Keith S Kaye

Detroit Medical Center, Detroit, Michigan, United States

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Publications (262)836.88 Total impact

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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; · 2.33 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; · 5.44 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. · 9.42 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.
    12/2014; 35(12):1531-4.
  • Debra A Goff, Keith S Kaye
    Clinical Infectious Diseases 12/2014; 59 Suppl 6:S365-6. · 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; · 4.45 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. · 9.42 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. · 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: 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: 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: A. baumannii is commonly recognized as an emerging multi-drug resistant (MDR) organism frequently impervious to majority of the commonly prescribed antibiotics. Colistin is one of the few therapeutic agents which possess activity against this pathogen, and its use has dramatically increased. As a result, colistin resistance is increasingly reported among A. baumannii and presents a unique challenge. Methods: A cluster of colistin-resistant A. baumannii cases at Detroit Receiving Hospital were identified from May 1st, 2013 to October 31st, 2013. Colistin resistance was defined as an MIC of >2 μg/ml (E-test). Epidemiologic data for these cases were collected and isolates assayed for clonality with Diversilab rep-PCR and multi-locus sequence typing (ST). Results: 11 cases were identified. The mean age of the patients was 48.8 years (range 17-76) and 10 (91%) resided in one of two intensive care units. All patients were treated with broad spectrum antimicrobials (but not colistin) prior to isolation of the colistin-resistant isolate. 9 (82%) patients were mechanically ventilated and the pathogen was detected from sputum specimen in 8 (73%) of patients. Other features frequently identified in these cases were the use of glucometer (73%) and tube feeds (82%). Colistin MIC ranged from 3-32. Environmental surveillance cultures were performed, but only one specimen was positive for the same organism. Genotyping was performed on 5 patient isolates which revealed 95% similarity between strains (Figure 1) and all isolates were ST281. In order to contain the outbreak, optimal infection prevention practices were reinforced, active surveillance screening of high risk patients implemented, with presumptive contact isolation. Conclusion: To our knowledge this is the first reported outbreak of colistin-resistant A. baumannii in United States. The hands of healthcare workers and environmental reservoirs are hypothesized to be the source of the outbreak. We observed a wide range of colistin MICs among outbreak strains, possibly due to 1) the emergence of heteroresistance or 2) differences in the population structure. A case-control study will help to further help delineate the cause of the outbreak. Genotype results (Figure 1):
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
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    ABSTRACT: Background: In January, 2013, the wording of the NHSN definition for CAUTI was changed to include fever as a diagnostic criteria regardless of the presence of an alternative fever source. The objective of this study was to determine the impact of changes in the CAUTI definition on the frequency and clinical relevance of CAUTI cases meeting NHSN criteria. Methods: We conducted a retrospective cohort analysis at the Detroit Medical Center (DMC). We included 4 DMC sites and 15 adult ICUs from July 1, 2012 to June 30, 2013. Patients were identified who met CAUTI criteria, based in part, on the presence of fever. Detailed data collection was conducted to identify other potential fever sources. Results: A total of 107 patients who met current NHSN criteria for CAUTI were studied, with a mean age of 57.1 ± 17.3 and 60.8% were female. Prior to urine culture, the median ICU length of stay was 20 days (IQR 7,33) and median foley days was 6 days (IQR 3,12). The most common pathogens responsible for CAUTI was Candida glabrata (23.1%) and enterococcus species (14.1%). 48 (44.8%) patients had another NHSN-defined infection other than CAUTI, including pneumonia (27.1%) and bloodstream infection (21.5%). Twelve patients (11.2%) had a non-infectious etiology of fever. Patients with alternative fever sources (n=60) were categorized as having CAUTI according to NHSN 2013 definitions only and would not have been diagnosed with CAUTI according to previous NHSN definitions. These patients were compared to those patients for whom CAUTI was the only source of fever (and thus would have been diagnosed with CAUTI by both older and new NHSN definitions) (n=47). There were no significant differences between the two groups although there were trends for a higher frequency of physician-diagnosed "other infections" (OR 5.8, p<0.001) among patients in the "new CAUTI only" group. Presence of Candida spp. was also more frequent among patients this group (OR 1.8, p=0.17). Conclusion: The change in NHSN CAUTI definition led to a more than 2-fold increase in CAUTIs. Using current, 2013 definitions, CAUTIs are frequently diagnosed in the presence of other infections. Positive urine cultures, (e.g. Candida spp.) often represent colonization rather than clinically meaningful urinary tract infection.
    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
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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: Currently the CDC recommends the use of Interferon-Gamma Release Assays (IGRAs) as an alternative to tuberculin skin tests (TSTs) in the diagnosis of M. tuberculosis infection. IGRAs are typically preferred in persons who have received BCG or with poor rates of follow up evaluation. Additional situations where IGRAs may be useful include those in which increased sensitivity is indicated (such as a negative TST in someone at high risk, healthcare workers (HCWs) who have been told they have a history of latent tuberculosis (LTBI)), or to increase acceptance and adherence to treatment guidelines (in cases of foreign-born HCWs who believe their positive test is a result of BCG). Methods: A retrospective review of IGRA results done at Detroit Medical Center (DMC) HCWs was conducted from 3/2013 to 3/2014. During the period, 6,138 T-Spot TB test results were obtained (4,631 employees, 343 staff and 1164 commercial clients, contractors, volunteers, students). Epidemiologic data on these HCWs was abstracted and their IGRA results compared with prior diagnosis of LTBI (defined as a prior TST result or on the basis of LTBI by history). Results: T-Spot testing revealed 5,815 negative (94.7%), 249 positive (4.1%), and 74 invalid or borderline (1.2%) values. Prior latent TB infection (LTBI) status was known for 3,478. Of these persons, 732 (21.0%) had previously been determined to have LTBI (110 positive TST and 622 by history of LTBI), whereas only 214 (6.2%) tested positive on the T-Spot. When prior TSTs were negative (n=2746), the T-Spot was negative 98.9% of the time. However, when prior LTBI history was positive (n=732), the T-Spot was positive only 25% of the time. Conclusion: T-Spot testing is very specific in identification of HCW with LTBI. Chemoprophylaxis, when based on TST results or a history of LTBI would be recommended three times more frequently than when based on T-Spot results. The use of IGRA testing may help identify HCW with a history of LTBI who are most likely to benefit from treatment for LTBI.
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
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    ABSTRACT: Background: Common antibiotic prophylactic strategies for prostate biopsy may be insufficient to prevent procedure-associated sepsis, particularly with the rise of Gram-negative pathogens that are resistant to fluoroquinolones. We aim to describe all-cause and infection-related readmission rates and costs in a national sample of men undergoing prostate biopsy. Methods: We compared mean rates of readmission within 30 days of prostate biopsy from January 2005 to December 2011. Insurance claims data was obtained from the Marketscan Commercial Claims and Encounters database. Yearly rates of prostate biopsy and readmissions were calculated from the number of inpatient admissions and outpatient services (including emergency room visits) in men of at least 40 years of age with a documented CPT-4 code of 55700 for prostate biopsy. Patients were required to be continuously enrolled in at least one insurance program for at least 30 days after prostate biopsy for inclusion in the analysis. Results: 447,486 men with a prostate biopsy were eligible for inclusion. Mean age of the population was 62.8 years of age (SD 8.9). 13,154 of these patients (2.9%) were readmitted within 30 days of biopsy. Median length of stay during readmission was 3 days (IQR: 2) and mean total payment for the hospitalization was $14,749.09 (SD $22,767.11). The most common major diagnostic category upon readmission was reproductive diseases (4786 readmissions) followed by infectious diseases (2539 readmissions; 0.6% of all prostate biopsies). Conclusion: Despite widespread use of antibiotic prophylaxis for prevention of infection following prostate biopsy, infection remains the second most common reason for 30-day hospital readmission, possibly due in part, to the emergence of multi-drug resistant pathogens. Continued efforts are needed to optimize prophylaxis strategies.
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
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    ABSTRACT: Background: Co-colonization with methicillin-resistant S. aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) is a key factor in the emergence of vancomycin-resistant S. aureus. Our objective is to describe the molecular epidemiology of MRSA co-colonization through comparison of MRSA spa types between co-colonized cases and matched controls. Methods: We conducted a prospective study among adult inpatients in six hospitals in and around Detroit, Michigan. Cases were defined as individuals with positive cultures for MRSA and VRE within 7 days of one another. Controls with a positive culture for MRSA and not VRE were matched to cases by hospital, infection type, healthcare associated infection, and requirement for intensive care unit (ICU) care. Patient demographics and clinical data were collected by medical record review. spa typing was conducted by sequencing of the staphylococcal protein a (spa) gene, and sequences were analyzed using DNAGear. Molecular characteristics were compared between matched study groups using generalized estimating equations. Results: 113 MRSA isolates were analyzed from 83 MRSA and VRE co-colonized case patients and 30 MRSA-only control patients. Isolates were most frequently identified from acute bacterial skin and skin structure infections (46%) and bloodstream infections (17%). The majority of clinical cultures (76%) occurred within 72 hours of admission. The most common spa types were t002 (n=42; 37%), t008 (n=33; 29%) or t1094 (n=12; 11%). The t002 type was significantly more common among co-colonized cases (n=39; 47%) than among MRSA-only controls (n=3; 10%) (p=0.002). Conversely, the t008 type was significantly more common among controls (n=15; 50%) than among cases (n=22; 22%) (p<0.001). Conclusion: Patients with MRSA and VRE co-colonization were more likely to be infected with USA100-associated type t002. In contrast, patients with MRSA-only were more likely to be infected with USA300-associated type t008. This difference in molecular epidemiology may represent underlying differences in the medical history of patients at risk for co-colonization.
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
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    ABSTRACT: Background: In the USA, extended-spectrum β-lactamases (ESBLs) are implicated in an estimated 26,000 infections resulting in 1700 deaths annually. Ceftolozane/tazobactam (C/T) is a novel antibacterial active against most ESBL-producing Enterobacteriaceae and drug-resistant Pseudomonas aeruginosa. C/T was studied in Phase 3 trials in patients with complicated intra-abdominal infection (cIAI) and complicated urinary tract infection (cUTI). Data from these studies were evaluated to describe the characteristics and outcomes of patients infected with ESBL- producing Enterobacteriaceae. Methods: All trials were randomized and double-blind. In cUTI, treatment consisted of 7 days of intravenous C/T or levofloxacin, and in cIAI, 4-14 days of C/T plus metronidazole or meropenem. A baseline culture was obtained in both indications. Enterobacteriaceae were selected for ESBL characterization based on predefined criteria. Clinical and microbiological outcomes were determined 7 days post-treatment and 26-30 days after initiation of treatment in the cUTI and cIAI studies, respectively. Results: A total of 150 patients (11%) had an ESBL-producing Enterobacteriaceae (genotypically verified) in the microbiologically evaluable population. Although most baseline characteristics were similar to the overall population, a greater proportion of patients with ESBLs were ≥65 years of age (31% vs 21%) or renally impaired (40% vs 31%) as compared with the overall population. Clinical cure rates for patients with ESBLs were 97% and 85% for the C/T arm and combined comparators, respectively. Microbiological eradication was achieved in 81% and 61% of patients in the C/T and comparator arms, respectively. At a breakpoint of 8 mg/L, 90% of ESBL-producing Enterobacteriaceae were susceptible to C/T; in the cUTI trials approximately 20% were susceptible to levofloxacin, and in the cIAI trials meropenem resistance was low (<5%). Conclusion: Ceftolozane/tazobactam achieved high clinical and microbiological cure rates in cUTI and cIAI patients with ESBL infections. This was particularly notable, as patients with ESBLs were more likely to be elderly and/or renally impaired. C/T provides an empiric treatment option for infections caused by ESBL-producing pathogens.
    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 increasingly important cause of pneumonia. In order to understand the factors that impact outcomes of CRKP pneumonia, we examined a nested cohort of patients that are enrolled in the prospective Consortium on Resistance against Carbapenems in K. pneumoniae (CRaCKle). Methods: CRaCKle is a prospective multicenter consortium which includes 21 hospitals serving more than 2 million people in the Great Lakes region. All hospitalized patients with CRKP pneumonia were included if their hospitalization began and ended within the study period from 12/24/2011 until 10/1/2013. Each patient was only included once at the time of their first respiratory culture from which CRKP was isolated. Criteria outlined by the American Thoracic Society and the Infectious Diseases Society of America were used to define pneumonia. Severe acute illness was defined as a Pitt bacteremia score ≥4. Results: 29 unique patients with CRKP pneumonia were included; median age was 71 years (IQR 57.5-80 years), median Charlson score was 3 (IQR 2-5), 18 (62%) were female, 16 (55%) were Caucasian, 13 (45%) had chronic obstructive pulmonary disease (COPD), 2 (7%) had bacteremia. 25 (86%) patients were on mechanical ventilation at the time of culture. Eight (28%) patients were admitted from home. Most patients were admitted from long term chronic care (12/29, 41%) or long term acute care (4/29, 14%), 5 (17%) patients were transferred from other hospitals; Median time from admission to first positive culture was 9 days (IQR 6-38 days) in patients admitted from home, vs. 7 days (IQR 1-15 days) in all other patients (p=NS). None of the 8 patients admitted from home died within 14 days of first positive culture, as compared to 9/21 (43%) of all other patients (p=0.03 by Fisher's Exact). In a multivariable model which adjusted for chronic comorbidities (Charlson comorbidity index) and severe acute illness, community origin remained significantly associated with decreased mortality (p<0.01). Conclusion: In this nested cohort of hospitalized patients with CRKP pneumonia, community origin prior to admission was associated with improved 14-day survival.
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014

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Institutions

  • 2010–2014
    • Detroit Medical Center
      Detroit, Michigan, United States
  • 2008–2014
    • Wayne State University
      • • Division of Infectious Diseases
      • • Department of Pharmacy Practice
      Detroit, Michigan, United States
    • Washington University in St. Louis
      San Luis, Missouri, United States
    • University of Manitoba
      Winnipeg, Manitoba, Canada
    • The Children's Hospital of Philadelphia
      Philadelphia, Pennsylvania, United States
    • Icahn School of Medicine at Mount Sinai
      Manhattan, New York, 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
  • 2002–2010
    • Johns Hopkins Medicine
      • Department of Medicine
      Baltimore, Maryland, United States
  • 2009
    • Johns Hopkins University
      Baltimore, Maryland, United States
    • University of Detroit Mercy
      Detroit, Michigan, United States
    • Duke University
      Durham, North Carolina, United States
    • American University of Beirut
      Beyrouth, Beyrouth, Lebanon
  • 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