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Aaron E Glatt

Publications and source records attributed to Aaron E Glatt.

7 recordsLinked to original sources
PubMed2003

Effectiveness and appropriateness of empiric metronidazole for Clostridium difficile-associated diarrhea.

OBJECTIVE: Although Clostridium difficile is the most common infectious etiology of nosocomial diarrhea, noninfectious causes are far more common. Empiric initiation of therapy for all patients is of unknown value. The aim of this study was to determine benefits of empiric metronidazole for Clostridium difficile-associated diarrhea (CDAD). METHODS: We conducted a 4-month prospective surveillance of all patients in two community teaching hospitals receiving metronidazole for empiric treatment of presumptive CDAD. A database including antibiotic usage, fever, white blood cell count, feeding formula usage, comorbidity, and response to therapy was maintained. RESULTS: Seventy-one patients on the medical (50), surgical (18), obstetric (two), and trauma (one) service were identified. Sixty-two had nosocomial diarrhea; nine had diarrhea on admission. Seventy (97%) received antibiotics; one (3%) was on nelfinavir only. Eighteen (25%) were subsequently proven to have CDAD; two (3%) had laxative-induced diarrhea; two (3%) had diarrhea secondary to a medication (colchicine [one] and nelfinavir [one]); one (1%) had diarrhea caused by bowel preparation for colonoscopy. The remaining 49 (68%) did not have a clearly established diarrhea etiology. (Four did not undergo stool examination.) Statistical analysis (chi(2) test) demonstrated a significant decrease in symptoms for metronidazole-treated patients with CDAD versus those with a different diagnosis (p = 0.05). Not surprisingly, multivariate regression analysis identified a strong correlation of diagnosing CDAD with age >60 yr, antibiotics exposure, fever, elevated white blood cell count, and resolution of symptoms with specific metronidazole treatment. CDAD was definitively diagnosed in 25% of our hospitalized patients with diarrhea, consistent with published data. Although some cases might have been missed, most patients did not have CDAD and received no benefit (and were potentially harmed) by empiric metronidazole. There was no way a priori to distinguish CDAD from non-CDAD. CONCLUSIONS: In the absence of clear guidelines, empiric metronidazole should be reserved for strongly presumptive CDAD patients (older patients with comorbid conditions receiving broad-spectrum antibiotics associated with CDAD) who cannot hemodynamically or otherwise tolerate diarrhea. Used judiciously, empiric therapy may more rapidly resolve symptoms, and could conceivably prevent/abate severe complications and nosocomial spread.

Anti-Infective Agents↗
PubMed2002

Underlying characteristics of patients harboring highly resistant Acinetobacter baumannii.

BACKGROUND: Highly resistant (HR) Acinetobacter baumannii (AB) are frequently hospital-acquired and may be important causes of severe nosocomial infections. OBJECTIVE: Determine risk factors associated with such colonization/infection. METHOD: Retrospective review in 2000 of all AB isolates from sterile (blood, cerebrospinal fluid [CSF]) and nonsterile (respiratory, urine, and miscellaneous) sites. HR was defined as resistance to amikacin and/or imipenem and/or ampicillin-sulbactam. Isolates were analyzed as representing infection or colonization. A database including prior hospitalization, prior antibiotic use, nursing home residency, and procedures undergone was compiled. RESULTS: One hundred twenty-two cases of AB were identified. Eighty-four met the definition of HR; 6 (4.9%) were completely resistant to all antibiotics. Four (4.7%) isolates were from sterile body sites (3 blood, 1 CSF); 43 (51.2%) were from respiratory sites; 20 (23.8%) were from urinary sites; and 17 (20.2%) were from "other" sites. Only 4 (20%) of the urinary, 6 (35.2%) of the miscellaneous, and 23 (53.4%) of the respiratory isolates were deemed true pathogens; all blood/CSF isolates were considered pathogens. Associated risk factors included prior antibiotic usage (71%); prior hospitalization (24%); prior nursing home residency (34%); ventilator use (77%); tracheostomy placement (56%); and Foley catheterization (85%). Twenty-seven (63%) of 43 respiratory, 8 (40%) of 20 urinary, and 6 (35%) of 17 "other" body isolates were treated. Outcome was not statistically significant in treated versus untreated patients. All patients with CSF/blood isolates underwent successful microbiologic eradication with 50% survival. The overall mortality rate was 10%. CONCLUSION: Antibiotics, Foley catheters, and tracheostomy/ventilator usage were strongly associated with AB isolation. Prior hospitalization and nursing home residency were less common risk factors. Outcome was not different in treated versus untreated patients, indicating colonization is a marker of severe illness but is not necessarily causal.

Acinetobacter Infections↗
PubMed2002

Completely resistant Acinetobacter baumannii strains.

Nosocomially acquired completely resistant Acinetobacter baumannii strains are a major clinical concern. We identified completely resistant A. baumannii in 6 (4.9%) of 122 A. baumannii isolates in a retrospective chart review at two teaching hospitals. All of these patients had received broad-spectrum antibiotics and had severe underlying comorbid illnesses, long hospitalizations, or recent surgical procedures; 3 had been in the intensive care unit. Five (83%) of the 6 patients were older than 70 years. Only one death occurred. Strict infection control measures may limit further spread.

Acinetobacter Infections↗