Houssein Jahamy

St. John's Medical Center, Jackson, Wyoming, United States

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Publications (6)2.99 Total impact

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    ABSTRACT: Concerns regarding the poor response of severe Clostridium difficile infection (CDI) treated with metronidazole have arisen over the last 5 y. We conducted a prospective, non-interventional study of CDI cases at our institution to evaluate the role of drug resistance, co-morbidities, and the emergence of hypervirulent strains on patient outcomes. A total of 118 adult inpatients with diarrhea and a positive stool for C. difficile toxin immunoassay had positive stool cultures and were included in the study. All 118 isolates had vancomycin and metronidazole susceptibility testing via the E-test method; rep-PCR was performed on 47 isolates. Of the 118 study patients, 107 were treated with either metronidazole or vancomycin. Initial therapy was metronidazole in 98.1% (n = 105) and vancomycin in 1.9% (n = 2) patients. Evaluable clinical response within 5 days of treatment was noted in 52.5% (52/99) of cases. The mean duration of treatment was 11.7 ± 7.2 days. The 30-day all-cause mortality rate was 24.6% (29/118). Recurrence occurred in 23.6% (21/89). A recent stay in the intensive care unit was associated with increased 30-day mortality (odds ratio 3.58, p = 0.012). There were no isolates resistant to metronidazole or vancomycin. Only 1 isolate was possibly related to the NAP1/BI/027 reference strain. No strain-related differences in deaths or recurrence were noted. Deaths related to CDI in our study appear to be related to multiple factors and did not appear to be independently related to antibiotic susceptibility, strain type, or treatment duration.
    Scandinavian Journal of Infectious Diseases 11/2011; 44(4):243-9. DOI:10.3109/00365548.2011.631029 · 1.50 Impact Factor
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    ABSTRACT: We assessed the role of Panton-Valentine leukocidin (PVL) and SCCmec type in community associated (CA) and healthcare associated (HC) Staphylococcus aureus (SA) skin/soft-tissue infections (STI). We prospectively monitored microbiology results (11 January 2005 to 6 January 2006), screened inpatients with SA in tissue samples or blood, and selected adults with STI. We recorded clinical/microbiological characteristics, and tested saved isolates for PVL genes (real time PCR) and SCCmec type (conventional multiplex PCR). We encountered 204 patients. MRSA strains that accounted for 70.5% CA and 66.0% HC cases, caused more abscesses (55.7% vs 29.7%; p =0.001) and were often PVL-positive (68.9% vs 4.8%; p <0.001). PVL-positive isolates caused more abscesses (72.9% vs 26.5%; p <0.001) but similar bacteremia (7.3% vs 7.1%). SCCmec IVa made up 95.8% of PVL-positive strains and accounted for 69.8% of the abscesses. SCCmec II caused higher mortality (14.8% vs 0-3.1%; p = 0.02). PVL was a predictor of abscesses (p <0.001). Predictors of bacteremia were age > or = 65 y (p =0.004), necrotizing infection (p =0.014), and head/neck location (p =0.05). These findings suggest that SCCmec type and PVL status influence STI manifestations and contribute to MRSA-MSSA differences. PVL is implicated in abscess formation but not bacteremia. Bacteremia is likely related to host condition and/or other virulence factors that were not studied.
    Infectious Diseases 01/2008; 40(8):601-6. DOI:10.1080/00365540701877312 · 1.50 Impact Factor
  • Basel Al Raiy · Houssein Jahamy · Mohamad G. Fakih · Riad Khatib ·
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    ABSTRACT: Purpose: To study clinicians' approach to distinguishing urinary tract infection (UTI) with sepsis from inconsequential bacteriuria with fever from other sources in the intensive care units (ICUs). Materials and Methods: The microbiology results (November 1, 2004-March 31, 2005) were retrospectively screened. All adult ICU patients with positive urine culture (≥105 colony-forming unit per milliliter) were identified, and their medical records were reviewed. The following information was recorded: demographics, comorbidity, vital signs, urinary catheter placement, and antibiotic treatment. The incidence of diarrhea was estimated based on the number of stool samples submitted for culture and Clostridium difficile tests. Results: We encountered 90 evaluable cases. Their age was 62.9 ± 17.6 years; 80 (89%) had indwelling catheters, 66 (73.3%) had leukocytosis (>113 white blood cell counts per microliter), 42 (46.7%) were febrile (≥38.3°C) or septic, and 5 (5.6%) had urinary symptoms. Other possible causes for fever/sepsis were present in 28 (70.0%) febrile/septic patients. Clinicians opted to initiate antibiotics in 43 (91.5%) of 47 patients with fever/sepsis or urinary symptoms (27 of 30 with other causes, 11 of 12 patients without other causes, and 5 of 5 with urinary symptoms without fever) and 25 (58.1%) of 43 patients without symptoms or fever/sepsis. The majority (86.0%) of asymptomatic patients had indwelling catheters. Antibiotic treatment was associated with higher incidence of diarrhea (relative risk, 2.8; 95% confidence interval, 1.03-7.74; P = 0.04). Conclusions: Clinicians often treat UTI in the ICU in the absence of symptoms and in the presence of infections in other sites. This approach is inappropriate in asymptomatic patients and questionable in patients with other conditions. Urinary tract infection treatment guidelines for ICU patients is urgently needed.
    Infectious Disease in Clinical Practice 10/2007; 15(6):382-384. DOI:10.1097/IPC.0b013e3181581493
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    ABSTRACT: Background: The increasing incidence and severity of CD colitis has been well documented recently and is frequently associated with a specific NAP1 strain of CD. We analyzed clinical and molecular features of our CD isolates to assess the relative effects on outcomes. Methods: Patients with diarrhea and stool positive for toxins A or B were prospectively followed, clinical information was collected and stool was cultured anaerobically on CCF modified agar (Remel). CD was identified by colony morphology, Gram stain and PRO test, then subcultured in Brucella broth and frozen. DNA was extracted and strain typed by rep-PCR (DiversiLab), dendrograms generated and compared to reference strains NAP1 and ATCC 9689. Strains were grouped as clonal (visually matching), related (1-3 bands different) or distinct (>3 bands different) based on bands present and percent similarity. A total of 49 clinical isolates were typed, including seven from patients who died due to CD colitis, 22 with recurrent CD disease, and 20 controls who responded to therapy without death or recurrent disease. Results: There were no significant differences among the groups in terms of age, comorbid conditions or treatment regimen. Among the 49 isolates, 24 unique patterns were identified; 30 (61.2%) were distributed among three groups of related strains. The isolates were widely distributed among patterns, including 68% of relapses, 60% of controls, and 43% of deaths among the three major groups. The other 19 isolates were more genetically heterogeneous including 13 unique strains. Three deaths were clonal and another was related to NAP1. Conclusion: There were no distinguishing clinical features or genetic patterns that predicted outcome in this small cohort. While there were three deaths caused by the same clone of CD, this clone was also seen in relapses and controls. Larger studies are needed to clarify the relative effects of host and strain type on patient outcome.
    Infectious Diseases Society of America 2007 Annual Meeting; 10/2007
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    ABSTRACT: Background: Staphylococcus aureus (SA) causes a wide range of community-associated (CA) and health care (HC)-associated soft tissue infections (STI). The severity is probably determined by strain-related virulence factors and host condition. We compared MRSA and MSSA STI and assessed the role of SCCmec type and Panton-Valentine leucocidin toxin (PVL). Methods: Microbiology laboratory results were prospectively monitored (11/1/05-6/1/06). All cases with SA in tissue samples or blood were screened. All patients with STI were selected. Demographics, comorbidities, lesion characteristics, location and bacteremia were recorded. All saved isolates were tested for PVL (realtime PCR) and SCCmec type (conventional multiplex PCR). Results: 204 patients were encountered, 8.8% had bacteremia. MRSA accounted for 70.0% CA and 64.8% of HC-cases. They were more likely to cause abscesses (57.0 vs 29.7%; p=0.001), affect non-diabetics (73.7% vs 59.6%; p=0.03) and possess PVL genes (68.9% vs 4.8%; p<0.001). SCCmec type IVa caused 81.8% of CA and 33.3% of HC cases and nearly always (98.9%) possessed PVL genes. Multivariate analysis revealed that predictors of abscess formation were PVL genes (p<0.001) and CA (p=0.001). Predictors of bacteremia were age ≥ 65 y (OR=5.64; CI=1.74-18.26; p=0.004), necrotizing infection (OR=7.91; CI=1.51-41.28; p=0.014) and head/neck location (OR=3.66; CI=1.00-13.45; p=0.05). Conclusion: MRSA surpassed MSSA STI in CA and HC settings and caused more abscesses. SCCmec type IVa caused most CA and one third of HA-cases. PVL genes were present in nearly all SCCmec type IVa isolates and rare MSSA isolates. Abscess formation is influenced by PVL toxin and/or SCCmec type whereas bacteremia is related to host condition and/or other virulence factors that were not studied.
    Infectious Diseases Society of America 2007 Annual Meeting; 10/2007
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    ABSTRACT: Background: There are increased reports of CO-CDAD but their characteristics are not well defined. We evaluated the frequency of CO-CDAD cases and compared them to those with healthcare associated onset (HO). Methods: A prospective chart review was conducted of all patients with positive C. difficile toxin assays from November 2005 through April 2006 at our institution. Data collected included the type of onset, risk factors, clinical characteristics and outcome. CO cases were defined as patients with a positive toxin assay within 48 hrs of admission and no hospitalizations or stay at an extended care facility within the month prior to detection. Patients with CO or HO were compared to evaluate for differences in risk factors and underlying conditions. Results: Among 100 cases of CDAD identified during the study period, 12 met the definition of CO-CDAD. There were no differences in CO-CDAD versus HO-CDAD in terms of age (64.4 ± 16.2 vs. 64.2 ± 18.5 y, p=0.96), male gender (50% vs. 55.2%, p=0.77), recent chemotherapy (8.3% vs. 14.8%, p=1.0), neutropenia (0 vs. 2.3%, p=1.0), recent antibiotics (58.3% vs. 73.9%, p=0.31), malignancies (8.3% vs. 29.5%, p=0.17), HIV (8.3% vs. 1.1%, p=0.23), or history of transplantation (0 vs. 3.4%, p=1.0). Duration of illness was similar (3.9 ± 1.2 days vs. 4.1 ± 0.46 days, p=0.5). There were no differences in the two groups in terms of persistent diarrhea, fever, relapse after therapy and mortality. Overall length of stay (LOS) was significantly less in CO-CDAD (7.2 ± 1.5 days vs. 20 ± 1.8 days, p=0.0005). Conclusion: A significant portion of CDAD is now CO. These cases are similar to HO cases with respect to risk factors, clinical presentation and outcome but their LOS is significantly shorter.
    Infectious Diseases Society of America 2006 Annual Meeting; 10/2006