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Milstone, Aaron

Michael Rosen, Brigitta U Mueller, Aaron M Milstone, Denise R Remus, Renee Demski, Peter J Pronovost, Marlene R Miller
BACKGROUND: Large multihospital health systems with multiple children's hospitals are relatively few in number. With a paucity of national pediatric measures for quality and patient safety, there are unique challenges to ensuring consistent levels of care across diverse health care delivery settings. At Johns Hopkins Medicine, a Pediatric Joint Council was created to help ensure high-quality and safe care across a health system encompassing two full-service children's hospitals and two community hospitals with significant pediatric volumes across two states...
May 2017: Joint Commission Journal on Quality and Patient Safety
Vidya Mave, Ajay Chandanwale, Anju Kagal, Sandhya Khadse, Dileep Kadam, Renu Bharadwaj, Vaishali Dohe, Matthew Robinson, Aarti Kinikar, Samir Joshi, Priyanka Raichur, Katie McIntire, Savita Kanade, Jonathan Sachs, Chhaya Valvi, Usha Balasubramanian, Vandana Kulkarni, Aaron M Milstone, Ivan Marbaniang, Jonathan Zenilman, Amita Gupta
Background.: In India, antimicrobial consumption is high, yet systematically collected data on the epidemiology, risk factors and outcomes of antimicrobial resistant (AMR) infections are limited. Methods.: A prospective study of adults and children hospitalized for acute febrile illness (AFI) was conducted between August 2013 and December 2015. In-hospital outcomes were recorded, and logistic regression was performed to identify independent predictors of AMR community-onset infections...
March 3, 2017: Journal of Infectious Diseases
Michael A Smit, Kenneth A Rasinski, Barbara I Braun, Linda L Kusek, Aaron M Milstone, Daniel J Morgan, Leonard A Mermel
OBJECTIVE To assess resource allocation and costs associated with US hospitals preparing for the possible spread of the 2014-2015 Ebola virus disease (EVD) epidemic in the United States. METHODS A survey was sent to a stratified national probability sample (n=750) of US general medical/surgical hospitals selected from the American Hospital Association (AHA) list of hospitals. The survey was also sent to all children's general hospitals listed by the AHA (n=60). The survey assessed EVD preparation supply costs and overtime staff hours...
March 6, 2017: Infection Control and Hospital Epidemiology
Charlotte Z Woods-Hill, James Fackler, Kristen Nelson McMillan, Judith Ascenzi, Diego A Martinez, Matthew F Toerper, Annie Voskertchian, Elizabeth Colantuoni, Sybil Ann Klaus, Scott Levin, Aaron M Milstone
Importance: Sepsis and septic shock are common and, at times, fatal in pediatrics. Blood cultures are often obtained when clinicians suspect sepsis, yet are low-yield with a false-positive rate up to 50%. Objectives: To determine whether a novel, 2-part, clinical practice guideline could decrease the rates of total blood cultures and cultures collected from central venous catheters in critically ill children and to examine the effect of the guideline on patient outcomes...
February 1, 2017: JAMA Pediatrics
Whitney R Buckel, Shahira Ghobrial, Pranita D Tamma, Aaron M Milstone, Yuan Zhao, Alice J Hsu
BACKGROUND: Achieving vancomycin troughs of 15-20 μg/mL remains challenging in children. Our objective was to identify risk factors associated with non-therapeutic initial vancomycin troughs in children. METHODS: We conducted a retrospective cohort study of children who received intravenous vancomycin with at least one initial steady-state trough obtained. Patients who achieved therapeutic troughs (15-20 μg/mL in the 20-mg/kg/dose sub-cohort and 10-15 μg/mL in the 15-mg/kg/dose sub-cohort) were compared with those with subtherapeutic troughs (<15 and <10 μg/mL, respectively) and supratherapeutic troughs (>20 and >15 μg/mL, respectively) separately to determine risk factors associated with non-therapeutic troughs...
February 2017: Paediatric Drugs
Nasia Safdar, Sharmila Sengupta, Jackson S Musuuza, Manisha Juthani-Mehta, Marci Drees, Lilian M Abbo, Aaron M Milstone, Jon P Furuno, Meera Varman, Deverick J Anderson, Daniel J Morgan, Loren G Miller, Graham M Snyder
OBJECTIVE To examine self-reported practices and policies to reduce infection and transmission of multidrug-resistant organisms (MDRO) in healthcare settings outside the United States. DESIGN Cross-sectional survey. PARTICIPANTS International members of the Society for Healthcare Epidemiology of America (SHEA) Research Network. METHODS Electronic survey of infection control and prevention practices, capabilities, and barriers outside the United States and Canada. Participants were stratified according to their country's economic development status as defined by the World Bank as low-income, lower-middle-income, upper-middle-income, and high-income...
November 7, 2016: Infection Control and Hospital Epidemiology
Katherine E Goodman, Justin Lessler, Sara E Cosgrove, Anthony D Harris, Ebbing Lautenbach, Jennifer H Han, Aaron M Milstone, Colin J Massey, Pranita D Tamma
BACKGROUND: Timely identification of extended-spectrum β-lactamase (ESBL) bacteremia can improve clinical outcomes while minimizing unnecessary use of broad-spectrum antibiotics, including carbapenems. However, most clinical microbiology laboratories currently require at least 24 additional hours from the time of microbial genus and species identification to confirm ESBL production. Our objective was to develop a user-friendly decision tree to predict which organisms are ESBL producing, to guide appropriate antibiotic therapy...
October 1, 2016: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Julia Johnson, Rebecca Bracken, Pranita D Tamma, Susan W Aucott, Cynthia Bearer, Aaron M Milstone
No abstract text is available yet for this article.
September 2016: Infection Control and Hospital Epidemiology
Graham M Snyder, Heather Young, Meera Varman, Aaron M Milstone, Anthony D Harris, Silvia Munoz-Price
Observational studies compare outcomes among subjects with and without an exposure of interest, without intervention from study investigators. Observational studies can be designed as a prospective or retrospective cohort study or as a case-control study. In healthcare epidemiology, these observational studies often take advantage of existing healthcare databases, making them more cost-effective than clinical trials and allowing analyses of rare outcomes. This paper addresses the importance of selecting a well-defined study population, highlights key considerations for study design, and offers potential solutions including biostatistical tools that are applicable to observational study designs...
October 2016: Infection Control and Hospital Epidemiology
Marin L Schweizer, Barbara I Braun, Aaron M Milstone
Quasi-experimental studies evaluate the association between an intervention and an outcome using experiments in which the intervention is not randomly assigned. Quasi-experimental studies are often used to evaluate rapid responses to outbreaks or other patient safety problems requiring prompt, nonrandomized interventions. Quasi-experimental studies can be categorized into 3 major types: interrupted time-series designs, designs with control groups, and designs without control groups. This methods paper highlights key considerations for quasi-experimental studies in healthcare epidemiology and antimicrobial stewardship, including study design and analytic approaches to avoid selection bias and other common pitfalls of quasi-experimental studies...
October 2016: Infection Control and Hospital Epidemiology
Daniel J Morgan, Nasia Safdar, Aaron M Milstone, Deverick J Anderson
Research in Healthcare Epidemiology and Antimicrobial Stewardship (HE&AS) is rapidly expanding with the involvement of researchers from varied countries and backgrounds. Researchers must use scientific methods that will provide the strongest evidence to advance healthcare epidemiology, but there are limited resources for information on specific aspects of HE&AS research or easy ways to access examples of studies using specific methods with HE&AS. In response to this need, the SHEA Research Committee has developed a series of white papers on research methods in HE&AS...
June 2016: Infection Control and Hospital Epidemiology
Patricia J Simner, Isabella Martin, Belita Opene, Pranita D Tamma, Karen C Carroll, Aaron M Milstone
Rectal swabs from high-risk patients were screened for carbapenem-resistant organisms (CROs) using several methods. The direct MacConkey plate method was the most sensitive for CROs (95%), while chromID CARBA and the Check-Direct CPE screen assay were the most sensitive for the detection of carbapenemase-producing organisms (CPOs) (100%; all blaKPC). All methods had a specificity of >90% for CROs, and for CPOs, the specificity ranged from 85 to 98%. Broth enrichment methods performed poorly compared to direct inoculation methods, negating the need for the broth enrichment step...
June 2016: Journal of Clinical Microbiology
Amanda Kovacich, Pranita D Tamma, Sonali Advani, Victor O Popoola, Elizabeth Colantuoni, Leslie Gosey, Aaron M Milstone
OBJECTIVE To identify the frequency of and risk factors associated with complications necessitating removal of the peripherally inserted central catheters (PICCs) in patients receiving outpatient parenteral antibiotic therapy (OPAT) and to determine the appropriateness of OPAT in children with OPAT-related complications. METHODS A retrospective cohort of children who had a PICC inserted at the Johns Hopkins Children's Center between January 1, 2003, and December 31, 2013, and were discharged from the hospital on OPAT was assembled...
April 2016: Infection Control and Hospital Epidemiology
Nuntra Suwantarat, Latania K Logan, Karen C Carroll, Robert A Bonomo, Patricia J Simner, Susan D Rudin, Aaron M Milstone, Tsigereda Tekle, Tracy Ross, Pranita D Tamma
OBJECTIVE: To determine the prevalence and acquisition of extended-spectrum β-lactamases (ESBLs), plasmid-mediated AmpCs (pAmpCs), and carbapenemases ("MDR Enterobacteriaceae") colonizing children admitted to a pediatric intensive care unit (PICU). DESIGN: Prospective study. SETTING: 40-bed PICU. METHODS: Admission and weekly thereafter rectal surveillance swabs were collected on all pediatric patients during a 6-month study period...
May 2016: Infection Control and Hospital Epidemiology
Preeti Mehrotra, Andi L Shane, Aaron M Milstone
No abstract text is available yet for this article.
March 2016: JAMA Pediatrics
Victor O Popoola, Elizabeth Colantuoni, Nuntra Suwantarat, Rebecca Pierce, Karen C Carroll, Susan W Aucott, Aaron M Milstone
BACKGROUND: Staphylococcus aureus is a common cause of healthcare-associated infections in neonates. OBJECTIVE: To examine the impact of methicillin-susceptible S. aureus (MSSA) decolonization on the incidence of MSSA infection and to measure the prevalence of mupirocin resistance. METHODS: We retrospectively identified neonates admitted to a tertiary care neonatal intensive care unit (NICU) from April 1, 2011, through September 30, 2014. We compared rates of MSSA-positive cultures and infections before and after implementation of an active surveillance culture and decolonization intervention for MSSA-colonized neonates...
April 2016: Infection Control and Hospital Epidemiology
Nicole Salazar-Austin, Alvaro A Ordonez, Alice Jenh Hsu, Jane E Benson, Mahadevappa Mahesh, Elizabeth Menachery, Jafar H Razeq, Max Salfinger, Jeffrey R Starke, Aaron M Milstone, Nicole Parrish, Eric L Nuermberger, Sanjay K Jain
Extensively drug-resistant (XDR) tuberculosis is becoming increasingly prevalent worldwide, but little is known about XDR tuberculosis in young children. In this Grand Round we describe a 2-year-old child from the USA who developed pneumonia after a 3 month visit to India. Symptoms resolved with empirical first-line tuberculosis treatment; however, a XDR strain of Mycobacterium tuberculosis grew in culture. In the absence of clinical or microbiological markers, low-radiation exposure pulmonary CT imaging was used to monitor treatment response, and guide an individualised drug regimen...
December 2015: Lancet Infectious Diseases
Bereketeab Haileselassie, Erik Su, Melania Bembea, Theodore Abraham, Aaron Milstone
No abstract text is available yet for this article.
December 2015: Critical Care Medicine
Charlotte Woods-Hill, Kristen Nelson, Annie Voskertchian, Judith Ascenzi, James Fackler, Aaron Milstone
No abstract text is available yet for this article.
December 2015: Critical Care Medicine
K E Goodman, P J Simner, P D Tamma, A M Milstone
The Centers for Disease Control and Prevention (CDC) defines carbapenem-resistant Enterobacteriaceae (CRE) based upon a phenotypic demonstration of carbapenem resistance. However, considerable heterogeneity exists within this definitional umbrella. CRE may mechanistically differ by whether they do or do not produce carbapenemases. Moreover, patients can acquire CRE through multiple pathways: endogenously through antibiotic selective pressure on intestinal microbiota, exogenously through horizontal transmission or through a combination of these factors...
2016: Expert Review of Anti-infective Therapy
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