Elizabeth Thottacherry

All Publications

• Implementing Oral Antibiotics for Bone and Joint Infections: Lessons Learned and Opportunities for Improvement. Open forum infectious diseases Hawkins, M. R., Thottacherry, E., Juthani, P., Aronson, J., Chang, A., Amanatullah, D. F., Markovits, J., Shen, S., Holubar, M., Andrews, J. R., Parsonnet, J., Furukawa, D. 2024; 11 (12): ofae683

  Abstract

  Although intravenous antibiotics have historically been the standard of care for bone and joint infections, clinical trial data have highlighted the safety and efficacy of oral antibiotics. Despite this, intravenous antibiotics are still commonly used, and evaluations of institutional guidelines advancing oral antibiotic use are limited.In April 2023, we implemented a new institutional guideline to preferentially treat patients with bone and joint infections with oral antibiotics. The postguideline cohort was compared with a historical preguideline cohort via retrospective chart review. The primary outcome was the proportion of patients discharged exclusively on oral antibiotics. Secondary outcomes included 90-day treatment failure, length of stay, and adverse effects.One hundred eighty-six patients (53 preguideline and 133 postguideline) were included in the analysis. Patients in the postguideline cohort were more likely to be discharged exclusively on oral antibiotics (25% vs 70%; P < .01), with no difference in 90-day treatment failure (8% vs 9%; P = .75). Patients in the postguideline cohort had a shorter length of stay than preguideline (median, 8 vs 7 days; P = .04) and trended toward fewer peripherally inserted central catheter-related adverse events (6% vs 1%; P = .07).An institutional guideline was effective in increasing the proportion of patients with bone and joint infections discharged on oral antibiotics. We observed similar clinical outcomes after implementing the guidelines while reducing length of hospital stay.

  View details for DOI 10.1093/ofid/ofae683

  View details for PubMedID 39660026

  View details for PubMedCentralID PMC11629981

• Chronic Nonspinal Osteomyelitis in Adults: Consensus Recommendations on Percutaneous Bone Biopsies from the Society of Academic Bone Radiologists. Radiology Debs, P., Boutin, R. D., Smith, S. E., Babic, M., Blankenbaker, D., Chandra, V., Murphey, M., Thottacherry, E., Kreulen, C., Fayad, L. M. 2024; 311 (1): e231348

  Abstract

  The diagnosis and management of chronic nonspinal osteomyelitis can be challenging, and guidelines regarding the appropriateness of performing percutaneous image-guided biopsies to acquire bone samples for microbiological analysis remain limited. An expert panel convened by the Society of Academic Bone Radiologists developed and endorsed consensus statements on the various indications for percutaneous image-guided biopsies to standardize care and eliminate inconsistencies across institutions. The issued statements pertain to several commonly encountered clinical presentations of chronic osteomyelitis and were supported by a literature review. For most patients, MRI can help guide management and effectively rule out osteomyelitis when performed soon after presentation. Additionally, in the appropriate clinical setting, open wounds such as sinus tracts and ulcers, as well as joint fluid aspirates, can be used for microbiological culture to determine the causative microorganism. If MRI findings are positive, surgery is not needed, and alternative sites for microbiological culture are not available, then percutaneous image-guided biopsies can be performed. The expert panel recommends that antibiotics be avoided or discontinued for an optimal period of 2 weeks prior to a biopsy whenever possible. Patients with extensive necrotic decubitus ulcers or other surgical emergencies should not undergo percutaneous image-guided biopsies but rather should be admitted for surgical debridement and intraoperative cultures. Multidisciplinary discussion and approach are crucial to ensure optimal diagnosis and care of patients diagnosed with chronic osteomyelitis.

  View details for DOI 10.1148/radiol.231348

  View details for PubMedID 38625010

• Diagnostic Stewardship: A Systematic Review and Meta-analysis of Blood Collection Diversion Devices Used to Reduce Blood Culture Contamination and Improve the Accuracy of Diagnosis in Clinical Settings. Open forum infectious diseases Callado, G. Y., Lin, V., Thottacherry, E., Marins, T. A., Martino, M. D., Salinas, J. L., Marra, A. R. 2023; 10 (9): ofad433

  Abstract

  Blood culture contamination may lead to misdiagnosis, overutilization of antibiotics, and prolonged length of stay. Blood specimen diversion devices can reduce contamination rates during blood culture collection procedures. We performed a systematic literature review and meta-analysis evaluating the influence of blood specimen diversion devices in blood culture contamination rates.We searched Medline, Cumulative Index to Nursing and Allied Health Literature, Embase, Cochrane, Scopus, and Web of Science, from database inception to 1 March 2023, for studies evaluating the impact of a diversion device on blood culture contamination. Blood culture contamination was a positive blood culture with microorganisms not representative of true bacteremia, but rather introduced during collection or processing the blood sample. Random-effects models were used to obtain pooled mean differences, and heterogeneity was assessed using the I2 test.Of 1768 screened studies, 12 met inclusion criteria for this systematic literature review. Of them, 9 studies were included in the meta-analysis. Studies were substantially heterogeneous, but stratified analyses considering only high-quality studies revealed that venipuncture using a diversion device was associated with a significant reduction in blood culture contamination in comparison to the standard procedure of collection (pooled odds ratio [OR], 0.26 [95% confidence interval {CI}, .13-.54]; I2 = 19%). Furthermore, the stratified analysis showed that the adoption of a diversion device did not reduce the detection of true infection (pooled OR, 0.85 [95% CI, .65-1.11]; I2 = 0%).Blood culture diversion devices was associated with decreased contamination rates and could improve quality of care, reduce costs, and avoid unnecessary antibiotic use.

  View details for DOI 10.1093/ofid/ofad433

  View details for PubMedID 37674630

  View details for PubMedCentralID PMC10478151