Scott T Micek

Scott T Micek
St. Louis College of Pharmacy · Department of Pharmacy Practice

About

233
Publications
21,957
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10,280
Citations
Citations since 2016
60 Research Items
5022 Citations
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20162017201820192020202120220200400600
20162017201820192020202120220200400600
20162017201820192020202120220200400600

Publications

Publications (233)
Article
Full-text available
Antibiotic resistance is recognised as a global threat to human health by national healthcare agencies, governments and medical societies, as well as the World Health Organization. Increasing resistance to available antimicrobial agents is of concern for bacterial, fungal, viral and parasitic pathogens. One of the greatest concerns is the continuin...
Article
Objective Ventilator-associated pneumonia (VAP) remains a challenge. The importance of viruses in VAP is not established. We sought to determine the prevalence of viruses in VAP and the outcomes of viral VAP. Design Retrospective study of VAP over 3 years. The frequency of a viral process represented the primary endpoint. Clinical outcomes served...
Article
Spectrum scores measure antimicrobial utilization while also quantifying the spectrum of activity. Accordingly, changes in spectrum score can be used to identify antimicrobial de-escalation. We show that spectrum-score–based de-escalation has a 95.7% positive percentage agreement and 81.6% negative percentage agreement versus de-escalation defined...
Article
Purpose of review: This review will provide rationale for the development of new antibiotics to treat severe or multidrug-resistant (MDR) Gram-negative infections. It will also provide an overview of recently approved and pipeline antibiotics for severe/MDR Gram-negative infections. Recent findings: MDR Gram-negative infections are recognized as...
Article
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Objective: β-lactams are the cornerstone of empiric and targeted antibiotic therapy for critically ill patients. Recently, there have been calls to use β-lactam therapeutic drug monitoring (TDM) within 24-48 hours after the initiation of therapy in critically ill patients. In this article, we review the dynamic physiology of critically ill patient...
Article
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Much remains unknown about the impact of initial antibiotic adequacy on mortality in community onset bacterial pneumonia (COBP). Therefore, we performed a study to determine how the adequacy of initial antibiotic therapy affects in-hospital mortality for patients with COBP. We carried out a retrospective cohort study among the 11 BJC Healthcare com...
Article
Effective antimicrobial therapy remains paramount to successful treatment of patients with critical illness, such as pneumonia and sepsis. Unfortunately, critically ill patients often exhibit altered pharmacokinetics and pharmacodynamics (PK/PD) that make this endeavor challenging. Particularly in sepsis, alterations in volume of distribution (Vd)...
Article
Purpose Recent data highlight unclear efficacy and potential negative sequelae of stress ulcer prophylaxis (SUP) in the intensive care unit (ICU). Minimizing SUP exposure has pertinent clinical and other implications. This study assessed medication use and clinical outcomes before and after implementation of a practice guideline promoting early dis...
Article
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Background Hospital-acquired and ventilator-associated pneumonia (HAP/VAP) cause significant morbidity and mortality. Guidelines recommend broad-spectrum empiric antibiotic therapy, including treatment for Pseudomonas aeruginosa (PSAR) and methicillin-resistant Staphylococcus aureus (MRSA), followed by de-escalation (DE). This study sought to asses...
Article
Full-text available
Severe or life threatening infections are common among patients in the intensive care unit (ICU). Most infections in the ICU are bacterial or fungal in origin and require antimicrobial therapy for clinical resolution. Antibiotics are the cornerstone of therapy for infected critically ill patients. However, antibiotics are often not optimally admini...
Article
Purpose In critically ill patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and without positive microbiological data, the efficacy and tolerability of short-course nonmacrolide antibiotics are ill-described and have pertinent implications in antimicrobial stewardship. This study compared the efficacy and tolerabili...
Article
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Background Hospital-acquired and ventilator-associated pneumonia (HAP/VAP) cause significant mortality. Guidelines recommend empiric broad-spectrum antibiotics followed by de-escalation (DE). This study sought to assess the impact of DE on treatment failure. Methods This single-center retrospective cohort study screened all adult patients with a d...
Article
Objectives: To determine whether race is a major determinant of sepsis outcomes when controlling for socioeconomic factors. Design: Retrospective cohort study. Setting: Barnes-Jewish Hospital a 1,350 bed academic medical center. Patients: Eleven-thousand four-hundred thirty-two patients hospitalized between January 2010 and April 2017 with s...
Article
Liposomal amphotericin B (LAmB) is used for various fungal infections, but it is unclear which dosing weight to use in obese patients. The purpose of this study was to compare clinical outcomes of adjusted body weight (adjBW) versus total body weight (TBW) dosing of LAmB. This single-center, retrospective cohort study included patients who received...
Article
Ceftolozane-tazobactam (C/T) is a new fifth-generation cephalosporin/β-lactamase inhibitor combination approved by the Food and Drug Administration and the European Medicines Agency for treatment of complicated intra-abdominal infections, complicated urinary tract infections, and hospital-acquired pneumonia in adult patients. This review will brief...
Article
Objective: The first 70 years of critical care can be considered a period of "industrial revolution-like" advancement in terms of progressing the understanding and care of critical illness. Unfortunately, like the industrial revolution's impact on the environment, advancing ICU care of increasingly elderly, immunosuppressed, and debilitated indivi...
Article
Objectives: To assess whether Black race is associated with a higher rate of all-cause readmission compared with White race following community-onset sepsis. Design: Retrospective cohort study. Setting: One-thousand three-hundred bed urban academic medical centers. Patients: Three-thousand three-hundred ninety patients hospitalized with comm...
Article
Background Streptococcus pneumoniae (SP) remains the leading pathogen in community-acquired pneumonia (CAP). Despite the increasing prevalence of macrolide resistance in SP, guidelines recommend the use of macrolides as part of a combination regiment for intensive care unit (ICU) patients with CAP. We sought to describe if macrolide resistance effe...
Article
Full-text available
Background Hospital-acquired (HAP) and ventilator-associated pneumonia (VAP) represent a significant source of morbidity and mortality in hospitalized patients. Numerous studies demonstrate mortality benefit with appropriate empiric therapy. Choosing the right empiric coverage is paramount; however, this decision becomes more challenging as rates o...
Article
Aims To assess the order of glucose-lowering medication (GLM) discontinuation following bariatric surgery among patients taking ≥2 GLMs. Methods Patients with diabetes mellitus taking ≥2 GLM classes who underwent bariatric surgery were identified using health claims data from the United States. The order of discontinuation was assessed in patients...
Article
(See the Major Article by Titov et al on pages e4539–48.) In this issue of Clinical Infectious Diseases, Titov et al [1] report on a randomized, double-blind multicenter trial comparing the efficacy and safety of imipenem/cilastatin/relebactam (ICR) (500 mg/500 mg/250 mg) with pipercillin/tazobactam (PT) (4 g/500 mg), both every 6 hours for 7 to 14...
Conference Paper
Objective: To compare median grades of drug information (DI) papers between faculty and non-faculty preceptors. We hypothesized that median grades determined by faculty would be lower compared to non-faculty. Methods: Students progressing through advanced pharmacy practice experiences (APPE) are required to complete at least one DI paper. The assig...
Article
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Infection due to Streptococcus pneumoniae (SP) requiring hospitalization is common. However, recent clinical studies describing patient characteristics and outcomes for SP infection in adults requiring hospitalization are lacking. Our goal was to evaluate patient characteristics, contemporary antibiotic resistance, and clinical outcomes among hospi...
Article
Evaluation of a ceiling effect on the association of new resistance development to antipseudomonal beta-lactam exposure in the critically ill - Besu F. Teshome, Scott Martin Vouri, Nicholas B. Hampton, Marin H. Kollef, Scott T. Micek
Article
Background: Studies have described risk factors for infections caused by resistant bacteria looking only at the index infection. We hypothesized that septic patients with bloodstream infections may transition across states characterized by different microbiology and that their trajectory is not uniform. We have also hypothesized that baseline risk...
Article
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Sepsis is a common reason for empiric antibiotics among hospitalized patients. We found that the median duration of empiric antibiotics (interquartile range) was 6 (4–9) days among 1047 survivivors with pathogen-negative sepsis. These findings suggest that patients with pathogen-negative sepsis could represent an important opportunity for antimicro...
Article
Prior attempts at identifying outcome determinants associated with bloodstream infection have employed a priori determined classification schemes based on readily identifiable microbiology, infection site, and patient characteristics. We hypothesized that even amongst this heterogeneous population, clinically relevant groupings can be described tha...
Article
Study objective: Minimizing the duration of broad-spectrum antimicrobial exposure in the critically ill is a commonly used strategy aimed at preventing resistance. Our objective was to correlate the duration of exposure to antipseudomonal β-lactam antibiotics with the development of new resistance in critically ill patients. Design: Single-cente...
Article
Critically ill patients are frequently treated with empiric antibiotic therapy including vancomycin and β-Lactams. Recent evidence suggests an increased risk of acute kidney injury (AKI) in patients who received the combination of vancomycin and piperacillin/tazobactam (VPT) compared with patients who received vancomycin alone or vancomycin in comb...
Article
Full-text available
Background Prior attempts at identifying outcome determinants associated with bloodstream infection have employed a priori determined classification schemes based on readily identifiable microbiology, infection site, and patient characteristics. We hypothesized that even amongst this heterogeneous population, clinically relevant groupings can be de...
Article
Full-text available
Objectives. While the inflammatory response to severe pneumonia is paramount in reining in and resolving the infection, the excessive inflammation can lead to deleterious effects. We theorized that patients with severe community-acquired pneumonia (CAP), treated with macrolides and aspirin, would receive benefit beyond conventional antibiotic thera...
Article
Background In culture-positive nosocomial pneumonia, de-escalation (DE) from broad-spectrum empirical antimicrobials to narrower-spectrum agents has shown to decrease broad-spectrum antibiotic use without compromising patient outcomes. However, uncertainty exists regarding the safety of anti-methicillin-resistant Staphylococcus aureus (MRSA) agent...
Article
Background: Limited data exist on the incidence and outcome of early infection after orthotopic heart transplantation (OHT). The purpose of this study was to describe characteristics and outcomes of OHT recipients with an early infection and to identify predictors of such infections. Methods: This retrospective, single-center study included pati...
Article
Background: Infections caused by carbapenem-resistant gram-negative bacilli are an emerging public health threat. However, there is a paucity of data examining comparative incidence rates, risk factors, and outcomes in this population. Methods: This single-center retrospective cohort study was conducted at an urban tertiary-care academic medical...
Article
Highlights en • There is a de‐escalation of antidiabetes medications prescribed following bariatric surgery. • Antidiabetes medication utilization following bariatric surgery does not appear to be consistent with clinical practice guidelines.
Article
In a retrospective analysis of 215 patients with carbapenem-resistant Pseudomonas aeruginosa sepsis, we observed significantly higher risk of mortality associated with respiratory tract infection (risk ratio [RR], 1.20; 95% confidence interval [CI], 1.04-1.39 P =0.010) and lower risk with urinary tract infection (RR, 0.80; 95% CI, 0.71-0.90; P =0.0...
Article
Objectives: To assess whether sepsis-associated coagulopathy predicts hospital mortality. Design: Retrospective cohort study. Setting: One-thousand three-hundred beds urban academic medical center. Patients: Six-thousand one-hundred forty-eight consecutive patients hospitalized between January 1, 2010, and December 31, 2015. Interventions:...
Article
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Background Antibiotics are commonly administered to hospitalized patients with infiltrates for possible bacterial pneumonia, often leading to unnecessary treatment and increasing the risk for resistance emergence. Therefore, we performed a study to determine if an enhanced antibiotic de-escalation practice could improve antibiotic utilization in me...
Article
Background: Pneumonia associated with mechanical ventilation (MV) results in substantial mortality and represents a leading reason for antibiotic utilization. The role of viruses in this setting is unclear. Identifying a viral etiology such instances could facilitate antibiotic stewardship. Methods: We performed a secondary analysis of a prospec...
Article
Sepsis and septic shock remain serious infections with reported mortality rates in excess of forty percent. Timely antibiotic therapy in sepsis and septic shock is recognized as an important determinant of outcome. However, the administration of ineffective empiric treatment (IET) (an initial antibiotic regimen that is not active against the identi...
Article
Full-text available
Background The association between the administration of inappropriate empiric antibiotic treatment (IEA) and an increased risk of hospital mortality has been consistently reported. This study explores pre-infection risk factors for IEA in patients with Gram-negative (GN) sterile site infections complicated by sepsis or septic shock. Methods Retro...
Article
Introduction: Although national surveillance data suggests that the incidence of ventilator associated pneumonia (VAP) is down-trending, it remains one of the most commonly encountered hospital acquired infections in the United States and worldwide. Its association with increased healthcare costs and worsened patient outcomes warrants continued eff...
Article
Background: Pneumonia and respiratory failure are common problems in the intensive care unit (ICU) setting, often occurring together. The relative prevalence of pneumonia types (community acquired, hospital acquired, ventilator associated) and causative pathogens is not well described in patients with respiratory failure. Methods: This was a pro...
Article
Background: Predicting antimicrobial resistance in gram-negative bacteria (GNB) could balance the need for administering appropriate empiric antibiotics while also minimizing the use of clinically unwarranted broad-spectrum agents. Our objective was to develop a practical prediction rule able to identify patients with GNB infection at low risk for...
Article
Full-text available
The main objective of the study was to assess whether augmented renal clearance was a risk factor for mortality in a cohort of patients with Enterobacteriaceae sepsis, severe sepsis, or septic shock that all received appropriate antimicrobial therapy within 12 hours. Using a retrospective cohort from Barnes-Jewish Hospital, a 1,250-bed teaching hos...
Article
Background: Hospital-acquired pneumonia arising in non-ventilated patients (NVHAP) is traditionally thought to be caused by bacteria, and little is known about viral etiologies in this syndrome. We sought to describe the prevalence of viruses causing NVHAP and to determine factors independently associated with the isolation of a virus. Methods:...
Article
Bacteremic pneumonia is usually associated with greater mortality. However, risk factors associated with hospital mortality in bacteremic pneumonia are inadequately described.The study was a retrospective cohort study, conducted in Barnes-Jewish Hospital (2008-2015). For purposes of this investigation, antibiotic susceptibility was determined accor...
Article
Introduction: Clinical deterioration alerts (CDAs) are increasingly employed to identify deteriorating patients. Methods: We performed a retrospective study to determine whether CDAs predict 30-day readmission. Patients admitted to 8 general medicine units were assessed for all-cause 30-day readmission. Results: Among 3015 patients, 567 (18.8%...
Article
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Background: Non-ventilated hospital-acquired pneumonia (NVHAP) is a serious nosocomial infection increasingly attributed to antibiotic-resistant bacteria. Methods: A retrospective case-control study comparing patients with and without NVHAP from 1 January 2014 to 31 December 2014 at Barnes-Jewish Hospital, a 1300-bed urban academic medical cente...
Article
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Introduction: Respiratory viruses are increasingly recognized as significant etiologies of pneumonia among hospitalized patients. Advanced technologies using multiplex molecular assays and polymerase-chain reaction increase the ability to identify viral pathogens and may ultimately impact antibacterial use. Method: This was a single-center retro...
Article
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Advanced technologies using polymerase-chain reaction have allowed for increased recognition of viral respiratory infections including pneumonia. Co-infections have been described for several respiratory viruses, especially with influenza. Outcomes of viral pneumonia, including cases with co-infections, have not been well described. This was observ...
Article
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Methicillin-resistant Staphylococcus aureus (MRSA) remains an important pathogen in pneumonia. Bacteremia may secondarily complicate MRSA pneumonia. The epidemiology and outcomes associated with bacteremia in the setting of MRSA pneumonia are unknown. We sought to describe the prevalence of bacteremia in MRSA pneumonia and its impact on hospital mo...
Article
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Practice-related projects and pharmacy practice research are requirements to complete postgraduate pharmacy residency programs. Many residents will complete residencies without fully developing the skills needed to perform research required for new clinical and academic positions. Many studies have quantified successes and identified characteristic...
Article
Patients with intra-abdominal sepsis and associated bacteremia have a high mortality rate. However, outcomes studies in this population are limited, in part because of the small numbers of such patients. The objective of this study was to describe characteristics of critically ill patients with secondary blood stream infection (BSI) of intra-abdomi...
Article
Background: With decreasing mortality in sepsis, attention has shifted to longer-term consequences associated with survivorship. Thirty-day readmission as a component of healthcare utilization is an important outcome. Objective: To examine the frequency of and risk factors for 30-day readmission among patients surviving sepsis. Design: Single-...
Article
OBJECTIVE To describe and compare the mortality associated with nosocomial pneumonia due to Pseudomonas aeruginosa ( Pa -NP) according to pneumonia classification (community-onset pneumonia [COP], hospital-acquired pneumonia [(HAP], and ventilator-associated pneumonia [VAP]). DESIGN We conducted a retrospective cohort study of adults with Pa -NP....
Article
To assess the timing of appropriate antibiotic therapy as a determinant of postinfection hospital and ICU lengths of stay in patients with sepsis. Single-center retrospective cohort study (January 2008-December 2012). One thousand two hundred fifty-bed academic hospital. One thousand fifty-eight consecutive blood culture positive patients. We retro...
Article
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Pseudomonas aeruginosa nosocomial pneumonia (Pa-NP) is associated with considerable morbidity, prolonged hospitalization, increased costs, and mortality. We conducted a retrospective cohort study of adult patients with Pa-NP to determine 1) risk factors for multidrug-resistant (MDR) strains and 2) whether MDR increases the risk for hospital death....
Article
The National Healthcare Safety Network (NHSN) has recently supported efforts to shift surveillance away from ventilator-associated pneumonia to ventilator-associated events (VAEs) to decrease subjectivity in surveillance and minimize concerns over clinical correlation. The goals of this study were to compare the results of an automated surveillance...