J. Daniel Markley
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P-1270. Surveillance of Antimicrobial Resistance Genes Detected Using BCID2 Among Veterans Affairs Medical Centers Within VISN 6 Open
Background Antimicrobial resistance (AMR) remains a top global health threat, accounting for 1.27 million deaths worldwide. Newer diagnostic tests have facilitated the rapid detection of genetic markers of resistance. However, regional sur…
Spontaneous Bacterial Peritonitis Is Associated With High Mortality, Which Interacts With Antibiotic Prophylaxis in a National Cirrhosis Cohort Open
Background With changes in bacteriology and cirrhosis demographics, the impact of spontaneous bacterial peritonitis (SBP) on cirrhosis outcomes needs re‐evaluation. Aim Determine the importance of SBP on mortality and liver transplant (LT)…
View article: Impact of High‐Titer Convalescent Plasma on Clinical and Virologic Outcomes Among Veterans Hospitalized With SARS‐CoV‐2 Infection: VA CoronavirUs Research and Efficacy Studies‐1 (VA CURES‐1)
Impact of High‐Titer Convalescent Plasma on Clinical and Virologic Outcomes Among Veterans Hospitalized With SARS‐CoV‐2 Infection: VA CoronavirUs Research and Efficacy Studies‐1 (VA CURES‐1) Open
In the initial absence of proven therapies, empirical COVID‐19 convalescent plasma (CCP) was rapidly introduced for individuals hospitalized for COVID‐19. Seventy‐five participants were randomized from November 2020 to June 2021 in a doubl…
P-349. Identification and Control of a <i>Candida auris</i> Outbreak in an Acute Spinal Cord Injury Unit at a Veterans Affairs Medical Center Open
Background Candida auris is an emerging pathogen that spreads easily in healthcare settings and can cause severe infections. In Dec. 2022, C. auris was identified at the Richmond VA Medical Center (VAMC) in an acute care spinal cord injury…
P-370. Impact of a Multidisciplinary Intervention to Reduce Infection after Prostate Biopsy at a Veterans Affairs Medical Center Open
Background Infection after prostate biopsy (IAPB) occurs in 2-6% of cases. Due to fluoroquinolone resistance at our facility, preprocedural prophylaxis for prostate biopsy was switched from Ciprofloxacin to Fosfomycin in 2017. However, the…
Evaluating chain-of-thought prompting in a GPT chatbot for BCID2 interpretation and stewardship: how does AI compare to human experts? Open
Background: Rapid molecular diagnostics, such as the BIOFIRE® Blood Culture Identification 2 (BCID2) panel, have improved the time to pathogen identification in bloodstream infections. However, accurate interpretation and antimicrobial opt…
View article: Higher Rate of SBP Recurrence with Secondary SBP Prophylaxis Compared to No Prophylaxis in Two National Cirrhosis Cohorts
Higher Rate of SBP Recurrence with Secondary SBP Prophylaxis Compared to No Prophylaxis in Two National Cirrhosis Cohorts Open
Objective Changes in bacteriology of spontaneous bacterial peritonitis (SBP) has been documented. Reappraisal of primary SBP prophylaxis showed an increased rate of resistance in patients on primary prophylaxis with resultant discontinuati…
Pre-Exposure Prophylaxis for HIV: Bioethical, Clinical, and Epidemiological Considerations Open
Public health authorities are broadly promoting a strategy known as pre-exposure prophylaxis (PrEP) for the prevention of human immunodeficiency virus (HIV) transmission in the context of high-risk sexual activity and injection drug use. H…
COVID-19 and myocardial injury: Targeting elevated biomarkers for potential novel therapies Open
Newly diagnosed COVID-19 during the pandemic was a common cause of elevated troponin in hospitalized patients without a Type 1 MI. Age, peak troponin level and peak CRP level were independent predictors of poor outcomes and suggest a need …
Liver manifestations of tick-borne diseases Open
INTRODUCTION In the US, the most common zoonotic infections are tick-borne diseases with clinical presentations ranging from asymptomatic to fulminant life-threatening infections. Ticks are a reservoir for bacterial, viral, and parasitic o…
Collaboration on antimicrobial stewardship practices amongst university health systems, Veterans Affairs medical centers, and other affiliates: opportunities for greater harmony Open
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View article: Synergistic effect of myocardial injury and mid-regional proAdrenomedullin elevation in determining clinical outcomes of SARS-CoV-2 patients
Synergistic effect of myocardial injury and mid-regional proAdrenomedullin elevation in determining clinical outcomes of SARS-CoV-2 patients Open
Objective Coronavirus disease 2019 (COVID-19) is a systemic disease induced by SARS-CoV-2 causing myocardial injury. To date, there are few data on the correlation between mid-regional proAdrenomedullin (MR-proADM) and myocardial injury. T…
View article: Active Surveillance Cultures and Procalcitonin in Combination With Clinical Data to Guide Empirical Antimicrobial Therapy in Hospitalized Medical Patients With Sepsis
Active Surveillance Cultures and Procalcitonin in Combination With Clinical Data to Guide Empirical Antimicrobial Therapy in Hospitalized Medical Patients With Sepsis Open
Objective The prevalence of colonization with multidrug-resistant organisms (MDRO) has increased over the last decade, reaching levels as high as 23% in certain patient populations. Active surveillance cultures (ASC) represent a valuable t…
Impact of cascade reporting of antimicrobial susceptibility on fluoroquinolone and meropenem consumption at a Veterans’ Affairs medical center Open
Objective: To determine whether cascade reporting is associated with a change in meropenem and fluoroquinolone consumption. Design: A quasi-experimental study was conducted using an interrupted time series to compare antimicrobial consumpt…
1530. A Cluster of Disseminated Gonococcal Infections in a Non-Immunocompromised Veteran Population Open
Background Disseminated gonococcal infection (DGI) is an uncommon manifestation of N. gonorrhoeae that is estimated to occur in 0.5-3% of cases, with a decreasing incidence that has been attributed to changes in circulating serotypes. At a…
A Descriptive Analysis of Outpatient Antimicrobial Use for Urinary Tract Infections in Virginia Open
Background: Data regarding outpatient antibiotic prescribing for urinary tract infections (UTIs) are limited, and they have never been formally summarized in Virginia. Objective: We describe outpatient antibiotic prescribing trends for UTI…
174. Impact of Cascade Reporting of Antimicrobial Susceptibility on Antimicrobial Consumption at a Veterans Affairs Medical Center Open
Background Cascade reporting (CR) is a strategy of reporting antimicrobial susceptibility test results in which secondary agents are only reported if an organism is resistant to primary, narrow spectrum agents within a drug class. A multid…
Outpatient Fluoroquinolone Medication Use Evaluation at an Academic Veterans Affairs Medical Center Open
Background: Fluoroquinolones (FQs) are one of the most commonly prescribed antibiotic classes in the United States. In recent years, their widespread use has come under heightened scrutiny due potential adverse drug reactions including ris…
Effect of Meropenem Restriction on Time Between Order and Administration in a Medical Intensive Care Unit Open
Background: In this study, we assessed whether meropenem restriction led to delays in administration for patients in a medical intensive care unit (MICU) at a large tertiary-care urban teaching hospital. Methods: The antimicrobial stewards…
Implementation of Two-Step <i>Clostridioides difficile</i> Testing Algorithm and Management of Possible Carriers Open
Background: Updated IDSA-SHEA guidelines recommend different diagnostic approaches to C. difficile depending on whether There are pre-agreed institutional criteria for patient stool submission. If stool submission criteria are in place, nu…
74. Interrupted Time Series Analysis of the Impact of Fluoroquinolone Cascade Reporting Open
Background Cascade reporting is a form of selective reporting where antibiotic susceptibility results are revealed in a sequential order to optimize antibiotic use. On May 1, 2019, Virginia Commonwealth University Health implemented cascad…
Impact of COVID-19 on pneumonia-focused antibiotic use at an academic medical center Open
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242. Evaluating the Effectiveness of Antimicrobial Restriction at an Academic Medical Center Open
BACKGROUND: Antimicrobial Stewardship Programs (ASPs) promote the optimal use of antimicrobial agents with the goal of preserving the effectiveness of existing drugs. One core ASP strategy is formulary restriction and preauthorization (PA)…
252. Relative Use of Carbapenems in Immunocompromised Patients Open
BACKGROUND: Gram-negative bacterial infections are associated with high mortality in immunocompromised hosts, and the presence of drug resistance further increases mortality. Antibiotic consumption is a key outcome measure for Antimicrobia…