Keith S Kaye

Wayne State University, Detroit, Michigan, United States

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Publications (292)978.11 Total impact

  • 12/2015; 4(1). DOI:10.1186/s13756-015-0057-4
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    ABSTRACT: OBJECTIVE To characterize the epidemiology of multidrug-resistant (MDR) Acinetobacter baumannii colonization in high-risk nursing home (NH) residents. DESIGN Nested case-control study within a multicenter prospective intervention trial. SETTING Four NHs in Southeast Michigan. PARTICIPANTS Case patients and control subjects were NH residents with an indwelling device (urinary catheter and/or feeding tube) selected from the control arm of the Targeted Infection Prevention study. Cases were residents colonized with MDR (resistant to ≥3 classes of antibiotics) A. baumannii; controls were never colonized with MDR A. baumannii. METHODS For active surveillance cultures, specimens from the nares, oropharynx, groin, perianal area, wounds, and device insertion site(s) were collected upon study enrollment, day 14, and monthly thereafter. A. baumannii strains and their susceptibilities were identified using standard microbiologic methods. RESULTS Of 168 NH residents, 25 (15%) were colonized with MDR A. baumannii. Compared with the 143 controls, cases were more functionally disabled (Physical Self-Maintenance Score >24; odds ratio, 5.1 [95% CI, 1.8-14.9]; P<.004), colonized with Proteus mirabilis (5.8 [1.9-17.9]; P<.003), and diabetic (3.4 [1.2-9.9]; P<.03). Most cases (22 [88%]) were colonized with multiple antibiotic-resistant organisms and 16 (64%) exhibited co-colonization with at least one other resistant gram-negative bacteria. CONCLUSION Functional disability, P. mirabilis colonization, and diabetes mellitus are important risk factors for colonization with MDR A. baumannii in high-risk NH residents. A. baumannii exhibits widespread antibiotic resistance and a preference to colonize with other antibiotic-resistant organisms, meriting enhanced attention and improved infection control practices in these residents.
    Infection Control and Hospital Epidemiology 06/2015; DOI:10.1017/ice.2015.143 · 3.94 Impact Factor
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    ABSTRACT: OBJECTIVE To develop an automated method for ventilator-associated condition (VAC) surveillance and to compare its accuracy and efficiency with manual VAC surveillance SETTING The intensive care units (ICUs) of 4 hospitals METHODS This study was conducted at Detroit Medical Center, a tertiary care center in metropolitan Detroit. A total of 128 ICU beds in 4 acute care hospitals were included during the study period from August to October 2013. The automated VAC algorithm was implemented and utilized for 1 month by all study hospitals. Simultaneous manual VAC surveillance was conducted by 2 infection preventionists and 1 infection control fellow who were blinded to each another's findings and to the automated VAC algorithm results. The VACs identified by the 2 surveillance processes were compared. RESULTS During the study period, 110 patients from all the included hospitals were mechanically ventilated and were evaluated for VAC for a total of 992 mechanical ventilation days. The automated VAC algorithm identified 39 VACs with sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 100%. In comparison, the combined efforts of the IPs and the infection control fellow detected 58.9% of VACs, with 59% sensitivity, 99% specificity, 91% PPV, and 92% NPV. Moreover, the automated VAC algorithm was extremely efficient, requiring only 1 minute to detect VACs over a 1-month period, compared to 60.7 minutes using manual surveillance. CONCLUSIONS The automated VAC algorithm is efficient and accurate and is ready to be used routinely for VAC surveillance. Furthermore, its implementation can optimize the sensitivity and specificity of VAC identification. Infect Control Hosp Epidemiol 2015;00(0):1-5.
    Infection Control and Hospital Epidemiology 06/2015; DOI:10.1017/ice.2015.127 · 3.94 Impact Factor
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    ABSTRACT: Epidemiological characteristics of patients with bloodstream infections (BSI) due to extended-spectrum β-lactamase producing (ESBL) and carbapenem-resistant (CRE) strains are often similar. Mortality rates for CRE BSI are 70 %, and mean time to initiation of appropriate therapy is ~5 days. A bedside score was developed to differentiate CRE-BSIs from ESBL-BSIs, in order to help decrease the time to initiation of appropriate therapy for CRE and mortality rates. Score was developed based of data (2007-2010) abstracted from charts of adult patients from Assaf Harofeh Medical Center (AHMC, Zeriffin, Israel), and validated on a cohort of patients from Detroit Medical Center (DMC, MI, USA). A multivariate model for presence of CRE was generated. A clinical prediction score and ROC curve was derived. 451 patients with ESBL BSIs (285 from AHMC and 166 from DMC) and 74 patients with CRE BSIs (58 from AHMC and 16 from DMC) were included. The prediction score included chemotherapy in the past 3 months (19 points), presence of foreign invasive devices (10 points), no peripheral vascular disease (10 points), reduced consciousness or cognition at time of acute illness (9 points), time in hospital prior to BSI ≥ 3 days (7 points), and age younger than 65 years (6 points). A score of ≥32 to define "high CRE risk" had sensitivity of 59 %, specificity of 76 %, PPV of 34 % and NPV of 90 %. The score's 90 % NPV implies it could reduce un-necessary (and toxic) empiric use of anti-CRE therapeutics, but this should be studied prospectively and on broader populations in order to test its potential role in reducing mortality.
    Annals of Clinical Microbiology and Antimicrobials 06/2015; 14(1):31. DOI:10.1186/s12941-015-0088-y · 1.51 Impact Factor
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    ABSTRACT: A recent, frequently quoted study has suggested that for bloodstream infections (BSIs) due to extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL) Escherichia coli, treatment with β-lactam/β-lactamase inhibitors (BLBLIs) might be equivalent to treatment with carbapenems. However, the majority of BSIs originate from the urinary tract. A multicenter, multinational efficacy analysis was conducted from 2010 to 2012 to compare outcomes of patients with non-urinary ESBL BSIs who received a carbapenem (69 patients) vs those treated with piperacillin-tazobactam (10 patients). In multivariate analysis, therapy with piperacillin-tazobactam was associated with increased 90-day mortality (adjusted odds ratio, 7.9, P=.03). For ESBL BSIs of a non-urinary origin, carbapenems should be considered a superior treatment to BLBLIs. Infect Control Hosp Epidemiol 2015;00(0):1-5.
    Infection Control and Hospital Epidemiology 05/2015; DOI:10.1017/ice.2015.101 · 3.94 Impact Factor
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    ABSTRACT: OBJECTIVE To determine the rates of and risk factors for tigecycline nonsusceptibility among carbapenem-resistant Klebsiella pneumoniae (CRKPs) isolated from hospitalized patients DESIGN Multicenter prospective observational study SETTING Acute care hospitals participating in the Consortium on Resistance against Carbapenems in Klebsiella pneumoniae (CRaCKle) PATIENTS A cohort of 287 patients who had CRKPs isolated from clinical cultures during hospitalization METHODS For the period from December 24, 2011 to October 1, 2013, the first hospitalization of each patient with a CRKP during which tigecycline susceptibility for the CRKP isolate was determined was included. Clinical data were entered into a centralized database, including data regarding pre-hospital origin. Breakpoints established by the European Committee on Antimicrobial Susceptibility Testing (EUCAST) were used to interpret tigecycline susceptibility testing. RESULTS Of 287 patients included in the final cohort, 155 (54%) had tigecycline-susceptible CRKPs. Of all index isolates, 81 (28%) were tigecycline-intermediate and 51 (18%) were tigecycline resistant. In multivariate modeling, independent risk factors for tigecycline nonsusceptibility were (1) admission from a skilled nursing facility (OR, 2.51; 95% CI, 1.51-4.21; P=.0004), (2) positive culture within 2 days of admission (OR, 1.82; 95% CI, 1.06-3.15; P=.03), and (3) receipt of tigecycline within 14 days (OR, 4.38, 95% CI, 1.37-17.01, P=.02). CONCLUSIONS In hospitalized patients with CRKPs, tigecycline nonsusceptibility was more frequently observed in those admitted from skilled nursing facilities and occurred earlier during hospitalization. Skilled nursing facilities are an important target for interventions to decrease antibacterial resistance to antibiotics of last resort for treatment of CRKPs. Infect Control Hosp Epidemiol 2015;00(0):1-7.
    Infection Control and Hospital Epidemiology 05/2015; DOI:10.1017/ice.2015.118 · 3.94 Impact Factor
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    ABSTRACT: Ceftaroline fosamil is a novel cephalosporin with bactericidal activity against common pathogens associated with hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP). Ceftaroline is inactive against extended-spectrum β-lactamase-producing or AmpC-overexpressing Enterobacteriaceae and has limited activity against Pseudomonas aeruginosa. CAPTURE is a multicenter, retrospective study designed to collect information on contemporary clinical use of ceftaroline fosamil in the USA. Data on off-label use of ceftaroline fosamil for the treatment of patients with HAP/VAP between September 2013 and March 2014 are presented. Data were collected at participating study centers by randomized selection and review of patients' charts, and included patients' demographics, disease characteristics, pathogens isolated, antibiotic treatment and clinical outcomes. Patients receiving at least four consecutive doses of ceftaroline fosamil, with data available for determination of clinical cure, comprised the evaluable population. Clinical success was defined as either clinical cure with no further need for antibiotics treatment, or clinical improvement with a switch to another antibiotic. A total of 40 patients were evaluated: 27 with HAP and 13 with VAP. Demographics for patients with HAP and VAP were similar (59% male, mean age of 63 years and 54% male, mean age of 58 years, respectively). The clinical success rates were 75% overall, 82% in patients with HAP and 62% in patients with VAP. Clinical success rates for patients with methicillin-resistant Staphylococcus aureus (MRSA) isolated were 58% in patients with HAP and 57% in patients with VAP. Ceftaroline fosamil was used as a second-line therapy in majority of patients (85%) with clinical success rates of 79% similar to the published literature. The CAPTURE study data support further evaluation of ceftaroline fosamil as an effective treatment option for HAP and VAP when a ceftaroline susceptible etiologic pathogen is identified, including MRSA, or as a concurrent therapy when resistant Gram-negative pathogens are suspected.
    05/2015; DOI:10.1080/21548331.2015.1037228
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    ABSTRACT: Antimicrobial resistance in Gram-negative bacteria is an emerging and serious global public health threat. Carbapenems have been used as the “last-line” treatment for infections caused by resistant enterobacteriaceae, including those producing extended spectrum ß-lactamases. However, enterobacteriaceae that produce carbapenemases, which are enzymes that deactivate carbapenems and most other ß-lactam antibiotics, have emerged and are increasingly being reported worldwide. Despite this increasing burden, the most optimal treatment for carbapenem-resistant enterobacteriaceae (CRE) infections is largely unknown. For the few remaining available treatment options, there is limited efficacy data to support their role in therapy. Nevertheless, current treatment options include the use of older agents, such as polymyxins, fosfomycin, and aminoglycosides, which have been rarely used due to efficacy and/or toxicity concerns. Optimization of dosing regimens and combination therapy are additional treatment strategies being explored. CRE infections are associated with poor outcomes and high mortality. Continued research is critically needed to determine the most appropriate treatment.
    05/2015; 2(2). DOI:10.1093/ofid/ofv050
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    ABSTRACT: Extended-spectrum β-lactamase (ESBL)-producing pathogens represent increasing challenges to physicians because of rising prevalence, high mortality, and challenging treatment. Identifying high risks and early appropriate therapy is critical to favorable outcomes. This is a 5-year retrospective case-case-control study performed at the Detroit Medical Center on adult patients with bloodstream infection (BSI) caused by ESBL-producing and non-ESBL-producing Escherichia coli or Klebsiella pneumoniae, each compared with uninfected controls. Data were collected from December 2004-August 2009. Multivariate analysis was performed using logistic regression. Participants included 103 patients with BSI caused by ESBL-producing pathogens and 79 patients with BSI caused by pathogens that did not produce ESBLs. The mean age of patients in the ESBL group was 67 years; of the patients, 51% were men, 77% were black, and 38% (n = 39) died in hospital. The mean age of patients in the non-ESBL group was 58 years; of the patients, 51% were men, 92% were black, and 22% (n = 17) died in hospital. On multivariate analysis, predictors of BSI caused by ESBL-producing pathogens included central venous catheter (odds ratio [OR], 29.4; 95% confidence interval [CI], 3.0-288.3), prior β-lactam-/β-lactamase-inhibitor therapy (OR, 28.1; 95% CI, 1.99-396.5), and prior cefepime therapy (OR, 22.7; 95% CI, 2.7-192.4). The only risk factor for BSI caused by non-ESBL-producing pathogens was urinary catheter insertion (OR, 18.2; 95% CI, 3.3-100.3). Prior antimicrobial therapy, particularly with β-lactam, was the strongest unique risk factor for BSI caused by ESBL-producing E coli or K pneumoniae. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
    American journal of infection control 04/2015; DOI:10.1016/j.ajic.2015.02.030 · 2.33 Impact Factor
  • Infection Control and Hospital Epidemiology 04/2015; 36(04):1-12. DOI:10.1017/ice.2014.79 · 3.94 Impact Factor
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    ABSTRACT: Both Clostidium difficile infection (CDI) rates in hospitals and interest in reducing 30-day readmission rates have increased dramatically in the United States. The objective of this study was to characterize the burden of CDI on 30-day hospital readmissions at a tertiary care health-system. A patient discharge database was used to identify patients with a CDI diagnosis (ICD-9 code 008.45) during their stay in 2012. Patients were classified as index admissions (CDI discharges) or 30-day readmissions (CDI readmissions). Readmission rates, length of stay (LOS), and time to readmission were assessed among CDI readmissions. Among discharges from the health system (n = 51,353), 615 were diagnosed with CDI (1%). Thirty-day readmissions were more common among CDI discharges (30.1%) than non-CDI discharges (14.4%). Average LOS for CDI readmissions was 5-6 days longer than non-CDI readmissions. Time to readmission was shorter among CDI discharges diagnosed on admission than CDI discharges diagnosed later during their hospital stay (median, 7 days). Reductions in hospital-onset CDI and readmission of patients with an index CDI can provide tremendous cost savings to hospitals. This calls for better infection control and antibiotic stewardship measures toward CDI management in the hospital and as patients transition to the next level of care. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
    American journal of infection control 04/2015; 43(4). DOI:10.1016/j.ajic.2014.11.004 · 2.33 Impact Factor
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    ABSTRACT: The Clinical Assessment Program and Teflaro(®) Utilization Registry (CAPTURE) is a multicenter registry study of acute bacterial skin and skin structure infection (ABSSSI) and community-acquired bacterial pneumonia (CABP) patients treated with ceftaroline fosamil in the US. Data for this analysis were collected between August 2011 and February 2013 at US study centres by randomly ordered chart review. Clinical success rates among ABSSSI patients were >81% when ceftaroline fosamil was used as first- or second-line therapy, including monotherapy and concurrent therapy. Among CABP patients, clinical success rates were >77% among first-line and second-line patients and patients who received first-line concurrent therapy or second line monotherapy or concurrent therapy. For CABP patients treated with ceftaroline fosamil as first-line monotherapy, the clinical success rate was 70%. Ceftaroline fosamil is an effective treatment option for patients with ABSSSI or CABP with similar clinical success rates when used as first-line or second-line treatment.
    Journal of chemotherapy (Florence, Italy) 03/2015; DOI:10.1179/1973947815Y.0000000010 · 1.07 Impact Factor
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    ABSTRACT: Portable electronic devices are increasingly being used in the hospital setting. As with other fomites, these devices represent a potential reservoir for the transmission of pathogens. We conducted a convenience sampling of devices in 2 large medical centers to identify bacterial colonization rates and potential risk factors. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
    American Journal of Infection Control 03/2015; 37(3). DOI:10.1016/j.ajic.2014.11.013 · 2.33 Impact Factor
  • Jisha John, Kyle Miletic, Keith S. Kaye
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    ABSTRACT: The aging population undergoes anatomical, physiological, and environmental changes, which puts them at increased risk for skin and skin structure infections. Skin and skin structure infections in older adults can range from simple cellulitis to life-threatening necrotizing fasciitis. Infections occur in both the community and healthcare settings. Understanding the pathophysiology of these infections, risk factors, microbiology, and antimicrobial resistance trends can help clinicians to manage effectively these infections. Antimicrobial therapy is an important component of management and is impacted by risk for methicillin-resistant Staphylococcus aureus (MRSA). Early diagnosis and prevention of infection recurrences are also important components in the management of skin and skin structure infections in older adults.
    03/2015; 4(1). DOI:10.1007/s13670-014-0113-6
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    ABSTRACT: Objectives: Acinetobacter baumannii is an emerging opportunistic nosocomial pathogen. Two factors that may enhance persistence in healthcare settings are antimicrobial resistance and biofilm-forming ability. The aim of this work was to determine whether A. baumannii isolates that persist in healthcare settings (endemic), can be differentiated from sporadic isolates based upon their ability to resist antibiotics and their biofilm-forming capability. Methods: Two hundred and ninety A. baumannii isolates were isolated over 17 months in the Detroit Medical Center. The isolates were genotyped using repetitive extragenic palindromic-PCR (REP-PCR). REP-types appearing greater than 10–times during active surveillance were considered endemic. The in vitro biofilm-forming ability and antibiotic resistance profile of each isolate were evaluated. Isolates were tested for the presence of two genetic markers - one implicated in biofilm formation (bap) and the other in antibiotic resistance (blaOXA-23). Results: Of the 290 isolates evaluated, 84% carried bap and 36% carried blaOXA-23. Five unique REP-PCR banding-types were detected >10 times (endemic) and constituted 58% of the 290 isolates. These five endemic REP-PCR types were 5.1 times more likely than sporadic isolates to carry both bap and blaOXA-23. Furthermore, endemic isolates were resistant to 3 more antibiotic classes, on average, than sporadic isolates and four of the five endemic REP-PCR types formed denser biofilms in vitro than sporadic isolates. Conclusions: Endemic A. baumannii isolates are more likely than sporadic isolates to possess factors that increase its virulence and enhance survival within a large healthcare system.
    Frontiers in Microbiology 02/2015; 6. DOI:10.3389/fmicb.2015.00182 · 3.94 Impact Factor
  • JAMA The Journal of the American Medical Association 02/2015; 313(6):630. DOI:10.1001/jama.2014.17448 · 30.39 Impact Factor
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    ABSTRACT: In the face of diminishing therapeutic options for the treatment of infections caused by multidrug-resistant, Gram-negative bacteria, dinicians are increasingly using colistin and polymyxin B. These antibiotics became available clinically in the 1950s, when understanding of antimicrobial pharmacology and regulatory requirements for approval of drugs was substantially less than today. At the 1st International Conference on Polymyxins in Prato, Italy, 2013, participants discussed a set of key objectives that were developed to explore the factors affecting the safe and effective use of polymuxins, identify the gaps in knowledge, and set priorities for future research. Participants identified several factors that affect the optimum use of polymyxins, including: confusion caused by several different conventions used to describe doses of colistin; an absence of appropriate pharmacopoeial standards for polymyxins; outdated and diverse product information; and uncertainties about susceptibility testing and breakpoints. High-priority areas for research included: better definition of the effectiveness of polymyxin-based combination therapy compared with monotherapy via well designed, randomised controlled trials; examination of the relative merits of colistin versus polymyxin B for various types of infection; investigation of pharmacokinetics in special patient populations; and definition of the role of nebulised polymyxins alone or in combination with intravenous polymyxins for the treatment of pneumonia. The key areas identified provide a roadmap for action regarding the continued use of polymyxins, and are intended to help with the effective and safe use of these important, last-line antibiotics.
    The Lancet Infectious Diseases 02/2015; 15(2):225-234. DOI:10.1016/S1473-3099(14)70850-3 · 19.45 Impact Factor
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    ABSTRACT: The past decade has brought a significant rise in antimicrobial resistance, and the ESKAPE pathogens have become a significant threat to public health. Three epidemiological features that negatively impact patients, which are consistently seen with the ESKAPE pathogens, are the following: 1) there has been a rise in incidence of these organisms as causative human pathogens, 2) there has been a significant increase in antimicrobial resistance in these bacterial species, and 3) the infections caused by these resistant strains are associated with worse outcomes when compared with infections caused by their susceptible counterparts. Significant delays in time to appropriate antimicrobial therapy of up to 5 days have been reported in infections due to these organisms and this is the strongest predictor of mortality with ESKAPE pathogens, particular in critically ill patients, where every hour delay has an incremental survival disadvantage for patients. Strategies to decrease these delays are urgently needed. Although routine broad-spectrum empiric coverage for these organisms would ideally limit this delay, agents with activity against these organisms are sometimes less effective, have significant toxicity risk, and their use can result in the development of resistance. Therefore, strategies to optimize therapy, although limiting unnecessary use of broad-spectrum antimicrobials, are urgently needed. This review will discuss potential strategies to optimize empiric therapy in the age of multi-drug resistance, the limitations of these strategies, and will discuss future directions and opportunities. Copyright © 2015 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
    Clinical Microbiology and Infection 01/2015; 21(4). DOI:10.1016/j.cmi.2014.12.025 · 5.20 Impact Factor
  • Infection Control and Hospital Epidemiology 01/2015; 36(03):346 - 349. · 3.94 Impact Factor

Publication Stats

6k Citations
978.11 Total Impact Points

Institutions

  • 2008–2015
    • Wayne State University
      • • School of Medicine
      • • Division of Infectious Diseases
      Detroit, Michigan, United States
  • 2009–2014
    • Detroit Medical Center
      Detroit, Michigan, United States
  • 2013
    • Sinai-Grace Hospital
      Detroit, Michigan, United States
  • 2012
    • Harper University Hospital
      Detroit, Michigan, United States
  • 2002–2012
    • Duke University
      • Department of Medicine
      Durham, North Carolina, United States
  • 2009–2010
    • University of Detroit Mercy
      Detroit, Michigan, United States
  • 2000–2009
    • Duke University Medical Center
      • • Division of Infectious Diseases
      • • Department of Medicine
      Durham, NC, United States
  • 2006
    • Tel Aviv Sourasky Medical Center
      • Geriatrics
      Tell Afif, Tel Aviv, Israel
  • 2002–2005
    • University of Maryland, Baltimore
      • Department of Medicine
      Baltimore, MD, United States
  • 2004
    • Campbell University
      North Carolina, United States
    • University of Utah
      Salt Lake City, Utah, United States
  • 2000–2001
    • Beth Israel Deaconess Medical Center
      • Division of Infectious Diseases
      Boston, MA, United States