1
|
Amir M, Dodani SK, Nasim A, Babar ZU. DRUG USE RECOMMENDATIONS FOR COLISTIN INJECTION IN THE ADULT POPULATION. J Ayub Med Coll Abbottabad 2023; 35:693-697. [PMID: 38406964 DOI: 10.55519/jamc-04-11988] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
BACKGROUND Colistin, also known as Polymyxin E, was the first polymyxin antibiotic. This bactericidal antibiotic plays a vital role as salvage therapy for untreatable gram-negative. Colistin dosing regimens differ worldwide. The published guidelines have different recommendations on the dosing regimens. Further confusion exists due to two different dosing units. Currently, Pakistan has no national guidelines for colistin use. The guideline was developed to improve the safety profile by developing standardization in colistin use and thus reduce the confusion amongst clinicians. METHODS The guideline was developed by a panel of five actively practising infectious disease specialists (physicians and pharmacists) with clinical and research expertise in this particular field. Different literature and international guidelines along with institutional data were used to develop the guideline. CONCLUSIONS The guideline provides ten recommendations on prescribing, transcribing, posology, preparation, administration and monitoring of colistin use. The guideline will give Pakistani healthcare providers a standard approach to using rationally and effectively, and to clear confusion and questions about this medicine.
Collapse
Affiliation(s)
| | - Sunil Kumar Dodani
- Department of Infectious Diseases, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Asma Nasim
- Department of Infectious Diseases, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Zaheer Udin Babar
- Department of Infectious Diseases, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| |
Collapse
|
2
|
Nasim A, Dodani SK, Rehman M, Babar ZU, Badlani S, Mushtaq M, Aziz T. Risk Factors and Outcome of Gram-Negative Bloodstream Infection in Living-Donor Renal Transplant Recipients: A Case-Control Study From Pakistan. EXP CLIN TRANSPLANT 2023; 21:562-567. [PMID: 37584536 DOI: 10.6002/ect.2023.0087] [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] [Indexed: 08/17/2023]
Abstract
OBJECTIVES Gram-negative rods are the most common cause of bloodstream infection in renal transplant recipients. Acute rejection, urologic abnormalities, and ureteral stents are risk factors. Graft dysfunction is independently associated with gram-negative rod bloodstream infection. Our aim is to investigate the incidence, risk factors, and outcome among living donor renal transplant recipients from Pakistan. MATERIALS AND METHODS In this case-control study, we reviewed the medical records until June 2021 of renal transplant recipients seen from 2015 to 2019 for gram negative bacteremia. For every case, controls were matched by age, date of transplant, and sex. Demographics, risk factors, graft function, and mortality were compared. Clinical features, immunosuppression, source of blood stream infection, and microbiology were noted in cases. RESULTS Of 1677 renal transplant recipients, 44 developed gram negative bacteremia. The incidence was 5.9 per 1000 person-years. Median time since transplant was 5 months. The most common source was urinary tract infection. On univariate analysis, antithymocyte globulin, urinary tract infection, and recurrent urinary tract infections were associated with gram negative bacteremia. On multivariate analysis, urinary tract infection (adjusted odds ratio = 3.46; 95% CI, 1.27-9.37) and recurrent urinary tract infections (adjusted odds ratio = 4.03; 95% CI, 1.15-14.15) were significant risk factors. We found no difference in 30-day mortality and estimated glomerular filtration rate on last follow-up between cases and controls. Kaplan-Meier survival curves showed significant differences in graft survival in patients with gram negative bacteremia. Escherichia coli was the most common organism, with 75% ceftriaxone and 13% imipenem resistance. CONCLUSIONS The most significant risk factor for gram negative rod bloodstream infection was recurrent urinary tract infections. Timely treatment and prevention of recurrent urinary tract infections areimperative for prevention of gram negative bacteremia.
Collapse
Affiliation(s)
- Asma Nasim
- From the Department of Infectious Diseases, Karachi, Pakistan
| | | | | | | | | | | | | |
Collapse
|
3
|
Babar ZU, Nasim A, Dodani SK, Aziz T. Successful Treatment and Long-term Follow-up of a Rhodococcus equi Brain Abscess in a Renal Transplant Recipient. Saudi J Kidney Dis Transpl 2023; 34:365-370. [PMID: 38345592 DOI: 10.4103/1319-2442.395453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Affiliation(s)
- Zaheer Udin Babar
- Department of Infectious Diseases, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Asma Nasim
- Department of Infectious Diseases, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Sunil Kumar Dodani
- Department of Infectious Diseases, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Tahir Aziz
- Department of Transplant Sciences, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| |
Collapse
|
4
|
Babar ZU, Dodani SK, Nasim A, Langhani JL, Badlani SK. Outcome of COVID-19 and tolerance of Remdesivir in patients with renal failure: a single center experience from Pakistan. J Infect Dev Ctries 2023; 17:812-818. [PMID: 37406071 DOI: 10.3855/jidc.17136] [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: 07/20/2022] [Accepted: 01/14/2023] [Indexed: 07/07/2023] Open
Abstract
INTRODUCTION Coronavirus disease-19 (COVID-19) is known to cause severe disease in chronic kidney disease and maintenance dialysis patients. We aim to report the outcome of COVID-19 and the adverse effects of Remdesivir (RDV) in patients with renal failure. METHODOLOGY A retrospective observational study included all admitted patients with COVID-19 who received Remdesivir. Clinical characteristics and outcomes were compared in patients with renal failure (RF) and non-renal failure (NRF). We also evaluated RDV-associated nephrotoxicity and observed renal functions during antiviral treatment. RESULTS A total of 142 patients received RDV, 38 (26.76%) in RF and 104 (73.23%) in the non-RF group. The median absolute lymphocyte count was low while C-reactive protein, ferritin, and D-dimer were significantly high on admission in the RF group. A significant number of patients in the RF group required ICU admission (58% vs. 35% p = 0.01) and expired (29% vs. 12.5 p = 0.02). Among survivors and non-survivors in the RF group, raised inflammatory markers and low platelet count on presentation were significantly associated with high mortality. Median serum creatinine (mg/dL) was 0.88 on admission, remained at 0.85 in the NRF group, and improved from 4.59 to 3.87 (mg/dL) after receiving five days of RDV in the RF group. CONCLUSIONS COVID-19 in renal failure has a high risk for ICU admissions leading to increased mortality. Multiple comorbidities and raised inflammatory markers are predictors of poor outcomes. We observed no significant drug-related adverse effects, and none of our patients required discontinuation of RDV due to worsening renal function.
Collapse
Affiliation(s)
- Zaheer Udin Babar
- Department of Infectious Diseases, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Sunil Kumar Dodani
- Department of Infectious Diseases, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Asma Nasim
- Department of Infectious Diseases, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Jawahar Lal Langhani
- Department of Internal Medicine, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Sanjay Kumar Badlani
- Department of Infectious Diseases, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| |
Collapse
|
5
|
Fatima M, Dodani SK, Babar ZU, Badlani S, Rani B, Mushtaq M, Nadeem A, Nasim A. Outcome, risk factors and therapeutic strategies in carbapenem-resistant Gram-negative bacteraemia from Pakistan. JAC Antimicrob Resist 2023; 5:dlad076. [PMID: 37325252 PMCID: PMC10265593 DOI: 10.1093/jacamr/dlad076] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/23/2023] [Indexed: 06/17/2023] Open
Abstract
Background Carbapenem-resistant Gram-negative (CRGN) bacteraemia has high mortality and limited therapeutic options. We assessed the risk factors and outcome of CRGN bacteraemia treated with limited options. Methods A prospective cohort study done at a tertiary care hospital in Pakistan, from October 2021 to August 2022. All patients >18 years with CRGN bacteraemia were assessed for demographics, source, risk factors and treatment received. Outcome was assessed as bacterial clearance and all-cause mortality at Day 14 of bacteraemia. Results We included 175 patients. Median age was 45 years (IQR 30-58) and the majority of our patients were on haemodialysis (75%). We found 14 day mortality in 26.8% of our patients; in addition, microbiological clearance was achieved in 95%. The central line (49.7%) was the most common source and Klebsiella spp. (47%) the most common organism. On multivariate analysis, risk factors for mortality were Foley's catheter [aOR 2.7 (95% CI 1.1-6.5)], mechanical ventilation [aOR 5.1 (95% CI 1.6-15.8)] and Pitt bacteraemia score >4 [aOR 3.48 (95% CI 1.1-10.5)]. Source control was a significant protective factor [aOR 0.251 (95% CI 0.09-0.6)]. The majority received a colistin-based regimen with no difference in mortality between monotherapy and combination therapy. Conclusions Our cohort of CRGN bacteraemia is unique, comprising younger patients mostly on haemodialysis with a central line as the source of bacteraemia and we have found 14 day mortality of 27%. Colistin with various combinations can be an effective option in patients with renal failure having prompt source control.
Collapse
Affiliation(s)
| | - Sunil Kumar Dodani
- Department of Infectious Diseases, Sindh Institute of Urology and Transplantation,Karachi, Pakistan
| | - Zaheer Udin Babar
- Department of Infectious Diseases, Sindh Institute of Urology and Transplantation,Karachi, Pakistan
| | - Sanjay Badlani
- Department of Infectious Diseases, Sindh Institute of Urology and Transplantation,Karachi, Pakistan
| | - Beena Rani
- Department of Infectious Diseases, Sindh Institute of Urology and Transplantation,Karachi, Pakistan
| | - Maryam Mushtaq
- Department of Infectious Diseases, Sindh Institute of Urology and Transplantation,Karachi, Pakistan
| | - Ali Nadeem
- Department of Microbiology, Sindh Institute of Urology and Transplantation,Karachi, Pakistan
| | - Asma Nasim
- Department of Infectious Diseases, Sindh Institute of Urology and Transplantation,Karachi, Pakistan
| |
Collapse
|
6
|
Abid Khan RM, Dodani SK, Nadeem A, Jamil S, Zafar MN. Bacterial isolates and their antimicrobial susceptibility profile of superficial and deep-seated skin and soft tissue infections. ASIAN BIOMED 2023; 17:55-63. [PMID: 37719324 PMCID: PMC10505063 DOI: 10.2478/abm-2023-0045] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Background Skin and soft tissue infections (SSTIs) are caused by microbial invasion of healthy or damaged skin. SSTIs are difficult to manage and contribute to chronicity and emergence of antimicrobial resistance. Objectives To ascertain the prevalence of bacteria causing SSTIs and their antimicrobial susceptibility patterns. Methods A prospective study between November 2020 and May 2021. A total of 447 samples from SSTIs were analyzed. Results A total of 347 samples revealed mono-bacterial growth, of which 67% were male. SSTIs are common among patients aged 21-50 years with the dominance (78%) of gram-negative rods (GNRs). Escherichia coli (36%), Klebsiella spp. (22%), Staphylococcus aureus (16%), and Pseudomonas aeruginosa (11%) were predominant organisms. GNRs were highly resistant (>65%) to ciprofloxacin and trimethoprim-sulfamethoxazole. For injectable antibiotics, the highest resistance was determined against ceftriaxone, and the least resistance was determined against amikacin. Resistance against carbapenem was the highest among P. aeruginosa (53%) and Klebsiella spp. (32%). S. aureus showed the highest resistance against ciprofloxacin, and the least resistance was determined against clindamycin. Of 57 S. aureus isolates, 86% isolates were methicillin-resistant Staphylococcus aureus (MRSA). All isolates of P. aeruginosa and S. aureus were sensitive to polymyxin B and vancomycin, respectively. The prevalence of multidrug-resistant E. coli and Klebsiella spp. was higher among deep-seated SSTIs (dSSTIs). Conclusions The predominant etiology of SSTIs is GNR. Currently, there is very high resistance against oral antibiotics. Antimicrobial resistance against carbapenem has also increased. Moreover, there is a high frequency of MRSA. MDR E. coli and Klebsiella spp. isolates are frequently involved in dSSTIs.
Collapse
Affiliation(s)
- Rao Muhammad Abid Khan
- Department of Microbiology, Sindh Institute of Urology and Transplantation, Karachi74200, Pakistan
| | - Sunil Kumar Dodani
- Department of Infectious Diseases, Sindh Institute of Urology and Transplantation, Karachi74200, Pakistan
| | - Ali Nadeem
- Department of Microbiology, Sindh Institute of Urology and Transplantation, Karachi74200, Pakistan
| | - Sana Jamil
- Department of Microbiology, Sindh Institute of Urology and Transplantation, Karachi74200, Pakistan
| | - Mirza Naqi Zafar
- Department of Biochemistry, Sindh Institute of Urology and Transplantation, Karachi74200, Pakistan
| |
Collapse
|
7
|
Ishaque S, Syed B, Dodani SK, Anwar S. Comparison of Single vs Combination Drug Therapy in Extensively Drug Resistant Salmonella typhi: An Observational Study from Pakistan. Infect Drug Resist 2022; 15:6093-6100. [PMID: 36277244 PMCID: PMC9584767 DOI: 10.2147/idr.s372136] [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: 04/24/2022] [Accepted: 08/01/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Antibiotic resistance has become a significant problem in typhoid fever due to the emergence of extensively drug resistant (XDR) Salmonella enterica serovar typhi. In Pakistan, an outbreak of ceftriaxone-resistant typhoid was first reported in November 2016. Methods A retrospective chart review was conducted at Liaquat National Hospital and Medical University, in Karachi, Pakistan. Patient records were identified from the microbiology laboratory data of all admitted patients who had blood culture positive for XDR Salmonella typhi from January 2017 to December 2019. Results Out of 254 patients, 179 (70%) were male with an average age of 11.7 ± 10.9 years. Around 190 (74%) patients were treated with combination therapy, 126 (49%) were given azithromycin and meropenem and 61 (24%) received azithromycin and imipenem. A total of 64 (25%) patients received single drug therapy, 33 (12%) were given azithromycin, 23 (9%) meropenem, and 8 (3%) imipenem. Analysis indicated that single drug therapy resulted in an earlier onset of defervescence compared with combination therapy (5.03±2.98 days vs 3.45±2.48 days; P <0.001), with a decreased occurrence of pancytopenia (P <0.001). Conclusion Single antimicrobial therapy achieved defervescence earlier than combination therapy, with carbapenems performing better than azithromycin.
Collapse
Affiliation(s)
- Sadia Ishaque
- Department of Medicine, Liaquat National Hospital, Karachi, Pakistan,Department of Infectious Disease Shaheed Mohtarma, Benazir Bhutto Institute of Trauma, Dow University of Health Sciences, Karachi, Pakistan,Correspondence: Sadia Ishaque, Department of Infectious Disease Shaheed Mohtarma, Benazir Bhutto Institute of Trauma, Dow University of health sciences, Chand Bibi Road, Karachi, Pakistan, Tel +92 300 3750407, Email
| | - Beenish Syed
- Department of Medicine, Liaquat National Hospital, Karachi, Pakistan,Department of Infectious Diseases, Sindh Infectious Diseases Hospital and Research Center, Karachi, Pakistan
| | - Sunil Kumar Dodani
- Department of Infectious Diseases, Sindh Institute of Urology & Transplantation, Karachi, Pakistan
| | - Sana Anwar
- Sana Anwar, Department of Microbiology, Liaquat National Hospital, Karachi, Pakistan
| |
Collapse
|
8
|
Nasim A, Dodani SK, Badlani S, Babar ZU, Shakil S, Mubarak M, Luck N, Aziz T. Whipple's disease in renal transplant recipients: Management experience of seven cases from Pakistan. Transpl Infect Dis 2021; 24:e13769. [PMID: 34837443 DOI: 10.1111/tid.13769] [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: 07/05/2021] [Revised: 10/23/2021] [Accepted: 11/10/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Whipple's disease (WD) is a rare multi-systemic disorder caused by actinomycetes, Tropheryma whipplei. It presents with weight loss, arthralgia, and diarrhea and may involve the heart, lung, or central nervous system. The use of immunosuppressive medications or underlying immunodeficiency states are associated risk factors. Six cases in transplant recipients have so far been reported worldwide. We describe our experience of WD in renal transplant recipients. METHODS All renal transplant recipients who presented with diarrhea and were diagnosed with WD on duodenal biopsy from 2016 till 2019 were included. Their data regarding duration since transplantation, immunosuppressive therapy, symptoms, treatment response, and outcome were analyzed. RESULTS Seven cases were diagnosed as WD based on duodenal biopsy, with histological findings of periodic acid Schiff-positive granules in macrophages. All were males. The most common symptoms were chronic diarrhea and weight loss. Average time since transplantation was 4.8 years. All patients were on azathioprine and everolimus. Clinical relapse or adverse effects was seen in five of seven patients treated with doxycycline and hydroxychloroquine which was discontinued. Trimethoprim/sulfamethoxazole for 1 year, with initial intravenous ceftriaxone in two patients, resulted in complete remission in all patients at a follow-up period averaging 1.5 years. CONCLUSION WDs in renal transplant recipients most commonly presents as an intestinal disorder. Treatment of 1 year with trimethoprim/sulfamethoxazole has good response with complete remission at 1.5 years of follow up.
Collapse
Affiliation(s)
- Asma Nasim
- Sindh Institute of Urology and Transplantation, Chand Bibi Road, Karachi, Pakistan
| | - Sunil Kumar Dodani
- Sindh Institute of Urology and Transplantation, Chand Bibi Road, Karachi, Pakistan
| | - Sanjay Badlani
- Sindh Institute of Urology and Transplantation, Chand Bibi Road, Karachi, Pakistan
| | - Zaheer Udin Babar
- Sindh Institute of Urology and Transplantation, Chand Bibi Road, Karachi, Pakistan
| | - Shaheera Shakil
- Sindh Institute of Urology and Transplantation, Chand Bibi Road, Karachi, Pakistan
| | - Mohammad Mubarak
- Sindh Institute of Urology and Transplantation, Chand Bibi Road, Karachi, Pakistan
| | - Nasir Luck
- Sindh Institute of Urology and Transplantation, Chand Bibi Road, Karachi, Pakistan
| | - Tahir Aziz
- Sindh Institute of Urology and Transplantation, Chand Bibi Road, Karachi, Pakistan
| |
Collapse
|
9
|
Dodani SK, Nasim A, Aziz T, Naqvi A. The efficacy of isoniazid prophylaxis in renal transplant recipients in a high tuberculosis burden country. Transpl Infect Dis 2021; 23:e13709. [PMID: 34331355 DOI: 10.1111/tid.13709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 07/08/2021] [Accepted: 07/19/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Renal transplant recipients are at high risk of tuberculosis (TB). We started isoniazid (INH) prophylaxis of 1 year duration in all renal transplant recipients from April 2009. Our aim was to assess the incidence of TB on INH prophylaxis and its tolerability. METHODS This was a retrospective observational study. The files of renal transplant recipients from April 2009 to December 2011 were reviewed till June 2015. We noted the incidence of TB, INH tolerability, and development of resistance. We compared the incidence of TB with the historical controls who never received the prophylaxis. RESULTS A total of 910 patients were reviewed and followed up for 4.8 years. INH prophylaxis was completed by 825 (91%) patients. A total of 46 patients (5%) developed active TB as compared to 15% in the historical controls. The median time of TB diagnosis from transplantation was 2.8 years. In the first-year post transplant, out of total TB cases, 52% occurred in the historical controls whereas 13% occurred in study cohort. Around 67% had TB >2 years after transplant. Overall 1.43% had hepatotoxicity. There was a significant reduction in TB among those who completed prophylaxis to those who did not (p < 0.001). Of 14 cultures, one isolate was INH resistant (7%). CONCLUSION INH prophylaxis was well tolerated. The incidence of TB decreased in the first 2 years. However there was a surge in TB cases 1 year after stopping INH therapy. We should consider prolonging the duration of INH prophylaxis in high TB burden countries in renal transplant recipients.
Collapse
Affiliation(s)
| | - Asma Nasim
- Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Tahir Aziz
- Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Anwar Naqvi
- Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| |
Collapse
|
10
|
Nasir N, Sarfaraz S, Khanum I, Ansari T, Nasim A, Dodani SK, Luxmi S. Tuberculosis in Solid Organ Transplantation: Insights from TB Endemic Areas. Curr Infect Dis Rep 2021. [DOI: 10.1007/s11908-021-00756-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
11
|
Babar ZU, Dodani SK, Nasim A. Treatment outcome and adverse effects of colistin in adult patients with carbapenem-resistant gram-negative bacteremia from Pakistan. Int J Infect Dis 2021; 106:171-175. [PMID: 33705852 DOI: 10.1016/j.ijid.2021.03.004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 02/15/2021] [Accepted: 03/02/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Polymyxins (colistin) have emerged for the treatment of carbapenem resistant (CR) gram-negative infections. There is a paucity of data on treatment outcomes and adverse effects of high-dose colistin treatment in Pakistan. The aim of this study was to determine the efficacy and toxicity of colistin in CR bacteremia, including patients with renal failure and on hemodialysis, and to determine patient outcomes. METHODS This prospective cohort study was performed from May to December 2017 at Sindh Institute of Urology and Transplantation, Karachi, Pakistan. Patients aged >18 years with documented gram-negative bacteremia were included. Data were compared between those who received colistin and those who did not, including risk factors for CR bacteremia, bacterial clearance, adverse effects, and all-cause mortality up to 14 days of follow-up. RESULTS The study included 137 patients, 73 (53.3%) in the colistin group and 64 (46.7%) in the non-colistin group. Patients in the colistin group were 1.47 times more likely to have died by day 14 of follow-up as compared to those in the non-colistin group (19.2% vs 7.8%; relative risk 1.47, p= 0.05). Patients in both groups achieved more than 80% bacteriological clearance. The colistin group patients were less likely to have received appropriate empirical antibiotics as compared to the non-colistin group patients (4.1% vs 62.5%; relative risk 0.09, p< 0.001). Factors significantly associated with mortality were inappropriate empirical antibiotics and acute renal failure. Of the 73 patients in the colistin group, 27 (37.0%) developed reversible neurological adverse effects. Patients with renal insufficiency, not on hemodialysis, were evaluated for colistin nephrotoxicity. Creatinine decreased from 8.08 mg/dl at baseline to 4.85 mg/dl on day 7 in the colistin group, and from 6.5 mg/dl to 3.9 mg/dl in the non-colistin group. Patients with normal renal function had no significant rise in serum creatinine. CONCLUSIONS Colistin is efficacious in clearing bacteremia even in patients with impaired renal function. The adverse effects were found to be minimal and reversible. We recommend the use of colistin in combination with carbapenems for CR gram-negative bacteria in renal failure. Most importantly, however, this study highlights the role of empirical colistin treatment in patients with risk factors for CR bacteremia.
Collapse
Affiliation(s)
- Zaheer Udin Babar
- Department of Infectious Diseases, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
| | - Sunil Kumar Dodani
- Department of Infectious Diseases, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
| | - Asma Nasim
- Department of Infectious Diseases, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
| |
Collapse
|
12
|
Batra S, Ochani RK, Diwan MN, Yasmin F, Qureshi SS, Bhimani S, Shaikh S, Tariq MA, Ahmed Ashraf M, Farooqi HA, Dodani SK. Clinical aspects of Ebola virus disease: a review. Infez Med 2020; 28:212-222. [PMID: 32487785] [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: 06/11/2023]
Abstract
Ebola Virus Disease (EVD), also known as Ebola Hemorrhagic Fever (EHF), initially emerged over 40 years ago in the Democratic Republic of Congo. Endemic to Africa, outbreaks have been recorded in six African countries since its detection in 1976. Fruit bats are believed to be the natural hosts of Ebola viruses (EBoV), with humans and other mammals serving as accidental hosts. Transmission of EBoV has been reported in various ways, including human to human transmission through close contact with blood and bodily fluids. The virus has an incubation period ranging from two to twenty-one days, followed by a multitude of clinical manifestations such as the sudden onset of high fever, chills and myalgia depicting a flu-like syndrome. It is usually diagnosed based on several clinical symptoms such as the sudden onset of illness, high fevers for less than three weeks, and at least two hemorrhagic symptoms despite no predisposing factors. This generally provides enough evidence for clinicians to consider EHF and begin supportive treatment until the virus is confirmed through laboratory findings. Management of patients involves supportive care such as maintaining fluid along with electrolyte balance, blood pressure and oxygen saturation. This also includes treating complications arising from secondary infections. The main options include: prophylactic strategies, anti-viral therapy for EVD, immunotherapies, vaccines, and ZMapp. Finally, the key to managing EBoV epidemics is to stop the transmission of disease in the most severely affected population, as prevention has become of utmost importance to alleviate the significant physical and economic burden.
Collapse
Affiliation(s)
- Simran Batra
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Rohan Kumar Ochani
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Farah Yasmin
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Suha Safi Qureshi
- Department of Internal Medicine, Ziauddin Medical University, Karachi, Pakistan
| | - Sameer Bhimani
- Department of Internal Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Shehryar Shaikh
- Department of Internal Medicine, Dow International Medical College, DUHS, Karachi, Pakistan
| | - Muhammad Ali Tariq
- Department of Internal Medicine, Dow International Medical College, DUHS, Karachi, Pakistan
| | | | - Hamza Ahmed Farooqi
- Department of Internal Medicine, Ziauddin Medical University, Karachi, Pakistan
| | - Sunil Kumar Dodani
- Department of Infectious Diseases, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| |
Collapse
|
13
|
Zuberi BF, Quraishy MS, Afsar S, Akhtar N, Kumar A, Dodani SK. Treatment outcome in patients of hepatitis B with hepatitis D: experience of 4 years at a tertiary care centre in Pakistan. J Coll Physicians Surg Pak 2007; 17:320-2. [PMID: 17623577 DOI: 06.2007/jcpsp.320322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/31/2006] [Accepted: 05/02/2007] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine HBV suppression in patients with dual HBV and HDV infection after 48 weeks with 10.0 MIU of interferon-a 2b. DESIGN Quasi experimental study. PLACE AND DURATION OF STUDY Civil Hospital, Karachi and Lyari General Hospital, Karachi, from July 2003 to June 2005. PATIENTS AND METHODS All HBsAg positive patients were screened for anti-HDV, all positives were included. Baseline investigations, liver chemistries and HBsAg; HBeAg; anti-HBcore IgM; HBV DNA quantitative PCR were done. Patients with hepatocellular carcinoma and decompensated cirrhosis were excluded. Patients were treated with Interferon-alpha 10.0 MIU sc t.i.w. for 48 weeks. HBeAg and quantitative HBV DNA was done at week 0, 24 and 48 while CBC and SGPT were done monthly. HBV suppression was defined as levels < 400 copies/ml. RESULTS Fifty-two patients were selected for intervention, including 34 males and 18 females. At the end of therapy after 48 weeks, HBV DNA suppression was achieved in 51.9% and HBeAg became undetectable in 53.8% of patients. Twenty-one patients with HBV suppression still had raised SGPT. CONCLUSION HDV should be screened in all patients eligible for HBV treatment.
Collapse
|