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Foong KS. Embracing Diversity, Equity, and Inclusion: Am I Part of the Picture? Clin Infect Dis 2024; 78:6-7. [PMID: 37791961 DOI: 10.1093/cid/ciad490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/16/2023] [Indexed: 10/05/2023] Open
Affiliation(s)
- Kap Sum Foong
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, USA
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Smith M, Foong KS. Cefiderocol-associated brown chromaturia. BMJ Case Rep 2023; 16:e258207. [PMID: 38103906 PMCID: PMC10728909 DOI: 10.1136/bcr-2023-258207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Cefiderocol is a novel siderophore cephalosporin antibiotic. In the present case report, a woman in her 70s presented with a 1-week history of altered mental status and progressive purulent discharge from a non-healing diabetic foot ulcer on her right heel. MRI of the right foot revealed chronic osteomyelitis of the calcaneum. Surgical debridement was performed, and the tissue cultures grew extensively drug resistant (XDR) Pseudomonas aeruginosa, XDR Acinetobacter baumannii and Enterococcus faecalis The patient received ampicillin-sulbactam and cefiderocol. The antibiotic treatment course was complicated by brown urine discolouration. Investigations were unrevealing for haemoglobinuria, myoglobinuria and bilirubinuria. A side effect from cefiderocol was suspected and subsequently discontinued. Her urine colour returned to its normal colour within 3 days of discontinuation of cefiderocol.
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Foong KS, Mabayoje M, AlMajali A. Clinical Impact of Noninvasive Plasma Microbial Cell-Free Deoxyribonucleic Acid Sequencing for the Diagnosis and Management of Pneumocystis jirovecii Pneumonia: A Single-Center Retrospective Study. Open Forum Infect Dis 2022; 9:ofac652. [PMID: 36578518 PMCID: PMC9793099 DOI: 10.1093/ofid/ofac652] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/30/2022] [Indexed: 12/03/2022] Open
Abstract
We present 23 cases of Pneumocystis jirovecii pneumonia (PCP) diagnosed with commercially available noninvasive plasma microbial cell-free deoxyribonucleic acid (mcfDNA) assay. Our findings suggest that plasma mcfDNA testing resulted in positive clinical impact for the diagnosis and treatment of PCP and coinfections in 82.6% of cases.
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Affiliation(s)
- Kap Sum Foong
- Correspondence: K. S. Foong, MD, Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, 800 Washington Street, Boston, MA 02111 ()
| | - Mojolaoluwa Mabayoje
- Department of Medicine, University of Illinois College of Medicine, Peoria, Illinois, USA
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Foong KS, Munigala S, Kern-Allely S, Warren DK. Blood culture utilization practices among febrile and/or hypothermic inpatients. BMC Infect Dis 2022; 22:779. [PMID: 36217111 PMCID: PMC9552399 DOI: 10.1186/s12879-022-07748-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 09/23/2022] [Indexed: 12/04/2022] Open
Abstract
Background Predictors associated with the decision of blood culture ordering among hospitalized patients with abnormal body temperature are still underexplored, particularly non-clinical factors. In this study, we evaluated the factors affecting blood culture ordering in febrile and hypothermic inpatients. Methods We performed a retrospective study of 15,788 adult inpatients with fever (≥ 38.3℃) or hypothermia (< 36.0℃) from January 2016 to December 2017. We evaluated the proportion of febrile and hypothermic episodes with an associated blood culture performed within 24h. Generalized Estimating Equations were used to determine independent predictors associated with blood culture ordering among febrile and hypothermic inpatients. Results We identified 21,383 abnormal body temperature episodes among 15,788 inpatients (13,093 febrile and 8,290 hypothermic episodes). Blood cultures were performed in 36.7% (7,850/ 21,383) of these episodes. Predictors for blood culture ordering among inpatients with abnormal body temperature included fever ≥ 39℃ (adjusted odd ratio [aOR] 4.17, 95% confident interval [CI] 3.91–4.46), fever (aOR 3.48, 95% CI 3.27–3.69), presence of a central venous catheter (aOR 1.36, 95% CI 1.30–1.43), systemic inflammatory response (SIRS) plus hypotension (aOR 1.33, 95% CI 1.26–1.40), SIRS (aOR 1.26, 95% CI 1.20–1.31), admission to stem cell transplant / medical oncology services (aOR 1.09, 95% CI 1.04–1.14), and detection of abnormal body temperature during night shift (aOR 1.06, 95% CI 1.03–1.09) or on the weekend (aOR 1.05, 95% CI 1.01–1.08). Conclusion Blood culture ordering for hospitalized patients with fever or hypothermia is multifactorial; both clinical and non-clinical factors. These wide variations and gaps in practices suggest opportunities to improve utilization patterns. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07748-x.
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Affiliation(s)
- Kap Sum Foong
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA, USA.,Division of Infectious Diseases, Washington University School of Medicine Hospital Epidemiologist, Barnes-Jewish Hospital, 4523 Clayton Ave., Campus Box 8051, 63110, Saint Louis, MO, USA
| | - Satish Munigala
- Division of Infectious Diseases, Washington University School of Medicine Hospital Epidemiologist, Barnes-Jewish Hospital, 4523 Clayton Ave., Campus Box 8051, 63110, Saint Louis, MO, USA
| | - Stephanie Kern-Allely
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - David K Warren
- Division of Infectious Diseases, Washington University School of Medicine Hospital Epidemiologist, Barnes-Jewish Hospital, 4523 Clayton Ave., Campus Box 8051, 63110, Saint Louis, MO, USA.
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Helms JM, Ansteatt KT, Roberts JC, Kamatam S, Foong KS, Labayog JMS, Tarantino MD. Severe, Refractory Immune Thrombocytopenia Occurring After SARS-CoV-2 Vaccine. J Blood Med 2021; 12:221-224. [PMID: 33854395 PMCID: PMC8040692 DOI: 10.2147/jbm.s307047] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 03/15/2021] [Indexed: 12/13/2022] Open
Abstract
The rollout of the SARS-CoV-2 vaccine is underway, and millions have already been vaccinated. At least 25 reports of "immune thrombocytopenia" (ITP) or "thrombocytopenia" following the Moderna or Pfizer vaccine have been added to the Vaccine Adverse Event Reporting System (VAERS) in the US. ITP is a rare but known complication of several vaccinations. SARS-CoV-2 vaccine is new, with a novel mechanism of action, and understanding the epidemiology, clinical manifestations, treatment success and natural history of post-vaccination thrombocytopenia is evolving. We report a 74-year-old man who developed refractory thrombocytopenia within one day of receiving the Moderna SARS-CoV-2 vaccine. Several hours after vaccination, he developed significant epistaxis and cutaneous purpura. Severe thrombocytopenia was documented the following day, and he developed extremity weakness and encephalopathy with facial muscle weakness. Over a 14-day period, thrombocytopenia was treated first with high dose dexamethasone, intravenous immunoglobulin, platelet transfusions, rituximab, plasma exchange (for presumed acute inflammatory demyelinating polyneuropathy (AIDP)), and four daily doses of the thrombopoietin receptor agonist (TPO-RA) eltrombopag (Promacta™), without a platelet response. Three days later, he received the TPO-RA romiplostim (Nplate™). Five days later, his platelet count began to rise and by post-vaccination day 25, his platelet count was in the normal range. Thrombocytopenia was refractory to frontline and second-line treatment. The eventual rise in his platelet count suggests that one or both TPO-RAs may have impacted platelet recovery. Possibly, but less likely given the temporality, the drug-induced thrombocytopenia was subsiding. The aggressive use of immunosuppressive treatment may jeopardize the intended purpose of the SARS-CoV-2 vaccine, and earlier use of non-immunosuppressive second-line treatment for vaccine-related severe thrombocytopenia, such as with TPO-RAs, should be considered. While it is imperative to continue the global vaccination program, vigilance to the occurrence of post-vaccination severe thrombocytopenia is warranted.
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Affiliation(s)
- Jackie M Helms
- The Bleeding and Clotting Disorders Institute, Peoria, IL, USA
| | | | - Jonathan C Roberts
- The Bleeding and Clotting Disorders Institute, Peoria, IL, USA
- Department of Medicine, University of Illinois College of Medicine-Peoria, Peoria, IL, USA
| | - Sravani Kamatam
- Department of Medicine, Saint Francis Medical Center, Peoria, IL, USA
| | - Kap Sum Foong
- Department of Medicine, University of Illinois College of Medicine-Peoria, Peoria, IL, USA
- Department of Medicine, Saint Francis Medical Center, Peoria, IL, USA
| | - Jo-mel S Labayog
- Department of Medicine, OSF Sacred Heart Medical Center, Danville, IL, USA
| | - Michael D Tarantino
- The Bleeding and Clotting Disorders Institute, Peoria, IL, USA
- Department of Medicine, University of Illinois College of Medicine-Peoria, Peoria, IL, USA
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Foong KS, Sung A, Burnham JP, Kronen R, Lian Q, Salazar Zetina A, Hsueh K, Lin C, Powderly WG, Spec A. Risk factors predicting Candida infective endocarditis in patients with candidemia. Med Mycol 2021; 58:593-599. [PMID: 31613365 DOI: 10.1093/mmy/myz104] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 09/19/2019] [Accepted: 10/01/2019] [Indexed: 12/15/2022] Open
Abstract
Candida infective endocarditis (CIE) is a rare but serious complication of candidemia. Incidence and risk factors associated with CIE among candidemic patients are poorly defined from small cohorts. Identification of clinical predictors associated with this entity may guide more judicious use of cardiac imaging. We conducted a retrospective analysis of all inpatients aged ≥18 years diagnosed with candidemia at our institution. CIE was diagnosed by fulfilling two of the major Duke criteria: specifically a vegetation(s) on echocardiogram and positive blood cultures for Candida spp. We used univariable and multivariable regression analyses to identify risk factors associated with CIE. Of 1,873 patients with candidemia, 47 (2.5%) were identified to have CIE. In our multivariable logistic model, existing valvular heart disease was associated with a higher risk for CIE (adjusted odds ratio [aOR], 7.66; 95% confidence interval [CI], 2.95-19.84). Predictors that demonstrated a decreased risk of CIE included infection with C. glabrata (aOR, 0.17; 95% CI, 0.04-0.69), hematologic malignancy (aOR, 0.09; 95% CI, 0.01-0.68), and receipt of total parenteral nutrition (aOR, 0.38; 95% CI, 0.16-0.91). The 90-day crude mortality for CIE was 48.9%, similar to the overall non-CIE mortality of 41.9% (P = .338). We identified a set of clinical factors that can predict the presence of CIE among patient with candidemia. These findings may reduce the need for unnecessary expensive and invasive imaging studies in a subset of patients with a lower risk profile for endocarditis and alternative infection source.
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Affiliation(s)
- Kap Sum Foong
- Section of Infectious Diseases, University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA
| | - Abby Sung
- Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - Jason P Burnham
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri, USA
| | - Ryan Kronen
- Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - Qinghua Lian
- Washington University School of Medicine, St Louis, Missouri, USA
| | - Ana Salazar Zetina
- Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - Kevin Hsueh
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri, USA
| | - Charlotte Lin
- Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - William G Powderly
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri, USA
| | - Andrej Spec
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri, USA
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Foong KS, Hsueh K, Bailey TC, Luong L, Iqbal A, Hoehner C, Connor L, Casabar E, Lane M, Burnett Y, Ritchie D, Krekel T, Newland H, Weilmuenster L, Heuring B, Durkin MJ, Hamad Y. A Cluster of Cefepime-induced Neutropenia During Outpatient Parenteral Antimicrobial Therapy. Clin Infect Dis 2020; 69:534-537. [PMID: 30590400 DOI: 10.1093/cid/ciy1112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 12/21/2018] [Indexed: 01/20/2023] Open
Abstract
A cluster of cefepime-induced neutropenia (CIN) was identified from June 2017 to May 2018 in a regional outpatient parenteral antimicrobial therapy population. Our data suggest prolonged courses of cefepime (≥2 weeks), administered by rapid intravenous push, were associated with a higher risk of CIN.
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Affiliation(s)
- Kap Sum Foong
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine
| | - Kevin Hsueh
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine
| | - Thomas C Bailey
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine
| | - Lan Luong
- Center for Clinical Excellence, BJC HealthCare
| | | | | | - Lee Connor
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine
| | - Ed Casabar
- Department of Pharmacy, Barnes-Jewish Hospital
| | - Michael Lane
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine
| | - Yvonne Burnett
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine.,Department of Pharmacy Practice, St. Louis College of Pharmacy
| | - David Ritchie
- Department of Pharmacy, Barnes-Jewish Hospital.,Department of Pharmacy Practice, St. Louis College of Pharmacy
| | | | | | | | | | - Michael J Durkin
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine
| | - Yasir Hamad
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine
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Foong KS, Carlson AL, Munigala S, Burnham CAD, Warren DK. Clinical Impact of Revised Cefepime Breakpoint in Patients With Enterobacteriaceae Bacteremia. Open Forum Infect Dis 2019; 6:ofz341. [PMID: 31660387 PMCID: PMC6735685 DOI: 10.1093/ofid/ofz341] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/17/2019] [Indexed: 11/14/2022] Open
Abstract
The impact of the revised Clinical and Laboratory Standards Institute interpretative criteria for cefepime in Enterobacteriaceae remains unclear. We applied the new breakpoint on 644 previously defined cefepime-susceptible Enterobacteriaceae isolates. We found no differences in mortality or microbiological failure, regardless of isolates being susceptible or cefepime-susceptible dose-dependent by current criteria.
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Affiliation(s)
- Kap Sum Foong
- Section of Infectious Diseases, Department of Medicine, University of Peoria, Peoria, Illinois., St Louis, Missouri
| | - Abigail L Carlson
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri.,Veterans Affairs St. Louis Health Care System, St Louis, Missouri
| | - Satish Munigala
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
| | - Carey-Ann D Burnham
- Division of Laboratory and Genomic Medicine, Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - David K Warren
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
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Foong KS, Kronen R, Salazar AS, Hsueh K, Lin C, Powderly W, Spec A. 1030. Risk Predictive Model for Candida Endocarditis in Patients with Candidemia: A 12-year Experience in a Single Tertiary Care Hospital. Open Forum Infect Dis 2018. [PMCID: PMC6253236 DOI: 10.1093/ofid/ofy210.867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Methods Results Conclusion Disclosures
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Affiliation(s)
- Kap Sum Foong
- Infectious Diseases, Washington University in St. Louis, St. Louis, Missouri
| | - Ryan Kronen
- Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Ana S Salazar
- Washington University in St. Louis, School of Medicine, St. Louis, Missouri
| | - Kevin Hsueh
- Infectious Disease, Barns Jewish Hospital/Washington University in St.Louis, St. Louis, Missouri
| | - Charlotte Lin
- Internal Medicine, Washington University in St.Louis, St. Louis, Missouri
| | - William Powderly
- Infectious Diseases, Barns Jewish Hospital/Washington University in St.Louis, St. Louis, Missouri
| | - Andrej Spec
- Infectious Diseases, Barns Jewish Hospital/Washington University in St.Louis, St. Louis, Missouri
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Abstract
Drugs, toxins, and infections are known to cause acute eosinophilic pneumonia. Daptomycin and minocycline are the commonly reported antibiotics associated with acute eosinophilic pneumonia. In this study, we present a case of imipenem/cilastatin-induced acute eosinophilic pneumonia. The patient presented with fever, acute hypoxic respiratory distress, and diffuse ground-glass opacities on the chest CT a day after the initiation of imipenem/cilastatin. Patient also developed peripheral eosinophilia. A reinstitution of imipenem/cilastatin resulted in recurrence of the signs and symptoms. A bronchoscopy with bronchoalveolar lavage showed 780 nucleated cells/mm(3) with 15% eosinophil. The patient's clinical condition improved significantly after the discontinuation of imipenem/cilastatin therapy and the treatment with corticosteroid.
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Affiliation(s)
- Kap Sum Foong
- Department of Medicine, Crozer Chester Medical Center, Upland, Pennsylvania, USA
| | - Ashley Lee
- Department of Radiology, Washington University in Saint Louis, Saint Louis, Missouri, USA
| | - Marijeta Pekez
- Department of Radiology, Washington University in Saint Louis, Saint Louis, Missouri, USA
| | - Wei Bin
- Division of Pulmonary and Critical Care Medicine, Crozer-Chester Medical Center, Upland, Pennsylvania, USA
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Abstract
Patient: Male, 52 Final Diagnosis: Cryptococcal ventriculoperitoneal shunt infection Symptoms: Confusion • fever • Lethargy Medication: Amphotericin B • Flucytosine Clinical Procedure: Ventriculoperitoneal shunt removal Specialty: Infectious disease
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Affiliation(s)
- Kap Sum Foong
- Department of Medicine, Crozer Chester Medical Center, Upland, PA, USA
| | - Ashley Lee
- Department of Radiology, Washington University, St. Louis, MO, USA
| | - Gustavo Vasquez
- Division of Infectious Disease, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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