Houssein Jahamy

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

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Publications (3)3.41 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. · 1.71 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.
    Scandinavian Journal of Infectious Diseases 01/2008; 40(8):601-6. · 1.71 Impact Factor
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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.