The Experts below are selected from a list of 5823 Experts worldwide ranked by ideXlab platform
Michael Klompas - One of the best experts on this subject based on the ideXlab platform.
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1476 objective surveillance definitions for Hospital Acquired Pneumonia in non ventilated patients
Open Forum Infectious Diseases, 2018Co-Authors: Wenjing Ji, Cara Smith, Zilu Zhang, Aileen Ochoa, Jessica G Young, Chanu Rhee, Michael KlompasAbstract:Background Pneumonia is the most common Hospital-Acquired infection; most cases occur in nonventilated patients, yet the majority of Hospitals do not track nonventilator Hospital-Acquired Pneumonia (NV-HAP) given the complexity and subjectivity of CDC’s current surveillance definition and large number of patients at risk. We sought to develop objective, electronically computable surveillance definitions for NV-HAP to facilitate routine surveillance.
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treatment of Hospital Acquired Pneumonia with linezolid or vancomycin a systematic review and meta analysis
BMJ Open, 2013Co-Authors: Andre C Kalil, Michael Klompas, Gleb Haynatzki, Mark Edmund RuppAbstract:Objective Hospital-Acquired Pneumonia remains the most lethal and expensive nosocomial infection worldwide. Optimal therapy remains controversial. We aimed to compare mortality and clinical response outcomes in patients treated with either linezolid or vancomycin. Design Systematic review and meta-analysis. Data sources PubMed, EMBASE, Cochrane Library, American College of Physicians Journal Club, Evidence-based Medicine BMJ and abstracts from infectious diseases and critical care meetings were searched through April 2013. Eligibility criteria for selecting studies All randomised clinical trials comparing linezolid to vancomycin for Hospital-Acquired Pneumonia. Data extraction Preferred reporting items for systematic reviews and meta-analyses guidelines were followed. One author extracted the data and two authors rechecked and verified all data. Results Nine randomised trials with a total of 4026 patients were included. The adjusted absolute mortality risk difference (RD) between linezolid and vancomycin was 0.01% (95% CI −2.1% to 2.1%; p=0.992; I 2 =13.5%. The adjusted absolute clinical response difference was 0.9% (95% CI −1.2% to 3.1%; p=0.409; I 2 =0%. The risk of both microbiological (RD=5.6%, 95% CI −2.2% to 13.3%; p=0.159; I 2 =0%) and methicillin-resistant Staphylococcus aureus (RD=6.4%, 95% CI −4.1% to 16.9%; p=0.230; I 2 =0%) eradication were not different between linezolid and vancomycin. Gastrointestinal side effects were more frequent with linezolid (RD=0.8% (95% CI 0% to 1.5%; p=0.05), but no differences were found with renal failure, thrombocytopenia and drug discontinuation due to adverse events. Our sample size provided 99.9% statistical power to detect differences between drugs regarding clinical response and mortality. Conclusions Linezolid and vancomycin have similar efficacy and safety profiles. The high statistical power and the near-zero efficacy difference between both antibiotics demonstrates that no drug is superior for the treatment of Hospital-Acquired Pneumonia.
Shoshana J Herzig - One of the best experts on this subject based on the ideXlab platform.
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acid suppressive medication use in acute stroke and Hospital Acquired Pneumonia
Annals of Neurology, 2014Co-Authors: Shoshana J Herzig, Christopher Doughty, Sourabh Lahoti, Sarah Marchina, Neha Sanan, Wuwei Feng, Sandeep KumarAbstract:Objective Pneumonia is a morbid complication of stroke, but evidence-based strategies for its prevention are lacking. Acid-suppressive medications have been associated with increased risk for nosocomial Pneumonia in Hospitalized patients. It is unclear whether these results can be extrapolated to stroke patients, where other factors strongly modulate Pneumonia risk. We investigated the association between acid-suppressive medication and Hospital-Acquired Pneumonia in patients with acute stroke.
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acid suppressive medication use and the risk for Hospital Acquired Pneumonia
JAMA, 2009Co-Authors: Shoshana J Herzig, Michael D Howell, Edward R MarcantonioAbstract:Context The use of acid-suppressive medication has been steadily increasing, particularly in the inpatient setting, despite lack of an accepted indication in the majority of these patients. Objective To examine the association between acid-suppressive medication and Hospital-Acquired Pneumonia. Design, Setting, and Patients Prospective pharmacoepidemiologic cohort study. All patients who were admitted to a large, urban, academic medical center in Boston, Massachusetts, from January 2004 through December 2007; at least 18 years of age; and Hospitalized for 3 or more days were eligible for inclusion. Admissions with time spent in the intensive care unit were excluded. Acid-suppressive medication use was defined as any order for a proton-pump inhibitor or histamine2 receptor antagonist. Traditional and propensity-matched multivariable logistic regression were used to control for confounders. Main Outcome Measure Incidence of Hospital-Acquired Pneumonia, defined via codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), in patients exposed and unexposed to acid-suppressive medication. Results The final cohort comprised 63 878 admissions. Acid-suppressive medication was ordered in 52% of admissions and Hospital-Acquired Pneumonia occurred in 2219 admissions (3.5%). The unadjusted incidence of Hospital-Acquired Pneumonia was higher in the group exposed to acid-suppressive medication than in the unexposed group (4.9% vs 2.0%; odds ratio [OR], 2.6; 95% confidence interval [CI], 2.3-2.8). Using multivariable logistic regression, the adjusted OR of Hospital-Acquired Pneumonia in the group exposed to acid-suppressive medication was 1.3 (95% CI, 1.1-1.4). The matched propensity-score analyses yielded identical results. The association was significant for proton-pump inhibitors (OR, 1.3; 95% CI, 1.1-1.4) but not for histamine2 receptor antagonists (OR, 1.2; 95% CI, 0.98-1.4). Conclusions In this large, Hospital-based pharmacoepidemiologic cohort, acid-suppressive medication use was associated with 30% increased odds of Hospital-Acquired Pneumonia. In subset analyses, statistically significant risk was demonstrated only for proton-pump inhibitor use.
Barbara Quinn - One of the best experts on this subject based on the ideXlab platform.
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Hospital Acquired Pneumonia prevention initiative 2 incidence of nonventilator Hospital Acquired Pneumonia in the united states
American Journal of Infection Control, 2018Co-Authors: Dian Baker, Barbara QuinnAbstract:Background Because nonventilator Hospital-Acquired Pneumonia (NV-HAP) is understudied, our purpose was to determine the incidence, overall burden, and level of documented Pneumonia preventive interventions of NV-HAP in 24 U.S. Hospitals. Methods This retrospective chart review extracted NV-HAP cases as per the 2014 ICD-9-CM codes for Pneumonia not present on admission and the 2013 Centers for Disease Control and Prevention case definition. Patient demographic data, outcomes, and documented preventive interventions were also collected. Results We found 1,300 NV-HAP patients who Acquired NV-HAP (rate, 0.12-2.28 per 1,000 patient days) across the 21 Hospitals that completed the data collection. Most NV-HAP infections (70.8%) were Acquired outside of intensive care units (ICUs); 18.8% required transfer into the ICU. In the 24 hours prior to diagnosis, most of the patients did not have fundamental Hospital care associated with Pneumonia prevention. Conclusions This multicenter, nationwide study highlights the significant burden of NV-HAP in the U.S. acute care Hospital setting. We found that NV-HAP occurred on every Hospital unit, including in younger, healthy patients. This indicates that although some patients are clearly at higher risk, all patients carry some NV-HAP risk. Therapeutic interventions aimed at NV-HAP prevention are frequently not provided for patients in acute care Hospitals.
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the epidemiology of nonventilator Hospital Acquired Pneumonia in the united states
American Journal of Infection Control, 2017Co-Authors: Dian Baker, Karen K Giuliano, Barbara QuinnAbstract:Background Nonventilator Hospital-Acquired Pneumonia (NV-HAP) is among the most common Hospital-Acquired infections. The purpose of our study was to quantify the incidence and influence of NV-HAP in the United States using a national dataset. Methods The 2012 US National Inpatient Sample dataset was used to compare an NV-HAP group to 4 additional group cohorts: Pneumonia on admission, general Hospital admissions, matched on mortality and disease severity, and ventilator-associated Pneumonia (VAP). The main outcome was NV-HAP incidence. The secondary outcome was to compare Hospital length of stay, total Hospital charges, and mortality between the NV-HAP group and the 4 additional group cohorts. Results The overall incidence of NV-HAP was 1.6%, which represents a rate of 3.63 per 1,000 patient-days. NV-HAP was associated with increased total Hospital charges, a longer Hospital length of stay, and greater likelihood of death in comparison to all groups except patients with VAP. Conclusion NV-HAP is an underappreciated and serious patient safety issue, resulting in significant increases in cost, length of stay, and mortality. Efforts toward prevention of NV-HAP should be raised to the same level of concern as VAP prevention.
Wenjing Ji - One of the best experts on this subject based on the ideXlab platform.
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development and assessment of objective surveillance definitions for nonventilator Hospital Acquired Pneumonia
JAMA Network Open, 2019Co-Authors: Wenjing Ji, Zilu Zhang, Aileen Ochoa, Jessica G Young, Chanu Rhee, Caroline Mckenna, Haiyan Ramirez Batlle, Roger ClarkAbstract:Importance Hospital-Acquired Pneumonia is the most common health care–associated infection in the United States. Most cases occur in nonventilated patients, but many Hospitals track Hospital-Acquired Pneumonia only in ventilated patients because of the complexity and subjectivity of conducting surveillance for large numbers of nonventilated patients. Objective To propose and assess potentially objective, efficient, and reproducible surveillance definitions for nonventilator Hospital-Acquired Pneumonia (NV-HAP) using routine clinical data stored in electronic health record systems. Design, Setting, and Participants This cohort study was conducted in 2 tertiary referral and 2 community Hospitals in Massachusetts between May 31, 2015, and July 1, 2018. All nonventilated patients aged 18 years or older who were admitted to these Hospitals were included (N = 310 651). Exposures Ten candidate definitions for NV-HAP based on clinically meaningful combinations of 6 potential surveillance criteria were proposed: worsening oxygenation, temperature higher than 38 °C (fever), abnormal white blood cell count of less than 4000/μL or more than 12 000/μL, performance of chest imaging, submission of respiratory specimen for culture, and 3 or more days of new antibiotics. Main Outcomes and Measures Incidence rates, lengths of stay, Hospital mortality rates, and odds ratios (ORs) for time to discharge and mortality compared with those of matched controls were calculated for each candidate definition. The ORs were adjusted for demographics, clinical service, comorbidities, and severity of illness. Results The study analyzed 310 651 patients with 489 519 admissions, including 205 054 patients with 311 484 admissions of 3 or more days. Among the patients with 311 484 admissions, the mean (SD) patient age was 58.3 (19.3) years and 176 936 (56.8%) were of women. Incidence rates for candidate definitions per 100 admissions ranged from 3.4 events for worsening oxygenation alone to 0.9 event for worsening oxygenation and at least 3 days of new antibiotics to 0.6 event for worsening oxygenation, at least 3 days of new antibiotics, fever, abnormal white blood cell count, and performance of chest imaging. Crude mortality rates ranged from 16.1% (n = 2643) for patients with worsening oxygen alone to 27.7% (n = 868) for patients with worsening oxygenation, at least 3 days of antibiotics, fever or abnormal white blood cell count, and chest imaging. Patients who met NV-HAP candidate definitions remained in the Hospital for twice as long as their matched controls (adjusted ORs ranged from 1.8 [95% CI, 1.7-1.8] to 2.1 [95% CI, 2.0-2.1]) and were 4 to 6 times as likely to die in the Hospital (adjusted ORs ranged from 3.8 [95% CI, 3.5-4.0] to 6.5 [95% CI, 5.2-8.2]). Agreement between candidate definitions and clinical diagnoses was fair (κ = 0.33). Conclusions and Relevance These findings suggest that objective surveillance for NV-HAP using electronically computable definitions that incorporate common clinical criteria is feasible and generates incidence, mortality, and adjusted ORs for Hospital mortality similar to estimates from manual surveillance. These definitions have the potential to facilitate widespread, automated surveillance for NV-HAP and thus inform the development and evaluation of prevention programs.
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1476 objective surveillance definitions for Hospital Acquired Pneumonia in non ventilated patients
Open Forum Infectious Diseases, 2018Co-Authors: Wenjing Ji, Cara Smith, Zilu Zhang, Aileen Ochoa, Jessica G Young, Chanu Rhee, Michael KlompasAbstract:Background Pneumonia is the most common Hospital-Acquired infection; most cases occur in nonventilated patients, yet the majority of Hospitals do not track nonventilator Hospital-Acquired Pneumonia (NV-HAP) given the complexity and subjectivity of CDC’s current surveillance definition and large number of patients at risk. We sought to develop objective, electronically computable surveillance definitions for NV-HAP to facilitate routine surveillance.
Joan M Korthbradley - One of the best experts on this subject based on the ideXlab platform.
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randomized phase 2 trial to evaluate the clinical efficacy of two high dosage tigecycline regimens versus imipenem cilastatin for treatment of Hospital Acquired Pneumonia
Antimicrobial Agents and Chemotherapy, 2013Co-Authors: Julio A Ramirez, Joan M Korthbradley, Nathalie Dartois, Hassan Gandjini, Paul C McgovernAbstract:ABSTRACT In a previous phase 3 study, the cure rates that occurred in patients with Hospital-Acquired Pneumonia treated with tigecycline at the approved dose were lower than those seen with patients treated with imipenem and cilastatin (imipenem/cilastatin). We hypothesized that a higher dose of tigecycline is necessary in patients with Hospital-Acquired Pneumonia. This phase 2 study compared the safety and efficacy of two higher doses of tigecycline with imipenem/cilastatin in subjects with Hospital-Acquired Pneumonia. Subjects with Hospital-Acquired Pneumonia were randomized to receive one of two doses of tigecycline (150 mg followed by 75 mg every 12 h or 200 mg followed by 100 mg every 12 h) or 1 g of imipenem/cilastatin every 8 h. Empirical adjunctive therapy was administered for initial coverage of methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa infection, depending on the randomization regimen. Clinical response, defined as cure, failure of treatment, or indeterminate outcome, was assessed 10 to 21 days after the last day of therapy. In the clinically evaluable population, clinical cure with tigecycline 100 mg (17/20, 85.0%) was numerically higher than with tigecycline 75 mg (16/23, 69.6%) and imipenem/cilastatin (18/24, 75.0%). No new safety signals with the high-dose tigecycline were identified. A numerically higher clinical response was observed with the 100-mg dose of tigecycline. This supports our hypothesis that a higher area under the concentration-time curve over 24 h in the steady state divided by the MIC (AUC/MIC ratio) may be necessary to achieve clinical cure in patients with Hospital-Acquired Pneumonia. Further studies are necessary. (The ClinicalTrials.gov identifier for this clinical trial is NCT00707239.)
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tigecycline population pharmacokinetics in patients with community or Hospital Acquired Pneumonia
Antimicrobial Agents and Chemotherapy, 2010Co-Authors: Christopher M Rubino, Alan Forrest, Sujata M Bhavnani, Gary Dukart, Angel Cooper, Joan M Korthbradley, Paul G AmbroseAbstract:Tigecycline is a new-generation of tetracycline (glycylcyclines) and is active in vitro against bacteria that possess any of the classical genes that confer tetracycline resistance through ribosomal protection or efflux pumps. Herein, tigecycline disposition in patients with community- or Hospital-Acquired Pneumonia was described using a population pharmacokinetic model. Additionally, the influence of covariates, such as body surface area, severity of illness, and clinical laboratory measures, on tigecycline disposition was evaluated. An intravenous loading dose of 100 mg was followed by 50 mg of tigecycline every 12 h. The final population pharmacokinetic model was a two-compartment model with linear elimination and with a relationship between tigecycline clearance and body surface area and creatinine clearance. The model was parameterized using total clearance (CL), the volume of the central compartment, distributional clearance from the central to the peripheral compartment, and volumes of distribution at steady state. Relationships between body surface area and creatinine clearance were identified as significant predictors of interindividual variability on CL. This model will serve as the basis for estimating tigecycline exposure for pharmacokinetic-pharmacodynamic analyses for efficacy and safety among patients with community- or Hospital-Acquired Pneumonia.
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comparison of tigecycline with imipenem cilastatin for the treatment of Hospital Acquired Pneumonia
Diagnostic Microbiology and Infectious Disease, 2010Co-Authors: Antonio T Freire, Gary Dukart, Vasyl Melnyk, Oleksiy Datsenko, Oleksandr Dzyublik, Felix Glumcher, Yinching Chuang, Robert Maroko, Angel C Cooper, Joan M KorthbradleyAbstract:To compare efficacy and safety of a tigecycline regimen with an imipenem/cilastatin regimen in Hospital-Acquired Pneumonia patients, a phase 3, multicenter, randomized, double-blind, study evaluated 945 patients. Coprimary end points were clinical response in clinically evaluable (CE) and clinical modified intent-to-treat (c-mITT) populations at test-of-cure. Cure rates were 67.9% for tigecycline and 78.2% for imipenem (CE patients) and 62.7% and 67.6% (c-mITT patients), respectively. A statistical interaction occurred between ventilator-associated Pneumonia (VAP) and non-VAP subgroups, with significantly lower cure rates in tigecycline VAP patients compared to imipenem; in non-VAP patients, tigecycline was noninferior to imipenem. Overall mortality did not differ between the tigecycline (14.1%) and imipenem regimens (12.2%), although more deaths occurred in VAP patients treated with tigecycline than imipenem. Overall, the tigecycline regimen was noninferior to the imipenem/cilastatin regimen for the c-mITT but not the CE population; this difference appears to have been driven by results in VAP patients.