Scott R Evans, Daniel Rubin, Dean Follmann, Gene Pennello, W Charles Huskins, John H Powers, David Schoenfeld, Christy Chuang-Stein, Sara E Cosgrove, Vance G Fowler, Ebbing Lautenbach, Henry F Chambers
Clinical trials that compare strategies to optimize antibiotic use are of critical importance but are limited by competing risks that distort outcome interpretation, complexities of noninferiority trials, large sample sizes, and inadequate evaluation of benefits and harms at the patient level. The Antibacterial Resistance Leadership Group strives to overcome these challenges through innovative trial design. Response adjusted for duration of antibiotic risk (RADAR) is a novel methodology utilizing a superiority design and a 2-step process: (1) categorizing patients into an overall clinical outcome (based on benefits and harms), and (2) ranking patients with respect to a desirability of outcome ranking (DOOR)...
September 1, 2015: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Sara Manning, Ebbing Lautenbach, Pam Tolomeo, Jennifer H Han
A case-control study to determine risk factors for clinical infection with Escherichia coli was conducted among nursing home residents colonized with fluoroquinolone-resistant E. coli. Among 94 subjects, 11 (12%) developed infections with E. coli. Risk factors included the presence of a urinary catheter or tracheostomy, diabetes mellitus, and trimethoprim-sulfamethoxazole exposure.
May 2015: Infection Control and Hospital Epidemiology
Valerie C Cluzet, Jeffrey S Gerber, Irving Nachamkin, Joshua P Metlay, Theoklis E Zaoutis, Meghan F Davis, Kathleen G Julian, Darren R Linkin, Susan E Coffin, David J Margolis, Judd E Hollander, Warren B Bilker, Xiaoyan Han, Rakesh D Mistry, Laurence J Gavin, Pam Tolomeo, Jacqueleen A Wise, Mary K Wheeler, Baofeng Hu, Neil O Fishman, David Royer, Ebbing Lautenbach
OBJECTIVE To identify risk factors for recurrent methicillin-resistant Staphylococcus aureus (MRSA) colonization. DESIGN Prospective cohort study conducted from January 1, 2010, through December 31, 2012. SETTING Five adult and pediatric academic medical centers. PARTICIPANTS Subjects (ie, index cases) who presented with acute community-onset MRSA skin and soft-tissue infection. METHODS Index cases and all household members performed self-sampling for MRSA colonization every 2 weeks for 6 months. Clearance of colonization was defined as 2 consecutive sampling periods with negative surveillance cultures...
July 2015: Infection Control and Hospital Epidemiology
A J Brink, G A Richards, E E G Lautenbach, N Rapeport, V Schillack, L van Niekerk, J Lipman, J A Roberts
The impact of decreased serum albumin concentrations on free antibiotic concentrations in non-critically ill patients is poorly described. This study aimed to describe the pharmacokinetics of a high-dose regimen of teicoplanin, a highly protein-bound antibiotic, in non-critically ill patients with hypoalbuminaemia. Ten patients with chronic bone sepsis and decreased serum albumin concentrations (<35 g/L) receiving teicoplanin 12 mg/kg 12-hourly intravenously for 48 h followed by 12 mg/kg once daily were enrolled...
June 2015: International Journal of Antimicrobial Agents
Heather M McLaughlin, Ozge Ceyhan-Birsoy, Kurt D Christensen, Isaac S Kohane, Joel Krier, William J Lane, Denise Lautenbach, Matthew S Lebo, Kalotina Machini, Calum A MacRae, Danielle R Azzariti, Michael F Murray, Christine E Seidman, Jason L Vassy, Robert C Green, Heidi L Rehm
BACKGROUND: The MedSeq Project is a randomized clinical trial developing approaches to assess the impact of integrating genome sequencing into clinical medicine. To facilitate the return of results of potential medical relevance to physicians and patients participating in the MedSeq Project, we sought to develop a reporting approach for the effective communication of such findings. METHODS: Genome sequencing was performed on the Illumina HiSeq platform. Variants were filtered, interpreted, and validated according to methods developed by the Laboratory for Molecular Medicine and consistent with current professional guidelines...
2014: BMC Medical Genetics
Valerie C Cluzet, Jeffrey S Gerber, Irving Nachamkin, Joshua P Metlay, Theoklis E Zaoutis, Meghan F Davis, Kathleen G Julian, David Royer, Darren R Linkin, Susan E Coffin, David J Margolis, Judd E Hollander, Rakesh D Mistry, Laurence J Gavin, Pam Tolomeo, Jacqueleen A Wise, Mary K Wheeler, Warren B Bilker, Xiaoyan Han, Baofeng Hu, Neil O Fishman, Ebbing Lautenbach
BACKGROUND: The duration of colonization and factors associated with clearance of methicillin-resistant Staphylococcus aureus (MRSA) after community-onset MRSA skin and soft-tissue infection (SSTI) remain unclear. METHODS: We conducted a prospective cohort study of patients with acute MRSA SSTI presenting to 5 adult and pediatric academic hospitals from 1 January 2010 through 31 December 2012. Index patients and household members performed self-sampling for MRSA colonization every 2 weeks for 6 months...
May 15, 2015: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Pinyo Rattanaumpawan, Irving Nachamkin, Warren B Bilker, Jason A Roy, Joshua P Metlay, Theoklis E Zaoutis, Ebbing Lautenbach
OBJECTIVES: The prevalence of high-MIC fluoroquinolone-susceptible Escherichia coli (FQSEC) has been increasing. These isolates are one step closer to full fluoroquinolone (FQ) resistance and may lead to delayed response to FQ therapy. Our study aimed to investigate the epidemiology of high-MIC FQSEC in ambulatory urinary tract infections (UTIs). PATIENTS AND METHODS: A case-control study was conducted at outpatient services within the University of Pennsylvania Health System, Philadelphia...
May 2015: Journal of Antimicrobial Chemotherapy
S A Iverson, A M Brazil, J M Ferguson, K Nelson, E Lautenbach, S C Rankin, D O Morris, M F Davis
Methicillin-resistant strains of Staphylococcus aureus (MRSA), Staphylococcus pseudintermedius (MRSP), and other pathogenic staphylococci can cause infections in companion animals and humans. Identification of colonized animals is fundamental to research and practice needs, but harmonized methods have not yet been established. To establish the optimal anatomic site for the recovery of methicillin-resistant coagulase positive staphylococci (CPS), survey data and swabs were collected from 196 pets (dogs, cats, reptiles, birds, fish and pocket pets) that lived in households with an MRSA-infected person...
March 23, 2015: Veterinary Microbiology
Jason L Vassy, Heather M McLaughlin, Heather L McLaughlin, Calum A MacRae, Christine E Seidman, Denise Lautenbach, Joel B Krier, William J Lane, Isaac S Kohane, Michael F Murray, Amy L McGuire, Heidi L Rehm, Robert C Green
As genome sequencing technologies increasingly enter medical practice, genetics laboratories must communicate sequencing results effectively to nongeneticist physicians. We describe the design and delivery of a clinical genome sequencing report, including a one-page summary suitable for interpretation by primary care physicians. To illustrate our preliminary experience with this report, we summarize the genomic findings from 10 healthy participants in a study of genome sequencing in primary care.
2015: Public Health Genomics
Pranita D Tamma, Jennifer H Han, Clare Rock, Anthony D Harris, Ebbing Lautenbach, Alice J Hsu, Edina Avdic, Sara E Cosgrove
BACKGROUND: The effectiveness of piperacillin-tazobactam (PTZ) for the treatment of extended-spectrum β-lactamase (ESBL) bacteremia is controversial. We compared 14-day mortality of PTZ vs carbapenems as empiric therapy in a cohort of patients with ESBL bacteremia who all received definitive therapy with a carbapenem. METHODS: Patients hospitalized between January 2007 and April 2014 with monomicrobial ESBL bacteremia were included. A decrease of >3 doubling dilutions in the minimum inhibitory concentration for third-generation cephalosporins tested in combination with 4 µg/mL of clavulanic acid was used to confirm ESBL status...
May 1, 2015: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
J A Priebe, M Messingschlager, S Lautenbacher
BACKGROUND: The vigilance-(attentional) avoidance hypothesis (VAH) developed for explaining phobic reactions describes an early attentional bias towards a feared stimulus followed by attentional avoidance of this stimulus. Such a pattern of attentional shifts might also be found when processing of pain-related stimuli is required. The purpose of the present study was to test the VAH for pain-associated stimuli, i.e., faces displaying pain, using the method of eye-tracking in a pain-free sample...
July 2015: European Journal of Pain: EJP
Michael Klompas, Deverick Anderson, William Trick, Hilary Babcock, Meeta Prasad Kerlin, Lingling Li, Ronda Sinkowitz-Cochran, E Wesley Ely, John Jernigan, Shelley Magill, Rosie Lyles, Caroline O'Neil, Barrett T Kitch, Ellen Arrington, Michele C Balas, Ken Kleinman, Christina Bruce, Julie Lankiewicz, Michael V Murphy, Christopher E Cox, Ebbing Lautenbach, Daniel Sexton, Victoria Fraser, Robert A Weinstein, Richard Platt
RATIONALE: The CDC introduced ventilator-associated event (VAE) definitions in January 2013. Little is known about VAE prevention. We hypothesized that daily, coordinated spontaneous awakening trials (SATs) and spontaneous breathing trials (SBTs) might prevent VAEs. OBJECTIVES: To assess the preventability of VAEs. METHODS: We nested a multicenter quality improvement collaborative within a prospective study of VAE surveillance among 20 intensive care units between November 2011 and May 2013...
February 1, 2015: American Journal of Respiratory and Critical Care Medicine
Jennifer H Han, Brian Johnston, Irving Nachamkin, Pam Tolomeo, Warren B Bilker, Xiangqun Mao, Connie Clabots, Ebbing Lautenbach, James R Johnson
This study examined molecular and epidemiologic factors associated with Escherichia coli sequence type 131 (ST131) among hospitalized patients colonized intestinally with fluoroquinolone (FQ)-resistant E. coli between 2002 and 2004. Among 86 patients, 21 (24%) were colonized with ST131. The proportion of ST131 isolates among colonizing isolates increased significantly over time, from 8% in 2002 to 50% in 2004 (P = 0.003). Furthermore, all 19 clonally related isolates were ST131. Future studies should identify potential transmissibility differences between ST131 and non-ST131 strains...
November 2014: Antimicrobial Agents and Chemotherapy
Jimish M Mehta, Kevin Haynes, E Paul Wileyto, Jeffrey S Gerber, Daniel R Timko, Steven C Morgan, Shawn Binkley, Neil O Fishman, Ebbing Lautenbach, Theoklis Zaoutis
OBJECTIVE: Although prior authorization and prospective audit with feedback are both effective antimicrobial stewardship program (ASP) strategies, the relative impact of these approaches remains unclear. We compared these core ASP strategies at an academic medical center. DESIGN: Quasi-experimental study. METHODS: We compared antimicrobial use during the 24 months before and after implementation of an ASP strategy change. The ASP used prior authorization alone during the preintervention period, June 2007 through May 2009...
September 2014: Infection Control and Hospital Epidemiology
Jason L Vassy, Denise M Lautenbach, Heather M McLaughlin, Sek Won Kong, Kurt D Christensen, Joel Krier, Isaac S Kohane, Lindsay Z Feuerman, Jennifer Blumenthal-Barby, J Scott Roberts, Lisa Soleymani Lehmann, Carolyn Y Ho, Peter A Ubel, Calum A MacRae, Christine E Seidman, Michael F Murray, Amy L McGuire, Heidi L Rehm, Robert C Green
BACKGROUND: Whole genome sequencing (WGS) is already being used in certain clinical and research settings, but its impact on patient well-being, health-care utilization, and clinical decision-making remains largely unstudied. It is also unknown how best to communicate sequencing results to physicians and patients to improve health. We describe the design of the MedSeq Project: the first randomized trials of WGS in clinical care. METHODS/DESIGN: This pair of randomized controlled trials compares WGS to standard of care in two clinical contexts: (a) disease-specific genomic medicine in a cardiomyopathy clinic and (b) general genomic medicine in primary care...
March 20, 2014: Trials
Franziska Lautenbach, Sylvain Laborde, Silvia Achtzehn, Markus Raab
The aims of this study were to examine the influence of salivary cortisol on tennis serve performance in a controlled setting and to investigate if cortisol predicts unique variance in performance beyond a subjective anxiety measure (i.e., Competitive State Anxiety Inventory-2 [CSAI-2]). Twenty-three tennis players performed two series of second tennis serves separated by an anxiety induction (i.e., arithmetic task). Cortisol was assessed six times during the experiment. Results show that cortisol response and a drop in serving performance are positively correlated (r=...
April 2014: Psychoneuroendocrinology
Henry F Chambers, John G Bartlett, Robert A Bonomo, Christine Chiou, Sara E Cosgrove, Heather R Cross, Robert S Daum, Michele Downing, Scott R Evans, Jane Knisely, Barry N Kreiswirth, Ebbing Lautenbach, Brenda S Mickley, Robin Patel, Melinda M Pettigrew, Keith A Rodvold, Brad Spellberg, Vance G Fowler
Funded by the National Institute of Allergy and Infectious Diseases, the Antibacterial Resistance Leadership Group (ARLG) is tasked with developing a clinical research agenda and conducting clinical studies to address the growing public health threat of antibacterial resistance. The ARLG has identified 4 high-priority areas of research: infections caused by gram-negative bacteria, infections caused by gram-positive bacteria, antimicrobial stewardship and infection prevention, and diagnostics. The ARLG will be accepting proposals from the scientific community for clinical research that addresses 1 or more of these high-priority areas...
June 2014: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Miriam Kunz, Parvaneh Mohammadian, Bertold Renner, Stephan Roscher, Gerd Kobal, Stefan Lautenbacher
UNLABELLED: Abstract Background: Chemo-somatosensory evoked potentials (CSSEPs) elicited by chemical stimulation (CO₂ gas) of the nasal mucosa have been shown to be sensitive enough to pick up even weak analgesic effects. With the present study we wanted to investigate whether CSSEPs are also a sensitive tool to capture endogenous pain inhibitory mechanisms elicited by conditioned pain modulation (CPM; where a first conditioning stimulus reduces the sensitivity for a second test stimulus) with a conditioning stimulus of rather low noxious load...
June 2014: Somatosensory & Motor Research
Miriam Kunz, Jessica Peter, Sonja Huster, Stefan Lautenbacher
The experience of pain and disgust share many similarities, given that both are aversive experiences resulting from bodily threat and leading to defensive reactions. The aim of the present study was to investigate whether facial expressions are distinct enough to encode the specific quality of pain and disgust or whether they just encode the similar negative valence and arousal level of both states. In sixty participants pain and disgust were induced by heat stimuli and pictures, respectively. Facial responses (Facial Action Coding System) as well as subjective responses were assessed...
2013: PloS One
Miriam Kunz, Kenneth Prkachin, Stefan Lautenbacher
Studies of facial responses during experimental and clinical pain have revealed a surprising phenomenon, namely, that a considerable number of individuals respond with a smile. So far, it is not known why smiling occurs during pain. It is possible that the "smile of pain" is socially motivated (e.g., reinforcing social bonds while undergoing an unpleasant experience). The present studies were conducted in an attempt to address the role of social motives in smiling during pain. In two studies, we varied the quantitative (level of sociality) and qualitative (properties of the relationship between interactants) components of the situations in which participants received painful stimulation...
2013: Pain Research and Treatment
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