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  Index cost comparison of laparoscopic vs robotic surgery in colon and rectal cancer resection: a retrospective financial investigation of surgical methodology innovation at a single institution

  Ekene Ezeokoli, Roula Hilli, and Harry J. Wasvary

  Publication Date: 5-2025

  Robotic assisted colorectal cancer resection (R-CR) has become increasingly commonplace in contrast to traditional laparoscopic cancer resection (L-CR). The aim of this study was to compare the total direct costs of R-CR to that of L-CR and to compare the groups with respect to costs related to LOS.

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  Treatment Rates in a Two-Step Clostridioides difficile Diagnostic Testing Algorithm

  Renee Ringler and Matthew Sims

  Publication Date: 5-2025

  Clostridioides difficile is a Gram-positive obligate anaerobe long associated with healthcare-acquired infections in the United States. 1 Clostridioides difficile infection (CDI) has thus become a key metric for assessing facility cleanliness and iatrogenic infection. C. difficile carriage is common, present in approximately 8% of hospitalized patients.2 Therefore, appropriate patient selection for testing and careful testing procedures is crucial to appropriately identify CDI while avoiding the detection of chronic colonization.

  Considerable variability exists among institutions regarding standardized CDI laboratory diagnostic methods. Historically, the gold standard for CDI testing was the clinically inefficient toxigenic culture (TC). 3 This was followed by cytotoxic assays (CTA) and then enzymelinked immunoassays (EIA), which directly tests for the bacterial toxin.4 However, EIA use alone was often deemed insufficient and required additional testing to improve sensitivity. 4 Testing for the isoenzyme glutamate dehydrogenase (GDH), specific to the Clostridioides species, can be added to EIA toxin testing to improve the sensitivity of the toxin testing result.5 However, GDH testing alone serves is a poor clinical indicator for CDI, as it does not differentiate those with active CDI vs those colonized with C. difficile, and has the potential to identify other close species.5 Combination toxin EIA and GDH testing improves both sensitivity and specificity for CDI, but can leave clinical uncertainty with incongruent results (ie. GDH+ Toxinpatients).

  PCR testing exists as another option for CDI, and identifies Toxin A and Toxin B genes with high sensitivity and produces rapid results.4 While PCR identifies toxigenic C. difficile strains and eliminates those that are non-toxigenic, it fails to identify the active production of toxins. Since toxin production is correlated with active infection, PCR alone is unable to distinguish active infection from colonization.

  Current CDI testing guidelines recommendation a multi-step approach that tests for C. difficile strains and active toxin production.1 This can be accomplished with GDH and toxin EIA or PCR and toxin EIA, with some algorithms reflexing to PCR in non-congruent GDH/EIA results. In November 2019, Beaumont Health changed its CDI testing policy to default to GDH and toxin EIA. While PCR remained available, testing could only be performed by consultation of and ordering by an infectious disease physician.

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  The Mysterious Case of Laryngeal TB

  James Aldridge, Katharine Glover, and Amal Khalife

  Publication Date: 5-9-2024

  ▪ Laryngeal Tuberculosis (TB) is a rare manifestation of tuberculosis. ▪ While historically common, it now only represents about 1% of TB cases.

  ▪ Mean patient age is 47 and about 72% were male.

  ▪ It most commonly occurs outside of the USA, and cases within are typically born outside of the USA.

  ▪ Mortality is about 3%.

  ▪ About 86% of the time, it is associated with pulmonary TB.

  ▪ Most common symptoms include dysphonia, dysphagia, odynophagia and weight loss.

  ▪ Unfortunately, due to these symptoms and its rarity in the USA, laryngeal TB is often overlooked in the differential for other infections or malignancies [1], [4].

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  Methenamine Prophylaxis Reduces Recurrent Urinary Tract Infections

  Salwan Al Hani and Matthew Sims

  Publication Date: 5-2024

  • Recurrent urinary tract infections (UTIs) are the most common outpatient infection in the US and are often managed with antibiotics in clinical practice.
  • A recurrent UTI is defined as 2 or UTIs each 6 months or 3 or more UTIs each year.
  • Methenamine is an antiseptic compound approved by the FDA to prevent rUTIs but is seldom used in clinical practice.
  • Under acidic conditions, methenamine is converted to 6 molecules of formaldehyde, a compound which prevents bacterial growth.
  • This study seeks to determine the effectiveness of methenamine for prevention of recurrent UTIs.

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  The HIV Care Continuum - A Quality Improvement Project to Reconnect with HIV-positive Patients Lost to Follow-up Care

  Kate Romero, Janet Lombardi, Carmen DeMarco, and Paul C. Johnson

  Publication Date: 5-2024

  • Human Immunodeficiency Virus (HIV): incurable illness transmitted through sex, blood, and trans placentally • Consistent management of HIV prevents progression to AIDS.
  • 2013 study à HIV-positive patients who failed to attend their follow-up visit within 4-6 months of the prior visit were more likely to have virologic failure.
  • Not much published on barriers to care, but one prior study found barriers shown in Figure 2 below – What are barriers to care faced by HIV-positive patients in Southeast Michigan?

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  HIV Diagnosis and Linkage to Care in the Emergency Department

  Gabrielle Rowlison and Christopher F. Carpenter

  Publication Date: 5-2024

  • It is estimated that 1.2 million people are living with human immunodeficiency virus (HIV) in the United States, and that 14% of this population are unaware of their status.
  • Approximately 40% of community transmissions happen between people who do not know they have HIV.
  • Current CDC recommendations are that anyone seeking treatment for a sexually transmitted infection (STI) be routinely screened for HIV.
  • The Emergency Department (ED) is an ideal place to test for HIV, especially in areas with underinsured populations and high rates of ED visits.
  • The HIV testing rate in Corewell Health (CH) East’s ED was previously found to be 0.2%.
  • Electronic health record (EHR) based initiatives have been shown to increase concurrent STI-HIV testing in the ED, but have not been implemented in our health system.
  • Increasing HIV testing in the ED will lead to more linkages to HIV care and less transmission in the community.

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  Polymicrobial Prosthetic Joint Infection Including Mycobacterium Tuberculosis: A Case Report

  Hernan Andres Yunis, Zachary J. Walker, Matthew E. Charlick, Daniel P. McCall, and Hind Hadid

  Publication Date: 5-9-2024

  Usual culprits of PJI affecting total hip and knee arthroplasty are Staphylococcus aureus and streptococcus epidermidis in the acute phase.

  During the chronic presentation, microbes become much more diverse as they may seed due to hematogenous spread from other body sites.

  The purpose of this case study was to illustrate an instance when polymicrobial total hip arthroplasty PJI included Mycobacterium Tuberculosis.

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  Review of Salvage Therapy for MRSA Bacteremia at Beaumont Health System

  Hazem Alakhras, Matthew D. Sims, and Tracey A.H. Taylor

  Publication Date: 5-2023

  Treating methicillin-resistant Staphylococcus aureus (MRSA) effectively is imperative to reduce mortality rates, as it contributes to a large amount of healthcare-associated bacteremia in the U.S. However, due to the insufficient and sometimes contradicting studies to guide salvage therapy, there is a lack of clear consensus on treatment of MRSA bacteremia after vancomycin failure. The goal of this study is to showcase the salvage therapies of choice for patients with MRSA bacteremia at Beaumont Health System.

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  Combining DRIP Score and Rapid Diagnostics For Improved Antibiotic Stewardship

  Richard Ramirez and Matthew Sims

  Publication Date: 5-2023

  Treatment analysis patterns for broad-spectrum antibiotic use in pneumonia revealed that 60% of patients were overtreated, highlighting the need for effective antibiotic stewardship practices. Systems such as the Drug Resistance in Pneumonia (DRIP) score select patients more likely to require broad spectrum antibiotics but still leads to overtreatment as it does not target specific pathogens. Rapid diagnostics such as the Unyvero Lower Respiratory Tract Panel (LRTP) combined with the DRIP score can identify specific pathogens to further narrow antibiotic use.

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  Designing a Surgical Scorecard to Inform and Evaluate Appropriate Perioperative Antibiotic Prophylaxis

  Rehan Tariq and Paul Chittick

  Publication Date: 5-2023

  Perioperative antibiotic prophylaxis (PAP) implementation is a widespread strategy used to ensure the minimization of surgical site infections (SSIs) during various surgical procedures including hip and knee replacements and organ transplants. Despite the widespread implementation of PAP, there exists a gap in understanding what is considered appropriate PAP. This may be due in part to the absence of a feedback mechanism that educates physicians on which antibiotics are truly appropriate for preventing the SSIs arising from certain surgical procedures. The goal of this project is to design an informative surgical prophylaxis scorecard that physicians can use to determine which antibiotic is appropriate for PAP. We are interested in the impact our quality improvement tool will have on appropriate perioperative prophylaxis services at Beaumont Royal Oak.

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  Quality Improvement Study on Human Papilloma Virus (HPV) Vaccination uptake in HIV patients

  Hassan Akram, Paul Johnson, and Trini A Mathew

  Publication Date: 5-2-2022

  INTRODUCTION HPV is strongly associated with cervical cancer and cancers of vagina, vulva, penis, anus, rectum. In 2019, WHO identified vaccine hesitancy as top 10 global threats and planned to increase the HPV vaccine coverage. In June 2019 Advisory Committee on Immunization Practices (ACIP) in the US recommended shared clinical decision-making regarding HPV vaccinations in adults aged 26 through 45 years. The goal of this project is to evaluate the uptake of HPV vaccination and challenges in the HIV patients at Beaumont Hospital.

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  Resistance in Gram-Negative Bacteria in the Pediatric Patient Population by Age and Sex

  Benjamin Malamet and Matthew Sims

  Publication Date: 5-2-2022

  INTRODUCTION
  Previous research within the Beaumont Infectious Diseases Research Program found an increase in antibiotic resistance in adult males versus females. Furthermore, there is a peak in resistance in 18-29-year-old males, not seen in females. The origin of this early peak of antibiotic resistance in adults is unclear. This study examines these trends in the pediatric patient population.

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  Relatedness Of Urinary Escherichia Coli Strains And Connection Between Strain Type And Clinical Presentation

  Anet Szatkowski, Venkathesh Bai, and Matthew D. Sims

  Publication Date: 5-2-2022

  INTRODUCTION
  Urine is often not a sterile body fluid. When bacteria in the urine cause symptoms it is by definition a urinary tract infection (UTI). The specific symptoms will point toward a bladder infection (cystitis) or a kidney infection (pyelonephritis). Presence of bacteria in the urine without symptoms defines asymptomatic bacteriuria (AB). Despite requiring symptoms to diagnose a UTI, often AB is misdiagnosed as a UTI and treated with antibiotics when none are needed. Escherichia coli is the most common cause of UTIs accounting for 80-90% of community-acquired UTIs and 30-50% of nosocomial UTIs. The goals of this study are to determine whether specific strains of E. coli are associated with cystitis, pyelonephritis, or asymptomatic bacteriuria; whether specific strains are related to more serious infections; and whether specific strains can be geomapped to specific areas within Southeast Michigan using postal codes.