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Dar S, Merza N, Haider M, Zafar Y, Din N, Ligresti R, Sebti R. Necrotizing Pancreatitis Infected with Stenotrophomonas maltophilia: An Emerging Rare Multidrug-Resistant Organism. Case Rep Gastrointest Med 2023; 2023:8071158. [PMID: 37397505 PMCID: PMC10313464 DOI: 10.1155/2023/8071158] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 11/11/2022] [Accepted: 01/11/2023] [Indexed: 07/04/2023] Open
Abstract
Stenotrophomonas maltophilia (SM) is a multidrug-resistant, Gram-negative (GN) bacillus that is an increasingly recognized nosocomial and environment pathogen. It is intrinsically resistant to carbapenems, a drug commonly utilized in the management of necrotizing pancreatitis (NP). We report a 21-year-old immunocompetent female with NP complicated by pancreatic fluid collection (PFC) infected with SM. One-third of patients with NP will develop infections by GN bacteria, while broad-spectrum antibiotics, including carbapenems, cover most infections, trimethoprim-sulfamethoxazole (TMP-SMX) is the first-line treatment antibiotic for SM. This case is critical because it highlights a rare pathogen that should be considered a causal pathogen in patients who do not respond to their care plan.
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Affiliation(s)
- Sophia Dar
- Department of Internal Medicine, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Nooraldin Merza
- Department of Medicine, Wayne State University, Detroit, MI, USA
| | - Maryam Haider
- Department of Internal Medicine DMC, Wayne State University, Sinai Grace Hospital, Detroit, MI, USA
| | - Yousaf Zafar
- Department of Medicine, University of Mississippi Medical Center, Oxford, MS, USA
| | - Noren Din
- Department of Internal Medicine DMC, Wayne State University, Sinai Grace Hospital, Detroit, MI, USA
| | - Rosario Ligresti
- Division of Gastroetnerology, The Pancreas Center, Hackensack University Medical Center, Hackensack University School of Medicine, National Pancreas Foundation, Hackensack, NJ, USA
| | - Rani Sebti
- Department of Medicine, Hackensack University School of Medicine, Division of Infectious Disease, Hackensack University Medical Center, Hackensack, NJ, USA
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Dar SH, Maniya MT, Merza N, Musheer A, Zahid M, Ahmed F, Shurjeel Q, Qazi S, Ahmed A, Shah H, Zafar A, Iqbal AZ, Khan SF, Rizwan T, Ligresti R. The Association of Antibiotic Exposure with New-Onset Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis. Clin Res Hepatol Gastroenterol 2023; 47:102129. [PMID: 37116651 DOI: 10.1016/j.clinre.2023.102129] [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] [Received: 12/31/2022] [Revised: 04/16/2023] [Accepted: 04/19/2023] [Indexed: 04/30/2023]
Abstract
INTRODUCTION The role of antibiotics in the development of inflammatory bowel disease (IBD) remains controversial, primarily due to conflicting data from individual studies. We conduct a systematic review and meta-analysis to study the effect of antibiotic exposure on IBD development. METHODOLOGY The MEDLINE and Cochrane CENTRAL databases were queried from their inception to April 2021 for published articles studying the association between antibiotic exposure and new-onset IBD. Our analysis was stratified by timing of antibiotic exposure - exposure in childhood and any lifetime exposure. Adjusted odds ratios (ORs) and corresponding 95% confidence intervals (CIs) from each study were pooled using a random-effects model. RESULTS 10 case-control studies and 2 cohort studies (N=29,880 IBD patients and N=715,548 controls) were included. Patients with Crohn's Disease (CD), compared with controls, were associated significantly with antibiotic exposure in childhood and any lifetime exposure to antibiotics (OR 1.52 [1.23-1.87]; p<0.00001). Patients with Ulcerative Colitis (UC), compared with controls, reported non-significant association with antibiotic exposure in childhood and any lifetime exposure. (OR 1.11 [0.93-1.33]; p=0.25) CONCLUSION: This meta-analysis suggests that exposure to antibiotics significantly increases the odds of developing CD and IBD in general. These findings re-emphasize the importance of cautious and judicious use of antibiotics.
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Affiliation(s)
- Sophia Haroon Dar
- Department of Medicine, Long Island Jewish Medical Center, Queens, New York, USA.
| | | | - Nooraldin Merza
- Department of Internal Medicine, University of Toledo, Ohio, USA
| | - Adeena Musheer
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Mariyam Zahid
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Furqan Ahmed
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Qazi Shurjeel
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Sana Qazi
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Aymen Ahmed
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Hamza Shah
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Adnan Zafar
- Department of Medicine, CMH Lahore Medical College, Lahore, Pakistan
| | - Arsalan Zafar Iqbal
- Department of Medicine, FMH of College of Medicine and Dentistry, Lahore, Pakistan
| | - Shah Fahad Khan
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Tehlil Rizwan
- Department of Medicine, AMITA Health Saint Joseph Hospital, Chicago, Illinois, USA
| | - Rosario Ligresti
- Hackensack University School of Medicine, Medical Director, National Pancreas Foundation, Hackensack University Medical Center, Hackensack, NJ
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Dar S, Choi C, Ligresti R. THE ASSOCIATION OF LIVER CIRRHOSIS WITH POOR OUTCOMES WITH INTERVENTIONAL MANAGEMENT FOR STEMI RELATED CARDIOGENIC SHOCK, A NATIONWIDE ANALYSIS. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02568-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Varghese AM, Ang C, Dimaio CJ, Javle MM, Gutierrez M, Yarom N, Stemmer SM, Golan T, Geva R, Semenisty V, Khamaysi I, Ligresti R, Rotkopf S, Gabai-Malka R, Galun E, Shemi A, Schattner M, O'Reilly EM. A phase II study of siG12D-LODER in combination with chemotherapy in patients with locally advanced pancreatic cancer (PROTACT). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.tps4672] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS4672 Background: KRAS alterations are the most frequent driver alterations identified in pancreas cancer; however, KRAS has remained an elusive therapeutic target. siG12D-LODER is a novel, miniature bio-degradable polymeric matrix encompassing a novel small interfering RNA targeting KRAS G12D and all additional G12X mutations (G12C, G12V...). The siG12D-LODER is inserted directly into the pancreas tumor via endoscopic intervention. A Phase 1/2a dose escalation and expansion study of patients receiving a one-time dose of siG12D-LODER with ongoing chemotherapy demonstrated that the combination was well-tolerated and safe and exhibited promising potential efficacy with 10/12 patients achieving disease control and median overall survival 15.1 months (Golan, Oncotarget 2015). Methods: This phase 2 study was initially designed as a randomized, two arm, open label study of gemcitabine and nab-paclitaxel with or without siG12D-LODER for patients with locally advanced pancreas cancer with planned 40 patients in each arm and primary endpoint of progression-free survival. Eighteen patients were enrolled in the chemotherapy alone arm and 18 in the chemotherapy and siG12D-LODER arm. After an interim analysis, the study design has been amended and is now a single arm study in which patients (N=39) with both borderline resectable and locally advanced pancreas cancer will receive investigator’s choice of chemotherapy (the combination of gemcitabine/nab-paclitaxel or modified FOLFIRINOX) and all patients will receive up to three doses of the siG12D-LODER administered once every 12 weeks. Primary endpoint is overall response rate after final siG12D-LODER insertion. Secondary endpoints include duration of response, progression-free survival, overall survival, time to response, percentage of patients proceeding to surgical resection, and percentage of patients receiving radiation therapy. Exploratory analyses include evaluation of KRAS mutation status and monitoring of circulating free DNA and circulating tumor cells. The amended protocol is now open for accrual and four patients having been enrolled to date. Trial accrual is anticipated to be completed by December 2020. Clinical trial information: NCT01676259 .
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Affiliation(s)
| | - Celina Ang
- Department of Medicine, Division of Hematology/Oncology, Tisch Cancer Institute, Mount Sinai Hospital, New York, NY
| | | | - Milind M. Javle
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Nirit Yarom
- The Ottawa Hosp Cancer Ctr, Ottawa, ON, Canada
| | - Salomon M. Stemmer
- Davidoff Cancer Center, Rabin Medical Center-Beilinson Hospital, Petah Tikva, Israel
| | - Talia Golan
- The Oncology Institute, Sheba Medical Center at Tel-Hashomer, Tel Aviv University, Tel Aviv, Israel
| | - Ravit Geva
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | | | | | | | | | - Eithan Galun
- Hadassah Hebrew University Hospital, Jerusalem, Israel
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Affiliation(s)
- F Byfield
- Gastrointestinal Division, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
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Affiliation(s)
- R Ligresti
- College of Physicians and Surgeons, Columbia University, New York, New York, USA
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