Keith S Kaye

Wayne State University, Detroit, Michigan, United States

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Publications (276)952.21 Total impact

  • 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; 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; DOI:10.1016/j.cmi.2014.12.025 · 4.58 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 01/2015; 37. DOI:10.1016/j.ajic.2014.11.013 · 2.33 Impact Factor
  • Infection Control and Hospital Epidemiology 01/2015; DOI:10.1017/ice.2014.79 · 3.94 Impact Factor
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    ABSTRACT: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is an important healthcare-associated pathogen. We evaluated the impact of CRKP strain type and treatment on outcomes of patients with CRKP bacteriuria. Physician-diagnosed CRKP urinary tract infection (UTI)-defined as those patients who received directed treatment for CRKP bacteriuria-was studied in the multicentre, prospective Consortium on Resistance against Carbapenems in Klebsiella pneumoniae (CRaCKle) cohort. Strain typing by repetitive extragenic palindromic PCR (rep-PCR) was performed. Outcomes were classified as failure, indeterminate or success. Univariate and multivariate ordinal analyses to evaluate the associations between outcome, treatment and strain type were followed by binomial analyses. One-hundred-and-fifty-seven patients with physician-diagnosed CRKP UTI were included. After adjustment for CDC/National Healthcare Safety Network (NHSN)-defined UTI, critical illness and receipt of more than one active antibiotic, patients treated with aminoglycosides were less likely to fail therapy [adjusted OR (aOR) for failure 0.34, 95% CI 0.15-0.73, P = 0.0049]. In contrast, patients treated with tigecycline were more likely to fail therapy (aOR for failure 2.29, 95% CI 1.03-5.13, P = 0.0425). Strain type data were analysed for 55 patients. The predominant clades were ST258A (n = 18, 33%) and ST258B (n = 26, 47%). After adjustment for CDC/NHSN-defined UTI and use of tigecycline and aminoglycosides, infection with strain type ST258A was associated with clinical outcome in ordinal analysis (P = 0.0343). In multivariate binomial models, strain type ST258A was associated with clinical failure (aOR for failure 5.82, 95% CI 1.47-28.50, P = 0.0113). In this nested cohort study of physician-diagnosed CRKP UTI, both choice of treatment and CRKP strain type appeared to impact on clinical outcomes. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.
    Journal of Antimicrobial Chemotherapy 12/2014; DOI:10.1093/jac/dku495 · 5.44 Impact Factor
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    ABSTRACT: We assessed for vancomycin-resistant Staphylococcus aureus (VRSA) precursor organisms in southeastern Michigan, an area known to have VRSA. The prevalence was 2.5% (pSK41-positive methicillin-resistant S. aureus, 2009-2011) and 1.5% (Inc18-positive vancomycin-resistant Enterococcus, 2006-2013); Inc18 prevalence significantly decreased after 2009 (3.7% to 0.82%). Risk factors for pSK41 included intravenous vancomycin exposure.
  • Debra A Goff, Keith S Kaye
    Clinical Infectious Diseases 12/2014; 59 Suppl 6:S365-6. DOI:10.1093/cid/ciu531 · 9.42 Impact Factor
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    ABSTRACT: In the era of carbapenem-resistance in Acinobacter baumannii and Enterobacteriaceae, there are limited treatment options for these pathogens. It is essential that clinicians fully assess all available therapeutic alternatives for these multidrug-resistant organisms. We herein describe the approach of the antimicrobial stewardship team at the Detroit Medical Center (DMC) for the evaluation and use of intravenous (IV) minocycline for the treatment of these resistant organisms, given potential advantages of IV minocycline over tigecycline and doxycycline. In vitro analyses at the DMC demonstrated good activity against A. baumannii (78% susceptibility), including 74% of carbapenem-resistant strains, but limited activity against our carbapenem-resistant K.pneumoniae (12% susceptibility.) Based in part on these results, IV minocycline was added to the formulary, primarily for the treatment of carbapenem-resistant A. baumannii. Early experience has been positive: 6/9 (67%) of patients who received IV minocycline had infections due to these organisms cured, including 6/7 (86%) who received doses of 200 mg twice daily.
    Clinical Infectious Diseases 12/2014; 59 Suppl 6:S388-93. DOI:10.1093/cid/ciu594 · 9.42 Impact Factor
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    ABSTRACT: The emergence of multidrug-resistant (MDR) Klebsiella pneumoniae (Kp) has resulted in a more frequent reliance on treatment using colistin. However, resistance to colistin (ColR) is increasingly reported from clinical settings. The genetic mechanisms that lead to colR are not fully characterized in K. pneumoniae. Using a combination of genome sequencing and transcriptional profiling by RNA-seq analysis, distinct genetic mechanisms were found among nine ColR clinical isolates. ColR was related to mutations in three different genes in Kp strains, with distinct impacts on gene expression. Up-regulation of the pmrH operon encoding 4-amino-4-deoxy-L-arabinose (Ara4N) modification of lipid A was found in all ColR strains. Alteration of the mgrB gene was observed in six strains. One strain had a mutation in phoQ. Common among these seven strains was elevated expression of phoPQ and unaltered expression of pmrCAB which is involved in phosphoethanolamine addition to LPS. In two strains, separate mutations were found in a previously uncharacterized histidine kinase gene that is part of a two-component regulatory system (TCRS) now designated crrAB. In these strains, expression of pmrCAB, crrAB, and an adjacent glycosyltransferase gene were elevated, but not phoPQ. The crrAB genes are present in most Kp genomes, but not in Escherichia coli. Complementation with the wild-type allele restored colistin susceptibility in both strains. Additional up-regulated genes in all strains include those involved in cation transport and maintenance of membrane integrity. Because the crrAB genes are only present in some strains, ColR mechanisms may be dependent on the genetic background.
    Antimicrobial Agents and Chemotherapy 11/2014; 59(1). DOI:10.1128/AAC.04037-14 · 4.45 Impact Factor
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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 10/2014; 59(suppl 3):S146-S153. DOI:10.1093/cid/ciu566 · 9.42 Impact Factor
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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 10/2014; 59(suppl 3):S112-S121. DOI:10.1093/cid/ciu546 · 9.42 Impact Factor
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    ABSTRACT: Background: The aims of this study were to compare the standard cleaning practice to cleaning using OxyCide™, a novel, sporicidal, one-step disinfectant concentrate on environmental contamination and hospital-acquired infections (HAIs). Methods: A cross-over study was conducted using 1 medical-surgical and 1 intensive care unit. In the intervention group, OxyCide™ was used for routine cleaning of all patient rooms. In the control group, standard cleaning was conducted using Virex II 256- quaternary ammonium compound and Dispatch for C. difficile rooms; and Virex II alone for other rooms. The study period was 13 months. Using moist cotton swabs, qualitative environmental cultures were collected after terminal cleaning from selected rooms of discharged patients with A. baumannii or C. difficile; and quantitative samples were collected from occupied rooms. Standard laboratory procedures were used. HAIs were tracked throughout the study period. Results: A total of 4,105 patients were cared for on study units during the study period, accounting for 20,932 patient days. After terminal cleaning, 747 samples were collected from 69 rooms (27 C. difficile and 42 A. baumannii). There was no growth from 331 swabs collected in the control group and 2/416 swabs (0.5%) from the intervention group grew (1/270 for A. baumannii and1/146 for C. difficile). 216 swabs were collected from high touch objects in 36 occupied patient rooms (18 in each group). 18/108 (17%) samples from the control group grew, as did 20/108 (18.5%) from the intervention group (p=0.85). There were a total of 122 unit-acquired infections, 24 device-related infections, 15 unique patients with A. baumannii and 25 with C. difficile. The rate of HAI was 6.6 in the control arm and 4.8/1000 patient days in the intervention arm (p=0.09); of device-related infection was 1.6 and 0.6/1000 patient days, respectively (p=0.04); of A. baumannii was 0.7 and 0.7/1000 patient days respectively (p=0.98); and of C. difficile, was 1.0 and 1.4/1000 patient days, respectively (p=0.36). Conclusion: Use of OxyCide™ was associated with decreased device-related hospital infections when compared to standard cleaning with quaternary ammonium compound +/- bleach. Recovery of environmental pathogens was low in both study arms.
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
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    ABSTRACT: Background: The aim of this study was to compare hospital-onset (Non-POA) CDI discharges to community-onset (POA) CDI discharges in order to assess the healthcare burden of hospital acquired CDI. Methods: A retrospective chart review of patients diagnosed with CDI was conducted at a tertiary-care hospital in Detroit between Jan 2011 and Dec 2012. CDI Patients were classified as present-on-admission (POA) if they were primarily admitted with CDI or tested positive for CDI 48 hours prior and/or 48 hours after admission. Non-present-on-admission (Non-POA) patients were defined as being tested positive for CDI 48 hours after admission. Collected data included demographics, admission source, comorbidities, and length-of-stay (LOS). Thirty-day readmissions due to all causes including recurrent CDI as well as 30-day mortality rates were calculated and compared between POA and Non-POA CDI discharges. Results: The cohort included 710 patients with POA CDI and 602 patients with Non-POA CDI. Although the mean age of POA group was not significantly different from the mean age of Non-POA group (61±19 vs 61±18, p=.95), Non-POA patients were more likely to be admitted with a rapidly fatal condition compared to POA patients (49 % vs 42%, p=.022). On the other hand, POA patients were more likely to be admitted from home compared to Non-POA patients (76% vs 70%, p= .015). The median LOS for Non-POA patients was significantly higher than that for POA patients (16 days, interquartile range {IQR} [10 – 27] vs 5 days, IQR [3 – 10], p<.001). Although not statistically significant, 30-day readmissions due to CDI recurrence in the POA group were higher than that in the Non-POA group (5% vs 3%, p=.09). The median time to readmission for POA patients was significantly higher than that for Non-POA patients (53 days, IQR [17 – 199] vs 34 days, IQR [11 – 137], p=.003). Thirty-day mortality rate of Non-POA CDI patients was higher than that of POA CDI patients (11.5 % vs 6%, p<.001). Conclusion: Given the high morbidity and mortality rates among patients with hospital-onset CDI (Non-POA), efforts should focus on prevention strategies including regular surveillance, antimicrobial stewardship and quality improvement programs.
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
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    ABSTRACT: Background: Carbapenem Resistant Klebsiella Pneumoniae (CRKP) is an emerging threat, and hospital readmissions of patients with persistent or recurrent CRKP may contribute to the spread of CRKP. We evaluated CRKP readmissions in the Consortium on Resistance against Carbapenems in K. pneumoniae (CRaCKle). Methods: CRaCKle is a prospective multicenter consortium which includes 21 hospitals in the Great Lakes region. All hospitalized patients who were discharged alive were included, if their hospitalization during which CRKP was isolated began and ended between 12/24/2011 and 7/1/2013. Each patient was included once at the time of the first CRKP positive culture. Standard criteria were used to define infection. All readmissions during which CRKP was again found (CRKP readmission) were documented. Risk factors for CRKP readmission were evaluated in multivariable logistic models. Kaplan-Meier curve was used to compare time to readmission. Results: 287 unique patients were included; 109 (38%) with CRKP infection. Most CRKP was recovered from urine (192, 67%). 56 (20%) patients had a CRKP readmission within 90 days. Risk factors for CRKP readmission included history of cancer (OR 2.74 95%CI 1.22-5.96, p=0.01), and renal insufficiency (OR 2.06, 95%CI 1.05-3.96, p=0.03). 160/287 (56%) of patients received anti-CRKP antibiotic treatment during their index hospitalization. In these 160 patients, 65/160 (41%) received aminoglycoside-based regimens, 49/160 (31%) tigecycline-based regimens, 27/160 (17%) colistin-based regimens, and 19/160 (12%) other regimens. Receiving a tigecycline-based regimen was associated with an increased risk for CRKP readmission; 14/49 (28%) of patients who received tigecycline were readmitted within 90 days, as compared to 16/111 (14%) of all other treatment regimens. The OR for tigecycline for 90-day CRKP readmission was 2.71 (95%CI 1.14-6.48, p=0.02) after adjusting for infection status, source, renal failure, and cancer history. Conclusion: Hospitalized patients with CRKP are at high risk of readmission with recurrent CRKP which may contribute to the spread of CRKP in health care systems. Treatment during index hospitalization with a tigecycline-based regimen may increase that risk.
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
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    ABSTRACT: Background: In January 2013, the National Healthcare Safety Network of (NHSN) reworded the CAUTI definition criteria to include fever regardless of the presence of an alternative fever source. At Detroit Medical Center (DMC) the change resulted in a sharp increase in CAUTI, particularly due to Candida spp. This study was conducted to better understand the epidemiology and clinical relevance of CAUTI due to Candida spp. Methods: This study was conducted at 15 adult ICUs at 4 DMC hospitals from July 1st, 2012 to June 31, 2013. It was a nested study from a cohort of ICU patients with CAUTI diagnosed according to current NHSN criteria, in which fever was the only symptom criteria present. Patients with CAUTI due to Candida spp. were compared to patients with CAUTI due to bacteria. Results: Of 99 patients with CAUTI and fever, 44 (44.4%) had Candida spp. as a pathogen and 55 (55.6%) had bacteria. The mean age of patients was 57.3 ± 17.2 and 58.59% were female. The median duration of the foley catheterization prior to positive urine culture was significantly longer in the Candida group (7.06 vs. 4.57 days in bacteria group, p=0.01) as was median length of stay (LOS) (31 vs. 16 days, p=0.007) and ICU LOS prior to urine culture (11.59 days vs. 5.98) (p= 0.003). 43.2% of Candida CAUTI patients had diabetes compared to 25.5% of bacterial CAUTI (p= 0.09). SIRS criteria was present in 90.9% of patients in the Candida group and 76.2% in the bacteria group (p= 0.07). Fever sources other than CAUTI (mainly pneumonia and bloodstream infections) were more often present in the Candida group than the bacteria group (50% and 38.1%, p=.35) as was the proportion of patients with physician-diagnosed infections (68.2% vs. 47.2%, p=0.04). In-hospital mortality was 29.6% in the Candida group and 18.2% in the bacteria group (p=0.15). Conclusion: Compared to bacterial CAUTI patients, Candida CAUTI patients had more intensive healthcare exposure, longer durations of indwelling urinary catheters, and more frequently had co-infections at the time of CAUTI diagnosis. These factors suggest that in many cases, Candida CAUTI is a marker or increased severity of illness, represents colonization rather than true infection and is not clinically relevant. NHSN criteria should be modified to account for these factors.
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
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    ABSTRACT: Background: Nasal carriage of Staphylococcus aureus (SA) has been shown to be an independent risk factor for SA surgical site infections (SSI), with a SSI rate 2-9 times higher in carriers. Decolonization with nasal mupirocin is often recommended for carriers or high risk individuals, however this process requires preoperative screening and patient compliance with application days prior to surgery. Nasal decontamination with nasal iodine just prior to surgery offers a rapid method of decreasing the nasal burden of SA in high risk joint implant surgeries. Methods: Nasal decontamination with nasal iodine (3MTM Skin and Nasal Antiseptic) of all patients undergoing hip and knee prosthetic joint replacement was implemented pre-operatively since March 2013 at Detroit Receiving Hospital. This intervention was coupled with reinforcement with perioperative CHG bathing and the addition of vancomycin to routine B-lactam prophylaxis. Hip arthroplasty (HPRO) and knee arthroplasty (KPRO) infection rates were reviewed for 1 year before and after intervention. Results: There was a 28.3% reduction in HPRO and KPRO infections during this time period. A decrease in the average rate from 2.59 to 1.86 infections per 100 procedures (OR-0.56, p=0.23) was seen. SA infection were reduced from an average rate of 1.29 to 0.63 infections per 100 procedures (OR – 0.48, p=0.30). This resulted in a reduction of 5 infections and an approximate net cost saving of $142,409 Conclusion: Nasal decontamination with iodine offers an alternative to nasal decolonization with mupirocin in the prevention of orthopedic implant infections and was effective as part of a perioperative SSI prevention bundle.
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014

Publication Stats

6k Citations
952.21 Total Impact Points

Institutions

  • 2008–2015
    • Wayne State University
      • • School of Medicine
      • • Department of Internal Medicine
      • • Division of Infectious Diseases
      Detroit, Michigan, United States
    • Infectious Diseases Society Of America
      Arlington, Virginia, United States
  • 2009–2014
    • Detroit Medical Center
      Detroit, Michigan, United States
  • 2010–2013
    • Sinai-Grace Hospital
      Detroit, Michigan, United States
  • 2012
    • Harper University Hospital
      Detroit, Michigan, United States
  • 2004–2012
    • Duke University
      • • Department of Medicine
      • • Department of Surgery
      Durham, North Carolina, United States
    • University of Utah
      Salt Lake City, Utah, United States
  • 2010–2011
    • University of Detroit Mercy
      Detroit, Michigan, United States
  • 2000–2010
    • Duke University Medical Center
      • • Department of Medicine
      • • Division of Infectious Diseases
      Durham, North Carolina, 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
  • 2001
    • Harvard Medical School
      Boston, Massachusetts, United States
  • 2000–2001
    • Beth Israel Deaconess Medical Center
      • Division of Infectious Diseases
      Boston, MA, United States