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Seagle EE, Jackson BR, Lockhart SR, Jenkins EN, Revis A, Farley MM, Harrison LH, Schaffner W, Markus TM, Pierce RA, Zhang AY, Lyman MM. Recurrent Candidemia: Trends and Risk Factors Among Persons Residing in 4 US States, 2011-2018. Open Forum Infect Dis 2022; 9:ofac545. [PMID: 36324324 PMCID: PMC9620433 DOI: 10.1093/ofid/ofac545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
Background Candidemia is a common healthcare-associated infection with high mortality. Estimates of recurrence range from 1% to 17%. Few studies have focused on those with recurrent candidemia, who often experience more severe illness and greater treatment failure. We describe recurrent candidemia trends and risk factors. Methods We analyzed population-based candidemia surveillance data collected during 2011-2018. Persons with >1 episode (defined as the 30-day period after a positive Candida species) were classified as having recurrent candidemia. We compared factors during the initial episode between those who developed recurrent candidemia and those who did not. Results Of the 5428 persons identified with candidemia, 326 (6%) had recurrent infection. Recurrent episodes occurred 1.0 month to 7.6 years after any previous episode. In multivariable logistic regression controlling for surveillance site and year, recurrent candidemia was associated with being 19-44 years old (vs ≥65 years; adjusted odds ratio [aOR], 3.05 [95% confidence interval {CI}, 2.10-4.44]), being discharged to a private residence (vs medical facility; aOR, 1.53 [95% CI, 1.12-2.08]), hospitalization in the 90 days prior to initial episode (aOR, 1.66 [95% CI, 1.27-2.18]), receipt of total parenteral nutrition (aOR, 2.08 [95% CI, 1.58-2.73]), and hepatitis C infection (aOR, 1.65 [95% CI, 1.12-2.43]). Conclusions Candidemia recurrence >30 days after initial infection occurred in >1 in 20 persons with candidemia. Associations with younger age and hepatitis C suggest injection drug use may play a modifiable role. Prevention efforts targeting central line care and total parenteral nutrition use may help reduce the risk of recurrent candidemia.
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Affiliation(s)
- Emma E Seagle
- ASRT, Inc, Atlanta, Georgia, USA,Mycotic Disease Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brendan R Jackson
- Mycotic Disease Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shawn R Lockhart
- Mycotic Disease Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Emily N Jenkins
- Correspondence: Emily N. Jenkins, MPH, ASRT, Inc, Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS H24-9, Atlanta, GA, 30329 ()
| | - Andrew Revis
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA,Foundation for Atlanta Veterans Education and Research, Atlanta, Georgia, USA,Georgia Emerging Infections Program, Atlanta, Georgia, USA
| | - Monica M Farley
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA,Georgia Emerging Infections Program, Atlanta, Georgia, USA,Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Lee H Harrison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | - Rebecca A Pierce
- Oregon Public Health Division, Oregon Health Authority, Portland, Oregon, USA
| | - Alexia Y Zhang
- Oregon Public Health Division, Oregon Health Authority, Portland, Oregon, USA
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Appa A, Adamo M, Le S, Davis J, Winston L, Doernberg SB, Chambers H, Martin M, Hills NK, Coffin PO, Jain V. Comparative 1-Year Outcomes of Invasive Staphylococcus aureus Infections Among Persons With and Without Drug Use: An Observational Cohort Study. Clin Infect Dis 2022; 74:263-270. [PMID: 33904900 PMCID: PMC8800187 DOI: 10.1093/cid/ciab367] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Persons who use drugs (PWUD) face substantial risk of Staphylococcus aureus infections. Limited data exist describing clinical and substance use characteristics of PWUD with invasive S. aureus infections or comparing treatment and mortality outcomes in PWUD vs non-PWUD. These are needed to inform optimal care for this marginalized population. METHODS We identified adults hospitalized from 2013 to 2018 at 2 medical centers in San Francisco with S. aureus bacteremia or International Classification of Diseases-coded diagnoses of endocarditis, epidural abscess, or vertebral osteomyelitis with compatible culture. In addition to demographic and clinical characteristic comparison, we constructed multivariate Cox proportional hazards models for 1-year infection-related readmission and mortality, adjusted for age, race/ethnicity, housing, comorbidities, and methicillin-resistant S. aureus (MRSA). RESULTS Of 963 hospitalizations for S. aureus infections in 946 patients, 372 of 963 (39%) occurred in PWUD. Among PWUD, heroin (198/372 [53%]) and methamphetamine use (185/372 [50%]) were common. Among 214 individuals using opioids, 98 of 214 (46%) did not receive methadone or buprenorphine. PWUD had lower antibiotic completion than non-PWUD (70% vs 87%; P < .001). While drug use was not associated with increased mortality, 1-year readmission for ongoing or recurrent infection was double in PWUD vs non-PWUD (28% vs 14%; adjusted hazard ratio [aHR], 2.0 [95% confidence interval {CI}: 1.3-2.9]). MRSA was independently associated with 1-year readmission for infection (aHR, 1.5 [95% CI: 1.1-2.2]). CONCLUSIONS Compared to non-PWUD, PWUD with invasive S. aureus infections had lower rates of antibiotic completion and twice the risk of infection persistence/recurrence at 1 year. Among PWUD, both opioid and stimulant use were common. Models for combined treatment of substance use disorders and infections, particularly MRSA, are needed.
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Affiliation(s)
- Ayesha Appa
- University of California, San Francisco, San Francisco, California, USA
| | - Meredith Adamo
- University of California, San Francisco, San Francisco, California, USA
| | - Stephenie Le
- University of California, San Francisco, San Francisco, California, USA
| | - Jennifer Davis
- University of California, San Francisco, San Francisco, California, USA
| | - Lisa Winston
- University of California, San Francisco, San Francisco, California, USA
| | - Sarah B Doernberg
- University of California, San Francisco, San Francisco, California, USA
| | - Henry Chambers
- University of California, San Francisco, San Francisco, California, USA
| | - Marlene Martin
- University of California, San Francisco, San Francisco, California, USA
| | - Nancy K Hills
- University of California, San Francisco, San Francisco, California, USA
| | - Phillip O Coffin
- University of California, San Francisco, San Francisco, California, USA
- San Francisco Department of Public Health, San Francisco, California, USA
| | - Vivek Jain
- University of California, San Francisco, San Francisco, California, USA
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Alexander R, Agboola O, Costales V. Sociodemographic characteristics associated with hepatitis C among patients admitted for medically managed opioid withdrawal in east Tennessee. J Addict Dis 2021; 40:92-95. [PMID: 34121634 DOI: 10.1080/10550887.2021.1935187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND While Opioid use disorder (OUD)-related mortality is epidemic in the United States, regions like Appalachia are disproportionately affected. Moreover, a dual epidemic of Hepatitis C virus (HCV) infections and OUD-related admissions has been observed. OBJECTIVE To evaluate sociodemographic characteristics of opioid-dependent patients admitted for medically managed withdrawal in East Tennessee and compare those with and without HCV. METHODS Cross-sectional study of patients with an OUD admitted for treatment, comparing those with and without a history of HCV. RESULTS The studied population was found to have high rates of HCV (36%), intravenous drug use (IVDU) (77%), polysubstance use (84%), previous incarceration (87%), and unemployment (80%). Patients with HCV, compared to those without, were significantly more likely to have a history of IVDU, IVDU complications, and polysubstance use. CONCLUSIONS This sample reflects the significant morbidity of OUD in East Tennessee. To prevent mortality, contributing factors such as polysubstance use and OUD treatment during incarceration need to be specifically addressed.
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Affiliation(s)
- Ryan Alexander
- Department of Preventive Medicine, Griffin Hospital, Derby, CT, USA.,Helen Ross McNabb Center, Knoxville, TN, USA
| | - Olayinka Agboola
- Department of Preventive Medicine, Griffin Hospital, Derby, CT, USA
| | - Victoria Costales
- Department of Preventive Medicine, Griffin Hospital, Derby, CT, USA.,Department of Internal Medicine, Griffin Hospital, Derby, CT, USA.,Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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Abstract
The breadth of fungi causing human disease and the spectrum of clinical presentations associated with these infections has widened. Epidemiologic trends display dramatic shifts with expanding geographic ranges, identification of new at-risk groups, increasing prevalence of resistant infections, and emergence of novel multidrug-resistant pathogenic fungi. Certain fungi have been transmitted between patients in clinical settings. Major health events not typically associated with mycoses resulted in larger proportions of the population susceptible to secondary fungal infections. Many health care-related, environmental, and socioeconomic factors have influenced these epidemiologic shifts. This review summarizes updates to clinically significant fungal pathogens in North America.
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Affiliation(s)
- Emma E Seagle
- ASRT, Inc, 4158 Onslow Pl, Smyrna, GA 30080, USA; Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road Northeast, Atlanta, GA 30329-4018, USA
| | - Samantha L Williams
- ASRT, Inc, 4158 Onslow Pl, Smyrna, GA 30080, USA; Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road Northeast, Atlanta, GA 30329-4018, USA
| | - Tom M Chiller
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road Northeast, Atlanta, GA 30329-4018, USA.
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Ala-Houhala M, Anttila VJ. Characteristics of late recurrent candidemia in adult patients. Mycoses 2021; 64:503-510. [PMID: 33377571 DOI: 10.1111/myc.13236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/23/2020] [Accepted: 12/24/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Candida species are one of the most common causes of health care-associated bloodstream infections. However, recurrent candidemia is rare, and the characteristics of late recurrent (LR) candidemia are partly unclear. Our aim was to evaluate the characteristics of LR candidemia in adult patients. PATIENTS AND METHODS A retrospective cohort study was performed in the hospital district of Helsinki and Uusimaa in Finland (2007-2016). All candidemia cases were searched in an electronic database during the study period. Patients with LR candidemia were compared with patients with a single candidemia episode to evaluate the characteristics of LR candidemia. LR candidemia was defined as having at least two episodes of candidemia more than 30 days apart. RESULTS We identified 24 episodes of LR candidemia in 20 patients. Patients with LR candidemia represented 6% of all patients with candidemia during the study period, and most of these cases were nosocomial. The median time between the first and the recurrent episode was 5.1 months. One-year mortality in LR candidemia was 45%. Underlying gastrointestinal disease (OR 7.21, 95% CI 2.52-20.61) and history of intra-venous drug use (IVDU) (OR 3.62, 95% CI 1.03-12.69) were independent risk factors for LR candidemia in the multivariable analysis. CONCLUSION Our study indicates that the gastrointestinal tract may be a continuous source of infection in patients with chronic gastrointestinal diseases. Gastrointestinal diseases and IVDU should be regarded as risk factors for LR candidemia.
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Affiliation(s)
- Mari Ala-Houhala
- Inflammation Center, Division of Infectious Diseases, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Veli-Jukka Anttila
- Inflammation Center, Division of Infectious Diseases, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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