Sorana Segal-Maurer

New York Hospital Queens, New York City, New York, United States

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Publications (37)167.27 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: HIV treatment outcomes and adverse events (AEs) may vary by gender. STaR is the first study to directly compare the safety and efficacy of the two single-tablet regimens (STRs), rilpivirine/emtricitabine/tenofovir DF (RPV/FTC/TDF) and efavirenz (EFV)/FTC/TDF. Methods: STaR was an open-label, 1:1 randomized, 96-week study in treatment-naïve HIV-1 infected subjects. The primary endpoint was the proportion of subjects with HIV-1 RNA <50 copies/mL at W48 (12% non-inferiority margin; Snapshot analysis). Post-hoc analyses included safety and efficacy by gender through W96. Results: For the primary endpoint, RPV/FTC/TDF (n=394) was non-inferior to EFV/FTC/TDF (n=392) for HIV RNA <50 copies/mL (85.8% RPV/FTC/TDF vs 81.6% EFV/FTC/TDF; difference 4.1%, 95% CI [-1.1%, 9.2%]) at W48 and also at W96 (77.9% vs 72.4%; difference 5.5%, 95% CI [-0.6%, 11.5%]) with p=0.76 for testing homogeneity of response between males and females at W96. W96 Virologic Suppression by Gender RPV/FTC/TDF EFV/FTC/TDF Strata Adjusted Diff (95% CI) Males 78.7% (288/366) 73.6% (268/364) 5.1% (-1.1% to 11.3%) Females 67.9% (19/28) 57.1% (16/28) 12.0% (-15.5% to 39.5%) For important AEs listed in the RPV and EFV prescribing information, rates of nervous system AEs were 27.0% RPV/FTC/TDF vs 48.4% EFV/FTC/TDF in males and 28.6% vs 35.7% in females with dizziness and headache being the most frequently reported; psychiatric AEs were 29.0% vs 50.3% in males and 17.9% vs 32.1% in females with abnormal dreams, anxiety, depression and insomnia being the most reported; and for rash events, 16.1% vs 23.4% in males and 10.7% vs 35.7% in females. Rates of Grade 3-4 TEAEs were 9.6% (35/366) RPV/FTC/TDF vs 16.2% (59/364) EFV/FTC/TDF in males, and 17.9% (5/28) vs 21.4% (6/28) in females. Rates of discontinuation due to AEs were 2.7% (10/366) vs 11.0% (40/364) in males and 7.1% (2/28) vs 10.7% (3/28) in females. Conclusion: Overall, treatment with RPV/FTC/TDF was non-inferior to EFV/FTC/TDF at W48 and W96. Though the number of females enrolled was small, there was no difference in rates of virologic suppression between genders. In the female subpopulation, there were lower rates of important nervous system, psychiatric, and rash AEs and lower rates of discontinuations due to AEs in the RPV/FTC/TDF arm.
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
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    ABSTRACT: Objective To study the use of ertapenem delivered in an outpatient parenteral antimicrobial therapy (OPAT) hospital-based unit setting for targeted transrectal ultrasound-guided prostate biopsy (TRUSPBx) prophylaxis in the setting of multidrug-resistant (MDR) Escherichia coli rectal colonization. E coli is the pathogen most commonly associated with post-TRUSPBx complications, and there is increasing prevalence of community-associated MDR E coli. Methods Prospective data analysis of all patients admitted to the OPAT unit for administration of intravenous antibiotics for prophylaxis for TRUSPBx over 18-month period was performed. Patients had identification of MDR E coli in rectal swab cultures and/or intolerance to available oral agents. Microbiologic data and tolerability of administered antibiotics and outcome after TRUSPBx were tabulated. Results Nine patients (median age 74 years) were referred because of antibiotic-resistant E coli from rectal swabs (all fluoroquinolone resistant, 7 MDR). All patients received ertapenem 1 g intravenously 1 day before TRUSPBx and the day of the procedure before TRUSPBx. None of the patients experienced infectious complications immediately after TRUSPBx or several weeks or months later, and no patient was lost to urologic follow-up. Conclusion Increasing worldwide reports of prostatitis, urinary tract infections, and septicemia after TRUSPBx because of MDR E coli suggest rectal screening before procedure may be useful in decreasing complications. Targeted prophylaxis in these instances is necessary. Although carbapenems are used for treatment, they are not routinely used for prophylaxis. We report successful use of ertapenem delivered in a hospital-based OPAT unit for TRUSPBx prophylaxis.
    Urology 01/2014; 83(4):710–713. · 2.42 Impact Factor
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    ABSTRACT: Background: Hospital-based outpatient parenteral antibiotic treatment (HB-OPAT) can avoid hospitalization, optimize early discharge, and facilitate access to hospital services. We report our first-year OPAT experience. Methods: Retrospective review of patients treated in a 535-bed university-affiliated community HB-OPAT unit including demographics, referral source, diagnosis, treatment, intravenous (IV) access, adverse events (A/E), and outcome. Results: Of 318 patients, median age 60 years (range 19-94), 207 (64%) male, 244 (73%) in-patient referrals, 196 (63%) commercially insured. One-half patients had peripheral IV (PIV) access (142), 42% peripherally-inserted central catheters (PICC) (others with chemoports or midlines). Infections included: 117 complicated skin and soft tissue (37%), 82 urologic (26%), 34 orthopedic (11%), 27 septicemia and/or endocarditis (9%), 22 gastrointestinal (7%), 11 pneumonia (3%), 7 others (2%). Non-infection diagnoses in 18 patients included: thrombosis, dehydration, anemia, steroid administration, etc. Two-thirds of urologic infections were due to pyelonephritis and post-prostate biopsy septicemia. Six patients with MDR E coli rectal colonization received pre-prostate biopsy IV antibiotics. One-quarter patients had microbiologic diagnoses (56% gram-positive organisms, 44% with concurrent bacteremia). Most gram-negative infections were due to MDR E coli. Most patients (145, 43%) received daptomycin (D) (median dose 8 mg/kg/day), 106 ertapenem (Ert), and 68 ceftriaxone (CTX). Ten of 318 patients failed clinically and 9 had non-OPAT related re-hospitalization. Adverse events in 14 patients included: 8 CPK elevation (D-related, 4 required discontinuation and 4 dose reduction, all resolved), 3 rash (2 CTX, 1 Ert), 1 pancytopenia (CTX), 1 seizure (Ert). No catheter-related infections occurred. Use HB-OPAT led to $824,569 antibiotic cost savings and $1,701,987 new hospital revenue in the first year. Conclusion: Over 90% OPAT patients successfully completed treatment with few A/Es. Over 25% of infections were urologic and most due to MDR Ecoli. Case Management and Antibiotic Stewardship Program were instrumental identifying OPAT-appropriate patients and facilitating clinician “buy-in.” Dedicated Infectious Diseases clinicians and skilled OPAT nurses optimized patient outcome.
    IDWeek 2013 Meeting of the Infectious Diseases Society of America; 10/2013
  • Peter Wasserman, Sorana Segal-Maurer, David S Rubin
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    ABSTRACT: Therapeutic goals for HIV-infected patients receiving antiretroviral therapy include minimizing risk of future physical disability. Presarcopenia and sarcopenia precede age-associated physical disability. We investigated their prevalence and the predictive value of patient mid-upper arm circumference (MUAC) for them. Eighty community-dwelling patients ≥45 years old demonstrating durable viral suppression were evaluated. Sarcopenia was defined as low skeletal muscle index (SMI, skeletal muscle kg/height m(2)) and either low strength or poor performance by handgrip dynamometry and gait speed, respectively. Presarcopenia was defined as low SMI only. MUAC was interpreted according to National Health Statistics percentile. Prevalence of sarcopenia and presarcopenia was 5.0% and 20.0%, respectively. Male gender (odds ratio [OR] 10.72; P < .026), recreational psychoactive substance use (OR 5.13; P < .037), and intravenous drug use transmission category (OR 6.94; P <.0327) were associated with presarcopenia. Higher body mass index (OR 0.80; P < .0007), MUAC (OR 0.83; P < .024), and large skeletal frame (OR 0.09; P < .003) were negatively associated with presarcopenia. Finding that a participant did not have a MUAC <25th percentile on physical examination had a 90.4% negative predictive value for presarcopenia. Although sarcopenia was uncommon, presarcopenia was highly prevalent in midlife and older HIV-infected males. Determination of MUAC percentile may identify those least likely to demonstrate skeletal muscle deficit and improve patient selection for mass and function testing.
    Journal of the International Association of Providers of AIDS Care. 09/2013;
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    ABSTRACT: Three neonates and 5 health care workers were identified as colonized with methicillin-resistant Staphylococcus aureus (MRSA) out of 222 individuals screened during an outbreak investigation in an 18-bed neonatal intensive care unit. Two of 3 MRSA neonatal isolates demonstrated identical pulsed-field gel electrophoresis clonal patterns but no clonal association was found among isolates from the 5 employees or between employees and neonates. Increased MRSA-unrelated strain colonization among health care workers supports increased MRSA community prevalence and probable decreased utility of mass screening.
    American journal of infection control 08/2013; · 3.01 Impact Factor
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    ABSTRACT: Forty-seven ESBL positive Klebsiella pneumoniae urinary tract isolates were identified in non-hospitalized patients and 79% harbored KPC and/or CTX-M β-lactamases. Approximately 90% of isolates were resistant to trimethoprim/sulfamethoxazole and levofloxacin, 40% to a carbapenem, while 92% were susceptible to polymyxin B, 87% to tigecycline, and 79 % to fosfomycin. Increased use of broader spectrum antibiotics may help to prevent their dissemination and reduce the risk of progression to invasive disease.
    Antimicrobial Agents and Chemotherapy 07/2013; · 4.57 Impact Factor
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    ABSTRACT: We have identified CTX-M group 1 β-lactamases in 87% of community-acquired Escherichia coli isolates that produce extended-spectrum β-lactamases, with the majority harboring CTX-M-15 and representing the ST131 clonal group. Seventy percent of CTX-M-bearing isolates were from urine specimens; a large proportion was nonsusceptible to levofloxacin, trimethoprim/sulfamethoxazole, and β-lactam antimicrobials. Many patients were relatively youthful (41% ≤65 years old; youngest, age 32). Patients with symptomatic bacteriuria received drugs to which the organisms were susceptible, and most had favorable outcomes. Timely recognition of such isolates could help physicians choose more appropriate antibacterial therapy.
    Diagnostic microbiology and infectious disease 03/2012; 72(3):248-52. · 2.45 Impact Factor
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    ABSTRACT: Coagulase-negative staphylococci (CoNS) are the main pathogens causing hospital-acquired external-ventricular-drain- (EVD-) and lumbar-drain- (LD-) associated meningitis and ventriculitis. The treatment of these infections can be challenging and may require combination of intraventricular and intravenous administration of antibiotics. Limited animal data demonstrate rapid daptomycin bactericidal activity, adequate penetration in the setting of inflamed meninges, and extended half-life in the ventricles Steenbergen et al. (2009). There are limited clinical data using daptomycin intravenously and/or intraventricularly for the treatment of central nervous system infections (CNS) Elvy et al. (2008), Stucki et al. (2007), Lee et al. (2008) and Wallace et al. (2009). We report here our experience in the treatment of an EVD-related infection.
    Case Reports in Medicine 01/2012; 2012:593578.
  • Sorana Segal-Maurer, Carl Urban, David S Rubin, W Wehbeh
    Clinical Infectious Diseases 11/2011; 53(12):1301-2. · 9.37 Impact Factor
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    ABSTRACT: HIV infection leads to ongoing immune activation and inflammation within gut-associated lymphoid tissue. Host response initiates events that participate in CD4+ T cell depletion and soft-tissue wasting. Chronic immune activation is associated with disruption of organized lymphoid tissue and gut-barrier integrity, and microbial translocation that may impact whole-body energy metabolism and protein turnover. Systemic stress leading to decreased food intake and/or viral damage to endocrine tissue is associated with wasting disease in HIV-infected patients. Clinical management requires appreciation of subjective, physical, and biochemical parameters, as well as addressing factors associated with food insecurity.
    Topics in clinical nutrition 12/2010; 26(1):14–28.
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    ABSTRACT: Bacteria harboring CTX-M extended-spectrum beta-lactamases (ESBLs) have been identified worldwide, with most reports coming from regions outside North America. We have identified CTX-M enzymes in 31% of ESBL-positive Escherichia coli isolates from our hospital and more than half (53%) of the isolates from associated long-term care facilities. Approximately 3/4 of all CTX-M-bearing isolates were from urine specimens, with a predominance of CTX-M-15. A large proportion of such isolates were nonsusceptible to levofloxacin, trimethoprim/sulfamethoxazole, and all beta-lactam antimicrobials with the exception of the carbapenems, requiring carbapenem therapy for acute urinary tract infection or urinary tract-related sepsis. CTX-M beta-lactamases have emerged within our location, and detection of bacteria harboring these enzymes in the clinical microbiology laboratory remains problematic because molecular methods are needed for their identification.
    Diagnostic microbiology and infectious disease 04/2010; 66(4):402-6. · 2.45 Impact Factor
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    ABSTRACT: There are limited safety data for high-dose and long-term daptomycin treatment (16mg/kg administered for >or=14 days). We present our experience in 61 patients. We performed a retrospective chart review for all patients treated with daptomycin at New York Hospital Queens (Flushing) from 1 January 2004 through 30 April 2007; patients were identified through a computerized hospital pharmacy database. Sixty-one patients (29 male and 32 female patients; mean age, 66.6 years) received a mean dose of 8 mg/kg of daptomycin for a median of 25 days (range, 14-82 days). Twelve patients (with bone and skin and softtissue infections) did not have an identified microbiologic isolate. Gram-positive infections included bloodstream infection with or without infective endocarditis (n = 32), skin and soft-tissue infection (n = 14), bone and joint infection (n = 9), and intra-abdominal infection (n = 5), and unidentified infection (n = 1). Prosthetic devices were removed from 11 of 20 patients. Grade 1 adverse events occurred in 22 patients and did not lead to daptomycin discontinuation. Fifty-eight patients underwent creatine phosphokinase (CPK) analysis (34 patients had paired CPK analyses at the beginning of and during therapy, and 13 patients had random CPK analysis performed during treatment). Three patients had constitutional and/or musculoskeletal symptoms accompanying CPK levels 110 times upper limit of normal (grade 3). All occurred after 24 days of treatment and improved after daptomycin treatment was discontinued. Two of 3 patients were morbidly obese (body mass index grade III). Daptomycin treatment was well tolerated at a mean dose of 8 mg/kg for a median duration of 25 days. The incidence of symptomatic CPK level elevation was within the range reported with lower doses of daptomycin and/or for shorter treatment durations.
    Clinical Infectious Diseases 07/2009; 49(2):177-80. · 9.37 Impact Factor
  • Farah Shams, Deborah Asnis, Charles Lombardi, Sorana Segal-Maurer
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    ABSTRACT: Tuberculosis (TB) is a major global health problem, and musculoskeletal TB occurs in approximately 10% of extrapulmonary cases. In this article we describe 2 cases of ankle joint tuberculous arthritis. Both of the patients were immunocompromised and presented with chronic pain and swelling. Both patients described a history of antecedent ankle trauma. The clinical presentations were consistent with chronic septic arthritis and were nonspecific as to a particular etiology. The pathology and microbiology results revealed infection with Mycobacterium tuberculosis. Tuberculous infection of bone and joint must be considered when predisposing epidemiological factors are present to avoid delay in therapy. Further exploration into the relationship of trauma to tuberculosis recrudescence is warranted. Level of Clinical Evidence: 4.
    The Journal of foot and ankle surgery: official publication of the American College of Foot and Ankle Surgeons 07/2009; 48(4):452-6.
  • Aman Dalal, Carl Urban, Sorana Segal-Maurer
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    ABSTRACT: Corynebacterium amycolatum, a normal inhabitant of human skin, is a Gram-positive, non-spore-forming, mycolic acid-free, aerobic or facultative anaerobic bacillus. Since its description in 1988, it has only rarely been associated with infective endocarditis. This paper describes a case of infective endocarditis successfully treated by combination therapy with daptomycin and rifampicin. To the best of our knowledge, this is the first case report of C. amycolatum endocarditis from the USA successfully treated with these agents.
    Journal of Medical Microbiology 11/2008; 57(Pt 10):1299-302. · 2.30 Impact Factor
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    ABSTRACT: Nine carbapenem-resistant Escherichia coli isolates harboring Klebsiella pneumoniae carbapenemase (KPC)-2 or KPC-3 enzymes were identified in patients residing in 7 distinct long-term care facilities. Cefotaxime-hydrolyzing (CTX-M)-type beta-lactamases were also documented in 3 isolates. The identification of these enzymes in patients staying in long-term care facilities should be of great concern to all components of health care systems.
    Clinical Infectious Diseases 07/2008; 46(11):e127-30. · 9.37 Impact Factor
  • Adam Friedman, Garron Solomon, Sorana Segal-Maurer, Fred Pereira
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    ABSTRACT: A 66-year-old Columbian man presented with a 15-day history of generalized weakness, cough, fever, and verrucous, ulcerating plaques of the face, upper chest, upper back, and arms. The patient proved to be HIV positive. Histopathologic examination showed a diffuse lymphocytic infiltrate coupled with a striking number of yeast forms within macrophages. The clinical presentation and histopathologic alterations are consistent with the diagnosis disseminated Histoplasma capsulatum. This case emphasizes the importance of increasing awareness of histoplasmosis in nonendemic areas as a result of the large subgroup of immunocompromised patients at risk. Disseminated histoplasmosis can be a treatable HIV complication if recognized early, although is unfortunately a harbinger for an overall poor prognosis.
    Dermatology online journal 02/2008; 14(1):12.
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    Peter Wasserman, Sorana Segal-Maurer, David Rubin
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    ABSTRACT: Men with acquired immunodeficiency syndrome (AIDS) wasting and hypogonadism are frequently treated with testosterone and oxandrolone, an orally administered anabolic-androgenic steroid hormone. We observed reductions in testosterone and sex hormone-binding globulin (SHBG) levels, in association with complaints of erectile dysfunction, after prolonged exposure to this therapeutic regimen. First description of an association between long-term receipt of oxandrolone with erectile dysfunction, low SHBG and testosterone. Case report of three human immunodeficiency virus-infected hypogonadal male patients receiving treatment for wasting syndrome and hypogonadism, and highly active antiretroviral therapy. All three patients received long-term oxandrolone in addition to testosterone replacement therapy. Testosterone and SHBG levels for patients 1, 2, and 3, respectively: total testosterone 183, 71, and 151 ng/dL (260-1,000 ng/dL); free testosterone (not done for patient 3) 58.3 and 26.9 pg/mL (50-210 pg/mL); SHBG 6, 9, and 6 nmol/L (7-50 nmol/L). No other hormonal abnormalities were detected. Following discontinuation of oxandrolone, levels of total testosterone rose, consistent with increase in SHBG. One patient received repeat SHBG assay documenting rise in SHBG level. Patient 2 reported return of libido and early morning erections several weeks after discontinuation of oxandrolone. Patients had erectile dysfunction in association with low testosterone and SHBG, in spite of exogenous testosterone replacement. Discontinuation of oxandrolone led to the normalization or improvement of testosterone levels in all three patients with symptomatic improvement in one patient. First pass metabolism of orally administered oxandrolone may decrease hepatic synthesis of SHBG, allowing exogenously supplied testosterone to be excreted. Further work is necessary to elucidate the relationship.
    Journal of Sexual Medicine 02/2008; 5(1):241-7. · 3.51 Impact Factor
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    ABSTRACT: To evaluate the efficacy of contact and droplet precautions in reducing the incidence of hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections. Before-after study.Setting. A 439-bed, university-affiliated community hospital. To identify inpatients infected or colonized with MRSA, we conducted surveillance of S. aureus isolates recovered from clinical culture and processed by the hospital's clinical microbiology laboratory. We then reviewed patient records for all individuals from whom MRSA was recovered. The rates of hospital-acquired MRSA infection were tabulated for each area where patients received nursing care. After a baseline period, contact and droplet precautions were implemented in all intensive care units (ICUs). Reductions in the incidence of hospital-acquired MRSA infection in ICUs led to the implementation of contact precautions in non-ICU patient care areas (hereafter, "non-ICU areas"), as well. Droplet precautions were discontinued. An analysis comparing the rates of hospital-acquired MRSA infection during different intervention periods was performed. The combined baseline rate of hospital-acquired MRSA infection was 10.0 infections per 1,000 patient-days in the medical ICU (MICU) and surgical ICU (SICU) and 0.7 infections per 1,000 patient-days in other ICUs. Following the implementation of contact and droplet precautions, combined rates of hospital-acquired MRSA infection in the MICU and SICU decreased to 4.3 infections per 1,000 patient-days (95% confidence interval [CI], 0.17-0.97; P=.03). There was no significant change in hospital-acquired MRSA infection rates in other ICUs. After the discontinuation of droplet precautions, the combined rate in the MICU and SICU decreased further to 2.5 infections per 1,000 patient-days. This finding was not significant (P=.43). In the non-ICU areas that had a high incidence of hospital-acquired MRSA infection, the rate prior to implementation of contact precautions was 1.3 infections per 1,000 patient-days. After the implementation of contact precautions, the rate in these areas decreased to 0.9 infections per 1,000 patient-days (95% CI, 0.47-0.94; P=.02). The implementation of contact precautions significantly decreased the rate of hospital-acquired MRSA infection, and discontinuation of droplet precautions in the ICUs led to a further reduction. Additional studies evaluating specific infection control strategies are needed.
    Infection Control and Hospital Epidemiology 12/2007; 28(11):1261-6. · 4.02 Impact Factor
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    ABSTRACT: Background: Carbapenemase enzymes (KPCs) acquisition in strains of KP results in resistance to all antibiotics except polymyxin B. T has excellent in vitro activity against MDRKP. Methods: We conducted a prospective, observational cohort study in patients with MDRKP infections who received T (100 mg then 50 mg Q12hrs) at our hospital from 11/1/05 to 10/30/06. Definitions: positive clinical response (CR): resolution of systemic and focal signs of infection; negative CR: persistent clinical illness or death from infection; indeterminate CR: insufficient data to determine response; positive microbiologic response (MR): repeat cultures were negative; negative MR: repeat cultures remained positive; indeterminate MR: inadequate data available; MDRKP defined as KP resistant to quinolones, aminoglycosides, carbapenems, and all β-lactams. Results: 27 patients were included. Among all infections (6 bacteremias (+BC), 9 respiratory (RI), 11 urinary (UTI), and 1 biliary) caused by MDRKP, 15 patients (55%) had positive CR with T treatment (66% of +BC, 55% of UTIs, 55% of RI, 0 biliary). Eleven patients (41%) had negative CR (17% of +BC, 45% of UTIs, 44% of RIs). One patient had an indeterminate CR. Data on MR was available for 16 patients (59%): 12 patients had a positive MR (3/4 +BC, 6/8 UTIs, and 3/4 RI), 4 patients had negative MR (1/4 +BC, 1/4 respiratory, and 2/8 UTIs). T was used as single agent therapy in 6 patients: 4 with uncomplicated UTIs and 2 with RIs. Positive CR occurred in 4 of and a positive MR in 2 of 6 of patients. When combined with other antibiotics, primarily polymyxin B, a positive CR was observed in 52% of patients and a positive MR was seen in 47% of patients. GI adverse events (nausea 33%, vomiting 22%, and diarrhea 11%) were consistent with published data. Conclusion: Our study indicates that T can be considered as an option in MDRKP treatment.
    Infectious Diseases Society of America 2007 Annual Meeting; 10/2007
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    ABSTRACT: Quinolone-resistant Streptococcus agalactiae bacteria were recovered from single-patient isolates and found to contain mutations in the gyrase and topoisomerase IV genes. Pulsed-field gel electrophoresis demonstrated that four isolates from the same long-term care facility were closely related; in seven cases, quinolone-resistant Haemophilus influenzae and S. agalactiae bacteria were isolated from the same patient.
    Antimicrobial Agents and Chemotherapy 07/2005; 49(6):2495-7. · 4.57 Impact Factor