Evaluation and use of a rapid Staphylococcus aureus assay by an antimicrobial stewardship program.
Humans; Time Factors; Microbial Sensitivity Tests; Sensitivity and Specificity; Prospective Studies; Hospitals; Anti-Bacterial Agents/administration & dosage/*pharmacology; Bacteriological Techniques; False Negative Reactions; Methicillin-Resistant Staphylococcus aureus/*isolation & purification; Staphylococcal Infections/*diagnosis/microbiology; Staphylococcus aureus/*isolation & purification; Cell Culture Techniques; Chromatography; Human; Funding Source; Community; Affinity; Observational Methods; Biological Assay – Methods; Methicillin-Resistant Staphylococcus Aureus – Analysis
PURPOSE: The performance of a rapid test for methicillin-resistant Staphylococcus aureus (MRSA) in a large community hospital was investigated. METHODS: A prospective observational study was conducted to evaluate an immunochromatographic assay (Alere PBP2a Culture Colony Test, Alere Scarborough, Inc.) for rapid differentiation of MRSA and methicillin-susceptible S. aureus (MSSA) strains using isolates cultured overnight on common laboratory media. S. aureus isolates cultured for 12-24 hours were tested with the assay, which detects penicillin-binding protein 2a (PBP2a) and provides results in six minutes. The test results were compared with data from standard overnight antimicrobial susceptibility testing to determine the assay's sensitivity and specificity. Changes in therapy associated with use of the rapid assay were evaluated. RESULTS: Over an 11-month period, 661 inpatient isolates from mostly nonhematologic sites were tested. There were six false-negative results, indicating assay sensitivity of 98.4%, with no false positives (specificity of 100%). Eight invalid test results were documented. During designated evaluation periods, a total of 169 patient cases involving PBP2a testing were reviewed by the hospital's antimicrobial stewardship pharmacist. In 63 of those cases (37%), changes in therapy were implemented on the day of test result posting. Interventions often involved switching patients from inappropriate to appropriate MRSA therapy or optimizing MRSA- or MSSA-targeted therapy. CONCLUSION: An assay for quickly differentiating between MRSA and MSSA was highly sensitive, highly specific, and inexpensive in actual hospital use and led to rapid prescription of appropriate antistaphylococcal therapy 24-48 hours after culture specimens were collected.
Trienski Tamara L; Barrett Heather L; Pasquale Timothy R; DiPersio Joseph R; File Thomas M Jr
American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists
2013
2013-11
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.2146/ajhp130118" target="_blank" rel="noreferrer noopener">10.2146/ajhp130118</a>
Gender differences in the association between antidepressant use and restless legs syndrome.
*Sex Characteristics; 80 and over; 80 and Over; Adult; Aged; Antidepressive Agents – Adverse Effects; Antidepressive Agents – Classification; Antidepressive Agents/*adverse effects/classification; Female; Human; Humans; Male; Middle Age; Middle Aged; Observation; Observational Methods; Primary Health Care – Statistics and Numerical Data; Primary Health Care/statistics & numerical data; Regression; Regression Analysis; Reproduction; Restless Legs – Chemically Induced; Restless Legs Syndrome/*chemically induced; Risk Factors; Veterans; Young Adult
Contradictory results have been reported for the association between antidepressant use and Restless Legs Syndrome (RLS). Our aim was to clarify the relationship and examine possible gender differences. We interviewed 1,693 veterans receiving primary care from the Cleveland VA Medical Center and obtained prescription drug information from their medical records. Overall, use of an antidepressant was associated with RLS for men (RR = 1.77, CI = 1.26, 2.48) but not for women (RR = 0.79, CI = 0.43, 1.47). Analyses of individual antidepressants revealed an association between RLS and fluoxetine for women (RR = 2.47, CI = 1.33, 4.56), and associations between RLS and citalopram, (RR = 2.09, CI = 1.20, 3.64), paroxetine (RR = 1.97, CI = 1.02, 3.79), and amitriptyline (RR = 2.40, CI = 1.45, 4.00) for men. We conclude that RLS may be associated with antidepressant use, but the association varies by gender and type of antidepressant. Antidepressant use is more strongly associated with RLS in men than in women.
Baughman Kristin R; Bourguet Claire C; Ober Scott K
Movement disorders : official journal of the Movement Disorder Society
2009
2009-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1002/mds.22517" target="_blank" rel="noreferrer noopener">10.1002/mds.22517</a>