin Fixed Paraffin Embedded

Melanoma is a heterogeneous neoplasm at the histomorphologic, immunophenotypic, and molecular levels. Melanoma with extreme histomorphologic heterogeneity can pose a diagnostic challenge in which the diagnosis may predominantly rely on its immunophenotypic profile. However, tumor survival and response to therapy are linked to tumor genetic heterogeneity rather than tumor morphology. Therefore, understating the molecular characteristics of such melanomas become indispensable. In this study, DNA was extracted from 11 morphologically distinct regions in eight formalin-fixed, paraffin-embedded melanomas. In each region, mutations in 50 cancer-related genes were tested using next-generation sequencing (NGS). A tumor was considered genetically heterogeneous if at least one non-overlapping mutation was identified either between the histologically distinct regions of the same tumor (intratumor heterogeneity) or among the histologically distinct regions of the paired primary and metastatic tumors within the same patient (intertumor heterogeneity). Our results revealed that genetic heterogeneity existed in all tumors as non-overlapping mutations were detected in every tested tumor (n = 5, 100%; intratumor: n = 2, 40%; intertumor: n = 3, 60%). Conversely, overlapping mutations were also detected in all the tested regions (n = 11, 100%). Melanomas exhibiting histomorphologic heterogeneity are often associated with genetic heterogeneity, which might contribute to tumor survival and poor response to therapy.

Emergence of Community-Associated Methicillin-ResistantStaphylococcus aureusInfection Among Patients With End-Stage Renal Disease

2006 ◽  
Vol 27 (10) ◽  
pp. 1057-1062 ◽  
Author(s):  
Leonard B. Johnson ◽  
Anilrudh A. Venugopal ◽  
Joan Pawlak ◽  
Louis D. Saravolatz
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Academic Medical Center ◽  
Molecular Features ◽  
Type Iv ◽  
Mrsa Strains ◽  
Stage Renal Disease ◽  
End Stage ◽  
Panton Valentine Leukocidin ◽  
Valentine Leukocidin

Objective.To evaluate the frequency of infections due to community-associated methicillin-resistantStaphylococcus aureus(CA-MRSA) strains among our patients with end-stage renal disease.Design.Prospective observational clinical and laboratory study of patients in 2005. Molecular features of isolates recovered from these patients were compared with those of isolates recovered in 2000 from patients with end-stage renal disease.Setting.A 600-bed urban academic medical center.Patients.Thirty-two patients with end-stage renal disease and MRSA infection at the time of hospitalization from 2005 were evaluated. For comparison, laboratory analysis was performed for 17 MRSA isolates recovered from patients with end-stage renal disease in 2000.Results.The patients from 2005 were more likely than the patients from 2000 to have infection with strains that carried the staphylococcal cassette chromosome (SCC)mectype IV complex (50% vs 11.8%; relative risk, 4.25 [95% confidence interval, 1.17-25.98];P= .012) and the Panton-Valentine leukocidin toxin genes (25% vs 0%;P= .038). Eight patients from 2005 were infected with a strain that is identical to MRSA clone USA300 in terms of molecular type and presence of SCCmectype IV and Panton-Valentine leukocidin genes. Among the patients from 2005, those infected with SCCmectype IV strains (ie, CA-MRSA strains) and those infected with SCCmectype II strains (ie, healthcare-associated MRSA [HA-MRSA] strains) were similar with respect to demographic characteristics, risk factors, and outcomes.Conclusions.We documented an increased proportion of infections with CA-MRSA strains, including clone USA300, among our population of patients undergoing dialysis. Patients infected with CA-MRSA strains and HA-MRSA strains were similar with respect to presenting illness and outcomes.

scholarly journals 800. Oral Vancomycin Prophylaxis Against Clostridioides difficile in Patients Admitted to a Tertiary Academic Medical Center

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S443-S444
Author(s):  
David B Kopelman ◽  
Sharon B Wright ◽  
Howard Gold ◽  
Preeti Mehrotra ◽  
Preeti Mehrotra
Keyword(s):  
Primary Prevention ◽  
Medical Center ◽  
Acute Infection ◽  
Academic Medical Center ◽  
Nucleic Acid Amplification ◽  
Prior History ◽  
Oral Vancomycin ◽  
Clostridioides Difficile ◽  
History Of ◽  
Systemic Antibiotics

Abstract Background In an effort to more accurately diagnose Clostridioides difficile infection (CDI), many hospitals have switched to two-step testing algorithms that rely on nucleic acid amplification testing with reflex enzyme immunoassay for toxin. Additionally, oral vancomycin prophylaxis (OVP) against CDI is increasingly being used; initial studies focused on preventing recurrence in patients with a prior history of CDI, but OVP is also being studied in primary prevention. We hypothesized that following the implementation of two-step testing, clinicians may use OVP for prevention of a patient’s first episode of CDI based on knowledge of prior PCR+/Toxin- testing. Methods We performed a single-center, retrospective cohort study of patients admitted to Beth Israel Deaconess Medical Center. We identified patients who received oral vancomycin once daily or BID for the prevention of CDI following implementation of two-step testing. Patients who received oral vancomycin as part of a taper following acute infection were excluded. We categorized rationale for prophylaxis based on clinical documentation and collected details of patients’ CDI history, antibiotic exposure, and subsequent CDI testing during hospitalization. Results In the 12 months following implementation of two-step testing, there were 80 patients who received OVP during hospitalization (2 daily and 78 BID). The vast majority (73, 91.3%) had a history of CDI and received OVP for secondary prevention while receiving systemic antibiotics. There were only 3 patients (3.8%) without known clinical history of CDI whose clinicians documented prophylaxis based on previous PCR+/Toxin- testing. Patients on OVP received a mean of 4.1 systemic antibiotics during hospitalization. When continuing OVP for a finite period after discontinuation of systemic antibiotics, this was most commonly done for 2-7 days (16 of 26, 61.5%). 22 patients underwent stool testing for CDI while receiving OVP in the hospital and all resulted PCR-negative. OVP Indication OVP Duration Conclusion Following implementation of two-step testing for CDI, use of OVP for primary prevention based solely on knowledge of PCR+/Toxin- testing in patients without a history of CDI was rare. Acute CDI appears unlikely in patients actively receiving OVP. Disclosures All Authors: No reported disclosures

Gender differences in career progress and satisfaction in an academic medical center

2002 ◽  
Vol 2 (3) ◽  
pp. 95-104 ◽  
Author(s):  
JoAnn Manson ◽  
Beverly Rockhill ◽  
Margery Resnick ◽  
Eleanor Shore ◽  
Carol Nadelson ◽  
...  
Keyword(s):  
Gender Differences ◽  
Medical Center ◽  
Academic Medical Center ◽  
Academic Medical ◽  
Career Progress
Sign in / Sign up

Export Citation Format

Share Document