Ellie J C Goldstein

Alden Research Laboratory, Inc.

Background We have previously reported on a US based national surveillance study from 6 geographically dispersed medical centers for the susceptibility and epidemiology of C. difficile isolates. This current survey was conducted with isolates collected in 2020-21 with specific attention to the susceptibility to ridinilazole as well as nine comparat...

Three strictly anaerobic strains of Escherichia coli were misidentified as Fusobacterium mortiferum, due to a deletion of the hemB gene which is involved in anaerobic respiration. An unusual antimicrobial susceptibility pattern sparked the further diagnostic strategies that eventually identified these strains as true anaerobic E. coli This phenomen...

We assessed risk factors for colistin resistance among carbapenem-resistant Klebsiella pneumoniae (CRKP) from 375 patients in long-term acute care hospitals. Recent colistin or polymyxin B exposure was associated with increased odds of colistin resistance (adjusted odds ratio = 1.11 per day of exposure, 95% confidence interval = 1.03–1.19, p = 0.00...

We assessed susceptibility patterns to newer antimicrobial agents among clinical carbapenem-resistant Klebsiella pneumoniae (CRKP) isolates from patients in long-term acute-care hospitals (LTACHs) from 2014 to 2015. Meropenem-vaborbactam and imipenem-relebactam nonsusceptibility were observed among 9.9% and 9.1% of isolates, respectively. Nonsuscep...

Stenotrophomonas maltophilia is an underappreciated source of morbidity and mortality among Gram-negative pathogens. Effective treatment options with acceptable toxicity profiles are limited. Phenotypic susceptibility testing via commercial automated test systems is problematic and no FDA breakpoints are approved for any of the first-line treatment...

Coccidioidomycosis is the second most common endemic fungal infection in the US. Prior descriptions of coccidioidal peritonitis include only single cases. We describe seventeen new cases previously unreported from healthcare institutions in California. The majority of cases presented with non-specific abdominal complaints. PubMed and Google Scholar...

Background CRKP infection is common among LTACH patients. However, CRKP antimicrobial susceptibility testing (AST) with newer antibiotics has not been described in this population. In this study, we performed AST on CRKP in LTACHs. Methods CRKP clinical cultures were collected from 21 Kindred Healthcare LTACHs (12 southern California, 6 Texas, 2 F...

Background Colistin resistance in CRKP presents a serious clinical challenge for patients of LTACHs. However, risk factors for colistin-resistant CRKP have not been previously characterized in this population. Here, we determined risk factors for colistin resistance among CRKP isolates from a network of LTACHs. Methods CRKP clinical cultures were...

This chapter highlights human and animal bites, which are common injuries. Human bites are either occlusional, where the teeth bite directly into flesh, or clenched-fist (closed-fist) injuries (CFIs). Most occur during fights, and the patient typically has a delayed presentation often resulting in infection. Patients may seek care at a hospital’s e...

There is an urgent need to improve our understanding of how new antibiotic resistant organisms emerge and spread. A high-priority resistance threat is the ST258 lineage of carbapenem-resistant Klebsiella pneumoniae . Here, we studied resistance to the last-line drug colistin among ST258 by tracking its evolution across 21 U.S. hospitals over the co...

When 70% of antibiotic users took a three-strain Lactobacillus probiotic preparation the hospital-wide rate of Healthcare-Associated Clostridioides difficile infection (CDI) improved significantly. The incidence of CDI for those taking the probiotic along with multiple antibiotics or a single high-risk antibiotic was decreased by at least half.

Medical care for patients hospitalized with COVID-19 is an evolving process. Most COVID-19 inpatients (58–95%) received empiric antibiotics to prevent the increased mortality due to ventilator-associated pneumonia and other secondary infections observed in COVID-19 patients. The expected consequences of increased antibiotic use include antibiotic-a...

Multidrug-resistant organisms, such as carbapenem-resistant Klebsiella pneumoniae

Bulleidia extructa is a rarely recognized anaerobic Gram-positive bacterium with an oral and gastroenterological ecological niche. It is difficult to isolate due to slow to grow in culture and usually requires identification techniques such as 16S rRNA gene sequencing or matrix-assisted laser desorption/ionization time of flight mass spectrometry (...

The role of empirical and even directed antimicrobial management of patients hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is problematic; antibiotics are used frequently among these patients to treat confirmed or suspected coinfection or just the symptoms. In the rapidly changing clinical landscape of SAR...

Clostridioides difficile infection (CDI) is a major cause of nosocomial diarrhea that is deemed a global health threat. C. difficile strain BI/NAP1/027 has contributed to the increase in the mortality, severity of CDI outbreaks and recurrence rates (rCDI). Updated CDI treatment guidelines suggest vancomycin and fidaxomicin as initial first-line the...

Background: Bezlotoxumab reduced rates of recurrent Clostridioides difficile infection (rCDI) versus placebo in MODIFY I/II trial participants receiving antibacterial drug treatment for CDI. A secondary objective of MODIFY I/II was to assess bezlotoxumab's efficacy against C. difficile strains associated with increased rates of morbidity and morta...

Background Among patients colonized with carbapenem-resistant Klebsiella pneumoniae (CRKP), only a subset develop clinical infection. While patient characteristics may influence risk for infection, it remains unclear if the genetic background of CRKP strains contributes to this risk. We applied machine learning to quantify the capacity of patient c...

Tedizolid's anaerobic activity is unappreciated. In this study, it was active against all 332 anaerobic isolates tested at ≤2 μg/ml except Bilophila wadsworthia and was more active than linezolid against Bacteroides fragilis group species (MIC90, 1 μg/ml versus 2 to 4 μg/ml). Tedizolid was active against Gram-positive anaerobes (MIC90 for clostridi...

Background Geographic and temporal trends in the distribution of PCR ribotypes for Clostridioides difficile associated diarrheal isolates obtained in the United States (US) are changing. As part of a US national surveillance program of C. difficile susceptibility to fidaxomicin, we quantified the distribution of PCR ribotypes of stool isolates coll...

Clostridioides (Clostridium) difficile remains the leading cause of healthcare-associated diarrhea, with ~30,000 deaths due to Clostridioides difficile infection (CDI) annually in the United States. Patients in long-term care facilities (LTCFs), particularly, carry an increased susceptibility to acquiring CDI and carry up to a 51% rate of asymptoma...

From Monoclonal Antibodies for C. difficile Therapy II, no participants (n = 0/69) with a sustained clinical cure through 12 weeks following bezlotoxumab infusion experienced recurrent Clostridioides difficile infection (rCDI) after 9 months (versus actoxumab + bezlotoxumab, n = 2/65; versus placebo, n = 1/34). Bezlotoxumab's efficacy appears to be...

Carbapenem-resistant Klebsiella pneumoniae (CRKP) is an antibiotic resistance threat of the highest priority. Given the limited treatment options for this multidrug-resistant organism (MDRO), there is an urgent need for targeted strategies to prevent transmission. Here, we applied whole-genome sequencing to a comprehensive collection of clinical is...

Background: In 2011, we initiated a sentinel surveillance network to assess changes in C. difficile antimicrobial susceptibility to fidaxomicin from 6 geographically dispersed medical centers in the US. This report summarizes data from 2013-2016. Methods:C. difficile isolates or toxin positive stools from patients were referred to a central laborat...

Introduction: Clostridioides (Clostridium) difficile Infection (CDI) is an urgent global threat causing ~500,000 infections annually in the United States of America (USA) and is associated with a 36% 30-day attributable mortality rate. Despite the availability of three therapeutic agents, CDI recurrence occurs in 20-40% of patients, with a 30-40% s...

Introduction Clinicians and patients face a daunting task when choosing the most appropriate probiotic for their specific needs. Available preparations encompass a diverse and continuously expanding product base, with most available products lacking evidence-based trials that support their use. Even when evidence exists, not all probiotic products...

An example of a search strategy. (DOCX)

McFarland dataset for probiotic trials. (DOCX)

Citations of included trials by disease indication. (DOCX)

Background Recurrence of CDI (rCDI) is associated with perturbation of the gut microbiome during treatment with vancomycin (VAN) or metronidazole (MTZ). RDZ is a novel, targeted spectrum antibacterial under investigation to treat CDI and reduce rCDI. Here correlation of in vitro spectrum of activity with preservation of the human gut microbiome and...

Antimicrobial stewardship programs (ASPs) are recommended by the Centers for Disease Control and Prevention and World Health Organization and mandated by The Joint Commission to curb antimicrobial resistance (AMR). However, < 50% of institutions have optimal ASPs in place. Building on its experience of antimicrobial stewardship (AMS) advocacy, Infe...

Eravacycline, a novel fluorocycline antibiotic, has been evaluated against complicated mixed aerobic/anaerobic intra-abdominal infections but scant supporting in vitro data against anaerobes has been published. We found that eravacycline had good anaerobic in vitro activity with MICs of 4 μg/ml or less against all Bacteroides and Parabacteroides st...

Oral vancomycin is used to treat Clostridioides (Clostridium) difficile infection. Several different preparations are available including reconstituted IV solutions, vancomycin capsules, and grape flavored Vancomycin oral solution kit (CutisPharma). The shelf life for IV after reconstitution varies between 7-14 days under refrigeration, and a stand...

Background As the use and diversity of probiotic products expands, the choice of an appropriate type of probiotic is challenging for both medical care professionals and the public alike. Two vital factors in choosing the appropriate probiotic are often ignored, namely, the probiotic strain-specificity and disease-specificity for efficacy. Reviews a...

The prevalence of C. difficile infection (CDI) and severe CDI are influenced by the prevalence of specific C. difficile strains, which are themselves influenced by antimicrobial susceptibility determinants as well as antimicrobial usage patterns. Restriction endonuclease analysis (REA) typing and antimicrobial susceptibility testing were used to ch...

The in vitro activity of DS-2969b, a novel GyrB inhibitor, and six comparator agents was studied against 101 recent North American Clostridioides difficile isolates, 46 other intestinal anaerobes and 51 strains of methicillin-resistant Staphylococcus aureus. The MIC ranges (MIC90s) of DS-2969b against C. difficile and S. aureus were 0.03–0.125 (0.1...

Omadacycline was tested against 125 isolates recovered from infected cat and dog bites in humans. Its activity was similar to other compounds in the tetracycline class and was active against strains exhibiting tetracycline resistance. Against anaerobic isolates, resistance to tetracyclines was more prominent, and omadacycline was the most active of...

Relebactam is an important beta-lactamase inhibitor for certain aerobic organisms but alone it has no anti-anaerobic activity, with most anaerobes having MICs ≥32 μg/ml with the exception of a very few strains. There was no enhancement or antagonism of imipenem activity with the addition of relebactam, including activity against imipenem resistant...

Pexiganan, a cationic peptide, exhibited a broad range of anti-anaerobic antimicrobial activity. MIC 90 s were as follows: B. fragilis, 16 μg/ml; other Bacteroidesfragilis group spp., 4 μg/ml; Prevotella and Fusobacterium spp., 32 μg/ml; and Porphyromonas spp., 64 μg/ml; P . acnes , 4 μg/ml; E. lenta and P. anaerobius , 32 μg/ml; other Gram-positiv...

Background Eravacycline (ERV is the first fully synthetic fluorocycline with activity against tetracycline (TET)-resistant organisms. In addition, it is 2–8 times more potent than tigecycline (TGC). Like other tetracyclines, it inhibits protein synthesis by binding to the 30S ribosomal subunit exhibiting a broad spectrum of activity. To further exp...

Background Trends in the distribution of ribotypes for C. difficile associated diarrheal isolates obtained over time in the United States are lacking. As part of surveillance program for C. difficile susceptibility, we analyzed stool isolates for ribotype distribution from a phase 2 trial of surotomycin (2010–2011) (North America sites) as well as...

Animal bite wounds affect more than 5 million Americans resulting in 300,000 Emergency Department visits, 10,000 hospitalizations and untold number of physician office visits annually. Various forms of topical therapy are empirically self-employed by many patients prior to seeking medical attention. Pexiganan, a 22-amino acid synthetic cationic ana...

Acinetobacter remains one of the most challenging pathogens in the field of infectious diseases owing primarily to the uniqueness and multiplicity of its resistance mechanisms. This resistance often leads to devastatingly long delays in time to appropriate therapy and increased mortality for patients afflicted with Acinetobacter infections. Selecti...

In February, 2016, WHO released a report for the development of national action plans to address the threat of antibiotic resistance, the catastrophic consequences of inaction, and the need for antibiotic stewardship. Antibiotic stewardship combined with infection prevention comprises a collaborative, multidisciplinary approach to optimise use of a...

Study objective: The incidence of Clostridium difficile infection has increased and has been observed among persons from the community who have not been exposed to antibiotics or health care settings. Our aims are to determine prevalence of C difficile infection among emergency department (ED) patients with diarrhea and the prevalence among patien...

To better characterize murine intestinal microbiota, a large number (187) of Gram-positive staining, rod- and coccoid-shaped facultative and strictly anaerobic bacteria were isolated from small and large intestinal contents from mice. Based on 16S rRNA gene sequencing, a total 115 isolates formed three phylogenetically distinct clusters located wit...

Background: The rapid emergence of carbapenem-resistant Klebsiella pneumoniae (CRKP) represents a major public health threat, including in the long-term acute care hospital (LTACH) setting. The objective of this study was to describe the epidemiologic characteristics of CRKP in a network of United States LTACHs. Methods: An observational study w...

Objectives: For reasons not well understood, antibacterials can yield lower cure rates in renally impaired patients. We explored this subject for the novel antibacterial ceftolozane/tazobactam. Methods: ASPECT-complicated intra-abdominal infections (cIAIs) and ASPECT-complicated urinary tract infections (cUTIs) were randomized, double-blinded cl...

The susceptibility trends for Bacteroides fragilis and related species against various antibiotics were determined using data from 3 years of surveillance (2010-2012) on 779 isolates referred by 7 medical centers. The antibiotic test panel included imipenem, ertapenem, meropenem, ampicillin-sulbactam, piperacillin-tazobactam, cefoxitin, clindamycin...

Background: The control of Clostridium difficile infections is an international clinical challenge. The incidence of C difficile in England declined by roughly 80% after 2006, following the implementation of national control policies; we tested two hypotheses to investigate their role in this decline. First, if C difficile infection declines in En...

In recent years, Clostridium difficile infection (CDI) has become a global public health threat associated with increased morbidity, mortality, and economic burden, all of which are exacerbated with disease recurrence. Current guidelines informing treatment decisions are largely based on definitions of disease severity at diagnosis, with subjective...

Because Bacteroides fragilis has the ability to develop mechanisms of resistance to almost all antibiotics, we studied the comparative in vitro activity of tedizolid against 124 Bacteroides group species clinical isolates, including carbapenem, metronidazole and piperacillin-tazobactam resistant strains. Tedizolid had an MIC90 of 2 μg/ml (range, 0....

Clostridium difficile infection (CDI) is the leading cause of infectious healthcare-associated diarrhoea. Recurrent CDI increases disease morbidity and mortality, posing a high burden to patients and a growing economic burden to the healthcare system. Thus, there exists a significant unmet and increasing medical need for new therapies for CDI. This...

Antimicrobial stewardship programs (ASPs) are a key national initiative to promote appropriate use of antibiotics and to reduce the burden of resistance. The dilemma of managing the outlier physician is especially complex. We outline strategies to establish a successful ASP that reviews appropriate efforts to achieve the goal of modifying outlier p...

We compared the eSwab system to a swab with an anaerobic transport semi-solid agar system for their capacities to maintain viability of 20 species of fastidious anaerobes inoculated on the bench and held at ambient and refrigerator temperature for 24 and 48h. On average, both systems maintained similar viability among analogous groups of organisms...

Clostridium difficile-associated diarrhea has been associated with the disruption of the normal intestinal microbiota, particularly Bacteroides fragilis group and Prevotella species. Surotomycin is a bactericidal cyclic lipopeptide in development for treatment of Clostridium difficile-associated diarrhea with selective and potent activity against C...

Worldwide, animal bite-related injuries to humans are a common daily occurrence. Injuries can range from minor puncture wounds to extensive crush injuries and even amputations and death. Increasing population, continued spread of habitation, and the popularity of owning various types of both traditional and non-traditional pets has made it easier f...

Diseases Transmitted by Cats, Page 1 of 2 Abstract Humans and cats have shared a close relationship since ancient times. Millions of cats are kept as household pets, and 34% of households have cats. There are numerous diseases that may be transmitted from cats to humans. General modes of transmission, with some overlapping features, can occur thr...

In 2011 a surveillance study for the susceptibility to fidaxomicin and epidemiology of C. difficile isolates in the USA was undertaken in 7 geographically dispersed medical centers. This report encompasses baseline surveillance for 2011-2012 on 925 isolates. A convenience sample of C. difficile isolates or toxin positive stools from patients were r...

In August 2003, the 284-bed community hospital Pierre-Le Gardeur (PLGH) in Quebec experienced a major outbreak associated with the Clostridium difficile NAP1/027/BI strain. Augmented standard preventive measures (SPMs) were not able to control this outbreak. It was decided in February 2004 to give to every adult inpatient on antibiotics, without an...

The genus Lactobacillus is a taxonomically complex and is composed of over 170 species that cannot be easily differentiated phenotypically and often require molecular identification. Although they are part of the normal human gastrointestinal and vaginal flora, they can also be occasional human pathogens. They are extensively used in a variety of c...

Across the United States, the baby boomers are entering into their elderly years. As they are America's largest generation to do so to date, their need for care will greatly affect nursing homes, long-term care facilities, and long-term acute-care hospitals (LTACHs). Unfortunately, the rise of Clostridium difficile infection (CDI), particularly in...

To address the significant morbidity and mortality rates associated with nosocomial Clostridium difficile-associated diarrhea (CDAD), a series of recommendations and a pathway to prevention were developed. An expert panel of infectious disease (ID) specialists participated in a modified Delphi process with specific objectives: (1) conduct a review...

Animals in Healthcare Facilities: Recommendations to Minimize Potential Risks - Volume 36 Issue 5 - Rekha Murthy, Gonzalo Bearman, Sherrill Brown, Kristina Bryant, Raymond Chinn, Angela Hewlett, B. Glenn George, Ellie J.C. Goldstein, Galit Holzmann-Pazgal, Mark E. Rupp, Timothy Wiemken, J. Scott Weese, David J. Weber

Twenty-one agents are approved by the US Food and Drug Administration (FDA) for the therapy of skin and soft tissue infections. Of these, the five newest agents, tedizolid, telavancin, oritavancin, dalbavancin, and ceftaroline, are active against and "non-inferior" to vancomycin against methicillin-resistant Staphylococcus aureus (MRSA). Oritavanci...

In the United States, more than 5 million animal bites and an untold number of human bite wounds occur each year. These account for 10 000 hospitalizations and 1% (300 000) of all emergency department visits annually. Patients with bite wounds are also commonly seen as outpatients in primary care physician and specialist (orthopedics, plastic/hand...

Background To ascertain which demographic, clinical, and microbiological factors might affect clinical outcomes of patients with diabetic foot infections, excluding known osteomyelitis, by analysing Clinical Assessment Program and Teflaro® Utilization Registry study data of patients treated with ceftaroline fosamil.Methods At participating study ce...

Objectives Empirical fluoroquinolone therapy is widely used in treating complicated urinary tract infections (cUTIs), even in areas of high fluoroquinolone resistance. While it is believed that high antibiotic concentrations in urine might be sufficient to overcome and effectively treat infections caused by resistant bacteria, clinical trial data v...

Background: The antimicrobial stewardship program (ASP) at Providence Saint John’s Health Center was implemented in June, 2013. The program was developed in three phases. Each phase was three months duration. Methods: The ASP tracked the following interventions in each phase: IV to PO, dose change, redundancy, de-escalation (of Daptomycin, Ertape...

Clostridium difficile infection (CDI) is a major public health problem worldwide with significant morbidity and mortality that is spread by spores and fecal oral transmission. A variety of risk factors have been identified. Some risk factors such as age, are not amenable to change, while others such as antimicrobial utilization have resulted in bro...