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Guo MZ, Balaji A, Murray JC, Reuss JE, Steinke SM, Bennett K, Naidoo J. Infectious Complications in Patients With Non-small Cell Lung Cancer Treated With Immune Checkpoint Inhibitors. Clin Lung Cancer 2023; 24:613-620. [PMID: 37419702 DOI: 10.1016/j.cllc.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/13/2023] [Accepted: 06/18/2023] [Indexed: 07/09/2023]
Abstract
INTRODUCTION Immune checkpoint inhibitors (ICI) are standard treatment for nonsmall cell lung cancer (NSCLC). However, the burden of infectious complications during ICI therapy is poorly described. MATERIALS AND METHODS We conducted a retrospective study of patients with NSCLC treated with ICIs between 2007 and 2020 at a tertiary academic center. The incidence, characteristics, and healthcare utilization outcomes of infections during ICI therapy and within 3 months of ICI discontinuation are presented using descriptive statistics. Cox proportional hazard models are used to examine infection-free survival by demographic and treatment factors. Associations between patient or treatment characteristics and hospitalization or ICU admission are analyzed by logistic regression, presented as odds ratios (OR). RESULTS Of 298 patients, infections occurred in 54.4% (n = 162). Of these patients, 59.3% (n = 96) required hospitalization and 15.4% (n = 25) required ICU admission. The most common infection was bacterial pneumonia. Fungal infections occurred in 12 patients (7.4%). Patients with chronic obstructive pulmonary disease (COPD) (OR 2.15, 95% CI, 1.01-4.58), corticosteroid treatment within 1 month prior to infection onset (OR 3.04, 95% CI, 1.47-6.30), and concomitant irAE and infection (OR 5.48, 95% CI, 2.15-14.00) had higher odds of hospitalization. Corticosteroid use was associated with higher odds of ICU admission (OR 3.09, 95% CI, 1.29-7.38). CONCLUSION In this large single-institution study we identify that more than half of patients with ICI-treated NSCLC develop infectious complications. We identify that patients with COPD, recent corticosteroid use, and concomitant irAE and infection have higher odds of hospitalization, and that unusual infections (eg, fungal) can occur. This highlights clinical awareness of infections as important complications during ICI therapy in patients with NSCLC.
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Affiliation(s)
- Matthew Z Guo
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Aanika Balaji
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Joseph C Murray
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Joshua E Reuss
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD; Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Seema Mehta Steinke
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kathleen Bennett
- Data Science Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Jarushka Naidoo
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD; Beaumont Hospital, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
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Sait AS, Chiang TPY, Marr KA, Massie AB, Cochran W, Shah P, Brennan DC, Thomas AG, Mehta Steinke S, Permpalung N, Shoham S, Merlo C, Jain T, Boyarsky B, Charnaya O, Gurakar A, Sharma K, Durand CM, Werbel WA, Huang CY, Ostrander D, Desai N, Kim MY, Alasfar S, Bloch EM, Tobian AA, Garonzik-Wang J, Segev DL, Avery RK. Outcomes of SOT Recipients With COVID-19 in Different Eras of COVID-19 Therapeutics. Transplant Direct 2022; 8:e1268. [PMID: 34966840 PMCID: PMC8710330 DOI: 10.1097/txd.0000000000001268] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 10/05/2021] [Accepted: 10/19/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Few reports have focused on newer coronavirus disease 2019 (COVID-19) therapies (remdesivir, dexamethasone, and convalescent plasma) in solid organ transplant recipients; concerns had been raised regarding possible adverse impact on allograft function or secondary infections. METHODS We studied 77 solid organ transplant inpatients with COVID-19 during 2 therapeutic eras (Era 1: March-May 2020, 21 patients; and Era 2: June-November 2020, 56 patients) and 52 solid organ transplant outpatients. RESULTS In Era 1, no patients received remdesivir or dexamethasone, and 4 of 21 (19.4%) received convalescent plasma, whereas in Era 2, remdesivir (24/56, 42.9%), dexamethasone (24/56, 42.9%), and convalescent plasma (40/56, 71.4%) were commonly used. Mortality was low across both eras, 4 of 77 (5.6%), and rejection occurred in only 2 of 77 (2.8%) inpatients; infections were similar in hypoxemic patients with or without dexamethasone. Preexisting graft dysfunction was associated with greater need for hospitalization, higher severity score, and lower survival. Acute kidney injury was present in 37.3% of inpatients; renal function improved more rapidly in patients who received remdesivir and convalescent plasma. Post-COVID-19 renal and liver function were comparable between eras, out to 90 d. CONCLUSIONS Newer COVID-19 therapies did not appear to have a deleterious effect on allograft function, and infectious complications were comparable.
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Affiliation(s)
- Afrah S. Sait
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Teresa Po-Yu Chiang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kieren A. Marr
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Allan B. Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, MD
| | - Willa Cochran
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Pali Shah
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Daniel C. Brennan
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Comprehensive Transplant Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alvin G. Thomas
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Seema Mehta Steinke
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nitipong Permpalung
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Shmuel Shoham
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christian Merlo
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Tania Jain
- Hematologic Malignancies and Bone Marrow Transplantation Program, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Brian Boyarsky
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Olga Charnaya
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ahmet Gurakar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kavita Sharma
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christine M. Durand
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - William A. Werbel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Chiung-Yu Huang
- Department of Statistics, University of California at San Francisco, San Francisco, CA
| | - Darin Ostrander
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Niraj Desai
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Min Young Kim
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sami Alasfar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Evan M. Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Aaron A.R. Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, MD
| | - Robin K. Avery
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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Guo M, Balaji A, Murray J, Reuss J, Steinke SM, Naidoo J. 237 Infectious complications in patients with non-small cell lung cancer treated with anti-PD(L)1 immune checkpoint inhibitors. J Immunother Cancer 2021. [DOI: 10.1136/jitc-2021-sitc2021.237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BackgroundImmune checkpoint inhibitors (ICI) are standard treatment for stage III/IV non-small cell lung cancer (NSCLC). ICIs may cause immune-related adverse events (irAEs) often requiring corticosteroids or other immunosuppressive therapy and are associated with increased risk of opportunistic infections.1 2 The burden of infectious complications in NSCLC patients (pts) treated with ICIs is poorly described.MethodsWe retrospectively reviewed NSCLC pts treated with ICIs between 2016–2020 at a large tertiary academic center. An infectious complication related to ICIs was defined as a pathogen-confirmed or clinically diagnosed infection requiring antimicrobials during or within 3 months of ICI discontinuation. High-grade infections were defined as those requiring IV antibiotics (grade 3), life-threatening or requiring ICU stay (grade 4), or resulting in death (grade 5). irAEs were defined by the treating provider and treated according to standard guidelines. Patient demographics, treatment data, cancer outcomes, infectious complications, and irAE details were annotated in an IRB-approved database. An AE treated as both an infection and/or irAE with antibiotics and immunosuppression was coded as a concomitant irAE/infection event. The association between patient features and infectious complications was examined using logistic regression. Treatment and disease characteristics for concomitant irAE with infection were also described.Results302 ICI-treated NSCLC pts were included. 211 pts received PD-1 monotherapy and 91 received PD-1 therapy with CTLA-4 therapy, chemotherapy, or other investigational therapy. The majority (175/302, 57.9%) had a documented infection (bacterial=138, viral=17, fungal=19, mycobacterial=1) during or within 3 months of ICI discontinuation. Grade ≥3 infections occurred in 33.4% of pts (101/302). Pulmonary infections were most common (35.4%), followed by gastrointestinal, urinary, and skin (<10%, each). A subset of pts were treated as having concomitant irAE/infection events (63/302, 20.9%). Among 63 pts who experienced irAEs, pneumonitis occurred most commonly (47/63, 74.6%) followed by colitis (7/63, 11.1%); other irAEs (hepatitis, myocarditis, thyroiditis) occurred in <3 patients each. A concomitant event was associated with a trend toward higher odds of hospitalization (OR 3.91, CI 0.5–30.76) when adjusted for grade ≥3 infection. Similarly, steroid use within one month prior to infection, was also associated with a trend toward higher odds of hospitalization (OR 8.88, CI 0.81–97.15), adjusted for grade ≥3 infection.ConclusionsIn this retrospective study of NSCLC pts treated with ICIs, the majority experienced infections during or within 3 months of ICI discontinuation. The most common infections were bacterial pulmonary in origin. Concomitant irAE/infection was associated with trend toward higher odds of hospitalization.ReferencesHamashima R, Uchino J, Morimoto Y, et al. Association of immune checkpoint inhibitors with respiratory infections: a review. Cancer Treatment Reviews 2020;90:102109. doi:10.1016/j.ctrv.2020.102109Lu M, Zhang L, Li Y, et al. Recommendation for the diagnosis and management of immune checkpoint inhibitor related infections. Thorac Cancer 2020;11(3):805–809. doi:10.1111/1759-7714.13313Ethics ApprovalThis retrospective chart review study has obtained ethics approval from the Institutional Review Board at the Johns Hopkins School of Medicine (number: IRB00129424).
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Gutiérrez-Gutiérrez B, Pérez-Nadales E, Pérez-Galera S, Fernández-Ruiz M, Carratalà J, Oriol I, Cordero E, Lepe JA, Tan BH, Corbella L, Paul M, Natera AM, David MD, Montejo M, Iyer RN, Pierrotti LC, Merino E, Steinke SM, Rana MM, Muñoz P, Mularoni A, van Delden C, Grossi PA, Seminari EM, Gunseren F, Lease ED, Roilides E, Fortún J, Arslan H, Coussement J, Tufan ZK, Pilmis B, Rizzi M, Loeches B, Eriksson BM, Abdala E, Soldani F, Lowman W, Clemente WT, Bodro M, Fariñas MC, Kazak E, Martínez-Martínez L, Aguado JM, Torre-Cisneros J, Pascual Á, Rodríguez-Baño J. Propensity Score and Desirability of Outcome Ranking Analysis of Ertapenem for Treatment of Nonsevere Bacteremic Urinary Tract Infections Due to Extended-Spectrum-Beta-Lactamase-Producing Enterobacterales in Kidney Transplant Recipients. Antimicrob Agents Chemother 2021; 65:e0110221. [PMID: 34370578 PMCID: PMC8522723 DOI: 10.1128/aac.01102-21] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/05/2021] [Indexed: 11/20/2022] Open
Abstract
There are scarce data on the efficacy of ertapenem in the treatment of bacteremia due to extended-spectrum-beta-lactamase (ESBL)-producing Enterobacterales (ESBL-E) in kidney transplant (KT) recipients. We evaluated the association between treatment with ertapenem or meropenem and clinical cure in KT recipients with nonsevere bacteremic urinary tract infections (B-UTI) caused by ESBL-E. We performed a registered, retrospective, international (29 centers in 14 countries) cohort study (INCREMENT-SOT, NCT02852902). The association between targeted therapy with ertapenem versus meropenem and clinical cure at day 14 (the principal outcome) was studied by logistic regression. Propensity score matching and desirability of outcome ranking (DOOR) analyses were also performed. A total of 201 patients were included; only 1 patient (treated with meropenem) in the cohort died. Clinical cure at day 14 was reached in 45/100 (45%) and 51/101 (50.5%) of patients treated with ertapenem and meropenem, respectively (adjusted OR 1.29; 95% CI 0.51 to 3.22; P = 0.76); the propensity score-matched cohort included 55 pairs (adjusted OR for clinical cure at day 14, 1.18; 95% CI 0.43 to 3.29; P = 0.74). In this cohort, the proportion of cases treated with ertapenem with better DOOR than with meropenem was 49.7% (95% CI, 40.4 to 59.1%) when hospital stay was considered. It ranged from 59 to 67% in different scenarios of a modified (weights-based) DOOR sensitivity analysis when potential ecological advantage or cost was considered in addition to outcome. In conclusion, targeted therapy with ertapenem appears as effective as meropenem to treat nonsevere B-UTI due to ESBL-E in KT recipients and may have some advantages.
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Affiliation(s)
- Belén Gutiérrez-Gutiérrez
- Spanish Network for Research in Infectious Diseases (REIPI)
- Clinical Unit of Infectious Diseases and Microbiology, Virgen Macarena University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain
| | - Elena Pérez-Nadales
- Spanish Network for Research in Infectious Diseases (REIPI)
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Salvador Pérez-Galera
- Clinical Unit of Internal Medicine, Virgen Macarena University Hospital, Seville, Spain
| | - Mario Fernández-Ruiz
- Spanish Network for Research in Infectious Diseases (REIPI)
- Unit of Infectious Diseases, “12 de Octubre” University Hospital, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Universidad Complutense, Madrid, Spain
| | - Jordi Carratalà
- Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedicine Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain
| | - Isabel Oriol
- Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedicine Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain
| | - Elisa Cordero
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain
| | - José Antonio Lepe
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain
| | - Ban Hock Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Laura Corbella
- Unit of Infectious Diseases, “12 de Octubre” University Hospital, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Universidad Complutense, Madrid, Spain
| | - Mical Paul
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
| | - Alejandra M. Natera
- Spanish Network for Research in Infectious Diseases (REIPI)
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Miruna D. David
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Miguel Montejo
- Infectious Diseases Unit, Cruces University Hospital, Bilbao, Spain
| | - Ranganathan N. Iyer
- Clinical Microbiology Identification and Infection Control, Global Hospitals, Hyderabad, India
| | - Ligia Camera Pierrotti
- Infectious Diseases Division, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Esperanza Merino
- Unit of Infectious Diseases, General University Hospital of Alicante, ISABIAL, Alicante, Spain
| | | | | | - Patricia Muñoz
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Christian van Delden
- Unit for Transplant Infectious Diseases, University Hospitals of Geneva and the Swiss Transplant Cohort Study (STCS), Geneva, Switzerland
| | - Paolo Antonio Grossi
- Infectious Diseases Section, Department of Medicine and Surgery, University of Insubria, Varese. National Center for Transplantation, Rome, Italy
| | - Elena María Seminari
- Division of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo Pavia, Pavia, Italy
| | - Filiz Gunseren
- Department of Infectious Diseases and Clinical Microbiology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Erika D. Lease
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, USA
| | - Emmanuel Roilides
- Infectious Diseases Unit and 3rd Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
| | - Jesús Fortún
- Ramón y Cajal University Hospital, Madrid, Spain
| | - Hande Arslan
- Bakent University School of Medicine, Ankara, Turkey
| | - Julien Coussement
- Division of Infectious Diseases, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Zeliha Koçak Tufan
- Infectious Diseases and Clinical Microbiology Department, Medical School of Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Benoit Pilmis
- Paris Descartes University, Necker-Enfants Malades University Hospital, Department of Infectious Diseases and Tropical Medicine, Centre d’Infectiologie Necker-Pasteur, Institut Imagine, AP-HP, Paris, France
| | - Marco Rizzi
- Infectious Diseases Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Belén Loeches
- Infectious Diseases Unit, Hospital La Paz, Madrid, Spain
| | - Britt Marie Eriksson
- Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden
| | - Edson Abdala
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Fabio Soldani
- Department of Medicine, Infectious Diseases Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Warren Lowman
- Wits Donald Gordon Medical Centre, Pathcare/Vermaak, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Wanessa Trindade Clemente
- Faculdade de Medicina, UFMG, Grupo de Transplante de Fígado, Instituto Alfa de Gastroenterologia, Hospital da Clínicas, Universidad de Federal Minas Gerais (HC-UFMG), Minas Gerais, Brazil
| | - Marta Bodro
- Infectious Diseases Department, Hospital Clinic – IDIBAPS, University of Barcelona, Barcelona, Spain
| | - María Carmen Fariñas
- Infectious Diseases Unit, Hospital Universitario Marqués de Valdecilla, University of Cantabria, Santander, Spain
| | | | - Luis Martínez-Martínez
- Spanish Network for Research in Infectious Diseases (REIPI)
- Clinical Unit of Microbiology, Reina Sofía University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Department of Microbiology, University of Cordoba, Córdoba, Spain
| | - José María Aguado
- Spanish Network for Research in Infectious Diseases (REIPI)
- Unit of Infectious Diseases, “12 de Octubre” University Hospital, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Universidad Complutense, Madrid, Spain
| | - Julián Torre-Cisneros
- Spanish Network for Research in Infectious Diseases (REIPI)
- Clinical Unit of Infectious Diseases, Reina Sofía University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Córdoba, Spain
| | - Álvaro Pascual
- Spanish Network for Research in Infectious Diseases (REIPI)
- Clinical Unit of Infectious Diseases and Microbiology, Virgen Macarena University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain
| | - Jesús Rodríguez-Baño
- Spanish Network for Research in Infectious Diseases (REIPI)
- Clinical Unit of Infectious Diseases and Microbiology, Virgen Macarena University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain
| | - Investigators from the REIPI/ESGICH/ESGBIS/INCREMENT-SOT Group
- Spanish Network for Research in Infectious Diseases (REIPI)
- Clinical Unit of Infectious Diseases and Microbiology, Virgen Macarena University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
- Clinical Unit of Internal Medicine, Virgen Macarena University Hospital, Seville, Spain
- Unit of Infectious Diseases, “12 de Octubre” University Hospital, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Universidad Complutense, Madrid, Spain
- Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedicine Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain
- Department of Infectious Diseases, Singapore General Hospital, Singapore
- Unit of Infectious Diseases, “12 de Octubre” University Hospital, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Universidad Complutense, Madrid, Spain
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Infectious Diseases Unit, Cruces University Hospital, Bilbao, Spain
- Clinical Microbiology Identification and Infection Control, Global Hospitals, Hyderabad, India
- Infectious Diseases Division, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
- Unit of Infectious Diseases, General University Hospital of Alicante, ISABIAL, Alicante, Spain
- Johns Hopkins University, School of Medicine, Baltimore, USA
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
- IRCCS ISMETT, Palermo, Italy
- Unit for Transplant Infectious Diseases, University Hospitals of Geneva and the Swiss Transplant Cohort Study (STCS), Geneva, Switzerland
- Infectious Diseases Section, Department of Medicine and Surgery, University of Insubria, Varese. National Center for Transplantation, Rome, Italy
- Division of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo Pavia, Pavia, Italy
- Department of Infectious Diseases and Clinical Microbiology, Akdeniz University Faculty of Medicine, Antalya, Turkey
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, USA
- Infectious Diseases Unit and 3rd Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
- Ramón y Cajal University Hospital, Madrid, Spain
- Bakent University School of Medicine, Ankara, Turkey
- Division of Infectious Diseases, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
- Infectious Diseases and Clinical Microbiology Department, Medical School of Ankara Yildirim Beyazit University, Ankara, Turkey
- Paris Descartes University, Necker-Enfants Malades University Hospital, Department of Infectious Diseases and Tropical Medicine, Centre d’Infectiologie Necker-Pasteur, Institut Imagine, AP-HP, Paris, France
- Infectious Diseases Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
- Infectious Diseases Unit, Hospital La Paz, Madrid, Spain
- Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Department of Medicine, Infectious Diseases Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
- Wits Donald Gordon Medical Centre, Pathcare/Vermaak, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Faculdade de Medicina, UFMG, Grupo de Transplante de Fígado, Instituto Alfa de Gastroenterologia, Hospital da Clínicas, Universidad de Federal Minas Gerais (HC-UFMG), Minas Gerais, Brazil
- Infectious Diseases Department, Hospital Clinic – IDIBAPS, University of Barcelona, Barcelona, Spain
- Infectious Diseases Unit, Hospital Universitario Marqués de Valdecilla, University of Cantabria, Santander, Spain
- Uludag University, Bursa, Turkey
- Clinical Unit of Microbiology, Reina Sofía University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Department of Microbiology, University of Cordoba, Córdoba, Spain
- Clinical Unit of Infectious Diseases, Reina Sofía University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Córdoba, Spain
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5
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Karaba AH, Figueroa A, Werbel WA, Dioverti MV, Steinke SM, Ray SC, Cox AL, Avery RK. Interleukin-18 and tumor necrosis factor-α are elevated in solid organ transplant recipients with possible cytomegalovirus end-organ disease. Transpl Infect Dis 2021; 23:e13682. [PMID: 34216086 PMCID: PMC8455421 DOI: 10.1111/tid.13682] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 12/14/2022]
Abstract
End-organ cytomegalovirus (CMV) disease can be life threatening to solid organ transplant recipients. Diagnosis is often complicated by variation in amount of CMV DNA in plasma and the need for an invasive procedure to obtain a biopsy of the suspected affected organ, which can delay recognition and treatment. Several inflammatory cytokines are elevated in CMV disease, and the purpose of this study was to determine if they could be used to distinguish solid organ transplant recipients with CMV DNAemia alone from those with possible end-organ CMV disease. We found that regardless of pre-transplant CMV serostatus, plasma interleukin (IL)-18, tumor necrosis factor-α (TNF-α), and amount of CMV DNA in plasma were increased in possible end-organ CMV disease, with elevated IL-18 associated with increased odds of possible end-organ CMV disease even after adjusting for amount of CMV DNA. These findings highlight IL-18 and TNF-α as potential non-invasive markers of possible end-organ CMV disease regardless of transplanted organ or serostatus in solid organ transplant recipients.
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Affiliation(s)
- Andrew H. Karaba
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Alexis Figueroa
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - William A. Werbel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Maria Veronica Dioverti
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Seema Mehta Steinke
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Stuart C. Ray
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrea L. Cox
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Bloomberg Kimmel Institute for Cancer Immunotherapy Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robin K. Avery
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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6
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Stern A, Alonso CD, Garcia-Vidal C, Cardozo C, Slavin M, Yong MK, Ho SA, Mehta Steinke S, Avery RK, Koehler P, Scheid C, Cornely OA, Maertens J, Abi Aad Y, Epstein DJ, Papanicolaou GA, Neofytos D. Safety and efficacy of intravenously administered cidofovir in adult haematopoietic cell transplant recipients: a retrospective multicentre cohort study. J Antimicrob Chemother 2021; 76:3020-3028. [PMID: 34324678 DOI: 10.1093/jac/dkab259] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 06/25/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To evaluate the safety and efficacy of cidofovir for the treatment of double-stranded DNA (dsDNA) viral infections following allogeneic haematopoietic cell transplant (HCT). METHODS This was a retrospective multicentre cohort study including adult HCT recipients who received ≥1 dose of IV-administered cidofovir for any dsDNA viral infection from 2006 to 2019. The objectives were to describe the rate of and risk factors for nephrotoxicity and virological response by the end of treatment (EOT). RESULTS We included 165 patients from nine centres. Cidofovir was administered at 5 mg/kg/week (N = 115; 69.7%), 1 mg/kg/week (18; 10.9%), 3 mg/kg/week (12; 7.3%) or 1 mg/kg three times/week (11; 6.7%). Cidofovir was administered for adenovirus, cytomegalovirus (CMV) and BK virus infection in 75 (45.5%), 64 (38.8%) and 51 (30.9%) patients, respectively. Among 158 patients with renal function data at baseline and EOT, 40 (25.3%) developed nephrotoxicity. In multivariable analyses, age (OR 1.04; P = 0.05), weight (OR 1.05; P = 0.01), CMV infection (OR 3.6; P = 0.02), liposomal amphotericin B (OR 8.06; P = 0.05) and IV voriconazole/posaconazole (OR 13.0; P = 0.003) were predictors of nephrotoxicity. Creatinine concentration was significantly higher at EOT (1.16 ± 0.95 mg/dL) compared with baseline (0.91 ± 0.39 mg/dL; P < 0.001), but improved by 2 weeks (0.91 ± 0.84 mg/dL; P = 0.007) and 4 weeks (0.96 ± 0.89 mg/dL; P = 0.03) post-EOT. Median viral load significantly declined for patients with adenovirus DNAaemia by EOT (P < 0.0001) and for patients with CMV DNAaemia by EOT + 4 weeks (P = 0.003), but not for patients with BK virus DNAaemia. CONCLUSIONS One in four HCT recipients treated with IV cidofovir developed largely reversible nephrotoxicity. Careful selection of patients and close follow-up of renal function may minimize toxicity.
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Affiliation(s)
- Anat Stern
- Infectious Disease Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
| | - Carolyn D Alonso
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, USA
| | | | - Celia Cardozo
- Division of Infectious Diseases, Hospital Clinic, Barcelona, Spain
| | - Monica Slavin
- Department of Infectious Disease and the National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Michelle K Yong
- Department of Infectious Disease and the National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Su Ann Ho
- Department of Infectious Disease and the National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Seema Mehta Steinke
- Division of Infectious Diseases, Johns Hopkins University, School of Medicine, Baltimore, USA
| | - Robin K Avery
- Division of Infectious Diseases, Johns Hopkins University, School of Medicine, Baltimore, USA
| | - Philipp Koehler
- Faculty of Medicine and University Hospital Cologne, Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Christof Scheid
- Faculty of Medicine and University Hospital Cologne, Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany
| | - Oliver A Cornely
- Faculty of Medicine and University Hospital Cologne, Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.,Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany.,German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany
| | | | - Yasmine Abi Aad
- Division of Infectious Diseases, University Hospital of Geneva, Geneva, Switzerland
| | - David J Epstein
- Division of Infectious Diseases, Stanford University, Stanford, CA, USA
| | | | - Dionysios Neofytos
- Division of Infectious Diseases, University Hospital of Geneva, Geneva, Switzerland
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7
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Avery RK, Chiang TPY, Marr KA, Brennan DC, Sait AS, Garibaldi BT, Shah P, Ostrander D, Steinke SM, Permpalung N, Cochran W, Makary MA, Garonzik-Wang J, Segev DL, Massie AB. Inpatient COVID-19 outcomes in solid organ transplant recipients compared to non-solid organ transplant patients: A retrospective cohort. Am J Transplant 2021; 21:2498-2508. [PMID: 33284498 PMCID: PMC9800757 DOI: 10.1111/ajt.16431] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/01/2020] [Accepted: 11/22/2020] [Indexed: 01/25/2023]
Abstract
Immunosuppression and comorbidities might place solid organ transplant (SOT) recipients at higher risk from COVID-19, as suggested by recent case series. We compared 45 SOT vs. 2427 non-SOT patients who were admitted with COVID-19 to our health-care system (March 1, 2020 - August 21, 2020), evaluating hospital length-of-stay and inpatient mortality using competing-risks regression. We compared trajectories of WHO COVID-19 severity scale using mixed-effects ordinal logistic regression, adjusting for severity score at admission. SOT and non-SOT patients had comparable age, sex, and race, but SOT recipients were more likely to have diabetes (60% vs. 34%, p < .001), hypertension (69% vs. 44%, p = .001), HIV (7% vs. 1.4%, p = .024), and peripheral vascular disorders (19% vs. 8%, p = .018). There were no statistically significant differences between SOT and non-SOT in maximum illness severity score (p = .13), length-of-stay (sHR: 0.9 1.11.4 , p = .5), or mortality (sHR: 0.1 0.41.6 , p = .19), although the severity score on admission was slightly lower for SOT (median [IQR] 3 [3, 4]) than for non-SOT (median [IQR] 4 [3-4]) (p = .042) Despite a higher risk profile, SOT recipients had a faster decline in disease severity over time (OR = 0.76 0.810.86 , p < .001) compared with non-SOT patients. These findings have implications for transplant decision-making during the COVID-19 pandemic, and insights about the impact of SARS-CoV-2 on immunosuppressed patients.
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Affiliation(s)
- Robin K. Avery
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,Correspondence Robin K. Avery, Department of Medicine and Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Teresa Po-Yu Chiang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kieren A. Marr
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniel C. Brennan
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,Comprehensive Transplant Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Afrah S. Sait
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Brian T. Garibaldi
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Pali Shah
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,Comprehensive Transplant Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Darin Ostrander
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Seema Mehta Steinke
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nitipong Permpalung
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Willa Cochran
- Comprehensive Transplant Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Martin A. Makary
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Allan B. Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
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8
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Avery RK, Motter JD, Jackson KR, Montgomery RA, Massie AB, Kraus ES, Marr KA, Lonze BE, Alachkar N, Holechek MJ, Ostrander D, Desai N, Waldram MM, Shoham S, Steinke SM, Subramanian A, Hiller JM, Langlee J, Young S, Segev DL, Garonzik Wang JM. Quantifying infection risks in incompatible living donor kidney transplant recipients. Am J Transplant 2021; 21:1564-1575. [PMID: 32949093 PMCID: PMC7972996 DOI: 10.1111/ajt.16316] [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: 05/01/2020] [Revised: 09/08/2020] [Accepted: 09/10/2020] [Indexed: 01/25/2023]
Abstract
Desensitization has enabled incompatible living donor kidney transplantation (ILDKT) across HLA/ABO barriers, but added immunomodulation might put patients at increased risk of infections. We studied 475 recipients from our center from 2010 to 2015, categorized by desensitization intensity: none/compatible (n = 260), low (0-4 plasmaphereses, n = 47), moderate (5-9, n = 74), and high (≥10, n = 94). The 1-year cumulative incidence of infection was 50.1%, 49.8%, 66.0%, and 73.5% for recipients who received none, low, moderate, and high-intensity desensitization (P < .001). The most common infections were UTI (33.5% of ILDKT vs. 21.5% compatible), opportunistic (21.9% vs. 10.8%), and bloodstream (19.1% vs. 5.4%) (P < .001). In weighted models, a trend toward increased risk was seen in low (wIRR = 0.77 1.402.56 ,P = .3) and moderately (wIRR = 0.88 1.352.06 ,P = .2) desensitized recipients, with a statistically significant 2.22-fold (wIRR = 1.33 2.223.72 ,P = .002) increased risk in highly desensitized recipients. Recipients with ≥4 infections were at higher risk of prolonged hospitalization (wIRR = 2.62 3.574.88 , P < .001) and death-censored graft loss (wHR = 1.15 4.0113.95 ,P = .03). Post-KT infections are more common in desensitized ILDKT recipients. A subset of highly desensitized patients is at ultra-high risk for infections. Strategies should be designed to protect patients from the morbidity of recurrent infections, and to extend the survival benefit of ILDKT across the spectrum of recipients.
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Affiliation(s)
- Robin K. Avery
- Division of Infectious DiseaseDepartment of MedicineJohns Hopkins University School of MedicineBaltimoreMaryland
| | - Jennifer D. Motter
- Department of SurgeryJohns Hopkins University School of MedicineBaltimoreMaryland
| | - Kyle R. Jackson
- Department of SurgeryJohns Hopkins University School of MedicineBaltimoreMaryland
| | - Robert A. Montgomery
- The NYU Transplant InstituteNew York University Langone Medical CenterNew YorkNew York
| | - Allan B. Massie
- Department of SurgeryJohns Hopkins University School of MedicineBaltimoreMaryland,Department of EpidemiologyJohns Hopkins School of Public HealthBaltimoreMaryland
| | - Edward S. Kraus
- Division of NephrologyDepartment of MedicineJohns Hopkins University School of MedicineBaltimoreMaryland
| | - Kieren A. Marr
- Division of Infectious DiseaseDepartment of MedicineJohns Hopkins University School of MedicineBaltimoreMaryland
| | - Bonnie E. Lonze
- The NYU Transplant InstituteNew York University Langone Medical CenterNew YorkNew York
| | - Nada Alachkar
- Division of NephrologyDepartment of MedicineJohns Hopkins University School of MedicineBaltimoreMaryland
| | - Mary J. Holechek
- Department of SurgeryJohns Hopkins University School of MedicineBaltimoreMaryland
| | - Darin Ostrander
- Division of Infectious DiseaseDepartment of MedicineJohns Hopkins University School of MedicineBaltimoreMaryland
| | - Niraj Desai
- Department of SurgeryJohns Hopkins University School of MedicineBaltimoreMaryland
| | - Madeleine M. Waldram
- Department of SurgeryJohns Hopkins University School of MedicineBaltimoreMaryland
| | - Shmuel Shoham
- Division of Infectious DiseaseDepartment of MedicineJohns Hopkins University School of MedicineBaltimoreMaryland
| | - Seema Mehta Steinke
- Division of Infectious DiseaseDepartment of MedicineJohns Hopkins University School of MedicineBaltimoreMaryland
| | | | - Janet M. Hiller
- Department of SurgeryJohns Hopkins University School of MedicineBaltimoreMaryland
| | - Julie Langlee
- Department of SurgeryJohns Hopkins University School of MedicineBaltimoreMaryland
| | - Sheila Young
- Division of NephrologyDepartment of MedicineJohns Hopkins University School of MedicineBaltimoreMaryland
| | - Dorry L. Segev
- Department of SurgeryJohns Hopkins University School of MedicineBaltimoreMaryland,Department of EpidemiologyJohns Hopkins School of Public HealthBaltimoreMaryland,Scientific Registry of Transplant RecipientsMinneapolisMinnesotaUSA
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9
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Pierrotti LC, Pérez-Nadales E, Fernández-Ruiz M, Gutiérrez-Gutiérrez B, Tan BH, Carratalà J, Oriol I, Paul M, Cohen-Sinai N, López-Medrano F, San-Juan R, Montejo M, Freire MP, Cordero E, David MD, Merino E, Mehta Steinke S, Grossi PA, Cano Á, Seminari EM, Valerio M, Gunseren F, Rana M, Mularoni A, Martín-Dávila P, van Delden C, Hamiyet Demirkaya M, Koçak Tufan Z, Loeches B, Iyer RN, Soldani F, Eriksson BM, Pilmis B, Rizzi M, Coussement J, Clemente WT, Roilides E, Pascual Á, Martínez-Martínez L, Rodríguez-Baño J, Torre-Cisneros J, Aguado JM. Efficacy of β-lactam/β-lactamase inhibitors to treat extended-spectrum beta-lactamase-producing Enterobacterales bacteremia secondary to urinary tract infection in kidney transplant recipients (INCREMENT-SOT Project). Transpl Infect Dis 2021; 23:e13520. [PMID: 33222379 DOI: 10.1111/tid.13520] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/23/2020] [Accepted: 11/07/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Whether active therapy with β-lactam/β-lactamase inhibitors (BLBLI) is as affective as carbapenems for extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) bloodstream infection (BSI) secondary to urinary tract infection (UTI) in kidney transplant recipients (KTRs) remains unclear. METHODS We retrospectively evaluated 306 KTR admitted to 30 centers from January 2014 to October 2016. Therapeutic failure (lack of cure or clinical improvement and/or death from any cause) at days 7 and 30 from ESBL-E BSI onset was the primary and secondary study outcomes, respectively. RESULTS Therapeutic failure at days 7 and 30 occurred in 8.2% (25/306) and 13.4% (41/306) of patients. Hospital-acquired BSI (adjusted OR [aOR]: 4.10; 95% confidence interval [CI]: 1.50-11.20) and Pitt score (aOR: 1.47; 95% CI: 1.21-1.77) were independently associated with therapeutic failure at day 7. Age-adjusted Charlson Index (aOR: 1.25; 95% CI: 1.05-1.48), Pitt score (aOR: 1.72; 95% CI: 1.35-2.17), and lymphocyte count ≤500 cells/μL at presentation (aOR: 3.16; 95% CI: 1.42-7.06) predicted therapeutic failure at day 30. Carbapenem monotherapy (68.6%, primarily meropenem) was the most frequent active therapy, followed by BLBLI monotherapy (10.8%, mostly piperacillin-tazobactam). Propensity score (PS)-adjusted models revealed no significant impact of the choice of active therapy (carbapenem-containing vs any other regimen, BLBLI- vs carbapenem-based monotherapy) within the first 72 hours on any of the study outcomes. CONCLUSIONS Our data suggest that active therapy based on BLBLI may be as effective as carbapenem-containing regimens for ESBL-E BSI secondary to UTI in the specific population of KTR. Potential residual confounding and unpowered sample size cannot be excluded (ClinicalTrials.gov identifier: NCT02852902).
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Affiliation(s)
- Ligia C Pierrotti
- Infectious Diseases Division, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Elena Pérez-Nadales
- Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Madrid, Spain.,Infectious Diseases Group, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofía University Hospital, University of Cordoba, Cordoba, Spain
| | - Mario Fernández-Ruiz
- Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Madrid, Spain.,Unit of Infectious Diseases, "12 de Octubre" University Hospital, Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Universidad Complutense, Madrid, Spain
| | - Belén Gutiérrez-Gutiérrez
- Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Madrid, Spain.,Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Virgen Macarena University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain
| | - Ban Hock Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Jordi Carratalà
- Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Madrid, Spain.,Department of Infectious Diseases, Bellvitge University Hospital-IDIBELL, University of Barcelona, L´Hospitalet de Llobregat, Barcelona, Spain
| | - Isabel Oriol
- Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Madrid, Spain.,Department of Infectious Diseases, Bellvitge University Hospital-IDIBELL, University of Barcelona, L´Hospitalet de Llobregat, Barcelona, Spain
| | - Mical Paul
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
| | | | - Francisco López-Medrano
- Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Madrid, Spain.,Unit of Infectious Diseases, "12 de Octubre" University Hospital, Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Universidad Complutense, Madrid, Spain
| | - Rafael San-Juan
- Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Madrid, Spain.,Unit of Infectious Diseases, "12 de Octubre" University Hospital, Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Universidad Complutense, Madrid, Spain
| | - Miguel Montejo
- Infectious Diseases Unit, Cruces University Hospital, Bilbao, Spain
| | - Maristela P Freire
- Working Committee for Hospital Epidemiology and Infection Control, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Elisa Cordero
- Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Madrid, Spain.,Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, University Hospitals Virgen del Rocío/CSIC/University of Seville, Seville, Spain
| | - Miruna D David
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Esperanza Merino
- Unit of Infectious Diseases, General University Hospital of Alicante, ISABIAL, Alicante, Spain
| | | | - Paolo A Grossi
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Ángela Cano
- Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Madrid, Spain.,Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Virgen Macarena University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain
| | - Elena M Seminari
- Infectious Diseases Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Maricela Valerio
- Clinical Microbiology and Infectious Disease Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Filiz Gunseren
- Department of Infectious Diseases and Clinical Microbiology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | | | - Alessandra Mularoni
- IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Pilar Martín-Dávila
- Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Madrid, Spain.,Infectious Diseases Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - Christian van Delden
- Unit for Transplant Infectious Diseases, University Hospitals of Geneva, Geneva, Switzerland
| | | | - Zeliha Koçak Tufan
- Infectious Diseases and Clinical Microbiology Department, Medical School of Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Belén Loeches
- Infectious Diseases Unit, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Ranganathan N Iyer
- Clinical Microbiology ID & Infection control, Global Hospitals, Hyderabad, India
| | - Fabio Soldani
- Division of Infectious Diseases, Department of Medicine, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Britt-Marie Eriksson
- Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden
| | - Benoît Pilmis
- Department of Infectious Diseases and Tropical Medicine, Paris Descartes University, Necker-Enfants Malades University Hospital, Centre d'Infectiologie Necker-Pasteur, Institut Imagine, AP-HP, Paris, France
| | - Marco Rizzi
- Infectious Diseases Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Julien Coussement
- Division of Infectious Diseases, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Wanessa T Clemente
- Faculdade de Medicina da Universidade Federal de Minas Gerais (UFMG), Transplant Infectious Disease, Liver Transplant Program, Hospital das Clínicas da UFMG, Belo Horizonte, Brazil
| | - Emmanuel Roilides
- Infectious Diseases Unit and 3rd Department of Pediatrics, Aristotle University School of Health Sciences, Hippokration Hospital, Thessaloniki, Greece
| | - Álvaro Pascual
- Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Madrid, Spain.,Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Virgen Macarena University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain
| | - Luis Martínez-Martínez
- Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Madrid, Spain.,Clinical Unit of Microbiology, Department of Microbiology, Reina Sofía University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Córdoba, Spain
| | - Jesús Rodríguez-Baño
- Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Madrid, Spain.,Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Virgen Macarena University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain
| | - Julian Torre-Cisneros
- Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Madrid, Spain.,Clinical Unit of Infectious Diseases, Reina Sofía University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Córdoba, Spain
| | - José María Aguado
- Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Madrid, Spain.,Unit of Infectious Diseases, "12 de Octubre" University Hospital, Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Universidad Complutense, Madrid, Spain
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10
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Sait AS, Patole SS, Dzintars K, Cosgrove SE, Steinke SM. 205. Rectal Stool Surveillance Cultures to Guide Empiric Antibiotic Therapy in Patients with Hematologic Malignancies with or without Hematopoietic Stem Cell Transplantation. Open Forum Infect Dis 2020. [PMCID: PMC7777835 DOI: 10.1093/ofid/ofaa439.249] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Patients with hematologic malignancies (HM) or hematopoietic stem cell transplant (HSCT) commonly receive broad-spectrum antimicrobials, often leading to the development of multidrug resistant organisms (MDRO). At our institution, rectal stool surveillance cultures (SSC) are done weekly on admitted adult patients with HMs or HSCT. The objective of this study is to determine the role of SSCs in predicting the development of a sterile site infection (StSI) with the same MDRO as identified in the SSC.
Methods
We retrospectively evaluated StSIs (blood, CSF, sputum/respiratory, pleural fluid, and urine) and SSC data from 242 adult patients admitted to the adult oncology ward at a large academic tertiary care center from 6/1/2017 to 2/28/2019. Demographics, SSC data, and StSIs in a 3-month period following the last SSC for each patient were collected from electronic medical records. SSCs were cultured on HardyCHROM ESBL™ media. MDRO similarity between SSC and StSI was determined by comparing susceptibility profiles. JMPÒ Pro 14.3.0 and RStudio were used for statistical analyses.
Results
Two hundred forty-two patients yielded 732 SSCs. We eliminated SSCs with incomplete (< 3 months of follow up) data. Thus, 579 SSCs were included in the analyses. 64% of patients were male. Leukemias (55.4%), lymphomas (21.9%), and multiple myeloma (10.3%) were the most common HMs. HSCT recipients comprised 50.4%. SSCs were positive for a MDRO in 251 cases (vancomycin-resistant enterococci, 52.2%; extended-spectrum beta-lactamase (ESBL) producing organisms, 22.2%; and carbapenamase producing organisms, 4.4%). There were 54 StSIs documented where the MDRO was the same as the SSC MDRO. The NPV of the SSC was 95.1% (95%CI 0.93,0.97). The positive likelihood ratio of the SSC was 2.5 (95%CI 2.07,3.02).
Conclusion
Our results suggest that a negative SSC is associated with a lower probability of identifying a StSI with an MDRO. Clinically, this can be useful in providing the opportunity to judiciously guide antimicrobial therapy, thereby avoiding the unnecessary usage of broad-spectrum antimicrobials when no MDRO is identified in the SSC.
Disclosures
All Authors: No reported disclosures
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Affiliation(s)
| | - Shalom S Patole
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Durand CM, Capoferri AA, Redd AD, Zahurak M, Rosenbloom DIS, Cash A, Avery RK, Bolaños-Meade J, Bollard CM, Bullen CK, Flexner C, Fuchs EJ, Gallant J, Gladstone DE, Gocke CD, Jones RJ, Kasamon YL, Lai J, Levis M, Luznik L, Marr KA, McHugh HL, Mehta Steinke S, Pham P, Pohlmeyer C, Pratz K, Shoham S, Wagner-Johnston N, Xu D, Siliciano JD, Quinn TC, Siliciano RF, Ambinder RF. Allogeneic bone marrow transplantation with post-transplant cyclophosphamide for patients with HIV and haematological malignancies: a feasibility study. Lancet HIV 2020; 7:e602-e610. [PMID: 32649866 PMCID: PMC7484204 DOI: 10.1016/s2352-3018(20)30073-4] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/21/2020] [Accepted: 02/27/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Allogeneic blood or marrow transplantation (alloBMT) is a potentially life-saving treatment for individuals with HIV and haematological malignancies; challenges include identifying donors and maintaining antiretroviral therapy (ART). The objectives of our study were to investigate interventions to expand donor options and to prevent ART interruptions for patients with HIV in need of alloBMT. METHODS This single-arm, interventional trial took place at the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center (Baltimore, MD, USA). Individuals with HIV who were at least 18 years of age and referred for alloBMT for a standard clinical indication were eligible. The only exclusion criterion was a history of documented resistance to enfuvirtide. We used post-transplant cyclophosphamide as graft-versus-host disease (GVHD) prophylaxis to expand donor options and an optimised ART strategy of avoiding pharmacoenhancers and adding subcutaneous enfuvirtide during post-transplant cyclophosphamide and during oral medication intolerance. Our primary outcome was the proportion of participants who maintained ART through day 60 after alloBMT. We measured the HIV latent reservoir using a quantitative viral outgrowth assay. This study is registered on ClinicalTrials.gov, NCT01836068. FINDINGS Between June 1, 2013, and August 27, 2015, nine patients who were referred for transplant provided consent. Two patients had relapsed malignancy before donor searches were initiated. Seven patients had suitable donors identified (two matched sibling, two matched unrelated, two haploidentical, and one single-antigen mismatched unrelated) and proceeded to alloBMT. All patients maintained ART through day 60 and required ART changes (median 1, range 1-3) in the first 90 days. One patient stopped ART and developed HIV rebound with grade 4 meningoencephalitis at day 146. Among six patients who underwent alloBMT and had longitudinal measurements available, the HIV latent reservoir was not detected post-alloBMT in four patients with more than 95% donor chimerism, consistent with a 2·06-2·54 log10 reduction in the HIV latent reservoir. In the two patients with less than 95% donor chimerism, the HIV latent reservoir remained stable. INTERPRETATION By using post-transplant cyclophosphamide as GVHD prophylaxis, we successfully expanded alloBMT donor options for patients with HIV. Continuing ART with a regimen that includes enfuvirtide post-alloBMT was safe, but life-threatening viral rebound can occur with ART interruption. FUNDING amfAR (the Foundation for AIDS Research), Johns Hopkins University Center for AIDS Research, and National Cancer Institute.
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Affiliation(s)
- Christine M Durand
- Johns Hopkins University School of Medicine, Baltimore, MD, USA; Sidney Kimmel Cancer Center, Baltimore, MD, USA.
| | | | - Andrew D Redd
- Johns Hopkins University School of Medicine, Baltimore, MD, USA; Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | | | - Daniel I S Rosenbloom
- Department of Pharmacokinetics, Pharmacodynamics and Drug Metabolism, Merck & Co, Kenilworth, NJ, USA
| | - Ayla Cash
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Robin K Avery
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Javier Bolaños-Meade
- Johns Hopkins University School of Medicine, Baltimore, MD, USA; Sidney Kimmel Cancer Center, Baltimore, MD, USA
| | - Catherine M Bollard
- Sidney Kimmel Cancer Center, Baltimore, MD, USA; Program for Cell Enhancement and Technologies for Immunotherapy Children's National Health System, George Washington University Washington, DC, USA
| | - C Korin Bullen
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Charles Flexner
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Joel Gallant
- Johns Hopkins University School of Medicine, Baltimore, MD, USA; Gilead Sciences, Foster City, CA, USA
| | | | | | | | | | - Jun Lai
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mark Levis
- Sidney Kimmel Cancer Center, Baltimore, MD, USA
| | - Leo Luznik
- Sidney Kimmel Cancer Center, Baltimore, MD, USA
| | - Kieren A Marr
- Johns Hopkins University School of Medicine, Baltimore, MD, USA; Sidney Kimmel Cancer Center, Baltimore, MD, USA
| | - Holly L McHugh
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Paul Pham
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Keith Pratz
- Sidney Kimmel Cancer Center, Baltimore, MD, USA
| | - Shmuel Shoham
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Daniel Xu
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Thomas C Quinn
- Johns Hopkins University School of Medicine, Baltimore, MD, USA; Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Robert F Siliciano
- Johns Hopkins University School of Medicine, Baltimore, MD, USA; Howard Hughes Medical Institute, Baltimore, MD, USA
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Naidoo J, Reuss JE, Suresh K, Feller-Kopman D, Forde PM, Mehta Steinke S, Rock C, Johnson DB, Nishino M, Brahmer JR. Immune-related (IR)-pneumonitis during the COVID-19 pandemic: multidisciplinary recommendations for diagnosis and management. J Immunother Cancer 2020; 8:e000984. [PMID: 32554619 PMCID: PMC7316105 DOI: 10.1136/jitc-2020-000984] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2020] [Indexed: 01/08/2023] Open
Abstract
Immune-related (IR)-pneumonitis is a rare and potentially fatal toxicity of anti-PD(L)1 immunotherapy. Expert guidelines for the diagnosis and management of IR-pneumonitis include multidisciplinary input from medical oncology, pulmonary medicine, infectious disease, and radiology specialists. Severe acute respiratory syndrome coronavirus 2 is a recently recognized respiratory virus that is responsible for causing the COVID-19 global pandemic. Symptoms and imaging findings from IR-pneumonitis and COVID-19 pneumonia can be similar, and early COVID-19 viral testing may yield false negative results, complicating the diagnosis and management of both entities. Herein, we present a set of multidisciplinary consensus recommendations for the diagnosis and management of IR-pneumonitis in the setting of COVID-19 including: (1) isolation procedures, (2) recommended imaging and interpretation, (3) adaptations to invasive testing, (4) adaptations to the management of IR-pneumonitis, (5) immunosuppression for steroid-refractory IR-pneumonitis, and (6) management of suspected concurrent IR-pneumonitis and COVID-19 infection. There is an emerging need for the adaptation of expert guidelines for IR-pneumonitis in the setting of the global COVID-19 pandemic. We propose a multidisciplinary consensus on this topic, in this position paper.
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Affiliation(s)
- Jarushka Naidoo
- Oncology, Johns Hopkins Medicine Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
- The Bloomberg-Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University, Baltimore, Maryland, USA
| | - Joshua E Reuss
- Oncology, Johns Hopkins Medicine Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
- The Bloomberg-Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University, Baltimore, Maryland, USA
| | - Karthik Suresh
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - David Feller-Kopman
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Patrick M Forde
- Oncology, Johns Hopkins Medicine Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
- The Bloomberg-Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University, Baltimore, Maryland, USA
| | - Seema Mehta Steinke
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, USA
| | - Clare Rock
- Division of Hospital Epidemiology and Infection Control, Johns Hopkins University, Baltimore, Maryland, USA
| | - Douglas B Johnson
- Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mizuki Nishino
- Radiology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Julie R Brahmer
- Oncology, Johns Hopkins Medicine Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
- The Bloomberg-Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University, Baltimore, Maryland, USA
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13
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Pérez-Nadales E, Gutiérrez-Gutiérrez B, Natera AM, Abdala E, Reina Magalhães M, Mularoni A, Monaco F, Camera Pierrotti L, Pinheiro Freire M, Iyer RN, Mehta Steinke S, Grazia Calvi E, Tumbarello M, Falcone M, Fernández-Ruiz M, María Costa-Mateo J, Rana MM, Mara Varejão Strabelli T, Paul M, Carmen Fariñas M, Clemente WT, Roilides E, Muñoz P, Dewispelaere L, Loeches B, Lowman W, Tan BH, Escudero-Sánchez R, Bodro M, Antonio Grossi P, Soldani F, Gunseren F, Nestorova N, Pascual Á, Martínez-Martínez L, Aguado JM, Rodríguez-Baño J, Torre-Cisneros J. Predictors of mortality in solid organ transplant recipients with bloodstream infections due to carbapenemase-producing Enterobacterales: The impact of cytomegalovirus disease and lymphopenia. Am J Transplant 2019; 20:S1600-6135(22)22362-4. [PMID: 31891235 DOI: 10.1111/ajt.15769] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 11/30/2019] [Accepted: 12/22/2019] [Indexed: 01/25/2023]
Abstract
Treatment of carbapenemase-producing Enterobacterales bloodstream infections in solid organ transplant recipients is challenging. The objective of this study was to develop a specific score to predict mortality in solid organ transplant recipients with carbapenemase-producing Enterobacterales bloodstream infections. A multinational, retrospective (2004-2016) cohort study (INCREMENT-SOT, ClinicalTrials.gov NCT02852902) was performed. The main outcome variable was 30-day all-cause mortality. The INCREMENT-SOT-CPE score was developed using logistic regression. The global cohort included 216 patients. The final logistic regression model included the following variables: INCREMENT-CPE mortality score ≥8 (8 points), no source control (3 points), inappropriate empirical therapy (2 points), cytomegalovirus disease (7 points), lymphopenia (4 points), and the interaction between INCREMENT-CPE score ≥8 and CMV disease (minus 7 points). This score showed an area under the receiver operating characteristic curve of 0.82 (95% confidence interval [CI] 0.76-0.88) and classified patients into 3 strata: 0-7 (low mortality), 8-11 (high mortality), and 12-17 (very-high mortality). We performed a stratified analysis of the effect of monotherapy vs combination therapy among 165 patients who received appropriate therapy. Monotherapy was associated with higher mortality only in the very-high (adjusted hazard ratio [HR] 2.82, 95% CI 1.13-7.06, P = .03) and high (HR 9.93, 95% CI 2.08-47.40, P = .004) mortality risk strata. A score-based algorithm is provided for therapy guidance.
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Affiliation(s)
- Elena Pérez-Nadales
- Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain
| | - Belén Gutiérrez-Gutiérrez
- Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Spain
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla, Seville, Spain
| | - Alejandra M Natera
- Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain
| | - Edson Abdala
- Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | | | | | | | | | | | | | | | - Mario Tumbarello
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Marco Falcone
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Mario Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Universidad Complutense, Madrid, Spain
| | - José María Costa-Mateo
- Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba, Universidad de Córdoba, Córdoba, Spain
| | | | | | - Mical Paul
- Infectious Diseases Institute, Rambam Health Care Campus and Faculty of Medicine, Technion - Israel Faculty of Technology, Haifa, Israel
| | - María Carmen Fariñas
- Infectious Diseases Unit, Hospital Universitario Marqués de Valdecilla, University of Cantabria, Santander, Spain
| | - Wanessa Trindade Clemente
- Faculty of Medicine, Liver Transplantation Program, Hospital das Clínicas -Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Emmanuel Roilides
- Infectious Diseases Unit and 3rd, Department of Pediatrics, Aristotle University School of Health Sciences, Hippokration Hospital, Thessaloniki, Greece
| | - Patricia Muñoz
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Laurent Dewispelaere
- Department of Microbiology, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Belén Loeches
- Infectious Diseases Unit, Hospital La Paz, Madrid, Spain
| | - Warren Lowman
- Wits Donald Gordon Medical Centre, Vermaak & Partners/Pathcare, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ban Hock Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Rosa Escudero-Sánchez
- Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Spain
- Ramón y Cajal University Hospital, Madrid, Spain
| | - Marta Bodro
- Infectious Diseases Department, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Fabio Soldani
- Department of Medicine, Infectious Diseases Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Filiz Gunseren
- Department of Infectious Diseases, Akdeniz University Hospital, Antalya, Turkey
| | | | - Álvaro Pascual
- Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Spain
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla, Seville, Spain
| | - Luis Martínez-Martínez
- Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Spain
- Unidad de Gestión Clínica de Microbiología, Hospital Universitario Reina Sofía, IMIBIC, Universidad de Cordoba, Cordoba, Spain
| | - José María Aguado
- Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Spain
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Universidad Complutense, Madrid, Spain
| | - Jesús Rodríguez-Baño
- Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Spain
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla, Seville, Spain
| | - Julián Torre-Cisneros
- Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Spain
- Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba, Universidad de Córdoba, Córdoba, Spain
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