Wasif Hafeez

Bio: Wasif Hafeez is an academic researcher from Wayne State University. The author has contributed to research in topics: Pneumonia & Endocarditis. The author has an hindex of 4, co-authored 9 publications receiving 336 citations. Previous affiliations of Wasif Hafeez include Detroit Medical Center & Sinai Grace Hospital.

Outbreak of Colistin-Resistant, Carbapenem-Resistant Klebsiella pneumoniae in Metropolitan Detroit, Michigan

Abstract: Carbapenem-resistant members of the family Enterobacteriaceae have spread across the world and within the United States (2, 5, 15). In the United States, carbapenem-resistant Klebsiella pneumoniae constitutes 92% of all carbapenem-resistant Enterobacteriaceae and carbapenemase production mediated by blaKPC is the most prevalent mechanism conferring resistance to carbapenems (5). Carbapenem-resistant Enterobacteriaceae are coresistant to almost all classes of antimicrobials (29), and infections are associated with extremely high rates of morbidity and mortality and high costs (30). Colistimethate sodium, i.e., colistin, is one of the few remaining therapeutic options available to treat infections due to carbapenem-resistant Enterobacteriaceae. Despite the toxicity of this relatively old agent, colistin is frequently used to treat infections due to carbapenem-resistant Enterobacteriaceae because (i) therapeutic alternatives are not yet available and (ii) colistin has a long history and track record in the treatment of invasive infections due to Gram-negative bacilli (28, 31, 35). In most cases, colistin is the last viable effective option for the treatment of invasive bloodstream infections due to carbapenem-resistant Enterobacteriaceae. In the past few years, there have been sporadic reports of colistin-resistant, carbapenem-resistant Enterobacteriaceae cases from various parts of the world, e.g., Greece (2, 37), Israel (28), South Korea (32), and Singapore (33). In Athens, Greece, an outbreak during the years 2004 and 2005 involving 13 patients in a single hospital unit was reported (2). Colistin-resistant, carbapenem-resistant Enterobacteriaceae cases have never been reported from the United States. There have been case reports of polymyxin B-resistant, carbapenem-resistant Enterobacteriaceae from the New York City area (usually, resistance to polymyxin B confers resistance to polymyxin E, i.e., colistin, and vice versa), but these events remain sporadic and rare, with no outbreaks reported thus far (4, 8, 17). The mechanism(s) of colistin resistance in carbapenem-resistant Enterobacteriaceae is not yet known. The genetic basis of colistin resistance in Acinetobacter baumannii is being investigated (1, 13, 18), but it remains unclear whether the same mechanism(s) is associated with colistin resistance in carbapenem-resistant Enterobacteriaceae. Additionally, the microbiological definitions of colistin resistance are also not well established, as formal Clinical and Laboratory Standards Institute (CLSI) criteria and breakpoints have not been established (7). Lastly, the clinical significance of colistin resistance remains to be defined. We describe here the first cluster, as far as we know, of colistin-resistant, carbapenem-resistant K. pneumoniae in the United States, which involved two hospitals and a long-term acute-care (LTAC) facility, in the summer of 2009. The epidemiologic and molecular outbreak investigations that followed are detailed.

Appropriateness of use of indwelling urinary catheters in patients admitted to the medical service.

Abstract: Of 836 medical admissions evaluated over a 1-month period, 89 (10.7%) had a urinary catheter placed within 24 hours; 34 placements (38%) had no justifiable indication. Risk for inappropriate catheterization was independent of age, gender, functional status, and mental status at admission. Preventive measures should focus on increasing awareness among healthcare providers.

Pulmonary carcinosarcoma initially presenting as invasive aspergillosis: a case report of previously unreported combination

Abstract: Carcinosarcoma of the lung is a malignant tumor composed of a mixture of carcinoma and sarcoma elements. The carcinomatous component is most commonly squamous followed by adenocarcinoma. The sarcomatous component commonly comprises the bulk of the tumor and shows poorly differentiated spindle cell features. Foci of differentiated sarcomatous elements such as chondrosarcoma and osteosarcoma may be seen. Aspergillus pneumonia is the most common form of invasive aspergillosis and occurs mainly in patients with malignancy, immunocompromizing or debilitating diseases. Patients with Aspergillus pneumonia present with fever, cough, chest pain and occasionally hemoptysis. Tissue examination is the most reliable method for diagnosis, and mortality rate is high. We describe a case of primary carcinosarcoma of the lung concurrently occurring with invasive pulmonary aspergillosis in a 66-year old patient.

Open-Label Randomized Trial of Early Clinical Outcomes of Ceftaroline Fosamil Versus Vancomycin for the Treatment of Acute Bacterial Skin and Skin Structure Infections at Risk of Methicillin-Resistant Staphylococcus aureus

Abstract: Acute bacterial skin and skin structure infections (ABSSSIs) remain among the most common infectious processes seen in the clinical setting. For patients with complicated ABSSSIs deemed to require intravenous antibiotics, vancomycin remains the mainstay therapy. Ceftaroline has been shown to be non-inferior to vancomycin and may result in faster resolution of signs of infection. Multicenter, prospective, open-label, randomized trial of ceftaroline versus vancomycin for the treatment of adult patients admitted for management of ABSSSIs from April 2012 to May 2016; 166 patients in the clinically evaluable (CE) group were needed to determine a 20% difference in primary outcome of clinical response at day 2 or 3 of antibiotics. Clinical response was defined as cessation of spread of lesion and improvement in systemic signs/symptoms of infection. A secondary outcome was a ≥ 20% reduction in lesion size at day 2 or 3 of antibiotics. One hundred seventy-four patients were enrolled in the intention-to-treat (ITT) group and 108 were CE. Among CE patients, 54 were randomized to ceftaroline and 54 to vancomycin. Baseline characteristics were similar except patients in the ceftaroline arm were older and had a non-significantly higher degree of comorbidities (median Charlson score 2 vs. 4, respectively). Cellulitis was the most common type of ABSSSI (85.2% vs. 79.6%, respectively). Rapid diagnostic testing of available cultures (n = 55) demonstrated high agreement with clinical microbiology for identification of Staphylococcus aureus (100%) and MRSA (100%). There was no significant difference in primary outcome of day 2 or 3 clinical response (50.0% vs. 51.9%). Early clinical response between vancomycin- and ceftaroline-treated ABSSSIs was similar. Patients with ABSSSIs rarely remained hospitalized for > 2–3 days, thus limiting our ability to critically assess clinical outcomes. ClinicalTrials.gov identifier, NCT02582203. Allergan plc.

A 46-Year-Old Woman Who Presented with Diabetic Ketoacidosis and COVID-19 Pneumonia with Multiple Pulmonary Thromboemboli: A Case Report.

Abstract: BACKGROUND Coronavirus disease 2019 (COVID-19) occurs because of a novel enveloped ribonucleic acid coronavirus called severe acute respiratory distress syndrome coronavirus-2 (SARS-CoV-2). One of the major reported complications of COVID-19 includes both arterial and venous thromboembolism (VTE). Here we describe a case of COVID-19 provoked pulmonary embolism in a young patient already receiving prophylactic treatment for VTE. CASE REPORT A 46-year-old female with past medical history of diabetes mellites, hypertension, and asthma presented in the emergency department (ED) with dyspnea requiring 6 liters per minute of oxygen on presentation. Her main complaints were cough and vomiting. In the ED, hypoxemia worsened, and she ultimately required endotracheal intubation. Labs were suggestive of diabetic ketoacidosis (DKA) and showed increase in all inflammatory markers and absolute lymphocytopenia. Chest X-ray showed bilateral diffuse patchy airspace opacities. Standard DKA management was started. She was also started on ceftriaxone, azithromycin, hydroxychloroquine, and subcutaneous heparin (5000 U every 8 h) for VTE prophylaxis. SARS-Cov2 reverse transcription-polymerase chain reaction returned positive. Ceftriaxone and azithromycin were discontinued the very next day because of low suspicion of bacterial infection while hydroxychloroquine was completed for 5 days. On the third day of admission, the patient self-extubated and was immediately placed on nonrebreather with spO₂ in low 90s. On the fourth day of admission, D-dimer came back 4.74 mg/L, which was elevated from a prior value, so computed tomography angiography of the lungs was done, which disclosed multiple emboli in the lungs. She was started on therapeutic doses of enoxaparin sodium, which was continued through her admission. She was switched to Apixaban on discharge. CONCLUSIONS The finding of the case suggested that low-molecular-weight heparin prophylaxis may not be sufficient to prevent VTE in COVID-19 pneumonia. Some of these patients may benefit from receiving prophylactic half doses or full doses of anticoagulants.

Diagnosis, Prevention, and Treatment of Catheter-Associated Urinary Tract Infection in Adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America

Abstract: Guidelines for the diagnosis, prevention, and management of persons with catheter-associated urinary tract infection (CA-UTI), both symptomatic and asymptomatic, were prepared by an Expert Panel of the Infectious Diseases Society of America. The evidence-based guidelines encompass diagnostic criteria, strategies to reduce the risk of CA-UTIs, strategies that have not been found to reduce the incidence of urinary infections, and management strategies for patients with catheter-associated asymptomatic bacteriuria or symptomatic urinary tract infection. These guidelines are intended for use by physicians in all medical specialties who perform direct patient care, with an emphasis on the care of patients in hospitals and long-term care facilities.

Guideline for prevention of catheter-associated urinary tract infections 2009.

Abstract: AND FULL-TEXT SCREENING To identify studies which were a) relevant to one or more key questions b) primary analytic research, systematic review or meta-analysis and c) written in English DATA EXTRACTION AND SYNTHESIS Data abstracted into evidence tables; study quality assessed DRAFT RECOMMENDATIONS Strength of evidence graded; summaries and recommendations drafted FINALIZE RECOMMENDATIONS Recommendations finalized; guideline published

Carbapenemases in Klebsiella pneumoniae and Other Enterobacteriaceae: an Evolving Crisis of Global Dimensions

Abstract: Summary: The spread of Enterobacteriaceae, primarily Klebsiella pneumoniae, producing KPC, VIM, IMP, and NDM carbapenemases, is causing an unprecedented public health crisis. Carbapenemase-producing enterobacteria (CPE) infect mainly hospitalized patients but also have been spreading in long-term care facilities. Given their multidrug resistance, therapeutic options are limited and, as discussed here, should be reevaluated and optimized. Based on susceptibility data, colistin and tigecycline are commonly used to treat CPE infections. Nevertheless, a review of the literature revealed high failure rates in cases of monotherapy with these drugs, whilst monotherapy with either a carbapenem or an aminoglycoside appeared to be more effective. Combination therapies not including carbapenems were comparable to aminoglycoside and carbapenem monotherapies. Higher success rates have been achieved with carbapenem-containing combinations. Pharmacodynamic simulations and experimental infections indicate that modification of the current patterns of carbapenem use against CPE warrants further attention. Epidemiological data, though fragmentary in many countries, indicate CPE foci and transmission routes, to some extent, whilst also underlining the lack of international collaborative systems that could react promptly and effectively. Fortunately, there are sound studies showing successful containment of CPE by bundles of measures, among which the most important are active surveillance cultures, separation of carriers, and assignment of dedicated nursing staff.

Polymyxins: Antibacterial Activity, Susceptibility Testing, and Resistance Mechanisms Encoded by Plasmids or Chromosomes

Abstract: Polymyxins are well-established antibiotics that have recently regained significant interest as a consequence of the increasing incidence of infections due to multidrug-resistant Gram-negative bacteria. Colistin and polymyxin B are being seriously reconsidered as last-resort antibiotics in many areas where multidrug resistance is observed in clinical medicine. In parallel, the heavy use of polymyxins in veterinary medicine is currently being reconsidered due to increased reports of polymyxin-resistant bacteria. Susceptibility testing is challenging with polymyxins, and currently available techniques are presented here. Genotypic and phenotypic methods that provide relevant information for diagnostic laboratories are presented. This review also presents recent works in relation to recently identified mechanisms of polymyxin resistance, including chromosomally encoded resistance traits as well as the recently identified plasmid-encoded polymyxin resistance determinant MCR-1. Epidemiological features summarizing the current knowledge in that field are presented.