blaVIM-2 and blaVIM-7 Carbapenemase-Producing Pseudomonas aeruginosa Isolates Detected in a Tertiary Care Medical Center in the United States: Report from the MYSTIC Program

Objectives.To identify risk factors for infection with imipenem-resistant Pseudomonas aeruginosa and determine the impact of imipenem resistance on clinical and economic outcomes among patients infected with P. aeruginosa.Designs.An ecologic study, a case-control study, and a retrospective cohort study.Setting.A 625-bed tertiary care medical center.Patients.All patients who had an inpatient clinical culture positive for P. aeruginosa between January 1, 1999, and December 31, 2000.Results.From 1991 through 2000, the annual prevalence of imipenem resistance among P. aeruginosa isolates increased significantly (P<.001 by the χ2 test for trend). Among 879 patients infected with P. aeruginosa during 1999-2000, a total of 142 had imipenem-resistant P. aeruginosa infection (the case group), whereas 737 had imipenem-susceptible P. aeruginosa infection (the control group). The only independent risk factor for imipenem-resistant P. aeruginosa infection was prior fluoroquinolone use (adjusted odds ratio, 2.52 [95% confidence interval {CI}, 1.61-3.92]; P<.001). Compared with patients infected with imipenem-susceptible P. aeruginosa, patients infected with imipenem-resistant P. aeruginosa had longer subsequent hospitalization durations (15.5 days vs 9 days; P = .02) and greater hospital costs ($81,330 vs $48,381; P<.001). The mortality rate among patients infected with imipenem-resistant P. aeruginosa was 31.1%, compared with 16.7% for patients infected with imipenem-susceptible P. aeruginosa (relative risk, 1.86 [95% CI, 1.38-2.51]; P<.001). In multivariable analyses, there remained an independent association between infection with imipenem-resistant P. aeruginosa and mortality.Conclusions.The prevalence of imipenem resistance among P. aeruginosa strains has increased markedly in recent years and has had a significant impact on both clinical and economic outcomes. Our results suggest that curtailing use of other antibiotics (particularly fluoroquinolones) may be important in attempts to curb further emergence of imipenem resistance.

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Gastrointestinal lymphomas in a North American population: clinicopathologic features from one major Central-Midwestern United States tertiary care medical center

Diagnostic Pathology ◽

10.1186/1746-1596-7-76 ◽

2012 ◽

Vol 7 (1) ◽

pp. 76 ◽

Cited By ~ 13

Author(s):

Joshua Warrick ◽

Jingqin Luo ◽

Diane Robirds ◽

Julie Branson ◽

John L Frater ◽

...

Keyword(s):

United States ◽

North American ◽

Medical Center ◽

Tertiary Care ◽

North American Population ◽

American Population ◽

Clinicopathologic Features ◽

Midwestern United States ◽

Tertiary Care Medical Center ◽

Gastrointestinal Lymphomas

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Abstract B20: Hypopharyngeal carcinoma management: 25-year experience from a tertiary care medical center in United States

10.1158/1557-3265.aacrahns19-b20 ◽

2020 ◽

Author(s):

Toms Vengaloor Thomas ◽

Mary R. Nittala ◽

Divyang Mehta ◽

Madhava Rao Kanakamedala ◽

Anu Abraham ◽

...

Keyword(s):

United States ◽

Medical Center ◽

Tertiary Care ◽

Hypopharyngeal Carcinoma ◽

Tertiary Care Medical Center

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Ability of an Antibiogram to Predict Pseudomonas aeruginosa Susceptibility to Targeted Antimicrobials Based on Hospital Day of Isolation

Infection Control and Hospital Epidemiology ◽

10.1086/665721 ◽

2012 ◽

Vol 33 (6) ◽

pp. 589-593 ◽

Cited By ~ 15

Author(s):

Deverick J. Anderson ◽

Becky Miller ◽

Ruchit Marfatia ◽

Richard Drew

Keyword(s):

Pseudomonas Aeruginosa ◽

Antimicrobial Agents ◽

Medical Center ◽

Tertiary Care ◽

Logistic Regression Models ◽

Tertiary Care Medical Center ◽

Clinical Culture ◽

Duration Of Hospitalization ◽

Hospital Wards ◽

Culture Positive

Objective.To determine the utility of an antibiogram in predicting the susceptibility of Pseudomonas aeruginosa isolates to targeted antimicrobial agents based on the day of hospitalization the specimen was collected.Design.Single-center retrospective cohort study.Setting.A 750-bed tertiary care medical center.Patients and Methods.Isolates from consecutive patients with at least 1 clinical culture positive for P. aeruginosa from January 1, 2000, to June 30, 2007, were included. A study antibiogram was created by determining the overall percentages of P. aeruginosa isolates susceptible to amikacin, ceftazidime, ciprofloxacin, gentamicin, imipenem-cilastin, piperacillin-tazobactam, and tobramycin during the study period. Individual logistic regression models were created to determine the day of infection after which the study antibiogram no longer predicted susceptibility to each antibiotic.Results.A total of 3,393 isolates were included. The antibiogram became unreliable as a predictor of susceptibility to ceftazidime, imipenem-cilastin, piperacillin-tazobactam, and tobramycin after day 10 and ciprofloxacin after day 15 but longer for gentamicin (day 21) and amikacin (day 28). Time to unreliability of the antibiogram varied for antibiotics based on location of isolation. For example, the time to unreliability of the antibiogram for ceftazidime was 5 days (95% confidence interval [CI], <1–8) in the intensive care unit (ICU) and 12 days (95% CI, 7–21) in non-ICU hospital wards (P = .003).Conclusions.The ability of the antibiogram to predict susceptibility of P. aeruginosa decreases as duration of hospitalization increases.

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Economic Impact of Diagnostic Imaging in the Workup of Uncomplicated Bell's Palsy

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0040-1722231 ◽

2021 ◽

Author(s):

Elycia Kazemian ◽

Hollie Marie Schaffer ◽

Amy Wozniak ◽

John P. Leonetti

Keyword(s):

Imaging Modality ◽

Medical Center ◽

Financial Burden ◽

Tertiary Care ◽

National Level ◽

The United States ◽

Bell’S Palsy ◽

Insurance Companies ◽

Bell's Palsy ◽

Tertiary Care Medical Center

Abstract Objective Our primary objective is to identify the costs associated with imaging in the diagnostic workup of uncomplicated Bell's palsy. Our secondary objective is to identify a dollar amount spent on extraneous diagnostic testing on a state and national level. Design and Setting Retrospective chart analysis was performed at our tertiary care medical center between 2007 and 2018. International Statistical Classification of Diseases-10 code G51.0 was used to identify patients with Bell's palsy seen by the senior author. A total of 163 patients were divided into two groups: those having received imaging and those diagnosed without imaging. The imaging group was then further subdivided by imaging modality: computed tomography (CT) only, magnetic resonance imaging (MRI) only, or both. There was a total of 138 scans in 115 patients. To quantify the amount spent by insurance companies or patients on these scans, net expected pay (NEP) for each modality was used as a representation of cost. The NEP for a CT was $618. The NEP for an MRI was $1,119. The NEP for both scans was $1,737. We extrapolated our results to a state and national level. Main Outcome Measurements Cost of workup; state and national economic burden. Results Extrapolating our data, we forecast that in Illinois and in the United States, over $2 million and $53 million, respectively, are spent on unnecessary imaging. Conclusion By highlighting an unnecessary financial burden, our study provides concrete evidence to support the American Academy of Otolaryngology's recommendation that clinicians should not perform routine imaging studies when diagnosing uncomplicated Bell's palsy.

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Identification of a Novel Clone, ST736, among Enterococcus faecium Clinical Isolates and Its Association with Daptomycin Nonsusceptibility

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02683-14 ◽

2014 ◽

Vol 58 (8) ◽

pp. 4848-4854 ◽

Cited By ~ 9

Author(s):

Guiqing Wang ◽

Sitharthan Kamalakaran ◽

Abhay Dhand ◽

Weihua Huang ◽

Caroline Ojaimi ◽

...

Keyword(s):

Enterococcus Faecium ◽

Medical Center ◽

Tertiary Care ◽

The United States ◽

Clinical Isolates ◽

Whole Genome Sequence ◽

Whole Genome ◽

Sequencing Analysis ◽

Content Type ◽

Tertiary Care Medical Center

ABSTRACTResistance to daptomycin in enterococcal clinical isolates remains rare but is being increasingly reported in the United States and worldwide. There are limited data on the genetic relatedness and microbiological and clinical characteristics of daptomycin-nonsusceptible enterococcal clinical isolates. In this study, we assessed the population genetics of daptomycin-nonsusceptibleEnterococcus faecium(DNSE) clinical isolates by multilocus sequence typing (MLST) and whole-genome sequencing analysis. Forty-two nonduplicate DNSE isolates and 43 randomly selected daptomycin-susceptibleE. faeciumisolates were included in the analysis. AllE. faeciumisolates were recovered from patients at a tertiary care medical center in suburban New York City from May 2009 through December 2013. The daptomycin MICs of the DNSE isolates ranged from 6 to >256 μg/ml. Three major clones ofE. faecium(ST18, ST412, and ST736) were identified among these clinical isolates by MLST and whole-genome sequence-based analysis. A newly recognized clone, ST736, was seen in 32 of 42 (76.2%) DNSE isolates and in only 14 of 43 (32.6%) daptomycin-susceptibleE. faeciumisolates (P< 0.0001). This report provides evidence of the association betweenE. faeciumclone ST736 and daptomycin nonsusceptibility. The identification and potential spread of this novelE. faeciumclone and its association with daptomycin nonsusceptibility constitute a challenge for patient management and infection control at our medical center.

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