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Preventing the inappropriate treatment of asymptomatic bacteriuria at a community teaching hospital

Chowdhury, Farhana; Sarkar, Kumkum; Branche, Angela; Kim, Juliette; Dwek, Philip; Nangit, Angelica; Tompkins, David; Visconti, Ernest
The goal of this study was to assess the overtreatment of asymptomatic bacteriuria (ASB) in hospitalized patients, calculate the total costs of inappropriate treatment, and determine if a multi-faceted educational intervention was effective in reducing the overtreatment of ASB in a resource-limited community hospital. The study encompassed three phases: a retrospective pre-intervention assessment of the baseline cost and treatment of ASB, the implementation of a multi-faceted educational intervention, and a prospective post-intervention assessment of the efficacy of the intervention. A positive urine culture was defined by bacterial counts >/=10(5) cfu/mL. In the pre-intervention group, 64 (83%) of 109 patients were asymptomatic: 30 (47%) were treated. In the post-intervention group, 13 (17%) of 55 patients were asymptomatic: 2 (15%) were treated, (p=0.04). Fewer urine cultures were collected during the post-intervention period than the pre-intervention period (3,127 and 3,419, respectively) (p<0.001). The total cost of inappropriately treating ASB in the pre-intervention group was $1200 compared to $600 in the post-intervention group. The results demonstrated a significant decrease in the inappropriate treatment of ASB and the associated costs.
PMCID:3714060
PMID: 23882368
ISSN: 2000-9666
CID: 1892232

Maternal-neonatal outcome with Staphylococcus aureus rectovaginal colonization

Ghanim, Nibal; Alchyib, Omrou; Morrish, Donald; Tompkins, David; Julliard, Kell; Visconti, Ernest; Hoskins, Iffath A
OBJECTIVE: To estimate prevalence of rectovaginal colonization by Staphylococcus aureus among pregnant women with group B streptococcus (GBS) screening results and its association with maternal and infant outcomes. STUDY DESIGN: Cultures that detected both group B streptococcus (GBS) and S. aureus were obtained at > or = 35 weeks of gestation. Computerized database search and chart review determined invasive neonatal infection and maternal outcomes at the time of delivery through 6 months postpartum. RESULTS: A total of 6,626 GBS screening cultures met study criteria, and 769 (11.6%) GBS isolates and 67 (1.0%) S. aureus were identified. No maternal S. aureus-related outcomes were found. The rate of maternal methicillin-resistant S. aureus colonization was 0.1% (7 in 6,626). GBS-positive patients were twice as likely to be colonized with methicillin-susceptible S. aureus than GBS-negative patients. GBS-positive culture rates differed significantly by primary language: Spanish 10.0%, English 13.7%, Russian 26.9%, Cantonese 13.2%, Mandarin 11.5%, Arabic 15.9%, and other 17.8%. CONCLUSION: In our population, S. aureus colonization percentage (1.0%) was lower than the 7.5-8.2% reported by other medical centers, as was overall GBS carriage rate. S. aureus did not predispose to maternal or infant morbidity or mortality up to 6 months postpartum.
PMID: 22010527
ISSN: 0024-7758
CID: 224222

Patterns of multidrug resistance in Acinetobacter at a community hospital [Meeting Abstract]

Shah, AG; Lucente, R; Wai, T; Visconti, E; Kuhn-Basti, M; Julliard, KN
ISI:000171226900582
ISSN: 1058-4838
CID: 2077352

Approaching "DNR" Issues with AIDS Patients

Madera, I; de Caprariis, P J; Carballo-Dieguez, A; Rodriguez, G; Stehney, M; Dansky, S F; Visconti, E
PMCID:2280845
PMID: 21249019
ISSN: 0008-350x
CID: 1895502

Diarrhea caused by group G streptococcus [Letter]

Bard, G; Visconti, E B; Curran, J P; de Caprariis, P J
PMID: 3475616
ISSN: 0028-7628
CID: 1895512

Improvements following an easy and inexpensive quality assurance program on the usage of antibiotics in the emergency room setting [Letter]

Porco, F V; de Caprariis, P J; Anderson, V; Leong, E C; Visconti, E B
PMID: 3647937
ISSN: 0195-9417
CID: 1895522