Elizabeth D. Hermsen

Pfizer (United States)

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Mark E. Rupp

University of Nebraska Medical Center

John C. Rotschafer

University of Minnesota

Laurie B. Hovde

University of Minnesota

Jessica C. Njoku

Nebraska Medical Center

David J. Weber

University of North Carolina Health Care

Daryl D. DePestel

Merck & Co., Inc., Rahway, NJ, USA (United States)

Keith M. Olsen

University of Nebraska Medical Center

Sara S. Shull

University of Wisconsin–Madison

Ann Arbor

New York University

Trevor Van Schooneveld

University of Nebraska Medical Center

Cooperative Institutions

Biology of Infection

174

Society for Healthcare Epidemiology of America

147

Engineering Associates (United States)

129

University of Pittsburgh

115

New York Proton Center

University of Chicago

Ontario Institute for Cancer Research

Communities In Schools of Orange County

University HealthSystem Consortium

University Hospitals Birmingham NHS Foundation Trust

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Clinical outcomes and nephrotoxicity associated with vancomycin trough concentrations during treatment of deep-seated infections

Expert Opinion on Drug Safety (2009)

Elizabeth D. Hermsen Monica Hanson Jayashri Sankaranarayanan Julie A. Stoner M Florescu

Higher vancomycin concentrations are thought necessary for treatment of deep-seated methicillin-resistant Staphylococcus aureus (MRSA) infection, yet this may result in greater risk of nephrotoxicity. We evaluated the relationship of serum vancomycin trough concentration with clinical outcomes and nephrotoxicity for patients with deep-seated MRSA infection.A retrospective cohort study evaluated adults with MRSA pneumonia, endocarditis or osteomyelitis who received vancomycin for > or = 5 days from June 2005 to June 2007. Patients were stratified by mean vancomycin trough level [low (< 15 mg/l), high (> or = 15 mg/l)]. Outcomes were clinical response, mortality, length of stay (LOS) and nephrotoxicity. Three definitions of nephrotoxicity were used: i) rise in serum creatinine (SCr) > or = 0.5 mg/dl; ii) 50% increase in SCr; and iii) 25% decrease in estimated creatinine clearance.Fifty-five patients experiencing MRSA pneumonia (n = 28), endocarditis (n = 9), osteomyelitis (n = 20) and multiple infections (n = 2) were stratified into low (n = 39) and high (n = 16) groups. High group patients were more likely to be septic (p = 0.01) and have a higher APACHE II score (p = 0.01). After adjustment for APACHE II score, clinical response rates among survivors did not differ significantly. Risk of death was not significantly different between the high (19%) and low (5%) group patients (p = 0.1). LOS did not differ significantly between groups (p = 0.7). Nephrotoxicity occurred in the low and high groups, respectively, for 10 and 31% (p = 0.04) with definition 1, 10 and 31% (p = 0.04) with definition 2, and 13 and 25% (p = 0.1) with definition 3. After adjustment for APACHE II score, odds of nephrotoxicity based on definitions 1 or 2 were increased among the high versus low groups (OR = 3.27, 95% CI: 0.7 - 15.25, p = 0.1), although not statistically significant.Clinical outcomes did not differ significantly between high and low trough groups for deep-seated MRSA infections. Nephrotoxicity was consistently higher in the high trough group, regardless of the definition used.

Nephrotoxicity

Trough Concentration

Trough (economics)

Trough level

10.1517/14740330903413514

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Citations (99)

Prospective Evaluation of Clinical and Economic Outcomes Associated With Treatment of Serious Infections Due to Gram-Positive Cocci

Infectious Diseases in Clinical Practice (2009)

Elizabeth D. Hermsen Sara S. Shull Isaac F. Mitropoulos Susan E. Puumala Mark E. Rupp

Comparative data are needed to define the use of agents to treat serious gram-positive cocci infections. This prospective, open-label, observational cohort study included adults receiving daptomycin, linezolid, vancomycin, or oxacillin/cefazolin for complicated skin and skin structure infections, bacteremia, endocarditis, or osteomyelitis. Primary outcome was clinical response at 180 days. Secondary outcomes included response at the end of therapy, antibiotic switch due to failure, length of stay (LOS), LOS after antibiotic start, mortality, infection-related readmission, and antibiotic and hospitalization costs. One hundred seventeen patients were evaluated for complicated skin and skin structure infections (n= 37), bacteremia (n = 49), endocarditis (n = 10), and osteomyelitis (n = 21). Daptomycin (P = 0.008) and linezolid (P = 0.02) were used more often as second-line therapy. No significant differences were found in outcomes except LOS (P = 0.05), and hospitalization costs (P = 0.004) were higher with linezolid; antibiotic costs were higher for linezolid (P = 0.001) and daptomycin (P = 0.03). Response rates were similar for the study drugs, although daptomycin and linezolid were used as second-line therapy and associated with higher drug costs.

Daptomycin

Linezolid

Bacteremia

Cefazolin

10.1097/ipc.0b013e318184d74e

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Citations (2)

Implementation of a Clinical Decision Support System for Antimicrobial Stewardship

Infection Control and Hospital Epidemiology (2012)

Elizabeth D. Hermsen Trevor Van Schooneveld Harlan Sayles Mark E. Rupp

Clinical decision support systems (CDSSs) for antimicrobial stewardship require considerable human resources and financial investments. This pre-/postimplementation study evaluated the effect of a CDSS on performance of prospective audit with intervention and feedback and demonstrated an increase in interventions and recommendation acceptance countered by a substantial number of nonactionable alerts.

Antimicrobial Stewardship

Stewardship

10.1086/664762

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Citations (55)

Mutation prevention concentration of ceftriaxone, meropenem, imipenem, and ertapenem against three strains of Streptococcus pneumoniae

Diagnostic Microbiology and Infectious Disease (2003)

Laurie B. Hovde Sarah E. Rotschafer Khalid H. Ibrahim Brent W. Gunderson Elizabeth D. Hermsen

Ertapenem

Carbapenem

10.1016/s0732-8893(02)00546-1

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Citations (8)

Incidence of Surgical Site Infection Associated with Robotic Surgery

Infection Control and Hospital Epidemiology (2010)

Elizabeth D. Hermsen Tim Hinze Harlan Sayles Lee Sholtz Mark E. Rupp

Objective. Robot-assisted surgery is minimally invasive and associated with less blood loss and shorter recovery time than open surgery. We aimed to determine the duration of robot-assisted surgical procedures and the incidence of postoperative surgical site infection (SSI) and to compare our data with the SSI incidence for open procedures according to national data. Design. Retrospective cohort study. Setting. A 689-bed academic medical center. Patients. All patients who underwent a surgical procedure with use of a robotic surgical system during the period from 2000-2007. Methods. SSIs were defined and procedure types were classified according to National Healthcare Safety Network criteria. National data for comparison were from 1992-2004. Because of small sample size, procedures were grouped according to surgical site or wound classification. Results. Sixteen SSIs developed after 273 robot-assisted procedures (5.9%). The mean surgical duration was 333.6 minutes. Patients who developed SSI had longer mean surgical duration than did patients who did not (558 vs 318 minutes; P <.001). The prostate and genitourinary group had 5.74 SSIs per 100 robot-assisted procedures (95% confidence interval [CI], 2.81–11.37), compared with 0.85 SSIs per 100 open procedures from national data. The gynecologic group had 10.00 SSIs per 100 procedures (95% CI, 2.79–30.10), compared with 1.72 SSIs per 100 open procedures. The colon and herniorrhaphy groups had 33.33 SSIs per 100 procedures (95% CI, 9.68–70.00) and 37.50 SSIs per 100 procedures (95% CI, 13.68–69.43), respectively, compared with 5.88 and 1.62 SSIs per 100 open procedures from national data. Patients with a clean-contaminated wound developed 6.1 SSIs per 100 procedures (95% CI, 3.5–10.3), compared with 2.59 SSIs per 100 open procedures. No significant differences in SSI rates were found for other groups. Conclusions. Increased incidence of SSI after some types of robot-assisted surgery compared with traditional open surgery may be related to the learning curve associated with use of the robot.

Surgical wound

Surgical procedures

10.1086/654006

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Citations (19)

Discontinuation of prophylaxis for HIV-associated opportunistic infections in the era of highly active antiretroviral therapy

American Journal of Health-System Pharmacy (2004)

Elizabeth D. Hermsen Heather E. Wynn JoCarol McNabb

Purpose: The rationale for recent changes in guidelines for the prevention of opportunistic infections (OIs) in HIV-infected persons is discussed. Summary: The epidemiology of AIDS has changed significantly since the advent of highly active antiretroviral therapy (HAART). Furthermore, the impact of HIV-associated OIs has decreased, leading to changes in the guidelines and recommendations for primary and secondary prophylaxis for such infections. While many patients can now be considered for discontinuation of suppressive therapy, clinical decision making surrounding the discontinuation of primary or secondary prophylaxis must take into account each patient's individual circumstances. Continued surveillance and careful monitoring of patients who stop prophylaxis will be critical to the overall success of OI treatment and prevention programs. Conclusion: The decision to discontinue primary or secondary prophylaxis for HIV associated OIs should be made on a case-by-case basis.

Discontinuation

Secondary prophylaxis

Opportunistic infection

10.1093/ajhp/61.3.245

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Citations (4)

ICE volume 29 issue 5 Cover and Front matter

Infection Control and Hospital Epidemiology (2008)

Donald B. Middleton Chyongchiou J. Lin Kevin M. Smith Richard K. Zimmerman Patricia Nowalk

An abstract is not available for this content so a preview has been provided. As you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Front cover

10.1017/s0195941700026758

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Citations (0)

Glycopeptide Pharmacodynamics

Infectious disease and therapy (2007)

Elizabeth D. Hermsen Gigi H. Ross John C. Rotschafer

Pharmacodynamics

10.3109/9781420017137.009

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Citations (3)

Polymyxins:

Infectious Disease Clinics of North America (2003)

Elizabeth D. Hermsen Christopher J. Sullivan John C. Rotschafer

Polymyxin

Scope (computer science)

Colistin

10.1016/s0891-5520(03)00058-8

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Citations (101)

Is incidental recovery of yeast from enteric pathogen stool cultures obtained from hospitalized patients clinically significant?

Infectious Disease Reports (2011)

Elizabeth D. Hermsen Rachel A. Pfeifer Peter C. Iwen Fang Qiu Mark E. Rupp

A matched case-control study was conducted to investigate gastrointestinal colonization with yeast as a predictor of invasive candidiasis (IC) in patients who underwent an enteric pathogen test. No significant association was detected between gastrointestinal colonization and IC. However, gastrointestinal colonization with yeast was associated with increased antimicrobial exposure and median length of hospitalization.

10.4081/idr.2011.e1

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Citations (3)