- Infectious Disease
Clinical Assistant Professor, Medicine - Infectious Diseases
Board Certification: American Board of Internal Medicine, Infectious Disease (2021)
Fellowship: UCLA Division of Infectious Diseases (2021) CA
Fellowship, UCLA NRSA Primary Care Research Fellowship, CA (2021)
MS, UCLA Fielding School of Public Health, Health Policy and Management (2020)
Board Certification: American Board of Internal Medicine, Internal Medicine (2018)
Residency: Cedars Sinai Medical Center (2018) CA
Medical Education: UCLA David Geffen School Of Medicine Registrar (2015) CA
Evaluation of antibiotic escalation in response to nurse-driven inpatient sepsis screen.
Antimicrobial stewardship & healthcare epidemiology : ASHE
2021; 1 (1): e59
To determine the frequency and predictors of antibiotic escalation in response to the inpatient sepsis screen at our institution.Retrospective cohort study.Two affiliated academic medical centers in Los Angeles, California.Hospitalized patients aged 18 years and older who had their first positive sepsis screen between January 1, 2019, and December 31, 2019, on acute-care wards.We described the rate and etiology of antibiotic escalation, and we conducted multivariable regression analyses of predictors of antibiotic escalation.Of the 576 cases with a positive sepsis screen, antibiotic escalation occurred in 131 cases (22.7%). New infection was the most documented etiology of escalation, with 76 cases (13.2%), followed by known pre-existing infection, with 26 cases (4.5%). Antibiotics were continued past 3 days in 17 cases (3.0%) in which new or existing infection was not apparent. Abnormal temperature (adjusted odds ratio [aOR], 3.00; 95% confidence interval [CI], 1.91-4.70) and abnormal lactate (aOR, 2.04; 95% CI, 1.28-3.27) were significant predictors of antibiotic escalation. The patient already being on antibiotics (aOR, 0.54; 95% CI, 0.34-0.89) and the positive screen occurred during a nursing shift change (aOR, 0.36; 95% CI, 0.22-0.57) were negative predictors. Pneumonia was the most documented new infection, but only 19 (50%) of 38 pneumonia cases met full clinical diagnostic criteria.Inpatient sepsis screening led to a new infectious diagnosis in 13.2% of all positive sepsis screens, and the risk of prolonged antibiotic exposure without a clear infectious source was low. Pneumonia diagnostics and lactate testing are potential targets for future stewardship efforts.
View details for DOI 10.1017/ash.2021.232
View details for PubMedID 36168494
View details for PubMedCentralID PMC9495422
- Antimicrobial Stewardship in a Pandemic: Picking Up the Pieces. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2021; 72 (10): e542-e544
- Real-life utilization of BioFire® Filmarray® pneumonia panel as an antibiotic stewardship tool. Infectious diseases (London, England) 2021; 53 (4): 308-313
- Antibiotic prophylaxis in beta-lactam allergic patients undergoing cesarean and vaginal delivery: An opportunity for stewardship. Infection control and hospital epidemiology 2021: 1-2
Using control charts to understand community variation in COVID-19.
2021; 16 (4): e0248500
Decision-makers need signals for action as the coronavirus disease 2019 (COVID-19) pandemic progresses. Our aim was to demonstrate a novel use of statistical process control to provide timely and interpretable displays of COVID-19 data that inform local mitigation and containment strategies. Healthcare and other industries use statistical process control to study variation and disaggregate data for purposes of understanding behavior of processes and systems and intervening on them. We developed control charts at the county and city/neighborhood level within one state (California) to illustrate their potential value for decision-makers. We found that COVID-19 rates vary by region and subregion, with periods of exponential and non-exponential growth and decline. Such disaggregation provides granularity that decision-makers can use to respond to the pandemic. The annotated time series presentation connects events and policies with observed data that may help mobilize and direct the actions of residents and other stakeholders. Policy-makers and communities require access to relevant, accurate data to respond to the evolving COVID-19 pandemic. Control charts could prove valuable given their potential ease of use and interpretability in real-time decision-making and for communication about the pandemic at a meaningful level for communities.
View details for DOI 10.1371/journal.pone.0248500
View details for PubMedID 33930013
View details for PubMedCentralID PMC8087083
Inpatient antibiotic utilization in the Veterans' Health Administration during the coronavirus disease 2019 (COVID-19) pandemic.
Infection control and hospital epidemiology
2021; 42 (6): 751-753
Antibiotic prescribing practices across the Veterans' Health Administration (VA) experienced significant shifts during the coronavirus disease 2019 (COVID-19) pandemic. From 2015 to 2019, antibiotic use between January and May decreased from 638 to 602 days of therapy (DOT) per 1,000 days present (DP), while the corresponding months in 2020 saw antibiotic utilization rise to 628 DOT per 1,000 DP.
View details for DOI 10.1017/ice.2020.1277
View details for PubMedID 33077000
View details for PubMedCentralID PMC7653226
Condyloma latum of the plantar foot: Case report of an unusual manifestation of secondary syphilis.
International journal of STD & AIDS
Condyloma lata, a cutaneous manifestation of secondary syphilis, typically presents as verrucous papules or plaques in the anogenital area. Here, we present a case of secondary syphilis presenting in a 38-year-old man as condyloma latum of the plantar foot in the absence of other cutaneous findings of secondary syphilis. The plantar foot is an unusual location for condyloma lata which has not previously been reported in the medical literature. Histopathology was essential to diagnosis in this case and demonstrated verrucous epidermal hyperplasia with a plasma cell-rich infiltrate in the dermis and innumerable spirochetes in the epidermis. The patient was successfully treated with intramuscular penicillin benzathine G. Given the recent rise in the incidence of primary and secondary syphilis, it is essential for clinicians to be aware of atypical presentations of secondary syphilis to avoid delays in treatment and decrease the risk of transmission to sexual partners.
View details for DOI 10.1177/09564624211032798
View details for PubMedID 34284668
- A Case of Fever of Unknown Origin Following Cardiac Arrest With Diagnosis Revealed on Autopsy INFECTIOUS DISEASES IN CLINICAL PRACTICE 2018; 26 (5): 297-299
- No to Pip-Tazo Identifying Inappropriate Use of Piperacillin-Tazobactam for Treatment of Skin and Soft Tissue Infections INFECTIOUS DISEASES IN CLINICAL PRACTICE 2017; 25 (4): 209-213