1
|
Okhuysen PC, Ramesh MS, Louie T, Kiknadze N, Torre-Cisneros J, de Oliveira CM, Van Steenkiste C, Stychneuskaya A, Garey KW, Garcia-Diaz J, Li J, Duperchy E, Chang BY, Sukbuntherng J, Montoya JG, Styles L, Clow F, James D, Dubberke ER, Wilcox M. A Randomized, Double-Blind, Phase 3 Safety and Efficacy Study of Ridinilazole Versus Vancomycin for Treatment of Clostridioides difficile Infection: Clinical Outcomes With Microbiome and Metabolome Correlates of Response. Clin Infect Dis 2024:ciad792. [PMID: 38305378 DOI: 10.1093/cid/ciad792] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Exposure to antibiotics predisposes to dysbiosis and Clostridioides difficile infection (CDI) that can be severe, recurrent (rCDI), and life-threatening. Nonselective drugs that treat CDI and perpetuate dysbiosis are associated with rCDI, in part due to loss of microbiome-derived secondary bile acid (SBA) production. Ridinilazole is a highly selective drug designed to treat CDI and prevent rCDI. METHODS In this phase 3 superiority trial, adults with CDI, confirmed with a stool toxin test, were randomized to receive 10 days of ridinilazole (200 mg twice daily) or vancomycin (125 mg 4 times daily). The primary endpoint was sustained clinical response (SCR), defined as clinical response and no rCDI through 30 days after end of treatment. Secondary endpoints included rCDI and change in relative abundance of SBAs. RESULTS Ridinilazole and vancomycin achieved an SCR rate of 73% versus 70.7%, respectively, a treatment difference of 2.2% (95% CI: -4.2%, 8.6%). Ridinilazole resulted in a 53% reduction in recurrence compared with vancomycin (8.1% vs 17.3%; 95% CI: -14.1%, -4.5%; P = .0002). Subgroup analyses revealed consistent ridinilazole benefit for reduction in rCDI across subgroups. Ridinilazole preserved microbiota diversity, increased SBAs, and did not increase the resistome. Conversely, vancomycin worsened CDI-associated dysbiosis, decreased SBAs, increased Proteobacteria abundance (∼3.5-fold), and increased the resistome. CONCLUSIONS Although ridinilazole did not meet superiority in SCR, ridinilazole greatly reduced rCDI and preserved microbiome diversity and SBAs compared with vancomycin. These findings suggest that treatment of CDI with ridinilazole results in an earlier recovery of gut microbiome health. Clinical Trials Registration.Ri-CoDIFy 1 and 2: NCT03595553 and NCT03595566.
Collapse
Affiliation(s)
- Pablo C Okhuysen
- Department of Infectious Diseases, Infection Control, and Employee Heatlh, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Thomas Louie
- Foothills Medical Center and University of Calgary, Calgary, Canada
| | | | - Julian Torre-Cisneros
- Reina Sofia University Hospital-IMIBIC, University of Córdoba, CIBERINFEC, Cordoba, Spain
| | | | | | | | - Kevin W Garey
- University of Houston College of Pharmacy, Houston, Texas, USA
| | | | - Jianling Li
- Summit Therapeutics, Menlo Park, California, USA
| | | | | | | | - Jose G Montoya
- Summit Therapeutics, Menlo Park, California, USA
- Dr. Jack S. Remington Laboratory for Specialty Diagnostics, Palo Alto Medical Foundation, Palo Alto, California, USA
| | - Lori Styles
- Summit Therapeutics, Menlo Park, California, USA
| | - Fong Clow
- Summit Therapeutics, Menlo Park, California, USA
| | | | - Erik R Dubberke
- Washington University School of Medicine, St.Louis, Missouri, USA
| | - Mark Wilcox
- Leeds Teaching Hospitals and University of Leeds, School of Medicine, Leeds, United Kingdom
| |
Collapse
|
2
|
Monday LM, Brar I, Alangaden G, Ramesh MS. SARS-CoV-2 neutralizing antibodies for COVID-19: Outcomes for bamlanivimab versus bamlanivimab-etesevimab combination in a racially diverse cohort of patients with significant comorbidities. J Clin Pharm Ther 2022; 47:1438-1443. [PMID: 35633095 PMCID: PMC9348308 DOI: 10.1111/jcpt.13694] [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: 12/22/2021] [Revised: 03/30/2022] [Accepted: 04/11/2022] [Indexed: 11/27/2022]
Abstract
What Is Known and Objective Anti‐spike monoclonal antibodies (MAB) including bamlanivimab (BAM) and bamlanivimab/etesevimab (BAM/E) have shown reduced hospitalization rates for non‐severe coronavirus disease 2019 (COVID‐19) in clinical trials. Recent data have provided real‐world hospitalization rates for high‐risk patients treated with BAM, however, data on a similar cohort treated with BAM/E are lacking. Methods This retrospective cohort study evaluated outpatients ≥18 years with laboratory‐confirmed mild/moderate COVID‐19 who received MAB from 1 December 2020 to 19 April 2021. Use of BAM monotherapy changed to BAM/E combination on 27 March 2021. Primary outcome was overall rate of COVID‐19 related‐hospitalization, including comparison of hospitalization rates between MAB‐formulation groups. Secondary outcomes were 30‐day mortality and length of stay (LOS). Results and Discussion The population included 643 patients (BAM and BAM/E); median age was 58 years, 43% were male, median BMI was 33 kg/m2, and 24% self‐identified as Black. Patients in the BAM/E combination group were significantly younger with higher median BMI and a longer time from symptom onset to infusion. The incidence of 30‐day COVID‐19 related hospitalization was similar between patients receiving either BAM or BAM/E combination (7.8% and 7.2%, respectively). What Is New and Conclusion This study represents the first such publication of real‐world BAM/E hospitalization outcomes. Hospitalization rates utilizing BAM/E were comparable to BAM in our real‐world study.
Collapse
Affiliation(s)
- Lea M Monday
- Division of Infectious Diseases, Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan, USA.,School of Medicine, Wayne State University, Detroit, Michigan, USA
| | - Indira Brar
- Division of Infectious Diseases, Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan, USA.,School of Medicine, Wayne State University, Detroit, Michigan, USA
| | - George Alangaden
- Division of Infectious Diseases, Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan, USA.,School of Medicine, Wayne State University, Detroit, Michigan, USA
| | - Mayur S Ramesh
- Division of Infectious Diseases, Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan, USA.,School of Medicine, Wayne State University, Detroit, Michigan, USA
| |
Collapse
|
3
|
Swaminathan L, Kaatz S, Chubb H, Tae K, Ramesh MS, Fadel R, Big C, Jones J, Flanders SA, Prescott HC. Impact of Early Corticosteroids on Preventing Clinical Deterioration in Non-critically Ill Patients Hospitalized with COVID-19: A Multi-hospital Cohort Study. Infect Dis Ther 2022; 11:887-898. [PMID: 35267172 PMCID: PMC8908754 DOI: 10.1007/s40121-022-00615-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 02/23/2022] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION While guidelines stronglyrecommend dexamethasone in critical COVID-19, the optimal threshold to initiate corticosteroids in non-critically ill patients with COVID-19 remains unclear. Using data from a state-wide COVID-19 registry, we evaluated the effectiveness of early corticosteroids for preventing clinical deterioration among non-critically ill patients hospitalized for COVID-19 and receiving non-invasive oxygen therapy. METHODS This was a target trial using observational data from patients hospitalized for COVID-19 at 39 hospitals participating in the MI-COVID19 registry between March 16, 2020 and August 24, 2020. We studied the impact of corticosteroids initiated within 2 calendar days of hospitalization ("early steroids") versus no early steroids among non-ICU patients with laboratory-confirmed SARS-CoV2 receiving non-invasive supplemental oxygen therapy. Our primary outcome was a composite of in-hospital mortality, transfer to intensive care, and receipt of invasive mechanical ventilation. We used inverse probability of treatment weighting (IPTW) and propensity score-weighted regression to measure the association of early steroids and outcomes. RESULTS Among 1002 patients meeting study criteria, 231 (23.1%) received early steroids. After IPTW, to balance potential confounders between the treatment groups, early steroids were not associated with a decrease in the composite outcome (aOR 1.1, 95%CI 0.8-1.6) or in any components of the primary outcome. CONCLUSION We found no evidence that early corticosteroid therapy prevents clinical deterioration among hospitalized non-critically ill COVID-19 patients receiving non-invasive oxygen therapy. Further studies are needed to determine the optimal threshold for initiating corticosteroids in this population.
Collapse
Affiliation(s)
- Lakshmi Swaminathan
- Division of Hospital Medicine, St. Joseph Mercy Hospital, 5301 McAuley Dr, Ypsilanti, 48197, USA.
| | - Scott Kaatz
- Division of Hospital Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Heather Chubb
- Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI), Ann Arbor, USA
| | - Kim Tae
- Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI), Ann Arbor, USA
| | - Mayur S Ramesh
- Division of Infectious Disease, Henry Ford Hospital, Detroit, MI, USA
| | - Raef Fadel
- Division of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Cecilia Big
- Division of Infectious Disease, Beaumont Hospital-Dearborn, Dearborn, MI, USA
| | - Jessica Jones
- Department of Pharmacy, Beaumont Hospital-Dearborn, Dearborn, MI, USA
| | - Scott A Flanders
- Division of Hospital Medicine, University of Michigan, Ann Arbor, MI, USA
- Michigan Hospital Medicine Safety Consortium, Ann Arbor, MI, USA
| | - Hallie C Prescott
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
- VA Center for Clinical Management Research, Ann Arbor, MI, USA
| |
Collapse
|
4
|
Bhagwat SS, Hariharan P, Joshi PR, Palwe SR, Shrivastava R, Patel MV, Devanga Ragupathi NK, Bakthavatchalam YD, Ramesh MS, Soman R, Veeraraghavan B. Activity of cefepime/zidebactam against MDR Escherichia coli isolates harbouring a novel mechanism of resistance based on four-amino-acid inserts in PBP3. J Antimicrob Chemother 2021; 75:3563-3567. [PMID: 32772098 DOI: 10.1093/jac/dkaa353] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/16/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Recent reports reveal the emergence of Escherichia coli isolates harbouring a novel resistance mechanism based on four-amino-acid inserts in PBP3. These organisms concomitantly expressed ESBLs or/and serine-/metallo-carbapenemases and were phenotypically detected by elevated aztreonam/avibactam MICs. OBJECTIVES The in vitro activities of the investigational antibiotic cefepime/zidebactam and approved antibiotics (ceftazidime/avibactam, ceftolozane/tazobactam, imipenem/relebactam and others) were determined against E. coli isolates harbouring four-amino-acid inserts in PBP3. METHODS Whole-genome sequenced E. coli isolates (n = 89) collected from a large tertiary care hospital in Southern India (n = 64) and from 12 tertiary care hospitals located across India (n = 25) during 2016-18, showing aztreonam/avibactam MICs ≥1 mg/L (≥4 times the aztreonam epidemiological cut-off) were included in this study. The MICs of antibiotics were determined using the reference broth microdilution method. RESULTS Four-amino-acid inserts [YRIK (n = 30) and YRIN (n = 53)] were found in 83/89 isolates. Among 83 isolates, 65 carried carbapenemase genes [blaNDM (n = 39), blaOXA-48-like (n = 11) and blaNDM + blaOXA-48-like (n = 15)] and 18 isolates produced ESBLs/class C β-lactamases only. At least 16 unique STs were noted. Cefepime/zidebactam demonstrated potent activity, with all isolates inhibited at ≤1 mg/L. Comparator antibiotics including ceftazidime/avibactam and imipenem/relebactam showed limited activities. CONCLUSIONS E. coli isolates concurrently harbouring four-amino-acid inserts in PBP3 and NDM are an emerging therapeutic challenge. Assisted by the PBP2-binding action of zidebactam, the cefepime/zidebactam combination overcomes both target modification (PBP3 insert)- and carbapenemase (NDM)-mediated resistance mechanisms in E. coli.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Mayur S Ramesh
- Department of Infectious Disease, Henry Ford Hospital, Detroit, MI, USA
| | - Rajeev Soman
- Department of Infectious Diseases, Jupiter Hospital, Pune, India
| | | |
Collapse
|
5
|
Alangaden G, Ramesh MS. Reply to Fernandez Cruz, et al. Clin Infect Dis 2021; 72:1487. [PMID: 32589700 DOI: 10.1093/cid/ciaa870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- George Alangaden
- Infectious Diseases, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mayur S Ramesh
- Infectious Diseases, Henry Ford Hospital, Detroit, Michigan, USA
| |
Collapse
|
6
|
Heldman MR, Kates OS, Haydel BM, Florman SS, Rana MM, Chaudhry ZS, Ramesh MS, Safa K, Kotton CN, Blumberg EA, Besharatian BD, Tanna SD, Ison MG, Malinis M, Azar MM, Rakita RM, Morillas JA, Majeed A, Sait AS, Spaggiari M, Hemmige V, Mehta SA, Neumann H, Badami A, Jeng A, Goldman JD, Lala A, Hemmersbach-Miller M, McCort ME, Bajrovic V, Ortiz-Bautista C, Friedman-Moraco R, Sehgal S, Lease ED, Limaye AP, Fisher CE. Healthcare resource use among solid organ transplant recipients hospitalized with COVID-19. Clin Transplant 2020; 35:e14174. [PMID: 33349940 PMCID: PMC7883125 DOI: 10.1111/ctr.14174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 11/18/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Madeleine R Heldman
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Olivia S Kates
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Brandy M Haydel
- Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sander S Florman
- Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Meenakshi M Rana
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Zohra S Chaudhry
- Transplantation Infectious Diseases and Immunotherapy, Henry Ford Health System, Detroit, MI, USA
| | - Mayur S Ramesh
- Transplantation Infectious Diseases and Immunotherapy, Henry Ford Health System, Detroit, MI, USA
| | - Kassem Safa
- Transplant Center and Division of Nephrology, Massachusetts General Hospital, Boston, MA, USA
| | - Camille N Kotton
- Transplant Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Emily A Blumberg
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Behdad D Besharatian
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sajal D Tanna
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael G Ison
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Maricar Malinis
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Marwan M Azar
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Robert M Rakita
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Jose A Morillas
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH, USA
| | - Aneela Majeed
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH, USA
| | - Afrah S Sait
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Mario Spaggiari
- Division of Transplantation, University of Illinois at Chicago, Chicago, IL, USA
| | - Vagish Hemmige
- Division of Infectious Disease, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | | | | | - Abbasali Badami
- SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Amy Jeng
- SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Jason D Goldman
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA.,Swedish Center for Research and Innovation, Swedish Medical Center, Seattle, WA, USA
| | - Anuradha Lala
- Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Margaret E McCort
- Division of Infectious Disease, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Valida Bajrovic
- Division of Infectious Disease, Department of Medicine, University of Colorado, Aurora, CO, USA
| | | | - Rachel Friedman-Moraco
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, GA, USA
| | - Sameep Sehgal
- Department of Thoracic Medicine and Surgery, Temple University, Philadelphia, PA, USA
| | - Erika D Lease
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA, USA
| | - Ajit P Limaye
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Cynthia E Fisher
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
| |
Collapse
|
7
|
Fadel R, Morrison AR, Vahia A, Smith ZR, Chaudhry Z, Bhargava P, Miller J, Kenney RM, Alangaden G, Ramesh MS. Early Short-Course Corticosteroids in Hospitalized Patients With COVID-19. Clin Infect Dis 2020; 71:2114-2120. [PMID: 32427279 PMCID: PMC7314133 DOI: 10.1093/cid/ciaa601] [Citation(s) in RCA: 262] [Impact Index Per Article: 65.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/15/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND There is no proven antiviral or immunomodulatory therapy for coronavirus disease 2019 (COVID-19). The disease progression associated with the proinflammatory host response prompted us to examine the role of early corticosteroid therapy in patients with moderate to severe COVID-19. METHODS We conducted a single pretest, single posttest quasi-experiment in a multicenter health system in Michigan from 12 March to 27 March 2020. Adult patients with confirmed moderate to severe COVID were included. A protocol was implemented on 20 March 2020 using early, short-course, methylprednisolone 0.5 to 1 mg/kg/day divided in 2 intravenous doses for 3 days. Outcomes of standard of care (SOC) and early corticosteroid groups were evaluated, with a primary composite endpoint of escalation of care from ward to intensive care unit (ICU), new requirement for mechanical ventilation, and mortality. All patients had at least 14 days of follow-up. RESULTS We analyzed 213 eligible subjects, 81 (38%) and 132 (62%) in SOC and early corticosteroid groups, respectively. The composite endpoint occurred at a significantly lower rate in the early corticosteroid group (34.9% vs 54.3%, P = .005). This treatment effect was observed within each individual component of the composite endpoint. Significant reduction in median hospital length of stay was also observed in the early corticosteroid group (5 vs 8 days, P < .001). Multivariate regression analysis demonstrated an independent reduction in the composite endpoint at 14-days controlling for other factors (adjusted odds ratio: 0.41; 95% confidence interval, .22 - .77). CONCLUSIONS An early short course of methylprednisolone in patients with moderate to severe COVID-19 reduced escalation of care and improved clinical outcomes. CLINICAL TRIALS REGISTRATION NCT04374071.
Collapse
Affiliation(s)
- Raef Fadel
- Internal Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | | | - Amit Vahia
- Infectious Diseases, Henry Ford Hospital, Detroit, Michigan, USA
| | | | - Zohra Chaudhry
- Infectious Diseases, Henry Ford Hospital, Detroit, Michigan, USA
| | - Pallavi Bhargava
- Infectious Diseases, Henry Ford Hospital, Detroit, Michigan, USA
| | - Joseph Miller
- Emergency Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | | | - George Alangaden
- Infectious Diseases, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mayur S Ramesh
- Infectious Diseases, Henry Ford Hospital, Detroit, Michigan, USA
| |
Collapse
|
8
|
Chaudhry ZS, Williams JD, Vahia A, Fadel R, Parraga Acosta T, Prashar R, Shrivastava P, Khoury N, Pinto Corrales J, Williams C, Nagai S, Abouljoud M, Samaniego-Picota M, Abreu-Lanfranco O, del Busto R, Ramesh MS, Patel A, Alangaden GJ. Clinical characteristics and outcomes of COVID-19 in solid organ transplant recipients: A cohort study. Am J Transplant 2020; 20:3051-3060. [PMID: 32654332 PMCID: PMC7405160 DOI: 10.1111/ajt.16188] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [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: 05/18/2020] [Revised: 06/24/2020] [Accepted: 06/28/2020] [Indexed: 01/25/2023]
Abstract
Solid organ transplant recipients (SOTr) with coronavirus disease 2019 (COVID-19) are expected to have poorer outcomes compared to nontransplant patients because of immunosuppression and comorbidities. The clinical characteristics of 47 SOTr (38 kidneys and 9 nonkidney organs) were compared to 100 consecutive hospitalized nontransplant controls. Twelve of 47 SOTr managed as outpatients were subsequently excluded from the outcome analyses to avoid potential selection bias. Chronic kidney disease (89% vs 57% P = .0007), diabetes (66% vs 33% P = .0007), and hypertension (94% vs 72% P = .006) were more common in the 35 hospitalized SOTr compared to controls. Diarrhea (54% vs 17%, P < .0001) was more frequent in SOTr. Primary composite outcome (escalation to intensive care unit, mechanical ventilation, or in-hospital all-cause mortality) was comparable between SOTr and controls (40% vs 48%, odds ratio [OR] 0.72 confidence interval [CI] [0.33-1.58] P = .42), despite more comorbidities in SOTr. Acute kidney injury requiring renal replacement therapy occurred in 20% of SOTr compared to 4% of controls (OR 6 CI [1.64-22] P = .007). Multivariate analysis demonstrated that increasing age and clinical severity were associated with mortality. Transplant status itself was not associated with mortality.
Collapse
Affiliation(s)
- Zohra S. Chaudhry
- Division of Infectious Diseases, Henry Ford Hospital, Detroit, Michigan, USA
| | | | - Amit Vahia
- Division of Infectious Diseases, Henry Ford Hospital, Detroit, Michigan, USA
| | - Raef Fadel
- Department of Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | | | - Rohini Prashar
- Division of Nephrology, Henry Ford Transplant Institute, Detroit, Michigan, USA
| | - Pritika Shrivastava
- Division of Nephrology, Henry Ford Transplant Institute, Detroit, Michigan, USA
| | - Nadeen Khoury
- Division of Nephrology, Henry Ford Transplant Institute, Detroit, Michigan, USA
| | - Julio Pinto Corrales
- Division of Pulmonology, Henry Ford Transplant Institute, Detroit, Michigan, USA
| | - Celeste Williams
- Division of Cardiology, Henry Ford Transplant Institute, Detroit, Michigan, USA
| | - Shunji Nagai
- Division of Hepatology, Henry Ford Transplant Institute, Detroit, Michigan, USA
| | - Marwan Abouljoud
- Division of Hepatology, Henry Ford Transplant Institute, Detroit, Michigan, USA
| | | | | | - Ramon del Busto
- Division of Infectious Diseases, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mayur S. Ramesh
- Division of Infectious Diseases, Henry Ford Hospital, Detroit, Michigan, USA
| | - Anita Patel
- Division of Nephrology, Henry Ford Transplant Institute, Detroit, Michigan, USA
| | - George J. Alangaden
- Division of Infectious Diseases, Henry Ford Hospital, Detroit, Michigan, USA,Correspondence George J. Alangaden
| |
Collapse
|
9
|
Zervos M, Arshad S, Kilgore P, Chaudhry ZS, Jacobsen G, Wang DD, Huitsing K, Brar I, Alangaden GJ, Ramesh MS, McKinnon JE, O’Neill W. A sound approach: Hydroxychloroquine reduces mortality in severe COVID-19. Int J Infect Dis 2020; 99:138-139. [PMID: 32745629 PMCID: PMC7834717 DOI: 10.1016/j.ijid.2020.07.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 11/28/2022] Open
|
10
|
Kates OS, Haydel BM, Florman SS, Rana MM, Chaudhry ZS, Ramesh MS, Safa K, Kotton CN, Blumberg EA, Besharatian BD, Tanna SD, Ison MG, Malinis M, Azar MM, Rakita RM, Morillas JA, Majeed A, Sait AS, Spaggiari M, Hemmige V, Mehta SA, Neumann H, Badami A, Goldman JD, Lala A, Hemmersbach-Miller M, McCort ME, Bajrovic V, Ortiz-Bautista C, Friedman-Moraco R, Sehgal S, Lease ED, Fisher CE, Limaye AP. COVID-19 in solid organ transplant: A multi-center cohort study. Clin Infect Dis 2020; 73:e4090-e4099. [PMID: 32766815 PMCID: PMC7454362 DOI: 10.1093/cid/ciaa1097] [Citation(s) in RCA: 262] [Impact Index Per Article: 65.5] [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: 06/24/2020] [Accepted: 07/27/2020] [Indexed: 12/15/2022] Open
Abstract
Background The COVID-19 pandemic has led to significant reductions in transplantation, motivated in part by concerns of disproportionately more severe disease among solid organ transplant (SOT) recipients. However, clinical features, outcomes, and predictors of mortality in SOT recipients are not well-described. Methods We performed a multi-center cohort study of SOT recipients with laboratory-confirmed COVID-19. Data were collected using standardized intake and 28-day follow-up electronic case report forms. Multivariable logistic regression was used to identify risk factors for the primary endpoint, 28-day mortality, among hospitalized patients. Results Four hundred eighty-two SOT recipients from >50 transplant centers were included: 318 (66%) kidney or kidney/pancreas, 73 (15.1%) liver, 57 (11.8%) heart, and 30 (6.2%) lung. Median age was 58 (IQR 46-57), median time post-transplant was 5 years (IQR 2-10), 61% were male, and 92% had ≥1 underlying comorbidity. Among those hospitalized (376 [78%]), 117 (31%) required mechanical ventilation, and 77 (20.5%) died by 28 days after diagnosis. Specific underlying comorbidities (age >65 [aOR 3.0, 95%CI 1.7-5.5, p<0.001], congestive heart failure [aOR 3.2, 95%CI 1.4-7.0, p=0.004], chronic lung disease [aOR 2.5, 95%CI 1.2-5.2, p=0.018], obesity [aOR 1.9, 95% CI 1.0-3.4, p=0.039]) and presenting findings (lymphopenia [aOR 1.9, 95%CI 1.1-3.5, p=0.033], abnormal chest imaging [aOR 2.9, 95%CI 1.1-7.5, p=0.027]) were independently associated with mortality. Multiple measures of immunosuppression intensity were not associated with mortality. Conclusions Mortality among SOT recipients hospitalized for COVID-19 was 20.5%. Age and underlying comorbidities rather than immunosuppression intensity-related measures were major drivers of mortality.
Collapse
Affiliation(s)
- Olivia S Kates
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Brandy M Haydel
- Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sander S Florman
- Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Meenakshi M Rana
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Zohra S Chaudhry
- Transplantation Infectious Diseases and Inmunotherapy, Henry Ford Health System, Detroit, MI, USA
| | - Mayur S Ramesh
- Transplantation Infectious Diseases and Inmunotherapy, Henry Ford Health System, Detroit, MI, USA
| | - Kassem Safa
- Transplant Center and Division of Nephrology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Emily A Blumberg
- Department of Medicine, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA, USA
| | - Behdad D Besharatian
- Department of Medicine, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA, USA
| | - Sajal D Tanna
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael G Ison
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Maricar Malinis
- Section of Infectious Diseases, Department of Internal Medicine, Yale-New School of Medicine, New Haven, CT, USA
| | - Marwan M Azar
- Section of Infectious Diseases, Department of Internal Medicine, Yale-New School of Medicine, New Haven, CT, USA
| | - Robert M Rakita
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Jose A Morillas
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH, USA
| | - Aneela Majeed
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH, USA
| | - Afrah S Sait
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Mario Spaggiari
- Division of Transplantation, University of Illinois at Chicago, Chicago, IL, USA
| | | | | | | | - Abbasali Badami
- SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Jason D Goldman
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA.,Swedish Center for Research and Innovation, Swedish Medical Center, Seattle, WA, USA
| | - Anuradha Lala
- Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Valida Bajrovic
- Division of Infectious Disease, Department of Medicine, University of Colorado, Aurora, CO, USA
| | | | - Rachel Friedman-Moraco
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, GA, USA
| | - Sameep Sehgal
- Department of Thoracic Medicine And Surgery, Temple University, Philadelphia, PA, USA
| | - Erika D Lease
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA, USA
| | - Cynthia E Fisher
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Ajit P Limaye
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
| | | |
Collapse
|
11
|
Arshad S, Kilgore P, Chaudhry ZS, Jacobsen G, Wang DD, Huitsing K, Brar I, Alangaden GJ, Ramesh MS, McKinnon JE, O'Neill W, Zervos M. Treatment with hydroxychloroquine, azithromycin, and combination in patients hospitalized with COVID-19. Int J Infect Dis 2020; 97:396-403. [PMID: 32623082 PMCID: PMC7330574 DOI: 10.1016/j.ijid.2020.06.099] [Citation(s) in RCA: 357] [Impact Index Per Article: 89.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/22/2020] [Accepted: 06/29/2020] [Indexed: 12/23/2022] Open
Abstract
SIGNIFICANCE The United States is in an acceleration phase of the COVID-19 pandemic. Currently there is no known effective therapy or vaccine for treatment of SARS-CoV-2, highlighting urgency around identifying effective therapies. OBJECTIVE The purpose of this study was to evaluate the role of hydroxychloroquine therapy alone and in combination with azithromycin in hospitalized patients positive for COVID-19. DESIGN Multi-center retrospective observational study. SETTING The Henry Ford Health System (HFHS) in Southeast Michigan: large six hospital integrated health system; the largest of hospitals is an 802-bed quaternary academic teaching hospital in urban Detroit, Michigan. PARTICIPANTS Consecutive patients hospitalized with a COVID-related admission in the health system from March 10, 2020 to May 2, 2020 were included. Only the first admission was included for patients with multiple admissions. All patients evaluated were 18 years of age and older and were treated as inpatients for at least 48h unless expired within 24h. EXPOSURE Receipt of hydroxychloroquine alone, hydroxychloroquine in combination with azithromycin, azithromycin alone, or neither. MAIN OUTCOME The primary outcome was in-hospital mortality. RESULTS Of 2,541 patients, with a median total hospitalization time of 6 days (IQR: 4-10 days), median age was 64 years (IQR:53-76 years), 51% male, 56% African American, with median time to follow-up of 28.5 days (IQR:3-53). Overall in-hospital mortality was 18.1% (95% CI:16.6%-19.7%); by treatment: hydroxychloroquine+azithromycin, 157/783 (20.1% [95% CI: 17.3%-23.0%]), hydroxychloroquine alone, 162/1202 (13.5% [95% CI: 11.6%-15.5%]), azithromycin alone, 33/147 (22.4% [95% CI: 16.0%-30.1%]), and neither drug, 108/409 (26.4% [95% CI: 22.2%-31.0%]). Primary cause of mortality was respiratory failure (88%); no patient had documented torsades de pointes. From Cox regression modeling, predictors of mortality were age>65 years (HR:2.6 [95% CI:1.9-3.3]), white race (HR:1.7 [95% CI:1.4-2.1]), CKD (HR:1.7 [95%CI:1.4-2.1]), reduced O2 saturation level on admission (HR:1.5 [95%CI:1.1-2.1]), and ventilator use during admission (HR: 2.2 [95%CI:1.4-3.3]). Hydroxychloroquine provided a 66% hazard ratio reduction, and hydroxychloroquine+azithromycin 71% compared to neither treatment (p<0.001). CONCLUSIONS AND RELEVANCE In this multi-hospital assessment, when controlling for COVID-19 risk factors, treatment with hydroxychloroquine alone and in combination with azithromycin was associated with reduction in COVID-19 associated mortality. Prospective trials are needed to examine this impact.
Collapse
Affiliation(s)
- Samia Arshad
- Infectious Diseases, Henry Ford Hospital, Detroit, MI, United States
| | - Paul Kilgore
- Eugene Applebaum College of Pharmacy, Wayne State University, Detroit, MI, United States; Wayne State University School of Medicine, Detroit, MI, United States
| | - Zohra S Chaudhry
- Infectious Diseases, Henry Ford Hospital, Detroit, MI, United States
| | - Gordon Jacobsen
- Public Health Sciences, Henry Ford Hospital, Detroit, MI, United States
| | - Dee Dee Wang
- Division of Cardiovascular Disease & Structural Heart, Henry Ford Hospital, Detroit, MI, United States
| | - Kylie Huitsing
- Infectious Diseases, Henry Ford Hospital, Detroit, MI, United States
| | - Indira Brar
- Infectious Diseases, Henry Ford Hospital, Detroit, MI, United States
| | - George J Alangaden
- Infectious Diseases, Henry Ford Hospital, Detroit, MI, United States; Wayne State University School of Medicine, Detroit, MI, United States
| | - Mayur S Ramesh
- Infectious Diseases, Henry Ford Hospital, Detroit, MI, United States
| | - John E McKinnon
- Infectious Diseases, Henry Ford Hospital, Detroit, MI, United States
| | - William O'Neill
- Division of Cardiovascular Disease & Structural Heart, Henry Ford Hospital, Detroit, MI, United States
| | - Marcus Zervos
- Infectious Diseases, Henry Ford Hospital, Detroit, MI, United States; Wayne State University School of Medicine, Detroit, MI, United States.
| |
Collapse
|
12
|
Morrison AR, Johnson JM, Griebe KM, Jones MC, Stine JJ, Hencken LN, To L, Bianchini ML, Vahia AT, Swiderek J, Ramesh MS, Peters MA, Smith ZR. Clinical characteristics and predictors of survival in adults with coronavirus disease 2019 receiving tocilizumab. J Autoimmun 2020; 114:102512. [PMID: 32646770 PMCID: PMC7332925 DOI: 10.1016/j.jaut.2020.102512] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [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: 06/03/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 01/08/2023]
Abstract
Coronavirus disease 2019 (COVID-19) can progress to cytokine storm that is associated with organ dysfunction and death. The purpose of the present study is to determine clinical characteristics associated with 28 day in-hospital survival in patients with coronavirus disease 2019 (COVID-19) that received tocilizumab. This was a retrospective observational cohort study conducted at a five hospital health system in Michigan, United States. Adult patients with confirmed COVID-19 that were admitted to the hospital and received tocilizumab for cytokine storm from March 1, 2020 through April 3, 2020 were included. Patients were grouped into survivors and non-survivors based on 28 day in-hospital mortality. Study day 0 was defined as the day tocilizumab was administered. Factors independently associated with in-hospital survival at 28 days after tocilizumab administration were assessed. Epidemiologic, demographic, laboratory, prognostic scores, treatment, and outcome data were collected and analyzed. Clinical response was collected and defined as a decline of two levels on a six-point ordinal scale of clinical status or discharged alive from the hospital. Of the 81 patients included, the median age was 64 (58-71) years and 56 (69.1%) were male. The 28 day in-hospital mortality was 43.2%. There were 46 (56.8%) patients in the survivors and 35 (43.2%) in the non-survivors group. On study day 0 no differences were noted in demographics, clinical characteristics, severity of illness scores, or treatments received between survivors and non-survivors. C-reactive protein was significantly higher in the non-survivors compared to survivors. Compared to non-survivors, recipients of tocilizumab within 12 days of symptom onset was independently associated with survival (adjusted OR: 0.296, 95% CI: 0.098-0.889). SOFA score ≥8 on day 0 was independently associated with mortality (adjusted OR: 2.842, 95% CI: 1.042-7.753). Clinical response occurred more commonly in survivors than non-survivors (80.4% vs. 5.7%; p < 0.001). Improvements in the six-point ordinal scale and SOFA score were observed in survivors after tocilizumab. Early receipt of tocilizumab in patients with severe COVID-19 was an independent predictor for in-hospital survival at 28 days.
Collapse
Affiliation(s)
- Austin R Morrison
- Department of Pharmacy, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA
| | - Joseph M Johnson
- Department of Pharmacy, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA
| | - Kristin M Griebe
- Department of Pharmacy, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA
| | - Mathew C Jones
- Department of Pharmacy, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA
| | - John J Stine
- Department of Pharmacy, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA
| | - Laura N Hencken
- Department of Pharmacy, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA
| | - Long To
- Department of Pharmacy, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA
| | - Monica L Bianchini
- Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO, 80045, USA
| | - Amit T Vahia
- Division of Infectious Diseases, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA
| | - Jennifer Swiderek
- Division of Pulmonary & Critical Care Medicine, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA
| | - Mayur S Ramesh
- Division of Infectious Diseases, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA
| | - Michael A Peters
- Department of Pharmacy, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA
| | - Zachary R Smith
- Department of Pharmacy, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA.
| |
Collapse
|
13
|
Banandur SP, Sukumar GM, Arelingaiah M, Garady L, Koujageri JM, Sajjanar SL, Hadapad B, Ramesh MS, Gopalkrishna G. Effectiveness of a Structured Training Module on Different Learning Domains among Yuva Parivarthakas under Yuva Spandana Program. Indian J Psychol Med 2020; 42:182-188. [PMID: 32346261 PMCID: PMC7173665 DOI: 10.4103/ijpsym.ijpsym_144_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 04/17/2019] [Accepted: 08/01/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Yuva Spandana (YS) is a youth mental health promotion program implemented across all 30 districts of Karnataka. Yuva Parivarthakas (YPs - youth change agents) are trained to provide mental health promotion services to any "youth with issues" through Yuva Spandana Kendras (guidance centers) situated within district stadiums across Karnataka. Aim of the study was to evaluate the change (comparing before and after training) in different learning domains (cognitive - knowledge, affective - attitude, and psychomotor - practice) among trainees (YPs) attending YS training. METHODS Quasiexperimental study design was utilized for this study. A semistructured interview schedule was developed and used before and after the training. Data were analyzed by descriptive statistics. The difference in change of mean score was assessed using the paired t-test. The shift in the proportion of trainees post-training in the three domains was assessed using McNemar's test. RESULTS The mean (±SD) age of trainees was 27.5 ± 3.3 years. Majority of them were males (63.8%), had completed bachelor's degree (53.4%), and were residing in rural Karnataka (77.7%). The knowledge and attitude scores significantly improved (P < 0.001) post-training, without significant improvement in practical skills. CONCLUSION It is recommended that future training programs need to be focused on creating opportunities to YPs in order to increase their practical skills to work with youth having issues.
Collapse
Affiliation(s)
- S Pradeep Banandur
- Yuva Spandana Program, Department of Epidemiology, Centre for Public Health, NIMHANS, Bengaluru, Karnataka, India
| | - Gautham M Sukumar
- Yuva Spandana Program, Department of Epidemiology, Centre for Public Health, NIMHANS, Bengaluru, Karnataka, India
| | - Mutharaju Arelingaiah
- Yuva Spandana Program, Department of Epidemiology, Centre for Public Health, NIMHANS, Bengaluru, Karnataka, India
| | - Lavanya Garady
- Department of Epidemiology, Yuva Spandana Program, NIMHANS, Bengaluru, Karnataka, India
| | - Jyoti M Koujageri
- Department of Epidemiology, Yuva Spandana Program, NIMHANS, Bengaluru, Karnataka, India
| | - Sateesh L Sajjanar
- Department of Youth Empowerment and Sports, Government of Karnataka, Bengaluru, Karnataka, India
| | - Basavaraj Hadapad
- Department of Youth Empowerment and Sports, Youth Services, Government of Karnataka, Bengaluru, Karnataka, India
| | - M S Ramesh
- Department of Youth Empowerment and Sports, Youth Services, Government of Karnataka, Bengaluru, Karnataka, India
| | - Gururaj Gopalkrishna
- Yuva Spandana Program, Department of Epidemiology, Centre for Public Health, NIMHANS, Bengaluru, Karnataka, India
| |
Collapse
|
14
|
Ramesh MS, Yee J. Clostridioides difficile Infection in Chronic Kidney Disease/End-Stage Renal Disease. Adv Chronic Kidney Dis 2019; 26:30-34. [PMID: 30876614 DOI: 10.1053/j.ackd.2019.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 01/09/2019] [Accepted: 01/09/2019] [Indexed: 11/11/2022]
Abstract
Clostridioides difficile infection (CDI) is a major health-care burden and increasingly seen in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). Increased antibiotic use, alteration in host defenses, and gastric acid suppression are some of the etiologies for increased risk of CDI in these populations. Patients with CKD/ESRD have a higher risk of initial episode, recurrence, and development of severe CDI than those without CKD or ESRD. Diagnosis and management of CDI in patients with CKD/ESRD are similar to that in the general population. The mortality, length of stay, and health-care costs are higher in patients with CDI and CKD/ESRD. Antimicrobial stewardship with reduction in antibiotic use along with infection-control measures such as contact isolation and hand hygiene with soap and water is essential in the control and prevention of CDI in patients with CKD/ESRD.
Collapse
|
15
|
Naik HB, Nassif A, Ramesh MS, Schultz G, Piguet V, Alavi A, Lowes MA. Are Bacteria Infectious Pathogens in Hidradenitis Suppurativa? Debate at the Symposium for Hidradenitis Suppurativa Advances Meeting, November 2017. J Invest Dermatol 2018; 139:13-16. [PMID: 30414909 DOI: 10.1016/j.jid.2018.09.036] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 09/07/2018] [Accepted: 09/10/2018] [Indexed: 11/27/2022]
Abstract
In November 2017, a formal debate on the role of bacteria in the pathogenesis of hidradenitis suppurativa (HS) was held at the 2nd Symposium on Hidradenitis Suppurativa Advances (SHSA) in Detroit, Michigan. In this report, we present both sides of the argument as debated at the SHSA meeting and then discuss the potential role of bacteria as classic infectious pathogens versus an alternative pathogenic role as activators of dysregulated commensal bacterial-host interactions. Although there was consensus that bacteria play a role in pathogenesis and thus are pathogenic, there was a compelling discussion about whether bacteria in HS incite an infectious disease as we classically understand it or whether bacteria might play a different role in HS pathogenesis.
Collapse
Affiliation(s)
- Haley B Naik
- Program for Clinical Research, Department of Dermatology, University of California, San Francisco, San Francisco, California, USA.
| | - Aude Nassif
- Centre d'Infectiologie Necker-Pasteur, Paris, France
| | - Mayur S Ramesh
- Division of Infectious Disease, Henry Ford Hospital, Detroit, Michigan, USA
| | - Gregory Schultz
- Institute of Wound Research, Department of Obstetrics and Gynecology, University of Florida, Miami, Florida, USA
| | - Vincent Piguet
- Division of Dermatology, University of Toronto, Toronto, Canada
| | - Afsaneh Alavi
- Division of Dermatology, University of Toronto, Toronto, Canada
| | | |
Collapse
|
16
|
Braunberger TL, Nartker NT, Nicholson CL, Nahhas AF, Parks-Miller A, Hanna Z, Jayaprakash R, Ramesh MS, Rambhatla PV, Hamzavi IH. Ertapenem - a potent treatment for clinical and quality of life improvement in patients with hidradenitis suppurativa. Int J Dermatol 2018; 57:1088-1093. [DOI: 10.1111/ijd.14036] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/05/2018] [Accepted: 04/22/2018] [Indexed: 12/27/2022]
Affiliation(s)
| | | | | | | | | | - Zachary Hanna
- Department of Dermatology; Wayne State University; Detroit MI USA
| | | | - Mayur S. Ramesh
- Division of Infectious Disease; Henry Ford Hospital; Detroit MI USA
| | | | | |
Collapse
|
17
|
Orenstein R, Dubberke E, Hardi R, Ray A, Mullane K, Pardi DS, Ramesh MS. Safety and Durability of RBX2660 (Microbiota Suspension) for Recurrent Clostridium difficile Infection: Results of the PUNCH CD Study. Clin Infect Dis 2015; 62:596-602. [PMID: 26565008 DOI: 10.1093/cid/civ938] [Citation(s) in RCA: 123] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 11/04/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Managing recurrent Clostridium difficile infection (CDI) presents a significant challenge for clinicians and patients. Fecal microbiota transplantation (FMT) is a highly effective therapy for recurrent CDI, yet availability of a standardized, safe, and effective product has been lacking. Our aim in this study was to assess the safety and effectiveness of RBX2660 (microbiota suspension), a commercially prepared FMT drug manufactured using standardized processes and available in a ready-to-use format. METHODS Patients with at least 2 recurrent CDI episodes or at least 2 severe episodes resulting in hospitalization were enrolled in a prospective, multicenter open-label study of RBX2660 administered via enema. Intensive surveillance for adverse events (AEs) was conducted daily for 7 days following treatment and then at 30 days, 60 days, 3 months, and 6 months. The primary objective was product-related AEs. A secondary objective was CDI-associated diarrhea resolution at 8 weeks. RESULTS Of the 40 patients enrolled at 11 centers in the United States between 15 August 2013 and 16 December 2013, 34 received at least 1 dose of RBX2660 and 31 completed 6-month follow-up. Overall efficacy was 87.1% (16 with 1 dose and 11 with 2 doses). Of 188 reported AEs, diarrhea, flatulence, abdominal pain/cramping, and constipation were most common. The frequency and severity of AEs decreased over time. Twenty serious AEs were reported in 7 patients; none were related to RBX2660 or its administration. CONCLUSIONS Among patients with recurrent or severe CDI, administration of RBX2660 via enema appears to be safe and effective. CLINICAL TRIALS REGISTRATION NCT01925417.
Collapse
Affiliation(s)
| | - Erik Dubberke
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Robert Hardi
- Chevy Chase Clinical Research, Capital Digestive Care, Maryland
| | - Arnab Ray
- Ochsner Clinic, New Orleans, Louisiana
| | - Kathleen Mullane
- Section of Infectious Diseases and Global Health, University of Chicago Medicine, Illinois
| | - Darrell S Pardi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | | | | |
Collapse
|
18
|
Manavathu EK, Ramesh MS, Baskaran I, Ganesan LT, Chandrasekar PH. A comparative study of the post-antifungal effect (PAFE) of amphotericin B, triazoles and echinocandins on Aspergillus fumigatus and Candida albicans. J Antimicrob Chemother 2004; 53:386-9. [PMID: 14729762 DOI: 10.1093/jac/dkh066] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To study the post-antifungal effect (PAFE) of antifungal drugs on Aspergillus fumigatus by a radiometric assay and compare the results with those obtained for Candida albicans. METHODS A. fumigatus cultures pregrown for 48 h in 96-well microtitre plate were exposed to various concentrations of the antifungal drug for 2 h. The drug-treated mycelia were washed, incubated in RPMI 1640 containing (14)C-labelled amino acids and the accumulation of radioactivity in the mycelia at different time intervals was determined. The PAFE was determined by plotting the amount of radioactivity associated with the mycelia against post-treatment incubation time. The PAFE of antifungal drug on C. albicans was examined by determining the multiplication (cfu/mL) of drug-pretreated cells at different time intervals for 24 h in drug-free medium. RESULTS Amphotericin B produced a prolonged PAFE (7.5 +/- 0.70 h) against A. fumigatus whereas itraconazole (0.5 +/- 0.0 h), voriconazole (0.5 +/- 0.0 h), posaconazole (0.75 +/- 0.35 h), ravuconazole (0.38 +/- 0.17 h) and the echinocandins caspofungin (< or =0.5 h) and micafungin (< or =0.5 h) produced short PAFE. Short exposure (1 h) of C. albicans to low concentrations (0.125-1 mg/L) of amphotericin B (5.3 +/- 1.15 h), caspofungin (5.6 +/- 0.57 h) and micafungin (5 +/- 1.0 h) produced prolonged PAFE whereas the triazoles produced a short (< or =0.5 h) PAFE. CONCLUSIONS Determination of (14)C-labelled amino acid accumulation in antifungal drug-pretreated mycelia is a suitable method for studying PAFE in A. fumigatus. Antifungal drugs with fungicidal activity tend to possess longer PAFE compared to fungistatic drugs.
Collapse
Affiliation(s)
- Elias K Manavathu
- Division of Infectious Diseases, Department of Internal Medicine, 427 Lande Building, Wayne State University, 550 E. Canfield, Detroit, MI 48201, USA.
| | | | | | | | | |
Collapse
|