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Han JH. Comment on: Bivalirudin during thrombolysis with catheter-directed tPA in a heparin-refractory patient: A case report. Pediatr Blood Cancer 2024; 71:e30992. [PMID: 38556764 DOI: 10.1002/pbc.30992] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/08/2024] [Accepted: 03/20/2024] [Indexed: 04/02/2024]
Affiliation(s)
- Jennifer H Han
- Indiana Hemophilia & Thrombosis Center (IHTC), Indianapolis, Indiana, USA
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Zhang HL, Gontjes KJ, Han JH, Alby K, Lapp Z, Snitkin E, Goldstein EJ, Muldoon S, Tolomeo P, Lautenbach E. Characterization of resistance to newer antimicrobials among carbapenem-resistant Klebsiella pneumoniae in the post-acute-care setting. Infect Control Hosp Epidemiol 2023; 44:1159-1162. [PMID: 35896514 PMCID: PMC9883590 DOI: 10.1017/ice.2022.185] [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] [Indexed: 01/31/2023]
Abstract
We assessed susceptibility patterns to newer antimicrobial agents among clinical carbapenem-resistant Klebsiella pneumoniae (CRKP) isolates from patients in long-term acute-care hospitals (LTACHs) from 2014 to 2015. Meropenem-vaborbactam and imipenem-relebactam nonsusceptibility were observed among 9.9% and 9.1% of isolates, respectively. Nonsusceptibility to ceftazidime-avibactam (1.1%) and plazomicin (0.8%) were uncommon.
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Affiliation(s)
- Helen L. Zhang
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Kyle J. Gontjes
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jennifer H. Han
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, PA, USA
| | - Kevin Alby
- Department of Pathology and Lab Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Zena Lapp
- Department of Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Evan Snitkin
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Ellie J.C. Goldstein
- R.M. Alden Research Laboratory, Santa Monica, CA, USA
- Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | | | - Pam Tolomeo
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, PA, USA
| | - Ebbing Lautenbach
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, PA, USA
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Wang LD, Zhang PH, Li Y, Li YH, Zhang B, Wang HJ, Wu J, Han JH, Li CN, Li N, Li XH, Ding GG, Wu ZS. [Deepening the Action on Salt Reduction in China-suggestions on strategy and implementation plan]. Zhonghua Yu Fang Yi Xue Za Zhi 2023; 57:1-10. [PMID: 37190746 DOI: 10.3760/cma.j.cn112150-20221205-01176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Excessive sodium/salt intake is the leading dietary risk factor for the loss of healthy life in the Chinese population. The "Healthy China 2030" Action Plan set the goal of reducing salt intake by 20% by 2030. However, salt intake in China is still at a very high level in the world, with adults reaching 11 g/d, more than twice the recommended limit of 5 g/d. The current policies and action plans of China have targeted catering workers, children, adolescents, and home chefs in salt, oil, and sugar reduction actions. However, there are still obvious deficiencies in the coordinated promotion and implementation. This study, therefore, proposed a set of comprehensive strategies (named CHRPS that is composed of communication and education, salt reduction in home cooking, salt reduction in restaurants, reducing salt content in pre-packaged food, and surveillance and evaluation) and key implementation points for further deepening the salt reduction action in China. These strategies were developed based on the main sources of dietary sodium for Chinese residents, the status of"knowledge, attitude and practice"in salt reduction, evidence of effective intervention measures, existing policies and requirements, and the salt reduction strategies of the World Health Organization and experience from some other countries. As a scientific reference, the CHRPS strategies will help the government and relevant organizations quickly implement salt reduction work and facilitate the earlier realization of China's salt reduction goal.
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Affiliation(s)
- L D Wang
- Chinese Preventive Medicine Association, Beijing 100062
| | - P H Zhang
- The George Institute for Global Health (Australia) Beijing Representative Office, Beijing 100600
| | - Y Li
- The George Institute for Global Health (Australia) Beijing Representative Office, Beijing 100600
| | - Y H Li
- Chinese Center for Health Education, Beijing 100011
| | - B Zhang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050
| | - H J Wang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050
| | - J Wu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050
| | - J H Han
- Chinese Nutrition Society, Beijing 100020
| | - C N Li
- Chinese Center for Health Education, Beijing 100011
| | - N Li
- China National Center for Food Safety Risk Assessment, Beijing 100024
| | - X H Li
- People's Medical Publishing House, Beijing 100021
| | - G G Ding
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050
| | - Z S Wu
- Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing 100029
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Anesi JA, Lautenbach E, Thom KA, Tamma PD, Blumberg EA, Alby K, Bilker WB, Werzen A, Ammazzalorso A, Tolomeo P, Omorogbe J, Pineles L, Han JH. Clinical Outcomes and Risk Factors for Carbapenem-resistant Enterobacterales Bloodstream Infection in Solid Organ Transplant Recipients. Transplantation 2023; 107:254-263. [PMID: 35856636 PMCID: PMC9772065 DOI: 10.1097/tp.0000000000004265] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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] [Indexed: 01/03/2023]
Abstract
BACKGROUND The clinical outcomes associated with, and risk factors for, carbapenem-resistant Enterobacterales (CRE) bloodstream infections (BSIs) in solid organ transplant (SOT) recipients remain ill-defined. METHODS A multicenter retrospective cohort study was performed, including SOT recipients with an Enterobacterales BSI between 2005 and 2018. Exposed subjects were those with a CRE BSI. Unexposed subjects were those with a non-CRE BSI. A multivariable survival analysis was performed to determine the association between CRE BSI and risk of all-cause mortality within 60 d. Multivariable logistic regression analysis was performed to determine independent risk factors for CRE BSI. RESULTS Of 897 cases of Enterobacterales BSI in SOT recipients, 70 (8%) were due to CRE. On multivariable analysis, CRE BSI was associated with a significantly increased hazard of all-cause mortality (adjusted hazard ratio, 2.85; 95% confidence interval [CI], 1.68-4.84; P < 0.001). Independent risk factors for CRE BSI included prior CRE colonization or infection (adjusted odds ratio [aOR] 9.86; 95% CI, 4.88-19.93; P < 0.001)' liver transplantation (aOR, 2.64; 95% CI, 1.23-5.65; P = 0.012)' lung transplantation (aOR, 3.76; 95% CI, 1.40-10.09; P = 0.009)' and exposure to a third-generation cephalosporin (aOR, 2.21; 95% CI, 1.17-4.17; P = 0.015) or carbapenem (aOR, 2.80; 95% CI, 1.54-5.10; P = 0.001) in the prior 6 months. CONCLUSIONS CRE BSI is associated with significantly worse outcomes than more antibiotic-susceptible Enterobacterales BSI in SOT recipients.
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Affiliation(s)
- Judith A. Anesi
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ebbing Lautenbach
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kerri A. Thom
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, University of Maryland, Baltimore, MD
| | - Pranita D. Tamma
- Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Emily A. Blumberg
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kevin Alby
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Warren B. Bilker
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Alissa Werzen
- Division of Infectious Diseases, University of Maryland Medical Center, Baltimore, MD
| | - Alyssa Ammazzalorso
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Pam Tolomeo
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jacqueline Omorogbe
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Lisa Pineles
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, University of Maryland, Baltimore, MD
| | - Jennifer H. Han
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Park S, Han JH, Hwang J, Yon DK, Lee SW, Kim JH, Koyanagi A, Jacob L, Oh H, Kostev K, Dragioti E, Radua J, Eun HS, Shin JI, Smith L. The global burden of sudden infant death syndrome from 1990 to 2019: a systematic analysis from the Global Burden of Disease study 2019. QJM 2022; 115:735-744. [PMID: 35385121 DOI: 10.1093/qjmed/hcac093] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/26/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Sudden infant death syndrome (SIDS) still remains one of the leading causes of infant death worldwide, especially in high-income countries. To date, however, there is no detailed information on the global health burden of SIDS. AIMS To characterize the global disease burden of SIDS and its trends from 1990 to 2019 and to compare the burden of SIDS according to the socio-demographic index (SDI). DESIGN Systematic analysis based on the Global Burden of Disease (GBD) 2019 data. METHODS Epidemiological data of 204 countries from 1990 to 2019 were collected via various methods including civil registration and vital statistics in the original GBD study. Estimates for mortality and disease burden of SIDS were modeled. Crude mortality and mortality rates per 100 000 population were analyzed. Disability-adjusted life years (DALYs) and DALY rates were also assessed. RESULTS In 2019, mortality rate of SIDS accounted for 20.98 [95% Uncertainty Interval, 9.15-46.16] globally, which was a 51% decrease from 1990. SIDS was most prevalent in Western sub-Saharan Africa, High-income North America and Oceania in 2019. The burden of SIDS was higher in males than females consistently from 1990 to 2019. Higher SDI and income level was associated with lower burden of SIDS; furthermore, countries with higher SDI and income had greater decreases in SIDS burden from 1990 to 2019. CONCLUSIONS The burden of SIDS has decreased drastically from 1990 to 2019. However, the improvements have occurred disproportionately between regions and SDI levels. Focused preventive efforts in under-resourced populations are needed.
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Affiliation(s)
- S Park
- From the Yonsei College of Medicine, Seoul, 03722, Republic of Korea
| | - J H Han
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - J Hwang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - D K Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, 02447, Republic of Korea
| | - S W Lee
- Department of Data Science, Sejong University College of Software Convergence, Seoul, 05006, Republic of Korea
- Department of Precision Medicine, Sungkyunkwan University School of Medicine, Suwon, 16419, Republic of Korea
| | - J H Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - A Koyanagi
- Department of Research and Development Unit, Parc Sanitari Sant Joan de Deu/CIBERSAM, Universitat de Barcelona, Fundacio Sant Joan de Deu, Sant Boi de Llobregat, Barcelona, 08830, Spain
- Life and Medical Sciences, ICREA, Pg. Lluis Companys 23, Barcelona, 08010, Spain
| | - L Jacob
- Department of Research and Development Unit, Parc Sanitari Sant Joan de Deu/CIBERSAM, Universitat de Barcelona, Fundacio Sant Joan de Deu, Sant Boi de Llobregat, Barcelona, 08830, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, 28029, Spain
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, 78180, France
| | - H Oh
- School of Social Work, University of Southern California, Los Angeles, CA, 90089, USA
| | - K Kostev
- University Clinic of Marburg, Marburg, 35043, Germany
| | - E Dragioti
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, 58183, Sweden
| | - J Radua
- Department of Psychosis Studies, Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, WC2R 2LS, UK
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), CIBERSAM, Barcelona, 08036, Spain
- Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, 17176, Sweden
| | - H S Eun
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - J I Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - L Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, CB1 1PT, UK
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Zhang HL, Han JH, Lapp Z, Snitkin E, Goldstein EJC, Muldoon S, Tolomeo P, Lautenbach E. Risk Factors for Colistin-Resistant Carbapenem-Resistant Klebsiella pneumoniae in the Postacute Care Setting. Open Forum Infect Dis 2022; 9:ofac452. [PMID: 36168553 PMCID: PMC9511120 DOI: 10.1093/ofid/ofac452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/30/2022] [Indexed: 12/01/2022] Open
Abstract
We assessed risk factors for colistin resistance among carbapenem-resistant Klebsiella pneumoniae (CRKP) from 375 patients in long-term acute care hospitals. Recent colistin or polymyxin B exposure was associated with increased odds of colistin resistance (adjusted odds ratio = 1.11 per day of exposure, 95% confidence interval = 1.03-1.19, P = .007).
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Affiliation(s)
- Helen L Zhang
- Correspondence: Helen L. Zhang, MD, MSCE, Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104 ()
| | - Jennifer H Han
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA,Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Zena Lapp
- Department of Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Evan Snitkin
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Ellie J C Goldstein
- R.M. Alden Research Laboratory, Santa Monica, California, USA,Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, California, USA
| | | | - Pam Tolomeo
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA,Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Yu X, Shi ZB, Jiang M, Yu GY, Zhu YL, Yang ZC, Chen W, Zhu YR, Fang KR, Tong RH, Han JH, Zhang XR. Analysis of synthetic electron cyclotron emission from the high field side of HL-2M tokamak plasmas. Rev Sci Instrum 2022; 93:083518. [PMID: 36050087 DOI: 10.1063/5.0098907] [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] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/26/2022] [Indexed: 06/15/2023]
Abstract
A synthetic electron cyclotron emission (ECE) diagnostic is used to interpret ECE signals from preset plasma equilibrium profiles, including magnetic field, electron density, and electron temperature. According to the simulation results, the electron temperature (Te) profile covering the harmonic overlap region can be obtained by receiving ECE signals at the high field side (HFS) of the HL-2M plasma. The third harmonic ECE at the low field side (LFS) cannot pass through the second harmonic resonance layer at the HFS unless the optical thickness (τ) of the second harmonic becomes gray (τ ≤ 2). In addition, the impact of the relativistic frequency down-shift has been evaluated and corrected. The measurable range of the HFS ECE has been calculated by scanning different parameters (electron density, temperature, and magnetic field). Higher plasma parameters allow a wider radial range of electron temperature measurements. The minimum inner measurable position can reach R = 120 cm (r/a = -0.89) when the product of core temperature (Te0) and density (ne0) is greater than 35 × 1019 keV m-3, which is extended by more than 30 cm inward compared with that of the LFS measurement. The HFS ECE will greatly improve the diagnostic ability of ECE systems on the HL-2M tokamak.
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Affiliation(s)
- X Yu
- Southwestern Institute of Physics, Chengdu 610041, China
| | - Z B Shi
- Southwestern Institute of Physics, Chengdu 610041, China
| | - M Jiang
- Southwestern Institute of Physics, Chengdu 610041, China
| | - G Y Yu
- Department of Electrical and Computer Engineering, University of California, Davis, California 95616, USA
| | - Y L Zhu
- Department of Electrical and Computer Engineering, University of California, Davis, California 95616, USA
| | - Z C Yang
- Southwestern Institute of Physics, Chengdu 610041, China
| | - W Chen
- Southwestern Institute of Physics, Chengdu 610041, China
| | - Y R Zhu
- Southwestern Institute of Physics, Chengdu 610041, China
| | - K R Fang
- Southwestern Institute of Physics, Chengdu 610041, China
| | - R H Tong
- Southwestern Institute of Physics, Chengdu 610041, China
| | - J H Han
- Sichuan University, Chengdu 610065, China
| | - X R Zhang
- Key Laboratory of Materials Modification by Beams of the Ministry of Education, School of Physics, Dalian University of Technology, Dalian 116024, China
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Anesi JA, Blumberg EA, Han JH, Lee DH, Clauss H, Hasz R, Molnar E, Alimenti D, Motzer AR, West S, Bilker WB, Tolomeo P, Lautenbach E. Impact of donor multidrug-resistant organisms on solid organ transplant recipient outcomes. Transpl Infect Dis 2022; 24:e13783. [PMID: 34968006 PMCID: PMC9495582 DOI: 10.1111/tid.13783] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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: 10/05/2021] [Revised: 11/12/2021] [Accepted: 12/07/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The impact of donor colonization or infection with multidrug-resistant organisms (MDROs) on solid organ transplant (SOT) recipient outcomes remains uncertain. We thus evaluated the association between donor MDROs and risk of posttransplant infection, graft failure, and mortality. METHODS A multicenter retrospective cohort study was performed. All SOT recipients with a local deceased donor were included. The cohort was divided into three exposure groups: recipients whose donors had (1) an MDRO, (2) a non-MDRO bacterial or candidal organism, or (3) no growth on cultures. The primary outcomes were (1) bacterial or invasive candidal infection within 3 months and (2) graft failure or death within 12 months posttransplant. Mixed effect multivariable frailty models were developed to evaluate each association. RESULTS Of 658 total SOT recipients, 93 (14%) had a donor with an MDRO, 477 (73%) had a donor with a non-MDRO organism, and 88 (13%) had a donor with no organisms on culture. On multivariable analyses, donor MDROs were associated with a significantly increased hazard of infection compared to those with negative donor cultures (adjust hazard ratio [aHR] 1.63, 95% CI 1.01-2.62, p = .04) but were not associated with graft failure or death (aHR 0.45, 95% CI 0.15-1.36, p = .16). CONCLUSIONS MDROs on donor culture increase the risk of early posttransplant infection but do not appear to affect long-term graft or recipient survival, suggesting organ donors with MDROs on culture may be safely utilized. Future studies aimed at reducing early posttransplant infections associated with donor MDROs are needed.
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Affiliation(s)
- Judith A. Anesi
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Emily A. Blumberg
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Dong Heun Lee
- Division of Infectious Diseases, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Heather Clauss
- Section of Infectious Diseases, Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Richard Hasz
- Gift of Life Donor Program, Philadelphia, Pennsylvania, USA
| | - Esther Molnar
- Section of Infectious Diseases, Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Darcy Alimenti
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew R. Motzer
- Section of Infectious Diseases, Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Sharon West
- Gift of Life Donor Program, Philadelphia, Pennsylvania, USA
| | - Warren B. Bilker
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pam Tolomeo
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ebbing Lautenbach
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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9
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Ziegler MJ, Babcock HH, Welbel SF, Warren DK, Trick WE, Tolomeo P, Omorogbe J, Garcia D, Habrock-Bach T, Donceras O, Gaynes S, Cressman L, Burnham JP, Bilker W, Reddy SC, Pegues D, Lautenbach E, Kelly BJ, Fuchs B, Martin ND, Han JH. Stopping Hospital Infections With Environmental Services (SHINE): A Cluster-randomized Trial of Intensive Monitoring Methods for Terminal Room Cleaning on Rates of Multidrug-resistant Organisms in the Intensive Care Unit. Clin Infect Dis 2022; 75:1217-1223. [PMID: 35100614 PMCID: PMC9525084 DOI: 10.1093/cid/ciac070] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Multidrug-resistant organisms (MDROs) frequently contaminate hospital environments. We performed a multicenter, cluster-randomized, crossover trial of 2 methods for monitoring of terminal cleaning effectiveness. METHODS Six intensive care units (ICUs) at 3 medical centers received both interventions sequentially, in randomized order. Ten surfaces were surveyed each in 5 rooms weekly, after terminal cleaning, with adenosine triphosphate (ATP) monitoring or an ultraviolet fluorescent marker (UV/F). Results were delivered to environmental services staff in real time with failing surfaces recleaned. We measured monthly rates of MDRO infection or colonization, including methicillin-resistant Staphylococcus aureus, Clostridioides difficile, vancomycin-resistant Enterococcus, and MDR gram-negative bacilli (MDR-GNB) during a 12-month baseline period and sequential 6-month intervention periods, separated by a 2-month washout. Primary analysis compared only the randomized intervention periods, whereas secondary analysis included the baseline. RESULTS The ATP method was associated with a reduction in incidence rate of MDRO infection or colonization compared with the UV/F period (incidence rate ratio [IRR] 0.876; 95% confidence interval [CI], 0.807-0.951; P = .002). Including the baseline period, the ATP method was associated with reduced infection with MDROs (IRR 0.924; 95% CI, 0.855-0.998; P = .04), and MDR-GNB infection or colonization (IRR 0.856; 95% CI, 0.825-0.887; P < .001). The UV/F intervention was not associated with a statistically significant impact on these outcomes. Room turnaround time increased by a median of 1 minute with the ATP intervention and 4.5 minutes with UV/F compared with baseline. CONCLUSIONS Intensive monitoring of ICU terminal room cleaning with an ATP modality is associated with a reduction of MDRO infection and colonization.
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Affiliation(s)
- Matthew J Ziegler
- Correspondence: M. Ziegler, 719 Blockley Hall—423 Guardian Dr, Philadelphia, PA 19104 ()
| | - Hilary H Babcock
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Sharon F Welbel
- Cook County Health, Chicago, Illinois, USA,Rush Medical College, Chicago, Illinois, USA
| | - David K Warren
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - William E Trick
- Cook County Health, Chicago, Illinois, USA,Rush Medical College, Chicago, Illinois, USA
| | - Pam Tolomeo
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jacqueline Omorogbe
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Tracy Habrock-Bach
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
| | | | - Steven Gaynes
- Hospital of the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Leigh Cressman
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jason P Burnham
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Warren Bilker
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sujan C Reddy
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - David Pegues
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA,Department of Healthcare Epidemiology, Infection Prevention and Control, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ebbing Lautenbach
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brendan J Kelly
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Barry Fuchs
- Division of Pulmonary Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Niels D Martin
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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10
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Wang R, Han JH, Lautenbach E, Tamma PD, Thom KA, Alby K, Blumberg EA, Bilker WB, Werzen A, Omorogbe J, Tolomeo P, Anesi JA. Clinical prediction tool for extended-spectrum beta-lactamase-producing enterobacterales as the etiology of a bloodstream infection in solid organ transplant recipients. Transpl Infect Dis 2021; 23:e13599. [PMID: 33724633 PMCID: PMC8443704 DOI: 10.1111/tid.13599] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/07/2021] [Accepted: 02/28/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Multidrug-resistant Gram-negative bacterial infections are increasingly common among solid organ transplant (SOT) recipients, leading to challenges in the selection of empiric antimicrobial therapy. We sought to develop a clinical tool to predict which SOT recipients are at high risk for extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales (EB) bloodstream infection (BSI). METHODS A multicenter case-control study was performed. The source population included SOT recipients with an EB BSI between 2005 and 2018. Cases were those with ESBL-EB BSI; controls were those with non-ESBL EB BSI. The population was subdivided into derivation and validation cohorts based on study site. The predictive tool was developed in the derivation cohort through iterative multivariable logistic regression analyses that maximized the area under the receiver-operating curve (AUC). External validity was assessed using the validation cohort. RESULTS A total of 897 SOT recipients with an EB BSI were included, of which 539 were assigned to the derivation cohort (135, 25% ESBL-EB) and 358 to the validation cohort (221, 62% ESBL-EB). Using multivariable analyses, the most parsimonious model that was predictive of ESBL-EB BSI consisted of 10 variables, which fell into four clinical categories: prior colonization or infection with EB organisms, recent antimicrobial exposures, severity of preceding illness, and immunosuppressive regimen. This model achieved an AUC of 0.81 in the derivation cohort and 0.68 in the validation cohort. CONCLUSIONS Though further refinements are needed in additional populations, this tool shows promise for guiding empiric therapy for SOT recipients with EB BSI.
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Affiliation(s)
- Rebecca Wang
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Ebbing Lautenbach
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Pranita D. Tamma
- Division of Infectious Diseases, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kerri A. Thom
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
- Division of Infectious Diseases, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kevin Alby
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Emily A. Blumberg
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Warren B. Bilker
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Alissa Werzen
- Division of Infectious Diseases, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jacqueline Omorogbe
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Pam Tolomeo
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Judith A. Anesi
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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11
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Kim HO, Kim JC, Chung BY, Kang SY, Park CW, Han JH. Harlequin syndrome with petechiae caused by a pituitary adenoma. J Eur Acad Dermatol Venereol 2021; 35:e605-e607. [PMID: 33974308 DOI: 10.1111/jdv.17338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- H O Kim
- Department of Dermatology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - J C Kim
- Department of Dermatology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - B Y Chung
- Department of Dermatology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - S Y Kang
- Department of Dermatology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - C W Park
- Department of Dermatology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - J H Han
- Department of Neurosurgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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12
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Truong TT, Ryutov A, Pandey U, Yee R, Goldberg L, Bhojwani D, Aguayo-Hiraldo P, Pinsky BA, Pekosz A, Shen L, Boyd SD, Wirz OF, Röltgen K, Bootwalla M, Maglinte DT, Ostrow D, Ruble D, Han JH, Biegel JA, Li M, Huang C, Sahoo MK, Pannaraj PS, O'Gorman M, Judkins AR, Gai X, Dien Bard J. Increased viral variants in children and young adults with impaired humoral immunity and persistent SARS-CoV-2 infection: A consecutive case series. EBioMedicine 2021; 67:103355. [PMID: 33915337 PMCID: PMC8072072 DOI: 10.1016/j.ebiom.2021.103355] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/22/2021] [Accepted: 04/08/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND There is increasing concern that persistent infection of SARS-CoV-2 within immunocompromised hosts could serve as a reservoir for mutation accumulation and subsequent emergence of novel strains with the potential to evade immune responses. METHODS We describe three patients with acute lymphoblastic leukemia who were persistently positive for SARS-CoV-2 by real-time polymerase chain reaction. Viral viability from longitudinally-collected specimens was assessed. Whole-genome sequencing and serological studies were performed to measure viral evolution and evidence of immune escape. FINDINGS We found compelling evidence of ongoing replication and infectivity for up to 162 days from initial positive by subgenomic RNA, single-stranded RNA, and viral culture analysis. Our results reveal a broad spectrum of infectivity, host immune responses, and accumulation of mutations, some with the potential for immune escape. INTERPRETATION Our results highlight the potential need to reassess infection control precautions in the management and care of immunocompromised patients. Routine surveillance of mutations and evaluation of their potential impact on viral transmission and immune escape should be considered.
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Affiliation(s)
- Thao T Truong
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Alex Ryutov
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Utsav Pandey
- Department of Pathology, Westchester Medical Center/New York Medical College, Valhalla, NY, United States
| | - Rebecca Yee
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Lior Goldberg
- Department of Pediatrics, Cancer and Blood Disease Institute, Division of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, CA, United States; Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Deepa Bhojwani
- Department of Pediatrics, Cancer and Blood Disease Institute, Division of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, CA, United States; Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Paibel Aguayo-Hiraldo
- Department of Pediatrics, Cancer and Blood Disease Institute, Division of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, CA, United States; Keck School of Medicine, University of Southern California, Los Angeles, CA, United States; Department of Pediatrics, Cancer and Blood Disorder Institute, Transplant and Cellular Therapy Section, Children's Hospital Los Angeles, CA, United States
| | - Benjamin A Pinsky
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States; Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Andrew Pekosz
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Lishuang Shen
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Scott D Boyd
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States; Sean N. Parker Center for Allergy and Asthma Research, Stanford, CA, United States
| | - Oliver F Wirz
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States
| | - Katharina Röltgen
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States
| | - Moiz Bootwalla
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Dennis T Maglinte
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Dejerianne Ostrow
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - David Ruble
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Jennifer H Han
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Jaclyn A Biegel
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, United States; Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Maggie Li
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - ChunHong Huang
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States
| | - Malaya K Sahoo
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States
| | - Pia S Pannaraj
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States; Department of Pediatrics, Division of Infectious Diseases, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Maurice O'Gorman
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, United States; Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Alexander R Judkins
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, United States; Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Xiaowu Gai
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, United States; Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Jennifer Dien Bard
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, United States; Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.
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13
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Anesi JA, Lautenbach E, Tamma PD, Thom KA, Blumberg EA, Alby K, Bilker WB, Werzen A, Tolomeo P, Omorogbe J, Pineles L, Han JH. Risk Factors for Extended-Spectrum β-lactamase-Producing Enterobacterales Bloodstream Infection Among Solid-Organ Transplant Recipients. Clin Infect Dis 2021; 72:953-960. [PMID: 32149327 DOI: 10.1093/cid/ciaa190] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 11/11/2019] [Accepted: 02/24/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Approximately 40% of all Enterobacterales (EB) bloodstream infections (BSIs) among solid organ transplant recipients (SOTRs) are due to extended-spectrum β-lactamase (ESBL)-producing organisms, but risk factors for such infections remain ill defined in this population. We sought to determine the risk factors for ESBL-EB BSIs among SOTRs. METHODS A multicenter case-control study was performed. All SOTRs with an EB BSI at the Hospital of the University of Pennsylvania and University of Maryland Medical Center between 1 January 2007 and 30 June 2018 and at The Johns Hopkins Hospital between 1 January 2005 and 31 December 2015 were included. Cases were those with an ESBL-EB BSI. Controls were those with a non-ESBL-EB BSI. Multivariable logistic regression was performed to determine risk factors for ESBL-EB BSI. RESULTS There were 988 episodes of EB BSI, of which 395 (40%) were due to an ESBL-EB. On multivariable analysis, the independent risk factors for ESBL-EB BSI included: ESBL-EB on prior culture (aOR, 12.75; 95% CI, 3.23-50.33; P < .001), a corticosteroid-containing immunosuppression regimen (aOR 1.30; 95% CI 1.03-1.65; P = .030), acute rejection treated with corticosteroids (aOR 1.18; 95% CI 1.16-1.19; P < .001), and exposure to third-generation cephalosporins (aOR 1.95; 95% CI 1.48-2.57; P < .001), echinocandins (aOR 1.61; 95% CI 1.08-2.40; P = .020), and trimethoprim-sulfamethoxazole (aOR 1.35; 95% CI 1.10-1.64; P = .003). CONCLUSIONS We identified several novel risk factors that are uniquely important to the SOTR population, including exposure to trimethoprim-sulfamethoxazole and corticosteroid-containing immunosuppressive regimens. Further studies exploring these associations and testing interventions aimed at these modifiable risk factors among SOTRs are needed.
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Affiliation(s)
- Judith A Anesi
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ebbing Lautenbach
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pranita D Tamma
- Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kerri A Thom
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Emily A Blumberg
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kevin Alby
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Warren B Bilker
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alissa Werzen
- Division of Infectious Diseases, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Pam Tolomeo
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jacqueline Omorogbe
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lisa Pineles
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, University of Maryland, Baltimore, Maryland, USA
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14
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Amoah J, Stuart EA, Cosgrove SE, Harris AD, Han JH, Lautenbach E, Tamma PD. Comparing Propensity Score Methods Versus Traditional Regression Analysis for the Evaluation of Observational Data: A Case Study Evaluating the Treatment of Gram-Negative Bloodstream Infections. Clin Infect Dis 2021; 71:e497-e505. [PMID: 32069360 DOI: 10.1093/cid/ciaa169] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 12/19/2019] [Accepted: 02/17/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Propensity score methods are increasingly being used in the infectious diseases literature to estimate causal effects from observational data. However, there remains a general gap in understanding among clinicians on how to critically review observational studies that have incorporated these analytic techniques. METHODS Using a cohort of 4967 unique patients with Enterobacterales bloodstream infections, we sought to answer the question "Does transitioning patients with gram-negative bloodstream infections from intravenous to oral therapy impact 30-day mortality?" We conducted separate analyses using traditional multivariable logistic regression, propensity score matching, propensity score inverse probability of treatment weighting, and propensity score stratification using this clinical question as a case study to guide the reader through (1) the pros and cons of each approach, (2) the general steps of each approach, and (3) the interpretation of the results of each approach. RESULTS 2161 patients met eligibility criteria with 876 (41%) transitioned to oral therapy while 1285 (59%) remained on intravenous therapy. After repeating the analysis using the 4 aforementioned methods, we found that the odds ratios were broadly similar, ranging from 0.84-0.95. However, there were some relevant differences between the interpretations of the findings of each approach. CONCLUSIONS Propensity score analysis is overall a more favorable approach than traditional regression analysis when estimating causal effects using observational data. However, as with all analytic methods using observational data, residual confounding will remain; only variables that are measured can be accounted for. Moreover, propensity score analysis does not compensate for poor study design or questionable data accuracy.
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Affiliation(s)
- Joe Amoah
- The Johns Hopkins University School of Medicine, Department of Pediatrics, Baltimore, Maryland, USA
| | - Elizabeth A Stuart
- The Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, Baltimore, Maryland, USA
| | - Sara E Cosgrove
- The Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, Maryland, USA
| | - Anthony D Harris
- The University of Maryland School of Medicine, Department of Epidemiology and Public Health, Baltimore, Maryland, USA
| | | | - Ebbing Lautenbach
- The University of Pennsylvania School of Medicine, Department of Medicine, Philadelphia, Pennsylvania, USA
| | - Pranita D Tamma
- The Johns Hopkins University School of Medicine, Department of Pediatrics, Baltimore, Maryland, USA
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15
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Lapp Z, Han JH, Wiens J, Goldstein EJC, Lautenbach E, Snitkin ES. Patient and Microbial Genomic Factors Associated with Carbapenem-Resistant Klebsiella pneumoniae Extraintestinal Colonization and Infection. mSystems 2021; 6:e00177-21. [PMID: 33727393 PMCID: PMC8546970 DOI: 10.1128/msystems.00177-21] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 11/30/2022] Open
Abstract
Carbapenem-resistant Klebsiella pneumoniae (CRKP) is a critical-priority antibiotic resistance threat that has emerged over the past several decades, spread across the globe, and accumulated resistance to last-line antibiotic agents. While CRKP infections are associated with high mortality, only a subset of patients acquiring CRKP extraintestinal colonization will develop clinical infection. Here, we sought to ascertain the relative importance of patient characteristics and CRKP genetic background in determining patient risk of infection. Machine learning models classifying colonization versus infection were built using whole-genome sequences and clinical metadata from a comprehensive set of 331 CRKP extraintestinal isolates collected across 21 long-term acute-care hospitals over the course of a year. Model performance was evaluated based on area under the receiver operating characteristic curve (AUROC) on held-out test data. We found that patient and genomic features were predictive of clinical CRKP infection to similar extents (AUROC interquartile ranges [IQRs]: patient = 0.59 to 0.68, genomic = 0.55 to 0.61, combined = 0.62 to 0.68). Patient predictors of infection included the presence of indwelling devices, kidney disease, and length of stay. Genomic predictors of infection included presence of the ICEKp10 mobile genetic element carrying the yersiniabactin iron acquisition system and disruption of an O-antigen biosynthetic gene in a sublineage of the epidemic ST258 clone. Altered O-antigen biosynthesis increased association with the respiratory tract, and subsequent ICEKp10 acquisition was associated with increased virulence. These results highlight the potential of integrated models including both patient and microbial features to provide a more holistic understanding of patient clinical trajectories and ongoing within-lineage pathogen adaptation.IMPORTANCE Multidrug-resistant organisms, such as carbapenem-resistant Klebsiella pneumoniae (CRKP), colonize alarmingly large fractions of patients in regions of endemicity, but only a subset of patients develop life-threatening infections. While patient characteristics influence risk for infection, the relative contribution of microbial genetic background to patient risk remains unclear. We used machine learning to determine whether patient and/or microbial characteristics can discriminate between CRKP extraintestinal colonization and infection across multiple health care facilities and found that both patient and microbial factors were predictive. Examination of informative microbial genetic features revealed variation within the ST258 epidemic lineage that was associated with respiratory tract colonization and increased rates of infection. These findings indicate that circulating genetic variation within a highly prevalent epidemic lineage of CRKP influences patient clinical trajectories. In addition, this work supports the need for future studies examining the microbial genetic determinants of clinical outcomes in human populations, as well as epidemiologic and experimental follow-ups of identified features to discern generalizability and biological mechanisms.
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Affiliation(s)
- Zena Lapp
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Jenna Wiens
- Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, Michigan, USA
| | - Ellie J C Goldstein
- R. M. Alden Research Laboratory, Culver City, California, USA
- David Geffen School of Medicine, University of California, Los Angeles, Santa Monica, California, USA
| | - Ebbing Lautenbach
- Department of Medicine (Infectious Diseases), University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Evan S Snitkin
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine/Division of Infectious Diseases, University of Michigan, Ann Arbor, Michigan, USA
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16
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Truong TT, Ryutov A, Pandey U, Yee R, Goldberg L, Bhojwani D, Aguayo-Hiraldo P, Pinsky BA, Pekosz A, Shen L, Boyd SD, Wirz OF, Röltgen K, Bootwalla M, Maglinte DT, Ostrow D, Ruble D, Han JH, Biegel JA, Li M, Huang C, Sahoo MK, Pannaraj PS, O’Gorman M, Judkins AR, Gai X, Bard JD. Persistent SARS-CoV-2 infection and increasing viral variants in children and young adults with impaired humoral immunity. medRxiv 2021:2021.02.27.21252099. [PMID: 33688673 PMCID: PMC7941650 DOI: 10.1101/2021.02.27.21252099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background There is increasing concern that persistent infection of SARS-CoV-2 within immunocompromised hosts could serve as a reservoir for mutation accumulation and subsequent emergence of novel strains with the potential to evade immune responses. Methods We describe three patients with acute lymphoblastic leukemia who were persistently positive for SARS-CoV-2 by real-time polymerase chain reaction. Viral viability from longitudinally-collected specimens was assessed. Whole-genome sequencing and serological studies were performed to measure viral evolution and evidence of immune escape. Findings We found compelling evidence of ongoing replication and infectivity for up to 162 days from initial positive by subgenomic RNA, single-stranded RNA, and viral culture analysis. Our results reveal a broad spectrum of infectivity, host immune responses, and accumulation of mutations, some with the potential for immune escape. Interpretation Our results highlight the need to reassess infection control precautions in the management and care of immunocompromised patients. Routine surveillance of mutations and evaluation of their potential impact on viral transmission and immune escape should be considered. Funding The work was partially funded by The Saban Research Institute at Children's Hospital Los Angeles intramural support for COVID-19 Directed Research (X.G. and J.D.B.), the Johns Hopkins Center of Excellence in Influenza Research and Surveillance HHSN272201400007C (A.P.), NIH/NIAID R01AI127877 (S.D.B.), NIH/NIAID R01AI130398 (S.D.B.), NIH 1U54CA260517 (S.D.B.), an endowment to S.D.B. from the Crown Family Foundation, an Early Postdoc.Mobility Fellowship Stipend to O.F.W. from the Swiss National Science Foundation (SNSF), and a Coulter COVID-19 Rapid Response Award to S.D.B. L.G. is a SHARE Research Fellow in Pediatric Hematology-Oncology.
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Affiliation(s)
- Thao T. Truong
- Department of Pathology and Laboratory Medicine, Children’s Hospital Los Angeles, Los Angeles, CA
| | - Alex Ryutov
- Department of Pathology and Laboratory Medicine, Children’s Hospital Los Angeles, Los Angeles, CA
| | - Utsav Pandey
- Department of Pathology, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Rebecca Yee
- Department of Pathology and Laboratory Medicine, Children’s Hospital Los Angeles, Los Angeles, CA
| | - Lior Goldberg
- Department of Pediatrics, Cancer and Blood Disease Institute, Division of Hematology-Oncology, Children’s Hospital Los Angeles, Los Angeles, CA
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Deepa Bhojwani
- Department of Pediatrics, Cancer and Blood Disease Institute, Division of Hematology-Oncology, Children’s Hospital Los Angeles, Los Angeles, CA
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Paibel Aguayo-Hiraldo
- Department of Pediatrics, Cancer and Blood Disease Institute, Division of Hematology-Oncology, Children’s Hospital Los Angeles, Los Angeles, CA
- Keck School of Medicine, University of Southern California, Los Angeles, CA
- Department of Pediatrics, Cancer and Blood Disorder Institute, Transplant and Cellular Therapy Section, Children’s Hospital Los Angeles, CA
| | - Benjamin A. Pinsky
- Department of Pathology, Stanford University School of Medicine, Stanford, CA
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Andrew Pekosz
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Lishuang Shen
- Department of Pathology and Laboratory Medicine, Children’s Hospital Los Angeles, Los Angeles, CA
| | - Scott D. Boyd
- Department of Pathology, Stanford University School of Medicine, Stanford, CA
- Sean N. Parker Center for Allergy and Asthma Research, Stanford, CA
| | - Oliver F. Wirz
- Department of Pathology, Stanford University School of Medicine, Stanford, CA
| | - Katharina Röltgen
- Department of Pathology, Stanford University School of Medicine, Stanford, CA
| | - Moiz Bootwalla
- Department of Pathology and Laboratory Medicine, Children’s Hospital Los Angeles, Los Angeles, CA
| | - Dennis T. Maglinte
- Department of Pathology and Laboratory Medicine, Children’s Hospital Los Angeles, Los Angeles, CA
| | - Dejerianne Ostrow
- Department of Pathology and Laboratory Medicine, Children’s Hospital Los Angeles, Los Angeles, CA
| | - David Ruble
- Department of Pathology and Laboratory Medicine, Children’s Hospital Los Angeles, Los Angeles, CA
| | - Jennifer H. Han
- Department of Pathology and Laboratory Medicine, Children’s Hospital Los Angeles, Los Angeles, CA
| | - Jaclyn A. Biegel
- Department of Pathology and Laboratory Medicine, Children’s Hospital Los Angeles, Los Angeles, CA
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Maggie Li
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - ChunHong Huang
- Department of Pathology, Stanford University School of Medicine, Stanford, CA
| | - Mayala K. Sahoo
- Department of Pathology, Stanford University School of Medicine, Stanford, CA
| | - Pia S. Pannaraj
- Keck School of Medicine, University of Southern California, Los Angeles, CA
- Department of Pediatrics, Division of Infectious Diseases, Children’s Hospital Los Angeles, Los Angeles, CA
| | - Maurice O’Gorman
- Department of Pathology and Laboratory Medicine, Children’s Hospital Los Angeles, Los Angeles, CA
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Alexander R. Judkins
- Department of Pathology and Laboratory Medicine, Children’s Hospital Los Angeles, Los Angeles, CA
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Xiaowu Gai
- Department of Pathology and Laboratory Medicine, Children’s Hospital Los Angeles, Los Angeles, CA
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Jennifer Dien Bard
- Department of Pathology and Laboratory Medicine, Children’s Hospital Los Angeles, Los Angeles, CA
- Keck School of Medicine, University of Southern California, Los Angeles, CA
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17
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Hecht A, Meyer JA, Behnert A, Wong E, Chehab F, Olshen A, Hechmer A, Aftandilian C, Bhat R, Choi SW, Chonat S, Farrar JE, Fluchel M, Frangoul H, Han JH, Kolb EA, Kuo DJ, MacMillan ML, Maese L, Maloney KW, Narendran A, Oshrine B, Schultz KR, Sulis ML, Van Mater D, Tasian SK, Hofmann WK, Loh ML, Stieglitz E. Molecular and phenotypic diversity of CBL-mutated juvenile myelomonocytic leukemia. Haematologica 2020; 107:178-186. [PMID: 33375775 PMCID: PMC8719097 DOI: 10.3324/haematol.2020.270595] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [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: 08/25/2020] [Indexed: 11/22/2022] Open
Abstract
Mutations in the CBL gene were first identified in adults with various myeloid malignancies. Some patients with juvenile myelomonocytic leukemia (JMML) were also noted to harbor mutations in CBL, but were found to have generally less aggressive disease courses compared to patients with other forms of Ras pathway-mutant JMML. Importantly, and in contrast to most reports in adults, the majority of CBL mutations in JMML patients are germline with acquired uniparental disomy occurring in affected marrow cells. Here, we systematically studied a large cohort of 33 JMML patients with CBL mutations and found that this disease is highly diverse in presentation and overall outcome. Moreover, we discovered somatically acquired CBL mutations in 15% of pediatric patients who presented with more aggressive disease. Neither clinical features nor methylation profiling were able to distinguish patients with somatic CBL mutations from those with germline CBL mutations, highlighting the need for germline testing. Overall, we demonstrate that disease courses are quite heterogeneous even among patients with germline CBL mutations. Prospective clinical trials are warranted to find ideal treatment strategies for this diverse cohort of patients.
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Affiliation(s)
- Anna Hecht
- Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA; Department of Hematology/Oncology, University Hospital Mannheim, Heidelberg University
| | - Julia A Meyer
- Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco
| | - Astrid Behnert
- Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco
| | - Eric Wong
- Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco
| | - Farid Chehab
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco
| | - Adam Olshen
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California
| | - Aaron Hechmer
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco
| | | | - Rukhmi Bhat
- Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Sung Won Choi
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, MI
| | - Satheesh Chonat
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA; Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Jason E Farrar
- Arkansas Children's Research Institute, Little Rock, AR; Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Mark Fluchel
- University of Utah, Department of Pediatrics, Division of Pediatric Hematology-Oncology, Salt Lake City, UT
| | - Haydar Frangoul
- The Children's Hospital at TriStar Centennial and Sarah Cannon Research Institute, Nashville, TN
| | - Jennifer H Han
- Division of Pediatric Hematology-Oncology, University of California, San Diego/ Rady Children's Hospital San Diego
| | - Edward A Kolb
- Nemours Center for Cancer and Blood Disorders/Alfred I. DuPont Hospital for Children, Wilmington, DE
| | - Dennis J Kuo
- Division of Pediatric Hematology-Oncology, University of California, San Diego/ Rady Children's Hospital San Diego
| | - Margaret L MacMillan
- Blood and Marrow Transplant Program, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN
| | - Luke Maese
- Department of Pediatrics and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | | | - Aru Narendran
- Pediatric Hematology and Oncology, Alberta Children's Hospital, Calgary, Alberta
| | | | - Kirk R Schultz
- British Columbia Children's Hospital and Research Institute, Vancouver, British Columbia
| | - Maria L Sulis
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center. 1275 York Avenue. 10065 New York, NY
| | - David Van Mater
- Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - Sarah K Tasian
- Division of Oncology and Center for Childhood Cancer Research, Children's Hospital of Philadelphia; Department of Pediatrics and Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Wolf-Karsten Hofmann
- Department of Hematology/Oncology, University Hospital Mannheim, Heidelberg University
| | - Mignon L Loh
- Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco
| | - Elliot Stieglitz
- Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco.
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18
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Park B, Bang CH, Lee C, Han JH, Choi W, Kim J, Park GS, Rhie JW, Lee JH, Kim C. 3D wide-field multispectral photoacoustic imaging of human melanomas in vivo: a pilot study. J Eur Acad Dermatol Venereol 2020; 35:669-676. [PMID: 33037671 DOI: 10.1111/jdv.16985] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/22/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The Breslow depth is an important parameter to determine the excision margin and prognosis of melanoma. However, it is difficult to accurately determine the actual Breslow depth before surgery using the existing ocular micrometer and biopsy technique. OBJECTIVES To evaluate the use of 3D wide-field multispectral photoacoustic imaging to non-invasively measure depth and outline the boundary of melanomas for optimal surgical margin selection. METHODS Six melanoma patients were examined in vivo using the 3D multispectral photoacoustic imaging system. For five cases of melanomas (one in situ, three nodular, and one acral lentiginous type melanoma), the spectrally unmixed photoacoustic depths were calculated and compared against histopathological depths. RESULTS Spectrally unmixed photoacoustic depths and histopathological depths match well within a mean absolute error of 0.36 mm. In particular, the measured minimum and maximum depths in the in situ and nodular type of melanoma were 0.6 and 9.1 mm, respectively. In the 3D photoacoustic image of one metastatic melanoma, feeding vessels were visualized in the melanoma, suggesting the neovascularization around the tumour. CONCLUSIONS The 3D multispectral photoacoustic imaging not only provides well-measured depth and sizes of various types of melanomas, it also visualizes the metastatic type of melanoma. Obtaining accurate depth and boundary information of melanoma before surgery would play a useful role in the complete excision of melanoma during surgery.
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Affiliation(s)
- B Park
- Departments of Electrical Engineering, Creative IT Engineering, Mechanical Engineering, and Medical Device Innovation Center, Pohang University of Science and Technology (POSTECH), Pohang, Korea
| | - C H Bang
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - C Lee
- Departments of Electrical Engineering, Creative IT Engineering, Mechanical Engineering, and Medical Device Innovation Center, Pohang University of Science and Technology (POSTECH), Pohang, Korea
| | - J H Han
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - W Choi
- Departments of Electrical Engineering, Creative IT Engineering, Mechanical Engineering, and Medical Device Innovation Center, Pohang University of Science and Technology (POSTECH), Pohang, Korea
| | - J Kim
- Departments of Electrical Engineering, Creative IT Engineering, Mechanical Engineering, and Medical Device Innovation Center, Pohang University of Science and Technology (POSTECH), Pohang, Korea.,Department of Cogno-Mechatronics Engineering, College of Nanoscience & Nanotechnology, Pusan National University, Busan, Korea
| | - G S Park
- Department of Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - J W Rhie
- Department of Plastic and Reconstructive Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - J H Lee
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - C Kim
- Departments of Electrical Engineering, Creative IT Engineering, Mechanical Engineering, and Medical Device Innovation Center, Pohang University of Science and Technology (POSTECH), Pohang, Korea
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19
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Anesi JA, Han JH, Lautenbach E, Lee DH, Clauss H, Climaco A, Bilker WB, Hasz R, Molnar E, Alimenti D, West S, Tolomeo P, Blumberg EA. Impact of deceased donor multidrug-resistant bacterial organisms on organ utilization. Am J Transplant 2020; 20:2559-2566. [PMID: 32090413 PMCID: PMC7483863 DOI: 10.1111/ajt.15830] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 10/08/2019] [Revised: 02/04/2020] [Accepted: 02/20/2020] [Indexed: 01/25/2023]
Abstract
The extent to which donor multidrug-resistant organisms (MDROs) affect organ utilization remains unclear. We performed a retrospective cohort study at 4 transplant centers between 2015 and 2016 to evaluate this question. All deceased donors who donated at least one organ were included. Exposed donors had at least one MDRO on culture. Unexposed donors had no MDRO-positive cultures. Only cultures obtained during the donor's terminal hospitalization were evaluated. Multivariable regression was used to determine the association between donor MDRO and (1) number of organs transplanted per donor and (2) the match run at which each organ was accepted. Subsequently, we restricted the analysis to donors with MDR-Gram-negative (GN) organisms. Of 440 total donors, 29 (7%) donors grew MDROs and 7 (2%) grew MDR-GNs. There was no significant association between donor MDRO and either measure of organ utilization. However, donor MDR-GNs were associated with a significant reduction in the number of organs transplanted per donor (incidence rate ratio 0.43, 95% confidence interval [CI] 0.39-0.48, P < .01), and organs were accepted significantly further down the match list (relative count 5.08, 95% CI 1.64-15.68, P = .01). Though donor MDR-GNs were infrequent in our study, their growing prevalence could meaningfully reduce the donor pool over time.
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Affiliation(s)
- Judith A. Anesi
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA;,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Ebbing Lautenbach
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA;,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA;,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Dong Heun Lee
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Drexel University College of Medicine, Philadelphia, PA
| | - Heather Clauss
- Section of Infectious Diseases, Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Antonette Climaco
- Division of Infectious Diseases, Department of Medicine, Albert Einstein Medical Center, Philadelphia, PA
| | - Warren B. Bilker
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA;,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Richard Hasz
- Gift of Life Donor Program, Philadelphia, PA, USA
| | - Esther Molnar
- Section of Infectious Diseases, Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Darcy Alimenti
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA;,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sharon West
- Gift of Life Donor Program, Philadelphia, PA, USA
| | - Pam Tolomeo
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA;,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Emily A. Blumberg
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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20
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Dorneden AM, Husen BS, Han JH, Magdaleno Y, Meiklejohn DA. Primary Presentation of Pediatric Hematopoietic Malignancy in the Temporal Bone: Case Report and Review of the Literature. Ear Nose Throat J 2020; 100:NP407-NP412. [PMID: 32383987 DOI: 10.1177/0145561320924146] [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] [Indexed: 11/16/2022] Open
Abstract
Malignancy of hematopoietic origin comprises a large portion of all pediatric malignancies; however, it is uncommon for patients with this condition to present only with symptoms related to temporal bone involvement. Here, we report a case of Burkitt Lymphoma of the temporal bone in an 8-year-old patient who initially presented with symptoms of acute otitis media. Additionally, we review the current literature on pediatric hematopoietic malignancy with primary temporal bone involvement and discuss the clinical presentation, management, and outcomes of these rare cases.
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Affiliation(s)
- Ashley M Dorneden
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of New Mexico Hospital, NM, USA
| | - Brian S Husen
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of New Mexico Hospital, NM, USA
| | - Jennifer H Han
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of California San Diego, CA, USA
| | - Yasmin Magdaleno
- Department of Pediatrics, University of New Mexico Hospital, NM, USA
| | - Duncan A Meiklejohn
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of New Mexico Hospital, NM, USA
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21
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Han JH, Lee JP, Lee JS, Song SH, Kim KS. Fate of the micropenis and constitutional small penis: do they grow to normalcy in puberty? J Pediatr Urol 2019; 15:526.e1-526.e6. [PMID: 31447312 DOI: 10.1016/j.jpurol.2019.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/11/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Penile length is an important indicator of male sexual development. Scarce data were reported on penile length measurements in children comparing changes between prepuberty and puberty for the small penile issue with long-term follow-up. OBJECTIVE The purpose of this study was to investigate the possibility of catch-up growth of the penile length of boys with a small penis in the long-term follow-up. STUDY DESIGN From April 2001 to December 2016, 27 boys who visited the outpatient clinic owing to a small penis, without any chromosomal anomalies and other genital disorder, were investigated retrospectively. Micropenis is defined as 2.5 standard deviations less than the mean stretched penile length (SPL) of age. Periodic penile length, testicular volume, hormonal levels (serum testosterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH)), and bone age were measured. Pubertal development was recorded by using the Tanner scale. The effect of hormonal therapy and the factors attributable to the increment of the penile length were evaluated. RESULTS The mean age at the first visit was 9.8 years (5-12 years) and that at puberty was 12.6 years (10-16 years). The length of the penis at the initial visit was 4.0 ± 0.8 cm (2.5-6.0) and at puberty, 7.3 ± 1.8 cm (4.0-12.0). Nine patients diagnosed with micropenis no longer had a micropenis in puberty. The less the age-matched SPL, the more the increment of SPL that was observed (rho = - 0.548, P = 0.003). The mean increment of SPL in the hormonal therapy group (11 boys) and the non-hormonal therapy group (16 boys) was not statistically different (43.5 ± 22. 9% vs 41.5 ± 21.6%, respectively, P = 0.497). DISCUSSION This study explains how much the growth of a small penis catches up in puberty. From the point of view of the increment of SPL, the increment was higher in boys who belonged to the smaller penis group. Hormonal therapy does not attribute to an increase in the length after long-term follow-up. Limitations of this study were its retrospective origin with a small number of patients in a single center. CONCLUSION Catch-up growth of the small penis at puberty was accomplished in most children with a small penis before puberty. Hormonal treatment was not significantly correlated with the penile length increment in the long-term follow-up.
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Affiliation(s)
- J H Han
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul 50555, South Korea
| | - J P Lee
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul 50555, South Korea
| | - J S Lee
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul 50555, South Korea
| | - S H Song
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul 50555, South Korea
| | - K S Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul 50555, South Korea.
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22
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Affiliation(s)
- Darunee Chotiprasitakul
- Department of Medicine, Division of Infectious Diseases, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Jennifer H Han
- Department of Medicine, Division of Infectious Diseases, The University of Pennsylvania School of Medicine, Philadelphia
| | - Sara E Cosgrove
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Anthony D Harris
- Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland
| | - Ebbing Lautenbach
- Department of Medicine, Division of Infectious Diseases, The University of Pennsylvania School of Medicine, Philadelphia
| | - Pranita D Tamma
- Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
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23
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Anesi JA, Blumberg EA, Han JH, Lee DH, Clauss H, Climaco A, Hasz R, Molnar E, Alimenti D, West S, Bilker WB, Tolomeo P, Lautenbach E. Risk factors for multidrug-resistant organisms among deceased organ donors. Am J Transplant 2019; 19:2468-2478. [PMID: 31162785 PMCID: PMC6711782 DOI: 10.1111/ajt.15488] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/26/2019] [Accepted: 05/15/2019] [Indexed: 01/25/2023]
Abstract
Donor infection or colonization with a multidrug-resistant organism (MDRO) affects organ utilization and recipient antibiotic management. Approaches to identifying donors at risk of carrying MDROs are unknown. We sought to determine the risk factors for MDROs among transplant donors. A multicenter retrospective cohort study was conducted at four transplant centers between 2015 and 2016. All deceased donors who donated at least one organ were included. Cultures obtained during the donor's terminal hospitalization and organ procurement were evaluated. The primary outcome was isolation of an MDRO on culture. Multivariable Cox regression was used to determine risk factors associated with time to donor MDRO. Of 440 total donors, 64 (15%) donors grew an MDRO on culture. Predictors of an MDRO on donor culture included hepatitis C viremia (hazard ratio [HR] 4.09, 95% confidence interval [CI] 1.71-9.78, P = .002), need for dialysis (HR 4.59, 95% CI 1.09-19.21, P = .037), prior hematopoietic cell transplant (HR 7.57, 95% CI 1.03-55.75, P = .047), and exposure to antibiotics with a narrow gram-negative spectrum (HR 1.13, 95% CI 1.00-1.27, P = .045). This is the first study to determine risk factors for MDROs among deceased donors and will be important for risk stratifying potential donors and informing transplant recipient prophylaxis.
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Affiliation(s)
- Judith A. Anesi
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania;,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania
| | - Emily A. Blumberg
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania
| | - Jennifer H. Han
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania;,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania;,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania
| | - Dong Heun Lee
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Drexel University College of Medicine
| | - Heather Clauss
- Section of Infectious Diseases, Department of Medicine, Lewis Katz School of Medicine, Temple University
| | - Antonette Climaco
- Division of Infectious Diseases, Department of Medicine, Albert Einstein Medical Center
| | - Richard Hasz
- Gift of Life Donor Program, Philadelphia, PA, USA
| | - Esther Molnar
- Section of Infectious Diseases, Department of Medicine, Lewis Katz School of Medicine, Temple University
| | - Darcy Alimenti
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania;,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania
| | - Sharon West
- Gift of Life Donor Program, Philadelphia, PA, USA
| | - Warren B. Bilker
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania;,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania
| | - Pam Tolomeo
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania;,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania
| | - Ebbing Lautenbach
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania;,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania;,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania
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24
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Park SY, Lee SJ, Han JH, Koh YW. Association between 18F-FDG uptake in PET/CT, Nrf2, and NQO1 expression and their prognostic significance in non-small cell lung cancer. Neoplasma 2019; 66:619-626. [PMID: 30868898 DOI: 10.4149/neo_2018_181007n742] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 01/15/2019] [Indexed: 11/08/2022]
Abstract
Two pentose phosphate pathway-related proteins, NF-E2-related factor 2 (Nrf2)/ NAD(P)H dehydrogenase (Quinone) 1 (NQO1) regulate the expression of glucose metabolism and antioxidant genes. We evaluated the prognostic significance of NRF2, NQO1 and 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) parameter and their relationship with non-small cell lung cancer (NSCLC) histology. A total of 241 patients, who underwent surgical resection for NSCLC, were reviewed retrospectively. Preoperative 18F-FDG PET and immunohistochemical results of Nrf2 and NQO1 were evaluated. In SQCC, the maximum standardized uptake value (SUVmax) was significantly higher in NQO1-high than in NQO1-low expression (p=0.023). In adenocarcinoma, SUVmax was not correlated with NQO1 expression. Patients with a high NQO1 expression showed poor recurrence-free survival (RFS) and overall survival (OS) than patients with a low NQO1 expression in squamous cell carcinoma (SQCC) (p=0.002 and p=0.014, respectively). NQO1 expression was not associated with clinical outcome in adenocarcinoma. Nrf2 expression was not correlated with prognosis in two types of NSCLC. High SUVmax was associated with poor RFS (p=0.03) but is not related to poor OS (p=0.569) in SQCC. In multivariate analyses, NQO1 expression and SUVmax were not independent prognostic factors in SQCC. However, in multivariate analysis combining NQO1 and SUVmax values, both low SUVmax and low NQO1 was independent prognostic factor for RFS and OS (HR= 3.790, p = 0.033 and HR= 2.961, p = 0.045, respectively). In conclusion, both low SUVmax and low NQO1 was an independent prognostic factor in SQCC alone. The sample size was small but there was a positive correlation between NQO1 expression and SUVmax in SQCC.
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Affiliation(s)
- S Y Park
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Yonsei University, Seoul, South Korea
| | - S J Lee
- Department of Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine, Ajou University, Suwon, South Korea
| | - J H Han
- Department of Pathology, Ajou University School of Medicine, Ajou University, Suwon, South Korea
| | - Y W Koh
- Department of Pathology, Ajou University School of Medicine, Ajou University, Suwon, South Korea
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Ziegler M, Han JH, Landsburg D, Pegues D, Reesey E, Gilmar C, Gorman T, Bink K, Moore A, Kelly BJ. Impact of Levofloxacin for the Prophylaxis of Bloodstream Infection on the Gut Microbiome in Patients With Hematologic Malignancy. Open Forum Infect Dis 2019; 6:ofz252. [PMID: 31281857 PMCID: PMC6602896 DOI: 10.1093/ofid/ofz252] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 05/29/2019] [Indexed: 12/13/2022] Open
Abstract
Background We evaluated the differential impact of levofloxacin administered for the prophylaxis of bloodstream infections compared with broad-spectrum beta-lactam (BSBL) antibiotics used for the treatment of neutropenic fever on the gut microbiome in patients with hematologic malignancy. Methods Stool specimens were collected from patients admitted for chemotherapy or stem cell transplant in the setting of the evaluation of diarrhea from February 2017 until November 2017. Microbiome characteristics were compared among those exposed to levofloxacin prophylaxis vs those who received BSBL antibiotics. Results Sixty patients were included, most with acute myeloid leukemia (42%) or multiple myeloma (37%). The gut microbiome of patients with BSBL exposure had significantly reduced Shannon's alpha diversity compared with those without (median [interquartile range {IQR}], 3.28 [1.73 to 3.71] vs 3.73 [3.14 to 4.31]; P = .01). However, those with levofloxacin exposure had increased alpha diversity compared with those without (median [IQR], 3.83 [3.32 to 4.36] vs 3.32 [2.35 to 4.02]; P = .03). Levofloxacin exposure was also associated with a trend toward lower risk of dominance of non-Bacteroidetes genera compared with those without levofloxacin exposure (3 [14%] vs 15 [38%]; P = .051). Conclusions The impact of antibiotics on the gut microbiome varies by class, and levofloxacin may disrupt the gut microbiome less than BSBLs in this patient population.
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Affiliation(s)
- Matthew Ziegler
- Division of Infectious Diseases, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jennifer H Han
- Division of Infectious Diseases, University of Pennsylvania, Philadelphia, Pennsylvania.,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Healthcare Epidemiology, Infection Prevention and Control, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel Landsburg
- Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Pegues
- Division of Infectious Diseases, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Healthcare Epidemiology, Infection Prevention and Control, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Emily Reesey
- Division of Infectious Diseases, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cheryl Gilmar
- Department of Healthcare Epidemiology, Infection Prevention and Control, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Theresa Gorman
- Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kristen Bink
- Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amy Moore
- Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brendan J Kelly
- Division of Infectious Diseases, University of Pennsylvania, Philadelphia, Pennsylvania.,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
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Ganetsky A, Han JH, Hughes ME, Babushok DV, Frey NV, Gill SI, Hexner EO, Loren AW, Luger SM, Mangan JK, Martin ME, Smith J, Freyer CW, Gilmar C, Schuster M, Stadtmauer EA, Porter DL. Oral Vancomycin Prophylaxis Is Highly Effective in Preventing Clostridium difficile Infection in Allogeneic Hematopoietic Cell Transplant Recipients. Clin Infect Dis 2019; 68:2003-2009. [PMID: 30256954 PMCID: PMC6541731 DOI: 10.1093/cid/ciy822] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [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: 06/08/2018] [Accepted: 09/20/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Clostridium difficile infection (CDI) is a leading cause of infectious complications in allogeneic hematopoietic cell transplant recipients (alloHCT). We sought to evaluate whether prophylactic oral vancomycin reduces the incidence of CDI in alloHCT recipients. METHODS We conducted a retrospective cohort study to examine the effectiveness of CDI prophylaxis with oral vancomycin, as compared to no prophylaxis, in 145 consecutive adult alloHCT recipients at the University of Pennsylvania between April 2015 and November 2016. Patients received oral vancomycin 125 mg twice daily, starting on admission and continuing until discharge. The primary outcome of interest was the association between oral vancomycin prophylaxis and CDI diagnosis. Secondary outcomes included graft-versus-host disease (GVHD) and relapse. RESULTS There were no cases of CDI in patients that received prophylaxis (0/90, 0%), whereas 11/55 (20%) patients who did not receive prophylaxis developed CDI (P < .001). Oral vancomycin prophylaxis was not associated with a higher risk of acute, grades 2-4 GVHD (subhazard ratio [sHR] 1.59; 95% confidence interval [CI] 0.88-2.89; P = .12), acute, grades 3-4 GVHD (sHR 0.65; 95% CI 0.25-1.66; P = .36), or acute, grades 2-4 gastrointestinal GVHD (sHR 1.95; 95% CI 0.93-4.07; P = .08) at day 180 post-transplant. No associations between oral vancomycin and relapse or survival were observed. CONCLUSIONS Prophylaxis with oral vancomycin is highly effective in preventing CDI in alloHCT recipients without increasing the risk of graft-versus-host disease or disease relapse. Further evaluation via a prospective study is warranted.
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Affiliation(s)
- Alex Ganetsky
- Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia
| | - Jennifer H Han
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Department of Healthcare Epidemiology, Infection Prevention and Control, Hospital of the University of Pennsylvania, Philadelphia
| | - Mitchell E Hughes
- Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia
| | - Daria V Babushok
- Blood and Marrow Transplantation Program, Abramson Cancer Center and the Division of Hematology and Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Noelle V Frey
- Blood and Marrow Transplantation Program, Abramson Cancer Center and the Division of Hematology and Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Saar I Gill
- Blood and Marrow Transplantation Program, Abramson Cancer Center and the Division of Hematology and Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Elizabeth O Hexner
- Blood and Marrow Transplantation Program, Abramson Cancer Center and the Division of Hematology and Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Alison W Loren
- Blood and Marrow Transplantation Program, Abramson Cancer Center and the Division of Hematology and Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Selina M Luger
- Blood and Marrow Transplantation Program, Abramson Cancer Center and the Division of Hematology and Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - James K Mangan
- Blood and Marrow Transplantation Program, Abramson Cancer Center and the Division of Hematology and Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Mary Ellen Martin
- Blood and Marrow Transplantation Program, Abramson Cancer Center and the Division of Hematology and Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Jacqueline Smith
- Blood and Marrow Transplantation Program, Abramson Cancer Center and the Division of Hematology and Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Craig W Freyer
- Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia
| | - Cheryl Gilmar
- Department of Healthcare Epidemiology, Infection Prevention and Control, Hospital of the University of Pennsylvania, Philadelphia
| | - Mindy Schuster
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Edward A Stadtmauer
- Blood and Marrow Transplantation Program, Abramson Cancer Center and the Division of Hematology and Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - David L Porter
- Blood and Marrow Transplantation Program, Abramson Cancer Center and the Division of Hematology and Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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27
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Lee JH, Kim HJ, Han KD, Han JH, Bang CH, Park YM, Lee JY, Lee SJ, Park YG, Lee YB. Incidence and prevalence of alopecia areata according to subtype: a nationwide, population-based study in South Korea (2006-2015). Br J Dermatol 2019; 181:1092-1093. [PMID: 31102412 DOI: 10.1111/bjd.18145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- J H Lee
- Department of Dermatology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - H J Kim
- Department of Dermatology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - K D Han
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 137-701, Korea
| | - J H Han
- Department of Dermatology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - C H Bang
- Department of Dermatology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Y M Park
- Department of Dermatology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - J Y Lee
- Department of Dermatology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - S J Lee
- Department of Business Management, Kwangwoon University, Seoul, Korea
| | - Y-G Park
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 137-701, Korea
| | - Y B Lee
- Department of Dermatology, Uijeongbu St Mary's Hospital, College of Medicine, The Catholic University of Korea, 271 Chunbo Street, Uijeongbu, 07345, Korea
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Weinstein EJ, Han JH, Lautenbach E, Nachamkin I, Garrigan C, Bilker WB, Dankwa L, Wheeler M, Tolomeo P, Anesi JA. A Clinical Prediction Tool for Extended-Spectrum Cephalosporin Resistance in Community-Onset Enterobacterales Urinary Tract Infection. Open Forum Infect Dis 2019; 6:ofz164. [PMID: 31041359 PMCID: PMC6483753 DOI: 10.1093/ofid/ofz164] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 03/27/2019] [Indexed: 11/21/2022] Open
Abstract
Background Bacterial resistance to first line antibiotics used to treat community-onset urinary tract infections (UTIs) continues to increase. We sought to create a clinical prediction tool for community-onset UTIs due to extended-spectrum cephalosporin-resistant (ESC-R) Enterobacterales (formerly Enterobacteriaceae, EB). Methods A case-control study was performed. The source population included patients presenting to an emergency department (ED) or outpatient practice with an EB UTI between 2010 and 2013. Case patients had ESC-R EB UTIs. Control patients had ESC-susceptible EB UTIs and were matched to cases 1:1 on study year. Multivariable conditional logistic regression was performed to develop the predictive model by maximizing the area under the receiver-operating curve (AUC). Internal validation was performed via bootstrapping. Results A total of 302 patients with a community-onset EB UTI were included, with 151 cases and 151 controls. After multivariable analysis, we found that presentation with an ESC-R EB community-onset UTI could be predicted by the following: (1) a history of malignancy; (2) a history of diabetes; (3) recent skilled nursing facility or hospital stay; (4) recent trimethoprim-sulfamethoxazole exposure; and (5) pyelonephritis at the time of presentation (AUC 0.73, Hosmer-Lemeshow goodness-of-fit P value 0.23). With this model, each covariate confers a single point, and a patient with ≥ 2 points is considered high risk for ESC-R EB (sensitivity 80%, specificity 54%). The adjusted AUC after bootstrapping was 0.71. Conclusions Community-onset ESC-R EB UTI can be predicted using the proposed scoring system, which can help guide diagnostic and therapeutic interventions.
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Affiliation(s)
| | - Jennifer H Han
- Division of Infectious Diseases, Department of Medicine.,Center for Clinical Epidemiology and Biostatistics.,Department of Biostatistics, Epidemiology and Informatics
| | - Ebbing Lautenbach
- Division of Infectious Diseases, Department of Medicine.,Center for Clinical Epidemiology and Biostatistics.,Department of Biostatistics, Epidemiology and Informatics
| | - Irving Nachamkin
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Charles Garrigan
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Warren B Bilker
- Center for Clinical Epidemiology and Biostatistics.,Department of Biostatistics, Epidemiology and Informatics
| | - Lois Dankwa
- Center for Clinical Epidemiology and Biostatistics
| | - Mary Wheeler
- Center for Clinical Epidemiology and Biostatistics
| | - Pam Tolomeo
- Center for Clinical Epidemiology and Biostatistics
| | - Judith A Anesi
- Division of Infectious Diseases, Department of Medicine.,Center for Clinical Epidemiology and Biostatistics
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29
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Tamma PD, Conley AT, Cosgrove SE, Harris AD, Lautenbach E, Amoah J, Avdic E, Tolomeo P, Wise J, Subudhi S, Han JH. Association of 30-Day Mortality With Oral Step-Down vs Continued Intravenous Therapy in Patients Hospitalized With Enterobacteriaceae Bacteremia. JAMA Intern Med 2019; 179:316-323. [PMID: 30667477 PMCID: PMC6439703 DOI: 10.1001/jamainternmed.2018.6226] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
IMPORTANCE Conversion to oral therapy for Enterobacteriaceae bacteremia has the potential to improve the quality of life of patients by improving mobility, eliminating catheter-associated discomfort, decreasing the risk for noninfectious and infectious catheter-associated adverse events, and decreasing health care costs. OBJECTIVE To compare the association of 30-day mortality with early oral step-down therapy vs continued parenteral therapy for the treatment of Enterobacteriaceae bloodstream infections. DESIGN, SETTING, AND PARTICIPANTS This retrospective multicenter cohort study included a 1:1 propensity score-matched cohort of 4967 unique patients hospitalized with monomicrobial Enterobacteriaceae bloodstream infection at 3 academic medical centers from January 1, 2008, through December 31, 2014. Eligibility criteria included appropriate source control measures, appropriate clinical response by day 5, active antibiotic therapy from day 1 until discontinuation of therapy, availability of an active oral antibiotic option, and ability to consume other oral medications or feeding. Statistical analysis was performed from March 2, 2018, to June 2, 2018. EXPOSURES Oral step-down therapy within the first 5 days of treatment of Enterobacteriaceae bacteremia. MAIN OUTCOMES AND MEASURES The main outcome was 30-day all-cause mortality. RESULTS Of the 2161 eligible patients, 1185 (54.8%) were male and 1075 (49.7%) were white; the median (interquartile range [IQR]) age was 59 (48-68) years. One-to-one propensity-score matching yielded 1478 patients, with 739 in each study arm. Sources of bacteremia included urine (594 patients [40.2%]), gastrointestinal tract (297 [20.1%]), central line-associated (272 [18.4%]), pulmonary (58 [3.9%]), and skin and soft tissue (41 [2.8%]). There were 97 (13.1%) deaths in the oral step-down group and 99 (13.4%) in the intravenous (IV) group within 30 days (hazard ratio [HR], 1.03; 95% CI, 0.82-1.30). There were no differences in recurrence of bacteremia within 30 days between the groups (IV, 6 [0.8%]; oral, 4 [0.5%]; HR, 0.82 [0.33-2.01]). Patients transitioned to oral step-down therapy were discharged from the hospital an average of 2 days (IQR, 1-6) sooner than patients who continued to receive IV therapy (5 days [IQR, 3-8 days] vs 7 days [IQR, 4-14 days]; P < .001). CONCLUSIONS AND RELEVANCE In this study, 30-day mortality was not different among hospitalized patients who received oral step-down vs continued parenteral therapy for the treatment of Enterobacteriaceae bloodstream infections. The findings suggest that transitioning to oral step-down therapy may be an effective treatment approach for patients with Enterobacteriaceae bacteremia who have received source control and demonstrated an appropriate clinical response. Early transition to oral step-down therapy may be associated with a decrease in the duration of hospital stay for patients with Enterobacteriaceae bloodstream infections.
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Affiliation(s)
- Pranita D Tamma
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore
| | - Anna T Conley
- Medical Student, Department of Medicine, University of Maryland School of Medicine, Baltimore
| | - Sara E Cosgrove
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore
| | - Anthony D Harris
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Ebbing Lautenbach
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania
| | - Joe Amoah
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore
| | - Edina Avdic
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore
| | - Pam Tolomeo
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania
| | - Jacqueleen Wise
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania
| | - Sonia Subudhi
- Medical Student, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore
| | - Jennifer H Han
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania
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30
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Jung SY, Han JH, Park SJ, Lee EG, Lee MH, Lee ES, Kang HS, Lee KS, Park IH, Sim SH, Jeong HJ, Kwon Y, Lee DE, Joo J, Kim SK, Lee S. Abstract P3-03-05: Not presented. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p3-03-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was not presented at the conference.
Citation Format: Jung S-Y, Han JH, Park SJ, Lee E-G, Lee MH, Lee ES, Kang H-S, Lee KS, Park IH, Sim SH, Jeong HJ, Kwon Y, Lee D-E, Joo J, Kim S-K, Lee S. Not presented [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-03-05.
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Affiliation(s)
- S-Y Jung
- National Cancer Center, Goyang, Republic of Korea; Wonkwang University Sanbon Hospital, Gunpo, Republic of Korea; Keimyung University School of Medicine, Daegu, Republic of Korea
| | - JH Han
- National Cancer Center, Goyang, Republic of Korea; Wonkwang University Sanbon Hospital, Gunpo, Republic of Korea; Keimyung University School of Medicine, Daegu, Republic of Korea
| | - SJ Park
- National Cancer Center, Goyang, Republic of Korea; Wonkwang University Sanbon Hospital, Gunpo, Republic of Korea; Keimyung University School of Medicine, Daegu, Republic of Korea
| | - E-G Lee
- National Cancer Center, Goyang, Republic of Korea; Wonkwang University Sanbon Hospital, Gunpo, Republic of Korea; Keimyung University School of Medicine, Daegu, Republic of Korea
| | - MH Lee
- National Cancer Center, Goyang, Republic of Korea; Wonkwang University Sanbon Hospital, Gunpo, Republic of Korea; Keimyung University School of Medicine, Daegu, Republic of Korea
| | - ES Lee
- National Cancer Center, Goyang, Republic of Korea; Wonkwang University Sanbon Hospital, Gunpo, Republic of Korea; Keimyung University School of Medicine, Daegu, Republic of Korea
| | - H-S Kang
- National Cancer Center, Goyang, Republic of Korea; Wonkwang University Sanbon Hospital, Gunpo, Republic of Korea; Keimyung University School of Medicine, Daegu, Republic of Korea
| | - KS Lee
- National Cancer Center, Goyang, Republic of Korea; Wonkwang University Sanbon Hospital, Gunpo, Republic of Korea; Keimyung University School of Medicine, Daegu, Republic of Korea
| | - IH Park
- National Cancer Center, Goyang, Republic of Korea; Wonkwang University Sanbon Hospital, Gunpo, Republic of Korea; Keimyung University School of Medicine, Daegu, Republic of Korea
| | - SH Sim
- National Cancer Center, Goyang, Republic of Korea; Wonkwang University Sanbon Hospital, Gunpo, Republic of Korea; Keimyung University School of Medicine, Daegu, Republic of Korea
| | - HJ Jeong
- National Cancer Center, Goyang, Republic of Korea; Wonkwang University Sanbon Hospital, Gunpo, Republic of Korea; Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Y Kwon
- National Cancer Center, Goyang, Republic of Korea; Wonkwang University Sanbon Hospital, Gunpo, Republic of Korea; Keimyung University School of Medicine, Daegu, Republic of Korea
| | - D-E Lee
- National Cancer Center, Goyang, Republic of Korea; Wonkwang University Sanbon Hospital, Gunpo, Republic of Korea; Keimyung University School of Medicine, Daegu, Republic of Korea
| | - J Joo
- National Cancer Center, Goyang, Republic of Korea; Wonkwang University Sanbon Hospital, Gunpo, Republic of Korea; Keimyung University School of Medicine, Daegu, Republic of Korea
| | - S-K Kim
- National Cancer Center, Goyang, Republic of Korea; Wonkwang University Sanbon Hospital, Gunpo, Republic of Korea; Keimyung University School of Medicine, Daegu, Republic of Korea
| | - S Lee
- National Cancer Center, Goyang, Republic of Korea; Wonkwang University Sanbon Hospital, Gunpo, Republic of Korea; Keimyung University School of Medicine, Daegu, Republic of Korea
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Anesi JA, Lautenbach E, Nachamkin I, Garrigan C, Bilker WB, Omorogbe J, Dankwa L, Wheeler M, Tolomeo P, Han JH. The role of extended-spectrum cephalosporin-resistance in recurrent community-onset Enterobacteriaceae urinary tract infections: a retrospective cohort study. BMC Infect Dis 2019; 19:163. [PMID: 30764770 PMCID: PMC6376680 DOI: 10.1186/s12879-019-3804-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 02/11/2019] [Indexed: 11/30/2022] Open
Abstract
Background Bacterial resistance to first line antibiotics used to treat community-onset urinary tract infections (UTIs) continues to emerge. We sought to determine the association between extended-spectrum cephalosporin resistance (ESC-R) and recurrence among Enterobacteriaceae (EB) UTIs. Methods A retrospective cohort study was performed. All patients presenting to the Emergency Departments (EDs) or outpatient practices in a large health system with EB UTIs between 2010 and 2013 were included. Exposed patients had ESC-R EB UTIs. Unexposed patients had ESC-susceptible EB UTIs and were matched to exposed patients 1:1 on study year. Multivariable Cox proportional hazards regression analyses were performed to evaluate the association between ESC-R EB UTI and time to recurrent UTI within 12 months. Results A total of 302 patients with an index community-onset EB UTI were included, with 151 exposed and 151 unexposed. Overall, 163 (54%) patients experienced a recurrent UTI with a median time to recurrence of 69 days (interquartile range 25–183). On multivariable analyses, ESC-resistance was associated with an increased hazard of recurrent UTI (hazard ratio [HR] 1.39, 95% confidence interval [CI] 1.01–1.91, P = 0.04). Other variables that were independently associated with recurrence included a history of UTI prior to the index UTI and presence of a urinary catheter at the time of the index UTI. Secondarily, we found that when the treatment for the index UTI was adjusted for, there was no longer a significant association between ESC-R status and time to recurrent UTI (aHR 1.26, 95% CI 0.91–1.76, P = 0.17). Conclusions Community-onset UTI due to EB demonstrating ESC-resistance is associated with a significantly increased hazard of recurrent UTI within 12 months compared to ESC-susceptible EB, even after adjusting for baseline factors that predispose patients to UTI recurrence. This association appears to be driven primarily by delayed or inappropriate treatment for the index ESC-R EB UTI.
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Affiliation(s)
- Judith A Anesi
- Division of Infectious Diseases, Department of Medicine; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, 719 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA.
| | - Ebbing Lautenbach
- Division of Infectious Diseases, Department of Medicine; Center for Clinical Epidemiology and Biostatistics; Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Irving Nachamkin
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Charles Garrigan
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Warren B Bilker
- Center for Clinical Epidemiology and Biostatistics; Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jacqueline Omorogbe
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lois Dankwa
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mary Wheeler
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Pam Tolomeo
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jennifer H Han
- Division of Infectious Diseases, Department of Medicine; Center for Clinical Epidemiology and Biostatistics; Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Wei LW, Yuan ZQ, Zhao MD, Gu CW, Han JH, Fu L. Inhibition of Cannabinoid Receptor 1 Can Influence the Lipid Metabolism in Mice with Diet-Induced Obesity. Biochemistry (Mosc) 2018; 83:1279-1287. [PMID: 30472964 DOI: 10.1134/s0006297918100127] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
A growing number of evidences accumulated about critical metabolic role of cannabinoid type 1 receptor (CB1), carnitine palmitoyltransferase-1 (CPT1) and peroxisome proliferator-activated receptors (PPARs) in some peripheral tissues, including adipose tissue, liver, skeletal muscle and heart. To better understand the interactions of CB1, CPT1 and PPARs in these tissues, 30 diet-induced obese (DIO) C57BL/6J male mice were obtained, weight-matched and divided into two groups (15 in each group): (i) DIO/vehicle mice (D-Veh) and (ii) DIO/SR141716 mice (D-SR) treated with SR141716 (or rimonabant, a selective CB1 receptor blocker) administered orally (10 mg/kg daily). Another 15 mice fed standard diet (STD) formed the STD/vehicle group (S-Veh). At the end of 3-week treatment, mean body weight was 28.4 ± 0.5, 36.5 ± 0.8, and 30.3 ± 1.2 g for the S-Veh, D-Veh, and D-SR group, respectively (p < 0.05; D-Veh vs. D-SR). Liver weight in the D-SR group was also decreased significantly compared to the D-Veh group (p < 0.05). Serum levels of total cholesterol, high-density lipoprotein cholesterol, leptin and adiponectin in the D-SR group were ameliorated compared to the D-Veh group (p < 0.05). Both qRT-PCR and Western blot assay revealed that CB1 expression levels were efficiently blocked by SR141716 in subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), skeletal muscles and liver (D-SR vs. D-Veh; p < 0.05), whereas there was no significant difference between S-Veh and D-Veh mice (p > 0.05). Simultaneously with the reduction of CB1 expression in the D-SR group, the expression levels of CPT1A isoform (protein) in the liver and heart and CPT1B isoform (protein) in the SAT, VAT, liver and skeletal muscles were significantly increased (p < 0.05; D-SR vs. D-Veh). Interestingly, the CPT1A and CPT1B expression levels in heart were detected slightly. The expression levels of PPARα in the SAT, VAT, liver and skeletal muscles and PPARγ in the SAT and skeletal muscles in the D-SR group were significantly increased compared to the D-Veh mice (p < 0.05). However, the PPARβ expression level differed from that of PPARα and PPARγ. Taken together, these data indicate that the inhibition of CB1 could ameliorate lipid metabolism via the stimulation of the CPT1A and CPT1B expression in vivo. Simultaneously, the PPARα and PPARγ expression levels significantly differed compared to that of PPARβ in obesity and lipid metabolism-related disorders under blockade of CB1. Both the mechanism of the influence of CB1 inhibition on lipid metabolism in the examined tissues and the specific mechanism of PPARα, PPARγ and PPARβ involvement in lipid exchange under these conditions remain to be further elucidated.
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Affiliation(s)
- L W Wei
- Laboratory Animal Center, Southwest Medical University, Luzhou, Sichuan, 646000, China
| | - Z Q Yuan
- Department of Orthopaedics, The First Affiliated Hospital, Orthopaedic Institute, Soochow University, Suzhou, Jiangsu, 215006, China.
| | - M D Zhao
- Laboratory Animal Center, Southwest Medical University, Luzhou, Sichuan, 646000, China
| | - C W Gu
- Laboratory Animal Center, Southwest Medical University, Luzhou, Sichuan, 646000, China
| | - J H Han
- Laboratory Animal Center, Southwest Medical University, Luzhou, Sichuan, 646000, China
| | - L Fu
- Laboratory Animal Center, Southwest Medical University, Luzhou, Sichuan, 646000, China.
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Ziegler M, Han JH, Landsburg D, Pegues D, Reesey E, Gilmar C, Gorman T, Bink K, Moore A, Kelly BJ. 1595. Impact of Levofloxacin for the Prophylaxis of Bloodstream Infection on the Gut Microbiome in Patients with Hematologic Malignancy. Open Forum Infect Dis 2018. [PMCID: PMC6254734 DOI: 10.1093/ofid/ofy210.1423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background Prophylactic antibiotics for the prevention of bloodstream infections (BSIs) during neutropenia (NTP) may reduce the incidence of BSIs, NTP fever, and mortality. However, antibiotics may also result in dysbiosis of the gut microbiome. We aimed to study the impact of levofloxacin prophylaxis compared with broad-spectrum β-lactam (BSBL) antibiotics used for the treatment of NTP fever on gut microbiome features in patients with hematologic malignancy. Methods Stool specimens from hematologic malignancy patients admitted for chemotherapy or stem cell transplant (SCT) in the setting of the evaluation of diarrhea were collected from September 2017 to November 2017. Levofloxacin prophylaxis was standard of care for patients undergoing autologous SCT or induction chemotherapy for acute myeloid leukemia (AML). 16S rRNA (V1–V2 amplicon) sequencing was performed using the Illumina HiSeq platform, formation of operational taxonomic units (OTUs) was performed using QIIME 1.9.1, and taxonomic assignment was performed via the GreenGenes database (13.8). Descriptive statistics were used to compare microbiome features. Results A total of 57 samples from 44 patients were included, most with AML (42%), multiple myeloma (33%), or non-Hodgkin’s lymphoma (12%). In the 7 days prior to sample collection, 28 (49%) patients received a BSBL and 17 (29%) received levofloxacin. The gut microbiome of patients with BSBL exposure had significantly reduced Shannon alpha diversity compared with those without: median 1.96 (IQR 1.08–2.57) vs. 2.58 (IQR 2.05–2.93); P < 0.01. However, those with and without levofloxacin exposure showed no difference: median 2.37 (IQR 2.19–2.75) vs. 2.22 (IQR 1.71–2.81), respectively; P = 0.48. Additionally, those with BSBL exposure trended toward increased dominance with non-Bacteroidetes taxa: 14 (60%) vs. 14 (41%); P = 0.14. In contrast, levofloxacin exposure was associated with a lower risk of dominance: 2 (8%) vs. 15 (55%); P < 0.01 and was associated with a greater proportion of Bacteroidetes taxa: 75% vs. 27% (P < 0.01). Conclusion Our findings suggest that the impact of antibiotics on the gut microbiome vary by class, and that levofloxacin may have limited impact on the gut microbiome in this patient population. Further studies are needed to investigate this potential differential impact of antibiotic classes. Disclosures D. Pegues, DaVita / Total Renal Care: Consultant, Consulting fee.
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Affiliation(s)
- Matthew Ziegler
- Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jennifer H Han
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel Landsburg
- Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Pegues
- Healthcare Epidemiology, Infection Prevention and Control, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Emily Reesey
- University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cheryl Gilmar
- Infection Prevention and Control, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Theresa Gorman
- Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kristen Bink
- Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amy Moore
- Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brendan J Kelly
- Division of Infectious Diseases, Dept. of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
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Warren DK, Nickel KB, Banks I, Han JH, Tolomeo P, Hostler C, Foy K, Fraser V, Olsen MA. 2128. Predictors of Post-Discharge Prophylactic Antibiotics Following Spinal Fusion. Open Forum Infect Dis 2018. [PMCID: PMC6253121 DOI: 10.1093/ofid/ofy210.1784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- David K Warren
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
| | - Katelin B Nickel
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
| | - Ian Banks
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
| | - Jennifer H Han
- Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Pam Tolomeo
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christopher Hostler
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina
| | - Katherine Foy
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina
| | - Victoria Fraser
- Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri
| | - Margaret A Olsen
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
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Ziegler M, Landsburg D, Pegues D, Bilker W, Gilmar C, Kucharczuk C, Gorman T, Bink K, Moore A, Fitzpatrick R, Stadtmauer EA, Mangan P, Kraus K, Han JH. Fluoroquinolone Prophylaxis Is Highly Effective for the Prevention of Central Line-Associated Bloodstream Infections in Autologous Stem Cell Transplant Patients. Biol Blood Marrow Transplant 2018; 25:1004-1010. [PMID: 30481595 DOI: 10.1016/j.bbmt.2018.11.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 08/27/2018] [Accepted: 11/19/2018] [Indexed: 01/16/2023]
Abstract
Patients undergoing stem cell transplant (SCT) for the treatment of hematologic malignancy are at increased risk for central line-associated bloodstream infections (CLABSIs). The use of prophylactic antibiotics to prevent CLABSIs in the setting of autologous SCT is of unclear benefit. We aimed to evaluate the impact of levofloxacin prophylaxis on reducing CLABSIs in this high-risk population. Patients undergoing autologous SCT at a tertiary care hospital received levofloxacin prophylaxis from January 13, 2016 to January 12, 2017. Levofloxacin was administered from autologous SCT (day 0) until day 13, absolute neutrophil count > 500/mm3, or neutropenic fever, whichever occurred first. Clinical outcomes were compared with a baseline group who underwent autologous SCT but did not receive antibacterial prophylaxis during the previous year. The primary endpoint was incidence of CLABSIs assessed using Cox proportional hazards regression. A total of 324 patients underwent autologous SCT during the entire study period, with 150 receiving levofloxacin prophylaxis during the intervention period. The rate of CLABSIs was reduced from 18.4% during the baseline period to 6.0% during the intervention period. On multivariable analysis levofloxacin prophylaxis significantly reduced CLABSI incidence (hazard ratio, .33; 95% confidence interval [CI], .16 to .69; P = .003). There was also a reduction in the risk of neutropenic fever (odds ratio [OR], .23; 95% CI, .14 to .39; P < .001) and a trend toward a reduction in intensive care unit transfer for sepsis (OR, .33; 95% CI, .09 to 1.24; P = .10) in patients receiving levofloxacin prophylaxis. Notably, there was no increase in Clostridium difficile infection in the levofloxacin group (OR, .66; 95% CI, .29 to 1.49; P = .32). Levofloxacin prophylaxis was effective in reducing CLABSIs and neutropenic fever in patients undergoing autologous SCT. Further studies are needed to identify specific patient groups who will benefit most from antibiotic prophylaxis.
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Affiliation(s)
- Matthew Ziegler
- Division of Infectious Diseases, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Daniel Landsburg
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Pegues
- Division of Infectious Diseases, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Healthcare Epidemiology, Infection Prevention and Control, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Warren Bilker
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cheryl Gilmar
- Department of Healthcare Epidemiology, Infection Prevention and Control, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Colleen Kucharczuk
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Theresa Gorman
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kristen Bink
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amy Moore
- Department of Healthcare Epidemiology, Infection Prevention and Control, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rebecca Fitzpatrick
- Department of Healthcare Epidemiology, Infection Prevention and Control, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Edward A Stadtmauer
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Patricia Mangan
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kelly Kraus
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jennifer H Han
- Division of Infectious Diseases, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Healthcare Epidemiology, Infection Prevention and Control, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Downes KJ, Fitzgerald JC, Schriver E, Boge CLK, Russo ME, Weiss SL, Balamuth F, Kubis SE, Tolomeo P, Bilker WB, Han JH, Lautenbach E, Coffin SE, Gerber JS. Implementation of a Pragmatic Biomarker-Driven Algorithm to Guide Antibiotic Use in the Pediatric Intensive Care Unit: the Optimizing Antibiotic Strategies in Sepsis (OASIS) II Study. J Pediatric Infect Dis Soc 2018; 9:36-43. [PMID: 30476186 PMCID: PMC7317158 DOI: 10.1093/jpids/piy113] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 10/18/2018] [Indexed: 11/13/2022]
Abstract
BACKGROUND Biomarkers can facilitate safe antibiotic discontinuation in critically ill patients without bacterial infection. METHODS We tested the ability of a biomarker-based algorithm to reduce excess antibiotic administration in patients with systemic inflammatory response syndrome (SIRS) without bacterial infections (uninfected) in our pediatric intensive care unit (PICU). The algorithm suggested that PICU clinicians stop antibiotics if (1) C-reactive protein <4 mg/dL and procalcitonin <1 ng/mL at SIRS onset and (2) no evidence of bacterial infection by exam/testing by 48 hours. We evaluated excess broad-spectrum antibiotic use, defined as administration on days 3-9 after SIRS onset in uninfected children. Incidence rate ratios (IRRs) compared unadjusted excess length of therapy (LOT) in the 34 months before (Period 1) and 12 months after (Period 2) implementation of this algorithm, stratified by biomarker values. Segmented linear regression evaluated excess LOT among all uninfected episodes over time and between the periods. RESULTS We identified 457 eligible SIRS episodes without bacterial infection, 333 in Period 1 and 124 in Period 2. When both biomarkers were below the algorithm's cut-points (n = 48 Period 1, n = 31 Period 2), unadjusted excess LOT was lower in Period 2 (IRR, 0.53; 95% confidence interval, 0.30-0.93). Among all 457 uninfected episodes, there were no significant differences in LOT (coefficient 0.9, P = .99) between the periods on segmented regression. CONCLUSIONS Implementation of a biomarker-based algorithm did not decrease overall antibiotic exposure among all uninfected patients in our PICU, although exposures were reduced in the subset of SIRS episodes where biomarkers were low.
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Affiliation(s)
- Kevin J Downes
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Pediatric Infectious Diseases Epidemiology and Antimicrobial Stewardship Research Group, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania,Correspondence: K. J. Downes, MD, Division of Infectious Diseases, Children’s Hospital of Philadelphia, 2716 South Street, Suite 10360, Philadelphia, PA 19146 ()
| | - Julie C Fitzgerald
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Emily Schriver
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Pediatric Infectious Diseases Epidemiology and Antimicrobial Stewardship Research Group, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Craig L K Boge
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Pediatric Infectious Diseases Epidemiology and Antimicrobial Stewardship Research Group, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Michael E Russo
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Scott L Weiss
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Fran Balamuth
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Division of Emergency Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sherri E Kubis
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Pam Tolomeo
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Warren B Bilker
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jennifer H Han
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania,Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ebbing Lautenbach
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania,Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Susan E Coffin
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Pediatric Infectious Diseases Epidemiology and Antimicrobial Stewardship Research Group, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeffrey S Gerber
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Pediatric Infectious Diseases Epidemiology and Antimicrobial Stewardship Research Group, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania,Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
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Chiotos K, Tamma PD, Flett KB, Karandikar MV, Nemati K, Bilker WB, Zaoutis T, Han JH. Increased 30-Day Mortality Associated With Carbapenem-Resistant Enterobacteriaceae in Children. Open Forum Infect Dis 2018; 5:ofy222. [PMID: 30338267 PMCID: PMC6186173 DOI: 10.1093/ofid/ofy222] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 08/30/2018] [Indexed: 11/25/2022] Open
Abstract
In this multicenter study, we identified an increased risk of 30-day mortality among hospitalized children with carbapenem-resistant Enterobacteriaceae (CRE) isolated from clinical cultures compared with those with carbapenem-susceptible Enterobacteriaceae. We additionally report significant variation in antibiotic treatment for children with CRE infections with infrequent use of combination therapy.
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Affiliation(s)
- Kathleen Chiotos
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Division of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Pranita D Tamma
- Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kelly B Flett
- Division of Infectious Diseases, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Manjiree V Karandikar
- Division of Infectious Diseases, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Koorosh Nemati
- Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Warren B Bilker
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Biostatistics, Informatics, and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Informatics, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Theoklis Zaoutis
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Biostatistics, Informatics, and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jennifer H Han
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Biostatistics, Informatics, and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania.,Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Affiliation(s)
- Darunee Chotiprasitakul
- Ramathibodi Hospital, Mahidol University, Department of Medicine, Division of Infectious Diseases, Bangkok, Thailand
| | - Jennifer H Han
- Department of Medicine, Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania
| | - Ebbing Lautenbach
- Department of Medicine, Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania
| | - Sara E Cosgrove
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Anthony D Harris
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Pranita D Tamma
- Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Tamma PD, Pierce VM, Cosgrove SE, Lautenbach E, Harris A, Rayapati D, Han JH. Can the Ceftriaxone Breakpoints Be Increased Without Compromising Patient Outcomes? Open Forum Infect Dis 2018; 5:ofy139. [PMID: 29992175 PMCID: PMC6022551 DOI: 10.1093/ofid/ofy139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 04/05/2018] [Accepted: 06/07/2018] [Indexed: 12/01/2022] Open
Abstract
Background In 2010, the Clinical Laboratory and Standards Institute recommended a 3-fold lowering of ceftriaxone breakpoints to 1 mcg/mL for Enterobacteriaceae. Supportive clinical data at the time were from fewer than 50 patients. We compared the clinical outcomes of adults with Enterobacteriaceae bloodstream infections treated with ceftriaxone compared with matched patients (with exact matching on ceftriaxone minimum inhibitory concentrations [MICs]) treated with extended-spectrum agents to determine if ceftriaxone breakpoints could be increased without negatively impacting patient outcomes. Methods A retrospective cohort study was conducted at 3 large academic medical centers and included patients with Enterobacteriaceae bacteremia with ceftriaxone MICs of 2 mcg/mL treated with ceftriaxone or extended-spectrum β-lactams (ie, cefepime, piperacillin/tazobactam, meropenem, or imipenem/cilastatin) between 2008 and 2014; 1:2 nearest neighbor propensity score matching was performed to estimate the odds of recurrent bacteremia and mortality within 30 days. Results Propensity score matching yielded 108 patients in the ceftriaxone group and 216 patients in the extended-spectrum β-lactam group, with both groups well-balanced on demographics, preexisting medical conditions, severity of illness, source of bacteremia, and source control interventions. No difference in recurrent bacteremia (odds ratio [OR], 1.16; 95% confidence interval [CI], 0.49–2.73) or mortality (OR, 1.27; 95% CI, 0.56–2.91) between the treatment groups was observed for patients with isolates with ceftriaxone MICs of 2 mcg/mL. Only 6 isolates (1.6%) with ceftriaxone MICs of 2 mcg/mL were extended-spectrum β-lactamase (ESBL)–producing. Conclusions Our findings suggest that patient outcomes are similar when receiving ceftriaxone vs extended-spectrum agents for the treatment of Enterobacteriaceae bloodstream infections with ceftriaxone MICs of 2 mcg/mL. This warrants consideration of adjusting the ceftriaxone susceptibility breakpoint from 1 to 2 mcg/mL, as a relatively small increase in the antibiotic breakpoint could have the potential to limit the use of large numbers of extended-spectrum antibiotic agents.
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Affiliation(s)
- Pranita D Tamma
- Division of Infectious Diseases, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Virginia M Pierce
- Microbiology Laboratory, Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Ebbing Lautenbach
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Anthony Harris
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Divya Rayapati
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jennifer H Han
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Simner PJ, Goodman KE, Carroll KC, Harris AD, Han JH, Tamma PD. Using Patient Risk Factors to Identify Whether Carbapenem-Resistant Enterobacteriaceae Infections Are Caused by Carbapenemase-Producing Organisms. Open Forum Infect Dis 2018; 5:ofy094. [PMID: 29876368 PMCID: PMC5961169 DOI: 10.1093/ofid/ofy094] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 04/25/2018] [Indexed: 02/03/2023] Open
Abstract
Evaluating all inpatient carbapenem-resistant Enterobacteriaceae (CRE) infections over a 1-year period, 47% were caused by carbapenemase-producing (CP) organisms. Compared with non-CP-CRE patients, patients with CP-CRE had an 18-fold greater odds of a recent stay in a foreign health care facility and a 3-fold greater odds of transfer from a post–acute care facility.
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Affiliation(s)
- Patricia J Simner
- Division of Medical Microbiology, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Katherine E Goodman
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Karen C Carroll
- Division of Medical Microbiology, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Anthony D Harris
- Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland
| | - Jennifer H Han
- Division of Infectious Diseases, Department of Medicine, The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Pranita D Tamma
- Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Lee EG, Kang H, Park SJ, Han JH, Jung SY, Lee S, Kang HS, Park B, Kong SY, Lim MC, Park SY, Lee ES. Abstract P4-06-12: Different patterns of risk reducing decisions in affected or unaffected BRCA mutation carriers. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p4-06-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND
Risk-reducing (RR) management decreases the risk of breast cancer and BRCA related gynecologic cancer. However, there are fewer reports on the RR management in Asia compared to Western countries.The aim of this study is to identify risk reducing management patterns with BRCA1 or BRCA2 mutation carriers.
METHODS
The study group consisted of all consecutive 1104 breast cancer, ovarian patients and their families of high-risk patients who underwent BRCA gene testing in National Cancer Center, Korea from 2008 to 2016. A total 220 BRCA mutations (19.9%) were detected with 125(11.3%) of BRCA1 gene and 95 (8.6%) of BRCA2 gene.
RESULTS
Out of 220 BRCA mutations carriers, they were consisted of 83 breast cancers, 10 ovarian cancers, 7 both cancers, and 120 unaffected carriers. Among them, 42 were men and 178 were women. About 90 % (198/ 220) had the familial history of breast, ovarian or both malignancies (113 in BRCA1 and 85 in BRCA2 mutation (p=0.821)).
All 42 men chose surveillance. Among 178 female BRCA mutation carriers, 98(55.1%) underwent risk reducing management including 18(10.1%) of chemoprevention, and 80(49.9%) had risk-reducing surgeries (RRSs) (1 case of risk-reducing mastectomy, 76 of risk reducing bilateral salphingo-oophorectomy (RRSO), and 3 of both) and 80 (54.9%) chose only intensive surveillance for both of breast and ovary cancer.
In affected carriers with breast cancer, 59 (71.1%) underwent RR management (1 case of risk reducing mastectomy, 53 of RRSO, 3 of both surgery, and 2 of chemoprevention). There was no risk reducing management in affected carrier with ovarian cancer patients. In 78 unaffected women carriers, 39(50.0%) women received RR management (23(29.5%) cases of RRSO and 16(20.5%) cases of chemoprevention). The rates of RRSs have increased annually since the 2013 year, (prior to 2013 vs. since 2013, RRSs 28.6% (6 cases/21 carriers) vs. 37.2% (74/199), p<0.01).
CONCLUSION
This study was conducted on the largest numbers of BRCA mutation carriers in Asian countries. RRSO is the more preferred management for affected carriers with breast cancer or unaffected carriers. The results might be explained by the severity of the illness and that RRSO was only reimbursed RR strategy from the Korean Government Insurance. Tailored genetic counseling and insurance policy may enhance overall levels of RR management.
Citation Format: Lee EG, Kang H, Park SJ, Han JH, Jung S-Y, Lee S, Kang H-S, Park B, Kong S-Y, Lim MC, Park S-Y, Lee ES. Different patterns of risk reducing decisions in affected or unaffected BRCA mutation carriers [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-06-12.
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Affiliation(s)
- EG Lee
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi-do, Korea; Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Gyeonggi-do, Korea; Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi-do, Korea
| | - H Kang
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi-do, Korea; Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Gyeonggi-do, Korea; Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi-do, Korea
| | - SJ Park
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi-do, Korea; Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Gyeonggi-do, Korea; Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi-do, Korea
| | - JH Han
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi-do, Korea; Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Gyeonggi-do, Korea; Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi-do, Korea
| | - S-Y Jung
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi-do, Korea; Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Gyeonggi-do, Korea; Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi-do, Korea
| | - S Lee
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi-do, Korea; Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Gyeonggi-do, Korea; Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi-do, Korea
| | - H-S Kang
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi-do, Korea; Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Gyeonggi-do, Korea; Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi-do, Korea
| | - B Park
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi-do, Korea; Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Gyeonggi-do, Korea; Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi-do, Korea
| | - S-Y Kong
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi-do, Korea; Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Gyeonggi-do, Korea; Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi-do, Korea
| | - MC Lim
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi-do, Korea; Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Gyeonggi-do, Korea; Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi-do, Korea
| | - S-Y Park
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi-do, Korea; Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Gyeonggi-do, Korea; Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi-do, Korea
| | - ES Lee
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi-do, Korea; Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Gyeonggi-do, Korea; Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi-do, Korea
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Yang SZ, Zhou CY, Wang F, Sun BC, Han ZL, Shen Y, Han JH, Zhang HJ. [Analysis of curative effect of transoral radiofrequency ablation microsurgery on glottic carcinoma with anterior commissure involvement at the early stage]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2018; 53:86-91. [PMID: 29429176 DOI: 10.3760/cma.j.issn.1673-0860.2018.02.002] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the key technique and outcome of transoral radiofrequency ablation microsurgery for early stage of glottic carcinoma with anterior commissure involvement (ACI). Methods: A retrospective analysis was conducted on 31 patients, who were diagnosed as early stage glottic carcinoma during January 2010 to March 2016 in ENT Department. According to whether the anterior commissure was involved or not, two groups were divided. There were eleven cases with ACI (stages T1a, T1b, and T2). Twenty cases without ACI (stages Tis, T1a, and T2). All the patients received transoral radiofrequency ablation microsurgery and followed up closely.Only one case received radiotheraphy after surgery. SPSS19.0 software was used to analyze data. Results: The follow-up time was 12-67 months, and the median follow-up time was 30 months. Nine among 11 cases with ACI obtained good oncologic outcomes, initial local recurrence was identified in 2/11 cases, including 2 cases of T2. Two cases ultimately required salvage total laryngectomy. Meanwhile, initial local recurrence was identified in 2/20 cases without ACI, including 1 case of T1a and 1 case of T2. One case underwent elective neck dissection, and another one received salvage total laryngectomy.Compared to the patients without ACI, it seemed that the cases with ACI always accomponied with a little higher initial local recurrence and lower overall laryngealpreservation, but the difference had no significance (P>0.05). Conclusions: Transoral radiofrequency ablation microsurgery is an effective treatment for glottic carcinoma with ACI. Its advantages, such as more flexibility and deformability, make it more feasible to operate at the narrow space of anterior commissure assisted with laryngeal endoscopy.Good oncologic outcomes can be obtained by this technique with lower initial local recurrence as well as higher overall laryngeal preservation rate.
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Affiliation(s)
- S Z Yang
- Department of Otorhinolaryngology, First Affiliated Hospital to the People Liberation Army General Hospital, Beijing 100048, China
| | - C Y Zhou
- Department of Otorhinolaryngology, First Affiliated Hospital to the People Liberation Army General Hospital, Beijing 100048, China
| | - F Wang
- Department of Otorhinolaryngology, First Affiliated Hospital to the People Liberation Army General Hospital, Beijing 100048, China
| | - B C Sun
- Department of Otorhinolaryngology, First Affiliated Hospital to the People Liberation Army General Hospital, Beijing 100048, China
| | - Z L Han
- Department of Otorhinolaryngology, First Affiliated Hospital to the People Liberation Army General Hospital, Beijing 100048, China
| | - Y Shen
- Department of Otorhinolaryngology, First Affiliated Hospital to the People Liberation Army General Hospital, Beijing 100048, China
| | - J H Han
- Department of Otorhinolaryngology, First Affiliated Hospital to the People Liberation Army General Hospital, Beijing 100048, China
| | - H J Zhang
- Department of Otorhinolaryngology, First Affiliated Hospital to the People Liberation Army General Hospital, Beijing 100048, China
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43
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Han JH, Harmoney KM, Dokmeci E, Torrez J, Chavez CM, Cordova de Ortega L, Kuttesch JF, Muller M, Winter SS. Dynamic re-immunization of off-treatment childhood cancer survivors: An implementation feasibility study. PLoS One 2018; 13:e0191804. [PMID: 29389976 PMCID: PMC5794110 DOI: 10.1371/journal.pone.0191804] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 01/11/2018] [Indexed: 12/20/2022] Open
Abstract
There are no universally approved re-vaccination guidelines for non-transplant pediatric cancer survivors. We hypothesized that by utilizing a response-based re-vaccination schedule, we could tailor vaccine schedules in off-treatment cancer survivors. Pre-vaccination antibody levels were obtained in 7 patients at an average of 20 days after the end of treatment date. In those without protective antibody levels, we administered vaccines 3 months after completion of treatment. Revaccinating patients 3 months after the end of treatment date resulted in protective antibody levels for most vaccines. We showed, on a preliminary basis, that vaccinating non-transplanted pediatric cancer survivors can be dynamically implemented in children with recovering immune function.
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Affiliation(s)
- Jennifer H. Han
- Department of Pediatrics, The University of New Mexico Health Sciences Center, 1 University of New Mexico, Albuquerque, New Mexico, United States of America
- * E-mail: (JHH); (KMH)
| | - Kathryn M. Harmoney
- Department of Pediatrics, Division of Hematology/Oncology, University of Iowa Stead Family Children’s Hospital, 200 Hawkins Drive, Iowa City, Iowa, United States of America
- * E-mail: (JHH); (KMH)
| | - Elif Dokmeci
- Department of Pediatrics, Division of Allergy/Immunology, The University of New Mexico Health Sciences Center, 1 University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Jacqueline Torrez
- Department of Pediatrics, Division of Hematology/Oncology, The University of New Mexico Health Sciences Center, 1 University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Cathy M. Chavez
- Department of Pediatrics, Division of Hematology/Oncology, The University of New Mexico Health Sciences Center, 1 University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Loretta Cordova de Ortega
- Department of Pediatrics, The University of New Mexico Health Sciences Center, 1 University of New Mexico, Albuquerque, New Mexico, United States of America
| | - John F. Kuttesch
- Department of Pediatrics, Division of Hematology/Oncology, The University of New Mexico Health Sciences Center, 1 University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Martha Muller
- Department of Pediatrics, Division of Infectious Diseases, The University of New Mexico Health Sciences Center, 1 University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Stuart S. Winter
- Cancer and Blood Disorders Program, Children’s Hospitals and Clinics of Minnesota, 2525 Chicago Avenue South, Minneapolis, Minnesota, United States of America
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Chotiprasitsakul D, Han JH, Cosgrove SE, Harris AD, Lautenbach E, Conley AT, Tolomeo P, Wise J, Tamma PD. Comparing the Outcomes of Adults With Enterobacteriaceae Bacteremia Receiving Short-Course Versus Prolonged-Course Antibiotic Therapy in a Multicenter, Propensity Score-Matched Cohort. Clin Infect Dis 2018; 66:172-177. [PMID: 29190320 PMCID: PMC5849997 DOI: 10.1093/cid/cix767] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [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: 07/04/2017] [Accepted: 08/21/2017] [Indexed: 01/14/2023] Open
Abstract
Background The recommended duration of antibiotic treatment for Enterobacteriaceae bloodstream infections is 7-14 days. We compared the outcomes of patients receiving short-course (6-10 days) vs prolonged-course (11-16 days) antibiotic therapy for Enterobacteriaceae bacteremia. Methods A retrospective cohort study was conducted at 3 medical centers and included patients with monomicrobial Enterobacteriaceae bacteremia treated with in vitro active therapy in the range of 6-16 days between 2008 and 2014. 1:1 nearest neighbor propensity score matching without replacement was performed prior to regression analysis to estimate the risk of all-cause mortality within 30 days after the end of antibiotic treatment comparing patients in the 2 treatment groups. Secondary outcomes included recurrent bloodstream infections, Clostridium difficile infections (CDI), and the emergence of multidrug-resistant gram-negative (MDRGN) bacteria, all within 30 days after the end of antibiotic therapy. Results There were 385 well-balanced matched pairs. The median duration of therapy in the short-course group and prolonged-course group was 8 days (interquartile range [IQR], 7-9 days) and 15 days (IQR, 13-15 days), respectively. No difference in mortality between the treatment groups was observed (adjusted hazard ratio [aHR], 1.00; 95% confidence interval [CI], .62-1.63). The odds of recurrent bloodstream infections and CDI were also similar. There was a trend toward a protective effect of short-course antibiotic therapy on the emergence of MDRGN bacteria (odds ratio, 0.59; 95% CI, .32-1.09; P = .09). Conclusions Short courses of antibiotic therapy yield similar clinical outcomes as prolonged courses of antibiotic therapy for Enterobacteriaceae bacteremia, and may protect against subsequent MDRGN bacteria.
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Affiliation(s)
- Darunee Chotiprasitsakul
- Department of Medicine, Division of Infectious Diseases, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Jennifer H Han
- Department of Medicine, Division of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia
| | - Sara E Cosgrove
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Anthony D Harris
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Ebbing Lautenbach
- Department of Medicine, Division of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia
| | - Anna T Conley
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Pam Tolomeo
- Department of Medicine, Division of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia
| | - Jacqueleen Wise
- Department of Medicine, Division of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia
| | - Pranita D Tamma
- Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Han JH, Goldstein EJC, Wise J, Bilker WB, Tolomeo P, Lautenbach E. Epidemiology of Carbapenem-Resistant Klebsiella pneumoniae in a Network of Long-Term Acute Care Hospitals. Clin Infect Dis 2017; 64:839-844. [PMID: 28013258 PMCID: PMC5399931 DOI: 10.1093/cid/ciw856] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 12/19/2016] [Indexed: 11/12/2022] Open
Abstract
Background The rapid emergence of carbapenem-resistant Klebsiella pneumoniae (CRKP) represents a major public health threat, including in the long-term acute care hospital (LTACH) setting. Our objective in this study was to describe the epidemiologic characteristics of CRKP in a network of US LTACHs. Methods An observational study was performed among 64 LTACHs from January 2014 to March 2015. Clinical cultures were included, with the first CRKP isolate recovered from each patient per study quarter evaluated. LTACH and geographic area-based CRKP prevalence and clinical and microbiologic characteristics were described. Results A total of 3846 K. pneumoniae cultures were identified, with an overall carbapenem resistance rate of 24.6%. There were significant differences in CRKP rates across geographic regions, with the highest in the West (42.2%). Of 946 CRKP isolates, 507 (53.6%) were from a respiratory source, 350 (37.0%) from a urinary source, and 9 (9.4%) from blood. Among 821 unique patients with CRKP colonization or infection, the median age was 73 years. There was a high prevalence of respiratory failure (39.8%) and the presence of a central venous catheter (50.9%) or tracheostomy (64.8%). Resistance rates of CRKP isolates were high for amikacin (59.2%) and fluoroquinolones (>97%). The resistance rate to colistin/polymyxin B was 16.1%. Conclusions Nearly 25% of K. pneumoniae clinical isolates in a US network of LTACHs were CRKP. Expansion of national surveillance efforts and improved communication among LTACHs and acute care hospitals will be critical for reducing the continued emergence of CRKP across the healthcare continuum.
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Affiliation(s)
- Jennifer H Han
- Division of Infectious Diseases, Department of Medicine.,Center for Clinical Epidemiology and Biostatistics, and.,Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Ellie J C Goldstein
- R.M. Alden Research Laboratory, Culver City, California; and.,Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles
| | | | - Warren B Bilker
- Center for Clinical Epidemiology and Biostatistics, and.,Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Pam Tolomeo
- Center for Clinical Epidemiology and Biostatistics, and
| | - Ebbing Lautenbach
- Division of Infectious Diseases, Department of Medicine.,Center for Clinical Epidemiology and Biostatistics, and.,Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Anderson DJ, Jenkins TC, Evans SR, Harris AD, Weinstein RA, Tamma PD, Han JH, Banerjee R, Patel R, Zaoutis T, Lautenbach E. The Role of Stewardship in Addressing Antibacterial Resistance: Stewardship and Infection Control Committee of the Antibacterial Resistance Leadership Group. Clin Infect Dis 2017; 64:S36-S40. [PMID: 28350902 DOI: 10.1093/cid/ciw830] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Antibacterial resistance is increasing globally and has been recognized as a major public health threat. Antibacterial stewardship is the coordinated effort to improve the appropriate use of antibiotics with the aim to decrease selective pressure for multidrug-resistant organisms in order to preserve the utility of antibacterial agents. This article describes the activities of the Antibacterial Resistance Leadership Group (ARLG) in the area of antibacterial stewardship. To date, the ARLG has focused intensely on development of rapid diagnostic tests, which (when coupled with educational and institutional initiatives) will enable the robust stewardship that is needed to address the current crisis of antibacterial resistance. In addition to exploring the effectiveness of stewardship techniques in community hospitals, the ARLG has also developed strategy trials to assess the feasibility of reducing antibacterial usage while preserving patient outcome.
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Affiliation(s)
- Deverick J Anderson
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, North Carolina
| | | | - Scott R Evans
- Center for Biostatistics in AIDS Research and the Department of Biostatistics, Harvard University, Boston, Massachusetts
| | | | | | - Pranita D Tamma
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jennifer H Han
- Department of Medicine, Division of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia
| | | | - Robin Patel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, and.,Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota ; and
| | - Theoklis Zaoutis
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Pennsylvania
| | - Ebbing Lautenbach
- Department of Medicine, Division of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia
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Sun BC, Wang F, Yang SZ, Han ZL, Han JH, Shen Y, Yan QH, Zhou CY. [Complications analysis of adenoidectomy and tonsillectomy assisted with ablation on children]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2017; 31:1720-1723. [PMID: 29798183 DOI: 10.13201/j.issn.1001-1781.2017.22.004] [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] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Indexed: 11/12/2022]
Abstract
Objective:To analyze the complications of adenotonsilectomy assisted with coblation in children. Method:Complications of 2 089 cases of children with adenoid and tonsil surgery assisted with coblation, in our hospital nearly 10 years, were analyzed by epidemiological methods through the method of retrospective analysis. Result:①the sex ratio of male to female was 2.08:1, average age (5.87±3.12) years old, and most of 2 089 cases 76.35% (1 595/2 089) were 3-7 years old; ②all cases underwent adenoidectomy. Different surgery methods of tonsil consisted of three groups as partial resection associated with ablation was 69.17% (1 445/2 089), ablation (channeling) alone was 22.26% (465/2 089) and total resection was 8.57% (179/208). The amount of bleeding in operation was (8.52±3.18)ml, average operation time was (30.15±8.26) minutes, the postoperative pain score was (3.77±1.61); ③The incidence of postoperative complications: postoperative bleeding (all were secondary bleeding cases) rate was 0.24% (5/2 089), recurrence rate was 0.14% (3/2 089), prevertebral lymphadenitis was 0.96% (20/2 089), the other was 0.29% (torus hyperplasia in 2 cases, dyspnea in 2 cases, 1 cases of angle of mouth burned, nasopharyngeal adhesion in 1 cases). Postoperative fever rate was 9.81% (205/2 089). Conclusion:coblation technique is a good method for the treatment of children's adenoids and tonsil diseases with high efficiency and low complications. But improving the operation procedure proficiency level and skills of operation is an important link to reduce complications.
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Affiliation(s)
- B C Sun
- Department of Otolaryngology, the First Affiliated Hospital of PLA General Hospital, Beijing, 100048, China
| | - F Wang
- Department of Otolaryngology, the First Affiliated Hospital of PLA General Hospital, Beijing, 100048, China
| | - S Z Yang
- Department of Otolaryngology, the First Affiliated Hospital of PLA General Hospital, Beijing, 100048, China
| | - Z L Han
- Department of Otolaryngology, the First Affiliated Hospital of PLA General Hospital, Beijing, 100048, China
| | - J H Han
- Department of Otolaryngology, the First Affiliated Hospital of PLA General Hospital, Beijing, 100048, China
| | - Y Shen
- Department of Otolaryngology, the First Affiliated Hospital of PLA General Hospital, Beijing, 100048, China
| | - Q H Yan
- Department of Otolaryngology, the First Affiliated Hospital of PLA General Hospital, Beijing, 100048, China
| | - C Y Zhou
- Department of Otolaryngology, the First Affiliated Hospital of PLA General Hospital, Beijing, 100048, China
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Van Duin D, Humphries R, Jacob JT, Cober E, Richter SS, Doi Y, Kaye KS, Dhar S, Arias C, Kim A, Garcia-Diaz J, Han JH, Satlin M, Desai S, Weston G, Ostrowsky B, Fries B, Salata R, Wong D, Wortmann G, Kalayjian R, Huskins WC, Anderson DJ, Eilertson B, Komarow L, Earley M, Evans SR, Marshall SH, Rudin SD, Domitrovic TN, Hujer A, Hujer KM, Bonomo RA. Ceftazidime–avibactam Susceptibility Patterns in Carbapenem-Resistant Enterobacteriaceae in the USA: Results from the Consortium on Resistance against Carbapenems in Klebsiella and Other Enterobacteriaceae (CRACKLE-2). Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- David Van Duin
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina
| | - Romney Humphries
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles, Los Angeles, California
| | - Jesse T Jacob
- Emory University School of Medicine, Atlanta, Georgia
| | - Eric Cober
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio
| | - Sandra S Richter
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Yohei Doi
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Keith S Kaye
- Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Medical School, Ann Arbor, Michigan
| | | | - Cesar Arias
- Infectious Diseases, University of Texas Medical School at Houston Molecular Genetics and Antimicrobial Resistance Unit, Universidad El Bosque, Bogota, Colombia., Houston, Texas
| | - Angela Kim
- North Shore-LIJ Health System, Manhasset, New York
| | - Julia Garcia-Diaz
- Infectious Diseases, Ochsner Clinic Foundation, New Orleans, Louisiana
| | - Jennifer H Han
- Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | | | - Samit Desai
- Hackensack University, Hackensack, New Jersey
| | | | - Belinda Ostrowsky
- Department of Medicine, Division of Infectious Diseases, Montefiore Medical Center, Bronx, New York
| | - Bettina Fries
- Albert Einstein College of Medicine, Bronx, New York
| | - Robert Salata
- University Hospitals Case Medical Center, Cleveland, Ohio
| | - Darren Wong
- University of Southern California, Los Angeles, California
| | - Glenn Wortmann
- Infectious Disease, MedStar Washington Hospital Center, Washington, DC
| | - Robert Kalayjian
- Department of Medicine, MetroHealth Medical Center, Cleveland, Ohio
| | | | - Deverick J Anderson
- Duke Antimicrobial Stewardship Outreach Network (DASON), Durham, North Carolina
| | | | - Lauren Komarow
- Statistical and Data Analysis Center, Harvard School of Public Health, Boston, Massachusetts
| | | | - Scott R Evans
- Harvard School of Public Health, Boston, Massachusetts
| | | | | | | | - Andrea Hujer
- Case Western Reserve University, Cleveland, Ohio
| | - Kristine M Hujer
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
| | - Robert A Bonomo
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
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Chotiprasitsakul D, Han JH, Conley AT, Cosgrove SE, Harris AD, Lautenbach E, Tamma PD. Comparing the Outcomes of Adults with Enterobacteriaceae Bacteremia Receiving Short-Course vs Prolonged-Course Antibiotic Therapy. Open Forum Infect Dis 2017. [PMCID: PMC5631848 DOI: 10.1093/ofid/ofx162.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The recommended duration of antibiotic treatment for Enterobacteriaceae bacteremia is between 7 and 14 days. We compared the clinical outcomes of patients receiving short-course (6–10 days) vs prolonged-course (11–15 days) antibiotic therapy for Enterobacteriaceae bacteremia.
Methods
A retrospective cohort study was conducted at The Johns Hopkins Hospital, The University of Maryland Medical Center, and The Hospital of the University of Pennsylvania including patients with monomicrobial Enterobacteriaceae bacteremia treated with in vitro active antibiotic therapy in the range of 6–15 days between 2008 and 2014. 1:1 nearest neighbor propensity score matching without replacement was performed, prior to regression analysis, to estimate the risk of all-cause mortality within 30 days after the end of antibiotic treatment for patients receiving short vs. prolonged durations of antibiotic therapy. Secondary outcomes included Clostridium difficile infection (CDI) and the emergence of multidrug-resistant Gram-negative (MDRGN) bacteria within 30 days after the end of antibiotic therapy.
Results
A total of 1,769 patients met eligibility criteria. There were 385 matched pairs who were well-balanced on baseline characteristics. The median duration of therapy in the short-course group and prolonged-course group was 8 days (interquartile range (IQR) 7–9 days) and 15 days (IQR 13–15 days), respectively. No difference in all-cause mortality between short- and prolonged-course treatment groups was observed (adjusted hazard ratio [aHR] 1.00; 95% CI 0.62–1.63). Rates of CDI were similar between the treatment groups (OR 1.17; 95% CI 0.39–3.51). There was a non-significant protective effect of short-course antibiotic therapy on the emergence of MDRGN bacteria (OR 0.59; 95% CI 0.32–1.09 P = 0.09).
Conclusion
Short courses of antibiotic therapy yields similar clinical outcomes to prolonged courses of antibiotic therapy for Enterobacteriaceae bacteremia, and may protect against subsequent MDRGN emergence.
Disclosures
All authors: No reported disclosures.
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Affiliation(s)
- Darunee Chotiprasitsakul
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Jennifer H Han
- Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Anna T Conley
- The University of Maryland School of Medicine, Baltimore, Maryland
| | - Sara E Cosgrove
- Department of Medicine, Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Anthony D Harris
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Ebbing Lautenbach
- Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Pranita D Tamma
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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Han JH, Lei J, Liu MQ, Fu KY. [The images of osteoarthrosis associated with anterior disc displacement without reduction detected by cone-beam CT]. Zhonghua Kou Qiang Yi Xue Za Zhi 2017; 52:22-26. [PMID: 28072990 DOI: 10.3760/cma.j.issn.1002-0098.2017.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To analyze the radiological characteristics of the condylar bone in patients with anterior disc displacement without reduction of temporomandibular joint using cone-beam CT (CBCT), and to further investigate the clinical factors possibly associated with the early-stage osteoarthritic changes. Methods: Two hundred and four individuals (≤30 years old) diagnosed as unilateral anterior disc displacement without reduction (disease duration≤1 year) were recruited. CBCT images of bilateral condyles were independently evaluated by two assessors and documented. Correlation between the early-stage osteoarthritic (OA) changes and gender, age, disease duration and mouth opening were analyzed using SPSS 21.0 software. Results: About sixty percent were presented with OA changes in the symptomatic joints, and most of them (47.1%) (96/204) were early-stage OA changes characterized by loss of continuity of articular cortex (Ⅰ) and/or surface erosion (Ⅱ). Logistics regression analyses indicated that disease duration (P =0.000) and mouth opening (P =0.002) were correlated significantly with early-stage OA changes. Conclusions: Disc displacement without reduction was closely related to OA occurrence. OA changes occurred in more than half of the patients after one month of the joint locked and more possibly in patients with increased mouth opening.
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Affiliation(s)
- J H Han
- Center for TMD and Orofacial Pain, Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - J Lei
- Center for TMD and Orofacial Pain, Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - M Q Liu
- Center for TMD and Orofacial Pain, Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - K Y Fu
- Center for TMD and Orofacial Pain, Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
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