The Experts below are selected from a list of 33816 Experts worldwide ranked by ideXlab platform
Sarah M Wieczorkiewicz - One of the best experts on this subject based on the ideXlab platform.
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effect of matrix assisted laser desorption ionization time of flight mass spectrometry maldi tof ms alone versus maldi tof ms combined with real time antimicrobial stewardship interventions on time to optimal antimicrobial therapy in patients with Positive blood cultures
Journal of Clinical Microbiology, 2017Co-Authors: Maya Beganovic, Michael S Costello, Sarah M WieczorkiewiczAbstract:Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) decreases the time to organism identification and improves clinical and financial outcomes. The purpose of this study was to evaluate the impact of MALDI-TOF MS alone versus MALDI-TOF MS combined with real-time, pharmacist-driven, antimicrobial stewardship (AMS) intervention on patient outcomes. This single-center, pre-post, quasiexperimental study evaluated hospitalized patients with Positive blood cultures identified via MALDI-TOF MS combined with prospective AMS intervention compared to a control cohort with MALDI-TOF MS identification without AMS intervention. AMS intervention included: real-time MALDI-TOF MS pharmacist notification and prospective AMS provider feedback. The primary outcome was the time to optimal therapy (TTOT). A total of 252 blood cultures, 126 in each group, were included in the final analysis. MALDI-TOF MS plus AMS intervention significantly reduced the overall TTOT (75.17 versus 43.06 h; P < 0.001), the Gram-Positive contaminant TTOT (48.21 versus 11.75 h; P < 0.001), the Gram-negative Infection (GNI) TTOT (71.83 versus 35.98 h; P < 0.001), and the overall hospital length of stay (LOS; 15.03 versus 9.02 days; P = 0.021). The TTOT for Gram-Positive Infection (GPI) was improved (64.04 versus 41.61 h; P = 0.082). For GPI, the hospital LOS (14.64 versus 10.31 days; P = 0.002) and length of antimicrobial therapy 24.30 versus 18.97 days; P = 0.018) were reduced. For GNI, the time to microbiologic clearance (51.13 versus 34.51 h; P < 0.001), the hospital LOS (15.40 versus 7.90 days; P = 0.027), and the intensive care unit LOS (5.55 versus 1.19 days; P = 0.035) were reduced. To achieve optimal outcomes, rapid identification with MALDI-TOF MS combined with real-time AMS intervention is more impactful than MALDI-TOF MS alone.
Keith R Walley - One of the best experts on this subject based on the ideXlab platform.
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il 17a rs1974226 gg genotype is associated with increased susceptibility to Gram Positive Infection and mortality of severe sepsis
Critical Care, 2012Co-Authors: Takaaki Nakada, James A Russell, John H Boyd, Keith R WalleyAbstract:IL-17A plays a key role in host defense against microbial Infection including Gram-Positive bacteria. Genetic factors contribute to the host defense. Whether genetic variation of IL-17A is associated with altered clinical outcome of severe sepsis is unknown.
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il17a genetic variation is associated with altered susceptibility to Gram Positive Infection and mortality of severe sepsis
Critical Care, 2011Co-Authors: Takaaki Nakada, James A Russell, John H Boyd, Keith R WalleyAbstract:Interleukin 17A (IL17A) plays a key role in host defense against microbial Infection including Gram-Positive bacteria. Genetic factors contribute to the host defense, but the role of IL17A single nucleotide polymorphisms (SNPs) has not yet been investigated in severe sepsis. Therefore, we hypothesized that SNPs in the IL17A gene alter susceptibility to Infection and clinical outcome of severe sepsis. We tested for the association of IL17A SNPs with susceptibility to Infection and clinical outcome of severe sepsis using two cohorts of European ancestry (derivation cohort, St Paul's Hospital (SPH), n = 679; validation cohort, Vasopressin and Septic Shock Trial (VASST), n = 517). The primary outcome variable was susceptibility to Gram-Positive bacterial Infection. The secondary outcome variable was 28-day mortality. Of four tested IL17A tag SNPs (rs4711998, rs8193036, rs2275913, rs1974226), rs1974226 SNP was associated with altered susceptibility to Gram-Positive Infection in the derivation SPH cohort (corrected P = 0.014). Patients having the rs1974226 GG genotype were more susceptible to Gram-Positive Infection, compared to AG/AA genotype in the two cohorts of severe sepsis (SPH, P = 0.0036, odds ratio (OR) 2.19, 95% confidence interval (CI) 1.28-3.72; VASST, P = 0.011, OR 1.95, 95%CI 1.16-3.27) and in the subgroup having lung Infection (P = 0.017, OR 1.90, 95%CI 1.12-3.21). Furthermore, the IL17A rs1974226 G allele was associated with increased 28-day mortality in two cohorts (SPH, adjusted OR 1.44, 95%CI 1.04-2.02, P = 0.029; VASST, adjusted OR 1.67, 95%CI 1.17-2.40, P = 0.0052). IL17A genetic variation is associated with altered susceptibility to Gram-Positive Infection and 28-day mortality of severe sepsis.
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a nonsynonymous polymorphism of irak4 associated with increased prevalence of Gram Positive Infection and decreased response to toll like receptor ligands
Journal of Innate Immunity, 2011Co-Authors: Ainsley M Sutherland, Takaaki Nakada, Keith R Walley, Andy H P Sham, Mark M Wurfel, James A RussellAbstract:Mutations in IRAK4 have been associated with recurrent Gram-Positive Infections in children. Given the central role of IRAK4 in innate immunity signaling, we hypothesized that common genetic variants of IRAK4 may be associated with prevalence of Gram-Positive Infection in critically ill adults. Haplotype clade tag single nucleotide polymorphisms (SNPs) of the IRAK4 gene were selected and genotyped in a cohort of 1,029 critically ill patients with systemic inflammatory response syndrome (SIRS). We found that a haplotype clade tagged by the A allele of the htSNP G29429A (Ala428Thr) was associated with increased relative risk of Gram-Positive Infection at admission to ICU (RR = 1.2, p
Takaaki Nakada - One of the best experts on this subject based on the ideXlab platform.
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il 17a rs1974226 gg genotype is associated with increased susceptibility to Gram Positive Infection and mortality of severe sepsis
Critical Care, 2012Co-Authors: Takaaki Nakada, James A Russell, John H Boyd, Keith R WalleyAbstract:IL-17A plays a key role in host defense against microbial Infection including Gram-Positive bacteria. Genetic factors contribute to the host defense. Whether genetic variation of IL-17A is associated with altered clinical outcome of severe sepsis is unknown.
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il17a genetic variation is associated with altered susceptibility to Gram Positive Infection and mortality of severe sepsis
Critical Care, 2011Co-Authors: Takaaki Nakada, James A Russell, John H Boyd, Keith R WalleyAbstract:Interleukin 17A (IL17A) plays a key role in host defense against microbial Infection including Gram-Positive bacteria. Genetic factors contribute to the host defense, but the role of IL17A single nucleotide polymorphisms (SNPs) has not yet been investigated in severe sepsis. Therefore, we hypothesized that SNPs in the IL17A gene alter susceptibility to Infection and clinical outcome of severe sepsis. We tested for the association of IL17A SNPs with susceptibility to Infection and clinical outcome of severe sepsis using two cohorts of European ancestry (derivation cohort, St Paul's Hospital (SPH), n = 679; validation cohort, Vasopressin and Septic Shock Trial (VASST), n = 517). The primary outcome variable was susceptibility to Gram-Positive bacterial Infection. The secondary outcome variable was 28-day mortality. Of four tested IL17A tag SNPs (rs4711998, rs8193036, rs2275913, rs1974226), rs1974226 SNP was associated with altered susceptibility to Gram-Positive Infection in the derivation SPH cohort (corrected P = 0.014). Patients having the rs1974226 GG genotype were more susceptible to Gram-Positive Infection, compared to AG/AA genotype in the two cohorts of severe sepsis (SPH, P = 0.0036, odds ratio (OR) 2.19, 95% confidence interval (CI) 1.28-3.72; VASST, P = 0.011, OR 1.95, 95%CI 1.16-3.27) and in the subgroup having lung Infection (P = 0.017, OR 1.90, 95%CI 1.12-3.21). Furthermore, the IL17A rs1974226 G allele was associated with increased 28-day mortality in two cohorts (SPH, adjusted OR 1.44, 95%CI 1.04-2.02, P = 0.029; VASST, adjusted OR 1.67, 95%CI 1.17-2.40, P = 0.0052). IL17A genetic variation is associated with altered susceptibility to Gram-Positive Infection and 28-day mortality of severe sepsis.
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a nonsynonymous polymorphism of irak4 associated with increased prevalence of Gram Positive Infection and decreased response to toll like receptor ligands
Journal of Innate Immunity, 2011Co-Authors: Ainsley M Sutherland, Takaaki Nakada, Keith R Walley, Andy H P Sham, Mark M Wurfel, James A RussellAbstract:Mutations in IRAK4 have been associated with recurrent Gram-Positive Infections in children. Given the central role of IRAK4 in innate immunity signaling, we hypothesized that common genetic variants of IRAK4 may be associated with prevalence of Gram-Positive Infection in critically ill adults. Haplotype clade tag single nucleotide polymorphisms (SNPs) of the IRAK4 gene were selected and genotyped in a cohort of 1,029 critically ill patients with systemic inflammatory response syndrome (SIRS). We found that a haplotype clade tagged by the A allele of the htSNP G29429A (Ala428Thr) was associated with increased relative risk of Gram-Positive Infection at admission to ICU (RR = 1.2, p
Maya Beganovic - One of the best experts on this subject based on the ideXlab platform.
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effect of matrix assisted laser desorption ionization time of flight mass spectrometry maldi tof ms alone versus maldi tof ms combined with real time antimicrobial stewardship interventions on time to optimal antimicrobial therapy in patients with Positive blood cultures
Journal of Clinical Microbiology, 2017Co-Authors: Maya Beganovic, Michael S Costello, Sarah M WieczorkiewiczAbstract:Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) decreases the time to organism identification and improves clinical and financial outcomes. The purpose of this study was to evaluate the impact of MALDI-TOF MS alone versus MALDI-TOF MS combined with real-time, pharmacist-driven, antimicrobial stewardship (AMS) intervention on patient outcomes. This single-center, pre-post, quasiexperimental study evaluated hospitalized patients with Positive blood cultures identified via MALDI-TOF MS combined with prospective AMS intervention compared to a control cohort with MALDI-TOF MS identification without AMS intervention. AMS intervention included: real-time MALDI-TOF MS pharmacist notification and prospective AMS provider feedback. The primary outcome was the time to optimal therapy (TTOT). A total of 252 blood cultures, 126 in each group, were included in the final analysis. MALDI-TOF MS plus AMS intervention significantly reduced the overall TTOT (75.17 versus 43.06 h; P < 0.001), the Gram-Positive contaminant TTOT (48.21 versus 11.75 h; P < 0.001), the Gram-negative Infection (GNI) TTOT (71.83 versus 35.98 h; P < 0.001), and the overall hospital length of stay (LOS; 15.03 versus 9.02 days; P = 0.021). The TTOT for Gram-Positive Infection (GPI) was improved (64.04 versus 41.61 h; P = 0.082). For GPI, the hospital LOS (14.64 versus 10.31 days; P = 0.002) and length of antimicrobial therapy 24.30 versus 18.97 days; P = 0.018) were reduced. For GNI, the time to microbiologic clearance (51.13 versus 34.51 h; P < 0.001), the hospital LOS (15.40 versus 7.90 days; P = 0.027), and the intensive care unit LOS (5.55 versus 1.19 days; P = 0.035) were reduced. To achieve optimal outcomes, rapid identification with MALDI-TOF MS combined with real-time AMS intervention is more impactful than MALDI-TOF MS alone.
Leonard Leibovici - One of the best experts on this subject based on the ideXlab platform.
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Beta lactam antibiotic monotherapy versus beta lactam-aminoglycoside antibiotic combination therapy for sepsis
Cochrane Database of Systematic Reviews, 2014Co-Authors: Adi Lador, Simona Grozinsky-glasberg, Leonard LeiboviciAbstract:BACKGROUND: Optimal antibiotic treatment for sepsis is imperative. Combining a beta lactam antibiotic with an aminoglycoside antibiotic may provide certain advantages over beta lactam monotherapy.\nOBJECTIVES: Our objectives were to compare beta lactam monotherapy versus beta lactam-aminoglycoside combination therapy in patients with sepsis and to estimate the rate of adverse effects with each treatment regimen, including the development of bacterial resistance to antibiotics.\nSEARCH METHODS: In this updated review, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2013, Issue 11); MEDLINE (1966 to 4 November 2013); EMBASE (1980 to November 2013); LILACS (1982 to November 2013); and conference proceedings of the Interscience Conference of Antimicrobial Agents and Chemotherapy (1995 to 2013). We scanned citations of all identified studies and contacted all corresponding authors. In our previous review, we searched the databases to July 2004.\nSELECTION CRITERIA: We included randomized and quasi-randomized trials comparing any beta lactam monotherapy versus any combination of a beta lactam with an aminoglycoside for sepsis.\nDATA COLLECTION AND ANALYSIS: The primary outcome was all-cause mortality. Secondary outcomes included treatment failure, superInfections and adverse events. Two review authors independently collected data. We pooled risk ratios (RRs) with 95% confidence intervals (CIs) using the fixed-effect model. We extracted outcomes by intention-to-treat analysis whenever possible.\nMAIN RESULTS: We included 69 trials that randomly assigned 7863 participants. Twenty-two trials compared the same beta lactam in both study arms, while the remaining trials compared different beta lactams using a broader-spectrum beta lactam in the monotherapy arm. In trials comparing the same beta lactam, we observed no difference between study groups with regard to all-cause mortality (RR 0.97, 95% CI 0.73 to 1.30) and clinical failure (RR 1.11, 95% CI 0.95 to 1.29). In studies comparing different beta lactams, we observed a trend for benefit with monotherapy for all-cause mortality (RR 0.85, 95% CI 0.71 to 1.01) and a significant advantage for clinical failure (RR 0.75, 95% CI 0.67 to 0.84). No significant disparities emerged from subgroup and sensitivity analyses, including assessment of participants with Gram-negative Infection. The subgroup of Pseudomonas aeruginosa Infections was underpowered to examine effects. Results for mortality were classified as low quality of evidence mainly as the result of imprecision. Results for failure were classified as very low quality of evidence because of indirectness of the outcome and possible detection bias in non-blinded trials. We detected no differences in the rate of development of resistance. Nephrotoxicity was significantly less frequent with monotherapy (RR 0.30, 95% CI 0.23 to 0.39). We found no heterogeneity for all these comparisons.We included a small subset of studies addressing participants with Gram-Positive Infection, mainly endocarditis. We identified no difference between monotherapy and combination therapy in these studies.\nAUTHORS' CONCLUSIONS: The addition of an aminoglycoside to beta lactams for sepsis should be discouraged. All-cause mortality rates are unchanged. Combination treatment carries a significant risk of nephrotoxicity.
