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Choi SH, Dagher M, Ruffin F, Park LP, Sharma-Kuinkel BK, Souli M, Morse AM, Eichenberger EM, Hale L, Kohler C, Warren B, Hansen B, Medie FM, McIntyre LM, Fowler VG. Risk Factors for Recurrent Staphylococcus aureus Bacteremia. Clin Infect Dis 2021; 72:1891-1899. [PMID: 32564065 DOI: 10.1093/cid/ciaa801] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 06/12/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND To understand the clinical, bacterial, and host characteristics associated with recurrent Staphylococcus aureus bacteremia (R-SAB), patients with R-SAB were compared to contemporaneous patients with a single episode of SAB (S-SAB). METHODS All SAB isolates underwent spa genotyping. All isolates from R-SAB patients underwent pulsed-field gel electrophoresis (PFGE). PFGE-indistinguishable pairs from 40 patients underwent whole genome sequencing (WGS). Acute phase plasma from R-SAB and S-SAB patients was matched 1:1 for age, race, sex, and bacterial genotype, and underwent cytokine quantification using 25-analyte multiplex bead array. RESULTS R-SAB occurred in 69 (9.1%) of the 756 study patients. Of the 69 patients, 30 experienced relapse (43.5%) and 39 reinfection (56.5%). Age, race, hemodialysis dependence, presence of foreign body, methicillin-resistant Staphyloccus aureus, and persistent bacteremia were individually associated with likelihood of recurrence. Multivariate risk modeling revealed that black hemodialysis patients were nearly 2 times more likely (odds ratio [OR] = 9.652 [95% confidence interval [CI], 5.402-17.418]) than white hemodialysis patients (OR = 4.53 [95% CI, 1.696-10.879]) to experience R-SAB. WGS confirmed PFGE interpretations in all cases. Median RANTES (regulated on activation, normal T cell expressed and secreted) levels in acute phase plasma from the initial episode of SAB were higher in R-SAB than in matched S-SAB controls (P = .0053, false discovery rate < 0.10). CONCLUSION This study identified several risk factors for R-SAB. The largest risk for R-SAB is among black hemodialysis patients. Higher RANTES levels in R-SAB compared to matched controls warrants further study.
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Affiliation(s)
- Seong-Ho Choi
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.,Division of Infectious Diseases, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Michael Dagher
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Felicia Ruffin
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Lawrence P Park
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.,Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | | | - Maria Souli
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.,Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Alison M Morse
- Departments of Molecular Genetics and Microbiology, University of Florida, Gainesville, Florida, USA.,University of Florida Genetics Institute University of Florida, Gainesville Florida, USA
| | - Emily M Eichenberger
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Lauren Hale
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Celia Kohler
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Bobby Warren
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Brenda Hansen
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.,Pediatric Gastroenterology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Felix Mba Medie
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Lauren M McIntyre
- Departments of Molecular Genetics and Microbiology, University of Florida, Gainesville, Florida, USA.,University of Florida Genetics Institute University of Florida, Gainesville Florida, USA
| | - Vance G Fowler
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.,Duke Clinical Research Institute, Durham, North Carolina, USA
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Podzolkov VI, Bragina AE. Chronic kidney disease as a multidisciplinary problem of contemporary medicine. TERAPEVT ARKH 2018; 90:121-129. [PMID: 30701915 DOI: 10.26442/terarkh2018906121-129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A review deals with the problem of chronic kidney disease (CKD) from the position of a physician and cardiologist. The epidemiology of the disease was discussed both abroad and in Russia, including the most up-to-date data. In Russia CKD markers were detected in 49.4% of hypertensives. Authors describe risk factors and mechanisms of CKD at the most important pathogenetic conditions: hypertension, diabetes and obesity. The current classification and methods for calculating the glomerular filtration rate are given. The review disclose a paradigm of the renal continuum and its relation to cardiovascular diseases. It is well known fact that the final causes of the death of patients with CKD, as a rule, are cardiovascular complications. Based on the literature data, the necessity and expediency of screening for renal dysfunction is justified. In the example of use of an angiotensin receptor blocker II - irbesartan nephroprotective demonstrated possibilities of intervention in patients with renal dysfunction of varying severity.
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Affiliation(s)
- V I Podzolkov
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University), Moscow, Russia
| | - A E Bragina
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University), Moscow, Russia
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Abstract
Gout affects 8.3 million Americans according to NHANES 2007-2008, approximately 3.9 % of the US population. Gout has substantial effect on physical function, productivity, health-related quality of life (HRQOL), and health care costs. Uncontrolled gout is also associated with significant use of emergency care services. Women are less likely to have gout than men, but in the postmenopausal years the gender difference in disease incidence decreases. Compared with whites, racial and/or ethnic minorities, especially blacks, have higher prevalence of gout. Blacks are also less likely to receive quality gout care, leading to disproportionate morbidity. Women are less likely than men to receive allopurinol, and less likely to undergo joint aspirations for crystal analysis to establish diagnosis, but those on urate-lowering therapy are as likely as, or more likely than, men to undergo serum urate check within six months of initiation. Although a few studies provide the knowledge related to gender and race and/or ethnicity disparities for gout, several knowledge gaps exist in gout epidemiology and outcomes differences by gender and race and/or ethnicity. These should be investigated in future studies.
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Affiliation(s)
- Jasvinder A Singh
- Medicine Service and Center for Surgical Medical Acute care Research and Transitions (C-SMART), Birmingham VA Medical Center, Birmingham, AL 35294, USA.
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Hall EC, Massie AB, James NT, Garonzik Wang JM, Montgomery RA, Berger JC, Segev DL. Effect of eliminating priority points for HLA-B matching on racial disparities in kidney transplant rates. Am J Kidney Dis 2011; 58:813-6. [PMID: 21802805 DOI: 10.1053/j.ajkd.2011.05.023] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 05/05/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND African Americans have lower rates of obtaining a deceased donor kidney transplant (DDKT) compared with their white counterparts. One proposed mechanism is differential HLA distributions between African Americans and whites. In May 2003, the United Network for Organ Sharing/Organ Procurement and Transplantation Network changed kidney allocation policy to eliminate priority based on HLA-B matching in an effort to address this disparity. The objective of this study was to quantify the effect of the change in policy regarding priority points for HLA-B matching. STUDY DESIGN Observational cohort study. SETTING & PARTICIPANTS A cohort of 178,902 patients registered for a DDKT between January 2000 and August 2009. FACTORS African Americans versus whites before and after the policy change. Cox models were adjusted for age, sex, diabetes, dialysis type, insurance status, education, panel-reactive antibody level, and blood type. OUTCOMES Adjusted relative rates (aRRs) of deceased donor kidney transplant for African Americans compared with whites. MEASUREMENTS Time from initial active wait listing to DDKT, censored for living donor kidney transplant and death. RESULTS Before the policy change, African Americans had 37% lower rates of DDKT (aRR, 0.63; 95% CI, 0.60-0.65; P < 0.001). After the policy change, African Americans had 23% lower rates of DDKT (aRR, 0.77; 95% CI, 0.76-0.79; P < 0.001). There was a 23% reduction in the disparity between African Americans and whites after the policy change (interaction aRR, 1.23; 95% CI, 1.18-1.29; P < 0.001). LIMITATIONS As an observational study, findings could have been affected by residual confounding or other changes in practice patterns. CONCLUSIONS Racial disparity in rates of DDKT was decreased by the HLA-B policy change, but parity was not achieved. There are unaddressed factors in kidney allocation that lead to continued disparity on the kidney transplant waiting list.
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Affiliation(s)
- Erin C Hall
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
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