Keith S Kaye

Detroit Medical Center, Detroit, Michigan, United States

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Publications (185)748.81 Total impact

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    ABSTRACT: The movement away from fee-for-service models to those that emphasize quality of care and patient outcomes affords a unique opportunity for antimicrobial stewardship programs to expand their value for hospital administration. Antimicrobial stewardship participants must collaborate with administrators and key stakeholders to position themselves to improve economic, process, and outcomes measures. This will allow the establishment of antimicrobial stewardship programs as essential components of the present and future healthcare quality journey.
    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 10/2014; 59(suppl 3):S146-S153.
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    ABSTRACT: To promote the judicious use of antimicrobials and preserve their usefulness in the setting of growing resistance, a number of policy-making bodies and professional societies have advocated the development of antimicrobial stewardship programs. Although these programs have been implemented at many institutions in the United States, their impact has been difficult to measure. Current recommendations advocate the use of both outcome and process measures as metrics for antimicrobial stewardship. Although patient outcome metrics have the greatest impact on the quality of care, the literature shows that antimicrobial use and costs are the indicators measured most frequently by institutions to justify the effectiveness of antimicrobial stewardship programs. The measurement of more meaningful outcomes has been constrained by difficulties inherent to these measures, lack of funding and resources, and inadequate study designs. Antimicrobial stewardship can be made more credible by refocusing the antimicrobial review process to target specific disease states, reassessing the usefulness of current metrics, and integrating antimicrobial stewardship program initiatives into institutional quality and safety efforts.
    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 10/2014; 59(suppl 3):S112-S121.
  • Antimicrobial Agents and Chemotherapy 10/2014; 58(10):6343. · 4.57 Impact Factor
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    ABSTRACT: Colistin, the most widely used polymyxin antibiotic, was originally introduced in the late 1950s before the establishment of the present-day drug approval process. Originally shelved due to toxicity concerns, colistin, in the form of its inactive prodrug colistin methanesulfonate, has undergone a renaissance in the past 15 years. Unfortunately, this is not because of an improved adverse-effect profile but because colistin is among the only remaining antibiotics with activity against multidrug-resistant gram-negative bacilli. Pharmacokinetic and pharmacodynamic data are limited to guide the appropriate use of colistin; however, important advances have occurred over the past 5 years. Since its reintroduction, published reports regarding colistin have produced discordant results in terms of both efficacy and safety. Because the efficacy and toxicity of colistin are dose dependent, the impact of discordant dosing recommendations cannot be understated. This review highlights the issues leading to differing and often conflicting dosing recommendations, reviews the recent pharmacokinetic advances, and provides recommendations for the optimal use of colistin.
    Pharmacotherapy 09/2014; · 2.31 Impact Factor
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    ABSTRACT: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is an increasing global threat. Here, we describe the prevalence and impact of tigecycline use in a cohort of patients with CRKP bacteriuria nested within a multicenter, prospective study. In the 21 month study period, 260 unique patients were included. Tigecycline was given to 80 (31%) patients. The use of tigecycline during the index hospitalization was significantly associated with the subsequent development of tigecycline resistance in the same patient (OR 6.13, 95%CI 1.15-48.65, p=0.03). In conclusion, the use of tigecycline with CRKP bacteriuria is common, and is associated with the subsequent development of tigecycline resistance. This article is protected by copyright. All rights reserved.
    Clinical Microbiology and Infection 06/2014; · 4.58 Impact Factor
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    ABSTRACT: Genome sequencing of carbapenem-resistant Klebsiella pneumoniae isolates from regional US hospitals was used to characterize strain diversity and the blaKPC genetic context. A phylogeny based on core single nucleotide variants (SNVs) supports a division of ST258 into two distinct groups. The primary differences between the groups are in the capsular polysaccharide locus (cps) and their plasmid content. A strict association between clade and KPC variant was found. The blaKPC gene was found on variants of two plasmid backbones. This study indicates that highly similar K. pneumoniae sub-populations co-exist within the same hospitals over time.
    Antimicrobial Agents and Chemotherapy 06/2014; · 4.57 Impact Factor
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    ABSTRACT: Identifying patients at risk for bloodstream infection (BSI) due to Acinetobacter baumannii-calcoaceticus complex (ABC) and providing early appropriate therapy is critical in improving patients' outcomes. A retrospective matched case-control study was conducted to investigate the risk factors of BSI due to ABC in patients admitted to the Detroit Medical Center (DMC) between January 2006 and April 2009. Cases were patients with BSI due to ABC; controls were patients not infected with ABC. Potential risk factors were collected 30 days prior to ABC positive culture date for the cases and 30 days prior to admission for the controls. A total of 245 case-patients were matched with 245 control-patients. Independent risk factors associated with BSI due to ABC included Charlson's comorbidity score≥3 (OR= 2.34, p= 0.001), direct admission from other health-care facilities (OR= 4.63, p< 0.0001), prior hospitalization (OR= 3.11, p< 0.0001), presence of an indwelling central venous line (OR= 2.75, p= 0.011 ), receipt of total parentral nutrition (OR= 21.2, p< 0.0001), prior receipt of β-lactams (OR= 3.58, p< 0.0001), prior receipt of carbapenems (OR= 3.18, p= 0.006), and prior receipt of chemotherapy (OR= 15.42, p< 0.0001). The median duration from ABC positive culture date to initiation of appropriate antimicrobial therapy was 2 days (Interquartile range, IQR [1 - 3]). In-hospital mortality was significantly higher among case patients compared to control patients (OR= 3.40, p< 0.0001). BSIs due to ABC are more common among critically ill and debilitated institutionalized patients, who are heavily exposed to health-care settings and invasive devices.
    Antimicrobial Agents and Chemotherapy 06/2014; · 4.57 Impact Factor
  • Infection Control and Hospital Epidemiology 06/2014; 35(6):605-27. · 4.02 Impact Factor
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    ABSTRACT: Carbapenem-resistant Enterobacteriaceae (CRE) isolation is associated with poor outcomes. The matched cohort study design enables investigation of specific role of resistance in contributing to patients' outcomes. Patients with CRE were matched to 3 groups: (1) patients with extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL), (2) patients with carbapenem-susceptible non-ESBL Enterobacteriaceae, and (3) uninfected controls.
    American journal of infection control. 06/2014; 42(6):612-20.
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    ABSTRACT: This study investigated the factors influencing influenza vaccination rates among health care personnel (HCP) and explored HCP's attitudes toward a policy of mandatory vaccination.
    American journal of infection control. 06/2014; 42(6):649-52.
  • Source
    American Geriatric Society; 05/2014
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    ABSTRACT: Carbapenem resistance in gram-negative bacteria is on the rise in the United States. A regional network was established to study microbiological and genetic determinants of clinical outcomes in hospitalized patients with carbapenem-resistant Klebsiella pneumoniae (CR-Kp) in a prospective, multi-center, observational study. To this end, pre-defined clinical characteristics and outcomes were recorded and K. pneumoniae isolates were analyzed for strain typing and resistance mechanism determination. In a 14 month period, 251 patients were included. While most patients were admitted from long term care settings, 28% of patients were admitted from home. Hospitalizations were prolonged and complicated. Non-susceptibility to colistin and tigecycline occurred in isolates of 7% and 45% of patients, respectively. Most CR-Kp belonged to rep-PCR types A and B (both ST258), and carried either blaKPC-2 (48%) or blaKPC-3 (51%). One isolate tested positive for blaNDM-1, a sentinel discovery in this region. Important differences between strain types were noted; rep-PCR B strains were associated with blaKPC-3 (OR 294, 95%CI 58-2552, p<0.001), gentamicin non-susceptibility (OR 24, 95%CI 8.39-79.38, p<0.001), amikacin susceptibility (OR 11.0, 95%CI 3.21-42.42, p<0.001), tigecycline non-susceptibility (OR 5.34, 95% CI 1.30-36.41, p=0.018), shorter length of stay (OR 0.98, 95% CI 0.95-1.00, p=0.043), and admission from a skilled nursing facility (OR 3.09, 95% CI 1.26-8.08, p=0.013). Our analysis shows that i) CR-Kp is primarily seen in the elderly long term care population and that ii) regional monitoring of CR-Kp reveals insights into molecular characteristics. This work highlights the crucial role of ongoing surveillance of carbapenem-resistance determinants.
    Antimicrobial Agents and Chemotherapy 05/2014; · 4.57 Impact Factor
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    ABSTRACT: Background:Vancomycin-resistant enterococci (VRE) are a growing health problem and uncertainties exist regarding the optimal therapy for bloodstream infection due to VRE. We conducted systematic comparative evaluations of the impact of different antimicrobial therapies on the outcomes of patients with bloodstream infections due to VRE.Methods:A retrospective study from 01/2008 to 10/2010 was conducted at Detroit Medical Center. Unique patients with blood cultures due to VRE were included and reviewed. Three major therapeutic classes were analyzed: daptomycin, linezolid, and β-lactams. Three multivariate models were conducted for each outcome matching for a propensity score predicting the likelihood of receipt of one of the therapeutic class.Results:Two hundred twenty-five cases of bacteremia due to VRE were included including 86 (38.2%) cases of VR E. faecalis and 139 (61.8%) of VR E. faecium. Bacteremia due to VR E. faecalis was more frequent among subjects treated with β-lactams compared to daptomycin or linezolid group. The median dose of daptomycin was 6mg/kg (range: 6-12mg/kg). After controlling for propensity score and bacteremia due to VR E. faecalis, differences in mortality were non-significant among the treatment groups. Therapy with daptomycin was associated with higher median variable direct cost per day than linezolid.Conclusions:This large study revealed the three therapeutic classes (daptomycin, linezolid, and β-lactams) are similarly efficacious in the treatment of bacteremia due to susceptible strains of VRE.
    Antimicrobial Agents and Chemotherapy 05/2014; · 4.57 Impact Factor
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    ABSTRACT: Clinical outcomes of older and younger adults with extended-spectrum β-lactamase-producing Escherichia coli isolation were compared. Two hundred thirty-two older adults (aged ≥65 years), and 145 younger adults with infection were identified between February 2010 and July 2011. After controlling for the propensity score and receipt of effective therapy, older adults were not at increased risk for adverse outcomes.
    American journal of infection control 05/2014; 42(5):565-8. · 3.01 Impact Factor
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    ABSTRACT: The electronic medical record (EMR) has huge potential for facilitating antimicrobial stewardship efforts by directing providers to preferred antimicrobials. Cerner Powerchart currently holds the number two position in the EMR market. Although Cerner Powerchart has limited "out of the box" functionalities to optimize stewardship efforts , there are many potential utilities that can be developed to assist in stewardship practice. However, in order to harness the stewardship potential of the EMR system, significant hospital information technology resources are needed. Herein we describe the experiences of three large healthcare systems utilizing Cerner to facilitate prior-authorization of antimicrobials, prospective audit and feedback of antimicrobials , as well as supplemental stewardship strategies.
    Clinical Infectious Diseases 04/2014; · 9.37 Impact Factor
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    ABSTRACT: Background. Carbapenem-resistant Enterobacteriaceae (CRE) are clinically challenging, threaten patient safety, and represent an emerging public health issue. CRE reporting is not mandated in Michigan. Methods. The Michigan Department of Community Health-led CRE Surveillance and Prevention Initiative enrolled 21 facilities (17 acute care and 4 long-term acute care facilities) across the state. Baseline data collection began September 1, 2012, and ended February 28, 2013 (duration, 6 months). Enrolled facilities voluntarily reported cases of Klebsiella pneumoniae and Escherichia coli according to the surveillance algorithm. Patient demographic characteristics, laboratory testing, microbiology, clinical, and antimicrobial information were captured via standardized data collection forms. Facilities reported admissions and patient-days each month. Results. One-hundred two cases over 957,220 patient-days were reported, resulting in a crude incidence rate of 1.07 cases per 10,000 patient-days. Eighty-nine case patients had test results positive for K. pneumoniae, whereas 13 had results positive for E. coli. CRE case patients had a mean age of 63 years, and 51% were male. Urine cultures (61%) were the most frequently reported specimen source. Thirty-five percent of cases were hospital onset; sixty-five percent were community onset (CO), although 75% of CO case patients reported healthcare exposure within the previous 90 days. Cardiovascular disease, renal failure, and diabetes mellitus were the most frequently reported comorbid conditions. Common ris k factors included surgery within the previous 90 days, recent infection or colonization with a multidrug-resistant organism, and recent exposures to antimicrobials, especially third- or fourth-generation cephalosporins. Conclusions. CRE are found throughout Michigan healthcare facilities. Implementing a regional, coordinated surveillance and prevention initiative may prevent CRE from becoming hyperendemic in Michigan.
    Infection Control and Hospital Epidemiology 04/2014; 35(4):342-9. · 4.02 Impact Factor
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    ABSTRACT: Background. This study aimed to identify risk factors associated with carbapenem-resistant Enterobacteriaceae (CRE) colonization among patients screened with rectal cultures upon admission to a hospital or long-term acute care (LTAC) center and to compare risk factors among patients who were screen positive for CRE at the time of hospital admission with those screen positive prior to LTAC admission. Methods. A retrospective nested matched case-control study was conducted from June 2009 to December 2011. Patients with recent LTAC exposure were screened for CRE carriage at the time of hospital admission, and patients admitted to a regional LTAC facility were screened prior to LTAC admission. Cases were patients with a positive CRE screening culture, and controls (matched in a 3∶1 ratio to cases) were patients with negative screening cultures. Results. Nine hundred five cultures were performed on 679 patients. Forty-eight (7.1%) cases were matched to 144 controls. One hundred fifty-eight patients were screened upon hospital admission and 521 prior to LTAC admission. Independent predictors for CRE colonization included Charlson's score greater than 3 (odds ratio [OR], 4.85 [95% confidence interval (CI), 1.64-14.41]), immunosuppression (OR, 3.92 [95% CI, 1.08-1.28]), presence of indwelling devices (OR, 5.21 [95% CI, 1.09-2.96]), and prior antimicrobial exposures (OR, 3.89 [95% CI, 0.71-21.47]). Risk factors among patients screened upon hospital admission were similar to the entire cohort. Among patients screened prior to LTAC admission, the characteristics of the CRE-colonized and noncolonized patients were similar. Conclusions. These results can be used to identify patients at increased risk for CRE colonization and to help target active surveillance programs in healthcare settings.
    Infection Control and Hospital Epidemiology 04/2014; 35(4):398-405. · 4.02 Impact Factor
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    ABSTRACT: Background: Tigecycline is one of few remaining therapeutic options for extensively drug resistant (XDR) Gram-negative bacilli (GNB). Minimal inhibitory concentrations (MICs) of tigecycline to Acinetobacter baumannii have been reported to be elevated when determined by E-test compared to broth microdilution (BMD). Study aims were to compare the susceptibility of GNBs to tigecycline by four different testing methods.Methods: GNBs were collected from six different healthcare systems (25 hospitals) in Southeast Michigan from 01/2010 - 09/2011. Tigecycline MICs among A. baumannii, carbapenem-resistant enterobacteriaceae (CRE), extended-spectrum β-lactamase producing enterobacteriaceae (ESBL) and susceptible enterobacteriaceae isolates were determined by E-test, BMD, Vitek-2, and MicroScan. Non-susceptibility was categorized as tigecycline MIC≥4 μg/mL for both A. baumannii and enterobacteriaceae.Results: The study included 4,427 isolates: 2,065 ESBLs, 1,105 A. baumannii, 888 susceptible enterobacteriaceae, and 369 CREs. Tigecycline resistance among A. baumannii isolates was significantly more common as determined by E-test compared to BMD (OR=10.3, p<0.001), MicroScan (OR=12.4, p<0.001), or Vitek-2 (OR=9.4, p<0.001). These differences were not evident with the other pathogens.Conclusion: Tigecycline MICs varied greatly according to in-vitro testing methods among A. baumannii isolates. E-test should probably not be used by laboratories for tigecycline MIC testing of A. baumannii, since MICs are significantly elevated compared to three other methods.
    Journal of clinical microbiology 03/2014; · 4.16 Impact Factor
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    ABSTRACT: (See the commentary by Anderson et al, on pages 222-224.) Objective. To determine whether increases in contact isolation precautions are associated with decreased adherence to isolation practices among healthcare workers (HCWs). Design. Prospective cohort study from February 2009 to October 2009. Setting. Eleven teaching hospitals. Participants. HCWs. Methods. One thousand thirteen observations conducted on HCWs. Additional data included the number of persons in isolation, types of HCWs, and hospital-specific contact precaution practices. Main outcome measures included compliance with individual components of contact isolation precautions (hand hygiene before and after patient encounter, donning of gown and glove upon entering a patient room, and doffing upon exiting) and overall compliance (all 5 measures together) during varying burdens of isolation. Results. Compliance with hand hygiene was as follows: prior to donning gowns/gloves, 37.2%; gowning, 74.3%; gloving, 80.1%; doffing of gowns/gloves, 80.1%; after gown/glove removal, 61%. Compliance with all components was 28.9%. As the burden of isolation increased (20% or less to greater than 60%), a decrease in compliance with hand hygiene (43.6%-4.9%) and with all 5 components (31.5%-6.5%) was observed. In multivariable analysis, there was an increase in noncompliance with all 5 components of the contact isolation precautions bundle (odds ratio [OR], 6.6 [95% confidence interval (CI), 1.15-37.44]; P = .03) and in noncompliance with hand hygiene prior to donning gowns and gloves (OR, 10.1 [95% CI, 1.84-55.54]; P = .008) associated with increasing burden of isolation. Conclusions. As the proportion of patients in contact isolation increases, compliance with contact isolation precautions decreases. Placing 40% of patients under contact precautions represents a tipping point for noncompliance with contact isolation precautions measures.
    Infection Control and Hospital Epidemiology 03/2014; 35(3):213-21. · 4.02 Impact Factor
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    ABSTRACT: Background: Ceftaroline has been approved for acute bacterial skin infections and community-acquired bacterial pneumonia. Limited clinical experience exists for use outside these indications.Methods: Retrospective analyses of patients receiving ceftaroline ≥ 72 hours from 2011 to 2013 were included. Clinical and microbiological outcomes were analyzed. Clinical success was defined as resolution of all signs and symptoms of infection with no further need for escalation while on ceftaroline treatment during hospitalization. The objective of this study was to describe the outcomes of patients treated with ceftaroline for various infections.Results: A total of 527 patients received ceftaroline and 67% were treated for off-label indications. Twenty eight percent (148/527) of patients had bacteremia. Most patients (80%) were initiated on ceftaroline after receipt of another antimicrobial, with 48% citing disease progression as a reason for switching. Median duration of ceftaroline was six days with an interquartile range of four to nine days. A total of 327 (62%) were culture positive and most prevalent pathogen was S. aureus by 83% (271/327). Of these, 88.9% (241/271) were MRSA. Clinically, 88% (426/484) achieved clinical success and hospital mortality was seen in 8% (40/527). While on ceftaroline, adverse events were experienced in 8% (41/527) of the patients and 9% (28/307) were readmitted within 30 days after discharge for the same infection.Conclusions: Patients treated with ceftaroline for both FDA-approved and off-label infections had favorable outcomes. Further research is necessary to further describe the role of ceftaroline in a variety of infections and its impact on patient outcomes.
    Antimicrobial Agents and Chemotherapy 02/2014; · 4.57 Impact Factor

Publication Stats

5k Citations
748.81 Total Impact Points

Institutions

  • 2010–2014
    • Detroit Medical Center
      Detroit, Michigan, United States
    • Oakwood Hospital
      Wayne, Michigan, United States
  • 2008–2014
    • Wayne State University
      • • Division of Infectious Diseases
      • • Department of Pharmacy Practice
      Detroit, Michigan, United States
    • University of Manitoba
      Winnipeg, Manitoba, Canada
    • Washington University in St. Louis
      San Luis, Missouri, United States
    • Icahn School of Medicine at Mount Sinai
      Manhattan, New York, United States
    • The Children's Hospital of Philadelphia
      Philadelphia, Pennsylvania, United States
  • 2013
    • Oregon Health and Science University
      • College of Pharmacy
      Los Angeles, CA, United States
  • 2010–2013
    • Sinai-Grace Hospital
      Detroit, Michigan, United States
  • 2010–2012
    • Harper University Hospital
      Detroit, Michigan, United States
  • 2000–2012
    • Duke University Medical Center
      • • Department of Medicine
      • • Division of Infectious Diseases
      Durham, NC, United States
    • Brigham and Women's Hospital
      • Division of Renal Medicine
      Boston, MA, United States
  • 2002–2010
    • Johns Hopkins Medicine
      • • Division of Infectious Diseases
      • • Department of Medicine
      Baltimore, Maryland, United States
  • 2009
    • Johns Hopkins University
      Baltimore, Maryland, United States
    • American University of Beirut
      Beyrouth, Beyrouth, Lebanon
    • University of Detroit Mercy
      Detroit, Michigan, United States
  • 2008–2009
    • Duke University
      Durham, North Carolina, United States
  • 2006–2009
    • Tel Aviv Sourasky Medical Center
      Tell Afif, Tel Aviv, Israel
    • Universidade Federal de São Paulo
      San Paulo, São Paulo, Brazil
  • 2002–2005
    • University of Maryland, Baltimore
      • Department of Medicine
      Baltimore, MD, United States
  • 2004
    • Harvard Medical School
      Boston, Massachusetts, United States
  • 2000–2001
    • Beth Israel Deaconess Medical Center
      • Division of Infectious Diseases
      Boston, MA, United States