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Milstone, Aaron

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
Clare Rock, Kerri A Thom, Anthony D Harris, Shanahan Li, Daniel Morgan, Aaron M Milstone, Brian Caffo, Manjari Joshi, Surbhi Leekha
BACKGROUND: Central-line-associated bloodstream infection (CLABSI) rate is an important quality measure, but it suffers from subjectivity and interrater variability, and decreasing national CLABSI rates may compromise its power to discriminate between hospitals. This study evaluates hospital-onset bacteremia (HOB, ie, any positive blood culture obtained 48 hours post admission) as a healthcare-associated infection-related outcome measure by assessing the association between HOB and CLABSI rates and comparing the power of each to discriminate quality among intensive care units (ICUs)...
February 2016: Infection Control and Hospital Epidemiology
Lisa A Degnan, Aaron M Milstone, Marie Diener-West, Carlton K K Lee
OBJECTIVES: Multidrug-resistant Gram-negative bacteria, including extended-spectrum beta-lactamase (ESBL)-producing organisms, are a growing problem. The primary objective of this study was to describe the proportion of children with ESBL-producing urinary isolates at a tertiary medical center as well as these organisms' susceptibility patterns. The secondary objective was to identify the risk factors for acquiring ESBL urinary pathogens. METHODS: This retrospective study evaluated a cohort of children with ESBL urinary isolates, admitted to a tertiary children's hospital during a 6-year period...
September 2015: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
Preeti Mehrotra, Andi L Shane, Aaron M Milstone
No abstract text is available yet for this article.
November 2015: JAMA Pediatrics
Aaron M Milstone, Danielle W Koontz, Annie Voskertchian, Victor O Popoola, Kathleen Harrelson, Tracy Ross, Susan W Aucott, Maureen M Gilmore, Karen C Carroll, Elizabeth Colantuoni
INTRODUCTION: More than 33,000 healthcare-associated infections occur in neonatal intensive care units (NICUs) each year in the USA. Parents, rather than healthcare workers, may be a reservoir from which neonates acquire Staphylococcus aureus (S. aureus) colonisation in the NICU. This study looks to measure the effect of treating parents with short course intranasal mupirocin and topical chlorhexidine antisepsis on acquisition of S. aureus colonisation and infection in neonates. METHODS AND ANALYSIS: The TREAT PARENTS trial (Treating Parents to Reduce Neonatal Transmission of S...
2015: BMJ Open
Alice J Hsu, Karen C Carroll, Aaron M Milstone, Edina Avdic, Sara E Cosgrove, Mercedes Vilasoa, Pranita D Tamma
Combination antibiograms can be used to evaluate organism cross-resistance among multiple antibiotics. As combination therapy is generally favored for the treatment of carbapenemase-producing Enterobacteriaceae (CPE), combination antibiograms provide valuable information about the combination of antibiotics that achieve the highest likelihood of adequate antibiotic coverage against CPE.
December 2015: Infection Control and Hospital Epidemiology
Rebecca A Pierce, Justin Lessler, Aaron M Milstone
PURPOSE OF REVIEW: Healthcare-associated infections (HAIs) are a leading cause of adverse patient outcomes. Further elucidation of the etiology of these infections and the pathogens that cause them has been a primary goal of research in infection control and healthcare epidemiology. Longitudinal studies, in particular, afford a range of statistical methods to better understand the process of pathogen acquisition or HAI development. This review intends to convey the scope of available statistical methodology...
August 2015: Current Opinion in Infectious Diseases
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