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Francisco DMA, Zhang L, Jiang Y, Olvera A, Adachi J, Guevara EY, Aitken SL, Garey KW, Peterson CB, Do KA, Dillon R, Obi EN, Jenq R, Okhuysen PC. Risk Factors Associated with Severe Clostridioides difficile Infection in Patients with Cancer. Infect Dis Ther 2023; 12:209-225. [PMID: 36443547 PMCID: PMC9868205 DOI: 10.1007/s40121-022-00722-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/31/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Antibiotic use is a risk factor for Clostridioides difficile infection (CDI). Few studies have correlated use of prior antibiotic classes with CDI, microbiome composition, and disease severity in patients with cancer. We hypothesized that previous antibiotic exposure and fecal microbiome composition at time of presentation are risk factors for severe CDI in patients with cancer. METHODS This non-interventional, prospective, cohort study examined 200 patients with cancer who had their first episode or first recurrence of CDI. C. difficile was identified using nucleic acid amplification testing. Univariate analysis was used to determine significant risk factors for severe CDI. Fecal microbiome composition was determined by sequencing the V3/V4 region of 16 s rDNA encoding gene. Differential abundance analyses were used to single out significant microbial features which differed across severity levels. RESULTS On univariate analysis, factors associated with severe CDI included the presence of toxin A/B in stools (odds ratio [OR] 2.14 [1.05-4.36] p = 0.04 and prior 90-day metronidazole use (OR 2.66 [1.09-6.50] p = 0.03). Although alpha and beta diversity was similar between disease severity groups and toxin A/B in stools, increased abundance of Bacteroides uniformis, Ruminococcaceae, and Citrobacter koseri were associated with protection from severe CDI (p < 0.05) and depletion of anaerobes was higher in patients with prior metronidazole exposure. CONCLUSION Use of metronidazole for non-CDI indications within 90 days prior to diagnosis and presence of toxin A/B in stools were associated with severe CDI. Findings provide valuable insights into risk factors for severe CDI in an underserved population with cancer that warrants further exploration.
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Affiliation(s)
- Denise Marie A. Francisco
- grid.39382.330000 0001 2160 926XSection of Infectious Diseases, Baylor College of Medicine, Houston, TX USA ,grid.430852.80000 0001 0741 4132College of Medicine, University of Illinois, Peoria C/O 530 NE Glen Oak Avenue, Peoria, IL 61637 USA
| | - Liangliang Zhang
- grid.240145.60000 0001 2291 4776Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Ying Jiang
- grid.240145.60000 0001 2291 4776Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1460, Houston, TX 77030 USA
| | - Adilene Olvera
- grid.240145.60000 0001 2291 4776Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1460, Houston, TX 77030 USA
| | - Javier Adachi
- grid.240145.60000 0001 2291 4776Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1460, Houston, TX 77030 USA
| | - Eduardo Yepez Guevara
- grid.240145.60000 0001 2291 4776Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1460, Houston, TX 77030 USA
| | - Samuel L. Aitken
- grid.240145.60000 0001 2291 4776Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Kevin W. Garey
- grid.266436.30000 0004 1569 9707College of Pharmacy, University of Houston, Houston, TX USA
| | - Christine B. Peterson
- grid.240145.60000 0001 2291 4776Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Kim-Anh Do
- grid.240145.60000 0001 2291 4776Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Ryan Dillon
- grid.417993.10000 0001 2260 0793Merck & Co., Inc., Kenilworth, NJ USA
| | - Engels N. Obi
- grid.417993.10000 0001 2260 0793Merck & Co., Inc., Kenilworth, NJ USA
| | - Robert Jenq
- grid.240145.60000 0001 2291 4776Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Pablo C. Okhuysen
- grid.39382.330000 0001 2160 926XSection of Infectious Diseases, Baylor College of Medicine, Houston, TX USA ,grid.240145.60000 0001 2291 4776Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1460, Houston, TX 77030 USA
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Meng L, Huang J, He Q, Zhao Y, Zhao W, Tan J, Sun S, Yang J. Hypnotics and infections: disproportionality analysis of the U.S. Food & Drug Administration adverse event reporting system database. J Clin Sleep Med 2022; 18:2229-2235. [PMID: 35713182 PMCID: PMC9435343 DOI: 10.5664/jcsm.10094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 04/24/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES There is no consensus information on infections associated with nonbenzodiazepines. Knowledge about infections related to newly marketed hypnotics (orexin receptor antagonists and melatonin receptor agonists) is scarce. The study aimed to detect infection signals for nonbenzodiazepines, orexin receptor antagonists, and melatonin receptor agonists by analyzing data from the U.S. Food & Drug Administration adverse event reporting system. METHODS A disproportionality analysis was performed to quantitatively detect infection signals for hypnotics by calculating the reporting odds ratio and the 95% confidence interval. Data registered in the U.S. Food & Drug Administration adverse event reporting system from 2010-2020 were retrieved. RESULTS A total of 3,092 patients with infection were extracted for the 3 classes of hypnotic drugs. Nonbenzodiazepines were associated with a higher disproportionality of infections (reporting odds ratio: 1.10; 95% confidence interval, 1.06-1.14). The association of infections was not present for melatonin receptor agonists (reporting odds ratio: 0.86; 95% confidence interval, 0.74-1.00) and orexin receptor antagonists (reporting odds ratio: 0.19; 95% confidence interval, 0.15-0.25). Significant reporting associations were identified for nonbenzodiazepines concerning the categories of bone and joint infections, dental and oral soft tissue infections, upper respiratory tract infections, and urinary tract infections. CONCLUSIONS Nonbenzodiazepines had a positive signal for infections, while orexin receptor antagonists and melatonin receptor agonists had a negative signal. More research needs to be conducted to confirm this relationship. CITATION Meng L, Huang J, He Q, et al. Hypnotics and infections: disproportionality analysis of the U.S. Food & Drug Administration adverse event reporting system database. J Clin Sleep Med. 2022;18(9):2229-2235.
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Affiliation(s)
- Long Meng
- Department of Pharmacy, The First Affiliated Hospital of Chongqing Medical University; Key Laboratory of Biochemistry and Molecular Pharmacology, Department of Pharmacology, Chongqing Medical University, Chongqing, China
| | - Jing Huang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qin He
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yibei Zhao
- Key Laboratory of Biochemistry and Molecular Pharmacology, Department of Pharmacology, Chongqing Medical University, Chongqing, China
| | - Wenlong Zhao
- College of Medical Informatics, Chongqing Medical University; Medical Data Science Academy, Chongqing Medical University, Chongqing, China
| | - Juntao Tan
- Medical Records and Statistics Room, People’s Hospital of Chongqing Banan District, Chongqing, China
| | - Shusen Sun
- Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Western New England University, Springfield, MA
- Department of Pharmacy, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Junqing Yang
- Key Laboratory of Biochemistry and Molecular Pharmacology, Department of Pharmacology, Chongqing Medical University, Chongqing, China
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Hinderer RK, Litt AR, McCaffery M. Habitat selection by a threatened desert amphibian. Ecol Evol 2021; 11:536-546. [PMID: 33437449 PMCID: PMC7790612 DOI: 10.1002/ece3.7074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 09/22/2020] [Accepted: 10/23/2020] [Indexed: 11/11/2022] Open
Abstract
Habitat degradation and fragmentation are major drivers of amphibian declines. The loss of environmental features that allow for movement between water sources may be particularly detrimental for amphibians in arid environments. Climate changes will increase the importance of microhabitats to amphibians. Enhancing areas to facilitate movement may be a necessary conservation strategy for many animal species that depend on wetlands, including federally threatened Chiricahua leopard frogs (Lithobates chiricahuensis). Habitat preferences of this frog species are not well understood. We sought to better understand fine-scale habitat selection, to inform conservation of Chiricahua leopard frogs. We conducted our study on the Ladder Ranch, a privately owned working bison ranch in New Mexico, USA that supports a large proportion of the remaining Chiricahua leopard frogs in the state. We attached radio transmitters to 44 frogs during summer 2014. We located each frog daily for up to 8 weeks (median = 30 days). We assessed fine-scale habitat selection by comparing characteristics at each frog location and a random location 5 m away using conditional logistic regression. Frogs preferred features that likely reduce desiccation, even after accounting for the presence of water. Frogs selected areas with more low-lying cover, especially aquatic vegetation and woody debris, a tree overstory, and a mud substrate. We recommend managing potential movement corridors for Chiricahua leopard frogs by ensuring the presence of muddy creek bottoms, woody debris, riparian overstory, low-lying ground cover, and pools. Microclimates created by these features seem especially valuable given warming temperatures and modified precipitation regimes, resulting in decreased surface water, soil moisture, and vegetation cover. Retaining or creating preferred habitat features and microclimates in areas between water sources may increase connectivity among isolated populations of Chiricahua leopard frogs and could improve persistence and recovery of other water-obligate species in arid landscapes.
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Affiliation(s)
| | - Andrea R. Litt
- Department of EcologyMontana State UniversityBozemanMTUSA
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Lalani F, Young EH, Panchal RM, Reveles KR. GABAergic but not Antidepressant Medications Increase Risk for Clostridioides difficile Infection in a National Cohort of Veterans. Open Forum Infect Dis 2020; 7:ofaa353. [PMID: 32939356 PMCID: PMC7486948 DOI: 10.1093/ofid/ofaa353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 08/10/2020] [Indexed: 12/20/2022] Open
Abstract
Background Clostridioides difficile infection (CDI) is primarily mediated by alterations in the host gut ecosystem. While antibiotic use is the primary risk factor for CDI, other medications that modulate the gut ecosystem, particularly those targeting the gut-brain axis, could impact CDI risk. This study aimed to investigate the association between recent antidepressant and gamma-aminobutyric acid (GABA)-ergic medication use with CDI risk in a national cohort of United States veterans. Methods This was a retrospective case-control study of patients seen in Veterans Health Administration facilities from October 2002 to September 2014. CDI and non-CDI control patients were propensity score matched 1:1 using a maximum caliper of 0.0001. Antidepressant and GABAergic medication use 90 days before cohort inclusion were analyzed for CDI association using bivariable and multivariable logistic regression models. Results A total of 85 831 patients were included, and 9287 CDI and 9287 control patients were propensity score matched. Antidepressant use overall was not significantly associated with CDI risk (odds ratio [OR], 1.05; 95% CI, 0.98-1.12), although GABAergic medication use was associated with increased risk (OR, 1.81; 95% CI, 1.70-1.92). In multivariable models of individual medications/classes, benzodiazepines had the strongest CDI association (OR, 1.91; 95% CI, 1.77-2.07). SSRIs (OR, 0.88; 95% CI, 0.81-0.95) and bupropion (OR, 0.67; 95% CI, 0.57-0.78) were negatively associated with CDI. Conclusions In this national study of veterans, GABAergic medication use was a positive predictor of CDI risk, though antidepressant use was not. Further research is needed to understand biological mechanisms, and confirmatory studies are needed to validate these findings.
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Affiliation(s)
- Falak Lalani
- College of Pharmacy, The University of Texas at Austin, Austin, Texas, USA.,Pharmacotherapy Education & Research Center, UT Health San Antonio, San Antonio, Texas, USA
| | - Eric H Young
- College of Pharmacy, The University of Texas at Austin, Austin, Texas, USA.,Pharmacotherapy Education & Research Center, UT Health San Antonio, San Antonio, Texas, USA
| | - Rupesh M Panchal
- College of Pharmacy, The University of Texas at Austin, Austin, Texas, USA.,Pharmacotherapy Education & Research Center, UT Health San Antonio, San Antonio, Texas, USA
| | - Kelly R Reveles
- College of Pharmacy, The University of Texas at Austin, Austin, Texas, USA.,Pharmacotherapy Education & Research Center, UT Health San Antonio, San Antonio, Texas, USA.,South Texas Veterans Health Care System, San Antonio, Texas, USA
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