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  1. Article ; Online: Duration of antibiotics through care transitions: A quality improvement initiative.

    Soto, Caitlin L / Dzintars, Kathryn / Keller, Sara C

    American journal of infection control

    2022  Volume 51, Issue 4, Page(s) 478–480

    Abstract: Antibiotic resistance is increasing worldwide and can be largely attributed to excess antibiotic use. At our institution, 75% of patients were prescribed excess antibiotic days and total duration of therapy was appropriate in only 24.5% of cases per the ... ...

    Abstract Antibiotic resistance is increasing worldwide and can be largely attributed to excess antibiotic use. At our institution, 75% of patients were prescribed excess antibiotic days and total duration of therapy was appropriate in only 24.5% of cases per the reviewers. Choice of antibiotic was appropriate in 70.4% of cases.
    MeSH term(s) Humans ; Anti-Bacterial Agents/therapeutic use ; Patient Transfer ; Quality Improvement ; Drug Resistance, Microbial ; Health Facilities
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2022-09-11
    Publishing country United States
    Document type Journal Article ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 392362-9
    ISSN 1527-3296 ; 0196-6553
    ISSN (online) 1527-3296
    ISSN 0196-6553
    DOI 10.1016/j.ajic.2022.09.001
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  2. Article ; Online: Development and implementation of a short duration antibiotic therapy algorithm for uncomplicated gram-negative bloodstream infections.

    Bae, Esther Y / Dzintars, Kathryn / Bernice, Fidelia / Tamma, Pranita D / Cosgrove, Sara E / Avdic, Edina

    Infection control and hospital epidemiology

    2021  Volume 42, Issue 9, Page(s) 1136–1138

    MeSH term(s) Algorithms ; Anti-Bacterial Agents/therapeutic use ; Humans ; Sepsis/drug therapy
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2021-05-04
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 639378-0
    ISSN 1559-6834 ; 0195-9417 ; 0899-823X
    ISSN (online) 1559-6834
    ISSN 0195-9417 ; 0899-823X
    DOI 10.1017/ice.2021.166
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  3. Article ; Online: Defining the Optimal Duration of Therapy for Hospitalized Patients With Complicated Urinary Tract Infections and Associated Bacteremia.

    McAteer, John / Lee, Jae Hyoung / Cosgrove, Sara E / Dzintars, Kathryn / Fiawoo, Suiyini / Heil, Emily L / Kendall, Ronald E / Louie, Ted / Malani, Anurag N / Nori, Priya / Percival, Kelly M / Tamma, Pranita D

    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

    2023  Volume 76, Issue 9, Page(s) 1604–1612

    Abstract: Background: Limited data are available to guide effective antibiotic durations for hospitalized patients with complicated urinary tract infections (cUTIs).: Methods: We conducted an observational study of patients ≥18 years at 24 US hospitals to ... ...

    Abstract Background: Limited data are available to guide effective antibiotic durations for hospitalized patients with complicated urinary tract infections (cUTIs).
    Methods: We conducted an observational study of patients ≥18 years at 24 US hospitals to identify the optimal treatment duration for patients with cUTI. To increase the likelihood patients experienced true infection, eligibility was limited to those with associated bacteremia. Propensity scores were generated for an inverse probability of treatment weighted analysis. The primary outcome was recurrent infection with the same species ≤30 days of completing therapy.
    Results: 1099 patients met eligibility criteria and received 7 (n = 265), 10 (n = 382), or 14 (n = 452) days of therapy. There was no difference in the odds of recurrent infection for patients receiving 10 days and those receiving 14 days of therapy (aOR: .99; 95% CI: .52-1.87). Increased odds of recurrence was observed in patients receiving 7 days versus 14 days of treatment (aOR: 2.54; 95% CI: 1.40-4.60). When limiting the 7-day versus 14-day analysis to the 627 patients who remained on intravenous beta-lactam therapy or were transitioned to highly bioavailable oral agents, differences in outcomes no longer persisted (aOR: .76; 95% CI: .38-1.52). Of 76 patients with recurrent infections, 2 (11%), 2 (10%), and 10 (36%) in the 7-, 10-, and 14-day groups, respectively, had drug-resistant infections (P = .10).
    Conclusions: Seven days of antibiotics appears effective for hospitalized patients with cUTI when antibiotics with comparable intravenous and oral bioavailability are administered; 10 days may be needed for all other patients.
    MeSH term(s) Humans ; Duration of Therapy ; Reinfection ; Retrospective Studies ; Anti-Bacterial Agents ; Urinary Tract Infections/drug therapy ; Bacteremia/complications ; Bacteremia/drug therapy
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2023-01-11
    Publishing country United States
    Document type Observational Study ; Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 1099781-7
    ISSN 1537-6591 ; 1058-4838
    ISSN (online) 1537-6591
    ISSN 1058-4838
    DOI 10.1093/cid/ciad009
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  4. Article ; Online: Infectious Diseases Consultation Associated With Reduced Mortality in Gram-Negative Bacteremia.

    Shulder, Stephanie / Tamma, Pranita D / Fiawoo, Suiyini / Dzintars, Kathryn / Escobar, Daniel / Livorsi, Daniel J / Malani, Anurag N / Palacio, Danica / Spivak, Emily S / Zimmerman, Matty / Bork, Jacqueline T

    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

    2023  Volume 77, Issue 9, Page(s) 1234–1237

    Abstract: Gram-negative bacteremia (GN-BSI) can cause significant morbidity and mortality, but the benefit of infectious diseases consultation (IDC) is not well defined. A 24-site observational cohort study of unique hospitalized patients with 4861 GN-BSI episodes ...

    Abstract Gram-negative bacteremia (GN-BSI) can cause significant morbidity and mortality, but the benefit of infectious diseases consultation (IDC) is not well defined. A 24-site observational cohort study of unique hospitalized patients with 4861 GN-BSI episodes demonstrated a 40% decreased risk of 30-day mortality in patients with IDC compared to those without IDC.
    MeSH term(s) Humans ; Communicable Diseases ; Cohort Studies ; Bacteremia ; Referral and Consultation ; Retrospective Studies ; Gram-Negative Bacterial Infections
    Language English
    Publishing date 2023-07-04
    Publishing country United States
    Document type Observational Study ; Journal Article
    ZDB-ID 1099781-7
    ISSN 1537-6591 ; 1058-4838
    ISSN (online) 1537-6591
    ISSN 1058-4838
    DOI 10.1093/cid/ciad383
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  5. Article ; Online: Identifying Effective Durations of Antibiotic Therapy for the Treatment of Carbapenem-resistant Enterobacterales Bloodstream Infections: A Multicenter Observational Study.

    Soto, Caitlin L / Hsu, Alice J / Lee, Jae Hyoung / Dzintars, Kathryn / Choudhury, Rebecca / Jenkins, Timothy C / McCreary, Erin K / Quartuccio, Katelyn S / Stohs, Erica J / Zimmerman, Matty / Tamma, Pranita D

    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

    2023  Volume 78, Issue 1, Page(s) 27–30

    Abstract: In a propensity-score-weighted cohort of 183 adults with carbapenem-resistant Enterobacterales bacteremia at 24 US hospitals, patients receiving short courses of active therapy (7-10 days, median 9 days) experienced similar odds of recurrent bacteremia ... ...

    Abstract In a propensity-score-weighted cohort of 183 adults with carbapenem-resistant Enterobacterales bacteremia at 24 US hospitals, patients receiving short courses of active therapy (7-10 days, median 9 days) experienced similar odds of recurrent bacteremia or death within 30 days as those receiving prolonged courses of active therapy (14-21 days, median 14 days).
    MeSH term(s) Adult ; Humans ; Sepsis ; Bacteremia/drug therapy ; Hospitals ; Anti-Bacterial Agents/pharmacology ; Anti-Bacterial Agents/therapeutic use ; Carbapenems/pharmacology ; Carbapenems/therapeutic use ; Microbial Sensitivity Tests ; Drug Combinations ; Ceftazidime
    Chemical Substances Anti-Bacterial Agents ; Carbapenems ; Drug Combinations ; Ceftazidime (9M416Z9QNR)
    Language English
    Publishing date 2023-08-13
    Publishing country United States
    Document type Multicenter Study ; Observational Study ; Journal Article ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 1099781-7
    ISSN 1537-6591 ; 1058-4838
    ISSN (online) 1537-6591
    ISSN 1058-4838
    DOI 10.1093/cid/ciad476
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  6. Article ; Online: Role of Metronidazole in Mild Clostridium difficile Infections.

    Fabre, Valeria / Dzintars, Kathryn / Avdic, Edina / Cosgrove, Sara E

    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

    2018  Volume 67, Issue 12, Page(s) 1956–1958

    MeSH term(s) Adult ; Child ; Clostridium Infections ; Clostridium difficile ; Humans ; Metronidazole
    Chemical Substances Metronidazole (140QMO216E)
    Language English
    Publishing date 2018-05-31
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 1099781-7
    ISSN 1537-6591 ; 1058-4838
    ISSN (online) 1537-6591
    ISSN 1058-4838
    DOI 10.1093/cid/ciy474
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  7. Article ; Online: Progressive Development of Cefiderocol Resistance in Escherichia coli During Therapy is Associated With an Increase in blaNDM-5 Copy Number and Gene Expression.

    Simner, Patricia J / Mostafa, Heba H / Bergman, Yehudit / Ante, Michael / Tekle, Tsigereda / Adebayo, Ayomikun / Beisken, Stephan / Dzintars, Kathryn / Tamma, Pranita D

    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

    2021  Volume 75, Issue 1, Page(s) 47–54

    Abstract: Background: As cefiderocol is increasingly being prescribed in clinical practice, it is critical that we understand key mechanisms contributing to acquired resistance to this agent.: Methods: We describe a patient with acute lymphoblastic leukemia ... ...

    Abstract Background: As cefiderocol is increasingly being prescribed in clinical practice, it is critical that we understand key mechanisms contributing to acquired resistance to this agent.
    Methods: We describe a patient with acute lymphoblastic leukemia and a New Delhi metallo-ß-lactamase (NDM)-5-producing Escherichia coli intra-abdominal infection in whom resistance to cefiderocol evolved approximately 2 weeks after the start of treatment. Through whole-genome sequencing (WGS), messenger RNA expression studies, and ethylenediaminetetraacetic acid inhibition analysis, we investigated the role of increased NDM-5 production and genetic mutations contributing to the development of cefiderocol resistance, using 5 sequential clinical E. coli isolates obtained from the patient.
    Results: In all 5 isolates, blaNDM-5 genes were identified. The minimum inhibitory concentrations for cefiderocol were 2, 4, and >32 μg/mL for isolates 1-2, 3, and 4-5, respectively. WGS showed that isolates 1-3 contained a single copy of the blaNDM-5 gene, whereas isolates 4 and 5 had 5 and 10 copies of the blaNDM-5 gene, respectively, on an IncFIA/FIB/IncFII plasmid. These findings were correlated with those of blaNDM-5 messenger RNA expression analysis, in which isolates 4 and 5 expressed blaNDM-5 1.7- and 2.8-fold, respectively, compared to, isolate 1. Synergy testing with the combination of ceftazidime-avibactam and aztreonam demonstrated expansion of the zone of inhibition between the disks for all isolates. The patient was successfully treated with this combination and remained infection free 1 year later.
    Conclusions: The findings in our patient suggest that increased copy numbers of blaNDM genes through translocation events are used by Enterobacterales to evade cefiderocol-mediated cell death. The frequency of increased blaNDM-5 expression in contributing to cefiderocol resistance needs investigation.
    MeSH term(s) Anti-Bacterial Agents/pharmacology ; Anti-Bacterial Agents/therapeutic use ; Cephalosporins ; DNA Copy Number Variations ; Drug Resistance, Multiple, Bacterial/genetics ; Escherichia coli/genetics ; Escherichia coli Infections/drug therapy ; Gene Expression ; Humans ; Microbial Sensitivity Tests ; Plasmids ; RNA, Messenger ; beta-Lactamases/genetics ; Cefiderocol
    Chemical Substances Anti-Bacterial Agents ; Cephalosporins ; RNA, Messenger ; beta-Lactamases (EC 3.5.2.6)
    Language English
    Publishing date 2021-10-06
    Publishing country United States
    Document type Case Reports ; Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 1099781-7
    ISSN 1537-6591 ; 1058-4838
    ISSN (online) 1537-6591
    ISSN 1058-4838
    DOI 10.1093/cid/ciab888
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  8. Article ; Online: A healthcare worker and patient-informed approach to oral antibiotic decision making during the hospital-to-home transition.

    Sharara, Sima L / Arbaje, Alicia I / Cosgrove, Sara E / Gurses, Ayse P / Dzintars, Kathryn / Ladikos, Nicholas / Qasba, S Sonia / Keller, Sara C

    Infection control and hospital epidemiology

    2021  Volume 42, Issue 10, Page(s) 1266–1271

    Abstract: In a qualitative study of healthcare workers and patients discharged on oral antibiotics, we identified 5 barriers to antibiotic decision making at hospital discharge: clinician perceptions of patient expectations, diagnostic uncertainty, attending ... ...

    Abstract In a qualitative study of healthcare workers and patients discharged on oral antibiotics, we identified 5 barriers to antibiotic decision making at hospital discharge: clinician perceptions of patient expectations, diagnostic uncertainty, attending physician-led versus multidisciplinary team culture, not accounting for total antibiotic duration, and need for discharge prior to complete data.
    MeSH term(s) Anti-Bacterial Agents/therapeutic use ; Decision Making ; Health Personnel ; Hospitals ; Humans ; Patient Discharge
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2021-01-21
    Publishing country United States
    Document type Journal Article ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 639378-0
    ISSN 1559-6834 ; 0195-9417 ; 0899-823X
    ISSN (online) 1559-6834
    ISSN 0195-9417 ; 0899-823X
    DOI 10.1017/ice.2020.1383
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  9. Article ; Online: Hospital-acquired infections among adult patients admitted for coronavirus disease 2019 (COVID-19).

    Smith, Leigh / Karaba, Sara M / Amoah, Joe / Jones, George / Avery, Robin K / Dzintars, Kathryn / Helsel, Taylor / Cosgrove, Sara E / Fabre, Valeria

    Infection control and hospital epidemiology

    2021  Volume 43, Issue 8, Page(s) 1054–1057

    Abstract: In a multicenter cohort of 963 adults hospitalized due to coronavirus disease 2019 (COVID-19), 5% had a proven hospital-acquired infection (HAI) and 21% had a proven, probable, or possible HAI. Risk factors for proven or probable HAIs included intensive ... ...

    Abstract In a multicenter cohort of 963 adults hospitalized due to coronavirus disease 2019 (COVID-19), 5% had a proven hospital-acquired infection (HAI) and 21% had a proven, probable, or possible HAI. Risk factors for proven or probable HAIs included intensive care unit admission, dexamethasone use, severe COVID-19, heart failure, and antibiotic exposure upon admission.
    MeSH term(s) Adult ; COVID-19/epidemiology ; Cross Infection/epidemiology ; Cross Infection/etiology ; Hospitalization ; Hospitals ; Humans ; Intensive Care Units ; Risk Factors
    Language English
    Publishing date 2021-04-13
    Publishing country United States
    Document type Journal Article ; Multicenter Study ; Research Support, N.I.H., Extramural
    ZDB-ID 639378-0
    ISSN 1559-6834 ; 0195-9417 ; 0899-823X
    ISSN (online) 1559-6834
    ISSN 0195-9417 ; 0899-823X
    DOI 10.1017/ice.2021.148
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  10. Article ; Online: Development of an antimicrobial stewardship module in an electronic health record: Options to enhance daily antimicrobial stewardship activities.

    Dzintars, Kathryn / Fabre, Valeria M / Avdic, Edina / Smith, Janessa / Adams-Sommer, Victoria / Townsend, Jennifer / Jenh Hsu, Alice / Cosgrove, Sara E

    American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists

    2021  Volume 78, Issue 21, Page(s) 1968–1976

    Abstract: Purpose: The purpose of this manuscript is to describe our experience developing an antimicrobial stewardship (AS) module as a clinical decision support tool in the Epic electronic health record (EHR).: Summary: Clinical decision support systems ... ...

    Abstract Purpose: The purpose of this manuscript is to describe our experience developing an antimicrobial stewardship (AS) module as a clinical decision support tool in the Epic electronic health record (EHR).
    Summary: Clinical decision support systems within the EHR can be used to decrease use of broad-spectrum antibiotics, improve antibiotic selection and dosing, decrease adverse effects, reduce antibiotic costs, and reduce the development of antibiotic resistance. The Johns Hopkins Hospital constructed an AS module within Epic. Customized stewardship alerts and scoring systems were developed to triage patients requiring stewardship intervention. This required a multidisciplinary approach with a team comprising AS physicians and pharmacists and Epic information technology personnel, with assistance from clinical microbiology and infection control when necessary. In addition, an intervention database was enhanced with stewardship-specific interventions, and workbench reports were developed specific to AS needs. We herein review the process, advantages, and challenges associated with the development of the Epic AS module.
    Conclusion: Customizing an AS module in an EHR requires significant time and expertise in antimicrobials; however, AS modules have the potential to improve the efficiency of AS personnel in performing daily stewardship activities and reporting through a single system.
    MeSH term(s) Anti-Bacterial Agents/therapeutic use ; Anti-Infective Agents ; Antimicrobial Stewardship ; Decision Support Systems, Clinical ; Electronic Health Records ; Humans
    Chemical Substances Anti-Bacterial Agents ; Anti-Infective Agents
    Language English
    Publishing date 2021-06-21
    Publishing country England
    Document type Journal Article
    ZDB-ID 1224627-x
    ISSN 1535-2900 ; 1079-2082
    ISSN (online) 1535-2900
    ISSN 1079-2082
    DOI 10.1093/ajhp/zxab222
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