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Linde-Ozola Z, Classen AY, Giske CG, Göpel S, Eliakim-Raz N, Semret M, Simonsen GS, Vehreschild JJ, Jørgensen SB, Kessel J, Kleppe LKS, Oma DH, Vehreschild MJGT, Vilde A, Dumpis U. Quality, availability and suitability of antimicrobial stewardship guidance: a multinational qualitative study. JAC Antimicrob Resist 2024; 6:dlae039. [PMID: 38486662 PMCID: PMC10939443 DOI: 10.1093/jacamr/dlae039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/19/2024] [Indexed: 03/17/2024] Open
Abstract
Background Antimicrobial stewardship (AMS) programmes are established across the world to treat infections efficiently, prioritize patient safety, and reduce the emergence of antimicrobial resistance. One of the core elements of AMS programmes is guidance to support and direct physicians in making efficient, safe and optimal decisions when prescribing antibiotics. To optimize and tailor AMS, we need a better understanding of prescribing physicians' experience with AMS guidance. Objectives To explore the prescribing physicians' user experience, needs and targeted improvements of AMS guidance in hospital settings. Methods Semi-structured interviews were conducted with 36 prescribing physicians/AMS guidance users from hospital settings in Canada, Germany, Israel, Latvia, Norway and Sweden as a part of the international PILGRIM trial. A socioecological model was applied as an overarching conceptual framework for the study. Results Research participants were seeking more AMS guidance than is currently available to them. The most important aspects and targets for improvement of AMS guidance were: (i) quality of guidelines; (ii) availability of infectious diseases specialists; and (iii) suitability of AMS guidance to department context. Conclusions Achieving prudent antibiotic use not only depends on individual and collective levels of commitment to follow AMS guidance but also on the quality, availability and suitability of the guidance itself. More substantial commitment from stakeholders is needed to allocate the required resources for delivering high-quality, available and relevant AMS guidance to make sure that the prescribers' AMS needs are met.
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Affiliation(s)
| | - Annika Y Classen
- Faculty of Medicine, University of Cologne, Cologne, Germany
- Department I for Internal Medicine, University Hospital Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Christian G Giske
- Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Siri Göpel
- Department of Internal Medicine I, Division of infectious diseases, University Hospital Tübingen, Tübingen, Germany
- Clinical Research Unit for Healthcare Associated and Antibiotic Resistant Bacterial Infections, German Centre for Infection Research (DZIF), Tübingen, Germany
| | - Noa Eliakim-Raz
- Internal Medicine E, Rabin Medical Center Beilinson Campus, Petah-Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Makeda Semret
- Infectious Diseases and Medical Microbiology, McGill University Health Centre, Montreal, Canada
| | - Gunnar Skov Simonsen
- Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
- UiT-The Arctic University of Norway, Tromsø, Norway
| | - Jörg Janne Vehreschild
- Faculty of Medicine, University of Cologne, Cologne, Germany
- Department I for Internal Medicine, University Hospital Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
- Department II of Internal Medicine, Haematology/Oncology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Silje Bakken Jørgensen
- Department of Medical Microbiology and Infection Control and Department of Emergency Care, Akershus University Hospital, Lørenskog, Norway
| | - Johanna Kessel
- Department of Internal Medicine, Infectious Diseases, Goethe University Frankfurt, Frankfurt Am Main, Germany
| | - Lars Kåre Selland Kleppe
- Department of Infection Prevention and Control, Stavanger University Hospital, Stavanger, Norway
| | - Dorthea Hagen Oma
- Section for Patient Safety, Haukeland University Hospital, Bergen, Norway
| | - Maria J G T Vehreschild
- Faculty of Medicine, University of Cologne, Cologne, Germany
- Department I for Internal Medicine, University Hospital Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
- Department of Internal Medicine, Infectious Diseases, Goethe University Frankfurt, Frankfurt Am Main, Germany
| | - Aija Vilde
- Faculty of Medicine, University of Latvia, Riga, Latvia
- Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Uga Dumpis
- Faculty of Medicine, University of Latvia, Riga, Latvia
- Pauls Stradins Clinical University Hospital, Riga, Latvia
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Ofer J, Drozdinsky G, Basharim B, Turjeman A, Eliakim-Raz N, Stemmer SM. Mortality and Hospitalization Risks in Patients With Cancer and the SARS-CoV-2 Omicron Variant. JAMA Oncol 2024; 10:137-138. [PMID: 37991749 PMCID: PMC10666037 DOI: 10.1001/jamaoncol.2023.5042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/29/2023] [Indexed: 11/23/2023]
Abstract
This cohort study compares the mortality and hospitalization risks among patients with vs without solid cancer and diagnosed with COVID-19 during the period when the Omicron variant was dominant.
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Affiliation(s)
- Jonathan Ofer
- Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Genady Drozdinsky
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Bar Basharim
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Adi Turjeman
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Noa Eliakim-Raz
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Salomon M. Stemmer
- Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Vronsky D, Finkelstein A, Shiber S, Heching M, Eliakim-Raz N, Ayalon-Dangur I. A Profound Vitamin B12 Deficiency in a Patient with Lofgren's Syndrome. Int Med Case Rep J 2023; 16:655-658. [PMID: 37840969 PMCID: PMC10576453 DOI: 10.2147/imcrj.s404956] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/11/2023] [Indexed: 10/17/2023] Open
Abstract
Lofgren's syndrome is a unique manifestation of sarcoidosis presenting with erythema nodosum, bilateral hilar lymphadenopathy and migratory polyarthritis. A concurrent vitamin B12 deficiency is not well described and may be related to a rare gastrointestinal manifestation of sarcoid and Lofgren's syndrome. We describe a case of a 57-year-old male presented with migratory polyarthritis, erythemic nodules, edema of his legs and fever. His laboratory tests showed anemia with a profound vitamin B12 deficiency. Imaging demonstrated bilateral hilar adenopathy. Pathology revealed non-necrotizing granulomas consistent with sarcoidosis. The patient was started on prednisone and vitamin B12 supplements with improvement of his complaints and vitamin B12 levels. Sarcoidosis can manifest in many extrapulmonary organs, including the gastrointestinal tract, resulting in nutritional deficiencies, such as vitamin B12 deficiency. Treatment of these nutritional deficiencies includes treatment with steroids, as well as vitamin supplementation. We suggest this case to be a rare manifestation of gastrointestinal involvement in Lofgren syndrome; however, a biopsy from the GI tract was not performed to confirm the diagnosis. An informed consent was obtained from the patient. An institutional approval was not required for the publication of this case.
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Affiliation(s)
- Daniella Vronsky
- Internal Medicine Department, Ward E, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel
| | | | - Shachaf Shiber
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Rheumatology, Rabin Medical Center, Petach Tikva, Israel
| | - Moshe Heching
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pulmonology, Rabin Medical Center, Petach Tikva, Israel
| | - Noa Eliakim-Raz
- Internal Medicine Department, Ward E, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Irit Ayalon-Dangur
- Internal Medicine Department, Ward E, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel
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Atamna A, Berkov E, Drozdinsky G, Shochat T, Ben Zvi H, Eliakim-Raz N, Bishara J, Elis A. Clinical Outcomes of Hospitalized Patients with SARS-CoV-2 Omicron Variant vs. Influenza A During Influenza Season 2021 to 2022: A Retrospective Observational Study. Isr Med Assoc J 2023; 25:585-589. [PMID: 37698307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
BACKGROUND Influenza and coronavirus disease 2019 (COVID-19) are respiratory diseases with similar modes of transmission. In December 2021, influenza re-emerged after it had been undetected since March 2020 and the Omicron variant replaced the Delta variant. Data directly comparing the two diseases are scarce. OBJECTIVES To compare the outcomes of patients with both the Omicron variant and influenza during 2021-2022. METHODS We performed a retrospective study conducted in Beilinson hospital, Israel, from December 2021 to January 2022. We included all hospitalized patients with either laboratory-confirmed COVID-19 or influenza. The primary outcome was 30-day mortality. RESULTS We identified 167 patients diagnosed with Omicron and 221 diagnosed with Influenza A. The median age was 71 years for Omicron and 65 years for influenza. Patients with Omicron had a significantly higher Charlson Comorbidity Index score (4 vs. 3, P < 0.001). Patients with Omicron developed more respiratory failure that needed mechanical ventilation (7% vs. 2%, P = 0.05) and vasopressors (14% vs. 2%, P < 0.001) than patients with influenza. In a multivariate model, 30-day mortality was lower in patients diagnosed with influenza than in patients diagnosed with Omicron (19/221 [9%] vs. 44/167 [26%], hazard ratio 0.45, 95% confidence interval 0.25-0.81). CONCLUSIONS Patients diagnosed with Omicron had higher mortality than patients diagnosed with seasonal influenza. This finding could be due to differences in co-morbidities, the virus pathogenicity, and host responses to infection.
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Affiliation(s)
- Alaa Atamna
- Infectious Disease Unit, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel, Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Evgeny Berkov
- COVID-19 Inpatient Department, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
| | - Genady Drozdinsky
- Internal Medicine Department E, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel, Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Tzippy Shochat
- Statistics Division, Clinical Research Authority, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel, Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Haim Ben Zvi
- Clinical Microbiology Laboratory, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel, Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Noa Eliakim-Raz
- Internal Medicine Department E, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel, Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Jihad Bishara
- Infectious Disease Unit, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel, Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Avishay Elis
- Internal Medicine Department C, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel, Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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Poran I, Mokh AA, Vronsky D, Drozdinsky G, Basharim B, Eliakim-Raz N. Outcomes of vaccinated versus unvaccinated COVID-19 patients in Israel during the Omicron and Delta waves-A retrospective cohort study. Med Clin (Barc) 2023:S0025-7753(23)00181-1. [PMID: 37248130 DOI: 10.1016/j.medcli.2023.04.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/31/2023] [Accepted: 04/01/2023] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Initiation of global vaccination significantly reduced the morbidity and mortality of COVID-19. During the Omicron wave, approximately 70% of the Israeli adult population was fully vaccinated, but the efficacy of the vaccine was questioned. METHODS We conducted a retrospective cohort study of all adult patients admitted to the COVID-19 departments in Rabin Medical Center, during the Delta wave and the Omicron wave. Patients were matched in the 2 waves using the inverse probability of treatment weighting (IPTW) method and risk for mechanical ventilation and 30-day all-cause mortality was assessed. RESULTS Vaccination had a significant effect on 30-day mortality in the Delta and Omicron waves with adjusted OR of 0.35 (0.17-0.70) and 0.5 (0.27-0.95) respectively. Nonetheless, the rate of mechanical ventilation was similar between the groups with OR of 0.75 (0.52-1.09) and 0.64 (0.40-1.01). Vaccination status did not change the length of admission in both waves. CONCLUSION We observed a decreased risk for 30-day mortality among vaccinated patients during the Delta and Omicron waves in Israel. This association, even though consistent, was of a lesser magnitude during the Omicron wave.
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Affiliation(s)
- Itamar Poran
- Rabin Medical Center, Beilinson Hospital, Internal Medicine E, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Amjaad Abu Mokh
- Rabin Medical Center, Beilinson Hospital, Internal Medicine E, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniella Vronsky
- Rabin Medical Center, Beilinson Hospital, Internal Medicine E, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Genady Drozdinsky
- Rabin Medical Center, Beilinson Hospital, Internal Medicine E, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Bar Basharim
- Rabin Medical Center, Beilinson Hospital, Internal Medicine E, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa Eliakim-Raz
- Rabin Medical Center, Beilinson Hospital, Internal Medicine E, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Danino D, Ashkenazi-Hoffnung L, Diaz A, Erps AD, Eliakim-Raz N, Avni YS, Greenberg D, Givon-Lavi N, Youngster I. Effectiveness of BNT162b2 Vaccination During Pregnancy in Preventing Hospitalization for Severe Acute Respiratory Syndrome Coronavirus 2 in Infants. J Pediatr 2023; 254:48-53.e1. [PMID: 36252864 PMCID: PMC9568274 DOI: 10.1016/j.jpeds.2022.09.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/11/2022] [Accepted: 09/16/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To assess the clinical effectiveness of the BNT162b2 vaccine during pregnancy in preventing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) hospitalizations of infants. STUDY DESIGN A retrospective, multicenter, 1:3 case-control (test-negative) study. Symptomatic hospitalized infants less than 6 months of age, with a positive SARS-CoV-2 polymerase chain reaction test between January 3, 2021, and March 11, 2021, were matched by age and time to negative controls, hospitalized with symptoms compatible with SARS-CoV-2 infection. Mothers were defined as fully vaccinated who received 2 doses of BNT162b2 with the second given 2 weeks to 6 months before delivery; or partially vaccinated, if they received only 1 dose or 2 doses with the second given more than 6 months or less than 2 weeks before delivery. Severe SARS-CoV-2 was defined as a need for assisted ventilation. RESULTS We matched 116 SARS-CoV-2 positive infants with 348 negative controls with symptoms compatible with SARS-CoV-2 infection. The effectiveness of fully vaccinated mothers was 61.6% (95% CI, 31.9-78.4) and the effectiveness of partially vaccinated mothers was not significant. Effectiveness was higher in infants 0-2 vs 3-6 months of age. The effectiveness (57.1%; 95% CI, 22.8-76.4) was similar when excluding mothers who were infected with SARS-CoV-2 during pregnancy. The OR of severe infection in infants born to unvaccinated vs fully vaccinated mothers was 5.8. CONCLUSIONS At least 2 doses of BNT162b2 vaccine administered during the second or third trimester of pregnancy had an effectiveness of 61.6% in decreasing hospitalization for SARS-CoV-2 infection in infants less than 6 months of age.
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Affiliation(s)
- Dana Danino
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel.
| | - Liat Ashkenazi-Hoffnung
- Department of Day Hospitalisation, Schneider Children's Medical Center, Petach-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel; Pediatric Infectious Diseases Unit, Schneider Children's Medical Center, Petach-Tikva, Israel
| | | | - Amir Dov Erps
- Department of Day Hospitalisation, Schneider Children's Medical Center, Petach-Tikva, Israel
| | - Noa Eliakim-Raz
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel; Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Yonat Shemer Avni
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Clinical Virology Laboratory, Soroka University Medical Center, Beer-Sheva, Israel
| | - David Greenberg
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Noga Givon-Lavi
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Ilan Youngster
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel; Pediatric Infectious Disease Unit, Shamir Medical Center, Zerifin, Israel
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Drozdinsky G, Atamna A, Banai H, Ben-Zvi H, Bishara J, Eliakim-Raz N. Clinical outcomes for Clostridioides difficile associated diarrhea in inflammatory bowel disease patients versus non-IBD population: A retrospective cohort study. Medicine (Baltimore) 2023; 102:e32812. [PMID: 36820599 PMCID: PMC9907955 DOI: 10.1097/md.0000000000032812] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
Patients with inflammatory bowel disease (IBD) have a higher incidence of Clostridioides difficile infection (CDI). Previous studies have demonstrated negative clinical outcomes in IBD patients with CDI compared to patients without CDI. The clinical presentation of CDI is indistinguishable from IBD exacerbation, thus posing a frequent clinical dilemma on the role of Clostridioides infection in the testing, diagnosis, and treatment of these patients. To compare clinical outcomes of CDI in patients with IBD to those without IBD. Retrospective cohort of adult patients admitted to Rabin Medical Center Israel between the years 2014 and 2020 with a concurrent diagnosis of IBD and CDI. Matching 1:2 was performed between the IBD patients and the non-IBD population with respect to age and sex. Sixty-seven patients with IBD and 134 patients without IBD were included in the study. The groups' median age was 40.6 (interquartile range [IQR] of 29.8-68.9), with 45.8% male and 54.2% female. The non-IBD group had a higher Charlson score with 2 (IQR 0; 5) versus 0 (IQR 0; 4) in the IBD group (P value <.01). Patients with IBD had more exposure to systemic antibiotics, 71.1% versus 26.3% (P value <.01). In a multivariable analysis we found no difference in 90-day mortality and rate of relapse between the 2 study groups with an odds ratio of 1.709 (95% confidence interval 0.321-9.905) and odds ratio of 0.209 (95% confidence interval 0.055-1.513) respectively. In our cohort patients with IBD who present with diarrhea and concomitant CDI have similar rates of relapse and mortality compared with patients without IBD.
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Affiliation(s)
- Genady Drozdinsky
- Internal Medicine E, Rabin Medical Center Beilinson Campus, Petah-Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- * Correspondence: Genady Drozdinsky, Internal Medicine E, Rabin Medical Center, Beilinson Campus, Petah-Tikva, Israel, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel (e-mail: )
| | - Alaa Atamna
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Hagar Banai
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Gastroenterology Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Haim Ben-Zvi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Clinical Microbiology, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Jihad Bishara
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Noa Eliakim-Raz
- Internal Medicine E, Rabin Medical Center Beilinson Campus, Petah-Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
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Turjeman A, Koppel F, Franceschini E, Yahav D, Dolci G, Bacca E, Babich T, Khazem E, Baum E, Nassar R, Bitterman R, Dishon-Benatta Y, Hassoun-Kheir N, Santoro A, Eliakim-Raz N, Poran I, Pertzov B, Stern A, Dickstein Y, Maroun E, Raines M, Meschiari M, Bishara J, Goldberg E, Venturelli C, Sarti M, Mussini C, Paul M, Leibovici L. External Validity of a Randomized Controlled Trial on Duration of Antibiotics for the Treatment of Gram-Negative Bacteremia. Gerontology 2023; 69:312-320. [PMID: 36273449 DOI: 10.1159/000526480] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/19/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Reports regarding the external validity of randomized controlled trials (RCTs) are scarce. We aimed to assess the population external validity of an investigator-initiated RCT on the duration of antibiotics for the treatment of Gram-negative bacteremia by comparing patients included in the RCT to patients that were not included in the trial. METHODS Hospitalized patients with Gram-negative bacteremia were recruited into an RCT and randomized to receive 7 or 14 days of covering antibiotic therapy in Israel and Italy from 2013 to 2017. In a concomitant observational study, RCT participants were compared with patients who fulfilled the inclusion criteria but were not included in the trial due to participation in other trials, discharge before approached by researchers, refusal to participate, or unwillingness of the treating physician to allow participants' recruitment. RESULTS Six hundred and four RCT patients were compared with 613 nonincluded patients. Almost 50% of nonincluded patients (288/613) were dependent on others for activities of daily living at baseline compared to 37.7% of RCT participants (228/604). Dementia was nearly 2-fold more frequent in nonincluded patients than those included (5.9% [36/613] versus 3.6% [22/604], p = 0.07). Patients who were not included in the RCT were more likely to acquire their infection in the hospital (53.3% [327/613] versus 29.1% [176/604], p < 0.001). The primary composite outcome of mortality, clinical failure, readmissions, or extended hospitalization at 90 days occurred in 353 of 613 nonincluded patients (57.6%) compared to 299 of 604 RCT participants (49.6%), p = 0.005. However, on multivariate analysis noninclusion in the RCT was not an independent risk factor for clinical failure and mortality. CONCLUSIONS RCTs, even with broad eligibility criteria, do not represent the whole spectrum of patients and leave out a population with more severe illness for whom the evidence is lacking.
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Affiliation(s)
- Adi Turjeman
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Fidi Koppel
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
| | - Erica Franceschini
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Dafna Yahav
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Giovanni Dolci
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Erica Bacca
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Tanya Babich
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ebtehal Khazem
- Department of Internal Medicine H, Rambam Health Care Campus, Haifa, Israel
| | - Eyal Baum
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
| | - Rima Nassar
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
| | - Roni Bitterman
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
| | - Yael Dishon-Benatta
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | | | - Antonella Santoro
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Noa Eliakim-Raz
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Itamar Poran
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Barak Pertzov
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pulmonary Division, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Anat Stern
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
| | - Yaakov Dickstein
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
| | - Elias Maroun
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
| | - Marina Raines
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
| | - Marianna Meschiari
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Jihad Bishara
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Elad Goldberg
- Department of Medicine F, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Claudia Venturelli
- Clinical Microbiology Lab, University of Modena and Reggio Emilia, Modena, Italy
| | - Mario Sarti
- Clinical Microbiology Lab, University of Modena and Reggio Emilia, Modena, Italy
| | - Cristina Mussini
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Mical Paul
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Leonard Leibovici
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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9
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Bigman-Peer N, Peer E, Pertzov B, Kramer M, Segal G, Eliakim-Raz N. A Biphasic COVID-19 Clinical Course in Anti-CD20 Treated Patients: Case Series and Review of the Literature. Eur J Case Rep Intern Med 2022; 9:003502. [PMID: 36093299 PMCID: PMC9451519 DOI: 10.12890/2022_003502] [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] [Received: 07/19/2022] [Accepted: 07/24/2022] [Indexed: 11/30/2022] Open
Abstract
We describe four cases of COVID-19 infection during the Omicron wave, in patients treated with anti-CD20 monoclonal antibodies. All cases follow a similar biphasic clinical course consisting of respiratory deterioration, which occurred a few weeks after convalescence from initial mild to asymptomatic infection. Possible explanations are discussed.
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Affiliation(s)
- Noa Bigman-Peer
- Department of Internal Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Eyal Peer
- Oncology Institute, Sheba Medical Center, Ramat Gan, Israel
| | - Barak Pertzov
- Pulmonary Division, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Mordechai Kramer
- Pulmonary Division, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gad Segal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Internal Medicine I, Sheba Medical Center, Ramat Gan, Israel
| | - Noa Eliakim-Raz
- Department of Internal Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
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10
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Eliakim-Raz N, Stemmer A, Leibovici-Weisman Y, Ness A, Awwad M, Ghantous N, Erez N, Bareket-Samish A, Levy-Barda A, Ben-Zvi H, Moskovits N, Bar-Haim E, Stemmer SM. Three-month follow-up of durability of response to the third dose of the SARS-CoV-2 BNT162b2 vaccine in adults aged 60 years and older: a prospective cohort study. BMJ Open 2022; 12:e061584. [PMID: 35918111 PMCID: PMC9350740 DOI: 10.1136/bmjopen-2022-061584] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To evaluate the durability of response 3 months after the third BNT162b2 vaccine in adults aged 60 years and older. DESIGN Prospective cohort study. SETTING Single tertiary centre. PARTICIPANTS Healthcare workers/family members aged ≥60 years old who received the third BNT162b2 dose. INTERVENTIONS Blood samples were drawn immediately before (T0), 10-19 days (T1) and 74-103 days (T2) after the third dose. PRIMARY AND SECONDARY OUTCOME MEASURES Anti-spike IgG titres were determined using a commercial assay and seropositivity was defined as ≥50 arbitrary units (AU)/mL. Neutralising antibody titres were determined at T2. Adverse events, COVID-19 infections and Clinical Frailty Scale (CFS) levels were documented. RESULTS The analysis included 97 participants (median age, 70 years (IQR, 66-74), 58% CFS level 2). IgG titres, which increased significantly from T0 to T1 (median, 440 AU/mL (IQR, 294-923) and median, 25 429 AU/mL (IQR, 14 203-36 114), respectively; p<0.001), decreased significantly by T2, but all remained seropositive (median, 8306 AU/mL (IQR, 4595-14 701), p<0.001 vs T1). In a multivariable analysis, only time from the second vaccine was significantly associated with lower IgG levels at T2 (p=0.017). At T2, 60 patients were evaluated for neutralising antibodies; all were seropositive (median, 1294 antibody titres; IQR, 848-2072). Neutralising antibody and anti-spike IgG levels were correlated (r=0.6, p<0.001). No major adverse events or COVID-19 infections were reported. CONCLUSIONS Anti-spike IgG and neutralising antibody levels remain adequate 3 months after the third BNT162b2 vaccine in healthy adults aged ≥60 years, although the decline in IgG is concerning. A third dose of vaccine in this population should be top priority.
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Affiliation(s)
- Noa Eliakim-Raz
- Department of Medicine E and Infectious Diseases Unit, Beilinson Hospital, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amos Stemmer
- Oncology, Sheba Medical Center at Tel Hashomer, Tel Hashomer, Israel
| | - Yaara Leibovici-Weisman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Medicine E, Beilinson Hospital, Petah Tikva, Israel
| | - Asaf Ness
- Department of Medicine E, Beilinson Hospital, Petah Tikva, Israel
| | - Muhammad Awwad
- Department of Medicine E, Beilinson Hospital, Petah Tikva, Israel
| | - Nassem Ghantous
- Department of Medicine E, Beilinson Hospital, Petah Tikva, Israel
| | - Noam Erez
- Department of Infectious Diseases, Israel Institute for Biological Research, Ness Ziona, Israel
| | | | - Adva Levy-Barda
- Biobank, Department of Pathology, Beilinson Hospital, Petah Tikva, Israel
| | - Haim Ben-Zvi
- Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
- Clinical Microbiology Laboratory, Beilinson Hospital, Petah Tikva, Israel
| | - Neta Moskovits
- Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Erez Bar-Haim
- Department of Biochemistry and Molecular Genetics, Israel Institute for Biological Research, Ness Ziona, Israel
| | - Salomon M Stemmer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Davidoff Center, Beilinson Hospital, Petah Tikva, Israel
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11
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Eliakim-Raz N, Stemmer A, Ghantous N, Ness A, Awwad M, Leibovici-Weisman Y, Stemmer SM. Antibody Titers After a Third and Fourth SARS-CoV-2 BNT162b2 Vaccine Dose in Older Adults. JAMA Netw Open 2022; 5:e2223090. [PMID: 35862048 PMCID: PMC9305380 DOI: 10.1001/jamanetworkopen.2022.23090] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This cohort study evaluates the response to a third and fourth SARS-CoV-2 BNT162b2 vaccine dose among individuals aged 60 years or older by evaluating antispike immunoglobulin G antibody titers before and after each dose.
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Affiliation(s)
- Noa Eliakim-Raz
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amos Stemmer
- Department of Oncology, Sheba Medical Center, Tel Hashomer, Israel
| | - Nassem Ghantous
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf Ness
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Muhammad Awwad
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaara Leibovici-Weisman
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Salomon M. Stemmer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
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12
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Vronsky D, Hershkowitz S, Hershko A, Eliakim-Raz N. A Transient Inflammatory Reaction with a B-Cell Lymphoid Infiltrate and Dysplastic Bone Marrow Changes Associated with the BNT162b2 COVID-19 Vaccine. Eur J Case Rep Intern Med 2022; 9:003381. [PMID: 35821902 PMCID: PMC9267711 DOI: 10.12890/2022_003381] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/02/2022] [Indexed: 11/15/2022] Open
Abstract
COVID-19 vaccines were introduced soon after the COVID-19 pandemic emerged in 2020. Various side effects were reported worldwide, including several types of common systemic side effects such as fever and general fatigue. Reports of other rare manifestations also emerged. We report the case of an adult male with a rare systemic syndrome mimicking lymphoma after he had received the first dose of an mRNA-based COVID-19 vaccine. After nearly 6 months of investigation with suspicion for an infection or malignancy, all symptoms resolved, laboratory tests normalized, and imaging showed no sign of active disease.
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Affiliation(s)
- Daniella Vronsky
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Shimrit Hershkowitz
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Alon Hershko
- Department of Medicine, Hadassah University Hospital, Jerusalem, Israel; Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Noa Eliakim-Raz
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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13
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Poran I, Elbaz M, Turjeman A, Huberman Samuel M, Eliakim-Raz N, Nashashibi J, Paul M, Leibovici L. Predicting In-Hospital Antibiotic Use in the Medical Department: Derivation and Validation Study. Antibiotics (Basel) 2022; 11:antibiotics11060813. [PMID: 35740219 PMCID: PMC9219723 DOI: 10.3390/antibiotics11060813] [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: 04/12/2022] [Revised: 06/12/2022] [Accepted: 06/13/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The rise of multi-drug-resistant pathogens and nosocomial infections among hospitalized patients is partially attributed to the increased use of antibiotic therapy. A prediction model for in-hospital antibiotic treatment could be valuable to target preventive strategies. Methods: This was a retrospective cohort study, including patients admitted in 2018 to medical departments and not treated with antibiotics during the first 48 h. Data available at hospital admission were used to develop a logistic model to predict the probability of antibiotic treatment during hospitalization. The performance of the model was evaluated in two independent validation cohorts. Results: In the derivation cohort, antibiotic treatment was initiated in 454 (8.1%) out of 5592 included patients. Male gender, lower functional capacity, prophylactic antibiotic treatment, medical history of atrial fibrillation, peripheral vascular disease, solid organ transplantation, chronic use of a central venous catheter, urinary catheter and nasogastric tube, albumin level, mental status and vital signs at presentation were identified as predictors for antibiotic use during hospitalization and were included in the prediction model. The area under the ROC curve (AUROC) was 0.72 (95% CI 0.70–0.75). In the highest probability group, the percentage of antibiotic treatment was 18.2% (238/1,307). In the validation cohorts, the AUROC was 0.73 (95% CI 0.68–0.77) and 0.75 (95% CI 0.72–0.78). In the highest probability group, the percentage of antibiotic treatment was 12.5% (66/526) and 20.7% (244/1179) of patients. Conclusions: Our prediction model performed well in the validation cohorts and was able to identify a subgroup of patients at high risk for antibiotic treatment.
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Affiliation(s)
- Itamar Poran
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petach Tikva 4941492, Israel; (M.E.); (A.T.); (M.H.S.); (N.E.-R.); (L.L.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Correspondence: ; Tel.: +972-524881870; Fax: +972-3-9376512
| | - Michal Elbaz
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petach Tikva 4941492, Israel; (M.E.); (A.T.); (M.H.S.); (N.E.-R.); (L.L.)
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva 4941492, Israel
| | - Adi Turjeman
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petach Tikva 4941492, Israel; (M.E.); (A.T.); (M.H.S.); (N.E.-R.); (L.L.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Maayan Huberman Samuel
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petach Tikva 4941492, Israel; (M.E.); (A.T.); (M.H.S.); (N.E.-R.); (L.L.)
| | - Noa Eliakim-Raz
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petach Tikva 4941492, Israel; (M.E.); (A.T.); (M.H.S.); (N.E.-R.); (L.L.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva 4941492, Israel
| | - Jeries Nashashibi
- Department of Medicine D, Rambam Health Care Campus, Haifa 3436212, Israel;
| | - Mical Paul
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa 3436212, Israel;
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3436212, Israel
| | - Leonard Leibovici
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petach Tikva 4941492, Israel; (M.E.); (A.T.); (M.H.S.); (N.E.-R.); (L.L.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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14
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Niv Y, Eliakim-Raz N, Bar-Lavi Y, Green M, Dreiher J, Hupert A, Freedman L, Weiss Y, Zetland R, Luz S, Menachemi D, Kuniavski M, Rahav G, Sagi R, Goldschmidt N, Mahalla H. Comparing Covid-19 pandemic waves in hospitalized patients - a retrospective, multicenter, cohort study. Clin Infect Dis 2022; 75:e389-e396. [PMID: 35142823 PMCID: PMC8903399 DOI: 10.1093/cid/ciac119] [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: 11/12/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Covid-19 disease was first diagnosed in Israel at the end of February 2020. Until the end of June 2021 842,536 confirmed cases and 6428 deaths were accumulated. The aim of our multicenter retrospective cohort study is to describe the demographic and clinical characteristics of hospitalized patients and to compare the pandemic waves before immunization. METHODS Out of 22302 patients hospitalized in general medical centers we randomly selected 6329 admissions for the study. Of these, 3582 and 1106 were eligible for the study in the first period (1 st & 2 nd waves), and in the second period (3 rd wave), respectively. RESULTS Thirty-day mortality was higher in the 2nd period than in the 1st period, 25.20% versus 13.68% (P<0.001). Invasive mechanical ventilation supported 9.19% and 14.21% of the patients in the 1st period and 2nd period, respectively. Extracorporeal Membrane Oxygenation (ECMO) was used more than twice as often on the 2nd period . CONCLUSIONS Invasive ventilation, use of ECMO and mortality rate were 1.5 to 2 times higher on the 2 nd period than in the 1 st period. Patients of the 2 nd period had a more severe presentation and higher mortality than those of the 1 st period.
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Affiliation(s)
- Yaron Niv
- Division of Quality and Safety, Ministry of Health, Israel.,Ariel University, Faculty of Medicine, Israel
| | - Noa Eliakim-Raz
- Department of Internal Medicine E, Rabin Medical Center, Beilinson Campus, Tel Aviv University, Israel
| | - Yaron Bar-Lavi
- Department of Critical Care Medicine, Rambam Medical Center, Technion, Israel
| | | | - Jacob Dreiher
- Hospital Management, Soroka Medical Center, Ben-Gurion University of the Negev, Israel
| | - Amit Hupert
- Unit of Bio-Statistics, Gertner Institue, Sheba Medical Center, Israel
| | - Laurence Freedman
- Unit of Bio-Statistics, Gertner Institue, Sheba Medical Center, Israel
| | - Yoram Weiss
- Hospital Management, Hadasa Ein-Cerem, Jerusalem, Israel
| | - Riki Zetland
- Nursing Management, Rabin Medical Center, Israel
| | - Shirli Luz
- Nursing Division, Ministry of Health, Israel
| | | | | | - Gaila Rahav
- Department of Infectious Diseases, Sheba Medical Center, Israel
| | - Ram Sagi
- Directorate of Government Medical Centers, Ministry of Health, Israel
| | | | - Hanna Mahalla
- Division of Quality and Safety, Ministry of Health, Israel
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15
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Massarweh A, Tschernichovsky R, Stemmer A, Benouaich-Amiel A, Siegal T, Eliakim-Raz N, Stemmer SM, Yust-Katz S. Immunogenicity of the BNT162b2 mRNA COVID-19 vaccine in patients with primary brain tumors: a prospective cohort study. J Neurooncol 2022; 156:483-489. [PMID: 35018613 PMCID: PMC8752179 DOI: 10.1007/s11060-021-03911-7] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 11/22/2021] [Indexed: 12/30/2022]
Abstract
Purpose Immunogenicity of Covid-19 vaccines may be negatively impacted by anti-cancer treatment. The management of primary brain tumors (PBTs) routinely includes temozolomide and steroids, which are immune-suppressive. We aimed to determine the rate of seropositivity in PBT patients following receipt of two doses of the BNT162b2 vaccine. Methods We prospectively evaluated IgG levels against SARS-CoV-2 spike protein in 17 PBT patients following two doses of the BNT162b2 vaccine. IgG levels were collected at two time points: T1—after a median of 44 days from the second vaccine dose and T2—after a median of 130 days from the second dose. Titers were compared against a group of healthy controls (HC) comprised of patients’ family members. Results At T1, 88.2% (15/17) of PBT patients achieved seroconversion, compared with 100% (12/12) of HCs. Median IgG titer was significantly lower in the PBT group (1908 AU/mL vs 8,198 AU/mL; p = 0.002). At T2, 80% (12/15) of PBT patients seroconverted, compared to 100% (10/10) of HCs. Median IgG titer remained significantly lower in the PBT group (410 AU/mLvs 1687 AU/mL; p = 0.002). During the peri-vaccination period, 15 patients received systemic treatment and 8 patients were treated with corticosteroids. All 3 patients who failed to seroconvert at T2 were treated with corticosteroids. In a univariate analysis, steroid use was negatively associated with antibody titer. Conclusion Most PBT patients successfully seroconvert following two doses of the BNT162b2 vaccine, albeit with lower antibody titer compared to HCs. Steroid use during the vaccination period is associated with lower titer.
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Affiliation(s)
- Amir Massarweh
- Department of Oncology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Roi Tschernichovsky
- Department of Oncology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.
| | - Amos Stemmer
- Department of Oncology, Sheba Medical Center, Tel Hashomer, Israel
| | - Alexandra Benouaich-Amiel
- Neuro-Oncology Unit, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Tali Siegal
- Neuro-Oncology Unit, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Noa Eliakim-Raz
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
- Infectious Disease Unit, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Salomon M Stemmer
- Department of Oncology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomit Yust-Katz
- Neuro-Oncology Unit, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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16
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Eliakim-Raz N, Leibovici-Weisman Y, Stemmer A, Ness A, Awwad M, Ghantous N, Stemmer SM. Antibody Titers Before and After a Third Dose of the SARS-CoV-2 BNT162b2 Vaccine in Adults Aged ≥60 Years. JAMA 2021; 326:2203-2204. [PMID: 34739043 PMCID: PMC8652594 DOI: 10.1001/jama.2021.19885] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This study assesses antispike (anti-S) IgG antibody titers before and after a third BNT162b2 dose (booster) in individuals aged 60 years and older in Israel.
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Affiliation(s)
- Noa Eliakim-Raz
- Rabin Medical Center, Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel
| | | | - Amos Stemmer
- Department of Oncology, Sheba Medical Center, Tel Hashomer, Israel
| | - Asaf Ness
- Rabin Medical Center, Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel
| | - Muhammad Awwad
- Rabin Medical Center, Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel
| | - Nassem Ghantous
- Rabin Medical Center, Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel
| | - Salomon M. Stemmer
- Rabin Medical Center, Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel
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17
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Turjeman A, Koppel F, Franceschini E, Yahav D, Dolci G, Babich T, Bitterman R, Neuberger A, Ghanem-Zoubi N, Santoro A, Eliakim-Raz N, Pertzov B, Stern A, Dickstein Y, Maroun E, Zayyad H, Meschiari M, Bishara J, Goldberg E, Venturelli C, Mussini C, Paul M, Leibovici L. Risk factors for functional decline among survivors of Gram-negative bloodstream infection: A prospective cohort study. PLoS One 2021; 16:e0259707. [PMID: 34788325 PMCID: PMC8598031 DOI: 10.1371/journal.pone.0259707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 10/26/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To identify risk factors for functional decline after hospitalization for Gram-negative bacteremia. PATIENTS AND METHODS A prospective cohort study based on a randomized controlled trial conducted between January 1, 2013 and August 31, 2017 in Israel and Italy. Hospitalized patients with Gram-negative bacteremia who survived until day 90 and were not bedridden at baseline were included. The primary end point was functional decline at 90 days. RESULTS Five hundred and nine patients were included. The median age of the cohort was 71 years (interquartile range [IQR], 60-80 years), 46.4% (236/509) were male and 352 of 509 (69%) patients were independent at baseline. Functional decline at 90 days occurred in 24.4% of patients (124/509). In multivariable analysis; older age (odds ratio [OR], 1.03; for an one-year increment, 95% confidence interval [CI] 1.01-1.05), functional dependence in instrumental activities of daily living at baseline (OR, 4.64; 95% CI 2.5-8.6), low Norton score (OR, 0.87; 95% CI 0.79-0.96) and underlying comorbidities: cancer (OR, 2.01; 95% CI 1.14-3.55) and chronic pulmonary disease (OR, 2.23 95% CI 1.12-4.42) and longer length of hospital stay (OR 1.09; for one-day increment, 95% CI 1.04-1.15) were associated with functional decline. Appropriate empirical antibiotic treatment was associated with lower rates of functional decline within 90 days (OR, 0.4; 95% CI 0.21-0.78). CONCLUSIONS Patients surviving bloodstream infections have poor long term trajectories after clinical recovery and hospital discharge. This has vast implications for patients, their family members and health policy makers.
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Affiliation(s)
- Adi Turjeman
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- * E-mail:
| | - Fidi Koppel
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
| | - Erica Franceschini
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Dafna Yahav
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Giovanni Dolci
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Tanya Babich
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roni Bitterman
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
| | - Ami Neuberger
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
| | - Nesrin Ghanem-Zoubi
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
| | - Antonella Santoro
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Noa Eliakim-Raz
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Barak Pertzov
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pulmonary Division, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Anat Stern
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
| | - Yaakov Dickstein
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
| | - Elias Maroun
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
| | - Hiba Zayyad
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
| | - Marianna Meschiari
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Jihad Bishara
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Elad Goldberg
- Department of Medicine F, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Claudia Venturelli
- Clinical Microbiology Lab, University of Modena and Reggio Emilia, Modena, Italy
| | - Cristina Mussini
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Mical Paul
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
| | - Leonard Leibovici
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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18
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Andreassen S, Møller JK, Eliakim-Raz N, Lisby G, Ward L. A comparison of predictors for mortality and bacteraemia in patients suspected of infection. BMC Infect Dis 2021; 21:864. [PMID: 34425790 PMCID: PMC8383375 DOI: 10.1186/s12879-021-06547-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 03/14/2021] [Accepted: 08/06/2021] [Indexed: 11/20/2022] Open
Abstract
Background Stratification by clinical scores of patients suspected of infection can be used to support decisions on treatment and diagnostic workup. Seven clinical scores, SepsisFinder (SF), National Early Warning Score (NEWS), Sequential Orgen Failure Assessment (SOFA), Mortality in Emergency Department Sepsis (MEDS), quick SOFA (qSOFA), Shapiro Decision Rule (SDR) and Systemic Inflammatory Response Syndrome (SIRS), were evaluated for their ability to predict 30-day mortality and bacteraemia and for their ability to identify a low risk group, where blood culture may not be cost-effective and a high risk group where direct-from-blood PCR (dfbPCR) may be cost effective. Methods Retrospective data from two Danish and an Israeli hospital with a total of 1816 patients were used to calculate the seven scores. Results SF had higher Area Under the Receiver Operating curve than the clinical scores for prediction of mortality and bacteraemia, significantly so for MEDS, qSOFA and SIRS. For mortality predictions SF also had significantly higher area under the curve than SDR. In a low risk group identified by SF, consisting of 33% of the patients only 1.7% had bacteraemia and mortality was 4.2%, giving a cost of € 1976 for one positive result by blood culture. This was higher than the cost of € 502 of one positive dfbPCR from a high risk group consisting of 10% of the patients, where 25.3% had bacteraemia and mortality was 24.2%. Conclusion This may motivate a health economic study of whether resources spent on low risk blood cultures might be better spent on high risk dfbPCR.
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Affiliation(s)
- Steen Andreassen
- Treat Systems ApS, Ålborg, Denmark. .,Department of Health Science and Technology, Aalborg University, Ålborg, Denmark.
| | - Jens Kjølseth Møller
- Department of Clinical Microbiology, University Hospital of Southern Denmark, Lillebælt Hospital, Vejle, Denmark
| | - Noa Eliakim-Raz
- Department of Medicine E, Beilinson Hospital, Rabin Medical Centre, Petah Tiqva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gorm Lisby
- Department of Clinical Microbiology, University Hospital of Copenhagen, Amager og Hvidovre Hospital, Hvidovre, Denmark
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19
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Eliakim-Raz N, Massarweh A, Stemmer A, Stemmer SM. Durability of Response to SARS-CoV-2 BNT162b2 Vaccination in Patients on Active Anticancer Treatment. JAMA Oncol 2021; 7:1716-1718. [PMID: 34379092 PMCID: PMC8358809 DOI: 10.1001/jamaoncol.2021.4390] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Noa Eliakim-Raz
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.,Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Massarweh
- Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Amos Stemmer
- Department of Oncology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Salomon M Stemmer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
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20
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Massarweh A, Eliakim-Raz N, Stemmer A, Levy-Barda A, Yust-Katz S, Zer A, Benouaich-Amiel A, Ben-Zvi H, Moskovits N, Brenner B, Bishara J, Yahav D, Tadmor B, Zaks T, Stemmer SM. Evaluation of Seropositivity Following BNT162b2 Messenger RNA Vaccination for SARS-CoV-2 in Patients Undergoing Treatment for Cancer. JAMA Oncol 2021; 7:1133-1140. [PMID: 34047765 PMCID: PMC8164144 DOI: 10.1001/jamaoncol.2021.2155] [Citation(s) in RCA: 193] [Impact Index Per Article: 64.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/20/2021] [Indexed: 12/29/2022]
Abstract
Importance Patients with cancer undergoing treatment are at high risk of COVID-19 following SARS-CoV-2 infection; however, their ability to produce an adequate antibody response to messenger RNA SARS-CoV-2 vaccines is unclear. Objective To evaluate rates of antispike (anti-S) antibody response to a BNT162b2 vaccine in patients with cancer who are undergoing systemic treatment vs healthy controls. Design, Setting, and Participants This prospective cohort study included 102 adult patients with solid tumors undergoing active intravenous anticancer treatment and 78 controls who received the second dose of the BNT162b2 vaccine at least 12 days before enrollment. The controls were taken from a convenience sample of the patients' family/caregivers who accompanied them to treatment. The study was conducted between February 22, 2021, and March 15, 2021 at Davidoff Cancer Center at Beilinson Hospital (Petah Tikva, Israel). Interventions Blood samples were drawn from the study participants. Serum samples were analyzed and the titers of the IgG antibodies against SARS-CoV-2 spike receptor-binding domain were determined using a commercially available immunoassay. Seropositivity was defined as 50 or greater AU/mL. Main Outcomes and Measures The primary outcome was the rate of seropositivity. Secondary outcomes included comparisons of IgG titers and identifying factors that were associated with seropositivity using univariate/multivariable analyses. Results The analysis included 180 participants, which comprised 102 patients with cancer (median [interquartile range (IQR)] age, 66 [56-72] years; 58 men [57%]) and 78 healthy controls (median [IQR] age, 62 [49-70] years; 25 men [32%]). The most common tumor type was gastrointestinal (29 [28%]). In the patient group, 92 (90%) were seropositive for SARS-CoV 2 antispike IgG antibodies after the second vaccine dose, whereas in the control group, all were seropositive. The median IgG titer in the patients with cancer was significantly lower than that in the controls (1931 [IQR, 509-4386] AU/mL vs 7160 [IQR, 3129-11 241] AU/mL; P < .001). In a multivariable analysis, the only variable that was significantly associated with lower IgG titers was treatment with chemotherapy plus immunotherapy (β, -3.5; 95% CI, -5.6 to -1.5). Conclusions and Relevance In this cohort study of patients with cancer who were receiving active systemic therapy, 90% of patients exhibited adequate antibody response to the BNT162b2 vaccine, although their antibody titers were significantly lower than those of healthy controls. Further research into the clinical relevance of lower titers and their durability is required. Nonetheless, the data support vaccinating patients with cancer as a high priority, even during therapy.
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Affiliation(s)
- Amir Massarweh
- Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Noa Eliakim-Raz
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amos Stemmer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adva Levy-Barda
- Biobank, Department of Pathology, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Shlomit Yust-Katz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Neuro-Oncology Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Alona Zer
- Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Haim Ben-Zvi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Clinical Microbiology Laboratory, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Neta Moskovits
- Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Baruch Brenner
- Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jihad Bishara
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dafna Yahav
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Boaz Tadmor
- Research Authority, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Tal Zaks
- Moderna, Cambridge, Massachusetts
| | - Salomon M. Stemmer
- Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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21
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Itzhaki Ben Zadok O, Shaul AA, Ben-Avraham B, Yaari V, Ben Zvi H, Shostak Y, Pertzov B, Eliakim-Raz N, Abed G, Abuhazira M, Barac YD, Mats I, Kramer MR, Aravot D, Kornowski R, Ben-Gal T. Immunogenicity of the BNT162b2 mRNA vaccine in heart transplant recipients - a prospective cohort study. Eur J Heart Fail 2021; 23:1555-1559. [PMID: 33963635 DOI: 10.1002/ejhf.2199] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/09/2021] [Accepted: 04/24/2021] [Indexed: 02/04/2023] Open
Abstract
AIMS To assess the short-term immunogenicity to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccine in a population of heart transplant (HTx) recipients. A prospective single-centre cohort study of HTx recipients who received a two-dose SARS-CoV-2 mRNA vaccine (BNT162b2, Pfizer-BioNTech). METHODS AND RESULTS Whole blood for anti-spike IgG (S-IgG) antibodies was drawn at days 21-26 and at days 35-40 after the first vaccine dose. Geometric mean titres (GMT) ≥50 AU/mL were interpreted positive. Included were 42 HTx recipients at a median age of 61 [interquartile range (IQR) 44-69] years. Median time from HTx to the first vaccine dose was 9.1 (IQR 2.6-14) years. Only 15% of HTx recipients demonstrated the presence of positive S-IgG antibody titres in response to the first vaccine dose [GMT 90 (IQR 54-229) AU/mL]. Overall, 49% of HTx recipients induced S-IgG antibodies in response to either the first or the full two-dose vaccine schedule [GMT 426 (IQR 106-884) AU/mL]. Older age [68 (IQR 59-70) years vs. 46 (IQR 34-63) years, P = 0.034] and anti-metabolite-based immunosuppression protocols (89% vs. 44%, P = 0.011) were associated with low immunogenicity. Importantly, 36% of HTx recipients who were non-responders to the first vaccine dose became S-IgG seropositive in response to the second vaccine dose. Approximately a half of HTx recipients did not generate S-IgG antibodies following SARS-CoV-2 two-dose vaccine. CONCLUSIONS The generally achieved protection from SARS-CoV-2 mRNA vaccination should be regarded with caution in the population of HTx recipients. The possible benefit of additive vaccine should be further studied.
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Affiliation(s)
- Osnat Itzhaki Ben Zadok
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviv A Shaul
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Binyamin Ben-Avraham
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Vicky Yaari
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haim Ben Zvi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Microbiology Laboratory, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Yael Shostak
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pulmonary Division, Rabin Medical Center, Petach Tikva, Israel
| | - Barak Pertzov
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pulmonary Division, Rabin Medical Center, Petach Tikva, Israel
| | - Noa Eliakim-Raz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Infectious Diseases, Rabin Medical Center, Petach Tikva, Israel
| | - Galia Abed
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
| | - Miriam Abuhazira
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Cardio-Thoracic Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Yaron D Barac
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Cardio-Thoracic Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Israel Mats
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai R Kramer
- Pulmonary Division, Rabin Medical Center, Petach Tikva, Israel.,Department of Infectious Diseases, Rabin Medical Center, Petach Tikva, Israel
| | - Dan Aravot
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Cardio-Thoracic Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tuvia Ben-Gal
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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22
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Ghantous N, Hershkovic S, Poran I, Benninger F, Molad Y, Eliakim-Raz N. [NEUROLOGIC COMPLICATIONS AROUND THE DIAGNOSIS OF KIKUCHI-FUJIMOTO DISEASE: A RARE PRESENTATION OF THE DISEASE OR A HINT OF AN ADDITIONAL DIAGNOSIS?]. Harefuah 2021; 160:307-310. [PMID: 34028223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Neurologic symptoms are an extremely rare presentation of Kikuchi-Fujimoto disease. We report a case of a young female patient diagnosed with Kikuchi-Fujimoto disease, presenting with neurologic symptoms compatible with aseptic meningitis, along with radiographic findings which improved with steroidal treatment. Despite the rarity of these findings, they were reported as part of the disease manifestation, however, since Kikuchi-Fujimoto disease is associated with other diseases, such as systemic lupus erythematosus (SLE), other diagnoses cannot be ruled out.
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Affiliation(s)
- Nassem Ghantous
- Department of Medicine E, Rabin Medical Center- Beilinson, Petah Tikva, Israel
| | - Shimrit Hershkovic
- Department of Medicine E, Rabin Medical Center- Beilinson, Petah Tikva, Israel
| | - Itamar Poran
- Department of Medicine E, Rabin Medical Center- Beilinson, Petah Tikva, Israel
| | - Felix Benninger
- Department of Neurology, Rabin Medical Center- Beilinson, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Molad
- Department of Rheumatology, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa Eliakim-Raz
- Department of Medicine E, Rabin Medical Center- Beilinson, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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23
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Daitch V, Paul M, Daikos GL, Durante-Mangoni E, Yahav D, Carmeli Y, Benattar YD, Skiada A, Andini R, Eliakim-Raz N, Nutman A, Zusman O, Antoniadou A, Cavezza G, Adler A, Dickstein Y, Pavleas I, Zampino R, Bitterman R, Zayyad H, Koppel F, Zak-Doron Y, Levi I, Babich T, Turjeman A, Ben-Zvi H, Friberg LE, Mouton JW, Theuretzbacher U, Leibovici L. Excluded versus included patients in a randomized controlled trial of infections caused by carbapenem-resistant Gram-negative bacteria: relevance to external validity. BMC Infect Dis 2021; 21:309. [PMID: 33789574 PMCID: PMC8010276 DOI: 10.1186/s12879-021-05995-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/25/2020] [Accepted: 03/17/2021] [Indexed: 01/19/2023] Open
Abstract
Background Population external validity is the extent to which an experimental study results can be generalized from a specific sample to a defined population. In order to apply the results of a study, we should be able to assess its population external validity. We performed an investigator-initiated randomized controlled trial (RCT) (AIDA study), which compared colistin-meropenem combination therapy to colistin monotherapy in the treatment of patients infected with carbapenem-resistant Gram-negative bacteria. In order to examine the study’s population external validity and to substantiate the use of AIDA study results in clinical practice, we performed a concomitant observational trial. Methods The study was conducted between October 1st, 2013 and January 31st, 2017 (during the RCTs recruitment period) in Greece, Israel and Italy. Patients included in the observational arm of the study have fulfilled clinical and microbiological inclusion criteria but were excluded from the RCT due to receipt of colistin for > 96 h, refusal to participate, or prior inclusion in the RCT. Non-randomized cases were compared to randomized patients. The primary outcome was clinical failure at 14 days of infection onset. Results Analysis included 701 patients. Patients were infected mainly with Acinetobacter baumannii [78.2% (548/701)]. The most common reason for exclusion was refusal to participate [62% (183/295)]. Non-randomized and randomized patients were similar in most of the demographic and background parameters, though randomized patients showed minor differences towards a more severe infection. Combination therapy was less common in non-randomized patients [31.9% (53/166) vs. 51.2% (208/406), p = 0.000]. Randomized patients received longer treatment of colistin [13 days (IQR 10–16) vs. 8.5 days (IQR 0–15), p = 0.000]. Univariate analysis showed that non-randomized patients were more inclined to clinical failure on day 14 from infection onset [82% (242/295) vs. 75.5% (307/406), p = 0.042]. After adjusting for other variables, non-inclusion was not an independent risk factor for clinical failure at day 14. Conclusion The similarity between the observational arm and RCT patients has strengthened our confidence in the population external validity of the AIDA trial. Adding an observational arm to intervention studies can help increase the population external validity and improve implementation of study results in clinical practice. Trial registration The trial was registered with ClinicalTrials.gov, number NCT01732250 on November 22, 2012.
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Affiliation(s)
- Vered Daitch
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Tel Aviv, Israel. .,Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Jebotinski 39, Petah Tikva, Israel.
| | - Mical Paul
- Institute of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - George L Daikos
- First Department of Medicine, Laikon General Hospital, Athens, Greece.,National and Kapodistrian University of Athens, Athens, Greece
| | - Emanuele Durante-Mangoni
- Internal Medicine, University of Campania 'L Vanvitelli', and AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Dafna Yahav
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Tel Aviv, Israel.,Unit of Infectious Diseases, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Yehuda Carmeli
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Tel Aviv, Israel.,Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel.,National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv, Israel
| | - Yael Dishon Benattar
- Internal Medicine, University of Campania 'L Vanvitelli', and AORN dei Colli-Monaldi Hospital, Naples, Italy.,Cheryl Spencer Department of Nursing, University of Haifa, Haifa, Israel
| | - Anna Skiada
- First Department of Medicine, Laikon General Hospital, Athens, Greece.,National and Kapodistrian University of Athens, Athens, Greece
| | - Roberto Andini
- Internal Medicine, University of Campania 'L Vanvitelli', and AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Noa Eliakim-Raz
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Tel Aviv, Israel.,Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Jebotinski 39, Petah Tikva, Israel
| | - Amir Nutman
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Tel Aviv, Israel.,National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv, Israel
| | - Oren Zusman
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Tel Aviv, Israel.,Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Jebotinski 39, Petah Tikva, Israel
| | - Anastasia Antoniadou
- National and Kapodistrian University of Athens, Athens, Greece.,Fourth Department of Medicine, Attikon University General Hospital, Athens, Greece
| | - Giusi Cavezza
- Internal Medicine, University of Campania 'L Vanvitelli', and AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Amos Adler
- Microbiology Laboratory, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Yaakov Dickstein
- Institute of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel
| | - Ioannis Pavleas
- Intensive Care Unit, Laikon General Hospital, Athens, Greece
| | - Rosa Zampino
- Internal Medicine, University of Campania 'L Vanvitelli', and AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Roni Bitterman
- Institute of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Hiba Zayyad
- Institute of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel
| | - Fidi Koppel
- Institute of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel
| | - Yael Zak-Doron
- Institute of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel
| | - Inbar Levi
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Tel Aviv, Israel.,National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv, Israel
| | - Tanya Babich
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Tel Aviv, Israel.,Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Jebotinski 39, Petah Tikva, Israel
| | - Adi Turjeman
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Tel Aviv, Israel.,Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Jebotinski 39, Petah Tikva, Israel
| | - Haim Ben-Zvi
- Clinical Microbiology Laboratory, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Lena E Friberg
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - Johan W Mouton
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | | | - Leonard Leibovici
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Tel Aviv, Israel.,Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Jebotinski 39, Petah Tikva, Israel
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24
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Babich T, Eliakim-Raz N, Turjeman A, Pujol M, Carratalà J, Shaw E, Gomila Grange A, Vuong C, Addy I, Wiegand I, Grier S, MacGowan A, Vank C, van den Heuvel L, Leibovici L. Risk factors for hospital readmission following complicated urinary tract infection. Sci Rep 2021; 11:6926. [PMID: 33767321 PMCID: PMC7994309 DOI: 10.1038/s41598-021-86246-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/11/2021] [Indexed: 11/19/2022] Open
Abstract
Hospital readmissions following severe infections are a major economic burden on the health care system and have a negative influence on patients' quality of life. Understanding the risk factors for readmission, particularly the extent to which they could be prevented, is of a great importance. In this study we evaluated potentially preventable risk factors for 60-day readmission in patients surviving hospitalization for complicated urinary tract infection (cUTI). This was a multinational, multicentre retrospective cohort study conducted in Europe and the Middle East. Our cohort included survivors of hospitalization due to cUTI during the years 2013-2014. The primary outcome was 60-day readmission following index hospitalization. Patient characteristics that could have influenced readmission: demographics, infection presentation and management, microbiological and clinical data; were collected via computerized medical records from infection onset up to 60 days after hospital discharge. Overall, 742 patients were included. The cohort median age was 68 years (interquartile range, (IQR) 55-80) and 43.3% (321/742) of patients were males. The all-cause 60-day readmission rate was 20.1% (149/742) and more than half were readmitted for infection [57.1%, (80/140)]. Recurrent cUTI was the most frequent cause for readmission [46.4% (65/140)]. Statistically significant risk factors associated with 60-day readmission in multivariable analysis were: older age (odds ratio (OR) 1.02 for an one-year increment, confidence interval (CI) 1.005-1.03), diabetes mellitus (OR 1.63, 95% CI 1.04-2.55), cancer (OR 1.7, 95% CI 1.05-2.77), previous urinary tract infection (UTI) in the last year (OR 1.8, 95% CI: 1.14-2.83), insertion of an indwelling bladder catheter (OR 1.62, 95% CI 1.07-2.45) and insertion of percutaneous nephrostomy (OR 3.68, 95% CI 1.67-8.13). In conclusion, patients surviving hospitalization for cUTI are frequently re-hospitalized, mostly for recurrent urinary infections associated with a medical condition that necessitated urinary interventions. Interventions to avoid re-admissions should target these patients.
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Affiliation(s)
- Tanya Babich
- Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petah-Tiqva, Israel.
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Noa Eliakim-Raz
- Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petah-Tiqva, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Adi Turjeman
- Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petah-Tiqva, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Miquel Pujol
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut D'Investigació Biomèdica de Bellvitge (IDIBELL), Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Jordi Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut D'Investigació Biomèdica de Bellvitge (IDIBELL), Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Evelyn Shaw
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut D'Investigació Biomèdica de Bellvitge (IDIBELL), Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Aina Gomila Grange
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut D'Investigació Biomèdica de Bellvitge (IDIBELL), Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Infectious Diseases, Hospital Universitari Parc Taulí, Barcelona, Spain
| | - Cuong Vuong
- AiCuris Anti-Infective Cures GmbH, Wuppertal, Germany
| | - Ibironke Addy
- AiCuris Anti-Infective Cures GmbH, Wuppertal, Germany
| | - Irith Wiegand
- AiCuris Anti-Infective Cures GmbH, Wuppertal, Germany
| | - Sally Grier
- Department of Infection Sciences, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Alasdair MacGowan
- Department of Infection Sciences, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | | | - Leo van den Heuvel
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Leonard Leibovici
- Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petah-Tiqva, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Turjeman A, Awwad M, Shiber S, Babich T, Eliakim-Raz N, Huttner A, Harbarth S, Leibovici L, Yahav D. Using external data to assess the external validity of a randomised controlled trial. Infect Dis (Lond) 2021; 53:325-331. [PMID: 33522839 DOI: 10.1080/23744235.2021.1879395] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Few studies have addressed external validity of randomized controlled trials in infectious diseases. We aimed to assess the external validity of an investigator-initiated trial on treatment for uncomplicated urinary tract infection. METHODS In the original study, women (n = 513) with urinary tract infection were randomized to nitrofurantoin or fosfomycin treatment in three countries between 2013 and 2017. In the present study we compared women who were screened for enrolment but excluded to women who participated in the trial, both groups in Israel. The primary outcome was the rate of emergency department index visits resulting in hospitalization within 28 days. RESULTS We compared 127 included to 110 excluded patients. The most common reasons for exclusion were logistic difficulties in recruitment and antibiotic use in the preceding month. Included patients tended to be older [39 (IQR 29-59) vs. 35.5 (IQR 24-56.25 years)], more likely to have history of recurrent infection and had more urinary symptoms. Among excluded patients, 13.6% (15/110) had initial visits resulting in hospitalization compared to 3.1% (4/127) of included participants (p = .003). The rate of emergency department visits within 28 days was similar in both groups. Clinical and microbiological failures were significantly more common in included patients [26% (33/127) vs. 1.8% (2/110), p < .001; 7.9% (10/127) vs. 0% (0/110), p = .003; respectively]. CONCLUSIONS While differences were observed between included and excluded patients, the excluded group did not represent a more 'complicated' population. The present study shows the importance of collecting data on patients excluded from randomized controlled trials.
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Affiliation(s)
- Adi Turjeman
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Muhammad Awwad
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Shachaf Shiber
- Department of Emergency Medicine, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Tanya Babich
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Noa Eliakim-Raz
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Angela Huttner
- Division of Infectious Diseases, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Stephan Harbarth
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Leonard Leibovici
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Dafna Yahav
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.,Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
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26
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Yahav D, Franceschini E, Koppel F, Turjeman A, Babich T, Bitterman R, Neuberger A, Ghanem-Zoubi N, Santoro A, Eliakim-Raz N, Pertzov B, Steinmetz T, Stern A, Dickstein Y, Maroun E, Zayyad H, Bishara J, Alon D, Edel Y, Goldberg E, Venturelli C, Mussini C, Leibovici L, Paul M. Seven Versus 14 Days of Antibiotic Therapy for Uncomplicated Gram-negative Bacteremia: A Noninferiority Randomized Controlled Trial. Clin Infect Dis 2020; 69:1091-1098. [PMID: 30535100 DOI: 10.1093/cid/ciy1054] [Citation(s) in RCA: 225] [Impact Index Per Article: 56.3] [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: 10/01/2018] [Accepted: 12/07/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Gram-negative bacteremia is a major cause of morbidity and mortality in hospitalized patients. Data to guide the duration of antibiotic therapy are limited. METHODS This was a randomized, multicenter, open-label, noninferiority trial. Inpatients with gram-negative bacteremia, who were afebrile and hemodynamically stable for at least 48 hours, were randomized to receive 7 days (intervention) or 14 days (control) of covering antibiotic therapy. Patients with uncontrolled focus of infection were excluded. The primary outcome at 90 days was a composite of all-cause mortality; relapse, suppurative, or distant complications; and readmission or extended hospitalization (>14 days). The noninferiority margin was set at 10%. RESULTS We included 604 patients (306 intervention, 298 control) between January 2013 and August 2017 in 3 centers in Israel and Italy. The source of the infection was urinary in 411 of 604 patients (68%); causative pathogens were mainly Enterobacteriaceae (543/604 [90%]). A 7-day difference in the median duration of covering antibiotics was achieved. The primary outcome occurred in 140 of 306 patients (45.8%) in the 7-day group vs 144 of 298 (48.3%) in the 14-day group (risk difference, -2.6% [95% confidence interval, -10.5% to 5.3%]). No significant differences were observed in all other outcomes and adverse events, except for a shorter time to return to baseline functional status in the short-course therapy arm. CONCLUSIONS In patients hospitalized with gram-negative bacteremia achieving clinical stability before day 7, an antibiotic course of 7 days was noninferior to 14 days. Reducing antibiotic treatment for uncomplicated gram-negative bacteremia to 7 days is an important antibiotic stewardship intervention. CLINICAL TRIALS REGISTRATION NCT01737320.
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Affiliation(s)
- Dafna Yahav
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Erica Franceschini
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Italy
| | - Fidi Koppel
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa
| | - Adi Turjeman
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.,Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva
| | - Tanya Babich
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.,Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva
| | - Roni Bitterman
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa
| | - Ami Neuberger
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa
| | | | - Antonella Santoro
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Italy
| | - Noa Eliakim-Raz
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Barak Pertzov
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva
| | - Tali Steinmetz
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva
| | - Anat Stern
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa
| | | | - Elias Maroun
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa
| | - Hiba Zayyad
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa
| | - Jihad Bishara
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Danny Alon
- Department of Medicine B, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Yonatan Edel
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.,Department of Medicine C, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Elad Goldberg
- Department of Medicine F, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Claudia Venturelli
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Italy
| | - Cristina Mussini
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Italy
| | - Leonard Leibovici
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.,Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva
| | - Mical Paul
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa
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Borisovsky G, Goldstein DA, Eliakim-Raz N, Tamir SR. Transitional Cell Carcinoma and Pseudocirrhosis— A Case Report and Review of the Literature. Journal of Gastrointestinal and Abdominal Radiology 2020. [DOI: 10.1055/s-0040-1713829] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
AbstractPseudocirrhosis is the occurrence of capsular retraction in patients with metastatic liver disease, usually of breast origin. It usually appears in these patients following chemotherapy and may result from shrinkage of the tumor, with scarring and nodular regeneration. In this article, we describe the first case of pseudocirrhosis, following treatment of transitional cell carcinoma metastatic to the liver. Portal vein thrombosis, a rare complication in pseudocirrhosis, was also detected in this patient.
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Affiliation(s)
- Gilad Borisovsky
- Radiology Department, Rabin Medical Center, Petah Tikva, Israel, affliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel A. Goldstein
- Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel, affliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa Eliakim-Raz
- Internal Medicine E, Rabin Medical Center, Petah Tikva, Israel, affliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomit R. Tamir
- Radiology Department, Rabin Medical Center, Petah Tikva, Israel, affliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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28
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Kristoffersson AN, Rognås V, Brill MJE, Dishon-Benattar Y, Durante-Mangoni E, Daitch V, Skiada A, Lellouche J, Nutman A, Kotsaki A, Andini R, Eliakim-Raz N, Bitterman R, Antoniadou A, Karlsson MO, Theuretzbacher U, Leibovici L, Daikos GL, Mouton JW, Carmeli Y, Paul M, Friberg LE. Population pharmacokinetics of colistin and the relation to survival in critically ill patients infected with colistin susceptible and carbapenem-resistant bacteria. Clin Microbiol Infect 2020; 26:1644-1650. [PMID: 32213316 DOI: 10.1016/j.cmi.2020.03.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 01/26/2020] [Revised: 02/26/2020] [Accepted: 03/15/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The aim was to analyse the population pharmacokinetics of colistin and to explore the relationship between colistin exposure and time to death. METHODS Patients included in the AIDA randomized controlled trial were treated with colistin for severe infections caused by carbapenem-resistant Gram-negative bacteria. All subjects received a 9 million units (MU) loading dose, followed by a 4.5 MU twice daily maintenance dose, with dose reduction if creatinine clearance (CrCL) < 50 mL/min. Individual colistin exposures were estimated from the developed population pharmacokinetic model and an optimized two-sample per patient sampling design. Time to death was evaluated in a parametric survival analysis. RESULTS Out of 406 randomized patients, 349 contributed pharmacokinetic data. The median (90% range) colistin plasma concentration was 0.44 (0.14-1.59) mg/L at 15 minutes after the end of first infusion. In samples drawn 10 hr after a maintenance dose, concentrations were >2 mg/L in 94% (195/208) and 44% (38/87) of patients with CrCL ≤120 mL/min, and >120 mL/min, respectively. Colistin methanesulfonate sodium (CMS) and colistin clearances were strongly dependent on CrCL. High colistin exposure to MIC ratio was associated with increased hazard of death in the multivariate analysis (adjusted hazard ratio (95% CI): 1.07 (1.03-1.12)). Other significant predictors included SOFA score at baseline (HR 1.24 (1.19-1.30) per score increase), age and Acinetobacter or Pseudomonas as index pathogen. DISCUSSION The population pharmacokinetic model predicted that >90% of the patients had colistin concentrations >2 mg/L at steady state, but only 66% at 4 hr after start of treatment. High colistin exposure was associated with poor kidney function, and was not related to a prolonged survival.
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Affiliation(s)
- A N Kristoffersson
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - V Rognås
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - M J E Brill
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - Y Dishon-Benattar
- Institute of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel; The Cheryl Spencer Institute for Nursing Research, University of Haifa, Israel
| | - E Durante-Mangoni
- Department of Precision Medicine, University of Campania 'L Vanvitelli' and AORN dei Colli-Monaldi Hospital, Napoli, Italy
| | - V Daitch
- Infectious Diseases University Research Centre, Rabin Medical Centre, Beilinson Hospital, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, and Department of Medicine E, Rabin Medical Centre, Beilinson Hospital, Petah Tikva, Israel
| | - A Skiada
- First Department of Medicine, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - J Lellouche
- National Centre for Infection Control and Antibiotic Resistance, Tel Aviv Medical Centre, Tel Aviv, Israel; National Laboratory for Antibiotic Resistance and Investigation of Outbreaks in Medical Institutions, Tel Aviv Medical Centre, Tel Aviv, Israel
| | - A Nutman
- National Centre for Infection Control and Antibiotic Resistance, Tel Aviv Medical Centre, Tel Aviv, Israel
| | - A Kotsaki
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, University General Hospital Attikon, Athens, Greece
| | - R Andini
- Department of Precision Medicine, University of Campania 'L Vanvitelli' and AORN dei Colli-Monaldi Hospital, Napoli, Italy
| | - N Eliakim-Raz
- Infectious Diseases University Research Centre, Rabin Medical Centre, Beilinson Hospital, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, and Department of Medicine E, Rabin Medical Centre, Beilinson Hospital, Petah Tikva, Israel
| | - R Bitterman
- Institute of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Techion - Israel Institute of Technology, Haifa, Israel
| | - A Antoniadou
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, University General Hospital Attikon, Athens, Greece
| | - M O Karlsson
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | | | - L Leibovici
- Sackler Faculty of Medicine, Tel-Aviv University, and Department of Medicine E, Rabin Medical Centre, Beilinson Hospital, Petah Tikva, Israel; Department of Medicine E, Rabin Medical Centre, Beilinson Hospital, Petah Tikva, Israel
| | - G L Daikos
- First Department of Medicine, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - J W Mouton
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, the Netherlands
| | - Y Carmeli
- National Centre for Infection Control and Antibiotic Resistance, Tel Aviv Medical Centre, Tel Aviv, Israel; National Laboratory for Antibiotic Resistance and Investigation of Outbreaks in Medical Institutions, Tel Aviv Medical Centre, Tel Aviv, Israel
| | - M Paul
- Institute of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Techion - Israel Institute of Technology, Haifa, Israel
| | - L E Friberg
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden.
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29
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Eliakim-Raz N, Babitch T, Shaw E, Addy I, Wiegand I, Vank C, Torre-Vallejo L, Joan-Miquel V, Steve M, Grier S, Stoddart M, Nienke C, Leo VDH, Vuong C, MacGowan A, Carratalà J, Leibovici L, Pujol M. Risk Factors for Treatment Failure and Mortality Among Hospitalized Patients With Complicated Urinary Tract Infection: A Multicenter Retrospective Cohort Study (RESCUING Study Group). Clin Infect Dis 2020; 68:29-36. [PMID: 29788118 DOI: 10.1093/cid/ciy418] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 05/10/2018] [Indexed: 12/26/2022] Open
Abstract
Background Complicated urinary tract infections (cUTIs) are responsible for a major share of all antibiotic consumption in hospitals. We aim to describe risk factors for treatment failure and mortality among patients with cUTIs. Methods A multinational, multicentre retrospective cohort study, conducted in 20 countries in Europe and the Middle East. Data were collected from patients' files on hospitalised patients with a diagnosis of cUTI during 2013-2014. Primary outcome was treatment failure, secondary outcomes included 30 days all-cause mortality,among other outcomes. Multivariable analysis using a logistic model and the hospital as a random variable was performed to identify independent predictors for these outcomes. Results A total of 981 patients with cUTI were included. Treatment failure was observed in 26.6% (261/981), all cause 30-day mortality rate was 8.7% (85/976), most of these in patients with catheter related UTI (CaUTI). Risk factors for treatment failure in multivariable analysis were ICU admission (OR 5.07, 95% CI 3.18-8.07), septic shock (OR 1.92, 95% CI 0.93-3.98), corticosteroid treatment (OR 1.92, 95% CI 1.12-3.54), bedridden (OR 2.11, 95%CI 1.4-3.18), older age (OR 1.02, 95% CI 1.0071.03-), metastatic cancer (OR 2.89, 95% CI 1.46-5.73) and CaUTI (OR 1.48, 95% CI 1.04-2.11). Management variables, such as inappropriate empirical antibiotic treatment or days to starting antibiotics were not associated with treatment failure or 30-day mortality. More patients with pyelonephritis were given appropriate empirical antibiotic therapy than other CaUTI [110/171; 64.3% vs. 116/270; 43%, p <0.005], nevertheless, this afforded no advantage in treatment failure rates nor mortality in these patients. Conclusions In patients with cUTI we found no benefit of early appropriate empirical treatment on survival rates or other outcomes. Physicians might consider supportive treatment and watchful waiting in stable patients until the causative pathogen is defined.
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Affiliation(s)
- Noa Eliakim-Raz
- Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petah-Tiqva.,Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Tanya Babitch
- Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petah-Tiqva.,Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Evelyn Shaw
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut Català de la Salut, Bellvitge Biomedical Research Institute, University of Barcelona.,Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain
| | - Ibironke Addy
- AiCuris Anti-infective Cures GmbH, Wuppertal, Germany
| | - Irith Wiegand
- AiCuris Anti-infective Cures GmbH, Wuppertal, Germany
| | | | - Laura Torre-Vallejo
- Department of Applied Health Research, University College London, United Kingdom
| | - Vigo Joan-Miquel
- Informatics Unit, Fundació Institut Català de Farmacologia, Barcelona, Spain
| | - Morris Steve
- Department of Applied Health Research, University College London, United Kingdom
| | - Sally Grier
- Department of Medical Microbiology, Southmead Hospital, North Bristol National Health Services Trust, United Kingdom
| | - Margaret Stoddart
- Department of Medical Microbiology, Southmead Hospital, North Bristol National Health Services Trust, United Kingdom
| | - Cuperus Nienke
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - van den Heuvel Leo
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - Cuong Vuong
- AiCuris Anti-infective Cures GmbH, Wuppertal, Germany
| | - Alasdair MacGowan
- Department of Medical Microbiology, Southmead Hospital, North Bristol National Health Services Trust, United Kingdom
| | - Jordi Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut Català de la Salut, Bellvitge Biomedical Research Institute, University of Barcelona.,Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain
| | - Leonard Leibovici
- Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petah-Tiqva.,Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Miquel Pujol
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut Català de la Salut, Bellvitge Biomedical Research Institute, University of Barcelona.,Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain
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30
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Gomila A, Carratalà J, Eliakim-Raz N, Shaw E, Tebé C, Wolkewitz M, Wiegand I, Grier S, Vank C, Cuperus N, Van den Heuvel L, Vuong C, MacGowan A, Leibovici L, Addy I, Pujol M. Clinical outcomes of hospitalised patients with catheter-associated urinary tract infection in countries with a high rate of multidrug-resistance: the COMBACTE-MAGNET RESCUING study. Antimicrob Resist Infect Control 2019; 8:198. [PMID: 31827779 PMCID: PMC6892205 DOI: 10.1186/s13756-019-0656-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 08/19/2019] [Accepted: 11/20/2019] [Indexed: 11/10/2022] Open
Abstract
Background Although catheter-associated urinary tract infection (CA-UTI) is a major healthcare-related problem worldwide, there is a scarcity of current data from countries with high antimicrobial resistance rates. We aimed to determine the clinical outcomes of patients with CA-UTI compared to those of patients with other sources of complicated urinary tract infection (cUTI), and to assess the impact of antimicrobial resistance. We also aimed to identify the factors influencing 30-day mortality among patients with CA-UTI. Methods This was a multicentre, multinational retrospective cohort study including hospitalised adults with cUTI between January 2013 and December 2014 in twenty hospitals from eight countries from southern Europe, Turkey and Israel. The primary endpoint was 30-day mortality. The secondary endpoints were length of hospital stay, symptom improvement after 7 days' treatment, symptom recurrence at 30 days and readmission 60 days after hospital discharge. Results Of the 807 cUTI episodes, 341 (42.2%) were CA-UTIs. The time from catheter insertion to cUTI diagnosis was less than 2 weeks in 44.6% of cases. Overall, 74.5% of cases had hospital or healthcare-acquired CA-UTI. Compared to patients with other cUTI aetiologies, those with CA-UTI had the following characteristics: they were more frequently males, older, admitted for a reason other than cUTI and admitted from a long-term care facility; had higher Charlson's comorbidity index; and more frequently had polymicrobial infections and multidrug-resistant Gram-negative bacteria (MDR-GNB). Patients with CA-UTI also had significantly higher 30-day mortality rates (15.2% vs 6%) and longer hospital stay (median 14 [interquartile range -IQR- 7-27] days vs 8 [IQR 5-14] days) than patients with cUTI of other sources. After adjusting for confounders, CA-UTI was not independently associated with an increased risk of mortality (odds ratio, 1.40; 95% confidence interval, 0.77-2.54), and neither was the presence of MDR-GNB. Conclusions CA-UTI was the most frequent source of cUTI, affecting mainly frail patients. The mortality of patients with CA-UTI was high, though this was not directly related to the infection.
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Affiliation(s)
- Aina Gomila
- 1Department of Infectious Diseases, Hospital Universitari de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Institut Català de la Salut (ICS-HUB), Barcelona, Spain.,2Corporació Sanitària Parc Taulí, Barcelona, Spain.,3Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Jordi Carratalà
- 1Department of Infectious Diseases, Hospital Universitari de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Institut Català de la Salut (ICS-HUB), Barcelona, Spain.,4University of Barcelona, Barcelona, Spain
| | - Noa Eliakim-Raz
- 5Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petah-Tiqva; and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Evelyn Shaw
- 1Department of Infectious Diseases, Hospital Universitari de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Institut Català de la Salut (ICS-HUB), Barcelona, Spain
| | - Cristian Tebé
- 6Institut d'Investigació Biomèdica de Bellvitge (IDIBELL) and Department of Basic Sciences, Universitat Rovira i Virgili, Tarragona, Spain
| | - Martin Wolkewitz
- 7Institute of Medical Biometry and Statistics, University of Freiburg, Freiburg, Germany
| | - Irith Wiegand
- AiCuris Anti-infective Cures GmbH, Wuppertal, Germany
| | - Sally Grier
- 9Department of Medical Microbiology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | | | - Nienke Cuperus
- 10Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Leonard Van den Heuvel
- 10Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Cuong Vuong
- AiCuris Anti-infective Cures GmbH, Wuppertal, Germany
| | - Alasdair MacGowan
- 9Department of Medical Microbiology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Leonard Leibovici
- 5Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petah-Tiqva; and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ibironke Addy
- AiCuris Anti-infective Cures GmbH, Wuppertal, Germany
| | - Miquel Pujol
- 1Department of Infectious Diseases, Hospital Universitari de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Institut Català de la Salut (ICS-HUB), Barcelona, Spain
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Zak-Doron Y, Dishon Benattar Y, Pfeffer I, Daikos GL, Skiada A, Antoniadou A, Durante-Mangoni E, Andini R, Cavezza G, Leibovici L, Yahav D, Eliakim-Raz N, Carmeli Y, Nutman A, Paul M. The Association Between Empirical Antibiotic Treatment and Mortality in Severe Infections Caused by Carbapenem-resistant Gram-negative Bacteria: A Prospective Study. Clin Infect Dis 2019; 67:1815-1823. [PMID: 29718143 DOI: 10.1093/cid/ciy371] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 04/25/2018] [Indexed: 12/14/2022] Open
Abstract
Background Empirical colistin should be avoided. We aimed to evaluate the association between covering empirical antibiotics (EAT) and mortality for infections caused by carbapenem-resistant gram-negative bacteria (CRGNB). Methods This was a secondary analysis of a randomized controlled trial, including adults with bloodstream infections, pneumonia, or urosepsis caused by CRGNB. All patients received EAT followed by covering targeted therapy. The exposure variable was covering EAT in the first 48 hours. The outcome was 28-day mortality. We adjusted the analyses by multivariable regression analysis and propensity score matching. Results The study included 406 inpatients with severe CRGNB infections, mostly Acinetobacter baumannii (312/406 [77%]). Covering EAT was given to 209 (51.5%) patients, mostly colistin (n = 200). Patients receiving noncovering EAT were older, more frequently unconscious and dependent, carrying catheters, and mechanically ventilated with pneumonia. Mortality was 84 of 197 (42.6%) with noncovering vs 96 of 209 (45.9%) with covering EAT (P = .504). Covering EAT was not associated with survival in the adjusted analysis; rather, there was a weak association with mortality (odds ratio [OR], 1.37; 95% confidence interval [CI], 1.02-1.84). Results were similar for colistin monotherapy and colistin-carbapenem combination EAT. In the propensity score-matched cohort (n = 338) covering antibiotics were not significantly associated with mortality (OR, 1.42; 95% CI, .91-2.22). Similar results were obtained in an analysis of 14-day mortality. Conclusions Empirical use of colistin before pathogen identification, with or without a carbapenem, was not associated with survival following severe infections caused by CRGNBs, mainly A. baumannii.
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Affiliation(s)
- Yael Zak-Doron
- Institute of Infectious Diseases, Rambam Health Care Campus, Israel.,Faculty of Medicine, Technion, Israel Institute of Technology, Israel
| | - Yael Dishon Benattar
- Institute of Infectious Diseases, Rambam Health Care Campus, Israel.,Cheryl Spencer Department of Nursing, University of Haifa, Israel
| | - Iris Pfeffer
- Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Centre, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - George L Daikos
- First Department of Medicine, Laiko General Hospital, Israel
| | - Anna Skiada
- First Department of Medicine, Laiko General Hospital, Israel
| | - Anastasia Antoniadou
- School of Medicine, University General Hospital Attikon, National and Kapodistrian University of Athens, Greece
| | - Emanuele Durante-Mangoni
- Internal Medicine, University of Campania "L. Vanvitelli" and Azienda Ospedaliera di Rilievo Nazionale dei Colli-Monaldi Hospital, Napoli, Italy
| | - Roberto Andini
- Internal Medicine, University of Campania "L. Vanvitelli" and Azienda Ospedaliera di Rilievo Nazionale dei Colli-Monaldi Hospital, Napoli, Italy
| | - Giusi Cavezza
- Internal Medicine, University of Campania "L. Vanvitelli" and Azienda Ospedaliera di Rilievo Nazionale dei Colli-Monaldi Hospital, Napoli, Italy
| | - Leonard Leibovici
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel.,Department of Medicine E, Beilinson Hospital, Petah Tikva, Israel
| | - Dafna Yahav
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel.,Unit of Infectious Diseases, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Noa Eliakim-Raz
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel.,Department of Medicine E, Beilinson Hospital, Petah Tikva, Israel
| | - Yehuda Carmeli
- Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Centre, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Amir Nutman
- Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Centre, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Mical Paul
- Institute of Infectious Diseases, Rambam Health Care Campus, Israel.,Faculty of Medicine, Technion, Israel Institute of Technology, Israel
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Pertzov B, Eliakim-Raz N, Atamna H, Trestioreanu AZ, Yahav D, Leibovici L. Hydroxymethylglutaryl-CoA reductase inhibitors (statins) for the treatment of sepsis in adults-Authors' reply. Clin Microbiol Infect 2019; 25:1572-1573. [PMID: 31473328 DOI: 10.1016/j.cmi.2019.08.015] [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] [Received: 06/26/2019] [Revised: 08/19/2019] [Accepted: 08/20/2019] [Indexed: 11/28/2022]
Affiliation(s)
- B Pertzov
- Department of Medicine E, Beilinson Hospital, Rabin Medical Centre, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - N Eliakim-Raz
- Department of Medicine E, Beilinson Hospital, Rabin Medical Centre, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - H Atamna
- Department of Medicine E, Beilinson Hospital, Rabin Medical Centre, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - A Z Trestioreanu
- Department of Family Medicine, Beilinson Hospital, Rabin Medical Centre, Petah Tikva, Israel
| | - D Yahav
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Infectious Diseases Unit, Rabin Medical Centre, Beilinson Hospital, Petah-Tikva, Israel
| | - L Leibovici
- Department of Medicine E, Beilinson Hospital, Rabin Medical Centre, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Golos M, Eliakim-Raz N, Stern A, Leibovici L, Paul M. Conjugated pneumococcal vaccine versus polysaccharide pneumococcal vaccine for prevention of pneumonia and invasive pneumococcal disease in immunocompetent and immunocompromised adults and children. Hippokratia 2019. [DOI: 10.1002/14651858.cd012306.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Miri Golos
- Rambam Health Care Campus; ICU; Ha-aliya 8 St Haifa Israel 33705
| | - Noa Eliakim-Raz
- Beilinson Hospital, Rabin Medical Center; Department of Medicine E; and Sackler Faculty of Medicine, Tel-Aviv University, Israel; 39 Jabotinski Street Petah Tikva Israel 49100
| | - Anat Stern
- Rambam Health Care Campus; Division of Infectious Diseases; Ha-aliya 8 St Haifa Israel 33705
| | - Leonard Leibovici
- Beilinson Hospital, Rabin Medical Center; Department of Medicine E; Kaplan Street Petah Tikva Israel 49100
| | - Mical Paul
- Rambam Health Care Campus; Division of Infectious Diseases; Ha-aliya 8 St Haifa Israel 33705
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Gomila A, Carratalà J, Eliakim-Raz N, Shaw E, Wiegand I, Vallejo-Torres L, Gorostiza A, Vigo JM, Morris S, Stoddart M, Grier S, Vank C, Cuperus N, Van den Heuvel L, Vuong C, MacGowan A, Leibovici L, Addy I, Pujol M. Risk factors and prognosis of complicated urinary tract infections caused by Pseudomonas aeruginosa in hospitalized patients: a retrospective multicenter cohort study. Infect Drug Resist 2018; 11:2571-2581. [PMID: 30588040 PMCID: PMC6302800 DOI: 10.2147/idr.s185753] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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] [Indexed: 11/23/2022] Open
Abstract
Purpose Complicated urinary tract infections (cUTIs) are among the most frequent health-care-associated infections. In patients with cUTI, Pseudomonas aeruginosa deserves special attention, since it can affect patients with serious underlying conditions. Our aim was to gain insight into the risk factors and prognosis of P. aeruginosa cUTIs in a scenario of increasing multidrug resistance (MDR). Methods This was a multinational, retrospective, observational study at 20 hospitals in south and southeastern Europe, Turkey, and Israel including consecutive patients with cUTI hospitalized between January 2013 and December 2014. A mixed-effect logistic regression model was performed to assess risk factors for P. aeruginosa and MDR P. aeruginosa cUTI. Results Of 1,007 episodes of cUTI, 97 (9.6%) were due to P. aeruginosa. Resistance rates of P. aeruginosa were: antipseudomonal cephalosporins 35 of 97 (36.1%), aminoglycosides 30 of 97 (30.9%), piperacillin-tazobactam 21 of 97 (21.6%), fluoroquinolones 43 of 97 (44.3%), and carbapenems 28 of 97 (28.8%). The MDR rate was 28 of 97 (28.8%). Independent risk factors for P. aeruginosa cUTI were male sex (OR 2.61, 95% CI 1.60-4.27), steroid therapy (OR 2.40, 95% CI 1.10-5.27), bedridden functional status (OR 1.79, 95% CI 0.99-3.25), antibiotic treatment within the previous 30 days (OR 2.34, 95% CI 1.38-3.94), indwelling urinary catheter (OR 2.41, 95% CI 1.43-4.08), and procedures that anatomically modified the urinary tract (OR 2.01, 95% CI 1.04-3.87). Independent risk factors for MDR P. aeruginosa cUTI were age (OR 0.96, 95% CI 0.93-0.99) and anatomical urinary tract modification (OR 4.75, 95% CI 1.06-21.26). Readmission was higher in P. aeruginosa cUTI patients than in other etiologies (23 of 97 [23.7%] vs 144 of 910 [15.8%], P=0.04), while 30-day mortality was not significantly different (seven of 97 [7.2%] vs 77 of 910 [8.5%], P=0.6). Conclusion Patients with P. aeruginosa cUTI had characteristically a serious baseline condition and manipulation of the urinary tract, although their mortality was not higher than that of patients with cUTI caused by other etiologies.
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Affiliation(s)
- Aina Gomila
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut Català de la Salut (ICS-HUB), Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III (ISCIII), Madrid, Spain, .,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain,
| | - J Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut Català de la Salut (ICS-HUB), Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III (ISCIII), Madrid, Spain, .,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain, .,Infectious Diseases Department, University of Barcelona, Barcelona, Spain
| | - N Eliakim-Raz
- Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petah-Tiqva and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - E Shaw
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut Català de la Salut (ICS-HUB), Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III (ISCIII), Madrid, Spain, .,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain,
| | - I Wiegand
- AiCuris Anti-infective Cures, Wuppertal, Germany
| | - L Vallejo-Torres
- UCL Department of Applied Health Research, University College London, London, UK
| | - A Gorostiza
- Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain,
| | - J M Vigo
- Informatics Unit, Fundació Institut Català de Farmacologia, Barcelona, Spain
| | - S Morris
- UCL Department of Applied Health Research, University College London, London, UK
| | - M Stoddart
- Department of Medical Microbiology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - S Grier
- Department of Medical Microbiology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - C Vank
- AiCuris Anti-infective Cures, Wuppertal, Germany
| | - N Cuperus
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - L Van den Heuvel
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - C Vuong
- AiCuris Anti-infective Cures, Wuppertal, Germany
| | - A MacGowan
- Department of Medical Microbiology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - L Leibovici
- Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petah-Tiqva and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - I Addy
- AiCuris Anti-infective Cures, Wuppertal, Germany
| | - M Pujol
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut Català de la Salut (ICS-HUB), Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III (ISCIII), Madrid, Spain, .,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain,
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Pertzov B, Eliakim-Raz N, Atamna H, Trestioreanu AZ, Yahav D, Leibovici L. Hydroxymethylglutaryl-CoA reductase inhibitors (statins) for the treatment of sepsis in adults - A systematic review and meta-analysis. Clin Microbiol Infect 2018; 25:280-289. [PMID: 30472427 DOI: 10.1016/j.cmi.2018.11.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [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] [Received: 05/14/2018] [Revised: 10/14/2018] [Accepted: 11/03/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The pleiotropic effect of hydroxymethylglutaryl-CoA reductase inhibitors (statins) might have a beneficial effect in sepsis through several mechanisms. The aim was to assess the efficacy and safety of statins, compared with placebo, for the treatment of sepsis in adults. METHODS We searched the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, 2017, Issue 12), OVID MEDLINE (from 1966 to January 2018), Embase (Ovid SP, from 1974 to January 2018), and LILACS (from 1986 to January 2018). We also searched the trial registries ISRCTN and ClinicalTrials.gov to January 2018. The eligibility criteria were randomized controlled trials comparing the treatment of statins versus placebo in adult patients who were hospitalized due to sepsis. Participants were adults (16 years and older) hospitalized because of sepsis or who developed sepsis during admission. Interventions were treatment with hydroxymethylglutaryl-CoA reductase inhibitors (statins) versus no treatment or placebo. We performed a systematic review of all randomized controlled trials published until January 2018, assessing the efficacy and safety of statins in sepsis treatment. Two primary outcomes were assessed: 30-day overall mortality and deterioration to severe sepsis during management. Secondary outcomes were hospital mortality, need for mechanical ventilation and drug related adverse events. RESULTS Fourteen trials evaluating 2628 patients were included. Statins did not reduce 30-day all-cause mortality neither in all patients (risk ratio (RR) 0.96, 95% confidence interval (CI) 0.83-1.10), nor in a subgroup of patients with severe sepsis (RR 0.97, 95% CI 0.84-1.12). The certainty of evidence for both outcomes was high. There was no change in the rate of adverse events between study arms (RR 1.24, 95% CI 0.94 to 1.63). The certainty of evidence for this outcome was high. CONCLUSIONS The use of statin therapy in adults for the indication of sepsis is not recommended.
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Affiliation(s)
- B Pertzov
- Department of Medicine E, Beilinson Hospital, Rabin Medical Centre, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - N Eliakim-Raz
- Department of Medicine E, Beilinson Hospital, Rabin Medical Centre, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - H Atamna
- Department of Medicine E, Beilinson Hospital, Rabin Medical Centre, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - A Z Trestioreanu
- Department of Family Medicine, Beilinson Hospital, Rabin Medical Centre, Petah Tikva, Israel
| | - D Yahav
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Infectious Diseases Unit, Rabin Medical Centre, Beilinson Hospital, Petah-Tikva, Israel
| | - L Leibovici
- Department of Medicine E, Beilinson Hospital, Rabin Medical Centre, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Eliakim-Raz N, Yahav D, Bishara J. Trimethoprim/sulfamethoxazole versus vancomycin in the treatment of healthcare/ventilator-associated MRSA pneumonia: a case-control study-authors' response. J Antimicrob Chemother 2018; 72:2685-2686. [PMID: 28859439 DOI: 10.1093/jac/dkx213] [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: 11/12/2022] Open
Affiliation(s)
- Noa Eliakim-Raz
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.,Department of Internal Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Dafna Yahav
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Jihad Bishara
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
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Lellouche J, Schwartz D, Elmalech N, Ben Dalak MA, Temkin E, Paul M, Geffen Y, Yahav D, Eliakim-Raz N, Durante-Mangoni E, Iossa D, Bernardo M, Daikos GL, Skiada A, Pantazatou A, Antoniadou A, Mouton JW, Carmeli Y. Combining VITEK ® 2 with colistin agar dilution screening assist timely reporting of colistin susceptibility. Clin Microbiol Infect 2018; 25:711-716. [PMID: 30291971 DOI: 10.1016/j.cmi.2018.09.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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] [Received: 04/09/2018] [Revised: 09/17/2018] [Accepted: 09/18/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The rise in carbapenem resistance among Gram-negative bacteria has renewed interest in colistin. Recently, the EUCAST-CLSI Polymyxin Breakpoints Working Group declared that broth microdilution (BMD) is the only valid method for colistin susceptibility testing. BMD is not easily incorporated into the routine work of clinical laboratories, and usually this test is incorporated serially, resulting in delayed susceptibility reporting. We tested a strategy of combining VITEK® 2 with a 2 μg/mL colistin agar dilution (VITEK® 2/AD) screening plate to improve performance and time to reporting of colistin susceptibility. METHODS Colistin susceptibility for 364 clinical isolates was determined by VITEK® 2/AD and compared with the reference standard BMD according to the ISO 20776-1:2007 and CLSI guidelines. The EUCAST colistin susceptibility breakpoint of ≤2 μg/mL was used. Escherichia coli NCTC 13846 served as quality control strain. Agreement, very major error (VME) and major error rates were determined using ISO 20776-2:2007. RESULTS The VME rate for VITEK® 2 alone was 30.6% (15/49, 95% CI 18.3-45.4%), and was reduced to 10.2% (5/49, 95% CI 3.4-22.2%) using the VITEK® 2/AD combined testing. The combined testing had categorical agreement with BMD of 97% (354/364, 95% CI 95.0-98.7%), and a major error (ME) rate of 1.6% (5/315, 95% CI 0.5-3.7%). Using the combined testing, even against challenging strains, 349 (95.8%, 95% CI 93.3-97.7%) colistin susceptibility results could be reported, and only 15 isolates required further analysis by BMD. DISCUSSION Our method is simple to apply and allows rapid reporting of colistin susceptibility.
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Affiliation(s)
- J Lellouche
- Molecular Epidemiology Laboratory, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; National Laboratory for Antibiotic Resistance and Investigation of Outbreaks in Medical Institutions, National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Israel.
| | - D Schwartz
- Molecular Epidemiology Laboratory, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; National Laboratory for Antibiotic Resistance and Investigation of Outbreaks in Medical Institutions, National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Israel
| | - N Elmalech
- Molecular Epidemiology Laboratory, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; National Laboratory for Antibiotic Resistance and Investigation of Outbreaks in Medical Institutions, National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Israel
| | - M A Ben Dalak
- Molecular Epidemiology Laboratory, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; National Laboratory for Antibiotic Resistance and Investigation of Outbreaks in Medical Institutions, National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Israel
| | - E Temkin
- Molecular Epidemiology Laboratory, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; National Laboratory for Antibiotic Resistance and Investigation of Outbreaks in Medical Institutions, National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Israel
| | - M Paul
- Institute of Infectious Diseases, Rambam Health Care Campus, Israel; Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Y Geffen
- Clinical Microbiology Laboratory, Rambam Health Care Campus, Haifa, Israel
| | - D Yahav
- Unit of Infectious Diseases, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel
| | - N Eliakim-Raz
- Unit of Infectious Diseases, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel; Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - E Durante-Mangoni
- Department of Precision Medicine, University of Campania 'L Vanvitelli' and AORN dei Colli-Monaldi Hospital, Napoli, Italy
| | - D Iossa
- Department of Precision Medicine, University of Campania 'L Vanvitelli' and AORN dei Colli-Monaldi Hospital, Napoli, Italy
| | - M Bernardo
- Department of Precision Medicine, University of Campania 'L Vanvitelli' and AORN dei Colli-Monaldi Hospital, Napoli, Italy
| | - G L Daikos
- First Department of Medicine, Laikon General Hospital, Greece; National and Kapodistrian University of Athens, Athens, Greece
| | - A Skiada
- First Department of Medicine, Laikon General Hospital, Greece; National and Kapodistrian University of Athens, Athens, Greece
| | - A Pantazatou
- National and Kapodistrian University of Athens, Athens, Greece; Clinical Microbiology Laboratory, Laikon General Hospital, Greece
| | - A Antoniadou
- National and Kapodistrian University of Athens, Athens, Greece; Fourth Department of Medicine, Attikon University General Hospital, Athens, Greece
| | - J W Mouton
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, the Netherlands
| | - Y Carmeli
- Molecular Epidemiology Laboratory, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; National Laboratory for Antibiotic Resistance and Investigation of Outbreaks in Medical Institutions, National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel
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Huttner A, Kowalczyk A, Turjeman A, Babich T, Brossier C, Eliakim-Raz N, Kosiek K, Martinez de Tejada B, Roux X, Shiber S, Theuretzbacher U, von Dach E, Yahav D, Leibovici L, Godycki-Ćwirko M, Mouton JW, Harbarth S. Effect of 5-Day Nitrofurantoin vs Single-Dose Fosfomycin on Clinical Resolution of Uncomplicated Lower Urinary Tract Infection in Women: A Randomized Clinical Trial. JAMA 2018; 319:1781-1789. [PMID: 29710295 PMCID: PMC6134435 DOI: 10.1001/jama.2018.3627] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
IMPORTANCE The use of nitrofurantoin and fosfomycin has increased since guidelines began recommending them as first-line therapy for lower urinary tract infection (UTI). OBJECTIVE To compare the clinical and microbiologic efficacy of nitrofurantoin and fosfomycin in women with uncomplicated cystitis. DESIGN, SETTING, AND PARTICIPANTS Multinational, open-label, analyst-blinded, randomized clinical trial including 513 nonpregnant women aged 18 years and older with symptoms of lower UTI (dysuria, urgency, frequency, or suprapubic tenderness), a positive urine dipstick result (with detection of nitrites or leukocyte esterase), and no known colonization or previous infection with uropathogens resistant to the study antibiotics. Recruitment took place from October 2013 through April 2017 at hospital units and outpatient clinics in Geneva, Switzerland; Lodz, Poland; and Petah-Tiqva, Israel. INTERVENTIONS Participants were randomized in a 1:1 ratio to oral nitrofurantoin, 100 mg 3 times a day for 5 days (n = 255), or a single 3-g dose of oral fosfomycin (n = 258). They returned 14 and 28 days after therapy completion for clinical evaluation and urine culture collection. MAIN OUTCOMES AND MEASURES The primary outcome was clinical response in the 28 days following therapy completion, defined as clinical resolution (complete resolution of symptoms and signs of UTI without prior failure), failure (need for additional or change in antibiotic treatment due to UTI or discontinuation due to lack of efficacy), or indeterminate (persistence of symptoms without objective evidence of infection). Secondary outcomes included bacteriologic response and incidence of adverse events. RESULTS Among 513 patients who were randomized (median age, 44 years [interquartile range, 31-64]), 475 (93%) completed the trial and 377 (73%) had a confirmed positive baseline culture. Clinical resolution through day 28 was achieved in 171 of 244 patients (70%) receiving nitrofurantoin vs 139 of 241 patients (58%) receiving fosfomycin (difference, 12% [95% CI, 4%-21%]; P = .004). Microbiologic resolution occurred in 129 of 175 (74%) vs 103 of 163 (63%), respectively (difference, 11% [95% CI, 1%-20%]; P = .04). Adverse events were few and primarily gastrointestinal; the most common were nausea and diarrhea (7/248 [3%] and 3/248 [1%] in the nitrofurantoin group vs 5/247 [2%] and 5/247 [1%] in the fosfomycin group, respectively). CONCLUSIONS AND RELEVANCE Among women with uncomplicated UTI, 5-day nitrofurantoin, compared with single-dose fosfomycin, resulted in a significantly greater likelihood of clinical and microbiologic resolution at 28 days after therapy completion. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01966653.
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Affiliation(s)
- Angela Huttner
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Anna Kowalczyk
- Centre for Family and Community Medicine, Medical University of Lodz, Lodz, Poland
| | - Adi Turjeman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tanya Babich
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Caroline Brossier
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Noa Eliakim-Raz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Internal Medicine E, Rabin Medical Center, Beilinson Campus, Peta-Tiqva, Israel
| | - Katarzyna Kosiek
- Faculty of Health Sciences, Division of Public Health, Medical University of Lodz, Lodz, Poland
| | - Begoña Martinez de Tejada
- Obstetrics Division, Department of Obstetrics and Gynecology, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Xavier Roux
- Department of Internal Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Shachaf Shiber
- Department of Emergency Medicine, Rabin Medical Center, Beilinson Campus, Peta-Tiqva, Israel
| | | | - Elodie von Dach
- Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Clinical Trials Unit, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Dafna Yahav
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tiqva, Israel
| | - Leonard Leibovici
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Internal Medicine E, Rabin Medical Center, Beilinson Campus, Peta-Tiqva, Israel
| | - Maciek Godycki-Ćwirko
- Centre for Family and Community Medicine, Medical University of Lodz, Lodz, Poland
- Faculty of Health Sciences, Division of Public Health, Medical University of Lodz, Lodz, Poland
| | - Johan W. Mouton
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, the Netherlands
| | - Stephan Harbarth
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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Pertzov B, Zalmanovici Trestioreanu A, Eliakim-Raz N, Yahav D, Leibovici L. Hydroxymethylglutaryl-CoA reductase inhibitors (statins) for the treatment of sepsis. Hippokratia 2018. [DOI: 10.1002/14651858.cd011329.pub2] [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: 11/06/2022]
Affiliation(s)
- Barak Pertzov
- Beilinson Hospital, Rabin Medical Center; Department of Medicine E; 39 Jabotinski Road Petah Tikva Israel 49100
- Tel-Aviv University; Sackler Faculty of Medicine; Tel-Aviv Israel
| | - Anca Zalmanovici Trestioreanu
- Beilinson Hospital, Rabin Medical Center; Department of Family Medicine; 39 Jabotinski Street Petah Tikva Israel 49100
| | - Noa Eliakim-Raz
- Tel-Aviv University; Sackler Faculty of Medicine; Tel-Aviv Israel
- Beilinson Hospital, Rabin Medical Center; Department of Medicine E; and Sackler Faculty of Medicine, Tel-Aviv University, Israel; 39 Jabotinski Street Petah Tikva Israel 49100
| | - Dafna Yahav
- Beilinson Hospital, Rabin Medical Center; Department of Medicine E; 39 Jabotinski Road Petah Tikva Israel 49100
- Tel-Aviv University; Sackler Faculty of Medicine; Tel-Aviv Israel
| | - Leonard Leibovici
- Beilinson Hospital, Rabin Medical Center; Department of Medicine E; 39 Jabotinski Road Petah Tikva Israel 49100
- Tel-Aviv University; Sackler Faculty of Medicine; Tel-Aviv Israel
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Vallejo-Torres L, Pujol M, Shaw E, Wiegand I, Vigo JM, Stoddart M, Grier S, Gibbs J, Vank C, Cuperus N, van den Heuvel L, Eliakim-Raz N, Carratala J, Vuong C, MacGowan A, Babich T, Leibovici L, Addy I, Morris S. Cost of hospitalised patients due to complicated urinary tract infections: a retrospective observational study in countries with high prevalence of multidrug-resistant Gram-negative bacteria: the COMBACTE-MAGNET, RESCUING study. BMJ Open 2018; 8:e020251. [PMID: 29654026 PMCID: PMC5898316 DOI: 10.1136/bmjopen-2017-020251] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Complicated urinary tract infections (cUTIs) impose a high burden on healthcare systems and are a frequent cause of hospitalisation. The aims of this paper are to estimate the cost per episode of patients hospitalised due to cUTI and to explore the factors associated with cUTI-related healthcare costs in eight countries with high prevalence of multidrug resistance (MDR). DESIGN This is a multinational observational, retrospective study. The mean cost per episode was computed by multiplying the volume of healthcare use for each patient by the unit cost of each item of care and summing across all components. Costs were measured from the hospital perspective. Patient-level regression analyses were used to identify the factors explaining variation in cUTI-related costs. SETTING The study was conducted in 20 hospitals in eight countries with high prevalence of multidrug resistant Gram-negative bacteria (Bulgaria, Greece, Hungary, Israel, Italy, Romania, Spain and Turkey). PARTICIPANTS Data were obtained from 644 episodes of patients hospitalised due to cUTI. RESULTS The mean cost per case was €5700, with considerable variation between countries (largest value €7740 in Turkey; lowest value €4028 in Israel), mainly due to differences in length of hospital stay. Factors associated with higher costs per patient were: type of admission, infection source, infection severity, the Charlson comorbidity index and presence of MDR. CONCLUSIONS The mean cost per hospitalised case of cUTI was substantial and varied significantly between countries. A better knowledge of the reasons for variations in length of stays could facilitate a better standardised quality of care for patients with cUTI and allow a more efficient allocation of healthcare resources. Urgent admissions, infections due to an indwelling urinary catheterisation, resulting in septic shock or severe sepsis, in patients with comorbidities and presenting MDR were related to a higher cost.
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Affiliation(s)
- Laura Vallejo-Torres
- UCL Department of Applied Health Research, University College London, London, UK
- Departamento de Métodos Cuantitativos en Economía y Gestión, Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Miquel Pujol
- Infectious diseases Department, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain
| | - Evelyn Shaw
- Infectious diseases Department, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain
| | - Irith Wiegand
- AiCuris Anti-infective Cures GmbH, Wuppertal, Germany
| | - Joan Miquel Vigo
- Informatics Unit, Fundació Institut Català de Farmacologia, Barcelona, Spain
| | - Margaret Stoddart
- Department of Medical Microbiology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Sally Grier
- Department of Medical Microbiology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Julie Gibbs
- Department of Medical Microbiology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | | | - Nienke Cuperus
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Leo van den Heuvel
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Noa Eliakim-Raz
- Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Petah Tikva, Israel
| | - Jordi Carratala
- Infectious diseases Department, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain
| | - Cuong Vuong
- AiCuris Anti-infective Cures GmbH, Wuppertal, Germany
| | - Alasdair MacGowan
- Department of Medical Microbiology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Tanya Babich
- Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Petah Tikva, Israel
| | - Leonard Leibovici
- Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Petah Tikva, Israel
| | - Ibironke Addy
- AiCuris Anti-infective Cures GmbH, Wuppertal, Germany
| | - Stephen Morris
- UCL Department of Applied Health Research, University College London, London, UK
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Paul M, Daikos GL, Durante-Mangoni E, Yahav D, Carmeli Y, Benattar YD, Skiada A, Andini R, Eliakim-Raz N, Nutman A, Zusman O, Antoniadou A, Pafundi PC, Adler A, Dickstein Y, Pavleas I, Zampino R, Daitch V, Bitterman R, Zayyad H, Koppel F, Levi I, Babich T, Friberg LE, Mouton JW, Theuretzbacher U, Leibovici L. Colistin alone versus colistin plus meropenem for treatment of severe infections caused by carbapenem-resistant Gram-negative bacteria: an open-label, randomised controlled trial. Lancet Infect Dis 2018; 18:391-400. [PMID: 29456043 DOI: 10.1016/s1473-3099(18)30099-9] [Citation(s) in RCA: 354] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 11/26/2017] [Accepted: 12/07/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Colistin-carbapenem combinations are synergistic in vitro against carbapenem-resistant Gram-negative bacteria. We aimed to test whether combination therapy improves clinical outcomes for adults with infections caused by carbapenem-resistant or carbapenemase-producing Gram-negative bacteria. METHODS A randomised controlled superiority trial was done in six hospitals in Israel, Greece, and Italy. We included adults with bacteraemia, ventilator-associated pneumonia, hospital-acquired pneumonia, or urosepsis caused by carbapenem-non-susceptible Gram-negative bacteria. Patients were randomly assigned (1:1) centrally, by computer-generated permuted blocks stratified by centre, to intravenous colistin (9-million unit loading dose, followed by 4·5 million units twice per day) or colistin with meropenem (2-g prolonged infusion three times per day). The trial was open-label, with blinded outcome assessment. Treatment success was defined as survival, haemodynamic stability, improved or stable Sequential Organ Failure Assessment score, stable or improved ratio of partial pressure of arterial oxygen to fraction of expired oxygen for patients with pneumonia, and microbiological cure for patients with bacteraemia. The primary outcome was clinical failure, defined as not meeting all success criteria by intention-to-treat analysis, at 14 days after randomisation. This trial is registered at ClinicalTrials.gov, number NCT01732250, and is closed to accrual. FINDINGS Between Oct 1, 2013, and Dec 31, 2016, we randomly assigned 406 patients to the two treatment groups. Most patients had pneumonia or bacteraemia (355/406, 87%), and most infections were caused by Acinetobacter baumannii (312/406, 77%). No significant difference between colistin monotherapy (156/198, 79%) and combination therapy (152/208, 73%) was observed for clinical failure at 14 days after randomisation (risk difference -5·7%, 95% CI -13·9 to 2·4; risk ratio [RR] 0·93, 95% CI 0·83-1·03). Results were similar among patients with A baumannii infections (RR 0·97, 95% CI 0·87-1·09). Combination therapy increased the incidence of diarrhoea (56 [27%] vs 32 [16%] patients) and decreased the incidence of mild renal failure (37 [30%] of 124 vs 25 [20%] of 125 patients at risk of or with kidney injury). INTERPRETATION Combination therapy was not superior to monotherapy. The addition of meropenem to colistin did not improve clinical failure in severe A baumannii infections. The trial was unpowered to specifically address other bacteria. FUNDING EU AIDA grant Health-F3-2011-278348.
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Affiliation(s)
- Mical Paul
- Institute of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel; Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
| | - George L Daikos
- First Department of Medicine, Laikon General Hospital, Athens, Greece; National and Kapodistrian University of Athens, Athens, Greece
| | - Emanuele Durante-Mangoni
- Internal Medicine, University of Campania 'L Vanvitelli', and AORN dei Colli-Monaldi Hospital, Napoli, Italy
| | - Dafna Yahav
- Unit of Infectious Diseases, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel
| | - Yehuda Carmeli
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel; Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel
| | - Yael Dishon Benattar
- Institute of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel; Cheryl Spencer Department of Nursing, University of Haifa, Haifa, Israel
| | - Anna Skiada
- First Department of Medicine, Laikon General Hospital, Athens, Greece; National and Kapodistrian University of Athens, Athens, Greece
| | - Roberto Andini
- Internal Medicine, University of Campania 'L Vanvitelli', and AORN dei Colli-Monaldi Hospital, Napoli, Italy
| | - Noa Eliakim-Raz
- Unit of Infectious Diseases, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel
| | - Amir Nutman
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel; Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel
| | - Oren Zusman
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel
| | - Anastasia Antoniadou
- National and Kapodistrian University of Athens, Athens, Greece; Fourth Department of Medicine, Attikon University General Hospital, Athens, Greece
| | - Pia Clara Pafundi
- Internal Medicine, University of Campania 'L Vanvitelli', and AORN dei Colli-Monaldi Hospital, Napoli, Italy
| | - Amos Adler
- Microbiology Laboratory, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel
| | - Yaakov Dickstein
- Institute of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel
| | - Ioannis Pavleas
- Intensive Care Unit, Laikon General Hospital, Athens, Greece
| | - Rosa Zampino
- Internal Medicine, University of Campania 'L Vanvitelli', and AORN dei Colli-Monaldi Hospital, Napoli, Italy
| | - Vered Daitch
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel
| | - Roni Bitterman
- Institute of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel
| | - Hiba Zayyad
- Institute of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel
| | - Fidi Koppel
- Institute of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel
| | - Inbar Levi
- Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel
| | - Tanya Babich
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel
| | - Lena E Friberg
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - Johan W Mouton
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, the Netherlands
| | | | - Leonard Leibovici
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel
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Eliakim-Raz N, Hellerman M, Yahav D, Cohen J, Margalit I, Fisher S, Zusman O, Shaked H, Bishara J. Trimethoprim/sulfamethoxazole versus vancomycin in the treatment of healthcare/ventilator-associated MRSA pneumonia: a case-control study. J Antimicrob Chemother 2017; 72:882-887. [PMID: 27999052 DOI: 10.1093/jac/dkw510] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 10/26/2016] [Indexed: 02/06/2023] Open
Abstract
Objectives Therapeutic options available to treat MRSA pneumonia are limited. Trimethoprim/sulfamethoxazole is an attractive treatment because of its bactericidal anti-MRSA activity, oral and parenteral formulations and good penetration to the lung tissue. We aimed to compare the efficacy and safety of trimethoprim/sulfamethoxazole with vancomycin in the treatment of healthcare/ventilator-associated MRSA pneumonia. Methods We carried out a retrospective case-control study of all consecutive hospitalized adult patients diagnosed with MRSA pneumonia at Beilinson Hospital during 2010-15 and treated with either vancomycin or trimethoprim/sulfamethoxazole. The primary outcomes were all-cause mortality at 30 days and clinical failure at the end of treatment. In order to reduce bias affecting the decision to use a specific antibiotic and as a sensitivity analysis, a propensity-score model for choosing between vancomycin and trimethoprim/sulfamethoxazole was used. Results We identified 42 patients with MRSA pneumonia treated with trimethoprim/sulfamethoxazole and 39 treated with vancomycin. There were no significant differences in the baseline characteristics between the groups. Vancomycin-treated patients showed significantly higher 30 day mortality on both multivariate analysis (HR = 5.28; 95% CI = 1.50-18.60; P < 0.05) and sensitivity analysis with propensity score [vancomycin 13/24 (54.1%) versus trimethoprim/sulfamethoxazole 4/24 (16.7%); P < 0.05], and higher clinical failure rates [vancomycin 23/39 (59%) versus trimethoprim/sulfamethoxazole 15/42 (35.7%); P < 0.05], also in the sensitivity analysis with propensity score [vancomycin 14/24 (58.3%) versus trimethoprim/sulfamethoxazole 6/24 (25%); P < 0.05]. The rates of side effects in both arms were comparable. Conclusions Trimethoprim/sulfamethoxazole appears to be superior to vancomycin in the treatment of MRSA pneumonia. A large-scale randomized controlled trial is needed to evaluate these findings.
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Affiliation(s)
- Noa Eliakim-Raz
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.,Department of Internal Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Moran Hellerman
- Department of Internal Medicine F, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Dafna Yahav
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Jonathan Cohen
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.,Intensive Care Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Ili Margalit
- Department of Internal Medicine F, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Sharon Fisher
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Oren Zusman
- Department of Internal Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Hila Shaked
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Jihad Bishara
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
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Eliakim-Raz N, Hellerman M, Yahav D, Cohen J, Margalit I, Fisher S, Zusman O, Shaked H, Bishara J. Trimethoprim/sulfamethoxazole versus vancomycin in the treatment of healthcare/ventilator-associated MRSA pneumonia: a case-control study. J Antimicrob Chemother 2017; 72:2687. [PMID: 28510730 DOI: 10.1093/jac/dkx153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Leibovici-Weissman Y, Atamna A, Schlesinger A, Eliakim-Raz N, Bishara J, Yahav D. Risk factors for short- and long-term mortality in very old patients with Clostridium difficile infection: A retrospective study. Geriatr Gerontol Int 2016; 17:1378-1383. [PMID: 27647625 DOI: 10.1111/ggi.12866] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 03/03/2016] [Revised: 06/01/2016] [Accepted: 06/14/2016] [Indexed: 11/30/2022]
Abstract
AIM Most cases of Clostridium difficile infections (CDI) occur in patients aged 65 years and older. Older age is associated with increased mortality. Risk factors for mortality in patients aged 80 years and older are not well recognized. METHODS We analyzed retrospective data including 184 patients aged 80 years and older hospitalized with CDI during 2009-2014. We aimed to delineate risk factors for short- and long-term mortality. RESULTS The 30-day mortality was 33.2%; 1-year mortality was 64.7%. Median survival was 110 days (interquartile range 24-655 days). All four patients who underwent colectomy died. Risk factors for 30-day mortality in multivariate analysis were diabetes mellitus, low albumin and therapy other than metronidazole monotherapy, the latter probably reflecting higher severity of disease rather than a true predictor of mortality. Risk factors for long-term mortality analyzed in Cox regression were albumin ≤2.5 g/dL (HR 0.58, 95% CI 0.395-0.850), presentation with sepsis (HR 0.597, 95% CI 0.408-0.873), a non-independent activities of daily living baseline status (HR 0.460, 95% CI 0.236--0.897) and Charlson score (HR 0.867, 95% CI 0.801-0.938). None of the traditional severity indices for CDI (such as leukocytosis or creatinine increase) proved to be predictors of mortality over the age of 80 years. CONCLUSIONS The prognosis of old patients with CDI is dismal. Considering the high mortality, efforts to prevent CDI should be first priority in patients aged 80 years and older. Assessment of albumin levels should be part of the evaluation at presentation and considered when choosing treatment, rather than standard severity indexes for CDI. Geriatr Gerontol Int 2017; 17: 1378-1383.
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Affiliation(s)
- Yaara Leibovici-Weissman
- Internal Medicine D, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel
| | - Alaa Atamna
- Internal Medicine C, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Agata Schlesinger
- Department of Acute Geriatrics, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel
| | - Noa Eliakim-Raz
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel.,Unit of Infectious Diseases, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Jihad Bishara
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel.,Unit of Infectious Diseases, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Dafna Yahav
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel.,Unit of Infectious Diseases, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
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Golos M, Eliakim-Raz N, Stern A, Leibovici L, Paul M. Conjugated pneumococcal vaccine versus polysaccharide pneumococcal vaccine for prevention of pneumonia and invasive pneumococcal disease in immunocompetent and immunocompromised adults and children. Hippokratia 2016. [DOI: 10.1002/14651858.cd012306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Miri Golos
- Rambam Health Care Campus; ICU; Ha-aliya 8 St Haifa Israel 33705
| | - Noa Eliakim-Raz
- Beilinson Hospital, Rabin Medical Center; Department of Medicine E; 39 Jabotinski Street Petah Tikva Israel 49100
| | - Anat Stern
- Rambam Health Care Campus; Division of Infectious Diseases; Ha-aliya 8 St Haifa Israel 33705
| | - Leonard Leibovici
- Beilinson Hospital, Rabin Medical Center; Department of Medicine E; 39 Jabotinski Street Petah Tikva Israel 49100
| | - Mical Paul
- Rambam Health Care Campus; Division of Infectious Diseases; Ha-aliya 8 St Haifa Israel 33705
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Shaw E, Addy I, Stoddart M, Vank C, Grier S, Wiegand I, Leibovici L, Eliakim-Raz N, Vallejo-Torres L, Morris S, MacGowan A, Carratalà J, Pujol M. Retrospective observational study to assess the clinical management and outcomes of hospitalised patients with complicated urinary tract infection in countries with high prevalence of multidrug resistant Gram-negative bacteria (RESCUING). BMJ Open 2016; 6:e011500. [PMID: 27473949 PMCID: PMC4985830 DOI: 10.1136/bmjopen-2016-011500] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 04/29/2016] [Accepted: 06/14/2016] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The emergence of multidrug resistant (MDR) Gram-negative bacteria (GNB), including carbapenemase-producing strains, has become a major therapeutic challenge. These MDR isolates are often involved in complicated urinary tract infection (cUTI), and are associated with poor clinical outcomes. The study has been designed to gain insight into the epidemiology, clinical management, outcome and healthcare cost of patients with cUTI, especially in countries with high prevalence of MDR GNB. METHODS AND ANALYSIS This multinational and multicentre observational, retrospective study will identify cases from 1 January 2013 to 31 December 2014 in order to collect data on patients with cUTI as a cause of hospital admission, and patients who develop cUTI during their hospital stay. The primary end point will be treatment failure defined as the presence of any of the following criteria: (1) signs or symptoms of cUTI present at diagnosis that have not improved by days 5-7 with appropriate antibiotic therapy, (2) new cUTI-related symptoms that have developed within 30 days of diagnosis, (3) urine culture taken within 30 days of diagnosis, either during or after completion of therapy, that grows ≥10(4) colony-forming unit/mL of the original pathogen and (4) death irrespective of cause within 30 days of the cUTI diagnosis. SAMPLE SIZE 1000 patients afford a power of 0.83 (α=0.05) to detect an absolute difference of 10% in the treatment failure rate between MDR bacteria and other pathogens. This should allow for the introduction of about 20 independent risk factors (or their interaction) in a logistic regression model looking at risk factors for failure. ETHICS AND DISSEMINATION Approval will be sought from all relevant Research Ethics Committees. Publication of this study will be considered as a joint publication by the participating investigator leads, and will follow the recommendations of the International Committee of Medical Journal Editors (ICMJE). TRIAL REGISTRATION NUMBER NCT02641015; Pre-results.
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Affiliation(s)
- Evelyn Shaw
- Departament of Infectious Diseases, Institut Català de la Salut-Hospital Universitari de Bellvitge (ICS-HUB)-IDIBELL, Barcelona, Spain
- Spanish network for research in Infectious Diseases (REIPI RD12/0012), Instituto de Salud Carlos III, Madrid Spain
| | - Ibironke Addy
- AiCuris Anti-infective Cures GmbH, Wuppertal, Germany
| | - Margaret Stoddart
- Department of Medical Microbiology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | | | - Sally Grier
- Department of Medical Microbiology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Irith Wiegand
- AiCuris Anti-infective Cures GmbH, Wuppertal, Germany
| | - Leonard Leibovici
- Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petah-Tiqva, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Petah Tikva, Israel
| | - Noa Eliakim-Raz
- Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petah-Tiqva, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Petah Tikva, Israel
| | | | - Stephen Morris
- Department of Applied Health Research, University College London, London, UK
| | - Alasdair MacGowan
- Department of Medical Microbiology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Jordi Carratalà
- Departament of Infectious Diseases, Institut Català de la Salut-Hospital Universitari de Bellvitge (ICS-HUB)-IDIBELL, Barcelona, Spain
- Spanish network for research in Infectious Diseases (REIPI RD12/0012), Instituto de Salud Carlos III, Madrid Spain
| | - Miquel Pujol
- Departament of Infectious Diseases, Institut Català de la Salut-Hospital Universitari de Bellvitge (ICS-HUB)-IDIBELL, Barcelona, Spain
- Spanish network for research in Infectious Diseases (REIPI RD12/0012), Instituto de Salud Carlos III, Madrid Spain
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Yahav D, Shaked H, Goldberg E, Yassin S, Eliakim-Raz N, Paul M, Bishara J, Leibovici L. Time trends in Staphylococcus aureus bacteremia, 1988-2010, in a tertiary center with high methicillin resistance rates. Infection 2016; 45:51-57. [PMID: 27411532 DOI: 10.1007/s15010-016-0919-6] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 06/24/2016] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Changes in the epidemiology of Staphylococcus aureus bacteremia (SAB) have been described in recent decades. Decreased mortality has been reported over time, mostly from countries with low methicillin resistance rates. We aimed to describe time trends in SAB in a tertiary center with high methicillin resistance rates. METHODS We retrospectively analyzed 1692 patients with SAB, and compared between three time periods: 1988-1994 (342 patients), 1998-2004 (597 patients) and 2005-2010 (753 patients). RESULTS In our cohort, 30 days mortality increased significantly with time, reaching 42.9 % during 2005-2010. The latter period was characterized by higher rates of older patients (35.1 % aged 80 years and older), with lower functional capacity (46.5 % bedridden) and higher rates of comorbidities (33.6 % renal disease, 24.8 % heart failure, 19.0 % dementia). These patients were more likely to be ventilated (18.7 %) and carry a urinary catheter at presentation (46.6 %); present with septic shock (15.9 %) and have pneumonia (20.5 %) or endocarditis (7.2 %) as source. Similar characteristics were found among patients younger than 50 years and with independent functional status. No significant increase in methicillin resistant Staph aureus (MRSA) rates or inappropriate empirical therapy was demonstrated during 2005-2010. CONCLUSIONS In our cohort, increased mortality in recent years in patients with SAB can be explained by baseline condition of patients. MRSA or inappropriate empiric therapy did not explain the increase in mortality. The patients afflicted with SAB changed over time. Epidemiology and outcomes of SAB vary with time and according to geographical location. External validity of studies should be taken into consideration.
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Affiliation(s)
- Dafna Yahav
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, 39 Jabotinsky Road, 49100, Petah-Tikva, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel.
| | - Hila Shaked
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, 39 Jabotinsky Road, 49100, Petah-Tikva, Israel
| | - Elad Goldberg
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel.,Department of Medicine F, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Sharief Yassin
- Department of Medicine D, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Noa Eliakim-Raz
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, 39 Jabotinsky Road, 49100, Petah-Tikva, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel.
| | - Mical Paul
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel.,Unit of Infectious Diseases, Rambam Hospital, Haifa, Israel
| | - Jihad Bishara
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, 39 Jabotinsky Road, 49100, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel
| | - Leonard Leibovici
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel.,Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
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Dickstein Y, Leibovici L, Yahav D, Eliakim-Raz N, Daikos GL, Skiada A, Antoniadou A, Carmeli Y, Nutman A, Levi I, Adler A, Durante-Mangoni E, Andini R, Cavezza G, Mouton JW, Wijma RA, Theuretzbacher U, Friberg LE, Kristoffersson AN, Zusman O, Koppel F, Dishon Benattar Y, Altunin S, Paul M. Multicentre open-label randomised controlled trial to compare colistin alone with colistin plus meropenem for the treatment of severe infections caused by carbapenem-resistant Gram-negative infections (AIDA): a study protocol. BMJ Open 2016; 6:e009956. [PMID: 27098822 PMCID: PMC4838684 DOI: 10.1136/bmjopen-2015-009956] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The emergence of antibiotic-resistant bacteria has driven renewed interest in older antibacterials, including colistin. Previous studies have shown that colistin is less effective and more toxic than modern antibiotics. In vitro synergy studies and clinical observational studies suggest a benefit of combining colistin with a carbapenem. A randomised controlled study is necessary for clarification. METHODS AND ANALYSIS This is a multicentre, investigator-initiated, open-label, randomised controlled superiority 1:1 study comparing colistin monotherapy with colistin-meropenem combination therapy for infections caused by carbapenem-resistant Gram-negative bacteria. The study is being conducted in 6 centres in 3 countries (Italy, Greece and Israel). We include patients with hospital-associated and ventilator-associated pneumonia, bloodstream infections and urosepsis. The primary outcome is treatment success at day 14, defined as survival, haemodynamic stability, stable or improved respiratory status for patients with pneumonia, microbiological cure for patients with bacteraemia and stability or improvement of the Sequential Organ Failure Assessment (SOFA) score. Secondary outcomes include 14-day and 28-day mortality as well as other clinical end points and safety outcomes. A sample size of 360 patients was calculated on the basis of an absolute improvement in clinical success of 15% with combination therapy. Outcomes will be assessed by intention to treat. Serum colistin samples are obtained from all patients to obtain population pharmacokinetic models. Microbiological sampling includes weekly surveillance samples with analysis of resistance mechanisms and synergy. An observational trial is evaluating patients who met eligibility requirements but were not randomised in order to assess generalisability of findings. ETHICS AND DISSEMINATION The study was approved by ethics committees at each centre and informed consent will be obtained for all patients. The trial is being performed under the auspices of an independent data and safety monitoring committee and is included in a broad dissemination strategy regarding revival of old antibiotics. TRIAL REGISTRATION NUMBER NCT01732250 and 2012-004819-31; Pre-results.
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Affiliation(s)
- Yaakov Dickstein
- Division of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel
| | - Leonard Leibovici
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Dafna Yahav
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
- Unit of Infectious Diseases, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Noa Eliakim-Raz
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
- Unit of Infectious Diseases, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - George L Daikos
- First Department of Medicine, University of Athens, Athens, Greece
| | - Anna Skiada
- First Department of Medicine, University of Athens, Athens, Greece
| | | | - Yehuda Carmeli
- Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel
| | - Amir Nutman
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
- Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel
| | - Inbar Levi
- Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel
| | - Amos Adler
- Microbiology Laboratory, Tel Aviv Sourasky Medical Centre, Tel-Aviv, Israel
| | | | - Roberto Andini
- Internal Medicine, Second University of Naples, Monaldi Hospital-AORN dei Colli, Napoli, Italy
| | - Giusi Cavezza
- Internal Medicine, Second University of Naples, Monaldi Hospital-AORN dei Colli, Napoli, Italy
| | - Johan W Mouton
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
- Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands
| | - Rixt A Wijma
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | | | - Lena E Friberg
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | | | - Oren Zusman
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Fidi Koppel
- Division of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel
| | | | - Sergey Altunin
- Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Mical Paul
- Division of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel
- Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
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Abstract
Bloodstream infections (BSIs) are both common and fatal in older patients. We describe data from studies evaluating older patients hospitalized with BSIs. Most older patients with BSIs present "typically" with either fever or leukocytosis. The most common source of BSI in older patients is the urinary tract, and accordingly, Gram-negative organisms predominate. A significant part of these BSIs may thus be preventable by removal of unnecessary urinary catheters. Increased long term mortality is reported following BSIs in older patients, however, data on other long-term outcomes, including functional capacity, cognitive decline and others are lacking. Management of BSIs may include less invasive procedures due to the fragility of older patients. This approach may delay the diagnosis and treatment in some cases. Older patients are probably under-represented in clinical trials assessing treatment of bacteremia. Physicians treating older patients should consider the relevance of these studies' outcomes.
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Affiliation(s)
- Dafna Yahav
- a Unit of Infectious Diseases, Rabin Medical Center, Beilinson Hospital , Petah-Tikva , Israel.,b Sackler Faculty of Medicine, Tel Aviv University , Ramat-Aviv , Israel
| | - Noa Eliakim-Raz
- a Unit of Infectious Diseases, Rabin Medical Center, Beilinson Hospital , Petah-Tikva , Israel.,b Sackler Faculty of Medicine, Tel Aviv University , Ramat-Aviv , Israel
| | - Leonard Leibovici
- b Sackler Faculty of Medicine, Tel Aviv University , Ramat-Aviv , Israel.,c Department of Medicine E , Rabin Medical Center, Beilinson Hospital , Petah-Tikva , Israel
| | - Mical Paul
- b Sackler Faculty of Medicine, Tel Aviv University , Ramat-Aviv , Israel.,d Unit of Infectious Diseases, Rambam Hospital , Haifa , Israel
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Eliakim-Raz N, Prokupetz A, Gordon B, Shochat T, Grossman A. Interventricular Septum and Posterior Wall Thickness Are Associated With Higher Systolic Blood Pressure. J Clin Hypertens (Greenwich) 2015; 18:703-6. [PMID: 26607051 DOI: 10.1111/jch.12738] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 09/10/2015] [Accepted: 09/22/2015] [Indexed: 11/26/2022]
Abstract
Elevated blood pressure (BP) is a known factor that affects the structure of the left ventricle. The association between left ventricular hypertrophy (LVH) and BP in normotensive individuals is poorly understood. All individuals who underwent routine echocardiography and BP measurements as aircrew candidates for the Israeli Air Force in the years 2006 to 2012 were identified. Participants with normal values were included. Associations between echocardiographic characteristics and BP were studied. A total of 2386 participants were included. Mean systolic BP was 125.31±11.18 mm Hg and mean diastolic BP was 68.69±9.02 mm Hg. Interventricular septal (IVS) thickness was positively correlated with systolic BP (P<.001, correlation coefficient 0.121) and significantly inversely correlated with heart rate and hematocrit level (P<.001 for both). Men with evidence of IVS or posterior wall thickening on echocardiography, even within the normal range, may require a closer follow-up of BP.
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Affiliation(s)
- Noa Eliakim-Raz
- Department of Medicine E, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Alex Prokupetz
- Israel Defense Forces Medical Corps, Petah Tikva, Israel
| | - Barak Gordon
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.,Israel Defense Forces Medical Corps, Petah Tikva, Israel
| | - Tzippy Shochat
- Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
| | - Alon Grossman
- Department of Medicine E, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.,Israel Defense Forces Medical Corps, Petah Tikva, Israel
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