Omar Ibrahim - Academia.edu (original) (raw)

Papers by Omar Ibrahim

Antimicrobial Agents and Chemotherapy

We analyzed the impact of vancomycin (VAN) combined with adjuvant β-lactam therapy (COMBO) on per... more We analyzed the impact of vancomycin (VAN) combined with adjuvant β-lactam therapy (COMBO) on persistent methicillin-resistant Staphylococcus aureus bacteremia (≥5 days) compared to VAN using pooled data from two previously published, observational studies (n=156). COMBO was inversely associated with persistent bacteremia (adjusted odds ratio 0.460, 95% confidence interval, 0.229-0.923). Acute kidney injury was more common in COMBO than VAN (18.9% and 7.6%, respectively; p=0.062).

Open Forum Infectious Diseases

Background: Infectious diseases societies recommend that hospitals risk-adjust their antimicrobia... more Background: Infectious diseases societies recommend that hospitals risk-adjust their antimicrobial use before comparing it to their peers, a process called benchmarking. The purpose of this investigation is to apply and compare 3 risk-adjustment procedures for benchmarking hospital antibacterial consumption (AbC). Two standardization of rates procedures, direct and indirect standardization, are compared with one another as well as with regression modeling. Methods. Total aggregate adult AbC for 52 systemic antibacterial agents was measured in 70 hospitals that subscribed to the University HealthSystem Consortium Clinical Resource Manager database in 2009 and expressed as days of therapy (DOTs) per either 1000 patients days (PDs) or 1000 discharges. The two AbC rates served the role of the outcome while several known risk factors for AbC served the role of potential predictor variables in the linear regression models. Selection criteria were applied to select a model that represented...

Antimicrobial agents and chemotherapy, 2014

Journal of managed care & specialty pharmacy, 2014

Trimethoprim/sulfamethoxazole (TMP/SMX) is the recommended first-line treatment for human immunod... more Trimethoprim/sulfamethoxazole (TMP/SMX) is the recommended first-line treatment for human immunodeficiency virus (HIV)-infected patients with Pneumocystis jirovecii pneumonia (PJP).However, in June 2010, the lone manufacturer of intravenous (IV) TMP/SMX in the United States stopped production of this medication. To (a) evaluate the impact of the national IV TMP/SMX shortage on PJP treatment outcomes between 2 groups of HIV-infected patients-those treated before the shortage and those after the shortage-and (b) compare the length of hospital stay (LOS) and PJP treatment used before and after the shortage. A retrospective, quasi-experimental study examining 2 groups of HIV-infected adult patients with PJP was performed at an academic medical center from September 1, 2008, to June 30, 2012. Patients treated when IV TMP/SMX was available, or preshortage (PRE), were compared with patients treated when IV TMP/SMX was not available, or postshortage (POST).PRE included patients treated bet...

Infectious Disease Clinics of North America, 2014

Measurement of antimicrobial use before and after an intervention and the associated outcomes are... more Measurement of antimicrobial use before and after an intervention and the associated outcomes are key activities of antimicrobial stewardship programs. In the United States, the recommended metric for aggregate antibiotic use is days of therapy/1000 patient-days. Clinical outcomes, including response to therapy and bacterial resistance, are critical measures but are more difficult to document than economic outcomes. Interhospital benchmarking of risk adjusted antimicrobial use is possible, although several obstacles remain before it can have an impact on patient care. Many challenges for stewardship programs remain, but the methods and science to support their efforts are rapidly evolving.

Expert Review of Anti-infective Therapy, 2012

Measuring and monitoring antibiotic use in hospitals is believed to be an important component of ... more Measuring and monitoring antibiotic use in hospitals is believed to be an important component of the strategies available to antimicrobial stewardship programs to address acquired antimicrobial resistance. Recent efforts to organize large numbers of hospitals into networks allow for interhospital comparisons of a variety of healthcare processes and outcomes, a process often called 'benchmarking'. For comparisons of antimicrobial use to be valid, usage figures must be risk-adjusted to account for differences in patient mix and hospital characteristics. The purpose of this review is to describe recent methods to benchmark antimicrobial drug use and to critically assess the potential advantages and the remaining challenges. While many methodological challenges remain, and the clinical outcomes resulting from benchmarking programs have yet to be determined, recent developments suggest that benchmarking antimicrobial drug use will become an important component of antimicrobial stewardship program activities.

Clinical Infectious Diseases, 2011

Background. Antimicrobial stewardship programs are advised to measure and risk-adjust antimicrobi... more Background. Antimicrobial stewardship programs are advised to measure and risk-adjust antimicrobial use to facilitate interhospital comparisons, a process called benchmarking. The purpose of this investigation was to evaluate a new benchmarking strategy for antibacterials. Methods. Hospital-wide adult antibacterial drug use in 2009 was measured as days of therapy (DOT) and length of therapy (LOT) from billing records in 70 US academic medical centers (AMCs). Patients were assigned to 1 of 35 clinical service lines (CSL) based on their Medicare Severity Diagnosis Related Group. Expected (E) use was determined by indirect standardization and compared with observed (O) use. Results. Of 1 791 180 discharged adults, 63.7% received antibacterial drugs; the range by CSL was 14.3% (psychiatry) to 99.7% (lung transplant). Mean 6 SD hospital-wide use was 839 6 106 DOTs (range, 594-1109) and 536 6 53.0 LOT (range, 427-684) per 1000 patient-days. The ventilator support CSL had the most DOT per discharge, 39.4 6 9.4 days; the LOT was 21.5 6 4.5 days. The hospital-wide O/E ratio range was 0.7-1.45; in 5 AMCs the ratio exceeded the 90% confidence interval (CI) and was below the 90% CI in 6. Variability in use was explained by the proportion of treated patients within each CSL and mean LOT and DOT per discharge. Conclusions. Adult antibacterial drug use was benchmarked to expected use adjusted for patient mix, and outlier hospitals were identified. Differences between expected and observed use reflect usage patterns that were benchmarked and are targets for evaluation and intervention.

Infection control and …, 2009

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Antimicrobial Agents and Chemotherapy

We analyzed the impact of vancomycin (VAN) combined with adjuvant β-lactam therapy (COMBO) on per... more We analyzed the impact of vancomycin (VAN) combined with adjuvant β-lactam therapy (COMBO) on persistent methicillin-resistant Staphylococcus aureus bacteremia (≥5 days) compared to VAN using pooled data from two previously published, observational studies (n=156). COMBO was inversely associated with persistent bacteremia (adjusted odds ratio 0.460, 95% confidence interval, 0.229-0.923). Acute kidney injury was more common in COMBO than VAN (18.9% and 7.6%, respectively; p=0.062).

Open Forum Infectious Diseases

Background: Infectious diseases societies recommend that hospitals risk-adjust their antimicrobia... more Background: Infectious diseases societies recommend that hospitals risk-adjust their antimicrobial use before comparing it to their peers, a process called benchmarking. The purpose of this investigation is to apply and compare 3 risk-adjustment procedures for benchmarking hospital antibacterial consumption (AbC). Two standardization of rates procedures, direct and indirect standardization, are compared with one another as well as with regression modeling. Methods. Total aggregate adult AbC for 52 systemic antibacterial agents was measured in 70 hospitals that subscribed to the University HealthSystem Consortium Clinical Resource Manager database in 2009 and expressed as days of therapy (DOTs) per either 1000 patients days (PDs) or 1000 discharges. The two AbC rates served the role of the outcome while several known risk factors for AbC served the role of potential predictor variables in the linear regression models. Selection criteria were applied to select a model that represented...

Antimicrobial agents and chemotherapy, 2014

Journal of managed care & specialty pharmacy, 2014

Trimethoprim/sulfamethoxazole (TMP/SMX) is the recommended first-line treatment for human immunod... more Trimethoprim/sulfamethoxazole (TMP/SMX) is the recommended first-line treatment for human immunodeficiency virus (HIV)-infected patients with Pneumocystis jirovecii pneumonia (PJP).However, in June 2010, the lone manufacturer of intravenous (IV) TMP/SMX in the United States stopped production of this medication. To (a) evaluate the impact of the national IV TMP/SMX shortage on PJP treatment outcomes between 2 groups of HIV-infected patients-those treated before the shortage and those after the shortage-and (b) compare the length of hospital stay (LOS) and PJP treatment used before and after the shortage. A retrospective, quasi-experimental study examining 2 groups of HIV-infected adult patients with PJP was performed at an academic medical center from September 1, 2008, to June 30, 2012. Patients treated when IV TMP/SMX was available, or preshortage (PRE), were compared with patients treated when IV TMP/SMX was not available, or postshortage (POST).PRE included patients treated bet...

Infectious Disease Clinics of North America, 2014

Measurement of antimicrobial use before and after an intervention and the associated outcomes are... more Measurement of antimicrobial use before and after an intervention and the associated outcomes are key activities of antimicrobial stewardship programs. In the United States, the recommended metric for aggregate antibiotic use is days of therapy/1000 patient-days. Clinical outcomes, including response to therapy and bacterial resistance, are critical measures but are more difficult to document than economic outcomes. Interhospital benchmarking of risk adjusted antimicrobial use is possible, although several obstacles remain before it can have an impact on patient care. Many challenges for stewardship programs remain, but the methods and science to support their efforts are rapidly evolving.

Expert Review of Anti-infective Therapy, 2012

Measuring and monitoring antibiotic use in hospitals is believed to be an important component of ... more Measuring and monitoring antibiotic use in hospitals is believed to be an important component of the strategies available to antimicrobial stewardship programs to address acquired antimicrobial resistance. Recent efforts to organize large numbers of hospitals into networks allow for interhospital comparisons of a variety of healthcare processes and outcomes, a process often called 'benchmarking'. For comparisons of antimicrobial use to be valid, usage figures must be risk-adjusted to account for differences in patient mix and hospital characteristics. The purpose of this review is to describe recent methods to benchmark antimicrobial drug use and to critically assess the potential advantages and the remaining challenges. While many methodological challenges remain, and the clinical outcomes resulting from benchmarking programs have yet to be determined, recent developments suggest that benchmarking antimicrobial drug use will become an important component of antimicrobial stewardship program activities.

Clinical Infectious Diseases, 2011

Background. Antimicrobial stewardship programs are advised to measure and risk-adjust antimicrobi... more Background. Antimicrobial stewardship programs are advised to measure and risk-adjust antimicrobial use to facilitate interhospital comparisons, a process called benchmarking. The purpose of this investigation was to evaluate a new benchmarking strategy for antibacterials. Methods. Hospital-wide adult antibacterial drug use in 2009 was measured as days of therapy (DOT) and length of therapy (LOT) from billing records in 70 US academic medical centers (AMCs). Patients were assigned to 1 of 35 clinical service lines (CSL) based on their Medicare Severity Diagnosis Related Group. Expected (E) use was determined by indirect standardization and compared with observed (O) use. Results. Of 1 791 180 discharged adults, 63.7% received antibacterial drugs; the range by CSL was 14.3% (psychiatry) to 99.7% (lung transplant). Mean 6 SD hospital-wide use was 839 6 106 DOTs (range, 594-1109) and 536 6 53.0 LOT (range, 427-684) per 1000 patient-days. The ventilator support CSL had the most DOT per discharge, 39.4 6 9.4 days; the LOT was 21.5 6 4.5 days. The hospital-wide O/E ratio range was 0.7-1.45; in 5 AMCs the ratio exceeded the 90% confidence interval (CI) and was below the 90% CI in 6. Variability in use was explained by the proportion of treated patients within each CSL and mean LOT and DOT per discharge. Conclusions. Adult antibacterial drug use was benchmarked to expected use adjusted for patient mix, and outlier hospitals were identified. Differences between expected and observed use reflect usage patterns that were benchmarked and are targets for evaluation and intervention.

Infection control and …, 2009

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