Browsing by Author "Louie, Thomas"

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    Comprehensive Strategy to Decolonize Methicillin-Resistant Staphylococcus aureus in the Outpatient Setting: a Randomized Controlled Study
    (2013-10-03) Kim, Joseph; Henderson, Elizabeth; Conly, John; Louie, Thomas; Sauve, Reg; Zhang, Kunyan
    The objective of this study was to examine the efficacy of a comprehensive decolonization treatment in reducing methicillin-resistant Staphylococcus aureus (MRSA) carriage among an outpatient population. Patients colonized with MRSA were randomized to receive pharmacological decolonization treatment or no treatment. The primary outcome was detection of MRSA at 3 months. Occurrence of MRSA infection was assessed at 6 months. Molecular analyses were performed on all MRSA isolates. Of 205 patients, 15 (7%) were enrolled into the study (9 treatment; 6 control). At 3 months, 4/8 (50%) in the treatment group had eradication and none in the control group (0/4, 0%). Infection occurred in 5 patients (3 treatment; 2 control). All of the MRSA isolates were community-associated MRSA strain types with USA300 accounting for 87%. Among persistent CA-MRSA carriers, our decolonization treatment was well tolerated. However, enrollment was limited. Future studies with different enrollment strategies are required.
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    Implementation strategies for hospital-based probiotic administration in a stepped-wedge cluster randomized trial design for preventing hospital-acquired Clostridioides difficile infection
    (2023-12-11) Bresee, Lauren C.; Lamont, Nicole; Ocampo, Wrechelle; Holroyd-Leduc, Jayna; Sabuda, Deana; Leal, Jenine; Dalton, Bruce; Kaufman, Jaime; Missaghi, Bayan; Kim, Joseph; Larios, Oscar E.; Henderson, Elizabeth; Raman, Maitreyi; Fletcher, Jared R.; Faris, Peter; Kraft, Scott; Shen, Ye; Louie, Thomas; Conly, John M.
    Abstract Background Clostridioides difficile infection (CDI) is associated with considerable morbidity and mortality in hospitalized patients, especially among older adults. Probiotics have been evaluated to prevent hospital-acquired (HA) CDI in patients who are receiving systemic antibiotics, but the implementation of timely probiotic administration remains a challenge. We evaluated methods for effective probiotic implementation across a large health region as part of a study to assess the real-world effectiveness of a probiotic to prevent HA-CDI (Prevent CDI-55 +). Methods We used a stepped-wedge cluster-randomized controlled trial across four acute-care adult hospitals (n = 2,490 beds) to implement the use of the probiotic Bio-K + ® (Lactobacillus acidophilus CL1285®, L. casei LBC80R® and L. rhamnosus CLR2®; Laval, Quebec, Canada) in patients 55 years and older receiving systemic antimicrobials. The multifaceted probiotic implementation strategy included electronic clinical decision support, local site champions, and both health care provider and patient educational interventions. Focus groups were conducted during study implementation to identify ongoing barriers and facilitators to probiotic implementation, guiding needed adaptations of the implementation strategy. Focus groups were thematically analyzed using the Theoretical Domains Framework and the Consolidated Framework of Implementation Research. Results A total of 340 education sessions with over 1,800 key partners and participants occurred before and during implementation in each of the four hospitals. Site champions were identified for each included hospital, and both electronic clinical decision support and printed educational resources were available to health care providers and patients. A total of 15 individuals participated in 2 focus group and 7 interviews. Key barriers identified from the focus groups resulted in adaptation of the electronic clinical decision support and the addition of nursing education related to probiotic administration. As a result of modifying implementation strategies for identified behaviour change barriers, probiotic adherence rates were from 66.7 to 75.8% at 72 h of starting antibiotic therapy across the four participating acute care hospitals. Conclusions Use of a barrier-targeted multifaceted approach, including electronic clinical decision support, education, focus groups to guide the adaptation of the implementation plan, and local site champions, resulted in a high probiotic adherence rate in the Prevent CDI-55 + study.
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    Invasive Streptococcus pneumoniae Infection Causing Hemolytic Uremic Syndrome in Children: Two Recent Cases
    (2003-01-01) Vanderkooi, Otto G; Kellner, James D; Wade, Andrew W; Jadavji, Tajdin; Midgley, Julian P; Louie, Thomas; Tyrrell, Gregory J
    INTRODUCTION: Streptococcus pneumoniae is an uncommon cause of hemolytic uremic syndrome (HUS) with a unique pathophysiology that differs from Shiga toxin-related HUS.METHODS: Case descriptions for each patient are provided. Each strain of S pneumoniae was subjected to a pulsed-field gel electrophoresis (PFGE) analysis, Shiga toxin assay and polymerase chain reaction to detect Shiga toxin genes. A review of the current literature was conducted.CASE PRESENTATIONS: Two patients with S pneumoniae-related HUS that presented to the Alberta Children's Hospital, Calgary, Alberta, within four weeks of each other in 2001 are described. Both presented with pneumonia and empyema with associated HUS. Both patients required dialysis, one patient for 10 days and the other for 18 days. Neither patient demonstrated evidence of Shiga toxin-related disease. S pneumoniae isolated from blood or pleural fluid was penicillin susceptible. One isolate was serotype 3 and the other was serotype 14. The two strains had different PFGE patterns. Both patients recovered well with no persistent renal dysfunction.CONCLUSIONS: S pneumoniae continues to be an uncommon but important cause of HUS. Most cases can be confirmed or at least considered probable without performing a renal biopsy.
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    Metabolic independence drives gut microbial colonization and resilience in health and disease
    (2023-04-17) Watson, Andrea R.; Füssel, Jessika; Veseli, Iva; DeLongchamp, Johanna Z.; Silva, Marisela; Trigodet, Florian; Lolans, Karen; Shaiber, Alon; Fogarty, Emily; Runde, Joseph M.; Quince, Christopher; Yu, Michael K.; Söylev, Arda; Morrison, Hilary G.; Lee, Sonny T. M.; Kao, Dina; Rubin, David T.; Jabri, Bana; Louie, Thomas; Eren, A. M.
    Abstract Background Changes in microbial community composition as a function of human health and disease states have sparked remarkable interest in the human gut microbiome. However, establishing reproducible insights into the determinants of microbial succession in disease has been a formidable challenge. Results Here we use fecal microbiota transplantation (FMT) as an in natura experimental model to investigate the association between metabolic independence and resilience in stressed gut environments. Our genome-resolved metagenomics survey suggests that FMT serves as an environmental filter that favors populations with higher metabolic independence, the genomes of which encode complete metabolic modules to synthesize critical metabolites, including amino acids, nucleotides, and vitamins. Interestingly, we observe higher completion of the same biosynthetic pathways in microbes enriched in IBD patients. Conclusions These observations suggest a general mechanism that underlies changes in diversity in perturbed gut environments and reveal taxon-independent markers of “dysbiosis” that may explain why widespread yet typically low-abundance members of healthy gut microbiomes can dominate under inflammatory conditions without any causal association with disease.
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    Utilization of Colistin for Treatment of Multidrug-Resistant Pseudomonas aeruginosa
    (2008-01-01) Sabuda, Deana M; Laupland, Kevin; Pitout, Johann; Dalton, Bruce; Rabin, Harvey; Louie, Thomas; Conly, John
    BACKGROUND: Colistin is uncommonly used in clinical practice; however, the emergence of multidrug-resistant organisms has rekindled interest in this potentially toxic therapeutic option. The present study describes the authors’ experience with colistin in the management of patients who were infected with metallo-beta-lactamase (MBL)-producing Pseudomonas aeruginosa within the Calgary Health Region (Calgary, Alberta).METHOD: Adult patients who received colistimethate sodium (colistin) between January 2000 and December 2005 were identified via pharmacy records, and their charts were reviewed retrospectively. Patients with cystic fibrosis were excluded. Patient demographics, clinical course and relevant laboratory data were extracted.RESULTS: Twenty-eight courses of colistin were received by 22 patients. The majority of these treatments were directed at MBL-producing Pseudomonas. One-half of the patients received nebulized colistin. Intravenous (IV) colistin was administered to 12 patients for a mean ± SD of 14.7±13.8 days (range 3.7 to 46 days). The highest IV dose used was 125 mg every 6 h or 6 mg/kg/day. Eight of 12 patients (67%) treated with IV colistin responded either fully or partially. Two patients received IV colistin as outpatients. Adverse effects considered to be due to colistin included drug fever, nephrotoxicity and neurotoxicity. Five of nine patients (56%) who had complete data available for evaluation had at least a doubling of creatinine levels from baseline.CONCLUSION: Patients in the present study received both IV and nebulized colistin for multidrug-resistant P aeruginosa. The use of IV colistin was associated with a favourable response, but mild nephrotoxicity occurred in two-third of patients. It was concluded that colistin may be a useful drug when choices are limited.