Last data update: Jan 27, 2025. (Total: 48650 publications since 2009)
Records 1-6 (of 6 Records) |
Query Trace: Munro T[original query] |
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Nonventilator hospital-acquired pneumonia: A call to action
Munro SC , Baker D , Giuliano KK , Sullivan SC , Haber J , Jones BE , Crist MB , Nelson RE , Carey E , Lounsbury O , Lucatorto M , Miller R , Pauley B , Klompas M . Infect Control Hosp Epidemiol 2021 42 (8) 1-6 In 2020 a group of U.S. healthcare leaders formed the National Organization to Prevent Hospital-Acquired Pneumonia (NOHAP) to issue a call to action to address non-ventilator-associated hospital-acquired pneumonia (NVHAP). NVHAP is one of the most common and morbid healthcare-associated infections, but it is not tracked, reported, or actively prevented by most hospitals. This national call to action includes (1) launching a national healthcare conversation about NVHAP prevention; (2) adding NVHAP prevention measures to education for patients, healthcare professionals, and students; (3) challenging healthcare systems and insurers to implement and support NVHAP prevention; and (4) encouraging researchers to develop new strategies for NVHAP surveillance and prevention. The purpose of this document is to outline research needs to support the NVHAP call to action. Primary needs include the development of better models to estimate the economic cost of NVHAP, to elucidate the pathophysiology of NVHAP and identify the most promising pathways for prevention, to develop objective and efficient surveillance methods to track NVHAP, to rigorously test the impact of prevention strategies proposed to prevent NVHAP, and to identify the policy levers that will best engage hospitals in NVHAP surveillance and prevention. A joint task force developed this document including stakeholders from the Veterans' Health Administration (VHA), the U.S. Centers for Disease Control and Prevention (CDC), The Joint Commission, the American Dental Association, the Patient Safety Movement Foundation, Oral Health Nursing Education and Practice (OHNEP), Teaching Oral-Systemic Health (TOSH), industry partners and academia. |
Antibiotic stewardship in the intensive care unit. An Official American Thoracic Society Workshop Report in Collaboration with the AACN, CHEST, CDC, and SCCM
Wunderink RG , Srinivasan A , Barie PS , Chastre J , Dela Cruz CS , Douglas IS , Ecklund M , Evans SE , Evans SR , Gerlach AT , Hicks LA , Howell M , Hutchinson ML , Hyzy RC , Kane-Gill SL , Lease ED , Metersky ML , Munro N , Niederman MS , Restrepo MI , Sessler CN , Simpson SQ , Swoboda SM , Guillamet CV , Waterer GW , Weiss CH . Ann Am Thorac Soc 2020 17 (5) 531-540 Intensive care units (ICUs) are an appropriate focus of antibiotic stewardship program efforts because a large proportion of any hospital's use of parenteral antibiotics, especially broad-spectrum, occurs in the ICU. Given the importance of antibiotic stewardship for critically ill patients and the importance of critical care practitioners as the front line for antibiotic stewardship, a workshop was convened to specifically address barriers to antibiotic stewardship in the ICU and discuss tactics to overcome these. The working definition of antibiotic stewardship is "the right drug at the right time and the right dose for the right bug for the right duration." A major emphasis was that antibiotic stewardship should be a core competency of critical care clinicians. Fear of pathogens that are not covered by empirical antibiotics is a major driver of excessively broad-spectrum therapy in critically ill patients. Better diagnostics and outcome data can address this fear and expand efforts to narrow or shorten therapy. Greater awareness of the substantial adverse effects of antibiotics should be emphasized and is an important counterargument to broad-spectrum therapy in individual low-risk patients. Optimal antibiotic stewardship should not focus solely on reducing antibiotic use or ensuring compliance with guidelines. Instead, it should enhance care both for individual patients (by improving and individualizing their choice of antibiotic) and for the ICU population as a whole. Opportunities for antibiotic stewardship in common ICU infections, including community- and hospital-acquired pneumonia and sepsis, are discussed. Intensivists can partner with antibiotic stewardship programs to address barriers and improve patient care. |
Methodologies for in vitro and in vivo evaluation of efficacy of antifungal and antibiofilm agents and surface coatings against fungal biofilms
Dijck PV , Sjollema J , Cammue BP , Lagrou K , Berman J , d'Enfert C , Andes DR , Arendrup MC , Brakhage AA , Calderone R , Canton E , Coenye T , Cos P , Cowen LE , Edgerton M , Espinel-Ingroff A , Filler SG , Ghannoum M , Gow NAR , Haas H , Jabra-Rizk MA , Johnson EM , Lockhart SR , Lopez-Ribot JL , Maertens J , Munro CA , Nett JE , Nobile CJ , Pfaller MA , Ramage G , Sanglard D , Sanguinetti M , Spriet I , Verweij PE , Warris A , Wauters J , Yeaman MR , Zaat SAJ , Thevissen K . Microb Cell 2018 5 (7) 300-326 Unlike superficial fungal infections of the skin and nails, which are the most common fungal diseases in humans, invasive fungal infections carry high morbidity and mortality, particularly those associated with biofilm formation on indwelling medical devices. Therapeutic management of these complex diseases is often complicated by the rise in resistance to the commonly used antifungal agents. Therefore, the availability of accurate susceptibility testing methods for determining antifungal resistance, as well as discovery of novel antifungal and antibiofilm agents, are key priorities in medical mycology research. To direct advancements in this field, here we present an overview of the methods currently available for determining (i) the susceptibility or resistance of fungal isolates or biofilms to antifungal or antibiofilm compounds and compound combinations; (ii) the in vivo efficacy of antifungal and antibiofilm compounds and compound combinations; and (iii) the in vitro and in vivo performance of anti-infective coatings and materials to prevent fungal biofilm-based infections. |
Accumulation of ubiquitin and sequestosome-1 implicate protein damage in diacetyl-induced cytotoxicity
Hubbs AF , Fluharty KL , Edwards RJ , Barnabei JL , Grantham JT , Palmer SM , Kelly F , Sargent LM , Reynolds SH , Mercer RR , Goravanahally MP , Kashon ML , Honaker JC , Jackson MC , Cumpston AM , Goldsmith WT , McKinney W , Fedan JS , Battelli LA , Munro T , Bucklew-Moyers W , McKinstry K , Schwegler-Berry D , Friend S , Knepp AK , Smith SL , Sriram K . Am J Pathol 2016 186 (11) 2887-2908 Inhaled diacetyl vapors are associated with flavorings-related lung disease, a potentially fatal airway disease. The reactive alpha-dicarbonyl group in diacetyl causes protein damage in vitro. Dicarbonyl/l-xylulose reductase (DCXR) metabolizes diacetyl into acetoin, which lacks this alpha-dicarbonyl group. To investigate the hypothesis that flavorings-related lung disease is caused by in vivo protein damage, we correlated diacetyl-induced airway damage in mice with immunofluorescence for markers of protein turnover and autophagy. Western immunoblots identified shifts in ubiquitin pools. Diacetyl inhalation caused dose-dependent increases in bronchial epithelial cells with puncta of both total ubiquitin and K63-ubiquitin, central mediators of protein turnover. This response was greater in Dcxr-knockout mice than in wild-type controls inhaling 200 ppm diacetyl, further implicating the alpha-dicarbonyl group in the protein damage. Western immunoblots demonstrated decreased free ubiquitin in airway-enriched fractions. Transmission electron microscopy and colocalization of ubiquitin-positive puncta with lysosomal markers lysosomal-associated membrane protein 1 and 2 and with the multifunctional scaffolding protein sequestosome-1 (SQSTM1/p62) confirmed autophagy. Surprisingly, immunoreactive SQSTM1 also accumulated in the olfactory bulb of the brain. Olfactory bulb SQSTM1 often congregated in activated microglial cells that also contained olfactory marker protein, indicating neuronophagia within the olfactory bulb. This suggests the possibility that SQSTM1 or damaged proteins may be transported from the nose to the brain. Together, these findings strongly implicate widespread protein damage in the etiology of flavorings-related lung disease. |
IMP-producing carbapenem resistant Klebsiella pneumoniae in the United States
Limbago BM , Rasheed JK , Anderson KF , Zhu W , Kitchel B , Watz N , Munro S , Gans H , Banaei N , Kallen AJ . J Clin Microbiol 2011 49 (12) 4239-45 The emergence and spread of carbapenem resistant Enterobacteriaceae (CRE) producing acquired carbapenemases has created a global public health crisis. In the United States, CRE producing the Klebsiella pneumoniae carbapenemase (KPC) are increasingly common, and are endemic in some regions. Metallo-beta-lactamase (MBL)-producing CRE have recently been reported in the United States among patients who received medical care in countries where such organisms are common. Here we describe three carbapenem resistant K. pneumoniae isolates recovered from pediatric patients at a single U.S. healthcare facility, none of whom had a history of international travel. The isolates were resistant to carbapenems but susceptible to aztreonam, trimethoprim-sulfamethoxazole and fluoroquinolones. The three isolates were closely related to each other by pulsed-field gel electrophoresis, and contained a common plasmid. PCR and sequence analysis confirmed that these isolates produce IMP-4, a MBL carbapenemase not previously published as present among Enterobacteriaceae in the United States. |
Guillain-Barre syndrome and Fisher syndrome: case definitions and guidelines for collection, analysis, and presentation of immunization safety data
Sejvar JJ , Kohl KS , Gidudu J , Amato A , Bakshi N , Baxter R , Burwen D , Cornblath DR , Cleerbout J , Edwards KM , Heininger U , Hughes R , Khuri-Bulos N , Korinthenberg R , Law BJ , Munro U , Maltezou HC , Nell P , Oleske J , Sparks R , Velentgas P , Vermeer P , Wiznitzer M . Vaccine 2010 29 (3) 599-612 Among the various events reported as adverse outcomes following immunizations, neurologic adverse events following immunization (AEFI) are among the most severe and the most difficult to assess. The multifaceted presentation of neurologic illness, the relative lack of familiarity of many clinicians with the approach to and diagnosis of neurologic disease, and the relative scarcity of trained neurologists in many parts of the world make neurologic AEFI some of the most challenging issues in clinical vaccinology. Further, the severity of central and peripheral nervous system events in individual patients often heightens the concern when such illnesses are associated with antecedent immunizations. The lack of a common definition of GBS and FS hinders comparability and uniform reporting of these adverse events. | Sections 2 Clinical case definitions: Guillain–Barré syndrome (GBS), 3 Guidelines for data collection, analysis, and presentation of GBS and FS as adverse events following immunization of this paper provide the case definitions and guidelines for data collection, analysis, and presentation that the Brighton Collaboration GBS Working Group (hereafter referred to as the Working Group) has developed for the standardized collection and assessment of information about GBS and FS. Widespread use of these definitions with their guidelines will improve data comparability and allow for a better understanding of these neurological events that are applicable in study settings with different availability of resources, in health care settings that differ by availability of and access to health care, and in different geographic regions. |
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