Jennifer H Han, Warren B Bilker, Irving Nachamkin, Pam Tolomeo, Xiangqun Mao, Neil O Fishman, Ebbing Lautenbach
OBJECTIVE: Infections due to fluoroquinolone-resistant Escherichia coli (FQREC) are associated with significant morbidity and mortality. Fluoroquinolone resistance likely arises at the level of gastrointestinal colonization. The objective of this study was to identify risk factors for the development of FQREC gastrointestinal tract colonization in hospitalized patients, including the impact of antibiotics prescribed during hospitalization. DESIGN: A prospective cohort study was conducted from 2002 to 2004 within a university health system...
October 2013: Infection Control and Hospital Epidemiology
Jennifer H Han, Joel Maslow, Xiaoyan Han, Sharon X Xie, Pam Tolomeo, Evelyn Santana, Lesley Carson, Ebbing Lautenbach
BACKGROUND: The objective of this study was to assess risk factors for the development of fluoroquinolone (FQ)-resistant Escherichia coli gastrointestinal tract colonization in long-term care facility (LTCF) residents. METHODS: A prospective cohort study was conducted from 2006 to 2008 at 3 LTCFs. Residents initially colonized with FQ-susceptible E. coli were followed by means of serial fecal sampling for new FQ-resistant E. coli colonization for up to 12 months or until discharge or death...
February 1, 2014: Journal of Infectious Diseases
Jennifer H Han, Irving Nachamkin, Pam Tolomeo, Xiangqun Mao, Warren B Bilker, Ebbing Lautenbach
The objective of this study was to characterize the temporal variability of fluoroquinolone resistance mechanisms among Escherichia coli colonizing the gastrointestinal tract of hospitalized patients. Patients with new fluoroquinolone-resistant E. coli (FQREC) colonization were followed with serial fecal sampling until discharge or death. Genetic mechanism(s) of resistance for all FQREC isolates was characterized, including mutations in gyrA and parC and efflux pump overexpression. Of 451 subjects, 73 (16.2%) became newly colonized with FQREC...
August 2013: Diagnostic Microbiology and Infectious Disease
Jennifer H Han, Irving Nachamkin, Theoklis E Zaoutis, Susan E Coffin, Darren R Linkin, Neil O Fishman, Mark G Weiner, Baofeng Hu, Pam Tolomeo, Ebbing Lautenbach
We describe the prevalence of and risk factors for colonization with extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella species (ESBL-EK) in hospitalized patients. The prevalence of colonization with ESBL-EK was 2.6%. Colonization was associated with cirrhosis, longer duration of hospital stay prior to surveillance, and prior exposure to clindamycin or meropenem.
December 2012: Infection Control and Hospital Epidemiology
K A Feemster, Y Li, A R Localio, J Shults, P Edelstein, E Lautenbach, T Smith, J P Metlay
This study investigates neighbourhood variation in rates of pneumococcal bacteraemia and community-level factors associated with neighbourhood heterogeneity in disease risk. We analysed data from 1416 adult and paediatric cases of pneumococcal bacteraemia collected during 2005-2008 from a population-based hospital surveillance network in metropolitan Philadelphia. Cases were geocoded using residential address to measure disease incidence by neighbourhood and identify potential neighbourhood-level risk factors...
August 2013: Epidemiology and Infection
J A Priebe, P Rieckmann, S Lautenbacher
Parkinson's disease (PD) is caused by degeneration of the dopaminergic neurons in the substantia nigra (SN) and a resulting dysfunction of the nigrostriatal pathways including the basal ganglia. Beside motor symptoms, different types of pain (e.g., dystonic musculoskeletal pain or central pain) occur in a considerable number of patients. In addition, abnormalities in pain processing have been observed in PD patients, which may present as increased pain sensitivity. The pathophysiological mechanisms involved in disturbed pain processing of PD, however, are still poorly understood...
December 2012: Der Schmerz
Nimalie D Stone, Muhammad S Ashraf, Jennifer Calder, Christopher J Crnich, Kent Crossley, Paul J Drinka, Carolyn V Gould, Manisha Juthani-Mehta, Ebbing Lautenbach, Mark Loeb, Taranisia Maccannell, Preeti N Malani, Lona Mody, Joseph M Mylotte, Lindsay E Nicolle, Mary-Claire Roghmann, Steven J Schweon, Andrew E Simor, Philip W Smith, Kurt B Stevenson, Suzanne F Bradley
(See the commentary by Moro, on pages 978-980 .) Infection surveillance definitions for long-term care facilities (ie, the McGeer Criteria) have not been updated since 1991. An expert consensus panel modified these definitions on the basis of a structured review of the literature. Significant changes were made to the criteria defining urinary tract and respiratory tract infections. New definitions were added for norovirus gastroenteritis and Clostridum difficile infections.
October 2012: Infection Control and Hospital Epidemiology
Jennifer H Han, Kei Kasahara, Paul H Edelstein, Warren B Bilker, Ebbing Lautenbach
There has been a significant increase in the prevalence of Enterobacteriaceae that produce CTX-M-type extended-spectrum β-lactamases. The objective of this study was to evaluate risk factors for infection or colonization with CTX-M-positive Escherichia coli. A case-control study was conducted within a university system from 1 January 2007 to 31 December 2008. All patients with clinical cultures with E. coli demonstrating resistance to extended-spectrum cephalosporins were included. Case patients were designated as those with cultures positive for CTX-M-positive E...
November 2012: Antimicrobial Agents and Chemotherapy
J H Han, W B Bilker, P H Edelstein, K B Mascitti, E Lautenbach
Reduced vancomycin susceptibility (RVS) may lead to poor clinical outcomes in Staphylococcus aureus bacteraemia. We conducted a cohort study of 392 patients with S. aureus bacteraemia within a university health system. The association between RVS, as defined by both Etest [vancomycin minimum inhibitory concentration (MIC) >1·0 μg/ml] and broth microdilution (vancomycin MIC ≥1·0 μg/ml), and patient and clinical variables were evaluated to create separate predictive models for RVS. In total, 134 (34·2%) and 73 (18·6%) patients had S...
January 2013: Epidemiology and Infection
Oliver Gruebner, M Mobarak H Khan, Sven Lautenbach, Daniel Müller, Alexander Krämer, Tobia Lakes, Patrick Hostert
BACKGROUND: Urban health is of global concern because the majority of the world's population lives in urban areas. Although mental health problems (e.g. depression) in developing countries are highly prevalent, such issues are not yet adequately addressed in the rapidly urbanising megacities of these countries, where a growing number of residents live in slums. Little is known about the spectrum of mental well-being in urban slums and only poor knowledge exists on health promotive socio-physical environments in these areas...
2012: BMC Public Health
D O Morris, E Lautenbach, T Zaoutis, K Leckerman, P H Edelstein, S C Rankin
Colonization by methicillin-resistant Staphylococcus aureus (MRSA) may be persistent in people and is horizontally transmissible. The scientific literature suggests that domestic pets may also participate in cross-transmission of MRSA within households. The objectives of this study were to evaluate the prevalence of and risk factors for MRSA carriage by pets residing in households with an MRSA-infected person. From 66 households in which an MRSA-infected patient resided, we screened 47 dogs and 52 cats using a swab protocol...
June 2012: Zoonoses and Public Health
Kara B Mascitti, Paul H Edelstein, Neil O Fishman, Knashawn H Morales, Andrew J Baltus, Ebbing Lautenbach
OBJECTIVE: Staphylococcus aureus is a cause of community- and healthcare-acquired infections and is associated with substantial morbidity, mortality, and costs. Vancomycin minimum inhibitory concentrations (MICs) among S. aureus have increased, and reduced vancomycin susceptibility (RVS) may be associated with treatment failure. We aimed to identify clinical risk factors for RVS in S. aureus bacteremia. DESIGN: Case-control. SETTING: Academic tertiary care medical center and affiliated urban community hospital...
February 2012: Infection Control and Hospital Epidemiology
Miriam Kunz, Nicole Faltermeier, Stefan Lautenbacher
The ability to facially communicate physical distress (e.g. pain) can be essential to ensure help, support and clinical treatment for the individual experiencing physical distress. So far, it is not known to which degree this ability represents innate and biologically prepared programs or whether it requires visual learning. Here, we address this question by studying evoked and voluntary facial expressions of pain in congenitally blind (N=21) and sighted (N=42) individuals. The repertoire of evoked facial expressions was comparable in congenitally blind and sighted individuals; however, blind individuals were less capable of facially encoding different intensities of experimental pain...
February 2012: Biological Psychology
Brian L Strom, Thomas O Kelly, Sandra A Norman, John T Farrar, Stephen E Kimmel, Ebbing Lautenbach, Harold I Feldman
An innovative training program to provide clinical research training for clinicians was created in 1979 at the University of Pennsylvania School of Medicine, now the Perelman School of Medicine. The program's principal and continuing aim is to provide trainees mentored experiences and the training needed to become skilled independent investigators able to conduct clinical research and develop academic careers as independent clinical investigators.The authors identify the vision that led to the creation of the master of science in clinical epidemiology (MSCE) degree program and describe today's training program, including administration, oversight, participating faculty, and trainees...
January 2012: Academic Medicine
Lauren A Beslow, Scott E Kasner, Sabrina E Smith, Michael T Mullen, Matthew P Kirschen, Rachel A Bastian, Michael M Dowling, Warren Lo, Lori C Jordan, Timothy J Bernard, Neil Friedman, Gabrielle DeVeber, Adam Kirton, Lisa Abraham, Daniel J Licht, Abbas F Jawad, Jonas H Ellenberg, Ebbing Lautenbach, Rebecca N Ichord
BACKGROUND AND PURPOSE: The Pediatric National Institutes of Health Stroke Scale (PedNIHSS), an adaptation of the adult National Institutes of Health Stroke Scale, is a quantitative measure of stroke severity shown to be reliable when scored prospectively. The ability to calculate the PedNIHSS score retrospectively would be invaluable in the conduct of observational pediatric stroke studies. The study objective was to assess the concurrent validity and reliability of estimating the PedNIHSS score retrospectively from medical records...
February 2012: Stroke; a Journal of Cerebral Circulation
T L Lemonovich, K Haynes, E Lautenbach, V K Amorosa
PURPOSE: Although limited data exist on the efficacy and potential risk of synergistic aminoglycoside therapy for persistent Staphylococcus aureus bacteremia and endocarditis, aminoglycosides are frequently used in clinical practice. METHODS: As our study population, we included subjects fulfilling the modified Duke criteria for S. aureus endocarditis and/or having greater than 72 h of S. aureus bacteremia. Among these subjects, we compared patients who did and did not receive aminoglycoside therapy for their S...
December 2011: Infection
Oliver Gruebner, Md Mobarak H Khan, Sven Lautenbach, Daniel Müller, Alexander Kraemer, Tobia Lakes, Patrick Hostert
BACKGROUND: The deprived physical environments present in slums are well-known to have adverse health effects on their residents. However, little is known about the health effects of the social environments in slums. Moreover, neighbourhood quantitative spatial analyses of the mental health status of slum residents are still rare. The aim of this paper is to study self-rated mental health data in several slums of Dhaka, Bangladesh, by accounting for neighbourhood social and physical associations using spatial statistics...
2011: International Journal of Health Geographics
P Rattanaumpawan, P Tolomeo, W B Bilker, N O Fishman, E Lautenbach
Past studies exploring risk factors for fluoroquinolone (FQ) resistance in urinary tract infections (UTIs) focused only on UTIs caused by Gram-negative pathogens. The epidemiology of FQ resistance in enterococcal UTIs has not been studied. We conducted a case-control study at two medical centres within the University of Pennsylvania Health System in order to identify risk factors for FQ resistance in enterococcal UTIs. Subjects with positive urine cultures for enterococci and meeting CDC criteria for healthcare-acquired UTI were eligible...
June 2011: Epidemiology and Infection
P Rattanaumpawan, P Tolomeo, W B Bilker, N O Fishman, E Lautenbach
The prevalence of urinary tract infections caused by fluoroquinolone-resistant Gram-negative bacilli (FQ-resistant GNB-UTIs) has been increasing. Previous studies that explored risk factors for FQ resistance have focused only on UTIs caused by Escherichia coli and/or failed to distinguish colonisation from infection. We conducted a case-control study at two medical centres within the University of Pennsylvania Health System to identify risk factors for FQ resistance among healthcare-acquired GNB-UTIs. Subjects with positive urine cultures for GNB and who met Centers for Disease Control and Prevention criteria for healthcare-acquired UTI were eligible...
December 2010: Journal of Hospital Infection
Ebbing Lautenbach, Joshua P Metlay, Xiangqun Mao, Xiaoyan Han, Neil O Fishman, Warren B Bilker, Pam Tolomeo, Mary Wheeler, Irving Nachamkin
BACKGROUND: Fluoroquinolones are the most commonly prescribed antimicrobials. The epidemiology of fecal colonization with Escherichia coli demonstrating reduced susceptibility to fluoroquinolones remains unclear. METHODS: During a 3-year period (15 September 2004 through 19 October 2007), all patients hospitalized for >3 days were approached for fecal sampling. All E. coli isolates with reduced susceptibility to fluoroquinolones (minimum inhibitory concentration [MIC] of levofloxacin, 0...
August 1, 2010: Clinical Infectious Diseases
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